- Email: [email protected]
Outcomes of first-trimester surgical abortion with immediate iud insertion compared between advance practice clinician and physician providers
454
Abstracts / Contraception 88 (2013) 433–473
Objectives: The use of LARC immediately after elective termination reduces the risk of a subsequent unintended pregnancy when compared with other forms of contraceptive use post-termination. In Delaware, insurers have adopted the policy of not reimbursing for LARC immediately after termination, which has resulted in women opting for other forms of contraception. We sought to determine if this policy affects health care costs and the subsequent pregnancy rate among women undergoing elective termination. Methods: A chart review of elective terminations from our outpatient Ryan clinic was performed in June 2007–April 2011. Charts were abstracted for demographic information, contraceptive use and subsequent pregnancy timing. A cost analysis was performed using the procedure prices at our institution. Results: A total of 665 patients were available for inclusion. Fifteen percent of the terminations were medical, and 85% were surgical. Eighty percent of women desired contraception, and, of those, 25% chose LARC. However, only 45% of this group attended their follow-up appointment for LARC placement, and 23% of those who did not attend their appointment had unintended pregnancies, with 40% opting for termination and 48% opting for delivery. LARC placement post-termination would have cost $53,865 to the insurers. Instead, the subsequent pregnancies and terminations cost $208,979 or $115,114 more than the cost of providing LARC at the time of termination. Conclusions: The policy of not providing LARC immediately after termination results in a high unintended pregnancy rate, which ultimately results in more health care dollars being spent. Payers and governmental and public policy agencies should reexamine the policy of not reimbursing for LARC placement immediately after termination.
P54 COMPARISON OF IUD INSERTION EXPERIENCE AND CLINICIAN UTILIZATION AT 6 MONTHS BETWEEN ADOLESCENTS AND NON-ADOLESCENTS IN A FEDERALLY QUALIFIED HEALTH CENTER NETWORK Ravi A Beth Israel Residency in Urban Family Practice, New York, NY, USA Rubin S, Waltermaurer E, Miller N, Prine L Objectives: Clinicians are often concerned that adolescents may not tolerate IUDs. We compared the experiences of adolescents and non-adolescents regarding the initial 6 months of IUD use in terms of device-related clinical contact, reasons for contact, device discontinuation and STIs. Methods: Retrospective chart review of women aged 35 and younger with IUDs inserted in 2011 at a New York City Federally Qualified Health Center network of family physician staffed clinics. Charts were reviewed through 6 months post-insertion, or until device was discontinued, whichever occurred first. We compared adolescents (those under 21) to non-adolescents. Results: Some 182 adolescents and 503 non-adolescents received IUDs (71% levonorgestrel and 29% Copper-T; no significant difference by age). Six months post-insertion, 57% of adolescents (N=103) and 40% of nonadolescents (N=201) initiated at least one IUD-related clinical contact. The top three contact reasons (bleeding changes, pelvic/abdominal pain, string check) did not differ by age-group or device type. Contact frequency differed by age but not by device type. Among adolescents with follow-up visits, 16% (n=18) had removals, 8% (n= 9) expelled and 5% (n=6) were diagnosed with chlamydia. Among non-adolescents, 17% (n=37) had removals, 5% (n= 11) expelled and 2% had chlamydia (n=3) or pelvic inflammatory disease (n= 1). Conclusions: Adolescents were more likely than older clients to make an IUD-related follow-up visit, yet clinical concerns and removal rates are similar for both groups. Although adolescents' expulsion and STI rates are slightly higher than non-adolescents’, both rates are low. These results may reassure clinicians regarding safety of IUD insertions in adolescents and inform them about potential IUD-related clinical visits.
P55 POST-PLACENTAL IUD PLACEMENT IN THE UNITED STATES, 2009 Satterwhite C Kansas University Medical Center, Kansas City, KS, USA Tao G, Altaf E, Tepper N, Hoover K Objectives: To describe prevalence of post-placental placement of intrauterine devices (IUDs) in the context of efforts to increase IUD use. Methods: Using administrative claims data (MarketScan) from commercially insured women in the United States, we used ICD-9 and CPT codes to identify women aged 14 or older who delivered a live infant in 2009. Women who received a hysterectomy or tubal ligation or who could not be followed up were excluded from analysis. We used additional administrative codes (i.e., HCPCS and NDC codes) to identify IUD receipt. IUD placement was classified according to the number of days after delivery; IUDs placed within 3 days of delivery were considered to have been inserted in the immediate post-placental period. Results: Of the 222,317 eligible women, 28,643 (12.9%) had had an IUD placed within the year following delivery. Only 27 IUD insertions were immediately post-placental (0.09%). The majority of IUD placements occurred within 31–70 days of delivery (53.9%). Younger women were more likely than older women to have had an IUD placed (19.0% younger than 20 vs. 7.0% aged 40–44, pb0.001). IUD placement was more likely among women residing in the West (15.7%) than in the Northeast (9.5%, pb0.001). Conclusions: Most IUDs are likely inserted in conjunction with the standard recommended 6-week postpartum visit, despite research suggesting that immediate post-placental IUD placement might be a viable approach to increase IUD uptake. Future efforts to increase IUD use should include consideration of post-placental placement.
P56 OUTCOMES OF FIRST-TRIMESTER SURGICAL ABORTION WITH IMMEDIATE IUD INSERTION COMPARED BETWEEN ADVANCE PRACTICE CLINICIAN AND PHYSICIAN PROVIDERS Patil E Oregon Health & Science University, Portland, OR, USA Orme-Evans K, Beckley E, Bergander L, Nichols M, Bednarek P Objectives: Oregon is one of four states where non-physicians can perform aspiration abortions (TABs). For 7 years, Advance practice clinicians (APCs) at Planned Parenthood Columbia-Willamette (PPCW) have performed this procedure. APCs also have been placing immediate postaspiration intrauterine devices (IUDs) for 4 years. This study compares outcomes of first trimester TABs and immediate IUD insertion between APCs and physicians (MDs). Methods: This retrospective cohort study identified all combined TAB/IUD procedures performed at PPCW between 2009 and 2011. The charts reviewed were examined for any complication, including excessive bleeding, perforation, need for same day re-aspiration, infection or IUD expulsion. Results: Of 1134 combined TAB/IUD procedures, 670 charts were available for review. APCs performed 224 (33.4%) procedures and MDs performed 446 (66.6%). Social and demographic characteristics were similar between groups. Of the TABs performed by APCs, 6/224 (2.68%) reported any major or minor complication versus 16/446 (3.59%) by MDs (p=0.87). For IUD insertion, APCs had 1/224 (0.45%) complications and MDs 6/446 (1.35%; p=0.43). APCs and MDs had similar rates of patient follow-up: 121/224 (54%) vs. 240/ 446 (53.8%; p=0.96). There were no statistically significant differences between APC and MD patients for total delayed complications (p=0.68), including 15/121 (12.4%) vs. 23/240 (9.6%) IUD expulsions and 5/121 (4.1%) vs. 15/240 (6.25%) infections.
Abstracts / Contraception 88 (2013) 433–473 Conclusions: These data are consistent with low complication rates previously reported for first-trimester abortion and immediate postabortion IUD insertion performed by MDs. Given the shortage of physician abortion providers in many states, APC providers offer the opportunity to increase patient access to abortion services without compromising safety.
P57 A RANDOMIZED TRIAL OF IMMEDIATE POSTPARTUM VERSUS INTERVAL INSERTION OF AN INTRAUTERINE DEVICE
bleeding prior to the 3-year period of efficacy (OR 0.84, 95% CI 0.52–1.36, p=.5). There were no social, demographic or clinical characteristics predictive of premature implant removal in either group. Conclusions: One-fifth of etonogestrel contraceptive implant users requested premature removal because of irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates. Mechanisms to help women manage irregular bleeding due to the implant are needed.
P59
Ogburn T University of New Mexico, Albuquerque, NM, USA
OUTCOMES OF INTRAUTERINE DEVICES PLACED IN LARGE UTERI
Espey E, Leeman L, Singh R, Pereda B, Carr S
Hofler L Beth Israel Deaconess Medical Center, Boston, MA, USA
Objectives: The primary objective was to compare rates of successful IUD insertion among women randomized to immediate postpartum vs. interval insertion. Secondary outcomes included IUD continuation, reasons for discontinuation and complications. Methods: After term vaginal or cesarean delivery, women who desired a Paragard IUD were randomized to immediate (within 10 min of placental delivery) IUD placement by one of four investigators or interval placement by their prenatal care provider (4–12 weeks postpartum). All IUDs were provided without cost. Participants were scheduled for a 6-week IUD check and contacted at 3, 6 and 12 months after placement. Rates of insertion were determined and marginal survival analysis of IUD continuation was conducted. Results: The 156 women participating were randomized into two groups of 78. Eighty-seven percent of the immediate group received an IUD, compared with 77% in the interval group (p=.30). Of women who did not receive an IUD, the most common reason was "no study provider available" (8/10) in the immediate group and "did not keep appointment" (11/18) in the interval group. For women who received an IUD, continuation was similar at six weeks after insertion (93% in both groups); at 12 months, it was 65% in the immediate group and 76% in the interval group (p=.23). No major complications occurred in either group. Conclusions: IUD insertion and continuation rates are similar among women randomized to immediate postpartum vs. interval insertion. Immediate insertion rates were decreased by the study requirement of insertion by an investigator.
