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Contraception Journal
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Contraception Highlights August 2012

This month’s featured editorial

ARHP and SFP Salute Dr. Daniel R. Mishell, Jr., and His Editorial Team for Four Decades of Leadership
Susan Higginbotham, Wayne Shields
pages 91-92
Dr. Daniel R. Mishell, Jr., M.D., officially retires this December after 42 years as editor-in-chief of Contraception: An International Reproductive Health Journal. Adequately expressing our thanks to an individual so personally instrumental in the growth and recognition of our journal is truly a daunting task, but we will try nonetheless. read more >

Review Article

Controversies in family planning: management of lethal fetal anomalies in the third trimester
Jamila B. Perritt, Alison B. Edelman, Anne E. Burke
pages 93-95
The patient received one dose of misoprostol 200 mcg vaginally. Her cervix was completely dilated 12 h later. She had an epidural for pain control and delivered the fetus vaginally (frank breech/occiput anterior) without difficulty within 1 h. Fetal demise occurred during labor, and the tissue was soft enough to allow easy delivery of the head without any need for decompression. The placenta was delivered spontaneously with the fetus. There were no complications, and the patient was discharged home shortly afterwards. 
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Original research articles

Normalization of blood loss in women with heavy menstrual bleeding treated with an oral contraceptive containing estradiol valerate/dienogest
Ian S. Fraser, Jeffrey Jensen, Matthias Schaefers, Uwe Mellinger, Susanne Parke, Marco Serrani 
pages   96-101
Background: The study was conducted to assess the efficacy of estradiol valerate/dienogest (E2V/DNG) administered using an estrogen step-down and progestogen step-up approach in a 28-day regimen in the treatment of heavy menstrual bleeding (HMB) using clinical end points allowing E2V/DNG to be compared with other available medical therapies.
Conclusions: E2V/DNG is highly effective for the treatment of HMB and is associated with a high rate of treatment success.
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Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study
Erika Levi, Evelyn Cantillo, Veronica Ades, Erika Banks, Amitasrigowri Murthy
pages 102-105
Background: Immediate postplacental insertion of intrauterine devices (IUDs) during cesarean delivery could reduce a substantial barrier to access to long-term effective contraception. Initiating IUD use prior to discharge from the hospital postpartum eliminates a 6-week postpartum waiting period and an additional office visit.
Conclusions: Immediate postplacental IUD insertion at the time of cesarean delivery is safe and acceptable.
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Pelvic surgery and hospitalization among Chilean women after nonsurgical sterilization with quinacrine pellets between 1977 and 1989
Paul J. Feldblum, Angie Wheeless, Valentin Trujillo, Sergio Guzman,Vera Halpern, David C. Sokal
pages 106-109
Background: Concern about quinacrine lingers because of its carcinogenic effects in rats. We describe results of long-term follow-up of women who underwent quinacrine pellet sterilization in Chile between 1977 and 1989 (N=1492).
Conclusions: During long-term follow-up of women who received quinacrine pellets for nonsurgical sterilization, the incidence of noncancer adverse outcomes was not unusually high, and no alarming patterns emerged.
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Bleeding profile of a flexible extended regimen of ethinylestradiol/drospirenone in US women: an open-label, three-arm, active-controlled, multicenter study
Jeffrey T. Jensen, Sona Grossova Garie, Dietmar Trummer, Jörg Elliesen
pages 110-118
Background: Unscheduled bleeding may affect satisfaction and compliance with extended oral contraceptive (OC) regimens. The bleeding patterns of two variants of a flexible dosing regimen designed to manage intracyclic bleeding problems during extended cycles were compared with that of a conventional OC regimen.
Conclusion: A flexibleMIB dosing regimen of EE 20 mcg/drospirenone 3 mg is associated with good contraceptive efficacy and fewer bleeding/spotting days than the conventional 24/4 regimen.
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Does using tampons or menstrual cups increase early IUD expulsion rates?
Ellen R. Wiebe, Konia J. Trouton
pages 119-121
Background: Many intrauterine device (IUD) users utilize intravaginal menstrual cups or tampons during menses, but no studies have investigated the impact this practice may have on IUD expulsions.
Conclusions: From this study, there is no evidence that women who report using menstrual cups or tampons for menstrual protection had higher rates of early IUD expulsion.
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Contraceptive choices of overweight and obese women in a publically funded hospital: possible clinical implications 
Renata Scott-Ram, Julie Chor, Varija Bhogireddy, Louis Keith, Ashlesha Patel
pages 122-126
Background: Despite the growing obesity epidemic in the United States, family planning for overweight and obese women has been understudied. The aim of this study was to describe the contraception methods selected by normal weight, overweight and obese women.
