Contraception最新文献

{"title":"ABORTION CARE IN THE EMERGENCY DEPARTMENT: A NATIONAL SURVEY OF EMERGENCY MEDICINE PHYSICIANS’ PERSPECTIVES","authors":"AM Kempf,&nbsp;MR Singer,&nbsp;M Haas-Kogan,&nbsp;A Pelletier,&nbsp;AB Friedman,&nbsp;S Easter,&nbsp;DA Bartz","doi":"10.1016/j.contraception.2024.110594","DOIUrl":"10.1016/j.contraception.2024.110594","url":null,"abstract":"<div><h3>Objectives</h3><div>The emergency department is a common setting of unintended pregnancy diagnoses, particularly for patients with limited access to healthcare. Reproductive health services can be provided in the emergency setting to expand care for this population, especially important post <em>Dobbs v Jackson Women’s Health Organization</em>. This study seeks to assess emergency medicine physicians’ current knowledge, attitudes, and practices, before and after <em>Dobbs,</em> related to pregnancy options counseling, referrals, and provision of induced abortion in the emergency department.</div></div><div><h3>Methods</h3><div>We surveyed a sample of emergency medicine physicians at a national meeting regarding knowledge, attitudes, and practices related to reproductive healthcare delivery. Kruskall-Wallis tests were used to evaluate differences between abortion restrictive and permissive states and chi-squared tests were used to compare proportions between the two groups. Thematic analysis was used to review qualitative responses.</div></div><div><h3>Results</h3><div>A total of 252 emergency medicine physicians completed the survey, 218 (86.5%) from abortion permissive and 30 (11.9%) from abortion restrictive states. Most (n=178, 70.6%) supported abortion provision in the emergency department if legally allowed although only about half (n=131, 52.0%) report ever prescribing medication abortion pills. Only 27 (10.7%) report possessing enough knowledge or having received adequate training to independently prescribe medication abortion.</div></div><div><h3>Conclusions</h3><div>Abortion can and should be provided in the emergency department, especially in an attempt to expand access to reproductive healthcare after the <em>Dobbs</em> decision. While most emergency medicine physicians support the provision of abortion care this setting, they do not routinely provide it due to a variety of factors including lack of knowledge, lack of training, and legal/institutional restrictions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110594"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSESSING THE IMPACT OF HEALTH EQUITY-INFORMED QUALITY IMPROVEMENT ON CONTRACEPTIVE CARE SCREENING, COUNSELING, AND PROVISION","authors":"EE Wingo,&nbsp;D Hessler-Jones,&nbsp;L Gibson,&nbsp;S Goetsch-Avila,&nbsp;R Kriz,&nbsp;C Dehlendorf","doi":"10.1016/j.contraception.2024.110576","DOIUrl":"10.1016/j.contraception.2024.110576","url":null,"abstract":"<div><h3>Objectives</h3><div>Improving contraceptive care quality is crucial to optimizing people’s reproductive health and achieving reproductive health equity. We assessed the impact of a health equity-focused quality improvement learning collaborative (QILC) on the quality of contraceptive care at community health centers (CHCs) through innovative, person-centered performance measurement.</div></div><div><h3>Methods</h3><div>We developed a nine-month QILC comprising monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources and strategies, peer-learning opportunities, and technical assistance. CHCs collected Person-Centered Contraceptive Counseling (PCCC) measure surveys from patients pre-post QILC to assess contraceptive counseling. CHCs implemented a novel health service needs-based contraception screening question, the Self-Identified Need for Contraception (SINC), into their EHRs. EHR data were extracted to calculate standardized electronic clinical quality measures (eCQMs) of contraceptive use. To assess intervention impact, we compared PCCC scores, percentage of eligible patients screened with SINC, and contraceptive use before and after the QILC.</div></div><div><h3>Results</h3><div>Baseline PCCC scores ranged from 30% to 94%. At endline, 6 of 10 CHCs improved their PCCC score (Δ 2% to 24%) and four of those surpassed the 80% benchmark for high-quality care. At baseline, few patients were screened with SINC (range: &lt;1% - 36%). Across sites, median increase in percentage of eligible patients screened was 10% (range: &lt;1% - 46%). Sites observed an increase in eCQMs for use of most or moderately effective contraceptive methods (mdn change: 2%; range: [&lt;1% -9%).</div></div><div><h3>Conclusions</h3><div>Participation in an equity-focused and performance measures-driven QILC led to increased person-centered screening for contraceptive need and improved contraceptive counseling.