European Journal of Contraception and Reproductive Health Care最新文献

{"title":"Feasibility and acceptability of outpatient medical induction at 13-18 weeks' gestation in public sector hospitals in Nepal: a prospective cohort study.","authors":"Anand Tamang, Ilana G Dzuba, Heera Tuladhar, Bhakta Batsal Raut, Sajan Kc, Achala Shrestha, Hillary Bracken, Ingrida Platais, Beverly Winikoff","doi":"10.1080/13625187.2024.2416054","DOIUrl":"https://doi.org/10.1080/13625187.2024.2416054","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility and acceptability of outpatient medical induction at 13-18 weeks' gestation to limit overnight hospital stays.</p><p><strong>Methods: </strong>In this prospective cohort study, participants with 13-18-week pregnancies seeking abortions at two government hospitals swallowed mifepristone 200 mg and self-administered misoprostol 400 mcg buccally 24-48 h later, 1-2 h before returning to the outpatient clinic (OPD). Repeat misoprostol was dosed every 3 h until expulsion. Participants requiring care beyond OPD hours were admitted as inpatients. Acceptability was evaluated by exit interview before discharge. Participants were contacted two weeks later to assess any subsequent issues.</p><p><strong>Results: </strong>Ninety-eight (82%) of 120 participants had successful outpatient abortions using a median two (IQR 2, 3) misoprostol doses. The median induction-to-abortion time was five hours (IQR 4, 7.5). Eleven (9%) participants expelled before clinic arrival. Twenty-two (18%) participants were transferred as inpatients at OPD closing. Transferred participants remained inpatient for a median 18 h (IQR 18, 21.25). There were no serious adverse events and satisfaction with the abortion process was high.</p><p><strong>Conclusions: </strong>Although the outpatient model did not meet statistical expectations, it is clinically feasible, acceptable, and improves efficiency, expands access, and reduces burdens for women and providers. Operational adjustments may facilitate higher outpatient success.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost burden of adolescent and young adult pregnancy: real-world evidence from the Brazilian public health care system.","authors":"Bruna Marmett, Julia Mathias Reis, Amanda Ferreira de Carvalho, Daniela Dal Forno Kinalski, Carmem Lisiane Escouto de Souza, Natália Jaeger Basso Werle, Mayara Ribeiro Masseli, Ana Paula Beck da Silva Etges, Carisi Anne Polanczyk, Tiago Chagas Dalcin, Sérgio Luis Amantea","doi":"10.1080/13625187.2024.2416587","DOIUrl":"https://doi.org/10.1080/13625187.2024.2416587","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries, pregnancy in adolescence represents an important public health issue. Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets.</p><p><strong>Aim: </strong>To estimate the cost implications of early pregnancies from the perspective of the Brazilian Unified Public Health System.</p><p><strong>Methods: </strong>This retrospective secondary data analysis focuses on assessing direct hospital costs. The study cohort comprises adolescents and young adults who underwent prenatal care at a reference maternity hospital between January and December 2021. Individual procedure costs were extracted from hospital records and converted into monetary values using the Brazilian Federal Fee. The sample size for each group was determined based on preliminary data collected during a pilot study. Descriptive analyses presented costs stratified by age groups. To estimate budgetary impacts and sensitivity we used national live birth incidence rates.</p><p><strong>Results: </strong>The mean cost per case of adolescent pregnancy was US$ 704.92 (SD: 1,707.74) and for adult pregnancy was US$ 592.40 (SD: 941.43). The cost of hospital admission accounted for 61% of the total cost of adolescent pregnancies. The annual budget impact of pregnancies among women under 30 years was estimated at US$ 1 billion, with 239 million coming from women under 20 years old.</p><p><strong>Conclusion: </strong>Pregnancy in adolescence may lead to a significant annual budget impact, representing 24% of costs attributed to pregnancies among women under 30 years. Costs related to hospital admissions and complications represent a substantial share of the total costs of adolescent pregnancy.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice.","authors":"Theodora A M Teunissen, Antoinette L M Lagro-Janssen, Demi Sturkenboom, Reinier P Akkermans, Annemarie A Uijen","doi":"10.1080/13625187.2024.2415361","DOIUrl":"https://doi.org/10.1080/13625187.2024.2415361","url":null,"abstract":"<p><strong>Background: </strong>In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited.</p><p><strong>Aim: </strong>The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation.</p><p><strong>Design and setting: </strong>Retrospective cohort study utilising data from a Dutch primary care research network.</p><p><strong>Methods: </strong>We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions.</p><p><strong>Results: </strong>We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26-20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60-6.23]). A high educational level (OR 0.33, 95% CI [0.12-0.89]) was associated with a lower risk of discontinuation.