Intrauterine device placement at 3 versus 6 weeks postpartum: a randomized trial

Baldwin, Maureen K.; Edelman, Alison; Lim, Jeong Youn; Nichols, Mark; Bednarek, Paula H.; Jensen, Jeffrey T.

doi:10.1016/j.contraception.2015.12.006

Cited by 23 publications

(24 citation statements)

References 13 publications

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“…Most couples had not resumed intercourse prior to the 2–3 week visit, allowing women to initiate effective contraception initiation before they are at risk of pregnancy (16). Our experience, albeit limited, also supports the present data on the safety of IUD insertion at 2–3 weeks postpartum (8,9). …”

Section: Discussionsupporting

confidence: 88%

“…Although IUD insertion at two (8) and three weeks (9) was acceptable to clinical trial participants, patient preferences accounted for almost half of the delays in IUD insertion among women scheduled for a 2–3 week postpartum visit. Provider barriers were the second most common reason for delay.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have demonstrated the feasibility and acceptability of IUD insertion at two and three weeks post-delivery with expulsion rates of 3–4% at 6 months postpartum (8,9). Women are more likely to attend an earlier postpartum visit within three weeks after delivery (10), and this increased attendance creates earlier opportunities for contraceptive counseling and LARC provision.…”

Section: Introductionmentioning

confidence: 99%

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Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Chen

Hou

Hsia

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2–3 weeks after delivery is associated with higher long-acting reversible contraception (LARC) initiation at the postpartum visit. Methods We conducted a quasi-experimental before–after study to evaluate LARC initiation, specifically an intrauterine device (IUD) or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2–3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We obtained delivery and postpartum information using the electronic medical record and contacted participants 3 and 6 months after delivery to assess contraception use and repeat pregnancies. Results We enrolled 586 participants between December 2014 and November 2015, of whom 512 women (256 in each cohort) continued to meet eligibility criteria after delivery. Long-acting reversible contraception initiation rates at the postpartum visit were lower in the 2–3 week (16.5%, 95%CI 12.2–21.8) compared to 6-week group (31.1%, 95%CI 25.2–37.7, p<0.01), primarily due to patient and health care provider preferences for delaying IUD insertion to a later visit. More women completed a scheduled 2–3 week postpartum visit (90.2%, 95%CI 86.0–93.3) compared to 6-week visit (81.6%, 95%CI 76.4–85.9, p<0.01). Deferral of any contraception initiation was higher in the 2–3 week group (27.3%, 95%CI: 21.9–33.4) compared to 6-week group (15.8%, 95%CI: 11.5–21.4, p<0.01), but there were no differences in overall contraceptive use patterns at 6 months postpartum. No IUD perforations or expulsions were observed in women who underwent insertion at 2–3 weeks postpartum. Five pregnancies were reported in each cohort by 6 months after delivery. Conclusions Scheduling a visit at 2–3 weeks after delivery was not associated with increased LARC initiation at this visit despite higher postpartum visit attendance.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Chen

Hou

Hsia

et al. 2017

Obstetrics &Amp; Gynecology

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“…12 Em um ensaio clínico randomizado, em populações com excelentes taxas de retorno na consulta puerperal a inserção pósplacentária pode ser menos benéfica devido a sua maior taxa de expulsão; contudo apresentaria benefícios em pacientes que se ausentam nas consultas .17 Como vantagens da inserção o DIU imediatamente após o parto, encontram-se a garantia de que a paciente não está grávida 3 e a possibilidade de não amamentação, gerando uma consequente ovulação. 2,9,11,13 Em um ensaio clínico de 2015, apenas 21% das mulheres do grupo pós-parto imediato e 25% do grupo tardio estavam amamentando aos 6 meses, colocando-as em risco de ovulação até esse momento. 10 Em outro estudo, 37% das mulheres estavam amamentando aos 6 meses.…”

Section: Resultsunclassified

Diu No Pós-Parto: Pontos E Contrapontos

Kirsneris¹,

Costa²,

Damerau³

et al. 2018

Blucher Medical Proceedings

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“…Post-abortion studies show that initiation of LARC should not be delayed for a follow-up visit, as up to 50% of women do not attend a scheduled follow-up visit [10,15,16]. Similarly, up to 30% of women do not attend a scheduled visit for placement of an IUCD up to 6 weeks postpartum [17]. Furthermore, there is good evidence that LARC should be the first-line recommendation for women in the postpartum period, to avoid early repeat pregnancy and abortion [18].…”

Section: Introductionmentioning

confidence: 99%

Risk of abortion within 1–2 years after childbirth in relation to contraceptive choice: a retrospective cohort study

Liljeblad

Kallner

Brynhildsen

2020

The European Journal of Contraception & Reproductive Health

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Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period. Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum. Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p ¼ .005). Smoking, age <25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk. Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.

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Intrauterine device placement at 3 versus 6 weeks postpartum: a randomized trial

Cited by 23 publications

References 13 publications

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Diu No Pós-Parto: Pontos E Contrapontos

Risk of abortion within 1–2 years after childbirth in relation to contraceptive choice: a retrospective cohort study

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