scholarly journals Immediate IUD insertion after second trimester abortion: implications for service delivery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
O. Somefun ◽  
D. Constant ◽  
M. Endler
Keyword(s):  
Service Delivery ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Medical Abortion ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Contraceptive Counselling ◽  
Long Acting ◽  
Study Participants ◽  
The Impact

Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

scholarly journals Immediate IUD insertion after second trimester abortion: process evaluation and implications for service delivery

2021 ◽  
Author(s):  
Oluwaseyi Dolapo Somefun ◽  
Deborah Constant ◽  
Margit Endler
Keyword(s):  
Service Delivery ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Medical Abortion ◽  
Barriers And Facilitators ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Post Abortion ◽  
Clinical Records

Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of post-abortion care. A randomized controlled trial (RCT) in South Africa compared immediate to interval insertion of the copper intrauterine device (IUD) after second trimester medical abortion (MA). Immediate insertion resulted in higher use at 6 weeks post-abortion, however expulsion rates were higher than interval insertion. This process evaluation sheds light on barriers and facilitators to the implementation of the study intervention.MethodsWe performed a process evaluation alongside the RCT in which we reviewed clinical records for fidelity to the RCT protocol and conducted in-depth interviews with 14 staff providing healthcare to RCT participants and 24 RCT participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the potential impact of context and supplementary trial activities on trial findings. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text.ResultsIn the RCT, there were 8 crossovers from the immediate to the delayed arm: 5 had a clinical contraindication to the IUD post-MA and 3 changed their mind about the IUD. In deviation of the RCT protocol 10 women in the delayed arm were given the injectable instead of oral contraceptives. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to the allocated intervention over the trial duration. For women, convenience, protection from pregnancy and privacy issues were paramount and they expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Clinical trials registration: clinicaltrials.gov/ (ID NCT03505047), Pan African Trials Registry (www.pactr.org), ID PACTR201804003324963ConclusionsWomen and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

scholarly journals Barriers and Facilitators to Immediate Insertion of the Copper IUD after Second-Trimester Medical Abortion - Process Evaluation of A Randomized Controlled Trial

2021 ◽  
Author(s):  
Oluwaseyi Dolapo Somefun ◽  
Deborah Constant ◽  
Margit Endler
Keyword(s):  
Randomized Controlled Trial ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Medical Abortion ◽  
Barriers And Facilitators ◽  
Second Trimester ◽  
Randomized Controlled ◽  
Post Abortion ◽  
Clinical Records

Abstract Introduction The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of post-abortion care. A randomized controlled trial (RCT) in South Africa compared immediate to interval insertion of the copper intrauterine device (IUD) after second trimester medical abortion (MA). Immediate insertion resulted in higher use at 6 weeks post-abortion, however expulsion rates were higher than interval insertion. This process evaluation sheds light on barriers and facilitators to the implementation of the study intervention.MethodsWe performed a process evaluation alongside the RCT in which we reviewed clinical records for fidelity to the RCT protocol and conducted in-depth interviews with 14 staff providing healthcare to RCT participants and 24 RCT participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the potential impact of context and supplementary trial activities on trial findings. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text.ResultsIn the RCT, there were 8 crossovers from the immediate to the delayed arm: 5 had a clinical contraindication to the IUD post-MA and 3 changed their mind about the IUD. In deviation of the RCT protocol 10 women in the delayed arm were given the 3 monthly injectable instead of oral contraceptives. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to the allocated intervention over the trial duration. For women, convenience, protection from pregnancy and privacy issues were paramount and they expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Clinical trials registration: clinicaltrials.gov/ (ID NCT03505047), Pan African Trials Registry (www.pactr.org), ID PACTR201804003324963ConclusionsWomen and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure continuity of care, communication that mitigates loss to follow up and training of staff to ensure competence.

DEGLOVING BOWEL INJURY FOLLOWING SECOND TRIMESTER PREGNANCY TERMINATION IN THE ERA OF MODERN OBSTETRICS: A CASE REPORT

2021 ◽  
pp. 5-6
Author(s):  
Shree Bharathi ◽  
Deepthi Nayak ◽  
Vinodhini Kadir ◽  
Niveditha Jha ◽  
Haritha Sagili
Keyword(s):  
Pregnancy Termination ◽  
Rare Complication ◽  
Medical Abortion ◽  
Bowel Injury ◽  
Second Trimester ◽  
Fetal Head ◽  
Trimester Abortion ◽  
Mortality And Morbidity ◽  
Breech Delivery ◽  
Degloving Injury

Degloving injury to the bowel following uterine instrumentation is a rare complication of second trimester abortion. Unsafe abortion practices can lead to such complications adding on the maternal mortality and morbidity. Here we present a case of 19-year-old unmarried girl who had undergone medical abortion and sustained decapitation of the fetal head during breech delivery which necessitated instrumentation for its retrieval leading to perforation and degloving bowel injury

