One analysis found similar discontinuation rates of the implant for irregular bleeding among women who underwent immediate postpartum insertion, insertion at 6–12 weeks postpartum, and interval insertion 139. Results from pooled Phase III studies of ulipristal acetate for emergency contraception. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, Thaithumyanon P, Punnahitananda S, Tosukhowong P, et al. The LNG-20 IUD is more effective than oral medications for treating heavy menstrual bleeding, including in women who do not use it for contraception 135 136. Intrauterine devices and pelvic inflammatory disease: an international perspective. The effects of Implanon on menstrual bleeding patterns. In a randomized trial of immediate versus delayed IUD insertion after first-trimester uterine aspiration, no difference was noted in the 6-month rate of expulsion (5% in the immediate group compared with 2.7% in the delayed group), but 6-month use rates in the immediate group (92.3%) were higher compared with the delayed insertion group (76.6%; P＜.001) because many were never inserted in the interval group 74. Women who have not undergone routine screening for STIs or who are identified to be at increased risk of STIs based on patient history should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. Naproxen or estradiol for bleeding and spotting with the levonorgestrel intrauterine system: a randomized controlled trial. Concerns remain that hormonal methods, including the LNG-IUD and the contraceptive implant, could have a negative effect on breastfeeding outcomes. La resucitación fetal intraútero o reanimación intrauterina constituye un conjunto de técnicas no operatorias aplicadas a la madre con el objetivo de mejorar la oxigenación fetal, revirtiendo la causa del deterioro del estado fetal, determinado por un patrón no tranquilizador de frecuencia cardiaca fetal (FCF). The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Natavio MF, Taylor D, Lewis RA, Blumenthal P,Felix JC, Melamed A, et al. Kapp N, Abitbol JL, Mathe H, Scherrer B, Guillard H, Gainer E, et al. In a study of IUD continuation at 6 months postpartum among 112 women randomized to immediate IUD insertion at cesarean delivery versus delayed insertion (6 weeks), significantly more women in the immediate postpartum placement group continued the IUD (83% versus 64%, relative risk [RR], 1.3; CI, 1.02–1.66). definición Reanimación Intrauterina o Resucitación Fetal Intraútero: MANIOBRAS no operatorias que se realizan ante un registro CTG ANORMAL con el objetivo de restaurar el bienestar fetal. In women who are breastfeeding, delayed insertion (ie, beyond 30 days postpartum), is classified as US MEC Category 1 47. Intrauterine devices may be offered to women with a history of ectopic pregnancies. The following recommendations are based primarily on consensus and expert opinion (Level C): Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. Two studies have examined continuation of the contraceptive implant in women who received postabortion placement compared with those who received interval placement. Goodman S, Hendlish SK, Reeves MF, Foster-Rosales A. Use of LARC increased substantially in nulliparous women, from 2.1% in 2009 to 5.9% in 2012 4. ACOG Practice Bulletin No. Initial guidance is to determine the location of the pregnancy because women who become pregnant with an IUD in place are more likely to have an ectopic pregnancy 48. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. During cervical ablation or excision procedures, IUD strings may be tucked into the cervical canal if possible, or cut. Reafirmado 2017. . All rights reserved. By reading this page you agree to ACOG's Terms and Conditions. Antibiotic prophylaxis for gynecologic procedures. Most women continue to ovulate while using the LNG-IUDs 21. The expulsion rate is between 2% and 10% during the first year 12. Insertion of the contraceptive implant on the same day as first-trimester or second-trimester induced or spontaneous abortion should be offered routinely as a safe and effective contraceptive option. American College of Obstetricians and Gynecologists. Neque porro quisquam est, qui dolorem ipsum quia dolor sit amet, consectetur, adipisci velit. Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods. 16 Diciembre 2019. Weisberg E, Hickey M, Palmer D, O’Connor V, Salamonsen LA, Findlay JK, et al. The increase in LARC use was accompanied by a 29% decrease in birth rates and a 34% decrease in abortion rates among teenagers. The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement. Location may be determined for both implants using high-frequency ultrasonography or magnetic resonance imaging, and for the barium-containing implant 34 using X-ray, computerized tomography, or fluoroscopy 3. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. A meta-analysis of 16 case–control studies concluded that IUDs do not increase the risk of ectopic pregnancy because they prevent pregnancy so effectively 148. Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists’ knowledge and attitudes. Appropriate follow up to detect potential adverse events after initiation of select contraceptive methods: a systematic review. The efficacy of the copper IUD is not affected by body weight 101 106. The following recommendations are based on good and consistent scientific evidence (Level A): Insertion of an IUD immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option. The hospital setting offers convenience for the patient and the health care provider. However, bleeding resumed for most women within 10 days after stopping treatment 141. This Practice Bulletin was developed by the Committee on Practice Bulletins—Gynecology and the Long-Acting Reversible Contraception Work Group in collaboration with Eve Espey, MD, MPH; and Lisa Hofler, MD, MPH, MBA. In another study, no pregnancies were reported among 102 study participants who used the etonogestrel implant for 5 years 110. • 2.