P58 THE EFFECT OF IMMEDIATE POSTPARTUM VS. INTERVAL INSERTION OF THE ETONOGESTREL CONTRACEPTIVE IMPLANT ON REMOVAL RATES FOR BLEEDING Doan L Warren Alpert Medical School of Brown University/Women and Infants Hospital, Providence, RI, USA Goyal V, Raker C, Murray A, Allen R Objectives: To determine whether the discontinuation rate of the etonogestrel contraceptive implant because of irregular vaginal bleeding among women with immediate postpartum insertion is elevated compared with such discontinuation after interval placement. Methods: This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) with those who underwent interval insertion (more than 6 weeks postpartum) between January 2008 and December 2010. Charts were reviewed for date of implant removal, if any; reasons for removal; and related social, demographic and clinical characteristics. A chi-square test was used to compare discontinuation due to bleeding between cohorts. Results: There were 261 women in the postpartum insertion group and 164 in the interval insertion group. Average age at insertion was 22.6 (± 5.5 years). Overall, 19% of women in the postpartum group and 22% of women in the interval group requested implant removal because of irregular
455
Hacker MR, Merport Modest A, Wu LH, Haider S Objectives: To examine the incidence of intrauterine device (IUD) discontinuation and expulsion in women with enlarged uteri at the time of placement. Methods: This was a retrospective cohort study of women with IUDs placed from 2006 to 2010. Details of placement and discontinuation were extracted from medical records. Results: Uterine sound measurements at IUD placement were documented for 1238 of 1322 (93.6%) women (median 8.0 cm, range 4.5–17.0 cm). Most IUDs (88.0%) were placed for contraception. Of 58 women with uterine sound of less than 10 cm, one IUD (1.7%) was discontinued within 1 month of insertion, compared with 5.1% discontinuation among women with uteri of 10 cm or less (p=.48). Among the 763 women with at least 12 months of follow-up, 39.5% with uteri of more than 10 cm discontinued at 12 months, compared with 29.9% among those with uteri of 10 cm or less (p=.21). Expulsion incidence at 1 year was similar for uteri of more than 10 cm (7.9%) and those 10 cm or less (6.9%; p=.74). There were four uterine perforations; three occurred in uteri measuring 10 cm or less at IUD placement. All six pregnancies that occurred with IUDs in place were in women with uterine sound of 10 cm or less. Conclusions: Package inserts for commercially available IUDs in the United States indicate a maximum uterine sound at the time of IUD placement. IUDs placed in women with uterine sound greater than 10 cm have similar expulsion incidence and adverse outcomes to those in women whose uterine sound is 10 cm or less. We did not detect a statistically significant difference in IUD discontinuation at 12 months; however, our study was underpowered to detect what may be a clinically meaningful difference. Women should not be denied IUDs based solely on large uterine size.
