This month’s featured editorial
Reproductive Coercion: Connecting The Dots Between Partner Violence and Unintended Pregnancy
pages 457-459
Reproductive health professionals are in a critical position to reach women victimized by abusive relationships. In the general population, physical and sexual violence victimization by an intimate partner affects an estimated one in four women across the life span, with one in five adolescent girls reporting such abuse. The prevalence of intimate partner violence reported among women utilizing sexual health services and seeking care in gynecologic and adolescent clinics is generally double these population-based estimates. This is not surprising, as such victimization is consistently associated with increased pregnancy and sexually transmitted infection (STI), with abused women demonstrating disproportionately higher rates of seeking care at family planning and other health services related to sexual health, such as HIV and STI testing.
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Commentary
Family planning: the essential link to achieving all eight Millennium Development Goals
Willard Cates
pages 460-461
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Clinical Guidelines
Induction of fetal demise before abortion: SFP Guideline 20101, Release date January 2010
Justin Diedrich, Eleanor Drey
pages 462-473
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Original Research articles
Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women
Carolyn L. Westhoff, Anupama H. Torgal, Elizabeth R. Mayeda, Malcolm C. Pike, Frank Z. Stanczyk
pages 474-480
Background: This study was conducted to compare oral contraceptive (OC) pharmacokinetics (PK) in normal-weight [body mass index (BMI) 19.0–24.9] and obese (BMI 30.0–39.9) women.
Conclusion: OC hormone peak levels are lower among obese women compared to normal-weight women, but their trough levels are similar. In this small study, the observed PK differences did not translate into more ovarian follicular activity among obese OC users.
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Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine system
Oskari Heikinheimo, Pirjo Inki, Michael Kunz, Sule Parmhed, Anna-Maija Anttila, Sven-Eric Olsson, Ritva Hurskainen, Kristina Gemzell-Danielsson
pages 481-486
Background: Misoprostol has been studied intensively to produce cervical dilatation. To date, no studies have evaluated the effectiveness, safety or acceptability of this treatment for repeat intrauterine device insertions.
Conclusion: Sublingual misoprostol did not have a significant effect on the ease of insertion in subjects having a repeat insertion of the LNG-IUS.
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Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously
Penina Segall-Gutierrez, DeShawn Taylor, Xinwen Liu, Frank Stanzcyk, Stanley Azen, Daniel R. Mishell
pages 487-495
Background: Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI ≥40 kg/m2). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC.
Conclusion: Fluctuating E2 levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.
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A nonhormonal model for emergency contraception: prostaglandin synthesis inhibitor effects on luteal function and lifespan, a pilot study
Alison B. Edelman, Jeffrey T. Jensen, Jon D. Hennebold
pages 496-500
Objectives: The purpose of this study is to determine if the use of a specific prostaglandin endoperoxide-2 inhibitor will prevent luteal development in women.
Conclusion: Daily administration of a prostaglandin synthesis inhibitor may delay the timing of luteal events and, therefore, fertility in women. PTGS2 inhibitors may hold potential as an emergency contraceptive.
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Long-term efficacy and safety of a monophasic combined oral contraceptive containing 0.02 mg ethinylestradiol and 2 mg chlormadinone acetate administered in a 24/4-day regimen
Cosima Brucker, Bernard Hedon, Hok Sien The, Kornelia Höschen, Natascha Binder, Annette Christoph
pages 501-509
Objective: This study was conducted to assess the long-term efficacy and safety of a low-dose monophasic combined oral contraceptive (COC) containing 0.02 mg ethinylestradiol (EE) and 2 mg chlormadinone acetate (CMA) in a novel regimen administered daily for 24 days followed by a 4-day placebo interval.
Conclusions: The low-dose COC 0.02 mg EE/2 mg CMA administered daily for 24 days followed by a 4-day placebo interval provides high contraceptive efficacy combined with an adequate cycle control and safety profile, beneficial effects on acne, and is well tolerated.
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Effect of etonogestrel implant on serum lipids, liver function tests and hemoglobin levels
Berna Dilbaz, Ozlem Ozdegirmenci, Eray Caliskan, Serdar Dilbaz, Ali Haberal
pages 510-514
Background: This study aimed to assess the possible effects of etonogestrel implant (Implanon®, Organon, Oss, The Netherlands) on total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Hb levels in a sample of Turkish population.
Conclusion: The effect of Implanon on liver functions and lipid metabolism does not lead to unhealthy alterations. Increase in Hb can be attributed to the high frequency of amenorrhea in patients.
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Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities
Renata Canteiro, M. Valeria Bahamondes, Arlete dos Santos Fernandes, Ximena Espejo-Arce, Nadia M. Marchi, Luis Bahamondes
pages 515-519
Background: In view of current controversies regarding the need for new, shorter intrauterine devices (IUDs) that would reduce expulsion rates in nulligravida, endometrial cavity length was measured in women of different parities using uterine sounding and ultrasonography.
Conclusions: By either technique, mean length of the endometrial cavity was >3.6 cm, the length of the most common IUDs, the TCu380A and the levonorgestrel-releasing intrauterine system. Therefore, the issue appears controversial for developing new, shorter IUDs, since current models fit most women, including nulligravida, albeit one third of the women of our sample showed endometrial length shorter than 3.2 cm.
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Improving hysterosalpingogram confirmatory test follow-up after Essure hysteroscopic sterilization
Maryam Guiahi, Kara N. Goldman, Margaret M. McElhinney, Christopher G. Olson
pages 520-524
Background: Given the need for a 90-day post-Essure hysterosalpingogram (HSG) to confirm proper tubal placement and occlusion, we examined the impact of dedicating a staff nurse to schedule HSG appointments, call with appointment reminders and track HSG compliance for patients who had Essure.
Conclusion: Dedicating a staff nurse to track patients' HSG follow-up as a multicheck system resulted in an improvement in HSG compliance and rates of confirmed tubal placement and occlusion.
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Obstetrician-gynecologist experiences with abortion training: physician insights from a qualitative study
Lori Freedman, Uta Landy, Jody Steinauer
pages 525-530
Background: Abortion is one of the most contested, yet common surgical procedures in the United States and a required component of obstetrics and gynecology resident education. Approaches to abortion training are variable.
Conclusions: Many physicians-in-training consider didactics related to the social context of care and respect for moral boundaries important components of abortion training.
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Future abortion provision among US graduating obstetrics and gynecology residents, 2004
Rebecca H. Allen, Christina Raker, Jody Steinauer, Katherine L. Eastwood, Jennifer E. Kacmar, Lori A. Boardman
pages 531-536
Background: This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice.
Conclusions: Intentions before residency to provide pregnancy termination services was the strongest predictor of future abortion provision.
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Benefits of using a digital video disk for providing information about abortion to women requesting termination of pregnancy
Rebecca Powell-Jackson, Anna Glasier, Sharon T. Cameron
pages 537-541
Background: A patient information digital video disk (DVD) on abortion was produced for use in a hospital abortion service (Scotland) for women requesting termination of pregnancy.
Conclusions: The DVD provided high-quality information for women requesting abortion and resulted in staff having more time to discuss patient concerns and contraception.
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Does bupivacaine in laparoscopic ports reduce postsurgery pain in tubal ligation by electrocoagulation? A randomized controlled trial
Ricardo F. Savaris, Lydia L. Chicar, Rafael S. Cristovam, Gisele S. Moraes, Oscar A. Miguel
pages 542-546
Background: Tubal ligation (TL) is the most popular method of permanent contraception. In order to reduce postoperative pain, different analgesic techniques have been proposed. The objective of this study was to compare the level of postoperative pain in patients submitted to TL with electrocoagulation, under general anesthesia, using bupivacaine infiltration vs. placebo in trocar ports.
Conclusion: The use of local injection of bupivacaine 0.5% in the trocar ports was not superior to placebo to reduce pain after laparoscopic TL with electrocoagulation under general anesthesia.
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Role of menstruation in contraceptive choice among HIV-infected women in Soweto, South Africa
Fatima Laher, Catherine S. Todd, Mark A. Stibich, Rebecca Phofa, Xoliswa Behane, Lerato Mohapi, Neil Martinson, Glenda Gray
pages 547-551
Background: Contraceptive preferences of HIV-infected women must be considered in efforts to integrate HIV and reproductive health services. In South Africa, contraception is often discontinued due to bleeding pattern changes. It is unknown whether HIV-infected women are more sensitive to menstrual changes and how this affects contraceptive choice. This study describes perceptions toward menses and contraceptive-induced amenorrhea among HIV-infected women.
Conclusion: In Soweto, HIV diagnosis may accentuate linking menstruation with health, leading to avoidance or discontinuation of methods causing amenorrhea. Providers should intensify education on the safety of contraceptive-induced oligo/amenorrhea.
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Letters to the Editor
Forgettable contraception
Mitchell D. Creinin
pages 552-553
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Response to Letter to the Editor
David A. Grimes
page 553
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Is there evidence to decrease the approved dose of 600 mg of mifepristone for medical abortion?
Michel Lièvre, Regine Sitruk-Ware
pages 553-554
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