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Barton BE, Erickson JA, Allred SI, Jeffries JM, Stephens KK, Hunter MI, Woodall KA, Winuthayanon W. Reversible female contraceptives: historical, current, and future perspectives†. Biol Reprod 2024; 110:14-32. [PMID: 37941453 PMCID: PMC10790348 DOI: 10.1093/biolre/ioad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.
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Affiliation(s)
- Brooke E Barton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffery A Erickson
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Stephanie I Allred
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jenna M Jeffries
- College of Art & Science, Washington State University, Pullman, WA, USA
| | - Kalli K Stephens
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Mark I Hunter
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Kirby A Woodall
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Wipawee Winuthayanon
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
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2
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Zhu GG, Ludwig DR, Rogers DM, Olpin JD, Barker E, Freeman EA, Eisenberg DL, Siegel CL. CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications. Abdom Radiol (NY) 2024; 49:237-248. [PMID: 37907685 DOI: 10.1007/s00261-023-04052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
Intrauterine devices (IUDs) are a commonly used form of long-acting reversible contraception, which either contain copper or levonorgestrel to prevent pregnancy. Although symptomatic patients with indwelling IUDs may first undergo ultrasound to assess for device malposition and complications, IUDs are commonly encountered on CT in patients undergoing evaluation for unrelated indications. Frequently, IUD malposition and complications may be asymptomatic or clinically unsuspected. For these reasons, it is important for the radiologist to carefully scrutinize the IUD on any study in which it is encountered. To do so, the radiologist must recognize that normally positioned IUDs are located centrally within the uterine cavity. IUDs are extremely effective in preventing pregnancy, though inadvertent pregnancy risk is higher with malpositioned IUDs. Presence of fibroids or Mullerian abnormalities may preclude proper IUD placement. Radiologists play an important role in identifying complications when they arise and special considerations when planning for an IUD placement. There is a wide range of IUD malposition, affecting IUDs differently depending on the type of IUD and its mechanism of action. IUD malposition is the most common complication, but embedment and/or partial perforation can and can lead to difficulty when removed. Retained IUD fragments can result in continued contraceptive effect. Perforated IUDs do not typically cause intraperitoneal imaging findings.
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Affiliation(s)
- Grace G Zhu
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA.
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
| | - Daniel R Ludwig
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Jeffrey D Olpin
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Emily Barker
- Planned Parenthood of St. Louis Region, 4251 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Emily A Freeman
- OB/GYN and Women's Health Clinic, Cleveland Clinic, 850 Columbia Road Suite 330, Cleveland, OH, 44145, USA
| | - David L Eisenberg
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave, Mailstop 8064-37-1005, St. Louis, MO, 63110, USA
| | - Cary L Siegel
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
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Sapapsap B, Leelakanok N, Boonpattharatthiti K, Siritientong T, Methaneethorn J. A systematic review and meta-analysis of the prevalence and association between levonorgestrel and ectopic pregnancy. Expert Opin Drug Saf 2023; 22:929-941. [PMID: 37577925 DOI: 10.1080/14740338.2023.2247965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The use of levonorgestrel emergency oral contraceptives (EOCs) is one of the factors that may be associated with ectopic pregnancy. We aimed to investigate the incidence of ectopic pregnancy in EOC users and the association between EOCs and ectopic pregnancy. RESEARCH DESIGN AND METHODS We searched for articles that provided the incidence of and the association between levonorgestrel EOCs and ectopic pregnancy in women of reproductive ages in CINAHL Complete, Medline, OpenDissertations, Scopus, Science Direct, and Thai Journal Online. The risk of bias was assessed by Risk Of Bias In Non-randomized Studies or Risk of Bias 2. A meta-analysis was conducted using the random-effects model. RESULTS We retrieved 1839 nonredundant articles from the systematic search. The meta-analysis showed that the prevalence of ectopic pregnancy was not statistically different from zero (pooled prevalence estimate = 0.029%; 95%CI: -0.006, 0.065; N = 9; I2 = 0) and rare. In addition, levonorgestrel EOCs increased the risk of ectopic pregnancy (OR = 6.17; 95%CI: 3.78, 10.08; N = 5; I2 = 43%). CONCLUSIONS Women with extrauterine or ectopic pregnancy had higher odds of using levonorgestrel emergency oral contraceptives than those with intrauterine pregnancy. However, the prevalence of ectopic pregnancy is rare.
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Affiliation(s)
- Bannawich Sapapsap
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Nattawut Leelakanok
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Kansak Boonpattharatthiti
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Irgens-Moller N, Baum CR. Complications of Long-Acting Reversible Contraceptive Modalities. Pediatr Emerg Care 2023; 39:443-449. [PMID: 37256282 DOI: 10.1097/pec.0000000000002970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ABSTRACT Long-acting reversible contraception has risen in popularity in recent decades and is becoming one of the more common modalities of contraception in the United States, with a growing adolescent population among its users. The 2 modalities of long-acting reversible contraception-intrauterine devices and subcutaneous hormonal implants/etonogestrel implants (referred to as Nexplanon in the US)-are beneficial for their excellent effectiveness, ease of use, and safety profile. This article reviews the pharmacology of these modalities, common complications and their presentations, and the initial evaluation and management in the pediatric emergency department setting. Where applicable, attention will be paid to problems unique to the adolescent population.
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Affiliation(s)
| | - Carl R Baum
- Attending, Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT
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Singer SR, Melchor J, Ripps SJ, Burgess J. Ectopic Pregnancy Observed With Kyleena Intrauterine Device Use: A Case Report. Cureus 2023; 15:e35637. [PMID: 36875246 PMCID: PMC9980839 DOI: 10.7759/cureus.35637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
Kyleena (levonorgestrel 19.5 mg), a type of intrauterine device (IUD), has an efficacy rate of 99% in preventing pregnancy. Because the overall failure rate of IUDs is low, ectopic pregnancy (EP) with IUD use is uncommon. This case reports an EP observed in a female with the Kyleena IUD in place. She had no known risk factors for an EP, which makes this case noteworthy. Ultrasound and surgery confirmed a 4 cm EP in the ampulla of the left fallopian tube. Insufficient evidence exists to conclude whether the Kyleena IUD has a higher risk of EP compared to other hormonal IUDs. As the Kyleena IUD becomes a more popular option for women in search of an effective contraceptive, patients and clinicians should be aware of this potential risk. Our case emphasizes that continued research on the prevalence of EP with Kyleena use is necessary.
