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Baró-Mariné F, Pijuan-Domènech A, Goya MDM, Suárez-Edo E, Miranda-Barrio B, Dos-Subirà L, Pancorbo ML, Ferreira-Gonzalez I, Carreras-Moratonas E. Progestogen only contraception in women with congenital heart disease. J OBSTET GYNAECOL 2024; 44:2320296. [PMID: 38466189 DOI: 10.1080/01443615.2024.2320296] [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: 07/15/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND There is little information of progestogen-only contraceptives in patients with congenital heart disease (CHD) on the long-term. OBJECTIVE To evaluate the use of contraception in patients with CHD. We studied both short-acting reversible contraceptives (SARCs), oral progestin-only pills (POPs) and long-acting reversible contraceptives (LARCs): intrauterine devices (IUD-IPs) and subdermal implants both impregnated with progestogens (SI-IPs). STUDY DESIGN Retrospective study of all women attending the preconception clinic. Contraceptive methods were classified in three TIERs of effectiveness before and after consultation. ESC classification regarding pregnancy risk, WHOMEC classification for combined oral contraceptive safety was collected. RESULTS Six hundred and fifty-three patients. A significant proportion of them switched from TIER 3 to TIER 2 or 1 (p < .001) after consultation. One hundred and ninety-nine patients used POPs, 53 underwent IUD-IPs implantation and 36 SI-IPs, mean duration was 58 ± 8, 59 ± 8 and 53 ± 38 months, respectively. CONCLUSIONS Because of their safety and efficacy, IUD-IPs and SI-IPs should be considered as first-line contraception in patients with CHD.
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Affiliation(s)
- Francesc Baró-Mariné
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonia Pijuan-Domènech
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Del Mar Goya
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elena Suárez-Edo
- Department of Anesthesiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Berta Miranda-Barrio
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Laura Dos-Subirà
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Luisa Pancorbo
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-ESP, Barcelona, Spain
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Rigler N, Kully G, Hildebrand MC, Averbach S, Mody SK. Offering extended use of the contraceptive implant via an implementation science framework: a qualitative study of clinicians' perceived barriers and facilitators. BMC Health Serv Res 2024; 24:697. [PMID: 38825705 PMCID: PMC11145768 DOI: 10.1186/s12913-024-10991-4] [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: 12/19/2023] [Accepted: 04/15/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively. RESULTS We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators. CONCLUSIONS There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years.
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Affiliation(s)
- Nicole Rigler
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Gennifer Kully
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9300 Campus Point Dr. MC 7433, La Jolla, San Diego, CA, USA
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Marisa C Hildebrand
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9300 Campus Point Dr. MC 7433, La Jolla, San Diego, CA, USA
| | - Sarah Averbach
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9300 Campus Point Dr. MC 7433, La Jolla, San Diego, CA, USA
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Sheila K Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9300 Campus Point Dr. MC 7433, La Jolla, San Diego, CA, USA.
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Rigler N, Averbach S, Sandoval S, Hildebrand M, Mody SK. Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians. Womens Health Issues 2024:S1049-3867(24)00041-0. [PMID: 38811280 DOI: 10.1016/j.whi.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) approved the etonogestrel contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use. METHODS We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression. RESULTS Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about pregnancy risk, bleeding, and lack of FDA approval in the past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it. CONCLUSIONS One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use.
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Affiliation(s)
- Nicole Rigler
- School of Medicine, University of California San Diego, San Diego, California
| | - Sarah Averbach
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Center on Gender Equity and Health, University of California, San Diego, California
| | - Selina Sandoval
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Marisa Hildebrand
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Sheila K Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California.
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Addison J, Hassan A, DiVasta A. Contraception in Medically Complex Adolescents and Young Adults. Open Access J Contracept 2024; 15:69-83. [PMID: 38812474 PMCID: PMC11134286 DOI: 10.2147/oajc.s424068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/29/2024] [Indexed: 05/31/2024] Open
Abstract
Contraception is a significant part of comprehensive sexual and reproductive health (SRH) care for adolescents and young adults (AYA). While providers may assume that AYA with chronic illness are not sexually active, studies have shown that there are no differences in their sexual practices compared to their counterparts without an illness. This assumption may result in less SRH screening, preventative services, and counseling by providers resulting in decreased basic sexual knowledge, increased risk of unplanned pregnancy, and other health disparities. Sexually active AYA with medical complexity are particularly in need of contraception for a variety of reasons. A better understanding of the complexities around contraception counseling can help increase utilization rates, improve shared-decision making around family planning, and reduce the stigma around sexual health counseling in this population. We have included three sections. First, a general overview of contraception methods. Next, an overview of contraceptive methods currently available, their efficacy, and medical eligibility criteria for their use in AYA who have certain characteristics or medical conditions. Finally, cases adapted from real clinical scenarios to highlight specific recommendations for contraception in AYA women living HIV, autoimmune conditions, and those who have received a solid organ transplant. This information will help providers to consider the multiple factors that influence contraception decision-making (including clinical status, thrombosis risk, medication interactions, safety), and optimize care for AYA living with chronic illness.
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Affiliation(s)
- Jessica Addison
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Areej Hassan
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Amy DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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5
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Giraudo F, Salinas A, Merino PM, Iñiguez G, López P, Castro A, Lardone MC, Cavada G, Cassorla F, Codner E. Subdermal Progestin Implant and an Oral Combined Hormonal Contraceptive in Youth with Type 1 Diabetes. J Pediatr Adolesc Gynecol 2024; 37:177-183. [PMID: 38012981 DOI: 10.1016/j.jpag.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To determine the metabolic effects of the subcutaneous etonogestrel implant compared with an oral contraceptive in adolescents and young adults (AYAs) with type 1 diabetes (T1D) on body weight, body composition, glucose, lipids, and C-reactive protein levels. METHODS This was a non-randomized, interventional, prospective study. Thirty-nine AYAs with T1D participated; 20 used the implant (Implant-T1D), and 19 used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring, lipids, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated. RESULTS All participants were followed for at least 12 months, and 26 completed the 24-month follow-up. No women discontinued the intervention due to adverse effects. Body weight increased by 0.8 ± 3.5 and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (P < .001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. CONCLUSION Glucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception.
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Affiliation(s)
- Franco Giraudo
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Abril Salinas
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Chilean Institute of Reproductive Medicine (ICMER), Santiago, Chile, 8320165
| | - Paulina M Merino
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Germán Iñiguez
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Patricia López
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Andrea Castro
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - María Cecilia Lardone
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Gabriel Cavada
- Public Health, School of Medicine, University of Chile, Santiago, Chile, 8380453
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160.
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Shams TM, Alhashemi HH, Fallatah AA, Alkhalid AM, Alhazmi FM, Bin Yunus MK, Radey RN, Hamad AF, Beyari HT, Alharazi SS. Outcomes of etonogestrel subdermal contraceptive implants: A single center cross-sectional study. Saudi Med J 2024; 45:261-266. [PMID: 38438213 PMCID: PMC11115393 DOI: 10.15537/smj.2024.45.3.20230840] [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: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To examine the prevalence of menstrual irregularities, side effects, and discontinuation rates of etonogestrel subdermal implants (ESI) in women attending King Abdulaziz Medical City, Jeddah, Saudi Arabia. METHODS This cross-sectional was carried out based on electronic medical records and a phone-based questionnaire administered to women who underwent ESI insertion in a single tertiary care hospital in Jeddah, Saudi Arabia, between 2019 and 2022. The primary objective was the prevalence of menstrual abnormalities. The secondary study objective included the discontinuation rate, reasons for discontinuation, and ESI side effects. RESULTS In total, 345 women with ESI were included in this study. The prevalence of any type of menstrual abnormalities was 88%. Other side effects included skin and mood changes, arm pain, and numbness. The discontinuation rate was 11% in the first year and 22% before the completion of 36 months. CONCLUSION Although menstrual abnormalities are a common side effect of ESI, only 22% of users discontinued this method of contraception.
