Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial

• Published in: American journal of obstetrics and gynecology 2024, Vol.231 (5), p.530.e1-530.e8
• Main Authors: Hogmark, Sara, Rydelius, Johanna, Envall, Niklas, Teleman, Pia, Gemzell-Danielsson, Kristina, Kopp Kallner, Helena
• Format: Article
• Language: English
• Subjects: Abortion; Abortion seekers; Abortion, Induced - methods; Adult; Clinical Medicine; Contraception; Copper; copper intrauterine devices; Family Planning Services; Female; Health Services Accessibility; Humans; Induced; induced abortion; Intrauterine Device Expulsion; Intrauterine Devices; Intrauterine Devices - adverse effects; Klinisk medicin; Long-Acting Reversible Contraception; Medical and Health Sciences; Medicated; medicated intra-uterine devices; medicated intrauterine devices; Medicin och hälsovetenskap; Obstetrics, Gynecology and Reproductive Medicine; Post abortion contraception; postabortion contraception; Pregnancy; Pregnancy Trimester, Second; repeated; repeated abortion seekers; Reproduktionsmedicin och gynekologi; Sweden; Time Factors; Young Adult
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2024.05.041

International guidelines recommend placement of intrauterine devices immediately after second-trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. This study aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at 2 to 4 weeks after second-trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at 2 to 4 weeks after the abortion, in terms of the proportion of intrauterine device use after 6 months, with maintained safety and acceptability. In this open-label, randomized, controlled, superiority trial, we recruited participants at 8 abortion clinics in Sweden. Eligible participants were aged ≥18 years, requesting medical abortion with gestation ≥85 days, and opting for use of a postabortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in nonnormal continuous variables were analyzed with the Mann–Whitney U test, and differences in dichotomous variables with the chi-square or Fisher exact tests. A P value