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Carroll AL, Strauss AM, Philipps NM, Kaczmarczik KD, Shakur Z, Ramirez G, Klc TR, Tessier KM, Boraas CM. Efficacy of medication abortion with concurrent initiation of progestin contraceptives: a retrospective cohort study. Contraception 2024:110536. [PMID: 38986862 DOI: 10.1016/j.contraception.2024.110536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To evaluate medication abortion (MAB) outcomes for participants receiving intramuscular depot medroxyprogesterone acetate (DMPA) injections or subdermal etonogestrel implants concurrently with mifepristone compared to those who did not in a real-world setting. STUDY DESIGN This retrospective cohort study included MAB patients from one Planned Parenthood health center in St. Paul, MN, between 2017-2019. We abstracted electronic health records and compared sociodemographic variables, clinical information, and treatment failure rates (primary outcome) between study groups with logistic regression (generating odds ratios [OR] and 95% confidence intervals [CI]). RESULTS Among 7296 MAB participants, 224 (3.1%) received DMPA injections and 309 (4.2%) received etonogestrel implants concurrently with mifepristone; 141 (62.9%) and 200 (64.7%) completed follow-up respectively. From a random sample of 1000, 990 comparison participants met inclusion criteria; 704 (71.1%) completed follow-up. Fourteen (9.9%) DMPA participants (aOR 4.26, 95% CI 1.87-9.68, p<0.001) and 6 (3.0%) etonogestrel implant participants (aOR 1.38, 95% CI 0.48-3.55, p=0.522) required additional treatment to empty the uterus and/or had an ongoing pregnancy, each contrasted with 15 (2.1%) comparison patients (models adjusted for gestational duration, patient age, parity, and race). CONCLUSION Although our study is limited by high rates of loss to follow-up, our analysis suggests that concurrent administration of DMPA with mifepristone may decrease MAB efficacy, while etonogestrel implant placement does not appear to alter MAB outcomes. These findings are overall consistent with prior literature and inform post-MAB contraception counseling. IMPLICATIONS This retrospective cohort study reinforces prior randomized controlled trial findings that concurrent depot medroxyprogesterone acetate injection with mifepristone administration may decrease medication abortion efficacy. Conversely, concurrent etonogestrel contraceptive implant placement with mifepristone administration does not appear to decrease medication abortion efficacy. These findings inform post-abortion contraception counseling.
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Affiliation(s)
- Anna L Carroll
- Department of Obstetrics, Gynecology & Women's Health, University of Minnesota, MMC 395, 420 Delaware St SE, Minneapolis, MN 55455.
| | - Anna M Strauss
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Nicole M Philipps
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Kyra D Kaczmarczik
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Zahrah Shakur
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Gerardo Ramirez
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Tenley R Klc
- Department of Obstetrics, Gynecology & Women's Health, University of Minnesota, MMC 395, 420 Delaware St SE, Minneapolis, MN 55455
| | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, 2221 University Avenue SE, Minneapolis, MN 55455
| | - Christy M Boraas
- Department of Obstetrics, Gynecology & Women's Health, University of Minnesota, MMC 395, 420 Delaware St SE, Minneapolis, MN 55455; Planned Parenthood North Central States, 671 Vandalia Street, St. Paul, MN 55114
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Liu Y, Lv W. The diagnostic value of transvaginal color Doppler ultrasonography plus serum β-HCG dynamic monitoring in intrauterine residue after medical abortion. Medicine (Baltimore) 2023; 102:e31217. [PMID: 36749252 PMCID: PMC9901960 DOI: 10.1097/md.0000000000031217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To probe the diagnostic value of transvaginal color Doppler ultrasonography plus serum β-human chorionic gonadotropin (β-HCG) dynamic monitoring in intrauterine residue after medical abortion.In total, 200 pregnant women undergoing medical abortion in our institution from January 2017 to December 2019 were picked, and assigned to either group A (n = 75, with residue) or group B (n = 125, without residue). We detected serum β-HCG, progesterone (P), follicle stimulating estrogen (FSH) levels and ultrasonic indicators endometrial thickness (ET), peak systolic velocity (PSV), resistance index (RI) values, dissected correlation of indicators using logistic linear regression analysis, and prospected the diagnostic value of relevant indicators in intrauterine residue after medical abortion utilizingreceiver operating characteristic curve.At 7 days after abortion (T3), total vaginal bleeding and visual analogue scalescore in group A were saliently higher in contrast to group B ( P < .05). At 72 hours after abortion (T2) and T3, serum β-HCG, P and FSH levels declined strikingly in both groups, but group B held plainly higher decrease rate than group A ( P HC.05). At T3, ET and PSV levels in both groups considerably waned, whereas RI levels notedly waxed, and group B owned markedly higher decrease/increase than group A ( P wa.05). At T3, serum β-HCG in group A possessed positive association with serum P, FSH, intrauterine ET, PSV levels separately ( P HC.05), whereas negative link with RI levels ( P , .05). The specificity and sensitivity of β-HCG, P, FSH, β-HCG/ET, β-HCG/PSV and β-HCG/RI in the diagnosis of intrauterine residue after medical abortion were high ( P < .05).Serum β-HCG dynamic monitoring plus transvaginal color Doppler ultrasonography is of great value in diagnosing intrauterine residue after medical abortion. Serum β-HCG, P, FSH levels can be combined with the results of intrauterine ET, PSV, RI values, so as to boost the diagnostic accuracy of the intrauterine residue after medical abortion.
