Same-Day Placement of Intrauterine Contraception for High-Risk Women

Abstract

INTRODUCTION: We studied the safety of same-day placement of an intrauterine contraceptive for women at high risk for sexually transmitted infection (STI) and undesired pregnancy. METHODS: Between September 2011 and May 2013 our inner-city clinic offered same-day testing for STI and intrauterine contraceptive placement to all women seeking emergency contraception or pregnancy testing who had no cervicitis on examination and wanted to avoid pregnancy for 6+ months. Participants completed surveys on the day of their clinic visit and 3 months later regarding contraceptive use and STI testing diagnosis and treatment. RESULTS: Of 947 eligible women 39% (n=366) completed surveys. Of those who completed surveys 28 women had opted for same-day intrauterine contraceptive insertion. Rates of pelvic inflammatory disease within 3 months of visiting the study clinic were similar with same-day intrauterine contraceptive placement (3.6% 95% confidence interval [CI] 0-10.4%) or without same-day intrauterine contraceptive placement (5.3% 95% CI 3.0-8.5% P=.82). Most (82%) women who opted for same-day intrauterine contraceptive placement reported still using intrauterine contraceptive 3 months later. Pregnancy within 3 months of visiting the study clinic was reported by (3.6% 95% CI 0-19.2%) of women who opted for same-day intrauterine contraceptive placement compared with 10.7% (95% CI 7.4-15.3%) of others compared with a clinic-wide rate of 11% (95% CI 6.4-18.1%) before change in clinic policy. CONCLUSIONS: Routine counseling about intrauterine contraceptive with the offer of same-day intrauterine contraceptive placement appears to have reduced rates of undesired pregnancy without increasing rates of pelvic inflammatory disease among women at high risk of STI and undesired pregnancy. Concern for asymptomatic STI should not delay intrauterine contraceptive placement.