Feasibility and uptake of intrauterine contraceptive device at the time of uterine evacuation in women presenting with incomplete miscarriage at Kalafong Provincial Tertiary Hospital

Abstract

BACKGROUND : Insertion of intrauterine contraceptive device at the time of uterine evacuation decreases the incidence of subsequent unintended pregnancies and repeat abortions. It also has advantages as the patient is known not to be pregnant, the uterine cervix is still dilated and the patient still under anaesthesia or sedation resulting in less pain during insertion. However, feasibility and uptake of IUD has not been investigated in South Africa. MATERIALS AND METHODS : This was a prospective, descriptive study over a period of 13 months describing the results of a cohort of 297 women presenting with fi rst and second trimester miscarriages at the emergency gynaecological service at Kalafong Provincial Tertiary Hospital (KPTH) in Atteridgeville, Pretoria. These women were offered IUD insertion following uterine evacuation. They were reviewed after six weeks post insertion to assess the satisfaction and continuation rate. RESULTS : Two hundred and ninety seven women were recruited to the study. Sixteen patients were excluded from the analysis for various reasons. Of the remaining 281 women, 135 (48.0%) accepted the offer of IUD insertion immediately following uterine evacuation, and 146 (52.0%) declined the offer of IUD insertion. Seventy one patients (52.6%) who had IUD insertion followed up after six weeks. Fifty one women (71.8)% women were satisfied and 57 (80.3%) elected to continue with the IUD as a form of contraception. One patient reported expulsion for an expulsion rate of 1.4%. CONCLUSION : The uptake IUD insertion at the time of uterine evacuation in women with incomplete miscarriage is high and it is feasible with a low expulsion rate. Most women are satisfied with the IUD and the continuation rate was high.