Immediate versus delayed IUD insertion after uterine aspiration

Paula Bednarek, Mitchell D. Creinin, Matthew F. Reeves, Carrie Cwiak, Eve Espey, Jeffrey Jensen

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

BACKGROUND: Intrauterine devices (IUDs) provide highly effective, reversible, long-term contraception that is appropriate for many women after first-trimester uterine aspiration. However, the effects of immediate versus delayed IUD insertion after uterine aspiration on rates of complications and IUD use are uncertain. METHODS: We performed a randomized noninferiority trial involving women undergoing uterine aspiration for induced or spontaneous abortion at 5 to 12 weeks of gestation who desired an IUD. Subjects were randomly assigned (in a 5:6 ratio) to IUD insertion immediately after the procedure or 2 to 6 weeks afterward (delayed insertion). The primary outcome was the rate of IUD expulsion 6 months after IUD insertion; an expulsion rate 8 percentage points higher in the immediate-insertion group was defined as inferior. RESULTS: Among 575 women who underwent randomization, an IUD was inserted in 100% (258 of 258) of the women in the immediate-insertion group and in 71.3% (226 of 317) of those in the delayed-insertion group (difference, 28.7 percentage points; 95% confidence interval [CI], 23.7 to 33.7). The 6-month expulsion risk was 5.0% (13 of 258 women) after immediate insertion and 2.7% (6 of 226) after delayed insertion (difference, 2.3 percentage points; 95% CI, -1.0 to 5.8), which was consistent with the predefined criterion for noninferiority. Six-month rates of IUD use were higher in the immediate-insertion group (92.3%, vs. 76.6% after delayed insertion; P

Original languageEnglish (US)
Pages (from-to)2208-2217
Number of pages10
JournalNew England Journal of Medicine
Volume364
Issue number23
DOIs
StatePublished - Jun 9 2011

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Intrauterine Devices
Intrauterine Device Expulsion
Confidence Intervals
Induced Abortion
Spontaneous Abortion
First Pregnancy Trimester
Random Allocation
Contraception
Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Immediate versus delayed IUD insertion after uterine aspiration. / Bednarek, Paula; Creinin, Mitchell D.; Reeves, Matthew F.; Cwiak, Carrie; Espey, Eve; Jensen, Jeffrey.

In: New England Journal of Medicine, Vol. 364, No. 23, 09.06.2011, p. 2208-2217.

Research output: Contribution to journalArticle

Bednarek, Paula ; Creinin, Mitchell D. ; Reeves, Matthew F. ; Cwiak, Carrie ; Espey, Eve ; Jensen, Jeffrey. / Immediate versus delayed IUD insertion after uterine aspiration. In: New England Journal of Medicine. 2011 ; Vol. 364, No. 23. pp. 2208-2217.
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