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Post-Abortion IUC Insertion

Post-Abortion IUC Insertion. Eleanor Drey, MD, EdM Assistant Clinical Professor Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Sarah Prager, MD, MAS Assistant Clinical Professor Obstetrics and Gynecology University of Washington. Disclosures.

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Post-Abortion IUC Insertion

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  1. Post-Abortion IUC Insertion Eleanor Drey, MD, EdM Assistant Clinical Professor Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Sarah Prager, MD, MAS Assistant Clinical Professor Obstetrics and Gynecology University of Washington

  2. Disclosures Eleanor Drey, MD, EdM Consultant and Speaker, Organon Research Grant, Ortho

  3. Cu T380A (ParaGard) regular menses heavier bleeding 10 years use no follicular cysts no PID protection no therapeutic role effective EC Levonorgestrel (Mirena) irregular bleeding reduced or no menses 5 years use cysts may form some PID protection DUB and HRT role not for EC Copper vs. Levonorgestrel IUC: Summary

  4. Why insert IUC immediately following abortion? • Patients motivated • Increased patient comfort • Cervix open enough for abortion to be done • Pre-medicated for pain control for abortion • No longer pregnant at time of placement • May not return for interval placement

  5. Is it safe to insert IUC immediately following abortion? • Does it increase risk of infection/PID? • Does it increase risk of bleeding after the abortion? • Does it increase risk of perforation or expulsion?

  6. “Immediate Postabortion Intrauterine Contraception in Nulliparous Adolescents.” Goldman, Israel J Med Sci, 1979

  7. 1983 WHO Study: PIDpost abortion insertion

  8. 1983 WHO Study: Expulsion of TCu220c post abortion *p<0.01 *p<0.01 *p<0.05 *p<0.05

  9. Immediate Post abortion IUC Insertion versus 2-week Delay of Insertion *all p=NS Moussa, Contraception, 2001

  10. Rates of complications after interval IUC insertion Johns Hopkins School of Public Health/Population Information Project; Managing Contraception

  11. Conclusions: Immediate Post-abortion IUC Insertion • IUD placement after abortion is safe • PID rate not increased • Expulsion rate after first-trimester abortion is less than or equal to interval insertion • IUDs inserted after abortion provide effective contraception • Pregnancy rate same as interval insertion • Limited data about post-second-trimester • No data about antibiotics or uterotonics

  12. How do LNG and Copper IUC compare?

  13. RCT of Mirena vs. NovaT after First-Trimester Abortion • 305 patients received Mirena® • 133 patients received NovaT (200 mm2 copper on same frame as Mirena®) • Multi-center in Denmark, Finland, Hungary, Norway, & Sweden. • Not blinded • Inserted after abortion at less than 12 weeks • Pakarinen, 2003, Contraception

  14. Results of Mirena vs. NovaT:Expulsion after Post abortion Insertion *p<0.01 Pakarinen, 2003.

  15. Cumulative Termination Rates Per 100 women: LNG vs. Cu T Expulsion Bleeding Problems Hormonal LNG IUS N=1821 Nova T N=937 Andersson et al. Contraception 1994;49:56

  16. Post-Abortion Mirena Compared with Norplant and “Traditional Methods” • 2 expulsions at 12 months (4%) • No pregnancies in Mirena or Norplant groups • 4 pregnancies in group using traditional methods *p<0.01 Ortayli, Contraception, 2001

  17. How do you do post-abortion IUC insertion?

  18. SFGH IUC Placement Protocol: Operative Technique • All D&E procedures done under ultrasound guidance • Methergine for bleeding/atony • Methergine is not routinely given • IUC placement under ultrasound guidance after D&E (second trimester) • Ring forceps used for T380a if >14 weeks • Ring forceps used to guide Mirena inserter if difficult to place

  19. When not to insert IUC immediately post-abortion: • If the patient’s bleeding post-procedure is not well controlled • If the patient appears to be infected • If you are concerned about perforation

  20. The Women’s Option Centerat San Francisco General Hospital • Abortions up to 23 weeks • >2000 terminations per year • Contraceptive failure common • Diverse patients

  21. WOC Post-Abortion IUC Insertion:Patient Satisfaction • 90% of patients are very or somewhat satisfied (65% “very”) • Patient quotes: • “I am not going to forget to take a pill, and I’m not going to get poked every 3 months.” • “I’m thrilled. It’s so easy. I don’t have to think about it.” • “My husband is a sex maniac, so I am more comfortable knowing it’s there”

  22. What are the benefits to immediate post-abortion insertion? • Patients leave with long-term, highly efficacious contraception • Don’t have to depend on patient follow-up • More comfortable insertion

  23. Thanks to : • Gillian Dean, MD, Assistant Professor, Einstein Univ. • Philip Darney, MD, MSc, Professor, UCSF/SFGH • Mathew Reeves, MD, Assistant Professor, Pittsburgh

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