Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy

Elizabeth G. Raymond, Mark A. Weaver, Yi Ling Tan, Karmen S. Louie, Manuel Bousiéguez, Elba M. Lugo-Hernández, Ana Gabriela Aranguré-Peraza, Patricio Sanhueza, Clair Kaplan, Sarita Sonalkar, Alisa B. Goldberg, Kelly R. Culwell, Lisa Memmel, Roxanne Jamshidi, Beverly Winikoff

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the effect of insertion of etonogestrel implants with mifepristone compared with after the abortion on the risks of medical abortion failure and repeat pregnancy over the subsequent 6 months. METHODS: In a randomized trial, we assigned patients undergoing medical abortion to receive etonogestrel implants either with the mifepristone (Quickstart group) or after the abortion (Afterstart group). We followed them for 7 months to ascertain abortion outcome, pregnancies, and contraception use. RESULTS: Between September 2013 and August 2014, we enrolled 236 participants in the Quickstart group and 240 in the Afterstart group. To examine abortion failure, we conducted a noninferiority analysis from which we excluded nine participants who had missing outcome data and four with specified protocol violations. Of the rest, 9 of 229 (3.9%) and 9 of 234 (3.8%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the difference of 0.08% (90% confidence interval -3.1% to 3.3%) excluded our prestipulated noninferiority margin of 5 percentage points. Among participants with pregnancy follow-up through 6 months, 1 of 213 (0.5%) and 3 of 208 (1.4%) in the Quickstart and Afterstart groups, respectively, became pregnant within that time; 6-month pregnancy rates did not differ significantly by group (exact log-rank test, P.28). At enrollment, significantly more participants in the Quickstart group than in the Afterstart group were satisfied with their group assignments (187/236 [79%] compared with 129/240 [54%], respectively; P<.001). CONCLUSION: Insertion of etonogestrel implants with mifepristone did not appreciably increase medical abortion failure risk and it enhanced patient satisfaction, but we found no evidence that it decreased repeat pregnancy rates.

Original languageEnglish (US)
Pages (from-to)306-312
Number of pages7
JournalObstetrics and Gynecology
Volume127
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Mifepristone
Induced Abortion
Pregnancy Rate
Pregnancy
Pregnancy Outcome
Patient Satisfaction
Contraception
Confidence Intervals
etonogestrel

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Raymond, E. G., Weaver, M. A., Tan, Y. L., Louie, K. S., Bousiéguez, M., Lugo-Hernández, E. M., ... Winikoff, B. (2016). Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy. Obstetrics and Gynecology, 127(2), 306-312. https://doi.org/10.1097/AOG.0000000000001274

Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy. / Raymond, Elizabeth G.; Weaver, Mark A.; Tan, Yi Ling; Louie, Karmen S.; Bousiéguez, Manuel; Lugo-Hernández, Elba M.; Aranguré-Peraza, Ana Gabriela; Sanhueza, Patricio; Kaplan, Clair; Sonalkar, Sarita; Goldberg, Alisa B.; Culwell, Kelly R.; Memmel, Lisa; Jamshidi, Roxanne; Winikoff, Beverly.

In: Obstetrics and Gynecology, Vol. 127, No. 2, 01.02.2016, p. 306-312.

Research output: Contribution to journalArticle

Raymond, EG, Weaver, MA, Tan, YL, Louie, KS, Bousiéguez, M, Lugo-Hernández, EM, Aranguré-Peraza, AG, Sanhueza, P, Kaplan, C, Sonalkar, S, Goldberg, AB, Culwell, KR, Memmel, L, Jamshidi, R & Winikoff, B 2016, 'Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy', Obstetrics and Gynecology, vol. 127, no. 2, pp. 306-312. https://doi.org/10.1097/AOG.0000000000001274
Raymond, Elizabeth G. ; Weaver, Mark A. ; Tan, Yi Ling ; Louie, Karmen S. ; Bousiéguez, Manuel ; Lugo-Hernández, Elba M. ; Aranguré-Peraza, Ana Gabriela ; Sanhueza, Patricio ; Kaplan, Clair ; Sonalkar, Sarita ; Goldberg, Alisa B. ; Culwell, Kelly R. ; Memmel, Lisa ; Jamshidi, Roxanne ; Winikoff, Beverly. / Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy. In: Obstetrics and Gynecology. 2016 ; Vol. 127, No. 2. pp. 306-312.
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abstract = "OBJECTIVE: To evaluate the effect of insertion of etonogestrel implants with mifepristone compared with after the abortion on the risks of medical abortion failure and repeat pregnancy over the subsequent 6 months. METHODS: In a randomized trial, we assigned patients undergoing medical abortion to receive etonogestrel implants either with the mifepristone (Quickstart group) or after the abortion (Afterstart group). We followed them for 7 months to ascertain abortion outcome, pregnancies, and contraception use. RESULTS: Between September 2013 and August 2014, we enrolled 236 participants in the Quickstart group and 240 in the Afterstart group. To examine abortion failure, we conducted a noninferiority analysis from which we excluded nine participants who had missing outcome data and four with specified protocol violations. Of the rest, 9 of 229 (3.9{\%}) and 9 of 234 (3.8{\%}) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the difference of 0.08{\%} (90{\%} confidence interval -3.1{\%} to 3.3{\%}) excluded our prestipulated noninferiority margin of 5 percentage points. Among participants with pregnancy follow-up through 6 months, 1 of 213 (0.5{\%}) and 3 of 208 (1.4{\%}) in the Quickstart and Afterstart groups, respectively, became pregnant within that time; 6-month pregnancy rates did not differ significantly by group (exact log-rank test, P.28). At enrollment, significantly more participants in the Quickstart group than in the Afterstart group were satisfied with their group assignments (187/236 [79{\%}] compared with 129/240 [54{\%}], respectively; P<.001). CONCLUSION: Insertion of etonogestrel implants with mifepristone did not appreciably increase medical abortion failure risk and it enhanced patient satisfaction, but we found no evidence that it decreased repeat pregnancy rates.",
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AU - Raymond, Elizabeth G.

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AU - Louie, Karmen S.

AU - Bousiéguez, Manuel

AU - Lugo-Hernández, Elba M.

AU - Aranguré-Peraza, Ana Gabriela

AU - Sanhueza, Patricio

AU - Kaplan, Clair

AU - Sonalkar, Sarita

AU - Goldberg, Alisa B.

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N2 - OBJECTIVE: To evaluate the effect of insertion of etonogestrel implants with mifepristone compared with after the abortion on the risks of medical abortion failure and repeat pregnancy over the subsequent 6 months. METHODS: In a randomized trial, we assigned patients undergoing medical abortion to receive etonogestrel implants either with the mifepristone (Quickstart group) or after the abortion (Afterstart group). We followed them for 7 months to ascertain abortion outcome, pregnancies, and contraception use. RESULTS: Between September 2013 and August 2014, we enrolled 236 participants in the Quickstart group and 240 in the Afterstart group. To examine abortion failure, we conducted a noninferiority analysis from which we excluded nine participants who had missing outcome data and four with specified protocol violations. Of the rest, 9 of 229 (3.9%) and 9 of 234 (3.8%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the difference of 0.08% (90% confidence interval -3.1% to 3.3%) excluded our prestipulated noninferiority margin of 5 percentage points. Among participants with pregnancy follow-up through 6 months, 1 of 213 (0.5%) and 3 of 208 (1.4%) in the Quickstart and Afterstart groups, respectively, became pregnant within that time; 6-month pregnancy rates did not differ significantly by group (exact log-rank test, P.28). At enrollment, significantly more participants in the Quickstart group than in the Afterstart group were satisfied with their group assignments (187/236 [79%] compared with 129/240 [54%], respectively; P<.001). CONCLUSION: Insertion of etonogestrel implants with mifepristone did not appreciably increase medical abortion failure risk and it enhanced patient satisfaction, but we found no evidence that it decreased repeat pregnancy rates.

AB - OBJECTIVE: To evaluate the effect of insertion of etonogestrel implants with mifepristone compared with after the abortion on the risks of medical abortion failure and repeat pregnancy over the subsequent 6 months. METHODS: In a randomized trial, we assigned patients undergoing medical abortion to receive etonogestrel implants either with the mifepristone (Quickstart group) or after the abortion (Afterstart group). We followed them for 7 months to ascertain abortion outcome, pregnancies, and contraception use. RESULTS: Between September 2013 and August 2014, we enrolled 236 participants in the Quickstart group and 240 in the Afterstart group. To examine abortion failure, we conducted a noninferiority analysis from which we excluded nine participants who had missing outcome data and four with specified protocol violations. Of the rest, 9 of 229 (3.9%) and 9 of 234 (3.8%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the difference of 0.08% (90% confidence interval -3.1% to 3.3%) excluded our prestipulated noninferiority margin of 5 percentage points. Among participants with pregnancy follow-up through 6 months, 1 of 213 (0.5%) and 3 of 208 (1.4%) in the Quickstart and Afterstart groups, respectively, became pregnant within that time; 6-month pregnancy rates did not differ significantly by group (exact log-rank test, P.28). At enrollment, significantly more participants in the Quickstart group than in the Afterstart group were satisfied with their group assignments (187/236 [79%] compared with 129/240 [54%], respectively; P<.001). CONCLUSION: Insertion of etonogestrel implants with mifepristone did not appreciably increase medical abortion failure risk and it enhanced patient satisfaction, but we found no evidence that it decreased repeat pregnancy rates.

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