European Journal of Contraception and Reproductive Health Care最新文献

Introduction: The historical evolution of abortion laws in the United States reflects significant shifts in societal attitudes and legal frameworks, particularly concerning reproductive rights and maternal consent. Prior to Roe v. Wade, abortion was largely criminalised, but gradual changes in public opinion and legislation paved the way for liberalised abortion laws.

Objective: This study aims to examine the legal and societal developments shaping abortion laws in the United States from the early 19th century to the pre-Roe era, focusing on the interplay between public opinion and legislative milestones.

Methods: A historical-legal methodology was employed, analysing primary sources such as court rulings and statutes, alongside secondary literature. The research explores the evolving legal definitions of foetal personhood and maternal autonomy, contextualised within broader societal changes.

Results: The findings reveal a transformation in perceptions of abortion, from being viewed as a criminal act to a recognised right influenced by medical, social, and political factors. Legal frameworks increasingly reflected public support for women's autonomy, culminating in the Roe v. Wade decision.

Conclusions: This study provides historical context for contemporary abortion debates, highlighting how pre-Roe legal and societal changes continue to inform discussions on women's health, autonomy, and reproductive rights.

Objective: To compare patient acceptability of inducing foetal demise procedures between intracardiac lidocaine and intra-amniotic digoxin administration prior to second trimester medical abortion.

Methods: We enrolled a prospective cohort of women who received either intra-cardiac lidocaine or intra-amniotic digoxin during second trimester medical abortion at later gestation (20-28 weeks) at our centre between April 2023 and March 2024. Data were collected prospectively using a structured questionnaire. For data analysis, Chi-squared test and Fisher's exact test were performed as appropriate. P-value less than 0.05 was used to present results significance.

Results: A total of 151 women (101 who had intra-amniotic digoxin injection and 50 women who had foetal intracardiac lidocaine injection) were analysed. The groups had similar mean gestational age (22.42 weeks vs 22.65 weeks, in the digoxin vs lidocaine groups respectively, p-value = 0.50). More women from the digoxin group described the pain associated with foeticide administration as 'as expected' than in the intra-cardiac lidocaine group (48% vs 30%, p-value = 0.005). Similarly, more women in the digoxin group described their overall experience of foeticide administration as 'not bad' compared to those who received intra-cardiac lidocaine (59.4% vs 32%, p-value = 0.006). Likewise, more women in the digoxin group stated they would recommend the same procedure for friends or family members should they face the same problem than in the lidocaine group (43% vs 14%, p-value = 0.001).

Conclusions: Our study shows that intra-amniotic digoxin has superior patient acceptability than intracardiac lidocaine by women undergoing safe second trimester medical abortion at later gestion.

Purpose: Multiple sclerosis (MS) is often diagnosed in people of reproductive age. However, family planning counselling is not always integrated within MS care. Decisions on family planning can be further complicated by potential side effects associated with several disease-modifying therapies. While neurologists may lack training in contraceptive use and family planning counselling, obstetricians and gynaecologists (OB-GYNs) and other health care professionals involved in reproductive life planning (RHCPs) may lack detailed knowledge and experience around the use of contemporary MS treatments.

Material and methods: Through a modified Delphi consensus programme, a multidisciplinary steering committee of 13 international experts developed practical clinical recommendations on contraceptive use and family planning for people with MS (PwMS). This article offers insights to help OB-GYNs and RHCPs implement these recommendations, focusing on contraceptive decision-making and MS medications.

Results: The perspectives discussed emphasise providing education on MS to OB-GYNs and other RHCPs, enabling informed counselling for PwMS and their partners regarding contraception and family planning. Close collaboration among the multidisciplinary team, including neurologists, is crucial in providing reproductive care for PwMS.

Conclusions: The detailed perspectives provided aim to enable OB-GYNs and other RHCPs to provide informed counselling for PwMS and their partners regarding contraception and family planning.

