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Probability of successful sterilization procedure with laparoscopic vs. hysteroscopic approach
Abstracts / Contraception 84 (2011) 302–336 enrolled in HIV care had undergone family planning counseling. Among clients who underwent Opt-Out FP Counseling, we have achieved 91% contraceptive uptake. Contraceptive methods included 15% condoms, 70% DMPA, 11% OCPS, 1% implants and 1% intrauterine device. Twenty percent of clients are using dual-method contraception (hormonal and barrier methods). Conclusions: Integrated Opt-Out FP Counseling increases uptake of contraception amongst HIV-infected women attending an HIV clinic in Kenya.
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TEMPORAL AND REGIONAL DIFFERENCES IN EMERGENCY CONTRACEPTION USE: A POPULATION-BASED ANALYSIS Soon J UBC Faculty of Pharmaceutical Sciences, Vancouver, Canada Leung V, Smith A, Shoveller J Objectives: Emergency contraception (EC) use has the potential to impact youth pregnancy at both an individual and a population level. This study examined temporal and regional trends in EC use and the relationship between sociodemographic factors and EC patterns following transition from physician-only to physician and pharmacist EC provision in 2001. Methods: Levonorgestrel (LNG) and Yuzpe (YZP) regimen EC data were obtained from the provincial prescription database for women aged 15 to 24 years. Sociodemographic census data (e.g., aboriginal identity, visible minorities, income inequality, lone parent families) and physician data (physicians/10,000 people) were obtained from Statistics Canada and the CHSPR Primary Care Report. A GIS system was then used to link and map all variables across 89 local health authorities (LHAs). Correlation analysis was utilized to estimate the association between the rate of EC prescriptions and sociodemographic variables. Results: Between 1996 and 2000, EC prescriptions/1000 women were stable at 19.8 to 21.0. After initiation of pharmacist-prescribing, it increased to 31.5 in 2001, 34.6 in 2002 and 39.3 in 2003. There was a weak but consistent positive correlation between rates of EC prescriptions and LHAs with higher proportions of visible minorities (r=0.08 to 0.28), aboriginal peoples (r=0.03 to 0.32), lone parent families with children (r=0.06 to 0.34) and physicians/10,000 residents (r=0.01–0.20), and a consistent negative correlation with income inequality (r=−0.03 to 0.22). Additionally, we observed the proportion of LNG prescriptions increased markedly over time. Conclusions: While pharmacy access increased EC use across all geographic regions over time, sociodemographic characteristics had only a modest association with usage patterns across space and time.
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PROBABILITY OF SUCCESSFUL STERILIZATION PROCEDURE WITH LAPAROSCOPIC VS. HYSTEROSCOPIC APPROACH
ization in the operating room and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources. When data was missing from published literature, we used data from our practice's active database, which was initiated in July 2003. Results: In the base case analysis, the proportion of women having a successful sterilization procedure on first attempt is 99% for laparoscopic, 87% for hysteroscopic in the office and 88% for hysteroscopic in the operating room. The probability of having any successful sterilization procedure within 1 year of the first procedure is 99% with laparoscopic, 94% for hysteroscopic in the office and 95% for hysteroscopic in the operating room. Hysteroscopic sterilization success rates include approximately 6% of women who are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts. Conclusions: Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization, subsequent pregnancy and potential complications must also be considered when choosing a method of sterilization.
P70
A RANDOMIZED CONTROL TRIAL OF MISOPROSTOL PRIOR TO IUD PLACEMENT IN NULLIPAROUS WOMEN Lotke P University of Arizona, Tucson, AZ, USA Tiwari A Objectives: To determine whether cervical preparation with misoprostol decreases pain of insertion during IUD placement in nulliparous women. Methods: Sixty-one nulliparous women desiring intrauterine contraception were randomly assigned to receive 400 mcg of misoprostol or placebo 2 h prior to IUD placement. The women were contacted at 1 week and returned for a visit at 1 month post-insertion. The primary outcome was pain on insertion, using a 100-mm visual analog scale. Additional outcomes included provider-assessed ease of insertion, use of adjuvant procedures, medication side effects, complications and patient satisfaction. Results: Successful IUD placement occurred in all 61 nulliparous women (100%), with only one patient, in the placebo group, requiring adjuvant measures. There were no complications, but one expulsion occurred prior to follow-up. There was no significant difference in the pain scale between the misoprostol and placebo groups (5.67±2.21 vs. 5.72±2.24, p=.92). Pain did correlate with age. There was a significant difference in ease of insertion (2.41±1.42 vs. 3.34±2.03, p=.04) using misoprostol. Subjects receiving misoprostol were more likely to have cramps and fevers and chills, but not nausea, vomiting or diarrhea. Conclusions: The use of misoprostol prior to IUD insertion in nulliparous women did not affect their perceived pain. Misoprostol does improve the ease of insertion, but it may not be of clinical significance. These results do not support the routine use of misoprostol prior to IUD placement in nulliparas.
