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1.
BMJ Sex Reprod Health ; 46(2): 147-151, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31941769

RESUMEN

BACKGROUND: There is a lack of research on young women's fertility knowledge and awareness. This has implications for contraceptive risk-taking, including the use of emergency hormonal contraception (EHC). By drawing on two research studies, this article shows how greater fertility knowledge could benefit young women in terms of pregnancy prevention. METHODS: We draw on two qualitative research studies ('fertility study' and 'abortion study') resulting in a composite sample of 46 interviews with women aged 16-24 years. Focused secondary analysis was undertaken looking specifically at fertility knowledge in relation to contraceptive behaviour. FINDINGS: A lack of accurate knowledge about the menstrual cycle was evident in two ways. Young women drew conclusions about their invulnerability to pregnancy if previous unprotected sexual intercourse (UPSI) had not resulted in pregnancy. Additionally, although participants were aware of EHC, there was no awareness of when it might fail other than after a certain time limit. CONCLUSIONS: Young women would benefit from a more nuanced understanding of fertility. Episodes of UPSI that do not result in pregnancy can encourage a belief that 'it won't happen to me', and this has implications for taking chances with contraception. Partial knowledge about the effectiveness of EHC may also lead to unintended pregnancy. Calculating the number of hours following UPSI generates overreliance on what is only one of the factors determining the effectiveness of EHC. Information regarding the link between EHC and failure rates near the day of ovulation needs to be more widely publicised.


Asunto(s)
Conducta Anticonceptiva/psicología , Fertilidad/fisiología , Alfabetización en Salud/normas , Asunción de Riesgos , Adolescente , Conducta Anticonceptiva/estadística & datos numéricos , Femenino , Fertilidad/efectos de los fármacos , Alfabetización en Salud/estadística & datos numéricos , Humanos , Entrevistas como Asunto/métodos , Embarazo , Embarazo no Planeado/efectos de los fármacos , Embarazo no Planeado/fisiología , Embarazo no Planeado/psicología , Investigación Cualitativa , Adulto Joven
2.
Rev. Soc. Bras. Clín. Méd ; 17(2): 76-80, abr.-jun. 2019. graf.
Artículo en Portugués | LILACS | ID: biblio-1026504

RESUMEN

Objetivo: Descrever o perfil de pacientes em idade reprodutiva internadas por epilepsia nas regiões brasileiras em 5 anos, elucidando os riscos promovidos por ela durante a gravidez e abordando o gerenciamento do quadro. Métodos: Pesquisa e análise de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), acerca das internações em mulheres em idade reprodutiva (10 a 49 anos) por epilepsia, avaliando a ocorrência, de acordo com faixa etária, etnia e região do Brasil, no período de janeiro de 2012 a dezembro de 2016. Resultados: No total, foram notificadas 42.204 internações de mulheres em idade reprodutiva associadas à epilepsia, estando a maior parte delas (22,66%) na faixa de 20 a 29 anos e na de 40 a 49 anos (22,59%). O Sudeste correspondeu a 43,01% do total de casos (18.152), seguido pela Região Sul, com 9.456 registros (22,4%), e pelo Nordeste (8.245; 19,53%). A etnia mais atingida foi a de brancas (15.804; 37,44% dos atendimentos) e pardas (12.200; 28,9%). Conclusão: O planejamento da gravidez em mulheres epilépticas contribui para redução dos riscos tanto maternos quanto fetais, pois permite ao prescritor e à gestante pesar quais os benefícios e os malefícios de cada terapia anticonvulsivante disponível. Vale lembrar que uma abordagem individualizada da paciente epiléptica grávida por equipe multidisciplinar se faz necessária para melhorar os desfechos e prevenir internações por crises convulsivas. (AU)


