This month’s featured editorials

Inviting the pharmacist: a model for improved reproductive care access
Don Downing
pages 2-4
On a Saturday afternoon in 1998, in a small town in Washington State, a 15-year-old young woman accompanied by her friend enters a local pharmacy and walks up to the counter. The tearful 15-year-old needs help and tells the pharmacist of being raped the night before. She expressed being too afraid to tell her parents, the police or her doctor. She decided to come to the pharmacy because it was “less scary” and she was aware that pharmacists in the state could prescribe emergency contraception. The pharmacist took the patient to a private counseling room, prescribed and provided her with emergency contraception, and gave her a glass of water to take the medication. After talking with the pharmacist, the patient agreed to have the pharmacist call a local Title X clinic where the pharmacist had a preexisting collaborative agreement; she was seen by clinicians there shortly thereafter. read more >

Controversies in family planning: management of second-trimester pregnancy terminations complicated by placenta accreta
Eva Lathrop, Courtney Schreiber
pages 5-8
The following case has come to the attention of our service: a 32-year-old, G2P1001, with a history of one cesarean section, presented at 17–18 weeks' gestation with preterm premature rupture of membranes (PPROM), heavy bleeding and a placenta previa highly suspicious for an accreta on MRI. She received 2 units of packed red cells upon admission to another service and is now in stable condition and in need of a termination of pregnancy. I am curious as to people's experiences and management strategies in these cases. Any thoughts or literature you can point us toward would be appreciated. read more >

Commentaries

Challenging the “insurance theory” of sexual and reproductive health behaviors
Caroline Moreau, James Trussell, Anna Glasier
pages 9-10
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Old barriers need not apply: opening doors for new contraceptives in the developing world
Elizabeth Greene, John Stanback
pages 11-14
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Review Article

Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review
Richdeep S. Gill, Dereck Mok, Matthew Hudson, Xinzhe Shi
pages 15-18
This systematic review highlights how advances in laparoscopic technique and skill have allowed surgeons to safely retrieve IUDs without laparotomy. We recommend an attempt at laparoscopic removal as first-line treatment in symptomatic patients and as a reasonable treatment option in asymptomatic patients.
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Original research articles

