Postpartum intrauterine devices: clinical and programmatic review

Goldthwaite, Lisa M.; Cahill, Erica P.; Voedisch, Amy; Blumenthal, Paul D.

doi:10.1016/j.ajog.2018.07.013

Cited by 17 publications

(14 citation statements)

References 51 publications

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“…Expulsion rates may also be affected by method of birth, timing of insertion within the first 72 hours, and type of IUD. Reported rates of expulsion are higher following vaginal birth (19%‐30%) versus cesarean birth (3%‐20%) . This may be due to a more contracted uterus during cesarean birth or the ease and certainty of a fundal placement that exists.…”

Section: Shared Decision Making and Mitigating Coercionmentioning

confidence: 99%

“…Guidelines suggest that postplacental insertion within 10 minutes of expulsion of the placenta may be best given the open state of the cervical os . However, there may be decreased expulsion rates if insertion occurs beyond this 10‐minute window but still within the immediate postpartum period when the uterus is slightly involuted and the os is beginning to close . This may offer added reassurance if postplacental insertion is not an option.…”

Section: Insertionmentioning

confidence: 99%

“…Use of ultrasound for confirmation of placement may be necessary if there is a question of placement; however, there is no evidence to support this practice at this time . Thus, it is reasonable to perform insertion without ultrasound guidance .…”

Section: Postinsertion Carementioning

confidence: 99%

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Immediate Postpartum Contraception: Intrauterine Device Insertion

Escobar

Shearin

2019

J Midwife Womens Health

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Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.

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Section: Shared Decision Making and Mitigating Coercionmentioning

confidence: 99%

Section: Insertionmentioning

confidence: 99%

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Immediate Postpartum Contraception: Intrauterine Device Insertion

Escobar

Shearin

2019

J Midwife Womens Health

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“…Postpartum family planning (PPFP) is defined as the use of family planning in the first 12 month following birth [1,2]. Fertility after birth can return as soon as 45 days after giving birth for women who are not breastfeeding [3,4] and it can also occur before menses is resumed on those who don't feed breast exclusively [5].…”

Section: Introductionmentioning

confidence: 99%

Immediate postpartum intrauterine contraceptive device utilization and influencing factors in Addis Ababa public hospitals: a cross-sectional study

Fikadu

Nejaga

Belete

et al. 2021

Contracept Reprod Med

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Background Postpartum intrauterine device (PPIUCD) utilization remains very low in Ethiopia beside high levels of unmet need for postpartum family planning even if nongovernmental organizations efforts to promote its use. This study investigates immediate PPIUCD utilization and influencing factors. Methods Institution based cross-sectional study was conducted on public hospitals of Addis Ababa city. All public hospitals which have PPIUCD service were included and systematic random sampling technique was used to select 286 participants. Data were entered using Epi Data and exported to SPSS for analysis. Bivariate and multivariate logistic regression analysis was used to determine the effect of independent variables on immediate PPIUCD utilization. Variables which have P-value< 0.2 on bivariate analysis were candidate for multivariate analysis. Variables which have P-value ≤0.05 on multivariate analysis was considered as statistically significant. Results Utilization of immediate PPIUCD among participants who gave birth in Addis Ababa public hospitals was 26.6% (95%CI: 21.3, 31.8). Eighty one percent respondents occupation was housewife were (AOR = 0.19, 95%CI: 0.06, 0.67) less likely to utilize PPIUCD compared to those who have personal job. In the other hand respondents who have discuss about PPFP with their partner were 1.21times (AOR = 1.21, 95%CI: 1.14, 25.67) more likely to utilize PPIUCD compared to those who never discuss. Contrarily 81% of respondents who need partner approval were (AOR = 0.19, 95%CI: 0.05, 0.79) less likely to utilize PPIUCD compared to those who doesn’t need approval. Respondents who have been counseled about PPIUCD were 1.13 times (AOR = 1.13, 95%CI: 1.10, 2.21) more likely to utilize PPIUCD compared to those who were not counseled. Similarly respondents who have good knowledge about PPIUCD were 7.50 times (AOR = 7.50, 95%CI: 4.06, 9.31) more likely to utilize PPIUCD compared to those who have poor knowledge. Conclusion This study verifies that immediate PPIUCD utilization is high compared to other studies. Having a housewife occupation and necessity of partner approval to utilize PPIUCD have negative influences, whereas spousal discussion about PPIUCD, counseled during pregnancy and having good knowledge have positive influences on PPIUCD utilization. Therefor empowering women by the government and other organizations working on maternal health will advance immediate PPIUCD utilization.