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Affiliation(s)
- Samantha R Singer
- Academic Institution, Florida State University College of Medicine, Tallahassee, USA
| | - Julian Melchor
- Academic Institution, Florida State University College of Medicine, Tallahassee, USA
| | - Sarah J Ripps
- Academic Institution, Florida State University College of Medicine, Tallahassee, USA
| | - Jennifer Burgess
- Obstetrics and Gynecology, Women's Health Specialist OBGYN, Stuart, USA
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Jenabi E, Ayubi E, Khazaei S, Soltanian AR, Salehi AM. The environmental risk factors associated with ectopic pregnancy: An umbrella review. J Gynecol Obstet Hum Reprod 2023; 52:102532. [PMID: 36592890 DOI: 10.1016/j.jogoh.2022.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/16/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Ectopic pregnancy(EP) is the implantation of a fertilized ovum outside of the uterine cavity. The incidence of EP has steadily increased around the world. The present umbrella review evaluated risk factors prior to conception associated with EP based on meta-analyses and systematic reviews. METHODS We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with EP were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). RESULTS Two risk factors including chlamydia trachomatis (OR: 3.03) and smoking (OR: 1·77) were graded as suggestive evidence (class III). IUD with pregnant control (OR: 10.63) and endometriosis for case-control studies (OR: 2·66) and tubal ligation with pregnant control (OR: 9.3) were graded as risk factors with weak evidence (class IV). Tubal ligation with non-pregnant control was a protective factor (class IV). IUD with non-pregnant control and endometriosis for cohort studies were not as risk factors for EP. CONCLUSION Two risk factors including chlamydia trachomatis and smoking were graded as suggestive evidence. IUD with pregnant control and endometriosis for case-control studies and tubal ligation with pregnant control were graded as risk factors with weak evidence. Strong evidence for risk factors of EP was not achieved, indicating the degree of uncertainty and bias, which bring an emergency to conduct further no-bias studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42021281632).
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Affiliation(s)
- Ensiyeh Jenabi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Non-Communicable Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Mohammad Salehi
- Student Research Committee, Hamadan University of Medical Sciences School of Medicine, Hamadan, Iran.
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Donval L, Oufkir N, Bondu D, Daoud E, Dumas E, Reyal F, Hamy AS. [Evolution of contraceptive practices in France: An overview from 2014 to 2019]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:535-541. [PMID: 35487494 DOI: 10.1016/j.gofs.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/17/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the use of reimbursed contraceptive methods in France between 2014 and 2019, with an analysis of the profile of users by age group and an analysis by type of prescriber. METHODS We conducted a national descriptive study using data from the Assurance Maladie Open Data database on the use of contraceptive methods reimbursed in France from January 1, 2014, to December 31, 2019. We analyzed the number of users by year, by age group (<20years, 20-60years), and by prescriber (liberal general practitioner, liberal gynecologist, hospital practitioner, liberal midwife). RESULTS In 2019, 50.1% (5,345,122) of women of childbearing age used a reimbursed contraceptive method. Hormonal oral contraception was the leading contraceptive method used (42.3%), followed by the intrauterine device (6.2%) and the implant (1.6%). Use of combined estrogen-progestogen oral contraception had been declining since 2015 (-8.1 points), to the benefit of the micro progestin pill (+9.1 points) and the copper intrauterine device (+1.4 points). Among women under 20, the hormonal implant was the second most popular contraceptive method (1.2%), followed by the copper intrauterine device (0.8%) and the hormonal intrauterine system (0.2%). Among women over 20years of age of childbearing age, the copper IUD was the second most-reimbursed contraceptive method (2.4%), followed by the hormonal intrauterine system (1.6%) and the hormonal implant (1.2%). There are disparities in prescribing practices: in 2019, 51% of prescribers were general practitioners and 97% of them prescribed hormonal oral contraception. CONCLUSION The contraceptive supply in France is diversifying, although oral contraception remains predominant. Disparities exist between age groups of users and there is great heterogeneity in practices among contraceptive prescribers.
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Affiliation(s)
- Lou Donval
- Département de chirurgie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - Nina Oufkir
- Département de chirurgie oncologique, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Dorian Bondu
- Département de recherche translationnelle, RT2Lab, Inserm, U932 immunité et cancer, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Eric Daoud
- Département de recherche translationnelle, RT2Lab, Inserm, U932 immunité et cancer, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Elise Dumas
- Département de recherche translationnelle, RT2Lab, Inserm, U932 immunité et cancer, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Fabien Reyal
- Département de chirurgie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Département de recherche translationnelle, RT2Lab, Inserm, U932 immunité et cancer, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Anne-Sophie Hamy
- Département de recherche translationnelle, RT2Lab, Inserm, U932 immunité et cancer, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Département d'oncologie médicale, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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8
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Resta C, Dooley WM, Malligiannis Ntalianis K, Burugapalli S, Hussain M. Ectopic Pregnancy in a Levonogestrel-Releasing Intrauterine Device User: A Case Report. Cureus 2021; 13:e18867. [PMID: 34804718 PMCID: PMC8598246 DOI: 10.7759/cureus.18867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Levonorgestrel-releasing intrauterine devices are considered to be a reliable contraceptive option with a low failure rate. The risk of ectopic pregnancy, however, if an unintended pregnancy occurs is significantly higher. In this study, we present a case of a tubal ectopic pregnancy in a woman with a levonorgestrel-releasing intrauterine device in situ for one year. Our case emphasises the importance of having a high index of suspicion in women who have an intrauterine device in situ, presenting with a positive pregnancy test. We also discuss the importance of timely ultrasound examination and the management considerations of similar cases. The importance of urgent review and investigation of women with positive pregnancy test and intrauterine contraceptive device in situ, given the higher possibility of ectopic pregnancy, is highlighted by this case.
