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Cosgriff L, Plummer M, Concepcion G, Danvers AA. Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge. Womens Health Rep (New Rochelle) 2024; 5:352-357. [PMID: 38666225 PMCID: PMC11044855 DOI: 10.1089/whr.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 04/28/2024]
Abstract
Objective To evaluate the utilization and outcomes of postpartum long-acting reversible contraception (PPLARC) following unmet postpartum bilateral tubal ligation (PPBTL) requests during a time in which elective surgeries were canceled due to the initial COVID-19 surge. Methods We conducted a mixed-methods study using an embedded design. Using a retrospective cohort design, we collected data from patients seeking PPBTL following vaginal delivery between March 15, 2020, and June 20, 2020; this reflects a time period during which elective surgery was canceled thus making PPBTL unavailable. We recorded demographic data, method of contraception at time of discharge and 18 months postpartum, and incidence of interval pregnancy at 18 months postpartum. Additionally, we conducted five semistructured interviews to gain deeper insights into patient experiences with PPLARC as a bridge method. Results Forty-five patients had unfilled PPBTL requests with follow-up data available for 35. The median age was 34 years. Ten (22%) accepted PPLARC as a bridge to interval bilateral tubal ligation (BTL). At the 18-month mark, only 1 out of 7 (14.3%) PPLARC users had undergone an interval BTL procedure, compared to 11 out of 28 (39.3%) nonusers. None of the PPLARC users experienced pregnancies, while 6 out of 28 (21.6%) nonusers became pregnant. Qualitative interviews underscored themes such as inadequate counseling preparation for unmet PPBTL requests and persistent barriers to BTL access. Conclusions Raising awareness of unmet PPBTL risks may drive greater adoption of PPLARC as a bridge method. While not a substitution for PPTBL, PPLARC provides a reliable form of interval contraception for patients seeking to delay pregnancy. It is essential to recognize that patient security with PPLARC's contraceptive efficacy may introduce delays in achieving the desired interval sterilization. Enhancing antenatal counseling on contraception options and providing transparency regarding barriers to sterilization could mitigate the challenges associated with unmet PPBTL requests.
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Affiliation(s)
- Lauren Cosgriff
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Plummer
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gabrielle Concepcion
- Department of Obstetric and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Antoinette A. Danvers
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Bleck RR, Danvers AA, Nimbvikar A, Gurney EP. Medical management of early pregnancy loss with mifepristone and misoprostol in Emergency Departments compared to a Complex Family Planning office: implementation of a COVID-19 institutional policy change. Contraception 2024:110467. [PMID: 38641155 DOI: 10.1016/j.contraception.2024.110467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES To evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to those in the Complex Family Planning (CFP) outpatient office. STUDY DESIGN In COVID-19's first wave, we expanded medication management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from 4/1/2020-3/31/2021, comparing treatment success, safety outcomes, and follow-up rates by location. We did not perform a power calculation. RESULTS Thirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in the ED (23, 70%) compared to CFP (34, 87.2%), but after adjusting for insurance status and type of pregnancy (miscarriage, uncertain viability, unknown location) this was not significant: aOR 0.48 (95%CI 0.13-1.81), p=0.28. More ED patients underwent emergent interventions (3 vs 0). Complications in the ED cohort included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Among these, two cases were attributed to misdiagnosis (a cesarean scar and a cervical ectopic pregnancy interpreted as incomplete miscarriages) and one to guideline nonadherence (anticoagulated patient). No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18.0%, p≤0.0001). CONCLUSIONS In this small sample, we observed a trend toward lower rates of treatment success following medication management of EPL in the ED, compared to the CFP office. This analysis highlights that both correctly making uncommon diagnoses and adhering to new guidelines presented challenges during our implementation process. IMPLICATIONS Implementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlight opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs. TWEETABLE ABSTRACT ED provision of mifepristone and misoprostol for early pregnancy loss during COVID-19 was less effective than outpatient care. There were more serious complications in the ED group due to misdiagnosis and guideline nonadherence.
