Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation: a randomized controlled trial

• Published in: Contraception (Stoneham) 2012-03, Vol.85 (3), p.240-245
• Main Authors: Hohmann, Heather L, Reeves, Matthew F, Chen, Beatrice A, Perriera, Lisa K, Hayes, Jennifer L, Creinin, Mitchell D
• Format: Article
• Language: English
• Subjects: Abortion, Induced; Adult; Biological and medical sciences; Birth control; clinical trials; complications; Contraception; Contraceptive Agents, Female - administration & dosage; Dilation and evacuation; evacuation; Female; Genital system. Reproduction; Gynecology. Andrology. Obstetrics; Humans; Induced abortion; Induced abortion. Therapeutic abortion; Intrauterine Devices, Medicated; Levonorgestrel - administration & dosage; Levonorgestrel-releasing intrauterine device; Medical sciences; Obstetrics and Gynecology; Pharmacology. Drug treatments; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Side effects; Time Factors; Young Adult
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2011.08.002

Abstract Background The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%–69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI −0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.