Intrauterine devices are a safe form of contraception in users with solid organ transplantation: A single-center experience.

Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22-55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty-five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty-four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years. . In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients.

Provision of Onsite Childcare in US Academic Health Centers: What Factors Make a Difference?

INTRODUCTION: Challenges to work-life balance, including childcare, have been cited as major barriers to career advancement for women in academic medicine. METHODS: We performed a cross-sectional study to investigate the availability of onsite childcare at academic health centers (AHCs) for US medical schools and examined institutional characteristics associated with its provision. Data from the Association of American Medical Colleges (AAMC) were used to identify US medical schools by region, type (private vs. public, community-based vs. not), financial relationship to the university, and numbers of female medical students, faculty, chairs, and deans. We assessed onsite childcare from publicly available information on institutional websites, plus phone calls to human resources departments at medical centers and/or medical schools. RESULTS: Our study identified 144 US medical schools from the AAMC database and collected complete data for 136 (95%). Most AHCs offered onsite childcare (62%, 84/136). AHCs in the Midwest (78%) were most likely to have onsite childcare, whereas AHCs in the Southwest were least likely (14%, p < .001). No associations were demonstrated between onsite childcare and the proportion of female chairs or female faculty, or the AHC's financial relationship with the parent university. CONCLUSIONS: Although accessible childcare is critical to the upward mobility of women in medicine, more than a third of AHCs do not offer onsite childcare. As more women in medicine navigate childcare demands, the expansion of accessible, quality onsite childcare at AHCs is needed to promote a diverse academic workforce.

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center.

INTRODUCTION: Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. METHODS: In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. RESULTS: Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). CONCLUSION: When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.