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Koch SK, Paul R, Addante AN, Brubaker A, Kelly JC, Raghuraman N, Madden T, Tepe M, Carter EB. Medicaid Reimbursement Program for Immediate Postpartum Long-Acting Reversible Contraception Improves Uptake Regardless of Insurance Status. Contraception 2022; 113:57-61. [PMID: 35588793 DOI: 10.1016/j.contraception.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether a Medicaid reimbursement program for immediate postpartum long-acting reversible contraception (LARC) is associated with an increased rate of LARC uptake. STUDY DESIGN We conducted a retrospective cohort study comparing patients who delivered at a large, urban, tertiary medical center one year before and after Missouri Medicaid coverage changed to reimburse immediate postpartum LARC in October 2016. Patients were identified through the electronic medical record and excluded if they delivered prior to 24 weeks gestation or had a contraindication to immediate postpartum LARC. The primary outcome was placement of immediate postpartum LARC, which we examined overall and stratified by insurance type. We used multivariable logistic regression to determine the impact of the policy change while adjusting for appropriate confounders. RESULTS A total of 6,233 eligible patients delivered during the study period: 3,105 before and 3,128 after the change in reimbursement for immediate postpartum LARC. Patients delivering after the policy change were more likely to be Hispanic, have commercial insurance or be uninsured, and have a BMI >30. Placement of immediate postpartum LARC increased from 0.7% pre- to 9.7% post-policy change (aOR 15.6; 95% CI 10.1-24.2). In our stratified analysis, immediate postpartum LARC uptake increased for patients with Medicaid (aOR 15.8; 95% CI 9.9-25.4) and commercial insurance (aOR 9.7; 95% CI 3.0-31.8). CONCLUSION The change in Missouri Medicaid reimbursement for placement of immediate postpartum LARC had systemic impact with an increase in postpartum LARC uptake in all patients, regardless of insurance provider. IMPLICATIONS Insurance reimbursement has the power to influence hospital policy and patient care. Overall, changes to Medicaid reimbursement increased access to postpartum LARC for all patients at a large academic institution, regardless of insurance status.
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Affiliation(s)
- Susannah K Koch
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, St. Louis, MO.
| | - Rachel Paul
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning, St. Louis, MO; Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Louis, MO
| | - Amy N Addante
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning, St. Louis, MO; Advocate Medical Group, Park Ridge, IL
| | - Allison Brubaker
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, St. Louis, MO; Women's Care of Wisconsin, S.C. Neenah, WI
| | - Jeannie C Kelly
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Louis, MO
| | - Nandini Raghuraman
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Louis, MO
| | - Tessa Madden
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning, St. Louis, MO
| | | | - Ebony B Carter
- Washington University in St. Louis School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, St. Louis, MO
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Fang NZ, Westhoff CL. Update on incidence of inpatient tubal ligation and long-acting reversible contraception in the United States. Am J Obstet Gynecol 2022:S0002-9378(22)00365-9. [PMID: 35569515 DOI: 10.1016/j.ajog.2022.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/17/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inpatient insertion of long-acting reversible contraception and immediate postpartum tubal ligation allow women to initiate highly effective contraception before hospital discharge. OBJECTIVE We measured rates of intrauterine device and contraceptive implant initiation and tubal ligations performed during delivery hospitalizations from 2016 to 2018 from a representative sample of US hospital discharges. STUDY DESIGN We used the 2016 to 2018 National Inpatient Sample database, a 20% sample of all community hospital discharges in the United States, to identify delivery hospitalizations with concomitant intrauterine device insertion, contraceptive implant insertion, or tubal ligation. We performed weighted multivariable logistic regression to examine associations between possible predictors (age, delivery mode, payer, geographic region, and year) and odds of long-acting reversible contraception and tubal ligation, and to compare characteristics of users. RESULTS This sample included 2,216,638 discharges, representing 20% of 11,083,180 delivery hospitalizations across the United States. Intrauterine device insertion increased from 2.2 per 1000 deliveries (2016) to approximately 5.0 per 1000 deliveries (2018; P<.0001); implant insertion increased from 0.3 per 1000 deliveries (2016) to 2.5 per 1000 deliveries (2018; P<.0001); tubal ligation procedures decreased (64.2 to 62.1 per 1000 deliveries; P<.0001). Women who underwent a cesarean delivery had higher odds of having a tubal ligation than those who had a vaginal delivery (adjusted odds ratio, 8.83; 95% confidence interval, 8.73-8.97). Women aged <25 years had 7 times higher odds of receiving long-acting reversible contraception than of receiving tubal ligation (adjusted odds ratio, 7.38; 95% confidence interval, 6.90-7.90). Women with public insurance had almost 5 times the odds of receiving long-acting reversible contraception compared with those with commercial insurance (adjusted odds ratio, 4.83; 95% confidence interval, 4.59-5.06). CONCLUSION Rates of long-acting reversible contraception insertion continue to increase while the rates of inpatient postpartum tubal ligations slowly decline. Variations in patient characteristics are associated with receiving long-acting reversible contraception or tubal ligation.
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Gatz JL, Armstrong MA, Postlethwaite D, Raine-Bennett T, Chillemi G, Alabaster A, Merchant M, Reed SD, Ichikawa L, Getahun D, Fassett MJ, Shi JM, Xie F, Chiu VY, Im TM, Takhar HS, Wang J, Saltus CW, Ritchey ME, Asiimwe A, Pisa F, Schoendorf J, Wahdan Y, Zhou X, Hunter S, Anthony MS, Peipert JF. Association between intrauterine device type and risk of perforation and device expulsion: results from the Association of Perforation and Expulsion of Intrauterine Devices study. Am J Obstet Gynecol 2022; 227:57.e1-57.e13. [PMID: 35395215 DOI: 10.1016/j.ajog.2022.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intrauterine devices, including levonorgestrel-releasing and copper devices, are highly effective long-acting reversible contraceptives. The potential risks associated with intrauterine devices are low and include uterine perforation and device expulsion. OBJECTIVE This study aimed to evaluate the risk of perforation and expulsion associated with levonorgestrel-releasing devices vs copper devices in clinical practice in the United States. STUDY DESIGN The Association of Perforation and Expulsion of Intrauterine Devices study was a retrospective cohort study of women aged ≤50 years with an intrauterine device insertion during 2001 to 2018 and information on intrauterine device type and patient and medical characteristics. Of note, 4 research sites with access to electronic health records contributed data for the study: 3 Kaiser Permanente-integrated healthcare systems (Northern California, Southern California, and Washington) and 1 healthcare system using data from a healthcare information exchange in Indiana (Regenstrief Institute). Perforation was classified as any extension of the device into or through the myometrium. Expulsion was classified as complete (not visible in the uterus or abdomen or patient reported) or partial (any portion in the cervix or malpositioned). We estimated the crude incidence rates and crude cumulative incidence by intrauterine device type. The risks of perforation and expulsion associated with levonorgestrel-releasing intrauterine devices vs copper intrauterine devices were estimated using Cox proportional-hazards regression with propensity score overlap weighting to adjust for confounders. RESULTS Among 322,898 women included in this analysis, the incidence rates of perforation per 1000 person-years were 1.64 (95% confidence interval, 1.53-1.76) for levonorgestrel-releasing intrauterine devices and 1.27 (95% confidence interval, 1.08-1.48) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 0.22% (95% confidence interval, 0.20-0.24) and 0.63% (95% confidence interval, 0.57-0.68) for levonorgestrel-releasing intrauterine devices and 0.16% (95% confidence interval, 0.13-0.20) and 0.55% (95% confidence interval, 0.44-0.68) for copper intrauterine devices, respectively. The incidence rates of expulsion per 1000 person-years were 13.95 (95% confidence interval, 13.63-14.28) for levonorgestrel-releasing intrauterine devices and 14.08 (95% confidence interval, 13.44-14.75) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 2.30% (95% confidence interval, 2.24-2.36) and 4.52% (95% confidence interval, 4.40-4.65) for levonorgestrel-releasing intrauterine devices and 2.30% (95% confidence interval, 2.18-2.44) and 4.82 (95% confidence interval, 4.56-5.10) for copper intrauterine devices, respectively. Comparing levonorgestrel-releasing intrauterine devices with copper intrauterine devices, the adjusted hazard ratios were 1.49 (95% confidence intervals, 1.25-1.78) for perforation and 0.69 (95% confidence intervals, 0.65-0.73) for expulsion. CONCLUSION After adjusting for potential confounders, levonorgestrel-releasing intrauterine devices were associated with an increased risk of uterine perforation and a decreased risk of expulsion relative to copper intrauterine devices. Given that the absolute numbers of these events are low in both groups, these differences may not be clinically meaningful.
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Affiliation(s)
| | | | | | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Giulia Chillemi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Darios Getahun
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael J Fassett
- Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA; Department of Clinical Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Jiaxiao M Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Vicki Y Chiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa M Im
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Harpreet S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jinyi Wang
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | | | - Mary E Ritchey
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | | | | | | | | | - Xiaolei Zhou
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | - Shannon Hunter
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | - Mary S Anthony
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
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Abern LE, Kiely KA, de Guzman GS, Maguire KE. Patient preference for intrauterine device follow-up. Am J Obstet Gynecol 2022; 226:570-571. [PMID: 34922923 DOI: 10.1016/j.ajog.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Lauren E Abern
- Department of Obstetrics and Gynecology, Atrius Health, 40 Holland St., Somerville, MA 02144.
| | - Kristen A Kiely
- Department of Obstetrics and Gynecology, Atrius Health, 40 Holland St., Somerville, MA 02144
| | - Glendell S de Guzman
- Department of Obstetrics and Gynecology, Atrius Health, 40 Holland St., Somerville, MA 02144
| | - Karla E Maguire
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study. Acta Obstet Gynecol Scand 2022; 101:424-430. [PMID: 35141886 PMCID: PMC9564423 DOI: 10.1111/aogs.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1 year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8 weeks postpartum. MATERIAL AND METHODS April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48 h after delivery (early group) or standard placement 6-8 weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. RESULTS The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p = 0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p = 0.22) had used the hormonal intrauterine device method continuously for 1 year. CONCLUSIONS Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Linköping, Sweden
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Pitts S, Milliren CE, Borzutzky C, Maslyanskaya S, Berg G, DiVasta AD. Adolescent/Young Adult Long-Acting Reversible Contraception: Experience from a Multisite Adolescent Medicine Collaborative. J Pediatr 2022; 243:158-166. [PMID: 34952007 DOI: 10.1016/j.jpeds.2021.11.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. STUDY DESIGN LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. RESULTS Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P = .63), 66% at 2 years (range, 62%-84%; P = .01), and 42% at 3 years (range, 36%-60%; P = .004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P = .82), 77% at 2 years (range, 76%-78%; P = .94), and 60% at 3 years (range, 57%-62%; P = .88). CONCLUSIONS LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.
