A Survey of Adult and Pediatric Cardiology Fellows on Training Received in Family Planning Counseling.

Background: This 2016 study aimed to investigate the training in contraception and preconception counseling received by cardiovascular science fellows. Method: The authors surveyed current adult and pediatric cardiology fellows in the United States. Questions assessed the availability of family planning counseling training within their training program, current practices of contraception and preconception counseling, and use of available tools for risk stratification of patients. Bivariate logistic regressions were utilized to predict demographic variables associated with survey responses, and associations between hours of training or perceived preparedness and clinical use of training. Results: There were 101 survey responses. Most participating fellows disagreed that their fellowship training had prepared them to counsel patients on contraception (69%) and preconception planning (62%). Sixty-one percent of participants do not routinely discuss contraception options and 55% do not routinely discuss preconception counseling with reproductive-age female patients at routine visits. Having more than 1 hour of training was predictive of more consistent counseling for both contraception and preconception counseling. Approximately 40% of participants routinely refer patients to an OB/Gyn for contraception or preconception counseling. Conclusion: This study highlights the need for increased training in contraceptive and preconception counseling within adult and pediatric cardiology fellowship programs.

Use of laparoscopy for resolution of intussusception in the third trimester of pregnancy: a case report.

BACKGROUND: Laparoscopy has been used for the resolution of acute abdominal surgical conditions in the second trimester of pregnancy for years. There are few case reports, however, regarding its use in rare presentations of the acute abdomen later in pregnancy. CASE: We report a case of the use of laparoscopy in the resolution of an intussusception in the 34th week, creating a smaller incision and providing the benefits of minimally invasive surgery. CONCLUSION: We suggest that laparoscopy be considered for further utilization as a safe and minimally invasive alternative for surgical procedures in the third trimester of pregnancy.

A randomized controlled trial evaluating same-day mifepristone and misoprostol compared to misoprostol alone for cervical preparation prior to second-trimester surgical abortion.

OBJECTIVE: We evaluated initial cervical dilation with the addition of oral mifepristone to vaginal misoprostol as cervical preparation for same-daysecond-trimester dilation and evacuation (D&E). STUDY DESIGN: Women desiring abortion between gestational ages 14weeks 0days and 19weeks 6days were randomized to 200-mg mifepristone or identical placebo immediately followed by 400-mcg misoprostol vaginally 4-6h prior to D&E. Primary outcome was cervical dilation assessed by largest Hegar dilator passed without resistance. Secondary outcomes included total procedure time and participant and provider perceptions. We had 90% power to detect a 2-mm change in initial cervical dilation with a mean of 10mm (SD=3.0mm), requiring 48 participants in each arm. RESULTS: Of 100 women enrolled, 96 were randomized and completed the study. Age, race, gestational age (mean 17.4weeks, SD=1.3) and parity did not significantly differ. Mean initial Hegar dilation measurements were 11.7 and 10.9mm in the mifepristone and placebo groups, respectively, with difference of 0.8 [95% CI=-0.4, 2.0mm]. We found total procedure times of 11.8 and 13.0min, respectively (difference of 1.2min [95% CI=-2.4, 4.8min]. Participant and provider perceptions did not differ. All 96 procedures were completed without hemorrhage, cervical laceration or other observed complications. CONCLUSION: The addition of mifepristone to vaginal misoprostol did not provide a significant increase in cervical dilation compared to misoprostol alone as cervical preparation 4-6h prior to D&E at 14weeks through 19weeks 6days. IMPLICATIONS: Adding mifepristone for a short interval (4-6h) did not improve cervical preparation with misoprostol prior to D&E at 14-19weeks. Future studies should evaluate alternative timing intervals of medications for this purpose.

Family Planning and Preconception Health Among Men in Their Mid-30s: Developing Indicators and Describing Need.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.