Lactogenesis After Early Postpartum Use of the Contraceptive Implant

Gurtcheff, Shawn E.; Turok, David K.; Stoddard, Greg; Murphy, Patricia A.; Gibson, Mark; Jones, Kirtly Parker

doi:10.1097/aog.0b013e3182165ee8

Cited by 93 publications

(63 citation statements)

References 22 publications

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“…There is no evidence that the use of progestogen‐containing contraceptives affects the quantity or quality of breast milk and they appear to have no deleterious effects on infant health 16, 17. Despite this, the 2010 WHO medical eligibility criteria categorised progestogen‐containing contraceptives as medical eligibility criteria category 3 (the theoretical or proven risks usually outweigh the advantages of the method) in the first four postpartum weeks in breastfeeding women, due to lack of data on possible long‐term health effects of neonatal exposure to progestogens 17, 18…”

Section: Introductionmentioning

confidence: 99%

A randomised clinical trial to assess satisfaction with the levonorgestrel‐ releasing intrauterine system inserted at caesarean section compared to postpartum placement

Braniff

Gomez

Müller

2015

Aust NZ J Obst Gynaeco

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BackgroundInsertion of levonorgestrel‐releasing intrauterine system (LNG‐IUS) at caesarean section (CS) provides contraception prior to resumption of ovulation or sexual activity. Patient satisfaction with insertion at CS has not previously been studied.AimsThe aim of this study was to compare patient satisfaction with LNG‐IUS inserted at the time of lower uterine segment CS to six weeks postpartum.Materials and MethodsOpen‐label randomised controlled trial. Women booked for elective CS were randomised to LNG‐IUS insertion either at the time of CS (study group) or at six weeks postpartum (control group). The primary outcome measure was patient satisfaction. Outcomes were measured at six weeks, three months and six months postpartum.ResultsForty‐eight women were randomised into two treatment groups. Twenty‐five women were randomised to have LNG‐IUS inserted at the time of CS, 23 of whom had the planned intervention and two had the LNG‐IUS inserted postpartum. Twenty‐three women were randomised to the control group, four of whom withdrew prior to treatment. The 44 remaining women contributed to data analysis. Patient satisfaction was high and similar in both groups. At six months postpartum, 90.5% of the study group were very satisfied or somewhat satisfied compared with 88.2% of the control group.ConclusionsPatient satisfaction is high with LNG‐IUS insertion at CS and not different to that with delayed insertion. LNG‐IUS insertion may be an option for women who find postpartum contraception difficult to access.

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Section: Introductionmentioning

confidence: 99%

A randomised clinical trial to assess satisfaction with the levonorgestrel‐ releasing intrauterine system inserted at caesarean section compared to postpartum placement

Braniff

Gomez

Müller

2015

Aust NZ J Obst Gynaeco

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“…Since this review was last updated in 2008 [13], four new randomized controlled trials (RCTs) [20][21][22][23] and five new observational studies were published [16,[24][25][26][27], and an additional five observational studies that were not included in the 2008 review were identified [28][29][30][31][32], for a total of eight reports of RCTs and 41 reports of nonrandomized clinical trials or observational studies for review (Table 1). These 49 articles reported on 47 different studies investigating the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance.…”

Section: Resultsmentioning

confidence: 99%

“…In total, eight studies address the effect of initiation of POCs before 6 weeks postpartum compared with later initiation, of which five are new [16,20,22,23,32]. The majority found no effect on breastfeeding or infant outcomes, although one RCT found that more women continued breastfeeding at 6 months in the later initiation group [22] and another found more infections in infants of DMPA users [32].…”

Section: Key Question Two: Early Versus Delayed Initiationmentioning

confidence: 99%

“…Another RCT compared postplacental placement of LNG-IUD with delayed placement at 6-8 weeks and found no difference in breastfeeding initiation between groups or in breastfeeding continuation at 6-8 weeks; women in the delayed group were more likely to be breastfeeding at 6 months [22]. A final study compared women randomly assigned to the ETG implant either 1-3 days postpartum or at 4-8 weeks postpartum and found no significant difference in breastfeeding outcomes [23].…”

Section: Breastfeeding Outcomes: Rcts and Observational Studiesmentioning

confidence: 99%

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Progestogen-only contraceptive use among breastfeeding women: a systematic review

2010

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Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes. Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs. Search strategy: We searched the PubMed database for all articles published from database inception through December 2014. Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, injectables, implants or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects). Results: Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breastfeeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association. Conclusion: The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems or impaired development. Evidence newly added to this review was largely consistent with previous evidence.

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“…Despite the increased expulsion rate of 10 -27% 12 compared to interval insertion of an intra-uterine device, strong evidence exists to suggest the effectiveness in preventing unwanted pregnancy, particularly in a Medicaid population where 1 in 4 will not attend the postpartum visit. 13 Many providers at our institution felt uncomfortable offering this immediately postpartum out fear of complications such as uterine perforation. This, unfortunately, continues to be an obstacle which may be overcome through proctoring and training.…”

Section: Wvmj Oa Retrospective Study |mentioning

confidence: 99%

Bilateral Tubal Ligation after Parturition Among Medicaid Patients in West Virginia: An Institutional Experience

Shapiro¹,

Simpson²,

Cox³

et al. 2017

WVMJ

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Postpartum tubal ligation is one of the safest and most effective methods of contraception. Yet, not all women who desire it actually undergo the procedure. We studied clinical and demographic factors that were associated with receipt of tubal ligation among West Virginia Medicaid patients. A retrospective study was performed evaluating Medicaid patients in West Virginia requesting postpartum sterilization from May 2012 to November 2014 (N = 153). Demographic information was obtained on these patients. Clinical factors complicating pregnancy were analyzed. For those patients choosing not to undergo tubal sterilization, contraceptive plan at discharge was also evaluated. Statistical tests included Chi square and Fisher's Exact Test where appropriate. 71% (n=96) received tubal ligation before discharge. 21% (n = 29) requesting postpartum tubal ligation went unsterilized. Women with a history of cesarean section (83% vs. 61%; p = <0.0007) and those delivering by cesarean section rather than vaginal delivery (86% vs. 55%; p = <0.001) were more likely to receive tubal ligation. All other factors did not significantly influence the completion rate for tubal sterilization. Twenty one percent of patients requesting postpartum tubal sterilization went unfulfilled, indicating that significant barriers remain.

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Lactogenesis After Early Postpartum Use of the Contraceptive Implant

Abstract: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00847587.

Cited by 93 publications

References 22 publications

A randomised clinical trial to assess satisfaction with the levonorgestrel‐ releasing intrauterine system inserted at caesarean section compared to postpartum placement

A randomised clinical trial to assess satisfaction with the levonorgestrel‐ releasing intrauterine system inserted at caesarean section compared to postpartum placement

Progestogen-only contraceptive use among breastfeeding women: a systematic review

Bilateral Tubal Ligation after Parturition Among Medicaid Patients in West Virginia: An Institutional Experience

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