{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:40:18Z","timestamp":1782513618534,"version":"3.54.5"},"reference-count":21,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100007687","name":"Swedish Society of Medicine","doi-asserted-by":"crossref","award":["SLS-783181"],"award-info":[{"award-number":["SLS-783181"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Swedish Society of Medical Research","award":["P17-0214"],"award-info":[{"award-number":["P17-0214"]}]},{"name":"National Research Foundation of South Africa \/Swedish Foundation for International Cooperation in Research and Higher Education","award":["170825260615\/112631"],"award-info":[{"award-number":["170825260615\/112631"]}]},{"name":"Anonymous Donor","award":["5290"],"award-info":[{"award-number":["5290"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2021,1,20]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This trial reports on use of the copper intrauterine device (IUD) after immediate compared with delayed insertion following medical abortion at 17\u201320 gestational weeks (GW).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This randomised controlled trial was conducted at one tertiary hospital and five community healthcare centres in Cape Town, South Africa. Eligible consenting women were randomised to immediate (within 24 hours) or delayed (3 weeks post-abortion) insertion of the copper IUD. Follow-up was at 6 weeks, 3 months and 6 months. Main outcomes were use of the original IUD and use of any IUD, including replacement IUDs at 6 weeks post-abortion. Secondary outcomes included rates of expulsion and malposition at 6 weeks, use of any IUD at 3 and 6 months, and acceptability of the IUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We recruited and randomised 114 women admitted for elective medical abortion between August 2018 and June 2019. In the immediate and delayed study arms, respectively, 45\/55 (82%) and 12\/57 (21%) women received the IUD as planned. By intention-to-treat, 56% in the immediate and 19% in the delayed arms were using the original IUD at 6\u2009weeks (p&lt;0.001), and 76% in the immediate and 40% in the delayed arms were using any IUD (p&lt;0.001). Complete expulsion or removal occurred in 32% in the immediate and 7% in the delayed arms (p=0.044).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Insertion of an IUD immediately after medical abortion at 17\u201320 GW results in increased use after 6 weeks compared with delayed insertion, however expulsion rates are higher than with interval insertion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trials registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT03505047\">NCT03505047<\/jats:ext-link>\n                      ), Pan African Trials Registry (www.pactr.org), 201804003324963\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2020-200932","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T17:49:59Z","timestamp":1613152199000},"page":"28-34","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Immediate versus delayed insertion of the copper intrauterine device after medical abortion at 17\u201320 gestational weeks: a randomised controlled trial"],"prefix":"10.1136","volume":"48","clinical-trial-number":[{"clinical-trial-number":"nct03505047","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct03505047","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7176-9963","authenticated-orcid":false,"given":"Deborah","family":"Constant","sequence":"first","affiliation":[{"name":"Women\u2019s Health Research Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margit","family":"Endler","sequence":"additional","affiliation":[{"name":"Women\u2019s Health Research Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"},{"name":"Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3221-9368","authenticated-orcid":false,"given":"Daniel","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Petro","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malika","family":"Patel","sequence":"additional","affiliation":[{"name":"Reproductive Health & Fertility Regulation, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"key":"2025090511233781000_48.1.28.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33104-5"},{"key":"2025090511233781000_48.1.28.2","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1097\/AOG.0000000000001587","article-title":"Committee opinion no. 670: immediate postpartum long-acting reversible contraception","volume":"128","year":"2016","journal-title":"Obstet Gynecol"},{"key":"2025090511233781000_48.1.28.3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1089\/jwh.2015.5191","article-title":"Preventing unintended pregnancy: the Contraceptive CHOICE Project in review","volume":"24","author":"Birgisson","year":"2015","journal-title":"J Womens Health"},{"key":"2025090511233781000_48.1.28.4","doi-asserted-by":"publisher","DOI":"10.1363\/4410012"},{"key":"2025090511233781000_48.1.28.5","article-title":"Improvement in abortion and contraception led by data-driven decisions in Gauteng Province, South Africa","volume":"2015","author":"Masilela","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090511233781000_48.1.28.6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.contraception.2009.05.015","article-title":"Provision of long-acting reversible contraception at US abortion facilities and barriers to immediate postabortion insertion","volume":"80","author":"Harper","year":"2009","journal-title":"Contraception"},{"key":"2025090511233781000_48.1.28.7","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.2017.v107i4.12141"},{"key":"2025090511233781000_48.1.28.8","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\u00a0following medical termination of pregnancy -\u00a01\u00a0year continuation rates: a randomised controlled trial","volume":"124","author":"Korjamo","year":"2017","journal-title":"BJOG"},{"key":"2025090511233781000_48.1.28.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.08.002"},{"key":"2025090511233781000_48.1.28.10","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001777.pub4"},{"key":"2025090511233781000_48.1.28.11","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/humupd\/dmz040","article-title":"Long-acting reversible contraception immediately after medical abortion: systematic review with meta-analyses","volume":"26","author":"Schmidt-Hansen","year":"2020","journal-title":"Hum Reprod Update"},{"key":"2025090511233781000_48.1.28.12","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12606"},{"key":"2025090511233781000_48.1.28.13","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002822"},{"key":"2025090511233781000_48.1.28.14","doi-asserted-by":"crossref","unstructured":"Lopez LM , Bernholc A , Hubacher D , et al . Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database Syst Rev 2015;121.doi:10.1002\/14651858.CD003036.pub3","DOI":"10.1002\/14651858.CD003036.pub3"},{"key":"2025090511233781000_48.1.28.15","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1111\/1471-0528.14813","article-title":"Expulsions and adverse events following immediate and later insertion of a levonorgestrel-releasing intrauterine system after medical termination of late first- and second-trimester pregnancy: a randomised controlled trial","volume":"124","author":"Korjamo","year":"2017","journal-title":"BJOG"},{"key":"2025090511233781000_48.1.28.16","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1097\/AOG.0b013e3182316308","article-title":"Malpositioned intrauterine contraceptive devices: risk factors, outcomes, and future pregnancies","volume":"118","author":"Braaten","year":"2011","journal-title":"Obstet Gynecol"},{"key":"2025090511233781000_48.1.28.17","doi-asserted-by":"crossref","first-page":"S118","DOI":"10.1016\/j.contraception.2007.01.008","article-title":"Treatment of menorrhagia with an LNG-IUS","volume":"75","author":"Pakarinen","year":"2007","journal-title":"Contraception"},{"key":"2025090511233781000_48.1.28.18","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.contraception.2010.10.005","article-title":"Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation","volume":"83","author":"Cremer","year":"2011","journal-title":"Contraception"},{"key":"2025090511233781000_48.1.28.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011600"},{"key":"2025090511233781000_48.1.28.20","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew238"},{"key":"2025090511233781000_48.1.28.21","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1080\/14767058.2016.1260115","article-title":"Inter-pregnancy interval and adverse outcomes: evidence for an additional risk in health disparate populations","volume":"30","author":"Appareddy","year":"2017","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2020-200932","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T18:47:26Z","timestamp":1757098046000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2020-200932"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,12]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,10]]},"published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1136\/bmjsrh-2020-200932"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2020-200932","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.741909366.793592491","asserted-by":"object"}]},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,12]]}}}