From the Guidelines
Yes, Nexplanon can be placed in a postpartum patient who has had unprotected intercourse within the past 2 weeks, with the understanding that a pregnancy test should be performed 2-3 weeks after the last unprotected intercourse to rule out pregnancy. According to the most recent guidelines from the CDC, as of 2024 1, the implant can be started at any time, with the benefits of starting the implant likely exceeding any risk, and a follow-up pregnancy test should be performed in 2-4 weeks.
The patient should use backup contraception, such as condoms, for 7 days after placement, as recommended by the CDC guidelines 1. It's also important to note that if Nexplanon is placed within 5 days of unprotected intercourse, it may act as emergency contraception.
For postpartum patients, the CDC guidelines suggest that progestin-only methods like Nexplanon can be safely started immediately postpartum, without the need for a waiting period 1. However, it's crucial to consider the individual patient's situation and medical history before making a decision.
In this case, the benefit of immediate contraception with Nexplanon typically outweighs the small risk of placing it with an undetected early pregnancy, especially since progestin-only contraceptives like Nexplanon do not harm an established pregnancy if one exists 1. A follow-up pregnancy test is essential to ensure the patient is not pregnant, as Nexplanon is not indicated for use during pregnancy.
Key considerations for the patient include:
- Using backup contraception for 7 days after placement
- Scheduling a follow-up pregnancy test 2-3 weeks after the last unprotected intercourse
- Understanding the potential risks and benefits of starting Nexplanon immediately postpartum
- Considering individual medical history and situation before making a decision.
From the Research
Placement of Nexplanon in Postpartum Patients
- The studies provided do not directly address the placement of Nexplanon in postpartum patients who have had unprotected intercourse within the past 2 weeks 2, 3, 4, 5, 6.
- However, the studies do discuss the use of emergency contraception, including intrauterine devices (IUDs), in women who have had unprotected intercourse 2, 3.
- One study found that the probability of pregnancy was low (0.9%) after the use of oral levonorgestrel plus a levonorgestrel IUD for emergency contraception, even in women who had multiple episodes of unprotected intercourse 2.
- Another study found that women who presented for emergency contraception and received a same-day IUD had a low probability of pregnancy (0-3.7%) regardless of whether they had a single or multiple episodes of unprotected intercourse 3.
- The studies also discuss the resumption of sexual intercourse and contraceptive use in postpartum women, but do not specifically address the placement of Nexplanon in this population 4, 5, 6.
- Overall, while the studies do not provide direct evidence on the placement of Nexplanon in postpartum patients who have had unprotected intercourse, they do suggest that emergency contraception, including IUDs, can be effective in preventing pregnancy in women who have had unprotected intercourse 2, 3.