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引用次数: 0
摘要
目前有几种有效的避孕方法可供青少年选择,包括长效可逆皮下埋植剂和宫内节育器,它们为青少年提供了高度的便利性、私密性和有效性。了解所有有效的节育方法对于儿科医生为青少年提供有效的避孕咨询至关重要。本文介绍了一种采用生殖公正框架进行咨询的方法,该框架允许医疗服务提供者和青少年患者共同做出决定。本文重点介绍了针对青少年的长效可逆性依托诺孕酮(ENG)皮下植入剂。ENG植入物被标注为通过抑制排卵来避孕。ENG植入物还可用于改善痛经和月经大量出血。标签发布后的研究表明,恩格列净植入物的有效期长达 5 年,尽管该设备的标签上注明有效期最长为 3 年。使用恩格列净植入体的主要禁忌症是怀孕本身。介绍了安全使用 ENG 植入物的方法,包括确定青少年是否怀孕的方法。恩格列净植入物的主要不良反应是不可预测的出血模式,如果患者没有禁忌症,使用非甾体类消炎药和雌激素通常可以改善这种出血模式。本文详细介绍了植入和取出过程,包括潜在的并发症,以便儿科医生为青少年提供有效的预期指导。
Long-Acting Reversible Etonogestrel Subdermal Implant in Adolescents.
Several effective contraceptive options are available for use by adolescents, including the long-acting reversible subdermal implant and intrauterine devices, which provide a high level of convenience, privacy, and effectiveness for an adolescent. Knowledge of all the effective birth control methods is essential for the pediatrician to be able to provide effective contraceptive counseling for an adolescent. An approach to counseling using a reproductive justice framework, which allows the provider and adolescent patient to engage in shared decision-making, is described. This article focuses on the long-acting reversible etonogestrel (ENG) subdermal implant for adolescents. The ENG implant is labeled for preventing pregnancy by suppressing ovulation. The ENG implant may also have a role in ameliorating dysmenorrhea and heavy menstrual bleeding. Postlabeling studies indicate that the ENG implant is effective for up to 5 years, although the device's labeling states effectivenessup to 3 years. The main contraindication to using the ENG implant is pregnancy itself. Safe initiation of the ENG implant is described, including an approach to determine whether an adolescent is pregnant. The main adverse effect of the ENG implant is an unpredictable bleeding pattern that is most often ameliorated by use of nonsteroidal anti-inflammatory medications, as well as estrogen, if not contraindicated for the patient. Details of the insertion and removal procedures, including potential complications, are described to enable the pediatrician to provide effective anticipatory guidance for the adolescent.
期刊介绍:
Pediatrics in Review (PIR) is the American Academy of Pediatrics’ monthly peer-reviewed continuing medical education journal, designed to keep the general pediatric clinician current in all areas of pediatric medicine and to assist those participating in the Maintenance of Certification program of the American Board of Pediatrics (ABP).
The journal is one of the key components of the Academy’s continuing medical education program: PREP® (the Pediatrics Review and Education Program). Together, PIR and the PREP Self-Assessment comprise PREP The Curriculum®.
Each PIR review article includes quiz questions formulated by topic experts.