Objective: To describe the profile of female patients in childbearing age hospitalized due to epilepsy in the Brazilian regions in 5 years, elucidating the risks it causes during pregnancy, and addressing the management of the condition. Methods: Research and analysis of data provided by the Informatics Department of the Unified Health System (DATASUS), concerning hospitalizations of women of childbearing age (10-49 years) due to epilepsy, evaluating the occurrence according to age, ethnicity and the region in Brazil, from January 2012 to December 2016. Results: A total of 42,204 admissions of women of childbearing age due to epilepsy were reported, with most of them in the age group from 20 to 29 years old (22,66%), and in the 40-49 age group (22.59%). The Southeast Region accounted for 43.01% of the total number of cases (18,152), followed by the South Region, with 9,456 records (22.4%), and the Northeast (8,245 - 19.53%). The most affected ethnic group was the white one (15,804; 37,44% of the admissions) and brown one (12,200; 28,9%). Conclusion: Pregnancy planning in epileptic women contributes to both maternal and fetal risk reduction, since it allows the prescriber and the pregnant woman to weigh the benefits and harms of each available anticonvulsant therapy. It is worth remembering that an individualized, multidisciplinary approach of the epileptic pregnant patient is necessary to improve the outcomes, and to prevent hospitalizations due to seizures. (AU)


Asunto(s)
Humanos , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Epilepsia/epidemiología , Hospitalización/estadística & datos numéricos , Complicaciones del Embarazo/prevención & control , Atención Prenatal , Anomalías Inducidas por Medicamentos/prevención & control , Embarazo/efectos de los fármacos , Demografía/estadística & datos numéricos , Incidencia , Prevalencia , Estudios Transversales , Interpretación Estadística de Datos , Distribución por Edad , Embarazo no Planeado/efectos de los fármacos , Epilepsia/tratamiento farmacológico , Distribución por Etnia , Servicios de Planificación Familiar , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico
3.
J Perinat Neonatal Nurs ; 33(2): E3-E11, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31021945

RESUMEN

The health impact of opioid use disorder on women and infant health alongside persistent rates of unintended pregnancy calls for better targeted reproductive healthcare for all women, especially those receiving treatment for opioid treatment disorder and decreasing barriers to care. This cross-sectional mixed-methods study explored the reproductive intentions and contraceptive practices of women (N = 50) in medication-assisted treatment of opioid use disorder with a focus on knowledge and use of long-acting reversible contraception (LARC), specifically intrauterine devices and implants. Eighty-four percent of the 50 women interviewed had experienced at least 1 unintended pregnancy, and 30% were using contraceptive methods with high failure rates. Although approximately 75% of women indicated awareness of both forms of LARCs, only 6% reported current or past use of either device. Qualitative results found the greatest barriers to the uptake of LARC were women's expressed fears of complications and inaccurate information from family, friends, and acquaintances. Increasing awareness of the benefits of LARC as ideal contraception for women who may desire a future pregnancy is important for improving reproductive health for women receiving treatment of opioid use disorder.


Asunto(s)
Anticoncepción/métodos , Anticonceptivos Femeninos/administración & dosificación , Trastornos Relacionados con Opioides/epidemiología , Embarazo no Planeado/efectos de los fármacos , Servicios de Salud Reproductiva/organización & administración , Factores de Edad , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Embarazo , Medición de Riesgo , Estados Unidos , Adulto Joven
4.
J Adolesc Health ; 63(3): 363-364, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30076014

RESUMEN

Case reports of pregnancies with inadvertent etonogestrel contraceptive implant exposure in the first-trimester have not demonstrated teratogenic risks or adverse pregnancy outcomes. We report the clinical observations of a 15-year-old nulligravida who continued her etonogestrel contraceptive implant throughout pregnancy and delivery, without any adverse maternal or neonatal outcomes. The patient then continued her contraceptive implant as a reliable postpartum contraceptive method. Although her favorable outcomes are consistent with available pharmacologic literature, more data is needed regarding maintenance of a contraceptive implant during a desired pregnancy.


Asunto(s)
Anticonceptivos Femeninos/uso terapéutico , Desogestrel/uso terapéutico , Implantes de Medicamentos , Embarazo no Planeado/efectos de los fármacos , Adolescente , Femenino , Humanos , Periodo Posparto , Embarazo , Resultado del Embarazo
5.
Nurs Womens Health ; 22(2): 181-190, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29628057

RESUMEN

The U.S. Centers for Disease Control and Prevention recently updated the U.S. Selected Practice Recommendations for Contraceptive Use to foster a reduction in unplanned pregnancy rates and to provide clinicians an evidence-based guide for contraception management. Nurses play an important role in helping women and families with reproductive life planning. By bridging knowledge gaps and removing access barriers with regard to contraception, nurses can contribute to reducing rates of unintended pregnancy. Nurses and other clinicians are encouraged to use the U.S. Selected Practice Recommendations for Contraceptive Use when counseling women about safe and effective contraception management.


