Postpartum Insertion Research Articles

Timing of Etonogestrel-Releasing Implants and Growth of Breastfed Infants: A Randomized Controlled Trial.

To evaluate the growth of breastfed infants whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. An open, randomized controlled, and parallel trial of postpartum women who were block-randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of an etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days) and a difference of equal to or greater than 10% between groups was considered clinically significant. The secondary outcomes were infant's height and head and arm circumferences. These variables were measured at baseline and at 14, 40, 90, 180, 270, and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes with a power of 80% and a significance level of 1% for the primary outcome and 0.3% for secondary outcomes as a result of correction for multiple hypothesis testing. From June to August 2015, a total of 100 women were randomized: 50 to early and 50 to conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups, except for educational attainment. The conventional insertion group included a higher proportion of women with 8 or more years of formal education than the early insertion group (88% [44/50] compared with 70% [35/50], P=.02). There was no difference in infant weight at 360 days between the groups (early [mean±standard deviation] 10.1±1.2 kg compared with conventional 9.8±1.3 kg, mean difference estimate 0.3 kg, 95% confidence interval 0-0.7 kg). Growth curves, height, and head and arm circumferences did not differ between the groups. There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant. ClinicalTrials.gov, NCT02469454.

Patient Preferences About Immediate Postpartum Long-Acting Reversible Contraception: A Qualitative Study [10F

INTRODUCTION: To acquire in-depth understanding about patient preferences regarding the timing of long-acting reversible contraceptive (LARC) insertion after childbirth. METHODS: We conducted semi-structured interviews with pregnant women planning to use LARC postpartum (n=5). Participants watched a standardized video explaining LARC insertion timing options. Interviews were audio recorded, transcribed verbatim, and coded by two authors (AAS, MHM) using qualitative content analysis. RESULTS: Interviewees identified a variety of personal preferences for timing of LARC insertion. Cited reasons for preferring immediate postpartum insertion (n=3 women) included strong desire to prevent rapid repeat pregnancy, wanting to initiate contraception prior to being occupied with a new baby, and ability to address potential issues with their LARC device at the postpartum visit. Women (n=2) preferring outpatient insertion reported wanting to let the body recuperate after childbirth before initiating contraception and concern about expulsion and potential risks to breastfeeding with immediate insertion. Regardless of personal preferences for timing of insertion, all interviewees supported making immediate postpartum insertion available to women. Participants reported enthusiasm for discussing contraceptive options with any provider at any time during their prenatal care visits and expressed an affinity for receiving information via in-person conversations and visual formats (e.g. video, pamphlets) that could be shared with a partner. CONCLUSION: Our findings suggest that pregnant women have a range of preferences regarding timing of postpartum LARC insertion and support making immediate postpartum insertion available to women who desire it. Enhancing access to this service may align with women’s contraceptive preferences and enhance their ability to meet their reproductive goals.

Immediate versus delayed postpartum insertion of contraceptive implant for contraception.

The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy. To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception. We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception. Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups. Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.

Location and content of counselling and acceptance of postpartum IUD in Sri Lanka

BackgroundThe immediate postpartum IUD (PPIUD) is a long-acting, reversible method of contraception that can be used safely and effectively following a birth. To appropriately facilitate the immediate postpartum insertion of IUDs, women must be informed of the method’s availability and must be counselled on its benefits and risks prior to entering the delivery room. We examine the relationship between the location and quality of antenatal counselling and women’s acceptance of immediate postpartum IUD (PPIUD) in four hospitals in Sri Lanka.MethodsData were collected between January 2015 and May 2015. Modified Poisson regressions with robust standard errors are used to assess the relationships between place of counselling, indicators of counselling quality, and PPIUD uptake following delivery.ResultsWe find that women who were counselled in hospital antenatal clinics and admission wards were much more likely to have a PPIUD inserted than women who were counselled in field clinics or during home visits. Hospital-based counselling had higher quality indicators for providing information on PPIUD, and women were more likely to receive PPIUD information leaflets in hospital locations than in lower-tiered clinics or during home visits. Women who were counselled at hospital locations also reported a higher level of satisfaction with the counselling that they received. Receipt of hospital-based counselling was also linked to higher PPIUD uptake, in spite of the fact that women were more likely to be given information about the risks and alternatives to PPIUD in hospitals. The information about the risks of and alternatives to PPIUD, whether provided in hospital or in non-hospital settings, tended to lower the likelihood of acceptance to have a PPIUD insertion. Counselling in hospital admission wards was focused on women who had not been counselled at field clinics.ConclusionsThe study findings call for efforts that improve the training of midwives who provide PPIUD counselling at field clinics and during the home visits. We also recommend that routine PPIUD counselling be conducted in hospitals, even if women have already been counselled elsewhere.

