Timing of postpartum etonogestrel-releasing implant insertion and bleeding patterns, weight change, 12-month continuation and satisfaction rates: a randomized controlled trial

Carolina Sales Vieira, Mariane Nunes de Nadai, Lilian Sheila de Melo Pereira do Carmo, Giordana Campos Braga, Bruna Fregonesi Infante, Bianca M. Stifani, Rui Alberto Ferriani, Silvana Maria Quintana

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate whether timing of etonogestrel (ENG) implant insertion during the postpartum period affects maternal bleeding patterns, body mass index (BMI) and 12-month satisfaction and continuation rates. Study design: This is a secondary analysis of an open, randomized, controlled trial. Postpartum women were block-randomized to early (up to 48 h postpartum) or delayed (6 weeks postpartum) insertion of an ENG implant. Bleeding patterns and BMI were evaluated every 90 days for 12 months. At 12 months, we measured implant continuation rates and used Likert and face scales to measure users' satisfaction. The level of significance was 0.4% (adjusted by Bonferroni test for multiplicity). Results: We enrolled 100 postpartum women; we randomized 50 to early and 50 to delayed postpartum ENG implant insertion. Bleeding patterns were similar between groups. Amenorrhea rates were high in both groups during the follow-up (52%–56% and 46%–62% in the early and delayed insertion group, respectively). Prolonged bleeding episodes were unusual in both groups during the follow-up (0–2%). Maternal BMI was similar between groups and decreased over time. Twelve-month continuation rates were similar between groups (early insertion: 98% vs. delayed insertion: 100%, p=.99). Most participants were either very satisfied or satisfied with the ENG implant in both groups (p=.9). Conclusion: Women who underwent immediate postpartum insertion of the ENG implant have similar bleeding patterns, BMI changes, and 12-month satisfaction and continuation rates compared to those who underwent delayed insertion. Implications: Our results from a secondary analysis of a clinical trial support that satisfaction, continuation and bleeding patterns do not differ when women received contraceptive implants immediately postpartum or at 6 weeks. However, the emphasis on infant growth in the trial and easy access to delayed placement may have influenced results.

Original languageEnglish (US)
Pages (from-to)258-263
Number of pages6
JournalContraception
Volume100
Issue number4
DOIs
StatePublished - Oct 2019

Fingerprint

Postpartum Period
Randomized Controlled Trials
Hemorrhage
Weights and Measures
Body Mass Index
Mothers
etonogestrel
Amenorrhea
Contraceptive Agents
Clinical Trials
Growth

Keywords

  • Bleeding pattern
  • Continuation
  • Etonogestrel implant
  • Postpartum
  • Satisfaction

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Timing of postpartum etonogestrel-releasing implant insertion and bleeding patterns, weight change, 12-month continuation and satisfaction rates : a randomized controlled trial. / Vieira, Carolina Sales; de Nadai, Mariane Nunes; de Melo Pereira do Carmo, Lilian Sheila; Braga, Giordana Campos; Infante, Bruna Fregonesi; Stifani, Bianca M.; Ferriani, Rui Alberto; Quintana, Silvana Maria.

In: Contraception, Vol. 100, No. 4, 10.2019, p. 258-263.

