This month’s featured editorial

Maternal Mortality in the United States: A Human Rights Failure
Francine Coeytaux, Debra Bingham, Nan Strauss
pages 189-193
With 99% of maternal deaths occurring in developing countries, it is too often assumed that maternal mortality is not a problem in wealthier countries. Yet, statistics released in September of 2010 by the United Nations place the United States 50th in the world for maternal mortality — with maternal mortality ratios higher than almost all European countries, as well as several countries in Asia and the Middle East. more

Review Articles

Expanding medical abortion: can medical abortion be effectively provided without the routine use of ultrasound?
Bliss Kaneshiro, Alison Edelman, Robyn K. Sneeringer, Rodolfo Gomez Ponce de Leon
pages 194-201
Medical abortion studies have traditionally relied on ultrasound to confirm gestational age, intrauterine location and abortion completion. However, the routine dependence on ultrasound can limit access to safe services for women living in low resource settings that are often most in need of safe abortion care. This review discusses the literature surrounding the safe provision of medical abortion without the routine use of ultrasonography and concludes that clinicians can use the reported last menstrual period (LMP) and physical examination to reasonably estimate gestational age. Completed pregnancy expulsion can be confirmed primarily through history and physical examination with some studies indicating that urine pregnancy tests may also play a limited role. Central to the discussion of whether medical abortion can be provided in most low resource settings without the routine use of ultrasonography is the fact that the mifepristone–misoprostol regimen is a highly effective procedure for pregnancy termination through 63 days' gestation.
Read abstract
Login to read full article

The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users
Diana Mansour, Luis Bahamondes, Hilary Critchley, Philip Darney, Ian S. Fraser
pages 202-210
The aim of this guidance is to review the management of unacceptable vaginal bleeding patterns in etonogestrel (ENG)-releasing contraceptive implant users concentrating, where possible, on the evidence for pharmacological treatments and identifying a pragmatic approach where this is not possible.
Read abstract
Login to read full article

Original research articles

Levonorgestrel-releasing and copper intrauterine devices and the risk of breast cancer
Jürgen Dinger, Kristina Bardenheuer, Thai Do Minh
pages 211-217
Background: This study compares the risk of breast cancer for levonorgestrel-releasing intrauterine devices (LNGIUD) versus copper IUDs (CUIUD) in women younger than 50 years of age.
Conclusions: This study does not indicate an increased risk of breast cancer for users of LNGIUD. No indications for tumor promotion or tumor induction were found.
Read abstract
Login to read full article

The effect of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) and evaluating changes in BMD after discontinuation of DMPA in Chinese women of reproductive age
Ling Gai, Jinglu Zhang, Huizhen Zhang, Ping Gai, Li Zhou, Yonghong Liu
pages 218-222
Background: Depot medroxyprogesterone acetate (DMPA) as a hormonal contraceptive is highly effective and widely used, but it may reduce bone mineral density (BMD) and increase the risk of osteoporosis. We compared BMD between users of intramuscular DMPA and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA.
Conclusion: These results show that BMD declined during use of DMPA in women aged 25 to 40 years. Bone loss occurring with DMPA use is reversible after DMPA discontinuation.
Read abstract
Login to read full article

Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study
Rossella E. Nappi, Grazia Sances, Gianni Allais, Erica Terreno, Chiara Benedetto, Valentina Vaccaro, Franco Polatti, Fabio Facchinetti
pages 223-228
Background: Migraine with aura (MA) is a contraindication to the use of combined oral contraceptives (COCs) because of the increased risk of ischemic stroke. Progestogen-only contraceptive pill (POP) is a safe alternative to COCs and it is preferable in women with cerebrovascular diseases or risk factors for stroke.
Conclusions: The present study supports the use of the POP containing desogestrel in a population of women with MA and underlines a positive effect on symptoms of aura, especially in MA sensitive to previous use of COCs.
Read abstract
Login to read full article

Pregnane progestin contraception in systemic lupus erythematosus: a longitudinal study of 187 patients
Nathalie Chabbert-Buffet, Zahir Amoura, Pierre-Yves Scarabin, Camille Frances, Delphine P. Lévy, Lionel Galicier, Bertrand Wechsler, Olivier Blétry, Jean-Charles Piette, Anne Gompel
pages 229-237
Background: Systemic lupus erythematosus (SLE) affects women of child-bearing age. Combined oral contraceptives can worsen the course and increase the risk of thrombosis. The objectives of this study were to provide an alternative contraception and thus evaluate the gynecological tolerability of pregnane progestins (PPs) in SLE patients. Systemic lupus erythematosus disease activity and vascular tolerance were also reported.
Conclusion: Pregnane progestin contraception is effective and well tolerated, thus providing SLE patients an excellent contraceptive alternative to the currently used methods.
Read abstract
Login to read full article

Postpartum contraception: needs vs. reality
Ariella B. Glazer, Abigail Wolf, Nicolle Gorby
pages 238-241
Background: The postpartum time is a unique time to address patient's contraceptive needs and provide education. There are little data to suggest the best approach to provide information about contraception after delivery.
Conclusions: Prenatal visits and postpartum contact with providers create an opportunity to discuss family planning and contraception and most patients report receiving counseling. However, significantly fewer reported continued contraceptive use at 4–6 months postpartum. Initiation of postplacental IUD placement would be acceptable and would increase contraceptive use at 6 months postpartum.
Read abstract
Login to read full article

Levonorgestrel-releasing intrauterine system for the management of heavy menstrual bleeding in women with inherited bleeding disorders: long-term follow-up
Claudia Chi, Farah Y. Huq, Rezan A. Kadir
pages 242-247
Background: There are currently limited data on the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the management of heavy menstrual bleeding (HMB) in women with inherited bleeding disorders (IBDs) particularly on its long-term (>12 months) efficacy.
Conclusion: The LNG-IUS appears to be an effective long-term treatment for HMB in women with IBDs.
Read abstract
Login to read full article

Three new female condoms: which do South-African women prefer?
Carol Joanis, Mags Beksinska, Catherine Hart, Katie Tweedy, Jabu Linda, Jenni Smit
pages 248-254
Background: The widespread distribution of female condoms (FCs) in developing countries has been hindered by high unit cost, making new less expensive devices a priority for donor agencies.
Conclusions: Three new FC types functioned similarly and were generally acceptable. Most participants preferred WC and FC2 over V-Amour, and WC was preferred over FC2 in several acceptability measures.
Read abstract
Login to read full article

Study on the mechanical properties of Cu/LDPE composite IUDs
Ying Tang, Xianping Xia, Yun Wang, Changsheng Xie
pages 255-262
Background: The copper/low-density polyethylene composite (Cu/LDPE composite) intrauterine devices (IUDs), which can eliminate or lessen the side effects of existing IUDs, have been developed in our laboratory. As a novel type of copper-containing IUDs, it is not clear whether the mechanical properties of the Cu/LDPE composite IUDs can meet the need of clinical use or not. Therefore, the mechanical properties of the Cu/LDPE composite IUDs have been studied in the present article.
Conclusions: The content and size of the copper particles have significant effect on the mechanical properties of Cu/LDPE composite IUDs. The mechanical properties of both the Cu/LDPE microcomposite IUDs and the Cu/LDPE nanocomposite IUDs with 25 wt.% of copper particles were superior to that of existing copper-containing IUDs, indicating that the novel Cu/LDPE composite IUDs can satisfy the requirement of mechanical properties in clinical application.
Read abstract
Login to read full article

Exploration of a new procedure for sterilization by intrauterine instillation of a methylcellulose gel
Elizabeth G. Raymond, Parvati Ramchandani, Alka Shaunik, Anja Lendvay, David Sokal, Kurt T. Barnhart
pages 263-267
Background: Our goal was to evaluate a new gel and procedure for non-surgical sterilization.
Conclusions: This study did not identify a gel and insertion procedure that would reliably provide exposure of both fallopian tubes to a sclerosing agent for more than a brief period of time.
Read abstract
Login to read full abstract

Social support in the post-abortion recovery room: evidence from patients, support persons and nurses in a Vancouver clinic
Mariana B. Veiga, Melanie Lam, Carla Gemeinhardt, Edwina Houlihan, Brian P. Fitzsimmons, Zoë G. Hodgson
pages 268-273
Background: The benefits of social support in post-surgical recovery are well documented; social support decreases preoperative stress and postoperative recovery time. However, a paucity of studies have examined the effect of social support in the context of pregnancy termination. This study is the first to examine the effect of postoperative accompaniment from the patient, support person and nurses' perspective.
Conclusions: In summary, the presence of a support person in the PAR was perceived in a positive manner by patients and support people. However, the reasoning behind the negative opinion of nurses requires further study before PAR accompaniment can be considered a possibility in the context of pregnancy termination.
Read abstract
Login to read full article

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion
Elizabeth Miller, Michele R. Decker, Heather L. McCauley, Daniel J. Tancredi, Rebecca R. Levenson, Jeffrey Waldman, Phyllis Schoenwald, Jay G. Silverman
pages 274-280
Background: This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.
Conclusion: Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.
Read abstract
Login to read full abstract

Case Report

Ectopic pregnancy after levonorgestrel emergency contraception
Zoltan Kozinszky, Ragnhild Tøsse Bakken, Marit Lieng
pages 281-283
Background: Although the possibility of ectopic pregnancy after intake of levonorgestrel (LNG) as an emergency contraceptive (EE) pill is well-known, the causality has not been well established.
Conclusion: The possible role of 1.5-mg LNG EE in causing ectopic pregnancy is discussed. A high serum LNG concentration decreases ciliary activity and tube motility, but further epidemiological studies are necessary to establish the risk of ectopic pregnancy following intake of LNG EE.
Read abstract
Login to read full abstract