Contraception and Reproductive Medicine最新文献

Background: Exposure of mothers to negative moods and stress before childbirth leads to negative consequences for the infants. Given the importance of psychological health, this study aimed to examine the effect of these factors on the infants' psychological health.

Method: This cross-sectional study was conducted in Shiraz hospitals on 110 pregnant women selected with multistage random sampling. Research tools included The McGill Pain Questionnaire (MPQ) to measure fatigue with three criteria; The Positive and Negative Emotion Schedule (PANAS); and The Spielberger State-Trait Anxiety Inventory (STAI) were used to measure maternal mood and anxiety level. Also, neonatal psychological health was assessed by a checklist. Neonatal psychological health's correlation with maternal anxiety, fatigue, and mental state was assessed. Data were analyzed by SPSS-19 software using Pearson correlation coefficient and statistical regression at the significance level of 0.05.

Result: Although there was no significant relationship between maternal anxiety score and neonatal psychological health after birth (p = 0.231; r=-0.343), the relationship was significant immediately after birth with positive (P < 0.001; r = 0.343) and negative affect scores (P < 0.001; r=-0.357).

Conclusions: There was a statistically significant relationship between the neonatal psychological health and maternal fatigue (p ≤ 0.001; r = -0.357) and PANAS (p ≤ 0.001) of the mother; however, it had no significant relationship with maternal anxiety (p = 0.231; r=- 0.343). Therefore, nurses and midwives can reduce maternal anxiety and improve neonatal mental health by supporting mothers.

Background: Postpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda.

Objective: We aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.

Methods: We conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion.

Results: We enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9-15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26-51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47-48.47, p = 0.017).

Conclusion: The cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.

Background: Contraception allows women to realize their human right to decide if and when to have children and helps people to attain their desired family size. Yet 214 million women of a reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method. Women who have recently given birth are among the group with the highest unmet need for contraception. Therefore, this study was aimed to assess the prevalence of postpartum family planning use and associated factors among postpartum women in Southern Ethiopia.

Methods: Institution based cross-sectional study design was conducted. A structured and pretested interviewer-administered questionnaire was used to collect the data from study participants. Study participants were selected using a systematic random sampling technique by allocating proportionally to each health facility. The data was entered using EPI data version 3.1statistical software and exported to Statistical Package for Social Sciences version 22.0 for further analysis. Both bivariate and multivariate logistic regression analyses were performed to identify associated factors. P values < 0.05 with 95% confidence level was used to declare statistica significance.

Result: Overall, 44% of postpartum women utilize postpartum family planning. Having an antenatal care visit [adjusted odds ratio (AOR) =1.89(95%CI, 2.42-7.90), having planned pregnancy [adjusted odds ratio (AOR) = 1.17(95%CI, 1.60-2.28)], being married (adjusted odds ratio (AOR) =2.86(1.94-8.73), and having a college and above level educational status (AOR) =1.66(1.28-3.55) were significantly associated with utilization of postpartum family planning.

Conclusion: This study showed that the prevalence of postpartum family planning was 44%. Marital status, educational status of mothers, the status of pregnancy, and having an antenatal care follow-up during pregnancy were some factors associated with postpartum family planning utilization. Therefore, strengthening family planning counselling during antenatal and postnatal care visits, improving utilization of postnatal care services and improving women's educational status are crucial steps to enhance contraceptive use among postpartum women.

Background: This paper provides estimates of contraceptive discontinuation and failure rates in a poor urban setting in Ghana. Contraceptive use is for the purposes of preventing unintended or mistimed pregnancies. Unfortunately, evidence abounds in many parts of the world where there is considerable levels of contraceptive failure and high levels of discontinuation resulting in unintended pregnancies.

Methods: We estimated discontinuation rates during a 12-month period since starting use by applying single and multiple decrement life table methods to the contraceptive calendar data collected in a survey of women in reproductive age of 15-49 years.

