Contraception and reproductive medicine最新文献

Background: Medication abortion (MAB) accounts for an increasing proportion of in-clinic abortions in the United States and poses unique considerations for provision of long-acting reversible contraception (LARC). Studies of LARC initiation among MAB patients mostly consist of trials where financial barriers to LARC were removed. We sought to identify correlates of LARC initiation post-MAB in a community-based setting.

Methods: This is a retrospective cohort study of patients who presented to a Planned Parenthood Health Center in Minnesota in 2016 for MAB, chose LARC as their intended post-abortion contraceptive method in counseling, and returned to the clinic for their routine follow-up visit (n = 335). We abstracted sociodemographic and reproductive health history variables and used logistic regression to estimate odds ratios (ORs) for LARC initiation post-abortion (≤ 30 days of mifepristone administration).

Results: Study participants predominantly self-identified as non-Hispanic and White and had a mean age of 26 years. Overall, 72.8% (n = 244) initiated their desired LARC method by 30 days post-abortion. There was no significant (p < 0.05) association between LARC initiation and most variables: race, ethnicity, age, distance from clinic, body mass index, gestational age, gravidity, prior abortions, and number of children. However, odds of LARC initiation were significantly lower among participants who did not use any health insurance (vs. private insurance) for contraceptive coverage at their MAB follow-up visit (age-adjusted OR 0.35, 95% CI 0.18-0.69). Findings were similar for initiation of the IUD, specifically (age-adjusted OR 0.42, 95% CI 0.18-0.97), but not statistically significant for the implant.

Conclusions: Lack of health insurance may be a barrier to LARC initiation for MAB patients. Facilitators of LARC initiation in the context of MAB remain unclear and warrant further research to optimize patient-centered care.

Background: Menstrual cups (MC) are being increasingly used for menstruation management as an alternative to tampons and sanitary pads. Intrauterine devices (IUD) are commonly and increasingly used for birth control. Displacement of an IUD from the uterine fundus can reduce its efficiency, potentially leading to unwanted pregnancies. Recently, concerns have been raised regarding a possible increase in the risk of IUD displacement, associated to the use of MC. This study measures the association between MC use and IUD displacement, taking into account the already known risk factors of IUD displacement.

Methods and findings: Women consulting for follow-up of an IUD in two primary care facilities in Paris were enrolled in the study between March 2020 and May 2021. IUD position was assessed by transvaginal ultrasound. Use of MC and exposition to known risk factors for IUD displacement were assessed by a standardized investigator-administered questionnaire. Frequency of MC use was compared between patients with well-positioned IUD and patients with displaced IUD. A linear regression model looked for an independent association between MC use and IUD displacement, with respect to known risk factors for IUD displacement. 747 patients were included, out of which 6.8% had a displaced IUD. MC use was reported by 17.0% of patients with a well-positioned IUD versus. 41.2% of patients with a displaced IUD. After adjustment for known risk factors of IUD displacement, MC use appeared to be significantly and independently associated with IUD displacement (aOR [95CI]: 3.09 [1.56-6.05]).

Conclusions: The use of a menstrual cup seems to be an independent risk factor for intrauterine device displacement.

Clinical trial registration: NCT04782583.

Background: Long-acting reversible and permanent contraceptive methods (LARC/PM) with high efficacy and continuity of use are highly effective pregnancy prevention methods. However, most sexually active women do not use it and end up with unintended pregnancies and unsafe abortions in Bangladesh. This study aims to assess the prevalence of LARC/PM use and its determinants among sexually active women who desire no more children in Bangladesh.

Methods: The study used Bangladesh Demographic and Health Survey (BDHS) 2017-18 data, which employed a two-stage cluster sampling design. This study extracted 6422 married women of reproductive age who desired no more children. Descriptive statistics were used to present the characteristics of the women. Chi-square and binary logistic regression were also used to identify the factors associated with LARC/PM use.

Results: A total of 20.2% of women use LARC/PM who desire no more children. Women aged 25-34 (aOR = 1.52, 95% CI: 1.10-2.09) and 35 years and above (aOR = 1.99, 95% CI: 1.41-2.81), women from Rangpur (aOR = 2.27, 95% CI = 1.57-3.28), Rajshahi (aOR = 2.15, 95% CI = 1.49-3.11), Khulna (aOR = 2.17, 95% CI = 1.48-3.17), Sylhet (aOR = 1.66, 95% CI = 1.07-2.58) and Dhaka (aOR = 1.97, 95% CI = 1.37-2.83) divisions, who were non-Muslims (aOR = 1.72, 95% CI = 1.40-2.11), having a desired number of children (2+) (aOR = 1.27, 95% CI = 1.08-1.49), whose contraceptive decision solely made by husband (aOR = 3.61, 95% CI = 2.73-1.77) or jointly (aOR = 1.59, 95% CI = 1.32-1.92) were more likely to use LARC/PM. On the other hand, women with primary education (aOR = 0.78, 95% CI = 0.65-0.92), secondary education (aOR = 0.59, 95% CI = 0.47-0.72) and higher education (aOR = 0.64, 95% CI = 0.43-0.95) belonging to richest wealth index (aOR = 0.73, 95% CI = 0.55-0.97), having at least two living children (aOR = 0.62, 95% CI = 0.44-0.85), partner with secondary education (aOR = 0.79 95% CI = 0.65-0.97) and women who were visited by family planning (FP) visitors (aOR = 0.34, 95% CI = 0.29-0.40) were less likely to use LARC/PM.

