European Journal of Contraception and Reproductive Health Care最新文献

Background: Evidence suggests routine pre-abortion ultrasound is unnecessary for women with regular menstrual cycles and without symptoms or risk factors for ectopic pregnancy in early gestation.

Objectives: We evaluated the safety and accuracy of using the decision aid for early medical abortion without ultrasound developed by the RCOG Abortion Care group in a Finnish setting.

Method: Using gestational age (GA) expected by last menstrual period (LMP), cycle irregularities, use of hormonal contraceptives, breastfeeding and self-reported symptoms indicative of possible ectopic pregnancy, women were classified into 'no ultrasound needed' and 'ultrasound needed' with a cut-off of 10 + 0 weeks or 70 days. Findings on US were then evaluated to assess classification accuracy.

Results: Between September and December 2023, 494 women attending the abortion clinic at the Helsinki University Hospital were assessed. Correct classification of the necessity of an ultrasound was made in 491/494 (99.4%) cases before the women had a scan. The remaining three cases were one woman with an unexpected GA just above 10 + 0, one asymptomatic ectopic pregnancy and one asymptomatic pregnancy of unknown location with high plasma hCG, diagnosed as a partial molar pregnancy on pathology after diagnostic vacuum aspiration.

Conclusions: Use of the structured flowchart developed by the RCOG highly accurately identifies women needing an ultrasound examination. The few cases that would have been undetected highlight the importance of informing women and health care providers about symptoms of ectopic or abnormal pregnancy similar to practices in wanted pregnancies not routinely examined and dated before late first trimester.

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.

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.

Anti-abortion protestors situated near premises providing abortion services create barriers and hurdles to accessing abortion services, which violates the right of pregnant people to seek sexual and reproductive health services. There has been shown to be a need for Safe Access Zones (SAZs) to guarantee physical access to abortion services without obstruction. SAZs usually operate within a prescribed radius around premises providing abortion services and set out what behaviour is prohibited. The objective of this paper is to present a summary of the international experience of introducing and implementing SAZ laws, and to explain the lessons to be learned from this experience. SAZ legislation has been successfully enacted internationally in 22 jurisdictions (USA excluded). Countries with SAZ laws include Australia, New Zealand, the UK, and parts of Canada. Despite the Parliamentary Assembly of the Council of Europe calling for the introduction of SAZs in 2022, only two European Union (EU) countries have implemented this recommendation so far. On the basis of the medical and legal insights gained from the functioning of SAZs to date, it is the authors' opinion that it would be feasible for the 25 EU countries that do not yet have such zones to legislate for SAZs.

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.

Objective: To determine whether intrauterine device (IUD) use is associated with a significantly increased risk of abnormal cervical cytology.

Methods: A retrospective cohort study was carried out at the University of Campinas, Campinas, SP, Brazil. Data came from medical records of 2,963 women from a family planning clinic who had undergone at least one cervical cytology for screening between 1990 and 2017. Women were split into three groups: users of either copper (Cu)- or the levonorgestrel 52 mg-IUD (2,305) and users of other contraceptive methods (658). The dependent variable was the cytological results as normal and abnormal, based on the Bethesda System. The most severe cytological result of each participant was considered and when all her results were normal, the last one was considered.

Results: IUD use was associated with a lower risk of abnormal cervical cytology after adjusting for the number of cytology assessments per participant (RR 0.74; 95% CI 0.55;0.99; p = 0.049). Abnormal cervical cytology was more common in women with multiple cytology assessments and a longer duration since sexual debut. For each additional cytology test, the risk increased by 33.8% (p < 0.001), and for every additional year since sexual debut, the risk increased by 6.2% (p < 0.001). A lower incidence of abnormal cervical cytology was observed among women with a history of caesarean delivery, with a 24.9% reduction in risk per additional caesarean (p < 0.001). IUD users underwent more cervical cytology assessments than non-IUD users.

Conclusion: We identified low risk of abnormal cervical cytology among IUD users.

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.

Implanon NXT^® is a single rod contraceptive implant that is a long-acting reversible contraceptive method. Placement and removal is usually simple if the instructions of use are followed. Deviation from these instructions may lead to the implant becoming impalpable and consequently difficult to remove. We report on a case of a 46- year- old woman who had an impalpable implant in both the left and the right upper arms simultaneously. They had been placed approximately ten and seven years previously and were probably not releasing etonogestrel and were no longer relied on for contraceptive efficacy. The implants were removed relatively easily after ultrasound mapping. This case highlights some of the problems with the provision of implants in low-resource settings. The problems of implant management and some practical suggestions regarding its use in these settings is discussed.

Purpose: To evaluate the feasibility and acceptability of outpatient medical induction at 13-18 weeks' gestation to limit overnight hospital stays.

Methods: In this prospective cohort study, participants with 13-18-week pregnancies seeking abortions at two government hospitals swallowed mifepristone 200 mg and self-administered misoprostol 400 mcg buccally 24-48 h later, 1-2 h before returning to the outpatient clinic (OPD). Repeat misoprostol was dosed every 3 h until expulsion. Participants requiring care beyond OPD hours were admitted as inpatients. Acceptability was evaluated by exit interview before discharge. Participants were contacted two weeks later to assess any subsequent issues.

Results: Ninety-eight (82%) of 120 participants had successful outpatient abortions using a median two (IQR 2, 3) misoprostol doses. The median induction-to-abortion time was five hours (IQR 4, 7.5). Eleven (9%) participants expelled before clinic arrival. Twenty-two (18%) participants were transferred as inpatients at OPD closing. Transferred participants remained inpatient for a median 18 h (IQR 18, 21.25). There were no serious adverse events and satisfaction with the abortion process was high.

Conclusions: Although the outpatient model did not meet statistical expectations, it is clinically feasible, acceptable, and improves efficiency, expands access, and reduces burdens for women and providers. Operational adjustments may facilitate higher outpatient success.

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.