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

OBJECTIVE: Intrauterine 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. DESIGN: Prospective cohort study SETTING: Multicentre study at five public health facilities in central Uganda. PARTICIPANTS: 1050 women with first-trimester incomplete abortion managed with misoprostol, recruited on giving informed consent. INTERVENTION: After 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 MEASURES: Primary outcome was IUD expulsion rates at 6 months. Secondary outcomes were risk factors for IUD expulsions. RESULTS: Between 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