Prenatal Contraceptive Counseling by Video.

OBJECTIVE: Effective postpartum contraception can improve interpregnancy intervals. Opportunities exist for counseling and education during prenatal care. Few studies have assessed the use of multimedia as a tool to improve long-acting reversible contraception (LARC) use postpartum. The objective of this study was to evaluate whether LARC-focused video counseling during prenatal care increases uptake of postpartum LARC and overall contraception use. METHODS: In this randomized controlled trial, women receiving their prenatal care at a university-based resident clinic were randomized to receive LARC FIRST video contraceptive counseling along with routine prenatal care or routine prenatal care alone. All of the participants received information regarding access to free LARC methods in the postpartum period. The primary outcome was LARC uptake by 12 weeks postpartum. Secondary outcomes included overall contraception use at 12 weeks postpartum, postpartum visit attendance, and acceptability of video counseling. RESULTS: LARC use at 12 weeks postpartum rose from an estimated 6% preintervention to 39.4% (13/33) in the video group compared with 29.4% (10/34) of the control group. The difference between groups was not statistically significant. Although overall contraceptive use (72.7% vs 54.8%) and postpartum visit attendance (91% vs. 76.5%) were higher in the video group relative to the control group, these differences were not statistically significant. Participants overwhelmingly liked the video (95.2%, 41/42) and believed viewing it was a good use of their appointment time (92%, 38/42). CONCLUSIONS: LARC use increased 32% across the entire study cohort; however, video-based contraceptive counseling did not increase LARC uptake at 12 weeks postpartum compared with routine prenatal care alone. Patients viewing the video reported high levels of acceptability and improved contraceptive knowledge. Video counseling may be a useful adjunct in many clinical settings.

The Impact of a 72-hour Waiting Period on Women's Access to Abortion Care at a Hospital-Based Clinic in North Carolina.

BACKGROUND In 2015, North Carolina became the 5th state to pass legislation requiring women to undergo state-mandated counseling 72 hours prior to abortion. Whether this legislation has changed the timing of abortion decision-making or receipt of care is not known.METHODS This is a cross-sectional study using anonymous survey data from women presenting for abortion at a hospital-based abortion clinic in North Carolina. Data were collected for 8 weeks immediately before and after implementation of the new waiting period.RESULTS 26/48 (54%) of eligible patients participated. More than half (56%) of women made their abortion decision relatively quickly (less than or equal to 3 days), but had a median time-to-care of almost a week.LIMITATIONS This small study is the 1st recent evaluation of abortion decision-making and receipt of care immediately before and after implementation of a 72-hour waiting period in a Southern state. Only women presenting for care at a single hospital-based clinic were surveyed. Data were self-reported.CONCLUSION In our clinical setting, most women decided to have an abortion quickly but still waited 10-15 days before receiving care. Extended waiting periods provide no medical benefits and the potential for harm and delay of care remains.

Management of Intrauterine Contraception in Early Pregnancy.

OBJECTIVES: Women with rare intrauterine contraception (IUC) failures are advised to have their IUC removed because of the risk of poor obstetric outcomes with a retained IUC. Specifics regarding IUC removal in early pregnancy including techniques for removal, rates of success, and immediate pregnancy outcomes following removal are not well described, however. The objective of this study was to identify women with an IUC in early pregnancy examined at a tertiary care center with the primary objective of describing IUC removal attempts, IUC removal successes, and pregnancy outcomes at 20 weeks following IUC removal. METHODS: Case series of women with concurrent IUC and early pregnancy who presented to a tertiary care ultrasound center by 12 weeks' gestation. RESULTS: A total of 3116 women had an early pregnancy ultrasound during the study period. Nineteen (19/3116, 0.61%) women underwent ultrasounds that identified a pregnancy before 12 weeks and an IUC in the uterus. A copper IUC was identified in 11 women (11/19, 58%) on their first ultrasound, and a levonogestrel IUC was identified in 5 women (5/19, 26%). Seventeen (17/19, 88%) women attempted to remove their IUC; 11 of 69 (69%) were successfully removed on the first attempt. Fourteen (14/19; 74%) women with an IUC examined by 12 weeks' gestation had an ongoing pregnancy at 20 weeks compared with 1782 (1782/2678, 67%; P = 0.209) women without an IUC. CONCLUSIONS: Pregnancy with IUC is rare. Among the 19 women who were found to have an in situ IUC and early pregnancy, most had a successful IUC removal and had an ongoing pregnancy at 20 weeks' gestation. In our case series, IUC removal in the first trimester was a straightforward procedure and likely successful.

Perceptions of High-Risk Situations for Sexual Assault: Gender Differences in the U.S. Air Force.

This study explored U.S. Air Force service members' perceptions of high-risk situations for sexual assault victimization. Qualitative data were collected from 52 active duty Airmen, including sexual assault survivors and general population officers and enlisted personnel. Participants were recruited through posted flyers, base-wide e-mail messages, and referrals from the Sexual Assault Response Coordinator's office. Content analysis was used to summarize participants' opinions and experiences. High-risk situations for all Airmen included excessive alcohol use, specific physical settings, and situations associated with work assignments. High-risk situations identified frequently by male and female sexual assault survivors and female (but not male) general population Airmen included power imbalance; isolation in the workplace and social settings; and youth, inexperience, and unfamiliarity with the military environment. Female Airmen identified workplaces with a predominance of men or being one of very few women in a group as a high-risk situation for sexual assault victimization. And female sexual assault survivors identified implicit but unwarranted trust between Airmen as a high-risk situation. This study provides new insight into gender differences in high-risk situations for sexual assault victimization, and the data can help policymakers better prevent sexual assault by appropriately tailoring and timing sexual assault risk reduction training.

Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes.

OBJECTIVE: To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum. STUDY DESIGN: This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14-20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: "Would you recommend Mirena placement at 2 weeks postpartum to a friend?" Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14-20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum). RESULTS: We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations. CONCLUSIONS: LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period. IMPLICATIONS: This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception.

Contraception Insurance Coverage and Receipt of Long-Acting Reversible Contraception or Depot Medroxyprogesterone Acetate on the Day of Abortion.

OBJECTIVE: To evaluate whether contraceptive insurance coverage for women who present for an abortion is associated with obtaining long-acting reversible contraception or depot medroxyprogesterone acetate (DMPA) on the day the abortion is completed. METHODS: We conducted a prospective cohort study of women presenting for medical or surgical abortion at a single health center in North Carolina. Eligible women were 18 years or older and fluent in English or Spanish. Data were from participant questionnaires, medical charts, and financial records. Our main exposure was whether the woman had insurance coverage for contraception at clinic intake. Our primary outcome was receiving DMPA, an intrauterine device, or a contraceptive subdermal implant on the same day of their surgical abortion or at the visit that determined their medication abortion was complete. We used univariable, bivariable, and multivariable analysis to report our findings. RESULTS: Five hundred seventy-five women enrolled in our cohort between September 2015 and April 2016. One hundred twenty-eight (22%) had insurance coverage and 447 (78%) did not. In the group with insurance coverage for contraception, 38% (49/128) received a long-acting reversible contraception method or DMPA compared with 7% (33/447) in the group without insurance coverage for contraception. After adjusting for confounding, women with contraceptive coverage were more than five times as likely to receive immediate postabortion contraception with one of these methods compared with women without coverage (relative risk 5.6, 95% confidence interval 3.8-8.3). CONCLUSION: Women with contraceptive insurance coverage on the day of their abortion were more likely to leave the abortion clinic with an intrauterine device or implant in place or receive DMPA injection compared with women without coverage.