Patterns of contraceptive use among Thai women aged ≥40 and at risk of pregnancy

OBJECTIVES

The aims of the study were to identify the patterns of contraceptive use among Thai women aged ≥40 years and the reasons for not using contraception.

METHODS

This cross-sectional study included sexually active women aged 40-49 years in Khon Kaen, Thailand. Information on contraceptive practice and reasons for not using contraception was collected through a self-reported questionnaire. The unmet need for a modern method of contraception and the unmet need for any method of contraception were calculated based on the percentage of participants who were not using contraception but who wanted to postpone or prevent pregnancy.

RESULTS

Of 400 women, 75.5% were currently using some form of contraception, with female sterilisation being the most used (35%). The main reasons for not using contraception included perceived low risk of pregnancy, health concerns, infrequent sexual intercourse and wish to become pregnant. The unmet need for a modern method of contraception was 23.3% (95% confidence interval [CI] 0.20%, 0.29%). Having children was a significant protective factor (adjusted odds ratio [OR] 0.18; 95% CI 0.08, 0.37; p = 0.000). The unmet need for any method of contraception was 12% (95% CI 0.09%, 0.16%). Previous abortion was a significant risk factor for not using any contraception (adjusted OR 2.23; 95% CI 1.12, 4.44; p = 0.022).

CONCLUSION

Although the use of contraception was common, some participants displayed a lack of knowledge and/or did not practise family planning. Our findings address the importance of improving knowledge about the risks of pregnancy and the need for effective contraception in this population.

Interventions for intra-operative pain relief during postpartum mini-laparotomy tubal ligation

BACKGROUND

Postpartum mini-laparotomy tubal ligation (PPTL) is a contraceptive method that works by interrupting the patency of the fallopian tubes. Several methods are used for intraoperative pain relief, such as systemic administration of opioids or intraperitoneal instillation of lidocaine.

OBJECTIVES

To evaluate the effectiveness of and adverse effects associated with interventions for pain relief in women undergoing PPTL.

SEARCH METHODS

We searched for eligible studies published on or before 31 July 2017 in the CENTRAL Register of Studies Online, MEDLINE, Embase, PsycINFO, and CINAHL. We examined review articles and searched registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies.

SELECTION CRITERIA

We included randomised controlled trials (RCT) that compared perioperative pain relief measures during PPTL.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the titles, abstracts, and full-text articles of potentially relevant studies for inclusion. We extracted the data from the included studies, assessed risk of bias, and calculated and compared results. Discrepancies were resolved by discussion, or by consulting a third review author. We computed the inverse variance risk ratio (RR) with 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) with 95% CI for continuous variables.

MAIN RESULTS

We found only three RCTs, in which a total of 230 postpartum women participated. Most of our analyses were based on relatively small numbers of patients and studies. Overall, the certainty of evidence regarding the effectiveness of interventions was low, due to risk of bias and imprecision. We found very low-certainty evidence regarding the safety of interventions because of risk of bias and imprecision. Two studies had unclear risk of selection bias. One study had unclear risk of reporting bias and a high risk of other bias associated with the study protocol.Women who received an intraperitoneal instillation of lidocaine experienced lower intensity intraperitoneal pain than those given a placebo (pooled MD -3.34, 95% CI -4.19 to -2.49, three studies, 190 participants, low-certainty evidence), or an intramuscular injection of morphine (MD -4.8, 95% CI -6.43 to -3.17, one study, 40 participants, low-certainty evidence). We found no clear difference in intraperitoneal pain between women who had an intramuscular injection of morphine added to an intraperitoneal instillation of lidocaine and those who had an intraperitoneal instillation of lidocaine alone (MD -0.40, 95% CI -1.52 to 0.72, one study, 40 participants, low-certainty evidence). An intramuscular injection of morphine alone was not effective for intraperitoneal pain relief compared to placebo (MD 0.50, 95% CI -1.33 to 2.33, one study, 40 women, low-certainty evidence). None of the studies reported any serious adverse events but the evidence was very low-certainty. Intraperitoneal instillation of lidocaine may reduce the number of women requiring additional pain control when compared to placebo (RR 0.27, 95% CI 0.17 to 0.44, three studies, 190 women, low-certainty evidence).

AUTHORS' CONCLUSIONS

An intraperitoneal instillation of lidocaine during postpartum mini-laparotomy tubal ligation before fallopian tubes were tied may offer better intraperitoneal pain control, although the evidence regarding adverse effects is uncertain. We found no clear difference in intraperitoneal pain between women who received a combination of an injection of morphine, and intraperitoneal instillation of lidocaine and those who received an intraperitoneal instillation of lidocaine alone. These results must be interpreted with caution, since the evidence overall was low to very low-certainty.

Immediate versus delayed postpartum insertion of contraceptive implant for contraception

BACKGROUND

The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy.

OBJECTIVES

To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception.

SEARCH METHODS

We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies.

SELECTION CRITERIA

We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception.

DATA COLLECTION AND ANALYSIS

Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables.

MAIN RESULTS

Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups.

AUTHORS' CONCLUSIONS

Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.

Contraceptive practices and pregnancy intendedness among pregnant adolescents

Background

Adolescent pregnancy is a major health problem in many developing countries.

Objective

To assess contraceptive practices and pregnancy intendedness in pregnant adolescents.

Materials and methods

This study was prospectively conducted from September 2013 to June 2014. All consecutively pregnant women between 15 and 19 years old attending the Antenatal Clinic at Srinagarind Hospital and the Khon Kaen Branch of the Planned Parenthood Association of Thailand were invited for participation. Face-to-face interviews by trained interviewers using standardized questionnaires were carried out. Logistic regression was used to determine an adjusted odds ratio (aOR) and 95% confidence interval (CI) of independent predictors.

Results

Two hundred participants were enrolled. Mean age was 17.2 years. One hundred and eighteen (59.0%) were currently in school. Seventy-five (37.5%) participants had never used any contraceptive methods. Of the 125 participants who had ever used contraception, regular use of contraceptives was reported in only 21 participants (16.8%). Only two participants (1.0%) had ever used an intrauterine device or implant. Participants’ age was a significant independent factor associated with non-use of contraceptives (aOR, 6.42; 95% CI, 2.94–14.04). Of the 200 participants, 132 (66.0%) declared that the pregnancy was unintended. Significant independent factors predicting unintended pregnancy were educational status (aOR, 6.17; 95% CI, 3.27–13.75) and participants’ age (aOR, 5.76; 95% CI, 2.42–13.70).

Conclusion

Non-use and use of contraceptive methods with high failure rates were major reasons leading to adolescent pregnancies. Participants’ age was an independent factor predicting non-use of contraceptives. Educational status and age of the participants were significant factors predicting unintended pregnancy.

Low prevalence of contraceptive counseling at Srinagarind hospital, Thailand among women of reproductive age with systemic lupus erythematosus

OBJECTIVE

Unplanned pregnancy in women with SLE can have grave complications both for the child and the woman. We studied the prevalence of contraceptive counseling among women of reproductive age with SLE at a university hospital in Northeast Thailand.

METHODS

Recruited: 125 women with SLE, between 15 and 50 years, followed up at the Rheumatology Clinic. A questionnaire was administered and the results analyzed to identify the prevalence of contraceptive counseling.

RESULTS

The majority of women with SLE had had their reproductive goals evaluated (76.00%, 95% CI 66-83) and received contraceptive counseling (72%). Among the SLE patients at risk for pregnancy, only one-third used effective contraception and one-fifth of those did not have any background knowledge about SLE and pregnancy. Contraceptive counseling was more frequently given to women who had had a previous pregnancy or who were already concerned about SLE as related to pregnancy.

CONCLUSION

The majority of SLE patients had at one time or other received contraceptive counseling, but some reported not grasping the gravity. The survey results presented herein suggest that a multidisciplinary team is needed to improve patient knowledge regarding SLE as it affects on pregnancy and relatedly contraceptive counseling.

Intraperitoneal lidocaine for decreasing intra-operative pain during postpartum tubal resection in Srinagarind Hospital

OBJECTIVE

To evaluate the effectiveness and determine the minimal dosage of intraperitoneal lidocaine for pain relief during postpartum tubal resection in Srinagarind Hospital.

