The contraceptive implant for long acting reversible contraception in patients undergoing first trimester medical termination of pregnancy

Abstract 

Background

Increasing the uptake of long acting reversible contraception (LARC) is part of the UK strategy to reduce the number of unintended pregnancies. The subdermal contraceptive implant is a safe and effective option however lack of skilled providers can be a barrier to its use. We conducted a pilot study to investigate whether insertion during the first part of medical termination of pregnancy rather than after completion would be acceptable to patients and whether, being a progestogen, this has any effect on the efficacy of medical termination with mifepristone and misoprostol.

Methods

Prospective observational study comparing outcomes in patients who chose the subdermal implant for contraception, inserted during the first part of medical termination of pregnancy, against patients who chose an alternative method of contraception commenced after the termination was complete; 39 patients in each group.

Results

The efficacy of medical termination of pregnancy in patients in the implant group was 89.7% compared to 97.4% in controls (p=0.3584). Patients in the implant group tended to require more doses of misoprostol to complete the termination than controls. The incidence of complications was very low in both groups.

Conclusions

Implant insertion earlier in the treatment process was acceptable to patients and none changed their minds about their decision for termination. The efficacy of medical termination was slightly reduced in those in the implant group. Larger controlled studies are needed to investigate whether this is a true effect and whether increasing the uptake of LARC actually reduces the number of repeat terminations.

Keywords: Subdermal implant, Long acting reversible contraception (LARC), Medical termination of pregnancy