Contraception最新文献

Objective: While an improved understanding of the epidemiology and outcomes of hormonal contraceptive use in persons with sickle cell disease is needed to better inform evidence-based guidelines, patterns of contraception use remain understudied. Our objective was to examine patterns of contraception use among patients with sickle cell disease and employer-sponsored insurance.

Study design: Our analyses utilized the Merative™ MarketScan® Commercial Database (2012-2019). The study included females 12-44 years meeting the study definition of sickle cell disease (presence of three ICD-9 or ICD-10 codes consistent with sickle cell disease). We utilized pharmacy and procedure claims to capture hormonal contraception use.

Results: We identified 5,957 unique females of reproductive age (12-44 years) with sickle cell disease, 1,653 (28%) of whom utilized hormonal contraception. When examining the first identified contraception prescription, 43.9% were prescribed estrogen-containing agents and 56.1% were prescribed progestin-only. The most frequently prescribed contraceptive was combined contraceptive pills (n=645, 39%), followed by depot medroxyprogesterone acetate (n=413, 25%). Intrauterine devices and subcutaneous implants were prescribed to 15.7% and 6.4% of individuals, respectively.

Conclusions: Our work identified hormonal contraception use in less than one-third of reproductive-age females with sickle cell disease using employer-sponsored insurance. Over 40% of new users of hormonal contraception received prescriptions for estrogen-containing agents, demonstrating a need for education regarding the 2024 U.S. MEC recommendations, which contradict estrogen for patients with sickle cell disease. Future directions should also include understanding patient characteristics and health outcomes among combined hormonal contraceptive users with sickle cell disease to better inform eligibility criteria.

Implications: Estrogen-containing agents make up a substantial percentage of contraception prescriptions in women with sickle cell disease and employer-sponsored insurance. High-quality data regarding the safety of hormonal contraception in the setting of sickle cell disease are needed to inform evidence-based guidelines and medical eligibility criteria.

Previable Preterm Prelabor Rupture of Membranes (PPROM) is a rare complication of transabdominal cerclage (TAC), with limited data to guide management. This case describes dilation and evacuation (D&E) at 23 weeks gestation with TAC in situ, highlighting management considerations and supporting the safety of D&E in this context.

The sexual and reproductive health (SRH) of millions of women, girls, and people of reproductive capacity is under threat across the Americas. Digital SRH tools can offer critical and life-saving resources in restrictive contexts, but data are often monitored and collected by third parties. This form of surveillance carries significant emotional, physical, and legal risks to the users of digital tools. To highlight the need for transparent, safe, and accountable FemTech and digital health environments, this commentary shares insights on the safeguarding considerations for Aya Contigo, a digital medication abortion and contraception tool. The app was developed in Venezuela through a participatory design methodology and was later expanded to other Latin American countries and the United States. To maximize user privacy and security, Aya Contigo was developed with a user-centered design approach and input from digital cybersecurity experts. The app safeguards users through its user-operated security features and back-end data minimization and security policies. Despite adhering to best practice guidelines, interactive digital health platforms such as Aya Contigo carry inherent privacy and security risks which must be transparently conveyed to users. In a global digital space where regulation is often sparse, SRH-focused resources must include a robust and adaptable safeguarding strategy to best protect users and create mechanisms for accountability.

Objectives: To describe temporal and geographic patterns of ulipristal acetate (UPA) dispensing in Alberta, Canada, following Health Canada approval, and to assess whether UPA access aligns with population demand.

Study design: Repeated cross-sectional, population-level analysis of all Alberta residents aged 15-49 years between September 1, 2015, and June 30, 2023. UPA dispensing was captured via the Pharmaceutical Information Network. Primary outcome was annual, population-standardized rate of UPA dispensing per 10,000 females. Secondary outcomes included travel time and distance to pharmacies, number of prescribers, and number and proportion of pharmacies dispensing UPA. Temporal trends were analyzed using ordinal least squares or median regression; spatial patterns were evaluated via subzone-level mapping of UPA demand and supply.

Results: A total of 1,990 UPA prescriptions were dispensed during the study period. First dispensation occurred 86 days post-approval. UPA utilization increased steadily over time at a rate 0.38 additional UPA uses per 10,000 females annually. Number of prescribers, and proportion of pharmacies dispensing UPA also increased over the interval. Median travel time and distance remained stable, with extended travel (more than two hours) only in remote regions. Geospatial analysis demonstrated general alignment between patient demand and pharmacy supply, including in rural regions, suggesting equitable geographic access.

Conclusions: UPA access in Alberta has steadily increased, with improving availability across the province and evidence that urban and rural populations are being equally served. Despite this progress, uptake of UPA post-approval was slower than expected for a newly marketed prescription drug, highlighting potential barriers related to awareness, adoption patterns, and coverage.

Implication statement: Ulipristal acetate use in Alberta, Canada steadily increased since approval, with equitable rural and urban access. First-year uptake appeared to have a lag compared to other new medications, suggesting adoption barriers. Clinician awareness, patient education, and policy support remain essential to ensure equitable access to this highly effective emergency contraception.

Objective: To determine whether a paracervical block (lidocaine 1% with epinephrine 1:100,000 10 mL) decreases pain during intrauterine device (IUD) placement STUDY DESIGN: We conducted a randomized, double-blind trial of three arms: paracervical block, saline injection, or capped needle from June 30, 2022, to August 16, 2024. The primary outcome was the global pain score, rated on a 100mm visual analog scale. Secondary outcomes included pain perception at procedural timepoints using a numeric score, and patient satisfaction.

