A randomized controlled trial observed that placing intrauterine devices within 48 hours following a second-trimester medical abortion led to significantly higher expulsion rates compared with delayed placement.

In the Swedish multicenter study, published in the American Journal of Obstetrics & Gynecology, researchers recruited 179 participants seeking medical abortion at 85 to 153 days gestation. The trial was halted early after an interim analysis found expulsion rates exceeded a predefined 20% threshold in the immediate placement group. The trial is among the first to assess intrauterine device (IUD) placement timing following a second-trimester abortion without requiring ultrasound follow-up.

According to a modified intention-to-treat (mITT) analysis, IUD expulsion occurred in 30.1% of the patients with immediate placement vs 2.9% in those with delayed placement. Six months postabortion, 50.7% of the patients who received early placement continued using an IUD compared with 71.6% of those in the delayed group.

Attendance at IUD placement visits was higher in the early group (89.6% vs 71.8%); however, one-third of the IUDs were expelled when placed within 48 hours. Only 3 of the 22 expelled IUDs in this group were replaced. Pain scores during IUD placement were also elevated in the immediate group, with a baseline score of 9.1 mm (standard deviation [SD] = 14.6) vs. 3.8 mm (SD = 7.4) and a tenaculum placement score of 35.2 mm (SD = 27.3) vs. 24.2 mm (SD = 20.2).

Expulsion rates varied by gestational age, with previous studies showing lower rates in first-trimester cases. The researchers concluded that immediate IUD placement after second-trimester abortion should be limited to selected patients after counseling on expulsion risks, with replacement devices ideally available.

Conflict of interest disclosures are available in the study.