WHO Medical Eligibility Research Articles

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort.

To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

EFFICACY AND SAFETY OF INTRA CAESAREAN IUCD

The objective of this study was to evaluate the effectiveness and complications of post-partum intrauterine contraceptive device (PPIUCD) insertion during cesarean delivery. The study was conducted at Nishtar Medical Hospital from June to December 2022. A total of 150 women were included in the study. In the first phase, medical eligibility for the intervention was assessed, while in the second phase, WHO Medical Eligibility Criteria were evaluated. The IUCD was manually inserted after delivery with its string towards the cervix. The patients were followed up at 2 and 6 months. After 6 months, 9 (6%) cases reported abdominal pain, 22 (15%) had menorrhagia, and 23 (15.3%) had missed threads with the IUCD in place. None of the patients reported pregnancy or perforation of the uterus. After 6 months, 133 (88.6%) patients continued to use this method of contraception, while 9(6%) were lost to follow-up, 4 (2.6%) had the device removed due to complications, and 4 (2.6%) had spontaneous expulsion. The study concluded that PPIUCD is a safe and effective long-term contraceptive method. Clinicians should evaluate patients' eligibility for PPIUCD and counsel women on adopting this method.

Review of PPIUCD at tertiary care centre in Southern Rajasthan

Background: This study was conducted to observe the acceptance rate and safety for PPIUCD as PPIUCD was used as contraceptive method under family welfare program in this institute. Aims and Objectives: To see pattern of acceptance and safety of PPIUCD among women admitted for childbirth. Materials and Methods: A prospective, preformed semi-structured questionnaire-based observational study was conducted between September 2012 and August 2020 in the Government Medical College Kota. CuT380A was used as PPIUCD for insertion. WHO medical eligibility criteria were met along with inclusion and exclusion criteria. After counseling and consent, PPIUCD was inserted post-placentaly and during LSCS. Acceptance rate was calculated along with safety profile. Results: In the present study majority of patients were in the age group of 21–30 years. 44.26% women were second para. 96.35% insertions were uneventful during the study. The most common reason for acceptance and refusal of PPIUCD was reversibility and for refusal was fear of complications, respectively. The acceptance was increasing over the years. On follow-up majority of clients had no complaints. Among those who had complaints, irregular bleeding was most common. Major cause of requesting for removal was irregular bleeding. Continuation rate was found to be 91.91% and 85.30% at 6 weeks and 6 months, respectively. Conclusion: PPIUCD is a safe and effective method of contraception. Acceptance rate is increasing over the years and which can further increase with antenatal, intra natal and postnatal counseling along with counseling of husband/family attendants and management of side effects.

One successful intrauterine device into a uterus, didelphys: a case report and literature review

Uterus didelphys represents a uterus malformation where the uterus is present as a double organ due to embryonic fusion failure of the mullerian ducts. As a result, there is a double uterus with separated cervices. This congenital malformation used to be a controversial contraindication of an intrauterine device (IUD) insertion. It is a category 4 WHO medical eligibility criteria: not being used because of its association with a high risk of IUD expulsion, malposition into the uterus, uterine perforation and its migration into the abdominal cavity and viscera. We present and discuss the case of a 35-year-old woman, P4+6, known with uterus didelphys who came to our outpatient clinic for family planning. She was counselled about all available methods and opted for a levonorgestrel IUD (LNG-IUD). We inserted the device into one of her double uterus and she is fully satisfied with the method now one year and three months ago. Levonorgestrel IUD is a long acting, highly effective and reversible form of contraception that works mainly by thickening of the cervical mucus and also by thinning the endometrial lining. Considering its effect on the endometrium and the cervical mucus; and its high level of progesterone pelvic release, we think one LNG-IUD contraception into one of the double uterus is enough and effective in individualized and known women with such condition instead of two IUDs, one being into each uterus, such published in all articles we read through. The purpose of this case report is to demonstrate that only one LNG-IUD contraception can be sufficient and effective method in known and selective women with uterus didelphys. However a case-series study is needed for more evidence.

