New Clinical Practice Guidelines, November 2017

John Anello; Brian Feinberg; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO; Yonah Korngold; John Heinegg; Sam Shlomo Spaeth


November 08, 2017

In This Article

Long-Acting Reversible Contraception

American College of Obstetricians and Gynecologists

Offer insertion of an IUD immediately after first-trimester uterine aspiration or medication-induced abortion, and on the same day as first-trimester or second-trimester induced or spontaneous abortion. Routine antibiotic prophylaxis before IUD insertion is not recommended.

Offer IUDs and the contraceptive implant routinely for nulliparous women and adolescents, and at any time during the menstrual cycle, provided reasonable exclusion of pregnancy.

Offer immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births).

Offer immediate postpartum placement of the contraceptive implant (ie, before hospital discharge), regardless of whether or not the woman is breastfeeding.

Provide sexually transmitted infection (STI) screening recommended by the Centers for Disease Control and Prevention during a single visit for IUD insertion for women with a history suggesting increased risk for STIs. Do not delay IUD insertion pending test results. Treat for positive test results without removing the IUD.

Women with a history of ectopic pregnancies may be offered IUDs.

Offer LARC to most women, as they are safe and effective and have few contraindications.

Offer the copper IUD to women who request emergency contraception and are appropriate for IUD placement.

Counsel women regarding expected bleeding changes and reassure them that these changes are normal.

It is safe to perform endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling while an IUD is in place.

A cytologic finding of actinomyces is incidental, and no antimicrobial treatment is necessary in asymptomatic women; the IUD can remain in place.

Remove the IUD in pregnant women provided the strings are visible or it can be removed safely from the cervical canal.

It is not necessary to remove an IUD or implant before its expiration date in women who are menopausal.


  • Brown T. New guidelines on LARC released by ACOG. Medscape News. WebMD Inc. October 24, 2017.

  • Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 186. Obstet Gynecol. 2017 Nov;130(5):e251-69.


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