SMFM recommends immediate postpartum LARC in high-risk patients

  • Vricella LK & al.
  • Am J Obstet Gynecol
  • 7 Feb 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • 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.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.