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Affiliation(s)
- Christina Resta
- Obstetrics and Gynaecology, Mid & South Essex NHS Foundation Trust, Southend-On-Sea, GBR
| | - William M Dooley
- Obstetrics and Gynaecology, Mid & South Essex NHS Foundation Trust, Southend-On-Sea, GBR
| | | | - Sarojini Burugapalli
- Obstetrics and Gynaecology, Mid & South Essex NHS Foundation Trust, Southend-On-Sea, GBR
| | - Munawar Hussain
- Obstetrics and Gynaecology, Mid & South Essex NHS Foundation Trust, Southend-On-Sea, GBR
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9
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Masud N, AlShaibi S, AlBassri T, Khan S, Khan F. Case of rupture ectopic pregnancy with emergency contraception levonorgestrel 0.075 mg in a lactating woman. Clin Case Rep 2021; 9:1605-1609. [PMID: 33768899 PMCID: PMC7981599 DOI: 10.1002/ccr3.3849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 12/05/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022] Open
Abstract
Levonorgestrel emergency contraception (LNG-EC) tends to make uterus unfavorable for implantation but does not prevent embryo implantation. Emergency contraceptives pills should be used with caution among lactating women who at the same time should be monitored closely for ectopic pregnancy.
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Affiliation(s)
- Nazish Masud
- Research UnitDepartment of Medical EducationCollege of Medicine King Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
- King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Saleh AlShaibi
- King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- College of Medicine King Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
| | - Tala AlBassri
- King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- College of Medicine King Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
| | - Saad Khan
- Department of MedicineKhyber Teaching HospitalMTIPeshawarPakistan
| | - Fahad Khan
- Department of MedicineLady Reading HospitalMTIPeshawarPakistan
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Rokhgireh S, Gorginzadeh M, Mehdizadehkashi A, Tahermanesh K, Alizadeh S. Broad ligament pregnancy in the presence of an intrauterine contraceptive device: A case report. Int J Surg Case Rep 2021; 79:421-423. [PMID: 33529821 PMCID: PMC7851414 DOI: 10.1016/j.ijscr.2021.01.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Abdominal pregnancy though scarce is associated with considerable morbidity and mortality. Few cases till now have been diagnosed or managed by laparoscopy. CASE PRESENTATION In this study, a case of an abdominal pregnancy in a woman with intrauterine contraceptive device (IUD) in situ and a history of cesarean section is described. CLINICAL DISCUSSION Our case was a brief description of a broad ligament pregnancy as a subcategory of abdominal pregnancy .It was located medial to the pelvic sidewall, lateral to the uterus, inferior to the fallopian tube and superior to the pelvic floor. CONCLUSION The pregnancy was in the location of the left broad ligament which was diagnosed on laparoscopic evaluation.
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Affiliation(s)
- Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shima Alizadeh
- Department of Obstetrics & Gynecology, Emam Complex, Vali-e-Asr Hospital, Tehran University of Medical Science(TUMS), Tehran, Iran.
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A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive. Clin Drug Investig 2020; 40:395-420. [PMID: 32162237 DOI: 10.1007/s40261-020-00901-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The levonorgestrel oral emergency contraceptive is well tolerated and effective, however its use is still limited, mainly due to safety concerns. OBJECTIVE This systematic review and meta-analysis aimed to summarize current evidence regarding the adverse events, and their prevalence, reported during the use of oral levonorgestrel emergency contraceptives. METHODS Four electronic databases and the US FDA Adverse Event Reporting System (FAERS) Public Dashboard were searched. Studies that reported or investigated safety outcomes or adverse reactions during the use of levonorgestrel as an emergency oral contraceptive were included. Data on study design, demographics of levonorgestrel and the control cohort, and reported adverse effects were extracted. RESULTS A total of 47 articles were included in this systematic review, from which it was shown that most of the adverse reactions were common and not serious. Uncommon adverse reactions identified included anorexia, ectopic pregnancy, exanthema, chloasma, miscarriage, and weight gain. Multiple serious adverse events, including convulsion, ectopic pregnancy, febrile neutropenia, stroke, abdominal hernia, anaphylaxis, cancer, ovarian cyst rupture, serious infections, and suicidal ideation, were reported. In addition, the prevalence of adverse events after a levonorgestrel 0.75 mg two-dose regimen and a levonorgestrel 1.5 mg single-dose regimen were not statistically different (p > 0.05). CONCLUSIONS The most common adverse effects of levonorgestrel were not serious. This systematic review shows that data regarding the adverse reactions of repeated use of levonorgestrel are scarce. Studies on the multiple uses of levonorgestrel emergency contraception are still required to ensure its safety.
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12
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Attini R, Cabiddu G, Montersino B, Gammaro L, Gernone G, Moroni G, Santoro D, Spotti D, Masturzo B, Gazzani IB, Menato G, Donvito V, Paoletti AM, Piccoli GB. Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology. J Nephrol 2020; 33:1343-1359. [PMID: 32166655 PMCID: PMC7701165 DOI: 10.1007/s40620-020-00717-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/25/2020] [Indexed: 01/09/2023]
Abstract
Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, Turin, Italy
| | | | - Benedetta Montersino
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, Turin, Italy
| | - Linda Gammaro
- Nephrology Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | | | - Gabriella Moroni
- Nephrology, Fondazione Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Domenico Santoro
- Nephrology and Dialysis, Azienda Ospedaliera Universitaria "G. Martino", Messina, Italy
| | - Donatella Spotti
- Nephrology and Dialysis, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, Turin, Italy
| | - Isabella Bianca Gazzani
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, Turin, Italy
| | - Guido Menato
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, Turin, Italy
| | - Valentina Donvito
- Department of Internal Medicine, Ospedale Sant'Anna, Città della Salute e della Scienza, Turin, Italy
| | - Anna Maria Paoletti
- Department of Surgical Sciences, Obstetrics and Gynecology, University Hospital of Cagliari, Cagliari, Italy
| | - Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy. .,Nephrology and Dialysis, Centre Hospitalier Le Mans, Le Mans, France.
