bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness and Accessibility of Contraception [08I]
Authors: Lee David , Cheng Abigail W. , Swayze Emma , Jones Alexis , Ellis Monica , Newbery Gisella
Published: April 2020

INTRODUCTION:

Our study sought to assess community member attitudes toward newly-acquired immediate postpartum long-acting reversible contraception (IPLARC) benefits and determine whether a lack of knowledge about contraception may be impacting their attitudes. Prior literature has extensively detailed contraceptive methods, impacts contraception has on at-risk populations, and inquiries regarding implementation of IPLARCs prior to inclusion under insurance benefits. Recently, studies from South Carolina and Georgia published proposals for implementation from provider and institutional perspectives, though no assessment of patient knowledge was conducted.

METHODS:

An electronic 8-question survey was administered to Western Michigan University School of Medicine (WMed) clinic visitors and data was recorded via REDCap database. Individuals ≥18 and <60 years of age and were English-speaking were included. This study was exempted by the WMed Institutional Review Board.

RESULTS:

107 submissions were completed. 100% self-reported familiarity with and ability to explain to a friend ≥1 forms of contraception. 97.2% reported experience using ≥1 forms of contraception, with 42.06% either previously or currently using a LARC. However, only 22.43% responded they were interested in IPLARCs if they got pregnant, 63.55% said they were not interested, and 14.02% were uncertain as they had never been pregnant.

CONCLUSION:

Respondents were generally knowledgeable about and experienced with contraception and their low receptiveness towards IPLARCs unlikely stems from ignorance regarding contraception. Additional factors including health literacy, psychosocial factors, and prior experiences with contraception likely also impacted their attitudes. These should be further explored to best position patients to make informed decisions regarding their reproductive health.
Barriers to Obtaining Long-Acting Reversible Contraception Among Low-Income Women [09I]
Authors: Henke Leah , Martins Summer , Boraas Christy
Published: April 2020

INTRODUCTION:

Low-income women in the United States shoulder a disproportionate burden of unintended pregnancy, reflecting possible difficulties in accessing contraception. We examined the association between income and barriers to obtaining long-acting reversible contraception (LARC).

METHODS:

Non-pregnant women aged 18 to 40 years completed an electronic, cross-sectional survey at the University of Minnesota Driven to Discover Research Facility at the Minnesota State Fair in 2018. Participants reported being biologically capable of pregnancy and sexually active with a male partner. Bivariate analyses examined perceptions of LARC, barriers to LARC, and LARC use by participants’ income status: low income (less than or equal to 200% of federal poverty guideline) versus higher income. This study was deemed IRB exempt.

RESULTS:

Low-income women (n=91) were more likely than higher income women (n=274) to encounter at least one perceived barrier to obtaining a LARC method (70% vs 47%, P<.01), to identify more concerns about LARC use (3.1 vs 2.5, P<.01), and note more bothersome side effects (4.2 vs 3.5, P=.02). Cost of LARC was the most frequently identified barrier and was of greater concern to low-income women (53% vs 32%, P<.01). However, there was a trend toward low-income women being less likely to choose LARC as their preferred method even if cost barriers were removed (35% vs 46% P=.06).

CONCLUSION:

Low-income women experience more barriers to access but also more negative perceptions of LARC. Efforts to increase access to LARC should address these barriers and focus on concerns more common among low-income women regarding LARC use.
Deeply Inserted Contraceptive Implants: Where Are They Placed? Experience From a University Hospital Center [12I]
Authors: Xu Liwen , Korotkaya Yelena , Rible Radhika
Published: April 2020

INTRODUCTION:

We describe our experience in a Family Planning specialty clinic for patients referred for nonpalpable or deep etonogestrel (ENG) implant removal.

METHODS:

We reviewed the charts of 77 patients evaluated for difficult ENG implant removal from September 2014 through September 2019. In our clinic, we localize implants using high-frequency ultrasound and then proceed with removal under local anesthesia.

RESULTS:

Most implants were placed in reproductive health clinics (n=26; 34%) and community clinics (n=16; 21%) versus academic medical centers (n=6; 8%) and abroad (n=4; 5%). 25 patients (32%) did not recall where their implant was inserted. We successfully removed 72 implants (94%; 45 suprafascial, 27 subfascial) in the office; one subfascial implant was removed in the OR and four were lost to follow up. Non-obese patients were more likely to have a subfascial implant (36/51) than obese patients (3/24; P=.0014). Nonpalpable subfascial implants were also more likely to be found in individuals with BMI<30 (19/21, P=.0004). Of the patients not desiring immediate pregnancy (n=64), 17% chose another implant (n=11), 16% picked a different LARC method (n=10), 38% chose a combined hormonal contraceptive method (n=24), and 28% opted for condoms or nothing for contraception (n=18).

CONCLUSION:

In our patient population, most had their implants placed at reproductive health or community clinics. Deeply inserted implants can be successfully removed in the office by experienced providers and many patients choose to continue with the implant for contraception despite complications.
Does Education Promote Acceptance?: Perceptions of Emergency Contraception on the U.S.-Mexico Border [13I]
Authors: Wong Melissa L. , Smith Theresa , Hinshaw Shirley J. , Bracamontes Christina G. , Mulla Zuber
Published: April 2020

INTRODUCTION:

Given the high unintended pregnancy rate and infrequent use of emergency contraception (EC) in the U.S., it is imperative that providers investigate patients’ beliefs regarding EC. This study’s aim was to assess the impact of EC patient education on knowledge of and willingness to use EC.

