- Email: [email protected]
Concordance between antenatal contraception plan and postpartum contraception received: how often do women receive their requested method?
Abstracts / Contraception 96 (2017) 263–306
Methods: We enrolled antepartum (n=86) and postpartum (n=98) women planning DMPA use for postpartum contraception. Women became ineligible if they did not initiate breastfeeding, decided against DMPA or refused randomization. Participants were randomized to receive DMPA either “predischarge” or “delayed” (in 4–6 weeks). We assessed breastfeeding and contraceptive use every 2–4 weeks for 28 weeks. We conducted intent-to-treat and as-treated analyses, conservatively assuming that all women lost to follow-up stopped breastfeeding and contraceptive use. Results: Of 184 women enrolled, 79 were randomized to “predischarge” and 78 to “delayed” DMPA; 27 women became ineligible before randomization. Mean age of randomized women was 24.2; some 46% (72/157) were primiparous. Five women did not receive DMPA “predischarge” as randomized; five randomized to “delayed” received DMPA predischarge. Twenty-four women were lost to follow-up and three withdrew (12 “predischarge, 15 “delayed”). In intent-to-treat analyses, breastfeeding (any or exclusive) was similar at all time points, with “pr-discharge” or “delayed” DMPA initiation. At 2 weeks postpartum, 48% (38/79) women in the “predischarge” group and 47% (37/78) in the “delayed” group reported exclusive breastfeeding (pN.99); at 28 weeks, 35% (28/79) and 32% (25/78) reported any breastfeeding (p=.74). As-treated analyses produced similar findings. At 28 weeks postpartum, use of DMPA or more effective contraceptives was similar between groups in both analyses. Conclusions: Providing postpartum women with DMPA at hospital discharge does not affect breastfeeding or contraception, suggesting that breastfeeding should not delay provision of postpartum DMPA.
http://dx.doi.org/10.1016/j.contraception.2017.07.065
P36 A randomized controlled trial of patient pain perception with tenaculum placement during in-office procedures TE Lambert Duke University Medical Center, Durham, NC, USA
279
P37 Concordance between antenatal contraception plan and postpartum contraception received: how often do women receive their requested method? OH Barry Johns Hopkins University School of Medicine, Baltimore, MD, USA JK Lee, A Burke Objectives: Timely initiation of postpartum contraception improves health outcomes and prevents rapid repeat pregnancy. Concordance between postpartum contraception and a woman’s antepartum plan is not well studied. We retrospectively assessed concordance between documented antepartum contraceptive plan and method received postpartum. Methods: We conducted a chart review focused on women who delivered between April and October 2015. The primary outcome was concordance, defined as whether an individual’s antepartum contraceptive plan matched the method she received postpartum. We extracted demographic data, timing/ frequency of antepartum contraceptive counseling, delivery characteristics and postpartum visits. We determined method-specific frequency of concordance. Bivariable and multivariable analyses were used to examine relationships between concordance and variables of interest. Results: At hospital discharge, 235 of 660 postpartum women (36%) had not received their planned contraceptive method. Nearly 30% of these women received no method. Concordance was highest for the implant (89%), 49.7% for an IUD and lowest for combined hormonal methods (39.2%). Hispanic ethnicity and uninsured status were positively correlated with concordance (pb.05). Timing of initial contraceptive counseling was not significantly associated with concordance. Concordance was significantly associated with contraceptive method in multivariable analysis (pb.001). By the postpartum visit, attended by 74% of women, concordance for the most effective methods increased (implant, 91.4% and IUD, 71.3%). Method choice remained significantly associated with postpartum concordance (pb.001) at this time point. Conclusions: The contraceptive method women receive postpartum often differs from expressed antepartum intentions. The postpartum visit represents an opportunity to close some of these gaps. Reasons for lack of ante/ postpartum contraceptive concordance merit further exploration to optimize woman-centered postpartum contraceptive provision. http://dx.doi.org/10.1016/j.contraception.2017.07.067
T Truong, B Gray Objectives: The single-tooth tenaculum is used in most gynecologic procedures involving cervical and uterine instrumentation. We aimed to compare pain with tenaculum use based on the method of placement: slow method vs. cough method. Methods: A randomized controlled trial of 66 women presenting for IUDs, powered to detect 16-mm difference in pain, included women aged 18 or older. Patients were randomized to tenaculum placement via slow method vs. cough method. The primary outcome was pain at time of tenaculum placement measured on a 100-mm visual analogue scale. Secondary outcomes included overall pain with device insertion and provider satisfaction with tenaculum grasp. Pain scores were analyzed with Wilcoxon rank sum test. Provider satisfaction was analyzed with Fisher’s Exact Test. Results: Some 33 women were randomized to each arm. Average pain score with slow placement was 44 (SD, 24.4) with median of 44 (IQR, 21–63). Average pain score with cough placement was 35.5 (SD, 23.9) with median of 32 (IQR, 19–54). Pain scores did not differ between methods of tenaculum placement (p=.16). Overall pain scores did not differ (p=.12). Provider satisfaction was not associated with one method over the other (p=1). Anxiety was significantly associated with pain at the time of tenaculum placement (p=.01). Conclusions: Providers should utilize the method of tenaculum placement of their choice since neither method significantly reduces pain or improves provider satisfaction. Pain with tenaculum use is significantly associated with anxiety. http://dx.doi.org/10.1016/j.contraception.2017.07.066
P38 Comic for contraceptive implant information: a pre–post test quasi-experimental study A Sridhar David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA AD Dragan Objectives: We aimed to develop an educational comic with structured information about the contraceptive implant. We conducted a quasiexperimental pre–post test among young adult women to assess the effect of the comic on their perceived knowledge about the implant. Methods: An implant comic based on health behavior theories was developed with an illustrator. We pilot tested the comic with five patients and providers. English-speaking 18–29-year-old women who had never used an implant were recruited to the quasi-experimental pre–post test study. The primary outcome was to assess subjective knowledge of the implant before and after exposure to the contraceptive implant comic. We planned to have a sample size of 30 for 80% power to detect an improvement in mean knowledge score of 1 assuming a standard deviation of the change in knowledge of 2.0, with a .050 two-sided significance level.
