Good News About Endometriosis and Preterm Delivery

Non peer reviewe

Contraception After an Induced Abortion and Childbirth

Publisher Copyright: © 2021, Springer Nature Switzerland AG.Even though the rate of unintended pregnancy has been declining globally during the last 20 years, unintended pregnancy remains a significant public health issue and burden throughout the world. In 2014, the rate of unintended pregnancy was globally 62/1000 15–44-year-old women, and varied from that of 41/1000 women in Europe to 96/1000 in Latin America. Also the proportion of unintended pregnancies resulting in an abortion varies markedly in different parts of the world. The highest proportion (70%) was seen in Europe and the lowest (36%) in North America (Bearak et al., Lancet Glob Health. 6(4):e380–e389, 2018]. In addition to the high need of induced abortion, unintended pregnancy is associated with an increased risk of adverse pregnancy outcomes, such as low birth weight. Similarly, recent studies from the US show that nearly 50% of all pregnancies are unintended. Approx. 40% of these result in an induced abortion, the risk being higher among older and highly educated women (Finer and Zolna, N Engl J Med. 374(9):843–852, 2016). Thus, unmet need of contraception remains a significant global public health challenge. Pregnancy and childbirth bring most women to the attention of medical professionals, and thus providing an opportunity for contraceptive counseling and initiation. Providing effective contraception—regardless of the pregnancy outcome—is highly justified and may even be life-saving in settings where abortion is illegal (Glasier et al., Acta Obstet Gynecol Scand 8(11):1378–1385, 2019; Morroni and Glasier, Lancet Glob Health. 8(3):e316–e317, 2020). The contraceptive effectiveness of a contraceptive method in a given woman depends on her capacity to conceive, frequency and timing of intercourse, degree of compliance and inherent contraceptive efficacy of the method (Steiner et al., Obstet Gynecol 88(3 Suppl):24S–30S, 1996). Thus, most women with a recent history of an induced abortion and/or childbirth are highly fertile and likely to resume sexual activity soon after the pregnancy. This is highlighted in studies analyzing the need of subsequent abortion in women with history of abortion. Previous pregnancies (both deliveries and induced abortions) and young age—indicators of high fertility and sexual activity—emerge as risk factors for a subsequent abortion. In contrast, the use of effective contraceptive methods requiring minimal daily compliance, such as contraceptive implants and/or intrauterine devices, significantly reduces this risk (Goodman et al., Contraception 78(2):143–148, 2008; Heikinheimo et al., Contraception. 78: 149–154, 2008; Niinimäki et al., Obstet Gynecol 113: 845–852, 2009; Rose and Lawton, Am J Obstet Gynecol 206(1):37.e1–6, 2012). Therefore, safe and effective contraception, preferably with minimal daily/regular remembering is important if another pregnancy is not desired soon. In this chapter, we focus on contraceptive choices after induced abortion and childbirth. The high efficacy of the long-acting reversible methods of contraception (i.e., contraceptive implants and intrauterine devices) and importance of rapid post-pregnancy initiation of contraception are highlighted.Peer reviewe

The current status of hormonal therapies for heavy menstrual bleeding

Hormonal treatment of abnormal uterine bleeding (AUB), especially bleeding related to endometrial causes (AUB-E), ovulatory dysfunction (AUB-O) and coagulopathy (AUB-C), and to some extent, uterine leiomyomas and adenomyosis, has become the first-line evidence-based management strategy during recent years. Hormonal treatment of heavy menstrual bleeding (HMB) is also endorsed as the first line of treatment in several international guidelines. In the present article, we review the efficacy of the commonly used and widely available hormonal treatments of AUB-O, AUB-E and AUB-C. The therapies include combined hormonal contraceptives, progestin-only preparations, and intrauterine release of levonorgestrel through the levonorgestrel-releasing intrauterine system. In addition, we make practical recommendations for patient management. We also review some of the current guidelines and their recommendations concerning the treatment of HMB. Finally, the effects of hormonal treatment on the overall management of AUB and its effects on the health care system and specialist training are discussed.(C) 2017 Published by Elsevier Ltd.Peer reviewe

Kenelle kierukkaehkäisy sopii?

Kie­rukka on pitkä­vai­kut­teinen ehkäi­sy­muoto, jon­ka te­hoon käyt­täjän vir­heet tai unoh­dukset ei­vät vai­kuta. Ikä tai synnyt­tä­neisyys ei­vät vai­kuta kieruk­kaeh­käisyn sopi­vuuteen tai turval­li­suuteen. Kie­rukkaa käyt­tävät nai­set ovat yleensä tyyty­väisiä ehkäi­sy­me­ne­tel­määnsä. Varmis­ta­malla kie­rukan help­po saa­tavuus voi­daan merkit­tä­västi vä­hentää suunnit­te­le­mat­tomia ras­kauksia.Peer reviewe

Mifepristone may inhibit the midcycle gonadotropin surge at both ovarian and pituitary sites of action : [correspondence]

Non peer reviewe

Risk factors and the choice of long-acting reversible contraception following medical abortion : effect on subsequent induced abortion and unwanted pregnancy

Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion. Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January-May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014. Results: During the 21 months ([median], IQR 20-22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68-2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06-0.48). When adjusted for LARC initiation status, age= 25 years (27/383, 7.0%, HR1.95, 95% CI 1.04-3.67). Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.Peer reviewe

Patient-controlled intravenous versus on-demand oral, intramuscular or mcs intravenous administration of oxycodone during medical induced abortion from 64 to 128 days of Gestation : A randomized controlled trial

Publisher Copyright: © 2022 The AuthorsObjective: To compare oxycodone administration via intravenous patient-controlled analgesia (IVPCA) vs on-demand administration during late-first- and second-trimester medically induced abortion. Study design: A prospective randomized controlled study. We enrolled women between 64 to 128 days of gestation in the study between June 2016 and August 2018. Participants were randomized to receive oxycodone either via IVPCA or given on-demand orally, intramuscularly, or intravenously. Pain intensity and satisfaction with care were measured using the visual analogue scale (VAS, 0–100mm). Results: Altogether 99 participants were randomized: 48 in IVPCA group and 51 in on-demand group. Median gestational age was similar between groups (74 days [Interquartile range, IQR 69–81] in the IVPCA group vs 72 [69–80] in the control group, p = 0.587). Peak maximal pain was severe in both groups (median pain VAS was 62 [IQR 44–84] and 71 [IQR 56–90], p = 0.52). The odds for severe pain (highest pain VAS≥70) were similar between the groups (IVPCA group OR 0.51 [95% Confidence Interval 0.22–1.18], p = 0.118). In contrast, the odds for mild or tolerable pain (highest pain VAS≤40) were higher in the IVPCA group (OR 4.06 [95% CI 1.05–16.04], p = 0.043). Nevertheless, satisfaction with care was high (VAS 94 [89–100]) in both groups. Of those experiencing severe pain, 94.0% declared pain medication as adequate. Conclusion: Women often experience severe pain during medical abortion irrespective of the mode of opiate administration. Oxycodone administration via IVPCA permits women to self-administer analgesics when experiencing pain, raising the odds for mild or tolerable pain during abortion care. Satisfaction with care was high.Peer reviewe

Miten valitsen yhdistelmäehkäisyn?

VertaisarvioituEhkäisyä aloitettaessa ja jatkettaessa on huomioitava yhdistelmäehkäisyn vasta-aiheet. Oikein käytettyinä yhdistelmävalmisteet ehkäisevät tehokkaasti raskautta. Lisäksi ne auttavat runsaisiin ja kivuliaisiin kuukautisiin sekä endometrioosiin ja akneen. Valmisteiden progestiinien aiheuttamat ihovaikutukset ja laskimotukosriski sekä yksilöllinen sopivuus poikkeavat toisistaan. Olennaisinta on löytää turvallinen valmiste, johon nainen on tyytyväinen ja joka parantaa hänen elämänlaatuaan