Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

Author(s):  
Pip Buckingham ◽  
Jessica E. Moulton ◽  
Asvini K. Subasinghe ◽  
Natalie Amos ◽  
Danielle Mazza
2021 ◽  
Vol 14 (6) ◽  
pp. 548
Author(s):  
Morena Luigia Rocca ◽  
Anna Rita Palumbo ◽  
Federica Visconti ◽  
Costantino Di Carlo

Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Akira Koarai ◽  
Mitsuhiro Yamada ◽  
Tomohiro Ichikawa ◽  
Naoya Fujino ◽  
Tomotaka Kawayama ◽  
...  

Abstract Background Recently, the addition of inhaled corticosteroid (ICS) to long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist (LABA) combination therapy has been recommended for patients with COPD who have severe symptoms and a history of exacerbations because it reduces the exacerbations. In addition, a reducing effect on mortality has been shown by this treatment. However, the evidence is mainly based on one large randomized controlled trial IMPACT study, and it remains unclear whether the ICS add-on treatment is beneficial or not. Recently, a large new ETHOS trial has been performed to clarify the ICS add-on effects. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety including ETHOS trial. Methods We searched relevant randomized control trials (RCTs) and analyzed the exacerbations, quality of life (QOL), dyspnea symptom, lung function and adverse events including pneumonia and mortality, as the outcomes of interest. Results We identified a total of 6 RCTs in ICS add-on protocol (N = 13,579). ICS/LAMA/LABA treatment (triple therapy) significantly decreased the incidence of exacerbations (rate ratio 0.73, 95% CI 0.64–0.83) and improved the QOL score and trough FEV1 compared to LAMA/LABA. In addition, triple therapy significantly improved the dyspnea score (mean difference 0.33, 95% CI 0.18–0.48) and mortality (odds ratio 0.66, 95% CI 0.50–0.87). However, triple therapy showed a significantly higher incidence of pneumonia (odds ratio 1.52, 95% CI 1.16–2.00). In the ICS-withdrawal protocol including 2 RCTs, triple therapy also showed a significantly better QOL score and higher trough FEV1 than LAMA/LABA. Concerning the trough FEV1, QOL score and dyspnea score in both protocols, the differences were less than the minimal clinically important difference. Conclusion Triple therapy causes a higher incidence of pneumonia but is a more preferable treatment than LAMA/LABA due to the lower incidence of exacerbations, higher trough FEV1 and better QOL score. In addition, triple therapy is also superior to LABA/LAMA due to the lower mortality and better dyspnea score. However, these results should be only applied to patients with symptomatic moderate to severe COPD and a history of exacerbations. Clinical Trial Registration: PROSPERO; CRD42020191978.


2018 ◽  
Vol 21 ◽  
pp. S164
Author(s):  
F Gomez de la Rosa ◽  
J Alvis Zakzuk ◽  
N Alvis Guzman ◽  
DJ Moreno ◽  
M Rincon ◽  
...  

2018 ◽  
Vol 4 (1) ◽  
pp. 1-5
Author(s):  
Bhaktabatsal Raut ◽  
Shreedhar Acharya

INTRODUCTION: This study was conducted to analyze the medical and surgical methods of first trimester of pregnancy. MATERIAL AND METHODS: A hospital based retrospective study done at Lumbini Zonal Hospital, Butwal over the period of one year, where all the women who had first trimester abortion services were analyzed. Age, parity, education status, failure rates and post abortion contraception were analyzed.RESULTS: There were total of 478 women who had abortion services, of which 244 women had medical method of abortion. Among them 4.89% were teenagers and 11.29% were primigravida and 6.9% were uneducated. The failure rate for medical method was 9% and for surgical method was 1.7%. Most women at their post abortion period asked for condoms, followed by DMPA, IUD and OCP as a method of contraception.CONCLUSION: Failure rate of medical method was high and acceptance of long acting post abortion contraception was low.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, page: 1-5


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