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. Bergin A, Tristan S, Terplan M, Gilliam ML, Whitaker AK. Optimally, women should be counseled prenatally about the option of immediate postpartum LARC. The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force: I Evidence obtained from at least one properly designed randomized controlled trial. In a case series of 40 pregnancies with a retained LNG-IUD, more than one half were ectopic; of the 10 cases of continued pregnancy, 8 ended in spontaneous pregnancy loss, and the other two pregnancies resulted in healthy infants born at term 147. Obstet Gynecol 2017;130:e251–69. Level B—Recommendations are based on limited or inconsistent scientific evidence. Selected Practice Recommendations for Contraceptive Use (available at www.cdc.gov/reproductivehealth/contraception/usspr.htm, which also has been endorsed by ACOG 48. 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. Committee Opinion No. 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. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility—follow-up after participation in a randomized clinical trial. Timing of copper intrauterine device insertion after medical abortion: a randomized controlled trial. Braga GC, Ferriolli E, Quintana SM, Ferriani RA, Pfrimer K, Vieira CS. Although the optimal time for IUD insertion among women treated for cervical infections is unclear, clinicians are advised to delay IUD insertion until the treatment course is complete, symptoms have resolved, the cervical examination results appear normal, and the bimanual examination is without masses or tenderness. Table 1. Another multicenter randomized trial also found that the LNG-20 IUD is effective for at least 7 years, with a 7-year pregnancy rate of 0.5 per 100 among women using the LNG-20 IUD 111. Does antibiotic prophylaxis before intrauterine device insertion decrease the risk of subsequent pelvic infection? Five IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs). Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Pregnancy in IUD users is uncommon. Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device? American College of Obstetricians and Gynecologists. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. 642. Vickery Z, Madden T, Zhao Q, Secura GM, Allsworth JE, Peipert JF. Ogburn JA, Espey E, Stonehocker J. 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). 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. 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. 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. Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. Post-Aspiration IUD Randomization (PAIR) Study Trial Group. intervención oportuna de resucitación intrauterina o parto, el objetivo secundario es evitar el daño neurológico en la medida de lo posible. Intrauterine devices may be offered to women with a history of ectopic pregnancies. Funk S, Miller MM, Mishell DRJr, Archer DF, Poindexter A, Schmidt J, et al. Factores transitorios: - Aumento de DU como taquisistolía: Muchas contracciones muy frecuentes impiden que The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. Young age, nulliparity, and continuation of long-acting reversible contraceptive methods. Immediate postpartum initiation of the contraceptive implant refers to insertion before discharge after a hospital stay for birth. Deans EI, Grimes DA. Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy: a randomized controlled trial. MÉTODO reanimación fetal intraútero. Grimes DA, Shields WC. Mansour D, Bahamondes L, Critchley H, Darney P, Fraser IS. During cervical ablation or excision procedures, IUD strings may be tucked into the cervical canal if possible, or cut. Raymond EG, Weaver MA, Tan YL, Louie KS, Bousieguez M, Lugo-Hernandez EM, et al. 3 likes. Beerthuizen R, vanBeek A, Massai R, Makarainen L, Hout J, Bennink HC. Insertion of LARC immediately after an induced or spontaneous abortion is safe and effective. Similar results were seen in women who received implants immediately after abortion versus those who received interval insertion 79. Women should be counseled about the increased expulsion risk, as well as signs and symptoms of expulsion 81. Similar to all women, adolescents and nulliparous women are more likely to choose an LNG-IUD rather than a copper IUD 57 61. To improve LARC method satisfaction and continuation, patient counseling should include information on expected bleeding changes and reassurance that these changes are not harmful. Committee Opinion No. Correlates of dual-method contraceptive use: an analysis of the National Survey of Family Growth (2006–2008). Madden T, Allsworth JE, Hladky KJ, Secura GM, Peipert JF. Rowe P, Farley T, Peregoudov A, Piaggio G, Boccard S, Landoulsi S, et al. Two studies have examined continuation of the contraceptive implant in women who received postabortion placement compared with those who received interval placement. In women who are breastfeeding, delayed insertion (ie, beyond 30 days postpartum), is classified as US MEC Category 1 47. Naproxen or estradiol for bleeding and spotting with the levonorgestrel intrauterine system: a randomized controlled trial. Sivin I, Stern J. The available evidence supports that LNG-IUDs do not disrupt pregnancy 15 and are not abortifacients. For women who have an intrauterine pregnancy, there are risks associated with removing and retaining the IUD. An advantage of the copper IUD is its lack of hormonal content, avoiding any theoretical effect on breastfeeding. Appropriate follow up to detect potential adverse events after initiation of select contraceptive methods: a systematic review. Each of the LARC methods affect menstrual bleeding differently. Turok DK, Jacobson JC, Dermish AI, Simonsen SE, Gurtcheff S, McFadden M, et al. Turok DK, Eisenberg DL, Teal SB, Keder LM, Creinin MD. Perforation is rare, occurring in 1.4 per 1,000 LNG-IUD insertions and in 1.1 per 1,000 copper-IUD insertions 32. Immediate postpartum long-acting reversible contraception. Jackson E, Glasier A. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012. The updated implant, introduced in the United States in 2011 34 is radio-opaque and is easily visualized on X-ray. MMWR Recomm Rep 2016;65(RR-3):1–103. American College of Obstetricians and Gynecologists. J Midwifery Womens Health 2007; 52: 229. II-1 Evidence obtained from well-designed controlled trials without randomization. The LNG-IUD has been found to be effective for noncontraceptive indications in menopausal women, such as the progestin component of hormone therapy 151. Bulk pricing was not found for item. Insertion of the copper IUD or a LNG-IUD from 10 minutes after placental delivery up until 4 weeks postpartum is classified as a US MEC Category 2, and insertion at or after 4 weeks postpartum is classified as a US MEC Category 1 47. In addition, women are at risk of an unintended pregnancy in the period immediately after delivery as resumption of ovulation may occur shortly after delivery 82. The immediate postpartum period is particularly favorable for IUD or implant insertion. Xiong X, Buekens P, Wollast E. IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies. Do intrauterine devices and implants cause ectopic pregnancy? In pregnant women, does removal of the intrauterine device affect pregnancy outcome? Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)—a systematic enquiry and overview. Women with bothersome implant-associated bleeding who are medically eligible for treatment with estrogen can receive a course of low-dose combined oral contraceptive pills 48 140. McNicholas C, Swor E, Wan L, Peipert JF. Aoun J, Dines VA, Stovall DW, Mete M, Nelson CB, Gomez-Lobo V. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. 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. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. 672. 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. 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). Xu H, Wade JA, Peipert JF, Zhao Q, Madden T, Secura GM. Building on outcomes from the CHOICE Project, the Colorado Family Planning Initiative provided access to LARC methods at no cost to clients through Title X-funded clinics in 37 of Colorado’s 64 counties, which comprised 95% of the state’s total population 9. Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates. Therefore, IUD removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal 48. Many postpartum women who choose the IUD undergo insertion at the postpartum visit (delayed postpartum insertion). However, the benefits of immediate insertion may outweigh the increased risk of expulsion. After implant insertion, changes in menstrual bleeding patterns are common and include amenorrhea or infrequent, frequent, or prolonged bleeding. Intrauterine device insertion immediately after second-trimester induced or spontaneous abortion is associated with higher expulsion rates compared with first-trimester postabortion insertion, but no differences in the rate of removal for pain 73. Ortiz ME, Croxatto HB. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. U.S. medical eligibility criteria for contraceptive use, 2016. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 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. The most common adverse effects reported are heavy menstrual bleeding and pain 16. There is insufficient evidence to determine whether any negative fetal effects occur in the setting of this very small exposure to levonorgestrel during gestation. 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. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. 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. 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. Merck & Co., Inc.: Whitehouse Station (NJ); 2016. Medidas de reanimación intrauterina o Resucitación Fetal Intraútero. Between 40% and 57% of women report having unprotected intercourse before the routine 6-week postpartum visit 83 84 85. Editorial 2 Laura Nieto Pascual Pólipos Endometriales: Visión General 3 Luis Alonso Pacheco / Ana Merino Márquez Evaluación de la Cavidad Uterina Approximately 10–14% of users experience worsening of acne; however, less than 2% of implant users discontinue the method for this reason 42 44. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. The cumulative pregnancy rate is 0.33 per 100 women-years of use 24. A small randomized controlled trial that compared the breastfeeding outcomes of women who received immediate postpartum implant placement with those who used no contraception found no significant differences in breast milk volume, newborn weight, or exclusive breastfeeding rates within the first 6 weeks after delivery 95. Trussell J, Hassan F, Lowin J, Law A, Filonenko A. In an observational study of 97 women who received either a copper IUD or LNG-IUD immediately after confirmation of completed medication-induced abortion, at 3-month follow-up there was a 4.1% expulsion rate (95% CI, 0–8%), no reported cases of pelvic infection or uterine perforation, and an 80% continuation rate for the copper IUD and LNG-IUD combined 75. 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. U.S. selected practice recommendations for contraceptive use, 2016. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. 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. The single-rod implant is 4 cm in length and 2 mm in diameter and is packaged preloaded in a disposable sterile applicator. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study. Immediate IUD insertion after confirmation of completed medication-induced abortion is associated with low expulsion rates, high continuation rates, and low risk of complications (ie, pelvic infection, uterine perforation, and hemorrhage) 75 76. An integrated analysis of 11 international clinical trials that assessed the variable bleeding patterns (in 90-day reference periods) among 923 implant users found that women usually experienced infrequent bleeding (33.6% of the reference periods) or amenorrhea (22.2% of the reference periods) 137. Committee Opinion No. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Irvine (CA): Allergan USA, Inc.; 2017. Release characteristics, ovarian activity and menstrual bleeding pattern with a single contraceptive implant releasing 3-ketodesogestrel. ABSTRACT: Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. Taneepanichskul S, Reinprayoon D, Thaithumyanon P, Praisuwanna P, Tosukhowong P, Dieben T. Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. 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. Antibiotic prophylaxis for gynecologic procedures. 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. In another study of 116 adolescents, continuation rates for the implant were high, 78% at 12 months and 50% at 24 months 65. Implanon US Study Group. ECLIPSE Trial Collaborative Group. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. 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. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc.; 2016. For additional quantities, please contact [email protected] 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). Multiplegestation: complicated twin, triplet, and high- order multifetal pregnancy. Young or low-risk women whose bleeding coincides with LARC initiation rarely require extensive evaluation. Continuation of the etonogestrel implant in women undergoing immediate postabortion placement. 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). A noncontraceptive benefit of the implant is a significant decrease in dysmenorrhea 44 137 138. Intrauterine device insertion should not be delayed while awaiting test results. Mark A, Sonalkar S, Borgatta L. One-year continuation of the etonogestrel contraceptive implant in women with postabortion or interval placement. Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. Women should be advised that menstrual bleeding and cramping may initially increase with use of the copper IUD 48. Actualmente denominado estado fetal no tranquilizador. 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. The number of bleeding or spotting days may be increased relative to baseline during the first year of use 134. Because LARC methods affect menstrual bleeding, some women may experience irregular, unpredictable bleeding over the entire course of LARC use. Although the reduction in unintended pregnancy is multifactorial, increased use of LARC likely has contributed 6 7. ACOG clinical content is the indispensable decision support resource for women's healthcare providers--reliable and relevant, grounded in scientific evidence, and developed through a rigorous and inclusive process. Obstet Gynecol 2004;104:869-83. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. 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. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. It is not intended to substitute for the independent professional judgment of the treating clinician. 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. Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact. Recuerda que . 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. Ganer H, Levy A, Ohel I, Sheiner E. Pregnancy outcome in women with an intrauterine contraceptive device. Immediate IUD insertion is contraindicated after septic abortion 47. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. Wu S, Godfrey EM, Wojdyla D, Dong J, Cong J, Wang C, et al. 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. Abraham M, Zhao Q, Peipert JF. Gurtcheff SE, Turok DK, Stoddard G, Murphy PA, Gibson M, Jones KP. Intrauterine device insertion is contraindicated in women with current purulent cervicitis or with known chlamydial infection or gonorrhea (US MEC Category 4) 47. Kapp N, Abitbol JL, Mathe H, Scherrer B, Guillard H, Gainer E, et al. The contraceptive implant is the most effective method of reversible contraception, with a typical-use pregnancy rate of 0.05% 12. Only 11.3% of patients discontinued the implant because of bleeding irregularities, mainly because of frequent and prolonged bleeding. Secura GM, Madden T, McNicholas C, Mullersman J, Buckel CM, Zhao Q, et al. Another trial found similar beneficial effects with the use of mifepristone in combination with ethinyl estradiol or doxycycline in improving bleeding, but with resumption of bothersome bleeding after treatment ended 142. Highlights of prescribing information . Birth and abortion rates also fell among young women enrolled in the study, with decreases of 14% and 18%, respectively 9. 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. No backup contraceptive method is needed after inserting the copper IUD, regardless of when in the menstrual cycle it is inserted 48. Chen BA, Reeves MF, Hayes JL, Hohmann HL, Perriera LK, Creinin MD. In addition, after the device is removed, the return of fertility is rapid 1 2. 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. 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. The hospital setting offers convenience for the patient and the health care provider. Lethaby A, Hussain M, Rishworth JR, Rees MC. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods. 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. McNicholas C, Madden T, Secura G, Peipert JF. Grimes DA, Lopez LM, Schulz KF. 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. 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. Postpartum insertion of levonorgestrel--intrauterine system at three time periods: a prospective randomized pilot study. A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users. Committee Opinion No. Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant. 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. There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women. 