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Commentary
Abortion jabberwocky: the need for better terminology
David A. Grimes, Gretchen Stuart
pages 93-96
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Original research articles
Mifepristone¨Cmisoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval
Olga G¨®mez, Aina Borr¨¢s, Aintzane Rabanal, Montse Palacio, Antonia Carceller, Oriol Coll, Eduard Gratac¨®s
pages 97-101
Background: This study was conducted to explore the effect of gestational age (GA) on the induction-to-abortion interval of mifepristone¨Cmisoprostol midtrimester termination of pregnancy (TOP) regimen.
Conclusions: The mean induction-to-abortion interval increases by 4 h after 20 weeks GA. This information may be relevant for counseling and planning of the procedure.
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Effect of a continuous regimen of contraceptive combination of ethinylestradiol and drospirenone on lipid, carbohydrate and coagulation profiles
Rog¨¦rio Bonassi Machado, Nilson Roberto de Melo, Hugo Maia, Achilles Machado Cruz
pages 102-106
Background: The objective of this study was to evaluate the effects of a contraceptive pill containing ethinylestradiol (30 mcg) and drospirenone (3 mg) in a continuous regimen on lipid, carbohydrate and coagulation parameters.
Conclusions: The contraceptive combination of ethinylestradiol and drospirenone used in a continuous regimen was associated with metabolic alterations similar to those found during the traditional cyclic regimen of oral contraceptive use.
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Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive
M¨¢rcia Pantoja, Tatiane Medeiros, Maria Carolina Baccarin, Sirlei Siani Morais, Luis Bahamondes, Arlete Maria dos Santos Fernandes
pages 107-111
Background: Weight gain is a frequent reason for discontinuing the contraceptive with depot-medroxyprogesterone acetate (DMPA).
Conclusions: Normal and overweight women increased BMI with DMPA use; however, obese women did not increase weight. Weight increase in DMPA users could be associated with metabolic alterations related to duration of use in normal and overweight women and to alterations already present in obese women. Prospective studies are required to determine triggering factors. DMPA use ¡Ü3 years was not associated with weight increase in women with BMI (kg/m 2) ¡Ý30.
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Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes
Tessa Madden, Jenifer E. Allsworth, Katherine J. Hladky, Gina M. Secura, Jeffrey F. Peipert
pages 112-116
Background: Many obstacles to intrauterine contraception (IUC) use exist, including provider and patient misinformation, high upfront cost and clinician practice patterns. The aim of our study was to investigate knowledge and attitudes about IUC among obstetricians and gynecologists in the area of Saint Louis.
Conclusions: Physician misconceptions about the risks of IUC continue to occur. Improved clinician education is greatly needed to facilitate the use of these highly effective, long-acting, reversible methods of contraception.
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Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue
Rodrigo Alves Ferreira, Carolina Sales Vieira, J¨²lio C¨¦sar Rosa-e-Silva, Ana Carolina J. S¨¢ Rosa-e-Silva, Antonio A. Nogueira, Rui A. Ferriani
pages 117-122
Background: The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6 months of treatment.
Conclusions: This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS, but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.
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Intrauterine contraception for adolescents aged 14¨C18 years: a multicenter randomized pilot study of Levonorgestrel-releasing intrauterine system compared to the Copper T 380A
Emily M. Godfrey, Lisa M. Memmel, Amy Neustadt, Megha Shah, Antonia Nicosia, Mydhili Moorthie, Melissa Gilliam
pages 123-127
Background: Intrauterine contraception can provide adolescents with effective, long-term contraception as well as with other health benefits. In adult populations, intrauterine contraception rates highly in patient satisfaction and safety. It is rarely prescribed to adolescents because of limited data.
Conclusions: This study shows that at 6 months, though not statistically significant, adolescent continuation rates trended towards being greater with the Levonorgestrel Intrauterine System compared to the Copper T 380A. These pilot data will be helpful in the design of a larger trial of intrauterine contraception use among adolescents.
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There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception
Rachel Johnson, Montsine Nshom, Andrea M. Nye, Alwyn T. Cohall
pages 128-132
Background: It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention.
Conclusion: Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.
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Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica
Dawn S. Chin-Quee, Maxine Wedderburn, Conrad Otterness, Barbara Janowitz, Mario Chen-Mok
pages 133-139
Background: Emergency contraception research has shifted from examining the public health effects of increasing access to emergency contraceptive pills (ECPs) to bridging ECP users to a regular contraceptive method as a way of decreasing unintended pregnancies.
Conclusions: The discount coupon intervention was not successful. Although a small proportion of ECP users did bridge, the coupon did not affect the decision to adopt a regular contraceptive method. The study highlighted the need for bridging strategies to consider women's reproductive and sexual behaviors, as well as their context. However, in countries like Jamaica where HIV/AIDS is of concern and condom use is appropriately high, bridging may not be an optimal strategy.
