1
|
Beringer S, Milewski N. A crisis in the life course? Pregnancy loss impacts fertility desires and intentions. ADVANCES IN LIFE COURSE RESEARCH 2024; 60:100612. [PMID: 38762969 DOI: 10.1016/j.alcr.2024.100612] [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: 03/01/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND An unintended spontaneous termination of a pregnancy can be a traumatic experience affecting the subsequent life course, but has received little attention in socio-demographic studies on fertility intentions or behavior. The theoretical background of our study draws on considerations from life course research, the Theory of Planned Behavior and the Traits-Desires-Intentions-Behavior framework. OBJECTIVE This study investigates whether the experience of pregnancy loss changes the fertility desires and intentions of women in their subsequent life course. METHODS We use 11 waves of the Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) with 5197 women in total, of which 281 women (5.4%) reported a miscarriage. Data have been collected annually in Germany since 2008. We investigate four dependent variables capturing different indicators of the ideational dimension of fertility: Personal ideal number of children, realistic number of (additional) children, intention to have a(nother) child in the next two years and importance of having a(nother) child. We study the intrapersonal changes in these items among women after a pregnancy loss, applying linear fixed effect regression models. Controls include parity, age, partnership status, pregnancy status and the interaction of pregnancy loss with whether the woman already had children before the pregnancy loss. RESULTS We found that the importance of having a(nother) child and the intention to have a(nother) child in the next two years increase after a pregnancy loss. These patterns can only partially be explained by control variables. By contrast, an effect on the ideal number of children as well as the realistic number of children could not be found. The patterns varied, however, across age and stage in the life course, most importantly between mothers and childless women. CONCLUSIONS Our results demonstrate that the effect of pregnancy loss on the subsequent life course varies across the indicators used and by duration after the pregnancy loss. Overall, they suggest that specifically the younger women in our sample might perceive pregnancy loss as a temporary crisis in their transition to motherhood, or to having another child, and as an impetus to reinforce their fertility goals, while for older respondents this might mark the end of their fertility career. Against the backdrop of rising ages at childbirth, future research on fertility and reproductive health care should pay more attention to reproductive complications and how affected women can be supported in coping with them.
Collapse
Affiliation(s)
- Samira Beringer
- Federal Institute for Population Research (BiB), Wiesbaden, Germany.
| | - Nadja Milewski
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| |
Collapse
|
2
|
Bergin K, Estevez SL, Alkon-Meadows T, Nyein E, Cohen N, Hernandez-Nieto C, Gounko D, Lee JA, Copperman AB, Buyuk E. Single Euploid Embryo Transfer Outcomes After Uterine Septum Resection. J Minim Invasive Gynecol 2024; 31:432-437. [PMID: 38360394 DOI: 10.1016/j.jmig.2024.02.001] [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: 09/14/2023] [Revised: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
STUDY OBJECTIVE To study pregnancy outcomes after single euploid embryo transfer (SEET) in patients who underwent prior uterine septum resection to those with uteri of normal contour, without Müllerian anomalies or uterine abnormalities including polyps or fibroids, and without a history of prior uterine surgeries. DESIGN Retrospective cohort study. SETTING Single academic affiliated center. PATIENTS 60 cycles of patients with prior hysteroscopic uterine septum resection who underwent an autologous SEET between 2012 and 2020 were used as the investigational cohort. A 3:1 ratio propensity score matched control cohort of 180 single euploid embryo transfer cycles from patients without a history of uterine septa were used as the control group. INTERVENTIONS No interventions administered. MEASUREMENTS AND MAIN RESULTS Pregnancy, clinical pregnancy loss, ongoing clinical pregnancy, and live birth rates in patients with a history of uterine septum resection compared with matched patients without Müllerian anomalies or uterine surgeries. Patients with a prior uterine septum had significantly lower rates of chemical pregnancy (58.33% vs 77.2%, p = .004), implantation (41.67% vs 65.6%, p = .001), and live birth (33.33% vs 57.8%, p = .001) per transfer. No statistical difference in clinical pregnancy loss rates was found when comparing septum patients with controls (8.33% vs 7.8%, p = .89). CONCLUSION Patients with a history of hysteroscopic resection who undergo in vitro fertilization are more susceptible to suboptimal clinical outcomes compared with patients with normal uteri. Early pregnancy loss rates in patients with a uterine septum are higher than in those without; however, after resection, the rates are comparable. Patients born with septate uteri require assessment of surgical intervention prior to SEET, and to optimize their reproductive outcomes.
