Can an intrauterine device be inserted immediately after a miscarriage? Let's take a look

The World Health Organization's "Medical Standards for the Selection of Contraceptive Methods" clearly stipulates that if there are no contraindications, an intrauterine device can be inserted immediately during an abortion. In areas where artificial abortion is more common, it indicates that there may be unmet demand for family planning, such as insufficient health (or family planning) service outlets, inconvenient transportation (relatively scattered settlements), and limited access to family planning services (lack of facilities, technical strength or information).

Data show that in areas where living conditions restrict residents' activities, only 1/4 of women return to health or family planning service agencies to implement contraceptive measures after abortion. Therefore, immediate placement of an intrauterine device (IUD) after abortion can fill the gap between abortion services and the implementation of family planning measures, which can reduce repeated abortions and improve the level of post-abortion care.

However, some people are concerned about whether inserting an IUD immediately after abortion will increase the risk of complications such as perforation, bleeding, and infection, and that the IUD may also be more likely to fall out after insertion. So far, there are nine randomized controlled clinical trials in the world that meet the requirements of the World Health Organization's systematic analysis. The results of the analysis of these nine clinical studies show that:

① The contraceptive failure rate and the incidence of serious complications (uterine perforation, pelvic inflammatory disease, etc.) do not increase when the IUD is placed immediately after abortion. There is no statistical difference between the two when the IUD is placed at a certain interval (usually a few weeks after abortion, during the menstrual period after normal menstruation resumes, or after the menstruation is over).

② In clinical trials of different types of IUDs, it was observed that the copper T220C IUD had a low expulsion rate and a high continuation rate when placed immediately after an abortion, and the pregnancy rate of the levonorgestrel-releasing IUD was relatively low; therefore, these two types of IUDs are more suitable for immediate placement after an abortion.

③ The shedding rate of the copper 7 IUD placed immediately after abortion (this type of intrauterine contraceptive device is not used in China) is higher than that of the IUD placed at a certain interval; the shedding rate of the IUD placed during mid-pregnancy abortion is significantly higher than that during early-pregnancy abortion.