title: A prospective cohort study of early postpartum etonogestrel implant (Implanon®) use and its effect on duration of lochia.
abstract: BACKGROUND
  Etonogestrel (ENG) implants (Implanon(®)/Nexplanon(®)/Implanon NXT(®)) are employed as contraception in early postpartum patients. Follow-up is often not conducted by the hospital prescriber. Little is known about duration of lochia, in a modern setting, and even less is known about the effect of ENG implants on lochia.
  
  
  OBJECTIVE
  To determine if early postpartum (pre-discharge) insertion of Implanon for contraception was associated with a significant difference in duration of lochia. To record the number of patients who went on to have their Implanon removed during the study period and the reasons for removal.
  
  
  METHODS
  Prospective cohort study of 152 postpartum patients from a tertiary maternity unit in Hobart, Tasmania, Australia. The treatment group was women requesting Implanon prior to discharge. Controls were recruited from the same unit over the same time period, with the aim to match for birth weight and parity. Information was collected during face-to-face interviews or via telephone contact. Multivariate survival analysis was used to investigate lochia duration.
  
  
  RESULTS
  There were 73 controls and 79 women who had early postpartum Implanon inserted. Fourteen (17.7%) patients in the treatment group had their Implanon removed during the postpartum study period. In all of these cases the reason for removal was bleeding disturbance - prolonged or intermittent vaginal bleeding beyond 50 days postpartum. There was no significant difference in duration of lochia between the groups [median predicted duration 25 days (95% CI 22-27) in controls and 24 days (95% CI 21-26) in the treatment group].
  
  
  CONCLUSIONS
  Early postpartum insertion of Implanon for contraception was not associated with a statistically or clinically significant difference in duration of lochia.
authors.affiliation: Accredited Registrar, Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Kim C
authors.initials: KC
authors.lastname: Dobromilsky
authors.affiliation: Research Fellow, Rural Clinical School, The University of Tasmania, Burnie, Tasmania, Australia.
authors.forename: Penny L
authors.initials: PL
authors.lastname: Allen
authors.affiliation: Staff Specialist, Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Raymond
authors.affiliation: Resident Medical Officer, Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Bhavna
authors.initials: B
authors.lastname: Maindiratta
keywords: Implanon; implants; lochia; long-acting reversible contraception; postpartum