Intra-abortion contraception with etonogestrel subdermal implant

Pereira, Ivana Cardoso; Carvalho, R.; Graça, Luís

doi:10.1016/j.ejogrb.2014.11.025

Cited by 19 publications

(7 citation statements)

References 12 publications

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“…The ENG-releasing subdermal implant could be employed immediately after a surgical abortion [190][191][192] or on the same day of mifepristone assumption, without an increase in pregnancy risk compared to the delayed placement 4-8 weeks after the procedure [195][196][197]199]. It has been shown to be effective in improving symptomatic endometriosis with reduction in pain severity and menstrual symptoms (dysmenorrhea and dyspareunia) [201,210,211]; ENG therapeutic efficacy for pain relief is not inferior to other progestins [209,210].…”

Section: Discussionmentioning

confidence: 99%

“…However, no definitive data about the timing of LARC placement are available, since the implant can be inserted on the same day of mifepristone administration (immediate placement) or 2-4 weeks after abortion (delayed placement). A prospective observational study by Barros Pereira et al [195] showed that the immediate implant placement does not reduce mifepristone action, and no significant difference in terms of efficacy was observed between groups (96.5% vs. 98.4% for immediate and delayed placement group, respectively); in the immediate implant insertion group, a higher 6-month continuation rate (73.7%) was observed, while only 16.1% of women in the delayed placement group chose to insert the implant [195]. In an RCT, Hognert et al confirmed that an implant inserted on the day of mifepristone did not impair the efficacy of the drug compared with routine insertion at 2-4 weeks after abortion (efficacy of medical abortion in 94.2% vs. 96% of patients, in immediate and delayed placement group, respectively).…”

Section: Post-abortion Implant Placementmentioning

confidence: 99%

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Safety and Benefits of Contraceptives Implants: A Systematic Review

et al. 2021

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Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.

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Section: Discussionmentioning

confidence: 99%

Section: Post-abortion Implant Placementmentioning

confidence: 99%

Safety and Benefits of Contraceptives Implants: A Systematic Review

et al. 2021

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“…Women seeking postabortion emergency care are particularly in need of contraceptive services: These clients are sexually active and at risk for subsequent pregnancy, not currently pregnant, and often highly desirous of avoiding childbearing. They are in contact with the health system, are often disinclined to return to the facility for a follow-up visit [5–7], and, according to global recommendations, are advised to delay a subsequent pregnancy for at least six months, for optimal health of the woman and her future newborn [8, 9].…”

Section: Introductionmentioning

confidence: 99%

What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania

Baynes

Kahwa²,

Lusiola³

et al. 2019

BMC Women's Health

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BackgroundThe family planning component of postabortion care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving postabortion contraceptive services.MethodsThis analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014.ResultsThis study suggests that efforts to integrate postabortion family planning into treatment for incomplete abortion contributed to higher postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used.ConclusionThe experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.

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“…Interestingly, the 3-month injection was the overall preferred method, especially among the rural residents, supporting a trend documented in recent studies from similar settings [ 6 , 12 ], and arguing for the inclusion of the 3-month injection under the NRHM family planning initiative. Additionally, hormonal IUDs and implants should be included as contraceptive options, given their long-acting nature, to avoid discontinuation soon after initiation [ 25 , 26 ]. Such methods may also be preferable for the women because their use could be kept secret from other family and community members, and hence increases the feasibility of using the method [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

et al. 2016

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BackgroundPost-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion.MethodsA randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114).ResultsThere were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use.ConclusionsSimplified follow-up after early medical abortion will not change women’s opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women’s postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods.Trial registrationClinicaltrials.gov NCT01827995

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Intra-abortion contraception with etonogestrel subdermal implant

Cited by 19 publications

References 12 publications

Safety and Benefits of Contraceptives Implants: A Systematic Review

Safety and Benefits of Contraceptives Implants: A Systematic Review

What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

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