Collapse
Affiliation(s)
- Keri Bergin
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York.
| | - Samantha L Estevez
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | | | - Ethan Nyein
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | - Natalie Cohen
- Reproductive Medicine Associates of New York (all authors)
| | | | - Dmitry Gounko
- Reproductive Medicine Associates of New York (all authors)
| | - Joseph A Lee
- Reproductive Medicine Associates of New York (all authors)
| | - Alan B Copperman
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| | - Erkan Buyuk
- Reproductive Medicine Associates of New York (all authors); Icahn School of Medicine at Mount Sinai (Drs. Bergin, Estevez, Nyein, Copperman, and Buyuk), New York
| |
Collapse
|
3
|
Chakhame BM, Darj E, Mwapasa M, Kafulafula UK, Maluwa A, Odland JØ, Odland ML. Women's perceptions of and experiences with the use of misoprostol for treatment of incomplete abortion in central Malawi: a mixed methods study. Reprod Health 2023; 20:26. [PMID: 36732793 PMCID: PMC9893686 DOI: 10.1186/s12978-022-01549-w] [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] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi. METHODS A descriptive cross-sectional study that used mixed methods was conducted in three hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part. RESULTS From the qualitative data, three themes emerged around the following areas: experienced effects, support offered, and women's perceptions. Most women liked misoprostol and reported that the treatment was helpful and effective in expelling retained products of conception. Quantitative data revealed that the majority of participants, 376 (94%) were satisfied with the support received, and 361 (90.3%) believed that misoprostol was better than surgical treatment. The majority of the women 364 (91%) reported they would recommend misoprostol to friends. CONCLUSIONS The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women.
Collapse
Affiliation(s)
- Bertha Magreta Chakhame
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elisabeth Darj
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway
| | - Mphatso Mwapasa
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Alfred Maluwa
- grid.493103.c0000 0004 4901 9642Malawi University of Science and Technology, Thyolo, Malawi
| | - Jon Øyvind Odland
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,grid.49697.350000 0001 2107 2298School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002 South Africa ,grid.465487.cFaculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Maria Lisa Odland
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Obstetrics and Gynecology, St. Olav’s University Hospital, Trondheim, Norway ,Malawi-Liverpool-Welcome Trust Research Institute, Blantyre, 312225 Malawi ,grid.10025.360000 0004 1936 8470Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3BX UK
| |
Collapse
|
4
|
Aziz T, Gobioff S, Flink-Bochacki R. Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss. PATIENT EDUCATION AND COUNSELING 2022; 105:3071-3077. [PMID: 35738964 DOI: 10.1016/j.pec.2022.06.010] [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: 12/16/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss. METHODS We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression. RESULTS We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005). CONCLUSIONS Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping. PRACTICE IMPLICATIONS Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.
Collapse
Affiliation(s)
- Tania Aziz
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Samantha Gobioff
- Albany Medical College, 47 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Rachel Flink-Bochacki
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| |
Collapse
|
5
|
Chen MJ, Kair LR, Schwarz EB, Creinin MD, Chang JC. Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study. Womens Health Issues 2022; 32:484-489. [PMID: 35491347 PMCID: PMC9532354 DOI: 10.1016/j.whi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices. METHODS We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant-comparative approach to code transcripts and identify themes. RESULTS We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7 weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception. CONCLUSIONS Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling.
Collapse
Affiliation(s)
- Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California.
| | - Laura R Kair
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - E Bimla Schwarz
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California
| | - Judy C Chang
- Departments of Obstetrics, Gynecology & Reproductive Sciences and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Narayanan N, Reynolds-Wright JJ, Cameron ST. Views of clinicians towards providing contraceptive advice and contraception to women following early pregnancy loss: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:bmjsrh-2022-201480. [PMID: 35523535 DOI: 10.1136/bmjsrh-2022-201480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/14/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION National guidelines advise that clinicians caring for women post-pregnancy should give women opportunities to discuss contraception, regardless of pregnancy outcome, and provide contraception to women who choose to take up a method. This study aimed to explore knowledge, views and needs of Early Pregnancy Unit (EPU) clinicians around discussing and offering contraception and discussing pregnancy intendedness with women after early pregnancy loss using a qualitative approach. METHODS Semi-structured, audio-recorded interviews with 11 clinicians from a single regional EPU in Edinburgh, Scotland. Interviews were transcribed verbatim and analysed thematically. RESULTS Clinicians were reluctant to discuss contraception as they believed women would find the topic overwhelming and distressing. Thoughts on discussing pregnancy intendedness were polarised; some considered it insensitive, and others essential. Barriers to discussing contraception and providing it were numerous and included time pressure, and inadequate knowledge and training on contraception. Participants suggested training on contraception, closer working with sexual and reproductive health (SRH) services, and availability of information on contraception specifically aimed at women who have experienced an early pregnancy loss could facilitate discussions and method provision. CONCLUSIONS EPU clinicians require ongoing training and support to be effective at discussing pregnancy intendedness and discussing and providing post-pregnancy contraception. This will require close working with SRH services and development of sensitive information around contraception for women experiencing an early pregnancy loss.