METHODS:

75 women ages 18-50 years were recruited from university clinics in El Paso, a multicultural city on the U.S.-Mexico border. IRB approval was obtained and participants underwent informed consent. Knowledge of EC was measured before and after subjects watched an educational video. Adjusted odds ratios for patients’ knowledge post-intervention were calculated from logistic regression models using Firth’s bias-reducing penalized likelihood.

RESULTS:

The average participant’s age was 28.4 years and 82.7% self-identified as Hispanic. Before watching the video, 30.7% of participants answered that EC would only work before implantation, and this proportion increased to 37.0% after the video. Women with moderate religious beliefs were less likely than women without very strong religious beliefs or with none at all to correctly identify that EC works before implantation occurs (OR 0.21, P=.03). 21.3% of subjects initially stated that they considered an abortion to be interrupting pregnancy after implantation occurs, whereas 37.8% conveyed the same opinion after the video. Prior to the educational intervention, 17.6% of patients reported they would never use EC, and after the video, this figure was 16.2% (P=.71).

CONCLUSION:

Women with moderately strong religious beliefs were less likely to correctly identify EC’s mechanism of action. The educational intervention did not significantly affect participants’ willingness to use EC.
Double-Blinded, Randomized, Placebo-Controlled Trial of Multimodal Analgesia at Intrauterine Device Insertion [15I]
Authors: Zdroik Anna V. , Kirsten Phillips , Dhanraj Dave , Devaiah Ganga , Corona Samaris , Crisp Catrina C.
Published: April 2020

INTRODUCTION:

The utilization of long acting reversible contraception has remained low. Pain and anxiety associated with intrauterine device (IUD) placement are barriers. The purpose of this study was to investigate the effects of cervical lidocaine injections and oral diazepam on pain and anxiety during office IUD insertion.

METHODS:

Following Institutional Review Board approval, subjects desiring IUD placement were randomized to diazepam 5 mg orally with cervical injections of 2.5 ml of 2% lidocaine or placebo pill with saline injections. Both groups received 800 mg oral Ibuprofen. Providers and subjects were blinded to their assigned group. Primary outcome was pain on a visual analog scale at various steps of IUD insertion. Power analysis set enrollment at 58, which is ongoing.

RESULTS:

At interim analysis, a total of 41 women have been enrolled. Of these, 39 (20 in the study arm, 19 in the placebo arm) underwent IUD insertion. Median anxiety was significantly decreased when placing the speculum in the study arm compared to placebo (5.5 mm vs. 31 mm; P=.004) respectively. Additionally, subjects in the intervention group reported lower pain scores during insertion of the IUD (24 mm vs. 71 mm, P=.030).

CONCLUSION:

At interim analysis, oral diazepam and cervical lidocaine injections compared to placebo show clinically significant decreases in anxiety and pain during IUD placement. If these early results are confirmed, the use of cervical lidocaine injections and oral diazepam may provide additional tools to help increase utilization of IUDs by decreasing pain and anxiety associated with insertion.
Genitourinary Side Effects With the Vaginal pH Regulator: Results From AMPOWER [19I]
Authors: Maximos Bassem , Culwell Kelly , Dart Clint , Howard Brandon
Published: April 2020

INTRODUCTION:

The investigational vaginal pH regulator (VPRTM) is a non-hormonal, woman-controlled contraceptive vaginal gel. The objectives of the current analysis are to report on genitourinary (GU) side effects with VPR based on the phase 3 AMPOWER trial.

METHODS:

AMPOWER was a single-arm, open-label, IRB-approved, multi-center trial based in the United States (NCT03243305). Women, aged 18-35 years, administered VPR intravaginally up to 1 hour before each episode of vaginal intercourse. The primary study objective was contraceptive efficacy over 7 cycles of use. Safety was assessed through adverse event reporting.

RESULTS:

In 1,330 women included in the safety analysis, the most common adverse events (10% or greater) were vaginal burning (20.0%) and itching (11.2%). Rates of vaginal burning and itching generally decreased over time (burning: Cycle 0=11.2%, Cycle 3=4.2%, Cycle 7=1.4%; itching: 4.5%, 1.1%, and 0.3%, respectively). Rates of burning and itching by act of intercourse were lower when VPR was used once/day (2.1% and 0.7%, respectively) compared to 2 or more times/day (4.6% and 1.0%, respectively). In women who had GU infections on-study (n=77), rates of burning (32.5%) and itching (22.1%) were higher than in the general study population. Women with a history of bacterial vaginosis (n=245) had similar rates of burning (21.6%) and itching (12.7%) compared to the general study population. Overall, 1% [13/1330] of women discontinued due to GU symptoms.

CONCLUSION:

In the phase 3 AMPOWER trial, rates of GU symptoms with VPR decreased substantially over time, with higher rates reported in women with existing GU infections compared to the general study population.
Innovative Trial Design Using Digital Approaches: An Example From Reproductive Medicine [21I]
Authors: Hamvas Györgyi , Hofmann Anja , Sakalidis Vanessa , Goodale Brianna , Shilaih Mohaned , Leeners Brigitte
Published: April 2020

INTRODUCTION:

Loss to follow-up and missing data are common reasons why clinical studies fail. In a site-less digital clinical trial we assessed the accuracy of a wearable fertility tracker, where we examined participants’ retention, compliance, and satisfaction with the site-less design.

