Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation: A randomized controlled trial

Heather L. Hohmann, Matthew F. Reeves, Beatrice A. Chen, Lisa K. Perriera, Jennifer L. Hayes, Mitchell D Creinin

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design: We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results: Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%-69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI -0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion: Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.

Original languageEnglish (US)
Pages (from-to)240-245
Number of pages6
JournalContraception
Volume85
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Levonorgestrel
Intrauterine Devices
Dilatation
Randomized Controlled Trials
Intrauterine Device Expulsion
Confidence Intervals
Lost to Follow-Up
Pregnancy
Population

Keywords

  • Contraception
  • Dilation and evacuation
  • Induced abortion
  • Levonorgestrel-releasing intrauterine device

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation : A randomized controlled trial. / Hohmann, Heather L.; Reeves, Matthew F.; Chen, Beatrice A.; Perriera, Lisa K.; Hayes, Jennifer L.; Creinin, Mitchell D.

In: Contraception, Vol. 85, No. 3, 03.2012, p. 240-245.

Research output: Contribution to journalArticle

Hohmann, Heather L. ; Reeves, Matthew F. ; Chen, Beatrice A. ; Perriera, Lisa K. ; Hayes, Jennifer L. ; Creinin, Mitchell D. / Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation : A randomized controlled trial. In: Contraception. 2012 ; Vol. 85, No. 3. pp. 240-245.
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abstract = "Background: The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design: We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results: Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100{\%}) randomized to immediate insertion had successful IUD placement, while only 20 (45.5{\%}) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5{\%}, 95{\%} confidence interval (CI) 39.8{\%}-69.3{\%}]. Seventeen (38.6{\%}) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2{\%}) and 17 of 27 women (62.9{\%}) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2{\%}, 95{\%} CI -0.4{\%} to 44.8{\%}). Intrauterine device expulsion occurred in three subjects (6.8{\%}) and one subject (5.0{\%}) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion: Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.",
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T2 - A randomized controlled trial

AU - Hohmann, Heather L.

AU - Reeves, Matthew F.

AU - Chen, Beatrice A.

AU - Perriera, Lisa K.

AU - Hayes, Jennifer L.

AU - Creinin, Mitchell D

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N2 - Background: The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design: We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results: Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%-69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI -0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion: Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.

AB - Background: The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design: We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results: Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%-69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI -0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion: Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.

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