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.

Study design: 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%).

Conclusion: 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.

Implications: The etonogestrel implant, when placed immediately postpartum for contraception, can have high continuation rates of use for up to 3 years duration.

Keywords: Immediate postpartum contraception; Long-acting reversible contraception; Rapid repeat pregnancy; Subdermal implant.