2. Outline  Background  Research questions  Methods and measures  Results  Implications

3. Pregnancy Facts Guttmacher Institute

5. Long-Acting Reversible Contraception (LARC) http://memphischoices.org

6. Research Questions

7. Methods

8. Target Population Specifics  Inclusion Criteria: 1.Patients with outpatient care records in CIS from all three Baystate OB/GYN practices 2.Patients with IUD/implant insertion between 1/1/2008 and 12/31/2012  Exclusion Criteria: 1.Women who had failed IUD/implant insertion 2.Women without any follow-up at Baystate after IUD/implant insertion

9. Measures

10. Measures

11. Results  1962 women had LARC placed in the target time period  586 charts completed from 1/4/2008 to 12/15/2009  424 had discontinuation information  350 prematurely discontinued  74 did not prematurely discontinue

12. Demographics

13. Patient History

14. Counseling vs inserting providers of LARC

15. Types of LARC placed BETWEEN 1/4/2008 AND 12/15/2009

16. Removal Reasons Removal Reasons for IUDs: Pain Desires pregnancy Irregular bleeding Complete expulsion Heavy bleeding Partial expulsion No bleeding Removal Reasons for Implants: Heavy bleeding Irregular bleeding Desires pregnancy

17. Implications  Determining risk factors for premature discontinuation  Better counseling  Even most of the women who prematurely discontinued their LARC used it for a while  Considered a success if a women had it removed for desiring pregnancy  Charting  Patient history taking

18. Sources  http://www.mirena-us.com/  http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html#14  http://larcfirst.com/resources/evidence/choice_slide_set/choice_key_findings/CHOIC E_Overview_and_Key_Findings_without_audio.pdf  http://www.plannedparenthood.org/health-info/birth-control/birth-control-implant- implanon  http://memphischoices.org/medical-services/birth-control/iud-information  http://www.medicinenet.com/birth_control_pictures_slideshow/article.htm (image)  http://www.gponline.com/therapeutic-areas/contraception (image)