Asunto(s)
Conducta Anticonceptiva/tendencias , Anticoncepción/métodos , Embarazo no Planeado/efectos de los fármacos , Adolescente , Adulto , Anticoncepción/tendencias , Femenino , Humanos , Embarazo , Embarazo no Planeado/psicología , Estados Unidos
6.
Aust Fam Physician ; 46(6): 372-377, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28609592

RESUMEN

BACKGROUND: Women who are perimenopausal are at risk of unintended pregnancy despite relatively low fertility at this stage. Contraceptive choice can be limited by increased comorbidities, but the UK Medical Eligibility Criteria (UKMEC) system provides a framework for safe prescribing. OBJECTIVE: This article provides evidence-based guidance on contraceptive options, and information to support decision-making about stopping contraception at menopause. DISCUSSION: Contraceptive choice is determined by several factors, including medical eligibility, side effects and risks, non-contraceptive benefits, cost and personal preference. Long-acting reversible contraceptives (LARCs) are an effective, acceptable and safe choice for many women. For women aged ≥50 years who are using a non-hormonal method, contraception is recommended until after 12 months of amenorrhoea, or 24 months if they are aged 50 years; serial follicle-stimulating hormone (FSH) levels can guide method cessation given amenorrhoea is not a reliable indicator of menopause in this context.


Asunto(s)
Anticoncepción/métodos , Perimenopausia/fisiología , Adulto , Compuestos de Anilina/farmacología , Compuestos de Anilina/uso terapéutico , Dispositivos Anticonceptivos , Quimioterapia Combinada/métodos , Femenino , Humanos , Dispositivos Intrauterinos de Cobre , Levonorgestrel/farmacología , Levonorgestrel/uso terapéutico , Perimenopausia/metabolismo , Embarazo , Embarazo no Planeado/efectos de los fármacos , Progesterona/farmacología , Progesterona/uso terapéutico
7.
Nurs Womens Health ; 21(3): 186-195, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28599740

RESUMEN

Initiation of long-acting reversible contraception (LARC) in the immediate postpartum period is becoming more common, resulting in increased requests for early removal, primarily because of unpredictable bleeding patterns. Competing interests of healthful spacing of pregnancies, impact on breastfeeding, risks associated with pregnancy versus contraceptive method, potential adverse effects of LARC, and timing of informed consent make immediate postpartum initiation of LARC an important issue. Nearly 40% of women do not attend a postpartum visit at all, resulting in decreased initiation of contraception and increased risk of unplanned pregnancy. Nurses caring for women during the peripartum period can help women make informed decisions and can provide anticipatory guidance regarding this method of contraception. Evidence-based postpartum education and support can result in women's increased continuation of and satisfaction with LARC.


Asunto(s)
Anticoncepción/métodos , Madres/psicología , Atención Posnatal/métodos , Factores de Tiempo , Adulto , Lactancia Materna , Anticoncepción/normas , Contraindicaciones , Desogestrel/farmacología , Desogestrel/uso terapéutico , Femenino , Humanos , Dispositivos Intrauterinos de Cobre/normas , Educación del Paciente como Asunto/normas , Seguridad del Paciente/normas , Embarazo , Embarazo no Planeado/efectos de los fármacos , Progestinas/farmacología , Progestinas/uso terapéutico
8.
J Am Assoc Nurse Pract ; 29(9): 527-534, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28639423

RESUMEN

BACKGROUND AND PURPOSE: The availability of emergency contraception pills (ECP) over the counter (OTC) has the potential to reduce the incidence of unintended pregnancy; however, the increased risk for sexually transmitted infection (STI) acquisition, related to unprotected intercourse, has not been adequately addressed. The purpose of this study is to gain insight into risk perceptions for STIs and subsequent unintended pregnancy in women who have purchased ECP OTC. METHODS: Twenty-one women, aged 18-24, attending a private university in an urban setting, who purchased and used ECP OTC participated in 1-h, individual interviews. CONCLUSIONS: Narrative, descriptive findings indicated that these women did not consider themselves at risk for STI or unintended pregnancy, despite having used ECP OTC. Pregnancy prevention was paramount for these women, which overshadowed concerns regarding STIs. IMPLICATIONS FOR PRACTICE: Women at risk for unintended consequences of sexual activity are not fully cognizant of those potential outcomes and do not take measures to prevent their occurrence. The availability of ECP OTC offers protection against unintended pregnancy; however, opportunities for health promotion and prevention counseling may be lost.


