{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:38:48Z","timestamp":1783489128192,"version":"3.55.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T00:00:00Z","timestamp":1582588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Long-acting reversible contraceptives (LARCs) are safe, effective and convenient post-abortal methods. However, there is concern that some LARCs may reduce the effectiveness of abortifacient drugs or result in other adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE AND RATIONALE<\/jats:title>\n                    <jats:p>We undertook two systematic reviews to examine the early administration of LARCs in women undergoing medical abortion with mifepristone and misoprostol. (i) For women who are having a medical abortion and who plan to use a progestogen-only contraceptive implant or injectable, does administration of the contraception at the same time as mifepristone influence the efficacy of the abortion? (Implant\/injectable review). (ii) For women who have had a medical abortion, how soon after expulsion of the products of conception is it safe to insert an intrauterine contraceptive device\/system? (LNG-IUS\/Cu-IUD review).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SEARCH METHODS<\/jats:title>\n                    <jats:p>On 19 November 2018, we searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily and Epub Ahead-of-Print, In-Process and Other Non-Indexed Citations; the Cochrane Library; Cinahl Plus; and Web of Science Core Collection. Eligible studies were randomised controlled trials (RCTs), in English from 1985 (Implant\/injectable review) or 2007 (LNG-IUS\/Cu-IUD review) onwards, conducted in women undergoing medical abortion with mifepristone and misoprostol and studying either (i) simultaneous administration of mifepristone and a progestogen-only contraceptive implant or injectable compared to administration &amp;gt;24\u00a0h after mifepristone, or (ii) immediate insertion of intrauterine contraception after expulsion of the products of conception compared to early insertion (\u22647\u00a0days) or to delayed insertion (&amp;gt;7\u00a0days) or early compared to delayed insertion. One author assessed the risk of bias in the studies using the Cochrane Collaboration checklist for RCTs. All the outcomes were analysed as risk ratios and meta-analysed in Review Manager 5.3 using the Mantel\u2013Haenszel statistical method and a fixed-effect model. The overall quality of the evidence was assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OUTCOMES<\/jats:title>\n                    <jats:p>Two RCTs (n\u2009=\u20091027) showed lower \u2018subsequent unintended pregnancy\u2019 rates and higher \u2018patient satisfaction\u2019 rates, and no other differences, after simultaneous administration of mifepristone and the implant compared to delayed administration. One RCT (n\u2009=\u2009461) showed higher \u2018patient satisfaction\u2019 rates after simultaneous administration than after delayed administration of mifepristone and the injectable, but no other differences between these interventions. Three RCTs (n\u2009=\u2009536) found no differences other than higher copper IUC uptake after early compared to delayed insertion at \u22649\u00a0weeks of gestation and higher rates of IUC expulsion, continuation and uptake after immediate compared to delayed insertion at 9+1\u201312+0 weeks of gestation and higher IUC continuation rates after immediate compared to delayed insertion at 12+1\u201320+0 weeks of gestation. The quality of this evidence ranged from very low to high and was mainly compromised by low event rates, high attrition and no blinding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>WIDER IMPLICATIONS<\/jats:title>\n                    <jats:p>The contraceptive implant or injectable should be offered on the day of taking mifepristone. Intrauterine methods of contraception should be offered as soon as possible after expulsion of the pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/humupd\/dmz040","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T07:11:18Z","timestamp":1571987478000},"page":"141-160","source":"Crossref","is-referenced-by-count":21,"title":["Long-acting reversible contraception immediately after medical abortion: systematic review with meta-analyses"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-6870","authenticated-orcid":false,"given":"Mia","family":"Schmidt-Hansen","sequence":"first","affiliation":[{"name":"National Guideline Alliance, The Royal College of Obstetricians and Gynaecologists, London, SE1 1SZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E","family":"Hawkins","sequence":"first","affiliation":[{"name":"National Guideline Alliance, The Royal College of Obstetricians and Gynaecologists, London, SE1 1SZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Lord","sequence":"first","affiliation":[{"name":"Department of Gynaecology, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Williams","sequence":"first","affiliation":[{"name":"National Guideline Alliance, The Royal College of Obstetricians and Gynaecologists, London, SE1 1SZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A","family":"Lohr","sequence":"first","affiliation":[{"name":"British Pregnancy Advisory Service, Stratford-upon-Avon, CV37 9BF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Hasler","sequence":"first","affiliation":[{"name":"National Guideline Alliance, The Royal College of Obstetricians and Gynaecologists, London, SE1 1SZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Cameron","sequence":"first","affiliation":[{"name":"Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, EH3 9ES, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,25]]},"reference":[{"key":"2020030612231563800_ref1","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1111\/1471-0528.14413","article-title":"Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service","volume":"124","author":"Aiken","year":"2017","journal-title":"Brit J Obstet Gynaec"},{"key":"2020030612231563800_ref2","author":"Department of Health and Social Care"},{"key":"2020030612231563800_ref3","author":"GRADEpro Guideline Development Tool [Software] [Computer program]","year":"2015"},{"key":"2020030612231563800_ref4","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1093\/humrep\/dei037","article-title":"A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion at 13-20 weeks gestation","volume":"20","author":"Hamoda","year":"2005","journal-title":"Hum Reprod"},{"key":"2020030612231563800_ref5","author":"Higgins","year":"2011"},{"key":"2020030612231563800_ref6","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1093\/humrep\/dew238","article-title":"Immediate versus delayed insertion of an etonogestrel releasing implant at medical abortion-a randomized controlled equivalence trial","volume":"31","author":"Hognert","year":"2016","journal-title":"Hum Reprod"},{"key":"2020030612231563800_ref7","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1111\/1471-0528.14802","article-title":"Immediate versus delayed initiation of the levonorgestrel-releasing intrauterine system following medical termination of pregnancy - 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