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Affiliation(s)
- Yanbo Liu
- Department of Gynecology, Litongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wen Lv
- Department of Gynecology, Litongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
- * Correspondence: Wen Lv, Department of Gynecology, Litongde Hospital of Zhejiang Province, 234 Gucui Road, Xihu District, Hangzhou, Zhejiang 310012, China (e-mail: )
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Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy. Obstet Gynecol 2016; 128:739-45. [DOI: 10.1097/aog.0000000000001627] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soon JA, Costescu D, Guilbert E. Medications Used in Evidence-Based Regimens for Medical Abortion: An Overview. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:636-45. [DOI: 10.1016/j.jogc.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/15/2016] [Indexed: 12/27/2022]
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Abstract
OBJECTIVE This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. INTENDED USERS Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. TARGET POPULATION Women with an unintended first trimester pregnancy. EVIDENCE Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). BENEFITS, HARMS AND/OR COSTS Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. SUMMARY STATEMENTS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care RECOMMENDATIONS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care.
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Hofmeyr GJ, Singata-Madliki M, Lawrie TA, Bergel E, Temmerman M. Effects of the copper intrauterine device versus injectable progestin contraception on pregnancy rates and method discontinuation among women attending termination of pregnancy services in South Africa: a pragmatic randomized controlled trial. Reprod Health 2016; 13:42. [PMID: 27091008 PMCID: PMC4835872 DOI: 10.1186/s12978-016-0153-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women's choices. METHODS Within the context of a South African program to increase women's access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, opaque, consecutively-numbered envelopes. Counselled, consenting women attending termination of pregnancy services were randomly assigned to IUD or IPC immediately post-termination. Condoms were promoted for the prevention of sexually-transmitted infections. The primary outcome was pregnancy; secondary outcomes were discontinuation, side-effects, and HIV acquisition and disease progression. Pregnancy and discontinuation outcomes are reported here. RESULTS The trial closed early with 2,493 participants randomised (IUD = 1,247, IPC = 1,246), due to international concerns regarding a possible association between IPC and HIV acquisition. Median follow-up was 20 months; 982 and 1000 participants were followed up in the IUD and IPC groups, respectively. Baseline group characteristics were comparable. Pregnancy occurred significantly less frequently among women allocated to the IUD than IPC: 56/971 (5.8%) versus 83/992 (8.4%), respectively; risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.96; P = 0.025. There were more protocol violations in the IUD group; however, discontinuation rates were similar between IUD and IPC groups (141/855 [16.5%] and 143/974 [14.7%], respectively). Women in the IUD group were more likely to discontinue contraceptive use due to abdominal pain or backache and non-specific symptoms, and those in the IPC group due to oligo- or amenorhoea and lack of sexual activity. CONCLUSIONS The IUD was significantly more effective in preventing pregnancy than IPC. Efforts to expand contraception options and improve access to the IUD in settings where it is under-utilised are worthwhile. This trial shows that randomising long-acting, reversible contraceptives is feasible. TRIAL REGISTRATION Pan African Clinical Trials Registry number PACTR201409000880157 (04-09-2014).
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Affiliation(s)
- G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa
| | - Theresa A Lawrie
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa. .,Royal United Hospital, Bath, UK.
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marleen Temmerman
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Park J, Robinson N, Wessels U, Turner J, Geller S. Progestin-based contraceptive on the same day as medical abortion. Int J Gynaecol Obstet 2016; 133:217-20. [PMID: 26868071 DOI: 10.1016/j.ijgo.2015.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/12/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the success rate of medical abortion when a progestin-based contraceptive-either an etonogestrel implant or depot medroxyprogesterone acetate (DMPA) injection-is given on the same day as mifepristone for medical abortion. METHODS In a retrospective chart review, data were assessed for women aged 15-49years who underwent medical abortion (≤63days of pregnancy) at two hospitals in KwaZulu Natal, South Africa, between August 2013 and July 2014. The women were given oral mifepristone (200mg) and buccal misoprostol (800μg), and received an etonogestrel implant or DMPA injection on the same day as mifepristone. The primary outcome was the success rate of medical abortion. Comparative data were obtained through a PubMed search. RESULTS A total of 89 women were included. Complete termination was achieved in 87 (98%, 95% confidence interval 95%-100%) women. This success rate is similar to that reported in a previous systematic review of the rate of medical abortion success without progestin contraceptive administration (94.8%). CONCLUSIONS Administration of a progestin-based contraceptive such as an etonogestrel implant or DMPA injection on the same day as mifepristone for medical abortion did not alter the success rates.
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Affiliation(s)
- Jeanna Park
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, USA.
| | - Nuriya Robinson
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, USA
| | - Ursula Wessels
- Department of Obstetrics and Gynecology, Lower Umfolozi District War Memorial Hospital, Empangeni, South Africa
| | - James Turner
- Department of Obstetrics and Gynecology, Lower Umfolozi District War Memorial Hospital, Empangeni, South Africa
| | - Stacie Geller
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, USA; Department of Obstetrics and Gynecology, Center for Research on Women and Gender, Chicago, USA
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