BMJ Sexual & Reproductive Health最新文献

Aim: This scoping review mapped quantitative evidence on men's preconception care (PCC) focusing on: (1) knowledge, (2) behaviours and attitudes, (3) reproductive intentions and (4) outcomes of educational or counselling interventions. The review also sought to identify evidence gaps and inform future policies and practices to enhance male engagement in reproductive health.

Methods: Quantitative studies involving men aged ≥18 years from high- and upper-middle-income countries were included. Studies focusing on couples, non-English-language publications, qualitative research, reviews and commentaries were excluded. Quantitative designs were prioritised to map measurable determinants and outcomes of engagement in PCC. Searches were conducted across seven databases in September 2025, following the PRISMA-ScR framework. No critical appraisal was performed, consistent with scoping review methodology.

Results: Fourteen studies (n=18 733 men) were included, most of which were observational. Findings indicated low fertility awareness, inconsistent engagement in preconception behaviours, and minimal use of supplements or healthcare services. Differences were noted by age, education and fatherhood status. One intervention improved knowledge but did not address systemic barriers.

Conclusions: Men remain underrepresented in PCC. Gender-transformative, system-level reforms integrating men into primary care, health education and public messaging are needed. Future research should test context-specific, equity-oriented interventions to promote inclusive PCC for all.

Objectives: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care.

Study design: We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare.

Results: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion.

Conclusions: Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.

Background: Medical abortion beyond 12 weeks' gestation increases experienced pain. The effectiveness of pain management protocols remains to be evaluated.

Methods: This was a secondary analysis of a randomised controlled trial, conducted in six Swedish hospitals from 2019 to 2022, investigating home administration of the first misoprostol dose. Paracetamol 1000 mg and a non-steroidal anti-inflammatory drug (NSAID) were provided with the first misoprostol dose and subsequent breakthrough pain medication as required. We recruited persons >18 years of age, with a viable singleton pregnancy between 12 weeks+1 day and 21 weeks+6 days of gestation. We collected data on patient-reported pain using a visual analogue scale (VAS, 0-100 mm) at fetal expulsion and maximum pain assessed retrospectively prior to discharge. We collected data on the use of breakthrough pain medication, satisfaction scores with pain relief, and VAS scores before/after administration of breakthrough analgesia.

Results: We included 425 individuals. The participants reported a mean VAS of 39.1 (SD 34.4) at expulsion and 65.4 (SD 28.6) as maximum pain (assessed after abortion before discharge) and 352/425 (82.8%) received breakthrough pain medication, with 266/425 (62.6%) receiving an oral opioid, 163/425 (38.4%) a paracervical block (PCB) and 86/425 (20.2%) a parenteral opioid. A total of 357/392 (91.1%) participants were satisfied with the pain relief. Administration of a PCB alone or following an opioid resulted in the largest decrease in VAS.

Conclusions: Many participants reported high VAS scores but most of them were satisfied with their analgesic treatment. A PCB was associated with the highest effectiveness in alleviating pain.

Objective: Abortion care in Germany is under-researched. Available data show regional disparities in the availability and accessibility of abortion services, but the structural causes for this remain unclear. In Germany, abortion is technically illegal but is exempt from punishment under the counselling regulation, which means that the pregnant person has to undergo mandatory counselling and observe a 3-day waiting period. This qualitative interview study examines the perspectives of abortion care providers on the provision of abortion care under this regulation in Germany.

Design: We included 42 gynaecologists and abortion counsellors nationwide. We conducted in-depth, guideline-based interviews that explored the participants' perspectives on challenges in abortion care. The data were analysed using qualitative content analysis according to Mayring. The results were evaluated against the WHO's components of the right to sexual and reproductive health: availability, accessibility, acceptability, quality, and equity, inclusivity and patient-centredness of care.

Results: We identified various structural barriers that limit the availability, accessibility, acceptability and quality of abortion care under the counselling regulation in Germany. Interviewees named the shortage of doctors performing abortions as one structural root cause for insufficient abortion care that is exacerbated by the procedure's criminalisation. A lack of information transparency, complex legal requirements, language barriers, disinformation as well as social stigmatisation were cited as important barriers to abortion care. These barriers were described as having a particularly strong impact on patients from marginalised groups.

Conclusions: Our study indicates that structural barriers associated with the current legal regulation create significant hurdles for both patients and providers and undermine the access, availability, acceptability, quality of care, and patient-centredness of care. In this context, we strongly support the recommendation of the German government's expert commission to revise the current legal regulation of abortion in Germany.

Introduction: High-sensitivity urine pregnancy tests can detect pregnancy before missed menses. The widespread availability of these tests, alongside improvements in abortion access in many settings, may mean more women present for abortion at a very early stage of pregnancy. We aimed to examine the outcome of early medical abortion (EMA) in pregnancies less than 30 days from last menstrual period (LMP).

Methods: This study analysed prospectively collected data on patients at less than 30 days from LMP seeking abortion at a single service in Edinburgh, UK between March 2020 and December 2023. We determined the effectiveness, outcomes of the pregnancy (complete abortion, ongoing pregnancy, incomplete abortion) and serious complications among those seeking EMA at this gestation.

Results: Of 13 565 patients seeking abortion, 78 (0.6%) presented with a self-reported positive home pregnancy test and less than 30 days from LMP. Some 63/78 patients (81%) proceeded to EMA with mifepristone followed by misoprostol. Of this group, 31/63 (49%) had a pre-abortion ultrasound. Complete abortion occurred in 58/63 (92%, 95% CI 82% to 97%), 4/63 (6%) had an ongoing pregnancy and 1 (1%) had a surgical evacuation for incomplete abortion. There were no serious complications.

Conclusions: Only a very small percentage of patients present for abortion before a missed period. Nevertheless, EMA at this stage is safe and effective. There may be a higher rate of ongoing pregnancy, and so those patients wishing to proceed to EMA should be advised of the importance of confirming success in line with local protocols.

Background: Hospital-based second-trimester dilation and evacuation (D&E) procedures are often completed using general anaesthesia (GA) despite emerging evidence for the safety of monitored anaesthesia care (MAC). Limited data exist comparing these approaches for key clinical outcomes.

Study design: This retrospective cohort study compared those who received GA versus MAC during second-trimester (14-24 weeks' gestation) hospital-based D&Es. The primary outcome was total operating room (OR) time; secondary outcomes included surgical time, anaesthetic time, post anaesthesia care unit (PACU) time, estimated blood loss, and respiratory complications. We hypothesised that MAC would reduce the total OR time. We estimated that a sample size of 63 participants in each group would detect a 15-min or greater difference in total OR time with 80% power and a significance level of 0.05. Propensity score matching was used for sensitivity analysis.

Results: During the study period, 125 patients received GA and 67 received MAC. Those receiving GA had significantly longer OR times (GA: 60.2±18.1 min vs MAC: 50.1±13.2 min, p=0.005) and greater estimated blood loss (GA: 150±286 mL vs MAC: 88±47 mL, p<0.001). No respiratory complications occurred in either group. A propensity score-matched analysis similarly found GA associated with longer OR time and higher blood loss.

Conclusions: MAC may offer additional clinical benefits compared with GA during hospital-based D&E care. MAC reduces OR time and blood loss without compromising safety, which may optimise patient care and resource use in abortion care settings.