Contraception: X最新文献_第4页

Ovulation suppression following subcutaneous administration of depot medroxyprogesterone acetate 皮下注射醋酸甲孕酮后排卵抑制

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100073

Douglas J. Taylor , Vera Halpern , Vivian Brache , Luis Bahamondes , Jeffrey T. Jensen , Laneta J. Dorflinger

Objectives

To characterize the relationship between serum medroxyprogesterone acetate (MPA) concentrations and ovulation suppression, and to estimate the risk of ovulation for investigational subcutaneous regimens of Depo-Provera CI (Depo-Provera) and Depo-subQ Provera 104 (Depo-subQ).

Study Design

We performed a secondary analysis of 2 studies that assessed the pharmacokinetics and pharmacodynamics of MPA when Depo-Provera is administered subcutaneously rather than by the labeled intramuscular route. Each woman received a single 45 mg to 300 mg subcutaneous injection of Depo-Provera, a single 104 mg subcutaneous injection of Depo-subQ, or 2 injections of Depo-subQ at 3-month intervals. We used an elevation of serum progesterone ≥4.7 ng/mL as a surrogate for ovulation and non-parametric statistical methods to assess pharmacokinetic and pharmacodynamic relationships.

Results

This analysis included 101 women with body mass index (BMI) 18 to 34 kg/m². Return of ovulation occurred at a median MPA concentration of 0.07 ng/mL (95% CI: 0.06–0.08) and the 90th percentile was 0.10 ng/mL (95% CI: 0.09–0.14). Neither age, race, nor BMI significantly influenced this relationship. The estimated probabilities of ovulation within 4 months of a 104 mg subcutaneous injection and within 7 months of a 150 mg subcutaneous injection (6 plus a 1-month grace) were each below 2.2%.

Conclusions

The typical MPA concentration associated with loss of ovulation suppression is substantially less than the commonly cited threshold of 0.2 ng/mL. Based on our results, MPA levels would rarely be low enough to permit ovulation if the Depo-subQ reinjection interval were extended to four months or if 150 mg Depo-Provera were injected subcutaneously every 6 months.

Implications

Extending the three-month Depo-subQ reinjection interval by one month would result in a 25% reduction in yearly MPA exposure, with little risk of pregnancy. Off-label subcutaneous administration of 150 mg Depo-Provera every 6 months would be a highly effective repurposing of an excellent product, with a similar reduction in cumulative exposure.

目的探讨血清羟孕酮醋酸酯(MPA)浓度与排卵抑制的关系，并评估皮下注射Depo-Provera CI (Depo-Provera)和Depo-subQ Provera 104 (Depo-subQ)的排卵风险。研究设计我们对2项研究进行了二次分析，这些研究评估了Depo-Provera皮下给药而不是标记肌内给药时MPA的药代动力学和药效学。每位妇女接受单次皮下注射45毫克至300毫克的Depo-Provera，单次皮下注射104毫克的Depo-subQ，或每3个月注射2次Depo-subQ。我们使用血清孕酮升高≥4.7 ng/mL作为排卵的替代指标，并采用非参数统计方法评估药代动力学和药效学关系。结果本研究纳入101例体重指数(BMI)为18 ~ 34 kg/m2的女性。MPA浓度中位数为0.07 ng/mL (95% CI: 0.06-0.08)，第90百分位数为0.10 ng/mL (95% CI: 0.09-0.14)时，排卵恢复。年龄、种族和体重指数都没有显著影响这一关系。皮下注射104mg后4个月内的排卵概率和皮下注射150mg后7个月内的排卵概率(6个月加上1个月的宽限期)均低于2.2%。结论与排卵抑制丧失相关的典型MPA浓度远低于常用阈值0.2 ng/mL。根据我们的研究结果，如果将Depo-subQ再注射间隔延长至4个月或每6个月皮下注射150 mg Depo-Provera, MPA水平很少会低到足以允许排卵。将三个月的Depo-subQ再注射间隔延长一个月，可使年MPA暴露量减少25%，且妊娠风险很小。标签外每6个月皮下给药150毫克Depo-Provera将是一个非常有效的重新利用一个优秀的产品，具有类似的减少累积暴露。

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引用次数: 3

Observational study of feasibility and acceptability of the levonorgestrel-releasing intrauterine device as a long-acting reversible contraceptive in a primary care setting in India 左炔诺孕酮释放宫内节育器在印度初级保健环境中作为长效可逆避孕药的可行性和可接受性观察研究

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100079

Sharad Iyengar , Kirti Iyengar , Ankit Anand , Virendra Suhalka , Manju Jain

Objectives

The levonorgestrel-releasing intrauterine device (LNG-IUD) is a well-accepted contraceptive across developed countries, yet there is limited experience in use and acceptance amongst women living in low-resource, developing country settings. We studied the feasibility of providing the LNG-IUD through a primary care service, and its acceptability amongst women living in a low-income, rural-tribal community in India.

