European Journal of Contraception and Reproductive Health Care最新文献

Background: It is 100 years since the discovery of oestrogen and nearly that since the discovery of progesterone. It is over 50 years since the concept of using intrauterine progesterone. Ten years after its synthesis, the research using levonorgestrel as an intrauterine agent was introduced.

Areas covered: The pharmacodynamics and pharmacokinetics of LNG-IUSs and the LNG-IUS 52 mg in particular explain why intrauterine LNG is so highly effective for contraception. When intrauterine LNG is used therapeutically it should ideally be based on clinical monitoring of the pathology being treated rather than a fixed time period While the LNG-IUS 52 mg is probably required for most medical conditions, consideration should be given for using the LNG-IUS 13.5 mg for hyperplasia and endometrial protection during oestrogen therapy and for older women who appear more prone to a low rate of LNG induced breast cancer, although there is not yet an official indication for this.

Conclusion: The desire for fertility control, therapy for various genital pathological conditions and reduction of repeated endometrial decidualization and inflammatory breakdown and its consequences, and menopausal problems can be aided by intrauterine LNG. This review explains how a contraceptive also became a WHO listed essential medicine.

Objective: Mid-trimester pregnancy terminations are becoming an increasingly common practice in obstetrics. Accurate prediction of delay from induction to abortion may help in planning the optimal time for the medical induction process and optimising the use of healthcare services. Therefore, we aimed to assess whether the transvaginal cervical length and cervical elastography can predict the time interval from medical induction to abortion in cases of medically indicated mid-trimester pregnancy termination.

Materials and methods: We performed a prospective observational pilot study between January 2022 and October 2022 in patients who have undergone medically indicated mid-trimester pregnancy termination with a non-dilated cervix for foetal morphological, chromosomal abnormalities or preterm premature rupture of membranes. Cervical length (CL) and cervical strain ratio (CSR) were measured by transvaginal sonography. The predictive value of CL and CSR on the induction to abortion interval was calculated after medical induction with misoprostol.

Results: Fifty-three eligible pregnant women were evaluated. The mean gestational age at abortion was 17.61 ± 2.81 weeks. The mean time interval from induction to abortion was 31.72 ± 16.57 h. In multivariate linear regression analysis, CL and the history of previous vaginal delivery were the significant independent predictors of the induction to abortion interval (all p < 0.01), with no additional significant contribution from CSR.

Conclusion: Transvaginal CSR is unlikely to be useful in the prediction of induction to abortion interval in the mid-trimester medically indicated termination of pregnancy.SHORT CONDENSATIONTransvaginal cervical length is the significant independent predictor of the induction to abortion interval in the mid-trimester medically indicated termination of pregnancy with no additional significant contribution from cervical strain ratio.

Introduction: Both Food and Drugs Administration and European Medicine Agency (EMA) approve the use of a triphasic combined oral contraceptive (COC) containing ethinyl-oestradiol (EE) and norgestimate (NGM) for acne vulgaris treatment in women requiring an effective contraception. COCs can target sebum production and may also play a role in decreasing follicular hyperkeratinisation.

Results: Specific advantages of the use of an anti-androgenic progestin such as NGM in this condition are presented in this review, including the lowest venous thrombosis risk in the COCs scenario, as established by the EMA, associated with a very satisfactory cycle control. The results of aggregate analysis of published data (n = 163 vs. n = 161 treated subjects) demonstrate a significant effect in comparison with the placebo of a greater than 50% reduction, in terms of inflammatory lesions (from 19.0 to 8.2), comedones (from 35.2 to 17.7) and total lesions (from 54.3 to 25.9) count.

Conclusions: The choice of a triphasic combination of EE/NGM seems a referenced, highly effective, easy-to-use and safe therapeutic approach for acne vulgaris, alone or in combination with different targeted drugs.

Purpose: The objective of the study was to see the difference in expulsion rates of two types of Copper containing intrauterine contraceptive devices (IUCDs): Cu 375 & CuT 380 A, within or at 6 weeks after insertion.

Methods: It was a randomised control trial. A total of 396 pregnant women were recruited. Ultrasonography was done to look for the position of the IUCD at the time of discharge and at six weeks follow-up and the expulsion rate was calculated.

