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Do family planning advice and maternal health care utilization changes course in contraception usage? A study based on Bihar, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rutaremwa G, Kabagenyi A. Postpartum family planning utilization in Burundi and Rwanda: a comparative analysis of population based cross-sectional data. Pan Afr Med J 2019; 30:303. [PMID: 30637087 PMCID: PMC6320455 DOI: 10.11604/pamj.2018.30.303.15105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/23/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Promotion of modern family planning is a major policy action for Africa to harness the demographic dividend. Family planning is an important public health intervention for maternal and child health. Methods Analysis was based on data from Demographic and Health Surveys conducted in 2010 on samples of women from Burundi (3396) and Rwanda (4670). Descriptive and multivariate logistic regression analyses to examine the contribution and comparison of the various predictors of uptake of modern contraceptives during the postpartum period (PPFP) in the two countries were carried out using STATA statistical software. Results Descriptive findings show only 20% of the samples of women in Burundi used while more than half of the women (51%) were using PPFP. Utilization of PPFP was significantly associated with primary (OR = 1.3, 95% CI = 1.1-1.6) and higher education (OR = 2.2, 95% CI = 1.6-3.1) in Burundi. Similarly in Rwanda increased use of PPFP in primary was (OR = 1.4, 95% CI = 1.2-1.6) while secondary education (OR = 1.6, 95% CI = 1.2-2.1). Protestant women were less likely to use PPFP in both Burundi (OR = 0.75, 95% CI = 0.6-0.9) and Rwanda (OR = 0.69, 95% CI = 0.6-0.8). Other significant variables in the regression models of both countries included wealth status, age of woman, number of living children and exposure to media. Professional birth delivery assistance was significant only in Rwanda. Conclusion Enhancing postpartum contraceptive use should target women with low education, low wealth status, and that the media has an important role to play in this transformation. Policies and programs must be put in place to ensure that the rural urban differences are eradicated.
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Affiliation(s)
- Gideon Rutaremwa
- United Nations Economic Commission for Africa (UNECA) Addis Ababa, Ethiopia
| | - Allen Kabagenyi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Kumaraswami T, Rankin KM, Lunde B, Cowett A, Caskey R, Harwood B. Acceptability of Postpartum Contraception Counseling at the Well Baby Visit. Matern Child Health J 2018; 22:1624-1631. [DOI: 10.1007/s10995-018-2558-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sempeera H, Kabagenyi A, Anguzu R, Muhumuza C, Hassen K, Sudhakar M. Family planning counseling during antenatal care and postpartum contraceptive uptake in Africa: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:17-25. [PMID: 27532135 DOI: 10.11124/jbisrir-2016-2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to systematically identify, appraise and synthesize the best available evidence on the effect of family planning counseling during antenatal care attendance on postpartum contraceptive uptake.The review question is, what is the effect of family planning counseling during antenatal care attendance on postpartum contraceptive uptake in Africa?
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Affiliation(s)
- Hassard Sempeera
- 1Department of Epidemiology and Biostatistics, Family Health Research and Development Centre, Makerere University School of Public Health, Kampala, Uganda 2Department of Population Studies, Makerere University School of Statistics and Planning, Kampala, Uganda 3School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda 4Department of Population and Family Health, Jimma University, Jimma, Ethiopia 5Department of Health Education and Behavioral Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Mahesan AM, Ilceski DM, Paul ABM, Vengalil S. Pelvic Examination at the 6-Week Postpartum Visit After Cesarean Birth. J Midwifery Womens Health 2016; 61:497-500. [PMID: 26971582 DOI: 10.1111/jmwh.12422] [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] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to assess the utility of the pelvic examination at the 6-week postpartum visit after cesarean birth. METHODS Data were collected from retrospective chart review in an obstetric resident clinic in Detroit, Michigan. Women included were those who had a cesarean birth between January 2012 and June 2014. RESULTS Of 388 women who had a cesarean birth, 211 (54.4%) presented for the 6-week postpartum visit and underwent pelvic examination. Of these women, 185 (87.7%) were asymptomatic, and 26 (12.3%) reported vaginal discharge. No other concerns were elicited. Of those with symptoms, 4 (15%) had no finding, 13 (50%) had bacterial vaginosis (BV) alone, 2 (8%) had BV and Candida sp, 2 (8%) had BV and Trichomonas vaginalis, 2 (8%) had T vaginalis alone, and 3 (11%) had Chlamydia trachomatis. One woman with C trachomatis had tested positive during pregnancy and possibly had treatment failure. Of the 185 asymptomatic women, 91 (49%) were deemed to have vaginal discharge on examination and underwent testing for Neisseria gonorrhoeae and C trachomatis; results were negative in all cases. DISCUSSION In this population, it appears unnecessary to perform routine pelvic examination on asymptomatic women at the 6-week postpartum visit after cesarean birth. When vaginal discharge was noted during pelvic examination of asymptomatic women, no pathology was identified.