Collapse
Affiliation(s)
- Nandaja Narayanan
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Sharon T Cameron
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Contraception Choice Among Those Seeking Abortion for Fetal Indication or Management of Pregnancy Loss. Obstet Gynecol 2021; 137:606-611. [PMID: 33706340 DOI: 10.1097/aog.0000000000004315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare contraception choices of those who are undergoing abortion procedures for fetal indications or surgical management of pregnancy loss with those who are having abortions for another indication. METHODS We conducted a cross-sectional study at University of California, Irvine, from December 1, 2017, through December 31, 2018, and included gestational ages up to 24 0/7 weeks. We abstracted data from electronic medical records and analyzed them using descriptive statistics, χ2, Fisher exact tests, and a multivariate logistic regression model for primary outcome (whether a contraception method was chosen) and secondary outcome (whether a long-active reversible contraception was chosen). RESULTS Those with fetal indication were less likely to choose contraception than those with other indication (68/134, 50.7% vs 142/158, 89.9%, P<.001), and among those choosing contraception those with fetal indication were less likely to choose long-acting reversible contraception (LARC) (19/68, 27.9% vs 94/142, 66.2%, P<.001). Differences remained significant in multivariable analysis that controlled for age, gestational age in weeks, race, parity, procedure type, and comorbidities (among those with fetal indication for choosing any contraception: adjusted odds ratio [aOR] 0.11, 95% CI 0.05-0.23; choosing LARC: aOR 0.17, 95% CI 0.07-0.39). CONCLUSION Only half of those seeking abortion for a fetal indication or surgical management of pregnancy loss were interested in contraception.
Collapse
|
8
|
Shorter JM, Pymar H, Prager S, McAllister A, Schreiber CA. Early pregnancy care in North America: A proposal for high-value care that can level health disparities. Contraception 2021; 104:128-131. [PMID: 33894252 DOI: 10.1016/j.contraception.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jade M Shorter
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, United States.
| | - Helen Pymar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
9
|
Mizrachi Y, Shoham G, Leong M, Sagiv R, Horowitz E, Raziel A, Weissman A. Misoprostol treatment for early pregnancy loss: an international survey. Reprod Biomed Online 2021; 42:997-1005. [PMID: 33785303 DOI: 10.1016/j.rbmo.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022]
Abstract
RESEARCH QUESTION What is the global variability in misoprostol treatment for the management of early pregnancy loss (EPL)? DESIGN An international web-based survey of fertility specialists and obstetrics and gynaecology clinicians was conducted between August and November 2020. The survey consisted of 16 questions addressing several aspects of misoprostol treatment for EPL. RESULTS Overall, 309 clinicians from 80 countries participated in the survey, of whom 67.3% were fertility specialists. Nearly one-half (47.9%) of the respondents let the patient choose the first line of treatment (expectant management, misoprostol treatment or surgical aspiration) according to her own preference. The 248 respondents who administer misoprostol in their daily practice were asked further questions; 59.7% of them advise patients to take the medication at home. The most common dose and route of administration is 800 µg administered vaginally. Only 28.6% of participants use mifepristone pretreatment. Variation in the timing of the first follow-up visit after misoprostol administration was wide, ranging from 24 h to 1 week in most clinics. In case of incomplete expulsion, only 42.3% of the respondents routinely administer a second dose. The timing of the final visit and the definition of successful treatment also differed greatly among respondents. CONCLUSIONS There is large variability in the use of misoprostol for the management of EPL. High-quality research is necessary to examine several aspects of the treatment. Particularly, the timing and effectiveness of a second dose administration and the criteria to decide on treatment failure or success deserve more research in the future.
