SMFM recommends immediate postpartum LARC in high-risk patients

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Takeaway

  • Long-acting reversible contraception (LARC) is important in high-risk patients, and the Society for Maternal-Fetal Medicine (SMFM) outlines suggestions for facilitating uptake.

Why this matters

  • 70% of pregnancies occurring within 1 year of delivery are unplanned.
  • The interconception period is a key time that may allow for optimization of health, especially in women with high-risk pregnancy or maternal complications.
  • Women may resume ovulation and sexual activity prior to their 6-week postpartum visit.

Key recommendations 

  • Contraception counseling throughout prenatal care may contribute to shared decision making and uptake of postpartum contraception.
  • Maternal-fetal medicine clinicians involved in managing high-risk patients should promote the use of immediate postpartum LARC.
  • Contraindications to LARC are few but include:
    • distorted uterine cavity,
    • Wilson's disease (copper intrauterine device [IUD]),
    • current breast, cervical, and endometrial cancer,
    • malignant gestational trophoblastic disease,
    • pelvic infection, or
    • unexplained vaginal bleeding.
  • IUD expulsion risk is higher in the immediate postpartum period (10%-25%).
  • High fundal placement has been shown to reduce the risk of expulsion; may be placed with ultrasound guidance.
  • Barriers to immediate postpartum LARC arise from the health care system, provider, and payment issues.
  • Dedicated LARC placement teams may reduce burdens on health care system and physicians.