Termination counseling among US perinatal genetic counselors in the setting of second trimester fetal anomalies.

Many pregnant people learn of fetal anomalies in the second trimester and subsequently present to prenatal genetic counselors (PGCs) for counseling, including but not limited to a nuanced discussion about whether to continue or terminate pregnancy. In those who choose to terminate, the decision between dilation and evacuation (D&E) or induction is often one of patient preference and as such, is heavily influenced by the quality of counseling received. PGCs are expertly trained to provide values-based counseling, yet little is known about their termination counseling practices, referral practice patterns, and perceived responsibilities in caring for this group of pregnant people. To gain this knowledge, we surveyed a national sample of PGCs in early 2022 and received 70 completed responses. The survey contained open- and closed-ended questions. Data were analyzed using descriptive statistics, and free response data were analyzed using inductive content analysis. Eighty percent (n = 56) of respondents reported that <50% of their patients had previously received termination options counseling. Most strikingly, 15% of respondents provided termination counseling that was beyond their self-identified comfort level. Scenario-based questions assessed respondents' counseling practice patterns in seven real-world situations, presented in order of decreasing severity for the fetus. Respondents were 50% less likely to provide termination options counseling to patients between the most lethal to the least lethal proposed fetal anomaly. The scenario-based analysis revealed two distinct termination counseling approaches: (1) all options counseling with an explicit discussion of options to continue or terminate and (2) discretionary options counseling focused on identifying patient preferences to guide counseling and not explicitly stating all available options. This study highlights the need to ensure PGCs feel well-trained to discuss the general features of second trimester pregnancy termination and, if unable to do so, to practice in systems with timely referral to providers well-versed in the counseling about all methods of termination.

Comparative efficacy of combined oral contraceptives and the levonorgestrel 52 mg IUD.

The relative risk of pregnancy with the levonorgestrel 52 mg IUD is 3 times lower than with optimal combined oral contraceptive use.

Levonorgestrel 52mg Intrauterine Device placement without uterine sounding: A Feasibility study.

OBJECTIVE: To evaluate feasibility of levonorgestrel 52mg intrauterine device (IUD) placement without uterine sounding. STUDY DESIGN: We performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation immediately following placement. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analogue Scale when the inserter was removed. Physicians rated procedures as easy, moderate, or difficult. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%. RESULTS: Successful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [IQR 42.3-55.0] seconds) compared to phases two (16.0 [IQR12.0-28.0] seconds, p<0.0001) and three (25.0 [IQR 18.5-32.2] seconds, p<0.0001). Participants' median placement pain was 21.0 (IQR 10.3-32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3-47.0] mm, p=0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, p=0.01).Physicians rated IUD placement "easy" most often in phase two (n=29[96.7%]) compared to phases one (n=22[73.3%], p=0.03) or three (n=22[73.3%], p=0.03). Participants experienced one perforation and one expulsion, both in phase three. CONCLUSION: Levonorgestrel 52mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.