Postpartum weight loss in overweight and obese women using the etonogestrel subdermal implant: a pilot study

ObjectiveTo compare weight loss during the first 6months postpartum in overweight and obese women using the etonogestrel implant, placed in the immediate postpartum period, with that of controls using nonhormonal contraception, utilizing a pilot design. Study designPilot, prospective cohort study. Analysis groups were divided by body mass index (overweight: 25–29.9kg/m2; Class I Obesity: 30–34.5kg/m2; Class II Obesity: 35–39.9kg/m2) and grouped by use of etonogestrel implant or nonhormonal contraception for all outcomes. Primary outcome was the proportion of women in each group returning to pregravid weight by 6months postpartum. Secondary outcomes included waist circumference, motivation to lose weight, eating habits, physical activity, feasibility of study procedures and assessment of recruitment potential in the first 6months postpartum. ResultsA total of 127 women enrolled between June 2014 and August 2015. Fifty-seven chose the etonogestrel implant for immediate postpartum contraception while 70 chose nonhormonal contraceptives. Six months after delivery, about half of women in each group returned to within 1.5 kg of pregravid weight (42% etonogestrel [ENG]-implant vs. 67% nonhormonal methods, p=.19). Retention rates were high with over 75% of total study population providing study data at 6months. Two nonhormonal contraceptive users conceived in the first 4months postpartum. ConclusionNo statistical difference in percentage return to pregravid weight was detected between groups, but data suggest that a somewhat lower proportion of implant users lost weight at 6months. Rapid recruitment, high retention and marked acceptance of immediate ENG implant use demonstrate feasibility for a larger, adequately powered trial. ImplicationsImmediate postpartum insertion of the ENG implant is safe and effective. Study findings suggest modest interference in overweight and obese women's ability to lose gestational weight. If future research demonstrates no statistical difference, increased uptake in immediate implant use should occur in most women, including those who are overweight or obese.

Healthcare Provider Attitudes of Safety of Intrauterine Devices in the Postpartum Period.

Immediate postpartum intrauterine devices (IUDs) have been underutilized in the United States despite their known safety. Understanding how providers' attitudes contribute to underutilization is important in improving access. Our objective was to examine healthcare providers' perceptions of the safety of immediate postpartum IUDs before publication of United States contraceptive guidelines. We analyzed survey data collected from December 2009 to March 2010 from 635 office-based physicians and 1368 Title X clinic providers (overall response rate of 64.8%). Providers were asked how safe they thought copper and levonorgestrel (LNG) IUDs were in postpartum women (very safe, safe, unsafe, very unsafe, and unsure). Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for characteristics associated with considering immediate and delayed postpartum IUDs to be safe. Less than 40% of respondents considered immediate or delayed IUD insertion to be safe. Providers with <1 day of family planning training had decreased odds of considering immediate postpartum IUD insertion to be safe compared with unsafe/unsure (aOR 0.18, 95% CI 0.04-0.84 for copper IUD and aOR 0.17, 95% CI 0.04-0.81 for LNG-IUD). Providers without training in postpartum or interval copper IUD insertion had decreased odds of considering immediate postpartum copper IUD insertion (aOR 0.40, 95% CI 0.16-0.79) and delayed postpartum insertion for both IUD types to be safe (aOR 0.34, 95% CI 0.18-0.66 for copper IUD and aOR 0.41, 95% CI 0.21-0.77 for LNG-IUD). Before United States contraceptive guidelines, a majority of providers perceived immediate postpartum IUDs to be unsafe.

