Contraception最新文献

{"title":"KNOWLEDGE OF MEDICATION ADMINISTRATION INSTRUCTIONS AMONG TRADITIONAL MEDICATION ABORTION PATIENTS","authors":"TX Chen,&nbsp;R Soon,&nbsp;M Tschann","doi":"10.1016/j.contraception.2024.110602","DOIUrl":"10.1016/j.contraception.2024.110602","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate patients’ immediate recall of medication abortion administration instructions.</div></div><div><h3>Methods</h3><div>This is a descriptive analysis of one cohort in a prospective non-inferiority study. We surveyed a convenience sample of medication abortion patients immediately after their appointment in Honolulu, HI between April 2023 and March 2024. Surveys assessed knowledge of medication abortion indications/contraindications, administration, and side effects/precautions, as well as their confidence in correctly completing the regimen. Incidentally, the clinic modified its written instructions for readability approximately halfway through recruitment; we compared outcomes before and after modification.</div></div><div><h3>Results</h3><div>We surveyed 100 patients. Mean age was 27.9 years (SD, 6.6). Thirty-two (32%) had undergone a medication abortion before. On average, patients correctly answered 79% (SD, 18%) of questions about medication abortion indications/contraindications, 97% (SD, 8.3%) of questions about medication regimen administration, and 93% (SD, 11%) of questions about side effects/precautions; the overall average number of correct answers for all questions was 90% (SD, 7.7%). Patients were completely or quite confident they could independently complete the process (n=95, 95%), teach a friend how to complete the process (n=86, 86%), recognize side effects (n=84, 84%), and seek emergency help when needed (n=95, 95%). Patient age, history of medication abortion, and the new medication abortion instructions were not associated with more accurate recall or higher confidence.</div></div><div><h3>Conclusions</h3><div>These findings may be a foundation for future studies that seek to compare the medication abortion knowledge and confidence of patients who pursue medication abortion outside of the clinic setting, such as advance provision or self-managed abortion, with that of traditional patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110602"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADOLESCENT DEMAND FOR MEDICATION ABORTION FROM AN ONLINE TELEMEDICINE SERVICE BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"DM Johnson,&nbsp;J Starling,&nbsp;R Gomperts","doi":"10.1016/j.contraception.2024.110563","DOIUrl":"10.1016/j.contraception.2024.110563","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to understand adolescent demand for medication abortion from an online telemedicine service, and to understand if demand varies due to state-level abortion bans and state-level parental involvement laws.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from an online telemedicine organization providing medication abortion in the US. We compared average weekly request rates by adolescent (under 18, 18-21) and adult (22+) age- groups and state policy environment pre and post the <em>Dobbs vs. JWHO</em> decision.</div></div><div><h3>Results</h3><div>From September 1, 2021 and October 31, 2023, 232,089 people in 50 states requested medications, and 6% of requestors were under 18, 24% were 18-21, and 70% were 22+. The average per-capita weekly request rate among ages 18-21 increased from 8.3 in the baseline period to 25.7 post-<em>Dobbs</em>, a 17.4 increase (15.6-19.2, p&lt;0.001); average requests among adults increased from 3.3 in the baseline period to 11.1, a 7.8 increase (7.1-8.4, p&lt;0.001). The most restrictive abortion law states saw the highest increase in post-<em>Dobbs</em> requests among adolescents (25.4, 20.7-30.0; p&lt;0.001), compared to smaller increases among adolescents in states without restrictions (8.3, 7.2-9.5; p&lt;0.001). Among adolescents under 18, requests in states with parental involvement laws were higher than in states without, both at baseline (1.1, 0.8-1.4; p&lt;0.001) and post-<em>Dobbs</em> (4.4, 3.7-5.1; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Demand for medications among adolescents increased post-<em>Dobbs</em> in similar patterns to adults, and requests among 18-21 were higher than other ages groups. This may be because of internet engagement or fewer financial resources for clinic-based care. Specialized support is needed to assist adolescents pursuing medication abortion via online telemedicine.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110563"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFICACY AND SAFETY OF THE ESTETROL/DROSPIRENONE ORAL CONTRACEPTIVE IN US STUDY PARTICIPANTS WITH AND WITHOUT OBESITY","authors":"AD Beasley,&nbsp;T Kimble,&nbsp;B Kaneshiro,&nbsp;R Maamari,&nbsp;JM Foidart,&nbsp;MD Creinin","doi":"10.1016/j.contraception.2024.110562","DOIUrl":"10.1016/j.contraception.2024.110562","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare contraceptive efficacy and safety of estetrol 15 mg/drospirenone 3 mg in US study participants with and without obesity.