Chlamydia rates in postcoital IUD recipients.

Full-term pregnancy with Implanon® in situ An 18-year-old nulliparous woman who had had no bleeding since the insertion of an etonogestrel subdermal contraceptive implant (Implanon®) 4 months earlier had a positive pregnancy test. The implant was easily palpable and correctly sited. An ultrasound scan showed the gestation was 27±2 weeks. Review of the patient’s general practitioner (GP) records indicated that the Implanon had been inadvertently inserted when she was already pregnant. She had not regained regular menstruation since stopping depot medroxyprogesterone acetate contraceptive injections (Depo-Provera®) 6 months previously and switching to condoms. At the time of fitting she denied any sexual intercourse since splitting up with her boyfriend 6 weeks previously. She had had two negative pregnancy tests, one on the day of fitting. Her GP (H.P.) referred her to a specialist contraception clinic for removal of the implant, where she attended 3 weeks after the pregnancy diagnosis (now 30 weeks’ gestation). The patient said she was happy with the implant and would wish to use it again after delivery, and she asked if it had to be removed. The doctor in the clinic (H.C.) discussed with the patient the lack of evidence about the correct course of action, and explained that progestogens in pregnancy have not been linked with fetal abnormality. In addition, it was unlikely that the rate of progestogen release from the implant would be altered in pregnancy and there was no reason to expect the low blood levels of progestogen to interfere with labour or delivery. Use of Implanon during lactation is standard (although the patient planned to bottle-feed). Keeping the implant in place therefore seemed to be an option. The GP informed the manufacturers of Implanon (Organon), who of course recommended removal. After discussion it was agreed that it was reasonable for the implant to be left in place, giving the patient the opportunity to return if she changed her mind and decided she wanted it removed. Informal discussion with a few colleagues indicated the majority would advise removal but could not give any clear reason why. The patient had a spontaneous labour and normal delivery of a healthy baby girl weighing 3.3 kg at 40+2 weeks’ gestation. At routine follow-up at 6 weeks the baby was being bottlefed and showed no signs of abnormality. The mother was healthy and the implant still had nearly 2.5 years of its licensed life left. What would other readers have advised in this situation?