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Affiliation(s)
- Sarah Pitts
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, CA
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital of Montefiore, Bronx, NY
| | - Grace Berg
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Amy D DiVasta
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
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Baniqued A, Murayama S, Cadiente RM, Calio B, Cabusog J, Goya K, Tyson J, Schiff-Elfalan T, Soin K, Kaneshiro B. Expanding Access to Contraception: Identifying Accessibility Gaps Across Hawai'i Communities. Hawaii J Health Soc Welf 2022; 81:46-51. [PMID: 35495073 PMCID: PMC9036455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In 2019, Hawai'i ended its Title X program resulting in a loss of federal family planning funds. Additionally, physician shortages have decreased family planning resources available to patients. The objective of this study was to assess contraception availability by determining the number and location of healthcare providers in Hawai'i that prescribed at least one form of contraception. A list of healthcare providers was compiled using Google searches, major health insurance, and hospital provider directories. Providers were organized by physical location (ie, address). Each location was contacted to inquire about each provider's ability to prescribe different forms of contraception (eg, intrauterine device, implant, injection, pill, patch, or ring). Of the 1,020 locations contacted, 274 prescribed at least one form of contraception. Of the 1,810 providers surveyed at these locations, 744 prescribed at least one form of contraception. In regard to insurance, 201 locations and 609 providers accepted at least one form of Medicaid. Most prescribing providers were located on the island of O'ahu. The majority of providers across the state prescribed the pill, patch, or ring. There are many additional barriers that were not addressed in this study, including factors that affect physician prescribing practices. Identifying these barriers is important to further address gaps in contraceptive accessibility. Consideration of improved support for training in specialties such as Family Medicine, Internal Medicine, and Pediatrics can expand access to contraception within primary care settings.
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Affiliation(s)
- Alyssandra Baniqued
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Sarah Murayama
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Rochelle Mae Cadiente
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Bianca Calio
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Jessica Cabusog
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Kellie Goya
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
(AB, SM, RMC, BC, JC, KG)
| | - Jasmine Tyson
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawai‘i , Honolulu, HI (JT, BK)
| | - Teresa Schiff-Elfalan
- Department of Family Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (TS, KS)
| | - Komal Soin
- Department of Family Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (TS, KS)
| | - Bliss Kaneshiro
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawai‘i , Honolulu, HI (JT, BK)
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Torun BC, Gök AFK, İlhan M, Yegen G, Başaran S, Ertekin C, Günay MK, Yanar H. A rare cause of acute abdominal pain: Actinomyces infection of colon mimicking a malignant neoplasm due to intrauterine device. ULUS TRAVMA ACIL CER 2022; 28:537-540. [PMID: 35485507 PMCID: PMC10520999 DOI: 10.14744/tjtes.2020.45672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a rare, chronic granulomatous disease that is challenging to diagnose because the clinical symptoms and signs are nonspecific. Usage of intrauterine device (IUD) or being immunocompromised is facilitating factors. Clinical and radiological findings can mimic malignant neoplasm, inflammatory bowel disorder, or acute diverticulitis. We report a case of actinomyces infection of the colon secondary to IUD, which is a rare cause of acute abdominal pain and can mimic a malignant neoplasm. We also provide a review of the literature. Unnecessary surgery can be avoided with the correct diagnosis of granulomatous infectious diseases that can be treated with antibiotics.
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Affiliation(s)
- Bahar Canbay Torun
- Department of General Surgery, Sultangazi Haseki Training and Research Hospital, İstanbul-Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mehmet İlhan
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Gülçin Yegen
- Department of Pathology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Seniha Başaran
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Cemalettin Ertekin
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mustafa Kayıhan Günay
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Hakan Yanar
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
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Getahun D, Fassett MJ, Gatz J, Armstrong MA, Peipert JF, Raine-Bennett T, Reed SD, Zhou X, Schoendorf J, Postlethwaite D, Shi JM, Saltus CW, Wang J, Xie F, Chiu VY, Merchant M, Alabaster A, Ichikawa LE, Hunter S, Im TM, Takhar HS, Ritchey ME, Chillemi G, Pisa F, Asiimwe A, Anthony MS. Association between menorrhagia and risk of intrauterine device-related uterine perforation and device expulsion: results from the Association of Uterine Perforation and Expulsion of Intrauterine Device study. Am J Obstet Gynecol 2022; 227:59.e1-59.e9. [PMID: 35292234 DOI: 10.1016/j.ajog.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Intrauterine devices are effective instruments for contraception, and 1 levonorgestrel-releasing device is also indicated for the treatment of heavy menstrual bleeding (menorrhagia). OBJECTIVE To compare the incidence of intrauterine device expulsion and uterine perforation in women with and without a diagnosis of menorrhagia within the first 12 months before device insertion STUDY DESIGN: This was a retrospective cohort study conducted in 3 integrated healthcare systems (Kaiser Permanente Northern California, Southern California, and Washington) and a healthcare information exchange (Regenstrief Institute) in the United States using electronic health records. Nonpostpartum women aged ≤50 years with intrauterine device (eg, levonorgestrel or copper) insertions from 2001 to 2018 and without a delivery in the previous 12 months were studied in this analysis. Recent menorrhagia diagnosis (ie, recorded ≤12 months before insertion) was ascertained from the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes. The study outcomes, viz, device expulsion and device-related uterine perforation (complete or partial), were ascertained from electronic medical records and validated in the data sources. The cumulative incidence and crude incidence rates with 95% confidence intervals were estimated. Cox proportional hazards models estimated the crude and adjusted hazard ratios using propensity score overlap weighting (13-16 variables) and 95% confidence intervals. RESULTS Among 228,834 nonpostpartum women, the mean age was 33.1 years, 44.4% of them were White, and 31,600 (13.8%) had a recent menorrhagia diagnosis. Most women had a levonorgestrel-releasing device (96.4% of those with and 78.2% of those without a menorrhagia diagnosis). Women with a menorrhagia diagnosis were likely to be older, obese, and have dysmenorrhea or fibroids. Women with a menorrhagia diagnosis had a higher intrauterine device-expulsion rate (40.01 vs 10.92 per 1000 person-years) than those without, especially evident in the first few months after insertion. Women with a menorrhagia diagnosis had a higher cumulative incidence (95% confidence interval) of expulsion (7.00% [6.70-7.32] at 1 year and 12.03% [11.52-12.55] at 5 years) vs those without (1.77% [1.70-1.84] at 1 year and 3.69% [3.56-3.83] at 5 years). The risk of expulsion was increased for women with a menorrhagia diagnosis vs for those without (adjusted hazard ratio, 2.84 [95% confidence interval, 2.66-3.03]). The perforation rate was low overall (<1/1000 person-years) but higher in women with a diagnosis of menorrhagia vs in those without (0.98 vs 0.63 per 1000 person-years). The cumulative incidence (95% confidence interval) of uterine perforation was slightly higher for women with a menorrhagia diagnosis (0.09% [0.06-0.14] at 1 year and 0.39% [0.29-0.53] at 5 years) than those without it (0.07% [0.06-0.08] at 1 year and 0.28% [0.24-0.33] at 5 years). The risk of perforation was slightly increased in women with a menorrhagia diagnosis vs in those without (adjusted hazard ratio, 1.53; 95% confidence interval, 1.10-2.13). CONCLUSION The risk of expulsion is significantly higher in women with a recent diagnosis of menorrhagia. Patient education and counseling regarding the potential expulsion risk is recommended at insertion. The absolute risk of perforation for women with a recent diagnosis of menorrhagia is very low. The increased expulsion and perforation rates observed are likely because of causal factors of menorrhagia.
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Munjal A, Tripathi R, Wu C, Radke S, Powers JG. Correlations between hormonal IUDs and androgenic skin conditions: a retrospective cohort study. J Am Acad Dermatol 2022:S0190-9622(22)00152-9. [PMID: 35219751 DOI: 10.1016/j.jaad.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
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Chen C, Strasser J, Banawa R, Luo Q, Bodas M, Castruccio-Prince C, Das K, Pittman P. Who is providing contraception care in the United States? An observational study of the contraception workforce. Am J Obstet Gynecol 2022; 226:232.e1-232.e11. [PMID: 34418348 DOI: 10.1016/j.ajog.2021.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Contraception care is essential to providing comprehensive healthcare; however, little is known nationally about the contraception workforce. Previous research has examined the supply, distribution, and adequacy of the health workforce providing contraception services, but this research has faced a series of data limitations, relying on surveys or focusing on a subset of practitioners and resulting in an incomplete picture of contraception practitioners in the United States. OBJECTIVE This study aimed to construct a comprehensive database of the contraceptive workforce in the United States that provides the following 6 types of highly effective contraception: intrauterine device, implant, shot (depot medroxyprogesterone acetate), oral contraception, hormonal patch, and vaginal ring. In addition, we aimed to examine the difference in supply, distribution, the types of contraception services offered, and Medicaid participation. STUDY DESIGN We constructed a national database of contraceptive service providers using multiple data sets: IQVIA prescription claims, preadjudicated medical claims, and the OneKey healthcare provider data set; the National Plan and Provider Enumeration System data set; and the Census Bureau's American Community Survey data on population demographics. All statistical analyses were descriptive, including chi-squared tests for groupwise differences and pairwise post hoc tests with Bonferroni corrections for multiple comparisons. RESULTS Although 73.1% of obstetrician-gynecologists and 72.6% of nurse-midwives prescribed the pill, patch, or ring, only 51.4% of family medicine physicians, 32.4% of pediatricians, and 19.8% of internal medicine physicians do so. The ratio of all primary care providers prescribing contraception to the female population of reproductive age (ages, 15-44 years) varied substantially across states, with a range of 27.9 providers per 10,000 population in New Jersey to 74.2 providers per 10,000 population in Maine. In addition, there are substantial differences across states for Medicaid acceptance. Of the obstetrician-gynecologists providing contraception, the percentage of providers who prescribe contraception to Medicaid patients ranged from 83.9% (District of Columbia) to 100% (North Dakota); for family medicine physicians, it ranged from 49.7% (Florida) to 91.1% (Massachusetts); and for internal medicine physicians, it ranged from 25.0% (Texas) to 75.9% (Delaware). For in-person contraception, there were large differences in the proportion of providers offering the 3 different contraceptive method types (intrauterine device, implant, and shot) by provider specialty. CONCLUSION This study found a significant difference in the distribution, types of contraception, and Medicaid participation of the contraception workforce. In addition to obstetrician-gynecologists and nurse-midwives, family medicine physicians, internal medicine physicians, pediatricians, advanced practice nurses, and physician assistants are important contraception providers. However, large gaps remain in the provision of highly effective services such as intrauterine devices and implants. Future research should examine provider characteristics, programs, and policies associated with the provision of different contraception services.