Purpose: The aim of this retrospective cohort study was to investigate the effects of hysteroscopic uterine septum resection on the clinical pregnancy rate (CPR), live birth rate (LBR) and miscarriage rate.

Materials and method(s): Hospital records of consecutive patients who underwent hysteroscopic uterine septum resection between February 2021 and December 2022 were reviewed. They were telephoned and interviewed about their reproductive performance after surgery, and pregnancy outcomes, if achieved.

Results and conclusions: Sixty-nine eligible patients were enrolled. Forty-one (59.4%) of these patients were referred to our clinic for otherwise unexplained infertility of at least 1 year and 28 (40.6%) for pregnancy loss. During the follow-up period, 32 patients conceived. The overall CPR was 46.4%, the LBR per woman was 36.2%, the LBR per pregnancy was 78.1% and the miscarriage rate was 12.5%. The LBRs per pregnancy were 83.3% and 71.4% in the infertility and miscarriage subgroups, respectively. The miscarriage rates per pregnancy were 0% and 28.6% in the infertility and miscarriage subgroups, respectively. Three of 6 patients whose uterine septum was incomplete but prominent became pregnant (CPR: 50.0%), and all pregnancies resulted in live birth (LBR per pregnancy:100%, LBR per woman:50%). Two patients with complete uterine septum didn't achieve pregnancy. Hysteroscopic uterine septum resection may improve the CPR, LBR and miscarriage rates in subfertile population with and without previous pregnancy loss.

Objective: To analyse the understanding of deaf women regarding contraceptive methods.

Method: We conducted a qualitative descriptive study in two referral centres for sexual and reproductive health (SRH) in São Paulo, Brazil, trough years 2020-2022. Twenty-eight deaf women who use Brazilian Sign Language (LIBRAS) were interviewed face-to-face and remotely via videocall using a semi-structured questionnaire containing sociodemographic and clinical data and questions about understanding and knowledge of contraceptive methods. We performed a content analysis through transcription, interpretation, and validation of the LIBRAS translation with the assistance of NVivo software.

Results: Communication barrier (28/28) was the primary factor associated with low knowledge about contraceptive methods. Regarding barrier methods, 20 (71%) participants reported be familiar with condoms, 13 (46%) with diaphragms, 20 (71%) about oral contraceptives, and 17 (60%) about injectable methods. Concerning long-acting reversible contraceptives (LARCs), 16 (57%) were aware about intrauterine devices and 7 (25%) with subdermal implants. Fifteen (53%) of participants were aware about female and male permanent contraception. Unplanned pregnancy rate was 59% and use of fertility awareness methods was reported by 6 (21%), barrier methods 5 (17%), short-acting methods 6 (21%), LARC 2 (7%) and permanent contraception among 4 (14%).

Conclusion: In our sample of deaf women, condoms and oral contraceptives were identified more often and were more in use. All interviewed deaf women cited communication as a barrier to accessing information about contraceptive methods, highlighting the low knowledge and use of LARC.

Objective: To determine practice patterns in the diagnosis and management of nongestational abnormal uterine bleeding (AUB) in women in reproductive years during the SARS-CoV-2 (COVID-19) pandemic in Brazil.

Materials and methods: A web-based survey was conducted to determine the impact of the COVID-19 pandemic on the diagnosis and management of women with AUB. Survey elements included treatment location, the use of ultrasonography, laboratory evaluation for iron deficiency and some hormone determinations, and endometrial evaluation by histopathology, as well as the practice of hysteroscopy, hysterectomy and medical therapy including the placement of the 52 mg levonorgestrel-intrauterine system (LNG-IUS₅₂). The survey was completed electronically at scientific meetings or sent by e-mail to Brazil-based OBGYNs between April and September 2021 during the COVID-19 quarantine.

