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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
IUDs are highly effective methods of contraception. Unfortunately, less than 50% of women who express interest in an IUD postpartum actually receive one [216]. Immediate postpartum placement has been shown to be safe and allows women to access contraception during the maternity hospitalization, though it is associated with an increased risk of expulsion compared with delayed insertion [217, 218]. In an RCT of postplacental versus delayed insertion, women randomized to postplacental insertion were more likely to have a device inserted (98% versus 90.2%, p = 0.20). There were no differences between groups in IUD use at 6 months postpartum (84.3% versus 76.5%). However, among women who were ineligible for the study and were advised to follow up for IUD placement as part of routine postpartum care, only 26.8% were using an IUD at 6 months postpartum [219]. These results were confirmed in a more recent Cochrane review, with IUD use at 6 months twice as likely, though expulsion was four times more likely [220]. These results suggest that women undergoing postplacental placement are more likely to use an IUD than those advised to follow up for placement during routine postpartum care. Immediate postplacental IUD placement has been classified as category 1 or 2 by the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria for Contraceptive Use [221].
Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Substance use is an important component of the history in female patients seeking preconception counseling because fetal drug exposure is preventable. Patients with a positive history and/or laboratory testing for substance abuse should be counseled about the reproductive effects of the specific substances along with the risks and benefits of pharmacological and non-pharmacologic treatment. They should be encouraged to postpone conception until after initiating or completing drug treatment. Because of the reproductive risks of certain pharmacological treatments, reliable methods of contraception should be encouraged. Anovulatory cycles and infertility are more common in substance-abusing female patients, especially with opioid use; however, it should be stressed that pregnancy can definitely occur without adequate contraception. There is some evidence that pre-pregnancy health promotion is associated with a positive effect on maternal behavior change (specifically binge drinking) but more research is needed (see Obstetric Evidence Based Guidelines, Chapter 1) [16].
Family planning
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
The first major adverse effect of the pill was documented by a family doctor, W.M. Jordan (1962) of Suffolk, England, who reported the occurrence of thrombosis and embolism in a patient using Enovid as treatment for endometriosis. Soon afterwards, Boyce et al. (1963) reported thrombotic effects of Conovid. Further reports implicated the oral contraceptive with hypertension and alterations in blood lipid levels. It was discovered that the complications directly related to the quantity of both estrogen and progesterone. Low-dose formulations were produced that had very low complication rates and were safe to use. Studies revealed that the oral contraceptive also had beneficial side effects.
Pharmacies: an important source of contraception for some adolescents, but not a panacea for all
Published in Sexual and Reproductive Health Matters, 2023
Lianne Gonsalves, Asantesana Kamuyango, Venkatraman Chandra-Mouli
Today, pharmacies and drug shops are receiving renewed attention. In countries around the world over the last 20 years, short-acting methods such as emergency contraception and daily contraceptive pills have become more broadly available in pharmacies without a prescription from a doctor.7 Additionally, innovation in contraceptive technologies, for example, through the development of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) self-injectable contraception, has also helped broaden potential options for contraceptive users outside of a health facility. Finally, there has been growing enthusiasm within the SRHR community for self-care and task-sharing of contraceptive service provision to community distributors, pharmacy personnel, and users themselves.8 Attention to self-care interventions accelerated even more out of necessity in the height of the COVID-19 pandemic, when contraceptive services were paused, or deprioritised within many health systems.9,10
A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)
Published in Southern African Journal of Gynaecological Oncology, 2021
The categorical variables were categorised into three modalities (Yes/No/Unknown). Contraception use was further detailed into seven categories, namely, oral, injectables, intrauterine contraceptive devices (IUCD), barrier methods (condoms, diaphragm and cervical cap), implants, tubal ligation or others. Biopsy types were categorised into cervical punch biopsy, cone biopsy (conization) or large loop excision of the transformation zone (LLETZ). The standard list of descriptive colposcopy observations listed were acetowhite lesions, metaplasia, leukoplakia, mosaicism, punctation, abnormal blood vessels (ABN) and warty atypia. The outcome categories referred to the confirmed histopathology results, separated into four categories, namely, normal, CIN1 (LSIL), CIN2-3 (HSIL) or CC. The treatment types were separated into excisional (i.e. LLETZ, cold knife conization and hysterectomy) and ablative (i.e. cryotherapy and laser therapy).
Low barrier perinatal psychiatric care for patients with substance use disorder: meeting patients across the perinatal continuum where they are
Published in International Review of Psychiatry, 2021
Edwin R. Raffi, Jessica Gray, Nkechi Conteh, Martha Kane, Lee S. Cohen, Davida M. Schiff
Approximately 45% of all pregnancies in the US are reported as unplanned (Guttmacher Institute, 2019). This number rises significantly in patients with SUD’s, with as many as 80% of pregnancies among people with OUD being reported as unplanned (Terplan et al., 2015). Further, use of reliable and long-acting contraception among women with SUD is also lowered as compared to the general population. When prescribing medications to women of reproductive age, one should minimise polypharmacy and utilize medications with known reproductive safety profile to the extent possible. Family planning and discussions around contraception should also be considered routine; many postpartum patients might forget or not know about the possibility of becoming pregnant even when still breastfeeding. Prescribing should be non-punitive, harm-reductive, personalised, and tailored to patients’ needs. Past trials, patient preference, evidence-based care, and patient needs should be taken into consideration. An example of this is decision-making around the use of medications for patients with OUD and use of other controlled substances during pregnancy.