Asunto(s)
Anticoncepción Postcoital/psicología , Conocimientos, Actitudes y Práctica en Salud , Percepción , Medición de Riesgo/normas , Adolescente , Anticoncepción/métodos , Femenino , Humanos , Medicamentos sin Prescripción/uso terapéutico , Embarazo , Embarazo no Planeado/efectos de los fármacos , Embarazo no Planeado/psicología , Investigación Cualitativa , Medición de Riesgo/métodos , Enfermedades de Transmisión Sexual/psicología , Universidades/organización & administración , Adulto Joven
9.
Eur J Contracept Reprod Health Care ; 22(3): 165-169, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28277799

RESUMEN

OBJECTIVES: Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions. METHODS: The article comprises a narrative review of the literature. RESULTS: Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression. CONCLUSIONS: For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Anticonceptivos Hormonales Orales/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Anticoncepción/métodos , Anticoncepción/psicología , Femenino , Humanos , Cumplimiento de la Medicación/psicología , Inhibición de la Ovulación/efectos de los fármacos , Inhibición de la Ovulación/psicología , Embarazo , Embarazo no Planeado/efectos de los fármacos , Progestinas/uso terapéutico , Adulto Joven
11.
Contraception ; 93(1): 52-7, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26410176

RESUMEN

OBJECTIVES: Safe and effective contraceptive options for obese women are becoming more important due to the obesity epidemic within the United States. This study evaluated the impact of body mass index (BMI) on efficacy, safety and bleeding patterns during use of an ultra-low-dose combined oral contraceptive (COC). STUDY DESIGN: Data are from a Phase 3 clinical efficacy and safety study of an ultra-low-dose COC containing 1.0-mg norethindrone acetate and 10-mcg ethinyl estradiol. Pearl Indices, adverse events and bleeding profile were calculated for BMI ranges of <25, 25-30 and >30 kg/m(2). RESULTS: Of the 1581 participants included in the analysis, 28.3% were overweight, and 18.0% were obese. For women aged 18-45 years, the Pearl Indices were 2.49, 2.32 and 1.89 for women with a BMI <25, 25-30 and >30 kg/m(2), respectively. The ultra-low dose of ethinyl estradiol did not impact scheduled bleeding or intensity of bleeding, but we observed a slight decline in amenorrhea and slight increase in unscheduled bleeding in obese women compared with other BMI categories. CONCLUSIONS: Our analysis of an ultra-low-dose COC did not find clinically important differences in contraceptive failure rates, adverse events or bleeding profile with increasing BMI. IMPLICATIONS: Our analysis of an ultra-low ethinyl estradiol dose COC did not find clinically important differences in contraceptive failure rates, adverse events or bleeding profile with increasing BMI. An ultra-low-dose COC provides another safe and effective contraceptive option for obese women.


Asunto(s)
Índice de Masa Corporal , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Sintéticos Orales/administración & dosificación , Estrógenos/administración & dosificación , Etinilestradiol/administración & dosificación , Noretindrona/análogos & derivados , Adolescente , Adulto , Amenorrea/inducido químicamente , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Sintéticos Orales/efectos adversos , Estrógenos/efectos adversos , Etinilestradiol/efectos adversos , Femenino , Humanos , Menstruación/efectos de los fármacos , Metrorragia/inducido químicamente , Persona de Mediana Edad , Noretindrona/administración & dosificación , Noretindrona/efectos adversos , Acetato de Noretindrona , Obesidad/complicaciones , Embarazo , Embarazo no Planeado/efectos de los fármacos , Adulto Joven
12.
Contraception ; 92(5): 445-52, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26247330