Conclusion: The LARC/PM use rate among women in Bangladesh is low. It must be increased to meet the targets of the Sustainable Development Goals (SDGs). To increase LARC/PM use in Bangladesh, attention should be given to factors like women's age, education, partner's education, religion, wealth index, division, number of living children, and desired number of children.

Background: Contraceptive use is vital to improve maternal and child health, promote economic stability, and empower women. Despite global progress in family planning, Somalia faces unique challenges due to cultural, economic, and infrastructural barriers, resulting in low contraceptive use. This study investigated the prevalence and determinants of the intention to use contraceptives among women of reproductive age in Somali.

Methods: Using data from the 2020 Somali Demographic and Health Survey (SDHS), this study analyzed a sample of 7,967 women aged 15-49. Contraceptive intention was categorized as "intent to use" versus "no intent to use." The SDHS questionnaire assesses intention to use contraceptives in the next 12 months, which aligns with standard DHS definitions. Bivariate and multivariable logistic regression analyses were conducted to assess the association between contraceptive intention and sociodemographic factors. Choropleth maps and bar charts illustrate regional disparities.

Results: Overall, only 7.6% of the women intended to use contraception, with substantial regional variation. Woqooyi Galbeed reported the highest prevalence of contraceptive intention at 18.4%, while Gedo had the lowest at 1.1%. Significant predictors of contraceptive intention included higher education (AOR: 2.34, 95% CI: 1.21-4.56), secondary education (AOR: 1.91, 95% CI: 1.12-3.26). Women residing in nomadic communities had significantly lower odds of intending to use contraception (AOR: 0.40, 95% CI: 0.23-0.68). Since nomadic residence often implies reduced healthcare access, this finding suggests logistical and cultural barriers to contraceptive intentions. Cultural and geographic factors significantly influence contraceptive intentions.

Conclusion: Regional, educational, and socioeconomic variations affect contraceptive intentions in Somalia. Addressing these disparities through targeted educational and healthcare access interventions could improve family planning and utilization, ultimately enhancing maternal and child health outcomes.

Background: A study investigating the association between premarital pregnancy and the adverse birth outcomes has not been conducted in Japan. This study aimed to investigate an association of premarital pregnancy with adverse birth outcomes and its characteristics in Japan, using national birth data.

Methods: Birth data from the Vital Statistics: Occupational and Industrial Aspects for the fiscal years 2010, 2015, and 2020 were used. Firstborn and singleton births were used, and we restricted the data to infants born to Japanese parents. We defined the status of premarital pregnancy based on the length of marriage at the time of birth. Rates of preterm birth, term low birth weight (TLBW), and small-for-gestational-age (SGA) were used as outcomes. Log-binomial regression analysis was conducted to calculate the adjusted risk ratio of premarital pregnancy for each of the outcomes. Furthermore, logistic regression analysis was conducted to identify factors associated with premarital pregnancy.

Results: Data from 888,459 births were included in the analysis. The results of log-binomial regression showed that the risk of premarital pregnancy was statistically significantly higher than that of postmarital pregnancy for all the outcomes, and the risk ratios were 1.65 (95% confidence intervals (CI):1.58, 1.72), 1.17 (95% CI:1.12, 1.22), and 1.12 (95% CI:1.08, 1.17) for preterm birth, TLBW, and SGA, respectively. The results of logistic regression analysis showed that lower non-manual workers, manual workers, and others were significantly and positively associated with premarital pregnancy compared to upper non-manual workers in terms of maternal and paternal occupations.

Conclusions: It was shown that premarital pregnancy was associated with a higher risk of preterm birth, TLBW, and SGA and was positively associated with parental occupations such as lower non-manual workers and manual workers in Japan.

Background: Intended to investigate the potential effects of endometrial preparation procedures on the results of subsequent frozen embryo transfer (FET) cycles in infertile women with chronic endometritis (CE) following a single course of antibiotic therapy.

Methods: From July 2020 to December 2023, 773 infertile patients participated in a retrospective research. CD138 was immunostained in endometrial tissues taken during the proliferative phase. CE was suggested by the presence of CD138-positive cells in the stromal cells. Oral antibiotics were administered to every patient with a CE diagnosis. After one course of drug treatment, patients had endometrial preparation and frozen embryo transfers. This study compared the impact of different endometrial preparation strategies on pregnancy outcomes.

Results: Four regimens, hormone replacement treatment (HRT), ovulation induction, natural cycle, and gonadotrophin-releasing hormone agonist-HRT (GnRH agonist-HRT), did not significantly alter the outcome of pregnancy in patients with CE. Compared to other groups, the ovulation induction cycle group had a higher clinical pregnancy rate and embryo implantation rate. In addition, the miscarriage rate is lower compared to other populations. Patients with treated CE who received HRT, GnRH agonist-HRT, ovulation induction cycle, and natural cycle did not differ substantially (P > 0.05).