Acceptance, perception, experience and satisfaction of the couple with postpartum intrauterine contraceptive devices (PPIUCD) insertion

Family planning can avert nearly one-third of maternal deaths and 10% of child mortality when couples space their pregnancies more than two years apart.In India 65% women in 1st year of postpartum period have unmet need for FP, but only 26% are using any contraceptive. Delivery may be the only time when they come into contact with health care providers; thereafter the chances of returning for contraceptive advice are uncertain. Insertion of intrauterine contraceptive device (IUCD) at 10 minutes after delivery is appealing. The Copper T 380A intra-uterine contraceptive device (IUCD) is a highly effective, non-hormonal method, long acting reversible and coitus independent contraceptive device that can be safely used by all women regardless of breastfeeding status during this interval. Thus increasing awareness and creating demand for postpartum intra-uterinecontraceptive devices (PPIUCD) is essential. Apart from the fact that its usage has to be increased, follow-up of the cases after insertion is an important factor since complications related to IUCD are extensive and vary with individuals. Thus routine followups and early measure is the base of PPIUCD insertion. Satisfaction related to IUCD insertion varies considerably. The studies also include the input of the husband’s opinion regarding the satisfaction related to IUCD as many problems related to interference in the sexual activity were recorded. We will conduct a study for acceptance, perception, experience and satisfaction of the couple with postpartum intrauterine contraceptive devices (PPIUCD) insertion at our institute.Objectives:1. Acceptability of postpartum intrauterine devices as a contraceptive method among women of reproductive age. 2. To record the experienceduring the procedure and first six weeks after insertion of IUCD. 3. To learn about satisfaction with PPIUCD among the couple. 4. Desire to continue the service in future. Methods: Study design- This will be an open prospective and longitudinal study toassess the acceptance, perception, experience and satisfaction of the 100 couples in the reproductive age group (19-49 years) who are willing for; with postpartum insertion of the Cu T 380 A within 10 minutes of placental expulsion. Couples will be recruited in this study after obtaining written informed consent. Institutional ethical committee clearance will be taken. Exclusion criteria will be severe anemia Hb 38°C during or after labor, and the patients with Postpartum Hemorrhage. Method of insertion: The Copper T model Cu T 380 A will be inserted with all asepticprecautions within 10 minutes of placental expulsion with a sponge holder and fundal placement will be ensured. String will be cut to the level of the cervix. The string will be visible at the cervix after the insertion. Participants will be interviewed prior and after insertion of PPIUCD and then six weeks later. Data collection: Data will be collected from participants using a structured questionnaire that includes basic demographic information, questions related to acceptance and perception of pain on insertion of PPIUCD. After six weeks, PPIUCD clients will again be interviewed using a structured follow-up questionnaire that will collect information about the clients overall satisfaction, problems or any complications, and retention /expulsion of the PPIUCD. In the cases where the client fails to return to the health facility for her follow-up visit, she will be contacted by telephone for the follow-up interview. Data analysis: Continuous variables will be reported using mean (standard deviation) and categorical variables will be reported using percentages. For two group comparisons, wherever applicable a student t-test will be used to compare means of continuous variables, and chi-square tests shall be used to compare categorical variables.Results:1.Acceptance of PPIUCD was 88% after counseling than 46% before counseling. 2. 79.54% did not have any pain during insertion. 3. 17.06% had mild discomfort while insertion and only 03.40% had painful insertion. 4. After 6 weeks 83% women followed-up. Rest 17% could not be contact even through telephones. 5. Major complications encountered were abdominal pain and expulsion 13.6% each than other complications. However 54.5% women had no complications. 6. 75.3% women were willing to continue the PPIUCD, rest demanded removal either due to complications or family opposes being the major reason. 7. Overall satisfaction rate was 78% in women and 73.9% in husbands Conclusions: The study thus concludes that acceptance rate was significantly improved after proper counseling and the complication rate of the PPIUCD were less as compared to the overall benefits.

