Contraception: X最新文献

{"title":"Dynamics of contraceptive use among married women in North and South Yangon, Myanmar: findings from a cross-sectional household survey","authors":"Myint Myint Wai ,&nbsp;Espen Bjertness ,&nbsp;Thein Thein Htay ,&nbsp;Tippawan Liabsuetrakul ,&nbsp;Aye Nyein Moe Myint ,&nbsp;Hein Stigum ,&nbsp;Johanne Sundby","doi":"10.1016/j.conx.2019.100015","DOIUrl":"10.1016/j.conx.2019.100015","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to explore the sociodemographic factors associated with contraceptive use, the variation in prevalence and duration of contraceptive use across the age groups and parity among 18–49-year-old married women in North and South Yangon.</p></div><div><h3>Study design</h3><p>We conducted a cross-sectional study regarding contraceptive use among married women aged 18–49 in North and South Yangon from September to November 2016. We used a questionnaire based on the Demographic and Health Surveys Program, with additional questions on the duration of contraception along the life-course. Associations between contraceptive prevalence and sociodemographic factors were tested by <em>χ</em>². We describe the percentages of contraceptive use and nonuse across the age and parity subgroups, and the mean duration of contraception. We compared the contraceptive prevalence ratios across the parity using logistic regression.</p></div><div><h3>Results</h3><p>The contraceptive prevalence of modern methods was 66% (95% confidence interval: 61.5%–69.9%) with better coverage in rural (69.6%) than in urban women (61.5%). Contraceptive use varied by age and parity, demonstrating lower prevalence in the oldest age group (45–49) and high parity (parity five and above). The mean duration of contraceptive use rose with increased age and parity, except in the oldest-age and high-parity groups.</p></div><div><h3>Conclusions</h3><p>The findings called for greater attention to improve the contraceptive coverage of married women living in urban areas around Yangon city (periurban women).</p></div><div><h3>Implications</h3><p>The study identified the pockets of low contraceptive coverage in a region with the highest contraceptive prevalence in Myanmar. Women above the age of 40 and women who had high parity had low contraceptive prevalence. Women living near the city showed lower contraceptive coverage compared to their rural counterparts.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100015"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38054528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buffered lidocaine for paracervical blocks in first-trimester abortions: a randomized controlled trial","authors":"Jennifer Chin,&nbsp;Bliss Kaneshiro,&nbsp;Jennifer Elia,&nbsp;Shandhini Raidoo,&nbsp;Michael Savala,&nbsp;Reni Soon","doi":"10.1016/j.conx.2020.100044","DOIUrl":"10.1016/j.conx.2020.100044","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to evaluate if buffered lidocaine decreases injection pain as compared to plain lidocaine for paracervical blocks during first-trimester outpatient surgical abortions.</p></div><div><h3>Study design</h3><p>We conducted a randomized, double-blind, placebo-controlled trial among women undergoing outpatient uterine aspiration of a first-trimester pregnancy or an early pregnancy loss. Subjects received a paracervical block with either lidocaine 1% 20 mL or lidocaine 1% 18 mL plus sodium bicarbonate 8.4% 2 mL. The primary outcome was pain from injection of the paracervical block measured on a 100-mm visual analog scale (VAS). Secondary outcomes included pain after cervical dilation, uterine aspiration and overall satisfaction with pain control. Scores were compared using the Mann–Whitney <em>U</em> test. We aimed to detect a 15-mm difference in pain from injection of the paracervical block.</p></div><div><h3>Results</h3><p>From May 2017 to October 2018, 48 women received plain lidocaine and 50 women received buffered lidocaine. Groups were similar in demographics. We found no clinically or statistically meaningful difference in pain when evaluating median VAS scores for paracervical block injection between the buffered and plain lidocaine [30.0 (interquartile range (IQR) 15.3–64.5); 44.5 (IQR 18.3–65), respectively, p = .32]. We found no difference in secondary outcomes between buffered and plain lidocaine.