Subdermal contraceptive implants in nurse-midwifery practice.
J Nurse Midwifery
; 38(2 Suppl): 80S-87S, 1993.
Article
in En
| MEDLINE
| ID: mdl-8483013
ABSTRACT
PIP: The US Food and Drug Administration approved the contraceptive implant system, Norplant, in February 1990. It has been used in other countries for more than 15 years before the US approved it. The 6 subdermally placed capsules in the upper inner arm release 50-80 mcg levonorgestrel/day into the bloodstream, resulting in a 99.8% efficacy rate. Patient education and counseling, especially about changes in the bleeding pattern and Norplant's inability to protect against sexually transmitted diseases, are important to maintain client satisfaction and continued use of Norplant. Side effects, from most to least common, are changes in menstrual bleeding, constant bleeding, missed periods, weight gain/increased appetite, headache, oily skin or acne, weight loss/nausea, breast tenderness, nervousness or loss of appetite, and hair loss. It is rare when complications are so severe that they require removal of the implants. Contraindications to Norplant include active liver disease, active thromboembolic disease, breast cancer, pregnancy, and undiagnosed dysfunctional uterine bleeding. Antiepileptic medications, barbiturates, treatment for tuberculosis, and Butazolidin/phenylbutazone reduce Norplant's efficacy. A trained person should insert Norplant within the first 5-7 days of the menstrual cycle when it is evident there is no pregnancy. Some reports recommend that, after childbirth, it should be inserted 6 weeks postpartum to avoid hemorrhage. Yet, nurse-midwives at the Center for Addiction and Pregnancy at the Francis Scott Key Medical Center in Baltimore, Maryland, insert Norplant 24-48 hours postpartum in non-breast-feeding mothers with no increase in hemorrhage. Norplant must be removed no longer than 5 years after insertion. Certified nurse-midwives wanting to incorporate Norplant into their practices should follow the Guidelines for the Incorporation of New Procedures into Nurse-Midwifery Practice and have available a consulting physician who is familiar with and skilled in inserting Norplant. The manufacturer conducts training sessions for health professionals.
Key words
Americas; Clinic Activities; Contraception; Contraception Termination--indications; Contraceptive Agents, Female--contraindications; Contraceptive Agents, Female--side effects; Contraceptive Agents, Progestin--contraindications; Contraceptive Agents, Progestin--side effects; Contraceptive Agents--contraindications; Contraceptive Agents--side effects; Contraceptive Implants--contraindications; Contraceptive Implants--indications; Contraceptive Methods--contraindications; Contraceptive Methods--indications; Counseling; Delivery Of Health Care; Developed Countries; Economic Factors; Education; Equipment And Supplies; Family Planning; Family Planning Training; Health; Health Personnel; Insertion; Levonorgestrel--contraindications; Levonorgestrel--side effects; Maryland; North America; Northern America; Nurse-midwives; Organization And Administration; Program Activities; Programs; Research And Development; Technology; Training Programs; Treatment; United States
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Levonorgestrel
/
Family Planning Services
/
Nurse Midwives
Type of study:
Guideline
Limits:
Female
/
Humans
Language:
En
Journal:
J Nurse Midwifery
Year:
1993
Document type:
Article
Country of publication:
United States