P71
Gariepy A University of Pittsburgh, Pittsburgh, PA, USA Creinin MD, Schwarz EB, Smith KJ Objectives: To estimate the true probability of successful sterilization after hysteroscopic or laparoscopic sterilization procedure. Methods: An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure via laparoscopic sterilization, hysteroscopic steril-
327
EFFECT OF PROSPECTIVELY MEASURED PREGNANCY INTENTION INDICATORS ON THE CONSISTENCY OF CONTRACEPTIVE USE AMONG YOUNG WOMEN Moreau C Princeton University, Princeton, NJ, USA INSERM U1018, Le Kremlin Bicêtre, France Hall K, Trussell J, Barber J
P68
TEMPORAL AND REGIONAL DIFFERENCES IN EMERGENCY CONTRACEPTION USE: A POPULATION-BASED ANALYSIS Soon J UBC Faculty of Pharmaceutical Sciences, Vancouver, Canada Leung V, Smith A, Shoveller J Objectives: Emergency contraception (EC) use has the potential to impact youth pregnancy at both an individual and a population level. This study examined temporal and regional trends in EC use and the relationship between sociodemographic factors and EC patterns following transition from physician-only to physician and pharmacist EC provision in 2001. Methods: Levonorgestrel (LNG) and Yuzpe (YZP) regimen EC data were obtained from the provincial prescription database for women aged 15 to 24 years. Sociodemographic census data (e.g., aboriginal identity, visible minorities, income inequality, lone parent families) and physician data (physicians/10,000 people) were obtained from Statistics Canada and the CHSPR Primary Care Report. A GIS system was then used to link and map all variables across 89 local health authorities (LHAs). Correlation analysis was utilized to estimate the association between the rate of EC prescriptions and sociodemographic variables. Results: Between 1996 and 2000, EC prescriptions/1000 women were stable at 19.8 to 21.0. After initiation of pharmacist-prescribing, it increased to 31.5 in 2001, 34.6 in 2002 and 39.3 in 2003. There was a weak but consistent positive correlation between rates of EC prescriptions and LHAs with higher proportions of visible minorities (r=0.08 to 0.28), aboriginal peoples (r=0.03 to 0.32), lone parent families with children (r=0.06 to 0.34) and physicians/10,000 residents (r=0.01–0.20), and a consistent negative correlation with income inequality (r=−0.03 to 0.22). Additionally, we observed the proportion of LNG prescriptions increased markedly over time. Conclusions: While pharmacy access increased EC use across all geographic regions over time, sociodemographic characteristics had only a modest association with usage patterns across space and time.
P69
PROBABILITY OF SUCCESSFUL STERILIZATION PROCEDURE WITH LAPAROSCOPIC VS. HYSTEROSCOPIC APPROACH
ization in the operating room and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources. When data was missing from published literature, we used data from our practice's active database, which was initiated in July 2003. Results: In the base case analysis, the proportion of women having a successful sterilization procedure on first attempt is 99% for laparoscopic, 87% for hysteroscopic in the office and 88% for hysteroscopic in the operating room. The probability of having any successful sterilization procedure within 1 year of the first procedure is 99% with laparoscopic, 94% for hysteroscopic in the office and 95% for hysteroscopic in the operating room. Hysteroscopic sterilization success rates include approximately 6% of women who are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts. Conclusions: Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization, subsequent pregnancy and potential complications must also be considered when choosing a method of sterilization.
P70
A RANDOMIZED CONTROL TRIAL OF MISOPROSTOL PRIOR TO IUD PLACEMENT IN NULLIPAROUS WOMEN Lotke P University of Arizona, Tucson, AZ, USA Tiwari A Objectives: To determine whether cervical preparation with misoprostol decreases pain of insertion during IUD placement in nulliparous women. Methods: Sixty-one nulliparous women desiring intrauterine contraception were randomly assigned to receive 400 mcg of misoprostol or placebo 2 h prior to IUD placement. The women were contacted at 1 week and returned for a visit at 1 month post-insertion. The primary outcome was pain on insertion, using a 100-mm visual analog scale. Additional outcomes included provider-assessed ease of insertion, use of adjuvant procedures, medication side effects, complications and patient satisfaction. Results: Successful IUD placement occurred in all 61 nulliparous women (100%), with only one patient, in the placebo group, requiring adjuvant measures. There were no complications, but one expulsion occurred prior to follow-up. There was no significant difference in the pain scale between the misoprostol and placebo groups (5.67±2.21 vs. 5.72±2.24, p=.92). Pain did correlate with age. There was a significant difference in ease of insertion (2.41±1.42 vs. 3.34±2.03, p=.04) using misoprostol. Subjects receiving misoprostol were more likely to have cramps and fevers and chills, but not nausea, vomiting or diarrhea. Conclusions: The use of misoprostol prior to IUD insertion in nulliparous women did not affect their perceived pain. Misoprostol does improve the ease of insertion, but it may not be of clinical significance. These results do not support the routine use of misoprostol prior to IUD placement in nulliparas.
P71
Gariepy A University of Pittsburgh, Pittsburgh, PA, USA Creinin MD, Schwarz EB, Smith KJ Objectives: To estimate the true probability of successful sterilization after hysteroscopic or laparoscopic sterilization procedure. Methods: An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure via laparoscopic sterilization, hysteroscopic steril-
327
EFFECT OF PROSPECTIVELY MEASURED PREGNANCY INTENTION INDICATORS ON THE CONSISTENCY OF CONTRACEPTIVE USE AMONG YOUNG WOMEN Moreau C Princeton University, Princeton, NJ, USA INSERM U1018, Le Kremlin Bicêtre, France Hall K, Trussell J, Barber J