Combined hormonal contraceptives use among women with contraindications according to the WHO criteria: A systematic review

IntroductionCombined hormonal contraceptives (CHC), containing estrogen, remain the most popular choice of contraceptive among women. While the method offers many benefits, the use of CHC involves potential health risks. The aim of this study was to analyze the available evidence on the prevalence of CHC use among women with contraindications to their use according to the WHO recommendations (2015). MethodsPubmed, Lilacs, and Web of Sciences databases were searched. Selection was based on articles that described the use of combined hormonal contraceptives according to the characteristics that are listed as contraindications in WHO medical eligibility criteria for contraceptive use. ResultsA total of 4363 articles were identified and 18 articles were selected for the review. The most prevalent contraindications against use of CHC were systemic arterial hypertension, migraine, and smoking (in women aged 35 years or older). Prevalence rates of contraindications against use of CHC ranged from 5.9% to 41.9%. ConclusionsA high proportion of women still use CHC when contraindicated to do so according to the WHO criteria. Health policies should focus on highlighting the importance of a detailed health evaluation on CHC candidates, to reduce the proportion of inappropriate prescriptions.

HIV and contraception.

Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available. It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.

Barriers and myths that limit the use of intrauterine contraception in nulliparous women: a survey of Brazilian gynaecologists

ObjectiveTo understand the extent to which barriers and misperceptions about intrauterine contraception (IUC) remain among Brazilian gynaecologists, particularly for nulliparous women.MethodsAn online survey was developed to assess Brazilian gynaecologists' knowledge...

Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods

ObjectiveTo evaluate neurologists’ knowledge of contraceptive counseling for women receiving antiepileptic drugs (AEDs). MethodsAn interview-based survey was conducted from February 2 to June 30, 2015, among neurologists working in Ribeirão Preto, Brazil. Direct interviews were conducted using a questionnaire that assessed knowledge of the pharmacological interactions between various contraceptive methods and six AEDs (carbamazepine, phenobarbital, topiramate, phenytoin, lamotrigine, and valproate) on the basis of WHO medical eligibility criteria for contraceptive use. ResultsAmong 42 neurologists who participated, 32 (76%) stated that they treated women with epilepsy and provided them with counseling for family planning. Overall, 34 (81%) recommended the use of a copper intrauterine device irrespective of the AED used, and 26 (60%) stated that they co-prescribed AEDs and hormonal contraceptives. Although 39 (93%) neurologists had knowledge that AEDs might contraindicate the use of some contraceptives, their knowledge regarding the specific drug interactions was lacking. Furthermore, 34 (81%) had no knowledge of WHO medical eligibility criteria for contraceptive use. ConclusionAlthough most neurologists interviewed had knowledge of interactions between AEDs and hormonal contraceptives, they did not know which specific AEDs interacted with these agents.

The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidance.

The purpose of this review is to revisit the inception of the WHO's medical eligibility criteria for contraceptive use (MEC), particularly its objectives and methodology, and to describe its impact over the last 20 years in the field of family planning. New recommendations are summarized from the newly released fifth edition of the guidance. Fourteen topics, encompassing over 575 recommendations were reviewed for the MEC, fifth edition. New recommendations include: changes for combined hormonal contraceptive use among postpartum women; progestogen-only methods among breastfeeding women; and women at high risk for HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy and hormonal contraception. New methods reviewed include subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring. Over the past 20 years, the MEC has become a remarkably influential document for practitioners and policy makers in family planning, as it provides up-to-date, evidence-based recommendations for contraceptive use for women with various medical conditions and medically relevant characteristics.

Lactation and contraception.

