PMID- 28692170 OWN - NLM STAT- MEDLINE DCOM- 20181212 LR - 20220330 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 124 IP - 13 DP - 2017 Dec TI - Expulsions and adverse events following immediate and later insertion of a levonorgestrel-releasing intrauterine system after medical termination of late first- and second-trimester pregnancy: a randomised controlled trial. PG - 1965-1972 LID - 10.1111/1471-0528.14813 [doi] AB - OBJECTIVES: To compare expulsions and adverse events (AEs) between immediate and delayed insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) following medical termination of pregnancy (MTOP). DESIGN: Randomised controlled trial. SETTING: Helsinki University Hospital, Finland, January 2013-December 2014. POPULATION: Cohorts of 102 (gestational age 64-84 days, late first trimester) and 57 (gestational age 85-140 days, second trimester) women requesting MTOP and LNG-IUS contraception. METHODS: LNG-IUS insertion occurred immediately (same day) or 2-4 weeks following MTOP. Follow-up visits were at 2-4 weeks, 3 months, and 1 year. MAIN OUTCOME MEASURES: LNG-IUS expulsion by 3 months and 1 year. AEs and bleeding profiles within 3 months. RESULTS: Following late first-trimester MTOP the LNG-IUS expulsion rates by 3 months were 14 (27.5%) in the immediate-insertion group and two (4.0%) in the delayed-insertion group (risk ratio, RR 6.86; 95% confidence interval, 95% CI 1.64-28.66). By 1 year the expulsion rates were 17 (33.3%) and six (12.0%) (RR 2.78, 95% CI 1.19-6.47). Following second-trimester MTOP LNG-IUS expulsion rates by 3 months and 1 year were five (18.5%) in the immediate-insertion group and one (3.6%) in the delayed-insertion group (RR 5.19, 95% CI 0.65-41.54). No differences in AEs and bleeding profiles emerged between the groups. CONCLUSIONS: Immediate LNG-IUS insertion after late first- or second-trimester MTOP is feasible, does not increase the complication rate, or alter the uterine bleeding patterns; however, immediate insertion increased the expulsion rate, which may limit the cost-effectiveness. TWEETABLE ABSTRACT: Immediate insertion of LNG-IUS following MTOP at 9-20 weeks of gestation is feasible and safe. CI - (c) 2017 Royal College of Obstetricians and Gynaecologists. FAU - Korjamo, R AU - Korjamo R AD - Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Mentula, M AU - Mentula M AD - Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Heikinheimo, O AU - Heikinheimo O AD - Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20170816 PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 RN - 0 (Contraceptive Agents, Female) RN - 5W7SIA7YZW (Levonorgestrel) SB - IM MH - *Abortion, Induced MH - Adult MH - Contraceptive Agents, Female/*administration & dosage MH - Feasibility Studies MH - Female MH - Humans MH - *Intrauterine Devices, Medicated MH - Levonorgestrel/*administration & dosage MH - Patient Safety MH - Pregnancy MH - Pregnancy Trimester, First MH - Pregnancy Trimester, Second MH - Time Factors MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - Contraception OT - contraceptive devices OT - induced termination of pregnancy OT - intrauterine devices OT - medical termination of pregnancy EDAT- 2017/07/12 06:00 MHDA- 2018/12/13 06:00 CRDT- 2017/07/11 06:00 PHST- 2017/06/30 00:00 [accepted] PHST- 2017/07/12 06:00 [pubmed] PHST- 2018/12/13 06:00 [medline] PHST- 2017/07/11 06:00 [entrez] AID - 10.1111/1471-0528.14813 [doi] PST - ppublish SO - BJOG. 2017 Dec;124(13):1965-1972. doi: 10.1111/1471-0528.14813. Epub 2017 Aug 16.