SARC e LARC: grau de conhecimento e frequência de uso em complexo hospitalar de referência no Paraná / SARC and LARC: degree of knowledge and frequency of use in a reference hospital complex in Paraná

Introdução: Contraceptivos representam um elemento essencial para a vida reprodutiva e para o planejamento familiar. O grau de conhecimento das mulheres sobre esse tema exerce influência sobre suas escolhas por determinados métodos anticoncepcionais. Objetivos: os objetivos deste estudo foram traçar o perfil etário e socioeconômico das pacientes do Ambulatório de Reprodução Humana do CHC-UFPR e avaliar seu conhecimento e uso de contraceptivos de curta e de longa ação (SARC e LARC), de forma a identificar lacunas de informação que pudessem ocasionargestações não planejadas e direcionar futuras estratégias educativas sobre contraceptivos. Métodos: Conduzimos entrevistas por meio de questionários objetivos aplicados a pacientes do sexo feminino entre 18 e 50 anos na ocasião de suas consultas, indagando-as sobre sua ciência da existência de diversos anticoncepcionais, tipo de método utilizado e tempo de uso, presença, frequência e motivos para gestações não planejadas. Resultados: Os principais resultados indicaram um grupo de pacientes jovens e com alta escolaridade, cuja utilização de métodos anticoncepcionais era semelhante entre SARC e LARC. O conhecimento dos anticoncepcionais foi satisfatório, principalmente entre os mais populares como anticoncepcional hormonal oral e DIU de cobre. Gestações não planejadas estiveram presentes na vida reprodutiva de 60% das pacientes, sendo o principal motivo o não uso de contraceptivos. Não houve associação entre uso de SARC ou LARC e maior número de gestações indesejadas. O número de contraceptivos conhecidos por mulheres sem gestações indesejadas foi uma mediana maior do que aquele das mulheres com esses eventos. Conclusão: A abordagem das pacientes do ambulatório da Reprodução Humana do CHC-UFPR deve ser direcionada para pacientes jovens, com alto grau de instrução e amplo conhecimento sobre contraceptivos. É importante que os profissionais de saúde do local busquem orientá-las de forma a reduzir a taxa de gestações não planejadas.Palavras chave: Anticoncepcionais, gravidez não planejada, ConhecimentoABSTRACT Introduction: Contraceptive agents represent an essential element in reproductive life and family planning. The knowledge extension for women about that subject influences choices for certain contraceptive methods. Objective: The aims of this study were to determine the age and socioeconomic profile of the patients of the Human Reproduction Clinic in the Hospital Complex of Federal University of Paraná and to evaluate their knowledge and use of short-acting reversible contraceptives (SARC) and long-acting reversible contraceptives (LARC), in order to idenfity information gaps that could cause unplanned pregnancies and direct future educational strategies on contraceptives. Methodology: We conducted interviews using objective questionnaires applied to female patients aged from 18 to 50 years old before or after their medical appointment, asking about their knowledge of the existence of diverse contraceptive agents, type of contraceptive utilized and duration of use, presence, number and reasons for unplanned pregnancies. Results: The main results indicated that the group was mostly young and highly educated, utilizing SARC and LARC in similar frequencies. The knowledge of the existence of the contraceptive agents was satisfactory and the most popular methods were the contraceptive pill and the Coopper IUD. Unplanned pregnancies were present in the reproductive life of 60% of the patients and the most common reasons for these events was the non use of contraceptives. There was no association between the use of SARC or LARC and a higher number of unplanned pregnancies. The number of contraceptives known by women without previous history of unintended pregnancy was a median higher than those of women with those events. Conclusion: Hereafter, the approach to patients in the Human Reproduction Clinic in the Hospital Complex of Federal University of Paraná should be directed to young and highly educated women, with broad knowledge about contraceptive agents. It is important that health professionals of the clinic guide patients aiming to reduce the local unplanned pregnancy rates.Keywords: Contraceptive agents, Unplanned pregnancy, Knowledge

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Immediate postnatal contraception: what women know and think

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2018-200078 ◽

2018 ◽

Vol 45 (2) ◽

pp. 111-117 ◽

Cited By ~ 3

Author(s):

Annette Thwaites ◽

Louise Logan ◽

Anthony Nardone ◽

Sue Mann

Keyword(s):

Unplanned Pregnancy ◽

Adverse Outcomes ◽

City Hospital ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Postnatal Ward ◽

