Intrauterine Device Expulsion After Medication Versus Procedural Management of Induced and Spontaneous Abortion: A Retrospective Study

<b><i>Objective:</i></b> To compare intrauterine device (IUD) expulsion rates between medication and procedural abortion management for induced or spontaneous abortion and identify risk factors for expulsion. <b><i>Methods:</i></b> We conducted a retrospective cohort study of patients undergoing medication or procedural management of induced or spontaneous abortion ≤10 weeks' gestation at a specialty clinic within a single academic center between 2010 and 2023. Included patients received a copper or levonorgestrel IUD at the time of uterine aspiration or within 30 days of medication management and had clinical or radiographical follow-up describing the IUD. The primary outcome was partial or complete IUD expulsion. Secondary analyses examined associations between clinical variables and expulsion risk. <b><i>Results:</i></b> Among 410 patients, 60 received medication for induced or spontaneous abortion, and 350 underwent procedural management for induced or spontaneous abortion. The IUD expulsion rate was 12% following medication management and 11% following procedural management, with no statistically significant difference. In a regression analysis, indication, treatment method, gestational age, and IUD type were not associated with IUD expulsion. Gravidity was the only independent risk factor (OR: 1.21; 95% CI: 1.09-1.35). <b><i>Conclusions:</i></b> IUD expulsion rate after procedural or medication management of induced or spontaneous abortion was approximately 11% and did not differ by indication or treatment.