Conference Coverage

Data support same-day IUD placement in women seeking contraceptive services

Key clinical point: Same-day IUD placement appears to be the better approach, compared with a two-visit protocol.

Major finding: In one study, EMR data showed that 6.5% and 5.0% of patients with and without same-day IUD placement, respectively, received a PID diagnosis, a difference that was not significant. In another study, less than 70% of patients returned for IUD placement in a two-visit protocol.

Data source: A survey and chart reviews.

Disclosures: Ms. Wang and Dr. Markham reported having no disclosures.


 

AT THE ACOG ANNUAL CLINICAL MEETING

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

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