Wilson Susan, Tennant Corina, Sammel Mary D, Schreiber Courtney
Hospital of the University of Pennsylvania.
Hospital of the University of Pennsylvania.
Contraception. 2014 Sep;90(3):259-64. doi: 10.1016/j.contraception.2014.05.006. Epub 2014 May 14.
To determine 3-year continuation rates of the etonogestrel contraceptive implant when inserted immediately postpartum and to identify factors associated with discontinuation.
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.
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%).
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.
The etonogestrel implant, when placed immediately postpartum for contraception, can have high continuation rates of use for up to 3 years duration.
确定产后立即植入依托孕烯避孕植入剂的3年续用率，并识别与停用相关的因素。
从电子病历中收集了2008年1月至2009年3月间产后立即植入避孕植入剂的262名妇女的回顾性队列。估计了1年、2年和3年的续用率。记录导致植入剂取出的不良反应。进行多变量Cox比例风险模型以确定与早期停用相关的因素。
研究患者的很大一部分是青少年（28.2%）和多产妇（71.8%），产前检查少于6次（38.5%）。3年中每年的随访率均超过70%。青少年和产前检查少于6次的妇女在1年时的续用率最高，分别为94.5%和94.1%。3年后植入剂的累积续用率为66.3%。多变量分析表明，产前检查6次或更多次是早期停用的唯一独立预测因素，在1年和3年时的风险比分别为3.1（p=0.04）和1.8（p<0.01）。早期取出最常见的报告原因是异常出血（41.2%）和体重增加（19.1%）。
产后立即植入避孕植入剂在其3年使用寿命内续用率较高。续用率在最易发生快速重复和意外怀孕的人群中最高。
产后立即放置依托孕烯植入剂用于避孕，其使用续用率可高达3年。
