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Progestin-Based Contraceptive on the Same PROGESTIN-BASED CONTRACEPTIVE ON THE SAME DAY AS MEDICAL ABORTION Jeanna Park, MD1, Nuriya Robinson, MD1, Ursula Wessels, MD2, James Turner, MD2, Stacie Geller, PhD1 1Department of Obstetrics and Gynecology, University of Illinois, Chicago, USA 2Department of Obstetrics and Gynecology, Lower Umfolozi District War Memorial Hospital, Empangeni, South Africa INTRODUCTION AND OBJECTIVES METHODS • Major cause of maternal mortality in South Africa = unsafe abortion Retrospective chart review in KwaZulu Natal, South Africa - Lower • New focus on family planning – providing immediate contraception with Umfolozi District War Memorial Hospital and Eshowe Hospital. etonogestrel implant or depot medroxyprogesterone acetate (DMPA) injection at the same time as medical abortion Inclusion criteria: • Historically, contraception offered at second follow-up visit after medical • Pregnant women aged 15-49 abortion complete – but many women lost to follow-up and never receive • Gestational age ≤ 63 days by ultrasound contraception (3) • Underwent medical abortion between August 2013 and July 2014 • Studies support when contraception is given at time of abortion, • Followed medical abortion protocol with oral mifepristone continuation rates high (4) and repeat abortion rates low (5) 200mg followed by sublingual misoprostol 800mcg 24 hours later • Theoretical risk - providing a progestin-based contraceptive (i.e. • Received either the etonogestrel implant or DMPA injection for etonogestrel or DMPA) at time of medical abortion may interfere with contraception on the same day as mifepristone anti-progestin effects of mifepristone, resulting in an incomplete abortion • Returned to clinic or reached by phone for follow-up Objective - determine the success rate of medical abortion when followed by Medical abortion completion = complete passage of products of immediate placement of a progestin-based contraceptive with the conception not requiring surgical evacuation etonogestrel implant or DMPA injection on the same day as mifepristone Independent samples t-tests and chi-squared tests to calculate statistically significant relationship between variables and outcome RESULTS Table 1: Demographic variables 87 (98%, 95% CI 95-100%) = complete abortion 89 charts reviewed All subjects 2 (2%) required surgical evacuation for an incomplete abortion • Mean age of women = 25 yrs (n=89) • Gravida 1 women Age (mean ± SD) 24.8 ± 5.3 • HIV negative • Mean gestational age = 53 d Parity (n, %) 0 22 (25%) • 28 days gestation and 62 days gestation 1 34 (38%) • DMPA for contraception • With known HIV status, over 2 15 (17%) 1/3 HIV positive 3 or more 11 (12%) Missing 7 (8%) Table 2: Medical abortion completion and chosen contraceptive Demographic variables - Gestational age in days (n, %) patient’s age, gestational age, ≤49 days 31 (35%) Complete Incomplete 50-56 days 33 (37%) abortion abortion parity, HIV status – 57-63 days 22 (25%) not statistically related to Missing 3 (3%) Contraception at time of abortion medical abortion failure or HIV status (n, %) Etonogestrel implant 38 (100%) 0 chosen contraception Negative 50 (56%) Positive 27 (30%) Depot medroxyprogesterone acetate 49 (96%) 2 (4%) Missing 12 (14%) Total 87 (98%) 2 (2%) CONCLUSIONS REFERENCES In our study, the success rate of medical abortion when a progestin-based contraceptive was 1. Saving Mothers 2011-2013: Sixth Report on the Confidential Enquiries into Maternal Deaths in South Africa. South Africa: administered on the same day as mifepristone was high (98%) Department of Health. http://www.kznhealth.gov.za/mcwh/Maternal/Saving-Mothers-2011- 2013-short-report.pdf. Published 2015. Accessed April 20, 2015. A streamlined one-visit approach for medical abortion and contraceptive placement on the same 2. Human Rights Watch. World Report 2011: South Africa. http://www.hrw.org/world-report-2012/world-report-2012-south- day may be an acceptable option africa. Published 2011. Accessed April 20, 2015. 3. Sonalkar S, Hou MY, Borgatta L. Administration of the etonogestrel contraceptive implant on the day of mifepristone for medical abortion: a pilot study. Contraception. 2013;88(5):671-3. FUTURE DIRECTIONS 4. Madden, T., Eisenberg, D. L., Zhao, Q., Buckel, C., Secura, G. M., & Peipert, J. F. Continuation of the etonogestrel implant in women undergoing immediate postabortion placement. Obstet Gynecol. 2012 Nov;120(5):1053-9 Larger prospective studies are needed to assess success rates with concurrent placement of 5. Rose SB, Lawton BA. Impact of long-acting reversible contraception progestin-based contraceptives on return for repeat abortion. Am J Obstet Gynecol. 2011 Acceptability and satisfaction studies to determine continuation of the chosen contraceptive, bleeding and side effect profiles, and time to next pregnancy are also necessary FUNDING SOURCE: UNIVERSITY OF ILLINOIS GLOBAL WOMEN’S HEALTH FELLOWSHIP 980-P Termination of pregnancy Poster presented at: 10.3252/pso.eu.XXIFIGO.2015 FIGO 2015 FIGO Jeanna Park.
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