Continuation of the Etonogestrel Implant in Women Undergoing Immediate Postabortion Placement

Abstract

Long-acting reversible contraceptive (LARC) methods can prevent repeat abortion. Two effective reversible LARC methods, the intrauterine device (IUD) and subdermal implant, have the potential to significantly reduce the rate of both unintended pregnancy and abortion. Some clinicians are concerned that women receiving an immediate postabortion etonogestrel implant may have higher rates of discontinuation compared with women who have the implant not in association with a recent pregnancy (interval insertion). Previous studies have not adequately investigated continuation rates for this implant following immediate postabortion insertion. The aim of this study was to compare 12-month continuation rates among women who received an immediate postabortion etonogestrel subdermal implant with those of women who had an interval insertion. The authors performed a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study designed to evaluate continuation and satisfaction for reversible LARC methods. Kaplan-Meier estimator of survival function and Cox proportional hazard models were used to compare continuation rates. Among 1178 women who received the implant during the study period, 141 received the implant immediately postabortion, and 935 had an interval insertion. Rates of 12-month continuation were similar in both groups: 81.5% for women who underwent immediate postabortion placement and 82.8% who had an interval placement (P = 0.54). Survival analysis showed that the likelihood of discontinuation among women who received an immediate postabortion implant was the same as those who had an interval placement; the adjusted hazard ratio was 1.04, with a 95% confidence interval of 0.68 to 1.60. In both groups, frequent or irregular bleeding was the most common reason given for discontinuation of the implant: 65.4% in the immediate postabortion group and 56.7% in the interval group (P = 0.29). These findings show that women who undergo immediate postabortion placement of the subdermal implant are no more likely to discontinue using it than women who have an interval placement. All women undergoing induced abortion should be offered immediate postabortion LARC to reduce the risk of unintended pregnancy and repeat abortion.