{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:33:25Z","timestamp":1772130805797,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2017,8,16]],"date-time":"2017-08-16T00:00:00Z","timestamp":1502841600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare expulsions and adverse events (<jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s) between immediate and delayed insertion of a levonorgestrel\u2010releasing intrauterine system (<jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content>) following medical termination of pregnancy (<jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Helsinki University Hospital, Finland, January 2013\u2013December 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Cohorts of 102 (gestational age 64\u201384\u00a0days, late first trimester) and 57 (gestational age 85\u2013140\u00a0days, second trimester) women requesting <jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> contraception.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> insertion occurred immediately (same day) or 2\u20134\u00a0weeks following <jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content>. Follow\u2010up visits were at 2\u20134\u00a0weeks, 3\u00a0months, and 1\u00a0year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> expulsion by 3\u00a0months and 1\u00a0year. <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s and bleeding profiles within 3\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following late first\u2010trimester <jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content> the <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> expulsion rates by 3\u00a0months were 14 (27.5%) in the immediate\u2010insertion group and two (4.0%) in the delayed\u2010insertion group (risk ratio, <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a06.86; 95% confidence interval, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.64\u201328.66). By 1\u00a0year the expulsion rates were 17 (33.3%) and six (12.0%) (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a02.78, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.19\u20136.47). Following second\u2010trimester <jats:styled-content style=\"fixed-case\">MTOP LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> expulsion rates by 3\u00a0months and 1\u00a0year were five (18.5%) in the immediate\u2010insertion group and one (3.6%) in the delayed\u2010insertion group (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a05.19, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.65\u201341.54). No differences in <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s and bleeding profiles emerged between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Immediate <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> insertion after late first\u2010 or second\u2010trimester <jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content> is feasible, does not increase the complication rate, or alter the uterine bleeding patterns; however, immediate insertion increased the expulsion rate, which may limit the cost\u2010effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Immediate insertion of <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> following <jats:styled-content style=\"fixed-case\">MTOP<\/jats:styled-content> at 9\u201320\u00a0weeks of gestation is feasible and safe.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14813","type":"journal-article","created":{"date-parts":[[2017,7,10]],"date-time":"2017-07-10T13:32:47Z","timestamp":1499693567000},"page":"1965-1972","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Expulsions and adverse events following immediate and later insertion of a levonorgestrel\u2010releasing intrauterine system after medical termination of late first\u2010 and second\u2010trimester pregnancy: a randomised controlled trial"],"prefix":"10.1111","volume":"124","author":[{"given":"R","family":"Korjamo","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Mentula","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O","family":"Heikinheimo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03407.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2008.03.013"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev233"},{"key":"e_1_2_6_5_1","unstructured":"Abortion Statistics England and Wales: 2015. 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