ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo evaluate whether advance provision of emergency contraception increases its use and/or adversely affects usual contraceptive practices.METHODSWe performed a randomized controlled trial comparing advance provision of emergency contraception with usual care in 370 postpartum women from an inner-city public hospital. Participants were followed for 1 year; 85% were available for at least one follow-up session. All participants received routine contraceptive education. The intervention group received a supply of emergency contraception (eight oral contraceptive pills containing 0.15 mg of levonorgestrel and 30 μg of ethinyl estradiol) and a 5-minute educational session. We compared use of emergency contraception and changes in contraceptive behaviors between groups.RESULTSWomen provided with pills were four times as likely to have used emergency contraception as women in the control group over the course of the year (17% versus 4%; relative risk [RR] 4.0; 95% confidence interval [CI] 1.8, 9.0). Women were no more likely to have changed to a less effective method of birth control (30% versus 33%; RR 0.92; 95% CI 0.63, 1.3), or to be using contraception less consistently (18% versus 25%; RR 0.74; 95% CI 0.45, 1.2). About half of each group reported at least one episode of unprotected intercourse during follow-up, but women who received emergency contraception were six times as likely to have used it (25% versus 4%; RR 5.8; 95% CI 2.1, 16.4).CONCLUSIONAdvance provision of emergency contraception significantly increased use without adversely affecting use of routine contraception. It is safe and appropriate to provide emergency contraception to all postpartum women before discharge from the hospital.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo evaluate use of an emergency contraceptive pill product dispensed under simulated over-the-counter conditions. Secondary objectives were to assess repeat use, pregnancy, and adverse events.METHODSThe study was conducted at family planning clinics and pharmacies in the United States. During enrollment, these facilities did not provide unsolicited counseling about or evaluations for emergency contraceptive pills. Women who requested emergency contraception were asked to examine a package that was modified for over-the-counter use. A package (levonorgestrel, two 0.75-mg tablets) was provided to each woman who met study criteria and indicated that she wished to receive one. Each subject paid the amount normally charged by the facility for emergency contraceptive pills. Subjects were contacted 1 and 4 weeks later and asked about use of the product, side effects, and pregnancy.RESULTSOf 665 women screened for the study, 585 received at least one package, and 540 reported having used the product. Of classifiable first uses, 1.3% (97.5% confidence interval [CI] 0.5%, 3%) were contraindicated and 28% (97.5% CI 23%, 32%) were incorrect by strict primary definitions of these inappropriate use patterns, based on the label instructions. Only 6.6% (97.5% CI 4.3%, 9.5%) of classifiable first uses were incorrect by a reasonable alternate definition. Ten subjects received the product more than once, and ten were found to be pregnant during the study. The pattern of adverse events was consistent with findings of previous studies.CONCLUSIONMost women used emergency contraceptive pills appropriately without provider evaluation and counseling.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate the effectiveness, side effects, and retention rate of the levonorgestrel two-rod implant used as a long-acting contraceptive.METHODSVoluntary participants, ages 18–40 years and desiring long-acting contraception, were enrolled in the study. The original design was to observe the participants for 5 years. Later, the follow-up period was extended to 6 years.RESULTSA total of 249 women underwent two-rod implant insertion and were observed for a total of 823 woman-years. There were two pregnancies observed during the study, yielding a pregnancy rate of 0.24 per 100 woman-years. One pregnancy occurred in the first month, and the other occurred after 6 years of use. The major side effect was menstrual irregularity. No serious side effects were observed during the study. Insertion of the device was easy and took less than 2 minutes; removal time averaged 4.5 minutes.CONCLUSIONThe levonorgestrel two-rod implant system is an effective, convenient, long-acting, and well-tolerated method of contraception.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate the current prevalence of prenatal exposure to methamphetamines and other drugs of abuse among infants born in Utah and compare the results with those of a maternal substance abuse prevalence study performed in 1991 in the same geographic area.METHODSThirteen well baby nurseries in calendar year 2000 and six neonatal intensive care units (NICUs) in 2001–2002 collected anonymous meconium samples and associated, but nonidentifiable, demographic data on consecutively born infants. Samples were screened by enzyme immunoassay and confirmed by gas chromotography/mass spectroscopy for methamphetamines, cannabinoids, and benzoylecognine.RESULTSMeconium samples were collected from 1202 well baby nursery infants and 317 NICU infants. There were no significant differences in the rates of positivity for methamphetamines (0.6% versus 0.4%) or marijuana (2.9% versus 1.8%) between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P= .04). The prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P= .02). The prevalence for positivity for any of these three drugs was higher in the NICUs (4.7%) than in the well baby nurseries (1.9%,P= .008).CONCLUSIONThe rate of drug-positive infants declined during the decade of the 1990s in a geographic area that is experiencing a sharp rise in the use of methamphetamine among women of childbearing age. Further studies that focus on women of childbearing age who use methamphetamine may help determine factors that impact their drug use during pregnancy and after the infant is born.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo assess whether prophylactic use of the McRoberts maneuver and suprapubic pressure decreased the head-to-body time, as a proxy for shoulder dystocia, in at-risk patients.METHODSPatients with estimated fetal weights over 3800 g were randomized to undergo the McRoberts maneuver and suprapubic pressure before delivery of the fetal head (prophylactic maneuvers) or to undergo maneuvers only after delivery of the head, if necessary (controls). A total of 185 patients were enrolled in the study. After exclusions (eg, abdominal delivery), there were 128 evaluable vaginal deliveries. The study had the power to detect a 30% difference in head-to-body time between groups.RESULTSHead-to-body delivery times did not differ between the prophylactic and control patients (24 ± 18 seconds versus 27 ± 20 seconds,P= .38). In addition, the two groups did not differ in rates of admission of the infant to the special care nursery or in birth injuries. There was a significant increase in the risk of delivering by cesarean for patients randomized to the use of prophylactic maneuvers.CONCLUSIONThis study does not support the hypothesis that prophylactic use of the McRoberts maneuver and suprapubic pressure speeds delivery in a population of patients at increased risk for shoulder dystocia.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUNDThe most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported.CASEWe encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the Wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft.CONCLUSIONNeonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID