Matthew L Zerden1, Gretchen S Stuart2, Samantha Charm2, Amy Bryant2, Joanne Garrett3, Jessica Morse2. 1. Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA; WakeMed Health & Hospitals, 10,000 Falls of Neuse Rd., Raleigh, NC 27614, USA. Electronic address: mzerden@gmail.com. 2. Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA. 3. Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA; Department of Epidemiology in the Gillings School of Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
Abstract
OBJECTIVE: To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum. STUDY DESIGN: This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14-20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: "Would you recommend Mirena placement at 2 weeks postpartum to a friend?" Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14-20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum). RESULTS: We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations. CONCLUSIONS: LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period. IMPLICATIONS: This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception. Copyright Â
OBJECTIVE: To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum. STUDY DESIGN: This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14-20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: "Would you recommend Mirena placement at 2 weeks postpartum to a friend?" Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14-20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum). RESULTS: We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations. CONCLUSIONS: LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period. IMPLICATIONS: This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception. Copyright Â
Authors: Sarah H Averbach; Yokabed Ermias; Gary Jeng; Kathryn M Curtis; Maura K Whiteman; Erin Berry-Bibee; Denise J Jamieson; Polly A Marchbanks; Naomi K Tepper; Tara C Jatlaoui Journal: Am J Obstet Gynecol Date: 2020-03-03 Impact factor: 8.661
Authors: Kathryn Wouk; Alan C Kinlaw; Narges Farahi; Henry Pfeifer; Brandon Yeatts; Moo Kho Paw; Whitney R Robinson Journal: Womens Health Rep (New Rochelle) Date: 2022-02-07