Uptake of IUD insertion is greater when it is offered immediately after termination than when insertion is delayed for four to six weeks. Expulsion and bleeding were no higher in the early insertion group.

A total of 156 women undergoing medical termination of pregnancy were randomised to immediate or delayed insertion of a copper IUD.

The 71 women in the former group were offered the IUD when reviewed one week after termination and the 85 women in the latter group were invited to return four to six weeks later for insertion. All patients were given prophylactic antibiotics.

Initial uptake was significantly higher in the immediate insertion group 69 (97%) compared with 65 (76%) in the delayed insertion group (p

Four pregnancies occurred before the six-month review. All were in women randomised to late insertion but who did not return for the procedure.

Removal of the IUD before the six-month review, mainly for menstrual problems, occurred in ten (14%) early and five (8%) late insertions. Expulsion rates were similar in the two groups: eight (12%) and seven (11%) of which three and four respectively were identified only by ultrasound examination.

The care of women undergoing termination of pregnancy is incomplete unless a plan for future contraception is addressed. The copper IUD is a reasonable option; it has a low failure rate and requires no further action from the woman for it to be effective.

The authors conclude that immediate insertion of a copper IUD after medical termination should be offered routinely to women. The suggestion from this paper is that diligent and proactive attention to post-termination contraception is beneficial although the trend for six-month continuation rates was lower for early IUD insertion. Careful follow-up checking for expulsion is also advisable.

Dr Chris Barclay

• Shimoni N, Davis A, Ramos ME et al. Timing of copper intrauterine device insertion after medical abortion: a randomised controlled trial. Obstet Gynecol 2001;118:623-8