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Experience with same-day placement of the 52mg levonorgestrel-releasing intrauterine system.

Abstract

BACKGROUND

Prescribing information for the levonorgestrel-releasing intrauterine system allows placement when the clinician is reasonably certain the patient is not pregnant. A six-item checklist aids clinicians in determining pregnancy risk, but may be too restrictive, resulting in delaying placement for many women. Same-day placement, however, may risk placement during an unrecognized luteal-phase pregnancy, that is, a pre-implantation fertilized ovum not yet detectable by urine pregnancy test.

OBJECTIVE

We assessed the applicability of pregnancy checklist criteria in two gynecology practices that routinely provide same-day placements following a negative urine pregnancy test.

STUDY DESIGN

In this retrospective cohort study, we reviewed electronic medical records of all women who underwent levonorgestrel-releasing intrauterine system placement from July 2009 to August 2012. We evaluated each record to identify whether the woman met any of the checklist criteria to exclude pregnancy. We ascertained luteal-phase pregnancies and other outcomes within 12 months following placement.

RESULTS

Of 885 placements, 293 (33%) were immediately post-abortion. Of the remaining 592 placements, 353 (60%) met at least one pregnancy checklist criterion to rule out pregnancy but 239 (40%) met none. Two percent received levonorgestrel emergency contraception at the time of placement. One luteal-phase pregnancy occurred in the group not meeting pregnancy checklist criteria. Removals and expulsions were rare and similar whether or not patients met checklist criteria.

CONCLUSIONS

In two practices that provide same-day intrauterine system placements, strict adherence to pregnancy checklist criteria would have resulted in 239 (40%) patients not receiving a same-day intrauterine system. Twelve-month outcomes were similar whether or not patients met pregnancy checklist criteria. Providers need not withhold intrauterine system placement based on the pregnancy checklist criteria.

Authors+Show Affiliations

Division of Family Planning, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, 622 W. 168(th) St., PH 16, New York, NY 10032. Electronic address: pc2137@columbia.edu.Division of Family Planning, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, 622 W. 168(th) St., PH 16, New York, NY 10032.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31945336

Citation

Castaño, Paula M., and Carolyn L. Westhoff. "Experience With Same-day Placement of the 52mg Levonorgestrel-releasing Intrauterine System." American Journal of Obstetrics and Gynecology, 2020.
Castaño PM, Westhoff CL. Experience with same-day placement of the 52mg levonorgestrel-releasing intrauterine system. Am J Obstet Gynecol. 2020.
Castaño, P. M., & Westhoff, C. L. (2020). Experience with same-day placement of the 52mg levonorgestrel-releasing intrauterine system. American Journal of Obstetrics and Gynecology, doi:10.1016/j.ajog.2019.12.268.
Castaño PM, Westhoff CL. Experience With Same-day Placement of the 52mg Levonorgestrel-releasing Intrauterine System. Am J Obstet Gynecol. 2020 Jan 13; PubMed PMID: 31945336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experience with same-day placement of the 52mg levonorgestrel-releasing intrauterine system. AU - Castaño,Paula M, AU - Westhoff,Carolyn L, Y1 - 2020/01/13/ PY - 2019/08/16/received PY - 2019/12/30/revised PY - 2019/12/30/accepted PY - 2020/1/17/entrez PY - 2020/1/17/pubmed PY - 2020/1/17/medline KW - Intrauterine device KW - luteal-phase pregnancy KW - pregnancy checklist criteria KW - same-day intrauterine device placement JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. N2 - BACKGROUND: Prescribing information for the levonorgestrel-releasing intrauterine system allows placement when the clinician is reasonably certain the patient is not pregnant. A six-item checklist aids clinicians in determining pregnancy risk, but may be too restrictive, resulting in delaying placement for many women. Same-day placement, however, may risk placement during an unrecognized luteal-phase pregnancy, that is, a pre-implantation fertilized ovum not yet detectable by urine pregnancy test. OBJECTIVE: We assessed the applicability of pregnancy checklist criteria in two gynecology practices that routinely provide same-day placements following a negative urine pregnancy test. STUDY DESIGN: In this retrospective cohort study, we reviewed electronic medical records of all women who underwent levonorgestrel-releasing intrauterine system placement from July 2009 to August 2012. We evaluated each record to identify whether the woman met any of the checklist criteria to exclude pregnancy. We ascertained luteal-phase pregnancies and other outcomes within 12 months following placement. RESULTS: Of 885 placements, 293 (33%) were immediately post-abortion. Of the remaining 592 placements, 353 (60%) met at least one pregnancy checklist criterion to rule out pregnancy but 239 (40%) met none. Two percent received levonorgestrel emergency contraception at the time of placement. One luteal-phase pregnancy occurred in the group not meeting pregnancy checklist criteria. Removals and expulsions were rare and similar whether or not patients met checklist criteria. CONCLUSIONS: In two practices that provide same-day intrauterine system placements, strict adherence to pregnancy checklist criteria would have resulted in 239 (40%) patients not receiving a same-day intrauterine system. Twelve-month outcomes were similar whether or not patients met pregnancy checklist criteria. Providers need not withhold intrauterine system placement based on the pregnancy checklist criteria. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/31945336/Experience_with_same-day_placement_of_the_52mg_levonorgestrel-releasing_intrauterine_system L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(20)30009-0 DB - PRIME DP - Unbound Medicine ER -