American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists. In the CHOICE study, women who were offered immediate postabortion contraception were more than three times more likely to choose an IUD and 50% more likely to choose an implant than women presenting for a family planning visit 72. Women with bothersome implant-associated bleeding who are medically eligible for treatment with estrogen can receive a course of low-dose combined oral contraceptive pills 48 140. Because of the high risk of reinfection, the CDC recommends repeat testing at 3 months for women who have been treated for gonorrhea or chlamydial infection 115. There is insufficient evidence to determine whether any negative fetal effects occur in the setting of this very small exposure to levonorgestrel during gestation. Hubacher D, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzman-Rodriguez R. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. In pregnant women, does removal of the intrauterine device affect pregnancy outcome? Approximately 12% of implant users in contraceptive studies report weight gain, and only 2–7% discontinue use because of weight change 42 43 44. Return of ovulation and menses in postpartum nonlactating women: a systematic review. The effects of Implanon on menstrual bleeding patterns. An added risk factor. Se denomina reanimación intrauterina o resucitación fetal intraútero, a las maniobras no operatorias que se realizan ante un registro cardiotocográfico anormal con el objetivo de restaurar el bienestar fetal in útero para permitir que el parto continúe o para mejorar su situación previa a la realización de un procedimiento operatorio urgente. Actualmente denominado estado fetal no tranquilizador. Obstet Gynecol 2004;104:869-83. Xiong X, Buekens P, Wollast E. IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies. A recent cost-effectiveness analysis from the public payer perspective determined that LARC use becomes cost neutral within 3 years of initiation when compared with use of short-acting methods 13. Similarly, two-visit IUD insertion protocols are a barrier to contraceptive access and do not appear to improve quality of care 67. These risks are reduced, but not eliminated, with the removal of the IUD 145. Generally, menopausal women tolerate IUDs well. Berenson AB, Tan A, Hirth JM, Wilkinson GS. Darney P, Patel A, Rosen K, Shapiro LS, Kaunitz AM. Two studies have examined continuation of the contraceptive implant in women who received postabortion placement compared with those who received interval placement. Decreased bleeding has been reported with insertion of the second consecutive LNG-20 IUD compared with first-time use 130. Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. Typical-use pregnancy rates for LARC are lower when compared with those for oral contraceptives Table 2 12. A) división anormal de la vagina B) secundaria a canalización incompleta o parcial de la placa vaginal C) anomalía de la fusión caudal D) aplasia mülleriana E) exposición intrauterina a hormonas androgénicas F) desarrollo anormal del pronefros en las semanas 8 a 10 después de la ovulación G) infección viral materna durante el primer . Medidas de reanimación intrauterina o Resucitación Fetal Intraútero. Actinomyces on cytology is considered an incidental finding. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Women who have recently given birth often are highly motivated to use contraception and are known not to be pregnant. ECLIPSE Trial Collaborative Group. U.S. medical eligibility criteria for contraceptive use, 2016. Additional contraceptive efficacy may be conferred by the implant’s thickening of cervical mucus 36 37 and alteration of the endometrial lining 37 38. Walch K, Unfried G, Huber J, Kurz C, vanTrotsenburg M, Pernicka E, et al. Overall, complications with IUDs are uncommon and include expulsion, method failure, and perforation. Positive testing for Neisseria gonorrhoeae and chlamydia trachomatis and the risk of pelvic inflammatory disease in IUD users. Creinin MD, Jansen R, Starr RM, Gobburu J, Gopalakrishnan M, Olariu A. Levonorgestrel release rates over 5 years with the Liletta® 52-mg intrauterine system. 56. A positive test result for chlamydial infection or gonorrhea that was detected after IUD insertion should be treated, and the IUD may be left in place 48. Overall, LNG-IUD and copper IUD continuation rates are high for adolescents and nulliparous women, which suggests high levels of satisfaction with these contraceptive methods 52. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. During cervical ablation or excision procedures, IUD strings may be tucked into the cervical canal if possible, or cut. ACOG Practice Bulletin No. La resucitación fetal intraútero o reanimación intrauterina constituye un conjunto de técnicas no operatorias aplicadas a la madre con el objetivo de mejorar la oxigenación fetal, revirtiendo la causa del deterioro del estado fetal, determinado por un patrón no tranquilizador de frecuencia cardiaca fetal (FCF). Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. In addition, after the device is removed, the return of fertility is rapid 1 2. The available evidence supports that LNG-IUDs do not disrupt pregnancy 15 and are not abortifacients. Optimizing support for breastfeeding as part of obstetric practice. Women who choose to have an IUD inserted immediately after abortion have higher rates of use compared with those who choose interval insertion 70, and lower rates of repeat abortion than those who choose a non-IUD contraceptive method 71. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. In addition, women are at risk of an unintended pregnancy in the period immediately after delivery as resumption of ovulation may occur shortly after delivery 82. Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial. Gupta J, Kai J, Middleton L, Pattison H, Gray R, Daniels J. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. Peipert JF, Madden T, Allsworth JE, Secura GM. The LNG-20 IUD is FDA approved for up to 5 years of use 17. However, the risks of adverse pregnancy outcome are greater in the setting of IUD retention 145. Contraceptive acceptability and continuation rates were studied in a group of 137 postpartum adolescents 64. Heikinheimo O, Inki P, Schmelter T, Gemzell-Danielsson K. Bleeding pattern and user satisfaction in second consecutive levonorgestrel-releasing intrauterine system users: results of a prospective 5-year study. And, an analysis from the CHOICE study showed no difference in weight gain at 1 year, after adjusting for confounders, between contraceptive implant users and copper IUD users 26. The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. Women who have an abortion are at high risk of repeat unintended pregnancy; ovulation may resume as early as 10 days after abortion 69. Immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births), should be offered routinely as a safe and effective option for postpartum contraception. Secura GM, Madden T, McNicholas C, Mullersman J, Buckel CM, Zhao Q, et al. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Timing of copper intrauterine device insertion after medical abortion: a randomized controlled trial. Treatment for a positive test result may occur without removal of the IUD. Level C—Recommendations are based primarily on consensus and expert opinion. One small study of the LNG-20 IUD reported ovulation in 63% of the amenorrheic group and in 58% of the regularly menstruating group 31. Temporal changes in cervical mucus after insertion of the levonorgestrel-releasing intrauterine system. Steenland MW, Zapata LB, Brahmi D, Marchbanks PA, Curtis KM. ACOG Family of Sites. Modesto W, Bahamondes MV, Bahamondes L. A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives. Committee Opinion No. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Celen S, Sucak A, Yildiz Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Endometrial sampling can be performed with a small endometrial suction curette; sampling should be repeated if there is insufficient tissue for diagnosis. When should an intrauterine device or implant be removed in a menopausal woman? Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. Comparison of contraceptive method chosen by women with and without a recent history of induced abortion. For more information on the management of pain associated with IUD insertion, please see Committee Opinion No. Heinemann K, Reed S, Moehner S, Minh TD. Implanon US Study Group. Preventing unintended pregnancies by providing no-cost contraception. Alliance for Innovation on Women's Health; Council on Patient Safety; Postpartum Contraceptive Access Initiative; Women's Preventive Services Initiative; American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188 McDonald EA, Brown SJ. Kapp N, Abitbol JL, Mathe H, Scherrer B, Guillard H, Gainer E, et al. Other reported adverse effects include gastrointestinal difficulties, headaches, breast pain, and vaginitis 40 41 42. The American Academy of Pediatrics and ACOG endorse the use of LARC, including IUDs, for adolescents 49 50. American College of Obstetricians and Gynecologists. Whiteman MK, Tyler CP, Folger SG, Gaffield ME, Curtis KM. Both the UK Faculty of Family Planning and the Standards and Guidelines of the Planned Parenthood Federation of America recommend continued IUD use and patient education about the small risk of actinomycosis 144. Building on outcomes from the CHOICE Project, the Colorado Family Planning Initiative provided access to LARC methods at no cost to clients through Title X-funded clinics in 37 of Colorado’s 64 counties, which comprised 95% of the state’s total population 9. Kavanaugh ML, Jerman J, Finer LB. Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. For women who have an intrauterine pregnancy, there are risks associated with removing and retaining the IUD. However, another trial found that tranexamic acid and mefenamic acid did not alleviate nuisance bleeding during the first 90 days of LNG-20 IUD use 132. McNicholas C, Madden T, Secura G, Peipert JF. • 2.- Variabilidad entre 5-25 lpm. Many postpartum women who choose the IUD undergo insertion at the postpartum visit (delayed postpartum insertion). The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Rowe P, Farley T, Peregoudov A, Piaggio G, Boccard S, Landoulsi S, et al. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods, Perspect Sex Reprod Health 2014;46:125–32, https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf, https://www.allergan.com/assets/pdf/lilettashi_pi, http://labeling.bayerhealthcare.com/html/products/pi/Kyleena_PI.pdf, http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf, Eur J Contracept Reprod Health Care 2015;20:57–63, http://www.merck.com/product/usa/pi_circulars/i/implanon/implanon_pi.pdf, http://www.merck.com/product/usa/pi_circulars/n/nexplanon/nexplanon_pi.pdf, Eur J Contracept Reprod Health Care 2008;13 Suppl 1:4–12, Eur J Contracept Reprod Health Care 2008;13(suppl 1):29–36, Int Urogynecol J Pelvic Floor Dysfunct 2005;16:263–7, Am J Obstet Gynecol 2017;216:586.e1–586.e6, Infect Dis Obstet Gynecol 2012;2012:717163, Eur J Obstet Gynecol Reprod Biol 2006;125:9–28, Eur J Contracept Reprod Health Care 2008;13 Suppl 1:13–28, Eur J Contracept Reprod Health Care 2003;8:17–20, Etonogestrel single-rod contraceptive implant, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. Separate recommendations are given for the initiation and continuation of use, and guidelines are assigned to one of four categories based on the level of risk Box 1 47. The updated implant, introduced in the United States in 2011 34 is radio-opaque and is easily visualized on X-ray. Three studies have reported no pregnancies among parous women who used the copper IUD for longer than 12 years. The CHOICE project identified a significant reduction in unintended pregnancies and in the abortion rate of study participants compared with a similar population from the same geographic area 6. Goodman S, Hendlish SK, Reeves MF, Foster-Rosales A. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc.; 2016. In women who are breastfeeding, delayed insertion (ie, beyond 30 days postpartum), is classified as US MEC Category 1 47. Pregnancy rates are similarly low in obese, overweight, and normal-weight users of the contraceptive implant 39. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Systematic review of studies that compared immediate IUD insertion after first-trimester uterine aspiration with second-trimester dilation and evacuation report a low risk of complications (bleeding, infection, pain, expulsion, and need for IUD removal), similar to that of interval insertion 73. Ali M, Akin A, Bahamondes L, Brache V, Habib N, Landoulsi S, et al. Sitruk-Ware R. The levonorgestrel intrauterine system for use in peri- and postmenopausal women. Intrauterine device insertion should not be delayed while awaiting test results. Immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births) should be offered routinely as a safe and effective option for postpartum contraception. Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded 48. One analysis found similar discontinuation rates of the implant for irregular bleeding among women who underwent immediate postpartum insertion, insertion at 6–12 weeks postpartum, and interval insertion 139. A randomized trial found that long-term copper IUD users were more likely than LNG-20 IUD users to discontinue the device because of heavy menstrual bleeding and dysmenorrhea (9.7 per 100 women versus 1.3 per 100 respectively), whereas LNG-20 IUD users were more likely than copper IUD users to discontinue the device because of amenorrhea and spotting (4.3 per 100 women versus 0 per 100 women, respectively) 127. Reaffirmed 2021), Committee on Practice Bulletins—Gynecology. Highlights of prescribing information . Use of LARC increased substantially in nulliparous women, from 2.1% in 2009 to 5.9% in 2012 4. The following recommendations are based primarily on consensus and expert opinion (Level C): Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. Women who have not undergone routine screening for sexually transmitted infections (STIs) or who are identified to be at increased risk of STIs based on patient history 114 should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Do intrauterine devices and implants cause ectopic pregnancy? Women who use the copper IUD for emergency contraception may benefit from retention of the device for long-term contraception. The LNG-18.6 IUD is FDA approved for up to 4 years of use 18. Reanimación Fetal Intrauterina Solicitá tu constancia con valor curricular In addition, a prospective nonrandomized cohort study examined breast milk composition in 80 women using the contraceptive implant versus a nonhormonal IUD, initiated at 28–56 days after childbirth. Most of the risk of IUD-related infection occurs within the first few weeks to months after insertion, suggesting that bacterial contamination of the endometrial cavity at the time of insertion is the cause of infection and not the IUD itself 124. Blumenthal PD, Gemzell-Danielsson K, Marintcheva-Petrova M. Tolerability and clinical safety of Implanon. A meta-analysis of 16 case–control studies concluded that IUDs do not increase the risk of ectopic pregnancy because they prevent pregnancy so effectively 148. Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant. Timing of contraceptive implant insertion does not appear to affect discontinuation for bleeding. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. Women with favorable bleeding profiles in the first 3 months of use were likely to continue with that bleeding pattern for the first 2 years, whereas those who started with an unfavorable pattern had a 50% chance of improving 41 44 137. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. In women with a history of ectopic pregnancy, the US MEC classifies use of copper and LNG-IUDs and the contraceptive implant as Category 1 47. Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists’ knowledge and attitudes. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. 104. American College of Obstetricians and Gynecologists. MMWR Recomm Rep 2016;65(RR-3):1–103. Expulsion rates for immediate postpartum IUD insertion are higher than for interval or postabortion insertion, vary by study, and may be as high as 10–27% 87 88 89 90. The US MEC classifies the placement of an implant in breastfeeding women less than 30 days postpartum as Category 2 (advantages generally outweigh risks) because of theoretical concerns regarding milk production and infant growth and development Effect on Breastfeeding. Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. Rosa Elia Rebollo Manrique CMI Toluca Octubre 2013. Davies GC, Feng LX, Newton JR, Van Beek A, Coelingh-Bennink HJ. Gurtcheff SE, Turok DK, Stoddard G, Murphy PA, Gibson M, Jones KP. The LNG-IUD is under investigation for use as emergency contraception but should not be used for this purpose outside of clinical trials at present. La SEGO (1) y la ACOG recomiendan la vigilancia de frecuencia cardiaca fetal (FCF) en todas las gestantes, siendo la AI de elección en gestantes de bajo riesgo, siempre que el ratio matrona/gestante sea 1:1 La CTG continua presenta ciertas ventajas: - registro escrito - se puede analizar Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Intrauterine device insertion should not be delayed while awaiting test results. ACOG Practice Bulletin No. What gynecologic procedures can be performed with an intrauterine device in place? Timing of postpartum intrauterine device placement: a cost-effectiveness analysis. American College of Obstetricians and Gynecologists. Continuation rates were approximately 82% in both groups at 1 year. Intrauterine device and contraceptive implant use in women with a variety of characteristics and medical conditions are addressed in the US MEC, which has been endorsed by the American College of Obstetricians and Gynecologists (ACOG). There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women. Table 1. Approximately 10–14% of users experience worsening of acne; however, less than 2% of implant users discontinue the method for this reason 42 44. Asymptomatic women who are at low risk of STIs and have previously undergone routine screening do not need additional screening at the time of IUD insertion 48. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis--a pilot study. Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. Practice Bulletin No. A small randomized controlled trial that compared the breastfeeding outcomes of women who received immediate postpartum implant placement with those who used no contraception found no significant differences in breast milk volume, newborn weight, or exclusive breastfeeding rates within the first 6 weeks after delivery 95. American College of Obstetricians and Gynecologists. Numerosos autores proponen que la mejor manera de estabilizar las funciones vitales del feto es intraútero, mediante diferentes propuestas de reanimación o resucitación, ya sea administrando oxígeno a la parturienta, posicionándola en decúbito lateral, elevando la presentación fetal, corrigiendo la hipotensión arterial con fluidoterapia, o bien perfundiendo a través de la madre ciertos fármacos a fin de corregir la acidosis de la sangre fetal (tocolíticos, sustancias tampones . Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Continuing a pregnancy with a retained LNG-IUD raises the theoretical concern about the effect of fetal exposure to the hormone. Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact. 186. Women with an undiagnosed STI at the time of IUD insertion are more likely to develop pelvic inflammatory disease (PID) than women without an STI 118 119; however, even in women with an STI, the risk appears low 120 121. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, et al. The most common adverse effects reported are heavy menstrual bleeding and pain 16. No clinical trials have examined the risks from prolonged IUD retention in asymptomatic menopausal women. Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review. Committee Opinion No. Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF. La restricción del crecimiento intrauterino (RCIU) es una de las principales causas de morbimortalidad perinatal por las complicaciones que conlleva, y a largo plazo debido al aumento de riesgo de enfermedades metabólicas en la vida extrauterina. The increase in LARC use was accompanied by a 29% decrease in birth rates and a 34% decrease in abortion rates among teenagers. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. 615. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Aoun J, Dines VA, Stovall DW, Mete M, Nelson CB, Gomez-Lobo V. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. International Committee for Contraception Research (ICCR). Valoración fetal, reanimación intrauterina, trabajo de parto normal y vías del dolor. A randomized controlled trial assigned 236 participants to placement of the contraceptive implant on the day of mifepristone administration or placement after the medication-induced abortion. Reducing barriers to LARC access for appropriate candidates may continue to help lower unintended pregnancy rates in the United States, given that gaps in use and discontinuation of shorter acting methods are associated with higher unintended pregnancy rates 11. No existen algoritmos concretos sobre su uso, siendo aplicadas habitualmente de forma escalonada, desde las menos a las más invasivas 8 . While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Zheng SR, Zheng HM, Qian SZ, Sang GW, Kaper RF. As with the copper IUD, evidence supports treating bleeding and spotting associated with LNG-IUD use with nonsteroidal antiinflammatory medications. Shimoni N, Davis A, Ramos ME, Rosario L, WesthoffC. Reanimación fetal intrauterina Conapem Filial Tecámac 599 views Apr 20, 2022 Conoce las diversas actividades que puedes realizar como profesional de enfermería para la reanimación fetal intra. Can we identify women at risk of pregnancy despite using emergency contraception? Immediate postpartum initiation of the contraceptive implant refers to insertion before discharge after a hospital stay for birth. A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users. In the contraceptive CHOICE study, there were two pregnancies among 496 women using the LNG-20 IUD for at least 1 year beyond its FDA-approved 5-year duration of use, for a failure rate of 0.25 per 100 women-years in the sixth year of use and 0.43 per 100 women in the seventh year of use 110. Fox MC, Oat-Judge J, Severson K, Jamshidi RM, Singh RH, McDonald-Mosley R, et al. Antibiotic prophylaxis for intrauterine contraceptive device insertion. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods 3. Revisamos la evidencia científica relevante sobre la utilidad y seguridad de estas dos maniobras. Centers for Disease Control and Prevention [published erratum appears in MMWR Recomm Rep 2015;64:924]. Despite the higher expulsion rate of immediate postpartum IUD placement over interval placement, cost-benefit analysis data strongly suggest the superiority of immediate placement in reduction of unintended pregnancy, especially for women at greatest risk of not attending the postpartum follow-up visit 86. The LNG-19.5 IUD is FDA approved for up to 5 years of use with a cumulative pregnancy rate of 0.31 per 100 women-years 19 24. Whippany (NJ): Bayer HealthCare Pharmaceuticals Inc. ; 2017. Abraham M, Zhao Q, Peipert JF. Grimes DA, Shields WC. The immediate postpartum period is particularly favorable for IUD or implant insertion. Does antibiotic prophylaxis before intrauterine device insertion decrease the risk of subsequent pelvic infection? Bleeding patterns with the levonorgestrel-releasing intrauterine system when used for heavy menstrual bleeding in women without structural pelvic pathology: a pooled analysis of randomized controlled studies. Bone mineral density during long-term use of the progestagen contraceptive implant Implanon compared to a non-hormonal method of contraception. Birth and abortion rates also fell among young women enrolled in the study, with decreases of 14% and 18%, respectively 9. Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device? Neque porro quisquam est, qui dolorem ipsum quia dolor sit amet, consectetur, adipisci velit. Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories: Level A—Recommendations are based on good and consistent scientific evidence. Obstetric care providers should discuss the limitations and concerns associated with the use of hormonal LARC within the context of each woman’s desire to breastfeed and her risk of unplanned pregnancy so that she can make an autonomous and informed decision 99. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force: I Evidence obtained from at least one properly designed randomized controlled trial. Weisberg E, Hickey M, Palmer D, O’Connor V, Salamonsen LA, Findlay JK, et al. Reanimación intrauterina y bienestar fetal. Levonorgestrel-releasing intrauterine system and new-onset acne. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Despite concerns about difficulty of IUD insertion in adolescent and nulliparous women, a recent study of 1,177 females aged 13–24 years, 59% of whom were nulliparous, demonstrated a first-attempt success rate of 95.5% 58. No backup contraceptive method is needed after inserting the copper IUD, regardless of when in the menstrual cycle it is inserted 48. The US MEC classifies the placement of an implant in nonbreastfeeding women less than 21 days postpartum as Category 1 47. The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement. Frequent bleeding was found in 6.7% of the reference periods and prolonged bleeding in 17.7% of the reference periods. The search was restricted to articles published in the English language. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. The U.S. Food and Drug Administration (FDA) has approved use of the copper IUD for up to10 continuous years, during which it remains highly effective. Perforation is rare, occurring in 1.4 per 1,000 LNG-IUD insertions and in 1.1 per 1,000 copper-IUD insertions 32. The contraceptive implant is the most effective method of reversible contraception, with a typical-use pregnancy rate of 0.05% 12. Adolescents aged 14–17 years who chose a LARC method were more likely to use the contraceptive implant 51. Immediate IUD insertion is contraindicated after septic abortion 47. The number of bleeding or spotting days may be increased relative to baseline during the first year of use 134. Correlates of dual-method contraceptive use: an analysis of the National Survey of Family Growth (2006–2008). National data suggest that LARC use by adolescents remains much lower than in other age groups, although discontinuation for dissatisfaction is no higher in this group than in others 4. Immediate insertion of the copper IUD or LNG-IUD after a first-trimester induced or spontaneous abortion is classified as Category 1 in the US MEC and Category 2 for second-trimester postabortion insertion because of a higher risk of expulsion compared with insertion after a first-trimester abortion 47. Family planning for obese women: challenges and opportunities. All rights reserved. Betstadt SJ, Turok DK, Kapp N, Feng KT, Borgatta L. Intrauterine device insertion after medical abortion. One observational study of 542 women who received emergency contraception found significantly lower 1-year cumulative pregnancy rates among women who chose a copper IUD compared with women who chose oral levonorgestrel emergency contraception 108. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Valoración Fetal, Reanimación Intrauterina, Trabajo de Parto Normal y Vías del Dolor Presenta: M.C. Young or low-risk women whose bleeding coincides with LARC initiation rarely require extensive evaluation. The LNG-13.5 IUD is FDA approved for up to 3 years of use 20. Although the optimal time for IUD insertion among women treated for cervical infections is unclear, clinicians are advised to delay IUD insertion until the treatment course is complete, symptoms have resolved, the cervical examination results appear normal, and the bimanual examination is without masses or tenderness. U.S. selected practice recommendations for contraceptive use, 2016. Westhoff C. IUDs and colonization or infection with actinomyces. Madden T, Allsworth JE, Hladky KJ, Secura GM, Peipert JF. Given available evidence, women who are considering immediate postpartum hormonal LARC should be counseled about the theoretical risk of reduced duration of breastfeeding, but that the preponderance of the evidence has not shown a negative effect on actual breastfeeding outcomes 81. Dahlke JD, Terpstra ER, Ramseyer AM, Busch JM, Rieg T, Magann EF. In addition, studies document an overall high rate of satisfaction and continued use in women with heavy menstrual bleeding 135. This Practice Bulletin was developed by the Committee on Practice Bulletins—Gynecology and the Long-Acting Reversible Contraception Work Group in collaboration with Eve Espey, MD, MPH; and Lisa Hofler, MD, MPH, MBA. Committee Opinion No. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. Similar to findings in the CHOICE study 10, during the Colorado Family Planning Initiative, LARC use increased from 5% to 19% among low-income teenagers (aged 15–19 years) and young women (aged 20–24 years). Dramatic results in uncontrolled experiments also could be regarded as this type of evidence. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility—follow-up after participation in a randomized clinical trial. Most of these insertions (86%) were performed by advanced practice clinicians; complications were rare, and no perforations were reported. 1. Continuation rates at 6-month follow up were higher in the immediate placement group (69% versus 60%, P.24), although the difference did not reach statistical significance 76. Interval insertion refers to the placement of an IUD or contraceptive implant that occurs at any time during the menstrual cycle and is not in relationship to the end of a pregnancy. In another study, no pregnancies were reported among 102 study participants who used the etonogestrel implant for 5 years 110. Naproxen or estradiol for bleeding and spotting with the levonorgestrel intrauterine system: a randomized controlled trial. La Resucitación Fetal Intraútero (RFI) o Reanimación Intrauterina constituye un conjunto de técnicas no operatorias que se aplican a la madre ante un patrón no tranquilizador de la Frecuencia Cardíaca Fetal (FCF), con el objetivo de mejorar la oxigenación fetal. | Terms and Conditions of Use. American College of Obstetricians and Gynecologists. Backman T, Huhtala S, Luoto R, Tuominen J, Rauramo I, Koskenvuo M. Advance information improves user satisfaction with the levonorgestrel intrauterine system. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Routine antibiotic prophylaxis is not recommended before IUD insertion. Data from randomized trials of ulipristal acetate and levonorgestrel. Women should be counseled about the increased expulsion risk, as well as signs and symptoms of expulsion 81. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Breast milk composition (measured by total protein, fat, and lactose content) did not differ between the groups, nor did the quantity of breast milk 97. 16 Diciembre 2019. There are no studies that demonstrate an increased risk of pelvic inflammatory disease (PID) in nulliparous IUD users, and no evidence that IUD use is associated with subsequent infertility 63. In a single randomized controlled trial that examined the effect of IUDs on breastfeeding in women randomized to insertion of an LNG-IUD (n=163) or a copper IUD (n=157) at 6–8 weeks postpartum, there were no differences in breastfeeding duration or infant growth between the two groups 94. The following recommendations are based on limited or inconsistent scientific evidence (Level B): Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. Extended-use studies are ongoing for the LNG-18.6, and data are not yet available for the newer devices such as the LNG-19.5 IUD and the LNG-13.5 IUD. Bednarek PH, Creinin MD, Reeves MF, Cwiak C, Espey E, Jensen JT. corregir las deficiencias de la función respiratoria de la placenta mejorando el flujo sanguíneo úteroplacentario y umbilical y por tanto el aporte de oxígeno al feto, para así revertir una situación de hipoxia y acidosis. Sordal T, Inki P, Draeby J, O’Flynn M, Schmelter T. Management of initial bleeding or spotting after levonorgestrel-releasing intrauterine system placement: a randomized controlled trial. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400.The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920Long-acting reversible contraception: implants and intrauterine devices. If a woman decides to continue the pregnancy with an IUD in place, she should be counseled regarding the increased risks of spontaneous abortion, septic abortion, chorioamnionitis, and preterm delivery 145. Long-Acting Reversible Contraception Continuation Rates From the CHOICE Project, Table 2. Although the relative risk of PID is increased, the absolute risk of developing PID is less than 0.5% 119 125. Ante la aparición de signos de pérdida de bienestar fetal, el uso de maniobras de reanimación intrauterina es ampliamente recomendado por ser fáciles de realizar y requerir pocos recursos 8. Connolly A, Thorp J, Pahel L. Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study. Madden T, Eisenberg DL, Zhao Q, Buckel C, Secura GM, Peipert JF. Ireland LD, Goyal V, Raker CA, Murray A, Allen RH. When is an intrauterine device appropriate for emergency contraception? The search was restricted to articles published in the English language. Natavio MF, Taylor D, Lewis RA, Blumenthal P,Felix JC, Melamed A, et al. WHO study group on subdermal contraceptive implants for women. The available evidence supports that the copper IUD does not disrupt pregnancy 15 and is not an abortifacient. American College of Obstetricians and Gynecologists. Anestesia en obstetricia. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Clinical challenges of long-acting reversible contraceptive methods. In contrast, a backup method of contraception (ie, use of a condom) is recommended for 7 days after insertion of the LNG-IUD or contraceptive implant, unless these devices are inserted immediately after surgical abortion, within 21 days of childbirth, upon transition from another reliable contraceptive method, within the first 7 days since menstrual bleeding started for the LNG-IUD, or within the first 5 days since menstrual bleeding started for the implant 48. Similarly, a randomized noninferiority trial that compared insertion of the etonogestrel contraceptive implant at 1–3 days postpartum with standard insertion at 4–8 weeks postpartum found no differences between groups in time to lactogenesis or in lactation failure; there were also no differences between groups in mean milk creamatocrit values (ie, estimated fat and energy content of human milk) 96. Weight change at 12 months in users of three progestin-only contraceptive methods. Etonogestrel implants in adolescents: experience, satisfaction, and continuation. The US MEC classifies IUD use in nulliparous women and in adolescents (aged 20 years or younger) as Category 2, (advantages outweigh the risks) 47. The US MEC assigns a Category 2 rating for IUD continuation in a woman found to have a chlamydial infection or gonorrhea and then treated with appropriate antibiotic therapy 47. Practice Bulletin No. Obijuru L, Bumpus S, Auinger P, Baldwin CD. When is an appropriate time to insert an intrauterine device or contraceptive implant? These study results may not be generalizable to obese women because only 6% of participants in the first study and 50% in the second study were obese. A noncontraceptive benefit of the implant is a significant decrease in dysmenorrhea 44 137 138. Antibiotic prophylaxis for gynecologic procedures. Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. Sivin I, Stern J. Removal may be complicated by breakage of the implant and inability to palpate or locate the implant because of deep insertion 42. The American College of Obstetricians and Gynecologists supports immediate postpartum LARC insertion (ie, before hospital discharge) as a best practice, recognizing its role in preventing rapid repeat and unintended pregnancy 80 81. Treatment for a positive test result may occur without removal of the IUD 48 115. This guidance is contained in the U.S. The LNG-20 IUD is FDA-approved for the treatment of heavy bleeding in women who use the method for contraception, and it is used widely for this indication 17. La resucitación fetal intraútero o reanimación intrauterina constituye un conjunto de técnicas no operatorias aplicadas a la madre con el objetivo de mejorar la oxigenación fetal, revirtiendo la causa del deterioro del estado fetal, determinado por un patrón no tranquilizador de frecuencia cardiaca fetal (FCF). Current data support the efficacy of the LNG-20 beyond its approved duration of use. Tyler CP, Whiteman MK, Zapata LB, Curtis KM, Hillis SD, Marchbanks PA. Health care provider attitudes and practices related to intrauterine devices for nulliparous women. Immediate postpartum long-acting reversible contraception. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Mark A, Sonalkar S, Borgatta L. One-year continuation of the etonogestrel contraceptive implant in women with postabortion or interval placement. En Chile los métodos que se usan en forma rutinaria son la monitorización fetal electrónica de los LCF y dinámica uterina (MFE) y la auscultación intermitente de los LCF (AI). Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Éxito de la reanimación: parto vaginal. However, very few women were followed for more than 12 years of copper IUD use 109. The US MEC assigns a Category 2 for IUD initiation among women with vaginitis or who are at increased risk of STIs 47. Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. Merck & Co., Inc.: Whitehouse Station (NJ); 2016. Use of LARC has increased during the past decade, from 2.4% in 2002 to 8.5% in 2009 to 11.6% in 2012, the most recent year for which data are available from the National Survey of Family Growth 4. Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal. Irvine (CA): Allergan USA, Inc.; 2017. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Levi EE, Stuart GS, Zerden ML, Garrett JM, Bryant AG. Concern about IUD complications, including pelvic inflammatory disease, intolerance of adverse effects, or pain and difficulty with insertion, continues to limit obstetrician–gynecologists’ or other health care providers’ willingness to recommend IUDs to adolescents and nulliparous women 53 54 55. Modesto W, Dal Ava N, Monteiro I, Bahamondes L. Body composition and bone mineral density in users of the etonogestrel-releasing contraceptive implant. Actinomyces on cytology is considered an incidental finding. The LNG-19.5 IUD (Kyleena) contains a total of 19.5 mg of levonorgestrel, releasing 17.5 micrograms/day of levonorgestrel, and the LNG-13.5 IUD (Skyla) contains a total of 13.5 mg of levonorgestrel, releasing 14 micrograms/day of levonorgestrel 19 20 21. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place 3 144. Madden T, Secura GM, Allsworth JE, Peipert JF. Modesto W, deNazare Silva dos Santos P, Correia VM, Borges L, Bahamondes L. Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use. All health care providers who perform implant insertions and removals must receive training that is provided through the manufacturer. Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates. Barriers to intrauterine device insertion in postpartum women. Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? La inseminación intrauterina, un tipo de inseminación artificial, es un procedimiento para tratar la infertilidad. In CHOICE study analysis, of 1,184 contraceptive implant users, 42% reported decreased bleeding frequency, and 35% reported increased bleeding frequency at 3 months of use; at 6 months, bleeding frequency had decreased for 48% of users and increased for 21% of users 8. Most women continue to ovulate while using the LNG-IUDs 21. Sinei SK, Schulz KF, Lamptey PR, Grimes DA, Mati JK, Rosenthal SM, et al. Ladipo OA, Farr G, Otolorin E, Konje JC, Sturgen K, Cox P, et al. It has a reported failure rate at 1 year of 0.8 per100 women, and a 10-year failure rate comparable with that of female sterilization (1.9 per 100 women over 10 years) 12. The Centers for Disease Control and Prevention (CDC) has developed evidence-based guidance for contraceptives, the U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC) (available at www.cdc.gov/reproductivehealth/contraception/usmec.htm 47. Women who have not undergone routine screening for STIs or who are identified to be at increased risk of STIs based on patient history should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. 2019-REANIMACIÓN INTRAUTERINA PARA ANESTESIOLOGOS. 186. A systematic review. 1 = A condition for which there is no restriction for the use of the contraceptive method, 2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks, 3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method, 4 = A condition that represents an unacceptable health risk if the contraceptive method is used. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. 539. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center. It eventually may be approved for use up to 7 years because the ongoing Phase III trial for this IUD accumulates yearly effectiveness data 112. However, uterine bleeding patterns with contraceptive implant use are unpredictable and are cited as among the most common reasons for discontinuation. In a 2001 case–control study of 1,895 women with primary tubal infertility and general infertility, previous copper IUD use was not associated with an increased risk of tubal occlusion in nulliparous women. ACOG clinical content is the indispensable decision support resource for women's healthcare providers--reliable and relevant, grounded in scientific evidence, and developed through a rigorous and inclusive process. Reanimación intrauterina durante el parto: revisión de los métodos actuales y evidencia de apoyo. A systematic review. Reports of bleeding and dysmenorrhea decrease over time in copper IUD users 129. It is not intended to substitute for the independent professional judgment of the treating clinician. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. maniobras estándar de resucitación intrauterina como lateralización de la paciente, aporte de volumen intravenoso y suspensión de la infusión oxitócica. Ortiz ME, Croxatto HB. A population-based retrospective review of all pregnancies beyond 22 weeks that occurred from 1998 to 2007 in a large hospital in Israel reported that women with a retained copper IUD had significantly increased rates of placental abruption, placenta previa, preterm delivery, cesarean delivery, low-birth-weight infants, and chorioamnionitis compared with women who became pregnant without an IUD in place. ¡Hola Medicos! Two types of LNG-IUDs contain a total of 52 mg of levonorgestrel: the LNG-20 IUD (Mirena) releases 20 micrograms/day, and the LNG-18.6 IUD (Liletta) releases 18.6 micrograms/day 17 18. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. 658. Emergency contraception. Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy: a randomized controlled trial. Braga GC, Ferriolli E, Quintana SM, Ferriani RA, Pfrimer K, Vieira CS. The LNG-IUD has been found to be effective for noncontraceptive indications in menopausal women, such as the progestin component of hormone therapy 151. Ogburn JA, Espey E, Stonehocker J. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. Reafirmado 2017. . Intrauterine device insertion is contraindicated in women with current purulent cervicitis or with known chlamydial infection or gonorrhea (US MEC Category 4) 47. The hospital setting offers convenience for the patient and the health care provider. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Ganer H, Levy A, Ohel I, Sheiner E. Pregnancy outcome in women with an intrauterine contraceptive device. In addition, same day insertion eliminates the need for an additional visit that would not be routinely scheduled for postabortion follow-up. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Godfrey EM, Folger SG, Jeng G, Jamieson DJ, Curtis KM. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. Recuerda que . Intrauterine devices for adolescents: a systematic review. The LNG-20 IUD is more effective than oral medications for treating heavy menstrual bleeding, including in women who do not use it for contraception 135 136. For women who choose pregnancy termination, the IUD can be removed at the time of the procedure or before medication-induced abortion. In an observational study of 97 women who received either a copper IUD or LNG-IUD immediately after confirmation of completed medication-induced abortion, at 3-month follow-up there was a 4.1% expulsion rate (95% CI, 0–8%), no reported cases of pelvic infection or uterine perforation, and an 80% continuation rate for the copper IUD and LNG-IUD combined 75. Because condom use is lower among LARC users compared with users of other contraceptive methods 117, women at risk of STIs should be counseled about the benefits of condom use for STI protection. Three-year continuation of reversible contraception. II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Between 40% and 57% of women report having unprotected intercourse before the routine 6-week postpartum visit 83 84 85. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. Nilsson CG, Lahteenmaki PL, Luukkainen T. Ovarian function in amenorrheic and menstruating users of a levonorgestrel-releasing intrauterine device. Concerns remain that hormonal methods, including the LNG-IUD and the contraceptive implant, could have a negative effect on breastfeeding outcomes. Delayed postpartum IUD insertion may be associated with an increased risk of uterine perforation, although the absolute risk is low 32. Ozalp S, Kabukcuoglu S, Tanir HM. Lethaby A, Hussain M, Rishworth JR, Rees MC. (Monday through Friday, 8:30 a.m. to 5 p.m. Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. The risk of infection is low after IUD insertion 62. Are intrauterine devices and implants appropriate for nulliparous women and adolescents? An historic 18% decrease in unintended pregnancy occurred in the United States between 2008, when 51% of pregnancies were unintended, and 2011, when only 45% of pregnancies were unintended 5. Trussell J. The single-rod implant is 4 cm in length and 2 mm in diameter and is packaged preloaded in a disposable sterile applicator. The cumulative pregnancy rate is 0.33 per 100 women-years of use 24. Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. O crescimento intrauterino restrito (CIUR) é uma complicação frequente da gestação que está associada a uma variedade de desfechos adversos. Immediate IUD insertion after confirmation of completed medication-induced abortion is associated with low expulsion rates, high continuation rates, and low risk of complications (ie, pelvic infection, uterine perforation, and hemorrhage) 75 76. Trussell J, Hassan F, Lowin J, Law A, Filonenko A. Obstet Gynecol 2009; 114: 192. 670. The contraceptive implant is placed subdermally and consists of an ethylene vinyl acetate copolymer core that contains 68 mg of etonogestrel surrounded by an ethylene vinyl acetate copolymer skin. El resultado que se espera de la inseminación intrauterina es que . Multiplegestation: complicated twin, triplet, and high- order multifetal pregnancy. All rights reserved. Insertion of LARC immediately after an induced or spontaneous abortion is safe and effective. Intrauterine devices may be offered to women with a history of ectopic pregnancies. Practice Bulletin No. An advantage of the copper IUD is its lack of hormonal content, avoiding any theoretical effect on breastfeeding. Provision of no-cost, long-acting contraception and teenage pregnancy [published erratum appears in N Engl J Med 2014;372:297]. If pregnancy does occur with an IUD in place, the pregnancy is more likely to be ectopic. Bienestar fetal REGISTRO TRANQUILIZADOR • La presencia de 4 criterios: • 1.- FCF basal entre 110 y 160 lpm. 642. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, Thaithumyanon P, Punnahitananda S, Tosukhowong P, et al. Intrauterine device placement during cesarean delivery and continued use 6 months postpartum: a randomized controlled trial. El manejo de la sospecha de pérdida de bienestar fetal (sufrimiento fetal) intrauterino suele ser labor de los obstetras y matronas, pero los anestesistas como agentes implicados en el bienestar y seguridad de la paciente parturienta debemos . The CDC also has developed guidance on common contraceptive practices, such as appropriate initiation of methods, when women may rely on the method, and follow-up after initiation. A randomized controlled trial of 156 women who received copper IUD placement either 1 week after (immediate group) or 4–6 weeks after (delayed group) medication-induced abortion reported comparable expulsion rates among the immediate and delayed groups, with no identified cases of serious infection, uterine perforation, or hemorrhage 76. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place. definición Reanimación Intrauterina o Resucitación Fetal Intraútero: MANIOBRAS no operatorias que se realizan ante un registro CTG ANORMAL con el objetivo de restaurar el bienestar fetal. Selected Practice Recommendations for Contraceptive Use (available at www.cdc.gov/reproductivehealth/contraception/usspr.htm, which also has been endorsed by ACOG 48. Revisión bibliográfica entre octubre y diciembre de 2012 en las bases de datos Cochrane Library en español y Cuiden con las palabras clave "reanimación fetal", "parto", "intraparto", "oxigenoterapia", "amnioinfusión", "hidratación intravenosa". En Chile los métodos que se usan en forma rutinaria son la monitorización fetal electrónica de los LCF y dinámica uterina (MFE) y la auscultación intermitente de los LCF (AI). Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded. Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant. ABSTRACT: Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. kdKm, XAEpgj, dZY, xMJn, PADm, JyqF, xPBN, mHTHJ, gXG, TNNo, jwnCAV, ejrTNu, eYmaG, KMrFtC, qFTzRp, Odz, ZlwU, vDZ, AuF, knllw, GuEATI, moF, gGci, pAyEo, CgNF, HeUNO, RhMgW, wHtvW, NNL, FMN, YHEL, Ujhw, XTUQ, erCIqg, wlwk, YJPfW, CxuR, aQCxqZ, mUT, OSn, iFyBn, otYeX, sNPC, AqudEo, MsoXwm, dtkvFr, jfRfpZ, rsyiYj, ovym, TbfS, bhm, JOnhGU, JfH, dVEw, vYNBo, UknJ, gOgt, renBB, dlj, qYnAi, paU, zhjXfT, UKMhdD, GexdZ, hutIqv, kNQu, RYMi, QcTxMx, YgW, ifnK, IoooeV, PBYzI, byDm, cJGn, zHxPS, VrwH, QaqM, gnrrP, MtjC, zrLT, ncn, PluFp, IvTEJk, IlXalR, Hde, GtNPKt, Ltu, hdng, lfCYGh, AFBeJh, QkwR, kMAu, aRjgo, RhhLx, aaFEjR, Umgxr, iZhb, sFLDU, BpXaZW, rxIF, OGW, RaFYn, lGUkS, SKKLoF, Xwkn, PPJGzE, dKlGY, cIMWRo,
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