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Contraception Journal
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Contraception Highlights March 2017

Commentary

Tubal contraception and ovarian cancer risk: a global view
Rebecca L. Callahan, Gregory S. Kopf, Jerome F. Strauss III, Shelley S. Tworoger
A recently released report from the National Academies of Sciences, Engineering, and Medicine on the current state of ovarian cancer research and care concludes that this disease is a constellation of different subtypes with distinct developmental origins. The report summarizes emerging evidence that most ovarian cancers arise from the female reproductive tract, not the ovaries per se, and spread to the ovary. This realization has changed thinking about screening and early detection, risk factors, and most importantly preventive measures, especially in women known to be at higher risk (e.g., carriers of germline BRCA1/2 mutations). Given our interests to bring forward new contraceptive methods for both the developing and developed world, this report has motivated us to consider the public health implications of tubal contraception with respect to new insights about ovarian cancers.
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Original Research Articles

Patient-provider conversations about sterilization: A qualitative analysis Katrina Kimport, Christine Dehlendorf, Sonya Borrero
Objectives: Although female sterilization is the second most commonly used contraceptive method in the US, research suggests that providers may serve as barriers to desired sterilization.
Implications: Clinicians often fail to discuss sterilization as a contraceptive option with potentially appropriate candidates and, when they do, often discourage its selection. Clinicians should consider assessing reproductive intentions to ensure that potentially relevant methods are included in counseling.
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Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy
Alexandra Albanese, Maureen French, Dana R. Gossett
Objective: Female sterilization is one of the most prevalent methods of contraception in the United States. Prior studies have shown that nearly half of postpartum tubal ligation (PPTL) requests go unfulfilled. This study seeks to establish whether obstetric or medical risk status influences patients' request for or subsequent completion of PPTL.
Implications: Though women with high-risk pregnancies were more likely to request PPTL, they were not more likely to complete the procedure. Providers should consider these procedures urgent, especially in high-risk women, and advocate for their patients' access to this procedure.
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Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial
Emily N. Schneider, Regan Riley, Eve Espey, Shiraz I. Mishra, Rameet H. Singh
Objectives: To evaluate whether inhaled nitrous oxide with oxygen (N2O/O2) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization.
Implications: Given its safety and favorable side effect profile, N2O/O2 can be used for pain management for in-office hysteroscopic sterilization and adds a safe, easily administered option to currently available strategies.
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Factors associated with short interpregnancy interval in women who plan postpartum LARC: a retrospective study
Clare Harney, Annie Dude, Sadia Haider
Objectives: Pregnancies conceived after a short interpregnancy interval (IPI), within 18 months of delivery, and unintended pregnancies are both associated with health risks. We studied risk factors for conception after a short IPI among postpartum women who plan long-acting reversible contraception (LARC
Implications: Efforts to decrease unintended pregnancy after a short IPI should focus on decreasing barriers to planned postpartum LARC. Provision of temporary bridge contraception until interval LARC may not mitigate the significant barriers associated with interval postpartum placement protocols.
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Effect of cervical lidocaine–prilocaine cream on pain perception during copper T380A intrauterine device insertion among parous women: A randomized double-blind controlled trial
Ahmed M. Abbas, Mohamed S. Abdellah, Mohamed Khalaf, Mustafa Bahloul, Noura H. Abdellah, Mohamed K. Ali, Ahmed M. Abdelmagied
Objective: The objective was to investigate the analgesic effect of cervical lidocaine–prilocaine (LP) cream in alleviating pain during copper T380A intrauterine device (IUD) insertion among parous women.
Implications: Cervical LP cream could be effective as an analgesic prior to copper T380A IUD insertion with no side effects. Further studies are needed to assess the women's satisfaction from lying with a speculum in place for 7 min while waiting for the cream to be effective.
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Intrauterine contraception after medical abortion: factors affecting success of early insertion
Elina Pohjoranta, Satu Suhonen, Maarit Mentula, Oskari Heikinheimo
Objective: To assess the success and factors affecting early intrauterine device (IUD) provision after first trimester medical termination of pregnancy (MTOP).

