BJOG : an international journal of obstetrics and gynaecology
April 19, 2026 · via Europe PMC
Immediate Versus Delayed Postpartum and Postabortion Insertion of Long-Acting Reversible Contraception: An Umbrella Review.
Zhang Y, Chen Y, Zhang X, Zhang Q, Wang J, Jin M, Zhang J, Jin H.
AI summary — for doctors, generated from the abstract only
Immediate postpartum and postabortion LARC insertion increased uptake and reduced unintended pregnancy compared with delayed insertion, at the cost of higher IUD expulsion rates.
What was studied
An umbrella review of nine systematic reviews and meta-analyses (92 comparisons) comparing immediate versus delayed LARC insertion after delivery or abortion.
Key findings
- Immediate postpartum insertion: higher LARC initiation and 6-month use
- 6-month pregnancy RR 0.16 (0.04-0.71; moderate certainty) postpartum
- Similar benefits after abortion (low certainty)
- Expulsion higher with immediate postpartum IUD after vaginal delivery (RR 5.09; high certainty)
- Expulsion higher after first-trimester medical abortion (RR 2.02; moderate certainty)
Clinical relevance
This supports offering immediate LARC insertion after delivery or abortion with counselling about higher expulsion risk.
Who should care
Limitations
Umbrella review dependent on quality of included reviews; postabortion evidence low certainty.
Placing LARC right after birth or abortion prevents more pregnancies, though IUDs expel more often.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Unintended pregnancy and repeat abortion remain significant challenges in the field of reproductive health.
Objectives
To summarize evidence from systematic reviews and meta-analyses (SRMAs) comparing immediate versus delayed long-acting reversible contraception (LARC) insertion in postpartum and postabortion populations.
Search strategy
Five databases were systematically searched in April 2025 without restrictions.
Selection criteria
SRMAs were included if they assessed the possible health outcomes between immediate and delayed LARC insertions for postabortion or postpartum populations.
Data collection and analysis
Pooled results were extracted as reported, with most effect sizes presented as relative risks (RRs) with 95% confidence intervals (CIs). Eligible SRMAs were assessed utilizing AMSTAR-2 for methodological quality. Evidence certainty was assessed by GRADE tool or predefined criteria.
Main results
From 1998 screened records, nine SRMAs were included, yielding 92 comparisons. Compared with the delayed group, postpartum women in the immediate group had higher LARC initiation, higher 6-month LARC utilization and lower 6-month pregnancy rates (RR, 0.16; 95% CI, 0.04-0.71; moderate-certainty evidence). Similar comparison results of such outcomes were discovered in postabortion populations. However, immediate intrauterine device insertion significantly increased the risk of expulsion, especially in the vaginal delivery subgroup for postpartum populations (RR, 5.09; 95% CI, 2.04-12.73; high-certainty evidence) and in the first trimester subgroup for medical abortion populations (RR, 2.02; 95% CI, 1.37-2.98; moderate-certainty evidence).
Conclusions
Compared with delayed insertion, immediate LARC placement after delivery (moderate-certainty) or abortion (low-certainty) was more effective in preventing unintended pregnancies. Additionally, abortion methods should be considered in future guideline updates, though supporting evidence was of low-certainty.
Trial registration
PROSPERO number: CRD420251031374.
DOI
10.1111/1471-0528.70248
PMID
42002303
PMCID
PMC13485442
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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