A Critical Appraisal of Guidelines for Antenatal Care: Components of Care and Priorities in Prenatal Education

There are a variety of published prenatal care (PNC) guidelines that claim a scientific basis for the information included. Four sets of PNC guidelines published between 2005 and 2009 were examined and critiqued. The recommendations for assessment procedures, laboratory testing, and education/counseling topics were analyzed within and between these guidelines. The PNC components were synthesized to provide an organized, comprehensive appendix that can guide providers of antepartum care. The appendix may be used to locate which guidelines addressed which topics to assist practitioners to identify evidence sources. The suggested timing for introducing and reinforcing specific topics is also presented in the appendix. Although education is often assumed to be a vital component of PNC, it was inconsistently included in the guidelines that were reviewed. Even when education was included, important detail was lacking. Addressing each woman's needs as the first priority was suggested historically and remains relevant in current practice to systematically provide care while maintaining the woman as the central player. More attention to gaps in current research is important for the development of comprehensive prenatal guidelines that contribute effectively to the long‐term health and well‐being of women, families, and their communities.     

Menstrual regulation and the law

The advent of menstrual regulation techniques has further clouded the once-clear legal distinction between contraception and abortion. This study, which attempts to assess the relationship between menstrual regulation and abortion laws throughout the world, focuses on the three distinct types of abortion laws that impinge on menstrual regulation practice: (1) those that focus on the "intent" to interrupt pregnancy, (2) those that require proof of pregnancy and (3) those that make abortion readily accessible for a wide variety of indications.     

A survey of practice preferences and attitudes to the New Zealand Guidelines for the Management of Heavy Menstrual Bleeding

OBJECTIVE: To survey the practice preferences and the attitudes of New Zealand gynaecologists, general practitioners and family planning doctors to Guidelines for the Management of Heavy Menstrual Bleeding. STUDY DESIGN: A postal survey collected information on the following: demographics, practice preferences, knowledge of, usage of and attitudes toward the Guidelines for the Management of Heavy Menstrual Bleeding. The survey was sent to randomly selected practising general practitioners (n = 531), all specialist gynaecologists (n = 194) and all Family Planning Association doctors (n = 69) in New Zealand. Replies were received from 441 (56%). RESULTS: The preferred first choice for the management of heavy menstrual bleeding by general practitioners and family planning doctors was nonsteroidal anti-inflammatory medications (23%). Tranexamic acid was the preferred first choice medication for the management of heavy menstrual bleeding by specialists (57%), and preferred second choice (as well as levonorgestrel intrauterine system) by general practitioners and family planning doctors (34%). Barriers identified by general practitioners and family planning doctors to implementing the guideline included inability to access ultrasound scanning and specialist services, and a lack of subsidy for tranexamic acid and the levonorgestrel intrauterine system. CONCLUSIONS: There has been a change in prescribing patterns since 1995 among specialist and general practitioners and family planning doctors in New Zealand in accordance with the Guidelines for the Management of Heavy Menstrual Bleeding. Further attention to reducing barriers should focus on increasing access to ultrasound scanning, specialist services and subsidising the levonorgestrel intrauterine system.     

Cross-Cultural Adaptation of the Cardiff Fertility Knowledge Scale and the Fertility Status Awareness Tool for the French-Canadian Population

Objective

The Cardiff Fertility Knowledge Scale (CFKS) and the Fertility Status Awareness Tool (FertiSTAT) are validated tools allowing the evaluation of fertility knowledge and raising awareness about risk indicators for reduced fertility. Their use by health care professionals practicing in the field of reproductive health might optimize fertility of the Canadian population. However, there currently is no version of these questionnaires for the French-Canadian population. The objective of this study was to translate and culturally adapt the CFKS and FertiSTAT to the French-Canadian population.

Menstrual Patterns in the First Gynecological Year: A Systematic Review

Study Objective

Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1.