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Affiliation(s)
- Candice Chen
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Julia Strasser
- Milken Institute School of Public Health, The George Washington University, Washington, DC.
| | - Rachel Banawa
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Qian Luo
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Mandar Bodas
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - Kirsten Das
- Department of Obstetrics and Gynecology, School of Medicine, The George Washington University, Washington, DC
| | - Patricia Pittman
- Milken Institute School of Public Health, The George Washington University, Washington, DC
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Beltz AM, Demidenko MI, Chaku N, Klump KL, Joseph JE. Intrauterine Device Use: A New Frontier for Behavioral Neuroendocrinology. Front Endocrinol (Lausanne) 2022; 13:853714. [PMID: 35937811 PMCID: PMC9352855 DOI: 10.3389/fendo.2022.853714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
Intrauterine devices (IUDs) are the most-used reversible contraceptive method for women in the world, but little is known about their potential modulation of brain function, cognition, and behavior. This is disconcerting because research on other hormonal contraceptives, especially oral contraceptives (OCs), increasingly shows that exogenous sex hormones have behavioral neuroendocrine consequences, especially for gendered cognition, including spatial skills. Effects are small and nuanced, however, partially reflecting heterogeneity. The goal of this paper is to introduce IUD use as a new frontier for basic and applied research, and to offer key considerations for studying it, emphasizing the importance of multimodal investigations and person-specific analyses. The feasibility and utility of studying IUD users is illustrated by: scanning women who completed a functional magnetic resonance imaging mental rotations task; taking an individualized approach to mapping functional connectivity during the task using network analyses containing connections common across participants and unique to individual women, focusing on brain regions in putative mental rotations and default mode networks; and linking metrics of brain connectivity from the individualized networks to both mental rotations task performance and circulating hormone levels. IUD users provide a promising natural experiment for the interplay between exogenous and endogenous sex hormones, and they are likely qualitatively different from OC users with whom they are often grouped in hormonal contraceptive research. This paper underscores how future research on IUD users can advance basic neuroendocrinological knowledge and women's health.
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Affiliation(s)
- Adriene M. Beltz
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Adriene M. Beltz,
| | | | - Natasha Chaku
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Jane E. Joseph
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
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Seinerová A, Kopáčková M, Buchvald P, Pavlásek J. Brain abscess as a rare complication of pelvic inflammatory disease. Ceska Gynekol 2022; 87:50-53. [PMID: 35240838 DOI: 10.48095/cccg202250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Description of the case history of a brain abscess as a rare complication of pelvic inflammatory disease. CASE REPORT We discuss a woman of reproductive age who had inserted a non-hormonal intrauterine device for seven years and developed pelvic inflammatory disease with no response to antibio-tic therapy. After surgery, some neurological symptoms led to a dia-gnosis of a brain abscess. CONCLUSION Brain abscess is a rare but potentially lethal complication from pelvic inflammatory disease, needing prompt dia-gnosis and interdisciplinary cooperation.
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Driák D, Sehnal B, Jarošová L, Dvořáčková K. Uterine perforation during intrauterine procedures and its management. Ceska Gynekol 2022; 87:295-301. [PMID: 36055792 DOI: 10.48095/cccg2022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Uterine perforation is a potential, not rare complication of all intrauterine procedures and may be associated with injury of surrounding organs and structures. The incidence, risk factors, possible prevention, dia-gnosis, management and impact on future reproduction is reviewed here. METHODS Systematic review of available sources on the topic was carried out using the PubMed database and textbooks of Czech authors. CONCLUSION Some risk factors that make access to the uterine cavity difficult may be prevented, however, others remain unpreventable. For patients in whom the perforation occurred during sondage, dilatation or insertion of blunt and cold instrument, without significant bleeding and who are hemodynamically stable, observation is recommended rather than immediate abdominal exploration. The exception are young women planning pregnancy in whom endoscopic suture is indicated. Abdominal exploration is required in patients who have been injured by electrosurgical or sharp device, laser, vacuum curette, who are hemodynamically unstable or show signs of severe bleeding or visceral injury.
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Rodriguez MI, Skye M, Ramanadhan S, Schrote K, Darney BG. Examining the association between short interpregnancy interval births and the type and timing of postpartum long acting reversible contraception. Contraception 2021:S0010-7824(21)00475-3. [PMID: 34971615 DOI: 10.1016/j.contraception.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births. STUDY DESIGN We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 - 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level. RESULTS Our study sample included 121,422 births to 97,084 individuals who had more than one birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by six months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5 - 25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4 - 16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2 - 43.0%). CONCLUSION Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval.
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Rivera del Alamo MM, Reilas T, Lukasik K, Galvão AM, Yeste M, Katila T. Inflammatory Markers in Uterine Lavage Fluids of Pregnant, Non-Pregnant, and Intrauterine Device Implanted Mares on Days 10 and 15 Post Ovulation. Animals (Basel) 2021; 11:ani11123493. [PMID: 34944269 PMCID: PMC8697965 DOI: 10.3390/ani11123493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary While intrauterine devices (IUDs) are used to prevent disturbing oestrous behaviour in sport mares, their mechanism of action has not been elucidated. The presence of an embryo or an IUD prevents cyclooxygenase-2 (COX-2) and subsequently prostaglandin (PG) release and luteolysis. It has been suggested that a plastic sphere would mimic the embryo by mechanotransduction. However, there is some evidence that IUDs also cause endometrial inflammation, which might contribute to luteostasis. The aim of this study was to investigate the presence and time course of possible inflammation by evaluating changes in uterine fluid composition. On Day 10 after ovulation, events leading to COX-2 and prostaglandin F2α (PGF2α) inhibition start, whereas either luteolysis occurs or the corpus luteum is maintained on Day 15. Therefore, uterine lavage fluid was evaluated at two time points in inseminated mares, either pregnant or not, and in mares inserted with an IUD. On Day 10, PGF2α concentration in the fluid was significantly lower in the IUD group than in the pregnant mare one but did not differ from the non-pregnant mare group. On Day 15, the IUD group had significantly higher levels of the modulatory cytokine IL-10 and inhibin A, which could indicate previous inflammation and resolution stage. Abstract Intrauterine devices (IUDs) are used in mares to suppress oestrous behaviour, but the underlying mechanism is yet to be elucidated. The presence of an embryo or an IUD prevents cyclooxygenase-2 (COX-2) and, subsequently, prostaglandin (PG) release and luteolysis. However, inflammation may also be involved. Endometrial inflammatory markers in uterine lavage fluid were measured on Day 10 (EXP 1, n = 25) and Day 15 (EXP 2, n = 27) after ovulation in inseminated mares, non-pregnant or pregnant, and in mares in which a small plastic sphere had been inserted into the uterus 4 (EXP 1) or 3 days (EXP 2) after ovulation. Uterine lavage fluid samples were analysed for nitric oxide (NO), prostaglandin E2 (PGE2) (only EXP 1), prostaglandin F2α (PGF2α), inhibin A and cytokines, and blood samples for progesterone and oestradiol. On Day 10, the concentration of PGF2α was lower (p < 0.05) in the IUD group than in pregnant mares. The concentration of the modulatory cytokine IL-10 was significantly higher in the IUD group in comparison to non-pregnant mares, and inhibin A was significantly higher in IUD mares than in the pregnant counterparts on Day 15. The results suggest that the presence of IUD causes endometrial inflammation which is at a resolution stage on Day 15.
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Affiliation(s)
- Maria Montserrat Rivera del Alamo
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Spain
- Correspondence: ; Tel.: +34-93-581-1045
| | - Tiina Reilas
- Natural Resources Institute Finland (Luke), 31600 Jokioinen, Finland;
| | - Karolina Lukasik
- Institute of Animal Reproduction and Food Research, PAS, 10-748 Olsztyn, Poland; (K.L.); (A.M.G.)
| | - Antonio M. Galvão
- Institute of Animal Reproduction and Food Research, PAS, 10-748 Olsztyn, Poland; (K.L.); (A.M.G.)
- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
- Epigenetics Programme, The Babraham Institute, Cambridge CB22 3AT, UK
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain;
| | - Terttu Katila
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, 59511 Saari, Finland;
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Abern L, Krempasky C, Diego D, De Guzman G, Kiely K, Cook J, Maguire K. The Intrauterine Device Experience Among Transgender and Gender-Diverse Individuals Assigned Female at Birth. J Midwifery Womens Health 2021; 66:772-777. [PMID: 34767305 DOI: 10.1111/jmwh.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The intrauterine device (IUD) is a long-acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD-AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD-AFAB individuals. METHODS TGD-AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data. RESULTS One hundred and five TGD-AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52-mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower-dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52-mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD. DISCUSSION Pregnancy can occur among TGD-AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD-AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
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Affiliation(s)
| | | | | | | | | | - Jake Cook
- Philadelphia Fight, Philadelphia, Pennsylvania
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Ou YC, Chen YY, Lan KC, Tsai CC, Chu LC, Cheng LY. Levonorgestrel intrauterine system for the treatment of intermenstrual spotting in patients with previous cesarean delivery scar defect. J Obstet Gynaecol Res 2021; 48:155-160. [PMID: 34734462 DOI: 10.1111/jog.15062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the efficacy of levonorgestrel 52 mg intrauterine system for intermenstrual bleeding in patients with previous cesarean delivery scar defects (PCDSs). METHODS The medical records of 28 consecutive patients with previous cesarean delivery scar defect and intermenstrual bleeding who had undergone conservative treatment with levonorgestrel 52 mg intrauterine system were reviewed. The efficacy of treatment and frequency of adverse events were measured retrospectively. RESULTS After 1 year of treatment, 22 patients (78.6%) reported an improvement in symptoms. The mean duration of menstruation were 18 and 5 days before and after treatment, respectively. No uterine perforations or pelvic inflammatory diseases occurred during or after the insertion procedures. Eighteen (64.3%) patients did not experience any adverse events, and the patients with adverse events reported that they could be managed by adjusting their medications or observation. CONCLUSION Levonorgestrel intrauterine system may have a role in the safe and effective management of intermenstrual spotting in patients with PCDSs.