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Affiliation(s)
- Roselle R Bleck
- Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Antoinette A Danvers
- Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anushri Nimbvikar
- Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth P Gurney
- Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Danvers AA, Gurney EG, Panushka KA, Peskin M, Evans TA. Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth. Am J Obstet Gynecol 2024; 230:350.e1-350.e11. [PMID: 37871872 DOI: 10.1016/j.ajog.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/26/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Hypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. OBJECTIVE The primary objective of the study is to compare contraception counseling and use between hypertensive and nonhypertensive individuals at risk for unintended pregnancy. Our secondary objectives are the following: (1) to evaluate the effect of race on the probability of counseling and the use of contraception, and (2) to evaluate the methods used by individuals with hypertension. METHODS Data from the 2015-2017 and 2017-2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the previous 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health. The social determinants of health covariate was based on reported experiences within 5 social determinants of health domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were used to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference-in-difference analyses, we compared the change in counseling and use between hypertensive and nonhypertensive respondents by race, relative to White respondents. RESULTS Of the 8625 participants analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95% confidence interval, 20.4-31.9) of hypertensive individuals and 20.7% (95% confidence interval, 19.3-22.2) of nonhypertensive individuals. Contraception use was reported by 39.8% (95% confidence interval, 33.2-46.5) of hypertensive and 35.3% (95% confidence interval, 33.3-37.2) of nonhypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes, and social determinants of health indicated that hypertensive individuals were 8 percentage points (95% confidence interval, 3-18 percentage points) more likely to receive counseling and 9 percentage points (95% confidence interval, 3-16 percentage points) more likely to use contraception. Hypertensive Black individuals did not receive more counseling or use more contraceptives compared with nonhypertensive Black individuals. The difference in counseling when hypertension was present was 13 percentage points lower than the difference observed for White respondents when hypertension was present (P=.01). The most frequently used contraceptive method among hypertensive individuals was combined oral contraceptive pills (54.0%; 95% confidence interval, 44.3%-63.5%). CONCLUSION Despite the higher likelihood of receiving contraception counseling and using contraception among hypertensive individuals at risk for unintended pregnancy, two-thirds of this population did not receive contraception counseling, and <40% used any contraceptive method. Furthermore, unlike White individuals, Black individuals with hypertension did not receive more contraception care than nonhypertensive Black individuals. Of all those who used contraception, half relied on a method classified as Centers for Disease Control and Prevention Medical Eligibility Criteria Category 3. These findings highlight a substantial unmet need for safe and accessible contraception options for hypertensive individuals at risk for unintended pregnancy, emphasizing the importance of targeted interventions to improve contraceptive care and counseling in this population.
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Affiliation(s)
- Antoinette A Danvers
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY.
| | - Elizabeth G Gurney
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY
| | - Katherine A Panushka
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY
| | - Melissa Peskin
- Department of Obstetrics and Gynecology, New York University Langone Hospital - Long Island, Mineola, NY
| | - Thomas A Evans
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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Bleck RR, Virani V, Nguyen N, McWalters J, Danvers AA, Gurney EP. P087Medical management of early pregnancy in emergency departments compared to outpatient: Evaluating a covid-19 institutional policy change to increase healthcare access. Contraception 2022. [PMCID: PMC9671652 DOI: 10.1016/j.contraception.2022.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shaber AG, Avila K, Wu H, Virani V, Danvers AA, Gurney EP. P091Impact of adverse childhood experiences, anxiety, and resilience on pain during office manual uterine aspiration. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Danvers AA, Chew Murphy E, Avila K, Gonzalez-Argoti T, Edwards AR, Hoffman S, Mantell JE, Bauman LJ, Dolan SM. Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention. Front Reprod Health 2022; 4:832287. [PMID: 36303639 PMCID: PMC9580770 DOI: 10.3389/frph.2022.832287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The objective of this study was to understand how women perceive the role of their Obstetrician and Gynecologist (OBGYN) in screening for and providing preexposure prophylaxis (PrEP) for HIV prevention. Methods We recruited women ages 18–45 years receiving obstetric or gynecological care at an academic medical center in the Bronx, NY. Thirty participants were enrolled: 10 seeking care for family planning, 10 seeking prenatal care, and 10 seeking care for a sexually transmitted infection. We screened participants for HIV acquisition risk using a PrEP screening tool. We conducted face-to-face, semi-structured interviews, which were audio-recorded, transcribed, and entered into Dedoose for analysis of themes using a grounded theory approach. Results Sixty percent of the participants were Latinx and 33% African American. Seventy percent had one or more risk factors for HIV acquisition based on the PrEP screening tool, indicating they would benefit from a PrEP discussion. Three main themes emerged from the analysis of interview data. Participants viewed OBGYNs as experts in sexual and reproductive healthcare and believed they were experts in PrEP. Participants were concerned about “PrEP stigma”, being judged by their clinicians as being sexually promiscuous if they expressed a need for PrEP. Lastly, when participants trusted their OBGYN, that trust became a facilitator for women to consider PrEP and offset stigma as a barrier to identifying patients who are candidates for PrEP. Conclusion Women established in care with an OBGYN are enthusiastic about having access to PrEP services incorporated into their sexual and reproductive healthcare. A universal approach to HIV prevention would avert stigma surrounding HIV care and prevention.
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Affiliation(s)
- Antoinette A. Danvers
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Antoinette A. Danvers
| | - Emma Chew Murphy
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karina Avila
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Angelic Rivera Edwards
- Montefiore School Health Program, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Susie Hoffman
- Department of Epidemiology, Joseph L. Mailman School of Public Health at Columbia University, New York, NY, United States
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Joanne E. Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Laurie J. Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Siobhan M. Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, United States
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Rodriguez M, Danvers AA, Sanabia C, Dolan SM. Educational behaviors of pregnant women in the Bronx during Zika's International emerging epidemic: "First mom … and then I'd Google. And then my doctor". BMC Pregnancy Childbirth 2021; 21:719. [PMID: 34702206 PMCID: PMC8547288 DOI: 10.1186/s12884-021-04170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objective of the study was to understand how pregnant women learned about Zika infection and to identify what sources of information were likely to influence them during their pregnancy. Methods We conducted 13 semi-structed interviews in English and Spanish with women receiving prenatal care who were tested for Zika virus infection. We analyzed the qualitative data using descriptive approach. Results Pregnant women in the Bronx learned about Zika from family, television, the internet and their doctor. Informational sources played different roles. Television, specifically Spanish language networks, was often the initial source of information. Women searched the internet for additional information about Zika. Later, they engaged in further discussions with their healthcare providers. Conclusions Television played an important role in providing awareness about Zika to pregnant women in the Bronx, but that information was incomplete. The internet and healthcare providers were sources of more complete information and are likely the most influential. Efforts to educate pregnant women about emerging infectious diseases will benefit from using a variety of approaches including television messages that promote public awareness followed up by reliable information via the internet and healthcare providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04170-0.
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Affiliation(s)
- Miguel Rodriguez
- Department of Family Medicine, Loma Linda University Health Educational Consortium, Loma Linda, CA, USA
| | - Antoinette A Danvers
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA. .,Department of Obstetrics, Gynecology, and Women's Health, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, 10461, USA.
| | - Carolina Sanabia
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System, New York, NY, USA
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Danvers AA, Dolan SM. Women's Health During the COVID-19 Surge in the Bronx: Reflections from Two OBGYNs on the Flatter Side of the Curve. Matern Child Health J 2020; 24:1089-1092. [PMID: 32638145 PMCID: PMC7340729 DOI: 10.1007/s10995-020-02977-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Antoinette A Danvers
- Department of Obstetrics & Gynecology and Women's Health at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics & Gynecology and Women's Health at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Department of Obstetrics & Gynecology and Women's Health at Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Road, Suite 301, Bronx, NY, 10461, USA.
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