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Contraceptive Options Following Gestational Diabetes: Current Perspectives 妊娠期糖尿病后的避孕选择:当前展望
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-10-01 DOI: 10.2147/OAJC.S184821
A. Turner, Emily A. Donelan, Jessica W. Kiley
Abstract Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the United States. Along with risk factors related to pregnancy, women with a history of GDM also have an increased risk of developing type 2 diabetes mellitus later in life. These women require special consideration when discussing contraception and other reproductive health issues. GDM carries a category 1 rating in the US Medical Eligibility Criteria for all contraceptive methods, which supports safety of the various methods but does not account for effectiveness. Contraceptive options differ in composition and mechanisms of action, and concerns have been raised about possible effects of contraception on metabolism. Clinical evidence is limited to suggest that hormonal contraception has significantly adverse effects on body weight, lipid, or glucose metabolism. In addition, the majority of evidence does not suggest a relationship between development of type 2 diabetes mellitus and use of hormonal contraception. Data are limited, so it is challenging to make a broad, general recommendation regarding contraception for women with a history of GDM. A woman’s history of GDM should be considered during contraceptive counseling. Discussion should focus on potential medical comorbidities and the implications of GDM on future health, with special consideration of issues including bone health, obesity, cardiovascular disease, and thrombosis risk. Providers must emphasize the importance of reliable, highly effective contraception for women with GDM, to optimize the timing of future pregnancies. This approach to comprehensive counseling will guide optimal decision-making on contraceptive use, lifestyle changes, and planning of subsequent pregnancies.
摘要妊娠期糖尿病(GDM)使美国约7%的妊娠复杂化。除了与妊娠相关的风险因素外,有GDM病史的女性在以后的生活中患2型糖尿病的风险也会增加。在讨论避孕和其他生殖健康问题时,需要特别考虑这些妇女。GDM在美国所有避孕方法的医疗资格标准中都属于1类,该标准支持各种方法的安全性,但不考虑有效性。避孕选择的成分和作用机制各不相同,人们对避孕可能对新陈代谢产生的影响表示担忧。临床证据仅限于表明激素避孕对体重、脂质或葡萄糖代谢有显著不利影响。此外,大多数证据并不表明2型糖尿病的发展与激素避孕的使用之间存在关系。数据有限,因此对有GDM病史的女性提出广泛、一般的避孕建议具有挑战性。在进行避孕咨询时,应考虑女性的GDM病史。讨论应集中在潜在的医学合并症和GDM对未来健康的影响上,特别考虑骨骼健康、肥胖、心血管疾病和血栓风险等问题。提供者必须强调GDM妇女可靠、高效避孕的重要性,以优化未来怀孕的时间。这种综合咨询方法将指导避孕药具使用、生活方式改变和后续妊娠计划的最佳决策。
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引用次数: 2
Postpartum Contraceptive Use In Parakou (A City In Northern Benin) In 2018: A Community Based Cross-Sectional Study 2018年贝宁北部帕拉库市产后避孕药使用情况:基于社区的横断面研究
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-09-19 DOI: 10.2147/OAJC.S219709
F. Hounkponou, Yolaine Glèlè Ahanhanzo, C. Biaou, Candide Russel Dos-Santos, A. Ahouingnan, A. A. Obossou, Rachidi Sidi Imorou, M. Vodouhè, H. Laourou, K. Salifou, R. Perrin
Background Over 30% of maternal deaths and 10% of infant deaths are avoidable if couples space out births at intervals of 2 years or greater. This study aimed to identify factors associated with contraceptive use in the postpartum period. Methods This was a cross-sectional study among postpartum women living in Parakou. Participants were selected using a two-stage sampling method. Postpartum contraceptive use was defined as the use of at least one contraceptive method at the time of the survey. Independent variables included socio demographic and reproductive history. For the analysis we performed a multiple logistic regression and we calculated odds ratios with 95% confidence intervals. Results The study included 453 postpartum women. Among the participants, 59 (13%) were using a contraceptive method. Injectable contraceptives were the most common method used (25.4%). Factors associated with contraceptive use in the postpartum period included history of contraceptive use (AOR=9.4; p<0.001), resumption of sexual intercourse (AOR=5.7; p<0.001), discussion with partner about contraceptive method (AOR=5.7; p=0.005), need of partner’s approval before adopting a contraceptive method (AOR=0.4; p=0.014) and counseling during pregnancy, in the delivery room, and during postnatal visits (AOR=2.7; p=0.019). Conclusion The prevalence of contraceptive use during the postpartum period remains low. Interventions should be designed with a focus on the associated factors in order to increase postpartum contraceptive use in Parakou.