Results: Amongst 396 participants, 22 PPIUCDs were expelled completely at 6 weeks (modified intention to treat analysis [ITA]), 10 (5.3%) and 12 (6.7%) in the Cu 375 and CuT 380 A groups respectively. The expulsion rate was 6.02%. However, this difference was not statistically significant. When ultrasonologically assessed partial expulsions were also considered, the total expulsion rate in both groups (14.3% and 14.1% respectively) was also not significantly different. The expulsion rate was higher in the vaginal delivery group (10.7%) than in the caesarean section (3.6%) group (p = 0.007) and early postpartum insertion 12.3% than in the immediate post-placental insertion group, 3.7% (p = 0.002).

Conclusions: The study concluded that the altered shape of Cu 375 has effectively no role in decreasing the expulsion rate. Placement of IUCD at or near the uterine fundus immediately after delivering the placenta (post-placental) decreases the expulsion rate, thereby increasing the contraceptive efficacy.SHORT CONDENSATIONThe altered shape of Cu 375 has effectively no role in decreasing the expulsion rate. Placement of IUCD at or near the uterine fundus immediately after delivering the placenta (post-placental) decreases the expulsion rate, thereby increasing the contraceptive efficacy.

Purpose: To assess the resources that oral contraceptive pill (OCP) users currently use and wish to use after missing pills.

Materials and methods: People 18-44 years old with a OCP prescription were emailed a cross-sectional survey to assess how they obtain information about managing missed pills, what information they would prefer to access, and whether they would use additional information if it were available. We performed a logistic regression and a dominance analysis to compare independent predictors of desire for a technological resource at the time of missed pills.

Results: We received 166 completed surveys. Nearly half of participants (47%, n = 76, 95% CI 39.0-54.4%) did not seek information about managing their missed pills. When missing a pill, more patients preferred non-technology-based information (57.1%, n = 93, 95% CI 49.3-64.5%) over technology-based information (43%, n = 70, 95% CI 35.5-50.7%). Most reported they would appreciate more information at the time of missed pills (76%, n = 124, 95% CI 68.9-82.0%). The strongest predictors for desire for technology-based information were: current use of technology, lower parity, white race, and higher educational attainment.

Conclusions: This study indicates that most OCP users would utilise additional information at the time of a missed pill if they had access to it and that they desire information in varying formats.

Objectives: To investigate factors associated with multiple induced abortions.

Materials and methods: A multi-centre cross-sectional survey among abortion-seeking women (n = 623;14-47y) in Sweden, 2021. 'Multiple abortions' was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions.

Results: 67.4% (n = 420) reported previous experience of 0-1 abortion, and 25.8% (n = 161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n = 109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n = 27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n = 65/161), compared to those with 0-1 abortion (n = 131/420), p=.034.

Conclusion: Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence.

Purpose: This study aimed to assess the experience and satisfaction with contraceptives and use of Combined Oral Contraceptives (COC) by women and compare their perceptions with those of gynaecologists.

Methods: This was a multicentre survey study conducted in Portugal, during April and May, 2021 with women using contraceptives and gynaecologists. Online quantitative questionnaires were carried out.

Results: A total of 1508 women and 100 gynaecologists were included. Cycle control was the pill non-contraceptive benefit most valued by gynaecologists and women. For gynaecologists, the main pill concern was the risk of thromboembolic events, but they believed that weight gain was the main concern for their patients. The pill was the most used contraceptive (70%) and women were largely (92%) satisfied. The pill was associated with health risks for 85% of users, mainly thrombosis (83%), weight gain (47%), and cancer (37%). The attributes of the pill most valued by women are contraceptive efficacy (82%), followed by low risk of thromboembolic events (68%), good cycle control (60%), non-interference with libido and mood (59%) and weight (53%).

Conclusion: Most women use contraceptive pills and are generally satisfied with their contraceptive. Cycle control was the most valued non-contraceptive benefit for gynaecologists and women, agreeing with physicians' beliefs about women. On the other hand, contrary to physicians' beliefs, that women's main concern is weight gain, women are mainly concerned with risks associated with contraceptives. Thromboembolic events are women's and gynaecologists most valued risk. Finally, this study indicates the need for physicians to better understand what COC users really fear.