What are the advantages of intrauterine device (IUD) insertion immediately following elective or spontaneous abortion?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Insertion After Elective or Spontaneous Abortion

IUDs are a safe and effective means of contraception following spontaneous or elective abortion. [14, 40, 41] Women who have elective abortions are at risk for future unplanned pregnancy and immediate postabortion IUD insertion has been convincingly shown to decrease unplanned pregnancies in these women. [42, 43]

Although both immediate insertion and interval insertion 4–8 weeks after the procedure are safe, data support immediate insertion for several reasons. [44, 14] First, patients are often motivated regarding contraception at this time and have access to health care that they might not otherwise seek. [45, 46, 47]

Immediate insertion is also advantageous because it eliminates concern for timing of insertion with regard to potential pregnancy. In addition, postinsertion bleeding may be masked by postabortion bleeding, resulting less patient dissatisfaction with IUD as method of contraception. Lastly, less than one-third of women who report planning to use an IUD for contraception postabortion actually follow-up to have IUD placed. [44, 48]

Immediate postabortion insertion is associated with an increased expulsion rate compared with interval insertion. This expulsion risk is higher with second-trimester abortions compared to first-trimester abortions. [14, 44] Immediate postabortal insertion should not be considered in women with septic abortions or with concern for postprocedural infection (endomyometritis). [7, 8]

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