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110576"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE ASSOCIATION OF INSERTION METHODS ON IMMEDIATE POSTPARTUM INTRAUTERINE DEVICE EXPULSION RATES: A RETROSPECTIVE COHORT STUDY","authors":"EM Perkins,&nbsp;J Federspiel,&nbsp;D Bhattacharya,&nbsp;S de los Reyes","doi":"10.1016/j.contraception.2024.110634","DOIUrl":"10.1016/j.contraception.2024.110634","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to evaluate the method of immediate postpartum IUD (ppIUD) insertion (manual versus ring forceps) and expulsion rate within six weeks postpartum.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients who had a singleton vaginal delivery and had an immediate ppIUD inserted at Rush University from January 2014 to September 2023. Subjects were excluded if they had a postpartum hemorrhage, no insertion data available, or did not have documentation of postpartum follow up. The primary outcome was rate of expulsion within six weeks postpartum. The rate of expulsion was compared by method of insertion, either using a manual technique versus using ring forceps. Univariable analyses were performed for the association between baseline maternal characteristics and the primary outcome.</div></div><div><h3>Results</h3><div>A total of 219 participants met eligibility with 117 immediate ppIUDs inserted manually and 102 inserted with ring forceps. Baseline maternal demographics were similar across study groups. In unadjusted analysis, expulsion rate in patients who had IUDs placed using ring forceps was significantly higher as compared to manual insertion (30.4% vs 16.2%, p =0.01). After adjusting for factors determined a priori (estimated blood loss, body mass index, GA at delivery, multiparity, type of IUD), ring forceps continued to be significantly more likely to result in expulsion (adjusted OR (aOR) 2.45, CI 1.28-4.90).</div></div><div><h3>Conclusions</h3><div>Insertion of immediate ppIUD with ring forceps was associated with a significantly increased rate of expulsion within six weeks postpartum when compared with manual insertion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110634"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIFFERENCES IN TYPES OF CHALLENGES EXPERIENCED BY SEXUAL MINORITY AND HETEROSEXUAL PATIENTS SEEKING ABORTION CARE","authors":"M Bornstein,&nbsp;A Norris Turner,&nbsp;S Bostic,&nbsp;T Odum,&nbsp;K Rivlin,&nbsp;D Bessett","doi":"10.1016/j.contraception.2024.110601","DOIUrl":"10.1016/j.contraception.2024.110601","url":null,"abstract":"<div><h3>Objectives</h3><div>Although sexual minorities are equally or more likely to need an abortion as heterosexual women, little research examines their experiences seeking abortion care. This study examines differences in challenges faced by sexual minority and heterosexual patients seeking abortion.</div></div><div><h3>Methods</h3><div>We analyzed survey data from 1,833 individuals who sought an abortion at 25 clinics in the Midwest from April 2020 to April 2022. We examined the types and number of challenges related to seeking abortion overall, and by sexual identity (sexual minority vs. heterosexual). We conducted negative binomial regression to quantify differences in number of challenges by sexual identity, controlling for factors commonly associated with challenges seeking abortion.</div></div><div><h3>Results</h3><div>A fifth of participants identified as a sexual minority (19%). Most participants, regardless of sexual identity, faced at least one challenge (90%), with sexual minority participants experiencing a mean of 3.8 challenges compared to 3.0 for heterosexual participants (p&lt;0.001). Sexual minorities were more likely than heterosexual participants to face nearly every challenge presented, including cost (73% vs. 64%; p&lt;0.01), transportation (19% vs. 12%; p&lt;0.001), emotional burden (40% vs. 29%; p&lt;0.001), and keeping the pregnancy/abortion secret (40% vs. 31%; p&lt;0.01). Controlling for other factors, sexual minorities faced significantly more challenges than heterosexual participants (aIRR=1.20; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Sexual minorities may need additional and tailored support when seeking an abortion, including financial, logistical, and emotional support specific to their circumstances. Addressing inequalities within society, as well as within reproductive healthcare, will help ensure that abortion is accessible to all, including those who identify as sexual minorities.