Immediate postpartum insertion of the norplant contraceptive device.
OBJECTIVE
To determine the safety and efficacy of Norplant (Wyeth-Ayerst Laboratories, Philadelphia, PA) insertion immediately postpartum.


METHODS
Prospective study of 14 women receiving Norplant immediately postpartum compared with controls (n = 6) having a bilateral tubal ligation. Subjects were followed for 3 months postpartum, and data were analyzed by analysis of variance and chi2.


METHODS
Academic Health Sciences Center.


METHODS
Female subjects 18 to 35 years old who had an uncomplicated term pregnancy, normal spontaneous vaginal delivery, and did not breast-feed.


METHODS
A brief interview, physical exam, and blood and urine samples were evaluated during a 12-week postpartum period.


METHODS
Major complaints, serum chemistry panels, hematologic and coagulative measures, serum E2, P, levonorgestrel, PRL, LH, FSH, and urinary estrone-3 conjugates and pregnanediol-3-glucuronide concentrations.


RESULTS
Serum levonorgestrel peaked at approximately 2,000 pg/mL (6,400 pmol/L) during the 1st week after Norplant insertion, declining to approximately 250 pg/mL (800 pmol/L) by the 8th week. Significant differences between Norplant and control groups included bleeding irregularities, headaches, alopecia, and abdominal discomfort. Serum electrolytes, metabolic markers, and blood components were within normal limits. Serum E2, P, and urinary steriod biomarkers indicated that steroid secretion was suppressed severely in the Norplant group compared with controls who exhibited normal postpartum ovarian activity.


CONCLUSIONS
Norplant inserted immediately postpartum appears to be a safe and effective method of contraception. However, the long-term hypoestrogenic state and contraceptive efficacy beyond the 3-month postpartum period as observed in this study are concerns that need further clinical evaluation.
Molland
J R
JR
Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at Odessa, USA.
Morehead
D B
DB
Baldwin
D M
DM
Castracane
V D
VD
Lasley
B
B
Bergquist
C A
CA
D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D004958:Estradiol / Q000097:blood; D004970:Estrone / Q000031:analogs & derivatives / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D016912:Levonorgestrel / Q000097:blood; D049590:Postpartum Period; D011276:Pregnanediol / Q000031:analogs & derivatives / Q000652:urine; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology; D013246:Sterilization, Tubal; D013997:Time Factors
D003271:Contraceptive Agents, Female; D004343:Drug Implants; C022270:pregnanediol-3 alpha-glucuronide; C015856:estrone-3-glucuronide; D004970:Estrone; D011374:Progesterone; D004958:Estradiol; D016912:Levonorgestrel; D011276:Pregnanediol