What is the role of contraception in the care of high-risk women?
When should providers discuss immediate postpartum contraception?
What is the role of long-acting reversible contraception?
|Method||Active ingredient||Failure rate|
|Length of time approved for use by FDA|
|Liletta||52 mg of levonorgestrel||0.1||5 yrs|
|Mirena||52 mg levonorgestrel||0.1||5 yrs|
|Kyleena||19.5 mg of levonorgestrel||0.1||5 yrs|
|Skyla||13.5 mg of levonorgestrel||0.1||3 yrs|
|Nexplanon||Etonogestrel 68 mg||0.2||3 yrs|
Which LARC methods are appropriate for women at high risk for complications?
What are the benefits of immediate postpartum LARC insertion?
What are the contraindications to immediate postpartum LARC?
What are the risks of immediate postpartum IUD placement?
What is the technique for immediate postpartum LARC placement?
What is the evidence supporting the use of immediate postpartum LARC?
Does immediate postpartum LARC placement inhibit breastfeeding?
What are the barriers to immediate postpartum LARC placement?
|Patient misconceptions about safety||Integrated antepartum contraceptive counseling|
|Outpatient provider time constraints||Dedicated contraceptive counseling appointment|
|Inpatient staff not supportive||In-service education sessions|
|Inpatient LARC devices not available||Prenatal assistance with device procurement|
|Inpatient providers not experienced with placement||Dedicated immediate LARC placement teams In-service training of all providers|
|Inpatient LARC placement not permitted||Early postpartum LARC placement after hospital discharge|
|Insurance and payment barriers||Advocacy and education for Medicaid and private insurers|
Health-care system issues
What is “early postpartum” LARC placement?
What is the MFM subspecialist’s role in implementing immediate postpartum LARC programs?
What steps can be used to increase access to immediate postpartum LARC?
Using long-acting reversible contraception right after childbirth 2018.
Dedicated LARC placement teams
Partnership with hospital systems
What are the barriers to LARC placement at the postpartum visit?
|1||We recommend that LARC be offered to women at highest risk for adverse health events as a result of a future pregnancy.||1B|
Strong recommendation, moderate-quality evidence
|2||We recommend that obstetric care providers discuss the availability of immediate postpartum LARC with all pregnant women during prenatal care and consult the US MEC guidelines to determine methods most appropriate for specific medical conditions.||1C|
Strong recommendation, low-quality evidence
|3||We recommend that women considering immediate postpartum IUD 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.||1C|
Strong recommendation, low-quality evidence
|4||We recommend that obstetric care providers wishing to utilize immediate postpartum LARC obtain training specific to the immediate postpartum period.||Best Practice|
|5||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.||1B|
Strong recommendation, moderate-quality evidence
|6||We recommend that women considering immediate postpartum LARC be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation.||1B|
Strong recommendation, moderate-quality evidence
|7||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.||2C|
Weak recommendation, low-quality evidence
|8||We recommend that contraceptive counseling programs be patient-centered and provided in a shared decision-making framework to avoid coercion.||Best Practice|
|The content of this document reflects the national and international guidelines related to long-acting reversible contraception|
|Organization||Title||Year of publication|
|American College of Obstetricians and Gynecologists||Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception||2016|
|Centers for Disease Control and Prevention||U.S. Medical Eligibility Criteria for Contraceptive Use||2016|
|American College of Obstetricians and Gynecologists||Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.||2017|
|Society of Family Planning||Society of Family Planning Guidelines: Postplacental Insertion of Intrauterine Devices||2017|
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