Peri-abortion contraceptive counseling: A systematic review of randomized controlled trials

Objective To assess the effects of peri-abortion contraceptive counseling interventions. Methods We performed a systematic review of randomized controlled trials (RCTs) that compared the effect of different types of peri-abortion contraceptive counseling interventions and were published as original papers in scientific journals. The literature search was performed in June 2021 in PubMed, Central Cochrane Library (CENTRAL), Scopus, and Google Scholar; without restrictions in language or publication date. Two independent authors identified studies that met the inclusion and exclusion criteria and extracted the data. The risk of bias was assessed using the Cochrane tool, and evidence certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Whenever possible, meta-analyses were performed. The protocol was registered at PROSPERO (CRD42020187354). Results Eleven RCTs were eligible for inclusion (published from 2004 to 2017), from which nine compared enhanced versus standard counseling. Pooled estimates showed that, compared to standard counseling, enhanced counseling was associated with a higher incidence of effective contraceptive use (>3 months) (relative risk [RR], 1.12; 95% confidence interval [CI], 1.09–1.16), although no significant difference was found in the incidence of long-acting reversible contraceptive use (RR, 1.25; 95% CI, 0.68–2.29), contraceptive uptake (RR, 1.06; 95% CI, 0.98–1.15), and obstetric event occurrence (RR, 0.91; 95% CI, 0.57–1.47). Certainty of evidence was very low for all outcomes. In addition, two studies compared contraceptive counseling provided by physicians versus that provided by non-physicians, which did not show significant differences. Conclusions Enhanced contraceptive counseling may favor effective contraceptive use but may not affect the rate of obstetric event occurrence. Also, the studies did not find a difference in the effects of counseling interventions given by different providers. Since evidence certainty was very low, future well-designed RCTs are needed to make informed decisions. Registration The study protocol was registered at PROSPERO (CRD42020187354).

Ectopic pregnancy with etonogestrel implant

The etonogestrel implant is the most effective contraceptive available. We report a case of ectopic pregnancy in a woman who had an etonogestrel implant inserted 15 months ago and the effective concentration of the implant was within normal limits.

PEMAHAMAN DAN DUKUNGAN SUAMI TERHADAP KEIKUTSERTAAN IBU MENJADI AKSEPTOR KB IUD DI KECAMATAN SECANGGANG LANGKAT

The decrease in TFR (Total Fertility Rate) will be closer to the condition of the population growing in balance, a strategy is needed in the implementation of the family planning program. Activities that can be carried out are promoting long-term effective contraceptive methods. This study aims to determine the understanding and support of husbands for the participation of mothers in becoming IUD KB acceptors in Secanggang District, Langkat Regency. The research design used in this study was an analytical survey with cross sectional approach. The sample in this study was 30 respondents who came and wanted to do family planning. The data analysis used was univariate and bivariate analysis. The results of this study indicate that there is a significant relationship between Husband's understanding of the participation of mothers in becoming IUD family planning acceptors in Secanggang District, Langkat Regency, with a pvalue of 0.000. And there is a significant relationship between the husband's support for the participation of mothers in becoming IUD family planning acceptors in Secanggang District, Langkat Regency with a p value of 0,000. It is hoped that it can increase respondents' knowledge about contraceptives so that they can support and understand their wives in choosing contraceptives. Keywords: Understanding, Support, IUD

An EFA of a revised Condom Fit and Feel Scale (CoFFee-R): Adding intimacy and pleasure

External condoms are an effective contraceptive and safe-sex practice when used properly. A focus on universal fit has produced a variety of latex, polyurethane, or polyisoprene condoms. However, researchers and manufacturers have given little attention to how condoms subjectively fit and feel for the user. Reece and colleagues (2007) developed the Condom Fit and Feel Scale in 2007 that focused on physical aspects of fit (e.g., loose along penis shaft). Yet, users’ perceptions of emotional intimacy and pleasurable sensations may also predict condom use. The original scale had items corresponding to one of five factors: Condoms Fit Fine, Condoms Feel Too Loose, Condoms Feel Too Tight, Condoms Are Too Long, and Condoms Are Too Short. We revised the measure to include a broader conceptualization of feel and to remove redundant items. This revised scale (CoFFee-R) was tested for its psychometric properties in a sample of 399 participants recruited through a university participant pool. After conducting parallel and exploratory factor analyses, we settled on a four-factor structure. Our resulting CoFFee-R scale contained 18 items with the following factors: Condom Fit, Condom Intimacy and Pleasure, Condom Big, Condom Small. The factor structure of the CoFFee-R accounted for 57.6% of the variance, with structure matrix loadings ranging from .54 to .99, and no cross-loadings above .33. We discuss benefits and uses of the CoFFee-R within a transtheoretical model of predicting condom-use. This study has implications for how researchers measure health behaviours, from the wording of items to the conceptualization of condom fit and feel.

Misplaced IUCD

The intra uterine device (IUD) is a popular family planning method worldwide. Some of the complications associated with the insertion of an IUD are well described in the literature. The frequency of IUD perforation is estimated to be between 0.05 & 1B per 1000 insertions. There are many reports of migrated intrauterine devices, but for fewer reports of IUDs which have penetrated into the rectum. Among the options available the multi-year cost of the copper T380A. IUD makes it one of the most cost-effective contraceptive options available. According to the World Health Organization Medical Eligibility Criteria, an IUCD can be inserted in the 48 hours postpartum, referred to here as Postpartum IUCD (PPIUCD), or after four weeks following a birth. With increased use of intra-uterine devices (IUDs) for contraception, an increase in the number of related problems are reported. A frequent clinical problem is the loss of filament at the external cervical os, the ‘lost tail’. The disappearance of the string or marker heralds potential problems such as retracted or turn off tail, misplacement within the cavity, intra-mural penetration or extra-uterine location.

Fetal proximal and distal limb anomalies following exposure to mycophenolate mofetil during pregnancy: A case report and review of the literature

Background Mycophenolate mofetil (MMF) is currently used in a wide spectrum of autoimmune diseases and has been rendered very effective in the management of systemic lupus erythematosus and lupus nephritis. MMF is known to be teratogenic (FDA category D) and therefore, women in childbearing period receiving MMF should be counselled to use effective contraceptive methods to avoid an unplanned pregnancy. Case A 22-year-old lady accidentally discovered to be pregnant while using MMF as a treatment of lupus nephritis which was replaced later on by azathioprine. After maternal and fetal evaluation, maternal lupus flare was confirmed and multiple fetal skeletal deformities associated with intrauterine growth restriction (IUGR) were diagnosed by 4-dimensional ultrasound. Termination of pregnancy was decided after shared decision making. Conclusion Women in childbearing period should be advised to postpone pregnancy for at least six weeks after stoppage of MMF therapy because of its potential teratogenic effects during pregnancy.

Adolescent pregnancy and current contraceptive use among adolescent and young women aged 16-24 years in Durban and Soweto, South Africa

Background High rates of adolescent pregnancies in South Africa continues to be a pressing public health concern. This study examines (1) the prevalence of current contraceptive use; and (2) the independent association between adolescent pregnancy and effective contraception use. Methods This study uses baseline cross-sectional data from a youth-centered sexual and reproductive health (SRH) cohort study among youth (aged 16–24) in Soweto and Durban (2011–2017). Among 207/253 females reporting consensual sexual activity, crude and adjusted logistic regression examine associations between ever having an adolescent pregnancy (aged 15–19) or pregnancy at age 20–24 (ref no pregnancy) and effective contraception use (barrier and/or hormonal methods) in the last 6 months. Results Over one-third (34.3%, n = 71) of females reported a history of adolescent pregnancy and 13.0% (n = 27) had a pregnancy at age 20–24. Nearly all (95.9%, n = 94) first pregnancies were unintentional. Current effective contraceptive use was reported by 74.6% (n = 53) with an adolescent pregnancy, 66.6% (n = 18) of those pregnant at 20–24 years, and 46.8% (n = 51) of never pregnant females (p < 0.001). All effective contraceptive users pregnant at 20–24 years and 83% (n = 44) of the adolescent pregnancy group reported using hormonal methods vs. 52.9% (n = 27) of never pregnant females. In the adjusted model, a history of adolescent pregnancy was associated with 3.45 (95%CI = 1.75–6.82) times greater odds of effective contraceptive use (vs. no pregnancy). Conclusion suggest that adolescent females are accessing effective methods of contraception including hormonal methods only after a pregnancy event, highlighting the need for earlier provision of youth-friendly SRH services.

Subfascial‐located contraceptive devices requiring surgical removal

Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.

KNOWLEDGE ,ACCEPTIBLITY AND COMPLIANCE OF DMPA IN TERTIARY CENTER OF BIHA

In India , a large proportion of women with an unmet need for contraception are within their rst year after childbirth. It is major obstacles for nation social and economic development. The present study concentrates to educate postpartum women for contraception and to study the acceptance and compliance of medroxyprogesterone acetate (DMPA) in Bihar women. METHODS: This is retrospective study with cross sectional data collection from 210 patients for a period of 14 month , from JANUARY 2019 TO FEBRUARY 2020. RESULTS: The study concluded that DMPA is highly effective contraceptive in the immeadiate post partum period with low failure rate .CONCLUSION: It should be available as a rst line method to all who wish to opt reversible method of contraception.

Perceptions and Experiences Regarding Vasectomy Among Vasectomized Men at Larterbiokorshie.

BackgroundVasectomy is an effective contraceptive method that has been approved worldwide and proven to be an effective method of contraception among males in the perspective of controlling a population. Although safer, simpler, less expensive and equally as effective as female sterilization, throughout the world, it is one of the least used and least known methods of contraception. It is perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. The study aimed at determining perceptions and experiences regarding vasectomy among vasectomized men at Larterbiokorshie. MethodsThis study adopted a qualitative method utilizing Phenomenological research design. The sample consisted of 18 vasectomized men selected through purposive sampling method. Face-face interviews were conducted with participants using a semi-structured interview guide. ResultsThe study discovered that the vasectomized men have a positive perception about vasectomy in terms of promoting couples sexual Health. Nevertheless, public perception regarding vasectomy was found to be poor. Socio-cultural and religious factors were also found to influence vasectomy uptake. In addition, several reasons were cited for motivating men regarding their decision on vasectomy and finally, participants shared their experiences following their vasectomy. ConclusionConclusively, despite all the misconceptions and concerns raised about vasectomy, the study revealed a positive perception among the vasectomized men. The study recommends that the government should formulate policies which will improve the utilization of vasectomy through ongoing monitoring and evaluation of services.