MATERIAL AND METHOD

Sixty postpartum women, undergoing postpartum tubal resection performed by residents at the Department of obstetrics and gynecologic, were included in this randomized, double-blinded, placebo controlled study. They were randomly assigned to one of three groups. They all received 20 ml solution intraperitoneally. Group one received it as isotonic normal saline; group 2 received it with 100 mg of lidocaine; and group 3 received it with 200 mg of lidocaine. The intra-operative and post-operative pain was measured by using a numerical rating score (NRS, from 0-10).

RESULTS

The mean of intra-operative NRS in the lidocaine groups (100 and 200 mg) were significantly lower than the isotonic normal saline group (3.40, 3.50 vs. 6.55, p-value 0.019 and 0.024). No significant difference was found in the intra-operative NRS between 100 and 200 mg lidocaine (NRS 3.40 vs. 3.50, respectively, mean difference 95% CI -2.41 to 2.21). There was no significant difference in the immediate post-operative pain among these three groups (p-value 0.613).

CONCLUSION

Intraperitoneal lidocaine instillation provides effective intra-operative pain relief in postpartum tubal resection under local anesthesia. 100 mg of lidocaine is effective in pain relief This technique was not effective for relief of immediate post-operative pain.

A modified LAVH to reduce urinary tract injuries: 102 consecutive case-series at Srinagarind Hospital, Khon Kaen University

OBJECTIVE

To describe the technique and results of modified laparoscopically assisted vaginal hysterectomy (LAVH), especially, on the urinary tract injury.

MATERIAL AND METHOD

One hundred two patients scheduled for modified LAVH between November 2007 and December 2010 were enrolled.

RESULTS

The majority of patients were middle-aged. The median parity was two; 16 patients were nulliparous. Among the 39 patients who had undergone prior abdominal or pelvic surgeries, eight had a prior cesarean delivery. The majority of LAVH indication was leiomyoma with complications. The median uterine weight was 300 g (range 120 to 1,450 g). The median operating time was 105 min (range 50 to 365 min). One patient had repeated laparoscopic uterine artery electrocoagulation 12 hours after surgery. Two patients were re-admitted with pelvic inflammatory disease (PID) two to three weeks post-operatively. No bowel or urinary tract injuries were detected during intra- and post-operation.

CONCLUSION

The modified LAVH presented here was a technique that showed a low incidence of urinary tract injury.

ThinPrep Pap-smear and cervical intraepithelial neoplasia in reproductive-aged Thai women

OBJECTIVE

To estimate the incidence of abnormal cervical cytology by ThinPrep Pap-tests and cervical intraepithelial neoplasia (CIN) in young adult reproductive-aged Thai women.

METHOD

A total of 1254 women distributed in all regions of Thailand were monitored from 2002 through 2004. Women were screened for abnormal cervical cytology using the ThinPrep method every 6 months. Interpretation of cervical cytology was based on the Bethesda system, version 2001. Women who had the ThinPrep Pap results as atypical squamous cells of undetermined significance or worse underwent colposcopic examination. The ThinPrep and all cervical tissue samples obtained from diagnostic or therapeutic procedures were analyzed and reviewed by Covance Central Laboratory Service, Inc., Indianapolis, USA.

RESULT

The cumulative incidence of abnormal ThinPrep Pap-tests was as follows: 15.3 per 100 woman years (WY) (95% confidence interval [CI] 12.3, 18.9) at 6 months; 12.3 per 100 WY (95% CI 10.3, 14.6) at 12 months; and 11.6 per 100 WY (95% CI 10.0, 13.5) at 18 months. Of 1448.6 woman years of follow up, the incidence of CIN1 was 4.1 per 100 WY (95% CI 3.2, 5.3); CIN2 0.8 per 100 WY (95% CI 0.4, 1.4); and CIN3 0.6 per 100 WY (95% CI 0.3, 1.2).

CONCLUSION

The incidence of abnormal ThinPrep Pap-test and CIN in young adult Thai women had been reported. No comparable data is available.