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. Immediate versus delayed IUD insertion after uterine aspiration. Overall, LNG-IUD and copper IUD continuation rates are high for adolescents and nulliparous women, which suggests high levels of satisfaction with these contraceptive methods 52. • 2.- Variabilidad entre 5-25 lpm. Centers for Disease Control and Prevention [published erratum appears in MMWR Recomm Rep 2015;64:924]. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. La Resucitación Fetal Intraútero (RFI) o Reanimación Intrauterina constituye un conjunto de técnicas no operatorias que se aplican a la madre ante un patrón no tranquilizador de la Frecuencia Cardíaca Fetal (FCF), con el objetivo de mejorar la oxigenación fetal. 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. ACOG Practice Bulletin No. Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. Continuing a pregnancy with a retained LNG-IUD raises the theoretical concern about the effect of fetal exposure to the hormone. Women who use the copper IUD for emergency contraception may benefit from retention of the device for long-term contraception. 615. | Terms and Conditions of Use. Se debate la utilidad de la hiperoxigenación materna y la tocolisis aguda. 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. In that trial, there were no pregnancies in the last 2 years of use 111. ⚕️ #Medicina #ENARM #Clases #RedMedicaVlog #MedicoGracias por ver este video espero y te haya servido para dominar el tema. These study results may not be generalizable to obese women because only 6% of participants in the first study and 50% in the second study were obese. 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 . The primary mechanism of action of the implant is suppression of ovulation 35. WHO study group on subdermal contraceptive implants for women. Insertion complications include pain, slight bleeding, hematoma formation, deep or incorrect insertion, and unrecognized noninsertion. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. 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. 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. Concerns remain that hormonal methods, including the LNG-IUD and the contraceptive implant, could have a negative effect on breastfeeding outcomes. Immediate postpartum initiation of the contraceptive implant (ie, insertion before hospital discharge after a hospital stay for birth) should be offered routinely as a safe and effective option for post-partum contraception, regardless of breastfeeding status. 56. É um assunto ainda um pouco controverso, visto que falta consenso na definição, critérios diagnósticos e idade gestacional para programação da interrupção da gestação. Actinomyces on cytology is considered an incidental finding. Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal. For more information on the management of pain associated with IUD insertion, please see Committee Opinion No. The US MEC classifies the placement of an implant in nonbreastfeeding women less than 21 days postpartum as Category 1 47. Sitruk-Ware R. The levonorgestrel intrauterine system for use in peri- and postmenopausal women. Etonogestrel is the active metabolite of desogestrel. The American College of Obstetricians and Gynecologists supports immediate postpartum LARC insertion (ie, before hospital discharge) as a best practice, recognizing its role in preventing rapid repeat and unintended pregnancy 80 81. Whiteman MK, Tyler CP, Folger SG, Gaffield ME, Curtis KM. Lahteenmaki P, Luukkainen T. Return of ovarian function after abortion. When is an intrauterine device appropriate for emergency contraception? 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. 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. However, when an intrauterine pregnancy does occur with an IUD in place, management depends on the woman’s desire to continue or terminate the pregnancy, gestational age, IUD location, and whether IUD strings are visible 3 48. Rosa Elia Rebollo Manrique CMI Toluca Octubre 2013. 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. II-3 Evidence obtained from multiple time series with or without the intervention. 152. Peipert JF, Madden T, Allsworth JE, Secura GM. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Overall, the mean number of spotting or bleeding episodes was less than the number reported in normal menstrual cycles. 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. Fox MC, Oat-Judge J, Severson K, Jamshidi RM, Singh RH, McDonald-Mosley R, et al. Three-year continuation of reversible contraception. Direcionamento para Atendimento. Modesto W, Dal Ava N, Monteiro I, Bahamondes L. Body composition and bone mineral density in users of the etonogestrel-releasing contraceptive implant. 186. Routine use of misoprostol to ease IUD insertion is not recommended 3 48. Effectiveness of long-acting reversible contraception. O crescimento intrauterino restrito (CIUR) é uma complicação frequente da gestação que está associada a uma variedade de desfechos adversos. Bone mineral density during long-term use of the progestagen contraceptive implant Implanon compared to a non-hormonal method of contraception. 104. 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. Expulsion rates for immediate postpartum IUD insertion are higher than for interval or postabortion insertion, vary by study, and may be as high as 10–27% 87 88 89 90. 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. Immediate postpartum initiation of the contraceptive implant (ie, insertion before hospital discharge after a hospital stay for birth) should be offered routinely as a safe and effective option for postpartum contraception, regardless of breastfeeding status. In one study, the rate of copper IUD removal for reports of pain and bleeding were higher than for the LNG-IUD 57. Counseling should include discussion of the advantages and disadvantages to allow for informed decision making 81. A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device. Zheng SR, Zheng HM, Qian SZ, Sang GW, Kaper RF. 