Contraceptive Update
(January 2002)

Contraceptive Pearl: Preparation of the Injection Site

Question: Assuming the skin at the injection site appears clean, what is the recommended approach to skin preparation prior to an injection such as the contraceptive DMPA?

1. Wipe with a single use antiseptic swab and inject immediately.
2. Wipe with a single use antiseptic swab. Wait for a recommended "contact time" for the antiseptic to take effect, and then inject.
3. Wipe with cotton previously soaked in antiseptic and inject immediately.
4. Any of the above.
5. Don't bother to swab the skin at all. Just give the injection.

Answer: The best answer is e) Just give the injection

According to WHO and its Safe Injection Global Network (SIGN), "Swabbing of the clean skin prior to giving an injection is unnecessary." "In controlled studies comparing the risk of infections ...., no infections were reported among patients who did not receive any skin preparation protocol. And "Review of microbiological studies do not suggest either that wiping the skin with an antiseptic before intradermal, subcutaneous and intramuscular injections reduces the risk of infection.

Partial credit for answer b)? Possibly. Clearly many providers do swab the skin prior to injection and one could argue that there is no harm in it. SIGN does make the point that if swabbing is done, it should be done with a single use swab and then wait for the recommended contact time before injecting. But in fact, wasting time, money and other resources on an unnecessary procedure detracts from the ability to provide needed services. And in actual practice few providers will wait the few minutes of contact time before injecting.

In any case c) is clearly not recommended. According to SIGN. "... unsafe skin preparation protocols may be harmful." "Cotton balls stored wet in multi-use container must not be used." Yet, this may actually be the most common practice in many developing countries.

Reference: Hutin Y et al. Best injection practices for intra?dermal, subcutaneous and intramuscular needle injections. WHO, Safe Injection Global Network, Geneva, 2002. 

Contraceptive Pearl: Weight Gain with DMPA

Question: Some of my friends say they have gained weight while using the injectable contraceptive DMPA (or Depo-Provera). Can that be true?

Answer: Yes. While not all women gain weight, many do. Bear in mind though, that many of us gain weight as we age. A recent study from Brazil is one of the few with a comparison group to help control for the effects of age. After 5 years the women on DMPA gained an average of 91/2 lbs (4.3 kg) versus a gain of 4 lbs (1.8 kg) for women with IUDs. The average age of the women at the beginning was 33.1 years and they gained weight throughout the 5-year period.

Reference: Bahamondes L et al. Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD for up to 5 years. Contraception 2001;64:223?225.

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These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID).

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