RESUMEN

OBJECTIVE: The objective of this investigation was to assess the potential effect of obesity on the effectiveness of hormonal contraceptives (HCs). STUDY DESIGN: A meta-analysis was conducted using individual participant data directly from the Phase 3 clinical trials of combination oral contraceptives (COCs) rather than extracting summary data from literature. Trials selected were reviewed by the US Food and Drug Administration (FDA) between 2000 and 2012, conducted in North America, had more than six 28-day cycle equivalents of exposure, and had readily retrievable participant-level data. Contraceptive effectiveness was measured by the Pearl Index (PI: the number of pregnancies per 100 woman-years) in women aged 18-35 at risk of unintended pregnancy. The incidence rate ratio (IRR), a ratio of PIs for obese women (defined as body mass index [BMI] ≥30 kg/m(2)) compared to non-obese women (BMI <30 kg/m(2)) was calculated. A Cox proportional-hazard regression model with fixed and random-effects were used to estimate hazard ratios (HRs) for unintended pregnancy in obese women compared to non-obese women. RESULTS: Seven clinical trials with COCs (N=14,024: 2707 obese and 11,317 non-obese women) met the inclusion criteria for the meta-analysis. The PI for each trial varied: 2.05-5.08 for obese and 1.84-3.80 for non-obese women. The pooled PI estimated using direct weighted average method was 3.14 (95% CI: 2.33-4.22) for obese and 2.53 (95% CI: 1.88-3.41) for non-obese women. The pooled IRRs estimated using direct weighted average and Mantel-Haenszel adjustment methods were comparable: 1.37 (95% CI: 1.02-1.84) and 1.43 (95% CI: 1.07-1.92), respectively. The overall HR of 1.44 (95% CI: 1.06-1.95; p=.018) in the meta-analysis suggested a 44% higher pregnancy rate during COC use for obese women after adjusting for age and race. IMPLICATIONS STATEMENT: Obesity may increase the risk of unintended pregnancy in women using COCs; more data on obese women from ongoing and future Phase 3 clinical trials are necessary to allow further evaluation of this topic. CONCLUSIONS: Results of this meta-analysis suggest that obese women may have a higher pregnancy rate during COC use compared to non-obese women. Future analysis should assess differences in pharmacodynamics or compliance that could potentially account for the observed difference in unintended pregnancy rates.


Asunto(s)
Anticoncepción/métodos , Anticonceptivos Orales Combinados/farmacología , Combinación Etinil Estradiol-Norgestrel/farmacología , Obesidad/metabolismo , Embarazo no Planeado/efectos de los fármacos , Índice de Masa Corporal , Ensayos Clínicos Fase III como Asunto , Femenino , Humanos , América del Norte , Obesidad/complicaciones , Embarazo , Índice de Embarazo , Modelos de Riesgos Proporcionales
13.
J Fam Plann Reprod Health Care ; 41(1): 33-7, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24465024

RESUMEN

OBJECTIVES: Although adolescents and young adults of lower socioeconomic status (SES) are disproportionately affected by unintended pregnancies, research on experiences with emergency contraception (EC) in this population has lagged. Furthermore, it is unclear whether EC-related knowledge and behaviour varies between young men and women. This study investigated knowledge, attitudes and experiences with EC among low SES young men and women aged 18-25 years. METHODS: One hundred and ninety-eight new enrollees at two Los Angeles primary medical care clinics completed surveys about their knowledge, past use and likelihood of using EC. Chi square (χ(2)) and regression analyses assessed gender differences in knowledge and attitudes. RESULTS: Women were more likely than men to accurately answer questions about EC and its use. Across both sexes, accurate knowledge predicted future willingness to use EC. Only half the women and a third of men knew that EC could be directly dispensed by pharmacists; even fewer knew that the legal access age for EC was 17 years (13%) or that men could access EC from pharmacies for their female partners (24%). Although respondents most commonly reported that friends were their source of current information about EC, both men and women chose health care professionals as their desired source of future information about EC. CONCLUSIONS: Young men in this sample were significantly less knowledgeable than young women about EC. Educating young men about EC by health care providers during routine visits may be a unique opportunity to increase EC knowledge, access and use among low-income young couples to decrease undesired pregnancies.


