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Time to lactogenesis stage II is noninferior with immediate vs delayed etonogestrel implant insertion
Clinical Question
Is time to lactogenesis stage II similar with an etonogestrel implant insertion immediately postpartum versus 24 to 48 hours later?
Bottom line
Onset of lactogenesis stage II by day 3 postpartum did not differ between groups that had an ETG implant placed within 2 hours after delivery versus at 24 to 48 hours postpartum. The mean time to lactogenesis stage II slightly favored the immediate implant group. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Self-funded or unfunded
Setting: Inpatient (any location)
Synopsis
These authors sought to compare time to lactogenesis stage II (perception of copious milk production) among patients who received an etonogestrel (ETG) implant in the delivery room within 2 hours postpartum (n =35) or at 24 to 48 hours postpartum (n = 34). The authors included patients who intended to breastfeed and desired ETG for contraception. They performed as-treated analysis as the most conservative approach to assess noninferiority. The groups were similar in age, gestational age at delivery, and previous breastfeeding experience. Time to onset of stage II lactogenesis was 65 hours (standard deviation +/- 25) in the delivery room group and 73 hours (+/- 61) in the delayed group (mean difference -9; 95% CI -27 to 10). By day 3 postpartum, lactogenesis stage II was present for 24 of 35 (74%) patients in the early group and 24 of 34 (71%) in the delayed group (NS).
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Impact assessment
Very 6
Estrogen implant postpartum
Had no idea estrogen implants weed used postpartum to boost milk production and provide contraception
Postpartum Nexplanon use in women wishing to breastfeed
I liked this study in general, but they didn’t look at, or at least they didn’t report, one key outcome: the total number of women in each group that were able to successfully breastfeed their babies. The study only included women who wished to both breastfeed their babies and have birth control through Nexplanon so why not include the number of women in each group that were successful in breastfeeding?
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