Background: Immediate postpartum long-acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. Aims:To assess self-reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Materials and methods:Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates.Secondary outcomes were reason for discontinuation, patient-reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data.Results: One hundred and ninety-three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79; VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07-6.90; P = 0.036). There were 60.8% of women post-CS and 56.3% of women post-VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow-up with their GP (89.5%). Conclusion:Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.

Background: Since the WOMAN trial, intravenous tranexamic acid (TXA) has been increasingly used in severe postpartum haemorrhage (PPH) but research evaluating use in high-income settings is limited. Aims:To assess whether implementation of a new guideline involving early administration of 1 g intravenous TXA in active PPH with blood loss ≥ 1000 mL, was associated with a change in maternal morbidity. Materials and Methods:Retrospective study of all singleton, term, vaginal births from November 2016 to June 2019 with a PPH of ≥1000 mL, before and after hospital adoption of a guideline recommending early (within three hours of birth) administration of TXA for women with active PPH ≥ 1000 mL. Univariate analysis assessed the impact of this guideline implementation on a primary outcome of maternal morbidity, defined as one or more of haemoglobin < 90 g/L, administration of blood products, hysterectomy or intensive care admission. Secondary outcomes were adverse events related to administration of TXA, use of an intrauterine balloon or postpartum iron infusion.Results: There was no difference in morbidity (odds ratio (OR) 0.86, 95% CI 0.57-1.29, P = 0.46) or postpartum iron infusion (OR 1.44, 95% CI 0.92-2.27, P = 0.11), but there was a reduction in the use of intrauterine balloon tamponade after the implementation of the TXA guideline (OR 0.33, 95% CI 0.16-0.67, P < 0.01). Conclusions:This retrospective analysis showed a reduced use of intrauterine balloon but failed to show a benefit in maternal morbidity with early administration of TXA for severe postpartum haemorrhage in a high-income setting.