Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion : first-year results of a randomized controlled trial

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Pohjoranta , E , Mentula , M , Gissler , M , Suhonen , S & Heikinheimo , O 2015 , ' Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion : first-year results of a randomized controlled trial ' , Human Reproduction , vol. 30 , no. 11 , pp. 2539-2546 . https://doi.org/10.1093/humrep/dev233

Title: Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion : first-year results of a randomized controlled trial
Author: Pohjoranta, Elina; Mentula, Maarit; Gissler, Mika; Suhonen, Satu; Heikinheimo, Oskari
Other contributor: University of Helsinki, Department of Obstetrics and Gynecology
University of Helsinki, Department of Obstetrics and Gynecology
University of Helsinki, Clinicum


Date: 2015-11
Language: eng
Number of pages: 8
Belongs to series: Human Reproduction
ISSN: 0268-1161
DOI: https://doi.org/10.1093/humrep/dev233
URI: http://hdl.handle.net/10138/300708
Abstract: STUDY QUESTION: Can the need of subsequent abortion be reduced by providing intrauterine contraception as a part of the abortion service? SUMMARY ANSWER: Provision of intrauterine devices (IUDs) in association with first trimester abortion more than halved the incidence of repeat abortion during the first year of follow-up. WHAT IS KNOWN ALREADY: Following abortion, the incidence of subsequent abortion is high, up to 30-40%. In cohort studies, intrauterine contraception has reduced the need of repeat abortion by 60-70%. STUDY DESIGN, SIZE, DURATION: A randomized controlled trial. The main outcome measure was the incidence of subsequent induced abortions during the follow-up. Altogether 751 women seeking first trimester induced abortion were recruited and randomized into two groups. Randomization was accomplished by computer-assisted permuted-block randomization with random block sizes of four to six. The investigators did not participate in randomization, which was done before commencing the study. The participants were recruited between 18 October 2010 and 21 January 2013. PARTICIPANTS, SETTINGS, METHODS: The inclusion criteria were age >= 18 years, duration of pregnancy This study was conducted in collaboration between the Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, and Centralized family planning of the City of Helsinki. The intervention group (n = 375) was provided with intrauterine contraception (either the levonorgestrel-releasing intrauterine system or copper-releasing intrauterine device) immediately following surgical abortion (18.1%) or at a follow-up 2-4 weeks after medical abortion (81.9%). Women in the control group were prescribed oral contraceptives and advised to contact their primary healthcare unit for a follow-up visit and further contraceptive services according to national guidelines. The women were followed-up to 28 February 2014 by using the Finnish National Abortion Registry, Helsinki University Hospital electronic database and clinical follow-up visit at 1 year. MAIN RESULTS AND THE ROLE OF CHANCE: The median age of the whole study group was 27 years and 44% had a history of induced abortion(s). During the follow-up year the number of women requesting subsequent abortion was significantly lower in the intervention than in the control group (9/375 [2.4%] versus 20/373 [5.4%], difference -3.0 [95% CI -6.0 to -0.2] percentage points, P = 0.038, according to intention-to-treat analysis and 5/346 [1.4%] versus 20/357 [5.6%], difference -4.2(-7.2 to -1.4) percentage points, P = 0.003, according toper-protocol analysis, respectively). Provision of intrauterine contraception was safe with rate of infection and expulsion similar to those reported previously. LIMITATIONS, REASONS FOR CAUTION: The powercalculation was calculated for a 5-year follow-up. However, significant differences between the two groups were already seen after 1 year. The present study was performed in a single clinic, where, similar to 15% of all abortions in Finland are performed. WIDER IMPLICATIONS OF THE FINDINGS: In order to decrease the need of subsequent abortions, IUDs should be provided at the time of abortion.
Subject: induced abortion
intrauterine contraception
counselling
repeat abortion
abortion registry
ACTING REVERSIBLE CONTRACEPTION
UNINTENDED PREGNANCY
IUD INSERTION
UNITED-STATES
FOLLOW-UP
IMMEDIATE
TERMINATION
WOMEN
COST
RISK
3123 Gynaecology and paediatrics
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