Neonatal Outcomes of Twins and Triplets

Abstract

BACKGROUND:Several studies have shown that postplacental intrauterine device (IUD) insertion is a safe, convenient, and effective option for postpartum contraception. Of the prior studies performed, few involve ultrasound-guided insertion, none involve the levonorgestrel intrauterine system, and none of the prior studies take place in a United States residency program. OBJECTIVE: To assess the safety and feasibility of ultrasound-guided postplacental insertion of levonorgestrel intrauterine system (Mirena) in a U.S. residency program. METHODS: Levonorgestrel intrauterine system IUDs were inserted within 10 minutes of placental delivery after vaginal delivery via either ringed forceps or hand technique. All insertions were ultrasound-guided. Of the 30 subjects that were enrolled, 20 received an levonorgestrel intrauterine system IUD. Subjects were examined at 4 weeks postpartum and 10 weeks postpartum for evidence of expulsion or infection. RESULTS: Of the subjects who have been followed to date, none have had evidence of intrauterine infection. There have been 2 expulsions, giving an expulsion rate of 10% at 10 weeks postpartum. CONCLUSION: This pilot study suggests that ultrasoundguided postplacental insertion of Mirena IUDs is a feasible, safe option for postpartum contraception in a U.S. residency program. OBJECTIVE:To compare the effects on ovulation incidence of 2 dosing regimens (21-and 24-day) of an oral contracep-tive (OC) containing ethinyl estradiol (EE) 20 g/drospirenone 3 mg following predefined dosing errors. METHODS: This double-blind, randomized study recruited women (18 -35 years) who had ovulated and had a follicular diameter of 15 mm or greater on day 23 during the cycle before starting study treatment. Women received 3 treatment cycles of EE 20 g/drospirenone 3 mg in a 21/7 (21 active/7 placebo) or 24/4 day (24 active/4 placebo) regimen. In treatment cycle 3, the initial 3 tablets in each pack in both dosing regimens were placebo. Ovarian activity was classified via Hoogland score. Secondary end points included serum concentrations of 17 ␤ estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). RESULTS: After 3 treatment cycles, the odds of having a lower Hoogland score with the 24-day regimen was 3.06 times higher (95% confidence interval 1.44 -6.65) than with the 21-day regimen. One ovulation was observed in the 24-day regimen (cycle 3), and 4 ovulations were observed in the 21-day regimen. More women in the 24-day regimen had Hoogland scores of 1 (no follicular activity) (51.9% versus 28.8%). Similar levels of serum estradiol, LH, and FSH suppression were achieved with both regimens, indicating good ovulation suppression. CONCLUSION: Both regimens demonstrated reliable ovulation inhibition, indicated by low Hoogland scores. Stronger suppression of follicular development was observed with the 24-day regimen when dosing errors were intentionally introduced. This should translate into improved contraceptive efficacy in clinical practice.