P60 VAGINAL MICROBIOME CHANGES WITH LEVONORGESTREL INTRAUTERINE DEVICE PLACEMENT Jacobson J University of Utah School of Medicine, Salt Lake City, UT, USA Dermish A, Nygaard I, Turok D Objectives: To investigate changes in female genital tract bacterial ecology associated with levonorgestrel intrauterine device (LNG IUD) use. Methods: Study participants were regularly cycling women without recent history of pregnancy or exogenous hormone use. Vaginal, cervical and uterine samples were obtained at nine time intervals, from 1 week before to 13 weeks after LNG IUD placement. Replicate vaginal and cervical specimens were collected to determine the consistency of specimen collection and processing. Vaginal wet mount, pH and prostate-specific antigen testing were conducted at each visit to identify confounders of infection and recent sexual activity. Results: A total of 406 samples from 11 women were available for analysis after DNA extraction, amplification and species identification. Of the 355 bacterial species or genera detected, Lactobacillus crispatus was most
Abstracts / Contraception 88 (2013) 433–473
Objectives: The use of LARC immediately after elective termination reduces the risk of a subsequent unintended pregnancy when compared with other forms of contraceptive use post-termination. In Delaware, insurers have adopted the policy of not reimbursing for LARC immediately after termination, which has resulted in women opting for other forms of contraception. We sought to determine if this policy affects health care costs and the subsequent pregnancy rate among women undergoing elective termination. Methods: A chart review of elective terminations from our outpatient Ryan clinic was performed in June 2007–April 2011. Charts were abstracted for demographic information, contraceptive use and subsequent pregnancy timing. A cost analysis was performed using the procedure prices at our institution. Results: A total of 665 patients were available for inclusion. Fifteen percent of the terminations were medical, and 85% were surgical. Eighty percent of women desired contraception, and, of those, 25% chose LARC. However, only 45% of this group attended their follow-up appointment for LARC placement, and 23% of those who did not attend their appointment had unintended pregnancies, with 40% opting for termination and 48% opting for delivery. LARC placement post-termination would have cost $53,865 to the insurers. Instead, the subsequent pregnancies and terminations cost $208,979 or $115,114 more than the cost of providing LARC at the time of termination. Conclusions: The policy of not providing LARC immediately after termination results in a high unintended pregnancy rate, which ultimately results in more health care dollars being spent. Payers and governmental and public policy agencies should reexamine the policy of not reimbursing for LARC placement immediately after termination.
P54 COMPARISON OF IUD INSERTION EXPERIENCE AND CLINICIAN UTILIZATION AT 6 MONTHS BETWEEN ADOLESCENTS AND NON-ADOLESCENTS IN A FEDERALLY QUALIFIED HEALTH CENTER NETWORK Ravi A Beth Israel Residency in Urban Family Practice, New York, NY, USA Rubin S, Waltermaurer E, Miller N, Prine L Objectives: Clinicians are often concerned that adolescents may not tolerate IUDs. We compared the experiences of adolescents and non-adolescents regarding the initial 6 months of IUD use in terms of device-related clinical contact, reasons for contact, device discontinuation and STIs. Methods: Retrospective chart review of women aged 35 and younger with IUDs inserted in 2011 at a New York City Federally Qualified Health Center network of family physician staffed clinics. Charts were reviewed through 6 months post-insertion, or until device was discontinued, whichever occurred first. We compared adolescents (those under 21) to non-adolescents. Results: Some 182 adolescents and 503 non-adolescents received IUDs (71% levonorgestrel and 29% Copper-T; no significant difference by age). Six months post-insertion, 57% of adolescents (N=103) and 40% of nonadolescents (N=201) initiated at least one IUD-related clinical contact. The top three contact reasons (bleeding changes, pelvic/abdominal pain, string check) did not differ by age-group or device type. Contact frequency differed by age but not by device type. Among adolescents with follow-up visits, 16% (n=18) had removals, 8% (n= 9) expelled and 5% (n=6) were diagnosed with chlamydia. Among non-adolescents, 17% (n=37) had removals, 5% (n= 11) expelled and 2% had chlamydia (n=3) or pelvic inflammatory disease (n= 1). Conclusions: Adolescents were more likely than older clients to make an IUD-related follow-up visit, yet clinical concerns and removal rates are similar for both groups. Although adolescents' expulsion and STI rates are slightly higher than non-adolescents’, both rates are low. These results may reassure clinicians regarding safety of IUD insertions in adolescents and inform them about potential IUD-related clinical visits.
P55 POST-PLACENTAL IUD PLACEMENT IN THE UNITED STATES, 2009 Satterwhite C Kansas University Medical Center, Kansas City, KS, USA Tao G, Altaf E, Tepper N, Hoover K Objectives: To describe prevalence of post-placental placement of intrauterine devices (IUDs) in the context of efforts to increase IUD use. Methods: Using administrative claims data (MarketScan) from commercially insured women in the United States, we used ICD-9 and CPT codes to identify women aged 14 or older who delivered a live infant in 2009. Women who received a hysterectomy or tubal ligation or who could not be followed up were excluded from analysis. We used additional administrative codes (i.e., HCPCS and NDC codes) to identify IUD receipt. IUD placement was classified according to the number of days after delivery; IUDs placed within 3 days of delivery were considered to have been inserted in the immediate post-placental period. Results: Of the 222,317 eligible women, 28,643 (12.9%) had had an IUD placed within the year following delivery. Only 27 IUD insertions were immediately post-placental (0.09%). The majority of IUD placements occurred within 31–70 days of delivery (53.9%). Younger women were more likely than older women to have had an IUD placed (19.0% younger than 20 vs. 7.0% aged 40–44, pb0.001). IUD placement was more likely among women residing in the West (15.7%) than in the Northeast (9.5%, pb0.001). Conclusions: Most IUDs are likely inserted in conjunction with the standard recommended 6-week postpartum visit, despite research suggesting that immediate post-placental IUD placement might be a viable approach to increase IUD uptake. Future efforts to increase IUD use should include consideration of post-placental placement.
