Contraceptive Advice Research Articles

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

STI with Mycoplasma genitalium-more common than Chlamydia trachomatis in patients attending youth clinics in Sweden.

The prevalence of Chlamydia trachomatis in Sweden is well known, whereas the prevalence of Mycoplasma genitalium is less well documented. Youth clinics offer free contraception advice, sexually transmitted infection (STI) testing and/or contact tracing for the age group 15-25years. The main objective of this study was to determine the prevalence of STIs, the presence of symptoms and the role of contact tracing. From July 2013 to March 2014, 1001 persons, 509 women and 492 men, were included in this study of six youth clinics in the Region of Västra Götaland. Symptoms were registered and whether the patient was tested because of contract tracing. Collection of urine samples, testing, treatment and disease registration were performed according to clinical routines. Urine samples were analysed for C. trachomatis/N. gonorrhoeae on the Cobas 4800 system (Roche). M. genitalium was analysed by lab-developed PCR. Genital infection was present in 16.8%. The prevalence of M. genitalium was higher than for C. trachomatis (9.6% and 7.1%). Men with symptoms have a significantly higher relative risk for infection with M. genitalium or C. trachomatis compared to asymptomatic men, while there is no increase for women. Contact tracing is important since positive outcome has a high relative risk for both infections. The prevalence of M. genitalium was higher than C. trachomatis in this study population. Initial testing for both C. trachomatis and M. genitalium should at least be considered for young men presenting with symptoms of genital infection. In finding positive cases, contact tracing is of great importance.

Policy, law and post-abortion care services in Kenya.

BackgroundUnsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy.MethodsA cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality.ResultsThe provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge.DiscussionLegal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination.ConclusionGreater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.

Female age and assisted reproductive technology

The age at first birth is ever increasing. Women above 35 years of age are a growing segment of patients attending for fertility services like in vitro fertilization. Open discussion about the limitations of assisted reproductive technology therapy at advanced female age, risks of pregnancy for the mother and child ensure that couples are fully informed and have realistic expectation before pursuing emotionally and financially exhaustive interventions. Preventive education to include the importance of establishing a family early in the female adulthood should be considered by health policy makers. Ideally, Institutions educating young adults should equally provide contraceptive and fertility advice under one umbrella of female and male reproductive health.

Mycophenolate mofetil for sustained remission in nephrotic syndrome.

The clinical application of mycophenolate mofetil (MMF) has significantly widened beyond the prophylaxis of acute and chronic rejections in solid organ transplantation. MMF has been recognized as an excellent treatment option in many immunologic glomerulopathies. For children with frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) experiencing steroid toxicity, MMF has been recommended as a steroid-sparing drug. Uncontrolled studies in patients with FRNS and SDSN have shown that many patients can achieve sustained remission of proteinuria with MMF monotherapy. Three randomized controlled trials have similarly demonstrated that MMF is beneficial in these patients, but less effective than the calcineurin inhibitors cyclosporin A or tacrolimus. Some, but not all, patients with steroid-resistant nephrotic syndrome (SRNS) may also respond to MMF, usually given in combination with other drugs, with partial or complete remission. There are important limitations to the interpretation and comparability of these studies including study design, sample size, patient selection, clinical endpoints, carry-over effects, and duration of follow-up. In all studies, MMF had relatively few side effects, no nephrotoxicity, or no systemic toxicity. MMF is teratogenic, and contraceptive advice is required in females. There is a poor correlation between MMF dose and mycophenolic acid (MPA) exposure and significant inter- and intra-patient variability in drug pharmacokinetics. A higher estimated MPA-AUC0-12 target range than recommended for pediatric renal transplant recipients is essential to prevent relapses. Therefore, therapy should be guided by drug monitoring to avoid relapses. Further studies are needed to test the efficacy of MMF in inducing remission and, as part of a combination therapy, achieving sustained remission in patients with SRNS.

Female Gynecologists and Their Birth Control Clinics: Eugenics in Practice in 1920s-1930s China.

