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Berlin Brandenburg

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  • 1
    In: Obstetrics & Gynecology, 2018, Vol.131 Suppl 1, pp.87S-88S
    Description: INTRODUCTION:: Pathologists routinely use fetal foot length (FFL) to estimate the gestational ages (GA) of aborted fetuses. However, there is no standard formula. We aimed to develop an updated FFL-to-GA reference range from patient reported last menstrual period (LMP), ultrasound estimate, and best estimate for GA based on American College of Obstetricians and Gynecologists’ criteria in our patient population. After determining a reference range, we compared our measurements to those of previously published, commonly referenced FFL tables, which may not represent the ethnic diversity, or increasing BMI of current patient populations. METHODS:: Retrospective chart review of 628 dilation and evacuation (D&E) clinical records and procedure pathology reports from October 2012 to December 2014 in Honolulu, HI. RESULTS:: A linear relationship exists between FFL and GA in our population. Linear regression analysis of three pregnancy dating methods demonstrated that ultrasound derived dating provided the best-fit regression formula: FFL (mm) =496*(GA in days)-34.53 with an R2 value of .916. Patient race/ethnicity and BMI did not affect these equations in regression analysis. Our mean FFL differed from historically referenced ranges by .36-3.92mm, dependent on GA. Our FFL by GA was similar to ranges more recently endorsed by the National Abortion Federation despite differences in population racial and ethnic backgrounds. CONCLUSION:: If post-abortion FFL measurement is utilized for GA estimation, then updated, modern ranges should be referenced to better reflect the diversity of abortion patients nationwide.
    ISSN: 0029-7844
    Source: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.〈img src=http://exlibris-pub.s3.amazonaws.com/LWW%20logo.png style="vertical-align:middle;margin-left:7px"〉
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  • 2
    In: Southern Medical Journal, 2019, Vol.112(3), pp.180-184
    Description: OBJECTIVE: To examine healthcare providers’ adherence to professional recommendations for advanced prescription of emergency contraceptive pills (ECPs). METHODS: We conducted a retrospective chart review of 432 visits by 282 unique nonpregnant women 14 to 25 years of age seen at an obstetrics and gynecology teaching clinic to determine the percentage of visits during which advanced prescriptions of ECPs were provided when indicated. A logistic regression model, which accounted for nonindependent observations through generalized estimating equations, was used to identify factors associated with the provision of ECP advanced prescriptions. RESULTS: Approximately one-fifth of eligible visits (19.9%) and eligible patients (19.1%) had documentation of an ECP advanced prescription when indicated. Healthcare providers in this clinical setting were more likely to prescribe ECPs to adolescents and women whose primary contraceptive methods were associated with higher failure rates in typical use, such as condoms. Compared with women aged 20 to 25 years, the adjusted odds ratio of receiving an advanced prescription for ECPs was 5.94 (95% confidence interval [CI] 2.85–12.41) for adolescents. Compared with users of depot medroxyprogesterone acetate, the adjusted odds ratio was 4.25 (95% CI 1.62–11.15) for condom users, and 3.90 (95% CI 1.54–9.86) for users of other short-term hormonal contraceptives. CONCLUSIONS: Despite clear professional recommendations for ECP advanced prescriptions for all women at risk for unintended pregnancy, a substantial gap exists between this standard of care and routine clinical service provision in an obstetrics and gynecology teaching clinic.
    Keywords: Practice Guidelines As Topic ; Contraceptives, Postcoital -- Therapeutic Use ; Guideline Adherence -- Statistics & Numerical Data ; Gynecology -- Standards ; Obstetrics -- Standards;
    ISSN: 0038-4348
    E-ISSN: 15418243
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  • 3
    In: Southern Medical Journal, 2015, Vol.108(8), pp.463-468
    Description: OBJECTIVES: The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned. METHODS: We conducted a retrospective chart review of women who had at least one prenatal visit and delivered a viable pregnancy at our academic medical center. Methods of planned and established postpartum contraceptive methods were recorded, as well as demographic information and documented reasons for failure to initiate planned intrauterine contraception. RESULTS: A total of 110 women planned postpartum IUD placement. Of these women, 84 (76%) presented for at least one postpartum appointment. Only 22.6% (95% confidence interval 13.7–31.5) of those presenting for postpartum follow-up underwent IUD placement within 8 weeks of delivery. Women planning postpartum IUD insertion were just as likely as women with no planned postpartum contraceptive method to fail to establish contraception within 8 weeks (P = 0.55). CONCLUSIONS: Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.
    Keywords: Postpartum Period ; Contraception -- Statistics & Numerical Data ; Intrauterine Devices -- Statistics & Numerical Data;
    ISSN: 0038-4348
    E-ISSN: 15418243
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  • 4
    Language: English
    In: PLoS ONE, 2010, Vol.5(6), p.e11359
    Description: In this report we demonstrate that differences in cage type brought unexpected effects on aggressive behavior and neuroanatomical features of the mouse olfactory bulb. A careful characterization of two cage types, including a comparison of the auditory and temperature environments, coupled with a demonstration that naris occlusion abolishes the neuroanatomical changes, lead us to conclude that a likely important factor mediating the phenotypic changes we find is the olfactory environment of the two cages. We infer that seemingly innocuous changes in cage environment can affect sensory input relevant to mice and elicit profound effects on neural output. Study of the neural mechanisms underlying animal behavior in the laboratory environment should be broadened to include neuroethological approaches to examine how the laboratory environment (beyond animal well-being and enrichment) influences neural systems and behavior.
