Contraception: X最新文献

{"title":"Bucket-handle uterine rupture during second-trimester medication abortion, a rare form of rupture of the lower uterine segment and vaginal fornix: a case report","authors":"Ferid A. Abubeker MD ,&nbsp;Abraham Fessehaye MD ,&nbsp;Mekdes Daba Feyssa MD,MPH ,&nbsp;Sarah Prager MD,MAS","doi":"10.1016/j.conx.2020.100025","DOIUrl":"10.1016/j.conx.2020.100025","url":null,"abstract":"<div><p>A bucket-handle uterine rupture, a rare form of uterine rupture involving the posterior lower uterine segment and posterior vaginal fornix, occurred in a primigravid woman at 23 weeks of gestation during successful medication abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38060107","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":"Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19","authors":"Ushma D. Upadhyay,&nbsp;Rosalyn Schroeder,&nbsp;Sarah C.M. Roberts","doi":"10.1016/j.conx.2020.100049","DOIUrl":"10.1016/j.conx.2020.100049","url":null,"abstract":"<div><h3>Objective</h3><p>Access to abortion care in the United States (US) is restricted by numerous logistical and financial barriers, which have been further intensified by the COVID-19 pandemic. We sought to understand the ways in which COVID-19 prompted changes in clinical practices in abortion care among independent abortion clinics.</p></div><div><h3>Study design</h3><p>We surveyed independent US abortion clinics and documented changes in practice regarding the provision of abortion since March 1, 2020.</p></div><div><h3>Results</h3><p>Among about 153 independent clinics invited, 100 clinics contributed relevant data and were included in the analytic sample. A total of 87% reported changes in protocols in response to the COVID-19 pandemic. Reported changes included moving to telehealth (phone or video) for follow-up (71%), starting or increasing telehealth for patient consultations and screening (41%), reducing Rh testing (43%) and other tests (42%), and omitting the preabortion ultrasound (15%). A total of 20% reported allowing quick pickup of medication abortion pills, and 4% began mailing medications directly to patients after a telehealth consultation. Clinical practice changes were reported throughout all regions of the US, but facilities in the Northeast (73%) were more likely to report starting or increasing telehealth than facilities in the South (23%, p &lt; .001).</p></div><div><h3>Conclusion</h3><p>The COVID-19 pandemic accelerated use of telehealth among independent abortion clinics, but many clinics, particularly those in the South, have been unable to make these changes. Other practices such as reducing preabortion ultrasounds were less common in all regions despite clinical guidelines and evidence supporting such changes in practice and positive benefits for public health and patient-centered care.</p></div><div><h3>Implications</h3><p>The COVID-19 pandemic has created a window of opportunity to remove barriers to abortion, including expanding telehealth and reducing preabortion tests. Clinics can strive for a culture shift towards simplifying the provision of medication abortion and routinely avoiding preabortion tests and in-person visits. Such changes in practice could have positive benefits for public health and patient-centered care.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100049"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38699538","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":"Combined hormonal contraceptive use in Europe before and after the European Commission mandated changes in product information","authors":"Deeksha Khialani ,&nbsp;Mary Elizabeth Jones ,&nbsp;Szimonetta Komjáthiné Szépligeti ,&nbsp;Anne Gulbech Ording ,&nbsp;Vera Ehrenstein ,&nbsp;Irene Petersen ,&nbsp;Astrid van Hylckama Vlieg","doi":"10.1016/j.conx.2020.100018","DOIUrl":"10.1016/j.conx.2020.100018","url":null,"abstract":"<div><h3>Objectives</h3><p>We investigated combined hormonal contraceptives (CHC) prescribing patterns (focusing on combined oral contraceptives; COC) in three countries (Netherlands, Denmark, United Kingdom) in a time period preceding and in a time period following the European Commission's decision to update product information, and we estimated changes in incidence of venous thromboembolism (VTE) between the two periods.</p></div><div><h3>Study design</h3><p>We conducted a drug utilization analysis and a cohort study using routinely collected data. We calculated number, proportion and incidence rate of new users, switchers, and stoppers of COC in both time periods. VTE incidence was calculated in new users of COC and in all women aged 18–49 years.