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Affiliation(s)
- Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Ying-Yi Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Chang Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Ching Chu
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Ling-Yun Cheng
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
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Brull E, Machado HC, Bahamondes L, Juliato CRT. Expulsion and continuation rates of the levonorgestrel 52 mg intrauterine system was similar among nulligravid and parous users. Int J Gynaecol Obstet 2021; 158:318-324. [PMID: 34714939 DOI: 10.1002/ijgo.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the expulsion and continuation rates of the levonorgestrel (LNG) 52 mg intrauterine system (IUS) in a cohort of nulligravid and parous users. METHODS We conducted a retrospective cohort study that included 996 participants in whom we placed an LNG-IUS, and the participants were monitored for up to 5 years after device placement. We identify 498 nulligravid participants in the medical record database between 2012 and 2020. Each nulligravida was paired with a parous users who had an LNG-IUS inserted on the same day, just before or after the nulligravida. The Kaplan-Meier method and the log-rank test were used to compare the survival curves of the two groups. RESULTS By the fifth year of use, the expulsion rates were 7.6/100 and 8.2/100 women-years (W-Ys) and the continuation rates were 641/100 W-Ys and 65.4/100 W-Ys without difference among nulligravid and parous users, respectively (P = 0.782 and P = 0.564, respectively). We observed 29 and 31 expulsions among nulligravid and parous users, respectively. CONCLUSION Nulligravid and parous participants who used the 52 mg LNG-IUS showed similar expulsion and continuation rates during five years of use.
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Affiliation(s)
- Eliza Brull
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Helymar Costa Machado
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luis Bahamondes
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cássia R T Juliato
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
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Grigore M, Popovici R, Himiniuc LM, Scripcariu IS, Toma BF, Grigore AM, Oancea M, Micu R. The added value of three-dimensional ultrasonography in uterine pathology. Exp Ther Med 2021; 22:1261. [PMID: 34603529 DOI: 10.3892/etm.2021.10696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
The rapid development achieved over the last decades in volume rendering of ultrasound data, known as three-dimensional (3D) ultrasound technique, leads to new opportunities for refining the diagnosis in many gynaecologic conditions. The aim of the present study was to evaluate the advantages of 3D ultrasound over two-dimensional (2D) ultrasound in uterine pathology and to establish the optimal time point during the menstrual cycle to perform 3D ultrasound examination in order to achieve the maximum of useful information. A cross-sectional study on 200 patients who underwent gynaecologic 2D and 3D ultrasound examinations was performed. The addition of 3D examination to 2D ultrasound in uterine pathology provided the most useful information concerning: Congenital uterine anomalies, intrauterine devices (IUDs), adenomyosis, and submucous myomas. The findings showed that the 3D ultrasound scan is a useful tool in gynaecology, especially in cases with congenital uterine anomalies, myoma, and IUD. Although initially it was used for research purposes only, recent findings suggest its usefulness in routine ultrasound scan and the possibility of witnessing its introduction as a recommended examination procedure in the foreseeable future. Further research should be conducted in order to establish the sensitivity of 3D ultrasound in the detection of minor endometrial conditions, by correlating the imaging findings with the hysteroscopic results.
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Affiliation(s)
- Mihaela Grigore
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Clinical Hospital of Obstetrics and Gynaecology, 'Cuza Voda', 700038 Iasi, Romania
| | - Razvan Popovici
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Clinical Hospital of Obstetrics and Gynaecology, 'Cuza Voda', 700038 Iasi, Romania
| | - Loredana Maria Himiniuc
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Clinical Hospital of Obstetrics and Gynaecology, 'Cuza Voda', 700038 Iasi, Romania
| | - Ioana Sadiye Scripcariu
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Clinical Hospital of Obstetrics and Gynaecology, 'Cuza Voda', 700038 Iasi, Romania
| | - Bogdan Florin Toma
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Clinical Hospital of Obstetrics and Gynaecology, 'Cuza Voda', 700038 Iasi, Romania
| | - Ana Maria Grigore
- Department of Obstetrics and Gynaecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Oancea
- Department of Obstetrics and Gynaecology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Romeo Micu
- Department of Obstetrics and Gynaecology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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71
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Balica A, Dickson KM, Egan S, Cabrera J. Predictors for Discontinuation of Intrauterine Devices That Underwent Ultrasound-Guided Placement in a Long-term Follow-up Cohort. J Ultrasound Med 2021; 40:2115-2122. [PMID: 33301197 DOI: 10.1002/jum.15593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate long-term outcomes of ultrasound-guided intrauterine device (IUD) insertion. The rate of and reasons for IUD discontinuation were reviewed, including the prevalence of uterine fibroids. METHODS A retrospective cohort of patients who underwent transabdominal ultrasound (TAUS)-guided IUD insertion was reviewed. Information collected included age, body mass index, insertion date, indication for IUD use, indication for using TAUS guidance, and presence of uterine fibroids. The date of and reason for discontinuation were recorded. RESULTS One hundred sixteen patients with successful TAUS-guided IUD placement were identified. Of these, 51 patients (43.97%) no longer had an IUD in place. An overall actual-to-expected use ratio was calculated to be 63.49%. The most common reason for IUD discontinuation was spontaneous expulsion (11.21%). The prevalence of fibroid uteri was 27.6% in our cohort. The actual-to-expected use ratio of those with a fibroid uterus was calculated to be 43.28%, which was significantly lower than that for a nonfibroid uterus (73.80%; P = .002). There were 27 of 104 patients with IUD use of less than 1 year, and fibroids were present 44.4% of the time. Comparatively, of the 77 patients that had IUD continuation of greater than 1 year, only 24.7% had fibroids (P = .022). The yearly continuation rates over 5 years were 74.04%, 55.84%, 41.67%, 35.14%, and 32.0% respectively. Of the 18 patients who received TAUS-guided insertion for a previous IUD expulsion, 33.3% had another spontaneous expulsion. CONCLUSIONS Uterine fibroids and a previous expulsion appear to be the most likely predictors of IUD discontinuation, particularly within 1 year after insertion.
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Affiliation(s)
- Adrian Balica
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kaitlyn M Dickson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Susan Egan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Javier Cabrera
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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72
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Envall N, Emtell Iwarsson K, Bizjak I, Gemzell Danielsson K, Kopp Kallner H. Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial. Acta Obstet Gynecol Scand 2021; 100:2044-2052. [PMID: 34435347 DOI: 10.1111/aogs.14243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intervention trials of structured contraceptive counseling have proved to increase use of long-acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers' and participants' satisfaction with an intervention used in a large trial in Sweden. MATERIAL AND METHODS A cross-sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi-structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. TRIAL REGISTRATION ClinicalTrials.gov (NCT03269357). RESULTS Fourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time-neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package. CONCLUSIONS The intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Isabella Bizjak
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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73
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D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada® System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices 2021; 18:849-853. [PMID: 34355991 DOI: 10.1080/17434440.2021.1962288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Abnormal postpartum uterine bleeding occurs commonly after birth and can quickly become an obstetric emergency. With postpartum hemorrhage representing the leading cause of maternal mortality, accounting for 25% of maternal deaths due to obstetric complications, there is a critical need for effective and easy to use treatment options. AREAS COVERED This profile describes the Jada System, a novel intrauterine vacuum-induced hemorrhage control device that provides a rapid and effective treatment option for abnormal postpartum uterine bleeding and postpartum hemorrhage. In addition to explaining the mechanism of action of vacuum-induced hemorrhage control and reviewing the device's safety and effectiveness, this profile elucidates how the Jada System compares to currently available medications and devices for treatment of this obstetric emergency. EXPERT OPINION New therapies to address this life-threatening condition are needed to reduce the risk of maternal mortality and severe maternal morbidity. Data demonstrate that the Jada System provides rapid, effective control of abnormal postpartum uterine bleeding and postpartum hemorrhage, while offering reported ease of use and short treatment duration. These results suggest that use of the Jada System in treatment algorithms may improve outcomes.
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Affiliation(s)
- Mary D'Alton
- Department of Obstetrics and Gynecology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Kara Rood
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Dena Goffman
- Department of Obstetrics and Gynecology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Peipert JF, Zhao Q, Schreiber CA, Teal S, Turok DK, Natavio M, Cordon S, Daggy J. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol 2021; 225:157.e1-9. [PMID: 33716075 DOI: 10.1016/j.ajog.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device led to a perception that all intrauterine devices cause upper genital tract infection and infertility. OBJECTIVE This study aimed to assess the association between intrauterine device use and time to conception. STUDY DESIGN The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; and Salt Lake City, UT. Women were eligible if they stopped their contraceptive method within the past 120 days before enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were observed longitudinally for up to 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios and their respective 95% confidence intervals. RESULTS Of the 461 participants, mean age was 28.2 years, 178 (38.7%) were Black, 157 (34.1%) were considered as low socioeconomic status, and 275 (59.7%) had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) than participants who never used an intrauterine device (7.5 months). After controlling for potential confounders, the association of past intrauterine device use with time to conception was not statistically significant (adjusted hazard ratio, 1.25; 95% confidence interval, 0.99-1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection were associated with longer times to conception (hazard ratio, 0.76; 95% confidence interval, 0.58-0.99). Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% vs 80% without past infection; P=.019). CONCLUSION We found no impairment of fertility with ever use of an intrauterine device. Serologic evidence of past Mycoplasma genitalium infection was associated with longer times to conception and higher rates of infertility. Mycoplasma genitalium infection is a potential modifiable cause of infertility.