Study design

We conducted an observational study of feasibility and acceptability at four health facilities (three rural, and one urban) in Rajasthan, India. Women seeking contraception were offered the LNG-IUD in addition to existing contraceptive methods. We followed all those who adopted LNG-IUD from August 2015 to September 2019 (n= 1266) till discontinuation or 12 months, whichever was earlier. The primary outcome was continuation rate and acceptability, and the secondary outcome was change in hemoglobin levels, which we measured before insertion and at 12-month follow-up, using Sahli's method.

Results

Most users lived in villages, were illiterate, belonged to marginalized groups, had 2 or more children, and wished to limit births when they adopted the method. The 12-month continuation rate was 87.6%. Amongst all users, 7.4% of women sought removal for side effects and 2% for change in reproductive intention, while another 2% reported spontaneous expulsion. Most continuing users reported hypomenorrhea (54%) or amenorrhea (42%) by 12 months of use. User satisfaction was high at 91.6%, with 92% of women rating their experience as equaling or exceeding expectations. Moderate and severe anemia reduced, and mean hemoglobin levels increased by 0.7 g/dL (p < 0.01).

Conclusion

Primary care clinics can feasibly deliver LNG-IUD, with high acceptability amongst women living in low resource settings. Given the paucity of long-acting reversible contraceptive options and high prevalence of anemia among women in India and similar countries, the method should be piloted through the public health system.

Implications

Long duration of contraceptive action, ability to reduce menstrual bleeding and reduce anemia, reversibility, and easy removal, combine to make LNG-IUD acceptable to women, especially in regions with high prevalence of anemia. This study demonstrates the feasibility and acceptability of introducing LNG-IUD in a low resource, primary care setting.

在发达国家，释放左炔诺孕酮的宫内节育器(LNG-IUD)是一种被广泛接受的避孕方法，但在资源匮乏的发展中国家，妇女在使用和接受方面的经验有限。我们研究了通过初级保健服务提供LNG-IUD的可行性，以及它在印度低收入农村部落社区妇女中的可接受性。研究设计我们在印度拉贾斯坦邦的四个卫生机构(三个农村，一个城市)进行了可行性和可接受性的观察性研究。除了现有的避孕方法外，还为寻求避孕的妇女提供了液化天然气宫内节育器。我们跟踪了2015年8月至2019年9月期间所有使用LNG-IUD的患者(n= 1266)，直到停用或12个月，以较早者为准。主要终点是持续率和可接受性，次要终点是血红蛋白水平的变化，我们在插入前和随访12个月时使用Sahli方法测量血红蛋白水平。结果大多数使用者生活在农村，不识字，属于边缘群体，有两个或两个以上的孩子，并希望在采用该方法时限制生育。12个月延续率为87.6%。在所有使用者中，7.4%的女性因副作用而寻求移除，2%的女性因改变生育意愿而寻求移除，另有2%的女性报告自发移除。大多数持续服用者在使用12个月时报告经期减少(54%)或闭经(42%)。用户满意度高达91.6%，其中92%的女性认为她们的体验等于或超过了预期。中度和重度贫血减少，平均血红蛋白水平升高0.7 g/dL (p <0.01)。结论初级保健诊所提供LNG-IUD是可行的，在资源匮乏地区妇女中可接受性高。鉴于印度和类似国家缺乏长效可逆避孕选择和妇女贫血的高流行率，这种方法应该通过公共卫生系统进行试点。作用时间长、能减少月经出血、减少贫血、可逆性、易取出，使LNG-IUD为妇女所接受，特别是在贫血高发区。本研究证明了在低资源的初级保健环境中引入LNG-IUD的可行性和可接受性。

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引用次数: 0

Pregnancy coercion and partner knowledge of contraceptive use among Ethiopian women 埃塞俄比亚妇女中的强迫怀孕和伴侣对避孕药具使用的了解

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100084

Jessica L. Dozier , Linnea A. Zimmerman , Bedilu A. Ejigu , Solomon Shiferaw , Assefa Seme , Mahari Yihdego , Robel Yirgu , Shannon N. Wood

Objective

To examine the relationship between pregnancy coercion and partner knowledge of contraceptive use.