</p><p><strong>Conclusion: </strong>The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous removal of impalpable implants in both the left and the right arm - a case report and implications for their use in low-resource settings.","authors":"Norman D Goldstuck, Pumza Mjuleka","doi":"10.1080/13625187.2024.2413615","DOIUrl":"https://doi.org/10.1080/13625187.2024.2413615","url":null,"abstract":"<p><p>Implanon NXT^® is a single rod contraceptive implant that is a long-acting reversible contraceptive method. Placement and removal is usually simple if the instructions of use are followed. Deviation from these instructions may lead to the implant becoming impalpable and consequently difficult to remove. We report on a case of a 46- year- old woman who had an impalpable implant in both the left and the right upper arms simultaneously. They had been placed approximately ten and seven years previously and were probably not releasing etonogestrel and were no longer relied on for contraceptive efficacy. The implants were removed relatively easily after ultrasound mapping. This case highlights some of the problems with the provision of implants in low-resource settings. The problems of implant management and some practical suggestions regarding its use in these settings is discussed.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual reality for the management of pain and anxiety during outpatient manual vacuum aspiration for miscarriage or incomplete abortion: a mixed methods trial.","authors":"Anna Alexandra McDougall, Eleanor Bard, Ora Jesner, Shereen Ibrahim, Schahrazed Rouabhi, Nandita Deo","doi":"10.1080/13625187.2024.2410838","DOIUrl":"https://doi.org/10.1080/13625187.2024.2410838","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy and acceptability of virtual reality (VR) as a distraction technique in the management of acute pain and anxiety during outpatient uterine aspiration using a manual vacuum aspirator (MVA).</p><p><strong>Materials and methods: </strong>This mixed methods study included a prospective multi-centre randomised controlled trial and structured individual interviews. Of the 72 patients approached, 50 consenting, eligible participants were randomised to VR intervention (immersive video content 'The Forest of Serenity') or standard care during MVA for the management of miscarriage or incomplete abortion from July 2021-July 2022 across two university hospitals in London, UK. Expected and actual pain scores, and anxiety before and after the procedure were measured as numeric rating scores (0-10). Structured interviews were undertaken after the procedure in women randomised to VR. Statistical analysis of pain and anxiety scores were by intention-to-treat including all randomised participants, using Stata-12 software. Qualitative analysis was achieved by thematic analysis of transcribed interviews.</p><p><strong>Results: </strong>There was no significant difference in pain or anxiety scores reported by participants randomised to VR compared with standard care. Mean worst pain scores were 5.98 and 6.88 in the standard care and VR groups respectively (p-value 0.13), with corresponding anxiety scores at the end of the procedure 3.94 and 3.3 (p-value 0.57). Qualitative analysis from interviews was highly favourable from women randomised to VR with all participants reporting a positive experience. 90% (18/20) of participants reported that VR reduced their anxiety and 71% (15/21) stated that it helped to reduce or distract from their pain.</p><p><strong>Conclusion: </strong>While virtual reality did not decrease pain or anxiety scores during MVA, it is a feasible and acceptable option that may improve patient experience.</p><p><strong>Short condensation: </strong>Randomisation to VR during MVA did not reduce pain or anxiety scores. However, at structured interview most participants reported that VR reduced their anxiety and reduced or distracted them from their pain. VR is a feasible and acceptable option that may improve patient experience during MVA.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the <i>Roe v. Wade</i> overturn on birth control prescriptions and sterilisation procedures in rural NC.","authors":"Eloise Joubert, Todd Anderson, Valeria Barreto-Nadal, David Schutzer","doi":"10.1080/13625187.2024.2409231","DOIUrl":"https://doi.org/10.1080/13625187.2024.2409231","url":null,"abstract":"<p><strong>Background/introduction: </strong>On June 24, 2022, the Supreme Court overturned the 1973 verdict in the <i>Roe v. Wade</i> legal suit that had established the constitutional right to medical abortion [1]. With the right to abortion now being left to the states, many restrictions regarding abortion procedures are being established [2]. We aim to evaluate whether this has led to an increase in the number of birth control prescriptions and sterilisation procedures at Cape Fear Valley Medical Centre in rural North Carolina.</p><p><strong>Methods: </strong>SlicerDicer program within EPIC medical records database was used to retrieve the records of all women that had an obstetrics and gynaecology appointment with Cape Fear Valley Health System between 11/01/21-12/31/2022 for contraception. The data was sorted into race/ethnicity, age, and types of birth control. Principal outcomes measured the trends in birth control prescription or sterilisation procedure appointments before and after the overturn of <i>Roe v. Wade</i>.</p><p><strong>Results: </strong>Contraceptive pill prescriptions decreased from 51.70% to 32.40%. IUD insertions decreased from 39.40% to 11.30%. Injectable birth control remained consistent, at approximately 16%. Nexplanon implantations dropped from 20.60% to 9.70%. Lastly, sterilisation procedures increased from 6.7% to 10.7%.