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Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation: a randomized controlled trial
Abstracts / Contraception 80 (2009) 194–226 peer's warnings about rare and/or serious side effects (infection, infertility) affected uptake. There were three repeat pregnancies among these 19 teens. Conclusions: African American teen mothers may face psychosocial and health care barriers to IUD placing them at risk of repeat pregnancy. Qualitative research can help us understand factors associated with repeat teen pregnancy.
P36 TIME TO PREGNANCY IN A COHORT OF LOW-INCOME, URBAN LATINAS: DOES DIABETES MATTER?
209
Results: We enrolled 23 participants at two Chicago sites. Twelve adolescents received the LNG-IUS, and 11 received the CuT380A. Nine teens in the LNG-IUS group (75%), and five teens in the CuT380A group (45%) continued the device after 6 months. Five discontinued the CuT380A prior to or at 6 months because of: excessive cramping and suspected pelvic infection (n=1), partial expulsion (n=2) and prolonged heavy bleeding (n=2). One discontinued the LNG-IUS after 2 months due to heavy bleeding and worsening anemia. The most common side effects among all participants were bothersome bleeding and/or spotting and pelvic and/or abdominal pain. Conclusions: An RCT evaluating two IUDs among adolescents is feasible. Clinical outcomes (e.g., pelvic infections, bleeding, pain and anemia) among teens using the IUDs should be investigated in a larger trial.
Sheeder J University of Colorado School of Medicine, Aurora, CO, USA Teal S Objectives: To describe and compare the time-to-pregnancy (TTP) during episodes of noncontraceptive use in Latinas with and without diabetes using life-history calendar (LHC) data. Method: LHCs were generated beginning with menarche and including sexual activity, contraceptive use and pregnancies. Event segments were computed using start and end dates. TTP segments began with sexual activity for which no contraception was used. 56 age-stratified subjects (32 diabetic, 24 nondiabetic) completed LHCs. Age range was 19–45 years (mean±S.D.: 32.0±6.6). Calendars encompassed 6.2–31.6 years (19.6±6.6). Results: 52 subjects conceived at least once for 172 pregnancies (3.3±2.0 DM, 2.8±1.4 non-DM). 141 (82%) conceptions were preceded by noncontraceptive use. Contraceptive failures were more common in nondiabetic subjects (29.4% vs. 10.6%; p=.002). TTP was longer for diabetics than nondiabetics (8.4±14.9 vs. 4.8±7.1 month; p=.05). The proportion of time of unprotected sexual activity before conception was longer for diabetics prior to their diagnosis of diabetes than nondiabetics (67.6% vs. 47.4%, NS). Diabetic subjects had been diabetic for 1.9–22.2 years (6.8±5.1). TTP was the same for diabetic patients both prior to and after their diagnosis of diabetes (8.4±16.9 vs. 8.4±11.0 mo). Conclusions: Latina diabetics have a significantly longer time-to-pregnancy than their nondiabetic counterparts, even prior to a diagnosis of diabetes. Latinas are the US population most at risk of developing diabetes. Delay in conception of a desired pregnancy may be an indication for diabetes screening.
P37 A MULTICENTER RANDOMIZED CONTROLLED FEASIBILITY TRIAL OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM COMPARED TO THE COPPER T380A AMONG ADOLESCENTS AGES 14–18 Memmel L University of Chicago, Chicago, IL, USA Godfrey E, Nicosia A, Neustadt A, Shah M, Moorthie M, Pius R, Gilliam M Objectives: A recent ACOG committee opinion states that use of intrauterine devices (IUDs) by adolescents is safe, “top-tier” and urged its “first-line” use. However, little empirical data are available on the clinical consequences of IUD use among adolescents in the United States to guide physicians. Feasibility data are needed to determine whether a larger trial comparing IUDs among adolescents is possible. Method: We conducted a single-blind, multi-centered, randomized controlled trial (RCT) of the levonorgestrel intrauterine system (LNGIUS) and copper T 380A IUD (CuT380A) to assess the feasibility of recruiting, enrolling, randomizing and retaining adolescents (ages 14–18) over a 6-month period. Enrollment and continuation rates, reasons for discontinuation, and side effects were evaluated.
P38 IMMEDIATE VERSUS DELAYED INSERTION OF THE LEVONORGESTREL-RELEASING INTRAUTERINE DEVICE FOLLOWING DILATION AND EVACUATION: A RANDOMIZED CONTROLLED TRIAL Hohmann HL University of Pittsburgh, Pittsburgh, PA, USA Reeves MF, Chen BA, Perriera L, Hayes JL, Creinin MD Objectives: To compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3–6 weeks after a dilation and evacuation (D&E) procedure. Method: We enrolled women undergoing D&E at 15–23 weeks gestation. At completion of D&E, subjects without contraindications to immediate insertion were randomized to immediate or delayed LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. Subjects in the delayed group had the LNG-IUD placed 3–6 weeks later. All subjects returned at 3–6 weeks and 8–10 weeks after the D&E and were contacted by phone at 6 months. Results: Of the 90 subjects enrolled, 88 were randomized. All 44 subjects randomized to immediate insertion had successful IUD placement. Only 20 (45%) subjects returned for delayed IUD placement. To date, 17 (40%) and 13 (35%) are lost to follow-up in the immediate and delayed groups, respectively (p=.6). Of subjects who have reached the 6 month time point, 85% (22/26) and 56% (14/25) were utilizing the LNG-IUD in the immediate and delayed group, respectively (p=.02). IUD expulsion occurred in three (7%) and 1 (5%) subjects in whom the IUD was placed in the immediate and delayed groups, respectively (p=.7). Conclusions: Women who have a D&E procedure exhibit poor follow-up for postprocedure LNG-IUD insertion. Immediate insertion of the LNG-IUD after D&E results in higher IUD utilization as compared to delayed insertion.
P39 “WHY DOES MY PARTNER FEEL STRINGS?” AND OTHER QUESTIONS POSED BY WOMEN WHO HAD IUC PLACED AFTER THEIR ABORTIONS Diedrich J University of California, San Francisco, San Francisco, CA, USA Pasternack T, Drey E, Steinauer J Objectives: The use of long-acting reversible contraceptives is increasing; however, little is known about contraceptive counseling in the abortion setting. The goal of this study is to document women's questions and assess knowledge retention after having chosen immediate postabortion intrauterine contraceptive (IUC) placement.
P36 TIME TO PREGNANCY IN A COHORT OF LOW-INCOME, URBAN LATINAS: DOES DIABETES MATTER?
209
Results: We enrolled 23 participants at two Chicago sites. Twelve adolescents received the LNG-IUS, and 11 received the CuT380A. Nine teens in the LNG-IUS group (75%), and five teens in the CuT380A group (45%) continued the device after 6 months. Five discontinued the CuT380A prior to or at 6 months because of: excessive cramping and suspected pelvic infection (n=1), partial expulsion (n=2) and prolonged heavy bleeding (n=2). One discontinued the LNG-IUS after 2 months due to heavy bleeding and worsening anemia. The most common side effects among all participants were bothersome bleeding and/or spotting and pelvic and/or abdominal pain. Conclusions: An RCT evaluating two IUDs among adolescents is feasible. Clinical outcomes (e.g., pelvic infections, bleeding, pain and anemia) among teens using the IUDs should be investigated in a larger trial.
Sheeder J University of Colorado School of Medicine, Aurora, CO, USA Teal S Objectives: To describe and compare the time-to-pregnancy (TTP) during episodes of noncontraceptive use in Latinas with and without diabetes using life-history calendar (LHC) data. Method: LHCs were generated beginning with menarche and including sexual activity, contraceptive use and pregnancies. Event segments were computed using start and end dates. TTP segments began with sexual activity for which no contraception was used. 56 age-stratified subjects (32 diabetic, 24 nondiabetic) completed LHCs. Age range was 19–45 years (mean±S.D.: 32.0±6.6). Calendars encompassed 6.2–31.6 years (19.6±6.6). Results: 52 subjects conceived at least once for 172 pregnancies (3.3±2.0 DM, 2.8±1.4 non-DM). 141 (82%) conceptions were preceded by noncontraceptive use. Contraceptive failures were more common in nondiabetic subjects (29.4% vs. 10.6%; p=.002). TTP was longer for diabetics than nondiabetics (8.4±14.9 vs. 4.8±7.1 month; p=.05). The proportion of time of unprotected sexual activity before conception was longer for diabetics prior to their diagnosis of diabetes than nondiabetics (67.6% vs. 47.4%, NS). Diabetic subjects had been diabetic for 1.9–22.2 years (6.8±5.1). TTP was the same for diabetic patients both prior to and after their diagnosis of diabetes (8.4±16.9 vs. 8.4±11.0 mo). Conclusions: Latina diabetics have a significantly longer time-to-pregnancy than their nondiabetic counterparts, even prior to a diagnosis of diabetes. Latinas are the US population most at risk of developing diabetes. Delay in conception of a desired pregnancy may be an indication for diabetes screening.
