European Journal of Contraception and Reproductive Health Care最新文献

Purpose: The use of vasectomy varies hugely depending on the countries, even though it is one of the safest and simplest male contraceptive method. In France, its use recently increased. The purpose of this study was to report the characteristics, motivations, decision-making process and experience of French men undergoing vasectomy.

Materials and methods: This cross-sectional multicentric study was conducted in 17 French andrology laboratories in 2021-2022. All patients referred for post vasectomy semen analysis were proposed to participate in an online anonymous survey about vasectomy.

Results: A total of 541 men were included in the study (56% participation rate). Participants were 41 years old on average and were mostly engaged in a stable relationship. Most of respondents had at least one child and waited >5 years after last birth before vasectomy A total of 134 men (25%) reported a history of unintended pregnancy. Most heard about vasectomy from relatives or media, rarely from doctors or authorities. Although most participants reported concerns about side effects, 81% experienced no side effects in the end of the procedure. The strong support of a partner (76%) appears to be a significant factor in the acceptance of this contraceptive method. A minority of participants had undergone semen cryopreservation before vasectomy.

Conclusion: This study contributes to the literature on male contraception, and highlights the history, motivations, experience, but also fears of men undergoing vasectomy.

The exercise of so-called 'conscientious objection' in reproductive healthcare is unchecked and subject to widespread abuse. A growing body of evidence shows that the practice creates significant harms for patients needing abortions by delaying their care or depriving them of care, sometimes even costing their lives. We have coined the more accurate term 'belief-based care denial' as the phrase 'conscientious objection' was inappropriately co-opted from military conscientious objection, with which it has nothing in common. In this article, we note the evidence against belief-based care denial, refute fallacies in the views that support the practice, and recommend measures to reduce the number of care deniers over time, with the prospect of an eventual return to the ethical standard that obligates healthcare professionals to provide medical care.

Purpose: To evaluate outcomes by gestational duration in patients who did and did not receive depomedroxyprogesterone acetate (DMPA) concurrently with mifepristone for mifepristone-misoprostol medication abortion and estimate the impact of DMPA on mifepristone action.

Materials and methods: In this secondary analysis of a retrospective study, we analysed treatment failure and continuing pregnancy as a reason for failure both overall and by gestational duration group. We assessed available literature to estimate that misoprostol alone would result in abortion in approximately 74% of pregnancies without mifepristone and calculated the impact of adding mifepristone to the treatment regimen and of DMPA on these outcomes.

Results: More than half of the patients in each group had pregnancies ≤49 days gestation (no DMPA: 432/704 [61.4%]; DMPA 73/141 [51.8%], p = 0.04). Ongoing pregnancy rates increased with advancing gestational duration both with (p = 0.0005) and without (p = 0.04) concomitant DMPA administration. No individual gestational duration group demonstrated a significant difference in outcomes between patients that did and did not receive DMPA, likely because of small numbers in each group. Overall, concomitant DMPA with mifepristone increased the likelihood of an ongoing pregnancy by 25.3% of the expected rate if DMPA completely blocked all mifepristone action but only by 16.1% for patients with pregnancies ≤49 days gestation.

Conclusion: Ongoing pregnancy as the reason for medication abortion failure occurs more frequently with advancing gestation in patients that do and do not receive DMPA concurrently with mifepristone. DMPA may impact mifepristone variably by gestational duration, but larger studies are needed.

Aim: We evaluated the current practices of abortion providers giving anti-D prophylaxis to RhD negative women undergoing first trimester medical abortion and factors that influenced the decision. We also examined RhD management strategies that could be safely adopted.

Methods: A Steering Committee of abortion providers drafted a questionnaire on anti-D prophylaxis practices and perceptions. The 28-question survey, hosted online from December 2022 to December 2023, targeted international abortion providers.

Results: Almost 62% of respondents perform medical abortion during the first trimester (up to 12 weeks of amenorrhoea [WA]), while 32.8% provide it during the second trimester (13 to 26 WA). Among providers, 55.8% administer anti-D prophylaxis to all RhD negative women during first trimester medical abortions, 25.5% provide it selectively, and 18.6% do not administer it at all. Providers who do not administer IgG anti-D rely on national guidelines (51.2%), hospital protocols (16.3%), or both (7.0%), citing early gestational age (36.5%) and insufficient evidence (22.9%) as reasons. The primary reason for administering IgG anti-D was preventing risks in future pregnancies (52.7%). Yet, 59.1% expressed interest in changing their anti-D prophylaxis practices during early abortion.

