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- W4313639307 abstract "Current recommendations to promote equitable care include moving away from tier-based and towards patient-centered contraceptive counseling. Long-acting reversible contraceptives (LARC) offer exceptional pregnancy protection but are not optimal for everyone. Patients who undergo unplanned or high-risk deliveries may be at risk for contraceptive coercion to use a LARC method. We aimed to assess immediate postpartum LARC (PPLARC) uptake in both low and high-risk populations. Retrospective cohort study of patients who delivered at a single academic center in 2019 with the low and high-risk obstetric services. Chart abstraction was performed by trained researchers. Patients were grouped into either low- or high-risk depending on which service performed the delivery. The primary outcome was PPLARC uptake. Multivariable logistic regression for PPLARC uptake by delivery service was calculated controlling for known confounders. Of the 239 deliveries, 140 (58.6%) occurred with low-risk service. Low-risk patients were more likely to be younger, Black and to have publicly funded insurance (table 1). Low-risk were more likely to be nulliparous (32.9%) than high-risk patients (20.2%,p< 0.04). Documented contraceptive counseling rates did not differ between groups. More low-risk (27.1%) patients desired the contraceptive implant prenatally than high-risk patients (7.1%, p< 0.002). Low-risk patients also desired the copper IUD more frequently than high-risk patients (12.9% and 3.0% respectively, p< 0.001). A higher number of low-risk patients received a PPLARC implant as compared to high-risk( 22.1% vs. 9.1%, p< 0.01). After controlling for age, nulliparity and cesarean delivery, low-risk patients were not more likely to receive a postpartum implant. Contrary to our hypothesis, in this cohort, there were no differences in rates of PPLARC after controlling for known confounders. Further prospective and qualitative research is planned to assess for patient perception of coercion when choosing postpartum contraception, particularly PPLARC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
- W4313639307 created "2023-01-07" @default.
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- W4313639307 date "2023-01-01" @default.
- W4313639307 modified "2023-09-26" @default.
- W4313639307 title "Immediate postpartum LARC use in a low versus high-risk academic practice" @default.
- W4313639307 doi "https://doi.org/10.1016/j.ajog.2022.11.1031" @default.
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