Contraception最新文献

This case explored a novel surgical method to fix levonorgestrel 52-mg intrauterine devices in the uterine cavity for adenomyosis with uterine septum. It successfully applied the technique in a 43-year-old patient, showing convenience, feasible. This method applies to patients with prior levonorgestrel 52-mg intrauterine device detachment and provides a reference for the management of individuals with uterine septum.

Objectives: Bleeding is a key expected result of medication abortion (MA); however, people's expectations and experiences of bleeding can affect their abortion experiences. Our objective was to document the measurement approaches of MA-related bleeding in the literature to date from a patient perspective.

Study design: We conducted a systematic scoping review of English language, peer-reviewed studies identified through PubMed from January 2000 to March 2025. The authors screened abstracts and full text in Covidence based on pre-determined inclusion and exclusion criteria. We included quantitative, qualitative, and mixed methods studies from any geographic region. All authors extracted data on time to onset, duration, volume, expectations, and acceptability of bleeding.

Results: The majority of the 111 included studies measured bleeding duration (89), followed by volume (65), time to onset (35), expectations (32), and acceptability (22). Studies used a variety of data collection approaches, including patient diaries/symptom logs, questionnaires, and in-depth interviews. Measurement of volume was most often in comparison to a menstrual period, and a variety of scales were also used. No studies mentioned using measurements that had been developed through a participatory process involving patients.

Conclusions: This review provides clinicians, researchers, and advocates an overview of the measurement approaches to date regarding MA-related bleeding. Learnings from other fields, including menstrual health, can guide the development of future patient-reported outcome measures that reflect a broader range of patient experiences with MA-related bleeding.

Objective: To determine the prevalence of self-reported medical contraindications to hormonal contraception among over-the-counter (OTC) users.

Study design: We conducted a cross-sectional survey of individuals aged 15-45 obtaining oral contraception (OTC using a progestin only pill (POP) versus a prescribed combined oral contraceptive (COC) pill) to determine the prevalence of medical contraindications to use. We recruited participants online and at pharmacies from April 2024 to March 2025. We defined contraindications using a simplified list of the Center for Disease Control's Medical Eligibility Criteria for Contraceptive Use category 3/4 conditions.

Results: Among OTC users, only 0.3% reported a contraindication to progestin only pill (POP) use. With regards to contraindications to a combined oral contraceptive pill (COC), the OTC users reported a higher rate of category 3/4 conditions to a COC (25.1%, n=75) versus the prescription group (15.5%), n=43).

Conclusion: Medical contraindications to a POP pill among OTC users in the United States is rare.

Objective: To describe over-the-counter (OTC) birth control pill sales relative to state policy environments.

Study design: We analyzed OTC pill sales data from March 2024 to September 2025. We analyzed sales as a ratio per population of women aged 15-44. States were categorized into quintiles based on previously published contraceptive workforce ratios and state abortion restrictions.

Results: OTC pills differed significantly by contraceptive workforce and abortion restrictions with the highest ratio of sales occurring in states with the lowest quintile of contraceptive workers (2.84) and the greatest number of abortion restrictions (3.02).

Conclusion: The OTC pill may bridge access in states with restrictive policy environments.

Objective: Clinicians, researchers, and policy-makers have limited understanding of how people seeking induced abortion think and feel about opportunities to engage with their pregnancies, including mementos. We sought to characterize why people desire or decline specific mementos for induced abortion and relate these decisions to grief or decisional uncertainty.

Study design: We conducted a mixed methods study of people seeking induced abortion, using purposive sampling to enroll patients in the first and second trimesters, and with and without diagnosed fetal anomalies. Enrollment dates were from 8/2019 to 4/2020. We report on mementos and opportunities to engage with the pregnancy including: viewing the ultrasound exam, receiving ultrasound photos or fetal footprints, learning multiple gestations are present, learning the presumed sex of the pregnancy, viewing the pregnancy tissue after the abortion, and arranging for private burial or cremation of the pregnancy tissue. We completed individual semi-structured interviews to explore each participant's memento choices and the reasons for those choices. We derived themes and subthemes from the transcripts using the constant comparative method. Participants completed validated surveys to measure feelings of grief and loss relating to their pregnancy, and their decisional certainty about their abortion.

