PMID- 28885429
OWN - NLM
STAT- MEDLINE
DCOM- 20170929
LR  - 20180714
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 130
IP  - 4
DP  - 2017 Oct
TI  - Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With
      a 6-Week Postpartum Visit.
PG  - 788-794
LID - 10.1097/AOG.0000000000002246 [doi]
AB  - OBJECTIVE: To evaluate whether a department policy changing the scheduling of the
      postpartum visit from 6 weeks to 2-3 weeks after delivery is associated with
      higher long-acting reversible contraception initiation at the postpartum visit.
      METHODS: We conducted a quasiexperimental before-after study to evaluate
      long-acting reversible contraception initiation, specifically an intrauterine
      device or contraceptive implant, at the postpartum visit between women scheduled 
      for follow-up at 6 weeks (before policy change) and 2-3 weeks after delivery
      (after policy change). Secondary outcomes included postpartum visit completion,
      overall contraception initiation at the postpartum visit, overall contraceptive
      use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We
      obtained delivery and postpartum information using the electronic medical record 
      and contacted participants 3 and 6 months after delivery to assess contraception 
      use and repeat pregnancies. RESULTS: We enrolled 586 participants between
      December 2014 and November 2015, of whom 512 women (256 in each cohort) continued
      to meet eligibility criteria after delivery. Long-acting reversible contraception
      initiation rates at the postpartum visit were lower in the 2- to 3-week (16.5%,
      95% CI 12.2-21.8) compared with the 6-week group (31.1%, 95% CI 25.2-37.7,
      P<.01), primarily as a result of patient and health care provider preferences for
      delaying intrauterine device insertion to a later visit. More women completed a
      scheduled 2- to 3-week postpartum visit (90.2%, 95% CI 86.0-93.3) compared with a
      6-week visit (81.6%, 95% CI 76.4-85.9, P<.01). Deferral of any contraception
      initiation was higher in the 2- to 3-week group (27.3%, 95% CI 21.9-33.4)
      compared with the 6-week group (15.8%, 95% CI 11.5-21.4, P<.01), but there were
      no differences in overall contraceptive use patterns at 6 months postpartum. No
      intrauterine device perforations or expulsions were observed in women who
      underwent insertion at 2-3 weeks postpartum. Five pregnancies were reported in
      each cohort by 6 months after delivery. CONCLUSION: Scheduling a visit at 2-3
      weeks after delivery was not associated with increased long-acting reversible
      contraception initiation at this visit despite higher postpartum visit
      attendance.
FAU - Chen, Melissa J
AU  - Chen MJ
AD  - Department of Obstetrics and Gynecology, University of California, Davis,
      Sacramento, California.
FAU - Hou, Melody Y
AU  - Hou MY
FAU - Hsia, Jennifer K
AU  - Hsia JK
FAU - Cansino, Catherine D
AU  - Cansino CD
FAU - Melo, Juliana
AU  - Melo J
FAU - Creinin, Mitchell D
AU  - Creinin MD
LA  - eng
GR  - UL1 TR001860/TR/NCATS NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - AIM
SB  - IM
MH  - Adult
MH  - Contraception/methods/*psychology
MH  - Contraception Behavior/*psychology
MH  - Female
MH  - Humans
MH  - Intrauterine Devices/*utilization
MH  - Non-Randomized Controlled Trials as Topic
MH  - Postpartum Period/*psychology
MH  - *Time Factors
MH  - Young Adult
PMC - PMC5610104
MID - NIHMS903718
EDAT- 2017/09/09 06:00
MHDA- 2017/09/30 06:00
CRDT- 2017/09/09 06:00
PMCR- 2018/10/01 00:00
PHST- 2018/10/01 00:00 [pmc-release]
PHST- 2017/09/09 06:00 [pubmed]
PHST- 2017/09/30 06:00 [medline]
PHST- 2017/09/09 06:00 [entrez]
AID - 10.1097/AOG.0000000000002246 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2017 Oct;130(4):788-794. doi: 10.1097/AOG.0000000000002246.