Collapse
Affiliation(s)
- Yossi Mizrachi
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, PO Box 5, Holon 58100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Gon Shoham
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Ron Sagiv
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, PO Box 5, Holon 58100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Horowitz
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, PO Box 5, Holon 58100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, PO Box 5, Holon 58100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, PO Box 5, Holon 58100, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
10
|
Kim C, Nguyen AT, Berry-Bibee E, Ermias Y, Gaffield ME, Kapp N. Systemic hormonal contraception initiation after abortion: A systematic review and meta-analysis. Contraception 2021; 103:291-304. [PMID: 33548267 PMCID: PMC8040936 DOI: 10.1016/j.contraception.2021.01.017] [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] [Received: 06/15/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
Background Immediate contraceptive initiation, including start of a method before abortion completion, is a convenient option for women seeking abortion care. Objectives To evaluate the effect of systemic hormonal contraception initiation on medical abortion effectiveness and the safety of hormonal contraceptive methods following abortion. Data sources PubMed, Popline, Cochrane Library, and Clinicaltrials.gov. Study eligibility criteria Studies that assessed medical abortion effectiveness after systemic hormonal contraception initiation and the safety of hormonal contraception initiation after abortion. Participants Pregnant persons undergoing or who had recently undergone an abortion. Interventions Initiation of systemic hormonal contraception post abortion or on the day of the first pill of the medical abortion. Study appraisal and synthesis methods We assessed study quality using the US Preventive Services Task Force evidence grading system. We created narrative summaries and calculated pooled relative risks when appropriate. Results We identified 16 studies for inclusion, 7 randomized controlled trials, and 9 cohorts. Nine studies assessed medical abortion effectiveness with hormonal contraception initiation and generally found no decreased risk of abortion success or increased risk of additional treatment. One fair-quality study reported a small increase in ongoing pregnancy rate with immediate depot medroxyprogesterone (DMPA) compared with delayed DMPA initiation (3.6% vs 0.9%, risk difference 2.7%, 90% confidence interval 0.4–5.6). We identified no bleeding-related safety concerns following hormonal contraception initiation after medical or surgical abortion. Pooled results were too imprecise to draw firm conclusions. Limitations Included studies were poor or fair quality and primarily in high-income or upper-middle-income settings. Conclusions Abortion effectiveness did not differ between immediate vs delayed initiation of most systemic hormonal contraceptive methods after a first trimester medical abortion. However, immediate DMPA initiation did show increased ongoing pregnancy. Bleeding effects with hormonal contraception initiation postabortion appeared minimal. Implications Initiating a hormonal contraceptive method after an abortion and as early as the same day as the first pill of the medical abortion is an option if contraception is desired. The slight increase in ongoing pregnancy with immediate DMPA initiation highlights the importance of information provision during contraceptive counseling.
Collapse
Affiliation(s)
- Caron Kim
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland.
| | - Antoinette T Nguyen
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Erin Berry-Bibee
- Planned Parenthood of the Great Northwest and Hawaiian Islands, Seattle, Washington, USA
| | - Yokabed Ermias
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Mary E Gaffield
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | | |
Collapse
|
11
|
Mizrachi Y, Ben-Ezry E, Kleiner I, Friedman G, Kerner R, Bar J, Raziel A, Weissman A, Sagiv R. Reproductive outcome after early pregnancy loss treated with misoprostol versus surgical aspiration. Reprod Biomed Online 2020; 41:707-713. [PMID: 32819838 DOI: 10.1016/j.rbmo.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION Does long-term reproductive outcome after early pregnancy loss (EPL) differ between women who are treated with misoprostol and surgical aspiration. DESIGN A historic cohort study of all women who were diagnosed with early pregnancy loss (≤12 weeks), in a single medical centre, between September 2016 and August 2017, was conducted. The women were treated with either misoprostol or surgical aspiration according to their own preferences. Women who were lost to follow-up or did not attempt to conceive again were excluded. The primary outcome measure was the cumulative pregnancy rate within 12 months from intervention. RESULTS Baseline characteristics were comparable between women who received misoprostol (n = 163) and women who underwent surgical aspiration (n = 122). Women who received misoprostol had a higher rate of interventions for retained products of conception (11.0% versus 3.3%, respectively; P = 0.015). The misoprostol and the surgical aspiration groups did not differ in rate of repeated miscarriages (17.8% versus 21.3%, respectively; P = 0.45), or pregnancy rate within 6 months (58.3% versus 50.0%, respectively; P = 0.16), 12 months (78.5% versus 78.7%, respectively; P = 0.97) and 24 months (92.0% versus 91.8%, respectively; P = 0.94). Live birth rate within 24 months was comparable (62.0% versus 58.2%, respectively; P = 0.52), as well as gestational age at birth (38.5 versus 38.6 weeks, respectively; P = 0.81) and birthweight (3295 versus 3161 g, respectively; P = 0.07). CONCLUSIONS Long-term reproductive outcomes are comparable in women with EPL who are treated with either misoprostol or surgical aspiration. Our findings may help counselling patients facing EPL who have concerns about their future reproduction.
