|
Recommendations for Contraceptive Use |
|
|
|
 |
Copper-Bearing Intrauterine Devices (IUDs)
|
Q.5. Can an intrauterine device (IUD)
be inserted immediately post-abortion?
|
|
|
| a) Yes, the IUD may be inserted
immediately post-abortion (spontaneous or induced) if the uterus is not infected,
or during the first seven days post-abortion, (or anytime you can be
reasonably sure the woman is not pregnant). |
a) With appropriate technique,
IUDs can be safely inserted post-abortion (spontaneous or induced). Expulsion rates vary
greatly depending on both the IUD type and provider. To minimize risk of expulsion, only
providers with proper training (according to relevant national or institutional standards)
and experience should insert IUDs. Clients should be carefully trained to detect
expulsions. Fertility returns almost immediately
post-abortion (spontaneous, or induced): within 2 weeks for first trimester abortion and
within 4 weeks for second trimester abortion. Within 6 weeks of abortion, 75% of women
have ovulated.
- Lähteenmaki P, Ylöstalo P, Sipinen
S, Toivonen J, Ruusuvaara L, Pikkola P, Nilsson CG, Luukkainen T. Return of ovulation
after abortion and after discontinuation of oral contraceptives. Fertility and
Sterility 1980;34(3):246-249.
|
| |
|
b) IUDs should not be
inserted in the following situations:
- With confirmed or presumptive diagnosis of infection
(signs of unsafe or unclean induced abortion, signs and symptoms of sepsis or infection,
or inability to rule out infection), do not insert IUD until risk of infection has been
ruled out or infection has fully resolved (approximately 3 months).
- With serious trauma to the genital tract (uterine
perforation, serious vaginal or cervical trauma, chemical burns), do not insert IUD until
trauma has healed.
- With hemorrhage and severe anemia, IUDs (inert or
copper-bearing) are not advised until hemorrhage or severe anemia is resolved. However,
progestin-releasing IUDs can be used with severe anemia (they decrease menstrual blood
loss).
- Post-abortion IUD insertion after 16 weeks gestation
requires special training of the provider for correct fundal placement. If this is not
possible, delay insertion for six weeks.
|
b) After 16 weeks gestation, the
uterine cavity will be too enlarged for post-abortion IUD placement to be accomplished by
routine IUD insertion techniques. Only providers trained to do postpartum IUD insertion
should perform immediate post-abortion IUD insertion for post-abortion clients after 16
weeks gestation.
- Maternal adaptation to pregnancy, in
Pritchard JA, Macdonald PC (eds). Williams Obstetrics, 16th edition. New York,
Appleton-Century-Crofts, 1980, p 223.
- Leonard AH, Ladipo OA. Postabortion
family planning: Factors in individual choice of contraceptive methods. Advances in
Abortion Care. 1994;4(2):1-4.
|
|
