Immediate versus delayed postabortal insertion of contraceptive implant

Area of Science:

• Reproductive Health
• Contraception
• Medical Abortion

Background:

• Contraceptive implants offer highly effective, long-term pregnancy prevention with a good safety profile.
• Women seeking abortion are at high risk for rapid repeat pregnancies, necessitating effective contraception.
• Providing contraception during abortion visits is crucial for increasing uptake and optimizing interpregnancy intervals.

Purpose of the Study:

• To compare contraceptive implant initiation rates following abortion.
• To evaluate contraceptive effectiveness between immediate and delayed implant insertion.
• To assess adverse outcomes associated with immediate versus delayed contraceptive implant insertion post-abortion.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases (e.g., CENTRAL, MEDLINE, Embase) up to March 2021.
• Extracted data and computed risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs).

Main Results:

• Three RCTs (1162 women) showed higher implant utilization at six months with immediate insertion (low certainty evidence).
• Unintended pregnancy within six months was probably lower with immediate insertion (moderate certainty evidence).
• Immediate insertion likely improved implant initiation rates for both medical and surgical abortions (moderate to low certainty evidence).

Conclusions:

• Concurrent provision of progestin-releasing implants with abortifacient agents has minimal negative impact on medical abortion failure rates.
• Immediate contraceptive implant insertion improves initiation rates and reduces short-term unintended pregnancies compared to delayed insertion.
• No significant difference in bleeding adverse effects at one month was observed between immediate and delayed insertion.