MR imaging of uterine morphology and dynamic changes during lactation

Daido, Sayaka; Kido, Aki; Kataoka, Masako; Nakai, Asami; Fujimoto, Koji; Kusahara, Hiroshi; Okada, Tomohisa; Togashi, Kaori

doi:10.1002/jmri.25375

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…More controversial, however, is the impact on the risk of expulsion. Breastfeeding is associated with short‐ and longer‐term maternal endocrine and genitourinary changes after birth (to uterine morphology, peristalsis, the uterotonic effect of oxytocin, and pituitary‐induced amenorrhea secondary to breastfeeding) and it may also be associated with expulsion of a IUD that has been immediately placed 62–64 . Although postpartum women with copper IUDs who were breastfeeding have been reported to experience similar or lower risks of expulsion relative to those who were not breastfeeding, 65 the association of breastfeeding with expulsion rates for other IUD types has not been extensively studied.…”

Section: Long‐acting Reversible Contraceptionmentioning

confidence: 99%

Postpartum contraception: A matter of guidelines

Grandi

Savio

Tassi

et al. 2023

Intl J Gynecology & Obste

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The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin‐only pill postpartum in non‐breastfeeding women (category 1). Differences are found in women who breastfeed. In non‐breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high‐income countries. Postpartum contraception is not a ‘matter of guidelines’: it is the best customization for each woman, as early as possible but at the ideal timing.

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Section: Long‐acting Reversible Contraceptionmentioning

confidence: 99%

Postpartum contraception: A matter of guidelines

Grandi

Savio

Tassi

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

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“…Lower rates were observed for insertion 4 or more weeks post partum (1.8%), and no complete expulsions were observed after early outpatient insertion (72 hours to <4 weeks) . Given that breastfeeding is associated with short-term and longer-term maternal endocrine and genitourinary changes after birth (including changes to uterine morphology, peristalsis, the uterotonic effect of oxytocin released during breastfeeding, and pituitary-induced amenorrhea secondary to breastfeeding), breastfeeding status may also be associated with expulsion risk for IUDs placed post partum . While postpartum women with copper IUDs who were breastfeeding have been reported to experience similar or lower risks of expulsion relative to those who were not breastfeeding, the association of breastfeeding with expulsion rates for other IUD types has not been extensively evaluated.…”

Section: Introductionmentioning

confidence: 99%

Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion

et al. 2022

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IMPORTANCE Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. OBJECTIVE To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. DESIGN, SETTING, AND PARTICIPANTS The Association of Perforation and Expulsion ofIntrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. EXPOSURES Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. MAIN OUTCOMES AND MEASURESIncidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. RESULTSThe full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79. 4%]).There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, (continued) Key Points Question Are timing of intrauterine device (IUD) insertion post partum and breastfeeding associated with the risk of IUD expulsion? Findings In this cohort study of 326 658 women, 5-year cumulative incidence of IUD expulsion was highest among women with postpartum IUD insertions at 0 to 3 days and lowest for those with insert...

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