Documentation of Sexual and Menstrual Histories for Adolescent Patients in the Inpatient Setting

Study ObjectiveIn this study, we aimed to determine the frequency of menstrual history and sexual history documentation in the inpatient setting.Design, Setting, and ParticipantsA retrospective chart review was conducted for 307 female patients ages 11-18 years admitted from the emergency department at a single institution within a 7-month period. These charts were reviewed for documentation of menstrual and sexual history.Interventions and Main Outcome MeasuresRates of menstrual and sexual history documentation were compared according to patient age, chief complaint, admitting specialty, and medical complexity.ResultsSexual history documentation was noted in 158 (45.9%) of the 344 reviewed charts. Sexual history documentation rates were higher for patients with mental health symptoms (62.9%; 61 of 98 charts; P = .02) and lower for patients admitted to surgical services (30.6%; 19 of 62 charts; P = .04). At least 1 aspect of menses was documented in 113 (32.8%) of the 344 reviewed charts. Last menstrual period was the most commonly documented aspect of menstrual history, appearing in 100 (29.1%) of the 344 reviewed charts. Menarche (4.4%; 15/344), menses frequency (7.0%; 24/344), menses duration (2.6%; 9/344), flow quantity (4.9%; 17/344), and dysmenorrhea (4.4%; 15/344) were rarely documented, regardless of chief complaint or admitting service. Menstrual history documentation rates were significantly higher for patients requiring a gynecology consultation (73.3%; 11 of 15 charts; P < .01).ConclusionMenstrual and sexual history documentation rates for adolescent patients requiring inpatient admission were low, with fewer than half of patients having a documented menstrual or sexual history.     

Menstrual dysfunction: A missed opportunity for improving reproductive health in developing countries

The field of population has undergone a paradigm shift to a broader focus on reproductive health, which recognises women's self-perceived health needs. Investigations in various countries reveal that menstruation is a primary concern of women. Yet sparse attention has been paid to understanding or ameliorating women's menstrual complaints. We propose including the management of menstrual complaints as part of reproductive health programming. Next steps should include further quantitative and qualitative research to understand the prevalence, determinants and consequences of menstrual dysfunction; developing appropriate protocols and low-cost interventions for diagnosis and treatment of menstrual morbidity and training of health care workers in resource-scarce settings; and developing educational interventions to facilitate women's understanding of normal menstrual function and variability as well as of the types, causes and appropriate treatments for menstrual dysfunction.     

A Critical Analysis of Candidacy for Penile Revascularization

IntroductionPenile revascularization (PR) is a potentially curative procedure for young men with isolated arteriogenic erectile dysfunction. Standard preoperative evaluation is erectile hemodynamics (HDX) using duplex Doppler penile ultrasound (DUS) and/or cavernosometry (DIC) and assessment of cavernosal arterial anatomy by selective internal pudendal arteriography (SIPA).AimThe aim of this study was to review our experience with men who sought a second opinion from us regarding their candidacy for PR.MethodStudy population consisted of men (i) who presented to us for a second opinion regarding PR; (ii) who had DUS/DIC and SIPA; and (iii) had been advised by outside surgeon to undergo PR. Review of the HDX study and SIPA was conducted. Discrepancies between these studies resulted in repeating the DIC in men with normal SIPA or repeating the SIPA in men with normal HDX studies.Main Outcome MeasuresDiscrepancies between HDX and SIPA and the results of repeat HDX or SIPA were the main outcome measures.ResultForty‐five patients participated in the study; mean age was 33 years with 4% ≥50 years old. Median vascular risk factor number was 1 (ranged 0–3). A credible trauma history was present in 11%. Thirty‐three percent had prior DIC and 49% of patients had a significant discrepancy between HDX study and SIPA, including all patients seen by a community urologist. Thirty‐eight percent had a discrepancy between side of abnormality on HDX and SIPA where both studies were abnormal (group A). Seven percent had abnormal HDX and normal SIPA (group B). Four percent had a normal HDX study with an abnormal SIPA (group C). Repeat DIC (n = 20) was conducted in groups A + B and was normal in 70% of cases. Repeat SIPA (n = 2) was conducted in group C and was normal in both patients.ConclusionAlmost one half of patients had a significant discrepancy between HDX and SIPA. Of these, 73% had normal repeat studies, making them no longer candidates for penile revascularization. Dabaja AA, Teloken P, and Mulhall JP. A critical analysis of candidacy for penile revascularization. J Sex Med 2014;11:2327‐2332.