Conclusion: This study highlights the huge variations in anti-D prophylaxis practices during first trimester medical abortion. These discrepancies mirror differences in national and international guidelines and underscore the need for robust clinical evidence to determine the gestational age limits for alloimmunization risk and support protocol updates.

Purpose: To investigate prescription for therapeutic purposes of combined oral contraceptives (COCs) in countries of the PRO-E2 study, with a special focus on Italy.

Methods: Therapeutic reasons for prescription of COCs currently approved with no therapeutic the sole contraceptive indication, such as associations of nomegestrol acetate plus oestradiol and levonorgestrel plus ethynylestradiol, were investigated in the overall population (Italy excluded) (n = 71,630) and, separately, the Italian subpopulation (n = 19,683) of PRO-E2 study.

Results: COC prescription for contraception only was 38.8% in Italy and 60.8% in the overall population (mainly European countries) (OR = 0.409; 95%CI:0.396-0.423; p < 0.0001). COCs were prescribed for therapeutic purposes and contraception in 44.2% of the Italian subpopulation and 30.2% of the overall population (OR = 1.809; 95%CI:1.752-1.869; p < 0.0001). More women in Italy than the overall population received COCs only for therapeutic purposes (16.7% vs. 6.9%, respectively; OR = 2.694; 95%CI:2.570-2.824; p < 0.0001). Problems related to menstruation, particularly in women aged below 20 or above 40 years, were the most important driver for COC therapeutic use.

Conclusion: COCs are extensively used for therapeutic purposes, mostly to manage menstruation-related disorders. This is particularly evident among Italian prescriptions. The widespread therapeutic use of COCs that are licenced only for contraception indirectly proves their efficacy and the need of a formal recognition of their properties.

In the present debate paper, authors seek to bring attention to the situation regarding abortion access in La Cerdanya - El Capcir, a cross-border region in the Pyrenees between Spain and France. Hospital de Cerdanya (HC) is the first cross-border health centre in Europe. It is placed in a high-altitude isolated mountain region, and the few physicians in town are conscientious objectors. An agreement with a tertiary hospital from Barcelona allows a gynaecologist to commute to the region weekly to guarantee the right of women to access abortion. In 2023, 67 abortions have been performed in HC: 58 pharmacological terminations and 9 surgical abortions. The Hospital protocol is described and data on the performed procedures are reviewed. Since requested until provided, mean time to pregnancy termination has been of 6.79 days. Difficulties in accessing health centres and professionals that women living in isolated areas experiment explain the major disparities among abortion rates in different regions, which are notable in Spain. Abortion rate in La Cerdanya is 13.7‰, showing no statistical difference compared to the global Catalan rate. Experiences such as the one at HC may be of interest in developing new protocols to address territorial inequities related to access to abortion.

Purpose: Amniotic fluid embolism (AFE) is a rare and catastrophic complication of pregnancy characterised by hypoxia, cardiovascular collapse, and disseminated intravascular coagulation (DIC). Scant literature exists on the prevalence of second trimester AFE or AFE at the time of abortion. Management recommendations specific to these settings are lacking. We present a case of AFE at the time of second trimester abortion.

Case: A 32-year-old woman, gravida 4, para 3, presented for induced abortion at 24 weeks and 2 days. Her history was significant for three prior caesarean sections and sleeve gastrectomy. During the dilation and evacuation, the patient developed persistent hypoxia and pulseless electrical activity. The procedure was completed during resuscitation and return of spontaneous circulation (ROSC) was achieved. The patient underwent uterine artery embolisation for persistent uterine bleeding without signs of active extravasation in the setting of DIC. She experienced transient short-term memory loss but was otherwise neurologically intact. AFE was diagnosed based on cardiovascular collapse and DIC out of proportion to haemorrhage.

Conclusion: AFE is sparsely described in abortion care. Clinicians must maintain a broad differential and consider AFE at the time of acute collapse in pregnancies greater than 20 weeks gestation. This is especially crucial as abortion bans may increase the incidence of AFE as delayed abortion care may yield an increase in gestational age and maternal morbidity. AFE and thromboembolism are the most likely diagnoses consistent with our case. Future investigation is needed to explore the long-term effects of abortion restrictions on maternal mortality and morbidity.

