1. IUCD: insertion after abortion
Doctor Marie-Laure Brival MD,Medical Director of Maternity of the Hospital
Les Lilas
Moscow,International Seminar
Abortion ,Contraception and Women’s Health
27-28 th October 2005

2. Definition
IUCD: reversible contraceptive method with high efficacy
It concerns about 100 millions women all over the world

3. Generalities 3 Types of IUCD Without Copper: Lippes Loop
With Copper: Copper T 200 (TCu 200)
Copper T 220 C(TCu 220 C) Copper T 380
( Gyne T380, TCu Ag 380)
Multiload IUD
NovaT
Copper 7
Levonorgestrel releasing device : Mirena®

4. Type A
Type D
Lippes loop

5. T 220 C
T 380
T 200

6. Multiload IUD : MLCu 250 (normal,short) MLCu 375

7. Nova T

8. Copper 7

9. Levonorgestrel releasing device
LNG-IUS Mirena®

10. Generalities Efficacy
Contraception failure
Ectopic
Pregnancy
Copper IUD
0,6%
0,3%
LNG-IUS
Miréna
0,09%
0,02%

11. Generalities Complications Contraindications
Pelvic inflammatory disease: RR3,8
Perforation: 0,6 to 1,6 °/°°
Expulsion: Copper 6,7%, LNG 5,8%
Contraindications
Pregnancy
STI, pelvic inflammatory disease
cancer,Bleeding fibroma,
copper allergy and CI for LNG

12. Randomized Studies 259 2,3 / 0,0 15,4 /2,8 NR 1,7 3,7 3,6 4,4 9,6 8,4
Author Nb
intervention
Pregnancy%
Expulsion%
Perforation %
PID
Gillet
1980
unicenter
259
I.A.
I Trim
Copper 7 immediate/delayed insertion
2,3 / 0,0
15,4 /2,8 NR
W.H.O.
1983 a
multicent
2340
T 220C
Lippes loopD
Copper 7
I..insertion
1,7
3,7
3,6
4,4
9,6
8,4
0,1
0,0
0,3
0, 3
0,7
1983 b
1060 SA
I.insertion
2,4
1,1
9,2
13,2
12,7
0,8
0,4

13. Randomized Studies Author Lim 549 NR 0,6 6,5 6,3 Randic 4,6 12,6 4,5Nb
intervention
pregnancy
expulsion
perforation
PID
Lim
1985
unicenter
549
I.A. gesta?
ML250
375 I.insertion
0,8
2,1
1,9
1,8 NR
Mccarthy
400
I.A.
gesta?
NovaT /MLCU250
I.insertion
0,6
6,5
6,3
Randic
1991
multicent
I Trim
Lippes loopD/
Lldcopper200
4,6
12,6
4,5
Pakarinen
2003 multicent after 5 years
438 I.A.
LNG-IUS/
NovaT
9,5
10,5
15,4
0,7
2,3

14. Nonrandomized Studies
Author Nb
intervention
pregnancy
expulsion
perforation
medical removals
El Tagy
2003
unicenter
300
I.A. I Trim
Copper IUD
immediate/delayed insertion +
Moussa
2001
2 centers
100
S.A.
I Trim
Copper T 380 Li
2004
20 I.A.
LNG-IUS
acceptability

15. Results IUCD insertion after abortion
W.H.O
CopperIUDs have best contraceptive efficacy
TCU 220 C > Copper 7 >Lippes Loop
Insertion of IUD immediatly after abortion or miscarriage: safe and practical
Pelvic imflammatory : rare
Perforation :similar to that of interval insertion

16. Results IUCD insertion after abortion
Gillet
Immediate and delayed Insertion with the same IUD:
no difference
Randic
Copper sleeves improve efficacity of Lippes Loop
Mac Carthy
MultiloadIUD > Nova T
Pakarinen
LNG-IUS > Nova T
LiM
MLCU 375/MLCU 250: no significant difference

17. immediate insertion 240 Women
Results 2004
3 weeks 
6 months
Expulsion
8 (3,5%)
perforation
PID 1
pregnancy
HÔPITAL PRIVE LES LILAS

18. Conclusion (1) IUCD insertion after abortion
Immediate post abortal IUCD
Safe and effective
Addition of Copper sleeves
Improves Contraceptive efficacy
LNG-IUS more effective than CopperIUCD

19. Conclusion (2) IUCD insertion after abortion
Immediate insertion versus delayed Insertion:
perforation
expulsion
P.I.D contraceptive failure
NO SIGNIFICATIVE DIFFERENCE

20. Conclusion (3) IUCD insertion after abortion
Benefits
Abortion and contraception at the same time
Opportunity for women who have limited access to clinicians
Painless insertion