背景如果夫妇间隔2年或更长时间分娩,超过30%的孕产妇死亡和10%的婴儿死亡是可以避免的。本研究旨在确定产后使用避孕药具的相关因素。方法对居住在帕拉库的产后妇女进行横断面调查。参与者采用两阶段抽样方法进行选择。产后避孕的使用被定义为在调查时至少使用一种避孕方法。自变量包括社会人口和生育史。在分析中,我们进行了多元逻辑回归,并计算了95%置信区间的优势比。结果本研究包括453名产后妇女。在参与者中,59人(13%)正在使用避孕方法。注射式避孕药具是最常见的使用方法(25.4%)。产后使用避孕药具的相关因素包括避孕史(AOR=9.4;p<0.001)、恢复性交(AOR=5.7;p<001)、与伴侣讨论避孕方法(AOR=570;p=0.005),在采用避孕方法之前需要伴侣的批准(AOR=0.4;p=0.014),在怀孕期间、产房和产后访视期间需要咨询(AOR=2.7;p=0.019)。干预措施的设计应关注相关因素,以增加帕拉库产后避孕药具的使用。
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引用次数: 4
Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives 经前焦虑症(PMDD)妇女的避孕咨询:当前观点
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-09-01 DOI: 10.2147/OAJC.S183193
Andrea J. Rapkin, Yelena Korotkaya, Kathrine C Taylor
Abstract Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) affecting up to 7% of reproductive age women. Women with PMDD are of reproductive age; therefore, contraception and treatment of PMDD are important considerations. The disorder as described in the DSM-V is characterized by moderate to severe psychological, behavioral and physical symptoms beginning up to two weeks prior to menses, resolving soon after the onset of menstruation and significantly interfering with daily functioning. PMDD develops in predisposed individuals after they are exposed to progesterone at the time of ovulation. It has been hypothesized that PMDD is in part attributable to luteal phase abnormalities in serotonergic activity and to altered configuration of ℽ-aminobutyric acid subunit A (GABAA) receptors in the brain triggered by the exposure to the neuroactive steroid progesterone metabolite, allopregnanolone (Allo). A large body of evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can be effective in the treatment of PMDD. Combined hormonal contraceptive (CHC) pills, specifically the 20 mcg ethinyl estradiol/3mg drospirenone in a 24/4 extended cycle regimen has been shown to significantly improve the emotional and physical symptoms of PMDD. Other combined monophasic, extended cycle hormonal contraceptive pills with less androgenic progestins may also be helpful, although not well studied. Copper intrauterine devices (IUDs) are recommended for those not seeking hormonal contraceptives. Progestin-only methods including the progestin-only pill (POP), levonorgestrel (LNG) IUD, etonorgestrel implant or depot medroxyprogesterone acetate (DMPA) have the potential to negatively affect mood symptoms for women with or without baseline mood disorders, including PMDD. Careful counseling and close follow-up is recommended for patients with PMDD seeking these contraceptive methods.
摘要月经前综合征(PMDD)是一种严重的经前综合征,影响多达7%的育龄妇女。患有PMDD的妇女已达到生育年龄;因此,预防和治疗PMDD是重要的考虑因素。DSM-V中描述的这种疾病的特征是在月经前两周开始出现中度至重度的心理、行为和身体症状,在月经开始后很快消失,并严重干扰日常功能。易感个体在排卵时暴露于黄体酮后会出现PMDD。据推测,PMDD在一定程度上可归因于5-羟色胺能活性的黄体期异常和ℽ-脑中氨基丁酸亚单位A(GABAA)受体,由暴露于神经活性类固醇孕酮代谢产物异孕纳龙(Allo)触发。大量证据表明,选择性血清素再摄取抑制剂(SSRIs)可以有效治疗PMDD。激素避孕药(CHC),特别是20 mcg乙炔雌二醇/3mg屈螺酮,采用24/4延长周期方案,已被证明可显著改善PMDD的情绪和身体症状。其他含有较少雄激素的单相、长周期激素避孕药也可能有帮助,尽管研究不充分。建议那些不寻求激素避孕药的人使用铜宫内节育器。仅使用孕激素的方法,包括仅使用孕激素药丸(POP)、左炔诺孕酮(LNG)宫内节育器、依托孕烯植入物或储备醋酸甲羟孕酮(DMPA),有可能对患有或不患有基线情绪障碍(包括PMDD)的女性的情绪症状产生负面影响。建议对寻求这些避孕方法的PMDD患者进行仔细的咨询和密切的随访。
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引用次数: 5
"When you least expect, this happens, it's already growing": Problematizing the definition of unmet need for family planning. “当你最意想不到的时候,它发生了,它已经在增长”:对未满足计划生育需求的定义提出质疑。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-05-29 eCollection Date: 2019-01-01 DOI: 10.2147/OAJC.S184909
Ielaf Khalil, Emma Zl Richardson

Background: Unmet need is an important indicator to understand baselines and set goals for family planning interventions. Women may not fall neatly in categories of met or unmet need for family planning as defined by the demographic and health surveys (DHS). We explore women's experiences of unmet need for family planning and provide empirical examples of how the static, binary DHS definitions of met and unmet need for family planning may be problematic. Methods: Based on Social Cognitive Theory, we conducted elicitation interviews with 16 married young women between the ages of 20 and 24 in Chimaltenango, Guatemala to explore barriers to accessing and using family planning. Half the participants (n=8) were using a modern method of family planning and half (n=8) were not. The current analysis focuses on data that was coded as ambiguous or unclear for unmet need status. Results: We identified framings of ambiguity from the women's narratives that are silenced by the dominant binary of met and unmet need. We show inconsistencies between women's lived experiences of unmet need and how their experiences would likely be represented in DHS questionnaires: 1) successful use of natural methods; 2) the complexity of "wantedness"; 3) conceptualizing met or unmet need as a trajectory; and 4) laughter obscuring clear response. Conclusion: Family planning status is a complex trajectory that the DHS may not accurately capture. As a way to reflect the diversity of women's family planning experiences, we suggest modifying the DHS classifications to incorporate latent met and unmet need as sub-classifications.

背景:未满足需求是了解计划生育干预基线和设定目标的重要指标。根据人口与健康调查(人口与健康调查)的定义,妇女在计划生育方面的需求可能并不完全属于满足或未满足的类别。我们探讨了妇女未满足计划生育需求的经历,并提供了实证例子,说明国土安全部对已满足和未满足计划生育需求的静态二元定义可能存在问题。方法:基于社会认知理论,对危地马拉Chimaltenango地区16名年龄在20 ~ 24岁的已婚年轻女性进行启发式访谈,探讨计划生育获取和使用的障碍。一半的参与者(n=8)使用现代计划生育方法,另一半(n=8)没有。当前的分析侧重于被编码为模糊或不明确的未满足需求状态的数据。结果:我们从女性叙事中确定了模糊的框架,这些框架被满足和未满足需求的主导二元性所沉默。我们显示了妇女未满足需求的生活经历与她们的经历在国土安全部问卷中可能表现的不一致:1)成功使用自然方法;2)“匮乏”的复杂性;3)将满足或未满足的需求概念化为一个轨迹;笑声掩盖了清晰的回应。结论:计划生育状况是一个复杂的轨迹,国土安全部可能无法准确捕捉。为了反映妇女计划生育经历的多样性,我们建议修改DHS分类,将潜在满足和未满足的需求纳入子分类。
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引用次数: 0
Contraception with estradiol valerate and dienogest: adherence to the method. 用戊酸雌二醇和双孕酮避孕:坚持方法。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-05-10 eCollection Date: 2019-01-01 DOI: 10.2147/OAJC.S204655
Franca Fruzzetti, Anna Maria Paoletti, Tiziana Fidecicchi, Giulia Posar, Riccardo Giannini, Marco Gambacciani

Purpose: The aim of the study was to examine the discontinuation rate of hormonal contraception with estradiol valerate (E2V) and dienogest (DNG). Patients and methods: We collected data at the Family Planning Clinics of the Departments of Obstetrics and Gynecology of Pisa and Cagliari. We included in the analysis 354 consecutive women using oral contraceptive pills containing E2V and DNG. We analyzed the rate and the reason for discontinuation, classifying the reasons in 5 categories: 1) minor side effects, 2) adverse events, 3) other events not directly caused by the drug or conditions for which the pill could represent a risk factor, 4) no compliance with the method and 5) no further need. Results: Of the 354 women examined, 50.8% had discontinued E2V/DNG pill. Excluding women who stopped the pill because of no further need (10.5%), 27.4% discontinued because of minor side effects, 1.7% discontinued for adverse events, 9.9% because of other events not directly caused by the drug or conditions for which the pill could represent a risk factor and 1.4% because of difficulties with compliance. Irregular bleedings were the main reasons reported for discontinuation. The time to discontinuation for irregular bleedings was significantly (p<0.02) longer in adults than in adolescents and slightly but not significantly longer in women who received information about this possible effect. Conclusion: Unacceptable cycle control was the principal cause of discontinuation of pill with E2V and DNG. An appropriate information about this possible effect may improve adherence to this combined oral contraceptive.

目的:研究戊酸雌二醇(E2V)和地诺孕酮(DNG)联合使用激素避孕的停药率。患者和方法:我们收集了比萨和卡利亚里妇产科计划生育诊所的数据。我们纳入了354名连续服用含E2V和DNG口服避孕药的妇女。我们分析了停药率和停药原因,将停药原因分为5类:1)轻微副作用,2)不良事件,3)非药物直接引起的其他事件或该药可能构成危险因素的情况,4)不符合该方法,5)不再需要。结果:在354名接受检查的女性中,50.8%的人停用了E2V/DNG药丸。不包括因不再需要而停药的妇女(10.5%),27.4%因轻微副作用停药,1.7%因不良事件停药,9.9%因非直接由药物引起的其他事件或避孕药可能构成危险因素的疾病停药,1.4%因难以遵医服药。不规则出血是停药的主要原因。结论:周期控制不良是导致E2V和DNG联合用药停药的主要原因。关于这种可能效果的适当信息可以提高对这种联合口服避孕药的依从性。
{"title":"Contraception with estradiol valerate and dienogest: adherence to the method.","authors":"Franca Fruzzetti,&nbsp;Anna Maria Paoletti,&nbsp;Tiziana Fidecicchi,&nbsp;Giulia Posar,&nbsp;Riccardo Giannini,&nbsp;Marco Gambacciani","doi":"10.2147/OAJC.S204655","DOIUrl":"https://doi.org/10.2147/OAJC.S204655","url":null,"abstract":"<p><p><b>Purpose:</b> The aim of the study was to examine the discontinuation rate of hormonal contraception with estradiol valerate (E2V) and dienogest (DNG). <b>Patients and methods:</b> We collected data at the Family Planning Clinics of the Departments of Obstetrics and Gynecology of Pisa and Cagliari. We included in the analysis 354 consecutive women using oral contraceptive pills containing E2V and DNG. We analyzed the rate and the reason for discontinuation, classifying the reasons in 5 categories: 1) minor side effects, 2) adverse events, 3) other events not directly caused by the drug or conditions for which the pill could represent a risk factor, 4) no compliance with the method and 5) no further need. <b>Results:</b> Of the 354 women examined, 50.8% had discontinued E2V/DNG pill. Excluding women who stopped the pill because of no further need (10.5%), 27.4% discontinued because of minor side effects, 1.7% discontinued for adverse events, 9.9% because of other events not directly caused by the drug or conditions for which the pill could represent a risk factor and 1.4% because of difficulties with compliance. Irregular bleedings were the main reasons reported for discontinuation. The time to discontinuation for irregular bleedings was significantly (<i>p</i><0.02) longer in adults than in adolescents and slightly but not significantly longer in women who received information about this possible effect. <b>Conclusion:</b> Unacceptable cycle control was the principal cause of discontinuation of pill with E2V and DNG. An appropriate information about this possible effect may improve adherence to this combined oral contraceptive.</p>","PeriodicalId":74348,"journal":{"name":"Open access journal of contraception","volume":"10 ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2019-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/OAJC.S204655","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37324531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives. 避孕药具的使用和性传播感染的风险:系统回顾和当前观点。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-11-12 eCollection Date: 2018-01-01 DOI: 10.2147/OAJC.S135439
Jennifer Deese, Subarna Pradhan, Hannah Goetz, Charles Morrison

Purpose: Evidence on the association between contraceptive use and risk of sexually transmitted infections (STIs) and bacterial vaginosis (BV) is lacking, with few prospective studies. We systematically reviewed the last 10 years' evidence on the association between contraception and STI/BV, building on the most recent systematic reviews published in 2006 and 2009.

Methods: We searched the MEDLINE and POPLINE databases for peer-reviewed articles p ublished between January 1, 2008 and January 31, 2018 reporting prospective studies that assessed the association between contraceptive use and incident STI and/or incident or recurrent BV.

Results: We identified 33 articles that evaluated combined oral contraceptives (COC), depot medroxyprogesterone acetate (DMPA), the copper intrauterine device (Cu-IUD), the levonorgestrel intrauterine system (LNG-IUS) and other methods. The strength of the evidence for many specific contraceptive method/STI associations is limited by few prospective studies with comparably defined exposures and outcomes. Available data suggest no association of COCs and Neisseria gonorrhoeae, Trichomonas vaginalis, HSV-2 or syphilis, and mixed evidence on the association with HPV, Chlamydia trachomatis, and BV. For DMPA, none of the studies identified found an association with N. gonorrhoeae or syphilis, and data on C. trachomatis, T. vaginalis, HPV and BV were mixed. Two large studies showed a highly clinically significant increased risk of HSV-2 infection with DMPA use. Data on the effect of Cu-IUD and the LNG-IUS on the acquisition of C. trachomatis, N. gonorrhoeae and T. vaginalis are sparse, and data on HPV and BV are mixed.

Conclusion: Few data are available from prospective studies, including randomized trials, to draw strong conclusions about the relationships between contraceptive methods and specific STIs. The overall evidence on the association between contraceptive use and STI/BV risk is limited by the lack of any randomized trials, few published prospective studies designed to analyze these associations, wide variability in exposure definitions and comparator groups, potential for confounding due to inaccurate sexual behavior data, differential confounder adjustment and differences in study populations and sizes. Despite these limitations, new evidence is supportive of a significantly increased risk of HSV-2 infection among DMPA users which warrants additional research to better understand this association.

目的:关于避孕药使用与性传播感染(STIs)和细菌性阴道病(BV)风险之间关系的证据缺乏,前瞻性研究很少。我们在2006年和2009年发表的最新系统综述的基础上,系统地审查了过去10年关于避孕与性传播感染/细菌性传播感染之间关系的证据。方法:我们检索MEDLINE和POPLINE数据库,检索2008年1月1日至2018年1月31日期间发表的同行评审文章,这些文章报道了评估避孕使用与性传播感染事件和/或性传播感染事件或复发性传播感染之间关系的前瞻性研究。结果:对复方口服避孕药(COC)、醋酸甲孕酮(DMPA)、铜宫内节育器(Cu-IUD)、左炔诺孕酮宫内系统(LNG-IUS)等方法进行评价的文献共33篇。许多特定避孕方法/性传播感染相关的证据强度受到少数具有可比较明确的暴露和结果的前瞻性研究的限制。现有资料显示COCs与淋病奈瑟菌、阴道毛滴虫、HSV-2或梅毒无关联,与HPV、沙眼衣原体和BV的关联证据不一。对于DMPA,没有一项研究发现它与淋病奈索菌或梅毒有关联,沙眼衣原体、阴道衣原体、HPV和BV的数据是混合的。两项大型研究显示,使用DMPA可显著增加2型单纯疱疹病毒感染的风险。关于Cu-IUD和LNG-IUS对沙眼衣原体、淋病奈球菌和阴道T.感染的影响的数据很少,关于HPV和BV的数据混杂。结论:从前瞻性研究(包括随机试验)中获得的数据很少,无法得出关于避孕方法与特定性传播感染之间关系的有力结论。由于缺乏任何随机试验,很少发表前瞻性研究来分析这些关联,暴露定义和比较组的差异很大,由于不准确的性行为数据,不同的混杂因素调整以及研究人群和规模的差异,可能导致混淆,关于避孕措施使用与性传播感染/细菌性传播感染风险之间关联的总体证据受到限制。尽管存在这些局限性,但新的证据支持DMPA使用者感染HSV-2的风险显著增加,这需要进一步研究以更好地了解这种关联。
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引用次数: 23
Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study. 布基纳法索和刚果民主共和国产后计划生育障碍和催化剂:一项多视角研究。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-11-09 eCollection Date: 2018-01-01 DOI: 10.2147/OAJC.S170150
Nguyen Toan Tran, Wambi Maurice E Yameogo, Mary Eluned Gaffield, Félicité Langwana, James Kiarie, Désiré Mashinda Kulimba, Seni Kouanda

Purpose: To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception.

Methods: Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural-urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health.

Results: Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3-6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services.

Conclusion: Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners.

目的:为了解决资源有限地区,特别是撒哈拉以南非洲地区对产后计划生育(PPFP)的高度未满足需求,本研究旨在确定与产后计划生育相关的障碍和催化剂,为政策和计划提供信息,以增加产后避孕的可及性。方法:采用定性方法,我们探讨了来自布基纳法索三个农村社区和刚果民主共和国三个城乡社区的妇女、少女、男性、宗教和社区领袖、服务提供者和决策者的观点。这两个国家对PPFP的需求未得到满足的程度都很高,而且都是法国马斯科卡妇幼保健基金的优先国家。结果:感知到的催化剂包括消极的传统观点,认为孩子和他们的母亲相距很近;产后6周的PPFP检查(尽管很少有人参加);计划生育的政治意愿和扶持政策;以及某些宗教领袖和男性的支持。据报道,主要的障碍是缺乏男性参与;自付避孕药具费用;依赖闭经预防怀孕而不了解其局限性;对现代避孕方法的误解,包括哺乳期闭经法的先决条件;宗教和传统规范支持的性禁欲长达3-6个月,尽管妇女报告较早恢复性活动;妇女产后检查的优先次序较低;容易获得的避孕方法、PPFP咨询材料以及专门用于避孕服务的门诊日和定期就诊有限。结论:根据最具可操作性的结果,以下干预措施有可能优化PPFP服务的可及性:通过使用适当的信息、教育和咨询材料,在分娩前后的不同时间点向妇女提供有关产后妊娠风险和选择的咨询;将PPFP服务纳入现有的妇幼保健检查;使避孕药具易于获得和负担得起;以及有意义地吸引男性伴侣。
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引用次数: 21
Venous thrombosis and hormonal contraception: what's new with estradiol-based hormonal contraceptives? 静脉血栓和激素避孕:以雌二醇为基础的激素避孕药有什么新发现?
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-11-08 eCollection Date: 2018-01-01 DOI: 10.2147/OAJC.S179673
Franca Fruzzetti, Angelo Cagnacci

Objective: Estradiol (E2)-based hormonal contraceptives impact less than ethinylstradiol (EE) contraceptives on venous thromboembolism (VTE) in comparison to formulations with EE.

Study design: In this article, the pharamacologic data of EE and E2 were briefly reviewed, along with the induced biologic effect. These data were then related to a recent large international prospective, controlled, non-interventional cohort active surveillance study, on the cardiovascular risk of users of different types of combined estroprogestin contraceptive (CEPC).

Results: The crude HR for E2-valerate (E2V)/dienogest vs other CEPCs with EE was 0.8 (95% CI, 0.4-1.6), but when the data were corrected for age, body mass index, duration of use, and family history of VTE, the corresponding adjusted HR was 0.5 (95% CI, 0.2-1.0). A comparison of the E2V/dienogest and EE/levonorgestrel groups showed that the two contraceptives induced a similar VTE risk with the crude and adjusted VTE HRs of 0.7 (95% CI, 0.3-1.8) and 0.5 (95% CI, 0.2-1.3), respectively. Similar results were obtained when the observation was prolonged to January 2017.

Conclusions: The reduced impact of E2 vs EE on coagulation translates into the epidemiologic evidence of a reduced number of events in E2V vs EE users, when progestins other than levonorgestrel are used. However, E2 may continue to negatively impact on the risk of VTE, and this should not be forgotten at the time of prescription. Family history of VTE or thrombophilia, age, and obesity are risk factors for VTE too. If these risk factors are not taken into consideration and excluded, they can overcome or hide the higher safety of E2 vs CEPCs with EE.

