Objective Intrauterine device (IUD) user rates remain below 5% in low-income countries yet fertility after first-trimester abortions returns within 2 weeks. IUDs provide effective contraception. This study set out to explore the risk factors for IUD expulsion after medical management of first-trimester incomplete abortions. Design Prospective cohort study Setting Multicentre study at five public health facilities in central Uganda. Participants 1050 women with first-trimester incomplete abortion managed with misoprostol, recruited on giving informed consent. Intervention After selecting either copper or levonorgestrel (LNG) IUDs, participants were randomised to early (within 1 week) or standard (at 2–4 weeks) insertion and assessed on IUD expulsion 6 months later. Main outcome measures Primary outcome was IUD expulsion rates at 6 months. Secondary outcomes were risk factors for IUD expulsions. Results Between 8 July 2023 and 31 May 2024, 532 (50.7%) participants chose LNG IUDs, 488 (46.5%) chose copper IUDs, while 30 (2.9%) participants chose not to use IUDs. The IUD expulsion rate was 4.6% (95% CI 3.48 to 6.07). IUD expulsion was significantly associated with low overall satisfaction with IUD insertion procedure and use (adjusted odds ratio (aOR)=7.99, 95% CI 4.83 to 13.22, p<0.001), anxiety during the IUD insertion (aOR=4.28, 95% CI 1.09 to 16.85, p=0.038), use of ultrasound at follow-up (aOR=8.41, 95% CI 4.56 to 15.5, p<0.001) and breastfeeding at the time of IUD insertion (aOR=1.48, 95% CI 0.26 to 4.98, p=0.042). Conclusion Offering IUD insertion immediately after medical management of first-trimester incomplete abortion is associated with low expulsion rates and should be offered as a safe choice.
Kayiga et al. (Mon,) studied this question.