Yang Chao Buwei, the first Chinese translator of Margaret Sanger's What Every Girl Should Know, was the first female gynecologist to open up a birth control clinic in China. By the 1930s, other female gynecologists, like Guo Taihua, had internalized and combined national and eugenic concerns of race regeneration to focus on the control of women's reproduction. This symbiosis between racial regeneration and birth control is best seen in Yang Chongrui's integration of birth control into her national hygiene program. This article traces the efforts of pioneer gynecologists in giving contraceptive advice at their birth control clinics, which they framed as a humanitarian effort to ease the reproductive burden of working-class women. It also examines their connections with Sanger's international birth control movement, and their advocacy of contraception as practitioners, translators, and educators. The author argues that these Chinese female gynecologists not only borrowed, but adapted, Western scientific knowledge to Chinese social conditions through their writings and translations and in their clinical work.

Knowledge, Attitude and Practice of Contraception by Doctors and Women in Kota Kinabalu, Sabah

Evidence-based data confirm the relationship between an increased availability of effective contraception and reduction in induced abortion rate. In Malaysia, the contraception prevalence rate in 1966 was 8.8 per cent to 52 per cent in 1984, but has levelled off since then. In recent years there has been increasing report of babies ‘abandonment’ in Malaysia. The aim of this study is to determine the knowledge, attitudes and practices related to contraception among women and doctors in Kota Kinabalu the capital of Sabah, Malaysia. Descriptive and analytical community-based cross-sectional study was used. A total of 240 women and 60 doctors were selected from either private or public clinics. The instrument used was face-to-face interview for the women and self-administered questionnaires for doctors. Analysis was done using SPSS version 21. The doctors (80%) felt that contraception is extremely important, and routinely discuss (63%) with their patients. Oral contraceptive pill (97%) is the most common type of contraceptive available in their clinics. About 68% of doctors surprisingly cited that abstinence plays a major part in their contraceptive advice. The average correct answer by doctors on knowledge is 62%. The women surveyed (98.8%) have heard of contraception. The main reason for using is for spacing of pregnancy and many stopped or did not use because of fear of side effects. Women attending the public clinic appear to know more about female and male sterilization and intrauterine contraceptive device compared to those attending private clinic. Further research is needed to reinforce this study.

A survey of Greek women's satisfaction of postnatal care.

BackgroundThe research described in this paper is a cross-sectional study which surveys women who delivered their babies in a regional hospital in Greece to investigate their satisfaction with their postnatal care. This is the first published study which measures satisfaction of postnatal services in Greece. The aim of this study is to determine which factors most influence postnatal satisfaction, which areas are lacking and therefore identify specific areas which should be targeted to improve the performance of health services.MethodsA cross sectional, quantitative study of 300 women who gave birth in a regional Greek hospital between January 2015 and July 2017 were surveyed 40 days after birth using a self-administered questionnaire. The questionnaire contained sociodemographic and clinical characteristic questions and a selection of questions from the WOMen's views of Birth Postnatal Satisfaction Questionnaire (WOMBPNSQ).ResultsThis study found that the dimensions with the higher satisfaction scores were “Professional support” and “Continuity”. The lower satisfaction scores were for the dimensions “Woman's health”, “Contraceptive advice” and “Social support” indicating that these are areas for improvement. The three dimensions most correlated with general satisfaction were “Time with woman”, “Feeding baby” and “Professional support”.ConclusionsThis study highlights the important role of health professionals showing that they can enhance postnatal satisfaction by spending time with the women, giving guidance on the care of the newborn and baby feeding. Focusing on improving these areas is expected to enhance the quality of postnatal care.

Community pharmacists’ services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study

ObjectivesThis study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists’ recommendations...

Buenas prácticas en el asesoramiento anticonceptivo a mujeres: recomendaciones del grupo de Expertos Multidisciplinar en Materia Anticonceptiva (EMMA)

Contraception allows women to avoid unplanned pregnancies. Not only should access to contraceptive methods be readily available to women, it is also important that they use the most appropriate birth control method that suits their needs and lifestyle in order to ensure proper use and continuity. This highlights the importance of contraceptive counselling, a practice that should be an integral part of the care of childbearing-age women. This document, prepared by a panel of experts representing the main healthcare professions involved in the provision of contraceptive advice in our country, describes the elements needed to offer women quality contraceptive advice using a multidisciplinary approach adapted to the specific individual needs. It includes relevant aspects, such as which women and at what time should contraceptive counselling be provided. The skills required for this counselling and the environment where contraceptive counselling should be provided, and the essential components it should cover are also included.