Study design

Cross-sectional Performance Monitoring for Action-Ethiopia data were collected in October-November 2019 from a nationally representative sample of women ages 15 to 49. The analytical sample (n = 2,469) included partnered women using contraception in the past year. We used multinomial logistic regression to examine associations between past-year pregnancy coercion (none, less severe, more severe) and partner knowledge/couple discussion of contraceptive use (overt use with couple discussion before method initiation (reference group), overt use with discussion after method initiation, and covert use of contraception).

Results

Most women reported their partner knew they were using contraception and had discussed use prior to method initiation (1,837/2,469, 75%); 16% used overtly and discussed use after method initiation, and 7% used contraception covertly. The proportion of covert users increased with pregnancy coercion severity (4%_none, 14%_{less severe}, 31%_{more severe}), as did the proportion of overt users who delayed couple contraceptive discussions, (14%_none, 23%_{less severe}, 26% _{more severe}); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%_none, 60%_{less severe}, 40%_{more severe}). The risk of covert use among women experiencing less severe pregnancy coercion was four times greater than women who experienced no pregnancy coercion (adjusted relative risk ratio, (aRRR) = 3.95, 95% confidence interval (CI) 2.20–7.09) and ten times greater for women who experienced the most severe pregnancy coercion (aRRR = 10.42, 95% CI 6.14–17.71). The risk of overt use with delayed couple discussion also increased two-fold among women who experienced pregnancy coercion compared to those who did not (less severe aRRR = 2.05, 95% CI 1.39–2.99; more severe aRRR = 2.89, 95% CI 1.76–4.73).

Conclusion

When experiencing pregnancy coercion, women may avoid or delay contraceptive conversations with their partners. Increased pregnancy coercion severity has the greatest association with covert use and couple contraceptive discussions.

Implications

The presence and timing of couple discussions about contraception are critical for ensuring safety for women experiencing pregnancy coercion. Screening for pregnancy coercion must be included within contraceptive counseling so that women can choose methods that maximize their reproductive autonomy.

目的探讨强迫怀孕与性伴避孕知识的关系。研究设计:埃塞俄比亚行动的横截面绩效监测数据于2019年10月至11月从15至49岁的全国代表性女性样本中收集。分析样本(n = 2469)包括在过去一年中使用避孕措施的有伴侣的妇女。我们使用多项逻辑回归来检验过去一年的强迫怀孕(无，较轻，较严重)与伴侣知识/夫妇讨论避孕措施使用之间的关系(在方法开始前公开使用并夫妇讨论(参照组)，在方法开始后公开使用并讨论，以及隐蔽使用避孕措施)。结果大多数妇女报告其伴侣知道她们正在使用避孕措施，并在开始使用方法前讨论过使用方法(1,837/2,469,75%);16%的人公开使用并在方法开始后讨论使用，7%的人秘密使用避孕措施。秘密使用者的比例随着怀孕胁迫的严重程度而增加(4%没有，14%不那么严重，31%更严重)，公开使用者推迟夫妻避孕讨论的比例也增加了(14%没有，23%不那么严重，26%更严重);然而，方法开始前夫妻讨论的公开使用随着妊娠胁迫严重程度的降低而减少(79%没有，60%较轻，40%较重)。经历过较不严重妊娠胁迫的妇女秘密使用的风险是没有经历过妊娠胁迫的妇女的4倍(调整相对风险比，(aRRR) = 3.95, 95%可信区间(CI) 2.20-7.09)，经历过最严重妊娠胁迫的妇女的风险是10倍(aRRR = 10.42, 95% CI 6.14-17.71)。在经历过强迫怀孕的妇女中，公开使用并推迟夫妻讨论的风险也比没有经历过强迫怀孕的妇女增加了两倍(较轻的aRRR = 2.05, 95% CI 1.39-2.99;更严重的aRRR = 2.89, 95% CI 1.76-4.73)。结论在遭遇强迫怀孕时，女性可能会避免或推迟与伴侣的避孕对话。增加怀孕强迫严重程度与隐蔽使用和夫妻避孕讨论有最大的关联。提示:夫妻讨论避孕的存在和时机对于确保遭受强迫怀孕的妇女的安全至关重要。避孕咨询必须包括对强迫怀孕的筛查，以便妇女可以选择最大限度地提高其生殖自主权的方法。

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引用次数: 1

An exploratory survey regarding the Maryland Contraceptive Equity Act: clinician awareness and impact on contraception provision 一项关于马里兰州避孕公平法案的探索性调查:临床医生对避孕措施提供的认识和影响

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2021.100071

Aneesha Cheedalla , Jessica K. Lee , Anne E. Burke

Objective

The Maryland Contraceptive Equity Act took effect in January 2018 with the goal of reducing insurance barriers to contraception. We sought to assess the Act's impact on contraceptive provision.

Study Design

From March-August 2019, we emailed an exploratory survey to clinicians providing contraception in Maryland that queried awareness of the Act and changing practices.

Results

The survey had a 13% response rate (164/1256 clinicians). Fifty (31%) were aware of the Act. Clinicians rated the Act was somewhat likely to change prescribing practices (3.5/5 point Likert Scale, SD 1.3).

Conclusion

The majority of clinicians providing contraception in Maryland are not aware of the Act. If aware of the Act, clinicians may change their contraceptive prescribing practices.

《马里兰州避孕公平法案》于2018年1月生效，旨在减少避孕的保险障碍。我们试图评估该法案对提供避孕药具的影响。研究设计从2019年3月至8月，我们通过电子邮件向马里兰州提供避孕措施的临床医生发送了一项探索性调查，询问他们对该法案的认识和改变做法。结果调查有效率为13%(164/1256名临床医生)。50人(31%)知道该法案。临床医生认为该法案有可能改变处方实践(3.5/5分李克特量表，SD 1.3)。结论马里兰州大多数提供避孕服务的临床医生不了解该法案。如果了解该法案，临床医生可能会改变他们的避孕处方做法。

引用次数: 0

Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities 埃塞俄比亚堕胎后护理服务的可得性:来自2020年全国公共设施样本的估计

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100087

Hayley V. McMahon , Celia Karp , Suzanne O. Bell , Solomon Shiferaw , Assefa Seme , Mahari Yihdego , Linnea A. Zimmerman

Objectives

Unsafe abortion is a leading cause of global maternal mortality and morbidity. This study sought to estimate availability of essential postabortion care (PAC) services among publicly managed health facilities in Ethiopia.

Study design

Data from public hospitals and health centers in Ethiopia were collected in 2020. Among facilities offering labor and delivery, we assessed the proportion that: (1) offered PAC, (2) were equipped for each PAC signal function, and (3) were equipped for all PAC signal functions falling within their scope of care by facility type.

Analysis

Our primary outcome was PAC service provision status. Descriptive statistics summarized the proportion of hospitals and health centers, respectively, categorized as each PAC status and with necessary equipment for individual signal functions. Per Federal Ministry of Health (FMOH) guidelines, hospitals are expected to provide comprehensive PAC, while health centers are expected to provide basic PAC.

Results

Altogether, 69.1% (n = 94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (n = 131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; n = 114) and uterine evacuation among health centers (84.6%; n = 170).

Conclusion

Meaningful progress has been made toward achieving the Ethiopian FMOH's goal of universal PAC service availability at hospitals and health centers by 2020. Despite this, sizable gaps remain and may endanger maternal health in Ethiopia, underscoring a need for continued prioritization of PAC services.

Implications

Ethiopia's commitment to PAC has fostered a service landscape that is stronger than many other low-resource settings; however, notable shortcomings are present. Further research is needed to understand the potential role of clinical training and supply-side interventions.

目的不安全堕胎是全球孕产妇死亡和发病的主要原因。本研究旨在估计埃塞俄比亚公共管理的卫生设施中基本堕胎后护理(PAC)服务的可用性。研究设计:2020年收集了埃塞俄比亚公立医院和卫生中心的数据。在提供分娩和分娩的设施中，我们评估了以下比例:(1)提供PAC，(2)配备每个PAC信号功能，(3)按设施类型配备其护理范围内的所有PAC信号功能。分析我们的主要结果是PAC服务提供状态。描述性统计分别总结了医院和保健中心的比例，按每个PAC状态进行分类，并具有各自信号功能所需的设备。根据联邦卫生部(FMOH)的指导方针，医院应提供综合PAC，而保健中心应提供基本PAC。结果总体而言，69.1% (n = 94)的医院配备了综合PAC, 65.2% (n = 131)的保健中心配备了基本PAC。N = 114)和子宫清除(84.6%;n = 170)。结论在实现埃塞俄比亚联邦卫生部到2020年在医院和保健中心普及PAC服务的目标方面取得了有意义的进展。尽管如此，仍然存在相当大的差距，可能危及埃塞俄比亚的产妇保健，强调需要继续优先考虑公共卫生服务。埃塞俄比亚对PAC的承诺促进了比许多其他低资源环境更强大的服务格局;然而，存在明显的缺点。需要进一步的研究来了解临床培训和供应方干预的潜在作用。

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引用次数: 0

DMPA-SC stock: Cross-site trends by facility type DMPA-SC库存:按设施类型的跨站点趋势

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100075

Sophia Magalona , Shannon N. Wood , Frederick Makumbi , Funmilola M. OlaOlorun , Elizabeth Omoluabi , Akilimali Z. Pierre , Georges Guiella , Jane Cover , Philip Anglewicz

Objectives

To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods.

Study design

We used repeated cross-sectional data from service-delivery-point surveys in six settings: Burkina Faso, Democratic Republic of Congo (Kinshasa and Kongo Central), Nigeria (Kano and Lagos), and Uganda, each with 3-5 rounds of data collected between 2016 and 2020. We analyzed trends in DMPA-SC availability using percent of service delivery points offering the method and percent experiencing stockouts; trends were compared with those for DMPA-IM, IUD, implants, and other short-acting methods, by facility type.

Results

All settings showed increased offering of DMPA-SC over time for both private and public facilities. Larger proportions of public facilities provided DMPA-SC compared to private facilities (66%–97% vs 16%–50% by 2019–2020). DMPA-SC was provided by fewer facilities than DMPA-IM (90%–100% public, 34%–69% private by 2019–2020), but comparable to implants (83%–100% public, 15%–52% private by 2019–2020) and IUDs (55%–91% public, 0%–44% private by 2019–2020). Trends of DMPA-SC stock varied by setting, with more consistent stock available in private facilities in the DRC and in public facilities in Burkina Faso and Nigeria. Uganda showed decreasing stock in public facilities but increasing stock in private facilities.

Conclusion

DMPA-SC availability has been increasing since its introduction in sub-Saharan Africa, yet significant gaps in stock exist. Countries should consider alternative distribution models to address these issues.

Implications

Our findings may help inform countries about the need to monitor DMPA-SC availability and to consider solutions that ensure contraceptive options are available to women who need them and disruptions to contraceptive use are minimized.

目的了解公立和私立卫生机构DMPA-SC的供应趋势，并与其他著名的现代方法进行比较。研究设计我们使用了六个国家服务交付点调查的重复横断面数据:布基纳法索、刚果民主共和国(金沙萨和刚果中部)、尼日利亚(卡诺和拉各斯)和乌干达，每个国家在2016年至2020年期间收集了3-5轮数据。我们使用提供该方法的服务交付点的百分比和经历缺货的百分比来分析DMPA-SC可用性的趋势;按设施类型比较DMPA-IM、宫内节育器、植入物和其他短效方法的趋势。结果所有设置都显示，随着时间的推移，私人和公共设施的DMPA-SC提供增加。与私人设施相比，公共设施提供DMPA-SC的比例更高(2019-2020年为66%-97%，而2019-2020年为16%-50%)。提供DMPA-SC的机构少于DMPA-IM(90%-100%公共，到2019-2020年为34%-69%私人)，但与植入物(83%-100%公共，到2019-2020年为15%-52%私人)和宫内节育器(55%-91%公共，到2019-2020年为0%-44%私人)相当。DMPA-SC库存的趋势因环境而异，刚果民主共和国的私人设施以及布基纳法索和尼日利亚的公共设施的库存较为稳定。乌干达显示公共设施的库存减少，但私人设施的库存增加。结论自dmpa - sc在撒哈拉以南非洲地区引入以来，其可用性一直在增加，但其存量仍存在显著差距。各国应考虑其他分配模式来解决这些问题。研究结果可能有助于告知各国有必要监测DMPA-SC的可用性，并考虑解决方案，确保有需要的妇女可以获得避孕选择，并尽量减少对避孕使用的干扰。

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引用次数: 1

Return to ovulation after Sayana Press is injected every 4 months for one year: Empirical and pharmacokinetic/pharmacodynamic modeling results 每4个月注射一次沙亚娜后恢复排卵，持续一年:经验和药代动力学/药效学建模结果

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100080

Douglas J. Taylor , Jennifer Deese , Luis Bahamondes , Vivian Brache , Nelio Veiga Jr , Rachael Fuchs , Vera Halpern , Laneta J. Dorflinger

Objective

To characterize return to ovulation after injecting Sayana Press (104 mg/0.65 mL medroxyprogesterone acetate [MPA] in the Uniject device) every 4 months for 1 year of treatment.

Study design

We followed a subset of women for return to ovulation in a trial that demonstrated Sayana Press remains highly effective when the subcutaneous reinjection interval is extended from 3 to 4 months. We measured serum progesterone in weeks 38 to 42 and 46 to 50 after a final (third) injection and used a concentration ≥4.7 ng/mL as a surrogate for ovulation. We also performed pharmacokinetic and pharmacodynamic modeling to predict differences in MPA accumulation and return to ovulation had - contrary to fact - injections been given every 3 months.

Results

Ten of 19 women (53%; 95% confidence interval: 29–76) ovulated within 50 weeks of their last injection. We predicted that typical 12-month trough MPA concentrations are 34% lower (0.46 vs 0.69 ng/mL) and the median time from last dose to ovulation is 1.1 months shorter (13.1 vs 14.2 months) when injections are given every four months for 1 year.

Conclusion

Extending the Sayana Press reinjection interval from 3 to 4 months leads to less drug accumulation, without a noticeable loss in efficacy. Although the Sayana Press patient leaflet specifies that over 80% of women desiring pregnancy will conceive within a year of stopping the method (independent of treatment duration), our empirical and modeling results indicate women should anticipate waiting a year or more for fertility to return after repeat dosing, with a somewhat shorter delay were the reinjection interval extended to four months.

Implications

Providers should counsel women regarding the distinct possibility that return to fertility will take a year or longer following repeat use of Sayana Press. Extending the dosing interval from 3 to 4 months would result in approximately a 1-month shorter delay, without any appreciable reduction in contraceptive efficacy.

目的观察每4个月注射一次赛亚娜压(104 mg/0.65 mL醋酸甲孕酮在Uniject装置中)治疗1年后的排卵恢复情况。研究设计:我们在一项试验中随访了一组恢复排卵的妇女，该试验表明，当皮下再注射间隔从3个月延长到4个月时，Sayana Press仍然非常有效。我们在最后一次(第三次)注射后的38至42周和46至50周测量血清黄体酮，并使用浓度≥4.7 ng/mL作为排卵指标。我们还进行了药代动力学和药效学建模，以预测MPA积累和恢复排卵的差异-与事实相反-每3个月注射一次。结果19例女性中有10例(53%;95%可信区间:29-76)在最后一次注射后50周内排卵。我们预测，如果每4个月注射一次，持续1年，典型的12个月波谷MPA浓度降低34% (0.46 vs 0.69 ng/mL)，从最后一次注射到排卵的中位时间缩短1.1个月(13.1 vs 14.2个月)。结论延长沙参叶再注射间隔3 ~ 4个月可减少药物蓄积，疗效无明显下降。尽管Sayana Press的患者手册明确指出，超过80%希望怀孕的女性在停止该方法后一年内怀孕(与治疗时间无关)，但我们的经验和模型结果表明，女性应该在重复给药后等待一年或更长时间才能恢复生育能力，如果再注射间隔延长至4个月，延迟时间会稍短一些。提示:提供者应就重复使用Sayana Press后恢复生育能力的明显可能性向妇女提供咨询。将给药间隔从3个月延长到4个月将导致大约缩短1个月的延迟，而避孕效果没有明显下降。

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引用次数: 1

Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review 在埃塞俄比亚的一家三级医院，心脏内利多卡因和羊膜内地高辛在20周以上的妊娠中期流产前诱导胎儿死亡的有效性:回顾性回顾

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100082

Abraham Fessehaye Sium , Tesfaye H. Tufa , Jaclyn M. Grentzer , Sarah Prager

Background

Current literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting.

