Journal of Family Planning and Reproductive Health Care最新文献

Background: Although within Latin America Chile has one of the lowest birth rates among adolescents, it has a high rate in comparison to other developed nations.

Aim: To explore trends in birth rates among adolescents by selected demographics in Chile.

Methods: The national trend in birth rates was examined for women aged 15-19 years between 1992 and 2012. The birth rates for regions and communes were calculated using birth and census data and were analysed to determine its relationship to the regional or communal poverty rate, which were obtained from the Casen Survey. Differences in educational attainment were explored among adolescents with first-order and second-order or higher births using the Chi-square test.

Results: The birth rate among adolescents has experienced a 25% decline in the past 20 years. Cross-regional variance in birth rates could not be explained by poverty rates. Within the Metropolitan Region, there is a positive correlation between poverty and adolescent birth rates. Among adolescents giving birth, 67% had completed 10-12 years of school at birth, but there is a significant difference in educational attainment between girls with a first-order and those with a higher-order birth.

Conclusions: In Chile, the adolescent birth rate varies greatly among regions and communes. This study found that urban and wealthy areas had lower birth rates than poor and rural ones, and that girls with a first-order birth had completed more years of school than girls with higher-order births.

Introduction: Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception - known as 'quick starting'. However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects.

Method: A systematic review was conducted, evaluating quick starting HC after oral EC [levonorgestrel 1.5 mg (LNG) or ulipristal acetate 30 mg (UPA)]. PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis.

Results: Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR 1.27; 95% CI 0.51-3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR 0.76; 95% CI 0.27-2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR 0.04; 95% CI 0.01-0.37). Side effects (OR 1.22; 95% CI 0.48-3.12) and unscheduled bleeding (OR 0.53; 95% CI 0.16-1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at 8 weeks among women quick starting POP after LNG, compared with women given LNG alone (OR 6.73; 95% CI 2.14-21.20).

Aim: To design and evaluate a pilot service for primary care endometrial sampling (PCES).

Design: Retrospective analysis of data from two service evaluations.

Setting: General practices and the gynaecology department in a large city in the UK.

Methods: These were two-fold: (1) To design the new service we identified all the endometrial samples taken in the city's gynaecology department in 2012/2013 and estimated the proportion of these with abnormal uterine bleeding (AUB) that would be suitable for PCES. (2) To evaluate the new PCES service we analysed data from the first year of activity.

Results: (1) A total of 1894 endometrial samples were taken in hospital in 2012/2013. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. (2) In the first year of the PCES service 108 samples were taken by general practitioners (GPs). Initial management of these patients was exclusively in primary care in 97.2% (104/108) of cases; most patients were treated with the Mirena intrauterine system (79/109; 73.1%) and there were no cases of hyperplasia or cancer.

Conclusions: Most premenopausal patients with AUB could potentially be managed in primary care without referral to hospital if endometrial sampling (ES) was made available to appropriately trained and supported GPs. However, this study was limited by its retrospective, non-interventional design, and more research is required to demonstrate safety and cost-effectiveness.

Aim: To assess the incidence of visible strings of intrauterine contraceptive devices (IUDs) after postplacental insertion following vaginal or caesarean delivery and to establish a management protocol of follow-up visits when strings are not visualised.

Methods: This was a prospective study of a cohort of 348 women who underwent postplacental insertion of Copper-T 380A IUDs following vaginal or caesarean delivery, conducted at a hospital in New Delhi, India. Women were followed up at 6 weeks, 3, 6 and 12 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualise the IUD strings. All women whose IUD strings could not be visualised at the cervical os at any given follow-up were identified. We analysed the cumulative incidence of visible strings and of procedures performed to locate the IUD when strings were not visible.

Results: At 1 year follow-up, the IUD was in situ in 313/348 (89.9%) women. There were eight (2.3%) expulsions and 15 (4.3%) IUD removals. Among women with IUDs in situ, the strings were not visible in 73 (21%) cases. Pelvic ultrasound confirmed intrauterine position of the IUDs in these cases. At 1 year, string visibility was significantly lower after intra-caesarean insertions as compared to vaginal insertions (72.4% vs 98.1%; p<0.05).

Conclusions: Visualisation of strings after postplacental vaginal insertion is more common than after intra-caesarean insertion. Pelvic ultrasonography can be used to verify the presence of the device in cases of missing strings.