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. American College of Obstetricians and Gynecologists. 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. When can a woman have an intrauterine device inserted? Most of the risk of IUD-related infection occurs within the first few weeks to months after insertion, suggesting that bacterial contamination of the endometrial cavity at the time of insertion is the cause of infection and not the IUD itself 124. 658. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. In the CHOICE study, women who were offered immediate postabortion contraception were more than three times more likely to choose an IUD and 50% more likely to choose an implant than women presenting for a family planning visit 72. ACOG Family of Sites. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement A study of Medicaid-insured women who requested IUDs in an urban clinic that required two visits found that only 54.4% actually had an IUD inserted 68. And, an analysis from the CHOICE study showed no difference in weight gain at 1 year, after adjusting for confounders, between contraceptive implant users and copper IUD users 26. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. Compared with the LNG-20 IUD, the LNG-13.5 IUD has a narrower inserter, smaller “T” frame, and releases less hormone daily 25. Access to contraception. Dahlke JD, Terpstra ER, Ramseyer AM, Busch JM, Rieg T, Magann EF. Fertility returns rapidly after discontinuation of the implant 42. Mechanisms that explain the contraceptive action of progestin implants for women. Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant. El manejo de la sospecha de pérdida de bienestar fetal (sufrimiento fetal) intrauterino suele ser labor de los obstetras y matronas, pero los anestesistas como agentes implicados en el bienestar y seguridad de la paciente parturienta debemos . Frequent bleeding was found in 6.7% of the reference periods and prolonged bleeding in 17.7% of the reference periods. 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. 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. These risks are reduced, but not eliminated, with the removal of the IUD 145. Ali M, Akin A, Bahamondes L, Brache V, Habib N, Landoulsi S, et al. 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. The effects of Implanon on menstrual bleeding patterns. 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. Most women who use an LNG-IUD continue to ovulate but experience diminished menstrual bleeding because of the local effect of levonorgestrel on the endometrium. Results from pooled Phase III studies of ulipristal acetate for emergency contraception. 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. 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. However, uterine bleeding patterns with contraceptive implant use are unpredictable and are cited as among the most common reasons for discontinuation. It is not intended to substitute for the independent professional judgment of the treating clinician. Sinei SK, Schulz KF, Lamptey PR, Grimes DA, Mati JK, Rosenthal SM, et al. Long-acting reversible contraception: implants and intrauterine devices. 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 copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement. Five IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs). A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Reanimación intrauterina durante el parto: revisión de los métodos actuales y evidencia de apoyo. 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. How many years can intrauterine devices and contraceptive implants protect against pregnancy? Celen S, Sucak A, Yildiz Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraceptive acceptability and continuation rates were studied in a group of 137 postpartum adolescents 64. Use of LARC increased substantially in nulliparous women, from 2.1% in 2009 to 5.9% in 2012 4. Harper CC, Rocca CH, Thompson KM, Morfesis J, Goodman S, Darney PD, et al. Intrauterine device placement during cesarean delivery and continued use 6 months postpartum: a randomized controlled trial. Available at: Graesslin O, Korver T. The contraceptive efficacy of Implanon: a review of clinical trials and marketing experience. Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. Creinin MD, Jansen R, Starr RM, Gobburu J, Gopalakrishnan M, Olariu A. Levonorgestrel release rates over 5 years with the Liletta® 52-mg intrauterine system. Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Committee Opinion No. 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. 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. All LNG-IUDs have a similar primary mechanism of action: they prevent fertilization by causing a profound change in the amount and viscosity of cervical mucus, making it impenetrable to sperm 15 22 23. Trussell J. 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). Madden T, Eisenberg DL, Zhao Q, Buckel C, Secura GM, Peipert JF. Accumulating evidence suggests that complications such as uterine perforation, ectopic pregnancy, and pelvic inflammatory disease are uncommon in all users, including adolescents and nulliparous women 56 57. 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. New-onset abnormal uterine bleeding should be evaluated similarly to abnormal bleeding in non-LARC users; the differential diagnosis remains similar, including complications of pregnancy, infection, and gynecologic malignancy. American College of Obstetricians and Gynecologists. 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. Provision of no-cost, long-acting contraception and teenage pregnancy [published erratum appears in N Engl J Med 2014;372:297].
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