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Affiliation(s)
- Taghreed M. Shams
- From the Department of Obstetrics and Gynecology (Shams), College of Medicine, King Saud bin Abdulaziz University For Health Sciences;
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Hashem H. Alhashemi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Albaraa A. Fallatah
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Asma M. Alkhalid
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Fai M. Alhazmi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Mohammed K. Bin Yunus
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Rani N. Radey
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Asalah F. Hamad
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Hatoon T. Beyari
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Shahad S. Alharazi
- from the Department of Obstetrics and Gynecology (Shams, Hamad, Beyari, Alharazi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Department of Medicine(Alhashemi), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the Batterjee Medical College (Alkhalid, Alhazmi), Jeddah, from King Abdullah International Medical Research Center, Riyadh; from the College of Medicine (Fallatah, Bin Yunus), Taibah University, Al-Madinah Al-Munawwarah, and from the College of Medicine (Radey), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
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Ruiz de Viñaspre-Hernández R, Garrido-Santamaria R, Urra-Martínez R, Sáenz-Cabredo P, Garrido-Rivas AE, Juárez-Vela R, Sánchez-González JL, Lafuente-Jimenez A, Ramón-Arbués E, Navas-Echazarreta N, Santolalla-Arnedo I. Early removal of the etonogestrel contraceptive implant in Spanish women: a prospective cohort study. Front Med (Lausanne) 2024; 11:1172793. [PMID: 38323032 PMCID: PMC10844390 DOI: 10.3389/fmed.2024.1172793] [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: 02/23/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Purpose To know the discontinuation rate and characterize predictors and reasons of contraceptive implant removal within 12 months of insertion in our community setting. Methods This prospective cohort study included women receiving the etonogestrel contraceptive implant at sexual and reproductive health centers between September 2019 and September 2020. The variables collected were implanted insertion timing, reproductive and demographic characteristics, medical conditions, sexual activity and counseling. Our primary outcome was implant discontinuation. Kaplan-Meier survival curves were used to show the cumulative discontinuation rate of implants contraceptive within the first year of insertion. We also identified factors that increased the risk of implant removal using the log-rank test and the Cox regression model. Reasons for discontinuation were documented. Results 199 women were followed up. Implant discontinuation was documented in 17.1% of implant users prior to 12 months. Factors that increase the risk of implant removal are living with a partner, being aged 25-34 years and not receiving comprehensive and structured counseling from the midwife. The main reason for removal was unsatisfactory bleeding (97.1%), but this was combined with other reasons such as cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) or decreased libido (50.0%). Conclusion The rate of discontinuous implant uses in the first year is relevant in relation to cost-effectiveness, there is room for improvement that should not be overlooked. Comprehensive and structured midwife-led counseling can reduce early implant abandonment removal. The development in different countries of the role of midwives in the management of contraceptives can contribute to the economic benefit of health services and the satisfaction of women.
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Affiliation(s)
- Regina Ruiz de Viñaspre-Hernández
- Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Grupac Research Group, Department of Nursing, University of La Rioja, Logroño, Spain
| | | | | | | | - Ana Elena Garrido-Rivas
- Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Grupac Research Group, Department of Nursing, University of La Rioja, Logroño, Spain
- Rioja Health Service, Logroño, Spain
| | - Raúl Juárez-Vela
- Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Grupac Research Group, Department of Nursing, University of La Rioja, Logroño, Spain
| | | | | | - Enrique Ramón-Arbués
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Spain
- SAPIENF Investigation Group, University of Zaragoza, Zaragoza, Spain
| | - Noelia Navas-Echazarreta
- Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Grupac Research Group, Department of Nursing, University of La Rioja, Logroño, Spain
| | - Ivan Santolalla-Arnedo
- Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Grupac Research Group, Department of Nursing, University of La Rioja, Logroño, Spain
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Lee KW, Mok MUS, Chai HZ, Yang L. Monochorionic twin pregnancy in a patient with type III osteogenesis imperfecta: a multidisciplinary challenge. BMJ Case Rep 2023; 16:e255738. [PMID: 37967934 PMCID: PMC10660905 DOI: 10.1136/bcr-2023-255738] [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: 11/17/2023] Open
Abstract
A woman with severe type III osteogenesis imperfecta spontaneously conceived a monochorionic, diamniotic twin pregnancy. Due to the severity of her condition, her pregnancy required close follow-up involving a multidisciplinary team, including high-risk obstetricians, anaesthetists, pulmonologists and respiratory therapists. Eventually, the twins were delivered via caesarean section at 26 weeks' gestation.We discuss the challenges and considerations in managing her high-risk pregnancy, highlighting the importance of multidisciplinary care in achieving a safe outcome for mother and babies.