Results: Memento choices and the reasons for those choices varied widely among the 39 participants who completed interviews. Choices were not predictable by gestational duration, level of grief, decisional certainty, or the presence of fetal anomalies. Reasons participants desired mementos included closure and to cope with loss, curiosity or disbelief about their pregnancy, and to maintain a memory. Others declined mementos because they did not want the reminder of the experience, they would raise difficult emotions, or they disagreed with the suggestion of the fetus's humanity.

Conclusion: Pregnant people seeking abortion make individualized, unpredictable choices regarding pregnancy mementos, but generally appreciate the offer. Best practice for holistic abortion care should include offering pregnancy mementos in a person-centered way that avoids assumptions.

Implications: We found that patients seeking induced abortion defy preconceived notions of who may want pregnancy mementos like ultrasound printouts or fetal footprints, and accept or decline those mementos for varied and nuanced reasons. These results suggest that pregnancy mementos should be universally offered, where feasible, but not mandated.

Objective: To evaluate the accuracy of Current Procedural Terminology (CPT) codes used to bill inpatient second- and third-trimester labor induction abortion relative to clinically confirmed encounters at a Northern California academic medical center.

Study design: We conducted a two-phase retrospective chart review. In phase one, we assessed whether encounters billed using CPT codes recommended for labor induction abortion (59850, 59851, 59855, 59856) from 2014 to 2024 represented true labor induction abortions based on electronic medical record (EMR) review using predefined clinical criteria. In phase two, we assessed how actual labor induction abortions were coded through identification of clinically confirmed encounters through manual review of labor and delivery unit paper logs from January to December 2024 and examined the CPT codes applied to these encounters, including use of vaginal delivery codes permitted by professional guidance for gestations ≥ 20 weeks.

Results: Of 57 encounters billed using labor induction abortion-specific CPT codes over the 11-year period in phase one, 26 (46%) represented clinically confirmed labor induction abortions. Manual review in phase two identified 47 such procedures in 2024 alone; of these, only 5 (11%) were coded using labor induction abortion-specific CPT codes. Including vaginal delivery coding permitted by professional guidance, 20 of 47 cases (43%) were coded appropriately.

Conclusions: CPT coding for inpatient second- and third-trimester labor induction abortion fails to reliably capture the true incidence of these procedures and demonstrates substantial inconsistency and misclassification, limiting utility of data for abortion research, surveillance, and financial analyses.

Implications: CPT coding and billing for second- and third-trimester labor induction abortion at one institution is highly inaccurate and does not capture the true incidence. Assuming this finding is representative of national trends, billing datasets for these procedures are likely unreliable and have limited utility for research and policy.

Objective: To understand the experiences and possible gaps in care, including availability of perinatal palliative care, in patients carrying a pregnancy diagnosed with life-limiting fetal anomalies who sought abortion.

Study design: From April 2020 to May 2021, we conducted in-depth semi-structured interviews 2-8 weeks after participants had aborted a pregnancy with a life-limiting fetal condition. We recruited English-speaking participants 18 years or older from multiple states with varying legislative support and restrictions towards abortion. Interviews were conducted over the telephone, audio-recorded, transcribed, and coded using QRS NVivo 12 software. We used a grounded-theory approach to identify key findings via inductive reasoning.

Results: Findings from 18 interviews centered around a desire to minimize suffering for a child and hardship for their families if the pregnancy continued, gaps in care by clinicians and health care systems, impact of state regulations, the complex emotional toll of the diagnosis and decision-making process, and the role of abortion stigma on their experience. Only three of the 18 participants had been offered perinatal palliative care or hospice; all were from Indiana, the only state that mandates providing information about perinatal palliative care as an alternative to abortion or full neonatal resuscitation.

Conclusions: Participants having an abortion for life-limiting fetal conditions have rarely heard of perinatal palliative care despite expressing similar goals of care.

Implications: Patients seeking abortion for life-limiting fetal conditions frequently describe goals of care that align with a palliative care framework of minimizing perinatal and family suffering. Perinatal palliative care should be offered upon diagnosis of a life-limiting fetal condition regardless of intentions to continue to carry the pregnancy.

Objective: To evaluate the effect of an educational video on knowledge of systemic lupus erythematosus (SLE) and pregnancy, contraceptive efficacy, attitudes toward contraception, and utilization of long-acting reversible contraception (LARC) among women with SLE.

