Short Pregnancy Interval Research Articles

Short inter-pregnancy interval and birthweight: a reappraisal based on a follow-up study of all women in Norway with two singleton deliveries during 1970–2019

We studied mean changes in birthweight from the first to the second delivery according to length of the inter-pregnancy interval. We also studied recurrence risk of low birthweight, preterm birth and perinatal death. We followed all women in Norway from their first to their second singleton delivery at gestational week 22 or beyond during the years 1970–2019, a total of 654 100 women. Data were obtained from the Medical Birth Registry of Norway. Mean birthweight increased from the first to the second delivery, and the increase was highest in pregnancies conceived < 6 months after the first delivery; adjusted mean birthweight increase 227 g (g) (95% CI; 219–236 g), 90 g higher than in pregnancies conceived 6–11 months after the first delivery (137 g (95% CI; 130–144 g)). After exclusion of women with a first stillbirth, the mean increase in birthweight at inter-pregnancy interval < 6 months was attenuated (152 g, 95% CI; 143–160 g), but remained higher than at longer inter-pregnancy intervals. This finding was particularly prominent in women > 35 years (218 g, 95% CI; 139 –298 g). In women with a first live born infant weighing < 2500 g, mean birthweight increased by around 1000 g to the second delivery, and the increase was most prominent at < 6 months inter-pregnancy interval. We found increased recurrence risk of preterm birth at inter-pregnancy interval < 6 months, but no increased recurrence risk of low birthweight, small for gestational age infant or perinatal death. In conclusion, we found the highest mean increase in birthweight when the inter-pregnancy interval was short. Our results do not generally discourage short pregnancy intervals.

Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019

BackgroundContraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being. ObjectiveThe objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh. MethodsWe analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding. ResultsThe prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65–0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47–0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities. ConclusionsThe study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.

Laparoscopic Management of Short-Interval Interstitial Pregnancy After Recent Tubal Ectopic: A Case Report [ID 2683561

INTRODUCTION: A 24-year-old G6P2032 presents with interstitial pregnancy 3 months after ipsilateral laparoscopic salpingectomy for ruptured tubal ectopic pregnancy. This case report demonstrates the management of short-interval interstitial pregnancy after recent ipsilateral laparoscopic salpingectomy. METHODS: The patient initially presented with a right-sided ruptured tubal ectopic pregnancy. Salpingectomy was performed to completely remove the fallopian tube and desiccate it at the cornua, leaving no residual visible tubal remnants. The patient presented with ipsilateral interstitial pregnancy 3 months later and initially underwent systemic methotrexate injection, which failed to resolve the pregnancy. She then underwent laparoscopic cornuostomy and dilation and curettage (D&amp;C). Cornuostomy was performed with injection of dilute vasopressin around the gestational sac to help minimize blood loss followed by hydrodissection and sharp dissection to remove the pregnancy. The myometrium and serosa were closed in layers. There was attention to preserve uterine myometrial tissue integrity at the cornua. The patient did well postoperatively and was discharged on postoperative day 0 (POD0). Her β-hCG trended from 11,902 mIU/mL pre-surgery to 7,726 on POD0, and 289 at 1 week. Pathology showed fragments of chorionic villi, and the D&amp;C showed decidualized secretory endometrium. CONCLUSION: Short-interval interstitial ectopic pregnancies after prior salpingectomy for tubal ectopic are extremely rare. We demonstrated successful management with a minimally invasive laparoscopic cornuostomy after failed methotrexate. Patients should be counseled carefully about the risks of short-interval pregnancy after tubal ectopic even after care is taken to remove all visible portions of the fallopian tube.