Unplanned Pregnancies ◽

Mother And Child ◽

Level Of Knowledge ◽

Long Acting

IntroductionPostpartum women are at risk of rapid repeat, unplanned pregnancy with associated adverse outcomes for mother and child. We aimed to better understand their contraceptive needs to improve delivery of services and prevent unplanned pregnancies.MethodsA cross-sectional survey of women on the postnatal ward of an inner-city hospital was administered over a 6-week period in June and July 2017 to determine their level of knowledge, intentions and preferences regarding postnatal contraception.Results272 women were surveyed: 86% of all women on the postnatal ward during the study period. 10% (26/272) had never used any method of contraception previously and 22% (59/272) had ever used a long-acting reversible contraception (LARC) method. 18% (48/272) recalled a health professional speaking to them about contraception at any point during their pregnancy and 32% (87/272) said they needed more information to decide on their postnatal contraceptive method. 54% (147/272) of women did not think any LARC methods were safe immediately postnatally, rising to 71% (194/272) if breastfeeding. However, 47% (129/272) of women said that they would prefer to get their contraception from the ward before discharge and 46% (126/272) were likely to accept LARC, if safe, in this setting.ConclusionsAlmost half the women in our survey would welcome provision of postnatal contraception, including LARC, on the postnatal ward but the women surveyed currently lack the knowledge to make informed choices in this setting. There is therefore a need for effective, tailored contraceptive choices discussions with every woman during pregnancy, as well as integrated planning for postnatal provision of the woman’s chosen method.

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Folic acid usage and awareness in pregnant women in Istanbul, Turkey

Journal of Hospital Administration ◽

10.5430/jha.v1n1p9 ◽

2012 ◽

Vol 1 (1) ◽

pp. 9 ◽

Cited By ~ 2

Author(s):

Nilgün Tekkeşin ◽

Figen Taser

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Unplanned Pregnancy ◽

Folic Acid Supplementation ◽

Study Group ◽

Turkish Women ◽

Educational Strategies ◽

Unplanned Pregnancies ◽

Periconceptional Period ◽

The Difference

Intake of folic in the periconceptional period reduces the risk of neural tube defects (NTDs). The aim of this study was to assess the level of awareness regarding the use of folic acid in pregnacy. We assessed the consumption of folic acid during pregnancy among Turkish women presented to the hospital and analyzed the difference of folic acid supplementation between planned and unplanned pregnancies. Of the 1076 women, 677 (62.9%) reported current use of a prenatal folic acid at the time of the department visit, while 399 pregnant women (37.0%) identified themselves as non-users (p = 0.006). In the unplanned pregnancy group, 302 (65.22%) women reported taking folic acid during pregnancy, but 161 (34.77%) women began three months prior to conception as recommended by their gynecologists (p<0.0001). Although, the study group was a significant user with a high awareness of folic acid, our findings may not be generalizable to other areas of the country. Because, parcitipants were likely to be one of the most educated group with a medium or high socio-economical status. Besides these hopeful results, we believe the necessity to re-evaluate our educational strategies and consider reduction of unplanned pregnancies as part of our goals.

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More than just contraception: the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200962 ◽

2021 ◽

pp. bmjsrh-2020-200962

Author(s):

Kristina Gemzell-Danielsson ◽

Ali Kubba ◽

Cecilia Caetano ◽

Thomas Faustmann ◽

Eeva Lukkari-Lax ◽

...

Keyword(s):

Unplanned Pregnancy ◽

Universal Access ◽

Waiting Times ◽

Hospital Environment ◽

Future Research ◽

Reproductive Health Services ◽

Therapeutic Benefits ◽

Cost Efficacy ◽

Long Acting ◽

The Impact

Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.

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Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03259-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Iddamalgoda Dissanayakage Jayani Ch Ranatunga ◽

Kapila Jayaratne

Keyword(s):

Health Outcomes ◽

Teaching Hospital ◽

Unplanned Pregnancy ◽

Public Health Issue ◽

Maternal And Newborn Health ◽

Discharge Data ◽

Low Mood ◽

Inadequate Knowledge ◽

Unplanned Pregnancies ◽

Emergency Contraceptives

Abstract Background Unplanned pregnancy is a significant public health issue in both low- and high-income countries. The burden of unplanned pregnancy is reflected in women opting for pregnancy terminations and it can be detrimental to the women and her family as well as the health system and society. Solid data on the proportion of unplanned pregnancies are using more specific tools such as the London Measure of Unplanned Pregnancy (LMUP) needed to address the issue in Sri Lankan contexts. The objective was to describe the proportion of unplanned pregnancies, their determinants and the health outcomes of women delivering at Colombo North Teaching Hospital-Ragama (CNTH). Methods A cross-sectional study was carried out among 494 consecutive pregnant women selected by non-probability consecutive sampling who were admitted for the confinement at CNTH. A pre-tested structured interviewer-administered questionnaire was used to collect data on antenatal women and intentionality measured by self-administered six-item LMUP. Maternal and newborn health outcomes were ascertained in each post-partum women before discharge. Data were analyzed with the Mann-Whitney U tests, Kruskal-Wallis tests and spearman rank correlation. We also evaluated the psychometric properties of the Sinhalese version of LMUP. Results The response rate was 97.8 and 17.2% of pregnancies ending at birth were unplanned, 12.7% were ambivalent and 70.1% were planned. Associated factor profile of women with unplanned pregnancies includes; not married women (p = 0.001), educated up to the passing of GCE ordinary level by women (p < 0.001) and spouse (p < 0.001), primiparity (p = 0.002) and inadequate knowledge on emergency contraceptives (p = 0.037). Less planned pregnancies were also significantly associated with anemia (p = 0.004), low mood for last 2 weeks (p < 0.001), having a partner with problematic alcohol consumption (p < 0.001), presence of Gender-Based Violence (GBV) (p < 0.001), poor relationship satisfaction with partner (p < 0.001) and family (p < 0.001). Inadequate pre-pregnancy preparation and antenatal care were associated with an unplanned pregnancy. No differences were found in neonatal outcomes. Sinhalese version of the LMUP scale was found to be accepted, valid and reliable with the Cronbach’s alpha of 0.936. Conclusions A sizeable proportion of pregnancies were unplanned. Teenage pregnancies, non-marital relationships and inadequate knowledge on emergency contraceptives, maternal anemia, low mood, and GBV were modifiable associated factors which could be prevented by evidence-based locally applicable approaches.

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A long-acting repeatable form of bromocriptine as long-term treatment of prolactin-secreting macroadenomas: a multicenter study†‡Supported by Sandoz Pharma, Ltd.†Presented in part at the Joint Meeting of the European Society of Human Reproduction and Embryology and the European Sterility Congress Organization, Milan, Italy, August 31, 1990.‡The following investigators were participants in this French multicenter study: Philippe Jaquet, M.D., Marseille; Jean-Pierre Louvet, M.D., Toulouse; Didier Dewailly, M.D., Lille; Patrick Roger, M.D., Bordeaux; Jean-Louis Schlienger, M.D., Strasbourg; Gèrard Schaison, M.D., Paris; Pierre Hartemann, M.D., Nancy.

Fertility and Sterility ◽

10.1016/s0015-0282(16)54779-7 ◽

1992 ◽

Vol 57 (1) ◽

pp. 74-80 ◽

Cited By ~ 9

Author(s):

Thierry Brue ◽

Ioana Lancranjan ◽

Jean-Pierre Louvet ◽

Didier Dewailly ◽

Patrick Roger ◽

...

Keyword(s):

Multicenter Study ◽

European Society ◽

Term Treatment ◽

Human Reproduction ◽

Joint Meeting ◽

Long Term Treatment ◽

Congress Organization ◽

Long Acting

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The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK

Journal of Family Planning and Reproductive Health Care ◽

10.1136/jfprhc-2016-101553 ◽

2017 ◽

Vol 43 (4) ◽

pp. 281-288 ◽

Cited By ~ 3

Author(s):

Catherine Rachel Morgan ◽

Hanhua Liu

Keyword(s):

