Qualitative analysis of African-American adolescent females' beliefs about emergency contraceptive pills

STUDY OBJECTIVE: This project was initiated to better understand why some African-American adolescent females do not use emergency contraceptive pills (ECP), despite their widespread availability. Adolescents are considered likely candidates for ECP because they are more likely to inconsistently use birth control and have sporadic sexual behavior patterns. These factors increase the risk of unprotected intercourse and unplanned pregnancy. DESIGN: A qualitative study design was employed to assess the knowledge of African-American adolescent females regarding ECP and their beliefs affecting use and nonuse of ECP. SETTING: An adolescent clinic at a large, urban, academic children's hospital. PARTICIPANTS: Twenty-nine African-American adolescent (age 13-18) females.Interventions. Semi-structured, qualitative interviews lasting 15-20 minutes. MAIN OUTCOME MEASURES: Interviews yielded qualitative data that was coded and categorized into themes.RESULTS: Through the interviews, eight themes emerged: Taking Care of Self, Lack of Knowledge of ECP, Inaccurate Information, Sources of Information, Acceptability of Adolescent Pregnancy, Partner's Influence on Adolescent Choices, Discomfort Talking About Sex, and Concern About Sexually Transmitted Infections (STIs). CONCLUSIONS: The results from this qualitative study will contribute to future quantitative research efforts by providing insight into the decision-making process regarding ECP among this population. The themes provide a foundation for clinical implications and educational interventions. Although a large proportion of the sample (24%) had used ECP, misinformation about ECP and basic reproductive health issues was prevalent. Most of the adolescents report they obtain reproductive health information from a complex network of information sharing, in which their primary sources tend to be peers.     

Screening for partner violence during pregnancy.

OBJECTIVES: An analysis of the international literature on partner violence provides insights for health care providers caring for women. METHODS: The current literature on partner violence epidemiology, screening, and interventions was reviewed, focusing on pregnancy. RESULTS: Adolescent girls and pregnant women are at highest risk for partner violence and homicide. CONCLUSIONS: Health care providers need to offer clinical screening and interventions to prevent consequences of partner violence, including homicide.     

Hypothyroidism: from the desire for pregnancy to delivery

The link between hypothyroidism and infertility is still a matter of debate. Hypothyroidism can result in cycle disturbances, such as oligomennorhea and functional bleeding. Additionally, several studies have shown that thyroid autoimmunity (detection of anti peroxydase antibodies) may account for the occurrence of repetitive miscarriages. In infertility work-up, screening thyroid function should be specifically recommended for women with clinical hypothyroidism, with a personal, familial history of thyroid or other auto immune diseases (such as type I diabetes) as well as for women with unexplained anovulation or functional bleeding. Moreover, detection of thyroid antibody seems to be worthwhile for the assessment of recurrent miscarriages, due to the potential benefit of thyroid supplementation. In pregnant women, assessment of thyroid function seems specifically crucial to ensure adequate foetal development. Indeed, it has been well established that untreated maternal hypothyroidism may be associated with disturbances of brain development and low intellectual quotient. Additionally, other foetal (growth deficiency, premature birth, low birth weight) as well as maternal (gestational hypertension, pre-eclampsia...) complications have been also reported in pregnant women with untreated hypothyroidism. Consequently, screening of thyroid function should be performed in every woman at risk of thyroid disease. Recent studies even advocate that thyroid screening should be extended to the overall pregnant population. The objective is to adjust L-thyroxin supplementation to maintain serum TSH concentrations below the threshold of 2.5 mUI/l. Finally, iodine deficiency, currently observed in pregnant women, should be prevented by iodine supply prior to conception, during pregnancy and during breast feeding as well.     

Care for adolescent pregnancy and childbirth.

