Contraception Following Abortion And The Treatment Of Incomplete Abortion

Family planning counseling and the provision of postabortion contraception should be an integrated part of abortion and postabortion care to help women avoid another unplanned pregnancy and a repeat abortion. Postabortion contraception is significantly more effective in preventing repeat unintended pregnancy and abortion when it is provided before women leave the healthcare facility where they received abortion care, and when the chosen method is a long-acting reversible contraceptive (LARC) method. This article provides evidence supporting these two critical aspects of postabortion contraception. It suggests that gynecologists and obstetricians have an ethical obligation to do everything necessary to ensure that postabortion contraception, with a focus on LARC methods, becomes an integral part of abortion and postabortion care, in line with the recommendations of the International Federation of Gynecology and Obstetrics and of several other organizations. © 2014 International Federation of Gynecology and Obstetrics.126SUPPL. 1S52S55Faúndes, A., Strategies for the prevention of unsafe abortion (2012) Int J Gynecol Obstet, 119 (SUPPL. 1), pp. 68-S71Schreiber, C.A., Sober, S., Ratcliffe, S., Creinin, M.D., Ovulation resumption after medical abortion with mifepristone and misoprostol (2011) Contraception, 84 (3), pp. 230-233Lähteenmäki, P., Luukkainen, T., Return of ovarian function after abortion (1978) Clin Endocrinol, 8 (2), pp. 123-132Boesen, H.C., Rørbye, C., Nørgaard, M., Nilas, L., Sexual behavior during the first eight weeks after legal termination of pregnancy (2004) Acta Obstet Gynecol Scand, 83 (12), pp. 1189-1192(2010) Medical Eligibility Criteria for Contraceptive Use, , World Health Organization 4th ed. WHO GenevaLähteenmäki, P., Influence of oral contraceptives on immediate postabortal pituitary-ovarian function (1978) Acta Obstet Gynecol Scand Suppl, 76, pp. 1-43Lähteenmäki, P., Rasi, V., Luukkainen, T., Myllyä, G., Coagulation factors in women using oral contraceptives or intrauterine contraceptive devices immediately after abortion (1981) Am J Obstet Gynecol, 141 (2), pp. 175-179Martin, C.W., Brown, A.H., Baird, D.T., A pilot study of the effect of methotrexate or combined oral contraceptive on bleeding patterns after induction of abortion with mifepristone and a prostaglandin pessary (1998) Contraception, 58 (2), pp. 99-103Niswonger, J.W., London, G.D., Anderson, G.V., Wolfe, L., Oral contraceptives during immediate postabortal period (1968) Obstet Gynecol, 32 (3), pp. 325-327Peterson, W.F., Contraceptive therapy following therapeutic abortion: An analysis (1974) Obstet Gynecol, 44 (6), pp. 853-857Tang, O.S., Gao, P.P., Cheng, L., Lee, S.W., Ho, P.C., A randomized double-blind placebo-controlled study to assess the effect of oral contraceptive pills on the outcome of medical abortion with mifepristone and misoprostol (1999) Hum Reprod, 14 (3), pp. 722-725Tang, O.S., Xu, J., Cheng, L., Lee, S.W., Ho, P.C., The effect of contraceptive pills on the measured blood loss in medical termination of pregnancy by mifepristone and misoprostol: A randomized placebo controlled trial (2002) Hum Reprod, 17 (1), pp. 99-102Gaffield, M.E., Kapp, N., Ravi, A., Use of combined oral contraceptives post abortion (2009) Contraception, 80 (4), pp. 355-362Fine, P.M., Tryggestad, J., Meyers, N.J., Sangi-Haghpeykar, H., Safety and acceptability with the use of a contraceptive vaginal ring after surgical or medical abortion (2007) Contraception, 75 (5), pp. 367-371Kurunmäki, H., Contraception with levonorgestrel-releasing subdermal capsules, Norplant, after pregnancy termination (1983) Contraception, 27 (5), pp. 473-482Kurunmäki, H., Toivonen, J., Lähteenmäki, P.L., Luukkainen, T., Immediate postabortal contraception with Norplant: Levonorgestrel, gonadotropin, estradiol, and progesterone levels over two postabortal months and return of fertility after removal of Norplant capsules (1984) Contraception, 30 (5), pp. 431-442Ortayli, N., Bulut, A., Sahin, T., Sivin, I., Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods (2001) Contraception, 63 (6), pp. 309-314Timonen, H., Luukkainen, T., Immediate postabortion insertion of the copper-T (TCu-200) with eighteen months follow-up (1974) Contraception, 9 (2), pp. 153-160Moussa, A., Evaluation of postabortion IUD insertion in Egyptian women (2001) Contraception, 63 (6), pp. 315-317Stanwood, N.L., Grimes, D.A., Schulz, K.F., Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: A review of the evidence (2001) BJOG, 108 (11), pp. 1168-1173Grimes, D., Schulz, K., Stanwood, N., Immediate postabortal insertion of intrauterine devices (2002) Cochrane Database Syst Rev, 3, p. 001777El Tagy, A., Sakr, E., Sokal, D.C., Issa, A.H., Safety and acceptability of post-abortal IUD insertion and the importance of counseling (2003) Contraception, 67 (3), pp. 229-234Pakarinen, P., Toivonen, J., Luukkainen, T., Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up (2003) Contraception, 68 (1), pp. 31-34Suvisaari, J., Lähteenmäk, P., Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system (1996) Contraception, 54 (4), pp. 201-208Gillett, P.G., Lee, N.H., Yuzpe, A.A., Cerskus, I., A comparison of the efficacy and acceptability of the Copper-7 intrauterine device following immediate or delayed insertion after first-trimester therapeutic abortion (1980) Fertil Steril, 34 (2), pp. 121-124Bednarek, P.H., Creinin, M.D., Reeves, M.F., Cwiak, C., Espey, E., Jensen, J.T., Post-Aspiration IUD Randomization (PAIR) Study Trial Group. Immediate versus delayed IUD insertion after uterine aspiration (2011) N Engl J Med, 364 (23), pp. 2208-2217Grimes, D.A., Lopez, L.M., Schulz, K.F., Stanwood, N.L., Immediate postabortal insertion of intrauterine devices (2010) Cochrane Database Syst Rev, 6, p. 001777Steenland, M.W., Tepper, N.K., Curtis, K.M., Kapp, N., Intrauterine contraceptive insertion postabortion: A systematic review (2011) Contraception, 84 (5), pp. 447-464Betstadt, S.J., Turok, D.K., Kapp, N., Feng, K.T., Borgatta, L., Intrauterine device insertion after medical abortion (2011) Contraception, 83 (6), pp. 517-521Shimoni, N., Davis, A., Ramos, M.E., Rosario, L., Westhoff, C., Timing of copper intrauterine device insertion after medical abortion: A randomized controlled trial (2011) Obstet Gynecol, 118 (3), pp. 623-628Sääv, I., Stephansson, O., Gemzell-Danielsson, K., Early versus delayed insertion of intrauterine contraception after medical abortion - A randomized controlled trial (2012) PLoS One, 7 (11), p. 48948Lähteenmäki, P., Toivonen, J., Lähteenmäki, P.L., Postabortal contraception with norethisterone enanthate injections (1983) Contraception, 27 (6), pp. 55-62Cameron, S.T., Glasier, A., Chen, Z.E., Johnstone, A., Dunlop, C., Heller, R., Effect of contraception provided at termination of pregnancy and incidence of subsequent termination of pregnancy (2012) BJOG, 119 (9), pp. 1074-1080Hardy, E., Bahamondes, L., Osis, M.J., Costa, R.G., Faúndes, A., Risk factors for tubal sterilization regret, detectable before surgery (1996) Contraception, 54 (3), pp. 159-162Holman, C.D., Wisniewski, Z.S., Semmens, J.B., Rouse, I.L., Bass, A.J., Population-based outcomes after 28,246 in-hospital vasectomies and 1,902 vasovasostomies in Western Australia (2000) BJU Int, 86 (9), pp. 1043-1049Hillis, S.D., Marchbanks, P.A., Tylor, L.R., Peterson, H.B., Poststerilization regret: Findings from the United States Collaborative Review of Sterilization (1999) Obstet Gynecol, 93 (6), pp. 889-895Langston, A.M., Joslin-Roher, S.L., Westhoff, C.L., Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice (2014) Contraception, 89 (2), pp. 103-108Heikinheimo, O., Gissler, M., Suhonen, S., Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion (2008) Contraception, 78 (2), pp. 149-154Peipert, J.F., Madden, T., Allsworth, J.E., Secura, G.M., Preventing unintended pregnancies by providing no-cost contraception (2012) Obstet Gynecol, 120 (6), pp. 1291-1297Rose, S.B., Lawton, B.A., Impact of long-acting reversible contraception on return for repeat abortion (2012) Am J Obstet Gynecol, 206 (1), pp. 37e1-37e6Ames, C.M., Norman, W.V., Preventing repeat abortion in Canada: Is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions? (2012) Contraception, 85 (1), pp. 51-55Heikinheimo, O., Gissler, M., Suhonen, S., Can the outcome of the next pregnancy be predicted at the time of induced abortion? (2009) Hum Reprod, 24 (4), pp. 820-826Winner, B., Peipert, J.F., Zhao, Q., Buckel, C., Madden, T., Allsworth, J.E., Effectiveness of long-acting reversible contraception (2012) N Engl J Med, 366 (21), pp. 1998-2007Secura, G.M., Allsworth, J.E., Madden, T., Mullersman, J.L., Peipert, J.F., The Contraceptive CHOICE Project: Reducing barriers to long-acting reversible contraception (2010) Am J Obstet Gynecol, 203 (2), pp. 115e1-115e7(2009) Committee for the Study of Ethical Aspects of Human Reproduction and Women's Health, , International Federation Of Gynecology And Obstetrics FIGO London(2013) Consensus Statement. Post Abortion Family Planning: A Key Component of Postabortion Care, , https://www.glowm.com/pdf/PAC-FP-Joint-Statement-November2013- final_printquality.pdf, International Federation Of Gynecology And Obstetrics (figo), International Confederation Of Midwives (icm), International Council Of Nurses (icn)United States Agency For International Development (usaid)White Ribbon Alliance (wra)Department For International Development (dfid)et a

