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Pulmonary Hypertension in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
All patients with a diagnosis of pulmonary hypertension should be counseled against pregnancy. A discussion of the contraceptive options should take place and preferably implemented prior to the patient's discharge to home. Common options are briefly reviewed (see Chapter 5). Long-acting reversible contraceptive (LARC) methods, such as intrauterine devices or subdermal hormonal implants, and permanent sterilization may be the most appropriate options with the lowest maternal risks.Permanent sterilization at time of cesarean delivery (if indicated).Estrogen-containing contraception is not recommended because of the increased risk of venous thromboembolic events (Medical Eligibility Criteria Category 4) [33]. In addition, exogenous estrogens may contribute to the pathogenesis of pulmonary hypertension [17].Progestin-only pills are not contraindicated, however have a relatively high “typical use” failure rate and are therefore are not an ideal choice.Injectable progestins (depo-provera) are Medical Eligibility Criteria Category 1 and therefore acceptable, although some evidence suggests risk of thrombotic events may be increased [17,33].
Contraception Across the Reproductive Life-Course
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
By the mid-1960s intrauterine devices (IUDs) began to enter the market. The earliest types, such as the Lippes loop, were made of inert materials. Copper-releasing devices were introduced in the 1970s and hormonal devices in the 1990s. IUDs suffered a significant set-back in the 1970s and 1980s due to a device called the Dalkon Shield whose unsealed multifilament thread was prone to harbour bacteria that could cause dangerous pelvic infections and even deaths (Christian, 1974). This resulted in mass class-action lawsuits and the eventual bankruptcy of the company that manufactured the device. Today, regulatory authorities across the world require large-scale multinational trials of new contraceptives. These have led to renewed recognition of the effectiveness of Long Acting Reversible Contraception (LARC) methods, which include IUDs as well as the contraceptive implants introduced in the early 2000s. Much of the evidence for the benefits of LARC comes from the CHOICE project (Secura, Allsworth, Madden, Mullersman, & Peipert, 2010) in the city of St. Louis (in the US) where the provision of free IUDs and implants to women aged 14–45 resulted in a significant reduction of adolescent pregnancy and abortion rates (Peipert, Madden, Allsworth, & Secura, 2012; Washington University Dept. of Obstetrics and Gynecology, n.d.). Increased access to LARC also played a significant role in the success of a multipronged ten-year strategy to reduce adolescent pregnancy in the UK (Hadley, Ingham, & Chandra-Mouli, 2016).
Adolescent pregnancy
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Shirley M. Dong, Emily K. Redman, Tia M. Melton, Joseph S. Sanfilippo
The U.S. adolescent birth rate overall decreased from 61.8/1000 in 1991 to 41.4/1000 in 2004. In 2017, the adolescent birth rate in females age 15–19 years continued to decrease to 18.8/1000 (Figure 20.2). While the decrease in the adolescent birth rate is promising, the rate in the United States continues to be higher than other developed countries, including the United Kingdom and Canada.11 The trend is a reflection of better education at all levels, access to contraception, and more recently, utilization of long-acting reversible contraception (LARC), including intrauterine devices and implants.2,10 To date, a number of predictors for teen pregnancy exist. These include early pubertal development, sexual abuse history, poverty, lack of attentive and nurturing parents, and cultural and family patterns that include substance abuse, poor school performance, and dropping out of school (Table 20.1).7,14,15
Long-Acting Reversible Contraceptive Users’ Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey
Published in International Journal of Sexual Health, 2021
Tsung-chieh Fu, Debby Herbenick, Brian M. Dodge, Jonathon J. Beckmeyer, Devon J. Hensel
The right to choose if and when to become pregnant has been identified by the World Association for Sexual Health as a sexual right (World Association for Sexual Health, 2014); it is also a key tenet of reproductive justice, which has been described as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities” (Sister Song, n.d.). Long-acting reversible contraceptive (LARC) methods, which include intrauterine devices (IUDs) and subdermal hormonal implants, are highly efficacious means for pregnancy prevention and are thus valuable tools for sexual health promotion (Harper et al., 2015; Winner et al., 2012). LARC methods do not depend on user compliance in contrast, for example, to individuals having to remember to take daily hormonal contraceptive pills or to those whose partner attempts to sabotage their contraceptive use (Grimes, 2009; Sherin & Waters, 2019). Consequently, LARC effectiveness in preventing pregnancy is greater than 99% for both perfect and typical use (Winner et al., 2012), making them important tools for supporting sexual health and sexual rights, as well as reducing costs associated with unintended pregnancies and abortions (Blumenthal et al., 2011; Foster et al., 2009; Trussell et al., 1995, 2013).
The inclusion of sexual and reproductive health services within universal health care through intentional design
Published in Sexual and Reproductive Health Matters, 2020
Gabrielle Appleford, Saumya RamaRao, Ben Bellows
The SRH community may conflate SRH inclusion in benefits packages with choice. However, this may not account for user preference in specific types of outlets or differential requirements for different services. For example, for family planning, non-clinical outlets, such as pharmacies or shops, may be preferred by some users, who desire methods such as condoms and emergency contraception that do not require visiting a medical facility21 and prefer a more anonymous, less interpersonal transaction. Long-acting reversible contraception (LARCs) on the other hand may benefit from explicit inclusion in a benefits package, given that these methods require a clinical setting and have additional competency and consumable requirements for their delivery. These differences may not be reflected within the global SRHR community, which may advocate for equal treatment of all family planning methods within benefits packages, without a more nuanced view of requirements. Similarly, CSE, although an essential health promotive intervention, may not need to be included in a health benefits package. CSE could be offered through alternative means including social media and non-health sectors such as education and youth and development.
Exploring college students’ sexual and reproductive health literacy
Published in Journal of American College Health, 2020
Cheryl A. Vamos, Erika L. Thompson, Rachel G. Logan, Stacey B. Griner, Karen M. Perrin, Laura K. Merrell, Ellen M. Daley
Lifestyle was also an important consideration for whether information about preventing pregnancy was applicable to them. Specifically, participants recognized that it was important to match the type of contraceptive to one’s daily routine. For instance, some contraception may need to be taken daily, compared to a long-acting reversible contraceptive (LARC) method, such as an intrauterine device (IUD) or implant, which requires a one-time provider insertion or removal visit. Participants explained how college students often have many competing demands and little consistency within their daily schedules, making the responsibility of remembering to take a daily oral contraceptive challenging. Another consideration discussed was whether a person wanted to use contraception to suppress their menstrual cycle.If we go back to evaluating not just cost, but also like if it's birth control, how easy or hard it is to take – if it's something…where I have to take it every day at the same time, that might be harder if you're a college student who is possibly working or has classes at different times every day. (FG 4, Female 6)