title: Immediate postpartum etonogestrel implant: a contraception option with long-term continuation.
abstract: OBJECTIVE
  To determine 3-year continuation rates of the etonogestrel contraceptive implant when inserted immediately postpartum and to identify factors associated with discontinuation.
  
  
  METHODS
  A retrospective cohort of 262 women who had the contraceptive implant inserted immediately postpartum between January 2008 and March 2009 was collected from electronic medical records. Continuation rates at 1, 2 and 3 years were estimated. Adverse effects leading to removal of the implant were recorded. Multivariable Cox proportional hazard models were performed to determine factors associated with early discontinuation.
  
  
  RESULTS
  Large subsets of the study patients were adolescent (28.2%) and multigravid (71.8%) and presented for fewer than six prenatal visits (38.5%). Follow-up rates were over 70% at each of the 3 years. Adolescents and women with fewer than six prenatal visits had the highest continuation rates at 1 year, 94.5% and 94.1%, respectively. The cumulative implant continuation rate after 3 years was 66.3%. Multivariable analysis indicated that having six or more prenatal care visits was the only independent predictor of early discontinuation, with a hazard ratio of 3.1 (p=0.04) and 1.8 (p=<0.01) at 1 and 3 years, respectively. The most commonly reported reasons for early removal were abnormal bleeding (41.2%) and weight gain (19.1%).
  
  
  CONCLUSIONS
  The contraceptive implant has high continuation over its 3-year lifespan when inserted immediately postpartum. Continuation rates were highest among populations most vulnerable to rapid repeat and unintended pregnancies.
  
  
  CONCLUSIONS
  The etonogestrel implant, when placed immediately postpartum for contraception, can have high continuation rates of use for up to 3 years duration.
authors.affiliation: Hospital of the University of Pennsylvania. Electronic address: susan.wilson@uphs.upenn.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilson
authors.affiliation: Hospital of the University of Pennsylvania.
authors.forename: Corina
authors.initials: C
authors.lastname: Tennant
authors.affiliation: Department of Biostatistics and Epidemiology & Center for Clinical Epidemiology and Biostatistics (CCEB), Perelman School of Medicine, University of Pennsylvania.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Hospital of the University of Pennsylvania.
authors.forename: Courtney
authors.initials: C
authors.lastname: Schreiber
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; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D059012:Lost to Follow-Up; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D015143:Philadelphia; D011181:Postnatal Care; D049590:Postpartum Period; D011295:Prenatal Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; 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: Immediate postpartum contraception; Long-acting reversible contraception; Rapid repeat pregnancy; Subdermal implant