Maternal Contraception Education Increases the Use of Highly Effective Contraceptive Methods Postpartum [ID 2683527

INTRODUCTION: Postpartum contraception planning is important for preventing short-interval pregnancies especially in populations at increased risk for adverse pregnancy and birth outcomes, such as those with gestational diabetes. This study evaluated the effect of antenatal contraception education on postpartum contraception plans and actual postpartum contraceptive use in patients with pregnancy hyperglycemia. METHODS: This pilot two-arm randomized controlled trial (Project Wellness, NCT04209348) assigned patients to receive contraception education (intervention, n=10) or standard-of-care (control, n=9). Postpartum contraceptive plans were assessed pre- and post-intervention. Contraceptive effectiveness was assessed pre- and post-intervention and 3 months postpartum. The primary outcome was a change in contraceptive plan from pre to post intervention (yes/no). The secondary outcome was contraceptive effectiveness; categorized as: 1) none, 2) least effective, 3) moderately effective, and 4) most effective methods. Fisher's exact test compared differences in contraceptive plans between groups and Mann–Whitney U test compared contraceptive effectiveness. RESULTS: Among participants in the contraception education group, 90% (n=9) changed their postpartum contraceptive plan after intervention, compared to 33.3% (n=3) in the control group (P=.02). Contraceptive effectiveness was significantly higher in the contraception education group immediately post-intervention (P=.045) and at 3 months postpartum (P=.030), compared to the control group. CONCLUSION: Structured education and planning for postpartum contraception may increase use of highly effective contraceptive methods in the early postpartum period to optimize family planning goals and decrease short interval births. Further research should evaluate satisfaction with contraception education and planning, and longer-term contraceptive use.

Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia.

Chronic energy deficiency (CED) in pregnant women is a condition of energy and protein deficiency that lasts for years and causes problems in the mother and fetus. Due to its significant consequences, determining the determinants associated with CED incidence is of utmost importance. The aim of this study was to determine the determinants of the incidence of CED in pregnant women in Indonesia. A cross-sectional study was conducted on pregnant women in Banyumas, Central Java, Indonesia, in 2022. Plausible determinants included maternal age, pregnancy interval, parity, educational attainment, nutritional knowledge, employment, frequency of antenatal care (ANC), and nutritional intake. The Chi-squared test followed by multivariate logistic regression were used to determine the factors associated with the incidence of CED. Our data indicated that 32% of the pregnant women had CED. Univariate analysis found that maternal age (p=0.022), pregnancy interval (p=0.009), educational attainment (p=0.012), knowledge of nutrition and CED (p=0.023), frequency of utilization of ANC services (p=0.028), energy intake (p=0.002), protein intake (p=0.006), vitamin C intake (p=0.016), folate intake (p=0.011), and calcium intake (p=0.004) were significantly associated with CED incidence in the pregnant women. Multivariate analysis indicated that extreme maternal age (OR; 3.49; 95%CI: 1.10-11.05), low educational attainment (OR: 4.12; 95%CI: 1.37-12.33), short pregnancy interval (OR; 7.30; 95%CI: 1.84-28.99), low frequency of ANC (OR: 3.06; 95%CI: 1.01-9.19) and low protein intake (OR: 6.80; 95%CI: 1.62-28.59) were associated with CED incidence. This study underscores the importance of increasing nutritional intake, frequency of ANC, and pregnancy interval among pregnant women to reduce the risk of CED and its adverse health outcomes.

Women's School "Ratho Ebhu" to Empower Women in Stunting Prevention-Based Family Centered Nursing in Pamorah Village, Tragah Prefecture

Stunting is a national problem, the solution of which requires cross-sectoral cooperation. Stunting is a chronic condition that cannot be cured but can be controlled. The growth and development period for toddlers is a period that happens quickly and will never be repeated. Stunting cases in children can be used as a predictor of the low quality of a country's human resources. Stunting causes poor cognitive abilities, low productivity, and an increased risk of disease, resulting in long-term losses for the Indonesian economy. Pamorah Village is the 2022 stunting locus village; there are 26 stunted children. The results of interviews with partners leading the Pamorah Village PKK driving team found that health problems related to high cases of stunting in children are still a problem caused by several factors, including the low number of Posyandu visits, low immunization coverage, distant access to health services, high cases of early marriage, low awareness of clean and healthy living behavior, low levels of exclusive breastfeeding, child care is handed over to grandmothers because parents work outside the island so that nutritional parenting patterns follow grandmother's family culture, some pregnant women do not have check-ups with health workers and health facilities, short pregnancy intervals due to low number of mothers of productive age who use contraception. The aim of community service is to increase community knowledge and change community behavior in health through women's schools in an effort to prevent stunting. The expected output is a pocket book on women's school health education and training, as well as publications in the mass media, women's school learning plans, and the publication of community service journals.