</p></div><div><h3>Conclusion</h3><p>Buffered lidocaine for paracervical blocks in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine.</p></div><div><h3>Implications statement</h3><p>Buffering the paracervical block in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine, nor does it increase patient satisfaction. Eliminating sodium bicarbonate allows for a more cost-effective and readily available solution for paracervical blocks.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100044"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38713198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drugs used to induce fetal demise prior to abortion: a systematic review","authors":"Tesfaye H. Tufa ,&nbsp;Sarah Prager ,&nbsp;Antonella F. Lavelanet ,&nbsp;Caron Kim","doi":"10.1016/j.conx.2020.100046","DOIUrl":"10.1016/j.conx.2020.100046","url":null,"abstract":"<div><p>Clinicians have used feticidal agents prior to second trimester abortion for many years. Despite the widespread use of various agents to induce fetal demise, a comprehensive or systematic review of the evidence is lacking on the safety, effectiveness, and most effective routes of administration.</p></div><div><h3>Objectives</h3><p>To evaluate the existing drugs and routes of administration used in inducing fetal demise prior to abortion, and to determine the safety, effectiveness, and acceptability of these feticidal agents.</p></div><div><h3>Methods</h3><p>We searched PubMed, EMBASE, CINAHL, POPLINE, and Global Index Medicus to identify studies describing pharmacologic agents used to induce fetal demise prior to termination of pregnancy. We included randomized controlled trials and observational studies comparing digoxin, potassium chloride (KCL), and lidocaine to induce fetal demise. We included studies that evaluated the primary outcomes of safety and effectiveness, including success in achieving fetal demise, induction to expulsion time for medical abortion, dilation and evacuation time, as well as maternal side effects and complications. Two authors independently screened abstracts and full texts. One reviewer extracted data from the included studies, which was counterchecked by a second reviewer.</p></div><div><h3>Results</h3><p>We identified eight studies that met inclusion criteria: three randomized controlled trials, and five observational studies. A total of 4505 women received drugs to induce fetal demise at 17 to 38 weeks' gestation, including digoxin (<em>n</em> <!-->=<!--> <!-->4174), KCL (<em>n</em> <!-->=<!--> <!-->324), and lidocaine (<em>n</em> <!-->=<!--> <!-->7). Intra-fetal digoxin was superior to intra-amniotic digoxin in achieving fetal demise (OR 3.51, 95% CI 1.60, 7.78). Intracardiac KCL 15% 2–3 mL reduced induction to expulsion time by 320 min (p<!--> <!-->&lt;.006).</p><p>Similarly, intracardiac KCL 15% 1–3 ml reduced dilation and evacuation time from 16.1<!--> <!-->±<!--> <!-->7.9 min to 12.7<!--> <!-->±<!--> <!-->5 min (p<!--> <!-->&lt;<!--> <!-->0.001). Intracardiac lidocaine 2% 10 mL was more effective at achieving fetal demise than intracardiac KCL 6 mmol (85.7% vs. 57.9%). Intra-amniotic and intra-fetal digoxin 1 mg, as compared to no feticidal agent, led to greater pre-procedure expulsion, hospital readmission, and the presence of one or more signs of infection.</p></div><div><h3>Conclusions</h3><p>Evidence from included cohort studies demonstrates that digoxin, KCL, and lidocaine are all effective in inducing fetal demise. Intra-fetal administration of digoxin is superior to intra-amniotic digoxin administration. Administration of feticide using intracardiac KCL may shorten the abortion experience. Limited data from observational studies also supports an increase in maternal side effects and/or complications related to the administration of digoxin.</p></div><div><h3>Implications</h3><p>Intra-fetal admin","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100046"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38351939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection","authors":"Jenny A. Higgins ,&nbsp;Kelsey Q. Wright ,&nbsp;David K. Turok ,&nbsp;Jessica N. Sanders","doi":"10.1016/j.conx.2020.100038","DOIUrl":"10.1016/j.conx.2020.100038","url":null,"abstract":"<div><h3>Objectives</h3><p>Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection.</p></div><div><h3>Study design</h3><p>Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18–45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates.</p></div><div><h3>Results</h3><p>Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as <em>quite</em> or <em>extremely important</em> were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection.</p></div><div><h3>Conclusions</h3><p>Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities.</p></div><div><h3>Implications</h3><p>Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38500943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the silence in the primary care office: patients' attitudes toward discussing abortion during contraceptive counseling","authors":"Shokoufeh Dianat ,&nbsp;Ilana A Silverstein ,&nbsp;Kelsey Holt ,&nbsp;Jody Steinauer ,&nbsp;Christine Dehlendorf","doi":"10.1016/j.conx.2020.100029","DOIUrl":"10.1016/j.conx.2020.100029","url":null,"abstract":"<div><h3>Objectives</h3><p>Abortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling.</p></div><div><h3>Study design</h3><p>In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes.</p></div><div><h3>Results</h3><p>We achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion.</p></div><div><h3>Conclusions</h3><p>Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma.</p></div><div><h3>Implications</h3><p>Mentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38165155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsatisfied contraceptive preferences due to cost among women in the United States","authors":"Kristen Lagasse Burke ,&nbsp;Joseph E. Potter ,&nbsp;Kari White","doi":"10.1016/j.conx.2020.100032","DOIUrl":"10.1016/j.conx.2020.100032","url":null,"abstract":"<div><h3>Objectives</h3><p>To examine prevalence and characteristics associated with cost barriers to preferred contraceptive use.</p></div><div><h3>Study design</h3><p>Among a nationally representative sample of women at risk of unplanned pregnancy in 2015–2017, we used Poisson regression to assess characteristics associated preferring a(nother) method in the absence of cost.</p></div><div><h3>Results</h3><p>Overall, 22% preferred to use a(nother) method. Women using less-effective methods, who were Black or Hispanic, ages 15–24 and had low incomes, were more likely to report cost barriers.</p></div><div><h3>Conclusions</h3><p>Using a preferred method is an indicator of access to care and reproductive autonomy. These results provide a benchmark to track the impact of policy changes.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38204025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System","authors":"Megan L. Kavanaugh,&nbsp;Ayana Douglas-Hall,&nbsp;Sean M. Finn","doi":"10.1016/j.conx.2019.100014","DOIUrl":"10.1016/j.conx.2019.100014","url":null,"abstract":"<div><h3>Objective</h3><p>To examine associations between health insurance coverage, income level and contraceptive use — overall and most/moderately effective method use — among women ages 18–44 at risk of pregnancy, within and across 41 United States jurisdictions in 2017.</p></div><div><h3>Study design</h3><p>Using data from the 2017 Behavioral Risk Factor Surveillance System, we calculated the proportions of women using any contraceptive method and using a most or moderately effective method for each state/territory and across all jurisdictions, categorized by health insurance coverage and income groups. For both contraceptive use outcomes, we ran simple and multivariable logistic regression models to test for significant differences in outcomes between insured and uninsured individuals.</p></div><div><h3>Results</h3><p>Across jurisdictions, compared to uninsured women, those who had health care coverage had higher levels of contraceptive use (65% versus 59%; p &lt; .001) and most/moderately effective contraceptive use (43% compared to 35%; p &lt; .001); low-income women with coverage also had higher levels of contraceptive use (64% versus 61%; p &lt; .05) and most or moderately effective contraceptive use (42% versus 36%; p &lt; .01) than their uninsured counterparts. Controlling for individual-level demographic characteristics, health insurance coverage was associated with increased odds of most or moderately effective contraceptive use across jurisdictions (adjusted odds ratio = 1.33, p &lt; .01). In 11 states, insured women had significantly higher odds of at least one contraceptive use metric than their uninsured counterparts.