Cowett AA, et al. - In this randomized controlled trial, the 6-month use rate of the etonogestrel implant placed immediately after dilation and evacuation (D&E) with placement 2–4 weeks postprocedure were compared. Researchers found that women were more likely to be using the etonogestrel implant at 6 months after D&E if they underwent immediate compared with delayed insertion, however, the very high loss to follow-up rate makes it difficult to draw conclusions about the acceptability of the device and pregnancy rates.

Methods

• In this randomized controlled trial, women seeking abortion between 14 0/7 and 23 5/7 weeks of gestation and desiring the etonogestrel contraceptive implant at an urban family planning clinic were included.
• Members were randomized to device insertion immediately after the D&E compared with delayed insertion in 2–4 weeks.
• Implant use rate at 6 months after insertion was the primary outcome and was determined by follow-up phone interviews.
• Repeat pregnancy rates and method satisfaction were the included secondary outcomes.
• The sample size of 120 members was calculated based on a power of 0.80 to demonstrate a 20% difference in implant use rates between groups assuming 40% of women overall are not using the device 6 months after the procedure.

Results

• 148 participants were enrolled between November 2015 and October 2016.
• 73 members (49.3%) were randomized to and underwent immediate implant insertion after D&E.
• However, the remaining 75 (50.6%) were randomized to delayed insertion.
• No significant differences in sociodemographic characteristics between the groups were found.
• Findings revealed that placement rate was 100% in the immediate group compared with 42.7% in the delayed group (P<.01).
• At 6 months, 40 of 43 (93%) women from the immediate group who completed follow-up continued use of the implant, on the other hand 19 of 30 (63.3%) women from the delayed group who completed follow-up were using the device (P=.002).
• It was noted that follow-up rates were low at 58.9% in the immediate group compared with 40.0% in the delayed group.