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Affiliation(s)
- Kai Wei Lee
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - May Un Sam Mok
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Hui Zhong Chai
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Liying Yang
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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Figa Z, Chekole TT, Tarekegn D, Mahamed AA, Bekele E. Early discontinuation of the IMPLANON® and associated factors in Ethiopia, systematic review and meta-analysis. Heliyon 2023; 9:e15972. [PMID: 37251447 PMCID: PMC10220320 DOI: 10.1016/j.heliyon.2023.e15972] [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] [Received: 12/07/2021] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Implanon® is a commonly used effective long-acting reversible contraceptive method. It provides contraception for up to three years. Its early discontinuation was associated with an unwanted pregnancy, abortion, and socioeconomic burden. Thus, the main aim of this systematic review and meta-analysis is to determine the rate of early discontinuation of Implanon® and associated factors in Ethiopia. Method This Systematic review and meta-analysis was performed by using online databases including PubMed, Google Scholar, Cochrane, HINARI, Web of Science, and other gray and online repositories of Ethiopian Universities. The JOANNA Briggs Institute standard data extraction and appraising sheet format was used for the extraction of all included studies. To test the heterogeneity of the studies the Cochran Q test and I2 statistics test were used. The Funnel plot and Egger's tests were used to detect possible publication biases of the included studies. The forest plots were used to present the finding of the overall prevalence of the early Implanon® discontinuation and the odds ratio (OR) along with a 95% CI. Result In this systematic review and meta-analysis seven studies with a total population of 3161 women using Implanon® were included. The overall pooled early Implanon® discontinuation rate was 31.34% (95%CI: 19.20, 43.47). Early discontinuation of Implanon® was associated with lack of counseling during service delivery 2.55times (OR: 2.55, 95%CI: 1.99, 3.25), the experienced side effect 3.25 times (OR: 3.25, 95%CI: 2.48, 4.24), absence of appointment after insertion 6.06 times (OR: 6.06, 95%CI: 2.15, 17.05), others decision on the women's choice 3.30 times (OR = 3.30, 95%CI: 2.52, 4.32), and lack the satisfaction of provided service 2.68 times (OR: 2.68, 96%CI: 1.61, 4.45). Conclusion About one-third of the women in Ethiopia discontinue the use of Implanon® within one year of the insertion. This is high compared to findings from other countries. Lack of counseling about the service, women's experience of the side effect, absence of the appointment following the service provision, other decisions on the method chosen, and lack of satisfaction were factors associated with the discontinuation of Implanon®. Hence, efforts should be made to reduce the rate of early discontinuation of Implanon® through drafting national guidelines and strategies accompanied by appropriate implementation, follow-up to foster adequate counseling, arrangement of appointments, helping women to decide on the choice, and increase the quality of care provision to enhance the satisfaction of the service.
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Affiliation(s)
- Zerihun Figa
- Dilla University College Health and Medical Science Department of Midwifery, Dilla, Ethiopia
| | | | - Dessalegn Tarekegn
- Dilla University College Health and Medical Science Department of Midwifery, Dilla, Ethiopia
| | - Abbas Ahmed Mahamed
- Dilla University College Health and Medical Science Department of Midwifery, Dilla, Ethiopia
| | - Etaferahu Bekele
- Dilla University College Health and Medical Science Department Nursing, Dilla, Ethiopia
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Hines G, Wang C, Walker T, Jereen A, Quinones JN, Waxman A. Continuation Rates of the Etonogestrel Implant and Factors Associated With Early Discontinuation. Cureus 2023; 15:e36117. [PMID: 37065304 PMCID: PMC10102878 DOI: 10.7759/cureus.36117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The etonogestrel implant is generally considered an effective, three-year, long-acting reversible contraceptive device. Previous research, such as the landmark CHOICE study, has reported a one-year continuation rate of 72% to 84%, however, in a real-world setting these rates may be significantly lower. OBJECTIVE To study etonogestrel implant continuation rates and factors associated with early discontinuation in a specific clinical setting. STUDY DESIGN Single-center, retrospective cohort study of patients who received the etonogestrel implant between January 1, 2015, and December 31, 2017, at several practices at an academic community hospital network. Records were reviewed up to three years after implant insertion to determine continuation rates (one to three years), early discontinuation rates (≤12 months), and reasons for early discontinuation. A sample size calculation was performed to guide a subanalysis of side effects. RESULTS A total of 774 patients underwent etonogestrel insertion during the study period. The one-year continuation rate was lower than that of the CHOICE study (62% vs. 83%, P <0.001). A subanalysis (n=216) revealed that a majority (82%, n=177) of patients reported side effects. Side effects were more common in patients with early discontinuation compared with patients who continued use longer than one year (93% vs. 71%, P <0.001). The most common side effect, abnormal uterine bleeding, was not significantly associated with early discontinuation. A significant association (P=0.02) was found between early discontinuation and neurologic/psychiatric complaints. CONCLUSIONS The one-year continuation rate of the etonogestrel implant in our population is significantly lower than the value reported by CHOICE. Implant side effects are common and significantly affect rates of discontinuation. Our data suggest there is an opportunity for education and counseling for individuals opting for this method of long-acting contraception.
