Pub Date : 2022-01-01Epub Date: 2022-04-08DOI: 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.
{"title":"DMPA-SC stock: Cross-site trends by facility type","authors":"Sophia Magalona , Shannon N. Wood , Frederick Makumbi , Funmilola M. OlaOlorun , Elizabeth Omoluabi , Akilimali Z. Pierre , Georges Guiella , Jane Cover , Philip Anglewicz","doi":"10.1016/j.conx.2022.100075","DOIUrl":"10.1016/j.conx.2022.100075","url":null,"abstract":"<div><h3>Objectives</h3><p>To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods.</p></div><div><h3>Study design</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151622000041/pdfft?md5=2b656ca268c0da1d394d1163166730ef&pid=1-s2.0-S2590151622000041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49395685","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}
Pub Date : 2022-01-01Epub Date: 2022-10-28DOI: 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.
{"title":"Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities","authors":"Hayley V. McMahon , Celia Karp , Suzanne O. Bell , Solomon Shiferaw , Assefa Seme , Mahari Yihdego , Linnea A. Zimmerman","doi":"10.1016/j.conx.2022.100087","DOIUrl":"10.1016/j.conx.2022.100087","url":null,"abstract":"<div><h3>Objectives</h3><p>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.</p></div><div><h3>Study design</h3><p>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.</p></div><div><h3>Analysis</h3><p>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.</p></div><div><h3>Results</h3><p>Altogether, 69.1% (<em>n</em> = 94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (<em>n</em> = 131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; <em>n</em> = 114) and uterine evacuation among health centers (84.6%; <em>n</em> = 170).</p></div><div><h3>Conclusion</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40495980","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}
Pub Date : 2022-01-01Epub Date: 2022-09-17DOI: 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。
{"title":"Pregnancy coercion and partner knowledge of contraceptive use among Ethiopian women","authors":"Jessica L. Dozier , Linnea A. Zimmerman , Bedilu A. Ejigu , Solomon Shiferaw , Assefa Seme , Mahari Yihdego , Robel Yirgu , Shannon N. Wood","doi":"10.1016/j.conx.2022.100084","DOIUrl":"10.1016/j.conx.2022.100084","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the relationship between pregnancy coercion and partner knowledge of contraceptive use.</p></div><div><h3>Study design</h3><p>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 (<em>n</em> = 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).</p></div><div><h3>Results</h3><p>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%<sub>none</sub>, 14%<sub>less severe</sub>, 31%<sub>more severe</sub>), as did the proportion of overt users who delayed couple contraceptive discussions, (14%<sub>none</sub>, 23%<sub>less severe</sub>, 26% <sub>more severe</sub>); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%<sub>none</sub>, 60%<sub>less severe</sub>, 40%<sub>more severe</sub>). 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).</p></div><div><h3>Conclusion</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486377","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}
Pub Date : 2022-01-01Epub Date: 2022-07-31DOI: 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 2nd 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}
Pub Date : 2022-01-01Epub Date: 2022-07-25DOI: 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。
{"title":"Return to ovulation after Sayana Press is injected every 4 months for one year: Empirical and pharmacokinetic/pharmacodynamic modeling results","authors":"Douglas J. Taylor , Jennifer Deese , Luis Bahamondes , Vivian Brache , Nelio Veiga Jr , Rachael Fuchs , Vera Halpern , Laneta J. Dorflinger","doi":"10.1016/j.conx.2022.100080","DOIUrl":"10.1016/j.conx.2022.100080","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Study design</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/1d/main.PMC9372597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40697332","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}
Pub Date : 2022-01-01Epub Date: 2022-03-19DOI: 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.
{"title":"Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia","authors":"Linnea A. Zimmerman , Dana O. Sarnak , Celia Karp , Shannon N. Wood , Mahari Yihdego , Solomon Shiferaw , Assefa Seme","doi":"10.1016/j.conx.2022.100074","DOIUrl":"10.1016/j.conx.2022.100074","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Study design</h3><p>Data come from the PMA Ethiopia 2019 nationally-representative, cross-sectional survey. Our analytic sample included women who were current (weighted <em>n</em> = 2190; unweighted <em>n</em> = 2020) or recent (past 24 months; weighted <em>n</em> = 627; unweighted <em>n</em> = 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.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Implications</h3><p>: 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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259015162200003X/pdfft?md5=a1575c2b208f96e47e59793cc006ec18&pid=1-s2.0-S259015162200003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47704154","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}
Pub Date : 2021-01-01Epub Date: 2021-07-30DOI: 10.1016/j.conx.2021.100069
Lauren Thaxton , Elizabeth Clark , Jocelyn Aubrey Wu , Alexandra Herman , Andrew L. Sussman , Eve Espey
Objective
In 2017, New Mexico approved an amendment allowing pharmacists to prescribe and dispense hormonal contraception. We interviewed rural New Mexico women to determine their perceptions of pharmacy access to hormonal contraception.
Study design
We conducted semi-structured telephone interviews with women recruited from rural New Mexico communities. The interview guide explained the amendment followed by questions about the advantages and disadvantages of pharmacy access to hormonal contraception within rural communities.