Evaluation of satisfaction with a model of structured contraceptive counseling : Results from the LOWE trial

Introduction: Intervention trials of structured contraceptive counseling have proved to increase use of long-acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers’ and participants’ satisfaction with an intervention used in a large trial in Sweden. Material and methods: A cross-sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi-structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. Trial registration: ClinicalTrials.gov (NCT03269357). Results: Fourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time-neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package. Conclusions: The intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods. © 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG

Association of maternal attention deficit hyperactivity disorder and preterm birth : a cohort study.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) affects 3-7% of women of childbearing age. Whether ADHD is associated with an increased risk of preterm birth is unclear. DESIGN: National register-based cohort study. SETTING: Sweden. POPULATION: Nulliparous women giving birth to singleton infants 2007-2014 (n = 377 381). METHODS: Women were considered to have ADHD if they had been dispensed at least one prescription for ADHD medication, i.e. a central nervous system stimulant or non-stimulant drugs for ADHD, prior to, during or after pregnancy (2005-2014). Women with ADHD were compared with women without ADHD in regard to prevalence, severity and mode of onset of preterm birth. Logistic regression models were used, estimating adjusted odds ratios (aOR) with 95% confidence intervals (CI). Adjustments were made for maternal age and country of birth (model 1), and in addition for body mass index (BMI), education, alcohol or substance use disorders, and pre-gestational medical and psychiatric co-morbidity (model 2). MAIN OUTCOME MEASURES: Preterm birth (<37 weeks). RESULTS: During the study period, 6327 (1.7%) women gave birth and had ADHD according to our definition. These women had a higher rate of preterm birth compared with women without ADHD (7.3 versus 5.8%, aOR model 2: 1.17; 95% CI 1.05-1.30). ADHD was particularly associated with very (<32 weeks) preterm births, and associations were seen with both spontaneous and medically indicated onsets. CONCLUSIONS: Women with ADHD (i.e. who had been dispensed ADHD medication at any time in 2005-2014) had an increased risk of preterm birth. TWEETABLE ABSTRACT: Women with ADHD have a higher risk of preterm birth but most of it is due to modifiable risk factors

Supplementary Material for: Persistence of Lactobacilli in Postmenopausal Women - A Double-Blind, Randomized, Pilot Study

<i>Aim:</i> To investigate the ability of lactobacilli to persist in the genital area (vagina and labia) of women after the topical application of an ointment containing <i>Lactobacillus gasseri</i> LN40, <i>L. fermentum</i> LN99 and <i>L. rhamnosus</i> LN113. Secondary objectives were to study the presence of <i>Escherichia coli</i> and other contaminants, as well as subjective symptoms in the genital tract. <i>Methods:</i> Eighteen healthy postmenopausal women were randomized to use either the study product or placebo for 10 days. Gynecological examinations, labial and vaginal samplings for bacterial cultivation were performed at baseline (visit 1), after treatment (visit 2), and at a 10-day follow-up (visit 3). LN strains were identified by specific cultivation methods. Subjective symptoms were evaluated by a self-administered questionnaire. <i>Results:</i> The presence of LN99 was shown in 7 out of 8 women in the investigational group at visit 2 (p < 0.001 compared to placebo) and in 5 out of 8 at visit 3 (p < 0.05), whereas the presence of LN113 was shown in 2 out of 8 at visit 2 and in 1 out of 8 at visit 3. Subjective symptoms were significantly reduced (p < 0.01) at visits 2 and 3 for both products. <i>Conclusion:</i> Topical application of a probiotic ointment is feasible to achieve persistence of lactobacilli for at least 10 days