</div></div><div><h3>Methods</h3><div>We analyzed US population data from a phase 3 trial of estetrol/drospirenone use for up to 13 cycles. The study enrolled 1,864 healthy US and Canadian participants 16-50 years old with body mass index (BMI) 18-35 kg/m². We evaluated efficacy (Pearl Index, pregnancies/100-person-years) in participants 16-35 years and safety (adverse events [AEs]) in all participants, with obesity defined as BMI≥30 kg/m².</div></div><div><h3>Results</h3><div>We included 1,712 (91.8%) US participants; 1,531(89.4%) were 16-35 years. BMIs for 418 (24.4%) participants with obesity were 32.6±1.7 kg/m² overall and 32.6±1.8 kg/m² for 365 participants aged 16-35. For participants without obesity, BMIs were 23.9±3.2 kg/m2 and 23.8±3.3 kg/m², respectively. Pearl indices for participants with and without obesity were 3.04 (95% CI, 1.116.61) and 2.86 (95% CI, 1.754.42), respectively (p&gt;0.05). AEs were reported by 418 (56.0%) and 670 (51.8%) of participants with and without obesity (p=0.13). The most common AE that differed between groups was weight gain (5.3% vs 2.7%, respectively, p=0.02). Two serious AEs (1 per group) were considered study treatment related. Discontinuation for an AE occurred in 40(9.6%) and 116 (9.0%), respectively (p=0.7).</div></div><div><h3>Conclusions</h3><div>Contraceptive efficacy did not differ for US estetrol/drospirenone users with and without obesity. Although participants with obesity more frequently report weight gain, overall AE discontinuation rates did not differ. These results demonstrate a favorable efficacy and safety profile of estetrol/drospirenone users with obesity.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110562"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMPLICATIONS ASSOCIATED WITH MIFEPRISTONE USE FOR DILATION AND EVACUATION ABORTION PROCEDURES BETWEEN 22 AND 24 WEEKS’ GESTATION","authors":"MB Wergeles,&nbsp;P Lohr,&nbsp;R Scott,&nbsp;M Lewandowska,&nbsp;A Andreeva","doi":"10.1016/j.contraception.2024.110606","DOIUrl":"10.1016/j.contraception.2024.110606","url":null,"abstract":"<div><h3>Objectives</h3><div>Dilation and evacuation is the most common method of procedural abortion after 20 weeks’ gestation. Adequate cervical dilation is essential for safe dilation and evacuation. In 2017, the British Pregnancy Advisory Service (BPAS) added mifepristone to their regimen of osmotic dilators for cervical ripening before dilation and evacuation. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening.</div></div><div><h3>Methods</h3><div>BPAS provided data which included dilation and evacuation procedures that occurred between 22 weeks’ and 23 weeks and 6 days’ gestation, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone use, the association between mifepristone use and dilation and evacuation complications was established. Multivariate logistic regression was used to calculate the odds for complications with and without mifepristone use while controlling for potential confounders.</div></div><div><h3>Results</h3><div>There were 6,516 dilation and evacuation procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (OR: 2.40, 95% CI: 1.62, 3.54). They also had higher odds of bleeding (OR: 3.08, 95% CI: 1.12, 8.48). Odds for cervical injury (OR: 2.21, 95% CI: 0.84, 5.80) and infection (OR: 1.89, 95% CI: 0.46, 7.69) were not different between those who did and did not receive mifepristone.</div></div><div><h3>Conclusions</h3><div>The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of dilation and evacuation, without attenuating the risk of complications related to cervical dilation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110606"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BY ADOLESCENTS, FOR ADOLESCENTS: CO-CREATING ‘FIRST STEPS,’ A MESSAGING TOOLKIT TO IMPROVE ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH SERVICES AND EDUCATION","authors":"L Gerchow,&nbsp;Y Lanier,&nbsp;A Fayard,&nbsp;A Squires","doi":"10.1016/j.contraception.2024.110642","DOIUrl":"10.1016/j.contraception.2024.110642","url":null,"abstract":"<div><h3>Objectives</h3><div>Adolescents experience poor sexual and reproductive health outcomes, yet existing education and health services are insufficient. This study aims to improve adolescent sexual health knowledge and outcomes by co-creating service improvements with adolescent mothers based on their experiences from pre-pregnancy through parenting.</div></div><div><h3>Methods</h3><div>Using human-centered design, 16 adolescent mothers in New York City participated in 47 interviews to identify problems in adolescent sexual and reproductive health services and education. In two co-creation workshops, participants (n=10) designed solution prototypes, with a specific focus on improving contraceptive counseling. Healthcare stakeholders (n=10) informed prototype refinement.</div></div><div><h3>Results</h3><div>Participants highlighted deficiencies in sexual health education and emphasized the roles of healthcare providers and parents, rather than schools, in improving it. Adolescent participants designed messaging to support quality conversations between adolescents, parents, and providers and created a pre-appointment checklist to help young patients initiate conversations with providers. Young participants stressed that the toolkits address topics beyond STIs and pregnancy, like emotional health and relationships. They created guidelines for healthcare providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to respectfully support young parents. Healthcare stakeholders recommended adding information on confidential care and supporting LGBTQ youth and suggested dissemination techniques. Prototypes were revised based on feedback.