Continuous oral levonorgestrel/ethinyl estradiol for treating premenstrual dysphoric disorder
Uriel Halbreich, Ellen W. Freeman, Andrea J. Rapkin, Lee S. Cohen
pages 19-27
Background: The study was conducted to investigate continuous daily levonorgestrel 90 mcg/ethinyl estradiol 20 mcg (LNG/EE) on premenstrual dysphoric disorder (PMDD).
Conclusions: Continuous daily LNG 90 mcg/EE 20 mcg was well tolerated and may be useful for managing the physical, psychological and behavioral symptoms and loss of work productivity related to PMDD.
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Co-prescription of antiepileptic drugs and contraceptives
Hao Wang, Jens H.J. Bos, Lolkje T.W. de Jong-van den Berg
pages 28-31
Background: Enzyme-inducing antiepileptic drugs (AEDs) reduce the efficacy of oral contraceptives. Little is known of contraceptive practice among reproductive-age women who receive AEDs.
Conclusion: Fertile-age women who received AEDs often relied on less effective contraceptive methods. Prescribers should be more aware of the interaction between AEDs and OCs.
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A qualitative exploration of emergency contraception users' willingness to select the copper IUD
Rachel L. Wright, Caren J. Frost, David K. Turok
pages 32-35
Background: The copper T intrauterine device (IUD) is an effective but underutilized method of emergency contraception (EC). This study investigates the factors influencing a woman's decision around which method of EC to select.
Conclusions: Women think about contraception in the context of each separate relationship and not as a long-term individual plan. Most women were unaware of the copper IUD for EC. Furthermore, there is little discussion between women and their health-care providers around EC.
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Deterioration in cardiometabolic risk markers in obese women during depot medroxyprogesterone acetate use
Penina Segall-Gutierrez, Anny H. Xiang, Richard M. Watanabe, Enrique Trigo
pages 36-41
Background: Highly effective contraception is essential in obese women, but it should not increase their risk of developing or worsening obesity-related cardiometabolic illness. The purpose of this 18-week prospective experimental study was to compare the impact of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) on cardiometabolic markers in obese and normal-weight women.
Conclusion: Obese women have an increased baseline cardiometabolic risk when compared with normal-weight women at baseline. There was a significantly greater decline in β-cell compensation for insulin resistance in obese women on DMPA. Our data suggest potential deleterious effects of DMPA on glucose regulation in obese women. Further studies should elucidate the long-term cardiometabolic consequences of DMPA use in obese women.
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Folate status and homocysteine levels during a 24-week oral administration of a folate-containing oral contraceptive: a randomized, double-blind, active-controlled, parallel-group, US-based multicenter study
Stephan Bart, Joachim Marr, Konstanze Diefenbach, Dietmar Trummer
pages 42-50
Background: This study investigated the effects of adding levomefolate calcium 0.451 mg (the calcium salt of L-5-methyltetrahydrofolate; Metafolin^®) to an oral contraceptive containing ethinylestradiol (EE) 20 mcg/drospirenone (drsp) 3 mg on folate levels in healthy women seeking contraception.
Conclusions: Clinically significant increases in folate status were observed with EE/drsp/levomefolate calcium compared with EE/drsp alone in US women of childbearing age.
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Contraceptive discontinuation and repeat unintended pregnancy within 1 year after an abortion
Ushma D. Upadhyay, Beth A. Brown, Abby Sokoloff, Tina R. Raine
pages 56-62
Background: We examined 12-month hormonal contraceptive continuation and pregnancy rates by abortion history.
Conclusion: The experience of having an unintended pregnancy and abortion does not lead to behavioral changes that protect against another unintended pregnancy.
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Characteristics of women who undergo second-trimester abortion in the setting of a fetal anomaly
Jennifer L. Kerns, Megan Swanson, Sherri Pena, Danny Wu
pages 63-68
Background: Most women diagnosed with a fetal anomaly terminate the pregnancy. Little is known about utilization of two procedures: dilation and evacuation (D&E) and induction termination.
Conclusions: The D&E procedure was more commonly utilized for terminating an anomalous pregnancy at UCSF than medical induction. Further inquiry is needed to explore how provider counseling influences the choice of D&E vs. induction.
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Knowledge and beliefs about mechanism of action of birth control methods among European women
Cristina Lopez-del Burgo, Rafael T. Mikolajczyk, Alfonso Osorio, Silvia Carlos
pages 69-77
Background: Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women.
Conclusions: European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.
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A pilot study of women's knowledge of pregnancy health risks: implications for contraception
Anita L. Nelson, Azadeh Rezvan
pages 78-82
Background: This study was performed to assess women's knowledge of the health risks of pregnancy and how their assessment of pregnancy risks compared to their estimates of the risks of oral contraceptives.
Conclusions: This pilot project clearly demonstrates a need to assess women's understanding of the health hazards of pregnancy on a national level. Underestimation of pregnancy risks can lead to contraceptive method discontinuation, can decrease motivation to seek preconceptional care and can lead to greater medicolegal liability for providers of obstetrical care.
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Factors influencing partners' involvement in women's contraceptive services
Megan L. Kavanaugh, Laura D. Lindberg, Jennifer Frost
pages 83-90
Background: Involving women's partners in family planning services may be one avenue by which rates of unplanned pregnancies can be reduced.
Conclusions: In designing future couple-focused programs, clinics may need to focus on the interpersonal dynamics of couple-based decision-making and behaviors and tailor their programs given the characteristics of clients most likely to avail themselves of these services
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Reduction of the “burst release” of copper ions from copper-based intrauterine devices by organic inhibitors
Florencia Alvarez, Patricia L. Schilardi, Monica Fernández Lorenzo de Mele
pages 91-98
Background: The copper intrauterine device is a contraceptive method that is based on the release of copper ions from a copper wire. Immediately after insertion, the dissolution of copper in the uterine fluid is markedly higher (“burst release”) than that necessary for contraception action, leading to a variety of harmful effects.
Conclusions: It was concluded that 10−3 M PU pretreatment is a promising strategy able to reduce the “burst release” of copper and to ensure contraceptive action.
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Couples' acceptability of the SILCS diaphragm for microbicide delivery
Ron G. Frezieres, Terri Walsh, Maggie Kilbourne-Brook, Patricia S. Coffey
pages 99-107
Background: Disposable plastic applicators used in microbicide gel studies are expensive and have a negative environmental impact. The SILCS diaphragm is a barrier contraceptive that could offer a reusable delivery system.
Conclusions: In this study population, participants found the gel applicator to be more acceptable than either single- or double-sided gel delivery from a SILCS diaphragm. Further research of the SILCS as a microbicide delivery system should be implemented to assess its acceptability among study populations that reflect diverse potential user groups such as women and men from both low and high HIV prevalence settings including HIV-positive populations and with and without experience using female barrier methods.
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Prevalence of genital tract infection with Entamoeba gingivalis among copper T 380A intrauterine device users in Egypt
Ashraf A. Foda, Mohamed M. El-Malky
pages 108-112
Background: This study was performed to study the prevalence and potential pathogenicity of E. gingivalis in the genital tracts of intrauterine contraceptive device (IUD) users.
Conclusions: Higher incidence of E. gingivalis infection in IUD users is related to oral cavity infection, residence, the facility where they inserted their IUD and washing hands attitude before checking the strings. We recommend treatment of gingival infection, proper counseling and medical education on oral and genital tract hygiene for IUD users.
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Extended intervention time and evaluation of sperm suppression by dienogest plus testosterone undecanoate in male rat
Rekha Meena, Man Mohan Misro, Debidas Ghosh, Deoki Nandan
pages 113-121
Background: The potential of using dienogest [DNG, 40 mg/kg body weight (bw)] plus testosterone undecanoate (TU, 25 mg/kg bw) in rats for development of a once-a-month male hormonal contraceptive has been reported earlier in our laboratories.
Conclusions: Dienogest plus testosterone undecanoate in the above doses retained contraceptive effectiveness when administered every 45 days but not 60 days. The spermatogenic arrest was completely reversible once drug treatment is stopped. The dose and the frequency of intervention can be extrapolated in future clinical trials.
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Contraceptive efficacy and safety of HerbOshield™ vaginal gel in rats
Kamalinder K. Singh, Shruti Parmar, Pratima A. Tatke
pages 122-127
Background: Spermicides represent one of the methods of contraception. The synthetic agents available as spermicides produce severe side effects. Hence, there is a need to replace these agents with safe and effective agents such as plant-based contraceptive agents.
Conclusions: HerbOshield^™ vaginal gel was found to be safe and effective in rats and could be developed as a potential vaginal contraceptive for future use in humans.
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Letters to the Editor

To improve maternity care in the United States, think midwives
Julie D. Cantor
pages 128-129
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Response to letter to the editor regarding maternal mortality in the United States: a human rights failure
Debra Bingham, Nan Strauss, Francine Coeytaux
pages 129
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