P37 A MULTICENTER RANDOMIZED CONTROLLED FEASIBILITY TRIAL OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM COMPARED TO THE COPPER T380A AMONG ADOLESCENTS AGES 14–18 Memmel L University of Chicago, Chicago, IL, USA Godfrey E, Nicosia A, Neustadt A, Shah M, Moorthie M, Pius R, Gilliam M Objectives: A recent ACOG committee opinion states that use of intrauterine devices (IUDs) by adolescents is safe, “top-tier” and urged its “first-line” use. However, little empirical data are available on the clinical consequences of IUD use among adolescents in the United States to guide physicians. Feasibility data are needed to determine whether a larger trial comparing IUDs among adolescents is possible. Method: We conducted a single-blind, multi-centered, randomized controlled trial (RCT) of the levonorgestrel intrauterine system (LNGIUS) and copper T 380A IUD (CuT380A) to assess the feasibility of recruiting, enrolling, randomizing and retaining adolescents (ages 14–18) over a 6-month period. Enrollment and continuation rates, reasons for discontinuation, and side effects were evaluated.
P38 IMMEDIATE VERSUS DELAYED INSERTION OF THE LEVONORGESTREL-RELEASING INTRAUTERINE DEVICE FOLLOWING DILATION AND EVACUATION: A RANDOMIZED CONTROLLED TRIAL Hohmann HL University of Pittsburgh, Pittsburgh, PA, USA Reeves MF, Chen BA, Perriera L, Hayes JL, Creinin MD Objectives: To compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3–6 weeks after a dilation and evacuation (D&E) procedure. Method: We enrolled women undergoing D&E at 15–23 weeks gestation. At completion of D&E, subjects without contraindications to immediate insertion were randomized to immediate or delayed LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. Subjects in the delayed group had the LNG-IUD placed 3–6 weeks later. All subjects returned at 3–6 weeks and 8–10 weeks after the D&E and were contacted by phone at 6 months. Results: Of the 90 subjects enrolled, 88 were randomized. All 44 subjects randomized to immediate insertion had successful IUD placement. Only 20 (45%) subjects returned for delayed IUD placement. To date, 17 (40%) and 13 (35%) are lost to follow-up in the immediate and delayed groups, respectively (p=.6). Of subjects who have reached the 6 month time point, 85% (22/26) and 56% (14/25) were utilizing the LNG-IUD in the immediate and delayed group, respectively (p=.02). IUD expulsion occurred in three (7%) and 1 (5%) subjects in whom the IUD was placed in the immediate and delayed groups, respectively (p=.7). Conclusions: Women who have a D&E procedure exhibit poor follow-up for postprocedure LNG-IUD insertion. Immediate insertion of the LNG-IUD after D&E results in higher IUD utilization as compared to delayed insertion.
P39 “WHY DOES MY PARTNER FEEL STRINGS?” AND OTHER QUESTIONS POSED BY WOMEN WHO HAD IUC PLACED AFTER THEIR ABORTIONS Diedrich J University of California, San Francisco, San Francisco, CA, USA Pasternack T, Drey E, Steinauer J Objectives: The use of long-acting reversible contraceptives is increasing; however, little is known about contraceptive counseling in the abortion setting. The goal of this study is to document women's questions and assess knowledge retention after having chosen immediate postabortion intrauterine contraceptive (IUC) placement.