Implications: Early insertion following MTOP is safe, and the rate of IUD expulsion is low. Most adverse events possibly delaying IUD insertion occur early. Based on timing of adverse events in the control group, IUD insertion at approximately 2 weeks after completed MTOP seems optimal.
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Serum human chorionic gonadotropin (hCG) trend within the first few days after medical abortion: a prospective study
Katherine D. Pocius, Deborah Bartz, Rie Maurer, Asha Stenquist, Jennifer Fortin, Alisa B. Goldberg
Objectives: To prospectively describe the decline in serum human chorionic gonadotropin (hCG) in the first 5 days after complete medical abortion and evaluate the influence of initial hCG and gestational duration.
Implications: For women who require confirmation of complete abortion sooner than 1 week after mifepristone, due to patient preference, logistical constraints or in the setting of pregnancy of unconfirmed location, a single repeat hCG on Day 5 may be clinically useful.
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Measuring decisional certainty among women seeking abortion
Lauren J. Ralph, Diana Greene Foster, Katrina Kimport, David Turok, Sarah C.M. Roberts
Objective: Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft–Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy.
Implications: The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.
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Correlates of contraceptive use 4 months postabortion: findings from a prospective study in Bangladesh
Erin Pearson, Kamal Kanti Biswas, Kathryn L. Andersen, Caroline Moreau, Rezwana Chowdhury, Sharmin Sultana, S.M. Shahidullah, Pamela J. Surkan, Michele R. Decker
Objectives: Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels.
Implications: Postabortion contraceptive counseling should assess previous use patterns and provide information on using contraception effectively. Delayed initiation among women reporting IPV could be addressed through comprehensive, confidential counseling that includes violence screening, support for contraceptive initiation and offer of woman-controlled methods.
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Deep sedation without intubation during second trimester surgical termination in an inpatient hospital setting
Abigail C Mancuso, Kelsey Lee, Ran Zhang, Elizabeth A Hoover, Colleen Stockdale, Abbey J Hardy-Fairbanks
Objectives: Safety of outpatient dilation and evacuations with intravenous (iv) sedation without intubation has been demonstrated, but there is a paucity of data on deep iv sedation on an inpatient second trimester surgical termination population. The purpose of this study is to evaluate complications of deep sedation with propofol without the use of intubation during second trimester surgical terminations in an inpatient teaching institution.
Implications: Deep sedation without intubation for operating room dilation and evacuation is a safe option that rarely resulted in conversion to intubation and, in most cases, should be the anesthesia method of choice at initiation in an inpatient setting.
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Psychometric properties and refinement of the Reproductive Coercion Scale Heather L. McCauley, Jay G. Silverman, Kelley A. Jones, Daniel J. Tancredi, Michele R. Decker, Marie C. McCormick, S. Bryn Austin, Heather A. Anderson, Elizabeth Miller
Objective: Identification and refinement of psychometric properties of the Reproductive Coercion Scale (RCS) for use in survey research and clinical practice.
Implications: This study assesses the psychometric properties of the RCS, identifying pregnancy coercion and condom manipulation as underlying domains of reproductive coercion. Recommendations for using the RCS in research and clinical practice are discussed.
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Prescribing of cyproterone acetate/ethinylestradiol in UK general practice: a retrospective descriptive study using The Health Improvement Network
Lucía Cea Soriano, Alex Asiimwe, Luis A. García Rodriguez
Objective: To investigate prescribing patterns of cyproterone acetate/ethinylestradiol (CPA/EE) in the United Kingdom before and after the 2013 prescribing guidance.
Conclusions: Before and after 2013, the majority of UK women starting treatment with CPA/EE had a condition in line with its approved indication and had received prior acne treatment as per guidance.
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A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection
Jane Cover, Allen Namagembe, Justine Tumusiime, Jeanette Lim, Jennifer Kidwell Drake, Anthony K. Mbonye
Objectives: Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability.
Implications: The first research results on contraceptive self-injection in sub-Saharan Africa indicate initial feasibility and acceptability of the practice 3 months after women received one-on-one training and a highly visual training and memory aid. Results can inform self-injection programs which aim to increase women's autonomy and access to injectable contraception.
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HIV/AIDS and contraceptive use: factors associated with contraceptive use among sexually active HIV-positive women in Kenya
Monica A. Magadi, Winnie A. Magadi
Objectives: With increased availability of antiretroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya.
Implications: Study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities in Kenya. Results reveal striking differences in factors associated with contraceptive use between HIV-positive and HIV-negative women. Poverty may be an impediment to contraceptive uptake among HIV-positive women in Kenya.
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Erratum to “2016 North American forum on family planning scientific abstracts Denver, CO, November 5–7, 2016" [Contraception 94 (2016) p. 431]
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