Conclusion: Patients with treated CE did not see any change in pregnancy outcomes as a result of endometrial preparation procedures.

Introduction: Caesarean section (CS) is an essential, life-saving surgical intervention used to address obstetric complications. Nonetheless, its excessive use has raised global concerns. In low- and middle-income countries (LMICs) like Ethiopia, the challenges of repeat CS and the limited success of VBAC are particularly problematic. Despite this, there is a significant gap in knowledge regarding vaginal births following a cesarean delivery in Ethiopia, especially in the specific study area.

Objectives: To determine the prevalence and associated factors of successful vaginal birth after one caesarean section in the University of Gondar Comprehensive Specialized Hospital.

Methods: Institutional based cross-sectional study was conducted among 409 women who were randomly selected and had one previous caesarean section delivery and underwent a trial of labor. Data were analyzed and computed using Stata version 14 Software. Multivariable logistic regression analysis was performed to identify the factors associated with successful vaginal birth after caesarean section. A crude and adjusted odds ratio with a 95% confidence interval was used to interpret the results. A P value of < 0.05 indicated statistically significant results.

Results: Of 385 completed charts reviewed, the success rate of vaginal birth after caesarean section was 38.2%,( 95%CI;33.3-43.1%).The factors associated with successful vaginal birth after cesarean section were: prior history of spontaneous vaginal delivery at any point time (AOR = 1.84,95% CI;1.02-3.33), prior history of successful vaginal birth after previous cesarean section (AOR = 2.12, 95%CI;0.97-4.64), no history of stillbirth (AOR = 1.78, 95% CI;1.03-3.07), cervical dilation on admission ≥ 3 cm (AOR = 2.22, 95% CI; 1.14-4.35), station on admission ≥ 0(AOR = 1.94, 95% CI; 1.12-3.37), and Antenatal care follow-up (AOR = 2.48,95%CI;1.26-4.88).

Conclusions: Our study demonstrated a low prevalence of successful VBAC, highlighting that factors such as a prior history of VBAC, spontaneous vaginal delivery at any time, cervical dilatation at admission, history of stillbirth, ANC follow-up, and fetal station at admission are significantly associated with positive outcomes. This evidence clearly indicates that targeted, evidence-based interventions are urgently needed to improve VBAC success rates. Therefore; the Federal Ministry of Health (FMOH), policymakers, and relevant stakeholders should collaborate to develop, implement, and continuously review comprehensive policies and guidelines that support these targeted interventions.

Sickle cell disease (SCD) is a chronic inflammatory condition characterized by hemoglobin polymerization that precipitates recurrent vaso-occlusion, endothelial dysfunction, and multi-organ damage. Menstruation in persons with SCD presents a unique challenge due to blood loss and its ability to exacerbate SCD pain. This interaction between SCD-related vascular stress and menstruation-induced inflammation amplifies the risk of acute pain episodes during menstruation. In this manuscript, we explore the intersection of SCD and menstruation, emphasizing the role of hormonal therapy in managing menstruation-associated acute SCD pain. Progestin-only therapies, such as depot medroxyprogesterone acetate (DMPA) and levonorgestrel intrauterine devices (LNG-IUDs), are particularly effective in reducing menstrual blood loss. Data suggests DMPA mitigates acute SCD pain episodes around menstruation with minimal thrombotic risk in persons with SCD. Despite their effectiveness in menstrual regulation, combined hormonal contraceptives (CHCs) pose a significant concern due to their potential to exacerbate the hypercoagulable state in individuals with SCD. We highlight the importance of comprehensive care and collaboration between gynecologists and hematologists to optimize the management of menstruation-associated SCD pain.

Objective: This study aimed to assess knowledge of and perceptions towards vasectomy as a family planning method among men of reproductive age in rural northern Uganda".

Methods: A cross-sectional study involving 624 participants was conducted. Sociodemographic characteristics, use of vasectomy, number of children, and knowledge of vasectomy were assessed. Perceptions of vasectomy were measured, focusing on cultural, religious, and gender-related aspects.

Results: The study revealed a predominantly adult, married, and Catholic population with low educational attainment. 2% of participants had used vasectomy as a family planning method, this indicates the right to preference in choosing vasectomy as a family planning method. Approximately half of the participants demonstrated awareness of vasectomy, and negative perceptions were recorded, with 63.5% expressing their opinions. Cultural and religious beliefs, along with concerns about promiscuity, play a significant role in shaping the perceptions. The majority believed in male dominance in family planning decisions, and a considerable portion endorsed sterilization exclusively for women.

Conclusion: This study highlights the low utilization and negative perceptions of vasectomy among men in rural northern Uganda, emphasizing the need for targeted interventions to address cultural and religious misconceptions and enhance education on family planning options. Public health campaigns should focus on dispelling misconceptions about vasectomy, particularly addressing cultural and spiritual concerns. Educational programs should target men and their communities, emphasizing the benefits of shared family planning decisions. Further research incorporating qualitative methods could provide a deeper understanding of the cultural aspects influencing vasectomy perceptions in this population.