P56 OUTCOMES OF FIRST-TRIMESTER SURGICAL ABORTION WITH IMMEDIATE IUD INSERTION COMPARED BETWEEN ADVANCE PRACTICE CLINICIAN AND PHYSICIAN PROVIDERS Patil E Oregon Health & Science University, Portland, OR, USA Orme-Evans K, Beckley E, Bergander L, Nichols M, Bednarek P Objectives: Oregon is one of four states where non-physicians can perform aspiration abortions (TABs). For 7 years, Advance practice clinicians (APCs) at Planned Parenthood Columbia-Willamette (PPCW) have performed this procedure. APCs also have been placing immediate postaspiration intrauterine devices (IUDs) for 4 years. This study compares outcomes of first trimester TABs and immediate IUD insertion between APCs and physicians (MDs). Methods: This retrospective cohort study identified all combined TAB/IUD procedures performed at PPCW between 2009 and 2011. The charts reviewed were examined for any complication, including excessive bleeding, perforation, need for same day re-aspiration, infection or IUD expulsion. Results: Of 1134 combined TAB/IUD procedures, 670 charts were available for review. APCs performed 224 (33.4%) procedures and MDs performed 446 (66.6%). Social and demographic characteristics were similar between groups. Of the TABs performed by APCs, 6/224 (2.68%) reported any major or minor complication versus 16/446 (3.59%) by MDs (p=0.87). For IUD insertion, APCs had 1/224 (0.45%) complications and MDs 6/446 (1.35%; p=0.43). APCs and MDs had similar rates of patient follow-up: 121/224 (54%) vs. 240/ 446 (53.8%; p=0.96). There were no statistically significant differences between APC and MD patients for total delayed complications (p=0.68), including 15/121 (12.4%) vs. 23/240 (9.6%) IUD expulsions and 5/121 (4.1%) vs. 15/240 (6.25%) infections.
Abstracts / Contraception 88 (2013) 433–473 Conclusions: These data are consistent with low complication rates previously reported for first-trimester abortion and immediate postabortion IUD insertion performed by MDs. Given the shortage of physician abortion providers in many states, APC providers offer the opportunity to increase patient access to abortion services without compromising safety.
P57 A RANDOMIZED TRIAL OF IMMEDIATE POSTPARTUM VERSUS INTERVAL INSERTION OF AN INTRAUTERINE DEVICE
bleeding prior to the 3-year period of efficacy (OR 0.84, 95% CI 0.52–1.36, p=.5). There were no social, demographic or clinical characteristics predictive of premature implant removal in either group. Conclusions: One-fifth of etonogestrel contraceptive implant users requested premature removal because of irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates. Mechanisms to help women manage irregular bleeding due to the implant are needed.
P59
Ogburn T University of New Mexico, Albuquerque, NM, USA
OUTCOMES OF INTRAUTERINE DEVICES PLACED IN LARGE UTERI
Espey E, Leeman L, Singh R, Pereda B, Carr S
Hofler L Beth Israel Deaconess Medical Center, Boston, MA, USA
Objectives: The primary objective was to compare rates of successful IUD insertion among women randomized to immediate postpartum vs. interval insertion. Secondary outcomes included IUD continuation, reasons for discontinuation and complications. Methods: After term vaginal or cesarean delivery, women who desired a Paragard IUD were randomized to immediate (within 10 min of placental delivery) IUD placement by one of four investigators or interval placement by their prenatal care provider (4–12 weeks postpartum). All IUDs were provided without cost. Participants were scheduled for a 6-week IUD check and contacted at 3, 6 and 12 months after placement. Rates of insertion were determined and marginal survival analysis of IUD continuation was conducted. Results: The 156 women participating were randomized into two groups of 78. Eighty-seven percent of the immediate group received an IUD, compared with 77% in the interval group (p=.30). Of women who did not receive an IUD, the most common reason was "no study provider available" (8/10) in the immediate group and "did not keep appointment" (11/18) in the interval group. For women who received an IUD, continuation was similar at six weeks after insertion (93% in both groups); at 12 months, it was 65% in the immediate group and 76% in the interval group (p=.23). No major complications occurred in either group. Conclusions: IUD insertion and continuation rates are similar among women randomized to immediate postpartum vs. interval insertion. Immediate insertion rates were decreased by the study requirement of insertion by an investigator.