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75
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Gungor Ugurlucan F, Demir O, Tas S, Dural O, Yasa C, Yalcin O. Contraception counselling during gynecology visit - does a questionnaire help? Ginekol Pol 2021; 91:582-588. [PMID: 33184825 DOI: 10.5603/gp.a2020.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effective contraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraception counselling promoting modern contraception methods during gynecology outpatient visit using a contraception counselling questionnaire. MATERIAL AND METHODS All reproductive-age women over 18 were given Contraception Counselling Project Form to fill in while in the waiting room. The form consisted of 15 questions evaluating patients' characteristics and contraceptive method used. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant, postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded. RESULTS 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%) used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counselling by the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desire pregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interrupted coitus for contraception were convinced to use modern contraception. There was a significant relationship between age, education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and the preferred contraception method. CONCLUSIONS More than half the women preferred to use modern contraception methods by means of contraception counselling questionnaire. Women's backgrounds significantly affected their choice of contraception method.
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Affiliation(s)
- Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Omer Demir
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sema Tas
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cenk Yasa
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Onay Yalcin
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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van den Brink MJ, Beelen P, Herman MC, Geomini PM, Dekker JH, Vermeulen KM, Bongers MY, Berger MY. The levonorgestrel intrauterine system versus endometrial ablation for heavy menstrual bleeding: a cost-effectiveness analysis. BJOG 2021; 128:2003-2011. [PMID: 34245652 PMCID: PMC8518490 DOI: 10.1111/1471-0528.16836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the costs and non‐inferiority of a strategy starting with the levonorgestrel intrauterine system (LNG‐IUS) compared with endometrial ablation (EA) in the treatment of heavy menstrual bleeding (HMB). Design Cost‐effectiveness analysis from a societal perspective alongside a multicentre randomised non‐inferiority trial. Setting General practices and gynaecology departments in the Netherlands. Population In all, 270 women with HMB, aged ≥34 years old, without intracavitary pathology or wish for a future child. Methods Randomisation to a strategy starting with the LNG‐IUS (n = 132) or EA (n = 138). The incremental cost‐effectiveness ratio was estimated. Main outcome measures Direct medical costs and (in)direct non‐medical costs were calculated. The primary outcome was menstrual blood loss after 24 months, measured with the mean Pictorial Blood Assessment Chart (PBAC)‐score (non‐inferiority margin 25 points). A secondary outcome was successful blood loss reduction (PBAC‐score ≤75 points). Results Total costs per patient were €2,285 in the LNG‐IUS strategy and €3,465 in the EA strategy (difference: €1,180). At 24 months, mean PBAC‐scores were 64.8 in the LNG‐IUS group (n = 115) and 14.2 in the EA group (n = 132); difference 50.5 points (95% CI 4.3–96.7). In the LNG‐IUS group, 87% of women had a PBAC‐score ≤75 points versus 94% in the EA group (relative risk [RR] 0.93, 95% CI 0.85–1.01). The ICER was €23 (95% CI €5–111) per PBAC‐point. Conclusions A strategy starting with the LNG‐IUS was cheaper than starting with EA, but non‐inferiority could not be demonstrated. The LNG‐IUS is reversible and less invasive and can be a cost‐effective treatment option, depending on the success rate women are willing to accept. Tweetable abstract Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation. Treatment of heavy menstrual bleeding starting with LNG‐IUS is cheaper but slightly less effective than endometrial ablation.
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Affiliation(s)
- M J van den Brink
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P Beelen
- Department of General Practice, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M C Herman
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - P M Geomini
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - J H Dekker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Obstetrics and Gynaecology, Grow Research School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - M Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Najib B, Arab W, Khazen J, Abdelkhalek Y, Abdallah W, Khaddage A, Atallah D. A case of pelvic actinomycosis affecting genital, urinary and digestive tracts: a rare misleading diagnosis. Future Sci OA 2021; 7:FSO740. [PMID: 34295540 PMCID: PMC8288245 DOI: 10.2144/fsoa-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
Pelvic actinomycosis is an uncommon chronic invasive disease caused by a bacteria of the Actinomyces spp. Its diagnosis constitutes a clinical challenge and is usually reached in the postoperative period after resecting a pelvic mass that usually mimics advanced ovarian cancer. Although pelvic actinomyocosis involving the digestive and genital tract has been commonly described, very few reports have described cases involving both ovaries and requiring partial cystectomy for bladder involvement. Herein, we illustrate a case of pelvic actinomycosis with extensive involvement of multiple pelvic organs, misleading the surgeon into undergoing a complete clearance of the wrongfully thought adnexal malignancy. Actinomycosis is an infection that affects the genital tract and is usually related to the presence of a foreign body on which the bacteria develops and then spreads to organs of the genital, urinary and digestive system. The infection can spread through organs by destroying and infiltrating the anatomical limits between them. Physicians are prone to performing a resection of these infiltrative lesions for fear of cancer. However, the disease can be simply cured by prescribing antibiotics for a prolonged period of time. New techniques can be used to identify the germ and prevent physicians from performing unnecessary resections.
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Affiliation(s)
- Bernard Najib
- Department of Obstetrics & Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Wissam Arab
- Department of Obstetrics & Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Joseph Khazen
- Department of Pathology, Saint Joseph University, Beirut, Lebanon
| | - Yara Abdelkhalek
- Department of Obstetrics & Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Wael Abdallah
- Department of Obstetrics & Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Abir Khaddage
- Department of Pathology, Saint Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics & Gynecology, Saint Joseph University, Beirut, Lebanon
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Claret AR, Salinas MSDV, García LM, Hurtado IF, Jiménez ÁM. Colouterine Fistula Treated by a Double Endoscopic Approach. J Obstet Gynaecol Can 2021; 44:1004-1005. [PMID: 34102287 DOI: 10.1016/j.jogc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
Colouterine fistula associated with the use of an intrauterine device (IUD) is extremely rare. Clinical presentation may vary; however, to our knowledge, only 1 paper has previously reported menochezia as the main symptom of an utero-intestinal fistula as a complication of IUD use.1 Surgery is generally needed for definitive resolution of the fistula. Various surgical approaches have been proposed, mainly using open approaches owing to the presence of severe pelvic adhesions.2 Reports of laparoscopic treatment have been rarely described.3-4 We performed a successful conservative double endoscopic repair, with hysteroscopy followed by laparoscopy. Follow-up of IUD users is important, as complications may appear at any time. Unusual signs or symptoms warrant attention. Imaging tests aid in diagnosis and treatment selection, which in the majority of cases means planning for surgery. An endoscopic approached is preferred because of its lower risk of complications and shorter postoperative recovery period.
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Affiliation(s)
- Albert Reyes Claret
- Department of Obstetrics and Gynecology, Surgical Endoscopic Unit. Hospital Universitari Son Llàtzer, Palma Spain.
| | | | - Laura Moles García
- Department of Obstetrics and Gynecology, Surgical Endoscopic Unit. Hospital Universitari Son Llàtzer, Palma Spain
| | | | - Ángel Martín Jiménez
- Department of Obstetrics and Gynecology, Surgical Endoscopic Unit. Hospital Universitari Son Llàtzer, Palma Spain
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Anthony MS, Reed SD, Armstrong MA, Getahun D, Gatz JL, Saltus CW, Zhou X, Schoendorf J, Postlethwaite DA, Raine-Bennett T, Fassett MJ, Peipert JF, Ritchey ME, Ichikawa LE, Lynen R, Alabaster AL, Merchant M, Chiu VY, Shi JM, Xie F, Hui SL, Wang J, Hunter S, Bartsch J, Frenz AK, Chillemi G, Im TM, Takhar HS, Asiimwe A. Design of the Association of Uterine Perforation and Expulsion of Intrauterine Device study: a multisite retrospective cohort study. Am J Obstet Gynecol 2021; 224:599.e1-599.e18. [PMID: 33460585 DOI: 10.1016/j.ajog.2021.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrauterine devices are effective and safe, long-acting reversible contraceptives, but the risk of uterine perforation occurs with an estimated incidence of 1 to 2 per 1000 insertions. The European Active Surveillance Study for Intrauterine Devices, a European prospective observational study that enrolled 61,448 participants (2006-2012), found that women breastfeeding at the time of device insertion or with the device inserted at ≤36 weeks after delivery had a higher risk of uterine perforation. The Association of Uterine Perforation and Expulsion of Intrauterine Device (APEX-IUD) study was a Food and Drug Administration-mandated study designed to reflect current United States clinical practice. The aims of the APEX-IUD study were to evaluate the risk of intrauterine device-related uterine perforation and device expulsion among women who were breastfeeding or within 12 months after delivery at insertion. OBJECTIVE We aimed to describe the APEX-IUD study design, methodology, and analytical plan and present population characteristics, size of risk factor groups, and duration of follow-up. STUDY DESIGN APEX-IUD study was a retrospective cohort study conducted in 4 organizations with access to electronic health records: Kaiser Permanente Northern California, Kaiser Permanente Southern California, Kaiser Permanente Washington, and Regenstrief Institute in Indiana. Variables were identified through structured data (eg, diagnostic, procedural, medication codes) and unstructured data (eg, clinical notes) via natural language processing. Outcomes include uterine perforation and device expulsion; potential risk factors were breastfeeding at insertion, postpartum timing of insertion, device type, and menorrhagia diagnosis in the year before insertion. Covariates include demographic characteristics, clinical characteristics, and procedure-related variables, such as difficult insertion. The first potential date of inclusion for eligible women varies by research site (from January 1, 2001 to January 1, 2010). Follow-up begins at insertion and ends at first occurrence of an outcome of interest, a censoring event (device removal or reinsertion, pregnancy, hysterectomy, sterilization, device expiration, death, disenrollment, last clinical encounter), or end of the study period (June 30, 2018). Comparisons of levels of exposure variables were made using Cox regression models with confounding adjusted by propensity score weighting using overlap weights. RESULTS The study population includes 326,658 women with at least 1 device insertion during the study period (Kaiser Permanente Northern California, 161,442; Kaiser Permanente Southern California, 123,214; Kaiser Permanente Washington, 20,526; Regenstrief Institute, 21,476). The median duration of continuous enrollment was 90 (site medians 74-177) months. The mean age was 32 years, and the population was racially and ethnically diverse across the 4 sites. The mean body mass index was 28.5 kg/m2, and of the women included in the study, 10.0% had menorrhagia ≤12 months before insertion, 5.3% had uterine fibroids, and 10% were recent smokers; furthermore, among these women, 79.4% had levonorgestrel-releasing devices, and 19.5% had copper devices. Across sites, 97,824 women had an intrauterine device insertion at ≤52 weeks after delivery, of which 94,817 women (97%) had breastfeeding status at insertion determined; in addition, 228,834 women had intrauterine device insertion at >52 weeks after delivery or no evidence of a delivery in their health record. CONCLUSION Combining retrospective data from multiple sites allowed for a large and diverse study population. Collaboration with clinicians in the study design and validation of outcomes ensured that the APEX-IUD study results reflect current United States clinical practice. Results from this study will provide valuable information based on real-world evidence about risk factors for intrauterine devices perforation and expulsion for clinicians.
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Affiliation(s)
| | - Susan D Reed
- Kaiser Permanente Washington, Seattle, WA; University of Washington, Seattle, WA
| | | | | | | | | | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, NC
| | | | | | | | | | - Jeffrey F Peipert
- Regenstrief Institute, Indianapolis, IN; Indiana University, Indianapolis, IN
| | | | | | | | | | | | - Vicki Y Chiu
- Kaiser Permanente Southern California, Pasadena, CA
| | | | - Fagen Xie
- Kaiser Permanente Southern California, Pasadena, CA
| | - Siu L Hui
- Regenstrief Institute, Indianapolis, IN
| | - Jinyi Wang
- RTI Health Solutions, Research Triangle Park, NC
| | | | | | | | | | - Theresa M Im
- Kaiser Permanente Southern California, Pasadena, CA
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80
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Lo CT, Abraham A, Lipworth L, Aronoff DM. Intrauterine devices as an exposure risk for urinary tract infections: A scoping review. Am J Reprod Immunol 2021; 86:e13476. [PMID: 34053122 DOI: 10.1111/aji.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The intrauterine device (IUD) as a potential source of uro-gynecologic infection has raised concern for decades. While a causal link between IUD and pelvic inflammatory disease has been refuted, the relationship between IUDs and urinary tract infections (UTIs) remains incompletely understood. METHODS We used a PubMed, CINAHL, and Cochrane Library search strategy to identify studies evaluating UTI occurrence and microbial signatures among women exposed to IUD. We evaluated the question, "what is currently known about the IUD as an exposure risk for UTIs?" RESULTS Nine studies met inclusion criteria and were summarized in this structured, scoping review. Studies to date have not reported a significant association between IUD exposue and UTI occurence. While all nine studies acknowledged the breadth of contraceptive methods, none evaluated the impact of different IUD types (i.e., copper vs. hormone-eluting) on UTI incidence. CONCLUSION Small sample sizes and inconsistent UTI definitions limit the current literature. Future studies should rigorously define the UTI phenotype and evaluate the association of UTI with IUD exposure accounting for known covariates.
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Affiliation(s)
- Claire T Lo
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Abin Abraham
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
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81
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Wan L, Wang Y, Xiao C, Li X, Cao J, Wang S, Wei X, Liu X. Four cases of heterotopia of an intrauterine device embedded in the bladder muscular layer causing cystolithiasis: case report and review of the literature. J Int Med Res 2021; 49:300060520979444. [PMID: 33472467 PMCID: PMC7829606 DOI: 10.1177/0300060520979444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Family planning is a basic national policy in China. An intrauterine device (IUD)
is an important method of achieving family planning owing to its high safety,
low cost, and convenient use. The indwelling birth control ring has no obvious
adverse effects on the sexual life of women after the operation, and the process
is reversible. This ring can be removed for women who want to have children
again. There are approximately 100 million women with IUDs worldwide, with
approximately 80 million in China. This finding accounts for approximately 40%
of women of childbearing age in China. Although an IUD is safe, the invasive
operation inevitably leads to complications, such as pelvic infection, abnormal
menstruation, and damage to adjacent organs. Among them, ectopic bladder stone
formation is a rare complication, but several related cases have been reported.
We report four cases of heterotopia of an IUD and cystolithiasis, with diagnosis
based on the medical history, clinical manifestations, imaging, and cystoscopic
findings. The four patients with ectopic IUDs were treated with cystoscopy
combined with laparoscopy (or hysteroscopy). We describe the process of
diagnosis and treatment of our patients, and the related literature on an
ectopic IUD is reviewed.
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Affiliation(s)
- Li Wan
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Yong Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Chuan Xiao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xin Li
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Jingzhao Cao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Shubin Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xupan Wei
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xiangyu Liu
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
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82
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D'Alessandro G, Frigerio M, Barra F, Costantini S, Gustavino C, Ferrero S. Systematic review and meta-analysis on the impact of the levonorgestrel-releasing intrauterine system in reducing risk of ovarian cancer. Int J Gynaecol Obstet 2021; 156:418-424. [PMID: 33969485 PMCID: PMC9290617 DOI: 10.1002/ijgo.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/07/2021] [Accepted: 05/07/2021] [Indexed: 11/12/2022]
Abstract
Background Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates. Objective To determine whether the levonorgestrel‐releasing intrauterine system (LNG‐IUS) can prevent OC. Search strategy The literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957). Selection criteria Studies assessing the impact of LNG‐IUS on the risk of OC were included. Data collection and analysis Data were extracted independently by two authors to ensure accuracy and consistency. Main results A total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person‐years were considered. Data pooling revealed that the use of LNG‐IUS did not confer a lower risk of OC relative to the never‐use of LNG‐IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41–1.08; I2 = 84%; P = 0.002). Conclusion The meta‐analysis did not demonstrate a preventive role of LNG‐IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG‐IUS on OC. The meta‐analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel‐releasing intrauterine device on ovarian cancer.
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Affiliation(s)
- Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | | | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Sergio Costantini
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
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83
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Abstract
Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
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Affiliation(s)
- Makia E Powers
- Children's Healthcare of Atlanta and Morehouse School of Medicine, Atlanta, Georgia; and
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84
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Zamani Bonab M, Anvari Aliabad R, Alimohammadi S. Migration of intrauterine device caused asymptomatic acute appendicitis: A case report. Clin Case Rep 2021; 9:e04283. [PMID: 34084522 PMCID: PMC8143274 DOI: 10.1002/ccr3.4283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/20/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Missing of IUD is not always due to expulsion. If the patient is sure that it has not got expulsed, further investigations such as abdominal ultrasound and X-ray should be performed to look for the device before any device-related complications.
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Affiliation(s)
- Mehrangiz Zamani Bonab
- Department of GynecologySchool of MedicineHamadan University of Medical SciencesHamadanIran
| | | | - Shohreh Alimohammadi
- Department of GynecologySchool of MedicineHamadan University of Medical SciencesHamadanIran
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85
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Abstract
The IUD insertion procedure triggers IUD migration. Women with implanted IUDs should be examined to evaluate the device's position regularly.
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Affiliation(s)
- Fadli Robby Amsriza
- Department of SurgeryFaculty of Medicine and Health SciencesUniversitas Muhammadiyah YogyakartaYogyakartaIndonesia
| | - Rizka Fakhriani
- Department of Otorhinolaryngology, Head and Neck SurgeryFaculty of Medicine and Health SciencesUniversitas Muhammadiyah YogyakartaYogyakartaIndonesia
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86
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Runyan A, Welch RA, Kramer KJ, Cortez S, Roberts LJ, Asamoah C, Ottum S, Sanders J, Shafi A, Recanati MA. Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic. J Clin Med 2021; 10:jcm10091918. [PMID: 33925203 PMCID: PMC8125758 DOI: 10.3390/jcm10091918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.
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Affiliation(s)
- Aliye Runyan
- Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Robert A. Welch
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI 48503, USA;
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Catholic Medical Centers, New York, NY 10011, USA;
| | - Sarah Cortez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - LeAnne J. Roberts
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Clementina Asamoah
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Sarah Ottum
- Department of Surgery, Wayne State University, Detroit, MI 48202, USA;
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Adib Shafi
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA;
| | - Maurice-Andre Recanati
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA
- Correspondence:
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87
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Pohjoranta E, Suhonen S, Gissler M, Ikonen P, Mentula M, Heikinheimo O. Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial. Hum Reprod 2021; 35:796-804. [PMID: 32266392 DOI: 10.1093/humrep/deaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? SUMMARY ANSWER Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3 years of the 5-year follow-up. WHAT IS KNOWN ALREADY An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. STUDY DESIGN, SIZE, DURATION The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5 years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n = 375) was provided with an IUD during surgical TOP or 1-4 weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n = 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. PARTICIPANTS/MATERIALS, SETTING, METHODS The inclusion criteria were age ≥18 years, duration of gestation ≤12 weeks, residence in Helsinki and accepting intrauterine contraception. Women with contraindications to IUD were excluded. MAIN RESULTS AND THE ROLE OF CHANCE The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000 years of follow-up, P = 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P = 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P = 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P = 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P = 0.631). LIMITATIONS, REASONS FOR CAUTION Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. WIDER IMPLICATIONS OF THE FINDINGS Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Helsinki University Central Hospital Research funds and by research grants provided by the Jenny and Antti Wihuri Foundation, the Yrjö Jahnsson Foundation and Finska Läkaresällskapet. E.P. has received a personal research grant from the Finnish Medical Society. The City of Helsinki supported the study by providing the IUDs. The funding organisations had no role in planning or execution of the study, or in analysing the study results. TRIAL REGISTRATION NUMBER The trial was registered at clinicaltrials.gov (NCT01223521). TRIAL REGISTRATION DATE 18 October 2010. DATE OF FIRST PATIENT’S ENROLMENT 18 October 2010.
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Affiliation(s)
- Elina Pohjoranta
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Suhonen
- Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Finnish Institute for Health and Wellfare, Helsinki, Finland
| | - Pirjo Ikonen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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88
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Lindley KJ, Bairey Merz CN, Davis MB, Madden T, Park K, Bello NA. Contraception and Reproductive Planning for Women With Cardiovascular Disease: JACC Focus Seminar 5/5. J Am Coll Cardiol 2021; 77:1823-1834. [PMID: 33832608 PMCID: PMC8041063 DOI: 10.1016/j.jacc.2021.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/30/2022]
Abstract
The majority of reproductive-age women with cardiovascular disease are sexually active. Early and accurate counseling by the cardiovascular team regarding disease-specific contraceptive safety and effectiveness is imperative to preventing unplanned pregnancies in this high-risk group of patients. This document, the final of a 5-part series, provides evidence-based recommendations regarding contraceptive options for women with, or at high risk for, cardiovascular disease as well as recommendations regarding pregnancy termination for women at excessive cardiovascular mortality risk due to pregnancy.