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11
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Wali R, Alghamdi AM, Ahmed ST, Gammash AM, Bukhari MM, Alkhozam KF, Asiri MH. Satisfaction With the Use of Subdermal Contraceptive Implant in Women Attending the Specialized Polyclinic Primary Health Care Center in Jeddah City: A Cross-Sectional Study. Cureus 2023; 15:e35902. [PMID: 37033501 PMCID: PMC10081069 DOI: 10.7759/cureus.35902] [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: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Subdermal contraceptive implants are a convenient method of contraception for many women due to the ease of insertion and removal and because they require less follow-up with their health facility. In addition to the contraceptive benefits, women's satisfaction with such devices is essential, as this can affect their quality of life. This study aims to measure women's satisfaction with the subdermal contraceptive implant, Implanon® (Organon & Co., Jersey City, New Jersey, United States), its main side effects, and reasons for removal. Methods A cross-sectional study was conducted on women between the ages of 19 and 65 years who visited the Family Planning Clinic at the Specialized Polyclinic Primary Health Care Center in Jeddah, Saudi Arabia, between January 2018 and December 2021. An online questionnaire was distributed to the women who had Implanon inserted and 84 responded. Demographic and contraceptive data were collected, including the dates of insertion and removal of Implanon and side effects experienced while on Implanon. Results Of the 84 women, 65.84% were satisfied with Implanon, while only 19.04% were unsatisfied with the implant. The most common side effect reported was weight gain (54.76%), followed by menstrual Irregularity. (39.29%). The most common reason for removal was the end of the implant's contraceptive duration (42.86%). Conclusion Most of the women treated at this primary healthcare clinic were satisfied with Implanon. In addition, most of the women removed the implant only due to its reaching the end of its contraceptive duration despite experiencing side effects, and most women said that they would recommend it to their family and friends.
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Affiliation(s)
- Razaz Wali
- Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulkarim M Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Samer T Ahmed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulaziz M Gammash
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed M Bukhari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Khozam F Alkhozam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mouath H Asiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
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12
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Cohen J, Shull D, Reed S. Co-delivery of an HIV prophylactic and contraceptive using PGSU as a long-acting multipurpose prevention technology. Expert Opin Drug Deliv 2023; 20:285-299. [PMID: 36654482 DOI: 10.1080/17425247.2023.2168642] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Poly(glycerol sebacate) urethane (PGSU) elastomers formulated with 4'-ethynyl-2-fluoro-2'-deoxyadenosine (EFdA), levonorgestrel (LNG), or a combination thereof can function as multipurpose prevention technology implants for prophylaxis against HIV and unintended pregnancies. For these public health challenges, long-acting drug delivery technologies may improve patient experience and adherence. Traditional polymers encounter challenges delivering multiple drugs with dissimilar physiochemical properties. PGSU offers an alternative option that successfully delivers hydrophilic EFdA alongside hydrophobic LNG. METHODS This article presents the formulation, design, and characterization of PGSU implants, highlighting the impact of API loading, dimensions, and individual- versus combination-loading on release rates. RESULTS Co-delivery of hydrophilic EFdA alongside hydrophobic LNG acted as a porogen to accelerate LNG release. Increasing the surface area of LNG-only implants increased LNG release. All EFdA-LNG, EFdA-only, and LNG-only formulated implants demonstrated low burst release and linear release kinetics over 245 or 122 days studied to date. CONCLUSION PGSU co-delivers two APIs for HIV prevention and contraception at therapeutically relevant concentrations in vitro from a single bioresorbable, elastomeric implant. A new long-acting polymer technology, PGSU demonstrates linear-release kinetics, dual delivery of APIs with disparate physiochemical properties, and biocompatibility through long-term subcutaneous implantation. PGSU can potentially meet the demands of complex MPT or fixed-dose combination products, where better solutions can serve and empower patients.