</p></div><div><h3>Conclusions</h3><p>Variation in contraceptive use across the states likely reflects broader demographic, social and structural differences across state and local populations. States' political will and support around contraceptive access likely play a role in individuals' ability to obtain and use contraception.</p></div><div><h3>Implications</h3><p>Our key finding that insurance coverage is significantly associated with use of most/moderately effective contraceptive methods across the states but not any contraceptive use underscores the importance of health insurance in aiding access to methods that are more costly and often require a visit to a health care provider.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38054527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion patients' preferences for care and experiences accessing services in Louisiana","authors":"Erin Carroll ,&nbsp;Kari White","doi":"10.1016/j.conx.2019.100016","DOIUrl":"10.1016/j.conx.2019.100016","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to compare abortion patients' expectations and preferences for care with their experiences accessing services in Louisiana where there are numerous restrictive abortion laws.</p></div><div><h3>Study design</h3><p>Between June 2018 and January 2019, we conducted in-depth interviews with 35 English-speaking Louisiana residents who were ≥<!--> <!-->18 years of age and seeking care from the three in-state facilities to explore their perspectives and experiences locating, obtaining and paying for abortion services. We analyzed interview transcripts using a theme-based approach and categorized themes into dimensions of health care access: availability/accessibility, accommodation, acceptability and affordability.</p></div><div><h3>Results</h3><p>Participants were surprised to learn that there were so few facilities providing abortion, which required some of them to drive between 1 and 3 h to the nearest clinic. Many were unable to schedule their visits at a convenient time or obtain care as early in pregnancy as desired because the next available appointment was often a week or more away. Protestor activity and congested waiting rooms did not provide most patients their desired level of privacy, but participants expressed diverse views about other approaches to care that would maintain their confidentiality. To pay for an unplanned health care expense that was not covered by insurance, many participants deferred paying monthly bills and borrowed money, which contributed to financial hardships and additional delays in care.</p></div><div><h3>Conclusions</h3><p>Many Louisiana abortion patients' expectations and preferences for care are not being met across multiple dimensions of health care access assessed in this study, and the state's highly regulated policy environment may limit options for tailoring services to patients' needs.</p></div><div><h3>Implications</h3><p>Abortion patients in Louisiana value accessible, timely, private and affordable services, but a constrained network of providers and medically unnecessary requirements make it difficult for them to obtain patient-centered care. Federal- and state-level policy changes, as well as local initiatives, could ensure abortion patients have access to quality, evidence-based services.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 1-year prospective, open-label, single-arm, multicenter, phase 3 trial of the contraceptive efficacy and safety of the oral progestin-only pill drospirenone 4 mg using a 24/4-day regimen","authors":"Thomas Kimble ,&nbsp;Anne E. Burke ,&nbsp;Kurt T. Barnhart ,&nbsp;David F. Archer ,&nbsp;Enrico Colli ,&nbsp;Carolyn L. Westhoff","doi":"10.1016/j.conx.2020.100020","DOIUrl":"10.1016/j.conx.2020.100020","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate contraceptive effectiveness and safety of oral drospirenone 4 mg 24/4-day regimen in the United States.</p></div><div><h3>Study design</h3><p>We performed a prospective, single-arm, multicenter phase 3 trial in sexually active women for up to thirteen 28-day treatment cycles. Primary outcome was the Pearl index, calculated using confirmed on-drug pregnancies and evaluable cycles in nonbreastfeeding women aged ≤<!--> <!-->35 years. We assessed adverse events (AEs), including hyperkalemia and venous thromboembolism.