Asunto(s)
Anticoncepción Postcoital/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud/etnología , Embarazo no Planeado/efectos de los fármacos , Factores Socioeconómicos , Adolescente , Femenino , Humanos , Los Angeles , Masculino , Embarazo , Embarazo no Planeado/etnología , Encuestas y Cuestionarios , Adulto Joven
14.
J Fam Plann Reprod Health Care ; 41(2): 96-101, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24860151

RESUMEN

BACKGROUND: Pregnancies in women with sickle cell disease (SCD) are known to have high rates of maternal and fetal mortality and morbidity. Given these pregnancy-associated problems for women with SCD, advice both about pregnancy planning and about effective contraception are of paramount importance. This study sought to discover the contraception methods used by women with SCD, what complications women with SCD encounter with contraception, and their experiences of pre-pregnancy counselling and pregnancy planning, and how such issues may have changed over the past two decades. METHOD: The study was a multicentre, interview-based, cross-sectional study. Interviews were carried out with 102 women with SCD, in north and central London during 2010, concerning their current and previous contraceptive use, their pregnancy history, their menstrual history, and the advice they received concerning pregnancy planning and contraception. Patient information was anonymised and ethical approval was obtained. These data were compared with data from a similar study undertaken in 1993. RESULTS: There were significant differences in a number of key areas: the number of unplanned pregnancies decreased from 64% in 1993 to 53% in 2010. The number of women with SCD who were advised not to become pregnant also fell, from 36% to 15%. The use of combined oral contraceptive pills declined, from 45% of the women in 1993 to 31% in 2010. Conversely the use of depot medroxyprogesterone acetate contraception (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) both increased. CONCLUSIONS: Significant changes in the contraceptive methods used by women with SCD are demonstrated in the London population. LNG-IUS use in SCD has not been investigated before. There has been an encouraging decrease in the number of women with SCD who are advised not to become pregnant, perhaps reflecting an improvement in their overall health. Although the number of unplanned pregnancies has fallen, it remains high - emphasising the continuing need for women with SCD to have access to informed advice about pregnancy-associated issues and contraception.


Asunto(s)
Anemia de Células Falciformes/terapia , Consejo/tendencias , Servicios de Planificación Familiar/estadística & datos numéricos , Servicios de Planificación Familiar/tendencias , Adolescente , Adulto , Anciano , Conducta Anticonceptiva/estadística & datos numéricos , Conducta Anticonceptiva/tendencias , Anticonceptivos Femeninos/uso terapéutico , Consejo/métodos , Consejo/estadística & datos numéricos , Estudios Transversales , Servicios de Planificación Familiar/métodos , Femenino , Humanos , Dispositivos Intrauterinos Medicados/tendencias , Levonorgestrel/uso terapéutico , Londres , Persona de Mediana Edad , Embarazo , Embarazo no Planeado/efectos de los fármacos , Encuestas y Cuestionarios
16.
Nurs Womens Health ; 16(4): 331-5, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22900810

RESUMEN

More than 50 percent of pregnancies in the United States are unplanned. Emergency contraception has been shown to possibly reduce the risk of pregnancy by as much as 75 percent. Ulipristal acetate is a selective progesterone receptor modulator that was approved by the U.S. Food and Drug Administration (FDA) for emergency contraceptive use in August 2010. This article reviews information on its mechanism of action, efficacy, safety and implications for women's health nurses.


Asunto(s)
Anticoncepción Postcoital/métodos , Anticonceptivos Poscoito/administración & dosificación , Norpregnadienos/administración & dosificación , Embarazo no Planeado/efectos de los fármacos , Femenino , Humanos , Seguridad del Paciente , Embarazo , Embarazo no Planeado/psicología , Resultado del Tratamiento
17.
Pharmacoepidemiol Drug Saf ; 21(8): 865-71, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22553004

