Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Obstet Gynecol. 2020 Jun;135(6):1275-1280. doi: 10.1097/AOG.0000000000003760.
To estimate the rate of readmissions for postpartum venous thromboembolism (VTE) during the first 30 days postdelivery between women with and without the immediate postpartum insertion of the etonogestrel contraceptive implant.
The Nationwide Readmissions Database from 2016 was used to identify women with a singleton delivery, immediate postpartum insertion of the etonogestrel contraceptive implant, and readmission for VTE within 30 days of discharge. Those with a prior history of VTE or anticoagulant therapy were excluded. These women were compared with the number of women readmitted within 30 days for VTE who did not have the contraceptive implant placed during delivery admission.
Of 3,387,120 deliveries, 8,369 women underwent etonogestrel contraceptive implant placement during the delivery admission. There was no difference identified in the rate of readmission for VTE between exposed and unexposed women. Of these, seven had received a postpartum etonogestrel contraceptive implant (0.85/1,000; 95% CI 0.22-1.45/1,000 deliveries), compared with 1,192 without an etonogestrel contraceptive implant (0.35/1,000; 95% CI 0.33-0.37/1,000 deliveries); odds ratio (OR) 2.41; 95% CI 0.58-9.89. The rates of diabetes, thrombophilia, systemic lupus erythematosus, and cesarean birth did not differ between groups. Women who underwent etonogestrel contraceptive implant placement were younger and were more likely to have government-sponsored health insurance, a smoking history, hypertension, peripartum infection, or postpartum hemorrhage than women who did not receive an etonogestrel contraceptive implant (P<.001). After adjusting for these confounders, there remained no difference in rates of VTE, adjusted OR 1.81; 95% CI 0.44-7.45.
The immediate postpartum placement of the etonogestrel contraceptive implant was not associated with an increased rate of VTE; however, our sample size was underpowered to determine no difference.
评估在产后 30 天内有和没有立即产后放置依托孕烯植入物的女性发生产后静脉血栓栓塞症（VTE）的再入院率。
使用 2016 年全国再入院数据库，确定有单胎分娩、产后立即放置依托孕烯避孕植入物和产后 30 天内因 VTE 再入院的女性。排除有 VTE 病史或抗凝治疗史的患者。将这些女性与因 VTE 在产后 30 天内再入院但分娩时未放置避孕植入物的女性人数进行比较。
在 3387120 例分娩中，有 8369 例女性在分娩时接受依托孕烯避孕植入物放置。暴露组和未暴露组 VTE 的再入院率无差异。其中，7 例接受产后依托孕烯避孕植入物（0.85/1000；95%CI0.22-1.45/1000 分娩），而 1192 例未接受依托孕烯避孕植入物（0.35/1000；95%CI0.33-0.37/1000 分娩）；比值比（OR）为 2.41；95%CI0.58-9.89。两组之间糖尿病、血栓形成倾向、系统性红斑狼疮和剖宫产的发生率无差异。接受依托孕烯避孕植入物放置的女性比未接受依托孕烯避孕植入物的女性更年轻，更有可能有政府赞助的健康保险、吸烟史、高血压、围产期感染或产后出血（P<.001）。在调整这些混杂因素后，VTE 的发生率仍无差异，调整后的 OR 为 1.81；95%CI0.44-7.45。
产后立即放置依托孕烯避孕植入物与静脉血栓栓塞症发生率增加无关；然而，我们的样本量不足以确定无差异。