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Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ki Park
- Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
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89
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Gemzell‐Danielsson K, Kubba A, Caetano C, Faustmann T, Lukkari‐Lax E, Heikinheimo O. Thirty years of mirena: A story of innovation and change in women's healthcare. Acta Obstet Gynecol Scand 2021; 100:614-618. [PMID: 33544887 PMCID: PMC8248365 DOI: 10.1111/aogs.14110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/14/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
Since its introduction in 1990, the levonorgestrel-releasing intrauterine system (LNG-IUS) has played a key role in shaping the healthcare landscape of women. Here we explore the development of the first LNG-IUS (Mirena®) and the early clinical trials that demonstrated its potential. We highlight the contraceptive and therapeutic benefits of Mirena®, and discuss how clinical practice has been changed since the introduction of LNG-IUS and other long-acting reversible contraceptive methods. The history of Mirena® is rich in innovation and has also paved the way to the development of smaller intrauterine systems with lower hormone doses. Along with Mirena®, these newer LNG-IUS contribute to improving contraceptive choices for women, allowing them to select the option that is right for them and that meets their needs no matter their age, parity or circumstances.
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Affiliation(s)
| | - Ali Kubba
- Guy’s and St Thomas’ NHS Foundation TrustLondonUK
| | | | | | | | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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90
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Buyuk GN, Oskovi-Kaplan ZA, Kansu-Celik H, Neselioglu S, Erel O, Engin-Ustun Y. Copper and levonorgestrel containing intrauterine devices: comparison of their effect on oxidative stress markers. Gynecol Endocrinol 2021; 37:320-323. [PMID: 33594922 DOI: 10.1080/09513590.2021.1878132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We aimed to evaluate the oxidative stress by measuring the thiol-disulfide balance in women who use either T380A or LNG-IUD as a contraceptive method. Material and method: The study included two groups; 30 women with LNG-IUD and 30 women with copper-IUD. Thiol-disulfide homeostasis as a marker of oxidative stress was analyzed before the IUD insertion and on the 6th month after insertion. Results: The LNG-IUD group had similar native thiol levels with Cu-IUD (293.1 ± 43.5 µmol/l vs. 290.4 ± 42.4 µmol/l respectively, p = 819). In the copper-IUD group total thiol levels were higher than LNG-IUD group (345.5 ± 58.2 µmol/l vs. 319.5 ± 52.4 µmol/l, p = .031). A significant increase was observed after 6 months in LNG-IUD patients in terms of disulfide/native thiol (7.9 ± 4.4% vs. 11.2 ± 2.6%, p = .006), disulfide/total thiol (6.2 ± 1.8% vs. 8.7 ± 1.9%, p = .004) and Native thiol/total thiol (87.1 ± 12.1% vs. 82.3 ± 8.2%, p = .004) levels. After 6 months in copper-IUD patients, disulfide (22.3 ± 7.3 µmol/l vs. 27.5 ± 6.9 µmol/l respectively, p = .006), disulfide/native thiol (7.7 ± 3.8% vs. 9.8 ± 2.4% respectively, p = .007), disulfide/total thiol (6.4 ± 2.03% vs. 8.2 ± 1.8% respectively, p = .007) and native thiol/total thiol (86.3 ± 9.4% vs. 83.8 ± 10.6% respectively, p = .007) levels were increased. Conclusion: An increase in oxidative stress markers were observed in both groups. Studies evaluating the long term subclinical risks of IUD's are needed to understand the outcomes of the increased oxidative stress.
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Affiliation(s)
- Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Z Asli Oskovi-Kaplan
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Department of Obstetrics and Gynecology, Lokman Hekim Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Clinical Biochemistry, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Ozcan Erel
- Department of Clinical Biochemistry, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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91
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Abu-Zaid A, Alshahrani MS, Albezrah NA, Miski NT, Abuzaid M, Aboudi SA, Baredwan A, Almadhi N, Baradwan A, Alomar O, Salem H, A Al-Badawi I, Baradwan S. Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomised controlled trials. EUR J CONTRACEP REPR 2021; 26:357-366. [PMID: 33691549 DOI: 10.1080/13625187.2021.1891411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To systematically and meta-analytically investigate the efficacy and safety of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. METHODS PubMed, Scopus, Web of Science, and Cochrane Library were screened till 1 October 2020. Only randomised placebo-controlled studies were included and assessed for risk of bias. Main outcomes included IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Pooled outcomes were summarised as standardised mean difference (SMD), weighted mean difference (WMD), or risk ratio (RR) with 95% confidence interval (95% CI). RESULTS Five studies were included, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies showed an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD = -0.79, 95% CI [-1.43, -0.16], p = 0.01), decreased pain at uterine sounding (SMD = -0.88, 95% CI [-1.54, -0.22], p = 0.009), decreased pain at IUD insertion (SMD = -1.18, 95% CI [-1.74, -0.61], p < 0.001), decreased need for additional analgesia (RR = 0.34, 95% CI [0.22, 0.53], p < 0.001), increased patient satisfaction (SMD = 1.41, 95% CI [0.62, 2.20], p < 0.001), and increased provider ease of IUD insertion (SMD = -1.17, 95% CI [-1.62, -0.73], p < 0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR = 3.73, 95% CI [1.47, 9.44], p = 0.006). All other side effects-including nausea, vomiting, shivering, diarrhoea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding-did not substantially differ between both groups. CONCLUSIONS This first ever meta-analysis advocates that dinoprostone compared with placebo is safe, effective, and yields favourable analgesic outcomes during IUD insertion.
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Affiliation(s)
- Ahmed Abu-Zaid
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Majed S Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Nisreen A Albezrah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Najlaa T Miski
- Department of Obstetrics and Gynecology, Faculty of Medicine in Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saud A Aboudi
- Department of Obstetrics and Gynecology, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Ahlam Baredwan
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Almadhi
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Afnan Baradwan
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Osama Alomar
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hany Salem
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ismail A Al-Badawi
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, HealthPlus Fertility and Women's Health Center, Jeddah, Saudi Arabia
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92
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Abstract
OBJECTIVES The increasing availability of health information online combined with reduced access to health care providers due to the coronavirus pandemic means that more people are using the internet for health information. However, with no standardised regulation of the internet, the population is vulnerable to misinformation regarding important health information. This review aimed to evaluate the quality and readability of the online information available on emergency contraception (EC) options. STUDY DESIGN In this descriptive study, a Google search was performed using the term 'emergency contraception options' on 13 April 2020 yielding 232 results. Seventy-one results were excluded (34 inaccessible, 37 contained no medical information). The remaining 161 results were categorised by typology and assessed for credibility (JAMA criteria and HONcode), reliability (DISCERN tool) and readability (Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook). RESULTS Of all webpages evaluated, the most common typology was governmental. Credibility of web pages was poor (average JAMA score of 1.47 out of 4). Only 10.6% of webpages were HONcode certified. The most common DISCERN category was Fair (29.81%), closely followed by Poor (27.95%) reliability. On average, readability levels were above the recommended grade level for health information. The intrauterine device was discussed least frequently (86.96%) of all the EC options. CONCLUSION Online information was of low credibility, reliability and written above the recommended reading level. Clinicians should be aware of the poor quality of online information on EC options, and actively educate patients on what makes a source credible.
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Affiliation(s)
- Simrita Agrawal
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ciara Irwin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rima K Dhillon-Smith
- Birmingham Women's Hospital Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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93
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Aksoy AN, Sarikas GT, Gozgec EG. The effect of copper intrauterine device use duration on uterine and ovarian blood flow parameters: A prospective cross-sectional study. J Clin Ultrasound 2021; 49:124-128. [PMID: 33269484 DOI: 10.1002/jcu.22953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE This prospective cross-sectional study aimed to compare uterine and ovarian arterial Doppler signals in regularly menstruating patients who had been using copper intrauterine devices (IUD) for different durations. METHODS Four groups of participants were formed (n = 30 for each) depending on the duration of copper IUD use: less than 1 year (group 1), 1 to 3 years (group 2), and over 3 years (group 3). Women without IUDs formed the control group. All participants were called in on the fifth-eighth days of their menstrual cycle for Doppler blood flow assessment. The pulsatility index (PI) and resistance index (RI) values were recorded in uterine and ovarian arteries. RESULTS The groups 2 and 3 had significantly higher uterine artery PI and RI values than groups 1 and 4. Furthermore, group 2 had uterine and ovarian artery PI and RI values similar to those of group 3. There was a positive relationship between uterine and ovarian arteries' PI and RI values with the duration of IUD use. CONCLUSIONS The presence of an IUD for over a year seems to cause changes in the uterine artery PI and RI values assessed by Doppler ultrasonography.
