Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence

Objective Assess the safety and efficacy of intrauterine contraceptive devi ce (IUCD) insertion immediately after induced or spontaneous abortion. Design Systematic search for randomised trials that had at least one treatm ent arm that involved IUCD insertion immediately after an induced or sponta neous miscarriage using Medline, Popline, EMBASE, and review articles, supp lemented by correspondence with investigators. Population Women of any age or gravidity who had all IUCD inserted immediat ely after evacuation for spontaneous or induced abortion. Methods Articles were abstracted and the ra data from tables, were analysed with RevMan 3.1 software. We focused on Tietze-Potter gross life table pro babilities with denominators of person-time of exposure. Main outcome measures Rates of perforation, expulsion. pelvic inflammatory disease, contraceptive failure, and method continuation. Results Complication rates for immediate post-abortal IUCD insertion were l ow. Perforation was rare with a rate of approximately one per 1000 insertio ns. One year gross cumulative expulsion rates, ranged from 1.8% to 12.6%. p regnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. T he net discontinuation rate due to pelvic inflammatory disease was low, ran ging from 0.0 to 0.8 per 100 women at one year. Increasing, gestational age at insertion was associated with increased expulsion rates, Conclusions Post-abortal IUCD insertion is safe and offective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive fail ure were low and similar to those reported for interval insertion. Second t rimester gestational age is associated with all increased risk of expulsion . Immediate insertion may have a higher expulsion rate than delayed inserti on. However. these risks may be outweighed by the benefit of immediate cont raception.