</p></div><div><h3>Results</h3><p>Of 1006 women who received at least one dose of drospirenone, 352 women (35.0%) completed the trial and 654 (65.0%) women discontinued before trial end. Most participants (92.2%) were ≤<!--> <!-->35 years; one third had a body mass index (BMI) ≥<!--> <!-->30 kg/m². Among nonbreastfeeding women aged ≤<!--> <!-->35 years, there were 17 pregnancies (Pearl index: 4.0; 95% confidence interval [CI], 2.3–6.4; <em>n</em> = 953), of which three were unconfirmed and two were from sites excluded from the main analysis for major breaches of Food and Drug Administration regulations. The Pearl index was 2.9 (95% CI: 1.5–5.1) for confirmed pregnancies among 915 nonbreastfeeding women aged ≤<!--> <!-->35 years from sites with no protocol violations. Nearly all (95.4%) treatment-emergent AEs were mild or moderate in intensity. No cases of venous thromboembolism were reported. The frequency of hyperkalemia was 0.5%. Women with baseline systolic/diastolic blood pressure ≥ 130/85 mmHg had a mean reduction from baseline in blood pressure at exit visit (−<!--> <!-->8.5/−<!--> <!-->4.9 mmHg; <em>n</em> = 119). No other clinically relevant changes were observed. Participant satisfaction was high.</p></div><div><h3>Conclusion</h3><p>Drospirenone 4 mg 24/4 regimen provides effective contraception with a good safety/tolerability profile in a broad group of women, including overweight or obese women.</p></div><div><h3>Implications</h3><p>This new progestin-only contraceptive, drospirenone 4 mg in a 24/4 regimen, provides a contraceptive option for the majority of women regardless of blood pressure or BMI.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100020"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis","authors":"Katherine Whitehouse ,&nbsp;Ashley Brant ,&nbsp;Marita Sporstol Fonhus ,&nbsp;Antonella Lavelanet ,&nbsp;Bela Ganatra","doi":"10.1016/j.conx.2020.100037","DOIUrl":"10.1016/j.conx.2020.100037","url":null,"abstract":"<div><h3>Background</h3><p>Mifepristone and misoprostol are recommended for second-trimester medical abortion, but consensus is unclear on the ideal regimen.</p></div><div><h3>Objectives</h3><p>The objectives were to systematically review randomized controlled trials (RCTs) investigating efficacy, safety and satisfaction of medical abortion at ≥<!--> <!-->12 weeks' gestation.</p></div><div><h3>Data sources</h3><p>We searched PubMed, Popline, Embase, Global Index Medicus, Cochrane Controlled Register of Trials and International Clinical Trials Registry Platform from January 2008 to May 2017.</p></div><div><h3>Study eligibility, participants and interventions</h3><p>We included RCTs on medical abortion at ≥<!--> <!-->12 weeks' gestation using mifepristone and/or misoprostol. We excluded studies with spontaneous abortion, fetal demise and mechanical cervical ripening and those not reporting ongoing pregnancy (OP).</p></div><div><h3>Study appraisal and synthesis methods</h3><p>After extracting prespecified data and assessing risk of bias in accordance with the Cochrane handbook, we used Revman5 software to combine data and GRADE to assess certainty of evidence.</p></div><div><h3>Results</h3><p>We included 43 of the 1894 references identified. Combination mifepristone–misoprostol had lower rates of OP [risk ratio (RR) 0.12, 95% confidence interval (CI) 0.04–0.35] vs. misoprostol only. A 24-h interval between mifepristone and misoprostol had lower OP rate at 24 h than simultaneous dosing (RR 3.13, 95% CI 1.23–7.94). Every 3-h dosing had lower OP rate at 48 h (RR 0.39, 95% CI 0.17–0.88).</p></div><div><h3>Limitations</h3><p>Direct comparisons of buccal misoprostol to sublingual or vaginal routes after mifepristone were limited. Evidence from clinical trials on how to best manage women with prior uterine incisions was lacking.</p></div><div><h3>Conclusion</h3><p>Our analysis supports the use of mifepristone 200 mg 1 to 2 days before misoprostol 400 mcg vaginally every 3 h at ≥<!--> <!-->12 weeks' gestation.</p></div><div><h3>Implications</h3><p>Where available, providers should use mifepristone plus misoprostol for second-trimester medical abortion. Vaginal misoprostol appears to be most efficacious with fewest side effects, but sublingual and buccal routes are also acceptable.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38500942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}