Methods

This is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2^nd trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies.

Results

More than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%.

Conclusion

In this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies.

Implications

In an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.

背景目前的文献建议在妊娠20周以上的中期药物流产前诱导胎儿死亡。关于这一程序在低收入国家的做法和有效性的文献不足。本研究旨在记录心脏内利多卡因和羊膜内地高辛在埃塞俄比亚妊娠中期药物流产前诱导胎儿死亡的有效性。方法本研究是在埃塞俄比亚圣保罗医院千年医学院进行的回顾性图表综述。回顾性分析了65例妊娠20 ~ 28周(2021年4月1日~ 2021年9月30日)中期药物流产前使用人工流产药的病例。主要终点是第一次注射堕胎药后一天胎儿心脏活动停止。通过使用英文准备的数据提取工具查看产妇图表提取数据。数据分析采用SPSS version 23。使用简单的描述性统计分析基线特征和胎儿死亡结局。结果以百分比和频率表示。结果羊膜内注射地高辛超过3 / 4，心脏内注射利多卡因占24.6%(16/65)。92.3%(60/65)的病例在给药后第一天注射地高辛或利多卡因诱导胎儿死亡有效。利多卡因注射后1天内诱导死胎的有效率为100%(16/16)，地高辛注射后1天内诱导死胎的有效率为89.8%。结论在本研究中，羊膜内地高辛和心脏内利多卡因均可有效诱导胎儿死亡，这与以往类似研究结果一致。在埃塞俄比亚，羊膜内注射地高辛和心脏内注射利多卡因可有效诱导妊娠中期流产前、妊娠20周以上的胎儿在堕胎后第二天内死亡。

{"title":"Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review","authors":"Abraham Fessehaye Sium , Tesfaye H. Tufa , Jaclyn M. Grentzer , Sarah Prager","doi":"10.1016/j.conx.2022.100082","DOIUrl":"10.1016/j.conx.2022.100082","url":null,"abstract":"<div><h3>Background</h3><p>Current literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting.</p></div><div><h3>Methods</h3><p>This is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2<sup>nd</sup> trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies.</p></div><div><h3>Results</h3><p>More than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%.</p></div><div><h3>Conclusion</h3><p>In this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies.</p></div><div><h3>Implications</h3><p>In an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33438190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia 在一个具有全国代表性的避孕药具使用者样本中测量有关避孕药具副作用的经验和关切:来自埃塞俄比亚PMA的证据

Q2 Medicine

Contraception: X

Pub Date : 2022-01-01 DOI: 10.1016/j.conx.2022.100074

Linnea A. Zimmerman , Dana O. Sarnak , Celia Karp , Shannon N. Wood , Mahari Yihdego , Solomon Shiferaw , Assefa Seme

Objective

Our objectives were to assess the prevalence of specific side-effects experienced by current and recent contraceptive users, describe patterns of side-effects that users were concerned about, and share measurement lessons learned.

Study design

Data come from the PMA Ethiopia 2019 nationally-representative, cross-sectional survey. Our analytic sample included women who were current (weighted n = 2190; unweighted n = 2020) or recent (past 24 months; weighted n = 627; unweighted n = 622) users of a hormonal method or IUD. We provide descriptive statistics of the percentage of current/recent users who report currently/ever experiencing specific side-effects, not experiencing but being concerned about experiencing specific side-effects, and both currently experiencing and being concerned about experiencing specific side-effects. All analyses are stratified by method type (implant, injectable, pill) to explore variation by method.

Results

Among current users, 648/2190 women (30%) reported experiencing any side-effect, while 252/644 (40%) of recent users reported ever experiencing any side-effect. Bleeding changes were reported most frequently and were higher among implant and injectable users. More recent users reported side-effects that were associated with physical discomfort, such as headaches, than current users. About one-third of current and recent users reported being concerned about at least one side-effect that they had not experienced, with about 15% of current and recent users reporting concerns about bleeding changes (307/2190 and 112/627, respectively) and concerns about physical discomfort (334/2019 and 98/627, respectively).

Conclusions

While bleeding changes are common, users report a range of side-effects related to physical discomfort underscoring the need for comprehensive counseling. We highlight challenges in measuring side-effects using quantitative tools and pose recommendations for future research and measurement efforts.