Racial and ethnic disparities in short interval pregnancy following delivery in Catholic vs non-Catholic hospitals among California Medicaid enrollees

ObjectivesWe examined the impact of Catholic hospital delivery on short interval pregnancy in the California 2010–2014 Medicaid population. Study designWe used Cox regression to estimate the association between hospital affiliation and short interval pregnancy, adjusting for patient factors. ResultsCatholic hospital delivery had increased the risk of pregnancy within 6 months for Black (hazard ratio [HR] 1.11, 95% CI 1.06, 1.17) and Hispanic (HR 1.07, 95% CI 1.05, 1.09) but not for White women (HR 1.02, 95% CI 0.98, 1.05). ConclusionsAmong California women with Medicaid, Catholic hospital delivery was associated with short interval pregnancy only among women of color.

Scoping review protocol: exploration of the barriers and facilitators to the uptake of early postnatal contraception

IntroductionIt is well documented that many women do not desire a short interpregnancy interval. Medical societies, government agencies and leaders in the field recommend that contraception should be part of...

Women's participation in childbearing decision-making and its effects on short-interval births in Rohingya refugee camps of Bangladesh.

Women's involvement in family planning decision-making is significantly low among refugee women, potentially leading to an increased unintended and short interval pregnancies. This study aims to investigate the relationship between women's decision-making in childbearing and short-interval births among Rohingya refugee women in Bangladesh. Data from 719 women residing in three Rohingya refugee camps in Ukhiya, Cox's Bazar, Bangladesh, were analyzed. The outcome variable was birth spacing, categorized as short (<33 months between the two most recent births) or normal (≥33 months between the two most recent births). The primary explanatory variable was women's involvement in fertility decision-making with their partner, classified as never, sometimes, and always. Multivariate logistic regression analysis was conducted to assess the association between the outcome and explanatory variable while adjusting for potential covariates. 58% of births occurred within a short interval, while almost 48% of women reported no participation in fertility decision-making with their partner. Short interval birth was found to be increasing with decreasing women's participation in fertility decision-making with their partner. Women who sometimes or never made fertility decisions with their partner had 1.20 times (95% CI, 1.01-1.88) and 1.69 times (95% CI, 1.06-2.29) higher likelihood of short interval births, respectively, compared to women who always decided with their partner. Low women's participation in fertility decision-making with their partner among Rohingya refugees increases short interval births and adverse maternal and child health outcomes, including mortality. This highlights the need for counselling programs to educate and empower women, promoting joint fertility decision-making by couples. This research did not receive any specific funds.

Fertilities Acceleration (Tempo) and Factors Affecting the First Birth Interval in Iranian Women: A Survival Analysis

Background: A short pregnancy interval (long fertility acceleration (Tempo)) is associated with adverse health and perinatal outcomes, including maternal, child, and neonatal mortality. Objectives: We aimed to investigate the duration and determining factors of first birth intervals among women of reproductive age in Semnan, Iran. Methods: In this cross-sectional study, the fertility history of 600 married women aged 15 to 49 in Semnan (Iran) was investigated from the list of health centers. Individuals were selected using a multistage sampling method in 2018. Finally, a married woman (15 - 49 years) was selected randomly from each household. Data were obtained by interview questionnaire, calculated tempos, and analyzed with a Cox proportional hazard model. Results: The median (first – third quartile) time of first birth intervals and age of women and men at the first marriage were estimated to be 24.0 (12 - 44) months, 20 (18 - 23), and 25 (22 - 28) years, respectively. The lowest estimated tempo was for third births (68.63 months), and the highest was for the 1st (26 months). Among explanatory variables of interest, the number of children expected, the father's age at the first marriage, the mother's occupation, and the desire to have children were significant predictors of the first birth intervals. Conclusions: Due to the decrease in the number of births in the past several years and also the prediction of a decrease in the coming years, one of the ways to reduce the birth interval and, as a result, increase the fertility rate is to reduce the age of marriage among young people and in general to marry on time among young people, as well as to control inflation and reduce the cost of having children.

Factors Limiting Magnetic Resonance Imaging Diagnosis of Placenta Accreta Spectrum.

Placenta accreta spectrum (PAS) disorders are characterized by an abnormal adherence of the placenta to the uterine myometrium. Magnetic resonance imaging (MRI) is an important adjunct in antenatal diagnosis. We sought to determine if there are patient and MRI characteristics that limit the accuracy of PAS diagnosis and degree of invasion. We conducted a retrospective cohort analysis of patients who were evaluated for PAS by MRI from January 2007 to December 2020. Patient characteristics evaluated included number of prior cesarean deliveries, history of dilation and curettage (D&C) or dilation and evacuation (D&E), short interval pregnancy less than 18 months, and delivery body mass index (BMI). All patients were followed until delivery and MRI diagnosis was compared with final histopathology. Of the 353 patients with suspected PAS, 152 (43%) underwent MRI evaluation and were included in the final analysis. In patients who underwent MRI evaluation, 105 (69%) had confirmed PAS on pathology. Patient characteristics were similar between groups and not associated with accuracy of MRI diagnosis. MRI was accurate in diagnosing PAS and the associated degree of invasion in 83 (55%) patients. Accuracy was associated with lacunae (8 vs. 0%, p = 0.02), abnormal bladder interface (25 vs. 6%, p = 0.002), and T1 hyperintensity (13 vs. 1%, p = 0.002). Of the 69 (45%) patients in whom MRI was inaccurate, overdiagnosis was seen in 44 (64%) patients and underdiagnosis in 25 (36%) patients. Overdiagnosis was significantly associated with dark T2 bands (45 vs. 22%, p = 0.005). Underdiagnosis was associated with earlier gestational age at MRI (28 vs. 30 weeks, p = 0.049) and lateral placentation (16 vs. 2.4%, p = 0.025). Patient factors did not change MRI accuracy of PAS diagnosis. MRI is associated with a significant overdiagnosis of PAS when dark T2 bands are present, and underdiagnose PAS when performed earlier in gestation or when lateral placentation is present. · Patient factors are not associated with MRI accuracy of PAS diagnosis.. · MRI overdiagnoses PAS invasion when there are dark T2 bands.. · MRI underdiagnoses PAS invasion when performed earlier in gestation.. · Underdiagnosis of PAS is associated with lateral placentation..

What Is the Most Cost-Effective Timing for Postpartum IUD Insertion? [ID: 1379571

INTRODUCTION: Postpartum intrauterine device (IUD) insertion is an effective contraception choice for reducing rates of unplanned and short-interval pregnancies. However, timing of placement is controversial, and risk of perforation and expulsion vary with timing. We aim to analyze the cost-effectiveness of postpartum IUD insertion intervals when considering risk of perforation or expulsion. METHODS: A decision-analytic model compared four intervals of postpartum IUD insertion: between 0 and 3 days, 4 days and 6 weeks, 6 and 14 weeks, or 14 and 52 weeks postpartum. A theoretical cohort of 600,000 was calculated using the estimate that 15.3% of postpartum people receive a long-acting reversible contraceptive. Probabilities, costs, and utilities were procured from the literature. Primary outcomes included IUD-related uterine perforation, expulsion, unplanned short-interval pregnancy, termination, stillbirth, ectopic pregnancy, and preterm delivery. The cost-effectiveness threshold was $100,000/quality-adjusted life-year (QALY). RESULTS: IUD insertion between 6 and 14 weeks postpartum was the cost-effective strategy despite having 1,978 and 1,982 additional perforations in intervals between 0–3 days and 14–52 weeks, respectively. All other outcomes were reduced. When compared to the intervals of 0–3 days, 4 days–6 weeks, and 14–52 weeks postpartum, this strategy resulted in 3,054, 282, and 3,816 more QALYs and decreased costs by $91 million, $22 million, and $316 million, respectively. CONCLUSION: Intrauterine device insertion between 6 and 14 weeks postpartum is the cost-effective strategy despite increased risk of perforation. Appropriately counseling patients on the risks and benefits associated with timing of IUD insertion is an important component of postpartum care.

Changes in postpartum contraception utilization rates during the early stage of the COVID-19 pandemic.

The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. Retrospective cohort review. Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.

Clinical Outcomes of Post Placental Intrauterine Contraceptive Device Insertion in Women Delivering by Cesarean Section

Background: Short pregnancy interval after caesarean section increases the risks of morbidity, mortality and surgical interventions. This can be easily avoided by post placental insertion of IUCD during caesarean section. Immediate post placental IUCD insertion is defined as insertion of IUCD within 10 minutes of delivery of the placenta. It is a very promising an appealing approach as patient does not have to come for a separate postpartum visit. Objectives: To determine the outcome (safety, complications, failure and continuation rate) of post placental IUCD insertion during caesarean section. Materials and Methods: Our study was a prospective cross-sectional study, carried out in the Department of Obstetrics and gynecology at Qazi Hussain Ahmad Medical Complex, Nowshera. All the pregnant women willing for post placental intrauterine contraceptive device were included in the study. Women who had postpartum hemorrhage, chorioamnionitis, structurally malformed uterus and fibroid uterus were excluded from the study. Follow up visits were scheduled at one month, 3 months and 6 months. Results: 156 women were included in this study. Majority(35.2%) belonged to 31- 35 years age group. 46.7% of them were illiterate and 30.7% have just primary education. 40.38% of women belonged to low socio-economic group. 26.2% of women were para 4. 26.9% had previous 3 caesarean section. The most common adverse events during follow up of 6months were vaginal discharge, menstrual irregularities and pelvic pain. At the end of 6 months there were 9expulsions, 12 removals and 2 pregnancies with the gross cumulative expulsions, removal, failure and continuation rate of 5.7%, 7.6%, 1.28% and 85.2% respectively. The incidence of undescended strings at the end of 6 months was high (32.4%). Conclusion: Post placental intra uterine Copper T 380 A insertion is a safe, effective and easy reversible method of contraception with low expulsion and high continuation rates. Keywords: Intrauterine device,Intra-cesarean section, Post placental insertion

Factors Affecting the Incidence of Anemia in Pregnant Women at Ampel and Gladagsari Public Health Center Boyolali Regency in 2019

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Anemia is a condition where the blood hemoglobin level is &amp;lt;11 g/dl. Anemia is often experienced by mothers during pregnancy. The main cause of anemia in pregnant women is due to iron deficiency in the body. This study aims to determine what factors are the main causes of anemia in the working area of Ampel Health Center and Gladagsari Health Center. Poor nutritional status, parity, short pregnancy intervals are believed to be the biggest contributors to the incidence of anemia in pregnant women.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study used secondary data with a cross sectional design. Chi Square test is used in statistical testing.&lt;strong&gt; &lt;/strong&gt;Study involved Ampel Health Center (193 samples) and Gladagsari Health Center (246 samples). The variables studied were the age of pregnant women, distance between pregnancies, parity, nutritional status, Antenatal Care and adherence to Fe tablet consumption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results showed that nutritional status (0.001), gestational distance (0.003), parity (0.032) and age of pregnant women (0.032) had a significant relationship with the incidence of anemia in Ampel Health Center &amp;lt; (0.05). Gladagsari Health Center samples showed different results where nutritional status (0.003), gestational distance (0.007), parity (0.005), adherence to Fe tablet consumption (0.049) and age of pregnant women (0.046) had a significant relationship with the incidence of anemia &amp;lt; (0, 05). Maternal nutritional status during pregnancy is the highest cause of anemia, many steps can be taken to improve the nutritional status of pregnant women, one of which is the provision of additional food.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Education of health workers about the importance of consuming Fe tablets for women of childbearing age (WUS) and pregnant women and self-compliance play an important role in preventing anemia during pregnancy.&lt;/p&gt;

Impact of Short Pregnancy Interval on Feto-Maternal Outcome in Women with Previous caesarean section

Background: Short inter-pregnancy interval has been associated with an increase risk of adverse pregnancy outcomes after caesarean section. Method: A descriptive study, carried out in tertiary care hospital on total 63 numbers of women for a duration of six months with short inter-pregnancy interval and history of previous caesarean section. Results: Among women with history of previous LSCS (n=63), mean age 26.5±4.6 years, gestational age 37.8±2.2 weeks, recommended IPI (&gt;18 months) was observed only in 15.9% women. Most common indications for current C-section were irregular pain (20.6%), term women (12.7%), and fetal distress (11.1%). Occurrence rate of uterine scar dehiscence was 33.3%, preterm birth 19.0%, low birth weight 15.9%, and uterine rupture 3.2%. Frequency of uterine scar dehiscence was significantly higher in IPI ≤6 months than in &gt;6 months (66.7% vs. 33.3%; p 0.040); and in IPI ≤12 months than in &gt;12 months (81% vs. 19%; p 0.036). All two cases of uterine rupture were observed in IPI ≤6 months but the difference was not statistically significant. Frequency of preterm birth was insignificantly higher in IPI ≤18 months than in &gt;18 months (66.7% vs. 33.3%; p 0.086). Conclusion: We found elevated risk of uterine scar dehiscence, uterine rupture, low birth weight babies along with preterm births. Keywords: IPI (Inter-pregnancy interval), LSCS (Lower Segment Cesarean Section), Scar dehiscence, Low Birth Weight.

Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature.

Background: When natural disasters strike, there is a sudden decrease in access to care due to infrastructure loss and displacement. A pandemic has the similar ability to acutely limit access to care. The relationship between decreased access to care and natural disasters has been previously explored.Objective: The purpose of this article is to present a focused review of the available and emerging literature regarding the overall impact of natural disasters and pandemics on unintended pregnancy and decreased care in this setting.Methods: A literature search was conducted on PubMed, Cochrane, Google Scholar, and Embase databases. The search was restricted to studies that were population-based, prospective or retrospective. Only peer-reviewed articles were considered. The search was further restricted to manuscripts in English or officially translated manuscripts. All qualifying papers from which data were extracted were subjected to a quality assessment conducted by two independent investigators (SK and AA). Each investigator reviewed all nine papers relevant to data collection using the Effective Public Health Practice Project (EPHP). MeSH terms were utilized across various databases. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcomes were the rates of unintended pregnancy. Secondary outcomes included the use of contraception, short interval pregnancy, and access to reproductive services.Results: An initial search yielded 74 papers, of which nine papers were reviewed for qualitative data, examining the subjects affected by natural disasters or pandemics. An additional two papers regarding theoretical data and COVID-19 were analyzed. Although there seems to be a rise in unintended pregnancy and more difficulty accessing care following natural disasters and pandemics, there are variations in the rates based on region and event.Conclusions: The full effects of the COVID-19 pandemic on the rates of unplanned pregnancies will become apparent in the months and years to come. As obstetrician-gynecologists, we must communicate openly with our patients regarding the use of available contraception, sexual education, and family planning services at times of natural disasters and pandemics.

Does a Short Interim between two Pregnancies Adversely Influence Maternal outcome – A Study from South Punjab

To investigate the occurrence of adverse perinatal outcome in pregnancies with short inter pregnancy interim. Study Design: A Cross – sectional study. Setting: Obstetrics &amp; Gynaecology Unit 1,Combined Military Hospital Multan. Study Duration: 6 months ,( 25-10-2019 to 24-04-2020) Subjects and Methods: Baseline information like age, obesity, parity and educational status was noted. The patients with short Inter pregnancy interval were recruited for perinatal outcomes. Results: Calculated mean of age of gestation of the patients was 38.45 ± 0.21 wks and 147 (61.3%) were at &gt; 38 wks of gestation. Mean age of patients included, was 28.21 ± 4.37 years. Of the 240 study cases, 158 (65.8 %) were living in countryside and 82 (34.2 %) came from inner-city. Of these 240 study cases, 166 (69.2 %) pregnant females had no primary education even and only 74 (30.8%) ladies were literate. Mean BMI of the subjects was 24.99 ± 2.17 kg/m2 while 33 (13.8 %) pregnant females were found obese . Parity mean found to be 2.11 ± 0.78 and 184 (76.7 %) had parity up to 3. Mean of marriage period was 5.22 ± 3.67 yrs and 124 (51.7%) marriage period upto 4.9 years. Preterm birth was noted in 47 (19.6%), premature rupture of membranes was noted in 95 (39.6%) while postpartum hemorrhage was noted in 31 (12.9%). Conclusion: A brief interim (&lt; 1.8 yrs) between two pregnancies, was found to be associated with more risks of preterm births (PTB), premature rupture of membranes (PROM) and postpartum hemorrhage (PPH). Higher frequencies of PTB, PROM and PPH have been observed in our study. Repeated unplanned pregnancies with brief interim between two pregnancies in under-developed countries particularly, lead to high maternal and neonatal morbidity and mortality. Since lack of optimization of maternal health has untoward consequences, awareness and education of mothers in pre and post natal visits about effective contraception is an important component of safe motherhood. Keywords: Inter pregnancy interim, IPI, perinatal outcomes.

Ultrasound-Guided Compared With Non–Ultrasound-Guided Placement of Immediate Postpartum Intrauterine Contraceptive Devices

Immediate postpartum placement of intrauterine devices (IUDs) can help reduce unintended short-interval pregnancy; however, the rate of spontaneous device expulsion is increased. The objective of this study is to evaluate the risk of expulsion with ultrasound-guided placement of immediate postpartum IUDs. Retrospective review of all patients receiving immediate postpartum IUDs after vaginal delivery at Prisma Health Richland Hospital from 2018 to 2020 was performed. Outcomes were available for 78 patients in the ultrasound-guided cohort and for 226 in the control cohort. The expulsion rate was 15.4% (95% CI 8.2-25.3%) for the ultrasound-guided cohort and 14.2% (95% CI 9.9-19.4%) for the control cohort. Our data suggest that using ultrasonography to guide placement of IUDs immediately after vaginal delivery is not associated with the risk of expulsion.

The causal effect of a family planning intervention on women’s contraceptive use and birth spacing

Studies have suggested that improving access to family planning (FP) may improve contraceptive use and reduce fertility. However, high-quality evidence, particularly from randomized implementation trials, of the effect of FP programs and interventions on longer-term fertility and birth spacing is lacking. We conduct a nonblinded, randomized, controlled trial to assess the causal impact of improved access to FP on contraceptive use and pregnancy spacing in Lilongwe, Malawi. A total of 2,143 married women aged 18 to 35 who were either pregnant or had recently given birth were recruited through home visits between September 2016 and January 2017 and were randomly assigned to an intervention arm or a control arm. The intervention arm received four services over a 2-y period: 1) up to six FP counseling sessions; 2) free transportation to an FP clinic; 3) free FP services at the clinic or financial reimbursement for FP services obtained elsewhere; and 4) treatment for contraceptive-related side effects. Contraceptive use after 2 y of intervention exposure increased by 5.9 percentage points, mainly through an increased use of contraceptive implants. The intervention group’s hazard of pregnancy was 43.5% lower 24 mo after the index birth. Our results highlight the positive impact of increased access to FP on a woman’s contraceptive use. In addition, we show that exposure to the FP intervention led to a prolongation of birth intervals among intervention women relative to control women and increased her control over birth spacing and postpartum fertility, which, in turn, may contribute to her longer-term health and well-being.