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Di Giacomo P, Sbarlati A, Bagnasco A, Sasso L. Woman's contraceptive needs and preferences in the postpartum period: an Italian study. J Clin Nurs 2015; 22:3406-17. [PMID: 24580788 DOI: 10.1111/jocn.12432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe what puerperal women know about postpartum contraception and to identify their related needs and expectations. BACKGROUND Puerperal women face the problem of beginning or resuming contraception, the choice of the right method of contraception and the right time to start it. This choice becomes particularly important in case they breastfeed since the contraceptive method should not interfere with breastfeeding. Different factors, such as the level of knowledge women have about various contraceptive methods, their individual preferences or their desire to have a baby, can strongly influence this choice. DESIGN A cross-sectional study had been carried out within the period of six months, from November 2011-February 2012. METHODS Three hundred puerperal women were interviewed before their discharge from a Maternity Home. The women were asked for their personal characteristics, their maternity history, the information they had received, their knowledge and expectations about postpartum contraception and their intention to use contraception. RESULTS During pregnancy and postpartum, 45.5% of the women reported that they had received adequate information about contraception. Of these ones, 64.3% reported their intention to use contraception either to avoid pregnancy or to space out future births, even if they did not always have appropriate knowledge about fertility and the use of contraceptive methods during postpartum. During this study, we also discovered that women's intention to use contraception was proportional to their level of education. CONCLUSION Women need more and appropriate information about postpartum contraception, to make a conscious choice in relation to their needs and without putting their health at risk. RELEVANCE TO CLINICAL PRACTICE To promote awareness of the choices related to postpartum contraception, it is important to understand the personal characteristics that influence or hinder this choice. Midwives can play a very important role in informing women and in developing educational interventions to support a safe contraceptive choice.
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Rutaremwa G, Kabagenyi A, Wandera SO, Jhamba T, Akiror E, Nviiri HL. Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study. BMC Public Health 2015; 15:262. [PMID: 25885372 PMCID: PMC4372233 DOI: 10.1186/s12889-015-1611-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rationale for promotion of family planning (FP) to delay conception after a recent birth is a best practice that can lead to optimal maternal and child health outcomes. Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa. However, little is known about how pregnant women arrive at their decisions to adopt PPFP. METHODS We used 3298 women of reproductive ages 15-49 from the 2011 UDHS dataset, who had a birth in the 5 years preceding the survey. We then applied both descriptive analyses comprising Pearson's chi-square test and later a binary logistic regression model to analyze the relative contribution of the various predictors of uptake of modern contraceptives during the postpartum period. RESULTS More than a quarter (28%) of the women used modern family planning during the postpartum period in Uganda. PPFP was significantly associated with primary or higher education (OR=1.96; 95% CI=1.43-2.68; OR=2.73; 95% CI=1.88-3.97 respectively); richest wealth status (OR=2.64; 95% CI=1.81-3.86); protestant religion (OR=1.27; 95% CI=1.05-1.54) and age of woman (OR=0.97, 95% CI=0.95-0.99). In addition, PPFP was associated with number of surviving children (OR=1.09; 95 % CI=1.03-1.16); exposure to media (OR=1.30; 95% CI=1.05-1.61); skilled birth attendance (OR=1.39; 95% CI=1.12-1.17); and 1-2 days timing of post-delivery care (OR=1.68; 95% CI=1.14-2.47). CONCLUSIONS Increasing reproductive health education and information among postpartum women especially those who are disadvantaged, those with no education and the poor would significantly improve PPFP in Uganda.
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Affiliation(s)
- Gideon Rutaremwa
- Centre for Population and Applied Statistics (CPAS), Makerere University, Kampala, Uganda.
| | - Allen Kabagenyi
- Centre for Population and Applied Statistics (CPAS), Makerere University, Kampala, Uganda.
| | | | - Tapiwa Jhamba
- United Nations Population Fund (UNFPA), Uganda Country Office, Kampala, Uganda.
| | - Edith Akiror
- United Nations Population Fund (UNFPA), Uganda Country Office, Kampala, Uganda.
