BMJ Sexual & Reproductive Health最新文献

{"title":"Method of anaesthesia impact on total operating room time for second-trimester procedural abortion.","authors":"Simranvir Kaur, Jessica Ansari, Andrea J Traynor, Paul D Blumenthal, Andrea Henkel","doi":"10.1136/bmjsrh-2025-202793","DOIUrl":"10.1136/bmjsrh-2025-202793","url":null,"abstract":"<p><strong>Background: </strong>Hospital-based second-trimester dilation and evacuation (D&E) procedures are often completed using general anaesthesia (GA) despite emerging evidence for the safety of monitored anaesthesia care (MAC). Limited data exist comparing these approaches for key clinical outcomes.</p><p><strong>Study design: </strong>This retrospective cohort study compared those who received GA versus MAC during second-trimester (14-24 weeks' gestation) hospital-based D&Es. The primary outcome was total operating room (OR) time; secondary outcomes included surgical time, anaesthetic time, post anaesthesia care unit (PACU) time, estimated blood loss, and respiratory complications. We hypothesised that MAC would reduce the total OR time. We estimated that a sample size of 63 participants in each group would detect a 15-min or greater difference in total OR time with 80% power and a significance level of 0.05. Propensity score matching was used for sensitivity analysis.</p><p><strong>Results: </strong>During the study period, 125 patients received GA and 67 received MAC. Those receiving GA had significantly longer OR times (GA: 60.2±18.1 min vs MAC: 50.1±13.2 min, p=0.005) and greater estimated blood loss (GA: 150±286 mL vs MAC: 88±47 mL, p<0.001). No respiratory complications occurred in either group. A propensity score-matched analysis similarly found GA associated with longer OR time and higher blood loss.</p><p><strong>Conclusions: </strong>MAC may offer additional clinical benefits compared with GA during hospital-based D&E care. MAC reduces OR time and blood loss without compromising safety, which may optimise patient care and resource use in abortion care settings.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"51-56"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324528","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":"Adherence to first-trimester medication abortion in telemedicine versus in-person care: a prospective cohort study in Colombia, 2024.","authors":"Biani Saavedra-Avendano, Karen Cárdenas-Garzón, Paola Montenegro-Ramírez, Guillermo Antonio Ortiz-Avendaño","doi":"10.1136/bmjsrh-2025-202796","DOIUrl":"10.1136/bmjsrh-2025-202796","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"79-80"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085880","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":"Abortion skills and workforce 50 years on: an ageing workforce in need of rejuvenation.","authors":"Edgar Kennedy Dorman","doi":"10.1136/bmjsrh-2024-202559","DOIUrl":"10.1136/bmjsrh-2024-202559","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"1-4"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909301","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":"Frequency and patterns of emergency contraceptive demand among users of a UK-based free online sexual and reproductive health service: an observational study using routinely collected health data.","authors":"Paula Baraitser, Shaun Anthony Brown","doi":"10.1136/bmjsrh-2025-202737","DOIUrl":"10.1136/bmjsrh-2025-202737","url":null,"abstract":"<p><strong>Objective: </strong>To describe patterns of oral emergency contraception (EC) orders among users of a free service, commissioned by the UK National Health Service, ordered online and delivered by post.</p><p><strong>Study design: </strong>Routinely collected anonymised data from an online sexual health service in the UK from 1 January to 31 December 2023 were analysed. The number of times EC was ordered and prescribed was calculated and the age and level of deprivation assigned to the postcode where the user resided were extracted. Individual time lines were developed for those prescribed more than 10 times in 12 months.</p><p><strong>Results: </strong>During 2023 there were 32 659 oral EC requests from 19 501 users, resulting in 29 073 prescriptions from 17 576 users. Ulipristal acetate (UPA) was prescribed in 90% of the orders. The majority of users (n=12 238; 69.63%) received EC once a year, 5237 (29.80%) received it more than once and 101 (0.57%) received it more than 10 times. The mean (SD) number of prescribed orders per user was 1.65 (1.49) and the highest was 29. Oral EC had been used in the previous week by 794 of the 17 576 users (4.5%) and nine (0.05%) were prescribed more than 150 mg of UPA in 30 days.</p><p><strong>Conclusions: </strong>A small group of people order EC repeatedly, sometimes within the same cycle, putting them at increased risk of pregnancy. A minority of people order doses of UPA of >150 mg in 30 days.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"26-31"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179678","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":"Comparison of sperm concentration in fresh and postal post-vasectomy semen samples: a prospective agreement study.","authors":"Melanie Atkinson, Louise Massey, Gareth James, Rosie Sullivan, Happy Tahirih Kampire, Michel Labrecque","doi":"10.1136/bmjsrh-2025-202768","DOIUrl":"10.1136/bmjsrh-2025-202768","url":null,"abstract":"<p><strong>Background: </strong>Most guidelines recommend post-vasectomy semen analysis (PVSA) on fresh samples to confirm success. Postal submission increases compliance although reliability remains controversial. We assessed agreement between first PVSA sperm concentrations on the same sample, freshly and following postage, and determined if any sperm concentration levels other than 'no sperm seen' on a postal sample could be used to advise cessation of other contraceptive methods.