Immediate versus delayed insertion of the copper IUD after medical
abortion at 17-20 gestational weeks: a randomized controlled trial
Abstract
Objective To compare use of the copper intrauterine device (IUD) after
immediate compared to delayed insertion following medical abortion (MA)
at 17-20 gestational weeks (GW). Design Randomized controlled trial
Setting One tertiary hospital and five community healthcare centres in
South Africa Population Women admitted August 2018 to June 2019 for
elective MA at 17-20 GW Methods Women were randomized to immediate
(within 24 hours) or delayed (3 weeks post-abortion) insertion of the
copper IUD. Follow-up was at 6 weeks, 3 and 6 months. Study outcomes
were compared by intention-to-treat (ITT) and per-protocol analyses.
Main outcomes Use of the original IUD, and use of any IUD at 6 weeks
post-abortion (ITT) Results In the immediate (n=55) and delayed arms
(n=57) respectively, 82% and 21% received the IUD as planned. By ITT,
56% in the immediate and 19% in the delayed arms were using the
original IUD at six weeks (p<0.001), 76% in the immediate and
40% in the delayed arms were using any IUD (p<0.001).
Loss-to-follow-up at 6 weeks was 2%. Complete expulsion or removal
occurred in 14 (31%) in the immediate and 1 (7%) in the delayed arms
(p=0.004). Conclusions Insertion of an IUD immediately after MA at 17-20
GW results in increased use after 6 weeks compared to delayed insertion.
Expulsion rates are higher than interval insertion and immediate
insertion at earlier gestation, but similar to immediate postpartum
insertion. Key words Second trimester, medical abortion, IUD Clinical
trials registration: clinicaltrials.gov/ (ID NCT03505047), Pan African
Trials Registry (www.pactr.org), ID PACTR201804003324963