Spotlight on … MBRRACE‐UK

Spotlight on … <scp>MBRRACE</scp>‐<scp>UK</scp>

Expert System Application of Forward Chaining and Certainty Factors Method for The Decision of Contraception Tools

The choice of contraceptive tools is not an easy thing because the risks or effects will give impact on the body that never using it previously. in the other side, there is no contraception always suit for everybody because the circumstances of each body is different, so the extensive knowledge must be needed to know the advantages and disadvantages of each contraceptive tools then adjusted to the user's body.The expert system for contraceptive tools uses Forward Chaining search method combined with Certainty Factors Method. These method value the patient’s indication. The Expert system gives the output data which define the kind of tool uses of the patient. the results obtained will be able to help people to find indications that lead to appropriate contraceptive tools and advice or suggestions about these tools. The success rate of the contraceptive tools decision experienced by experienced by the user by using forward chaining combined with the CF computation method is also influenced by the number of indication criteria selected by the user. Based on testing that has been done, expert system contraception tools has accuracy level equal to 75%.

Methods of contraception: the nurse's role in providing care and advice.

Most women require contraception during their reproductive years, and many methods are available. Women should have access to all of these methods and be encouraged to take an active role in decision-making about their choice of contraceptive, within medical eligibility constraints. Long-acting reversible contraceptives are more effective than user-dependent methods, such as condoms, and should be offered to all women during contraceptive consultations. In primary care settings, nurses often provide much basic contraception care and advice. Nurses should ensure that they work within the limits of their competence and are aware of how and where to refer women for specialist support, if required.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

Pregnancy and bariatric surgery.

A large number of women experience pregnancy after bariatric surgery. The purpose of this review was to understand the evidence base in this area to come up with practical, evidence-based recommendations. We examined PubMed for all published articles on pregnancy in patients who have previously undergone a bariatric surgery. There is an increasing body of evidence pointing towards a beneficial effect of weight loss induced by bariatric surgery on female and male fertility prompting calls for recognition of infertility as a qualifying co-morbidity for patients between the Body Mass Index of 35.0 kg/m2 and 40.0 kg/m2. Women in childbearing age group should be routinely offered contraceptive advice after bariatric surgery and advised to avoid pregnancy until their weight has stabilized. Until more focused studies are available, the advice to wait for 12 months or 2 months after the weight loss has stabilized, whichever is latter, seems reasonable. Patients should be advised to seek clearance from their bariatric teams prior to conception and looked after by a multi-disciplinary team of women health professionals, bariatric surgeons, and dietitians during pregnancy. The main objective of care is to ensure adequate nutritional state to allow for a satisfactory weight gain and fetal growth. There is a relative lack of studies and complete lack of Level 1 evidence to inform practice in this area. This review summarizes current literature and makes a number of practical suggestions for routine care of these women while we develop evidence to better inform future practice.

Contraception for teenagers: accessible sexual health advice

With changes to trends in sexual activity in people aged 16 and under, primary care nurses have a duty to provide appropriate contraceptive advice. Sally Kelsey discusses the practical and ethical considerations of the subject Young people are beginning sexual activity at an increasingly young age with many having their first sexual experience before the age of 16. It is important to provide contraception and sexual health services which young people find safe and accessible. Although no method of contraception is contraindicated on grounds of age alone, specific factors may influence acceptability, choice and continuation of method. Young people can be at risk of sexual exploitation and violence and practitioners should be confident in assessing young people for signs of this. Confidentiality is an important issue and should be always be maintained, unless there is reason to believe the young person is at risk of significant harm.

P036 Improving larc uptake: a retrospective study into the role and impact of enhanced sexual health services in community pharmacies

IntroductionUnwanted pregnancies and low uptake of LARC continues to be problematic in 15–44 year olds in an East London Borough. Between April 15 and March 16, 45 pharmacies were commissioned, as part of the local enhanced sexual health service (LES) to provide emergency hormonal contraception (EHC) and contraception advice with the aim of increasing LARC uptake in &lt;25s and others at high risk of unwanted pregnancy. Pharmacies taking part in the pilot received PGD and safeguarding training and pathways into LARC were refreshed.MethodsAnalysis of self-sample STI tests via the Doctor’s Laboratory and consultations documented via PharmOutcomes, and corresponding search of PreView for attendances for contraceptive/LARC care during time period.Results35/45 pharmacies (77.8%) dispensed 324 Levonorgestrel (1500 microgram) doses to women resident in the borough &gt;13 years (average age 24.9 years; range 14.2-49.6 years). 100% of &lt;16s had Fraser competency assessed (4). 6.2% (20/324) women had &gt;1 attendance for EHC. 16 women (4.9%) subsequently attended local CaSH/GUM services for LARC; 8 (2.5%) for implant; 4 (1.2%) for injectable; 4 (1.2%) for IUD.DiscussionPharmacy delivered EHC and signposting to LARC services in primary and secondary care is feasible. There were limitations in the ability to gather data regarding women accessing LARC in primary care following contact with pharmacy so these numbers may under report the actual figures of those accepting LARC following pharmacy contact. Online booking systems should be accessible to pharmacists to facilitate LARC referral. Further work looking at acceptability of this strategy should be conducted.

Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative.

BackgroundOpportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013–2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines.AimTo determine young adults’ opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice.Design and settingQualitative interviews were conducted in a general practice setting in England between March and June 2013.MethodThirty interviews were conducted with nine male and 21 female patients aged 16–24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework.ResultsParticipants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation.ConclusionGeneral practice staff should facilitate patients’ preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way.

Feasibility and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation

To determine the feasibility and acceptability of routine antenatal contraceptive counselling and contraception provision including long-acting reversible contraception (LARC) postpartum. Health service research evaluation. Community antenatal clinics and hospital maternity settings in National Health Service, Scotland UK. Women booked for antenatal care. Contraceptive counselling with a community midwife (22weeks' gestation) and provision of contraception (with facilitated access to LARC methods) prior to discharge from maternity hospital. Evaluation consisted of (i) self administered questionnaire (32-34weeks) of women's views of antenatal contraceptive counselling, (ii) database review of contraceptive methods provided at discharge, and (iii) focus groups with midwives and obstetricians. Women's views on antenatal contraceptive counselling. Secondary outcomes included (i) uptake of LARC methods and (ii) barriers and facilitators to providing antenatal counselling and contraception. There were 1369 women in the cohort. Questionnaires were distributed to 1064 women (78%) and completed by 794 (75%). In all, 78% of respondents (n=621) discussed contraception antenatally with a community midwife and 74% (n=461) found thishelpful. Although 43% of respondents (n=341) were planning to use LARC, only 9% of the cohort (118 of 1369) received LARC prior to discharge. Community midwives indicated that antenatal contraceptive counselling was now embedded in their role, but hospital staff indicated that workloads impacted upon ability to provide contraception for women. Antenatal contraceptive counselling, delivered by community midwives, is feasible and highly acceptable to women. However, providing contraception and LARC for women before they are discharged homeremains a challenge. Giving contraceptive advice antenatally is feasible and acceptable.

Body composition and psychological improvement in healthy premenopausal women assuming the oral contraceptive containing micronized estradiol (E2) and nomegestrol acetate (NOMAC)

This observational study was conducted in healthy premenopausal women, who presented themselves for contraceptive advice at the outpatient Family Planning Clinics of the Department of Obstetrics and Gynecology of the University of Cagliari, Hospital–University of Cagliari (Italy). After a screening period of three menstrual cycles, 48 women without contraindications to estroprogestin contraceptives (OCs) were included in the study. The primary purposes of the study were to evaluate whether a 12-month-treatment with the combined OC containing micronized estradiol (1.5 mg, E2) plus nomegestrol acetate (2.5 mg, NOMAC) (E2/NOMAC) interfere on anthropometric indices (AI), body composition (BC) and psychological status (PS). In subjects with dysmenorrhea (#36), its intensity was evaluated using the visuo analogic scale (VAS), both before and during the 12-month-treatment with E2/NOMAC. E2/NOMAC did not modify neither AI nor BC in the 40 subjects who concluded the study. The PS and the VAS of dysmenorrhea were significantly (p < 0.0001) improved from the first cycle of treatment and throughout the E2/NOMAC treatment in comparison with basal values. The study suggests that E2/NOMAC is devoid of negative effects on AI and BC, with additional benefits on PS and dysmenorrhea.