Study design: We conducted a randomized controlled trial at a university hospital rheumatology clinic from June 2023 to April 2024. We randomized 114 women with SLE who were at risk of pregnancy to the intervention or control groups. All participants received standard contraceptive counseling; the intervention group additionally viewed an educational video addressing the relationship between SLE and pregnancy and contraceptive methods. We assessed knowledge of SLE and pregnancy, contraceptive efficacy, attitudes toward contraception, and contraceptive use before and after the intervention.

Results: After the intervention, a significantly higher proportion of women in the intervention group demonstrated proficient knowledge about SLE's effects on pregnancy outcomes compared with those in the control group (99.6% vs. 48.5%, P < 0.05). Women in the intervention group considered contraceptive efficacy as the main reason for choosing a specific contraceptive method, whereas the effect on SLE was the reason in the control group. Immediately after the intervention, 45.6% of women in the intervention group expressed interest in LARC, compared with 5.3% in the control group (P < 0.001). However, at one-month follow-up, LARC use did not differ significantly between intervention and control groups (5.3% vs. 1.8%, P = 0.618).

Conclusion: The educational video improved immediate knowledge and increased initial interest in LARC among women with SLE. Nonetheless, the impact on actual LARC use was minimal.

Implication: Educational video-based counseling significantly improved knowledge about SLE and pregnancy, particularly in recognizing highly effective contraceptive methods and understanding contraceptive efficacy. This finding highlights the important role of educational videos in enhancing contraceptive awareness and guiding the selection of an appropriate method.

Objectives: We analyzed contraceptive utilization among rural migrant populations accessing fixed and outreach clinics under the Strengthening Migrant Access to Reproductive Healthcare in Tak Province, Thailand initiative (SMARH-T), and internally displaced at fixed clinics in Eastern Myanmar.

Study design: Observational, retrospective review of contraceptive utilization from 2020 to 2024 at 19 outreach clinics (all in Thailand) and four fixed clinics (two in Thailand, two in Myanmar). SMARH-T was launched in 2021 only in Thailand.

Results: Consultations in conflict affected Myanmar fixed clinics was lower than in Thailand. Outreach clinics hosted the majority (54.6%) of the 20,959 consultations, mostly for short-acting hormonals (66.9%) and mainly depot medroxyprogesterone acetate (88.4%). Women chose implants (96%) at consultations involving long-acting reversible contraceptive methods (31.7%). Total consultations increased 4.2-fold from 2020 to 2024.

Conclusions: Outreach clinics enhanced accessibility and significantly increased contraceptive uptake for marginalized populations. This model effectively expands reproductive healthcare in rural, border, resource-limited settings.

Objectives: To assess informational and financial barriers to abortion access at hospital facilities that advertise services by examining required calls, hold times, transfers, appointment availability, and costs encountered by callers seeking information about care.

Study design: We used a mystery-caller design, posing as patients seeking abortions at a gestational age of 6 weeks, to contact all U.S. facilities currently advertising abortion services (N = 772). The primary outcome was whether hospital facilities (N = 48) presented informational barriers to abortion access. Secondary outcomes included appointment availability, wait times, and costs. We collected data on calls, transfers, hold times, appointment availability, and costs. Low information barriers were defined as: appointment information provided at the first call, fewer than two transfers, less than two minutes of hold time, and no patient chart requirement. Data were analyzed using descriptive statistics and comparative analysis between facility types.

Results: Ten of 48 hospitals required callers to leave a message and await a return call; 4 never returned the call. Among the 44 hospitals where contact was ultimately made, 75% were classified as presenting at least one information barrier: 41% required multiple calls, 14% multiple transfers, and 36% left callers on hold for more than 2 min. Only 52% of hospitals offered an appointment within one week, compared to 72% of non-hospital facilities. At hospital facilities, the median self-pay costs of an abortion were highly variable and systematically higher than those reported by other types of providers.

Conclusions: Many hospitals that advertise abortion services online present substantial informational and financial barriers to patients, limiting timely access to care.

Implications: Patients may contact hospitals expecting clinic-like accessibility, only to encounter unexpected barriers to obtaining information and scheduling an appointment. Reducing these barriers requires either significant operational restructuring or clearer patient guidance about how hospital abortion services differ from other types of facilities.