    Keywords: Research Article ; Neuroscience -- Behavioral Neuroscience ; Neuroscience -- Sensory Systems ; Neuroscience -- Psychology
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: Contraception, May 2013, Vol.87(5), pp.602-604
    Description: Hormonal emergency contraception can postpone ovulation, making a woman vulnerable to pregnancy later in the same cycle. However, concern exists as to whether concurrently administered emergency contraception pills (ECP) and other hormonal methods of contraception may affect the effectiveness of both medications. A systematic review of the literature using PubMed and the Cochrane databases was performed to identify articles concerning the resumption or initiation of regular contraception within the same cycle as ECP use. We searched for articles in any language, published between 1980 and April 2012 and included all methods of emergency contraception pills available in the USA. The search strategy identified 184 articles in the PubMed and Cochrane databases, of which none met inclusion criteria. The drug manufacturer advises continuation or initiation of routine contraception as soon as possible after use of ulipristal acetate, with concomitant use of a reliable barrier method until next menses. However, a theoretical concern exists that given ulipristal acetate's function as a selective progesterone receptor modulator, coadministration of a progestin could decrease its effectiveness as an emergency contraceptive. Initiation of hormonal contraception following levonorgestrel or the Yuzpe regimen for emergency contraception carries no similar concern for decreased method effectiveness.
    Keywords: Emergency Contraception ; Ecp ; Levonorgestrel ; Ulipristal Acetate ; Yuzpe Method ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 6
    In: Obstetrics & Gynecology, 2018, Vol.132(3), pp.612-618
    Description: OBJECTIVE:: To evaluate whether prophylactic pregabalin reduces pain experienced with medication abortion. METHODS:: We conducted a randomized, double-blind, placebo-controlled trial of women initiating medication abortion with mifepristone and buccal misoprostol up to 70 days of gestation. Participants were randomized to 300 mg oral pregabalin or a placebo immediately before misoprostol. The primary outcome was maximum pain on an 11-point numerical rating scale, reported using real-time electronic surveys over 72 hours. Secondary outcomes included pain at each time point, ibuprofen and narcotic use, side effects, and satisfaction. We estimated that 110 women would be required to have 80% power to detect a difference in pain of 1.3 points. RESULTS:: Between June 2015 and October 2016, 241 women were screened and 110 were randomized (56 pregabalin, 54 placebo). Three were lost to follow-up. The primary outcome of mean maximum pain in the pregabalin group was 5.0±2.6 vs 5.5±2.2 in the placebo group (P=.32). Excluding medication taken before the study capsule, ibuprofen was used by 64% (35/55) of the pregabalin group vs 87% (45/52) placebo (P〈.01). Narcotics were used by 29% (16/55) of the pregabalin group vs 50% (26/52) placebo (P〈.03). More dizziness (P〈.001), sleepiness (P〈.04), and blurred vision (P〈.05) occurred in the pregabalin group. Satisfaction scores for the analgesic regimen were higher in the pregabalin group (very satisfied: 47% vs 22%; P=.006). CONCLUSION:: Compared with placebo, 300 mg pregabalin coadministered with misoprostol during medication abortion did not significantly decrease maximum pain scores. Women who received pregabalin were less likely to require any ibuprofen or narcotic and were more likely to report higher satisfaction with analgesia, despite an increase in dizziness, sleepiness, and blurred vision. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02782169.
    Keywords: Abortion, Induced -- Adverse Effects ; Analgesics -- Therapeutic Use ; Pain -- Prevention & Control ; Pregabalin -- Therapeutic Use;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 7
    In: Obstetrics & Gynecology, 2017, Vol.130(2), pp.387-392
    Description: OBJECTIVE:: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS:: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS:: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0). CONCLUSION:: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02454296.
    Keywords: Abortion, Induced–Methods ; Adult–Methods ; Anesthesia, Obstetrical–Administration & Dosage ; Double-Blind Method–Administration & Dosage ; Female–Administration & Dosage ; Gestational Age–Administration & Dosage ; Hawaii–Administration & Dosage ; Humans–Administration & Dosage ; Laminaria–Administration & Dosage ; Lidocaine–Administration & Dosage ; Pain Measurement–Administration & Dosage ; Patient Satisfaction–Administration & Dosage ; Pregnancy–Administration & Dosage ; Pregnancy Trimester, Second–Administration & Dosage ; Sodium Bicarbonate–Administration & Dosage ; Abridged ; Sodium Bicarbonate ; Lidocaine;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 8
    Language: English
    In: Journal of Pediatric and Adolescent Gynecology, April 2017, Vol.30(2), pp.290-290
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jpag.2017.03.050 Byline: Jennifer Salcedo, Mary Tschann, Jennifer Elia Author Affiliation: Department of Obstetrics, Gynecology & Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI Article Note: (miscellaneous) 33
    Keywords: Medicine
    ISSN: 1083-3188
    E-ISSN: 1873-4332
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  • 9
    Language: English
    In: Maternal health, neonatology and perinatology, 2017, Vol.3, pp.1
    Description: Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
    Keywords: Breastfeeding ; Contraception ; Inter-Pregnancy Interval ; Lactation ; Postpartum
    ISSN: 2054-958X
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  • 10
    Language: English
    In: Current Women`s Health Reviews, 2014, Vol.10(2), p.66-71
    Description: Use of any form of contraception results in cost-savings compared to non-use of contraception, regardless of payer type. Long-acting reversible contraceptive (LARC) methods are significantly more cost-effective than short-term hormonal and barrier methods, even when LARC methods are not used for their full duration of efficacy. Despite increased contraceptive coverage and reduced patient cost-sharing under the Affordable Care Act, significant barriers remain in addressing the unmet need for effective contraception and fully realizing the decreased health care costs associated with use of contraception in the United States.
    Keywords: Contraception Larc Cost-Effectiveness Affordable Care Act (Aca) Sterilization Emergency Contraception.
    ISSN: 1573-4048
    E-ISSN: 1875-6581
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