Results: We included a total of 246 patients (n=82 per group). Overall, participants who received a paracervical block reported lower global pain scores during IUD placement (median 30 mm, IQR 10-50) compared with those receiving saline injection (median 45 mm, IQR 25-60) or a capped needle (median 45 mm, IQR 20-70) (p=0.003 and p=0.001, respectively). Among nulliparous participants, the paracervical block also reduced pain (median 40 mm, IQR 25-53) compared with saline (median 50 mm, IQR 30-68) and capped needle (median 60 mm, IQR 33-70) (p<0.001). Paracervical injection pain was minimal with a median of 1 out of 10 (IQR 0.00 - 2.00). Secondary outcomes demonstrated reduced patient pain at all timepoints of IUD insertion (e.g. tenaculum placement, uterine sounding, and IUD insertion) as well as higher patient satisfaction (p<0.01) in comparison to the capped needle group.

Conclusion: The paracervical block significantly reduced global pain score during IUD insertion, particularly for nulliparous participants, and is associated with minimal injection pain.

Implications: Findings from this randomized, double-blind trial support incorporating paracervical block into routine IUD insertion, especially for nulliparous patients who experience higher pain. Wider adoption may improve procedural comfort, satisfaction, and acceptability of IUD use. Future research should evaluate implementation, patient preferences, and variations in technique.

Objectives: Postpartum permanent contraception (PPPC) surgeries via minilaparotomy following vaginal delivery are effective and safe. We evaluated PPPC case volume and confidence among graduating obstetrics and gynecology (OBGYN) residents.

Study design: We conducted a cross-sectional survey between August 10, 2021, and January 31, 2022 of fourth-year obstetrics and gynecology residents at Ryan Residency programs to evaluate case volume, barriers to completion, and confidence. We used descriptive statistics for baseline characteristics. We assessed associations between case volume and region using a linear mixed-effects model with square-root transformation and evaluated associations between case volume and procedural confidence using multivariable mixed-effects logistic regression with random intercepts for programs.

Results: One hundred and thirty-three of 654 eligible residents (20%) from 62 of 98 eligible programs (63%) completed the survey. Respondents reported performing a median of 10 PPPC surgeries (interquartile ranges 5-20). By graduation, 78% felt comfortable performing PPPC surgeries, and 86% felt prepared to do so independently in emergencies (proxy for surgical independence). Confident residents performed more PPPC surgeries than less confident peers (15.0 vs 3.0 and 13.5 vs 3.0, p < 0.0001). Each additional surgery increased the odds of confidence by graduation (odds ratios 1.24, 95% CI 1.12-1.38, p < 0.0001) and in emergencies (odds ratios 1.22, 95% CI 1.07-1.38, p = 0.004), adjusting for race, ethnicity, and gender identity. Residents felt less confident performing salpingectomies (64%) and managing complications (63%). Barriers included lack of operating room (66.9%) and nursing availability (51.9%), obesity (64.7%), and invalid consents (56.4%).

Conclusions: PPPC case volume remains low. Higher procedural volume correlates with greater confidence, though gaps remain in managing complications and salpingectomies.

Implications: PPPC case volume during residency is low, limiting residents' confidence across procedural steps. Reported barriers reduce training opportunities, though surgical confidence parallels minimally invasive hysterectomy. Removing systemic barriers can enhance patient autonomy, strengthen resident education, and prevent future provider shortages, an especially urgent priority in today's shifting reproductive health landscape.

Objectives: To evaluate the impact of increased outpatient access on care for pregnancy of unknown location (PUL).

Study design: Retrospective cohort study comparing patients diagnosed with PUL at Albany Medical Center at baseline (2018-2019) and with expanded outpatient access (2022-2023).

Results: Initial ultrasounds occurring outpatient increased from 23/72 (32%) in the baseline cohort to 49/86 (57%) in the expanded access cohort, with shorter time to final diagnosis (median 13.5 days to 5 days) and increased documentation of patient coping (8% to 49%) and reproductive planning (31% to 65%). All p < 0.01.

Conclusion: Expanded outpatient access is associated with improved diagnostic efficiency and patient-centered care for PUL.

Implications: Greater access to timely outpatient early pregnancy care prompts more patient touchpoints over a shorter timeframe, decreasing time to diagnosis for pregnancy of unknown location. Further study is needed to explore cost-effectiveness and patient preferences around more concentrated care.

Objective: In the United States, women disproportionately bear the responsibility of preventing pregnancy. Although vasectomy is safer, less invasive, and more cost-effective than tubal ligation, it remains significantly underutilized. To better understand this disparity, our study examines gender-based differences in contraceptive counseling during medical visits.

Study design: We examined data from the National Survey for Family Growth, a nationally representative weighted survey capturing data on reproductive health, contraceptive use, and family planning. Between 2017-2019, 11,347 respondents (6,141 females and 5,206 males) aged 15-49 were interviewed. Demographics and responses related to healthcare utilization were compared between males and females.

Results: During medical visits, males were less likely than females to receive contraceptive counseling (OR 0.12, [95% CI 0.11 - 0.14), STI prevention counseling (OR 0.09, [95% CI 0.06 - 0.12]), or permanent contraception counseling (OR 0.46, [95% CI 0.23-0.92]). Males without health insurance were less likely than insured males to have received vasectomy counseling (OR 0.29, [95% CI 0.04-0.52]) while a lack of insurance was unrelated to permanent contraception counseling in females.

Conclusion: Our study demonstrates gender-based disparities in counseling for reversible contraception, permanent contraception, and STI prevention. Medical providers must improve counseling of male patients for contraceptive options, especially vasectomy, as it remains amongst the safest and most cost-effective forms of contraception.

Implications: This study reveals that men are less likely than women to receive counseling on contraception, including permanent contraception during medical visits. Providers can promote reproductive health equity by engaging both men and women in discussions about contraception and family planning during routine care.