Use of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use Guidance in sub-Saharan African Countries: A Cross-Sectional Study.

Given recent updates to the postpartum contraception recommendations in the fifth edition of the Medical Eligibility Criteria for Contraceptive Use (MEC), published by the World Health Organization (WHO), the purpose of this qualitative study was to assess the extent to which national family planning policies in sub-Saharan African countries are in agreement with the WHO MEC, particularly with regard to postpartum contraceptive use. WHO headquarters sent questionnaires to country-level focal points to complete with their Ministry of Health counterparts. Between February and May 2016, 23 of 32 (72%) surveys were completed. All respondents reported that their countries had used the MEC document in the past, with most reporting that they had used the guidance as a reference (n = 20, 87%), for training purposes (n = 19, 83%), to change clinical practices (n = 17, 74%), and to develop national policies (n = 16, 70%). While many respondents (16, 70%) indicated their countries already include immediate postpartum intrauterine device insertion among breastfeeding women in their family planning policies, few reported currently allowing use of progestogen-only pills (n = 8, 35%) or implants (n = 8, 35%) during the immediate postpartum period (i.e., less than 48 hours after delivery) for breastfeeding women. A higher percentage of respondents indicated their countries allowed breastfeeding women the option of progestogen-only pills (n = 16, 70%) and implants (n = 13, 57%) between 48 hours and 6 weeks postpartum. Findings from this baseline assessment suggest that many countries may benefit from training and policy formulation support to adapt both new WHO MEC updates as well as existing recommendations from previous MEC revisions into national family planning guidelines.

Breastfeeding and infant growth parameters among a prospective cohort of Malawian women who underwent immediate postpartum implant or copper intrauterine device insertion

Objectives: We aimed to compare 3-month postdelivery breastfeeding and infant growth parameters between women who underwent immediate postpartum implant or copper intrauterine device (Cu-IUD) insertion. Methods: This is a secondary analysis of a prospective cohort study of 171 Malawian women who underwent immediate postpartum insertion of the implant or Cu-IUD between September 2014 and March 2015. The study's primary objective was to compare contraceptive continuation rates between implant and Cu-IUD users 1 year postdelivery. For this secondary analysis, we used Fisher's Exact Test and t tests to compare the breastfeeding and infant growth parameters of women with a singleton pregnancy and live infant at their 3-month postdelivery survey. Results: Some 122 women (71%) completed the 3-month postdelivery survey, and 108 women (61%) were eligible for this secondary analysis: 10 Cu-IUD and 98 implant users. All women (100%) reported that they were breastfeeding, with no significant difference in exclusive breastfeeding (90% for Cu-IUD vs. 93% for implant, p=.55). There were also no significant differences in infant weight (6.3 kg for Cu-IUD vs. 6.2 kg for implant, p=.69), length (60.8 cm for Cu-IUD vs. 59.6 cm for implant, p=.42) or head circumference (40.9 cm for Cu-IUD vs. 41.2 cm for implant, p=.74). Conclusions: Almost all women were still exclusively breastfeeding at 3 months postdelivery, with no differences in infant growth between implant and Cu-IUD users, although sample size limited our power. The high rate of exclusive breastfeeding at 3 months in both groups suggests that both options should be offered to postpartum women who want to prevent short interpregnancy intervals.