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Affiliation(s)
- Ayse Nur Aksoy
- Department of Obstetrics and Gynecology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gulsah Tanas Sarikas
- Department of Obstetrics and Gynecology, Nenehatun Maternity Hospital, Erzurum, Turkey
| | - Elif Guven Gozgec
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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94
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Beelen P, van den Brink MJ, Herman MC, Geomini PMAJ, Dekker JH, Duijnhoven RG, Mak N, van Meurs HS, Coppus SF, van der Steeg JW, Eising HP, Massop-Helmink DS, Klinkert ER, Nieboer TE, Timmermans A, van der Voet LF, Veersema S, Smeets NAC, Schutte JM, van Baal M, Bossuyt PM, Mol BWJ, Berger MY, Bongers MY. Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding. Am J Obstet Gynecol 2021; 224:187.e1-187.e10. [PMID: 32795428 DOI: 10.1016/j.ajog.2020.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/30/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Heavy menstrual bleeding affects the physical functioning and social well-being of many women. The levonorgestrel-releasing intrauterine system and endometrial ablation are 2 frequently applied treatments in women with heavy menstrual bleeding. OBJECTIVE This study aimed to compare the effectiveness of the levonorgestrel-releasing intrauterine system with endometrial ablation in women with heavy menstrual bleeding. STUDY DESIGN This multicenter, randomized controlled, noninferiority trial was performed in 26 hospitals and in a network of general practices in the Netherlands. Women with heavy menstrual bleeding, aged 34 years and older, without a pregnancy wish or intracavitary pathology were randomly allocated to treatment with either the levonorgestrel-releasing intrauterine system (Mirena) or endometrial ablation, performed with a bipolar radiofrequency device (NovaSure). The primary outcome was blood loss at 24 months, measured with a Pictorial Blood Loss Assessment Chart score. Secondary outcomes included reintervention rates, patient satisfaction, quality of life, and sexual function. RESULTS We registered 645 women as eligible, of whom 270 women provided informed consent. Of these, 132 women were allocated to the levonorgestrel-releasing intrauterine system (baseline Pictorial Blood Loss Assessment Chart score, 616) and 138 women to endometrial ablation (baseline Pictorial Blood Loss Assessment Chart score, 630). At 24 months, mean Pictorial Blood Loss Assessment Chart scores were 64.8 in the levonorgestrel-releasing intrauterine system group and 14.2 in the endometrial ablation group (difference, 50.5 points; 95% confidence interval, 4.3-96.7; noninferiority, P=.87 [25 Pictorial Blood Loss Assessment Chart point margin]). Compared with 14 women (10%) in the endometrial ablation group, 34 women (27%) underwent a surgical reintervention in the levonorgestrel-releasing intrauterine system group (relative risk, 2.64; 95% confidence interval, 1.49-4.68). There was no significant difference in patient satisfaction and quality of life between the groups. CONCLUSION Both the levonorgestrel-releasing intrauterine system and endometrial ablation strategies lead to a large decrease in menstrual blood loss in women with heavy menstrual bleeding, with comparable quality of life scores after treatment. Nevertheless, there was a significant difference in menstrual blood loss in favor of endometrial ablation, and we could not demonstrate noninferiority of starting with the levonorgestrel-releasing intrauterine system. Women who start with the levonorgestrel-releasing intrauterine system, a reversible and less invasive treatment, are at an increased risk of needing additional treatment compared with women who start with endometrial ablation. The results of this study will enable physicians to provide women with heavy menstrual bleeding with the evidence to make a well-informed decision between the 2 treatments.
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95
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Kwon YS, Paneque T, Chandra AA, Chua KJ, Munshi FI, Findlay BL, Harmon KA. Endoscopic Removal of an Intrauterine Device in the Left Distal Ureter. J Endourol Case Rep 2021; 6:502-504. [PMID: 33457713 DOI: 10.1089/cren.2020.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intrauterine device (IUD) migration to the ureter is rare. Symptoms can vary, but often mimic renal colic. Radiographic imaging may aid the diagnosis of a foreign body in the ureter. Reports on endoscopic managements of a migrated IUD are not well described. Case Presentation: We present a 36-year-old woman with a history of IUD insertion. Her symptoms included hematuria, dysuria, and suprapubic/abdominal pressure. After the removal of her IUD by her gynecologist, her hematuria eventually stopped, but she presented again with persistent pain. CT revealed a radiopaque foreign body in the distal left ureter protruding into the bladder. A careful resection with a resectoscope uncovered a long cylindrical shaped foreign body, suspicious of a broken piece of the IUD. Conclusion: Although not always feasible and long-term results remain to be determined, endoscopic management is a safe and effective method of identifying and removing a retained IUD in the ureter. When evaluating a woman with abdominal pain who has an indwelling IUD, a spontaneous migration of the IUD should be considered in the differential diagnosis.
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Affiliation(s)
- Young Suk Kwon
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Tomas Paneque
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Akhil A Chandra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kevin J Chua
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Faizanahmed I Munshi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Bridget L Findlay
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Keith A Harmon
- Division of Urology, Rutgers Robert Wood Johnson University Hospital Somerset, Somerville, New Jersey, USA
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96
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Crandell L, Mohler N. A Literature Review of the Effects of Copper Intrauterine Devices on Blood Copper Levels in Humans. Nurs Womens Health 2021; 25:71-81. [PMID: 33460577 DOI: 10.1016/j.nwh.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/19/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
Copper is a trace mineral that is essential to human health but can be harmful in excess. Since the introduction of copper-containing intrauterine devices in the 1970s, their possible relationship to abnormal/toxic blood copper levels has been researched. Here, we summarize and interpret 12 studies that evaluate blood copper levels in users of copper-containing intrauterine devices. The data are inconclusive, with the results of eight studies indicating no increase in blood copper levels with use and the results of four studies showing significant increases in blood copper levels with use. Investigators in all studies reviewed appear to have evaluated for total copper rather than free copper (the form of copper that is toxic), which raises questions about the clinical significance of all research on this subject to date.
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97
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Singata-Madliki M, Carayon-Lefebvre d'Hellencourt F, Lawrie TA, Balakrishna Y, Hofmeyr GJ. Effects of three contraceptive methods on depression and sexual function: An ancillary study of the ECHO randomized trial. Int J Gynaecol Obstet 2021; 154:256-262. [PMID: 33448029 PMCID: PMC8359257 DOI: 10.1002/ijgo.13594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/08/2020] [Accepted: 01/11/2021] [Indexed: 11/21/2022]
Abstract
Objective To compare the effects of depot medroxyprogesterone acetate (DMPA‐IM), levonorgestrel (LNG) implant, and copper intrauterine device (IUD) on mood and sexual function. Methods At the Effective Care Research Unit in South Africa, women already randomized in the ECHO Trial to the three methods were asked to participate in this study. Participants were interviewed at 3 and 12 months after enrollment using the Beck Depression Inventory and Arizona Sexual Experiences Scale, and at 12 months using the WHO‐5 Wellbeing Index and the Patient Global Impression scale. Results A total of 605 women participated. There was little difference in depression at 3 months across the three study groups. Contrary to our hypothesis, at 12 months, depression was lowest among DMPA‐IM users (16/167, 9.6%) and highest among IUD users (28/158, 17.7%) (p = 0.032). There was little difference in sexual function at any time‐point. More women in the DMPA‐IM group felt “very much better” on the PGI scale than in the IUD and LNG implant groups (p = 0.003). Conclusion Depression may be less likely with DMPA‐IM than with the other methods 1 year after initiation. Major differences in sexual functioning are unlikely. Unhappiness related to not using DMPA‐IM, the most popular method in our setting, may have skewed results. Trial registration number: PACTR201706001651380. Depression at 12 months after initiation may be less likely with DMPA‐IM than the IUD and LNG implant; major differences in sexual functioning are unlikely.
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Affiliation(s)
- Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | | | - Theresa A Lawrie
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa.,Evidence-based Medicine Consultancy Ltd, Bath, UK
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
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98
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Naor MS, Kaploun A, Friedman B. A feasibility study with a novel, dynamic, and disposable over-the-counter device for the management of stress urinary incontinence. Neurourol Urodyn 2020; 40:653-658. [PMID: 33348425 DOI: 10.1002/nau.24598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022]
Abstract
AIMS This study aimed to evaluate the initial efficacy, safety, and usability of a novel, dynamic, and disposable intravaginal device in women suffering from stress urinary incontinence (SUI). METHODS Twenty-six women with SUI were recruited to perform a modified 1-h Pad Weight Gain (PWG) test. In this test, women drank 250-500 ml of water, were given a pre-weighed pad, and asked to perform a set of incontinence-inducing activities. At the end of the activities session, the pad was removed and weighed. This test was performed both with and without the Nolix device. Three efficacy endpoints measured were continuous percent reduction in urine leakage, dryness (defined as pad weight increase by no more than 1 g), and improvement in pad weight (measured as continuous percent reduction in PWG ≥ 50%). Any adverse events, reported by subjects during the device use were recorded. The usability and user's satisfaction were assessed using the Benefit, Satisfaction, and Willingness to Continue and Nolix Satisfaction questionnaires. RESULTS The average reduction in PWG was 79.4%. The average reduction in urine leakage while using the device was at least 70%. In addition, in 79.5% of tests, the clinically meaningful level of improvement in PWG was achieved. Use of the device produced substantial improvement in the patient's perceived quality of life. No adverse events were reported during the study. CONCLUSION The Nolix device served as a noninvasive, effective, and well-tolerated treatment option for reducing SUI in a modified 1-h PWG test with a set of incontinence-inducing activities.
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Affiliation(s)
- Mika S Naor
- Sackler School of Medicine New York State/American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Alex Kaploun
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Boris Friedman
- Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel
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99
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Koirala S, Balla P, Pokhrel A, Koirala S, Pant S, Paudyal S. A rare case of ovarian ectopic pregnancy with IUD in situ: A case report from Nepal. Clin Case Rep 2020; 8:3240-3243. [PMID: 33363912 PMCID: PMC7752645 DOI: 10.1002/ccr3.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 11/12/2022] Open
Abstract
High index of suspicion of ectopic (much likely ovarian) pregnancy should be considered if a woman with IUD in situ presents with abdominal pain, vaginal bleeding, and positive urine pregnancy test.
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Affiliation(s)
- Saugat Koirala
- Department of Obstetrics and GynecologyDhaulagiri HospitalBaglungNepal
| | - Pujan Balla
- Department of Anesthesia and Critical CareDhaulagiri HospitalBaglungNepal
| | - Ajay Pokhrel
- Department of Radiodiagnosis and ImagingDhaulagiri HospitalBaglungNepal
| | - Sachin Koirala
- Department of Anesthesia and Critical CareDhaulagiri HospitalBaglungNepal
| | - Smriti Pant
- Department of Community Health SciencesPatan Academy of Health SciencesLalitpurNepal
| | - Supriya Paudyal
- Department of Emergency MedicineDhaulagiri HospitalBaglungNepal
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100
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Jones DD, Kummer T, Schoen JC. Ruptured Ectopic Pregnancy with an Intrauterine Device: Case Report and Sonographic Considerations. Clin Pract Cases Emerg Med 2020; 4:559-563. [PMID: 33217272 PMCID: PMC7676810 DOI: 10.5811/cpcem.2020.7.48258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ectopic pregnancy carries a high morbidity and mortality; patients are at risk for rupture and life-threatening hemorrhage. CASE REPORT We present a rare case of ruptured abdominal ectopic pregnancy in a patient with a well-positioned intrauterine device (IUD) and discuss the diagnostic utility that transabdominal point-of-care ultrasound (POCUS) can have when performed at the bedside. CONCLUSION While pregnancy with an IUD in place is rare, when it is encountered the emergency provider should maintain a high degree of suspicion for extrauterine pregnancy and perform prompt evaluation for hemorrhagic shock using diagnostic POCUS.
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Affiliation(s)
- Derick D. Jones
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
| | - Tobias Kummer
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Jessica C. Schoen
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
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