Prevention of pregnancy resulting from rape: a neglected preventive health measure

Abstract: Pregnancy following rape is a continuing and significant public health issue. We estimate that the 333,000 sexual assaults and rapes reported in 1998, along with many more unreported, were responsible for 25,000 pregnancies. Potentially, as many as 22,000 such pregnancies could be prevented if all women who were raped received prompt medical services, and if not already protected against pregnancy, were provided with emergency contraceptive treatment.     

十一酸睾酮与棉酚合用对雄大鼠生育力的影响

本研究探讨十一酸睾酮(TU)与醋酸棉酚(G)序列使用对雄大鼠生育力的影响。SD 雄大鼠肌注TU 12mg/kg 共3次,9/10鼠生育力下降至零(P<0.001),附睾精子密度和活率明显下降(P<0.001);然后胃饲G 12mg/kg·d,每周6日,共3个月。使雄鼠可维持在不育状态,无论在注射TU 或胃饲G 期间,大鼠体重增长如常。停用棉酚3周后,10鼠中6只生育力恢复,停用5周后10鼠生育力全部恢复。二药合用可减少各自的用药量,因TU 所致睾丸体积缩小及单用棉酚引起的不良反应的均可有所减轻,为降低二药的副作用提供了一条可能的途径。     

Contraceptive Decision Making Among Medicaid-Eligible Women

The purpose of this study was to examine the influence of sociodemographic factors, attitudes, knowledge, and experiences regarding the use of various contraceptive methods, future plans prenatally, and actual use postpartum among a population of low income pregnant women. Women were interviewed prenatally and during the postpartum period in a large, urban academic health center serving primarily an indigent population. The primary analytic method employed was logistic regression. The key finding in this study is that women are not consistently using the method of contraception postpartum that they planned during the prenatal period. Only 54.7% of the women planning to use oral contraceptive pills were using them postpartum, and only 31.3% of the women planning to use condoms were actually using them postpartum. Expanding contraceptive education and counseling throughout the perinatal period may assist women's decision making.     

Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC).

Design: Cross-sectional study.

Setting: Survey carried out in Spain.

Participants: 1000 Spanish women reporting unprotected sex in 2017.

Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided.

Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented.

Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.     

Effect of desogestrel 75 µg on headache frequency and intensity in women with migraine: a prospective controlled trial

Objective: In contrast with combined hormonal contraception, progestin-only contraception is not associated with an increase in venous thromboembolism or stroke. Women with migraine are at increased risk of ischaemic stroke. Several studies have reported a reduction in migraine frequency and intensity with desogestrel 75 µg, a progestin-only pill. At present the quality of data is limited by retrospective study designs, lack of control groups and small sample sizes. We present the first prospective nonrandomised controlled trial.

Methods: A total of 150 women with migraine visiting our clinic for contraceptive counselling were screened. The intervention group comprised women who opted for contraception with desogestrel (n?=?98); the control group comprised women who continued their usual contraceptive (n?=?36). Participants completed daily diaries for 90 days before the intervention and 180 days after the intervention.

Results: In the intervention group, we found improvements in migraine frequency (p?<?.001), migraine intensity (p?<?.001) and the number of triptans used (p?<?.001). These improvements were already significant after 90 days of desogestrel use (p?<?.001). Disability scores also decreased significantly. No improvement was seen in the nonintervention group.

Conclusion: These data demonstrate for the first time in a prospective controlled setting that daily use of the progestin desogestrel is associated with a decrease in migraine frequency, migraine intensity and pain medication use in women with migraine, with and without aura, who had previously been experiencing at least three days of migraine per month.

Trial registration: The study is registered in the University of Zürich database (www.research-projects.uzh.ch/unizh.htm).     

Vaginal misoprostol before copper IUD insertion after previous insertion failure: a double-blind,placebo-controlled,parallel-group,randomised clinical trial

Objective: The aim of the study was to assess whether vaginal administration of misoprostol before copper intrauterine device (IUD) insertion increased the success of the procedure among parous women with previous insertion failure.

Methods: A single-centre, parallel-group, double-blind, placebo-controlled, randomised clinical trial was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between October 2015 and August 2016. The study comprised 90 parous women undergoing TCu380A IUD insertion after a failed attempt. A computer-generated list of random numbers was used to assign participants to receive either misoprostol 200?μg or a placebo tablet, applied vaginally 10?h and 4?h prior to the second attempted IUD insertion, without ultrasound guidance. The primary outcome was the success of IUD insertion. Secondary outcomes were to establish the effect on insertion success of cervical dilation, cervical softening and previous mode of delivery.

Results: Forty-two women (93.3%) in the misoprostol group and 24 women (53.3%) in the placebo group had a successful IUD insertion (p?<?.001). Cervical dilation was required in 24 women in the misoprostol group and 44 women in the placebo group. Misoprostol application significantly increased insertion success in women with previous caesarean delivery (p?<?.001) but did not affect insertion success in women with previous vaginal delivery (p?=?.481).

Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous caesarean delivery.     

Use of Emergency Contraception could Halve Induced Abortion Rate in Shanghai, China

Objective To investigate and estimate the proportion of the induced abortion that could have been prevented by using emergency contraception in Shanghai.Method Structured interviews were conducted in 606 women (413 married and 193 unmarried) aged 18-49 years, who were attending three health care centers in Shanghai for termination of first trimester pregnancy.Results A total of 98.2% of the pregnancies were unwanted, and 63.7% of the women.recognized that they were at risk of pregnancy soon after the intercourse. It is estimated that 52.2% of the induced abortion could have been prevented if the women had used levonorgestrel-only emergency contrdcception. Only 28.5% of the respondents were aware of emergency contraception. The most important sources of information about emergency contraception identified by respondents were books/newspapers/periodicals (38.2%), and relatives/friends (30.6%). Family planning health education on emergency contraception was noted by 28.9% of married women but only by 5.8% of unmarried women. A portion of 85.5% of all respondents reported they would be willing to use emergency contraception when needed. Those more willing to use emergency contraception included younger, better educated, and unmarried women experiencing their first pregnancy. Women preferred drugstores (60.1%) than hospitals (30.29%)for obtaining emergency contraception.Conclusion Women‘s needs for emergency contraception were enormous. Promotion of emergency contraception by providing information and improving service could have a substantial impact on reducing the rate of induced abortion in Shanghai.     

The influence of parents,church, and peers on the sexual attitudes and behaviors of college students

Male and female undergraduate students were surveyed concerning their sexual attitudes, sexual behaviors, and contraceptive behavior. In addition, the general attitudes about sexuality the students perceived as communicated to them by their parents, their church, and their peers were assessed. It was found for female students that general attitudes about sexuality, as defined on an erotophilia-erotophobia dimension, and sexual behaviors were correlated with the perceived attitudes of peers, rather than those of parents and church. However, male students' attitudes and some sexual behaviors were correlated with the perceived attitudes of their parents, rather than the views of their peers and church. Church attitudes were not found to be related to any of the measures. None of the sources of influence, parents, peers, or church attitudes, or erotophilia-erotophobia was related to contraceptive behavior.This article is taken from the first author's undergraduate honors thesis, prepared under the supervision of the second author.     

TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age

OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.     

Reproductive health, the Arab world and the internet: usage patterns of an Arabic-language emergency contraception web site

Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analysis of use shows that the Arabic web site users are interested in different aspects of EC than the English web site users, suggesting the importance of creating culturally specific content when adapting and translating health education materials. Arabic web site users demonstrate significant interest in general reproductive health issues not specific to EC, suggesting a need for greater availability of Arabic-language health education resources through the Internet.