METHODS:

In this IRB approved study, participants were recruited remotely through social media, online platforms, and email invitations. Participants wore the Ava Fertility Tracker for up to 6 menstrual cycles, took body temperature and urinary luteinizing hormone tests. We collected all self-reported outcomes and wearable device data via a mobile app, wherein the study coordinator could monitor compliance and send participation reminders. An independent customer support team provided technical support. Participants gave input on the site-less study design via an online survey.

RESULTS:

Fifty-six Swiss women completed the satisfaction survey (85% of the 66 enrolled study participants), rating their experience with social media recruitment (83%), online registration (98%) and online invitations (98%) as good or very good. Almost two-thirds of respondents considered the trial design easy to integrate into their everyday life. Most participants were highly satisfied with the technical support (78%), while 98% reported the study coordinator’s remote support as very helpful.

CONCLUSION:

Our predominantly digital approach resulted in high rates of completion (92%) and procedural compliance (87%), while maintaining participant satisfaction. This suggests site-less designs in reproductive health research could increase the quality and quantity of clinical data collected while minimizing participation burden. Future replication studies with longer follow-up times should consider whether the sampled population is biased towards digital natives.
Is There Sperm in Pre-ejaculate? How to Study Pre-ejaculate to Determine Contraceptive Efficacy for Withdrawal [23I]
Authors: Patel Jasmine , Nelson Anita L. , Nguyen Brian T.
Published: April 2020

INTRODUCTION:

The perfect-use failure rate of withdrawal for contraception is not informed by controlled clinical trials, but rather inferred by the presumption of sperm in the pre-ejaculate. Several studies comprising a range of collection and examination methods provide contradictory data, highlighting the importance of a review that summarizes previous evaluation methods and defines optimized research methods.

METHODS:

We included peer-reviewed literature indexed in PubMed, EMBASE, and Web of Science that evaluated the sperm content of pre-ejaculatory fluid as a defined outcome. Pre-ejaculate collection and evaluation methods were identified for each study, assessing strengths, limitations, and the validity of conclusions drawn from the findings. These findings were synthesized to provide optimal guidelines for evaluating the contributory risk of pre-ejaculate in contraceptive failure.

RESULTS:

Of six human trials examining the sperm content of pre-ejaculatory fluid, three concluded that sperm was absent from their samples, however small sample size and selection bias were present. Four studies examined dried preparations, which could not evaluate motility nor measure volume. Only two differentiated between pre-ejaculate and ejaculate. No studies reported on participant characteristics or behavioral antecedents that might influence collection of an uncontaminated sample.

CONCLUSION:

Previous pre-ejaculate research have methodological problems that limit the reliability of their findings. Future research should measure and examine wet and dry specimens, differentiate between pre-ejaculate and ejaculate, examine sperm for motility and concentration, as well as query for clinical factors associated with sperm leakage and presence in the pre-ejaculate. Findings via these methods will better inform guidance on pregnancy risk with pre-ejaculate and withdrawal.
Logistical Barriers to Obtaining a Hospital-Based Abortion in New Jersey [25I]
Authors: Unsal Aylin , Segui Morit , Vlahos Alec , Musa Tina , Barlog Lauren , Brandi Kristyn
Published: April 2020

INTRODUCTION:

Many women face logistical obstacles delaying access to abortion. This study aimed to identify logistical barriers to care in women obtaining hospital-based abortions in New Jersey (NJ) a state with limited restrictions.

METHODS:

This prospective cross-sectional study of women seeking abortion care at University Hospital in Newark surveyed participants using questions from the Guttmacher Institute’s “National Survey of Women Having Abortions.” IRB approval and informed consent were obtained prior to patient enrollment. Cross-sectional comparisons were made using Wilcoxon rank-sum tests and likelihood ratios.

RESULTS:

Of 121 patients, 93 women (81.8%) cited yearly household income below $40,000 with 59 (51.7%) reporting a yearly household income below $20,000. Length of time to abortion is significantly longer in women with a household income <$40,000 compared to those with incomes >$40,000 (32.98+/-27.2 days vs. 17.3+/-10.3 days, P=.03). Twenty (17.1%) cite high treatment cost as a factor hindering earlier abortion. Similarly, 12 (10.3%) cite transportation issues as another barrier. Time to abortion is significantly longer for those who cited cost and transportation as barriers compared to those who did not report this (26.4+/-20.2 days vs. 47.9+/-39.8 days, P=.039; 28.4+/-25.6 days vs. 45.5+/-23.3 days, P=.006, respectively). Age, race, ethnicity, and educational status are not significantly associated with time to abortion.

CONCLUSION:

Access to abortion services in NJ are limited by logistical barriers to care, particularly for women with lower yearly household income and lack of transportation. Providing financial and transportation support for patients may improve access to abortion.
Patient-Reported Outcomes of Peripartum Contraceptive Care Quality [29I]
Authors: Peahl Alex , Bonawitz Kirsten , Owens Lauren , Dehlendorf Christine , Kolenic Giselle , Moniz Michelle
Published: April 2020

INTRODUCTION:

Patient-reported outcomes are underutilized in peripartum populations. Little is known about the patient experience of care, and some studies raise concern that care is not always respectful nor patient-centered. We evaluated patient-reported outcomes of peripartum contraceptive care to guide future quality improvement efforts.

METHODS:

We conducted a cross-sectional, online survey at a tertiary care center in September/October 2018 using two convenience samples: pregnant women (32+ weeks gestation) and postpartum women (4-8 weeks postpartum). We evaluated patient contraceptive care experiences at prenatal visits (pregnant sample) and during childbirth hospitalizations and postpartum visits (postpartum sample). We used the validated, 4-item Patient-Centered Contraceptive Counseling [PCCC] measure (positive score, all items rated excellent), analyzing data with descriptive statistics.

RESULTS:

We included 117 pregnant patients (response rate 49.5%) and 84 postpartum patients (response rate 43.8%). Participants were largely white (87.1%), aged 25-35 years (66.7%), college graduates (77.6%), and wanting to avoid pregnancy for 2 or more years (63.2%). Positive PCCC scores varied across practice settings (prenatal visit, 66.7%, childbirth hospitalization, 45.2%, postpartum visit, 68.8%). On individual PCCC items, “Excellent” ratings were least common for “my provider gave me enough information to make the best decision about my birth control method” (prenatal visit, 68.9%, childbirth hospitalization, 50.6%, postpartum visit, 69.1%), and “my provider let me say what mattered to me about my birth control method” (prenatal visit, 78.8%, childbirth hospitalization, 63.1%, postpartum visit, 76.3%).

CONCLUSION:

Findings suggest opportunities to improve patient-centeredness in peripartum contraceptive care, with a goal of providing adequate information and respecting patient preferences and priorities.
Perfect-Use Pregnancy Rates With the Vaginal pH Regulator: Efficacy Results From AMPOWER [30I]
Authors: Chappell B. Todd , Culwell Kelly , Dart Clint , Howard Brandon
Published: April 2020

INTRODUCTION:

To address women’s unmet contraceptive needs, the investigational vaginal pH regulator (VPR™) was developed as a novel, non-hormonal, woman-controlled vaginal gel. The IRB-approved, phase 3 AMPOWER study met its primary efficacy endpoint: the typical-use 7-cycle cumulative pregnancy percentage with VPR was 13.7% (95% CI 9.91%, 17.39%) (Thomas et al, ASRM 2019). Here we present perfect-use VPR efficacy results.

METHODS:

AMPOWER (NCT03243305) was a single-arm, open-label, confirmatory trial conducted at 112 U.S. sites. Women were instructed to administer a single prefilled applicator of study drug intravaginally before each episode of intercourse. For inclusion in the perfect-use analyses, study cycles met rigorous criteria including: 21 to 35-day cycle; no back-up or emergency contraception; 1 or more recorded act of intercourse; and correct use of VPR for every act of intercourse in that cycle, per eDiaries. To more accurately evaluate efficacy, the perfect-use analysis was repeated to remove factors that confounded efficacy assessment in ad hoc sensitivity analyses.

RESULTS:

AMPOWER enrolled 1,384 women; in the efficacy-evaluable population (n=1,003), the perfect-use 7-cycle cumulative pregnancy percentage was 9.99% (95% CI 7.17%, 12.81%). When including all 21 to 42-day cycles and removing subjects with incomplete washout of previous hormonal contraceptive and removing pregnancies from cycles with inconsistent eDiary reporting, the 7-cycle cumulative pregnancy percentage ranged from 6.67% (95% CI 4.61%, 8.73%) based on all evaluable cycles to 8.44% (95% CI 5.90, 10.98%) based on perfect-use cycles.

CONCLUSION:

Using multiple sensitivity analyses to determine perfect-use efficacy, women’s 7-cycle cumulative pregnancy percentage ranged from 6.67% to 9.99% with VPR.
Pulling Away From Pulling Out? A Survey of Family Planning Providers’ Perceptions of Withdrawal [31I]
Authors: Or Maya , Nelson Anita L. , Nguyen Brian T. , Patel Jasmine
Published: April 2020

INTRODUCTION:

While more than half of women report ever using withdrawal for contraception, family planning providers have limited evidence with which to counsel patients; their attitudes may vary, leading to inconsistent patient counseling. We examined providers’ perspectives on the efficacy of withdrawal and their patients’ use of withdrawal for contraception.

METHODS:

We examined provider perspectives on withdrawal by distributing an IRB-approved close and open-ended survey to healthcare professionals attending women’s health contraception conferences in 2019. Free-response items underwent content analysis and coding for salient themes, which were modified iteratively until adequate inter-rater agreement was reached; remaining responses were coded independently. Pearson chi-square tests demonstrated associations between provider characteristics and salient themes.

RESULTS:

Nearly all (n=422/445, 95%) approached individuals participated in the survey. Providers’ positive and open-minded attitudes on withdrawal significantly differed from their perceptions of their colleagues’ negative attitudes (P<.01). Providers suggested that withdrawal might be appropriate for pregnancy ambivalent individuals (155/422, 36.8%) or those in a monogamous relationship (70/422, 16.6%). Successful use of withdrawal was thought to be linked to education on the method (119/422, 28.2%) and physiologic awareness (107/422, 25.4%). Providers linked premature ejaculation (104/422, 24.6%) to withdrawal failure.

CONCLUSION:

While family planning providers were generally open-minded to withdrawal use, they perceived negative attitudes from their peers, which may influence their patient interactions and counseling. While education was thought to positively influence the successful use of withdrawal, it remains unclear whether providers were referring to education on efficacy versus operationalizing the method. Further research on factors associated with successful withdrawal is needed.
Sociodemographic Trends in Long Acting Reversible Contraception vs. Female Sterilization, 2006-2017 [33I]
Authors: Beshar Isabel B. , Chelvakumar Meena , So Jodi , Cahill Erica P. , Shaw Kate A. , Shaw Jonathan G.
Published: April 2020

INTRODUCTION:

Historically, female sterilization (FS) has been disproportionately concentrated among racial minorities and women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examined changing socio-demographic patterns of FS and LARC usage.

METHODS:

We used data files from the National Survey of Family Growth 2006-2010 (earlier) and 2015-2017 (later) survey waves. We analyzed all women of reproductive age not seeking pregnancy, with a sub-analysis of FS and LARC, and extracted socio-demographic information.

RESULTS:

We included 11,073 respondents. From the earlier to later cohort, the prevalence of LARC increased 3-fold (7% to 20%), while FS dropped (25% to 22%). In our sub-analysis comparing LARC vs FS users (n=3918), the adjusted likelihood of LARC use was greater in the later cohort (OR 2.3 [1.6, 3.4]). When comparing LARC to FS in both cohorts, there were non-significant trends of reduced LARC use in black women (OR 0.51 [0.3, 1.1]), while Hispanic women emerged as more likely to use LARCs in the later cohort (OR 1.5 [0.9, 2.7]). Overall, the most significant predictors of LARC use in the later cohort remained younger age (>35), higher income ($75,000), and more education (OR 3.6 [1.9, 6.6], 5.3 [1.8, 15.9], and 4.5 [2.1, 9.7], respectively). Living in a metropolitan area emerged as a new predictor of LARC use over FS in the later cohort (OR 3.0 [1.3, 7.3]).

CONCLUSION:

Although LARC use increased and FS decreased, the most significant predictors of LARC over FS include higher income, more education and metropolitan residence, suggesting inequities in access.
The Impact of Body Mass Index on Bleeding Pattern in Women Discontinuing Usage of a Subdermal Contraceptive Implant [34I]
Authors: Davis Susan , Hansen Katie , Pike Jordyn , Gabriel Kelley , Tristan Bri
Published: April 2020

INTRODUCTION:

The etonogestrel subdermal contraceptive implant is among the most effective contraceptive methods available. The most common associated side effect is irregular menstrual bleeding. Approximately 15% of users discontinue implant usage prematurely due to unacceptable bleeding. Understanding of how obesity impacts the side effect profile of the implant is limited, since the initial clinical trials excluded obese patients. However, recent studies have suggested that obese patients are less likely report irregular or heavy bleeding than are their normal-weight counterparts, although these studies were small and examined predominately white patients. We sought to study whether BMI impacted the bleeding pattern of implant users in our large, racially diverse population.

METHODS:

This study was deemed exempt from the UT Austin IRB. We conducted a chart review of patients in Austin’s CommUnity Care clinic system who had an implant removed between 2012 and 2017. For each subject, we abstracted age, race/ethnicity, gravidity/parity, BMI, and indication for implant discontinuation. Univariate analysis was conducted to determine whether the reason for implant discontinuation varied between underweight, normal-weight, overweight, and obese patients.

RESULTS:

Data were abstracted for 636 subjects. 40% of normal-weight subjects discontinued usage of a contraceptive implant due to irregular bleeding, compared to 55% of underweight and 26% of obese subjects. Duration of implant usage did not vary between BMI classes.

CONCLUSION:

Underweight women were more likely to discontinue implant usage due to irregular bleeding than normal-weight women, and obese women were less likely to do so. This may guide counseling regarding expected bleeding pattern for prospective implant users.
Trends in Contraceptive Methods Among Substance Abusers Reveals Unmet Need [36I]
Authors: Freer Katherine , Hopper Taylor , Kruse Alexandra , Robinson William R.
Published: April 2020

INTRODUCTION:

Female substance abusers are a vulnerable population facing numerous barriers to care, especially gynecological health. Access to contraception is a crucial part of women’s health; however, research on contraceptive use in substance abusers is limited. Our aim was to investigate contraceptive methods in a women’s substance abuse rehabilitation facility.

METHODS:

Data was taken from 697 intake surveys of reproductive-aged women between 2013 and 2019. Analysis examined contraceptive use by sociodemographic variables. Trends were compared with data from 2015-2017 National Surveys of Family Growth and 2017 state-level data from the CDC.

RESULTS:

The majority of women did not use contraceptives (40.3%), were sterilized (22.7%) or used condoms (21.1%). Compared to national and Louisiana-specific rates, this data reveals significantly higher proportions of no contraception and sterilization; conversely, there were lower rates of hormonal and long-acting reversible contraceptive methods (6.9; 4.9%). Substance-abusing women reported sterilization at a younger age (37) compared to national averages. 64.8% reported Medicaid enrollment; education and insurance were independent of contraceptive choice (X2=5.76, P=.22; X2=3.15, P=.53; P<.05).

CONCLUSION:

Women in rehabilitation reported both a high rate of sterilization, and limited use of reversible contraceptives. Lack of variability in method could include amenorrhea from chronic substance use, mistrust of the healthcare system, and inadequate education on gynecological health. Residential rehabilitation facilities provide a unique opportunity for providers to deliver contraceptive education in a positive, encouraging environment, while women are focused on making positive lifestyle changes. Addressing this need would give these women greater autonomy over their health and fertility.
Weight Gain Associated With LARC Within a Racially Diverse Patient Population [38I]
Authors: Hattiangadi Rohan
Published: April 2020

INTRODUCTION:

This study aims to evaluate and compare weight gain in reproductive-age women using long acting reversible contraception over 12, 36 and 60-month periods.

METHODS:

Retrospective cohort study of 36,584 female patients between 15 and 45 years old with either the LNG-IUS, ENG implant or copper IUD for at least 12 consecutive months between April 2008 and April 2017. A Kruskal-Wallis test was performed to compare the magnitude of weight gain at the specified time intervals. The influence of race and age were evaluated through multivariate linear regression. IRB approval was obtained.

RESULTS:

After 12 months, copper IUD and LNG-IUS users lost weight (0.58 and 0.08 kg, respectively), while ENG implant users gained weight 1.15 kg (P<.01). After 36 months, copper IUD users gained 0.46 kg, LNG-IUS users gained 0.72 kg and ENG implant users gained 3.84 kg (P<.01). After 60 months, LNG-IUS users gained twice as much weight as copper IUD users (1.52 and 0.87 kg, respectively). Black and Hispanic women gained more weight than white and Asian women, especially in those younger than 35 years old. (P<.01).

CONCLUSION:

At 12 and 36 months, ENG implant users demonstrated both statistically and clinically significant weight gain compared to LNG-IUS and copper IUD users. However, in the adjusted model, only ENG implant users younger than 35 demonstrated a significant weight gain. Race proved to be a predictor of weight gain. These observations may help counsel women towards an appropriate LARC method, taking into consideration age and race.
Association of Immediate Postpartum Etonogestrel Implant Insertion and Venous Thromboembolism [01J]
Authors: Floyd Jessica L. , Beasley Anitra , Swaim Laurie S. , Turrentine Mark , Nijjar J. Biba
Published: April 2020

INTRODUCTION:

Placement of the etonogestrel contraceptive implant (ECI) during the delivery admission provides immediate, reliable and convenient contraception. The implant manufacturer recommends delaying placement until 21 days postpartum due to concern for increased risk of postpartum venous thromboembolism (VTE). This study compares the rate of VTE between women with and without delivery admission contraceptive implant insertion.

METHODS:

The Nationwide Readmissions Database from 2016 was used to identify women with a singleton delivery, immediate postpartum ECI, and readmission for VTE within 30 days of discharge. Those with a prior history of VTE or anticoagulant therapy were excluded. These women were compared to the number of women readmitted for VTE who did not have the contraceptive implant placed during delivery admission.

RESULTS:

Of 3,387,120 deliveries, 8,369 women underwent ECI placement during the delivery admission. Of women readmitted with VTE, 7 had received a postpartum ECI (0.8 per 1,000 deliveries) compared to 1,192 without an ECI (0.4 per 1,000 deliveries), Odds Ratio (OR) 2.41; 95th CI 0.58-9.89. The rates of diabetes, thrombophilia, lupus and cesarean delivery did not differ between groups. Women that underwent ECI placement were younger, on Medicaid, smoked, had hypertension, intrauterine growth restriction, peripartum infection, or postpartum hemorrhage (P<.01). Adjusting for these confounders showed no impact, adjusted OR 1.80; 95th CI 0.44-7.37.

CONCLUSION:

No significant difference was noted in the rate of VTE in women after immediate postpartum insertion of the ECI, suggesting that the implant may not be associated with VTE if placed in the immediate postpartum period.
Benefits of Routine, Opt-Out Abortion and Family Planning Training: 20 Years of the Ryan Program [02J]
Authors: Steinauer Jody , Turk Jema , Koenemann Katheryn , Simonson Kristin , Landy Uta
Published: April 2020

INTRODUCTION:

To describe the effects of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation skills and intentions to provide abortion post-residency.

METHODS:

Data from the first 20 years of the Ryan Residency Training Program in Abortion and Family Planning (RP) were analyzed. Post-rotation surveys assessed residents’ experiences with abortion and intentions to provide abortions post-residency. The 2019 residency program director survey assessed benefits of training from the educators’ perspective. This study is considered exempt by the University of California San Francisco IRB.

RESULTS:

A total of 3,197 residents completed post-rotation surveys, for an overall response rate of 80.1%. During the rotation, residents, including those who partially participated, gained significant exposure to all methods of first- and second-trimester termination, with an average of 7.4 medication abortions, 11.8 manual uterine aspirations, 15.6 electric uterine aspirations and 5.8 second-trimester dilation and evacuations (D&E). Residents reported feeling competent to do aspiration procedures independently up to an average of 12.8 weeks. Eighty-one percent of residents intend to do abortions for medical reasons after residency and sixty-one percent for all reasons. Ninety-six percent of directors reported increased clinical competence in abortion and contraception among all residents after the rotation, and 68% reported the RP training helped improve continuity of care for patients.

CONCLUSION:

Routine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to gain the clinical skills necessary to integrate abortion into their patient care after residency.
Clinical Outcomes of Intrauterine Devices Inserted After Peripartum Intrauterine Infection [06J]
Authors: Ye Peggy P. , Kyrillos Alexandra , Teng Stephanie , Fernandez Stephen
Published: April 2020

INTRODUCTION:

Postpartum intrauterine device (IUD) insertion is contraindicated after intrauterine infection such as chorioamnionitis or endometritis, as this theoretically increases risk of pelvic inflammatory disease (PID). We conducted a retrospective study to evaluate PID risk associated with IUD placement after delivery complicated by intrauterine infection.

METHODS:

A retrospective cohort receiving an IUD off-label within 3 months of a delivery complicated by intrauterine infection (INF+IUD) was identified and propensity matched to two control cohorts: patients with intrauterine infection but no IUD (INF Only), and patients without infection but receiving an IUD (IUD Only). PID and other complications within 9 months post-delivery were assessed by chart review. IRB approval was obtained.

RESULTS:

Eighty patients in each cohort had similar demographics with the exceptions of higher age, gravidity, and parity in the IUD Only group. Documented follow up occurred for 79 (99%), 44 (55%), and 77 (96%) in the INF+IUD, INF Only, and IUD Only groups, respectively (P<.0001). PID developed in one patient each in the INF+IUD and IUD Only cohorts, which was not statistically significant (P=1). The INF+IUD cohort experienced more abnormal bleeding (12.1% vs 0% vs 3.9% in INF+IUD, INF Only, and IUD Only groups, respectively, P=.048), which was not significant after controlling for IUD type. Three patients in the INF Only cohort were pregnant within 9 months, compared to 0 in both IUD groups (P=.024).

CONCLUSION:

This retrospective review does not show an increased risk of PID in patients receiving an IUD after peripartum intrauterine infection. Larger studies are needed to confirm these findings.
Contraceptive Counseling in the Zika Era: Primary Care Providers’ Perspective [07J]
Authors: Kaiser Jennifer , Sanders Jessica , Simmons Rebecca , Gawron Lori M. , Turok David Keith
Published: April 2020

INTRODUCTION:

The 2015 Zika virus (ZIKV) outbreak emphasized the imperative for contraceptive counseling for at-risk populations such as Latinx women. This study assessed primary care providers’ knowledge, perception of risk, and approach to contraceptive counseling in response to ZIKV.

METHODS:

We performed a sequential mixed-methods, cross-sectional study with a survey and semi-structured interview. From 06/2018 to 08/2018 we recruited primary care providers from a federally qualified health organization in the Salt Lake City area that provides preventive care to non-pregnant Latinx women of reproductive age. The survey assessed demographics, contraceptive and ZIKV knowledge, and CDC ZIKV guideline adherence. The Health Belief Model informed our interview guide on contraceptive and ZIKV counseling. We performed descriptive analyses on survey data and analyzed qualitative data for dominant themes.

RESULTS:

Twenty-two of 40 (57%) providers participated. Twelve (55%) are family medicine physicians, seven are physician assistants (32%), and three are nurse practitioners (14%); 53% are women, and 96% identify as white. On contraceptive and ZIKV knowledge questions, providers averaged 69% and 81% correct respectively. Sixty-five percent reported CDC ZIKV guideline adherence. Qualitative themes include conditional ZIKV risk, neonatal-related severity of ZIKV, specific cues to action for counseling about ZIKV and contraception, and omission of the ZIKV risk to non-pregnant women who may become pregnant.

CONCLUSION:

Primary care providers perceive the risk of ZIKV; however, their knowledge, guideline adherence, and perception of risk do not translate into ZIKV-aware counseling. Our results demonstrate the need for action plans that ensure practice changes in response to emerging infectious diseases.
Contraceptive Uptake After Obstetric Anal Sphincter Injuries (OASIS): A 5-Year Retrospective Review [08J]
Authors: Fields Ian , Knapper Allyson , Garg Bharti , Gregory W. Thomas
Published: April 2020

INTRODUCTION:

OASIS is a complication of vaginal delivery. Although recurrence rates are low, women often feel apprehensive regarding subsequent births, with some wishing to delay future pregnancy. We aimed to evaluate contraceptive practices and interpregnancy interval of women who sustained OASIS.

METHODS:

We conducted a retrospective chart review of women who sustained OASIS from 2012–2017. We selected women who delivered during the same time period without OASIS as controls. We abstracted relevant demographic characteristics, delivery data, and documented postpartum contraceptive choice provided. We performed our analysis using independent two-sample t-test and chi-square test for unadjusted analyses and multivariable logistic regression for adjusted analyses, with alpha<0.05.

RESULTS:

We included 314 women with OASIS and 297 without as controls. Women who experienced OASIS were more likely to be nulliparous, have an assisted vaginal delivery, and experience a wound complication. There were similar rates of postpartum contraceptive uptake in both groups (82% vs 84%, P=.58). Greater than 50% of women in each cohort chose hormonal or long-acting contraceptives, with the majority choosing long-acting methods. Our multivariable regression showed no difference in method choice between groups. Of women with OASIS who had a subsequent delivery, 14% chose elective Cesarean section and the OASIS recurrence rate was 6%. Average interpregnancy interval was no different between cohorts (19.6 vs 20.7 months, P=.53).

CONCLUSION:

Although there were no significant differences in contraception uptake or type used in women who experienced OASIS, overall hormonal and long-acting contraception uptake was high. Experiencing OASIS does not appear to affect interpregnancy interval.
Differences in Postpartum Contraceptive Use in Patients Delivered by Academic Versus Private Hospitalists [09J]
Authors: Cuartas Karen , Corey Joey , Pineles Beth , Wagner Stephen
Published: April 2020

INTRODUCTION:

Research has shown that women discharged postpartum without a contraception plan are significantly more likely to have a suboptimal interpregnancy interval. There is a lack of evidence examining the differences in postpartum contraception rates in patients treated by an academic hospitalist versus a private hospitalist.

METHODS:

A retrospective cohort study was completed examining women who delivered at a community hospital under the care of the hospitalist service surrounding a transition from a private to academic hospitalist service. Institutional Review Board approval was obtained. Records were collected for deliveries during six months in 2018. The primary outcome was postpartum women discharged without a contraceptive plan. Data was compared using a chi-square test. Relative risks with 95% confidence intervals were calculated.

RESULTS:

245 patients were delivered by a private physician and 447 patients were delivered by an academic physician. Patients delivered by an academic physician chose not to receive any contraception less often than patients delivered by a private physician (24% vs 32%: relative risk [RR] 0.67, 95% confidence interval [CI] [0.47-0.95]). Those delivered by an academic physician chose to receive long-acting reversible contraception more often than those delivered by a private physician (11% vs 1%: RR 9.48 [CI 2.92-30.79]). There was no difference in receiving a bilateral tubal ligation (1% vs 2%: RR 0.82 [CI 0.23-2.93]) or user-dependent contraception between the two groups (64% vs 65%: RR 0.96 [CI 0.69-1.33]).

CONCLUSION:

Postpartum patients receiving care from an academic laborist were more likely to have a contraception plan at discharge and to desire long-acting reversible contraception.
Effect of Delivery Room Postpartum Contraceptive Implant Insertion on Initiation of Breastfeeding [11J]
Authors: Shaw Kate A. , Lerma Klaira , Reyes Griselda , Gutow Hanna , Shaw Jonathan G.
Published: April 2020

INTRODUCTION:

Initiation of postpartum contraception prior to hospital discharge has been limited by concerns about the impact of progestins on breastfeeding. Previous studies support initiation prior to hospital discharge. Insertion of the contraceptive implant in the delivery room is a convenient strategy to ensure desired contraceptive uptake prior to discharge. We designed a non-inferiority randomized controlled trial to determine if time to lactogenesis stage II (LTII; initiation of copious milk secretion) differs by timing of implant insertion.

METHODS:

We randomly assigned 95 pregnant people with intent to breastfeed, who desired the contraceptive implant to insertion 0-2-hours (delivery room) or 24-48-hours (delayed) post-delivery. We collected demographics and self-reported LTII using a validated tool.

RESULTS:

As-treated analysis included 71 participants (n=35 delivery room, n=36 delayed). Participants were similar between groups: mean age 25.5 years and median gestation over 39 weeks. The majority were admitted for labor induction (54%), used epidural anesthesia (87%) and had a vaginal delivery (81%) with no differences by group. Mean time to LTII did not differ significantly (delivery room: 64.97-hours, SD 25.1, delayed: 73.61-hours, SD 50.8; P=.37). Using an a priori margin of 12-hours, onset of LTII was non-inferior for delivery room insertion as compared to delayed insertion (mean difference -8.64-hours, 95% CI -27.69–10.42). Overall, the majority of participants achieved LTII before Day 4: 74.3% (n=26) delivery room and 72.2% (n=26) delayed, respectively (P=.84).

CONCLUSION:

Postpartum insertion of the contraceptive implant in the delivery room does not delay onset of lactogenesis and should be offered.
Physician Attitudes Toward Reproductive Justice: Results From an Institution-Wide Survey [21J]
Authors: Wautlet Cynthie , Schmuhl Nicholas B. , Higgins Jenny , Zukin Helen , Rice Laurel W.
Published: April 2020

INTRODUCTION:

Reproductive justice (RJ) is a framework that promotes universal reproductive rights by addressing underlying economic, social, and political inequities. Although increasingly integrated into reproductive health specialties, broader physicians’ attitudes toward RJ have been unexamined – even though knowing and promoting RJ principles could improve patient care and public and social health.

METHODS:

Using mail and online recruitment methods, we surveyed clinical faculty at the largest academic medical center in one Midwestern state. On a five-point Likert-type scale (“strongly disagree” to “strongly agree”), physicians responded to five principles adapted directly from widely held RJ tenets.

RESULTS:

913 physicians representing 20 specialties responded (67% response rate). Majorities somewhat or strongly agreed that every woman has the right to parent or not parent a child if she chooses (89%); health systems should ensure that every woman has access to the full range of contraceptives (93%) and abortion (87%); health systems should ensure everyone achieves full autonomy over reproductive decisions (90%) and raises children in safe and healthy environments (96%). Given high reliability (Cronbach alpha=.85), we collapsed items into a bivariate outcome of support for all five principles vs any opposition. A majority (88%) supported all five principles. Chi-square tests of independence (P<.05) found that men, physicians over 40 years of age, religious physicians, and those who oppose legal abortion were less likely to support RJ principles.

CONCLUSION:

Physician support for RJ was high but not unanimous. We join the call to incorporate RJ principles into medical curricula and healthcare policy.