{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:41:42Z","timestamp":1788586902269,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2018,6,28]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The primary objective of this study was to determine whether intramuscular depot medroxyprogesterone acetate (IM DMPA) given at the time of misoprostol administration, 24\u201348\u2009hours after mifepristone, affects the rate of continuing pregnancy. In addition, the study explored factors predictive of continuing pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Case-control study based on database review of women who underwent early medical abortion (EMA) over a 4-year period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Single abortion service in Scotland.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>5122 women who underwent an EMA within the timeframe of this study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Continuing pregnancies among women receiving IM DMPA were compared with those choosing other hormonal methods of contraception, non-hormonal contraception or no contraception at the time of misoprostol administration. Logistic regression was performed to assess the effects of demographic characteristics, gestation at presentation and method of contraception provided, on outcome of pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 4838 women with complete data were included, of which there were 20 continuing pregnancies (0.4%); 284 women were excluded due to missing data. There was no increased risk of a continuing pregnancy among women who initiated IM DMPA at the time of misoprostol administration (24\u201348\u2009hours after mifepristone) compared with women who initiated no hormonal contraception at this time (RR 0.48; 95%\u2009CI 0.06 to 3.81). Gestation \u22658\u2009weeks and previous terminations were factors associated with increased likelihood of continuing pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Women choosing IM DMPA after EMA can be reassured that IM DMPA can be safely initiated at the time of misoprostol administration 24\u201348\u2009hours after mifepristone without an increase in the risk of a continuing pregnancy. Both increasing gestation and previous termination were factors associated with an increased likelihood of continuing pregnancy following an EMA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2017-101928","type":"journal-article","created":{"date-parts":[[2018,7,26]],"date-time":"2018-07-26T12:20:29Z","timestamp":1532607629000},"page":"242-247","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Initiating intramuscular depot medroxyprogesterone acetate 24\u201348 hours after mifepristone administration does not affect success of early medical abortion"],"prefix":"10.1136","volume":"44","author":[{"given":"Christina","family":"Lang","sequence":"first","affiliation":[{"name":"The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong Eric","family":"Chen","sequence":"additional","affiliation":[{"name":"Chalmers Sexual Health Clinic, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Johnstone","sequence":"additional","affiliation":[{"name":"Chalmers Sexual Health Clinic, Edinburgh, UK"},{"name":"Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Chalmers Sexual Health Clinic, Edinburgh, UK"},{"name":"Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,26]]},"reference":[{"key":"2025090511514322000_44.4.242.1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.contraception.2010.12.010","article-title":"Controversies in family planning: timing of ovulation after abortion and the conundrum of postabortion intrauterine device insertion","volume":"84","author":"Stoddard","year":"2011","journal-title":"Contraception"},{"key":"2025090511514322000_44.4.242.2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew238"},{"key":"2025090511514322000_44.4.242.3","unstructured":"World Health Organisation. Safe abortion: technical and policy guidance for health care systems. 2nd edn. Geneva: WHO, 2012."},{"key":"2025090511514322000_44.4.242.4","unstructured":"Faculty of Sexual & Reproductive Healthcare. Contraception after pregnancy. https:\/\/www.fsrh.org\/standards-and-guidance\/documents\/contraception-after-pregnancy-guideline-january-2017\/ (accessed 23 Jan 2018)."},{"key":"2025090511514322000_44.4.242.5","unstructured":"Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. Evidence-based Clinical Guideline No. 7. 2011 https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/abortion-guideline_web_1.pdf (accessed 23 Jan 2018)."},{"key":"2025090511514322000_44.4.242.6","unstructured":"Scottish Government. Chief Medical Officer Directorate. Abortion \u2013 Improvement to existing services \u2013 Approval for misoprostol to be taken at home. http:\/\/www.sehd.scot.nhs.uk\/cmo\/CMO(2017)14.pdf (accessed 23 Jan 2018)."},{"key":"2025090511514322000_44.4.242.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2013.07.008"},{"key":"2025090511514322000_44.4.242.8","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1097\/AOG.0000000000001627","article-title":"Effects of depot medroxyprogesterone acetate injection timing on medical abortion efficacy and repeat pregnancy: a randomized controlled trial","volume":"128","author":"Raymond","year":"2016","journal-title":"Obstet Gynecol"},{"key":"2025090511514322000_44.4.242.9","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199733010-00002"},{"key":"2025090511514322000_44.4.242.10","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2015-101177"},{"key":"2025090511514322000_44.4.242.11","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2015-101216"},{"key":"2025090511514322000_44.4.242.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.09.009"},{"key":"2025090511514322000_44.4.242.13","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1136\/bmjsrh-2017-101868","article-title":"Comparison of two low-sensitivity urine pregnancy tests for confirming the success of early medical abortion","volume":"44","author":"Millar","year":"2018","journal-title":"BMJ Sex Reprod Health"},{"key":"2025090511514322000_44.4.242.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.06.011"},{"key":"2025090511514322000_44.4.242.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2004.01.011"},{"key":"2025090511514322000_44.4.242.16","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-0528.2002.02156.x"},{"key":"2025090511514322000_44.4.242.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199804303381801"},{"key":"2025090511514322000_44.4.242.18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/14647273.2016.1243817","article-title":"Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy","volume":"20","author":"Verma","year":"2017","journal-title":"Hum Fertil"},{"key":"2025090511514322000_44.4.242.19","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/AOG.0000000000001688","article-title":"Simultaneous administration compared with a 24-hour mifepristone-misoprostol interval in second-trimester abortion: a randomized controlled trial","volume":"128","author":"Abbas","year":"2016","journal-title":"Obstet Gynecol"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2017-101928","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T19:04:20Z","timestamp":1757099060000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2017-101928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,26]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,10,10]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/bmjsrh-2017-101928"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2017-101928","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,26]]}}}