Seminars in reproductive medicine最新文献

{"title":"Medical Abortion before Confirmed Intrauterine Pregnancy: A Systematic Review.","authors":"Karin Brandell,&nbsp;John J Reynolds-Wright,&nbsp;Clare Boerma,&nbsp;Gillian Gibson,&nbsp;Helena Hognert,&nbsp;Heera Tuladhar,&nbsp;Oskari Heikinheimo,&nbsp;Sharon Cameron,&nbsp;Kristina Gemzell-Danielsson","doi":"10.1055/s-0042-1760117","DOIUrl":"https://doi.org/10.1055/s-0042-1760117","url":null,"abstract":"<p><p>\"Very early medical abortion\" (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (<i>n</i> = 2) of ruptures were reported. Most studies used serial serum human chorionic gonadotrophin (s-hCG) levels to determine success of abortion; one study used low sensitivity urine hCG. From the available evidence, VEMA appears to be efficacious and does not appear to cause harm to ectopic pregnancies. Treatment can be assessed with pre- and postabortion s-hCG. Good quality, randomized controlled trial evidence is needed to best inform practice.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10673657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measures of Pregnancy Intention: Why Use Them and What Do They Tell Us?","authors":"Edwina Dorney,&nbsp;Geraldine Barrett,&nbsp;Jennifer Hall,&nbsp;Kirsten I Black","doi":"10.1055/s-0042-1760118","DOIUrl":"https://doi.org/10.1055/s-0042-1760118","url":null,"abstract":"<p><p>Understanding pregnancy intention is an important public health measure that captures the ability of individuals to access information, resources, and services needed to plan the timing and spacing of pregnancies. Pregnancy intention is a complex construct impacted by social, emotional, financial, cultural, and contextual factors. In this review, we will examine the range of available tools for individuals and populations to evaluate pregnancy intention, the timing of the tools in relation to pregnancy, their interpretation, and use for policy and practice. Traditionally, pregnancy intention was only assessed in population health surveys; however, more sophisticated tools and measures have been developed. These tools can be used at several time points: before pregnancy, during pregnancy, or after the pregnancy has ended. It is important to appreciate the varied contexts globally for women and their partners when assessing pregnancy intention, and the ability of a given tool to capture this when used retrospectively or prospectively. These tools can inform targeted delivery of services for a person or couple before, during, and after pregnancy. This knowledge can inform strategies at an individual, community, and population level as an indicator of access to sexual and reproductive health information and knowledge and uptake of preconception health.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10683177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Access to and Quality of Postpartum Contraception Provision.","authors":"Michelle Cooper,&nbsp;Sharon Cameron","doi":"10.1055/s-0042-1758114","DOIUrl":"https://doi.org/10.1055/s-0042-1758114","url":null,"abstract":"<p><p>Sexual activity and fertility can resume shortly after childbirth, but there are barriers to contraceptive access in the postpartum period. Unintended pregnancy and short interpregnancy intervals (of less than one year) can increase the risk of obstetric and neonatal complications. The antenatal period presents an opportunity to discuss contraceptive options, many of which can be safely initiated immediately after childbirth. Successful delivery of a postpartum contraception program requires an adequate number of maternity staff trained to provide the full range of methods.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10673658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and Reproductive Health.","authors":"Danielle Mazza,&nbsp;Jessica R Botfield","doi":"10.1055/s-0042-1759553","DOIUrl":"https://doi.org/10.1055/s-0042-1759553","url":null,"abstract":"Contraception, preconception care, and abortion are integral and intertwined aspects of women’s reproductive health.We know that nearly half of all pregnancies worldwide are unintended, which can have significant consequences for women, girls, and society more broadly.1 Over 60% of unintended pregnancies, and almost 30% of all pregnancies, end in abortion (noting that nearly half of all abortions performed globally are unsafe).1 Most unintended pregnancies can be attributed to nonor incorrect use of contraception or contraceptive failure,2,3 yet there are approximately 257 million women globally who want to avoid pregnancy but are not using a safe,modernmethod of contraception due to lack of access.1 It is therefore imperative that women are able to access effective methods of contraception, support in pregnancy planning, and abortion care so they can achieve their reproductive life goals. In this issue, we address these aspects of reproductive health. We examine the tools available to evaluate pregnancy intention and the implications of their use for policy and practice. Understanding pregnancy intentions can help women (and the clinicians supporting them)make decisions about contraception to suit their needs. We explore the opportunities for increasing access to effective contraception, using examples from the Australian context, and consider how to improve access to and quality of postpartum contraception provision. We present a common clinical scenario, that of obesity amongwomen of reproductive age seeking contraception and discuss the considerations and approaches for facilitating provision of inclusive contraceptive care for this population group. This includes a review of current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy. Finally, we present several articles relating to medical abortion, including a systematic review relating to another common clinical scenario, that of very early medical abortion (VEMA), to report thecurrentevidenceonefficacy, safety, and treatment success of VEMA. We conclude with two case studies from Canada: one focused on access to abortion care for incarcerated people and another on the deregulation ofmedical abortion to support access to safe, early abortion care in primary care settings. The articles in this issue will be of interest to clinicians as well as public health–focused researchers and decision-makers. The issue provides an overviewof current global challenges in reproductive health and provides reviews of the evidence to guide clinical practice and public health responses to key issues relating to pregnancy intention, contraception, and abortion care.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10683174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Reproductive Health through Policy-Engaged Research in Abortion Care.","authors":"Sarah B Munro,&nbsp;Sheila Dunn,&nbsp;Edith R Guilbert,&nbsp;Wendy V Norman","doi":"10.1055/s-0042-1760213","DOIUrl":"https://doi.org/10.1055/s-0042-1760213","url":null,"abstract":"<p><p>Mifepristone medication abortion was first approved in China and France more than 30 years ago and is now used in more than 60 countries worldwide. It is a highly safe and effective method that has the potential to increase population access to abortion in early pregnancy, closer to home. In both Canada and the United States, the initial regulations for distribution, prescribing, and dispensing of mifepristone were highly restricted. However, in Canada, where mifepristone was made available in 2017, most restrictions on the medication were removed in the first year of its availability. The Canadian regulation of mifepristone as a normal prescription makes access possible in community primary care through a physician or nurse practitioner prescription, which any pharmacist can dispense. In this approach, people decide when and where to take their medication. We explore how policy-maker-engaged research advanced reproductive health policy and facilitated this rapid change in Canada. We discuss the implications of these policy advances for self-management of abortion and demonstrate how in Canada patients \"self-manage\" components of the abortion process within a supportive health care system.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10683176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Economics and Equity in Preconception Health Care: A Systematic Review.","authors":"Alayna Carrandi,&nbsp;Claudia Bull,&nbsp;Emily Callander","doi":"10.1055/s-0042-1749684","DOIUrl":"https://doi.org/10.1055/s-0042-1749684","url":null,"abstract":"<p><p>Poor pregnancy outcomes affect a child's lifelong health and disadvantaged populations are at higher risk of poor pregnancy outcomes. Preconception care aims to improve pregnancy outcomes by managing conditions and risks prior to conception. Given known inequities in pregnancy outcomes, the adoption of preconception care may benefit disadvantaged populations. Health economics plays an important role in the implementation of interventions, as economic evaluations seek to identify the most efficient and equitable care options. This review aimed to identify the cost-effectiveness of preconception care and how equity has been considered in these evaluations. A systematic review of literature published between 2012-2022 was undertaken to identify studies that evaluate the economic outcomes of preconception care. Studies that met the inclusion criteria were manually searched for consideration of equity in the economic evaluation analysis. Costs were presented and a narrative synthesis of studies reporting on outcomes of equity was conducted. Eight studies met the inclusion criteria, and only two reported on aspects of equity, specifically ethnicity. Considering the significant disparities in pregnancy outcomes among disadvantaged populations, aspects of equity are important to consider when implementing and evaluating preconception interventions. Therefore, it is recommended that future research focuses on the cost-effectiveness of preconception care and that these evaluations incorporate aspects of equity.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40470970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconception.","authors":"Kirsten I Black,&nbsp;Jacqueline A Boyle","doi":"10.1055/s-0042-1754339","DOIUrl":"https://doi.org/10.1055/s-0042-1754339","url":null,"abstract":"","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40639990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School-Based Education: An Opportunity to Promote Equitable Access to Sexual and Reproductive Health Knowledge.","authors":"Ruth Walker,&nbsp;Jessica Fields,&nbsp;Jen Gilbert,&nbsp;Deana Leahy","doi":"10.1055/s-0042-1742336","DOIUrl":"https://doi.org/10.1055/s-0042-1742336","url":null,"abstract":"<p><p>All young people are entitled to knowledge and support that protects their sexual and reproductive health. School-based education is the most opportune setting for young people to have equitable access to sexual and reproductive health education. However, there is room for significant improvements in the provision of sexual and reproductive health education globally, and a range of barriers to be addressed. The Global Standards for Health Promoting Schools is a framework for governments, policy-makers, and schools to ensure that all students receive sexual and reproductive health education and support that promotes their sexual and reproductive health and overall health and well-being. The Global Standards for Health Promoting Schools acknowledges that school environments, partnerships, governance, policies, and resources are ultimately influenced by government resources and policy, and that advocacy and meaningful action across each standard is required.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40600797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting Preconception Care Priorities in Australia Using a Delphi Technique.","authors":"Jacqueline A Boyle,&nbsp;Kirsten Black,&nbsp;Edwina Dorney,&nbsp;David J Amor,&nbsp;Louise Brown,&nbsp;Emily Callander,&nbsp;Renea Camilleri,&nbsp;Kate Cheney,&nbsp;Adrienne Gordon,&nbsp;Karin Hammarberg,&nbsp;Dheepa Jeyapalan,&nbsp;Deana Leahy,&nbsp;Jo Millard,&nbsp;Catherine Mills,&nbsp;Loretta Musgrave,&nbsp;Robert J Norman,&nbsp;Claire O'Brien,&nbsp;Vijay Roach,&nbsp;Helen Skouteris,&nbsp;Amie Steel,&nbsp;Sue Walker,&nbsp;Ruth Walker","doi":"10.1055/s-0042-1749683","DOIUrl":"https://doi.org/10.1055/s-0042-1749683","url":null,"abstract":"<p><p>Preconception health affects fertility, pregnancy, and future health outcomes but public awareness of this is low. Our aims were to rank priorities for preconception care (PCC), develop strategies to address these priorities, and establish values to guide future work in preconception healthcare in Australia. A Delphi technique involved two rounds of online voting and mid-round workshops. Inputs were a scoping review of PCC guidelines, a priority setting framework and existing networks that focus on health. During July and August, 2021, 23 multidisciplinary experts in PCC or social care, including a consumer advocate, completed the Delphi technique. Ten priority areas were identified, with health behaviors, medical history, weight, and reproductive health ranked most highly. Six strategies were identified. Underpinning values encompassed engagement with stakeholders, a life course view of preconception health, an integrated multi-sectorial approach and a need for large scale collaboration to implement interventions that deliver impact across health care, social care, policy and population health. Priority populations were considered within the social determinants of health. Health behaviors, medical history, weight, and reproductive health were ranked highly as PCC priorities. Key strategies to address priorities should be implemented with consideration of values that improve the preconception health of all Australians.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40403876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconception Health in the Workplace: An Opportunity to Support Equitable Access to Education.","authors":"Briony Hill,&nbsp;Melissa Savaglio,&nbsp;Claire Blewitt,&nbsp;Kiran Ahuja,&nbsp;Pragya Kandel,&nbsp;Seonad Madden,&nbsp;Andrew P Hills,&nbsp;Helen Skouteris","doi":"10.1055/s-0042-1750132","DOIUrl":"https://doi.org/10.1055/s-0042-1750132","url":null,"abstract":"<p><p>Preconception health is a key determinant of pregnancy and offspring outcomes, but challenges reaching people during preconception are frequently cited by health professionals. This article highlights the workplace as an important setting for promoting equitable access to preconception health-related information and education to support optimal well-being before pregnancy. Workplaces can support equitable access to education and knowledge for preconception health: (1) due to the high engagement of reproductive-age women in the workforce and (2) by reaching vulnerable or high-risk population groups who may otherwise face barriers to accessing preconception health information. Literature that explicitly investigates workplace delivery of preconception health promotion programs is scarce. However, workplace health promotion more broadly is associated with improved corporate competitiveness, productivity, and strengthened employee-employer relationships. Workplace health promotion activities may also address social determinants of health and improve employee well-being outcomes. The opportunity for workplaces to benefit from an increase in the bottom line makes workplace health promotion programs more attractive, but organizational support and stakeholder engagement are needed to facilitate the design and delivery of successful workplace preconception health education programs. Such programs have the potential to facilitate health gains for women and their families.</p>","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40403877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}