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“…Although the benefits of LARC are well known in the family planning community, lack of awareness or misperceptions among MFM subspecialists and general obstetricians can impede immediate postpartum LARC placement. 50 Counseling high-risk women about postpartum contraceptive options may not be prioritized during management of a complicated pregnancy. 51 MFM subspecialists and referring providers may not address LARC and other postpartum contraceptive methods because of lack of knowledge, lack of time, or the perception that it is not their role.…”

Section: Provider Barriersmentioning

confidence: 99%

Society for Maternal-Fetal Medicine (SMFM) Consult Series #48: Immediate postpartum long-acting reversible contraception for women at high risk for medical complications

Vricella

Gawron

Louis

2019

American Journal of Obstetrics and Gynecology

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The Society of Family Planning (SFP) endorses this document. The American College of Obstetricians and Gynecologists (ACOG) supports the value of this clinical document as an educational tool; February 2019. Reproductive planning is essential for all women and most important for those with complex health conditions or at high risk for complications. Pregnancy planning can allow these high-risk women the opportunity to receive preconception counseling, medication adjustment, and risk assessment related to health conditions that have a direct impact on maternal morbidity and mortality risk. Despite the need for pregnancy planning, medically complex women face barriers to contraceptive use, including systemic barriers, such as underinsurance for women at increased risk for complex medical conditions as well as low uptake of effective postpartum contraception. Providing contraceptive counseling and a full range of contraceptive options, including immediate postpartum long-acting reversible contraception (LARC), is a means of overcoming these barriers. The purpose of this document is to educate all providers, including maternal-fetal medicine subspecialists, about the benefits of postpartum contraception, and to advocate for widespread implementation of immediate postpartum LARC placement programs. The following are Society for Maternal-Fetal Medicine recommendations: we recommend that LARC be offered to women at highest risk for adverse health events as a result of a future pregnancy (GRADE 1B); we recommend that obstetric care providers discuss the availability of immediate postpartum LARC with all pregnant women during prenatal care and consult the U.S. Medical Eligibility Criteria for Contraceptive Use guidelines to determine methods most appropriate for specific medical conditions (GRADE 1C); we recommend that women considering immediate postpartum intrauterine device insertion be counseled that although expulsion rates are higher than with delayed insertion, the benefits appear to outweigh the risk of expulsion, as the long-term continuation rates are higher (GRADE 1C); we recommend that obstetric care providers wishing to utilize immediate postpartum LARC obtain training specific to the immediate postpartum period (BEST PRACTICE); for women who desire and are eligible for LARC, we recommend immediate postpartum placement after a high-risk pregnancy over delayed placement due to overall superior efficacy and cost-effectiveness (GRADE 1B); we recommend that women considering immediate postpartum LARC be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation (GRADE 1B); for women who desire and are eligible for LARC, we suggest that early postpartum LARC placement be considered when immediate postpartum LARC placement is not feasible (GRADE 2C); and we recommend that contraceptive counseling programs be patient-centered and provided in a shared decision-making framework to avoid coercion (BEST PRACTICE).

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Postpartum intrauterine devices: clinical and programmatic review

Cited by 17 publications

References 51 publications

Immediate Postpartum Contraception: Intrauterine Device Insertion

Immediate Postpartum Contraception: Intrauterine Device Insertion

Immediate postpartum intrauterine contraceptive device utilization and influencing factors in Addis Ababa public hospitals: a cross-sectional study

Society for Maternal-Fetal Medicine (SMFM) Consult Series #48: Immediate postpartum long-acting reversible contraception for women at high risk for medical complications

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