Postabortion Intrauterine Device Insertion Research Articles

Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion.

To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

The Effect of Postabortion Intrauterine Device Placement on Immediate Postoperative Recovery

INTRODUCTION: Immediate postabortion intrauterine device (IUD) placement has been shown to be safe and is effective in decreasing repeat abortion. Data are available to counsel patients on expulsion, perforation, and infection; however, little has been reported about immediate postoperative pain and recovery after postabortion IUD insertion. METHODS: We performed a retrospective cohort study to compare the immediate postoperative experience of patients who had postabortion IUDs placed (n=250) matched for gestational age and type of anesthesia with patients who did not have IUDs placed (n=250). The primary outcome was postabortion pain on a 0–10 scale approximately 20 minutes after the procedure. Secondary outcomes included pain score before discharge, length of stay in the recovery room, use of pain medication, and complications. RESULTS: Of the 500 records reviewed, 461 met inclusion criteria. We found no difference in the mean 20-minute pain score between women who received an IUD postabortion and those who did not (4.1 compared with 3.9, P=.50). Pain score at discharge, use of additional pain medication, and complication rates were low and not statistically different between groups. The non-IUD group spent longer in the recovery room (57 compared with 53 minutes, P=.04). Stratified analysis by gestational age and type of anesthesia and multivariate regression were performed. Pain scores between the groups remained comparable. CONCLUSIONS: We found no evidence that placing an IUD postabortion results in a higher postoperative pain score or longer stay in the recovery room. The average pain score reported by both groups was low.

Cost analysis of immediate postabortal IUD insertion compared to planned IUD insertion at the time of abortion follow up

BackgroundImmediate postabortal intrauterine device (IUD) insertion decreases rates of repeat abortions. However, only one third of high-volume, non-hospital abortion providers in the United States offer immediate postabortal IUD placement. Study DesignWe conducted a cost analysis from a public payer perspective to evaluate the potential cost savings associated with a policy of immediate postabortal IUD insertion, compared to planned IUD insertion at the time of abortion follow up. Sensitivity analyses and Monte Carlo simulation were performed. ResultsConsidering only direct costs of contraception and pregnancy-related care over 1 year, immediate postabortal IUD provision decreases public program expenditures by US$111 per woman compared to planned IUD placement at follow up. Over 5 years, the savings increases to $4296 per woman, when public health and social program costs are also considered. ConclusionImmediate postabortal IUD insertion is cost saving from a public payer perspective, compared to planned insertion at the time of follow up. These savings are seen over a wide range of model inputs.

Immediate post-abortion IUD insertion compared with planned insertion at abortion follow-up: a cost analysis

To evaluate whether providing immediate post-abortion intrauterine device (IUD) insertion, compared with a policy of scheduling IUD insertion for the abortion follow-up appointment, is cost saving.

Immediate Postabortion Intrauterine Device Insertion: Continuation and Satisfaction

BackgroundThe provision of intrauterine devices (IUDs) immediately postabortion has the potential to decrease unintended pregnancy in the United States. Studies have demonstrated safety and efficacy; however, there are limited data about continuation, satisfaction, and bleeding patterns among women receiving immediate postabortion IUDs. Study DesignWe performed a retrospective cohort study of women undergoing immediate postabortion IUD insertion. Demographics and clinical data were collected from intake forms and procedure notes. We attempted to contact women by telephone to administer a short questionnaire to assess continuation, satisfaction, and bleeding patterns. ResultsWe were able to contact 77 of 225 (34%). Women lost to follow-up were more likely to have higher parity or a pregnancy of greater gestational age at the time of abortion compared with women who were successfully contacted. Continuation and satisfaction rates were high (80.5% and 80.6%, respectively). Reported bleeding patterns with IUD use were similar to previously reported patterns. ConclusionFollow-up of women undergoing immediate postabortion IUD insertion is challenging. However, we found that women choosing immediate postabortion IUD had high rates of continuation and satisfaction.

