Factors Affecting Early Intrauterine Device Expulsion Inserted Immediately After Voluntary Termination of Pregnancy

Abstract

Background: Post-abortion insertion of an intrauterine device (IUD) is recommended for the prevention of repetitive voluntary termination of pregnancy (VTOP) in women who choose to have a reliable contraceptive method. Aim: This study aimed to analyze the incidence of IUD dislocation and its factors in patients who had an IUD immediately inserted after VTOP. Methods: In this retrospective study, 288 consequent patients who came to our hospital for VTOP between August 1st, 2018 to August 26th, 2019, and had given signed consent for immediate IUD insertion were taken as the study group. The demographic characteristics, obstetric history, and gestational age at the time of the procedure were obtained from the patient records. On the 10th day of post-abortion, the localization of the IUD was evaluated by speculum examination and transvaginal ultrasonography. The effects of obstetric history and gestational age at the time of termination on IUD dislocation rates were analyzed statistically. Results: The overall incidence of IUD dislocation was 16.3 % at the 10th-day follow-up visit. The incidence of IUD dislocation was similar in patients with gestational age < 5w, 5-7w, and 7-10w (21 %, 14.5 %, and 13 %, respectively, p=0.36). However, the incidence increased with high gravity and parity. The gravity, parity, number of vaginal deliveries, and cesarean section were higher in patients with an IUD dislocation than the ones with an IUD in place. Conclusion: The IUD insertion after voluntary legal termination of pregnancy is suitable for all gestational ages. A high number of previous pregnancies and deliveries are risk factors for IUD expulsion after immediate IUD insertion.