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Mousa A, Elkhateb IT, Mohye Eldeen R. Unintended pregnancy with IUD in situ reveals the IUD placement into one of the uterine horns in a bicornuate uterus. BMJ Case Rep 2019; 12:e232638. [PMID: 31796441 PMCID: PMC7001715 DOI: 10.1136/bcr-2019-232638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Abdalla Mousa
- OBGYN department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Islam Tarek Elkhateb
- OBGYN department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Riham Mohye Eldeen
- Dermatology department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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Evans AT, Szlachetka K, Thornburg LL. Ultrasound Assessment of the Intrauterine Device. Obstet Gynecol Clin North Am 2019; 46:661-681. [DOI: 10.1016/j.ogc.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Gaskins AJ, Missmer SA, Rich-Edwards JW, Williams PL, Souter I, Chavarro JE. Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy. Fertil Steril 2019; 110:1328-1337. [PMID: 30503132 DOI: 10.1016/j.fertnstert.2018.08.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the relationship between demographic, lifestyle, and reproductive factors and the risk of ectopic pregnancy (EP). DESIGN Prospective cohort. SETTING United States. PATIENT(S) Nurses' Health Study II cohort comprising 41,440 pregnancies from 22,356 women. INTERVENTION(S) Demographic, lifestyle, and reproductive factors self-reported in 1989 then updated every 2 years. Multivariable log-binomial regression models with generalized estimating equations were used to estimate adjusted risk ratios (aRR). MAIN OUTCOME MEASURE(S) Ectopic pregnancy. RESULT(S) Incident EP was reported in 411 (1.0%) pregnancies. Former and current smokers had 1.22 (95% confidence interval [CI], 0.97-1.55) and 1.73 (95% CI, 1.28-2.32) times, respectively, the risk of EP compared with never smokers. The risk of EP 10 years after quitting was similar to never smokers (aRR 0.90; 95% CI, 0.60-1.33). Women consuming ≥10 g/day of alcohol had 1.50 (95% CI, 1.08-2.09) times the risk of EP compared with never consumers. In utero exposure to diethylstilbestrol (aRR 3.55; 95% CI, 2.51-5.01), earlier initiation of oral contraceptives (aRR 2.64; 95% CI, 1.70-4.09 for <16 years vs. never), intrauterine device use (aRR 3.99; 95% CI, 2.06-7.72), or history of infertility (aRR 3.03; 95% CI, 2.48-3.71) or tubal ligation (aRR 16.27; 95% CI, 11.76-22.53) also were associated with a higher risk of EP. CONCLUSION(S) Women who were current or former smokers, consumed ≥10 g/day of alcohol, were exposed to diethylstilbestrol in utero, initiated oral contraceptives at earlier than age 16 years (which may be a marker of riskier sexual behaviors), and who had a history of infertility, intrauterine device use, or tubal ligation had a higher risk of EP.
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Affiliation(s)
- Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Stacey A Missmer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Janet W Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Abstract
To reduce the rate of unintended pregnancies, patients should select a contraceptive option that fits their needs and lifestyle. Long-acting reversible contraceptives (LARCs) are a relatively safe and effective option. This article outlines the characteristics of available LARCs and identifies the appropriate method for specific patient populations.
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17
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Neth MR, Thompson MA, Gibson CB, Gullett JP, Pigott DC. Ruptured Ectopic Pregnancy in the Presence of an Intrauterine Device. Clin Pract Cases Emerg Med 2019; 3:51-54. [PMID: 30775665 PMCID: PMC6366366 DOI: 10.5811/cpcem.2019.1.41345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/11/2018] [Accepted: 01/04/2019] [Indexed: 11/24/2022] Open
Abstract
Ruptured ectopic pregnancy is the leading cause of first trimester maternal mortality. The diagnosis of ectopic pregnancy should always be suspected in patients with abdominal pain, vaginal bleeding or syncope. While the use of an intrauterine device (IUD) markedly reduces the incidence of intrauterine pregnancy, it does not confer equal protection from the risk of ectopic pregnancy. In this report we discuss the case of a female patient who presented with a ruptured ectopic pregnancy and hemoperitoneum despite a correctly positioned IUD.
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Affiliation(s)
- Matthew R Neth
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Maxwell A Thompson
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Courtney Blayke Gibson
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - John P Gullett
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - David C Pigott
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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18
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Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:806-822. [PMID: 30429071 DOI: 10.1016/j.gofs.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide national clinical guidelines focusing on intrauterine contraception. METHODS A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
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Affiliation(s)
- F Vidal
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
| | - L Paret
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France
| | - Y Tanguy le Gac
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Guerby
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
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19
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20
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Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol 2017; 130:e251-e269. [PMID: 29064972 DOI: 10.1097/aog.0000000000002400] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid (1, 2). The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods (3).
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21
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Howard DL, Beasley LM. Pregnant with a perforated levonorgestrel intrauterine system and visible threads at the cervical os. BMJ Case Rep 2017; 2017:bcr-2017-220071. [PMID: 28536231 DOI: 10.1136/bcr-2017-220071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present a case in which a patient presented with a pregnancy of unknown location and normally rising human chorionic gonadotropin (hCG) levels but with a levonorgestrel intrauterine device (LNG-IUD) present. The LNG-IUD had been placed 4.5 years ago. Although unintended, this pregnancy was desired. Strings were clearly visible and initial 2D ultrasound suggested intrauterine location of the LNG-IUD. The LNG-IUD could not be removed however. The patient was managed expectantly with close follow-up, serial beta-hCGs and serial ultrasounds until definitive diagnosis of the location of the pregnancy. The patient was diagnosed with an ectopic pregnancy and during laparoscopy the body of the IUD was noted in the posterior cul-de-sac. When patients present with multiple competing clinical problems it is important to look at the patient as a whole, taking into account their desires, in order to construct a cohesive management plan.
