title: Effects of the etonogestrel-releasing contraceptive implant inserted immediately postpartum on maternal hemostasis: a randomized controlled trial.
abstract: BACKGROUND
  The puerperium is the period of highest risk for thrombosis during a woman's reproductive life and it is an important time for initiating an effective contraceptive method in order to increase intergestational interval. Thus, the objective of the present study was to evaluated the effects of the etonogestrel (ENG)-releasing contraceptive implant inserted immediately postpartum on maternal hemostasis markers during the first six weeks of delivery.
  
  
  METHODS
  Forty healthy women aged 18 to 35 years-old were randomized to receive either the ENG-releasing implant 24-48 h after delivery (implant group; n=20) or nothing (control group) until the sixth postpartum week. Blood samples were collected at 24-48 h and at 6 weeks after delivery, and hemostatic variables, including fibrinogen, coagulation factors, protein C, free protein S, antithrombin, α2-antiplasmin, plasminogen activator inhibitor 1, thrombin-antithrombin complex (TAT), prothrombin fragment (PF)1+2, and D-dimers, as well as normalized activated protein C sensitivity ratio (nAPCsr), thrombin time, activated partial thromboplastin time, and prothrombin time were evaluated.
  
  
  RESULTS
  Insertion of the ENG-releasing contraceptive implant did not change the physiological reduction in overall coagulation (TAT and PF1+2) and fibrinolysis (D-dimer) markers, or nAPCsr. Reductions in factors II, VII, X and fibrinogen and increases in factor V were greater in the control than in the implant group. Clotting factors remained within normal limits throughout the study.
  
  
  CONCLUSIONS
  The ENG-releasing contraceptive implant inserted immediately postpartum did not have negative effects on physiological variations of the hemostatic system during the first 6 weeks postpartum.
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto School of Medicine, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: Milena B
authors.initials: MB
authors.lastname: Brito
authors.forename: Rui A
authors.initials: RA
authors.lastname: Ferriani
authors.forename: Joost C M
authors.initials: JC
authors.lastname: Meijers
authors.forename: Andréa A
authors.initials: AA
authors.lastname: Garcia
authors.forename: Silvana M
authors.initials: SM
authors.lastname: Quintana
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Silva de Sá
authors.forename: Carolina S
authors.initials: CS
authors.lastname: Vieira
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation / Q000187:drug effects*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D017135:Desogestrel / Q000008:administration & dosage* / Q000009:adverse effects*; D004343:Drug Implants; D005260:Female; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D049590:Postpartum Period / Q000097:blood / Q000187:drug effects; D011644:Puerperal Disorders / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control*; D013927:Thrombosis / Q000097:blood* / Q000139:chemically induced / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel