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Contraception Journal
 
Contraception Highlights April 2015

Original Research Articles

Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days
Mary Gatter, Kelly Cleland, Deborah L. Nucatola
Objective: The aim of this study was to report on the safety and efficacy of an evidence-based medical abortion regimen utilizing 200 mg of mifepristone orally followed by home use of 800 mcg misoprostol buccally 24–48 h later through 63 days estimated gestational age.
Implications: This study reinforces the safety and efficacy of the evidence-based regimen for medical abortion (200 mg mifepristone orally followed by home use of 800 mcg of misoprostol buccally 24–48 h later) through 63 days estimated gestational age, and contributes to the existing evidence against restrictions requiring use of the FDA-approved regimen.
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Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices
Klaas Heinemann, Suzanne Reed, Sabine Moehner, Thai Do Minh
Objectives: The objectives were to identify and compare the incidence of uterine perforation and other medically adverse events associated with levonorgestrel-releasing intrauterine systems (LNG-IUSs, releasing 20 mcg LNG daily) and copper intrauterine devices (IUDs) under routine conditions of use in a study population representative of typical users.
Implications: The European Active Surveillance Study on Intrauterine Devices is the first large-scale, prospective, noninterventional study to compare the perforation risk in LNG-IUS and copper IUD users. It is the first to examine the independent roles that breastfeeding status and postpartum status have on perforation risk. Conducted during routine clinical practice, the findings are generalizable to broader populations.
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Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices
Klaas Heinemann, Suzanne Reed, Sabine Moehner, Thai Do Minh
Objectives: The objective was to measure the rate of unintended pregnancies in women using levonorgestrel-releasing intrauterine systems (LNG IUSs, releasing 20 mcg LNG daily) and copper intrauterine devices (IUDs) in a typical population of IUD users and to describe associated complications.
Implications: To our knowledge, this is the first large-scale, multinational, prospective epidemiological study to measure and compare the contraceptive effectiveness of LNG IUSs and copper IUDs during routine clinical practice. Clinicians and patients should be aware of differences in rates of unintended pregnancies and associated complications in relation to IUD us.
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A randomized trial of levonorgestrel intrauterine system insertion 6 to 48h compared to 6weeks after vaginal delivery; lessons learned
Gretchen S. Stuart, Catherine R. Lesko, Alison M. Stuebe, Amy G. Bryant, Erika E. Levi, Antoinette I. Danvers
Abstract: The objective of this randomized trial was to compare breastfeeding among women who received a levonorgestrel-releasing intrauterine system within 6–48 h (early) or 4–6 weeks (standard) after an uncomplicated vaginal birth. Analysis groups of 86 women in each arm were needed to demonstrate a 20% difference in any breastfeeding. Thirty-five women were randomized to the early (N=17) and standard (N=18) arms. The combination of unsuccessful placement (2/17; 12%), expulsions (7/17; 41%) and removals (3/17; 18%) reached 71% (12/17) in the early arm, so the study was stopped. In our small study cohort, levonorgestrel-releasing intrauterine system insertion between 6 and 48 h after vaginal birth was associated with a high rate of expulsion or removal soon after insertion.
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Influences on women’s decision making about intrauterine device use in Madagascar
Ann Gottert, Karin Jacquin, Bakoly Rahaivondrafahitra, Kathryn Moracco, Suzanne Maman
Objective: We explored influences on decision making about intrauterine device (IUD) use among women in the Women’s Health Project (WHP), managed by Population Services International in Madagascar.
Implications: This qualitative study suggests that women in Madagascar perceive multiple IUD benefits but also fear the method even after misinformation is corrected, leading to a staged decision-making process about IUD use. Programs should identify and supply the types of social support that women find helpful at each stage of decision making.
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The levonorgestrel intrauterine system: cohort study to assess satisfaction in a postpartum population in Kenya
David Hubacher, Rose Masaba, Carolyne Kemunto Manduku, Mario Chen, Valentine Veena
Background: The levonorgestrel intrauterine system (LNG IUS) may become the next long-acting contraceptive to be introduced in public sector programs of resource-poor countries. Whereas service provision for subdermal implants and intrauterine devices is growing, little is known about how the LNG IUS might fit in.
Implications: The LNG IUS may soon be purchased by international donor agencies for use in public sector programs in sub-Saharan Africa and other resource-poor countries. The results of this study suggest that the product will be successful in future introduction activities.
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Contraceptive discontinuation and pregnancy postabortion in Nepal: a longitudinal cohort study
Mahesh Puri, Jillian T. Henderson, Cynthia C. Harper, Maya Blum, Deepak Joshi, Corinne H. Rocca
Objective: To examine postabortion contraceptive discontinuation and pregnancy in Nepal, where abortion was decriminalized in 2002.
Implications: Initiation of modern contraception was high postabortion; however, 1-year discontinuation was high for the condom, pill and injectable, the methods most commonly used. Rates for intrauterine devices and implants were low. Results support efforts to facilitate patient knowledge and access to the full range of contraceptives, including long-acting reversible methods.
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Prevalence and risk factors of inadequate cervical dilation following laminaria insertion in second-trimester abortion — case control study
Ido Ben-Ami, Sharon Stern, Zvi Vaknin, Noam Smorgick, David Schneider, Reuvit Halperin
Objective: The objective was to explore the prevalence of and risk factors for inadequate cervical dilation following insertion of a single set of laminaria in women scheduled for dilation & evacuation (D&E) at 14–24 weeks' gestation.
Conclusions: Previous cesarean section/s, cervical procedures and primigravidity were found to be risk factors for failure to achieve adequate cervical dilation after a single set of laminaria. Women who are scheduled for D&E, and in whom one of these risk factors exists, might benefit from additional interventions to achieve better cervical preparation.
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Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial
Kate A. Shaw, Jonathan G. Shaw, Michele Hugin, Griselda Velasquez, Frederick W. Hopkins, Paul D. Blumenthal
Objective: The objective was to investigate mifepristone as a potential adjunct to cervical preparation for surgical abortion after 19 weeks of gestation, with the aim of improving procedure access, convenience and comfort.
Implications: Use of mifepristone for cervical preparation before surgical abortion after 19 weeks allows for fewer visits and fewer osmotic dilators without compromising cervical dilation or increasing procedure time.
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Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure
Jenny A. Higgins, Yu Wang
Objectives: Use of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors.
Implications statement: Since a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.
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Examining quality of contraceptive services for adolescents in Oregon's family planning program
Maria Isabel Rodriguez, Blair G. Darney, Emily Elman, Rachel Linz, Aaron B. Caughey, K. John McConnell
Objective: To assess the quality of care provided to adolescents (10–19 years old) compared to women (aged 20–25 years) who accessed services in Oregon's Contraceptive Care (CCare) program.
Implication: Efforts are needed to ensure that adolescents have access to highly effective reversible contraception.
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An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception
Jenny Francis, Liandra Presser, Katherine Malbon, Debra Braun-Courville, Lourdes Oriana Linares
Objective: We examine the association between depressive symptoms and contraceptive method choice among adolescents initiating prescription contraception.
Conclusions: Inner-city, minority adolescents with elevated symptoms of depression who present for prescription contraceptive initiation may be more likely to select an IUD rather than shorter-acting methods. By recognizing adolescent females with depressive symptoms, providers can strategize their approach to effective contraception counseling.
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Benchmark pregnancy rates and the assessment of post-coital contraceptives: an update
Daniel Li, Allen J. Wilcox, David B. Dunson
Objective: In 2001, we provided benchmark estimates of probability of pregnancy given a single act of intercourse. Those calculations assumed that intercourse and ovulation are independent. Subsequent research has shown that this assumption is not valid. We provide here an update of previous benchmark estimates.
Implication statement: The chance of pregnancy with a single act of unprotected intercourse is greater than previously estimated. Previous benchmarks may underestimate the efficacy of post-coital contraception.
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Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) into an abortion clinic: an exploratory study of acceptability
Lindsay Appel, Shaalini Ramanadhan, Katherine Hladky, Chris Welsh, Mishka Terplan
Abstract: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6, respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.
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Case Series

Hypersensitivity to laminaria: a case report and review of literature
Tania Sierra, Melissa M. Figueroa, Katherine T. Chen, Britt Lunde, Adam Jacobs
We report a case of laminaria hypersensitivity treated with diphenhydramine and corticosteroids. A literature review identified 10 previously reported cases, with 8 recognized as anaphylaxis, and good outcomes with corticosteroids and antihistamines despite limited epinephrine utilization. Laminaria hypersensitivity is likely IgE mediated with an increased anaphylaxis risk with prior exposure.
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Correspondence

Response to commentary titled “Global family planning metrics — time for new definitions”
Aisha N.Z. Dasgupta, Amelia C. Crampin, Basia Zaba
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Author response to letter to the editor: response to commentary titled “Global family planning metrics — time for new definitions”
John Stanback, Baker Maggwa, Willard Cates
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