Results: Fully completed questionnaires were received from 541 physicians aged (mean ± SD) 46.6 ± 12.5 years. Whereas the overall number of AUB-related visits decreased (p < 0.001) compared to the pre-pandemic period, the reduction was in office-based encounters; AUB-related visits at emergency facilities did not change. Telehealth-based AUB consultations increased from 1.3% at pre-pandemic to 34.3% (p < 0.001) during the pandemic. There were significant reductions in the use of diagnostic hysteroscopy (p < 0.001), endometrial biopsy (p < 0.001), therapies with the LNG-IUS₅₂, combined oral contraceptives and hysterectomies (p = 0.002, p = 0.006 and p < 0.001, respectively).

Conclusions: In Brazil, during the COVID-19 pandemic, there was a decrease in AUB-related consultations, a slight increase in telehealth visits and a reduction in the use of procedures and treatments.

Purpose: Spousal authorisation for abortion (SA) is in direct conflict with the right to bodily autonomy. The World Health Organisation guideline on abortion specifically recommends that abortion should be available on request without third-party authorisation. The objectives of this study were to: a) determine which countries insist by law on SA, b) describe shared characteristics of these countries, c) assess the impact of such legislation on access to abortion and d) evaluate the chances of repeal of such laws.

Methods: Interrogation of known databases on global abortion laws. Grouping of countries with SA laws according to their characteristics. A literature review of material on how mandatory SA relates to reproductive rights.

Results: Fifteen countries were found to require SA. Nine of these countries have low freedom and democracy scores. Three South Eastern Asian countries, Japan, South Korea and Taiwan, have high freedom and democracy scores and no dominant religion. Broader studies on third-party authorisation for abortion show delayed access to abortion and emphasise the general principle that it is the healthcare seeker alone whose consent should be required for a health intervention. A qualitative study from Türkiye showed specifically how SA requirements could impair access to abortion.

Conclusions: Twelve of the countries do not appear to have the necessary government or societal conditions necessary for abortion law modernisation in the near future. In contrast, Japan, South Korea and Taiwan are prime candidates for immediate liberalisation of their abortion laws.

The use of long-acting reversible contraceptives (LARCs) is increasing globally due to their higher ability to effectively prevent unintended pregnancies in comparison to short-acting reversible contraceptives (SARCs), especially in adolescence. LARCs include intrauterine devices (copper- or levonorgestrel-releasing) and subcutaneous implants. For LARCs application a dedicated training is needed. Particularly, this Expert Opinion is aiming to open to expert debates on the subcutaneous implant, in particular etonogestrel (ENG)-releasing one, as a cutting-edge form of hormonal contraception. It provides up-to-date guidance about practical advice and technical tips for the ENG implant insertion/removal derived from many years of clinical experience, along with recommendations for the management of unscheduled bleeding during contraception with this method.

Objectives: To evaluate improvements in laboratory markers of anaemia (haemoglobin, haematocrit, serum iron, and ferritin) in women with subjective heavy menstrual bleeding (HMB) treated with the levonorgestrel 19.5-mg intrauterine device.

Materials and methods: We conducted a pilot study at the Department of Obstetrics and Gynaecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil. We compared anaemia markers in 73 women aged 18-48 years suffering from HMB, one year after placement of the IUD.

Results: The mean age of participants was 30.0 years (range 24-38); more than half were white, and the mean body mass index (kg/m²) was 27.0. Twenty (27.4%) participants exited the study due to loss to follow-up (n = 12; 16.4%), expulsion (n = 7; 9.6%) and uterine perforation (n = 1; 1.4%). One-year post-IUD placement, amenorrhoea was reported by 10 (13.7%) women. According to intention-to-treat and per protocol analyses, the proportion of women with normal haemoglobin levels significantly improved (p = 0.014 in both analyses), as did haematocrit (p < 0.001 in both analyses) and serum iron (p = 0.003 in both analyses) compared to baseline evaluations. The proportion of women with normal ferritin levels also improved (p < 0.001) in both analyses using a cut-off of 15 ng/ml, though no significant difference was observed using a 30 ng/ml cut-off (p = 0.083 in both analyses).

Conclusion: The levonorgestrel 19.5-mg IUD effectively improved laboratory markers of anaemia one year after placement in women with HMB.