الفهرس 
Post placental insertion of levonorgestrel 52 mg (LNG) intrauterine device at the time of cesarean section delivery and its effect on breast feeding
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Abstract
Background: Intrauterine devices (IUDs) are one of the most effective methods of
preventing pregnancy. Studies have shown that immediate postpartum initiation of
long-acting reversible contraception (LARC) methods leads to increased utilization of
LARC and prevention of unintended pregnancies, with effect on breastfeeding
success. Recent changes to reimbursement policies and clinical guidelines encourage
increased access to immediate post placental initiation of IUDs.
Objectives: A comparison of the complications rate at 6 weeks after post placental
insertion of the LNG IUD. Second, a comparison of breastfeeding after LNG IUD
post placental insertion
Methods: A study investigator will explain the study procedure for all women
seeking post placental insertion of an LNG IUD at the time of caesarean section and
the effect of breast feeding. All women will receive an LNG 52-mg IUD (Mirena®;
Bayer Healthcare Pharmaceuticals, Whippany, NJ). After discharge, participants will
be contacted for the first 6 weeks postpartum. Surveys will include questions
regarding IUD expulsion, displacement, cramps, infection, bleeding, perforation,
removal, and breastfeeding. Participants will return for a 6-week postpartum visit with
their obstetric provider and a study investigator will attend each visit. The provider
will perform a speculum examination, and if IUD strings are not visible, a
transvaginal ultrasound (TVUS) will be performed at the time of the visit to confirm
the IUD location. An abdominal radiograph will be performed if a patient does not
report a clinical history of expulsion and no IUD is seen in the uterus by TV.
Results: A total of 50 pregnant women seeking post-placental insertion of
intrauterine devices at the time of caesarean section were enrolled. Participants
returned for 3 postpartum visits with their obstetric provider and the study investigator
attended each visit. The first visit was 7– 10 days, the second one was 40 days, and
the third one was 3 months after delivery. All women were asked about breast feeding
and bleeding patterns after previous deliveries compared with the current delivery.
Statistical analysis of the current study showed that regarding the flow of breast milk
and its comparison with breast feeding after last delivery, and regarding bleeding
patterns and their comparison with bleeding after delivery, and regarding intrauterine
device position and expulsion rates.
Conclusion: There was no contraindication. All women seeking an effective
postpartum contraceptive method and treatment of associated abnormal uterine
bleeding, menorrhagia should use this device as an adjuvant modality for all women
seeking an effective postpartum contraceptive method and treatment of menorrhagia.