</p></div><div><h3>Results</h3><p>In all countries, the largest proportion (&gt;<!--> <!-->75%) of new users used COC containing levonorgestrel, norethisterone, or norgestimate, (i.e., indicated by European Medicines Agency (EMA) as the safest preparations) in both time periods. Switching did not demonstrate a clear pattern towards these types of COC and distribution of stoppers was similar in both time periods. While the proportion of new users initiating COC containing levonorgestrel, norethisterone, or norgestimate increased slightly, this did not translate to a decrease in the overall VTE incidence.</p></div><div><h3>Conclusion</h3><p>All three countries had the greatest proportion of women initiating a COC containing levonorgestrel, norethisterone, or norgestimate, and this proportion increased in the period after the European Commission decision albeit the increase was small due to the high percentage of use before the decision. This did not translate into a measureable change in the incidence of VTE.</p></div><div><h3>Implications</h3><p>Both before and after the European Commission's decision, the largest proportion of new users started with combined oral contraceptives containing levonorgestrel, norethisterone, or norgestimate. Earlier studies had already indicated an increased risk of VTE associated with COC containing other progestogens compared with these preparations, so it is possible that physicians were already preferentially prescribing COC containing levonorgestrel, norethisterone, or norgestimate to new users.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059127","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":"Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011–2017","authors":"Aneesha Cheedalla ,&nbsp;Caroline Moreau ,&nbsp;Anne E. Burke","doi":"10.1016/j.conx.2020.100048","DOIUrl":"10.1016/j.conx.2020.100048","url":null,"abstract":"<div><h3>Objectives</h3><p>The effects of the comprehensiveness of sex education on sexual health measures have not been well-studied. We compared trends in comprehensive sex education and its relation to contraceptive use at first intercourse and current contraceptive use for women ages 15–24 in the United States between 2011 and 2017.</p></div><div><h3>Study design</h3><p>Analyses included females ages 15–24 from the 2011–2017 National Survey of Family Growth. We defined comprehensive sex education as including 6 topics queried in the NSFG (how to say no to sex, birth control methods, where to get birth control, how to use condoms, sexually transmitted infections, HIV/AIDS), and non-comprehensive sex education as including less than 6 topics. Multivariable regression models investigated associations with contraceptive indicators.</p></div><div><h3>Results</h3><p>Among 5445 respondents, percentages of women receiving comprehensive sex education in 2011–2013, 2013–2015, and 2015–2017 were 35%, 40%, and 34%. Across all periods, respondents reporting comprehensive sex education before first sex were less likely to report first sexual intercourse before age 15 (aOR 0.55; 95% CI: 0.40–0.74) and non-volitional first intercourse (aOR 0.42, 95% CI: 0.26–0.72) compared to those with non-comprehensive sex education. At first intercourse, those with comprehensive sex education were more likely to have used any (aOR = 1.63; 95% CI: 1.18–2.25) and very effective (aOR = 1.35; 95% CI: 1.04–1.75) contraception. Comprehensive sex education was unrelated to current contraceptive use (aOR = 0.87; 95% CI: 0.63–1.21).</p></div><div><h3>Conclusions</h3><p>Comprehensive sex education was associated with increased odds of contraceptive use at first intercourse, but not current contraceptive use.</p></div><div><h3>Implications</h3><p>Programs that promote comprehensive sex education may have a positive impact on preventive behaviors at sexual debut.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100048"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38727107","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 service delivery in clinics by state policy climate in 2017","authors":"Elizabeth Witwer,&nbsp;Rachel K. Jones,&nbsp;Liza Fuentes,&nbsp;S. Kate Castle","doi":"10.1016/j.conx.2020.100043","DOIUrl":"10.1016/j.conx.2020.100043","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to examine service delivery in clinics that provided abortions in 2017, including differences by abortion policy climate.