Current Guidelines: Immediate Postpartum Long-Acting Reversible Contraception
Long acting reversible contraception (LARC) has an effectiveness of greater than 99%. Placement of LARC in the immediate postpartum period is a safe and effective way to prevent unintended pregnancy, especially given 70% of pregnancies in the first year postpartum are unintended. Women should be counseled prenatally about benefits and risks of immediate postpartum LARC.
No additional risks or contraindications
Intrauterine Devices (IUDs)
Insert within 10 minutes of placenta delivery in both vaginal and cesarean births
Following vaginal delivery
Remove IUD from the inserter
Place with a ring or manually at the fundus, with the strings cut to 10 cm
During a cesarean delivery
Place at the fundus after initiating closure of the uterine incision
The string is gently placed manually or with ringed forceps in the cervix
Hysterotomy is then closed
Patients should be counseled on increased risk of expulsion compared with interval IUD insertion, including unrecognized expulsion
Expulsion of IUD can be as high as 10% to 27%
Women should be counseled about the safety and effectiveness of immediate postpartum LARC
Long term data show no effect of progestin-only contraceptives impacting breastfeeding
Patients should be counseled on increased risk of expulsion
If immediate postpartum LARC is not chosen, women should be offered and able to receive LARC during postpartum visit
OBGYNs and institutions should undertake systems-based steps to facilitate placement of LARC after vaginal and cesarean births
Additional resources available (see ACOG Initiative in ‘Learn More – Primary Resources’ below)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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