Expulsion rates and risk factors for intrauterine device expulsion following medical management of first-trimester incomplete abortions: A prospective cohort study in central Uganda

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dc.contributor.authorKayiga, Herbert;
dc.contributor.authorLooft-Trägårdh, Emelie;
dc.contributor.authorCleeve, Amanda ;
dc.contributor.authorKakaire, Othman;
dc.contributor.authorTumwesigye, Nazarius Mbona;
dc.contributor.authorByamugisha, Josaphat;
dc.contributor.authorGemzell-Danielsson, Kristina
dc.date.accessioned2026-01-22T10:39:49Z
dc.date.issued2025-11-25
dc.description.abstractObjectiveIntrauterine device (IUD) user rates remain below 5% in low-income countries yet fertility after first-trimester abortions returns within 2 weeks. IUDs provide effective contraception. This study set out to explore the risk factors for IUD expulsion after medical management of first-trimester incomplete abortions.DesignProspective cohort studySettingMulticentre study at five public health facilities in central Uganda.Participants1050 women with first-trimester incomplete abortion managed with misoprostol, recruited on giving informed consent.InterventionAfter selecting either copper or levonorgestrel (LNG) IUDs, participants were randomised to early (within 1 week) or standard (at 2–4 weeks) insertion and assessed on IUD expulsion 6 months later.Main outcome measuresPrimary outcome was IUD expulsion rates at 6 months. Secondary outcomes were risk factors for IUD expulsions.ResultsBetween 8 July 2023 and 31 May 2024, 532 (50.7%) participants chose LNG IUDs, 488 (46.5%) chose copper IUDs, while 30 (2.9%) participants chose not to use IUDs. The IUD expulsion rate was 4.6% (95% CI 3.48 to 6.07). IUD expulsion was significantly associated with low overall satisfaction with IUD insertion procedure and use (adjusted odds ratio (aOR)=7.99, 95% CI 4.83 to 13.22, p<0.001), anxiety during the IUD insertion (aOR=4.28, 95% CI 1.09 to 16.85, p=0.038), use of ultrasound at follow-up (aOR=8.41, 95% CI 4.56 to 15.5, p<0.001) and breastfeeding at the time of IUD insertion (aOR=1.48, 95% CI 0.26 to 4.98, p=0.042).ConclusionOffering IUD insertion immediately after medical management of first-trimester incomplete abortion is associated with low expulsion rates and should be offered as a safe choice. ProQuest Health & Medical Complete (Alumni)
dc.identifier.citationKayiga, Herbert, Emelie Looft-Trägårdh, Amanda Cleeve, et al. 'Expulsion Rates and Risk Factors for Intrauterine Device Expulsion Following Medical Management of First-Trimester Incomplete Abortions: A Prospective Cohort Study in Central Uganda', BMJ Sexual & Reproductive Health, (2026), pp. bmjsrh-2025-203045.
dc.identifier.issnISSN 2515-1991
dc.identifier.issnEISSN 2515-2009
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/11956
dc.language.isoen
dc.publisherBritish Medical Journal Publishing Group
dc.subjectIntrauterine device (IUD)
dc.subjectfirst-trimester abortions
dc.subjectlow-income countries
dc.subjectrisk factors for IUD
dc.titleExpulsion rates and risk factors for intrauterine device expulsion following medical management of first-trimester incomplete abortions: A prospective cohort study in central Uganda
dc.typeArticle
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