Immediate postpartum insertion of intrauterine device for contraception

Lopez, Laureen M; Bernholc, Alissa; Hubacher, David; Stuart, Gretchen S.; Vliet, Huib A.A.M. van

doi:10.1002/14651858.cd003036.pub3

Cited by 128 publications

(189 citation statements)

References 44 publications

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“…The most recent Cochrane review meta-analysis of immediate postpartum intrauterine contraception (PPIUC) of 15 trials of moderate quality found that use at 6 months was twice as likely than with standard interval insertion (OR 2.04, 95% CI 1.01 to 4.09; participants 243; studies=4) 2. This is particularly striking in the context of the higher expulsion rates seen with immediate insertion (OR 4.89, 95% CI 1.47 to 16.32; participants=210; studies=4).…”

Section: Resultsmentioning

confidence: 99%

Women’s and healthcare professionals’ views on immediate postnatal contraception provision: a literature review

Thwaites

Tran

Mann

2019

BMJ Sex Reprod Health

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ObjectivesProvision of immediate postnatal contraception, including long-acting reversible contraceptive (LARC) methods, is increasingly identified and endorsed as a key strategy for reducing unplanned and rapid repeat pregnancies. This literature review aims to evaluatethe views of women and healthcare professionals regarding the receipt, initiation or delivery of these services.MethodsDatabases (Embase, Medline, CINAHL, HMIC) were searched for relevant English language studies, from January2003 to December 2017. In addition, Evidence Search, Google Scholar and Scopus (citation search) were used to identify further literature. Other relevant websites were accessed for policies, guidance and supplementary grey literature.ResultsThere is clear guidance on how to deliver good-quality postnatal contraception to women, but the reality of service delivery in the UK does not currently meet these aspirations, and guidance on implementation is lacking. The available evidence on the provision of immediate postnatal contraception focuses more on clinical rather than patient-centred outcomes. Research on postnatal women’s views is limited to receptivity to LARC and contraception counselling rather than what influences their decision-making process at this time. Research on views of healthcare professionals highlights a range of key systemic barriers to implementation.ConclusionsWhile views of postnatal women and healthcare professionals are largely in support of immediate postnatal contraception provision, important challenges have been raised and present a need for national sharing of service commissioning and delivery models, resources and evaluation data. Provider attitudes and training needs across multidisciplinary groups also need to be assessed and addressed as collaborative working across a motivated, skilled and up-to-date network of healthcare professionals is viewed as key to successful service implementation.

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Section: Resultsmentioning

confidence: 99%

Women’s and healthcare professionals’ views on immediate postnatal contraception provision: a literature review

Thwaites

Tran

Mann

2019

BMJ Sex Reprod Health

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“…69 The safety and tolerability of immediate postpartum placement of IUDs (within 10 minutes of delivery of the placenta) and postabortal placement of these devices have been demonstrated by numerous studies. 68,[70][71][72][73][74] Higher expulsion rates following postpartum placement have been observed following vaginal delivery, 47 but may be lower, at least short term, when IUDs are placed through the uterine incision at the time of elective cesarean delivery. 75,76 Utilization rates of IUDs at 6 and 12 months postpartum may be higher in those who have these methods placed immediately after delivery than those who have planned placement at their routine postpartum visit; and pregnancy rates are also lower among those who receive them promptly postpartum.…”

Section: Approaches To Reduce Rapid Repeat Pregnancies Among Adolescementioning

confidence: 99%

Prevention of Unintended Pregnancy Among Sexually Active Adolescents in the United States

Kakaiya¹

2016

Primary Prevention Insights

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BACKGROUND: Adolescent pregnancy and birth rates in the United States have declined dramatically from their peaks in 1991, but remain much higher than those seen in most other developed countries. METHODS: Recent results from relevant clinical trials, periodic surveys of reproductive age women, and focus group work as well as professional group recommendations in the United States are presented to provide insights into the problem of unintended teen pregnancy and suggest potential solutions. RESULTS: Dramatic changes in contraceptive technologies and practices have been implemented in the past several years to reduce the barriers young women have in accessing the most effective methods of contraception. However, new reports about how young women view their risks suggest that new strategies will be needed to motivate more sexually active young women to prevent pregnancy. CONCLUSIONS: The safety and efficacy of modern methods of contraceptives are the highest they have ever been, but if unintended pregnancy rates among teens in the United States are to be more significantly reduced, young women's attitudes about contraception and pregnancy prevention need to be better understood and remaining barriers to its access need to be reduced.

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“…39 Expulsion rates vary widely by study population but are generally lower when the IUD is inserted immediately after delivery of the placenta (3 to 27%) than when it is inserted 10 minutes to 48 hours after delivery of the placenta (11 to 27%); both rates are higher than those with standard insertion at 4 to 8 weeks post partum (0 to 6%). 39 Trials that compared immediate versus delayed IUD insertion during either the postpartum or postabortion period showed that even with higher expulsion rates after immediate insertion, IUD continuation rates at 6 to 12 months were generally higher among the women whose IUDs were placed immediately post partum or post abortion.…”

mentioning

confidence: 94%