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Assessment of a disposable trocar for insertion of contraceptive implants
Markus J. Steiner, Tania Boler, George Obhai, David Hubacher
pages 140-142
Background: Reusable stainless steel trocars have traditionally been used to insert levonorgestrel-releasing contraceptive implants, yet they are cumbersome to maintain because of sterilization requirements. In addition, sterilization equipment is not always available in many settings and inadequate cleaning could lead to HIV transmission.
Conclusions: Disposable trocars eliminate the need for sterilization; this will facilitate provision of contraceptive implants in resource-constrained settings and may decrease the risk of HIV transmission. Combined with recent reduction in prices of implants, these new developments should increase access to this important contraceptive technology in many parts of the world
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Feasibility of telephone follow-up after medical abortion
Lisa K. Perriera, Matthew F. Reeves, Beatrice A. Chen, Heather L. Hohmann, Jennifer Hayes, Mitchell D. Creinin
pages 143-149
Background: This study was conducted to assess the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing as a primary method of follow-up after medical abortion.
Conclusion: Telephone follow-up combined with urine pregnancy testing after medical abortion is a feasible alternative to routine ultrasonography or serial serum hCG measurements.
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Early molar pregnancy: experience in a large abortion service
Maureen Paul, Suzan Goodman, Juan Felix, Rebekah Lewis, Mitchel Hawkins, Eleanor Drey
pages 150-156
Background: With 1.1 million US women having first-trimester abortions annually, clinicians have an opportunity to diagnose molar pregnancy early. Early moles, however, may lack ¡°classic¡± diagnostic hallmarks.
Conclusions: Improved, cost-effective strategies for detection of early moles would benefit patients and providers.
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The effect of phloroglucinol on pain in first-trimester surgical abortion: a double-blind randomized controlled study
Yaling Zhuang, Xiufang Zhu, Li-Li Huang
pages 157-160
Background: First-trimester surgical abortion is a common procedure. Pain control during this procedure is still an unsolved problem.
Conclusion: The use of this dose of phloroglucinol, during first-trimester abortion by suction evacuation under local anesthesia with lidocaine, did not relieve pain, but caused no side effects.
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Buccal misoprostol for cervical ripening prior to first trimester abortion
Hemang B. Panchal, Emily M. Godfrey, Ashlesha Patel
pages 161-164
Background: Cervical priming prior to uterine suction evacuation softens the cervix and lessens the force needed for dilation, thereby potentially reducing the probability of procedural complications. The use of buccal misoprostol has been shown to be an adequate cervical primer in second trimester surgical procedures, but its use in first trimester aspiration procedures is not well documented. Our objective was to assess the necessity of manual dilation of the cervix when buccal misoprostol is used for cervical priming prior to first trimester uterine aspiration procedures.
Conclusion: Buccal misoprostol appeared to decrease our need for manual dilation prior to first trimester aspiration abortion. Earlier gestations and parous patients showed less need for manual dilitation than later gestations or nulliparous women. A larger study with a control group is needed to confirm the benefit of the use of buccal misoprostol in first trimester aspiration abortion.
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Evaluation of the phosphodiesterase 3 inhibitor ORG 9935 as a contraceptive in female macaques: initial trials
Jeffrey T. Jensen, Richard L. Stouffer, Jessica E. Stanley, Mary B. Zelinski
pages 165-171
Background: The study was conducted to determine whether a phosphodiesterase (PDE) 3 inhibitor has potential as a novel contraceptive in primates.
Conclusions: These results demonstrate that ORG 9935 may prevent pregnancy in primates at serum concentrations above 300 nmol/L and that the effect is reversible.
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Letters to the Editor
Commentary ¡ª A historical note on the development of the frameless IUD
Dirk Wildemeersch, Amaury Andrade
pages 172-173
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Meta-analysis of 200 or 600 mg mifepristone in association with two prostaglandins for termination of early pregnancy
Michel Li¨¨vre, Regine Sitruk-Ware
pages 173-174
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Caitlin Shannon, Beverly Winikoff
pages 174-175
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BMI and OCP failure
Susan Richman
page 175
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Response to Letter to the Editor by Susan Richman regarding Burkman RT, et al. Contraception 2009;79:424¨C7
Ronald T. Burkman
page 175
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Letter in response to the article ¡°Accuracy of information given by Los Angeles County pharmacies about emergency contraception to sham patient in need¡±
Belle Taylor-McGhee
pages 175-176
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Letter to the Editor in response to Belle Taylor-McGhee
Anita L. Nelson
page 176
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