RESUMEN

PURPOSE: To investigate whether there is an association between use of antibiotics and breakthrough pregnancy. METHODS: The study was performed in a population-based prescription database (IADB.nl). We computed case-crossover odds ratios of 397 cases of defined breakthrough pregnancy comparing the use of antibiotics in the exposure window with the use of antibiotics in two control windows. We defined a control group consisting of 29 022 other pregnancies. We computed case-control odds ratios of the use of antibiotics in cases as compared with controls in the different time windows. RESULTS: The case-crossover odds ratios comparing the use of antibiotics in the exposure window with both control windows were 2.21 (95%CI = 1.03-4.75) and 1.65 (95%CI = 0.78-3.48), respectively. The traditional case-control odds ratios after adjustment for age were 1.71 (95%CI = 1.09-2.66) in the exposure window, 0.81 (95%CI = 0.44-1.47) 2 months before the exposure window, and 1.04 (95%CI = 0.61-1.78) 12 months before the exposure window. CONCLUSIONS: We did find a relationship between the use of antibiotics and breakthrough pregnancy in a population-based prescription database. The results did not hold for broad-spectrum antibiotics or in a sensitivity analysis. The results are partly not the same as those found in a pharmacoepidemiological study with a similar design using two US pregnancy databases. Both studies can suffer from bias and confounding, but these will be different because of the use of different databases.


Asunto(s)
Antibacterianos/efectos adversos , Anticonceptivos Orales Combinados/administración & dosificación , Embarazo no Planeado/efectos de los fármacos , Adulto , Estudios de Casos y Controles , Estudios Cruzados , Interacciones Farmacológicas , Femenino , Humanos , Países Bajos , Oportunidad Relativa , Embarazo
18.
J Neurol Sci ; 307(1-2): 164-5, 2011 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-21601225

RESUMEN

Multiple sclerosis is a common disease of young adults in which accidental and unplanned pregnancies under disease modifying or immunosuppressive therapies may occur. The experience with mitoxantrone (MIX) especially in the first trimenon is very limited, until now only one case of a pregnant woman with MS who was exposed to MIX in early pregnancy and delivered a growth restricted but healthy child was published. We report a case of a secondary progressive MS patient who was exposed periconceptionally to MIX and delivered a child with Pierre Robin Sequence (PRS), a syndrome with the main features of glossoptosis, micrognathia, and palate clefts. PRS is a very rare defect and therefore a causal relation with MIX seems possible.


Asunto(s)
Anomalías Inducidas por Medicamentos/metabolismo , Mitoxantrona/efectos adversos , Esclerosis Múltiple Crónica Progresiva/tratamiento farmacológico , Síndrome de Pierre Robin/inducido químicamente , Síndrome de Pierre Robin/metabolismo , Lesiones Preconceptivas , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/metabolismo , Anomalías Inducidas por Medicamentos/patología , Adulto , Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Femenino , Humanos , Recién Nacido , Masculino , Esclerosis Múltiple Crónica Progresiva/metabolismo , Ondansetrón/uso terapéutico , Síndrome de Pierre Robin/patología , Embarazo , Embarazo no Planeado/efectos de los fármacos , Efectos Tardíos de la Exposición Prenatal/patología
20.
Arch Gynecol Obstet ; 283(3): 525-30, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20111970

RESUMEN

OBJECTIVE: Aim of the study was to evaluate Evra use in adolescents and compare the outcome with adult users. METHODS: A total of 80 adolescents and 178 adults were followed-up at 1-, 3-, and 6-month interval with their compliance, satisfaction, cycle control, and adverse events being assessed. RESULTS: Compliance rate was generally higher among adult users (p < 0.05). Partial and complete patch detachment were both significantly higher among adolescents (p < 0.05). Self-reported side effects did not differ between both groups and declined over the time. Overall satisfaction was high among most subjects. Compared with previous contraception, most subjects reported better satisfaction with Evra (p < 0.05). CONCLUSION: This investigation observed an overall positive impression of Evra with good compliance among adolescent and adult users. This might be an effect of the convenience of the weekly dosing schedule. Compliance is of utmost importance in teenagers as this age group is at highest risk of unintended pregnancy.


Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Anticonceptivos Orales Combinados/administración & dosificación , Etinilestradiol/administración & dosificación , Norgestrel/análogos & derivados , Cooperación del Paciente , Satisfacción del Paciente , Embarazo en Adolescencia/prevención & control , Parche Transdérmico , Adolescente , Adulto , Combinación de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Norgestrel/administración & dosificación , Embarazo , Embarazo no Planeado/efectos de los fármacos , Embarazo no Deseado/efectos de los fármacos , Resultado del Tratamiento , Adulto Joven
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