Immediate placement of intrauterine device after second-trimester medical abortion—Secondary outcomes with one-year follow-up

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2026-08-07 Epub Date: 2026-06-10 DOI:10.1111/aogs.70259

Sara Hogmark, Caroline Westermark, Niklas Envall, Kristina Gemzell-Danielsson, Helena Kopp Kallner

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引用次数: 0

Abstract

Introduction

Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after second-trimester medical abortion.

Material and Methods

We performed a 12-month follow-up of a multicenter randomized controlled trial comparing IUD placement within 48 h (intervention) with placement at 2–4 weeks (control) after medical abortion with 85 to 153 days' gestation. Secondary outcomes such as proportions of long-term IUD use, subsequent pregnancies and abortions, and participant satisfaction are presented (ClinicalTrials.gov NCT03603145).

Results

A total of 179 women were included. The 12-month follow-up rate was 71.1% (64/90) in the intervention group and 73.0% (65/89) in the control group. Fewer women in the intervention group were using an IUD after 12 months: 51.6% (33/64) vs. 69.2% (45/65, p = 0.04). The total expulsion rate over 12 months was 36.4% (24/66) in the intervention group compared to 3.1% (2/65) in the control group (p < 0.001), with only two IUDs being expelled between 6 and 12 months, both in the intervention group. The most common contraceptive method at 12 months was any hormonal IUD at 54.3% (70/129). Among IUD users at 12 months, the overall satisfaction with their contraceptive method was high, at 88.3% (68/77). In the intervention group, 26.2% (16/61) had at least one subsequent pregnancy within 12 months compared to 13.6% (9/66, p = 0.08) in the control group. We found no significant difference in the number of subsequent abortions; 13.1% (8/61) in the intervention group and 6.1% (4/66) in the control group reported at least one subsequent abortion (p = 0.23).

Conclusions

Immediate IUD placement after second-trimester medical abortion did not lead to a higher proportion of IUD use at 12 months compared to delayed placement. Rather, immediate IUD placement was associated with a higher incidence of expulsion and lower use; however, no significant increase in subsequent pregnancies or abortions was observed. High satisfaction levels with IUD use were reported in both groups, but women with immediate placement were less likely to recommend a friend to use an IUD post abortion.

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妊娠中期药物流产后立即放置宫内节育器-随访一年的次要结果。

导读：宫内节育器能有效预防意外怀孕。对于妇女在妊娠中期药物流产后选择宫内节育器的长期结果知之甚少。材料和方法：我们对一项多中心随机对照试验进行了为期12个月的随访，比较药物流产后（妊娠85 ~ 153天）48小时内放置IUD（干预）和2 ~ 4周放置IUD（对照组）。次要结局，如长期使用宫内节育器的比例，随后的怀孕和流产，以及参与者满意度（ClinicalTrials.gov NCT03603145）。结果：共纳入179名妇女。干预组12个月随访率为71.1%(64/90)，对照组为73.0%（65/89）。干预组12个月后使用宫内节育器的妇女较少：51.6%（33/64）对69.2% （45/65,p = 0.04）。干预组12个月内总排出率为36.4%(24/66)，对照组为3.1%（2/65）。(p)结论：妊娠中期药物流产后立即放置宫内节育器并不比延迟放置宫内节育器导致12个月内使用宫内节育器的比例更高。相反，立即放置宫内节育器与较高的排出率和较低的使用率有关；然而，没有观察到随后怀孕或流产的显著增加。两组对使用宫内节育器的满意度都很高，但立即放置宫内节育器的妇女不太可能推荐朋友在流产后使用宫内节育器。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.