Controversies in family planning: timing of ovulation after abortion and the conundrum of postabortion intrauterine device insertion

Questions: When does ovulation occur after an induced abortion? Is it different with regard to medical versus surgical abortion? Does ovulation occur at a different time point if the woman had a first versus second trimester abortion? If one is unable to provide an immediate post- abortion intrauterine device (IUD), when is the ideal time to insert the IUD and be sure your patient is not pregnant? What if the patient reports an act of unprotected intercourse between the abortion and her return for IUD insertion? Can one be certain she has not just conceived if her return for the IUD is 7 days post-abortion? What if it was 10 versus 14 or more days post- abortion? Respondent #1: Most data support three weeks for ovulation, therefore insertion within two weeks with no bridge method is fine. That said, about a third of women will not come back so some method right away might be a good idea. Respondent #2: I used to do one week for first trimester patients and two weeks for second trimester patients before we could do immediate insertion. We are currently working on an analysis of nearly 200 women who got IUDs at two weeks after first trimester abortion and there were no complications. These women received the IUD at two weeks, not before. There were no pregnancies with IUD in place. Most women reported they were abstinent or used condoms. Our expulsion rate was low at about 2.5% at 6 months. Respondent #3: Our beliefs that ovulation occurs one to two weeks earlier post-abortion than after delivery are based on some older studies. I think the best time for a post-abortion visit is within one week because that is when the problems occur. One study showed higher IUD expulsion at two weeks than right after first trimester abortion, so one week might be better. The date of post-abortion visit return for contraception is sometimes determined by how long after the abortion insurance will pay. It used to be we had to wait two weeks for post-abortion IUD insertion where I work but now it is as soon as the patient is not pregnant, which means now we can insert IUDs immediately. Respondent #4: I would keep in mind the range, not just the average date of ovulation after abortion. Some papers show ovulation occurring as early as six days post-abortion.

Immediate Postabortion IUD Insertion: Why Wait?

Each year, half of the 1.2 million U.S. women who undergo abortions have undergone previous pregnancy terminations; therefore, intrauterine device (IUD) insertion immediately postabortion could be particularly effective. In a retrospective review of records at one clinic, researchers assessed IUD insertion rates and outcomes in 221 women who chose to undergo the procedure right after abortion (immediate group; mean age, 24) and 87 women …

Immediate placement of intrauterine devices after first and second trimester pregnancy termination

Background We reviewed our experience with intrauterine device (IUD) placement after surgical abortion up to 20 weeks' gestation. Study Design Women presenting for elective abortion between January 2004 and March 2009 who requested an IUD were included in this retrospective review. Results Of 308 women requesting postabortion IUD placement, 221 (72%) planned insertion at the time of abortion (immediate group) and 87 (28%) planned insertion at their postoperative visit (interval group). IUDs were placed in 96% of the immediate group and in 23% of the interval group (212/221 vs. 20/87; p<.0001). Failure to return for placement was the most common reason for noninsertion in the interval group (60/87=69%). Follow-up information was obtained for 56% of patients and was documented a median of 137 days postabortion (range 3–1594 days). There was no difference in complication rates between groups. Expulsion rates were 3% and 0% in the immediate and interval groups, respectively (6/212 vs. 0/20; p=.4). Considering only those with documented follow-up after immediate insertion (119), there was a nonsignificant trend towards increased expulsion with placement after second vs. first trimester abortion (4/54=7% vs. 2/65=2%; p=.3). When analyzing the 172 subjects with documented follow-up, those planning immediate insertion were more likely to have an IUD in situ at the last contact than those planning later insertion (84/124=68% vs. 20/48=42%; p=.002). Conclusion Immediate postabortion IUD insertion is safe and effective. Given the low rate of return for interval insertion, immediate placement may be preferable.

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand

Background Many misconceptions still prevail about the appropriateness of use of the intrauterine device (IUD), particularly for younger women. This study examines the factors associated with post abortion IUD use as compared to the combined oral contraceptive pill (COC). It then examines the effect of type of post abortion contraception with the likelihood of seeking subsequent abortions. Study design This prospective cohort study followed, for a period of 3 years, 1422 women who had a first trimester surgical abortion between November 2004 and January 2005 in Auckland's public abortion clinic. Results Compared to women who left the clinic with COC, those leaving with an IUD (OR 0.3) at baseline were less likely to return for a subsequent abortion. Among women who had not had a previous termination, younger women were less likely than older women to have had an IUD inserted post abortion. With every additional live birth, women were three times as likely to have left the abortion clinic with an IUD. Among women who had had a previous termination, age was no longer significantly associated with post abortion IUD insertion. However, parity was still significantly associated, as was having a negative sexually transmitted infection test. Conclusions Young and nulliparous women are less likely to use an IUD as a method of contraception following an abortion. However, those women who have an IUD inserted following an abortion are much less likely to return for a subsequent abortion. IUDs are a safe and effective method of contraception that are currently still underused among the younger population.

Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion

Background Of the 1.3 million abortions performed annually in the United States, approximately half are repeat procedures. Immediate postabortal intrauterine device (IUD) insertion is a safe, effective, practical and underutilized intervention that we hypothesize will significantly decrease repeat unintended pregnancy and abortion. Study design All women receiving immediate postabortal IUD insertion in eight clinics of a Northern California Planned Parenthood agency during a 3-year period comprise the IUD cohort. We selected a cohort of controls receiving abortions but choosing other, non-IUD contraception on the day of the abortion visit in a 2:1 ratio matched by date of abortion. We obtained follow-up data on repeat abortions within the agency for both cohorts through 14 months after the 3-year period. We evaluated differences in repeat abortion between cohorts. All analyses were intent-to-treat. Results Women who received an immediate postabortal IUD had a lower rate of repeat abortions than controls (p<.001). Women who received a postabortal IUD had 34.6 abortions per 1000 woman-years of follow-up compared to 91.3 for the control group. The hazard ratio for repeat abortion was 0.38 [95% confidence interval (CI), 0.27–0.53] for women receiving a postabortal IUD compared to controls. When adjusted for age, race/ethnicity, marital status, and family size, the hazard ratio was 0.37 (95% CI, 0.26–0.52). Conclusion Immediate postabortal intrauterine contraception has the potential to significantly reduce repeat abortion.

Decision analysis of immediate vs. delayed insertion of intrauterine devices after abortion to prevent pregnancy

Introduction: Immediate postabortal intrauterine device (IUD) insertion has been shown to be safe and effective, yet it is not commonly available. Materials and Methods: We performed a decision analysis to examine pregnancy rates at 1 year following abortion with immediate or delayed IUD insertion. The base case assumed an 80% 1-year continuation rate for both groups, an additional 10% expulsion risk with immediate insertion, a 30% risk for not returning for delayed insertion, and pregnancy rates of 8% without an IUD and 0.5% with an IUD. Pregnancy between abortion and delayed IUD insertion was not considered. One-way, two-way and Monte Carlo sensitivity analyses were performed. Results: In the decision model, the 12-month pregnancy rate was 20 per 1000 women in the immediate-insertion group and 33 per 1000 women in the delayed-insertion group. Sensitivity analyses show the model to be dependent on the expulsion rate in the immediate-insertion group (varied up to 30%) and the rate of not returning in the delayed-insertion group. Analysis of multiple scenarios showed that immediate insertion results in fewer pregnancies 83% of the time, with an absolute difference in pregnancy rate of 1%. If the expulsion rate is less than 10%, immediate insertion is favored in 99.5% of scenarios. Conclusion: Despite assumptions in the model heavily favoring delayed insertion, immediate postabortal IUD insertion is predicted to result in 13 fewer pregnancies per 1000 women in the following year than delayed insertion. Future research should examine cost-effectiveness and nonpregnancy outcomes.

Evaluation of postabortion IUD insertion in Egyptian women

This study was carried out at Alhussein University Hospital and Elmonera General Hospital to assess the safety and efficacy of intrauterine device (IUD) insertion immediately after spontaneous abortion compared with insertion 2 weeks after abortion. One hundred women between ages 18 and 40 years were recruited from those admitted via the emergency room with first trimester spontaneous abortion. All women were counseled about a method of contraception, particularly copper T-380, and divided into two groups: Group I, which included 69 women who preferred immediate IUD insertion, and Group II, which included 31 women who asked for late IUD insertion 2 weeks after an abortion. All women were followed at 2, 6, and 10 weeks after insertion of IUDs. Bleeding patterns were comparable in both groups. Mild bleeding occurred in 9.2% and 16% in Groups I and II, respectively; moderate bleeding occurred in 80% and 64%, respectively, and severe bleeding was observed in 10.8% and 20%, respectively. This was not significant. Expulsion rate was 4.5% and 3.4% in Groups I and II, respectively, which was also not significant. There were no cases of perforation or pelvic infections. This study showed that insertion of an IUD immediately after a spontaneous abortion is safe and could be offered to those who have had an abortion and who ask for a method of contraception.