Collapse
Affiliation(s)
- Yossi Mizrachi
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Emilie Ben-Ezry
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilia Kleiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Friedman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Roe AH, McAllister A, Sammel MD, Schreiber CA. Pregnancy intentions and contraceptive uptake after miscarriage. Contraception 2020; 101:427-431. [PMID: 32199790 PMCID: PMC7430048 DOI: 10.1016/j.contraception.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors associated with contraceptive uptake among participants in a miscarriage management clinical trial. STUDY DESIGN We performed a secondary analysis of a multi-center, randomized controlled trial of medical management regimens for miscarriage between 5 and 12 completed weeks. Pregnancy intention was measured by patient report after miscarriage diagnosis. Participants were offered contraception in accordance with standard clinical care once their miscarriage was completed. We analyzed participants as a cohort and fit a multivariable model to describe demographic characteristics and pregnancy intentions independently associated with contraceptive uptake. RESULTS Of 244 participants with available contraceptive outcomes, 121 (50%) stated that this pregnancy was planned, and 218 (90%) stated that they had planned to continue the pregnancy to term. Ninety-seven participants (40%) initiated contraception: 33 (14%) selected a long-acting reversible method, 44 (18%) a short-acting reversible method, and 20 (8%) condoms or emergency contraception, while 147 (60%) declined contraception after miscarriage completion. In the multivariable model, unplanned pregnancy (aRR 2.13, 95% CI: 1.45-3.13) and lack of intention to continue the pregnancy (aRR 1.61, 95% CI: 1.18-2.20) were independently associated with contraceptive uptake. Of participants who declined contraception, 85 (57%) did so in order to conceive again. Nearly one-quarter of participants who declined contraception described the index pregnancy as unplanned, but after miscarriage planned to conceive a new pregnancy. CONCLUSION Patients with unplanned pregnancy who miscarried were twice as likely to initiate contraception as those with planned pregnancy, however pregnancy intentions sometimes changed after miscarriage. IMPLICATIONS Miscarriage management represents an important opportunity to clarify pregnancy goals and provide contraceptive counseling. Although unplanned pregnancy correlates with contraceptive uptake, we do not recommend using this clinically to predict contraceptive need. Future research should examine how best to measure pregnancy intention and its relationship to the experience of miscarriage.
Collapse
Affiliation(s)
- Andrea H Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States.
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, 13001 E. 17th Place, B119, Bldg 500, 3rd Floor West Wing, Aurora, CO 80045, United States
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| |
Collapse
|
13
|
Clement EG, Horvath S, McAllister A, Koelper NC, Sammel MD, Schreiber CA. The Language of First-Trimester Nonviable Pregnancy: Patient-Reported Preferences and Clarity. Obstet Gynecol 2019; 133:149-154. [PMID: 30531561 PMCID: PMC10302403 DOI: 10.1097/aog.0000000000002997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon. METHODS We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios. RESULTS We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms "miscarriage" (n=109 [75.2%]) and "early pregnancy loss" (n=73 [50.3%]) more than "early pregnancy failure" (n=31 [21.3%]) and "spontaneous abortion" (n=21 [14.4%]). The majority selected "miscarriage" (n=79 [54.5%]) followed by "early pregnancy loss" (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that "spontaneous abortion" and "early pregnancy failure" were significantly less clear than "early pregnancy loss" (53/145, adjusted risk ratio 0.12, 95% CI 0.07-0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24-0.61, respectively, as compared with 118/145 for "early pregnancy loss"). "Miscarriage" scored similarly to "early pregnancy loss" in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62-1.77). CONCLUSION The terminology used to communicate "nonviable pregnancy in the first trimester" is highly variable. In this cohort of women, most preferred the term "miscarriage" and classified both "miscarriage" and "early pregnancy loss" as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient-clinician communication. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02012491.
Collapse
Affiliation(s)
- Elizabeth G. Clement
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3701 Market Street, 3 Floor, Philadelphia PA 19104
| | - Sarah Horvath
- Department of Obstetrics and Gynecology, Division of Family Planning, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1000 Courtyard, Philadelphia PA 19104
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Division of Family Planning, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1000 Courtyard, Philadelphia PA 19104
| | - Nathanael C. Koelper
- Department of Obstetrics and Gynecology, Division of Family Planning, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1000 Courtyard, Philadelphia PA 19104
| | - Mary D. Sammel
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1000 Courtyard, Philadelphia PA 19104
| | - Courtney A. Schreiber
- Department of Obstetrics and Gynecology, Division of Family Planning, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1000 Courtyard, Philadelphia PA 19104
| |
Collapse
|
14
|
|