title: The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding.
abstract: OBJECTIVE
  To determine whether the discontinuation rate of the etonogestrel contraceptive implant due to irregular vaginal bleeding among women with immediate postpartum insertion is increased compared to delayed postpartum and interval placement.
  
  
  METHODS
  This retrospective cohort study compared women who underwent immediate postpartum etonogestrel contraceptive implant insertion (within 96 h of delivery) to delayed postpartum (6 to 12 weeks postpartum) and interval insertion between January 2008 and December 2010. Charts were reviewed for date and reason for removal. A chi-squared test was used to compare discontinuation due to bleeding between cohorts. Baseline characteristics predictive of implant removal were evaluated by simple logistic regression.
  
  
  RESULTS
  There were 259 women in the immediate postpartum group, 49 in the delayed postpartum group and 106 in the interval group. Average age at insertion was 22.6 (±5.5) years. Overall, 19.3% of women in the immediate postpartum group requested removal due to irregular bleeding compared to 18.4% in the delayed postpartum group [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.48-2.33] and 20.8% in the interval group (OR 0.91, 95% CI 0.52-1.60). There was no difference between groups in premature removal rates for any side effect. There were no sociodemographic or clinical characteristics predictive of removal in any group.
  
  
  CONCLUSIONS
  One-fifth of etonogestrel contraceptive implant users requested premature removal due to irregular bleeding. Immediate postpartum implant insertion does not lead to increased removal rates and may help reduce unintended pregnancy. Mechanisms to help women manage irregular bleeding due to the implant are needed.
  
  
  CONCLUSIONS
  Immediate postpartum insertion of the etonogestrel contraceptive implant does not lead to increased removal rates due to vaginal bleeding compared to delayed postpartum or interval insertion. Immediate postpartum implant insertion may increase uptake of long-acting reversible contraception and help reduce short interpregnancy intervals and unintended pregnancy.
authors: David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: lireland@mednet.ucla.edu.
authors: Luu Doan
authors: LD
authors: Ireland
authors: The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.
authors: Vinita
authors: V
authors: Goyal
authors: The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.
authors: Christina A
authors: CA
authors: Raker
authors: The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.
authors: Anne
authors: A
authors: Murray
authors: The Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI, USA.
authors: Rebecca H
authors: RH
authors: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D017135:Desogestrel / Q000009:adverse effects*; D020878:Device Removal; D004343:Drug Implants / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008499:Medical Records; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011181:Postnatal Care; D049590:Postpartum Period; D012189:Retrospective Studies; D012237:Rhode Island; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel
keywords: Etonogestrel; Implanon; Implant; Nexplanon; Postpartum contraception