Conclusion: In our population, the contraceptive choices of overweight and obese women differed from those of normal weight women. These differences in contraceptive selection are important to recognize in light of the potential effect of BMI on the safety and efficacy of different contraceptive methods. Further research is needed to evaluate the contraceptive preferences, risks and benefits for overweight and obese women.
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Practice makes perfect: reduction in female condom failures and user problems with short-term experience in a randomized trial 
Mags Beksinska, Jenni Smit, Carol Joanis, Catherine Hart
pages 127-131
Background: Female condom (FC) failure (breakage, slippage, invagination and misdirection) declines with user experience. Participants in FC performance trials are commonly novice users, and failure rates may be inflated related to inexperience.
Conclusions: FC failure rates decreased markedly after use of the first five condoms, regardless of FC type, and stabilized in the second and third use periods. Consideration should be given to the number of condoms used in trials to ensure that failure rates are not inflated by limiting the numbers of condoms used by novice users.
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Ethnic differences in factors associated with the use of contraception among 20- to 44-year-old women in Estonia and St. Petersburg, Russia 
Made Laanpere, Kaja Rahu, Kai Part, Tatiana Dubikaytis, Helle Karro
pages 132-140
Background: The aim of this study was to explore factors associated with contraception among 20- to 44-year-old women in different ethnic groups in two Eastern European countries.
Conclusions: The importance of different risk factors associated with contraceptive use varies between different ethnic groups. Cross-national comparisons are essential for the design of public health policies that decrease the burden of sexual ill health.
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Risk factors of surgical evacuation following second-trimester medical termination of pregnancy
Maarit Mentula, Oskari Heikinheimo
pages 141-146
Background: Second-trimester medical termination of pregnancy (TOP) is associated with a higher risk of surgical evacuation than earlier medical TOP. Little is known about risk factors of surgical evacuation. Therefore, we assessed these risk factors among women undergoing second-trimester medical TOP.
Conclusions: History of curettage, fetal indication, increasing age and 2-day interval between mifepristone and misoprostol increase the risk of surgical evacuation in cases of second-trimester medical TOP. These findings are important when optimizing clinical service in second-trimester TOP.
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Effects of parity and gestational age on second-trimester induction–abortion interval in combination with osmotic dilators and gemeprost
Kentaro Kai, Shinya Karakida, Michiharu Kono, Toshio Sasaki, Kazumi Togo, Akitoshi Tsuno, Yoshihiro Nishida, Hisashi Narahara
pages 147-152
Background: The true prognostic factors for induced medical abortion are unknown. We sought to investigate the effects of a patient's obstetric parameters on the induction–abortion interval in second-trimester medical abortion.
Conclusions: In combination with osmotic dilators and gemeprost, gestational age and parity are independent factors that affected the induction to abortion interval of second-trimester medical abortion.
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Contraception and abortion coverage: what do primary care physicians think?
Cynthia H. Chuang, Melissa E. Martenis, Sara M. Parisi, Rachel E. Delano,Mindy Sobota, Melissa Nothnagle, Eleanor Bimla Schwarz
pages 153-156
Background: Insurance coverage for family planning services has been a highly controversial element of the US health care reform debate. Whether primary care providers (PCPs) support public and private health insurance coverage for family planning services is unknown.
Conclusions: The majority of PCPs support health insurance coverage of contraception and abortion, as well as tax dollar subsidization of contraception and abortion services for low-income women.
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Music as an auxiliary analgesic during first trimester surgical abortion: a randomized controlled trial
Jacqueline M. Guerrero, Paula M. Castaño, Elizabeth O. Schmidt, Linette Rosario, Carolyn L. Westhoff
pages 157-162
Background: Music has served as an auxiliary analgesic in perioperative settings. This study evaluates the impact of intraoperative music added to routine pain control measures during first trimester surgical abortion.
Conclusions: Intraoperative music added to routine pain control measures increases pain reported during abortion.
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Complete sperm suppression induced by dienogest plus testosterone undecanoate is associated with down-regulation in the expression of upstream steroidogenic enzyme genes in rat testis
Rekha Meena, Man Mohan Misro, Debidas Ghosh, Deoki Nandan
pages 163-171
Background: We had shown that dienogest (DNG) + testosterone undecanoate (TU) induced complete sperm suppression in rats when administered together every 45 days. On the other hand, individual drugs given alone in a similar fashion failed to achieve the same result.
Conclusions: Taken together, the above findings corroborate the fact that regulation of expression of three of the upstream steroidogenic enzymes genes and the StAR protein in rat testis is crucial in leading to complete sperm suppression as observed with DNG+TU treatment.
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