LONG-ACTING REVERSIBLE CONTRACEPTIVE METHODS AFTER ABORTION
ESC Congress Library. Fernandes S. May 28, 2014; 50572; A-157
Dr. Sílvia Fernandes
Dr. Sílvia Fernandes
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Abstract
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 Background: Women who seek an abortion are highly motivated to use contraceptive methods afterwards. Because unintended pregnancy results, most of the time, of inconsistent or irregular use of hormonal oral contraception, the method of choice should preferably be long-acting. Lastly, there is a need for effective and safe contraception promptly after the termination of pregnancy because the return of fertility is immediate.


Objectives: This study compares bleeding pattern, discontinuance and failure rate, satisfaction and method's complications, on women undergoing postabortion intrauterine devices or etonogestrel implant insertion.



  Design & Methods: We performed a retrospective cohort study of women undergoing postabortion intrauterine devices or etonogestrel implant insertion between 2010-2012. Demographics and clinical data were collected from clinical records. We contacted women by phone to do a questionnaire assessing discontinuation, satisfaction, and bleeding patterns or by consultation clinical records, when telephone contact was impossible. Statistical analysis was performed with Excel and Statistical Package for the Social Sciences v17.



  Results: From 1642 abortions at women's request performed in our maternity from 2010-2012, only 11% showed interest in a long-acting reversible contraceptive (LARC). 125 chose etonogestrel implant and 52 intrauterine devices (38 copper devices and 14 with levonogestrel).


We observe statistically significant difference in groups age (34 ± 6 vs 27 ± 7 years, respectively in intrauterine devices vs etonogestrel implant group;  p <0,001). In etonogestrel implant group 38% were nulliparous (comparing to 4% in intrauterine devices group).


90% of etonogestrel implant were placed in consultation two weeks after abortion vs 31% in intrauterine devices group.


 The implant was associated to higher abnormality cycle control (33 vs 16%, p <0,001), mainly metrorrhagia.


 In intrauterine device group occurred one case of pregnancy.


Bad compliance to method (expulsion, remove for side effects or failure) was identical in two methods (17 vs 16%, p = 0.836). Mean time follow up was 23 ± 10 months vs 15.6 ± 11 months, with greater rate satisfaction in intrauterine devices group (89% with 4-5/5 satisfaction level, compared to 74% on women with implant, p=0.017).



  Conclusions: LARC methods are excellent option after abortion, having a high efficacy rate (in our study 99.3%). Implant is associated with worse cycle control. Compliance rate was identical in two groups, obtaining a higher level of satisfaction in intrauterine device group (89%).

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