</p><p><strong>Conclusion: </strong>Majority of birth control prescriptions decreased following the overturn of <i>Roe v. Wade</i>, except for sterilisation, which increased by 4.0%. This may indicate that women are now looking for more permanent birth control options after the overturn of <i>Roe v. Wade</i>. Future research should investigate whether similar trends of increasing prevalence of sterilisation procedures is seen throughout the United States.</p><p><strong>Short condensation: </strong>We aim to assess the impact of the Supreme Court overturn regarding the <i>Roe v. Wade</i> legal suit on contraceptive decisions in rural North Carolina.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences and impacts of side effects among contraceptive users in the UK: exploring individual narratives of contraceptive side effects.","authors":"Catherine Stewart, Rose Stevens, Fiona Kennedy, Paulina Cecula, Elena Rueda Carrasco, Jennifer Hall","doi":"10.1080/13625187.2024.2410841","DOIUrl":"https://doi.org/10.1080/13625187.2024.2410841","url":null,"abstract":"<p><strong>Purpose: </strong>While many women worldwide use contraception, there is a paucity of research on individual experiences of side effects. To address this gap, we investigated individual's contraception experiences.</p><p><strong>Methods: </strong>Women aged 18 to 35, living in the UK were invited to participate in an online survey on contraception. Free text responses were collected. Through a directed content analysis approach, we developed a coding framework (based on existing literature and initial response review) including six themes; method(s) of contraception, side effect(s) experienced, impact of side effect(s), timing of side effect(s), interactions with healthcare practitioners, and trial-and-error.</p><p><strong>Results: </strong>Overall, 337 participants provided free-text responses. Side effect experiences and impacts varied greatly between individuals and contraceptives. Most participants described negative effects, including mental health issues and bleeding problems. However, some shared positive experiences mainly related to bleeding management or the absence of side effects. Participants described how side effects often varied or appeared over time. Some participants felt unheard by healthcare practitioners.</p><p><strong>Conclusions: </strong>This study highlights how specific contraceptive experience is to the individual. We advocate for a patient-centred approach to contraceptive counselling. Practitioners should play an active role in improving contraception prescription, acknowledging the diverse experiences and preferences of patients.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of a pill containing ethinylestradiol-norgestimate improves female sexuality despite the decrease in circulating androgen: Correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1080/13625187.2024.2380910","DOIUrl":"10.1080/13625187.2024.2380910","url":null,"abstract":"","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of laboratory markers of anaemia in the treatment of heavy menstrual bleeding with a 19.5-mg intrauterine device: a pilot study.","authors":"Marco Viscola, Ana C Marcelino, Paula da C Pereira, Ilza Monteiro, Ximena Espejo-Arce, Luis Bahamondes","doi":"10.1080/13625187.2024.2406496","DOIUrl":"https://doi.org/10.1080/13625187.2024.2406496","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate improvements in laboratory markers of anaemia (haemoglobin, haematocrit, serum iron, and ferritin) in women with subjective heavy menstrual bleeding (HMB) treated with the levonorgestrel 19.5-mg intrauterine device.</p><p><strong>Materials and methods: </strong>We conducted a pilot study at the Department of Obstetrics and Gynaecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil. We compared anaemia markers in 73 women aged 18-48 years suffering from HMB, one year after placement of the IUD.</p><p><strong>Results: </strong>The mean age of participants was 30.0 years (range 24-38); more than half were white, and the mean body mass index (kg/m²) was 27.0. Twenty (27.4%) participants exited the study due to loss to follow-up (<i>n</i> = 12; 16.4%), expulsion (<i>n</i> = 7; 9.6%) and uterine perforation (<i>n</i> = 1; 1.4%). One-year post-IUD placement, amenorrhoea was reported by 10 (13.7%) women. According to intention-to-treat and per protocol analyses, the proportion of women with normal haemoglobin levels significantly improved (<i>p</i> = 0.014 in both analyses), as did haematocrit (<i>p</i> < 0.001 in both analyses) and serum iron (<i>p</i> = 0.003 in both analyses) compared to baseline evaluations. The proportion of women with normal ferritin levels also improved (<i>p</i> < 0.001) in both analyses using a cut-off of 15 ng/ml, though no significant difference was observed using a 30 ng/ml cut-off (<i>p</i> = 0.083 in both analyses).</p><p><strong>Conclusion: </strong>The levonorgestrel 19.5-mg IUD effectively improved laboratory markers of anaemia one year after placement in women with HMB.</p>","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Daungsupawong and Wiwanitkit's Letter to the Editor.","authors":"Maurizio Guida, Luciano Quercitelli, Pasquale De Franciscis, Mariano Fiorenza, Alice Sgandurra, Antonio La Marca, Giovanni Grandi","doi":"10.1080/13625187.2024.2381392","DOIUrl":"10.1080/13625187.2024.2381392","url":null,"abstract":"","PeriodicalId":50491,"journal":{"name":"European Journal of Contraception and Reproductive Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}