Placement of an intrauterine device within 48 hours after early medical abortion—a randomized controlled trial

Hogmark, Sara; Liljeblad, Karin Lichtenstein; Envall, Niklas; Gemzell‐Danielsson, Kristina; Kallner, Helena Kopp

doi:10.1016/j.ajog.2022.07.063

Cited by 6 publications

(24 citation statements)

References 18 publications

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“…The flow of participants up to a 6 months’ follow‐up was previously described 18 . The 12‐month follow‐up rate was 93.3% (112/120) in the intervention group and 94.2% (113/120) in the control group.…”

Section: Resultsmentioning

confidence: 99%

“…In this trial, we could not show superiority with immediate placement in terms of the primary outcome, but more women in the immediate group preferred their allocated placement time and pain scores at IUD placement were lower. IUD expulsion within 6 months and other adverse events were rare and did not differ between groups 18 …”

Section: Introductionmentioning

confidence: 84%

“…We performed an open‐label, randomized, controlled, multicenter, superiority trial (phase 3). The full study design has been published elsewhere 18 . In brief, we recruited women aged ≥18 years requesting medical abortion at ≤63 days’ gestation and opting for IUD as post‐abortion contraception.…”

Section: Methodsmentioning

confidence: 99%

“…Follow‐up data were collected with structured questionnaires at 3, 6 and 12 months. In our previous publication, we presented the primary outcome of rates of IUD use in both groups at 6 months after the abortion and secondary outcomes up to a 6 months’ follow‐up 18 . In the current paper, we report secondary outcomes based on data from the 12‐month follow‐up including continuation rates of IUD and reasons for discontinuation during the first year after the abortion.…”

Section: Methodsmentioning

confidence: 99%

“…IUD expulsion within 6 months and other adverse events were rare and did not differ between groups. 18 In the current paper we present the results of secondary outcome analyses with the aim to explore continued use of IUD, reasons for discontinuation, subsequent pregnancies and satisfaction with use of IUD or other contraceptives up to 1 year after early medical abortion.…”

Section: Introductionmentioning

confidence: 99%

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One‐year follow up of contraceptive use and pregnancy rates after early medical abortion: Secondary outcomes from a randomized controlled trial of immediate post‐abortion placement of intrauterine devices

Hogmark,

Envall,

Gemzell‐Danielsson

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionIntrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long‐term outcomes of women choosing an IUD after early medical abortion.Material and methodsWe present secondary outcome data of continuation rates, factors associated with continuation and discontinuation, choice of IUD type, women's satisfaction with IUD, and IUD expulsions, subsequent pregnancies, and abortions within 1 year post‐abortion in a randomized, controlled, multicenter trial on IUD placement within 48 hours compared with placement 2–4 weeks after medical abortion up to 63 days’ gestation (ClinicalTrials.gov NCT03603145).ResultsOf the 240 women studied, 112/120 (93.3%) in the intervention group vs 113/120 (94.2%) in the control group completed the 12‐month follow‐up. The rate of IUD use at 12 months was 84/112 (75%) in the intervention group vs 75/113 (66.4%) in the control group (P = 0.19). Attendance at the IUD placement visit was the only predictor of long‐term IUD use (relative risk [RR] = 5.7, 95% confidence interval [CI] 2.03–16.0; P = 0.001). The main reason for choosing an IUD was high contraceptive effectiveness. The most common reasons for IUD discontinuation were bleeding problems and abdominal pain. IUD expulsion was rare and did not differ between groups. Satisfaction among IUD users at 1 year was high (>94%) and the majority of all participants would recommend IUD to a friend (65.8%). Use of no contraception and experience of unprotected intercourse were less common in the intervention group (11/112 [9.8%] vs 25/113 [22.1%], P = 0.02 and 17/112 [15.2%] vs 32/113 [28.3%], P = 0.02, respectively). There was no difference in the rate of subsequent pregnancies and abortions (pregnancies 14/112, 12.5% in the intervention group vs 8/113, 7.1% in the control group, P = 0.19; abortions 5/112, 4.5% vs 3/113, 2.7%, P = 0.5).ConclusionsIUD placement after medical abortion led to high continuation and satisfaction rates with no difference between groups. We found no difference in IUD expulsions after immediate compared with later placement. Unprotected intercourse was significantly less common in the immediate group. In clinical practice, immediate placement of IUDs available free of charge at the abortion clinic is likely to increase attendance to the placement visit and continued use of IUDs after abortion.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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