Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States.
Center for Women's Reproductive Health, Birmingham, AL, United States.
Contraception. 2022 Jan;105:55-60. doi: 10.1016/j.contraception.2021.09.005. Epub 2021 Sep 14.
To evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease.
Retrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum.
Of 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred.
LARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.
Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease - as well as all people with high-risk health conditions - to reduce their disproportionate burden of maternal morbidity and mortality.
评估为患有心脏病的孕妇提供即刻产后长效可逆避孕措施的效果。
回顾性队列研究纳入了由综合妊娠与心脏项目管理的患有心脏病的孕妇。患者被分为 2 个队列：即刻产后长效可逆避孕措施实施前（2015 年 3 月至 2017 年 1 月）和实施后（2017 年 2 月至 2019 年 6 月）。主要结局是产后使用长效可逆避孕措施（宫内节育器[IUD]或依托孕烯植入剂），定义为即刻产后或产后就诊时使用长效可逆避孕措施。次要结局包括分娩时的避孕意愿和即刻产后放置的 IUD 的脱落率。
在纳入的 159 名患者中，96 名（60%）在实施后期间分娩。方案实施后，长效可逆避孕措施的使用率增加了两倍，从 11%增至 35%，p<0.01。具体而言，即刻产后 IUD 的使用率从 1 例（1.6%）增至 10 例（10.4%），p=0.05，即刻产后植入剂的使用率从 0 增至 14 例（14.6%），p=0.002。分娩时无避孕计划的女性比例从 32%降至 14%，p<0.01，而使用醋酸甲羟孕酮的女性比例从 16%降至 4%，p=0.01。方案实施前后，输卵管结扎率无差异：分别为 24%和 29%，p=0.46。即刻产后就诊率在 Pre 组和 Post 组之间相似：分别为 70%和 72%，p=0.78。有 1 例即刻产后 IUD 脱落。
在实施即刻产后长效可逆避孕措施后，产科心脏病项目中的孕妇使用长效可逆避孕措施的比例增加了两倍。为患有心脏病的妇女以及所有患有高风险健康状况的妇女提供即刻产后宫内节育器和植入物应成为公共卫生的重点，以降低她们在孕产妇发病率和死亡率方面不成比例的负担。
为患有心脏病的妇女以及所有患有高风险健康状况的妇女提供即刻产后宫内节育器和植入物应成为公共卫生的重点，以降低她们在孕产妇发病率和死亡率方面不成比例的负担。
