Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Guidelines for LARC Initiation and Management

Obstet Gynecol; ePub 2017 Nov; ACOG, et al

Long-acting reversible contraceptives (LARC) have few contraindications and should be offered routinely as safe and effective contraceptive options for most women, according to a new clinical practice bulletin from the American College of Obstetricians and Gynecologists (ACOG). The practice bulletin provides information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. Among the additional ACOG recommendations:

Level A:

  • Insertion of an intrauterine device (IUD) immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option.
  • Insertion of the contraceptive implant on the same day as first-trimester or second-trimester induced or spontaneous abortion should be offered routinely as a safe and effective contraceptive option.
  • Routine antibiotic prophylaxis is not recommended before IUD insertion.

Level B:

  • Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents.
  • Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded.
  • Insertion of an IUD immediately after confirmed completion of first-trimester medication-induced abortion should be offered routinely as a safe and effective contraceptive option.
  • Immediate postpartum IUD insertion should be offered routinely as a safe and effective option for postpartum contraception.
  • Immediate postpartum initiation of the contraceptive implant should be offered routinely as a safe and effective option for postpartum contraception, regardless of breastfeeding status.

Citation:

Long-acting reversible contraception: Implants and intrauterine devices. Practice Bulletin No. 186. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e251–69.