Berlan Elise, Mizraji Kelly, Bonny Andrea E
Section of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
The Ohio State University College of Medicine, Columbus, OH.
Contraception. 2016 Jul;94(1):81-6. doi: 10.1016/j.contraception.2016.02.030. Epub 2016 Mar 3.
The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation.
A retrospective chart review identified adolescent females aged 12 to 22years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12months) and ENG continuers (continued for ≥12months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ(2)/Fisher's Exact Tests and backwards stepwise logistic regression.
Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12months of use. The mean length of implant use for those who discontinued was 7.5months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive (p<.01) of method discontinuation.
The vast majority of adolescents continued the ENG implant at 12months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers.
The ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.
依托孕烯（ENG）避孕植入剂是最有效的可逆避孕方法。在意外怀孕风险较高的青少年群体中，其使用率仍然有限。本研究的目的是确定门诊环境中青少年使用ENG植入剂的12个月停用率，并确定停用的风险因素。
一项回顾性病历审查确定了2011年1月1日至2014年4月15日期间在一家儿科机构接受ENG植入剂的12至22岁青少年女性。患者被分为ENG停用者（在12个月前取出）和ENG继续使用者（持续使用≥12个月）。通过t检验、χ²/Fisher精确检验和向后逐步逻辑回归评估人口统计学、临床和植入后特征与ENG停用类别之间的关联。
在750名植入ENG的患者中，77名（10.3%）在使用12个月前取出了该装置。停用者的平均植入使用时间为7.5个月。出血问题是最常被提及的停用原因。植入时年龄较大、有怀孕史以及因植入相关问题（不包括取出）进行≥1次就诊是方法停用的独立预测因素（p<0.01）。
绝大多数青少年在12个月时继续使用ENG植入剂，使其成为门诊儿科环境中青少年的极佳避孕选择。儿科提供者应做出更大努力以增加其使用。
ENG植入剂是门诊儿科环境中青少年的极佳避孕选择。