The rise in adolescent pregnancy in the 20th century has been influenced by declining age at menarche, increased schooling, delay of marriage, inadequate contraception and poverty. The main problems are preterm labor, hypertensive disease, anemia, more severe forms of malaria, obstructed labor in very young girls in some regions, poor maternal nutrition and poor breastfeeding. In many regions HIV infection is an important problem. The infants of adolescent mothers are more prone to low birth weight and increased neonatal mortality and morbidity. Antenatal care is often inadequate. The most important problem is the increased incidence of preterm labor and delivery, the youngest age groups running the highest risk. Technically, care of adolescents during labor need not differ from care of older women; most adolescents are not at increased risk during labor, although, they are more in need of empathic support. Generally, care of pregnant adolescents should be adjusted to their specific needs.     

Obstetric aspects of adolescent pregnancy and delivery.

An analysis of 31 years of adolescent pregnancies and deliveries at Novi Sad Medical Facility is presented. Obstetric complications are discussed. The psychological impact of adolescent pregnancy is examined.     

Association between early prenatal care and mother's intention of and desire for the pregnancy

OBJECTIVE: To examine the associations between having planned to become pregnant and valuing an unintended pregnancy with seeking early prenatal care. DESIGN: This historical cohort study, using data from the National Survey of Family Growth (NSFG), Cycle V (1995), examined separately the associations of having a planned pregnancy (timing of pregnancy) and valuing an unintended pregnancy (feelings about the pregnancy) with timing of initiation of prenatal care. PARTICIPANTS: The NSFG was based on a national probability sample of women ages 15 to 44 (N= 1,989). OUTCOME MEASURE: Timing of initiation of prenatal care (early or late/no). Early prenatal care was defined as care sought within the first 13 weeks of pregnancy. It was hypothesized that unwanted and unintended pregnancies were predictors of late or no prenatal care. RESULTS: In agreement with previous research using logistic regression, unwanted pregnancy was found to be a predictor of late/no prenatal care. Black ethnicity also was found to be a predictor of late/no prenatal care. CONCLUSIONS: Interventions that are sensitive to culture and involve patient education regarding family planning are needed.     

Intimate partner violence and unplanned pregnancy in the Pacific Islands Families Study.

OBJECTIVE: To examine the association between maternal intimate partner violence (IPV) victimization and unplanned pregnancy. METHOD: Mothers of the Pacific Islands Families (PIF) Study cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed when the children were 6 weeks old. A total of 1088 mothers cohabiting in married or de-facto partnerships were questioned about IPV and whether their pregnancy had been planned. RESULTS: Women identified as victims of physical violence were more likely to report an unplanned pregnancy than those who were not victims (68.7% vs 55.1%, odds ratio [OR] 1.78; 95% confidence interval [CI], 1.32-2.40). The adjusted odds remained statistically significant (OR 1.52; 95% CI, 1.01-2.26). CONCLUSION: The findings of this study suggest an association between IPV and unplanned pregnancy in the Pacific birth cohort.     

Sexuality, partner relations and contraceptive practice after termination of pregnancy.

The aim of this study was to determine the impact of termination of pregnancy (TOP) on women's sexual well-being, the couple and contraceptive practice. In a prospective qualitative and quantitative study, 103 women undergoing induced abortion by vacuum aspiration were interviewed before the abortion and 6 months later. The interview was performed by means of a questionnaire including open and closed questions, and two psychological tests (Locke-Wallace and Horowitz). After TOP, the majority of women did not report changes in their sexual behavior and satisfaction. Eighteen per cent of women reported a decrease in sexual desire and 17% reported orgasmic disorders. About one-third of women described psychosomatic symptoms, but a minority were traumatized by the event. Ninety-eight per cent of the women were informed about, and had practiced, contraception in the past; 69% had actually used some kind of contraception during the menstrual cycle that had resulted in pregnancy (31% had had unprotected intercourse). Six months later, 83% practiced contraception, and only 17% did not. Fourteen out of 84 couples separated after TOP (one in six). Six months after TOP, the large majority of women interviewed seemed able to cope with TOP. A minority presented some persisting sexual dysfunction and/or some psychosomatic symptoms.     

