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

Author:

Hogmark Sara12ORCID,Envall Niklas134ORCID,Gemzell‐Danielsson Kristina456ORCID,Kopp Kallner Helena17ORCID

Affiliation:

1. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet Stockholm Sweden

2. Center for Clinical Research Dalarna Uppsala University Falun Sweden

3. School of Health and Welfare Dalarna University Falun Sweden

4. Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

5. World Health Organization Collaborating Center for Research and Research Training in Human Reproduction Stockholm Sweden

6. Department of Gynecology and Reproductive medicine Karolinska University Hospital Stockholm Sweden

7. Department of Obstetrics and Gynecology Danderyd Hospital Stockholm Sweden

Abstract

AbstractIntroductionIntrauterine 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.

Funder

Centrum fÖr Klinisk Forskning Dalarna

Karolinska Institutet

Svenska Läkaresällskapet

Publisher

Wiley

Subject

Obstetrics and Gynecology,General Medicine

Reference31 articles.

1. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019

2. Abortion Surveillance — United States, 2020

3. Swedish National Board of Health and Welfare.Statistik om aborter 2021 (Abortion statistics). Accessed March 19 2023. 2022.https://www.socialstyrelsen.se/statistik‐och‐data/statistik/alla‐statistikamnen/aborter/

4. Finnish Institute for Health and Welfare.Induced abortions 2021. Accessed March 19 2023.https://thl.fi/en/web/thlfi‐en/statistics‐and‐data/statistics‐by‐topic/sexual‐and‐reproductive‐health/abortions/induced‐abortions

5. Abortion statistics England and Wales: 2021. UK Government. Accessed March 19 2023.https://www.gov.uk/government/statistics/abortion‐statistics‐for‐england‐and‐wales‐2021/abortion‐statistics‐england‐and‐wales‐2021

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