</p><p><strong>Methods: </strong>12 weeks after vasectomy, men submitted fresh semen samples to laboratory A. Samples were analysed within 2 hours. The remainder of each sample was posted to laboratory B for analysis 72 hours later. Both laboratories examined one aliquot of 25 µL using 100 µm CellVision counting chambers. Sperm counts for the entire slide were reported. No exact count was performed at concentrations estimated >100 000/mL.</p><p><strong>Results: </strong>We analysed the results of 197 paired PVSA. The Bland-Altman plot showed high agreement between fresh and postal sperm concentrations, with only seven samples outlying 95% CIs. Fresh PVSA sperm concentrations were classified higher than postal in 47 (22.1%) pairs and lower in 42 (19.8%). Most discrepancies were observed at sperm concentrations <1000 sperm/mL. 'No sperm seen' was reported in 86 (43.7%) pairs with false negatives encountered in both laboratories (McNemar's test p=0.045). Negative predictive values of postal compared with fresh results were >99% at all cut-off values from 1000 to 100 000 sperm/mL CONCLUSION: Our study showed high agreement in sperm concentrations of first PVSA performed on the same samples submitted fresh or by postal submission. The current postal testing strategy could be modified to encompass clearance on postal PVSA showing very low sperm concentrations.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"38-44"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648533","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":"Safety and efficacy of early medical abortion at home between 10+0 and 11+6 weeks' gestation: a retrospective review.","authors":"Jacqueline Quinn, John Joseph Reynolds-Wright, Karen McCabe, Sharon T Cameron","doi":"10.1136/bmjsrh-2025-202947","DOIUrl":"10.1136/bmjsrh-2025-202947","url":null,"abstract":"<p><strong>Introduction: </strong>Since 2020, legislation in Britain has allowed both mifepristone and misoprostol to be taken at home for early medical abortion (EMA). In England and Wales, legislation restricts this to 9+6 weeks, but in Scotland this is permitted up to 11+6 weeks. Data on the outcomes of EMA at home >10 weeks' gestation is limited and so we aimed to establish the safety and efficacy of this in comparison with EMA in a hospital setting.</p><p><strong>Methods: </strong>We conducted a retrospective review from our abortion service in Edinburgh, Scotland of outcomes of EMA at home versus hospital between 10+0 and 11+6 weeks' gestation over the 5-year period April 2020-March 2025. The primary outcome was complete abortion rate. Secondary outcomes were rates of incomplete abortion, ongoing pregnancy and serious complications.</p><p><strong>Results: </strong>A total of 371 EMAs occurred at this gestation (n=258 home, n=113 hospital). Complete abortion rates were not statistically significantly different between groups: 251/258 (97%) (95% CI: 94% to 99%) at home and 110/113 (97%) (95% CI: 92% to 99%) in hospital. Neither incomplete abortion rates (home: 4/258, 1.6%; hospital: 3/113, 2.6%) nor ongoing pregnancy rates (home: 3/258, 1.2%; hospital: 0/113, 0%) were significantly different between groups. There was one case of haemorrhage requiring transfusion and three cases of infection receiving intravenous antibiotics, all in the at home group.</p><p><strong>Conclusions: </strong>EMA at home between 10+0 and 11+6 weeks has the same high efficacy and safety as when conducted in hospital. Action is needed to extend EMA at home after 10 weeks' gestation to women across the rest of the UK and beyond.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"57-62"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211739","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":"In reproductive health policy and access, Canada is not the 51st US state.","authors":"Laura Schummers, Wendy V Norman","doi":"10.1136/bmjsrh-2025-202912","DOIUrl":"10.1136/bmjsrh-2025-202912","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"63-65"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943555","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":"'Making abortion safe': abortion and post-abortion care providers' experiences of stigma in Rwanda, Zimbabwe, Sierra Leone and Nigeria.","authors":"Suzanna Bright, Emma Parnham, Rebecca Blaylock, Louise Bury, Friday Okonofua, Sunhurai Mukwambo, Munyaradzi Nyakanda, Theodomir Sebazungu, Godwin Akaba, Lesley Hoggart","doi":"10.1136/bmjsrh-2024-202495","DOIUrl":"10.1136/bmjsrh-2024-202495","url":null,"abstract":"<p><strong>Background: </strong>Social stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists' 'Making Abortion Safe' programme, aimed to understand providers' experiences of abortion stigma in four African countries with restrictive legislation.</p><p><strong>Methods: </strong>In-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.</p><p><strong>Results: </strong>Four themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as 'dirty work', conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers' well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in 'doing the right thing' helped them resist stigma.</p><p><strong>Conclusions: </strong>Legal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"45-50"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892137","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":"Response to the letter: 'Sexual and reproductive health clinical consultations: preconception care' by Chingara <i>et al</i>.","authors":"Amy Hough, Jayne Kavanagh, Neha Pathak","doi":"10.1136/bmjsrh-2025-202733","DOIUrl":"10.1136/bmjsrh-2025-202733","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"78"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063907","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":"Should patient-centred abortion care involve the offer of an ultrasound to all, including those who do not clinically require it?","authors":"Sinead Cook, Carrie Hazel, Sarah Wallage","doi":"10.1136/bmjsrh-2024-202538","DOIUrl":"10.1136/bmjsrh-2024-202538","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"81"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892261","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}