P58 THE EFFECT OF IMMEDIATE POSTPARTUM VS. INTERVAL INSERTION OF THE ETONOGESTREL CONTRACEPTIVE IMPLANT ON REMOVAL RATES FOR BLEEDING Doan L Warren Alpert Medical School of Brown University/Women and Infants Hospital, Providence, RI, USA Goyal V, Raker C, Murray A, Allen R Objectives: To determine whether the discontinuation rate of the etonogestrel contraceptive implant because of irregular vaginal bleeding among women with immediate postpartum insertion is elevated compared with such discontinuation after interval placement. Methods: This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) with those who underwent interval insertion (more than 6 weeks postpartum) between January 2008 and December 2010. Charts were reviewed for date of implant removal, if any; reasons for removal; and related social, demographic and clinical characteristics. A chi-square test was used to compare discontinuation due to bleeding between cohorts. Results: There were 261 women in the postpartum insertion group and 164 in the interval insertion group. Average age at insertion was 22.6 (± 5.5 years). Overall, 19% of women in the postpartum group and 22% of women in the interval group requested implant removal because of irregular
455
Hacker MR, Merport Modest A, Wu LH, Haider S Objectives: To examine the incidence of intrauterine device (IUD) discontinuation and expulsion in women with enlarged uteri at the time of placement. Methods: This was a retrospective cohort study of women with IUDs placed from 2006 to 2010. Details of placement and discontinuation were extracted from medical records. Results: Uterine sound measurements at IUD placement were documented for 1238 of 1322 (93.6%) women (median 8.0 cm, range 4.5–17.0 cm). Most IUDs (88.0%) were placed for contraception. Of 58 women with uterine sound of less than 10 cm, one IUD (1.7%) was discontinued within 1 month of insertion, compared with 5.1% discontinuation among women with uteri of 10 cm or less (p=.48). Among the 763 women with at least 12 months of follow-up, 39.5% with uteri of more than 10 cm discontinued at 12 months, compared with 29.9% among those with uteri of 10 cm or less (p=.21). Expulsion incidence at 1 year was similar for uteri of more than 10 cm (7.9%) and those 10 cm or less (6.9%; p=.74). There were four uterine perforations; three occurred in uteri measuring 10 cm or less at IUD placement. All six pregnancies that occurred with IUDs in place were in women with uterine sound of 10 cm or less. Conclusions: Package inserts for commercially available IUDs in the United States indicate a maximum uterine sound at the time of IUD placement. IUDs placed in women with uterine sound greater than 10 cm have similar expulsion incidence and adverse outcomes to those in women whose uterine sound is 10 cm or less. We did not detect a statistically significant difference in IUD discontinuation at 12 months; however, our study was underpowered to detect what may be a clinically meaningful difference. Women should not be denied IUDs based solely on large uterine size.
P60 VAGINAL MICROBIOME CHANGES WITH LEVONORGESTREL INTRAUTERINE DEVICE PLACEMENT Jacobson J University of Utah School of Medicine, Salt Lake City, UT, USA Dermish A, Nygaard I, Turok D Objectives: To investigate changes in female genital tract bacterial ecology associated with levonorgestrel intrauterine device (LNG IUD) use. Methods: Study participants were regularly cycling women without recent history of pregnancy or exogenous hormone use. Vaginal, cervical and uterine samples were obtained at nine time intervals, from 1 week before to 13 weeks after LNG IUD placement. Replicate vaginal and cervical specimens were collected to determine the consistency of specimen collection and processing. Vaginal wet mount, pH and prostate-specific antigen testing were conducted at each visit to identify confounders of infection and recent sexual activity. Results: A total of 406 samples from 11 women were available for analysis after DNA extraction, amplification and species identification. Of the 355 bacterial species or genera detected, Lactobacillus crispatus was most