</div></div><div><h3>Conclusions</h3><div>This study highlighted the important roles that parents and healthcare workers play in adolescent sexual health education. Co-created toolkits offer a practical approach for providers, adolescents, and parents to have adolescent-centered conversations that promote adolescent autonomy, safety, and well-being.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110642"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of evidence for expulsion rates of copper IUDs","authors":"Tanja Boehnke,&nbsp;Anja Bauerfeind,&nbsp;Lisa Eggebrecht,&nbsp;Camille Cellier,&nbsp;Jens A. Lange,&nbsp;Klaas Heinemann,&nbsp;Tessa Madden","doi":"10.1016/j.contraception.2024.110707","DOIUrl":"10.1016/j.contraception.2024.110707","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"140 ","pages":"Article 110707"},"PeriodicalIF":2.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society of Family Planning Clinical Recommendation: Induction of fetal asystole before abortion Jointly developed with the Society for Maternal-Fetal Medicine","authors":"Justin Diedrich, Caroline N. Goldfarb, Shandhini Raidoo, Eleanor Drey, Matthew F. Reeves, with the assistance of Jessica Atrio Vinita Goyal and Sarah Prager on behalf of the Clinical Affiars Committee and Lorie Harper on behalf of the Society for Maternal-Fetal Medicine","doi":"10.1016/j.contraception.2024.110551","DOIUrl":"https://doi.org/10.1016/j.contraception.2024.110551","url":null,"abstract":"This document serves as a revision to the Society of Family Planning's 2010 guidelines, integrating literature on new techniques and research and addressing the clinical, medical, and sociolegal questions surrounding the induction of fetal asystole. Insufficient evidence exists to recommend routine induction of fetal asystole before previable medication and procedural abortion. However, at periviable gestations and after fetal viability, inducing fetal asystole before abortion prevents the infrequent but serious occurrence of unanticipated expulsion of a fetus with cardiorespiratory activity (Best Practice). Defining viability is complicated as it represents a physiological continuum impacted by gestational duration along with multiple other individual clinical factors and circumstances; therefore, the exact gestational duration to offer fetal asystole will depend on the setting and clinical circumstances. If induction of fetal asystole before abortion is available, we recommend engaging in patient-centered counseling regarding the risks and benefits of induction of fetal asystole in the setting of each unique pregnancy scenario and the patient's beliefs and priorities (Best Practice). We recommend that clinicians identify the optimal pharmacologic agent to administer for a given clinical scenario based on factors such as availability of each agent; the time frame in which fetal asystole needs to be established; and clinicians' technical ability, preferences, and practice (Best Practice). Potassium chloride, lidocaine, and digoxin are all acceptable pharmaceutical agents to induce fetal asystole before abortion. To establish asystole rapidly, we suggest the use of potassium chloride (via intracardiac or intrafunic injection) or lidocaine (via intracardiac or intrafunic injection) (GRADE 2C), although intrathoracic administration of lidocaine may be acceptable. We recommend potassium chloride not be used if intracardiac or intrafunic location cannot be achieved to avoid the risk of accidental administration to the pregnant individual and because insufficient data support its efficacy via other intrafetal locations (GRADE 1C). When using digoxin, we recommend intrafetal administration (GRADE 1C), although intraamniotic administration may be acceptable depending on a clinician's technical ability and setting. Because digoxin may take several hours to induce asystole, an alternative agent should be considered in settings where fetal asystole must be confirmed rapidly.","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"10 1","pages":"110551"},"PeriodicalIF":2.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Dr. Winter's letter","authors":"Yan Che","doi":"10.1016/j.contraception.2024.110698","DOIUrl":"10.1016/j.contraception.2024.110698","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"140 ","pages":"Article 110698"},"PeriodicalIF":2.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(24)00384-6","DOIUrl":"10.1016/S0010-7824(24)00384-6","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"138 ","pages":"Article 110685"},"PeriodicalIF":2.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0010782424003846/pdfft?md5=ff20936e536f0a43f31b8986b232e13c&pid=1-s2.0-S0010782424003846-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GeneFlex—A Chinese generic intrauterine device not to be confused with GyneFix","authors":"Maarten De Winter","doi":"10.1016/j.contraception.2024.110693","DOIUrl":"10.1016/j.contraception.2024.110693","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"140 ","pages":"Article 110693"},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}