- Variabilidad entre 5-25 lpm. Madden T, McNicholas C, Zhao Q, Secura GM, Eisenberg DL, Peipert JF. Because of the high risk of reinfection, the CDC recommends repeat testing at 3 months for women who have been treated for gonorrhea or chlamydial infection 115. Highlights of prescribing information . 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods 3. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc.; 2016. In a study of 1,963 women who underwent insertion of a copper IUD for emergency contraception, including 95 nulliparous women, the pregnancy rate was 0.23% 107. Association of age and parity with intrauterine device expulsion. II-1 Evidence obtained from well-designed controlled trials without randomization. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. Nelson A, Apter D, Hauck B, Schmelter T, Rybowski S, Rosen K, et al. Etonogestrel is the active metabolite of desogestrel. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. Anestesia en obstetricia. The most common adverse effects reported are heavy menstrual bleeding and pain 16. Blumenthal PD, Gemzell-Danielsson K, Marintcheva-Petrova M. Tolerability and clinical safety of Implanon. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods 3. Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial. McNicholas C, Madden T, Secura G, Peipert JF. Consideration should be given to use of a copper IUD as an alternative to oral emergency contraception for all women, but particularly for obese women 102. A noncontraceptive benefit of the implant is a significant decrease in dysmenorrhea 44 137 138. Copyright November 2017 by the American College of Obstetricians and Gynecologists. intervención oportuna de resucitación intrauterina o parto, el objetivo secundario es evitar el daño neurológico en la medida de lo posible. Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. J Midwifery Womens Health 2007; 52: 229. The copper T380A IUD is a T-shaped device of polyethylene wrapped with copper wire around the stem and arms. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. Irvine (CA): Allergan USA, Inc.; 2017. Godfrey EM, Folger SG, Jeng G, Jamieson DJ, Curtis KM. American College of Obstetricians and Gynecologists. Peipert JF, Madden T, Allsworth JE, Secura GM. Pregnancy outcomes with an IUD in situ: a systematic review. Each of the LARC methods affect menstrual bleeding differently. Five IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs). After implant insertion, changes in menstrual bleeding patterns are common and include amenorrhea or infrequent, frequent, or prolonged bleeding. Obstetric care providers should discuss the limitations and concerns associated with the use of hormonal LARC within the context of each woman’s desire to breastfeed and her risk of unplanned pregnancy so that she can make an autonomous and informed decision 99. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. Reanimación Fetal Intrauterina Solicitá tu constancia con valor curricular Se debate la utilidad de la hiperoxigenación materna y la tocolisis aguda. ¡Hola Medicos! In the interval group, 39% did not obtain the IUD, 25% did not return for the postpartum visit, and 14% either declined the IUD or had an unsuccessful insertion 92. American College of Obstetricians and Gynecologists. Steroidal contraceptives and bone fractures in women: evidence from observational studies. U.S. selected practice recommendations for contraceptive use, 2016. Grentzer JM, Peipert JF, Zhao Q, McNicholas C, Secura GM, Madden T. Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion. Therefore, IUD removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal 48. National data suggest that LARC use by adolescents remains much lower than in other age groups, although discontinuation for dissatisfaction is no higher in this group than in others 4. Mark A, Sonalkar S, Borgatta L. One-year continuation of the etonogestrel contraceptive implant in women with postabortion or interval placement. Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device? Case–control studies of ectopic pregnancy associated with IUD use indicate an increased relative risk; however, prospective data from randomized controlled trials describe a low absolute risk, a measure that is more useful clinically 149 150. The etonogestrel implant is effective for at least 4 years.One large study reported no pregnancies among 204 women using the etonogestrel implant for 5 years 113. Deans EI, Grimes DA. Merck & Co., Inc: Whitehouse Station, (NJ); 2016. Women who received immediate postabortion implant placement did not have a statistically significant change in risk of discontinuation at 1 year compared with women who received interval placement (unadjusted hazard ratio, 1.79; 95% CI, 0.86–3.96). Continuation of the etonogestrel implant in women undergoing immediate postabortion placement. Other reported adverse effects include gastrointestinal difficulties, headaches, breast pain, and vaginitis 40 41 42. Young age, nulliparity, and continuation of long-acting reversible contraceptive methods. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Clinical challenges of long-acting reversible contraceptive methods. Intrauterine device insertion should not be delayed while awaiting test results. Data on implant use in adolescents and nulliparous women are limited, although the CHOICE study demonstrated high uptake of IUDs and implants by adolescents when these contraceptive methods are made readily available 51. A review of 18 studies of the LNG-20 IUD used for the treatment of heavy menstrual bleeding found a menstrual blood loss reduction of 79–97% 133. These risks are reduced, but not eliminated, with the removal of the IUD 145. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. La restricción del crecimiento intrauterino (RCIU) es una de las principales causas de morbimortalidad perinatal por las complicaciones que conlleva, y a largo plazo debido al aumento de riesgo de enfermedades metabólicas en la vida extrauterina. The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement 47 48 102. Release characteristics, ovarian activity and menstrual bleeding pattern with a single contraceptive implant releasing 3-ketodesogestrel. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Revisamos la evidencia científica relevante sobre la utilidad y seguridad de estas dos maniobras. For additional information on the management of pregnancy with an IUD in place, see Committee Opinion No. Bleeding patterns with the levonorgestrel-releasing intrauterine system when used for heavy menstrual bleeding in women without structural pelvic pathology: a pooled analysis of randomized controlled studies. Darney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Frequent bleeding was found in 6.7% of the reference periods and prolonged bleeding in 17.7% of the reference periods. Many postpartum women who choose the IUD undergo insertion at the postpartum visit (delayed postpartum insertion). A recent cost-effectiveness analysis from the public payer perspective determined that LARC use becomes cost neutral within 3 years of initiation when compared with use of short-acting methods 13. In addition, same day insertion eliminates the need for an additional visit that would not be routinely scheduled for postabortion follow-up. Insertion complications include pain, slight bleeding, hematoma formation, deep or incorrect insertion, and unrecognized noninsertion. Only 11.3% of patients discontinued the implant because of bleeding irregularities, mainly because of frequent and prolonged bleeding. The US MEC classifies immediate postpartum IUD insertion as Category 1 except in the case of immediate postpartum LNG-IUD insertion in breastfeeding women, which is MEC Category 2, mainly based on conflicting results in studies of this IUD Effect on Breastfeeding 47. Raymond EG, Weaver MA, Tan YL, Louie KS, Bousieguez M, Lugo-Hernandez EM, et al. U.S. medical eligibility criteria for contraceptive use, 2016. Actinomyces on cytology is considered an incidental finding. The cumulative pregnancy rate is 0.33 per 100 women-years of use 24. Bergin A, Tristan S, Terplan M, Gilliam ML, Whitaker AK. Risk of abortion failure was low and similar between groups; the group that received the implant at the time of mifepristone was more satisfied with their assignment than the later start group 77. Routine antibiotic prophylaxis is not recommended before IUD insertion 48 122. In a prospective cohort study of 105 women, 53 received an implant immediately postabortion and 52 received the implant at a family planning visit 78. Long-acting reversible contraception: implants and intrauterine devices. U.S. medical eligibility criteria for contraceptive use, 2016. Despite the higher expulsion rate of immediate postpartum IUD placement over interval placement, cost-benefit analysis data strongly suggest the superiority of immediate placement in reduction of unintended pregnancy, especially for women at greatest risk of not attending the postpartum follow-up visit 86. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Immediate insertion of the copper IUD or LNG-IUD after a first-trimester induced or spontaneous abortion is classified as Category 1 in the US MEC and Category 2 for second-trimester postabortion insertion because of a higher risk of expulsion compared with insertion after a first-trimester abortion 47. Women with an undiagnosed STI at the time of IUD insertion are more likely to develop pelvic inflammatory disease (PID) than women without an STI 118 119; however, even in women with an STI, the risk appears low 120 121. Can we identify women at risk of pregnancy despite using emergency contraception? Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women. A randomized controlled trial of 156 women who received copper IUD placement either 1 week after (immediate group) or 4–6 weeks after (delayed group) medication-induced abortion reported comparable expulsion rates among the immediate and delayed groups, with no identified cases of serious infection, uterine perforation, or hemorrhage 76. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place. Grimes DA, Hubacher D, Lopez LM, Schulz KF. However, very few women were followed for more than 12 years of copper IUD use 109. Optimally, women should be counseled prenatally about the option of immediate postpartum LARC. Overall, the mean number of spotting or bleeding episodes was less than the number reported in normal menstrual cycles. Tyler CP, Whiteman MK, Zapata LB, Curtis KM, Hillis SD, Marchbanks PA. Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Five IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs). 186. Additional contraceptive efficacy may be conferred by the implant’s thickening of cervical mucus 36 37 and alteration of the endometrial lining 37 38. The US MEC assigns a Category 2 rating for IUD continuation in a woman found to have a chlamydial infection or gonorrhea and then treated with appropriate antibiotic therapy 47. When is an appropriate time to insert an intrauterine device or contraceptive implant? Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Continuing a pregnancy with a retained LNG-IUD raises the theoretical concern about the effect of fetal exposure to the hormone. Most of these insertions (86%) were performed by advanced practice clinicians; complications were rare, and no perforations were reported. The US MEC classifies IUD use in nulliparous women and in adolescents (aged 20 years or younger) as Category 2, (advantages outweigh the risks) 47. Cheng L, Che Y, Gülmezoglu AM. Extended-use studies are ongoing for the LNG-18.6, and data are not yet available for the newer devices such as the LNG-19.5 IUD and the LNG-13.5 IUD. Immediate versus delayed IUD insertion after uterine aspiration. A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Steenland MW, Zapata LB, Brahmi D, Marchbanks PA, Curtis KM. In women with a history of ectopic pregnancy, the US MEC classifies use of copper and LNG-IUDs and the contraceptive implant as Category 1 47. Practice Bulletin No. Zheng SR, Zheng HM, Qian SZ, Sang GW, Kaper RF. A) división anormal de la vagina B) secundaria a canalización incompleta o parcial de la placa vaginal C) anomalía de la fusión caudal D) aplasia mülleriana E) exposición intrauterina a hormonas androgénicas F) desarrollo anormal del pronefros en las semanas 8 a 10 después de la ovulación G) infección viral materna durante el primer . Although the reduction in unintended pregnancy is multifactorial, increased use of LARC likely has contributed 6 7. Ilse JR, Greenberg HL, Bennett DD. The use of an IUD or implant does not increase the absolute risk of ectopic pregnancy, thus intrauterine devices may be offered to women with a history of ectopic pregnancy. Fertility returns rapidly after discontinuation of the implant 42. Committee Opinion No. The LNG-20 IUD is FDA-approved for the treatment of heavy bleeding in women who use the method for contraception, and it is used widely for this indication 17. A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Obese women may have higher failure rates with the use of levonorgestrel and ulipristal oral emergency contraception than women of normal body weight 103 104 105. Heinemann K, Reed S, Moehner S, Minh TD. Intrauterine device and contraceptive implant use in women with a variety of characteristics and medical conditions are addressed in the US MEC, which has been endorsed by the American College of Obstetricians and Gynecologists (ACOG). Available at: Graesslin O, Korver T. The contraceptive efficacy of Implanon: a review of clinical trials and marketing experience. Rosa Elia Rebollo Manrique CMI Toluca Octubre 2013. Committee Opinion No. Obstet Gynecol 2004;104:869-83. In the contraceptive CHOICE study, there were two pregnancies among 496 women using the LNG-20 IUD for at least 1 year beyond its FDA-approved 5-year duration of use, for a failure rate of 0.25 per 100 women-years in the sixth year of use and 0.43 per 100 women in the seventh year of use 110. A positive test result for chlamydial infection or gonorrhea that was detected after IUD insertion should be treated, and the IUD may be left in place 48. Similar to findings in the CHOICE study 10, during the Colorado Family Planning Initiative, LARC use increased from 5% to 19% among low-income teenagers (aged 15–19 years) and young women (aged 20–24 years). The MEDLINE database, the Cochrane Library, and ACOG’s own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 2000 and June 2017. Available at. Ricketts S, Klingler G, Schwalberg R. Game change in Colorado: widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women. Celen S, Sucak A, Yildiz Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. In the Contraceptive CHOICE research project, a prospective cohort of 9,256 women aged 14–45 years were offered their choice of contraceptive method without charge 6. Hayes JL, Cwiak C, Goedken P, Zieman M. A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device. Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant. Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. A randomized multicenter study comparing the efficacy and bleeding pattern of a single-rod (Implanon) and a six-capsule (Norplant) hormonal contraceptive implant. Both the UK Faculty of Family Planning and the Standards and Guidelines of the Planned Parenthood Federation of America recommend continued IUD use and patient education about the small risk of actinomycosis 144. Obstet Gynecol 2017;130:e251–69. Interval insertion refers to the placement of an IUD or contraceptive implant that occurs at any time during the menstrual cycle and is not in relationship to the end of a pregnancy. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center. Insertion of an IUD immediately after confirmed completion of first-trimester medication-induced abortion should be offered routinely as a safe and effective contraceptive option. Fueron analizados los datos de 135 gestantes con diagnóstico de riesgo de pérdida del bienestar fetal a través de la interpretación de las cardiotocografías, analizándose características sociodemográficas, condiciones clínicas como polisistolia, patologías maternas y fetales, utilización de medidas de reanimación intrauterina, aplicación e interpretación de los criterios de ACOG, puntuación APGAR, los hallazgos transoperatorios y la forma de inicio del trabajo de parto. Decreased bleeding has been reported with insertion of the second consecutive LNG-20 IUD compared with first-time use 130. An advantage of the copper IUD is its lack of hormonal content, avoiding any theoretical effect on breastfeeding. The LNG-19.5 IUD is FDA approved for up to 5 years of use with a cumulative pregnancy rate of 0.31 per 100 women-years 19 24. Personal médico capacitado en reanimación neonatal Carro rojo para atención específica de recién nacidos Cuna radiante Fuente de oxígeno y aire *Verificar que todo esté en buen estado y funcional CUADRO CLÍNICO Los datos clínicos que sugieren que un recién nacido estuvo expuesto a uno o varios eventos de asfixia son: Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy: a randomized controlled trial. Abraham M, Zhao Q, Peipert JF. Three-year continuation of reversible contraception. The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. American College of Obstetricians and Gynecologists. En Chile los métodos que se usan en forma rutinaria son la monitorización fetal electrónica de los LCF y dinámica uterina (MFE) y la auscultación intermitente de los LCF (AI). American College of Obstetricians and Gynecologists. Levi EE, Stuart GS, Zerden ML, Garrett JM, Bryant AG. Insertion of an IUD immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option 73 74. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc. ; 2017. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility—follow-up after participation in a randomized clinical trial. Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device. Interventions for emergency contraception. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods, Perspect Sex Reprod Health 2014;46:125–32, https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf, https://www.allergan.com/assets/pdf/lilettashi_pi, http://labeling.bayerhealthcare.com/html/products/pi/Kyleena_PI.pdf, http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf, Eur J Contracept Reprod Health Care 2015;20:57–63, http://www.merck.com/product/usa/pi_circulars/i/implanon/implanon_pi.pdf, http://www.merck.com/product/usa/pi_circulars/n/nexplanon/nexplanon_pi.pdf, Eur J Contracept Reprod Health Care 2008;13 Suppl 1:4–12, Eur J Contracept Reprod Health Care 2008;13(suppl 1):29–36, Int Urogynecol J Pelvic Floor Dysfunct 2005;16:263–7, Am J Obstet Gynecol 2017;216:586.e1–586.e6, Infect Dis Obstet Gynecol 2012;2012:717163, Eur J Obstet Gynecol Reprod Biol 2006;125:9–28, Eur J Contracept Reprod Health Care 2008;13 Suppl 1:13–28, Eur J Contracept Reprod Health Care 2003;8:17–20, Etonogestrel single-rod contraceptive implant, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. For women who have an intrauterine pregnancy, there are risks associated with removing and retaining the IUD. The reduction in menstrual bleeding is less pronounced with IUDs that contain lower doses of levonorgestrel; women using these lower-dose IUDs experience more bleeding or spotting days on average than women using the LNG-20 IUD with higher doses of levonorgestrel, although overall bleeding patterns are similar and well tolerated 25. Fox MC, Oat-Judge J, Severson K, Jamshidi RM, Singh RH, McDonald-Mosley R, et al. Available at: Liletta® (levonorgestrel-releasing intrauterine system). Immediate IUD insertion is contraindicated after septic abortion 47. Clinicians traditionally have inserted the IUD during menses; however, a systematic review concluded that outcomes of continuation, effectiveness, and safety were no better when a copper IUD was inserted during menses and that requiring a woman to be menstruating is an obstacle to access 66. The available evidence supports that the copper IUD does not disrupt pregnancy 15 and is not an abortifacient. Westhoff C. IUDs and colonization or infection with actinomyces. Selected Practice Recommendations for Contraceptive Use (available at www.cdc.gov/reproductivehealth/contraception/usspr.htm, which also has been endorsed by ACOG 48. Several types of LNG-IUDs are currently available in the United States; all are T-shaped and include a polydimethylsiloxane sleeve that contains levonorgestrel on the stem. Ganer H, Levy A, Ohel I, Sheiner E. Pregnancy outcome in women with an intrauterine contraceptive device. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:Level A—Recommendations are based on good and consistent scientific evidence.Level B—Recommendations are based on limited or inconsistent scientific evidence.Level C—Recommendations are based primarily on consensus and expert opinion.Copyright November 2017 by the American College of Obstetricians and Gynecologists. The CDC also has developed guidance on common contraceptive practices, such as appropriate initiation of methods, when women may rely on the method, and follow-up after initiation. The updated implant, introduced in the United States in 2011 34 is radio-opaque and is easily visualized on X-ray. Jackson E, Glasier A. (Level III) [PubMed] [Obstetrics &amp; Gynecology] A; Machin A. Velamentous cord insertion in monochori- onic twin gestation. Levonorgestrel-releasing intrauterine system and new-onset acne. All health care providers who perform implant insertions and removals must receive training that is provided through the manufacturer. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place 3 144. However, the risks of adverse pregnancy outcome are greater in the setting of IUD retention 145. Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. The following recommendations are based on limited or inconsistent scientific evidence (Level B): Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. Adolescents and long-acting reversible contraception: implants and intrauterine devices. Are intrauterine devices and implants appropriate for nulliparous women and adolescents? Given that amenorrhea may be a secondary effect of the LNG-IUD and the contraceptive implant, and that no well-validated tool exists to confirm menopause, it is reasonable to continue these methods until age 50–55 years, which is when most women in North America will reach natural menopause 48. Multiplegestation: complicated twin, triplet, and high- order multifetal pregnancy. Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. El esperma que se lavó y se concentró se coloca directamente en el útero cerca de la fecha en la que el ovario libera uno o más óvulos para la fecundación. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Is routine screening for sexually transmitted infections required before insertion of an intrauterine device? Actualmente denominado estado fetal no tranquilizador. In a meta-analysis of all known randomized controlled trials, antibiotic prophylaxis at the time of IUD insertion did not decrease the risk of PID nor did it reduce the likelihood of IUD removal within the first 3 months 123. The LNG-IUD has been found to be effective for noncontraceptive indications in menopausal women, such as the progestin component of hormone therapy 151. Practice Bulletin No. Similar to all women, adolescents and nulliparous women are more likely to choose an LNG-IUD rather than a copper IUD 57 61. Shimoni N, Davis A, Ramos ME, Rosario L, WesthoffC. ABSTRACT: Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. In the CHOICE study, 141 women received an immediate postabortion implant, whereas 935 women had interval placement 79. Lethaby A, Hussain M, Rishworth JR, Rees MC. In a study of more than 60,000 women who received delayed postpartum IUD insertion, the risk of uterine perforation was increased in women who were breastfeeding at the time of IUD placement (RR, 6.1; 95% CI, 3.9–9.6) and who received an IUD at 36 weeks or less postpartum (RR, 1.7; 95% CI, 0.8–3.1). Sufrin CB, Postlethwaite D, Armstrong MA, Merchant M, Wendt JM, Steinauer JE. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Approximately 12% of implant users in contraceptive studies report weight gain, and only 2–7% discontinue use because of weight change 42 43 44. At 24 months, continuation rates were higher in contraceptive implant users compared with contraceptive injection and combined contraceptive pill users (P<.001) 64. There is insufficient evidence to determine whether any negative fetal effects occur in the setting of this very small exposure to levonorgestrel during gestation. Current data support the efficacy of the LNG-20 beyond its approved duration of use. For more information on the management of pain associated with IUD insertion, please see Committee Opinion No. An historic 18% decrease in unintended pregnancy occurred in the United States between 2008, when 51% of pregnancies were unintended, and 2011, when only 45% of pregnancies were unintended 5. One small study of the LNG-20 IUD reported ovulation in 63% of the amenorrheic group and in 58% of the regularly menstruating group 31. III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Xu H, Wade JA, Peipert JF, Zhao Q, Madden T, Secura GM. 1 = A condition for which there is no restriction for the use of the contraceptive method, 2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks, 3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method, 4 = A condition that represents an unacceptable health risk if the contraceptive method is used. When can a woman have an intrauterine device inserted? Reaffirmed 2021), Committee on Practice Bulletins—Gynecology. McDonald EA, Brown SJ. Of the 11.6% of U.S. women who rely on LARC, 10.3% use IUDs and 1.3% use the implant. Obstet Gynecol 2017;130:e251–69.This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Xiong X, Buekens P, Wollast E. IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies. Data from Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. The risk of infection is low after IUD insertion 62. However, another trial found that tranexamic acid and mefenamic acid did not alleviate nuisance bleeding during the first 90 days of LNG-20 IUD use 132. Bulk pricing was not found for item. Ladipo OA, Farr G, Otolorin E, Konje JC, Sturgen K, Cox P, et al. If a woman decides to continue the pregnancy with an IUD in place, she should be counseled regarding the increased risks of spontaneous abortion, septic abortion, chorioamnionitis, and preterm delivery 145. Insertion of LARC immediately after an induced or spontaneous abortion is safe and effective. Implanon® (etonogestrel implant). II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Intrauterine device placement during cesarean delivery and continued use 6 months postpartum: a randomized controlled trial. There are no studies that demonstrate an increased risk of pelvic inflammatory disease (PID) in nulliparous IUD users, and no evidence that IUD use is associated with subsequent infertility 63. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Berenson AB, Tan A, Hirth JM, Wilkinson GS. Backman T, Huhtala S, Luoto R, Tuominen J, Rauramo I, Koskenvuo M. Advance information improves user satisfaction with the levonorgestrel intrauterine system. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods 3. Women who use the copper IUD for emergency contraception may benefit from retention of the device for long-term contraception. Ali M, Akin A, Bahamondes L, Brache V, Habib N, Landoulsi S, et al. La SEGO (1) y la ACOG recomiendan la vigilancia de frecuencia cardiaca fetal (FCF) en todas las gestantes, siendo la AI de elección en gestantes de bajo riesgo, siempre que el ratio matrona/gestante sea 1:1 La CTG continua presenta ciertas ventajas: - registro escrito - se puede analizar Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review. The US MEC assigns a Category 2 for IUD initiation among women with vaginitis or who are at increased risk of STIs 47. Women with favorable bleeding profiles in the first 3 months of use were likely to continue with that bleeding pattern for the first 2 years, whereas those who started with an unfavorable pattern had a 50% chance of improving 41 44 137. In CHOICE study analysis, of 1,184 contraceptive implant users, 42% reported decreased bleeding frequency, and 35% reported increased bleeding frequency at 3 months of use; at 6 months, bleeding frequency had decreased for 48% of users and increased for 21% of users 8. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. Level B—Recommendations are based on limited or inconsistent scientific evidence. The LNG-13.5 IUD is FDA approved for up to 3 years of use 20. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Disadvantages of waiting 4–6 weeks postpartum for interval insertion include failure to return for follow up and not obtaining an IUD at the follow-up visit 87 91. However, the benefits of immediate insertion may outweigh the increased risk of expulsion. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Centers for Disease Control and Prevention [published erratum appears in MMWR Recomm Rep 2015;64:924]. Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant. Sordal T, Inki P, Draeby J, O’Flynn M, Schmelter T. Management of initial bleeding or spotting after levonorgestrel-releasing intrauterine system placement: a randomized controlled trial. Two types of LNG-IUDs contain a total of 52 mg of levonorgestrel: the LNG-20 IUD (Mirena) releases 20 micrograms/day, and the LNG-18.6 IUD (Liletta) releases 18.6 micrograms/day 17 18. For women who choose pregnancy termination, the IUD can be removed at the time of the procedure or before medication-induced abortion. Van den Bosch T, Donders GG, Riphagen I, Debois P, Ameye L, De Brabanter J, et al. In pregnant women, does removal of the intrauterine device affect pregnancy outcome? Long-Acting Reversible Contraception Continuation Rates From the CHOICE Project, Table 2. The LNG-IUD is under investigation for use as emergency contraception but should not be used for this purpose outside of clinical trials at present. Grimes DA, Shields WC. Walch K, Unfried G, Huber J, Kurz C, vanTrotsenburg M, Pernicka E, et al. However, systematic review findings show that progestin-only contraceptives do not appear to adversely affect a woman’s ability to successfully initiate and continue breastfeeding or an infant’s growth and development 93. MÉTODO reanimación fetal intraútero. Numerosos autores proponen que la mejor manera de estabilizar las funciones vitales del feto es intraútero, mediante diferentes propuestas de reanimación o resucitación, ya sea administrando oxígeno a la parturienta, posicionándola en decúbito lateral, elevando la presentación fetal, corrigiendo la hipotensión arterial con fluidoterapia, o bien perfundiendo a través de la madre ciertos fármacos a fin de corregir la acidosis de la sangre fetal (tocolíticos, sustancias tampones . Acne is rarely reported with use of the LNG-IUD 28. How many years can intrauterine devices and contraceptive implants protect against pregnancy? Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded 48. Despite concerns about difficulty of IUD insertion in adolescent and nulliparous women, a recent study of 1,177 females aged 13–24 years, 59% of whom were nulliparous, demonstrated a first-attempt success rate of 95.5% 58. Obstet Gynecol 2009; 114: 192. In a 2001 case–control study of 1,895 women with primary tubal infertility and general infertility, previous copper IUD use was not associated with an increased risk of tubal occlusion in nulliparous women. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Obijuru L, Bumpus S, Auinger P, Baldwin CD. American College of Obstetricians and Gynecologists. Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant. Highlights of prescribing information . Intrauterine device insertion should not be delayed while awaiting test results. Asymptomatic women who are at low risk of STIs and have previously undergone routine screening do not need additional screening at the time of IUD insertion 48. International Committee for Contraception Research (ICCR). For more information on addressing the clinical challenges of LARC use, please see Committee Opinion No. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Health during prolonged use of levonorgestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices: a multicenter study. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Although only a small amount of steroid is released from the LNG-IUD, some women may experience hormone-related effects, such as headaches, nausea, breast tenderness, mood changes, and ovarian cyst formation. 3 likes. Turok DK, Eisenberg DL, Teal SB, Keder LM, Creinin MD. The prevalence of actinomycosis, characterized by granulomatous pelvic abscesses, has been estimated to be less than 0.001% 144. 670. Insertion of a copper IUD is the most effective method of emergency contraception when inserted no later than 5 days after unprotected intercourse 48 100 101 102. In a single randomized controlled trial that examined the effect of IUDs on breastfeeding in women randomized to insertion of an LNG-IUD (n=163) or a copper IUD (n=157) at 6–8 weeks postpartum, there were no differences in breastfeeding duration or infant growth between the two groups 94. Committee Opinion No. The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. Wu JP, Pickle S. Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Treatment for a positive test result may occur without removal of the IUD. Immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births), should be offered routinely as a safe and effective option for postpartum contraception. Brahmi D, Steenland MW, Renner RM, Gaffield ME, Curtis KM. Most frequently, however, IUD users whose Pap test results incidentally report a finding of actinomyces are asymptomatic and are at extremely low risk of pelvic actinomycosis. Reports of bleeding and dysmenorrhea decrease over time in copper IUD users 129. Similar results were seen in women who received implants immediately after abortion versus those who received interval insertion 79. Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. | Terms and Conditions of Use. Madden T, Eisenberg DL, Zhao Q, Buckel C, Secura GM, Peipert JF. Comparison of contraceptive method chosen by women with and without a recent history of induced abortion. Does method of birth make a difference to when women resume sex after childbirth? Sinei SK, Schulz KF, Lamptey PR, Grimes DA, Mati JK, Rosenthal SM, et al. The U.S. Food and Drug Administration (FDA) has approved use of the copper IUD for up to10 continuous years, during which it remains highly effective. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. If pregnancy does occur with an IUD in place, the pregnancy is more likely to be ectopic. Immediate postpartum long-acting reversible contraception. Bahamondes MV, Monteiro I, Castro S, Espejo-Arce X, Bahamondes L. Prospective study of the forearm bone mineral density of long-term users of the levonorgestrel-releasing intrauterine system. Preventing unintended pregnancies by providing no-cost contraception. Three studies have reported no pregnancies among parous women who used the copper IUD for longer than 12 years. 186. The US MEC classifies the placement of an implant in breastfeeding women less than 30 days postpartum as Category 2 (advantages generally outweigh risks) because of theoretical concerns regarding milk production and infant growth and development Effect on Breastfeeding. 