Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. METHODS: In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. RESULTS: From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. CONCLUSION: Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.

Original languageEnglish (US)
Pages (from-to)739-745
Number of pages7
JournalObstetrics and Gynecology
Volume128
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Medroxyprogesterone Acetate
Randomized Controlled Trials
Pregnancy
Injections
Mifepristone
Pregnancy Outcome
Contraceptive Agents
Patient Satisfaction
Contraception
Confidence Intervals

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Raymond, E. G., Weaver, M. A., Louie, K. S., Tan, Y. L., Bousiéguez, M., Aranguré-Peraza, A. G., ... Winikoff, B. (2016). Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial. Obstetrics and Gynecology, 128(4), 739-745. https://doi.org/10.1097/AOG.0000000000001627

Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy : A Randomized Controlled Trial. / Raymond, Elizabeth G.; Weaver, Mark A.; Louie, Karmen S.; Tan, Yi Ling; Bousiéguez, Manuel; Aranguré-Peraza, Ana Gabriela; Lugo-Hernández, Elba M.; Sanhueza, Patricio; Goldberg, Alisa B.; Culwell, Kelly R.; Kaplan, Clair; Memmel, Lisa; Sonalkar, Sarita; Jamshidi, Roxanne; Winikoff, Beverly.

In: Obstetrics and Gynecology, Vol. 128, No. 4, 01.10.2016, p. 739-745.

Research output: Contribution to journalArticle

Raymond, EG, Weaver, MA, Louie, KS, Tan, YL, Bousiéguez, M, Aranguré-Peraza, AG, Lugo-Hernández, EM, Sanhueza, P, Goldberg, AB, Culwell, KR, Kaplan, C, Memmel, L, Sonalkar, S, Jamshidi, R & Winikoff, B 2016, 'Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial', Obstetrics and Gynecology, vol. 128, no. 4, pp. 739-745. https://doi.org/10.1097/AOG.0000000000001627
Raymond, Elizabeth G. ; Weaver, Mark A. ; Louie, Karmen S. ; Tan, Yi Ling ; Bousiéguez, Manuel ; Aranguré-Peraza, Ana Gabriela ; Lugo-Hernández, Elba M. ; Sanhueza, Patricio ; Goldberg, Alisa B. ; Culwell, Kelly R. ; Kaplan, Clair ; Memmel, Lisa ; Sonalkar, Sarita ; Jamshidi, Roxanne ; Winikoff, Beverly. / Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy : A Randomized Controlled Trial. In: Obstetrics and Gynecology. 2016 ; Vol. 128, No. 4. pp. 739-745.
@article{dbb3b774231d4704acbccfb07140d236,
title = "Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial",
abstract = "OBJECTIVE: To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. METHODS: In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. RESULTS: From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4{\%}) and 12 of 226 (5.3{\%}) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90{\%} confidence limit on this difference was 4.9{\%}, within our prestipulated 5{\%} noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6{\%}]) than in the Afterstart group (2/226 [0.9{\%}]); the difference was 2.7{\%} (90{\%} confidence interval 0.4-5.6{\%}). By 6 months, 5 of 213 (2.3{\%}) and 7 of 217 (3.2{\%}) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. CONCLUSION: Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.",
author = "Raymond, {Elizabeth G.} and Weaver, {Mark A.} and Louie, {Karmen S.} and Tan, {Yi Ling} and Manuel Bousi{\'e}guez and Arangur{\'e}-Peraza, {Ana Gabriela} and Lugo-Hern{\'a}ndez, {Elba M.} and Patricio Sanhueza and Goldberg, {Alisa B.} and Culwell, {Kelly R.} and Clair Kaplan and Lisa Memmel and Sarita Sonalkar and Roxanne Jamshidi and Beverly Winikoff",
year = "2016",
month = "10",
day = "1",
doi = "10.1097/AOG.0000000000001627",
language = "English (US)",
volume = "128",
pages = "739--745",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy

T2 - A Randomized Controlled Trial

AU - Raymond, Elizabeth G.

AU - Weaver, Mark A.

AU - Louie, Karmen S.

AU - Tan, Yi Ling

AU - Bousiéguez, Manuel

AU - Aranguré-Peraza, Ana Gabriela

AU - Lugo-Hernández, Elba M.

AU - Sanhueza, Patricio

AU - Goldberg, Alisa B.

AU - Culwell, Kelly R.

AU - Kaplan, Clair

AU - Memmel, Lisa

AU - Sonalkar, Sarita

AU - Jamshidi, Roxanne

AU - Winikoff, Beverly

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE: To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. METHODS: In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. RESULTS: From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. CONCLUSION: Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.

AB - OBJECTIVE: To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. METHODS: In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. RESULTS: From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. CONCLUSION: Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.

UR - http://www.scopus.com/inward/record.url?scp=84986188662&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84986188662&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000001627

DO - 10.1097/AOG.0000000000001627

M3 - Article

AN - SCOPUS:84986188662

VL - 128

SP - 739

EP - 745

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 4

ER -