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The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding.
Contraception 2014; 90(3):253-8C

Abstract

OBJECTIVE

To determine whether the discontinuation rate of the etonogestrel contraceptive implant due to irregular vaginal bleeding among women with immediate postpartum insertion is increased compared to delayed postpartum and interval placement.

STUDY DESIGN

This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) to delayed postpartum (6 to 12 weeks postpartum) and interval insertion between January 2008 and December 2010. Charts were reviewed for date and reason for removal. A chi-squared test was used to compare discontinuation due to bleeding between cohorts. Baseline characteristics predictive of implant removal were evaluated by simple logistic regression.

RESULTS

There were 259 women in the immediate postpartum group, 49 in the delayed postpartum group and 106 in the interval group. Average age at insertion was 22.6 (±5.5) years. Overall, 19.3% of women in the immediate postpartum group requested removal due to irregular bleeding compared to 18.4% in the delayed postpartum group [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.48-2.33] and 20.8% in the interval group (OR 0.91, 95% CI 0.52-1.60). There was no difference between groups in premature removal rates for any side effect. There were no sociodemographic or clinical characteristics predictive of removal in any group.

CONCLUSION

One-fifth of etonogestrel contraceptive implant users requested premature removal due to irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates and may help reduce unintended pregnancy. Mechanisms to help women manage irregular bleeding due to the implant are needed.

IMPLICATIONS

Immediate postpartum insertion of the etonogestrel contraceptive implant does not lead to increased removal rates due to vaginal bleeding compared to delayed postpartum or interval insertion. Immediate postpartum implant insertion may increase uptake of long-acting reversible contraception and help reduce short interpregnancy intervals and unintended pregnancy.

Authors+Show Affiliations

David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: lireland@mednet.ucla.edu.The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24973904

Citation

Ireland, Luu Doan, et al. "The Effect of Immediate Postpartum Compared to Delayed Postpartum and Interval Etonogestrel Contraceptive Implant Insertion On Removal Rates for Bleeding." Contraception, vol. 90, no. 3, 2014, pp. 253-8.
Ireland LD, Goyal V, Raker CA, et al. The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Contraception. 2014;90(3):253-8.
Ireland, L. D., Goyal, V., Raker, C. A., Murray, A., & Allen, R. H. (2014). The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Contraception, 90(3), pp. 253-8. doi:10.1016/j.contraception.2014.05.010.
Ireland LD, et al. The Effect of Immediate Postpartum Compared to Delayed Postpartum and Interval Etonogestrel Contraceptive Implant Insertion On Removal Rates for Bleeding. Contraception. 2014;90(3):253-8. PubMed PMID: 24973904.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. AU - Ireland,Luu Doan, AU - Goyal,Vinita, AU - Raker,Christina A, AU - Murray,Anne, AU - Allen,Rebecca H, Y1 - 2014/05/24/ PY - 2013/12/18/received PY - 2014/05/08/revised PY - 2014/05/21/accepted PY - 2014/6/30/entrez PY - 2014/6/30/pubmed PY - 2016/4/30/medline KW - Etonogestrel KW - Implanon KW - Implant KW - Nexplanon KW - Postpartum contraception SP - 253 EP - 8 JF - Contraception JO - Contraception VL - 90 IS - 3 N2 - OBJECTIVE: To determine whether the discontinuation rate of the etonogestrel contraceptive implant due to irregular vaginal bleeding among women with immediate postpartum insertion is increased compared to delayed postpartum and interval placement. STUDY DESIGN: This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) to delayed postpartum (6 to 12 weeks postpartum) and interval insertion between January 2008 and December 2010. Charts were reviewed for date and reason for removal. A chi-squared test was used to compare discontinuation due to bleeding between cohorts. Baseline characteristics predictive of implant removal were evaluated by simple logistic regression. RESULTS: There were 259 women in the immediate postpartum group, 49 in the delayed postpartum group and 106 in the interval group. Average age at insertion was 22.6 (±5.5) years. Overall, 19.3% of women in the immediate postpartum group requested removal due to irregular bleeding compared to 18.4% in the delayed postpartum group [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.48-2.33] and 20.8% in the interval group (OR 0.91, 95% CI 0.52-1.60). There was no difference between groups in premature removal rates for any side effect. There were no sociodemographic or clinical characteristics predictive of removal in any group. CONCLUSION: One-fifth of etonogestrel contraceptive implant users requested premature removal due to irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates and may help reduce unintended pregnancy. Mechanisms to help women manage irregular bleeding due to the implant are needed. IMPLICATIONS: Immediate postpartum insertion of the etonogestrel contraceptive implant does not lead to increased removal rates due to vaginal bleeding compared to delayed postpartum or interval insertion. Immediate postpartum implant insertion may increase uptake of long-acting reversible contraception and help reduce short interpregnancy intervals and unintended pregnancy. SN - 1879-0518 UR - https://www.unboundmedicine.com/medline/citation/24973904/The_effect_of_immediate_postpartum_compared_to_delayed_postpartum_and_interval_etonogestrel_contraceptive_implant_insertion_on_removal_rates_for_bleeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0010-7824(14)00291-1 DB - PRIME DP - Unbound Medicine ER -