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Ogle K, Handy AB. The Effects of Hormonal and Non-Hormonal Intrauterine Devices on Female Sexual Function: A Systematic Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:67-81. [PMID: 38596762 PMCID: PMC10903617 DOI: 10.1080/19317611.2022.2155898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/22/2022] [Accepted: 11/25/2022] [Indexed: 04/11/2024]
Abstract
Objectives The goal of this paper was to review and synthesize the extant literature exploring the impact, if any, of copper (Cu) and levonorgestrel (LNG) intrauterine devices on female sexual function. Methods To review the literature, Medline, PubMed, and PsychINFO, were searched for primary research articles that were available in English and measured female sexual function in Cu- and LNG-IUD users. 35 quantitative and 2 qualitative research papers met criteria for inclusion in this systematic review. The 35 quantitative articles were then rated based on the STROBE statement. Results The included articles indicated a positive impact of LNG-IUDs on sexual pain, and a positive-to-neutral effect of IUDs on sexual desire, however more research is warranted. This review also found IUDs to be generally non-impactful on other domains of sexual function, including arousal, lubrication, orgasm, satisfaction, and overall sexual function. Conclusions As this review highlights that LNG-IUDs may improve sexual pain, future research should explore this connection further. Additional RCTs should also be conducted to confirm effects on sexual function with little bias. A better understanding of the impact of both Cu- and LNG-IUDs is necessary to expand upon this field of research and uncover any other benefits or detriments from IUDs.
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Affiliation(s)
- Katherine Ogle
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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14
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Black KI, Trane W, Dorney E, Mola G. A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea. Contraception 2023; 117:25-29. [PMID: 36252651 DOI: 10.1016/j.contraception.2022.09.133] [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: 03/20/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In 2016 the Port Moresby General Hospital in Papua New Guinea introduced a midwife led postpartum contraception service to educate patients and provide contraceptive implants. This study examines the factors that were associated with immediate postpartum uptake of the implants. STUDY DESIGN We conducted a cross-sectional study of patients on the hospital postnatal ward who gave birth between March 2017 and January 2018. Patients aged 16-45 who had a vaginal birth with a singleton, live baby not requiring admission to the special care nursery were eligible for inclusion and invited to complete a survey prior to discharge. RESULTS Of 2082 patients approached, all consented to participate in the survey. Of those completing the survey, 531 (25.5%) chose to have the contraceptive implant provided immediately postpartum. Excluding patients who chose tubal ligation (n = 330), in multivariable analysis, higher odds of implant uptake was associated with no prior contraception use compared to prior use (aOR 1.38; 95% CI 1.07 -1.77), unplanned pregnancy compared to planned (aOR 1.37, 95% CI 1.07-1.79), and having received antenatal education about the implant compared to no information (AOR 1.65, 95% CI 1.23-2.10). CONCLUSIONS Antenatal education about the contraceptive implant impacted on likelihood of immediate postpartum method uptake. Patients who had no prior use of contraception and those with unplanned pregnancies were also more likely to request the implants, suggesting that the midwife-led postpartum service is successfully reaching patients with a previous unmet need for contraception. IMPLICATIONS This study demonstrates successful delivery of a postpartum implant program in a setting where community access to contraception is limited. Antenatal information and education can support implant uptake and that the program provides the opportunity for birth spacing and limiting in patients with a previous unmet need.