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Yadav D, Dhillon P. Assessing the impact of family planning advice on unmet need and contraceptive use among currently married women in Uttar Pradesh, India. PLoS One 2015; 10:e0118584. [PMID: 25738707 PMCID: PMC4349805 DOI: 10.1371/journal.pone.0118584] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Counseling/advice is one of the key interventions to promote family planning (FP) in developing countries, including India. It helps to improve the quality of care and reduce maternal deaths. This paper investigates the continuity of maternal health (MH) service utilization from antenatal care to post-natal care and the impact this service utilization has on contraceptive use and on meeting the demand for family planning among currently married women in rural Uttar Pradesh, India. METHODS AND FINDINGS The study assesses the impact of FP advice on unmet need and contraceptive use by adopting the propensity score matching method. It uses data from the District Level Household Survey (DLHS) (2007-08) that covered 76,147 currently married women (CMW) in the age group 15-44 years in Uttar Pradesh. Results show that the utilization of MH services [Antenatal care (ANC), institutional delivery, Postnatal care (PNC)] and FP advice during ANC and PNC has led to increase in current use of contraception by 3.7% (p<.01), 7.3% (p<.01) and 6.8% (p<.01), respectively. However, a greater utilization of these services has not translated into a reduction of unmet need for contraception at a similar manner. CONCLUSION MH service utilization including FP advice is more effective in increasing current use of spacing methods as compared to limiting methods. Findings support the need for "effective FP advice" interventions to reduce unintended births and unmet need. However, women from Scheduled Caste/Scheduled Tribe communities are less likely to receive MH services. Thus, efforts are required to ensure that currently married women across socio-economic backgrounds have equal opportunity to receive MH services and information on contraceptive use to meet the demand for family planning methods.
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Affiliation(s)
- Diwakar Yadav
- Population Services International, Lucknow, Uttar Pradesh, India
- * E-mail:
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Chersich MF, Kley N, Luchters SMF, Njeru C, Yard E, Othigo MJ, Temmerman M. Maternal morbidity in the first year after childbirth in Mombasa Kenya; a needs assessment. BMC Pregnancy Childbirth 2009; 9:51. [PMID: 19891784 PMCID: PMC2777848 DOI: 10.1186/1471-2393-9-51] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 11/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, few services specifically address the needs of women in the first year after childbirth. By assessing the health status of women in this period, key interventions to improve maternal health could be identified. There is an underutilised opportunity to include these interventions within the package of services provided for woman-child pairs attending child-health clinics. METHODS This needs assessment entailed a cross-sectional survey with 500 women attending a child-health clinic at the provincial hospital in Mombasa, Kenya. A structured questionnaire, clinical examination, and collection of blood, urine, cervical swabs and Pap smear were done. Women's health care needs were compared between the early (four weeks to two months after childbirth), middle (two to six months) and late periods (six to twelve months) since childbirth. RESULTS More than one third of women had an unmet need for contraception (39%, 187/475). Compared with other time intervals, women in the late period had more general health symptoms such as abdominal pain, fever and depression, but fewer urinary or breast problems. Over 50% of women in each period had anaemia (Hb <11 g/l; 265/489), with even higher levels of anaemia in those who had a caesarean section or had not received iron supplementation during pregnancy. Bacterial vaginosis was present in 32% (141/447) of women, while 1% (5/495) had syphilis, 8% (35/454) Trichomonas vaginalis and 11% (54/496) HIV infection. CONCLUSION Throughout the first year after childbirth, women had high levels of morbidity. Interface with health workers at child health clinics should be used for treatment of anaemia, screening and treatment of reproductive tract infections, and provision of family planning counselling and contraception. Providing these services during visits to child health clinics, which have high coverage both early and late in the year after childbirth, could make an important contribution towards improving women's health.
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Adegbola O, Okunowo A. Intended postpartum contraceptive use among pregnant and puerperal women at a university teaching hospital. Arch Gynecol Obstet 2009; 280:987-92. [PMID: 19322573 DOI: 10.1007/s00404-009-1056-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 03/10/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the intention to use postpartum contraceptives and factors influencing use. METHOD A total of 423 consecutive consenting women attending the pregnancy and puerperal clinics at a university teaching hospital were interviewed using structured questionnaire. RESULTS The prevalence of previous contraceptive use was 35.5%. Fifty-four percent of the respondents intended to use contraceptives after delivery, though 3% were yet to decide. Condoms (38.3%) followed by intrauterine contraceptive device (IUCD) 11.5%, were the most preferred choice of postpartum contraceptives. However, spermicide (0.4%) was the least preferred. Advanced age and high parity significantly predicted intention to use postpartum contraceptives (P = 0.02 and 0.01, respectively). Also high level of respondent's education and family planning counseling by doctors and nurses increased the intention to use postpartum contraceptives (P = 0.03 and 0.01, respectively). CONCLUSION Family planning counseling and education play a vital role in increasing the use of contraceptives in the postpartum period.