Human chorionic somatomammotropin in normal adolescent primiparous pregnancy. I. Effect of smoking

Human chorionic somatomammotropin (HCS) levels were studied in normal smoking and nonsmoking primiparous adolescent pregnancies. 136 teenagers, aged 12-18 years, were divided into groups: nonsmokers, deep, and shallow inhalers, long, and short puffers, high, and low tar, and high, and low nicotin. Shallow inhaling and low nicotine exposure patients were found to have a later age of menarche than did nonsmokers (13.2 vs. 12.3 years, p=.03). The mean body weight of the mothers who smoked was slightly less (61 gm) than that of nonsmoking mothers. Except for long puffers, overall, smokers had significantly lower HCS values throughout pregnancy than noosmokers (p = .48 high tar-p = .002 low tar). However, in the third trimester those with the lowest smoking exposures had the lowest HCS values and the heavier smokers had slightly higher mean values than nonsmokers. These data suggest that HCS production may be more sensitive to low tar and nicotine exposure with possible tolerance or even stimulation occurring in larger doses.     

Impact of adolescent pregnancy as we approach the new millennium

Between 1990 and 1997 teen pregnancy and birth rates have fallen dramatically, especially in black teens. However, the teen birth rate in the United States remains the highest of any industrialized nation: four times higher than Germany, six times higher than France. Contraception use has also increased. Condoms were used during last intercourse approximately 55% of the time in 1997 vs. only approximately 38% in 1991. Likewise, the percentage of teens having intercourse has dropped, and the number of abortions is down. The negative social and economic impact of early teenage pregnancy is tremendous. It is estimated to cost the nation about $21 billion annually (in 1993 dollars). The long-term productive life prospects are also lower for teenage mothers and their offspring. Many programs have been utilized to reduce the incidence of teen pregnancy. While some have had modest success, no single or simple solution is on the horizon.     

Cervical pregnancy: the importance of early diagnosis and treatment

STUDY OBJECTIVE: To report the evolution and outcome of 12 cases of cervical pregnancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Twelve women with cervical pregnancy. INTERVENTIONS: Methotrexate, uterine artery embolization, curettage, ligation of the descending branch of uterine vessels, or hysterectomy. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was success of conservative management. From January 1985 through December 2005, we encountered 12 cases of cervical pregnancy. The final diagnosis was established by ultrasound, operative findings, and histopathology. We obtained information from the medical records of the patients regarding when and how the diagnosis was made, the characteristics of the pregnancy, and treatment modalities. The prevalence of cervical pregnancy was 1:10,000 deliveries. The patients' history revealed previous curettage in 6 (50%) and cesarean delivery in 2 others (16.7%). Four patients (33.3%) initially not diagnosed to have cervical pregnancy required a hysterectomy. Initial diagnosis of cervical pregnancy was correct in 5 patients. They were treated with methotrexate, uterine artery embolization, curettage, or ligation of the descending branch of uterine vessels. None of these patients required blood transfusion or hysterectomy. CONCLUSION: The success of conservative treatment for cervical pregnancy depends on the diagnostic accuracy of the initial ultrasound. Correct diagnosis would reduce the chance of hysterectomy or blood transfusion.     

The importance of uterine vascular systems in the maintenance of pregnancy

The mesometrial artery (MA), which is the final part of the uterine artery in guinea pig, supplies nutrients and oxygen to the fetus and placenta during pregnancy. Accompanying fetal growth, MA increases 8-fold in diameter, and 30- to 50-fold in weight, protein content and deoxyribonucleic acid (DNA) content. The importance of MA in the maintenance of pregnancy was examined by comparing the proliferative rate of MA during pregnancy and abortion induced by antiprogesterone RU38486 30 mg/kg. MA was incubated in Medium 199 with 185kBq/ml 3H-thymidine for 4h and the rate of 3H-incorporation into MA was used as the proliferative rate. The proliferative rate of MA during the first trimester (day less than 20) was 2,825 +/- 1,036 Bq/mg.h, which is almost 100 times higher than the rate in diestrus animals. During the later course of pregnancy, the proliferative rate decreased logarithmically, being 352 +/- 58 (40 less than or equal to d less than 50), 158 +/- 23 (50 less than or equal to d less than 60) and 75 +/- 10 (60 less than or equal to d). The proliferative rate of MA was measured also in animals which received RU38486 30 mg/kg at 24-48 h prior to the measurement and whose fetuses were still alive. The proliferative rates of MA in such animals decreased markedly to 141 +/- 21 (40 less than or equal to d less than 50) and 37 +/- 8 (50 less than or equal to d less than 60) (p less than 0.01), which means that the proliferation of MA is reduced even before the death of the fetus.(ABSTRACT TRUNCATED AT 250 WORDS)     