Evaluation of female sterilization at Srinagarind Hospital

A retrospective study of female sterilization at Srinagarind Hospital since 1978 until 2002 revealed 35,094 cases those were in the period of 25 years. These operations were performed by physicians, medical students and trained nurses in 21,383; 8,465 and 5,246 cases respectively. The presented cases were post partum tubal resection, interval tubal resection and cesarean section with tabul resection in 25,706; 4,4244 and 4,964 cases respectively. There were 350 cases of complication. The most common complication was tubal complications. Pregnancy post tubal resection were 74 cases or 0.21 percent. Different operators had statistically significant complication rates with Pearson chi square and Fisher exact test. Wound complication and pelvic pathology or operative difficulties were 2 types of statistically significant complications. Different types of operations had statistically significant complication rates. Six types of complications were tubal complication, wound complication, pregnancy, pelvic pathology or operative difficulties, bowel injury, and bladder injury.

Maternal knowledge, attitude and practice of safety belt use during pregnancy at Srinagarind Hospital

From January 2002 to July 2002, 260 pregnant women of more than 20 weeks gestation at the antenatal care unit of Srinagarind Hospital, who fulfilled the criteria and had signed consent forms, and had answered the structured questionnaires. This cross sectional study showed that 230 women (88.5%) had an acceptable level of knowledge. Only 85 pregnant women (32.7%) had received information about safety belt use during pregnancy and mostly from books or magazines. There were 97, 154, and 9 pregnant women (37.3%, 59.2%, and 3.5%) who had a good, fair and poor attitude about safety belt use during pregnancy. Prevalence of safety belt use during pregnancy was 93.5 per cent and 17 pregnant women (6.5%) never used it during pregnancy. The most frequent reason for not wearing safety belt was discomfort. Two hundred and twenty pregnant women (90.5%) identified the correct position of safety belt use.

Prevalence and risk factors of Streptococcus agalactiae (group B) colonization in mothers and neonatal contamination at Srinagarind Hospital

From July 1999 to November 1999, 901 pregnant women at Srinagarind Hospital, who fulfilled the criteria and had signed consent forms, were cultured from the lower vagina and perineum for group B streptococcus (GBS). Their neonates were also cultured from ears and anuses within 30 minutes after birth. There were 56 cases or 6.22 per cent colonization in pregnant mothers at the onset of labor and 14 cases or 1.55 per cent colonization in their neonates. Risk factors for GBS colonization in mothers were intrapartum fever and episiotomy. The risk factors for GBS colonization in the neonates were; 1. husband's occupation, 2. antepartum fever, 3. intrapartum fever, 4. postpartum morbidity and 5. gestational age. No cases during the study period had clinical infection from GBS. The prevalence rate in this study was much lower than the United States but similar to many developing countries. At this moment, it is not possible to culture for GBS in all pregnant women in Thailand. Intrapartum antibiotic prophylaxis for GBS infection was recommended if, 1. maternal fever was more than 38 degrees C, 2. ruptured membranes of more than 18 hours and 3. previous birth with neonatal GBS infection.

Protective effect of depot-medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case--control study

OBJECTIVE

To assess the protective effect of depot-medroxyprogesterone acetate (DMPA) on uterine leiomyomas. DMPA has been widely used in Thailand for many years; uterine leiomyomas is the most common female tumour.

DESIGN

A multicentre hospital-based case--control study.

SETTING

University and regional hospitals.

PATIENTS

Cases were all newly diagnosed patients with pathologically proven diagnosis of uterine leiomyomas, who were admitted to eight hospitals in three regions of Thailand from January 1991 to June 1993. Three controls matched with cases by sex, age within five years and date of admission within three months were recruited.

MAIN OUTCOME MEASURES

Information on socio-demographic factors, personal and family history, current disease, reproductive and contraceptive history was collected from cases and controls by interview.

RESULTS

There were 910 cases and 2709 controls. After univariate and unconditional multiple logistic regression analysis, risk factors associated positively with uterine leiomyomas are tubal ligation, family history of uterine leiomyomas, higher education, obesity and abortion. In contrast, DMPA, use of oral contraceptives, higher parity and smoking are associated with a lower relative risk suggesting that they have a protective effect against uterine leiomyomas. This causative relation is further strengthened by the strong duration-response relation between DMPA and uterine leiomyomas. This protection may persist for more than 10 years after the last dose.

CONCLUSION

We have demonstrated a strong, duration dependent protective effect of DMPA against uterine leiomyomas.