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110601"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A QUALITATIVE EXPLORATION OF THE IMPACT OF ABORTION RESTRICTIONS ON PEOPLE WITH HIGH-RISK PREGNANCIES IN GEORGIA: EAR ON GA","authors":"AG Maples,&nbsp;P Goedken,&nbsp;V Larrivey,&nbsp;V Walke,&nbsp;N Verma","doi":"10.1016/j.contraception.2024.110620","DOIUrl":"10.1016/j.contraception.2024.110620","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess what barriers people with high-risk pregnancies face while attempting to access abortion care in Georgia, and understand how House Bill (HB) 481, which bans most abortions in the state after fetal cardiac activity, has affected these care-seeking journeys.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study using semi-structured Zoom interviews with people with high-risk pregnancies seeking abortion care at hospital and independent clinic sites in Atlanta, GA. The interviews focused on participant’s journeys attempting to access abortion care within or outside the state after HB481 went into effect. We transcribed, coded, and analyzed the interviews, and are presenting a subset of themes.</div></div><div><h3>Results</h3><div>We interviewed 18 people from January 2023 through January 2024. Participants with high-risk pregnancies often described a lack of understanding of how HB481 would impact their ability to access abortion care in Georgia, and discussed ways in which they felt their specific abortion was necessary and should qualify for care under the law. As participants attempted to access abortion care post-HB481, many described feeling betrayed and abandoned by the government, healthcare system, their individual support networks, and even God and/or the universe. Participants shared how HB481 exacerbated their suffering as they attempted to navigate the “best” of multiple “bad” options available to them.</div></div><div><h3>Conclusions</h3><div>Our results indicate that, even when abortion bans include exceptions for “medical emergency” and “medically futile pregnancy,” people with high-risk pregnancies face additional barriers to accessing care that exacerbate suffering and lead to feelings of betrayal and abandonment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110620"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SELF-MANAGED, BUT NOT ALONE: THE HEALTHCARE NEEDS OF SELF-MANAGED MEDICATION ABORTION USERS","authors":"E Sully,&nbsp;I DoCampo,&nbsp;S Cech,&nbsp;A Aiken,&nbsp;J Scott","doi":"10.1016/j.contraception.2024.110610","DOIUrl":"10.1016/j.contraception.2024.110610","url":null,"abstract":"<div><h3>Objectives</h3><div>Post-<em>Dobbs v Jackson Women’s Health Organization</em>, self-managed medication abortion (SMMA) is increasingly common in the US (Aiken et al 2024). This analysis assesses whether, and why, SMMA users seek medical attention post-SMMA. It also explores how user demographics and abortion policy environment influence treatment-seeking post-SMMA.</div></div><div><h3>Methods</h3><div>From July 2023-February 2024, we surveyed SMMA users in Florida, Indiana, and Louisiana about their abortion experiences and treatment-seeking behaviors. An additional round of data will be collected from May-August 2024. We recruited respondents through seven SMMA providers; analyses will also incorporate Aid Access client follow-up data. We examine three dimensions of post-SMMA care: (1) any post-abortion care, (2) care for symptoms requiring medical attention or additional abortive interventions and (3) adverse events requiring treatment. We assess treatment-seeking by user demographics via multivariate regression; we also compare treatment-seeking before and after abortion bans in Indiana and Florida relative to Louisiana, where abortion policy was static throughout the study.</div></div><div><h3>Results</h3><div>Data from 2023 fielding (n=154) indicate high SMMA efficacy (95%) and infrequent complications. 39% of respondents sought medical attention post-SMMA—85% to verify their pregnancy had ended. Black individuals, and parents, were significantly more likely to seek treatment than others. Final findings will incorporate data from Aid Access, May-August 2024 survey data, and estimates of the impact of abortion bans on treatment-seeking.</div></div><div><h3>Conclusions</h3><div>A sizeable proportion of users sought treatment after SMMA, despite high efficacy and low rates of complications. Policymakers, advocates, and providers should ensure that SMMA users can safely access desired medical attention, regardless of state policy environment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110610"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABORTION TRENDS AT A SINGLE CLINIC IN SOUTHERN ILLINOIS BEFORE AND AFTER THE DOBBS V. JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"J Trevino,&nbsp;R Paul,&nbsp;E King,&nbsp;J Reeves,&nbsp;D Eisenberg,&nbsp;T Madden","doi":"10.1016/j.contraception.2024.110611","DOIUrl":"10.1016/j.contraception.2024.110611","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe trends in abortion volume and gestational duration at time of abortion 12 months before and after the <em>Dobbs v Jackson Women’s Health Organization</em> decision.