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Affiliation(s)
- David L Howard
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center, Las Vegas, Nevada, USA
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22
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Family Planning and Contraception. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Parks C, Peipert JF. Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC). Am J Obstet Gynecol 2016; 214:681-8. [PMID: 26875950 PMCID: PMC4884485 DOI: 10.1016/j.ajog.2016.02.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022]
Abstract
Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career opportunities and may contribute to socioeconomic deprivation and widening income disparities. Long-acting reversible contraception (LARC), including intrauterine devices and implants, offer the opportunity to change the default from drifting into parenthood to planned conception. LARC methods are forgettable; once placed, they offer highly effective, long-term pregnancy prevention. Increasing evidence in the medical literature demonstrates the population benefits of use of these methods. However, barriers to more widespread use of LARC methods persist and include educational, access, and cost barriers. With increasing insurance coverage under the Affordable Care Act and more widespread, no-cost coverage of methods, more and more women are choosing intrauterine devices and the contraceptive implant. Increasing the use of highly effective contraceptive methods may provide one solution to the persistent problem of the health disparities of unplanned and teen pregnancies in the United States and improve women's and children's health.
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Affiliation(s)
- Caitlin Parks
- Division of Family Planning, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St Louis, MO; Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN
| | - Jeffrey F Peipert
- Division of Family Planning, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, School of Medicine, St Louis, MO; Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN.
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24
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Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review. Contraception 2015; 92:514-22. [DOI: 10.1016/j.contraception.2015.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 08/25/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022]
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25
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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Zhang J, Li C, Zhao WH, Xi X, Cao SJ, Ping H, Qin GJ, Cheng L, Huang HF. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study. Sci Rep 2015; 5:8487. [PMID: 25674909 PMCID: PMC4325579 DOI: 10.1038/srep08487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/14/2015] [Indexed: 12/30/2022] Open
Abstract
Cases of ectopic pregnancy (EP) following levonorgestrel emergency contraception (LNG-EC) failure have been reported continuously, but whether there is an association between EP risk and LNG-EC is unclear. We concluded a case-control study to explore this association by recruiting 2,411 EP patients as case group, and 2,416 women with intrauterine pregnancy and 2,419 non-pregnant women as control groups. Odds ratios (ORs) and their 95% confidential intervals (CIs) were calculated and adjusted for potential confounding factors. Previous use of LNG-EC was not correlated with the EP. Compared to women who did not use contraceptives, current use of LNG-EC reduced the risk for intrauterine pregnancy (Adjusted OR [AOR] = 0.20, 95%CI: 0.14-0.27), but did not increase the risk for EP (AOR2 = 1.04, 95%CI: 0.76-1.42). Furthermore, compared to women who did not have further act of intercourse, women with unprotected further act of intercourse were at a higher risk of EP (AOR1 = 2.35, 95%CI: 1.17-4.71), and women with repeated use of LNG-EC for further intercourse during the same cycle was also associated with a higher risk for EP (AOR1 = 3.08, 95%CI: 1.09-8.71; AOR2 = 2.49, 95%CI: 1.00-6.19). A better understanding of the risk of EP following LNG-EC failure can optimize LNG-EC use and thus reduce the risk of EP.
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Affiliation(s)
- Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Cheng Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Wei-Hong Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Xiaowei Xi
- Department of Obstetrics and Gynecology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Shu-Jun Cao
- Department of Obstetrics and Gynecology, Songjiang Central Hospital, Shanghai 201600, China
| | - Hua Ping
- Department of Obstetrics and Gynecology, Songjiang Maternity and Child Health Hospital, Shanghai 201620, China
| | - Guo-Juan Qin
- Department of Obstetrics and Gynecology, Minhang Central Hospital, Shanghai 201100, China
| | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research, Shanghai 200030, China
| | - He-Feng Huang
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
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Wildemeersch D, Goldstuck N, Hasskamp T, Jandi S, Pett A. Intrauterine device quo vadis? Why intrauterine device use should be revisited particularly in nulliparous women? Open Access J Contracept 2015; 6:1-12. [PMID: 29386919 PMCID: PMC5683133 DOI: 10.2147/oajc.s72687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs) and the contraceptive implant, are considered the best methods for preventing unintended pregnancies, rapid repeat pregnancy, and abortion in young women. An opinion paper of 2012 by the American College of Obstetricians and Gynecologists recommends Mirena and Paragard for use in nulliparous and adolescent women. However, these IUDs are not designed for young women and are not optimal as they often lead to early discontinuation. Objective This article was written with the objective to respond to the urgent need to improve intrauterine contraception as it is likely that the objectives of LARC will not be met without significant improvement of IUD design. Anatomical variations in size and shape of the uterus are not sufficiently considered, producing harm and suffering, which often lead to early removal of the IUD. Proposed problem solving The article describes why IUDs should be revisited to meet the challenge of LARC and proposes how to solve these problems. The opinion statement presented here may be considered provocative but is based on hundreds of women with IUD problems who consult or are referred to the practices of the authors of this article due to the disproportion between the IUD and their small uterine cavity. The solution is simple but requires a revision of the current design of IUDs. One-dimensional (longitudinal) IUDs are likely to be the first option. Framed devices with shortened transverse arm and IUDs which adapt to the width of the given uterus are viewed as second best. Conclusion One of the reasons of the high unintended pregnancy rate in the USA may be the paucity of suitable IUDs. Also, the legal climate in the USA seems to be a problem for developers as many lawsuits have recently been reported. Clinical studies conducted in young nulliparous and adolescent women suggest that IUDs that fit well in the uterine cavity, like a shoe, result in better tolerance, less side effects, and last but not least, higher use continuation rates.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
| | | | - Sohela Jandi
- Gynecological Outpatient Clinic, Berlin, Germany
| | - Ansgar Pett
- Gynecological Outpatient Clinic, Berlin, Germany
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Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study. PLoS One 2014; 9:e115031. [PMID: 25493939 PMCID: PMC4262460 DOI: 10.1371/journal.pone.0115031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle. Methods A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs). Results Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48–2.37]; AOR2 = 1.84 [1.49–2.27]), and the risk increased with the duration of previous use (P1 for trend <10−4, P2 for trend <10−4). The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03–0.05]; withdrawal method: AOR = 0.10 [0.07–0.13]; calendar rhythm method: AOR = 0.54 [0.40–0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02–0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16–0.30]; IUDs: AOR = 0.01 [0.005–0.012]; tubal sterilization: AOR = 0.01 [0.001–0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04–0.06]; withdrawal method: AOR1 = 0.13 [0.09–0.19]; calendar rhythm method: AOR1 = 0.66 [0.48–0.91]; OCPs: AOR1 = 0.14 [0.07–0.26]; IUDs: AOR1 = 0.17 [0.13–0.22]; tubal sterilization: AOR1 = 0.04 [0.02–0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64–10.07]), LNG-EC (AOR2 = 4.87 [3.88–6.10]), IUDs (AOR2 = 21.08 [13.44–33.07]), and tubal sterilization (AOR2 = 7.68 [1.69–34.80]) increased the risk of EP compared with the non-use of contraceptives. Conclusion Current use of most contraceptives reduce the risk of both IUP and EP. However, if the contraceptive method fails, the proportions of EP may be higher than those of non-users. In the case of contraceptive failure in the current cycle, EP cases should be differentiated according to current use of OCPs, LNG-EC, IUDs, and tubal sterilization. In addition, attention should be paid to women with previous long-term use of IUDs.
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29
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Erol O, Simavlı S, Derbent AU, Ayrım A, Kafalı H. The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study. EUR J CONTRACEP REPR 2014; 19:187-93. [PMID: 24738915 DOI: 10.3109/13625187.2014.900532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare vaginal microflora and cervical cytology before and after insertion of a copper-containing intrauterine device (Cu-IUD) or a levonorgestrel releasing-intrauterine system (LNG-IUS). METHODS Between April 2009 and February 2011, all women requesting insertion of an intrauterine contraceptive for family planning or noncontraceptive indications were enrolled. One hundred and eight Cu-IUDs and 42 LNG-IUSs were placed. Cervical cytological and vaginal microbiological findings before insertion and after 12 months were recorded. RESULTS With regard to cervical cytology, nonspecific inflammatory changes became more frequent (but not significantly so; p = 0.062) after one year of use of a Cu-IUD, whereas their prevalence remained unchanged among women fitted with a LNG-IUS. Colonisation by Candida spp. and mycoplasma infections were diagnosed significantly more often after one year of use of the Cu-IUD than at baseline. During the study period, women wearing a Cu-IUD complained significantly more frequently of vaginal discharge, pelvic pain, and increased menstrual flow. CONCLUSION Use of a Cu-IUD - but not that of a LNG-IUS - was associated with an alteration of the vaginal flora and showed a trend towards a higher frequency of nonspecific inflammatory changes affecting cervical cytology.
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Affiliation(s)
- Onur Erol
- * Department of Obstetrics and Gynaecology, Antalya Training and Research Hospital , Antalya , Turkey
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Benagiano G, Gabelnick H, Farris M. Contraceptive devices: intravaginal and intrauterine delivery systems. Expert Rev Med Devices 2014; 5:639-54. [DOI: 10.1586/17434440.5.5.639] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Greenberg GM, Ursu A, Hertz MI. Family Planning and Contraception. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mullady B, Ruppersberger L. The Moral Nature and Practice of Natural Family Planning versus Contraception. LINACRE QUARTERLY 2013; 80:202-212. [PMID: 30082996 DOI: 10.1179/0024363913z.00000000031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The morality of contraception has not always been clear to many Catholics. Although the popes have been clear in their teaching that it is a grave evil, many theologians, priests, and Catholics either deny this teaching or, at least, are skeptical as to its truth. Many health-care providers seem unclear concerning the evil of this practice also. Many do not seem interested in discovering the possible good moral fruits of the practice of natural family planning. To understand the essential evil of contraception and how it differs from natural family planning in both theory and practice first requires a clear delineation of the sources for determining Catholic moral action. These are the object, circumstances, and intention. Each is objectively determined by the relationship of the act in question to an objective human nature which can be discovered by reason alone. To be good, all three of these factors must conform to human nature. The sexual act is evil while using artificial pills or devices to preclude birth and no circumstances or intention can justify one in doing such use. This not only denies children, but also precludes total self-giving love from being expressed in such an act. It has the further result of introducing self-fulfillment as the primary value into the most important natural act of all, the one which leads to human life. Natural family planning is not a form of contraception and so it is objectively completely different in its moral nature. The human decision to refrain from the sexual act is not contraception. When undertaken in the right circumstances and for the right intention, natural family planning is an objective cooperation with the justice due to the Creator in the transmission of life and not a denial of his rights. A physician who would assist in the performance of the sexual act in which the possibility of birth is excluded by prescribing some artificial means to preclude birth would be cooperating with the evil of contraception. One could not do this with a correct conscience.
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Affiliation(s)
- Brian Mullady
- Holy Apostles College and Seminary, Cromwell, CT, USA
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Brown WM, Trouton K. Intrauterine device insertions: which variables matter? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 40:117-21. [DOI: 10.1136/jfprhc-2012-100383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kohn JE, Hacker JG, Rousselle MA, Gold M. Knowledge and likelihood to recommend intrauterine devices for adolescents among school-based health center providers. J Adolesc Health 2012; 51:319-24. [PMID: 22999831 DOI: 10.1016/j.jadohealth.2011.12.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend intrauterine devices (IUDs) as safe and highly effective contraceptives for adolescents. Nevertheless, many U.S. providers do not recommend or provide IUDs to adolescents-a population at high risk for unintended pregnancy. The purpose of this study was to identify barriers to IUD provision for adolescents. METHODS A 36-item self-administered survey of knowledge and attitudes regarding IUDs was completed by 162 staff of New York City school-based health centers, including 69 clinicians (e.g., pediatricians and nurse practitioners) and 93 nonclinicians (e.g., social workers and health educators). RESULTS Half (55%) of all respondents would be likely to recommend an IUD to a patient under age 20 years. Respondents were less likely to recommend an IUD for patients with history of recent STD (31%), remote pelvic inflammatory disease (37%), and patients not in a monogamous relationship (38%). Whereas 77% of respondents indicated that IUDs are safe for adolescents, 18% of those respondents would be unlikely to recommend an IUD to a patient under age 20 years. While 86% of respondents knew that IUDs can be used in nulliparous women, 25% of those respondents would be unlikely to recommend an IUD to a patient who has never been pregnant. Additionally, 61% believed that counseling patients about IUDs would take more time than other methods. CONCLUSIONS Misinformation about risks associated with IUDs and beliefs about patient eligibility may present barriers to provision. Apparent contradictions between knowledge and likelihood to recommend IUDs warrant further study.
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Affiliation(s)
- Julia E Kohn
- New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, New York City, New York, USA.
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Black K, Lotke P, Buhling KJ, Zite NB. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. EUR J CONTRACEP REPR 2012; 17:340-50. [PMID: 22834648 PMCID: PMC4950459 DOI: 10.3109/13625187.2012.700744] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives Intrauterine contracepives (IUCs) are highly effective and safe for use in all women, including those who are nulliparous. However, many myths and barriers prevent more widespread utilisation. The objective of this article was to explore the health care provider (HCP), health system and user issues that prevent more widespread use of IUCs, particularly among nulliparous women, and to present the evidence that supports achieving greater utilisation of these devices. Methods MEDLINE, PubMed and Embase were used to identify studies reporting attitudes and beliefs around IUCs, and clinical studies providing evidence of their risks and benefits. Results HCP, health system and user factors limiting use of IUCs were identified. The most widely explored barriers in published studies are those at the HCP level. User barriers are less well documented and health system barriers are mostly assessed through indirect evidence. Many, but not all, of the barriers can be reduced through greater understanding of the evidence. Conclusions Efforts need to be made to disseminate the evidence, which shows that few contraindications exist to IUC use. Addressing HCP lack of knowledge, training and confidence with IUC insertions, particularly in nulliparous women, could make a substantial positive impact on IUC utilisation.
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Affiliation(s)
- Kirsten Black
- Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, Australia
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Boortz HE, Margolis DJA, Ragavendra N, Patel MK, Kadell BM. Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics 2012; 32:335-52. [PMID: 22411936 DOI: 10.1148/rg.322115068] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Intrauterine devices (IUDs) are a commonly used form of contraception worldwide. However, migration of the IUD from its normal position in the uterine fundus is a frequently encountered complication, varying from uterine expulsion to displacement into the endometrial canal to uterine perforation. Different sites of IUD translocation vary in terms of their clinical significance and subsequent management, and the urgency of communicating IUD migration to the clinician is likewise variable. Expulsion or intrauterine displacement of the IUD leads to decreased contraceptive efficacy and should be clearly communicated, since it warrants IUD replacement to prevent unplanned pregnancy. Embedment of the IUD into the myometrium can usually be managed in the outpatient clinical setting but occasionally requires hysteroscopic removal. Complete uterine perforation, in which the IUD is partially or completely within the peritoneal cavity, requires surgical management, and timely and direct communication with the clinician is essential in such cases. Careful evaluation for intraabdominal complications is also important, since they may warrant urgent or emergent surgical intervention. The radiologist plays an important role in the diagnosis of IUD migration and should be familiar with its appearance at multiple imaging modalities.
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Affiliation(s)
- Hillary E Boortz
- Department of Radiology, University of California at Los Angeles, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
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C Warren F, R Abrams K, Golder S, J Sutton A. Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event. BMC Med Res Methodol 2012; 12:64. [PMID: 22553987 PMCID: PMC3528446 DOI: 10.1186/1471-2288-12-64] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 04/16/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention. METHODS Using a collection of reviews identified previously, 166 references including a meta-analysis were selected for review. At least one of the primary outcomes in each review was an adverse or unintended event. The nature of the intervention, source of funding, number of individual meta-analyses performed, number of primary studies included in the review, and use of meta-analytic methods were all recorded. Specific areas of interest relating to the methods used included the choice of outcome metric, methods of dealing with sparse events, heterogeneity, publication bias and use of individual patient data. RESULTS The 166 included reviews were published between 1994 and 2006. Interventions included drugs and surgery among other interventions. Many of the references being reviewed included multiple meta-analyses with 44.6% (74/166) including more than ten. Randomised trials only were included in 42.2% of meta-analyses (70/166), observational studies only in 33.7% (56/166) and a mix of observational studies and trials in 15.7% (26/166). Sparse data, in the form of zero events in one or both arms where the outcome was a count of events, was found in 64 reviews of two-arm studies, of which 41 (64.1%) had zero events in both arms. CONCLUSIONS Meta-analyses of adverse events data are common and useful in terms of increasing the power to detect an association with an intervention, especially when the events are infrequent. However, with regard to existing meta-analyses, a wide variety of different methods have been employed, often with no evident rationale for using a particular approach. More specifically, the approach to dealing with zero events varies, and guidelines on this issue would be desirable.
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Affiliation(s)
- Fiona C Warren
- Peninsula College of Medicine and Dentistry, St Luke’s Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Keith R Abrams
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Su Golder
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Alex J Sutton
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Butt S, Saydain G. Hypotension after medical termination of pregnancy: think outside of the uterus. J Emerg Med 2012; 43:50-3. [PMID: 22325554 DOI: 10.1016/j.jemermed.2011.06.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 04/06/2011] [Accepted: 06/04/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Under usual circumstances, an ectopic pregnancy would not be generally considered in the initial differential diagnosis of shock after voluntary termination of pregnancy. OBJECTIVE To present a rare case of a young woman with shock after voluntary termination of pregnancy due to undiagnosed ectopic pregnancy with concealed hemorrhage. CASE REPORT A 37-year-old woman presented to the Emergency Department (ED) 3 days after termination of pregnancy with clinical features of shock. The patient had some evidence of infection and was initially managed as a case of septic shock secondary to possible complication of recent termination of pregnancy. Subsequent work-up led to suspicion of internal bleeding, and ruptured ectopic pregnancy was confirmed and managed successfully. CONCLUSION Ruptured ectopic pregnancy can present with a wide range of symptoms and under variable circumstances. Recognition of subtle signs of hemorrhage and consideration of the diagnosis of ruptured pregnancy in the ED will lead to early diagnosis and appropriate management.
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Affiliation(s)
- Sanobar Butt
- Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan, USA
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Middleton AJ, Naish J, Singer N. General practitioners' views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK. EUR J CONTRACEP REPR 2011; 16:311-8. [DOI: 10.3109/13625187.2011.580864] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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40
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Bednarek PH, Edelman AB. Contraception Following Ectopic Pregnancy, and Induced or Spontaneous Abortion. Contraception 2011. [DOI: 10.1002/9781444342642.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yen S, Saah T, Hillard PJA. IUDs and adolescents--an under-utilized opportunity for pregnancy prevention. J Pediatr Adolesc Gynecol 2010; 23:123-8. [PMID: 19896396 DOI: 10.1016/j.jpag.2009.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/05/2009] [Accepted: 09/11/2009] [Indexed: 11/24/2022]
Abstract
Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infertility, nor rate of ectopic pregnancy. Adolesecnts need more education about and increased access to IUDs. Practical points regarding IUD selection and insertion in adolescents are reviewed, including pain prophylaxis, anticipatory guidance, side effects and complications. In summary, IUDs are safe for contraception in most adolescents. IUDs are effective and eliminate the need for ongoing adherence and thus have the potential to decrease unplanned pregnancies.
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Affiliation(s)
- Sophia Yen
- Division of Adolescent Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, California, USA.
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The effect of patient gynecologic history on clinician contraceptive counseling. Contraception 2010; 82:281-5. [PMID: 20705158 DOI: 10.1016/j.contraception.2010.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Contraceptive providers have an important influence on women's selection of contraception. Previous studies suggest that clinicians inappropriately limit use of intrauterine contraception (IUC). This study investigated the influence of patients' gynecologic histories on recommendations for IUC and other methods of contraception. STUDY DESIGN Videos of standardized patients varying by history of pelvic inflammatory disease (PID) and parity were shown to clinicians at meetings of national medical societies. Participants indicated their contraceptive recommendations for the patient and whether they would have concerns were the patient to use IUC. RESULTS Five hundred twenty-four providers viewed one video of a standardized patient and completed the survey. Gynecologic history was significantly associated with recommendations for the contraceptive ring, contraceptive patch, and copper IUC. Many clinicians indicated that they had concerns about the use of IUC with respect to risks such as PID, infertility and ectopic pregnancy. Concerns about infertility and pain with use of IUC were related to gynecologic history. CONCLUSIONS Patient gynecologic characteristics affect recommendations for some reversible contraceptive methods. Clinicians continue to have concerns about IUC use despite evidence supporting its safety.
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Forthofer KV. A Clinical Review of the Intrauterine Device as an Effective Method of Contraception. J Obstet Gynecol Neonatal Nurs 2009; 38:693-698. [DOI: 10.1111/j.1552-6909.2009.01067.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mettler L, Sodhi B, Schollmeyer T, Mangeshikar P. Ectopic pregnancy treatment by laparoscopy, a short glimpse. MINIM INVASIV THER 2009; 15:305-10. [PMID: 17062405 DOI: 10.1080/13645700600771942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ectopic pregnancy is a life-threatening emergency, the incidence of which is increasing globally. There are a number of factors predisposing to this condition; today, the most common of these is salpingitis. Due to advancements in diagnostic technology it is possible to diagnose this condition early and thus try to achieve a favourable outcome for the patient. Treatment options in the form of medical and surgical modalities are widely available. As minimally invasive therapy techniques are rapidly advancing, laparoscopic treatment has become the most popular and preferred method for treating ectopic pregnancy. Both salpingotomy as well as salpingectomy can be performed through the laparoscope. This paper gives a short glimpse at the predisposing factors and the diagnostic investigations available for ectopic pregnancy and an insight into its laparoscopic treatment. It also reviews the pregnancy outcome and laparoscopic treatment of cases at the Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein.
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Affiliation(s)
- L Mettler
- Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein, Kiel, Germany.
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47
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Xiong X, Saunders LD, Wang FL, Davidge ST, Buekens P. Preeclampsia and Cerebral Palsy in Low-Birth-Weight and Preterm Infants: Implications for the Current “Ischemic Model” of Preeclampsia. Hypertens Pregnancy 2009. [DOI: 10.3109/10641950109152637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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48
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Upta SG, Irkman RK. Intrauterine devices – perceptions overestimate the hazards. EUR J CONTRACEP REPR 2009. [DOI: 10.1080/ejc.6.4.231.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin HH, Huang MC, Lin CJ, Chen CP. Ectopic pregnancy with oral contraceptive use. Taiwan J Obstet Gynecol 2008; 47:341-2. [PMID: 18936002 DOI: 10.1016/s1028-4559(08)60137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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50
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Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet 2008; 279:443-53. [DOI: 10.1007/s00404-008-0731-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/08/2008] [Indexed: 12/27/2022]
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