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Affiliation(s)
- Kirsten I Black
- Central Clinical School, Faculty of Medicine and Health, Susan Wakil Health Building D18, University of Sydney, New South Wales, 2006, Australia.
| | - Willie Trane
- Discipline of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD 111, Papua New Guinea
| | - Edwina Dorney
- Central Clinical School, Faculty of Medicine and Health, Susan Wakil Health Building D18, University of Sydney, New South Wales, 2006, Australia
| | - Glen Mola
- Discipline of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD 111, Papua New Guinea
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Phianphitthayakul OA, Li J, Rongkapich R, Karroon P, Vatrasresth J, Jaisamrarn U, Santibenchakul S. Client experiences with telehealth using LINE for consultation and assessment of adverse effects of contraceptive implants during the COVID-19 pandemic in Thailand. Digit Health 2023; 9:20552076231203877. [PMID: 37780063 PMCID: PMC10540598 DOI: 10.1177/20552076231203877] [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] [Received: 05/07/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aimed to examine clients' experiences with telehealth use for contraceptive implant consultation. Methods An online, self-administered survey was conducted with women who used contraceptive implants and faced adverse effects, inquired about side effects, or had concerns. Clients received consultations via LINE, which is a free chat application widely used in Thailand. Participants completed a questionnaire regarding their experiences and satisfaction within 7 days after using the service and a follow-up questionnaire to inquire about the need for in-person services 30 days after using the service. Results The participants were 200 women, with a response rate of 82%. Overall, 94% of participants were satisfied with the consultation. Moreover, 37.5% received a message response within 6 hours, and most (89.5%) got a response within 24 hours. The three most frequently reported symptoms were abnormal bleeding or spotting, mood swings, and itching or pain at the surgical site. Most adverse effects were managed through online consultation. Approximately one-third of the participants required in-person visits 30 days after telehealth consultation. Conclusions Telehealth consultation for contraceptive implant follow-up resulted in high client satisfaction. Most adverse effects could be managed using telehealth services. Therefore, telehealth could ensure sustained accessibility to reproductive healthcare during and post-COVID-19.
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Affiliation(s)
- On-anya Phianphitthayakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiayu Li
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Parichart Karroon
- Nursing Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jarika Vatrasresth
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Unnop Jaisamrarn
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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16
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Dugré N, Choksi N, Kirkwood J. Etonogestrel implant effectiveness. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:594. [PMID: 35961721 PMCID: PMC9374080 DOI: 10.46747/cfp.6808594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Nicolas Dugré
- Pharmacist at the CIUSSS du Nord-de-l'Île-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal in Quebec
| | - Nidhi Choksi
- Pharmacy Manager at the North West Company in Halifax, NS
| | - Jessica Kirkwood
- Family physician and Assistant Professor in the Department of Family Medicine at the University of Alberta in Edmonton
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17
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Pitts S, Milliren CE, Borzutzky C, Maslyanskaya S, Berg G, DiVasta AD. Adolescent/Young Adult Long-Acting Reversible Contraception: Experience from a Multisite Adolescent Medicine Collaborative. J Pediatr 2022; 243:158-166. [PMID: 34952007 DOI: 10.1016/j.jpeds.2021.11.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. STUDY DESIGN LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. RESULTS Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P = .63), 66% at 2 years (range, 62%-84%; P = .01), and 42% at 3 years (range, 36%-60%; P = .004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P = .82), 77% at 2 years (range, 76%-78%; P = .94), and 60% at 3 years (range, 57%-62%; P = .88). CONCLUSIONS LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.
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Affiliation(s)
- Sarah Pitts
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, CA
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital of Montefiore, Bronx, NY
| | - Grace Berg
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Amy D DiVasta
- The Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
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18
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Sanghavi M, Triebwasser JE. Women's Cardiovascular Health: Selecting the Best Contraception. Med Clin North Am 2022; 106:365-376. [PMID: 35227436 DOI: 10.1016/j.mcna.2021.11.011] [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: 10/19/2022]
Abstract
Basic knowledge about contraceptive types, efficacy, and indications is absolutely necessary for cardiologists caring for reproductive-age women for whom pregnancy could cause significant morbidity or mortality and for those on teratogenic medications. This summary provides a comprehensive overview of contraception options.
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Affiliation(s)
- Monika Sanghavi
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Jourdan E Triebwasser
- Division of Maternal-Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/SportsDoc2009
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Castillo K, Zambrano K, Barba D, Robayo P, Sanon S, Caicedo A, Jijon Chiriboga AJ. Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management. Eur J Obstet Gynecol Reprod Biol 2022; 270:231-238. [DOI: 10.1016/j.ejogrb.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/22/2022]
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20
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Kafi Mallak F, Kopp Kallner H. Migration of a subdermal contraceptive implant into a subsegmental pulmonary artery and etonogestrel serum concentration over time - a case report. EUR J CONTRACEP REPR 2022; 27:261-264. [PMID: 35174737 DOI: 10.1080/13625187.2022.2036977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Nexplanon is a single-rod contraceptive implant that should be placed subdermally at the inner side of the upper nondominant arm approximately 8-10 cm above the medial epicondyle of the humerus. Insertion guidelines were recently updated to place of insertion superficial of the triceps muscle to lower risk of insertion into vessels and nerves. If migration however occurs, it is most commonly around the insertion site. Migration above 2 cm is rarely reported [Ismail H, Mansour D, Singh M. Migration of implanon®. BMJ Sexual Reproduct Health. 2006;32:157-159]. This is a case report of a 24-year-old caucasian woman who presented with an impalpable Nexplanon implant that was, with the help of chest radiography and CT, located in a posterior basal subsegmental pulmonary artery in the left lower lobe of the lung. An attempt to remove the contraceptive implant by endovascular approach was unsuccessful. The implant remains in situ. Etonogestrel and oestradiol concentrations were followed over time.
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Affiliation(s)
| | - Helena Kopp Kallner
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Solna, Sweden
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Deyaso ZF, Chekole TT, Bedada RG, Molla W, Uddo EB, Mamo TT. Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221091659. [PMID: 35435068 PMCID: PMC9019356 DOI: 10.1177/17455057221091659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
An episiotomy is one of the most commonly performed obstetrics surgeries indicated in emergencies during the second stage of labor like fetal distress, dystocia, and tight perineum. As a result, this systematic review and meta-analysis aimed to assess the prevalence of episiotomy practice and associated factors in Ethiopia. Ten cross-sectional studies with a total population of 3718 were included in this study. The search was done using online databases like PubMed, HINARI, Web of Science, other gray, and online repositories of Universities. All the included papers were extracted and appraised using the standard extraction sheet format of JOANNA Briggs Institute. The Cochran Q-test and I2 statistics test were used to test the heterogeneity of studies. To detect the publication bias of the included studies, a funnel plot and Egger's test were used. The pooled prevalence of episiotomy practice and the odds ratio with a 95% confidence interval were presented using forest plots. The overall pooled prevalence of episiotomy practice was 45.11% (95% CI; 37.04-53.18; I2 = 96.3%). Prolonged second stage of labor (OR: 4.79, 95% CI: 3.03, 7.57), face presentation (OR: 4.26, 95% CI: 1.21, 15.07), birth weight > 4000 g (OR: 6.71, 95% CI: 3.14-14.33), instrumental delivery (OR: 4.26, 95% CI 2.95, 6.14), and primiparity (OR: 3.70, 95% CI: 1.90, 7.2) were factors associated with episiotomy practice. The overall prevalence of episiotomy practice was higher in Ethiopia compared to studies conducted in other countries. The prolonged second stage of labor, face presentation, birth weight > 4000 g, instrumental delivery, and primiparity of women were the factors associated with episiotomy practice. Therefore, efforts should be made to prevent routine episiotomy practice through creating awareness, adjusting national guidelines, affecting the World Health Organization episiotomy policy, and monitoring the activities of the health care facilities in executing the protocols.
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Affiliation(s)
- Zerihun Figa Deyaso
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
- Zerihun Figa Deyaso, Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, 419, Ethiopia.
| | - Tesfaye Temesgen Chekole
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Rediet Gido Bedada
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Etaferahu Bekele Uddo
- Department of Emergency Critical Nursing, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- Department of Epidemiology, College of Health and Medical Science, School of Public Health, Dilla University, Dilla, Ethiopia
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Safety and Benefits of Contraceptives Implants: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:ph14060548. [PMID: 34201123 PMCID: PMC8229462 DOI: 10.3390/ph14060548] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.
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