Predicting poor compliance with follow-up and intrauterine contraception services after medical termination of pregnancy

Pohjoranta, Elina; Mentula, Maarit; Suhonen, Satu; Heikinheimo, Oskari

doi:10.1136/bmjsrh-2018-200098

Cited by 9 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fertility resumes rapidly after pregnancy regardless of outcome. If contraception is left until a follow‐up appointment (which many women fail to attend) many women are already at potential risk of pregnancy and those choosing LARC methods often face further delays accessing trained providers.…”

Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

View full text Add to dashboard Cite

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

show abstract

Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…In an RCT from Finland, the post abortion IUD placement rate was 91% for placement at the abortion clinic, compared with only 24% for primary healthcare placement 27 . Non‐attendance has been associated with a history of previous pregnancy and abortion, 28 whereas we could not identify any predictors for attendance. It is noteworthy that, in our study, all women who chose an IUD based on recommendation from the healthcare provider attended the placement visit.…”

Section: Discussionmentioning

confidence: 61%

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

View full text Add to dashboard Cite

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.

show abstract

“…Both of these prospective studies had attendance rates >85% with follow-up at the abortion clinic. 15,16 In contrast, the Pohjoranta et al study, 13 also performed in Finland, retrospectively found that 57% of patients attended follow-up at a primary healthcare center. These results support the positive impact of scheduled follow-ups, preferably at the abortion clinic.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 93%

“…12 Patients who miss this follow-up visit risk being left without contraception. 13 Previous trials have examined the effectiveness and safety of IUD placement after medical abortion within 1 week of mifepristone administration or at a later time point. 14,15 However, these trials have been performed with an ultrasound examination before IUD placement as part of the protocol.…”

Section: Introductionmentioning

confidence: 99%