The feasibility and uptake of the etonogestrel implant and the intrauterine device at the time of uterine evacuation in women managed with incomplete miscarriage

Abstract

BACKGROUND: Unintended pregnancies account for an estimated 44% of all pregnancies worldwide and 75% of pregnancies in South Africa. The use of effective contraception decreases the incidence of unintended pregnancies and the subsequent termination of unwanted pregnancies. Professional counselling on contraception and the methods available should be offered at every patient contact. This has been shown to increase contraceptive uptake. OBJECTIVE: To investigate the feasibility and uptake of offering a choice of immediate etonogestrel implant (EI) or intra uterine device (IUD) insertion at the time of evacuation in women managed with incomplete miscarriage. Alternative contraceptive options chosen by participants who declined long acting reversible contraceptives (LARCs) and their motivation was also assessed. METHODS: This was a prospective study conducted at the Department of Obstetrics and Gynaecology, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa over a six-month period. All women older than eighteen years who were able and willing to provide informed consent, diagnosed with and managed for first or second trimester incomplete miscarriages were eligible for recruitment into the study. All participants were managed according to standard protocol for patients presenting with incomplete miscarriage, counselled on all the contraceptive methods available to them and then allowed the opportunity to choose their preferred contraceptive. RESULTS: A total of 155 patients were enrolled. One hundred and thirty-two women (85.16%) opted to use contraception. Of these, 67 women (43.22%) opted for LARCs, of which 32 (20.65%) had an IUD inserted and 35 (22.58%) had an EI inserted. Sixtyfi ve (41.93%) women accepted other methods of contraception. The most common reason for declining LARCs was that the participant was comfortable with other forms of contraception. Twenty-three (14.84%) women declined any form of contraception, with the most common reason being the desire for another pregnancy. CONCLUSION: The uptake of all forms of contraception was very high amongst a population of women presenting with incomplete miscarriage. This fi nding emphasises the importance of offering all these women contraception at the time of managing their miscarriages