Screening positive urine pregnancy tests for sexually transmitted diseases expedites the treatment of infected adolescent gravidas

Objective: To test the utility of screening the urine samples used to diagnose pregnancies at urban teen clinics for Chlamydia trachomatis and Neisseria gonorrhoeae by polymerase chain reaction (PCR). We hypothesized that urine screening would increase the proportion of teenagers treated for these two sexually transmitted diseases (STDs) before they initiated pregnancy-related care. Design:A randomly selected subset of the urine samples used to diagnose 212 teen pregnancies were tested for C. trachomatis and N. gonorrhoeae by PCR. Endocervical testing was at the providers' discretion. Bivariate analyses were used to compare the teenagers randomized to the urine screening group (n = 102) and the non-screening group (n = 110). Results: Of the 102 urine PCR tests, 14 (13.7%) were positive. Endocervical swabs were obtained in 31 (14.6%) of the 212 teenagers and five (16.1%) were positive. Since pelvic examinations were performed so infrequently, the net endocervical swab detection rate was significantly lower than the urine-based detection rate (1.8% compared to 13.7%; p = 0.001). Only one infected teenager was untreated when she initiated pregnancy-related care. Thus, the treatment rate was more than six times higher when urine samples were screened (12.7% compared to 1.8%; p = 0.003). Conclusions: Screening the urine samples used to diagnose teen pregnancies for two common STDs is a simple, non-invasive procedure that is acceptable to providers and patients, and significantly increases the number of teenagers who are treated for genital infection before they initiate pregnancy-related care.     

Involving the male partner for interpreting the basal body temperature graph.

OBJECTIVE: To determine if the male cohabiting partner of a woman may serve as a control for exogenous influences on basal body temperature (BBT). METHODS: Twelve couples from the Atlanta area were enrolled for a total of 41 couple-cycles. Couples recorded their oral temperatures daily and used urinary test kits for luteinizing hormone to estimate the day of ovulation. The covariability between the pre-ovulatory temperature of the women and their partners was assessed. The gaps in the couples' temperatures (female temperature minus male temperature) were compared in the pre- and postovulatory phases. RESULTS: Considerable covariability was found between temperatures of partners in the pre-ovulatory phase (covariance parameter = 0.49; P <.001). The pre- and postovulatory temperature gaps for all couples were significantly different in size (P <.001). For all couple-cycles, the size of the mean postovulatory temperature gap was at least 0.3-degree Fahrenheit greater than the mean pre-ovulatory temperature gap. CONCLUSION: Recording the BBT of women's partners may improve interpretation and accuracy of the BBT method. An increase in the size of a couple's temperature gap accompanies the transition from the pre- to the postovulatory phase. By this method, a given couple could determine their unique temperature gap indicating this transition.     

A school-, hospital- and university-based adolescent pregnancy prevention program. A cooperative design for service and research

Based upon prior service and research findings, a program was designed to reduce the incidence of early childbearing among a high-risk, inner-city junior and senior high school population. Combining a strong research design with medical and educational service in a school- and clinic-based program, the project team sought to develop a replicable model the individual components of which could be evaluated against baseline data collected from 1,709 male and female students before the program began. This paper reports levels of sexual activity, contraceptive use and pregnancy in the student population, using data from anonymous, self-administered questionnaires, and outlines the program's objectives and major features. It also suggests variables that can be used in the measurement of program impact.