Research output: Contribution to journalArticle

Vieira, Carolina Sales ; de Nadai, Mariane Nunes ; de Melo Pereira do Carmo, Lilian Sheila ; Braga, Giordana Campos ; Infante, Bruna Fregonesi ; Stifani, Bianca M. ; Ferriani, Rui Alberto ; Quintana, Silvana Maria. / Timing of postpartum etonogestrel-releasing implant insertion and bleeding patterns, weight change, 12-month continuation and satisfaction rates : a randomized controlled trial. In: Contraception. 2019 ; Vol. 100, No. 4. pp. 258-263.
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abstract = "Objectives: To evaluate whether timing of etonogestrel (ENG) implant insertion during the postpartum period affects maternal bleeding patterns, body mass index (BMI) and 12-month satisfaction and continuation rates. Study design: This is a secondary analysis of an open, randomized, controlled trial. Postpartum women were block-randomized to early (up to 48 h postpartum) or delayed (6 weeks postpartum) insertion of an ENG implant. Bleeding patterns and BMI were evaluated every 90 days for 12 months. At 12 months, we measured implant continuation rates and used Likert and face scales to measure users' satisfaction. The level of significance was 0.4{\%} (adjusted by Bonferroni test for multiplicity). Results: We enrolled 100 postpartum women; we randomized 50 to early and 50 to delayed postpartum ENG implant insertion. Bleeding patterns were similar between groups. Amenorrhea rates were high in both groups during the follow-up (52{\%}–56{\%} and 46{\%}–62{\%} in the early and delayed insertion group, respectively). Prolonged bleeding episodes were unusual in both groups during the follow-up (0–2{\%}). Maternal BMI was similar between groups and decreased over time. Twelve-month continuation rates were similar between groups (early insertion: 98{\%} vs. delayed insertion: 100{\%}, p=.99). Most participants were either very satisfied or satisfied with the ENG implant in both groups (p=.9). Conclusion: Women who underwent immediate postpartum insertion of the ENG implant have similar bleeding patterns, BMI changes, and 12-month satisfaction and continuation rates compared to those who underwent delayed insertion. Implications: Our results from a secondary analysis of a clinical trial support that satisfaction, continuation and bleeding patterns do not differ when women received contraceptive implants immediately postpartum or at 6 weeks. However, the emphasis on infant growth in the trial and easy access to delayed placement may have influenced results.",
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T2 - a randomized controlled trial

AU - Vieira, Carolina Sales

AU - de Nadai, Mariane Nunes

AU - de Melo Pereira do Carmo, Lilian Sheila

AU - Braga, Giordana Campos

AU - Infante, Bruna Fregonesi

AU - Stifani, Bianca M.

AU - Ferriani, Rui Alberto

AU - Quintana, Silvana Maria

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AB - Objectives: To evaluate whether timing of etonogestrel (ENG) implant insertion during the postpartum period affects maternal bleeding patterns, body mass index (BMI) and 12-month satisfaction and continuation rates. Study design: This is a secondary analysis of an open, randomized, controlled trial. Postpartum women were block-randomized to early (up to 48 h postpartum) or delayed (6 weeks postpartum) insertion of an ENG implant. Bleeding patterns and BMI were evaluated every 90 days for 12 months. At 12 months, we measured implant continuation rates and used Likert and face scales to measure users' satisfaction. The level of significance was 0.4% (adjusted by Bonferroni test for multiplicity). Results: We enrolled 100 postpartum women; we randomized 50 to early and 50 to delayed postpartum ENG implant insertion. Bleeding patterns were similar between groups. Amenorrhea rates were high in both groups during the follow-up (52%–56% and 46%–62% in the early and delayed insertion group, respectively). Prolonged bleeding episodes were unusual in both groups during the follow-up (0–2%). Maternal BMI was similar between groups and decreased over time. Twelve-month continuation rates were similar between groups (early insertion: 98% vs. delayed insertion: 100%, p=.99). Most participants were either very satisfied or satisfied with the ENG implant in both groups (p=.9). Conclusion: Women who underwent immediate postpartum insertion of the ENG implant have similar bleeding patterns, BMI changes, and 12-month satisfaction and continuation rates compared to those who underwent delayed insertion. Implications: Our results from a secondary analysis of a clinical trial support that satisfaction, continuation and bleeding patterns do not differ when women received contraceptive implants immediately postpartum or at 6 weeks. However, the emphasis on infant growth in the trial and easy access to delayed placement may have influenced results.

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KW - Continuation

KW - Etonogestrel implant

KW - Postpartum

KW - Satisfaction

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