{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:01Z","timestamp":1792787281762,"version":"4.5.0"},"reference-count":26,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009914","name":"Makerere University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009914","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Swedish Research Council","award":["Grant 2019-04256"],"award-info":[{"award-number":["Grant 2019-04256"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Intrauterine device (IUD) user rates remain below 5% in low-income countries yet fertility after first-trimester abortions returns within 2\u2009weeks. IUDs provide effective contraception. This study set out to explore the risk factors for IUD expulsion after medical management of first-trimester incomplete abortions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Multicentre study at five public health facilities in central Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1050\u2009women with first-trimester incomplete abortion managed with misoprostol, recruited on giving informed consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>After selecting either copper or levonorgestrel (LNG) IUDs, participants were randomised to early (within 1\u2009week) or standard (at 2\u20134 weeks) insertion and assessed on IUD expulsion 6\u2009months later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcome was IUD expulsion rates at 6\u2009months. Secondary outcomes were risk factors for IUD expulsions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%\u2009CI 4.83 to 13.22, p&lt;0.001), anxiety during the IUD insertion (aOR=4.28, 95%\u2009CI 1.09 to 16.85, p=0.038), use of ultrasound at follow-up (aOR=8.41, 95%\u2009CI 4.56 to 15.5,\u2009p&lt;0.001) and breastfeeding at the time of IUD insertion (aOR=1.48, 95%\u2009CI 0.26 to 4.98, p=0.042).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Offering 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2025-203045","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:20:20Z","timestamp":1768242020000},"page":"109-119","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Expulsion rates and risk factors for intrauterine device expulsion following medical management of first-trimester incomplete abortions: A prospective cohort study in central Uganda"],"prefix":"10.1136","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4707-1282","authenticated-orcid":false,"given":"Herbert","family":"Kayiga","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emelie","family":"Looft-Tr\u00e4g\u00e5rdh","sequence":"additional","affiliation":[{"name":"Department of Women's and Children\u2019s Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8115-5503","authenticated-orcid":false,"given":"Amanda","family":"Cleeve","sequence":"additional","affiliation":[{"name":"Department of Women's and Children\u2019s Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"WHO collaborating center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Othman","family":"Kakaire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazarius Mbona","family":"Tumwesigye","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josaphat","family":"Byamugisha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-1444","authenticated-orcid":false,"given":"Kristina","family":"Gemzell-Danielsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children\u2019s Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026102002151075000_52.2.109.1","unstructured":"Ministry of Health - Uganda . 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