目的:以雌二醇(E2)为基础的激素避孕药对静脉血栓栓塞(VTE)的影响小于炔雌醇(EE)避孕药。研究设计:本文简要综述了EE和E2的药理资料,以及诱导的生物学效应。这些数据随后与最近的一项大型国际前瞻性、对照、非干预性队列主动监测研究相关,该研究针对不同类型的联合雌激素-孕激素避孕药(CEPC)使用者的心血管风险。结果:e2 - valate (E2V)/dienogest与其他具有EE的cepc的粗HR为0.8 (95% CI, 0.4-1.6),但当数据校正年龄、体重指数、使用时间和VTE家族史时,相应的调整HR为0.5 (95% CI, 0.2-1.0)。E2V/dienogest组和EE/左炔诺孕酮组的比较显示,两种避孕药诱导的静脉血栓栓塞风险相似,粗静脉血栓栓塞风险比为0.7 (95% CI, 0.3-1.8),调整后的静脉血栓栓塞风险比为0.5 (95% CI, 0.2-1.3)。将观测时间延长至2017年1月,也得到了类似的结果。结论:E2与EE对凝血的影响降低转化为流行病学证据,表明当使用左炔诺孕酮以外的孕激素时,E2V与EE使用者的事件数量减少。然而,E2可能会继续对静脉血栓栓塞的风险产生负面影响,在处方时不应忘记这一点。静脉血栓栓塞家族史、年龄和肥胖也是静脉血栓栓塞的危险因素。如果不考虑和排除这些危险因素,它们可以克服或掩盖E2与EE的cepc的更高安全性。
{"title":"Venous thrombosis and hormonal contraception: what's new with estradiol-based hormonal contraceptives?","authors":"Franca Fruzzetti,&nbsp;Angelo Cagnacci","doi":"10.2147/OAJC.S179673","DOIUrl":"https://doi.org/10.2147/OAJC.S179673","url":null,"abstract":"<p><strong>Objective: </strong>Estradiol (E2)-based hormonal contraceptives impact less than ethinylstradiol (EE) contraceptives on venous thromboembolism (VTE) in comparison to formulations with EE.</p><p><strong>Study design: </strong>In this article, the pharamacologic data of EE and E2 were briefly reviewed, along with the induced biologic effect. These data were then related to a recent large international prospective, controlled, non-interventional cohort active surveillance study, on the cardiovascular risk of users of different types of combined estroprogestin contraceptive (CEPC).</p><p><strong>Results: </strong>The crude HR for E2-valerate (E2V)/dienogest vs other CEPCs with EE was 0.8 (95% CI, 0.4-1.6), but when the data were corrected for age, body mass index, duration of use, and family history of VTE, the corresponding adjusted HR was 0.5 (95% CI, 0.2-1.0). A comparison of the E2V/dienogest and EE/levonorgestrel groups showed that the two contraceptives induced a similar VTE risk with the crude and adjusted VTE HRs of 0.7 (95% CI, 0.3-1.8) and 0.5 (95% CI, 0.2-1.3), respectively. Similar results were obtained when the observation was prolonged to January 2017.</p><p><strong>Conclusions: </strong>The reduced impact of E2 vs EE on coagulation translates into the epidemiologic evidence of a reduced number of events in E2V vs EE users, when progestins other than levonorgestrel are used. However, E2 may continue to negatively impact on the risk of VTE, and this should not be forgotten at the time of prescription. Family history of VTE or thrombophilia, age, and obesity are risk factors for VTE too. If these risk factors are not taken into consideration and excluded, they can overcome or hide the higher safety of E2 vs CEPCs with EE.</p>","PeriodicalId":74348,"journal":{"name":"Open access journal of contraception","volume":"9 ","pages":"75-79"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/OAJC.S179673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36799526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 26
Programmatic implications of unmet need for contraception among men and young married women in northern Nigeria. 尼日利亚北部男性和年轻已婚妇女避孕需求未得到满足对计划的影响。
IF 16.4 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-11-08 eCollection Date: 2018-01-01 DOI: 10.2147/OAJC.S172330
Irit Sinai, Jabulani Nyenwa, Olugbenga Oguntunde

Purpose: The study was designed to provide programmatic recommendations for interventions to increase contraceptive prevalence in northern Nigeria. Family-planning use in North-East and North-West regions of Nigeria has remained very low, despite years of domestic and donor investments. We examine respondents' perceptions of their own need for contraception and specifically focus on young women because of their higher risk for maternal mortality.

Methods: In this cross-sectional study, we interviewed 1,624 married women younger than 25 years and 1,627 men married to women younger than 25 years, in Kaduna and Katsina states in northern Nigeria. We classified respondents into five categories: 1) having no real need for contraception, 2) perceiving no need for contraception, despite physical or behavioral need, 3) having met need by using a modern contraceptive method, 4) perceiving met need by employing traditional practices, and 5) having unmet need for contraception.

Results: Half of female respondents had no need for contraception because they were either pregnant or desiring a pregnancy at the time of the survey. A quarter of female and male respondents were not using contraception because of their religious beliefs. Less than 2% of respondents had unmet need because of lack of availability or access, or due to poor quality of care. Men had more positive views of family planning than women.

Conclusion: Our findings suggest that young women in northern Nigeria would benefit from a programmatic approach that targets men, utilizes religious leaders, and addresses the prevalent religious and sociocultural norms that present barriers to contraceptive use. Such interventions have the potential to increase contraceptive prevalence more substantially, but the literature on these types of interventions in northern Nigeria is scarce. Therefore, more research is needed to identify and document what approaches work or do not work to increase contraceptive use in northern Nigeria.

目的:本研究旨在为提高尼日利亚北部避孕普及率的干预措施提供方案建议。尽管国内和捐助方多年来一直在投资,但尼日利亚东北部和西北部地区的计划生育使用率仍然很低。我们研究了受访者对自身避孕需求的看法,并特别关注年轻女性,因为她们的孕产妇死亡风险较高:在这项横断面研究中,我们在尼日利亚北部的卡杜纳州和卡齐纳州采访了 1624 名 25 岁以下的已婚女性和 1627 名与 25 岁以下女性结婚的男性。我们将受访者分为五类1) 没有实际避孕需求;2) 尽管有生理或行为需求,但认为没有避孕需求;3) 通过使用现代避孕方法满足了需求;4) 通过使用传统方法满足了需求;5) 未满足避孕需求:半数女性受访者没有避孕需求,因为她们在接受调查时已经怀孕或希望怀孕。四分之一的女性和男性受访者因宗教信仰而不采取避孕措施。只有不到 2%的受访者因为缺乏避孕药具或无法获得避孕药具,或者因为护理质量不佳而未满足需要。男性对计划生育的看法比女性更为积极:我们的研究结果表明,针对男性、利用宗教领袖、解决阻碍避孕药具使用的普遍宗教和社会文化规范的计划方法将使尼日利亚北部的年轻女性受益。此类干预措施有可能更大幅度地提高避孕普及率,但有关尼日利亚北部此类干预措施的文献却很少。因此,需要开展更多的研究,以确定和记录哪些方法对提高尼日利亚北部的避孕药具使用率有效或无效。
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引用次数: 0
Percutaneous extraction of an embolized progesterone contraceptive implant from the pulmonary artery. 经皮从肺动脉取出栓塞的孕酮避孕植入物。
Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-07-17 eCollection Date: 2018-01-01 DOI: 10.2147/OAJC.S165827
Mohammed Majid Akhtar, Amit Bhan, Zhan Yun Lim, Mohammed Abid Akhtar, Neha Sekhri, Preeti Bharadwaj, Michael Mullen

The Nexplanon® implant is a commonly used radiopaque contraceptive device that contains progestogen associated with an ethylene vinyl-acetate copolymer resulting in a slow release of the active hormonal ingredient. It is inserted into the subdermal connective tissue and provides contraceptive efficacy for up to 3 years. Device removal for clinical, personal or device "end-of-life span" reasons is straightforward. In rare cases, implant migration can occur locally within centimeters of the insertion site. Distant device embolization is extremely rare and can result in complications including chest pain, dyspnoea, pneumothorax and thrombosis or prevent conception until the active ingredient is depleted. We present one such case, where a Nexplanon® implant embolized into the pulmonary artery of a young female patient. We describe the initial "missed" diagnosis of embolized device on a chest radiograph and subsequent successful percutaneous removal once distant embolization was diagnosed.

Nexplanon®植入物是一种常用的不透射线避孕装置,含有孕激素与乙烯乙烯-醋酸酯共聚物,导致活性激素成分缓慢释放。它被插入皮下结缔组织,提供长达3年的避孕效果。出于临床、个人或设备“寿命结束”的原因而移除设备是直截了当的。在极少数情况下,植入物迁移可发生在植入部位几厘米内的局部。远端器械栓塞极为罕见,可能导致并发症,包括胸痛、呼吸困难、气胸和血栓形成,或阻止受孕,直到有效成分耗尽。我们提出一个这样的案例,其中一个Nexplanon®植入物栓塞到肺动脉的年轻女性患者。我们描述了最初的“错过”诊断的栓塞装置胸片和随后的成功经皮切除一旦远处栓塞的诊断。
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引用次数: 6
期刊
Open access journal of contraception
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