Etonogestrel-Releasing Contraceptive Implant for Postpartum Adolescents: A Randomized Controlled Trial

Study ObjectiveTo compare immediate postpartum insertion of the contraceptive implant to placement at the 6-week postpartum visit among adolescent and young women. DesignNon-blinded, randomized controlled trial. Setting and ParticipantsPostpartum adolescents and young women ages 14-24 years who delivered at an academic tertiary care hospital serving rural and urban populations in North Carolina. InterventionsPlacement of an etonogestrel-releasing contraceptive implant before leaving the hospital postpartum, or at the 4-6 week postpartum visit. Main Outcome MeasuresContraceptive implant use at 12 months postpartum. ResultsNinety-six participants were randomized into the trial. Data regarding use at 12 months were available for 64 participants, 37 in the immediate group and 27 in the 6-week group. There was no difference in use at 12 months between the immediate group and the 6-week group (30 of 37, 81% vs 21 of 27, 78%; P = .75). At 3 months, the immediate group was more likely to have the implant in place (34 of 37, 92% vs 19 of 27, 70%; P = .02). ConclusionPlacing the contraceptive implant in the immediate postpartum period results in a higher rate of use at 3 months postpartum and appears to have similar use rates at 12 months compared with 6-week postpartum placement. Providing contraceptive implants to adolescents before hospital discharge takes advantage of access to care, increases the likelihood of effective contraception in the early postpartum period, appears to have no adverse effects on breastfeeding, and might lead to increased utilization at 1 year postpartum.

Committee Opinion No. 670 Summary: Immediate Postpartum Long-Acting Reversible Contraception.

Immediate postpartum long-acting reversible contraception (LARC) has the potential to reduce unintended and short-interval pregnancy. Women should be counseled about all forms of postpartum contraception in a context that allows informed decision making. Immediate postpartum LARC should be offered as an effective option for postpartum contraception; there are few contraindications to postpartum intrauterine devices and implants. Obstetrician-gynecologists and other obstetric care providers should discuss LARC during the antepartum period and counsel all pregnant women about options for immediate postpartum initiation. Education and institutional protocols are needed to raise clinician awareness and to improve access to immediate postpartum LARC insertion. Obstetrician-gynecologists and other obstetric care providers should incorporate immediate postpartum LARC into their practices, counsel women appropriately about advantages and risks, and advocate for institutional and payment policy changes to support provision.

Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception.

Immediate postpartum long-acting reversible contraception (LARC) has the potential to reduce unintended and short-interval pregnancy. Women should be counseled about all forms of postpartum contraception in a context that allows informed decision making. Immediate postpartum LARC should be offered as an effective option for postpartum contraception; there are few contraindications to postpartum intrauterine devices and implants. Obstetrician-gynecologists and other obstetric care providers should discuss LARC during the antepartum period and counsel all pregnant women about options for immediate postpartum initiation. Education and institutional protocols are needed to raise clinician awareness and to improve access to immediate postpartum LARC insertion. Obstetrician-gynecologists and other obstetric care providers should incorporate immediate postpartum LARC into their practices, counsel women appropriately about advantages and risks, and advocate for institutional and payment policy changes to support provision.

Clinical Study of Acceptability And Safety of Postpartum Intrauterine Contraceptive Devices

Objective: India is first to introduce family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). To assess the acceptability and safety of Postpartum Intrauterine Contraceptive Device insertion among women on bases of two key outcomes of PPIUCD insertions — expulsion and infection,who delivered at Rajkiya Mahila Chikitsalya J.L.N. Medical College and Hospital. Method: this is a prospective interventional analytical study. The postpartum family planning services offered are in the form of health education in group counseling session at the postnatal ward. Results: Total women counseled 1000, accepted 312, declined 688, lost to follow up 56, followed up 256, complications 82 (Expulsion 8, Bleeding 21, String problem 32, Removal 8, continuation 231) Interpretation and conclusions: Immediate post-partum IUCD insertion provides highly effective contraception immediately after delivery. Although the expulsion rate for immediate post-partum is higher than for interval insertion particularly in country where women have limited access to medical care. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources. It is also important to arrange training on PPIUCD in order to increase knowledge and skills among health care providers. This will also further promote PPIUCD use and aid in reduction of expulsion rates. Case incentives to the acceptor, motivator and provider will bring about substantial progress in the PPIUCD use in developing countries like India.