P19 Attitudes about second-trimester abortion and the impact of restrictive laws among reproductive-aged Texas women

Contraception ◽  
2020 ◽  
Vol 102 (4) ◽  
pp. 283
Author(s):  
K. White ◽  
G. Sierra ◽  
S. Baum ◽  
K. Hopkins ◽  
J. Potter ◽  
...  
Keyword(s):  
Second Trimester ◽  
Trimester Abortion ◽  
Second Trimester Abortion ◽  
Texas Women ◽  
The Impact

scholarly journals Comparative study between sequential use of Foley catheter with vaginal misoprostol versus sequential use of oral mifepristone with vaginal misoprostol for second trimester medical abortion

2018 ◽  
Vol 7 (11) ◽  
pp. 4545
Author(s):  
Michelle N. Fonseca ◽  
Vernica Sah
Keyword(s):  
Side Effects ◽  
Foley Catheter ◽  
Medical Abortion ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Sequential Administration ◽  
Group A ◽  
Low Incidence ◽  
Vaginal Misoprostol ◽  
Group B

Background: Abortions are one of the most commonly performed procedures in gynaecological departments worldwide. They are still a major problem in developing countries contributing to a significant percentage of maternal morbidity and mortality. The main objective of this study is to compare the efficacy, side effects and acceptability of intracervical Foley and oral Mifepristone both followed with sequential administration of vaginal misoprostol for second trimester medical abortion.Methods: This was a prospective randomized trial of 36 healthy women opting for termination of pregnancy with ultrasound confirmed intrauterine gestation between 12 to 20 completed weeks. Intracervical Foley catheter with administration of misoprostol (200µg) vaginally was done for Group A. Mifepristone 200mg was administered on day one followed by misoprostol (200µg) vaginally, 48 hours later, to Group B. Both groups received misoprostol (200µg) vaginally at 4 hourly intervals. Completeness of abortion was assessed, and surgical evacuation was performed, if abortion was found to be incomplete.Results: The two groups were comparable with respect to age, parity and gestational age. 83-89% of the women in both the groups had complete abortion. The mean induction abortion interval was 20.11 hours in Group A and 54.77 hours in Group B, which was statistically significant. Side effect profile was comparable in both groups however the intensity and the duration of persistence of pain was greater among patients from Group A.Conclusions: Authors conclude that medical abortions with both methods were found to be safe, effective, inexpensive and acceptable methods. Whereas a shorter induction abortion interval was observed in the Foley induction group, induction with mifepristone was the preferred regimen in second trimester abortion because of its high efficacy, low incidence of side effects, better tolerance by the patients and due to lower dose of misoprostol required following mifepristone administration.

Immediate versus delayed insertion of the copper intrauterine device after medical abortion at 17–20 gestational weeks: a randomised controlled trial

2021 ◽  
pp. bmjsrh-2020-200932
Author(s):  
Deborah Constant ◽  
Margit Endler ◽  
Daniel Grossman ◽  
Gregory Petro ◽  
Malika Patel
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Medical Abortion ◽  
Tertiary Hospital ◽  
Community Healthcare ◽  
Intention To Treat ◽  
Randomised Controlled ◽  
Post Abortion ◽  
Copper Intrauterine Device

IntroductionThis trial reports on use of the copper intrauterine device (IUD) after immediate compared with delayed insertion following medical abortion at 17–20 gestational weeks (GW).MethodsThis randomised controlled trial was conducted at one tertiary hospital and five community healthcare centres in Cape Town, South Africa. Eligible consenting women were randomised to immediate (within 24 hours) or delayed (3 weeks post-abortion) insertion of the copper IUD. Follow-up was at 6 weeks, 3 months and 6 months. Main outcomes were use of the original IUD and use of any IUD, including replacement IUDs at 6 weeks post-abortion. Secondary outcomes included rates of expulsion and malposition at 6 weeks, use of any IUD at 3 and 6 months, and acceptability of the IUD.ResultsWe recruited and randomised 114 women admitted for elective medical abortion between August 2018 and June 2019. In the immediate and delayed study arms, respectively, 45/55 (82%) and 12/57 (21%) women received the IUD as planned. By intention-to-treat, 56% in the immediate and 19% in the delayed arms were using the original IUD at 6 weeks (p<0.001), and 76% in the immediate and 40% in the delayed arms were using any IUD (p<0.001). Complete expulsion or removal occurred in 32% in the immediate and 7% in the delayed arms (p=0.044).ConclusionsInsertion of an IUD immediately after medical abortion at 17–20 GW results in increased use after 6 weeks compared with delayed insertion, however expulsion rates are higher than with interval insertion.Clinical trials registrationNCT03505047), Pan African Trials Registry (www.pactr.org), 201804003324963

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