Immediate postpartum insertion of the Norplant contraceptive device

To determine the safety and efficacy of Norplant (Wyeth-Ayerst Laboratories, Philadelphia, PA) insertion immediately postpartum. Prospective study of 14 women receiving Norplant immediately postpartum compared with controls (n=6) having a bilateral tubal ligation. Subjects were followed for 3months postpartum, and data were analyzed by analysis of variance and χ2. Academic Health Sciences Center. Female subjects 18 to 35 years old who had an uncomplicated term pregnancy, normal spontaneous vaginal delivery, and did not breast-feed. A brief interview, physical exam, and blood and urine samples were evaluated during a 12-week postpartum period. Major complaints, serum chemistry panels, hematologic and coagulative measures, serum E2, P, levonorgestrel, PRL, LH, FSH, and urinary estrone-3 conjugates and pregnanediol-3-glucuronide concentrations. Serum levonorgestrel peaked at approximately 2,000pg/mL (6,400pmol/L) during the 1st week after Norplant insertion, declining to approximately 250pg/mL (800pmol/L) by the 8th week. Significant differences between Norplant and control groups included bleeding irregularities, headaches, alopecia, and abdominal discomfort. Serum electrolytes, metabolic markers, and blood components were within normal limits. Serum E2, P, and urinary steroid biomarkers indicated that steroid secretion was suppressed severely in the Norplant group compared with controls who exhibited normal postpartum ovarian activity. Norplant inserted immediately postpartum appears to be a safe and effective method of contraception. However, the long-term hypoestrogenic state and contraceptive efficacy beyond the 3-month postpartum period as observed in this study are concerns that need further clinical evaluation.