Feasibility, acceptability, and uptake of postpartum intrauterine contraceptive devices in southern Nigeria

ObjectiveTo evaluate the effect of postpartum intrauterine contraceptive device (PPIUD) implantation on existing low contraceptive uptake and utilization in Nigeria. MethodsA prospective analytical cohort study was conducted at eight medical facilities in southern Nigeria between June 1, 2014 and May 31, 2015. Patients undergoing delivery during the study period were considered for eligibility and the exclusion criteria included any contraindications to PPIUD implantation. Following counselling, participants underwent PPIUD insertion within either 10minutes (post-placental) or 48hours (immediate) of delivery, or at cesarean delivery. All participants were scheduled to attend 14-day and 6-week follow-up. The primary outcome measure was the PPIUD-uptake rate and secondary outcome measures included patient satisfaction and complication rates. ResultsThere were 1061 deliveries recorded during the study period; 746 patients were offered PPIUDs, with 374 (50.1%) accepting and undergoing insertion. Immediate post-partum insertion was performed for 199 (53.2%) participants, with 169 (45.2%) and 6 (1.6%) undergoing post-placental and intra-cesarean insertion, respectively. ConclusionPPIUD was safe and acceptable to Nigerian women. Increasing the education of patients and training of healthcare providers is recommended to scale-up PPIUD use in Nigeria.

Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Objectives: The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters.Methods: This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6–12 months after PPIUD insertion and asked to return to the clinic for interview and examination. If the IUD strings were not visible, an ultrasound was performed. Participants were asked about their satisfaction with the PPIUD. Main outcome measures were short-term PPIUD continuation and reported complications according to time of insertion.Results: Of 591 women enrolled, 305 women attended the follow-up appointment for interview and examination, giving a power of 80% to estimate an expulsion rate of 10 ± 5%. The IUD was inserted within 10 min of placental delivery (post-placental insertion) in 24.3% of participants (n = 74) and within 48 h (immediate post-partum insertion) in 71.1% of participants (n = 217). The total expulsion rate was 5.6%. Expulsion rates for post-placental and immediate post-partum insertions were 10.8% and 4.1%, respectively. No significant difference in expulsion rates was found (p = 0.10). Of those with an expulsion, 76.5% (n = 13) recognised that it had occurred. There were no reported complications, and 94.1% of women reported being satisfied or very satisfied with their PPIUD (n = 287).Conclusions: Overall, expulsion rates were lower than previously reported, particularly for immediate post-partum insertions. Attention to high fundal placement at insertion is a likely explanation for the low expulsion rates. Contrary to conventional wisdom, these low expulsion rates indicate that previous notions regarding insertion timing may not be accurate. Satisfaction levels were also favourable. PPIUD can be safe, acceptable and feasible in an African setting.

A prospective cohort study of early postpartum etonogestrel implant (Implanon®) use and its effect on duration of lochia

BackgroundEtonogestrel (ENG) implants (Implanon®/Nexplanon®/Implanon NXT®) are employed as contraception in early postpartum patients. Follow-up is often not conducted by the hospital prescriber. Little is known about duration of lochia, in...

Six-month and 1-year continuation rates following postpartum insertion of implants and intrauterine devices

ObjectiveStudies show immediate postpartum (PP) insertion increases use of contraceptive implants and intrauterine devices (IUDs). Our objective was to compare the satisfaction and continuation rates of the two types of devices at 6 months and 1 year following PP insertion. Study DesignWe enrolled 133 women in a prospective cohort study following immediate PP insertion of an implant or IUD at two academic hospitals during 8 months of 2011. Subjects completed an enrollment survey during hospital admission and a follow-up phone survey 6 months and 1 year PP. ResultsAt 6 months PP, 72% of subjects provided follow-up information. Implant users were more likely to be using the originally-placed device (40/41, 98% vs. 45/55, 82%, p=0.02); nine women reported IUD expulsions. When accounting for replacement of expelled IUDs, IUD continuation at 6 months was 89% yielding similar continuation rates between groups (p=0.12). At 1 year PP, 51% provided follow-up. Of those, 82% still had a LARC method in place with similar continuation by device type (84% for implants, 81% for IUDs, p=0.96). Overall, satisfaction was similarly high in both groups. ConclusionDue to IUD expulsion, implants had a higher continuation rate than IUDs six months following immediate PP insertion. After replacement of expelled IUDs, continuation and satisfaction were similar for both devices at 6 months and 1 year. ImplicationsPlacement of implants and IUDs immediately PP can lead to high satisfaction. Despite early IUD expulsions, continuation rates were similar to those placed outside of the immediate PP period.

Initial assessment of a dedicated device for immediate postpartum IUD insertion

Initial assessment of a dedicated device for immediate postpartum IUD insertion

Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact

BackgroundBreast milk volume has never been evaluated when the etonogestrel (ENG) implant was inserted immediately postpartum. Thus, this study evaluated if the immediate postpartum insertion of the ENG implant alters breast milk volume. Study designTwenty-four postpartum women and their newborns (NBs) were randomized into two groups: Implant group (ENG implant inserted within 48h after delivery) and Control group (absence of contraceptive method). The primary outcome was the amount of breast milk intake by the NBs in the first 6weeks after delivery. Five and ten grams of deuterium (D2O) were orally administered to the postpartum women on the day of randomization (day 0) and on the 29th study day, respectively. Saliva samples were collected from the mother–NB pairs prior to each D2O dose administration and after D2O ingestion (periodic collection). The amount of breast milk ingested by the NBs was estimated by the amount of deuterium (D2O) ingested by the NBs through breastfeeding, using mass spectrometry in the saliva samples. ResultsTwenty-four postpartum women and their NB were randomized (12 per group). The median of breast milk intake by NBs following the two D2O doses were similar between groups {first D2O dose [Implant: 340mL/day (240–420mL/day) vs. Control: 330mL/day (300–530mL/day), p=.54]; second D2O dose [Implant: 845mL/day (770–980mL/day) vs. Control: 785mL/day (680–980mL/day), p=.63]}. The exclusive breastfeeding rate and NB weight were similar between groups in the first 6weeks postpartum. ConclusionENG implant insertion immediately postpartum does not alter the volume of breast milk intake by NBs. ImplicationsConsidering the benefits of immediate postpartum initiation of ENG implant on reducing unintended pregnancy and pregnancy recurrence, especially in vulnerable populations, our study adds safety data on breastfeeding effect of this practice.

Postpartum IUCD: Rediscovering a Languishing Innovation.

The National Family Planning Programme of India, since its inception in 1951, has been able to successfully achieve significant reductions in maternal mortality and fertility. Over the past decade, the need for contraception has changed dramatically in India. Couples no longer desire sterilization, but prefer modern reversible long-term methods of contraception. The ideal time to discuss contraception is in the antenatal period when there is a good rapport between the doctor and the patient. The window period when the patient is admitted in the hospital during delivery can be used effectively to offer postpartum contraception. It has been found that the highest chance of unwanted pregnancy is in the first year after delivery, when women do not report to the doctor if this window period is missed. Postpartum intrauterine contraceptive devices are ideal for a country like India and it can be used to cover the unmet need of contraception if inserted immediately after delivery. There are two types of insertion: post placental, within 10min of delivery of placenta and postpartum, within 48h of delivery. Although there is a greater chance of expulsion in the postpartum insertions, it can be significantly reduced with proper training and user experience. Postpartum IUCD should be routinely offered to all patients delivering in institutions to provide complete care to a parturient and to achieve safe motherhood.