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Affiliation(s)
- Omololu Adegbola
- Department of Obstetrics and Gynaecology, University of Lagos/Lagos University Teaching Hospital, Nigeria.
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Sannisto T, Kosunen E. Initiation of postpartum contraception: a survey among health centre physicians and nurses in Finland. Scand J Prim Health Care 2009; 27:244-9. [PMID: 19958065 PMCID: PMC3413917 DOI: 10.3109/02813430903234914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres. DESIGN A survey study with self-administered online questionnaires. SETTING All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005. SUBJECTS A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups. MAIN OUTCOME MEASURES Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses. RESULTS The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum. CONCLUSION Professionals' reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.
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Affiliation(s)
- Tuire Sannisto
- Medical School, Department of General Practice, University of Tampere, and Pirkanmaa Hospital District, Centre of General Practice, Tampere, Finland
| | - Elise Kosunen
- Medical School, Department of General Practice, University of Tampere, and Pirkanmaa Hospital District, Centre of General Practice, Tampere, Finland
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Okuda M, Yamanaka M, Takahashi T, Ishikawa H, Endoh M, Hirahara F. Positive rates for rubella antibody in pregnant women and benefit of post-partum vaccination in a Japanese perinatal center. J Obstet Gynaecol Res 2008; 34:168-73. [PMID: 18412777 DOI: 10.1111/j.1447-0756.2007.00689.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study of pregnant women was undertaken to clarify their immune status for rubella and to evaluate the efficacy of, and adverse reaction to, post-partum rubella vaccination. METHODS We determined the levels of both rubella antibody by hemagglutination inhibition test and IgM antibody by enzyme-linked immunosorbent assay in the first gestational trimester and surveyed the positive rates for rubella antibody in pregnant women at our perinatal center; we recommended post-partum vaccination for women with poor immune status. We also evaluated the effectiveness of the vaccine and any adverse reaction. RESULTS Among 2741 pregnant women, 185 cases (6.7%) were seronegative for rubella virus. This rate was especially high (12.4%) in the population who had opted out of the vaccination because of a change in Japanese government policy. A total of 30 cases (1.1%) were positive or false-positive for IgM antibody, but no congenital rubella syndrome (CRS) developed. The seropositive rate was 93.3% in total, but this figure includes those who required post-partum vaccination (558 cases or 20.3%) because their titers were 16x or lower. Among 145 cases who received post-partum rubella vaccine, no severe adverse reaction was detected, and in all 37 cases with hemagglutination inhibition antibody titers of 8x or lower, the efficacy rate was 100%. CONCLUSIONS It is necessary to appropriately evaluate the CRS risk. Also, we need to emphasize the importance and safety of post-partum rubella vaccination in Japan.
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Affiliation(s)
- Mika Okuda
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan.
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Hunter MI, Monk BJ, Tewari KS. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynecol 2008; 199:3-9. [PMID: 18585520 DOI: 10.1016/j.ajog.2008.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 03/07/2008] [Accepted: 04/04/2008] [Indexed: 10/21/2022]
Abstract
Cervical cancer screening is an essential component of prenatal care. The diagnosis and management of cervical intraepithelial neoplasia (CIN) during pregnancy are challenging, and sufficient information does not exist to allow for a definitive evidence-based approach. The American Society for Colposcopy and Cervical Pathology has recently published guidelines regarding the evaluation of abnormal Papanicolaou tests and the treatment of CIN in this setting. Many techniques traditionally recommended in the evaluation of abnormal cervical cytology and the treatment of CIN in the nonpregnant woman, such as colposcopy, cervical biopsy, and electrosurgical excision, can be applied to the pregnant patient with important exceptions. The vascular cervix associated with the gravid condition and the risk of premature pregnancy loss mandates deviation from existing consensus guidelines in screening for cervical cancer in pregnancy and treating associated CIN. In the present review, current guidelines regarding cervical cancer screening are reviewed, and data from studies of pregnant populations are summarized.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000185331.32574.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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