Results: Modern contraceptive method use was estimated to be 13.7% at the time of the survey. The results show that contraceptive method discontinuation vary markedly by type of contraceptive method but are high for almost all methods, except for implants (23.7%). Discontinuation rate for emergency contraception was estimated at 88.5%, withdrawal 87.6%, and male condom use 80.9%. However, discontinuation rates were moderately high for rhythm (63.6%), pills (65.6%) and injectables (56%). In terms of failure rates, overall contraceptive failure for all methods was estimated at 7.9%. The factors significantly associated with method failure include being within age bracket 40-44 years (OR = 0.3, p < 0.05), having secondary/higher education (OR = 0.4, p < 0.01), belonging to the richest household wealth scale (OR = 3.3, p < 0.01), currently in union with a partner (OR = 2.2, p < 0.01), and using contraceptive methods such as rhythm (OR = 5.6, p < 0.01) and withdrawal (OR = 3.7, p < 0.01). On the flip side, the odds for method discontinuation were significantly higher for women in their 20s and mid 30s, formerly in union (OR = 1.9, p < 0.05) and use of withdrawal method (OR = 1.4, p < 0.05) and lower for women formerly in union (OR = 0.4, p < 0.01) and use of implants (OR = 0.2, p < 0.01) and injectables (OR = 0.6, p < 0.01).

Conclusion: While contraceptives use is low, both discontinuation and failure rates are high and variable among different methods. Failure and discontinuation rates are lowest for long-acting methods such as implants while higher failure rates are more prevalent among women who rely on withdrawal and the rhythm methods.

Background: Despite calls to increase contraceptive use among adolescents and youth, large gaps still exist, creating an unmet need for family planning. Past research has focused on barriers to seeking a method. There is less understanding of the types of methods young women want and who and what influences these decisions. This study examines what method characteristics young Nigerian women prioritize when choosing a method to inform future family planning programming.

Methods: In 2018, eight focus group discussions (FGD) were conducted in the Nigerian cities of Ilorin and Jos with 83 young women ages 15-24. Participants were identified by community contacts and separated into groups by religion and marital status. The discussion guide utilized a vignette structure to understand the participants' perceptions on contraceptive behavior and attitudes and misconceptions surrounding different types of methods. The FGDs were undertaken and analyzed by collaborative teams from the University of Ibadan and the University of North Carolina-Chapel Hill. A thematic analysis of the transcripts was performed using Atlas.ti, including two rounds of coding, and multiple reviews by the research team.

Results: The method characteristics associated with young women's contraceptive decisions include: side effects, reliability, length of coverage, privacy, cost, and accessibility. Side effects, reliability, and privacy were described as negatively linked to short-acting methods whereas easy accessibility and low cost were positive characteristics of these methods. Long-acting methods were generally viewed as positive. Participants' focus on side effects commonly resulted from concerns about the impact on future fertility. The characteristics prioritized by individuals change throughout their adolescence and as their marital status changes. Providers, peers, parents, and partners were all found to have an influence over method choice in different ways. The role of these influencers also changes over the adolescent years.

Conclusion: This study demonstrates that programs should prioritize expanding method choice to increase the number of available options to ensure all young women can access a method that fits their desired method characteristics. Programming should ensure that medically accurate information is widely distributed to harness providers, peers, parents and partners as a resource for information about specific methods.

Background: Postpartum intrauterine device (PPIUCD) utilization remains very low in Ethiopia beside high levels of unmet need for postpartum family planning even if nongovernmental organizations efforts to promote its use. This study investigates immediate PPIUCD utilization and influencing factors.

Methods: Institution based cross-sectional study was conducted on public hospitals of Addis Ababa city. All public hospitals which have PPIUCD service were included and systematic random sampling technique was used to select 286 participants. Data were entered using Epi Data and exported to SPSS for analysis. Bivariate and multivariate logistic regression analysis was used to determine the effect of independent variables on immediate PPIUCD utilization. Variables which have P-value< 0.2 on bivariate analysis were candidate for multivariate analysis. Variables which have P-value ≤0.05 on multivariate analysis was considered as statistically significant.