This review examines evidence relevant to the effect of hormonal contraception on breastfeeding; and compares global and US recommendations for contraceptive initiation and use. Breastfeeding and use of postpartum contraception have high public health priority, making research in this area critical for optimizing guidance. High quality evidence remains limited with only a small number of well-conducted randomized controlled trials of hormonal methods and breastfeeding/neonatal growth outcomes. More evidence supports early initiation of progestin-only methods. Evidence on early initiation of combination hormonal methods is sparse. The WHO Medical Eligibility Criteria (MEC) differs from that of the US MEC. Generally, the WHO MEC is more restrictive, reflecting the potential greater impact on maternal child health if there is a negative impact from hormonal contraception on breastfeeding. Only well conducted clinical trials will further elucidate such an impact. http://links.lww.com/COG/A15.

A clinical evaluation of bleeding patterns, adverse effects, and satisfaction with the subdermal etonogestrel implant among postpartum and non-postpartum users.

The etonogestrel implant (Implanon; Merck Sharp and Dohme, Kenilworth, NJ, USA) is an effective contraceptive with a good safety profile for up to 3 years [1]. However, its adverse effects include irregular vaginal bleeding (affecting 68.0% of users), weight gain (20.7%), acne (15.3%), breast pain (9.1%), and headache (8.5%) [2]. To provide further information about contraception options for women in the postpartum period, the aim of the present study was to investigate the bleeding patterns and adverse effects reported by women who underwent Implanon insertion within 8 weeks of delivery and compare them with those experienced by non-postpartum women. A prospective study was undertaken at Hospital Tengku Ampuan Afzan, Pahang, Malaysia, between July 1, 2010, and June 30, 2012. Women attending the postnatal clinic or family planning/gynecology clinic who met WHO medical eligibility criteria 1 and 2 (no medical restriction for use of contraception or advantages of using contraception outweigh the risks) [3] were enrolled. Nulliparous women and women who had last delivered 8 weeks to 6 months previously were excluded. The institutional ethical committee approved the study and informed consent was obtained from participants. Participants were divided into two groups. Women in the postpartum group had delivered up to 8 weeks previously and underwent Implanon insertion 4–8 weeks after delivery. Women in the non-postpartum group had last delivered at least 6 months previously and underwent Implanon insertion between day 1 and day 5 of menses. Baseline body weight was recorded for each participant. Follow-up visits were scheduled at 3 and 6 months. Bleeding patterns were categorized using the WHO 90-day reference period [4]. Non-menstrual adverse effects and satisfaction were recorded at 6 months. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA). The Student t test and Fisher exact test were used to compare variables. P < 0.05 was considered statistically significant. A total of 110 women were included in the study, 60 in the postpartum group and 50 in the non-postpartum group. There were no differences in bleeding patterns between the groups at 3 months (Table 1). However, at 6 months, amenorrhea was significantly more common in the postpartum group than in the non-postpartum group (P = 0.005), and infrequent bleeding was more common in the non-postpartum group (P = 0.024) (Table 1). With regard to non-menstrual adverse effects, headache and acne were significantly more common in the non-postpartum group than in the postpartum group (P = 0.001 and P = 0.040, respectively) (Table 1). There were no significant differences for other adverse effects. Weight gain was the most frequent adverse effect, but there was no significant difference between groups (Table 1). Most users from both groups were satisfied with Implanon, with no difference in terms of satisfaction between groups ( Table 1). This finding implies that most women who experienced adverse effects were able to tolerate them. In conclusion, the present study has shown that bleeding patterns and non-menstrual adverse effects can differ according to timing of Implanon insertion after delivery. However, despite menstrual irregularities and other adverse effects, Implanon was well accepted in both groups.

INDICATORS OF DYNAMICAL PROINFLAMMATORY CYTOKINES IN WOMEN USING INTRAUTERINE CONTRACEPTIVES

Birth rate regulation is a major problem of modern medicine. Unfortunately, frequency of artificial abortions is still high not only in developing, but also in developed countries. Abortion results in severe gynecologic and endocrine complications in the woman’s body (Alieva, 2001).Use of intrauterine devices (IUDs) is a most effective method of contraception. A great number of studies in the field of utilization and possible complications of IUDs revealed the occurrence of inflammatory diseases of small pelvis organs (IDSPO).With this in mind, we studied the data obtained from 77 women using copper IUDs in maternity facility №2 of the city of Andizhan (Uzbekistan). Duration of patients’ follow-up ranged 40 days to 6 months. Women did not have contraindications for IUDs according to WHO medical eligibility criteria. Blood was a material for study; it was taken in 40 days, 3 and 6 months following IUD insertion. After insertion of copper IUDs to women, a cytokine cascade was studied in dynamics. The serum content of IL-1, IL-6 and concentration of TNFα was measured in all patients according to the instruction attached to immunoenzymatic analyzer "АТ-858" manufactured in China. The minimum concentration of TNFα reliably identified in this test system made 4 pg/ml.During the study, the women of the test group showed increased proinflammatory cytokines. The further study of vaginal smears confirmed development of bacterial vaginoses in them that suggests a relation of complications due to IUDs with imbalance of the cytokine cascade.Elevated serum concentration of cytokines was revealed in women with IUDs already on the first days of their application.Sharp increase in IL-1 on days 40 and 90 after insertion of IUDs is associated with presence of complications in the form of expulsions and possible development of inflammatory diseases of small pelvis organs.

IContraception®: a software tool to assist professionals in choosing contraceptive methods according to WHO medical eligibility criteria

ObjectiveTo design software to assist health care providers with contraceptive counselling.MethodsThe Model-View-Controller software architecture pattern was used. Decision logic was incorporated to automatically compute the safety category of each contraceptive...

CANNABIS AND PSYCHOSIS – THE STATE OF THE ART

Combined hormonal contraceptives (CHC), containing estrogen, remain the most popular choice of contraceptive among women. While the method offers many benefits, the use of CHC involves potential health risks. The aim of this study was to analyze the available evidence on the prevalence of CHC use among women with contraindications to their use according to the WHO recommendations (2015).Pubmed, Lilacs, and Web of Sciences databases were searched. Selection was based on articles that described the use of combined hormonal contraceptives according to the characteristics that are listed as contraindications in WHO medical eligibility criteria for contraceptive use.A total of 4363 articles were identified and 18 articles were selected for the review. The most prevalent contraindications against use of CHC were systemic arterial hypertension, migraine, and smoking (in women aged 35 years or older). Prevalence rates of contraindications against use of CHC ranged from 5.9% to 41.9%.A high proportion of women still use CHC when contraindicated to do so according to the WHO criteria. Health policies should focus on highlighting the importance of a detailed health evaluation on CHC candidates, to reduce the proportion of inappropriate prescriptions.

Infection risk and intrauterine devices

For most women, intrauterine contraceptive devices (IUCD) are a safe option. Upper genital tract infections (pelvic inflammatory disease, PID) occur when pathogenic microorganisms ascend from the cervix and invade the endometrium and the fallopian tubes, causing an inflammatory reaction. Evidence-based recommendations regarding intrauterine contraception and risk of infection were presented at the Congress of the European Society of Contraception, in Prague, 2008: A clinical history (including sexual history) should be taken as part of the routine assessment for intrauterine contraception to identify women at high risk of sexually transmitted infections (STI); if appropriate a test should be offered; if symptoms or signs are present, appropriate diagnostic tests should be done, results awaited, necessary treatment completed, and IUCD insertion postponed until resolution. Prophylactic antibiotics are not recommended (evidence level II-3). STI screening is not routinely recommended. PID among IUCD users is most strongly related to the insertion process and to the background risk of STI (evidence level II-2). Conditions which represent an unacceptable health risk if an IUCD is inserted (WHO Medical Eligibility Criteria, MEC, Categories 3-4) are current PID, current purulent cervicitis, chlamydial or gonorrheal infection. For continuation as well as initiation, WHO MEC categories 3-4 are allotted to women with known pelvic tuberculosis, puerperal sepsis and septic abortion.

New WHO medical eligibility criteria for contraceptives: adaptation for use in a local service in UK

The medical eligibility criteria are based on the work of a group of international experts who reviewed all the clinical evidence on methods of contraception ‐ looking for the circumstances...