Teenage Pregnancy ◽

Unplanned Pregnancy ◽

Cost Effective ◽

Reproductive Age ◽

Electronic Prescribing ◽

Area Deprivation ◽

Health Clinics ◽

Long Acting ◽

To Receive ◽

The Relationship

BackgroundReducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in the most deprived areas. One possible explanation could be contraceptive prescribing inequality. This study examined the relationship between area deprivation measured by the Scottish Index of Multiple Deprivation and LARC prescription.MethodsUsing Scottish electronic prescribing data from primary care and sexual and reproductive health clinics, this study analysed female Lothian residents with a valid postcode aged 16–49 years who received a contraceptive prescription from 1 April 2012 to 31 March 2014. Prescription of LARC (intrauterine, implant or injectable contraceptive) compared with non-LARC (oral pill, patch, ring or diaphragm) was examined. Logistic regression was performed adjusting for age group and prescription location.ResultsA total of 90 150 women were included; 21.1% of prescriptions were LARC and 15.3% vLARC (intrauterine method or implant). Women residing in the most deprived quintile (Q1) and prescribed contraception received a significantly higher proportion of LARC than quintiles 2–5 (Q2–5). Odds ratios compared with Q1 were: Q2 0.86, Q3 0.77, Q4 0.59 and Q5 0.51. Women in quintile 1 were also significantly more likely to receive vLARC than quintiles 2–5.ConclusionWomen in the most deprived quintile in Lothian who are prescribed contraception are significantly more likely to receive LARC and vLARC compared with women in less deprived quintiles.

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414. The contraceptive potential of a long-acting IL-11 inhibitor

Reproduction Fertility and Development ◽

10.1071/srb08abs414 ◽

2008 ◽

Vol 20 (9) ◽

pp. 94

Author(s):

E. Menkhorst ◽

L. Salamonsen ◽

L. Robb ◽

E. Dimitriadis

Keyword(s):

Nature Medicine ◽

Embryo Implantation ◽

Hormonal Contraceptive ◽

Cyclin D3 ◽

Human Reproduction ◽

Luminal Epithelium ◽

Endometrial Stromal Cells ◽

Decidual Cells ◽

Implantation Sites ◽

Long Acting

Interleukin 11 (IL-11) signalling is essential for the establishment of pregnancy in mice, through its action on the differentiation of uterine endometrial stromal cells (decidualisation), a critical process during embryo implantation. IL-11Rα deficient mice are infertile due to defective decidualisation1. IL-11 expression peaks between days (D) 4.5–9.5 of pregnancy (D0: day of plug) in mouse decidua. We examined the effect of administering (intraperitoneal [IP] injection or vaginal gel) a PEGylated IL-11 antagonist (PEGIL-11A) on decidualisation and pregnancy outcome in mice. The sera half-life of PEGIL-11A (IC50 2.8nM) following IP injection was 24h, compared with <1 h for the non-PEGylated antagonist (IC50 0.26nM). Following IP injection, PEGIL-11A localised to decidual cells and blocked the IL-11 decidual target protein, cyclin D3. IP injection of 600µg/application PEGIL-11A (or PEG control) at 1000 h and 1600 h on D3 and 1000 h on D4 (n = 4/group), resulted in smaller implantation sites than controls on D6 due to retarded mesometrial decidual formation. On D10, severe decidual destruction was visible: implantation sites contained regions of haemorrhage and the uterine luminal epithelium had reformed, suggesting a return to oestrous cycling. Following vaginal application in aqueous placebo gel, PEGIL-11A localised to decidual cells. Vaginal application of 200µg/application PEGIL-11A (or control) twice daily from D2 to D5 (n = 4/group), resulted in smaller implantation sites than controls on D6 due to partial inhibition of mesometrial decidual formation. This study demonstrates that PEGIL-11A blocked IL-11 action in the uterus, resulting in total pregnancy loss, equivalent to the IL-11Rα deficient mouse. In women, IL-11 and its receptor are produced by the uterine luminal and glandular epithelium during the period of uterine receptivity2, suggesting that IL-11 may act during initial blastocyst attachment to the luminal epithelium as well as stromal decidualisation. This study provides proof-of-principle for the development of a novel, non-hormonal contraceptive for women. (1) Robb L et al. Nature Medicine 1998; 4: 303–308. (2) Dimitriadis E et al. Molecular Human Reproduction 2000; 6: 907–914.

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Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy among Women with Substance Use Disorders

Substance Abuse Research and Treatment ◽

10.4137/sart.s34555 ◽

2016 ◽

Vol 10s1 ◽

pp. SART.S34555 ◽

Cited By ~ 2

Author(s):

Kirsten I. Black ◽

Carolyn A. Day

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Unplanned Pregnancy ◽

Economic Benefits ◽

Treatment Programs ◽

Contraceptive Methods ◽

Unintended Pregnancies ◽

Long Acting ◽

Long Acting Reversible Contraceptive ◽

Access To Contraception

Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area.

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