Use of Norplant during the immediate postpartum period - adapted from the American Journal of Obstet

Date: May 15, 1995

The use of levonorgestrel contraceptive implants (Norplant) during the immediate postpartum period has not been studied in controlled trials. Theoretically, implant use during this time would offer patients the convenience of effective contraception before leaving the hospital. Phemister and associates performed a prospective, randomized clinical trial to determine the impact of contraceptive implants on weight and blood pressure, as well as any side effects, during the postpartum period.

A total of 241 women who had delivered vaginally were randomized to receive levonorgestrel contraceptive implants either within 48 hours of delivery or at the four-to six-week postpartum visit. None of the women were nursing their infants. Patients maintained a daily diary of physical conditions. Baseline hemoglobin, weight and blood pressure were recorded on the second day postpartum and again at the follow-up visit. The two groups did not differ with. regard to demographic variables, postpartum characteristics, or potential confounding variables such as smoking or obstetric history.

Although the two groups differed significantly in terms of total number of days of bleeding, total days of spotting and total days of both bleeding and spotting, hemoglobin levels of the two groups were identical. No significant differences existed between the groups in the incidence of nausea, hirsutism or abnormal hair loss. The two groups did not differ with regard to weight or blood pressure. However, significantly more women who received immediate insertion of the contraceptive reported headache, with 15.1 percent reporting daily frequency of headache. Of the women in the immediate insertion group, 18.9 percent reported three or more days of acne, compared with 6.4 percent of women in the delayed insertion group. A total of 40 percent of the women in both groups reported having sexual intercourse before the follow-up visit.

The findings demonstrate that women receiving contraceptive implants immediately after delivery experience significantly more postpartum bleeding. However, identical hemoglobin levels in both groups indicated that this finding was not clinically significant. Six patients in the delayed insertion group did not receive implants at the follow-up visit because of possible pregnancy; insertion of the implants in the immediate postpartum period would have given these women early access to effective contraception.

The authors conclude that levonorgestrel contraceptive implants are safe when inserted during the immediate postpartum period. The incidence of side effects in these patients does not appear to differ from the incidence of side effects observed in women who are not postpartum. (American Journal of Obstetrics and Gynecology, January 1995, vol. 172, p. 175.)

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