early versus delayed insertion of intrauterine contraception after medical abortion — a randomized controlled trial药物流产后子宫内避孕的早期和延迟插入u2014u2014一个随机对照试验.pdfVIP

Early versus Delayed Insertion of Intrauterine Contraception after Medical Abortion — A Randomized Controlled Trial ¨ ¨ 1 1,2 1 Ingrid Saav , Olof Stephansson , Kristina Gemzell-Danielsson * 1 Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden, 2 Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden Abstract Background: Today, a large proportion of early abortions are medical terminations, in accordance to the woman’s choice. Intrauterine contraceptives (IUC) provide highly effective, reversible, long-acting contraception. However, the effects of timing of IUC insertion after medical abortion are not known. Methods: Women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUC were randomised to early insertion (day 5–9 after mifepristone) or delayed (routine) insertion (at 3–4 weeks after mifepristone). The primary outcome was the rate of IUC expulsion at six months after IUC insertion. Results: A total of 129 women were randomized, and 116 women had a successful IUC insertion. There was no difference in expulsion rate between early (9.7%) vs. delayed (7.4%) IUC insertion (risk difference 29.2–13.4). Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI: 1.8–20.6%, p = 0.015), and a higher proportion of women (41%) had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16%) (p = 0.015). Adverse events were rare an