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of people obtaining abortions at an independent clinic in Southern Illinois for 12 months pre- and post-<em>Dobbs</em>. We used descriptive statistics to characterize trends and compared mean gestational duration pre- and post-<em>Dobbs</em> using independent sample t-tests.</div></div><div><h3>Results</h3><div>In total, 12,920 abortions occurred in the study period: 4,666 pre-<em>Dobbs</em> and 8,254 post-<em>Dobbs</em> (177% increase). Overall, the mean gestation duration increased from 8.8±4.3 weeks to 9.2±4.4 weeks (<em>p</em>&lt;0.001), likely due to the increase in the absolute number of first trimester abortions post-<em>Dobbs</em> (n=2,990). When compared month-by-month, the largest increases in mean gestational duration were in July and August (pre-<em>Dobbs</em>: 8.8 weeks, post-<em>Dobbs</em>: 10.2 weeks). We observed no increase in the proportion of second trimester abortions in the 12 months post-<em>Dobbs</em> (14.3% vs 15.4%, <em>p</em>=0.11); however, we observed an increase in the proportion of second trimester abortions in July (12.0% pre-<em>Dobbs</em>, 16.6% post-<em>Dobbs</em>) and August (15.0% pre-<em>Dobbs</em>, 19.6% post-<em>Dobbs</em>).</div></div><div><h3>Conclusions</h3><div>Post-<em>Dobbs</em>, we observed a nearly two-fold increase in abortion volume. While we found only a slight increase in mean gestational duration and proportion of abortions occurring in the second trimester post-<em>Dobbs</em>, we did see an increase in the two months after <em>Dobbs</em>. These changes may reflect the clinic's dramatic increase in capacity or the impact of abortion funds on maintaining abortion access for people in restrictive states.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110611"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MATERNAL MORBIDITY AMONG PATIENTS WITH SEVERE OR LIFE-LIMITING FETAL CONDITIONS","authors":"S Yazdani,&nbsp;ME Weiss,&nbsp;AS McLennan,&nbsp;MD Creinin","doi":"10.1016/j.contraception.2024.110579","DOIUrl":"10.1016/j.contraception.2024.110579","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare maternal morbidity with pregnancy continuation or abortion in pregnancies with severe or life-limiting fetal conditions.</div></div><div><h3>Methods</h3><div>We extracted data from a de-identified quality database of patients with fetal conditions who received care at our institution to compare maternal outcomes with pregnancy continuation and abortion. We included patients with fetal conditions which would significantly impact future quality of life, require serious intervention to sustain life, or be incompatible with life after delivery. We excluded multiple gestations, previable membrane rupture or fetal demise at time of diagnosis, concern for placenta accreta, and patients that delivered outside of our institution. We considered major morbidity as unplanned intra-abdominal surgery, intensive care unit admission, blood transfusion, venous thromboembolism, readmission within 6 weeks, sepsis, fourth-degree vaginal laceration, uterine rupture, and eclampsia. Minor morbidity included uterine infection requiring intravenous antibiotics, retained products requiring repeat procedure, shoulder dystocia, blood patch post-epidural, cervical lacerations, and third-degree vaginal lacerations.</div></div><div><h3>Results</h3><div>Overall, 387 and 423 individuals chose pregnancy continuation and abortion, respectively. Major morbidity occurred in 23(5.9%) and 7(1.7%), respectively (OR 3.76, 95% CI 1.59-8.85). Minor morbidity occurred in 32(8.3%) and 31(7.3%), respectively (OR 1.20, 95% CI 0.72-2.00). In the continuation group, documented fetal/neonatal demise occurred in 46(11.9%) and cesarean delivery occurred in 180(46.5%) patients. Major abdominal surgery (excluding cesarean delivery) occurred in 2(0.5%) and 2(0.5%), respectively. No mortality occurred in either group.</div></div><div><h3>Conclusions</h3><div>We observed increased maternal morbidity with pregnancy continuation compared to abortion in pregnancies with severe or life-limiting fetal conditions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110579"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRENATAL GENETIC COUNSELORS’ CHANGING MEDICAL DOCUMENTATION PRACTICES IN THE AFTERMATH OF THE DOBBS V JACKSON SUPREME COURT DECISION","authors":"G Joseph,&nbsp;J Harris-Wai,&nbsp;L Riddle,&nbsp;J Silver,&nbsp;M Norton","doi":"10.1016/j.contraception.2024.110573","DOIUrl":"10.1016/j.contraception.2024.110573","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to identify and document the impacts of evolving abortion regulations on prenatal genetic counseling (GC) practice and training.</div></div><div><h3>Methods</h3><div>We conducted semi-structured qualitative interviews with 27 GC Masters program directors, instructors, and clinical supervisors in 15 states and performed thematic content analysis after inductive and deductive coding.</div></div><div><h3>Results</h3><div>We found that documentation practices are changing in states with abortion restrictions. GCs described their medical record documentation as becoming more “vague” or “generic.” Some reported using code words agreed upon among colleagues, making clinical notes more inconspicuous, or not documenting discussions about abortion altogether. Some relied on verbal rather than written communication. Further, GCs reported receiving vague guidance from their institutions’ legal teams, while those practicing in states with exceptions for lethal fetal anomalies highlight complexity in defining ‘lethal’ and specific documentation required to justify abortion. For those in protective states, it can be unclear how best to document care for patients referred from restrictive states.</div></div><div><h3>Conclusions</h3><div>In the aftermath of <em>Dobbs</em>, the risk calculus for documenting abortion, and even pregnancy status in the medical record is shifting. Our study shows GCs are changing documentation practices, sometimes in coordination with other providers (eg, maternal-fetal medicine and complex family planning), or with guidance from institutional lawyers, but often in ad hoc ways. Medical documentation has the potential to impact trust and rapport between patients and providers, care continuity, research and public health surveillance. Our results have implications for providers who work in care teams with GCs and are facing similar challenges in the post-<em>Dobbs</em> environment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110573"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESTIMATING EMERGENCY CONTRACEPTION EFFICACY WITH LEVONORGESTREL AND COPPER INTRAUTERINE DEVICES","authors":"SE Nourse,&nbsp;AL Woodcock,&nbsp;KS Brown,&nbsp;DK Turok,&nbsp;A Gero,&nbsp;LM Gawron","doi":"10.1016/j.contraception.2024.110565","DOIUrl":"10.1016/j.contraception.2024.110565","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to determine observed vs. expected pregnancy risk among levonorgestrel 52 mg and copper T380A intrauterine device (IUD) emergency contraception (EC) users.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of participants in a 1:1 randomized controlled trial comparing levonorgestrel 52 mg IUD and copper T380A IUD EC users who reported all episodes of unprotected intercourse in the two weeks prior to enrollment. We estimated number of expected pregnancies via two established approaches (Trussell, 2003 and modified Wilcox, 2015) to create a range of expected pregnancy risk among methods using risk estimates per menstrual cycle day. With both approaches, we calculated the proportion of pregnancies prevented based on those expected using both the day of most recently reported unprotected intercourse and all reported current menstrual cycle unprotected intercourse.</div></div><div><h3>Results</h3><div>One pregnancy occurred among the 327 participants assigned to the levonorgestrel IUD with 137 (41.9%) reported multiple episodes of unprotected intercourse. No pregnancies occurred among the 328 participants randomized to the copper IUD with 142 (43.2%) reporting multiple episodes of unprotected intercourse. In the levonorgestrel IUD group, expected pregnancies ranged from 12.4 (Trussell)-14.8 (Wilcox) using only the most recent episode of unprotected intercourse to 22.0 (T)-26.3 (W) accounting for all episodes. In the copper IUD group, there were 12.6 (T)-15.0 (W) and 24.8 (T)-29.6 (T) expected pregnancies respectively. Levonorgestrel IUD users prevented 92.0 (T)-96.2 (W)% of pregnancies and copper IUD users experienced 100% pregnancy prevention.</div></div><div><h3>Conclusions</h3><div>Levonorgestrel IUDs for EC prevented 92% of expected pregnancies, approaching the 100% prevention rate observed in the copper IUD group.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110565"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}