European Journal of Contraception and Reproductive Health Care最新文献

Objective: The aim of our study was to assess the associated factors of planned and unplanned pregnancies (UPs) among pregnant women in São Paulo, Brazil.

Methods: We conducted a cross-sectional study from March 2023 to June 2024 and invited pregnant women aged 18 to 49 years. We used the Brazilian-validated version of the London Measure of Unplanned Pregnancy to assess pregnancy intentions. We estimated absolute and relative frequencies of planned and UPs by sociodemographic and reproductive characteristics. Bivariate and multiple regression analysis were performed to evaluate the associated factors for UPs.

Results: We included 534 participants; 65.7% reported an UP. Black or Biracial vs White women (74% vs. 57%, p < 0.001), with 0 to 9 years vs. those with >9 of schooling (77% vs. 51%, p < 0.001), and single vs married women (85% vs. 48%, p < 0.001) were associated with UPs. Parous women or those reporting a younger age at their sexual debut were more commonly reported UPs. The associated factors to UPs were being Black or Biracial (Odds ratio [OR] 1.68, 95% Confidence Interval [CI] 1.11;2.57), reporting fewer schooling years (OR 1.61, 95% CI 1.01;2.54), not being married [(OR 2.41, 95% CI 1.53;3.84) for cohabiters and OR 5.23, 95% CI 2.93;9.74) for single] and reporting additional births (OR 1.28, 95% CI 1.07;1.56).

Conclusion: Black or Biracial, with fewer years of schooling, not married, and parous women were at a higher risk of UPs. These women tend to face structural barriers to planning the size and timing of their families, requiring actions like increasing tertiary education access and guaranteeing universal modern contraceptive availability to leverage these disadvantages and fulfil their sexual and reproductive rights.

Purpose: To evaluate physicians' barriers and facilitators, as well as knowledge, practices, attitudes, and beliefs, regarding analgesia for IUD insertion.

Methodology: A multi-center online survey was conducted from January to July 2023 in Ontario, Canada. Data was analysed using descriptive statistics, chi-square tests, ANOVA, and thematic analysis.

Results: Among 85 providers who responded to the survey, there was a lack of consensus regarding provision of analgesia for IUD insertion, as only 52.9% routinely provided pain control. The remaining 40 providers (47.1%) stated that they do not routinely provide pain control for IUD insertion, although 87.5% of participants stated that they would provide pain control if the patient specifically requested analgesia. No differences were found between academic and community staff (p = 0.94) or less experienced providers in provision of pain control (p = 0.24). Reasons for provision of pain control included patient comfort, care, and procedure safety. Conversely, other physicians believed the pain was minimal or short-lived, or faced logistical barriers in providing analgesia.

Conclusions: Patients and providers should engage in shared decision-making regarding pain control for IUD insertion.

Introduction: Antispasmodic drugs are used to facilitate the insertion of intrauterine devices (IUD), and to decrease uterine cramping during the procedure. Evidence supporting these benefits is scarce, and little is known about the prevalence of antispasmodic use before IUD insertion.

Methods: EURAS-LCS12 is an ongoing non-interventional cohort study in ten European countries. Information is gathered from health care professionals (HCP) and IUD users via questionnaires at the time of IUD insertion. Patterns of antispasmodics before IUD insertion, by participating country, were assessed using descriptive methods.

Results: 96,024 users were included in the study, of which 2.7% (N = 2,565) received antispasmodics before IUD insertion, with notable differences observed between countries. Highest antispasmodic use was observed in France and Germany: in France, almost 50% of HCPs (68/144) gave antispasmodics at least once during the study period. In Germany, 16% of enrolling HCPs used antispasmodics at least once during the study period; two HCPs (0.8%) administered antispasmodics in 69% of all study participants.

Conclusion: Clinical practices for prescribing and administering antispasmodics during IUD insertion vary by country and seem to rely on local recommendations, or locally applicable best practices. The heterogeneous use of antispasmodics with uncertain benefits highlights the need for evidence-based recommendations.

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.

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.

Primary objective: A randomized study to compare the induction abortion interval (IAI) using two different routes of Low-dose misoprostol administration Sublingual (S/L) and vaginal, after priming with two sequential doses of mifepristone for second-trimester medical abortion.

Study design: After randomization in two groups, participants received two doses of mifepristone (200 mg) 24 h apart. On day 3, 200mcg of misoprostol was given by S/L route to group 1 and by vaginal route to group 2, (400mcg among women with gestation ≤16 weeks) and every 6 hours for a maximum of 3 doses.

Results: The mean IAI (13.71±8.55 h and 13.22±8.22 h; p=0.768), mean number of misoprostol doses (2.08±1.08 and 2.54±1.12, p=0.05) and mean misoprostol dose (453.9±224.93 and 492.31±208.23 mcg, p=0.409) was similar. The complete abortion rate after 24 h (77.5% vs 87.5%, p=0.23), after 48 h (95% vs 97.5%, p=1.00) and minimal untoward effects seen were all similar in the two groups.

Conclusions: Both SL and vaginal routes of misoprostol, after two doses of mifepristone were equally effective. The mean cumulative doses of misoprostol were similar, and a complete abortion rate of > 95% at 48 h was achieved with either route.$>95$.

Introduction: Artificial intelligence (AI) has many applications in health care. Popular AI chatbots, such as ChatGPT, have the potential to make complex health topics more accessible to the general public. The study aims to assess the accuracy of current long-acting reversible contraception information provided by ChatGPT.

Methods: We presented a set of 8 frequently-asked questions about long-acting reversible contraception (LARC) to ChatGPT, repeated over three distinct days. Each question was repeated with the LARC name changed (e.g., 'hormonal implant' vs 'Nexplanon') to account for variable terminology. Two coders independently assessed the AI-generated answers for accuracy, language inclusivity, and readability. Scores from the three duplicated sets were averaged.

Results: A total of 264 responses were generated. 69.3% of responses were accurate. 16.3% of responses contained inaccurate information. The most common inaccuracy was outdated information regarding the duration of use of LARCs. 14.4% of responses included misleading statements based on conflicting evidence, such as claiming intrauterine devices increase one's risk for pelvic inflammatory disease. 45.1% of responses used gender-exclusive language and referred only to women. The average Flesch readability ease score was 42.8 (SD 7.1), correlating to a college reading level.

Conclusion: ChatGPT offers important information about LARCs, though a minority of responses are found to be inaccurate or misleading. A significant limitation is AI's reliance on data from before October 2021. While AI tools can be a valuable resource for simple medical queries, users should be cautious of the potential for inaccurate information.

Short condensation: ChatGPT generally provides accurate and adequate information about long-acting contraception. However, it occasionally makes false or misleading claims.