Purpose: Globally, women are postponing childbearing and total fertility rates are decreasing. In Sweden, a 2018 law requires consent before sexual activity and LARC is now recommended as a first-hand choice. This study compares sexual behaviour (including consent), contraceptive use and family planning intentions with past surveys.

Material and methods: This is a cross-sectional survey that has been repeated every fifth-tenth year since 1989 in Sweden. It explores sexual behaviour, contraceptive use and family planning intentions among women attending a gynaecology clinic for contraceptive counselling and compares these results with previous surveys.

Results: Of the 596 women surveyed, 558 were sexually experienced, the majority (98%) of which perceived consent during their most recent sexual activity. Over 30 years, there was a significant trend towards having more sexual partners (p = 0.02). The use of SARC (p = <0.01) and LARC (p = 0.04) has increased since 2014, while condom use and emergency contraceptive use have decreased (p = <0.01 for both). Three out of four respondents (n = 449) wanted children, significantly fewer than 2014.

Conclusions: Sexual behaviour and contraceptive use have changed over the last ten years in Sweden. More women use effective forms of contraception and informed consent laws may have positive implications. Yet fewer women have decided to have children in the future.

Purpose: This study aims to determine the effects of menstrual headaches on quality of life in young women. It also determines the frequency and examines variables associated with menstrual headaches.

Materials and methods: A cross-sectional study was conducted from October 2021 to April 2022 among 984 young women aged 18-28. The SF-36 Health-Related Quality of Life questionnaire was used for assessment, and data were analysed using IBM SPSS 20.0. Sociodemographic factors, menstrual characteristics, and lifestyle habits were included as variables.

Results: Menstrual headaches were reported by 35.6% (n = 318) of participants. These headaches were significantly associated with disrupted family structures, shorter menstrual cycles, dysmenorrhoea, smoking, cola-containing drink consumption, medication-dependent chronic diseases, and early menarche. Women with menstrual headaches had lower median scores across all SF-36 subscales compared to those without. This study also found that delayed-onset menstrual headaches are more common than early-onset menstrual headaches in women.

Conclusion: Menstrual headaches adversely affect health-related quality of life in women. The prevalence and severity of these risk factors can be reduced by modifying lifestyles and implementing targeted interventions. A healthcare provider plays a critical role in helping women learn self-management strategies to alleviate menstrual headaches' adverse effects.

Objective: Since the US Supreme Court decision in Dobbs v. Jackson Women's Health to overturn the constitutional right to abortion in June 2022, 24 states have enacted laws prohibiting termination of pregnancy before most foetal anomalies are diagnosed. Few practical exceptions are made for trisomy 13, trisomy 18, or anencephaly, which are severe life-limiting conditions with significant morbidity for survivors. In this cost-effectiveness model, we estimated the difference in cost and maternal health outcomes associated with a termination ban for severe life-limiting foetal anomalies.

Methods: A decision-analytic model was built using TreeAge software to compare a total ban on termination in a theoretical cohort of 868 women desiring a termination of pregnancy based on the annual incidence of trisomy 13, trisomy 18, or anencephaly (5.76/10,000) and birth data from the 24 states with bans. Probabilities, utilities and societal costs were derived from the literature. National data were used to estimate the number of women who would travel out-of-state to obtain an abortion (27.2%). The threshold for cost-effectiveness was set at $100,000 per quality-adjusted life year (QALY). Clinical outcomes included maternal death, stillbirth, birth of neonates with severe disease, severe preeclampsia, blood transfusion for haemorrhage, and infections.

Results: With an abortion ban as compared to without, there would be an additional 406 live births affected by a severe life-limiting anomaly, 223 stillbirths, 3 cases of pre-eclampsia, 5 cases of haemorrhage requiring transfusion, and 12 cases of postpartum or postoperative infection. A policy restricting termination is associated with higher costs ($46,223,865) and decreased quality of life (3242 QALYs) annually. Two hundred and thirty-six women would travel out-of-state to obtain abortions.

Conclusion: Termination bans without exceptions for severe life-limiting foetal anomalies significantly restrict access to care for pregnant people and are associated with increased costs and worse health outcomes. Policies addressing abortion access should consider these health and cost impacts for both individuals and society.