Implications

: Experiencing and fearing contraceptive-induced menstrual bleeding changes and physical discomfort, particularly headaches, is high among hormonal contraceptive and IUD users in Ethiopia. counseling that addresses an array of side-effects is needed. Additional research is also needed to disentangle the effect of experiencing versus fearing side-effects on contraceptive use.

我们的目的是评估当前和近期避孕药使用者所经历的特定副作用的发生率，描述使用者所关注的副作用模式，并分享测量经验教训。研究设计数据来自PMA埃塞俄比亚2019年全国代表性横断面调查。我们的分析样本包括目前(加权n = 2190;未加权n = 2020)或最近(过去24个月;加权n = 627;未加权n = 622)激素避孕法或宫内节育器使用者。我们提供了目前/最近报告正在/曾经经历过特定副作用的用户百分比的描述性统计数据，没有经历但担心经历特定副作用，以及目前经历和担心经历特定副作用的用户百分比。所有的分析都按方法类型(植入，注射，药丸)分层，以探索方法的变化。结果在当前服用者中，648/2190名妇女(30%)报告出现任何副作用，而最近服用者中有252/644名(40%)报告曾出现任何副作用。出血改变是最常见的，并且在植入和注射使用者中更高。与目前的使用者相比，最近的使用者报告了与头痛等身体不适相关的副作用。大约三分之一的当前和最近的使用者报告说，他们担心至少一种他们没有经历过的副作用，大约15%的当前和最近的使用者报告担心出血变化(分别为307/2190和112/627)，担心身体不适(分别为334/2019和98/627)。结论:虽然出血变化很常见，但使用者报告了一系列与身体不适相关的副作用，强调了全面咨询的必要性。我们强调了使用定量工具测量副作用的挑战，并对未来的研究和测量工作提出了建议。含义:在埃塞俄比亚，激素避孕药和宫内节育器使用者中，经历和担心避孕药引起的月经出血变化和身体不适，特别是头痛的比例很高。需要针对一系列副作用进行咨询。还需要进一步的研究来弄清经历和担心避孕药副作用对使用的影响。

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引用次数: 3

Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas 短效激素避孕药在德克萨斯州低收入产后妇女中的延续

Q2 Medicine

Contraception: X

Pub Date : 2021-01-01 DOI: 10.1016/j.conx.2020.100052

Kristen Lagasse Burke , Lauren Thaxton , Joseph E. Potter

Objective

The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas.

Study design

Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued.

Results

Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1–75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50–0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12–1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12–1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method.

Conclusions

Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable.

Implications

Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.

目的评估避孕药、贴片、避孕环或注射剂(即短效激素避孕药)的持续使用情况;与停药有关的特征;以及后续方法在德克萨斯州低收入产后妇女中的应用。研究设计:对1700名在德克萨斯州8家医院分娩的妇女进行了为期24个月的队列研究，这些妇女在分娩时没有保险或公共保险，我们重点研究了456名在分娩后6个月内使用短效激素避孕的妇女。我们根据特征和方法偏好对样本进行分类，并使用生命表和Cox模型估计停药率和相关预测因子。我们评估了停药的原因和停药后的避孕药使用情况。结果大约一半的人服用避孕药，一半的人服用注射剂。178人(39%)对他们使用的方法表示基线偏好，162人(36%)倾向于长效可逆避孕方法，41人(9%)倾向于绝育。1年后，72%的患者停药[95%可信区间(CI) 67.1-75.7]。在国外出生的西班牙裔妇女比在美国出生的西班牙裔妇女更不可能停止服用[调整风险比(aHR)， 0.65;95% ci 0.50-0.84]。那些想要更有效方法的人(aHR, 1.44;95% CI 1.12-1.85)和失去保险覆盖的患者(aHR, 1.47;95% CI 1.12-1.92)更有可能停止治疗。停药最常见的原因是副作用和可及性/费用。在停止治疗的患者中，243例(68%)改用效果较差的方法或没有方法。只有47人(13%)改用他们喜欢的方法。结论该人群短效激素避孕药停药率较高。许多人在停药后转而使用效果较差的方法，尽管他们更喜欢至少与避孕药、贴片、避孕环或注射剂一样有效的方法。在分娩后2年内扩大避孕覆盖范围应成为州和联邦政策的优先事项。在诊所，提供者应该讨论整个怀孕期间的避孕偏好和妊娠间隔。

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引用次数: 6