- 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.
- 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.