An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

Pulmonary Venous Thrombosis and Cerebrovascular Accident in a Young Oral Contraceptive User Patient: A Case Report

Since there are millions of pill users around the world, the relationship between oral contraceptives, thrombotic events, and the cerebrovascular accident has been the focus of numerous studies. Most of the cases described in the literature are of deep venous thrombosis in the lower limbs and thromboembolism in the pulmonary artery. This article aims to report a rare case of pulmonary vein thrombosis, along with cerebrovascular accident in a young patient who uses oral contraceptives. We seek to elucidate this relationship between the use of different oral contraceptives and the risk of thrombus formation, in addition to providing a brief review of these pathological episodes in the body. In view of the scarce existence of studies with reports of pulmonary venous thrombosis, it is expected to provide information to the entire medical community.

Pattern of Contraceptive Used by Tribal Couples of Chattogram Hill Tract

Introduction: Chattogram hill tract is the least economically developed area of Bangladesh where, education and health care facilities are hard to reach. Pattern of contraceptive use depends on couples’ socio-cultural, education and economic condition. Objective: To find out the pattern of contraceptive used by selected tribal couples of Guimara Upazila of Khagrachari District. Materials and Methods: This descriptive cross-sectional study was conducted from October 2016 to March 2017 on 145 married women age ranging from 15 to 45 years reported to outpatient department of Border Guard Hospital, Guimara, Khagrachari were selected purposively after informed written consent. All the necessary data were collected in a pretested structured questionnaire by face to face interview. Results: Among the 145 respondents highest 50.3% was in age group of 15-25 years. Respondents’ ethnicity was Marma 37.9%, Tripura 38.6% and Chakma 23.5%. Majority 52.4% of the respondents’ profession was farming, 68.3% was illiterate and 55.9% had monthly family income less than five thousand Taka. Only 39.3% respondents were using various types of contraceptives. Among the ethnic groups 47.1 Chakma, 39.3% Tripura and 34.5% Marma respondents were using contraceptives. Among the contraceptive user, 93% were using temporary methods and only 7% using permanent methods. Among the contraceptives users oral contraceptive pill (OCP) was highest 56.1% followed by condom 15.8% and injectable 8.8%. Respondents got information about contraceptives mostly from family planning workers 50.9% followed by relatives 19.3%. Conclusion: Majority of the tribal couple of this study population were not using any contraceptives. Those couple were using contraceptives among them OCP was most common. Appropriate measure should be taken to increase the contraceptive use rate by tribal couples of Chattogram Hill Tracts. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 158-160

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

ObjectivesTo review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals.MethodsNarrative review and ethical analysis.FindingsThere is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care.ConclusionsThis review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.

The Reasons for not Utilization of Intrauterine Device among Short Term Modern Contraceptive User Women in Hossana Town Public Health Facilities: Qualitative Study

Background Intrauterine device (IUD) is a safe, long-acting, and effective method of contraception. However, is under-utilized in many countries, including Ethiopia. The several studies presented to address the problem, nearly all are quantitative. These have primarily generated a list of associated factors and reasons that did not seem to help health systems to design effective strategies to address the problem. This study looked at the problem with a different approach to explore the issue in detail and help to develop locally appropriate strategies to increase the utilization of IUD in the study area. To this end, qualitative method focused entirely on understanding why short term contraceptive user women are not using IUD from the maternal health service programs. Objective To explore the reasons for not utilization of IUD among short term modern contraceptive users in Hossana town public health facilities, southern Ethiopia. Method A Phenomenological qualitative study was conducted in Hossana town public health facilities, Southern Ethiopia from November 1-30, 2019. A total of 13 in-depth interviews were conducted: eleven short term contraceptive users, one health centre head and one health extension worker/community health worker/ were included in the study. Semi-structured interviewer guided questions and tape recorder were used to collect data. The collected data were expanded, labelled and ordered chronologically. Data were organized after subsequent detailed reading and analysis. Thematic analysis was used to analyze the collected data. Result In this study, the reasons for not utilization of IUD was poor knowledge about the benefits of IUD, insufficient counseling and not providing informed choices, and the absence of trained health personals and shortage of necessary supplies. Conclusion The main reasons for not utilization of IUD was poor counseling of mothers, unsupportive provider-client relationships, and poor counseling by service providers. Efforts to rise IUD users need to focus on improving counseling of mothers and strengthening the health systems.

Analisis Kenaikan Berat Badan Pada Akseptor KB Suntik DI BPM HJ. M

Latar Belakang: Program Keluarga Berencana digunakan sebagai salah satu cara untuk menekan pertumbuhan jumlah penduduk. Banjarmasin adalah pengguna kontrasepsi suntik terbanyak. Studi pendahuluan yang saya dilakukan di BPM yaitu dari 10 akseptor kontrasepsi suntik 6 akseptor yang mengalami kenaikan berat badan yaitu 4 pengguna KB suntik 3 bulan dengan lama pemakaian 1,5 tahun dan 2 pengguna akseptor suntik 1 bulan dengan lama pemakaian 2 tahun.Tujuan: Menganalisis kenaikan berat badan pada akseptor KB suntik.Metode: Non eksperimental dengan pendekatan Cross Sectional. Populasi penelitian adalah akseptor kontrasepsi suntik yang menggunakan Cyclofem dan suntik DMPA (Depo Medroxyprogesterone Acetat) di BPM Hj. M dari bulan oktober sampai bulan Desember 2015 berjumlah 188 orang. Jumlah sampel 65 peserta KB Suntik. Teknik sampling menggunakan Purposive Sampling. Pengumpulan data menggunakan angket. Analisis dengan Uji T tidak Berpasangan (P=0,05).Hasil: Menganalisis kenaikan berat badan pada akseptor KB suntik yaitu rata-rata suntik 1 bulan 1,3 dan suntik 3 bulan 3,8 dengan nilai p 0,001 hasil penelitian ini menunjukan adanya perbedaan kenaikan berat badan suntik 1 bulan dan suntik 3 bulan.Simpulan: Ada perbedaan pengguna kontrasepsi hormonal suntikan dengan kenaikan berat badan. Dalam penelitian ini dapat disimpulkan bahwa pengguna KB suntik 3 bulan lebih besar mengalami kenaikan berat badan dibandingkan suntik 1 bulan. Kata Kunci: Berat Badan, Kontrasepsi Hormonal SuntikanAbstract :Background: The Family Planning Program is used as a way to reduce population growth. Banjarmasin is the most injectable contraceptive user. The preliminary study I conducted at BPM was from 10 injectable contraceptive acceptors 6 acceptors who gained weight, namely 4 users of 3-month injection contraception with 1.5 years of usage duration and 2 users of 1-month injection acceptors with 2 years of usage duration.Objective: To analyze weight gain in injection KB acceptors.Method: Non experimental with Cross Sectional approach. The study population was injection contraceptive acceptors who used Cyclofem and injected DMPA (Medroxyprogesterone Acetat Depo) at BPM Hj. M from October to December 2015 amounted to 188 people. The total sample is 65 injecting family planning participants. The sampling technique uses Purposive Sampling. Data collection uses questionnaires. Analysis with the No Paired T Test (P = 0.05).Results: Analyzing the increase in body weight in injectable family planning acceptors, namely 1 month 1.3 injection and 3.8 months injection with 3.8 p values 0.001. The results of this study showed a difference in 1 month injection and 3 month injections.Conclusion: There are differences in injectable hormonal contraceptive users with weight gain. In this study it can be concluded that injecting family planning users 3 months bigger experience weight gain compared to 1 month injection.Keywords: Weight Loss, Hormonal Contraception Injections