615. Nilsson CG, Lahteenmaki PL, Luukkainen T. Ovarian function in amenorrheic and menstruating users of a levonorgestrel-releasing intrauterine device. Does antibiotic prophylaxis before intrauterine device insertion decrease the risk of subsequent pelvic infection? Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal. Committee on Adolescence. Achieving cost-neutrality with long-acting reversible contraceptive methods. In addition, a prospective nonrandomized cohort study examined breast milk composition in 80 women using the contraceptive implant versus a nonhormonal IUD, initiated at 28–56 days after childbirth. Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Sitruk-Ware R. The levonorgestrel intrauterine system for use in peri- and postmenopausal women. Reanimación fetal intrauterina Conapem Filial Tecámac 599 views Apr 20, 2022 Conoce las diversas actividades que puedes realizar como profesional de enfermería para la reanimación fetal intra. 642. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Editorial 2 Laura Nieto Pascual Pólipos Endometriales: Visión General 3 Luis Alonso Pacheco / Ana Merino Márquez Evaluación de la Cavidad Uterina A randomized controlled trial assigned 236 participants to placement of the contraceptive implant on the day of mifepristone administration or placement after the medication-induced abortion. The limited evidence available is reassuring that implants do not have a major effect on bone mineral density, a surrogate marker for fracture risk 45 46. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Postpartum insertion of levonorgestrel--intrauterine system at three time periods: a prospective randomized pilot study. En Chile los métodos que se usan en forma rutinaria son la monitorización fetal electrónica de los LCF y dinámica uterina (MFE) y la auscultación intermitente de los LCF (AI). A systematic review. In a cohort of 57,728 women, the incidence of pelvic inflammatory disease was equivalent among women prescreened for STIs and those screened on the day of IUD insertion 116. The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. When is an intrauterine device appropriate for emergency contraception? Insertion of an IUD immediately after confirmed completion of first-trimester medication-induced abortion should be offered routinely as a safe and effective contraceptive option 75 76. Hubacher D, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzman-Rodriguez R. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. The contraceptive implant is the most effective method of reversible contraception, with a typical-use pregnancy rate of 0.05% 12. Reanimación intrauterina durante el parto: revisión de los métodos actuales y evidencia de apoyo. Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. In another study of 116 adolescents, continuation rates for the implant were high, 78% at 12 months and 50% at 24 months 65. Concern about IUD complications, including pelvic inflammatory disease, intolerance of adverse effects, or pain and difficulty with insertion, continues to limit obstetrician–gynecologists’ or other health care providers’ willingness to recommend IUDs to adolescents and nulliparous women 53 54 55. No backup contraceptive method is needed after inserting the copper IUD, regardless of when in the menstrual cycle it is inserted 48. Modesto W, deNazare Silva dos Santos P, Correia VM, Borges L, Bahamondes L. Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use. Prompt initiation of a contraceptive method for women who desire it may reduce repeat unintended pregnancy. It eventually may be approved for use up to 7 years because the ongoing Phase III trial for this IUD accumulates yearly effectiveness data 112. In one randomized placebo-controlled trial, naproxen significantly reduced bleeding and spotting days in the first 12 weeks of LNG-20 IUD use, whereas transdermal estradiol significantly increased bleeding and spotting 131. ACOG Practice Bulletin No. Ireland LD, Goyal V, Raker CA, Murray A, Allen RH. Ozalp S, Kabukcuoglu S, Tanir HM. Luchowski AT, Anderson BL, Power ML, Raglan GB, Espey E, Schulkin J. Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Dahlke JD, Terpstra ER, Ramseyer AM, Busch JM, Rieg T, Magann EF. ECLIPSE Trial Collaborative Group. Washington CI, Jamshidi R, Thung SF, Nayeri UA, Caughey AB, Werner EF. 106: Monitoreo de la frecuencia cardíaca fetal intraparto: nomenclatura, interpretación y principios generales de manejo. Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)—a systematic enquiry and overview. 2019-REANIMACIÓN INTRAUTERINA PARA ANESTESIOLOGOS. Similarly, a randomized noninferiority trial that compared insertion of the etonogestrel contraceptive implant at 1–3 days postpartum with standard insertion at 4–8 weeks postpartum found no differences between groups in time to lactogenesis or in lactation failure; there were also no differences between groups in mean milk creamatocrit values (ie, estimated fat and energy content of human milk) 96. Additionally, the updated inserter is designed to prevent deep implant insertion and to keep the implant from falling out of the preloaded applicator before the insertion procedure. Ante la aparición de signos de pérdida de bienestar fetal, el uso de maniobras de reanimación intrauterina es ampliamente recomendado por ser fáciles de realizar y requerir pocos recursos 8. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. Medidas de reanimación intrauterina o Resucitación Fetal Intraútero. To improve LARC method satisfaction and continuation, patient counseling should include information on expected bleeding changes and reassurance that these changes are not harmful 48 126. Highlights of prescribing information . Women who have not undergone routine screening for sexually transmitted infections (STIs) or who are identified to be at increased risk of STIs based on patient history 114 should receive CDC-recommended STI screening at the time of a single visit for IUD insertion.