title: Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial.
abstract: BACKGROUND
  We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion.
  
  
  METHODS
  Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes.
  
  
  CONCLUSIONS
  The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier NCT01174225.
authors.affiliation: Contraception Access Research Team, Women's Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada. wendy.norman@ubc.ca
authors.forename: Wendy V
authors.initials: WV
authors.lastname: Norman
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Chiles
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Turner
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
authors.forename: Andra
authors.initials: A
authors.lastname: Aslan
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
mesh_terms: D000028:Abortion, Induced; D001955:British Columbia; D004867:Equipment Design; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion / Q000209:etiology; D007435:Intrauterine Devices, Copper / Q000009:adverse effects; D017060:Patient Satisfaction; D011247:Pregnancy; D018873:Pregnancy Rate; D011261:Pregnancy Trimester, First; D049168:Pregnancy, Unplanned; D011275:Pregnancy, Unwanted; D011446:Prospective Studies; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome