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Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis.
Am J Obstet Gynecol 2017; 217(1):51.e1-51.e7AJ

Abstract

BACKGROUND

In-hospital placement of intrauterine devices and contraceptive implants following vaginal and cesarean delivery is increasingly popular and responds to maternal motivation for highly effective postpartum contraception. Immediate postpartum intrauterine device insertion is associated with higher expulsion than interval placement, but emerging evidence suggests that the levonorgestrel intrauterine device may have a higher expulsion rate than the copper intrauterine device.

OBJECTIVE

This study evaluated in-hospital provision, expulsion, and 6-month continuation of immediate postpartum copper T380 intrauterine devices, levonorgestrel intrauterine devices, and contraceptive implants.

STUDY DESIGN

We offered enrollment in this prospective observational trial to women presenting to the University of Utah labor and delivery unit from October 2013 through February 2016 who requested an intrauterine device or implant for postpartum contraception during prenatal care or hospitalization at the time of delivery. Following informed consent, participants completed questionnaires prior to hospital discharge and at 3 and 6 months postpartum. Data on expulsions at 6 months were validated by chart abstraction.

RESULTS

During the study period, 639 patients requested a postpartum intrauterine device or implant and 350 patients enrolled in prospective follow-up prior to discharge from the hospital. Among enrollees, 325 (93%) received their preferred contraceptive device prior to hospital discharge: 88 (27%) copper intrauterine device users, 123 (38%) levonorgestrel intrauterine device users, and 114 (35%) implant users. Participants predominantly were Hispanic (90%), were multiparous (87%), reported a household income <$24,000 per year (87%), and underwent a vaginal delivery (77%). At 6 months postpartum, 289 of 325 device recipients (89%) completed follow-up. Among levonorgestrel intrauterine device users 17% reported expulsions relative to 4% of copper intrauterine device users. The adjusted hazard ratio for expulsion was 5.8 (confidence interval, 1.3-26.4). There was no statistically significant difference in expulsions by delivery type or continuation by device type. Among the 21 women who experienced intrauterine device expulsions, 14 (67%) requested a replacement long-acting reversible contraception device for contraception. The 6-month device continuation was ≥80% for all device types.

CONCLUSION

An immediate postpartum long-acting reversible contraception program effectively provides women who desire highly effective reversible contraceptive devices with their method of choice prior to hospital discharge. Immediate postplacental levonorgestrel intrauterine device users have higher expulsion rates than copper intrauterine device users, but >8 of 10 women initiating an intrauterine device or implant continue use at 6 months postpartum.

Authors+Show Affiliations

University of Utah Department of Obstetrics and Gynecology, Salt Lake City, UT. Electronic address: Jennifer.Eggebroten@hsc.utah.edu.University of Utah Department of Obstetrics and Gynecology, Salt Lake City, UT.University of Utah Department of Obstetrics and Gynecology, Salt Lake City, UT.

Pub Type(s)

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

Language

eng

PubMed ID

28342716

Citation

Eggebroten, Jennifer L., et al. "Immediate Postpartum Intrauterine Device and Implant Program Outcomes: a Prospective Analysis." American Journal of Obstetrics and Gynecology, vol. 217, no. 1, 2017, pp. 51.e1-51.e7.
Eggebroten JL, Sanders JN, Turok DK. Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis. Am J Obstet Gynecol. 2017;217(1):51.e1-51.e7.
Eggebroten, J. L., Sanders, J. N., & Turok, D. K. (2017). Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis. American Journal of Obstetrics and Gynecology, 217(1), pp. 51.e1-51.e7. doi:10.1016/j.ajog.2017.03.015.
Eggebroten JL, Sanders JN, Turok DK. Immediate Postpartum Intrauterine Device and Implant Program Outcomes: a Prospective Analysis. Am J Obstet Gynecol. 2017;217(1):51.e1-51.e7. PubMed PMID: 28342716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis. AU - Eggebroten,Jennifer L, AU - Sanders,Jessica N, AU - Turok,David K, Y1 - 2017/03/23/ PY - 2016/11/14/received PY - 2017/03/07/revised PY - 2017/03/14/accepted PY - 2017/3/28/pubmed PY - 2017/8/22/medline PY - 2017/3/27/entrez KW - contraception KW - contraceptive implant KW - immediate postpartum intrauterine device insertion KW - intrauterine device expulsion KW - removals SP - 51.e1 EP - 51.e7 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 217 IS - 1 N2 - BACKGROUND: In-hospital placement of intrauterine devices and contraceptive implants following vaginal and cesarean delivery is increasingly popular and responds to maternal motivation for highly effective postpartum contraception. Immediate postpartum intrauterine device insertion is associated with higher expulsion than interval placement, but emerging evidence suggests that the levonorgestrel intrauterine device may have a higher expulsion rate than the copper intrauterine device. OBJECTIVE: This study evaluated in-hospital provision, expulsion, and 6-month continuation of immediate postpartum copper T380 intrauterine devices, levonorgestrel intrauterine devices, and contraceptive implants. STUDY DESIGN: We offered enrollment in this prospective observational trial to women presenting to the University of Utah labor and delivery unit from October 2013 through February 2016 who requested an intrauterine device or implant for postpartum contraception during prenatal care or hospitalization at the time of delivery. Following informed consent, participants completed questionnaires prior to hospital discharge and at 3 and 6 months postpartum. Data on expulsions at 6 months were validated by chart abstraction. RESULTS: During the study period, 639 patients requested a postpartum intrauterine device or implant and 350 patients enrolled in prospective follow-up prior to discharge from the hospital. Among enrollees, 325 (93%) received their preferred contraceptive device prior to hospital discharge: 88 (27%) copper intrauterine device users, 123 (38%) levonorgestrel intrauterine device users, and 114 (35%) implant users. Participants predominantly were Hispanic (90%), were multiparous (87%), reported a household income <$24,000 per year (87%), and underwent a vaginal delivery (77%). At 6 months postpartum, 289 of 325 device recipients (89%) completed follow-up. Among levonorgestrel intrauterine device users 17% reported expulsions relative to 4% of copper intrauterine device users. The adjusted hazard ratio for expulsion was 5.8 (confidence interval, 1.3-26.4). There was no statistically significant difference in expulsions by delivery type or continuation by device type. Among the 21 women who experienced intrauterine device expulsions, 14 (67%) requested a replacement long-acting reversible contraception device for contraception. The 6-month device continuation was ≥80% for all device types. CONCLUSION: An immediate postpartum long-acting reversible contraception program effectively provides women who desire highly effective reversible contraceptive devices with their method of choice prior to hospital discharge. Immediate postplacental levonorgestrel intrauterine device users have higher expulsion rates than copper intrauterine device users, but >8 of 10 women initiating an intrauterine device or implant continue use at 6 months postpartum. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28342716/Immediate_postpartum_intrauterine_device_and_implant_program_outcomes:_a_prospective_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(17)30426-X DB - PRIME DP - Unbound Medicine ER -