</p></div><div><h3>Study design</h3><p>Using data from the Guttmacher Institute's 2017 Abortion Provider Census, we examine amount charged for abortion care, pregnancy gestation at which abortions were offered, number of days per week that clinics provided abortions and types of nonabortion services offered. Our analysis focuses on the 808 clinic facilities that provided 95% of abortions that year. Measures were calculated nationally and according to whether the clinic was in a state we categorized as hostile, middle ground or supportive of abortion rights.</p></div><div><h3>Results</h3><p>In 2017, 64% of clinics offered abortion at 11 weeks pregnancy gestation, and 22% did so at 20 weeks gestation. Supportive states had a higher density of clinics that provide abortion for every measured gestation than hostile states. Clinics charged an average of $549 for a surgical abortion at 10 weeks and $551 for medication abortion. Some 46% of clinics in supportive states offered abortion care 5 or more days per week compared to 29% in hostile states. Most clinics offered standalone contraception and family planning (87%) and gynecological care (85%), but the proportion of clinics that provided these services was higher in supportive states (93% and 90%) than in hostile states (75% and 73%).</p></div><div><h3>Conclusions</h3><p>A substantial proportion of abortion facilities provide a range of other health care services. Aspects of service delivery, such as number of days abortions are provided, may vary according to abortion policy climate.</p></div><div><h3>Implications statement</h3><p>Onerous policies in states hostile to abortion rights may inhibit some facilities from providing abortion more days per week, and if so, could further burden patients obtaining abortion care in these states.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38517453","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":"Measuring contraceptive self-efficacy in sub-Saharan Africa: development and validation of the CSESSA scale in Kenya and Nigeria","authors":"Lillian Whiting-Collins ,&nbsp;Lindsay Grenier ,&nbsp;Peter J. Winch ,&nbsp;Amy Tsui ,&nbsp;Pamela K. Donohue","doi":"10.1016/j.conx.2020.100041","DOIUrl":"10.1016/j.conx.2020.100041","url":null,"abstract":"<div><h3>Objectives</h3><p>Contraceptive self-efficacy, a women's belief about her own ability to complete the actions necessary for successful family planning, is a well-documented determinant of contraceptive use. However, there is currently no validated measure appropriate for low-resource settings. We developed and tested a new scale to measure Contraceptive Self-Efficacy among women in sub-Saharan Africa (CSESSA) using samples in Kenya and Nigeria.</p></div><div><h3>Study design</h3><p>The CSESSA scale was administered to women in Kenya (<em>n</em> = 314) and Nigeria (<em>n</em> = 414). Reliability and validity were analyzed separately by setting. Validity analysis included assessment of the area under the curve (AUC) to demonstrate predictive capability of CSESSA score for contraceptive use. Logistic regression was employed to test the relationship between CSESSA score and contraceptive use.</p></div><div><h3>Results</h3><p>Item reduction resulted in 11 items in Kenya (<em>α</em> = 0.90) and 10 items in Nigeria (<em>α</em> = 0.93). Three domains of contraceptive self-efficacy emerged in both settings: (1) husband/partner communication, (2) provider communication and (3) choosing and managing a method. Items related to the first two subscales, but not the third, were identical across settings. The AUC indicated predictive capability as mild in Kenya (AUC = 0.58) and strong in Nigeria (AUC = 0.73). In both settings, CSESSA score was associated with use of a modern contraceptive method at 12 months postpartum.</p></div><div><h3>Conclusions</h3><p>The CSESSA scale is a reliable and valid measure in two countries. Variation of the third subscale by site indicates that certain scale items may be more relevant in areas of low versus high contraceptive prevalence. Further research should be done to validate this subscale in other contexts.</p></div><div><h3>Implications</h3><p>This study contributes a reliable, valid measure of contraceptive self-efficacy in two African countries. The CSESSA scale and subscales can be administered in research (for example for evaluation of interventions to increase contraceptive uptake) or in a clinical setting to inform and improve contraceptive counseling.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38659636","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":"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}