Results: Utilization of immediate PPIUCD among participants who gave birth in Addis Ababa public hospitals was 26.6% (95%CI: 21.3, 31.8). Eighty one percent respondents occupation was housewife were (AOR = 0.19, 95%CI: 0.06, 0.67) less likely to utilize PPIUCD compared to those who have personal job. In the other hand respondents who have discuss about PPFP with their partner were 1.21times (AOR = 1.21, 95%CI: 1.14, 25.67) more likely to utilize PPIUCD compared to those who never discuss. Contrarily 81% of respondents who need partner approval were (AOR = 0.19, 95%CI: 0.05, 0.79) less likely to utilize PPIUCD compared to those who doesn't need approval. Respondents who have been counseled about PPIUCD were 1.13 times (AOR = 1.13, 95%CI: 1.10, 2.21) more likely to utilize PPIUCD compared to those who were not counseled. Similarly respondents who have good knowledge about PPIUCD were 7.50 times (AOR = 7.50, 95%CI: 4.06, 9.31) more likely to utilize PPIUCD compared to those who have poor knowledge.

Conclusion: This study verifies that immediate PPIUCD utilization is high compared to other studies. Having a housewife occupation and necessity of partner approval to utilize PPIUCD have negative influences, whereas spousal discussion about PPIUCD, counseled during pregnancy and having good knowledge have positive influences on PPIUCD utilization. Therefor empowering women by the government and other organizations working on maternal health will advance immediate PPIUCD utilization.

Since the introduction of the first modern contraceptive methods, the interlink between bleeding control and contraceptive development has been a dominant and critical factor. This interplay has led to the development of safer and better contraceptive methods that are often used to control bleeding in both women with normal bleeding patterns as well as in those suffering from heavy menstrual bleeding (HMB). The success of progestin-only methods, such as hormonal IUDs or progestin dominant oral contraceptives in substantially decreasing and controlling menstrual bleeding, has led to development of multiple progestin-only protocols for the sole purpose of bleeding control. These include protocols designed to stop acute heavy bleeding as well as manage long-term bleeding. Recent publications describe a variety of protocols using high dose oral progestin pills with or without a medroxyprogesterone acetate (MPA) injection that demonstrate high effectiveness and good tolerability. Comparted to many other progestins, MPA is not converted in part into ethinyl estradiol and appears to have a progestin-only advantage. Norethindrone acetate (NET acetate) is converted in part to ethinyl estradiol and therefore is an especially good option for bleeding control in patients with low estrogen levels that would benefit from estrogen replacement (such as in premenopausal women with premature menopause or hypothalamic hypogonadism).

Background: The insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients.

Objective: Establish impact of postpartum TCu380A on amount and duration of lochia.

Methods: A prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0-4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS.

Results: Two hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001).

Conclusion: PPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients' needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.

Background: Despite endorsements supporting the use of intrauterine devices (IUDs) for adolescents and young adult women (AYA), they have limited knowledge about them Male partners can influence contraceptive decisions, however their perceived knowledge about IUDs is lower than their objective knowledge. We aim to establish current AYA baseline contraceptive knowledge and attitudes so providers can better target their sexual health educational interventions.

Methods: Females and males, aged 13 to 23 years old, from our suburban adolescent clinic, completed an anonymous survey that assessed their knowledge and attitudes towards methods of contraception, with an emphasis on the IUD.

Results: Completed surveys totaled 130 (99 females/31 males). Demographic results revealed 31.3% Black/African-American, 30.5% Latino/Hispanic, 17.6% White, 3.0% Asian, and 14.5% Other. The majority of participants (80%) were sexually active. The majority (69.5%) stated they/their partner were currently using a contraceptive method; only 2.6% used IUDs. Half of females (56.6%) and 10.1% of males had heard of IUDs. Despite this, male and female participants lacked knowledge regarding specific IUD facts. Of the participants who had used emergency contraception (EC), only 6.4% knew the copper IUD could be used for EC.

Conclusion: Contraceptive knowledge deficits, especially regarding the IUD, continue to exist for AYA patients. Many participants stated they required EC despite "satisfaction" with their birth control method(s) and most were unaware that the copper IUD could be used as EC. These discrepancies highlight the importance of comprehensive contraceptive education for AYA patients. Enhanced and consistent contraceptive options counseling can help providers ensure that their AYA patients make well-informed decisions about family planning, thus improving their quality of life.