Results
Between November 2017 and May 2018, we recruited 32 women to participate. Participants were young (26/32 18–29 years old), gravid (27/31), employed (30/32), white (22/32) and Hispanic (26/31). The majority used Medicaid as their primary insurance (16/28). Most participants were supportive of pharmacy access to hormonal contraception. Participants saw their rural communities as facing health care barriers, some of which could be alleviated by pharmacy access. Perceived benefits of pharmacy access included convenience of pharmacy hours, shorter wait times, and no need for an appointment. Participants expressed concerns about lack of privacy in their pharmacies. Many expressed trust in their pharmacist to review side effects and explain usage of contraception- a role that was considered separate from that of a primary care provider who offers regular medical visits for routine screening and nuanced or complex discussions about contraception. Some participants expressed that pharmacy access could be especially beneficial for teens.
Conclusions
Rural New Mexico women were supportive of pharmacy access to contraception and accept pharmacists as trusted members of the health care team.
Implications
Rural New Mexico women find benefit in pharmacy access to hormonal contraception, citing improved access to contraceptives in their communities.
{"title":"Perspectives on pharmacy access to hormonal contraception among rural New Mexico women","authors":"Lauren Thaxton , Elizabeth Clark , Jocelyn Aubrey Wu , Alexandra Herman , Andrew L. Sussman , Eve Espey","doi":"10.1016/j.conx.2021.100069","DOIUrl":"10.1016/j.conx.2021.100069","url":null,"abstract":"<div><h3>Objective</h3><p>In 2017, New Mexico approved an amendment allowing pharmacists to prescribe and dispense hormonal contraception. We interviewed rural New Mexico women to determine their perceptions of pharmacy access to hormonal contraception.</p></div><div><h3>Study design</h3><p>We conducted semi-structured telephone interviews with women recruited from rural New Mexico communities. The interview guide explained the amendment followed by questions about the advantages and disadvantages of pharmacy access to hormonal contraception within rural communities.</p></div><div><h3>Results</h3><p>Between November 2017 and May 2018, we recruited 32 women to participate. Participants were young (26/32 18–29 years old), gravid (27/31), employed (30/32), white (22/32) and Hispanic (26/31). The majority used Medicaid as their primary insurance (16/28). Most participants were supportive of pharmacy access to hormonal contraception. Participants saw their rural communities as facing health care barriers, some of which could be alleviated by pharmacy access. Perceived benefits of pharmacy access included convenience of pharmacy hours, shorter wait times, and no need for an appointment. Participants expressed concerns about lack of privacy in their pharmacies. Many expressed trust in their pharmacist to review side effects and explain usage of contraception- a role that was considered separate from that of a primary care provider who offers regular medical visits for routine screening and nuanced or complex discussions about contraception. Some participants expressed that pharmacy access could be especially beneficial for teens.</p></div><div><h3>Conclusions</h3><p>Rural New Mexico women were supportive of pharmacy access to contraception and accept pharmacists as trusted members of the health care team.</p></div><div><h3>Implications</h3><p>Rural New Mexico women find benefit in pharmacy access to hormonal contraception, citing improved access to contraceptives in their communities.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39344100","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}
Pub Date : 2021-01-01Epub Date: 2020-12-28DOI: 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。
{"title":"Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas","authors":"Kristen Lagasse Burke , Lauren Thaxton , Joseph E. Potter","doi":"10.1016/j.conx.2020.100052","DOIUrl":"10.1016/j.conx.2020.100052","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Study design</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38861064","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}
Pub Date : 2021-01-01Epub Date: 2021-01-07DOI: 10.1016/j.conx.2020.100053
Jessica K. Lee , Anne E. Burke , Katrina Thaler , Jennifer A. Robinson , Carolyn Sufrin
Objective
Assess oral sedation versus placebo for pain control with cervical dilator placement.
Study design
We randomized participants presenting for dilation and evacuation to lorazepam 1 mg/oxycodone 5 mg or placebo 45 min before cervical dilator placement. Our primary outcome was median visual analog scale (VAS) pain score after dilator placement using a 100-mm VAS. We used our outcome data to calculate median pain score changes from baseline to better reflect pain score differences between study groups. Planned sample size was 30 participants per group, for a total of 60.
Results
We randomized 27 participants; 9 received sedation and 11 placebo. Median pain score increase from baseline to last dilator placement was 20 [interquartile range (IQR) 8–29] and 31 (IQR 15–81) in the oral sedation and placebo groups, p = .16.
Conclusion
We were unable to enroll our desired sample size, and our sample is underpowered to make any conclusions. Our results suggest that oral sedation may provide some benefit for pain relief with dilator insertion and indicate that further research might be worthwhile especially in settings that do not routinely provide these analgesics.
Implications
We had difficulty with study recruitment because many patients desired oral sedation for pain management for cervical dilator placement and declined randomization. Randomized trials of pain management with a placebo arm may find recruitment challenging especially if default clinical care already includes a pain management option that patients would have to opt out of.
目的评估口服镇静与安慰剂在宫颈扩张器置入后疼痛控制中的作用。研究设计:在宫颈扩张器放置前，我们随机分组接受劳拉西泮1 mg/羟考酮5 mg或安慰剂45 min的扩张和疏散治疗。我们的主要结局是使用100毫米视觉模拟评分(VAS)测量扩张器放置后的中位疼痛评分。我们使用结果数据计算疼痛评分中位数从基线的变化，以更好地反映研究组之间疼痛评分的差异。计划样本量为每组30人，总共60人。结果随机选取27例受试者;镇静组9例，安慰剂组11例。口服镇静组和安慰剂组从基线到最后一次扩张器放置的疼痛评分中位数增加为20[四分位数间距(IQR) 8-29]和31 (IQR 15-81)， p = .16。我们无法招募到我们想要的样本量，而且我们的样本量不足以得出任何结论。我们的研究结果表明口服镇静可能对置入扩张器的疼痛缓解有一定的好处，并表明进一步的研究可能是值得的，特别是在没有常规提供这些镇痛药的环境中。我们在招募研究时遇到困难，因为许多患者在放置宫颈扩张器时需要口服镇静来缓解疼痛，因此拒绝随机分组。用安慰剂组进行疼痛管理的随机试验可能会发现招募具有挑战性，特别是如果默认的临床护理已经包括患者必须选择退出的疼痛管理选项。
{"title":"Oral sedation for pain with cervical dilator placement: a randomized controlled trial","authors":"Jessica K. Lee , Anne E. Burke , Katrina Thaler , Jennifer A. Robinson , Carolyn Sufrin","doi":"10.1016/j.conx.2020.100053","DOIUrl":"10.1016/j.conx.2020.100053","url":null,"abstract":"<div><h3>Objective</h3><p>Assess oral sedation versus placebo for pain control with cervical dilator placement.</p></div><div><h3>Study design</h3><p>We randomized participants presenting for dilation and evacuation to lorazepam 1 mg/oxycodone 5 mg or placebo 45 min before cervical dilator placement. Our primary outcome was median visual analog scale (VAS) pain score after dilator placement using a 100-mm VAS. We used our outcome data to calculate median pain score changes from baseline to better reflect pain score differences between study groups. Planned sample size was 30 participants per group, for a total of 60.</p></div><div><h3>Results</h3><p>We randomized 27 participants; 9 received sedation and 11 placebo. Median pain score increase from baseline to last dilator placement was 20 [interquartile range (IQR) 8–29] and 31 (IQR 15–81) in the oral sedation and placebo groups, p = .16.</p></div><div><h3>Conclusion</h3><p>We were unable to enroll our desired sample size, and our sample is underpowered to make any conclusions. Our results suggest that oral sedation may provide some benefit for pain relief with dilator insertion and indicate that further research might be worthwhile especially in settings that do not routinely provide these analgesics.</p></div><div><h3>Implications</h3><p>We had difficulty with study recruitment because many patients desired oral sedation for pain management for cervical dilator placement and declined randomization. Randomized trials of pain management with a placebo arm may find recruitment challenging especially if default clinical care already includes a pain management option that patients would have to opt out of.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38869164","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}
Pub Date : 2021-01-01Epub Date: 2021-05-10DOI: 10.1016/j.conx.2021.100065
Rubina Hussain, Megan L. Kavanaugh
Objectives
To describe changes in use and receipt of emergency contraceptive (EC) pills among women in the United States during a period of key EC policy changes, from 2008 to 2015.
Study design
Using data from the 2006 to 2010 and 2013 to 2017 National Surveys of Family Growth, we present changes in the percent of women who ever used EC between 2008 and 2015 by select sociodemographic and sexual and reproductive health characteristics, and we examine multivariable relationships of these characteristics with EC ever use in 2015. We also examine changes in repeat EC use, receipt of EC counseling, reasons for EC use and source of EC between the time periods.
Results
Among sexually experienced women ages 15 to 44, EC ever use increased from 11% in 2008 to 23% in 2015 overall and among nearly all groups of women. In 2015, age 20 to 29, non-Hispanic other or Hispanic race, at least a high school education, working part-time, income at least 100% of the federal poverty level, ever having been married, and having received EC counseling in the prior year all represent characteristics associated with higher odds of having ever used EC. In 2015, a smaller share of women last obtained EC with a prescription or at a health facility than in 2008.
Conclusions
Increases in EC use occurred as access to EC was broadened through regulatory changes that moved some forms of EC from behind-the-counter to fully over-the-counter between 2008 and 2015.
Implications
Over-the-counter provision of many forms of EC pills may have increased access and introduced more flexibility in how EC is obtained, but these changes may have come with tradeoffs, both in the form of cost barriers and decreased opportunities for clinicians to discuss EC with their patients. Despite improved access to contraception more broadly through the Affordable Care Act, EC remains a necessary component of the overall contraceptive method mix, and clinicians can play a key role in discussing EC as one option among many during contraceptive counseling sessions.
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