A total of 124 women who re-inserted a TCu-200B intrauterine device (IUD) following an expulsion were followed up for 1 year after the IUD re-insertion. The cumulative expulsion rate at 6 months was 21.7 and 31.4 per 100 women at the end of the first year. Women who expelled the first IUD within the first 3 months of use had a significantly higher expulsion rate with the second IUD. Our conclusion is that women who expelled a copper IUD are at a significantly higher risk of expelling the re-inserted IUD than the first IUD. Health workers must also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.
PIP: Researchers analyzed retrospective data on 124 women aged 16-35 who had experienced spontaneous expulsion of the copper T-200 B IUD and then re-insertion of the same type of IUD at the family planning clinic of the State University of Campinas in Brazil during August 1986-December 1992. They were followed for 12 months after IUD re-insertion. Two senior nurses/midwives and two senior physicians performed 86 and 38 of the IUD re-insertions, respectively. Even though the re-expulsion rate was higher when performed by physicians than nurses (34.2% vs. 26.7%), the difference was not statistically significant. The net cumulative re-expulsion rates at 6 and 12 months were high (21.7% and 31.4%, respectively). There were few removals for medical and personal reasons. The 12-month continuation rate stood at 64.3%. Women who had experienced the first expulsion within 3 months after insertion had a significantly higher re-expulsion rate than those whose first expulsion occurred 3 months after insertion (41% vs. 18%; p 0.001). Both these re-expulsion rates were higher than the expulsion rate during the first period of IUD use in the same family planning clinic (3.1-3.9%). These findings suggest that women who have already experienced expulsion of a copper IUD face a much higher risk of expelling the re-inserted IUD than the first IUD. They also indicate that an expulsion after IUD re-insertion due to an earlier expulsion is more likely to happen than after a re-insertion due to life-span expiration. Providers should perform careful follow-up and adequate counseling to all IUD women who have had an IUD re-inserted after expulsion during the first year. The providers should also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.