Methods: We enrolled antepartum (n=86) and postpartum (n=98) women planning DMPA use for postpartum contraception. Women became ineligible if they did not initiate breastfeeding, decided against DMPA or refused randomization. Participants were randomized to receive DMPA either “predischarge” or “delayed” (in 4–6 weeks). We assessed breastfeeding and contraceptive use every 2–4 weeks for 28 weeks. We conducted intent-to-treat and as-treated analyses, conservatively assuming that all women lost to follow-up stopped breastfeeding and contraceptive use. Results: Of 184 women enrolled, 79 were randomized to “predischarge” and 78 to “delayed” DMPA; 27 women became ineligible before randomization. Mean age of randomized women was 24.2; some 46% (72/157) were primiparous. Five women did not receive DMPA “predischarge” as randomized; five randomized to “delayed” received DMPA predischarge. Twenty-four women were lost to follow-up and three withdrew (12 “predischarge, 15 “delayed”). In intent-to-treat analyses, breastfeeding (any or exclusive) was similar at all time points, with “pr-discharge” or “delayed” DMPA initiation. At 2 weeks postpartum, 48% (38/79) women in the “predischarge” group and 47% (37/78) in the “delayed” group reported exclusive breastfeeding (pN.99); at 28 weeks, 35% (28/79) and 32% (25/78) reported any breastfeeding (p=.74). As-treated analyses produced similar findings. At 28 weeks postpartum, use of DMPA or more effective contraceptives was similar between groups in both analyses. Conclusions: Providing postpartum women with DMPA at hospital discharge does not affect breastfeeding or contraception, suggesting that breastfeeding should not delay provision of postpartum DMPA.
http://dx.doi.org/10.1016/j.contraception.2017.07.065
P36 A randomized controlled trial of patient pain perception with tenaculum placement during in-office procedures TE Lambert Duke University Medical Center, Durham, NC, USA
279
P37 Concordance between antenatal contraception plan and postpartum contraception received: how often do women receive their requested method? OH Barry Johns Hopkins University School of Medicine, Baltimore, MD, USA JK Lee, A Burke Objectives: Timely initiation of postpartum contraception improves health outcomes and prevents rapid repeat pregnancy. Concordance between postpartum contraception and a woman’s antepartum plan is not well studied. We retrospectively assessed concordance between documented antepartum contraceptive plan and method received postpartum. Methods: We conducted a chart review focused on women who delivered between April and October 2015. The primary outcome was concordance, defined as whether an individual’s antepartum contraceptive plan matched the method she received postpartum. We extracted demographic data, timing/ frequency of antepartum contraceptive counseling, delivery characteristics and postpartum visits. We determined method-specific frequency of concordance. Bivariable and multivariable analyses were used to examine relationships between concordance and variables of interest. Results: At hospital discharge, 235 of 660 postpartum women (36%) had not received their planned contraceptive method. Nearly 30% of these women received no method. Concordance was highest for the implant (89%), 49.7% for an IUD and lowest for combined hormonal methods (39.2%). Hispanic ethnicity and uninsured status were positively correlated with concordance (pb.05). Timing of initial contraceptive counseling was not significantly associated with concordance. Concordance was significantly associated with contraceptive method in multivariable analysis (pb.001). By the postpartum visit, attended by 74% of women, concordance for the most effective methods increased (implant, 91.4% and IUD, 71.3%). Method choice remained significantly associated with postpartum concordance (pb.001) at this time point. Conclusions: The contraceptive method women receive postpartum often differs from expressed antepartum intentions. The postpartum visit represents an opportunity to close some of these gaps. Reasons for lack of ante/ postpartum contraceptive concordance merit further exploration to optimize woman-centered postpartum contraceptive provision. http://dx.doi.org/10.1016/j.contraception.2017.07.067
T Truong, B Gray Objectives: The single-tooth tenaculum is used in most gynecologic procedures involving cervical and uterine instrumentation. We aimed to compare pain with tenaculum use based on the method of placement: slow method vs. cough method. Methods: A randomized controlled trial of 66 women presenting for IUDs, powered to detect 16-mm difference in pain, included women aged 18 or older. Patients were randomized to tenaculum placement via slow method vs. cough method. The primary outcome was pain at time of tenaculum placement measured on a 100-mm visual analogue scale. Secondary outcomes included overall pain with device insertion and provider satisfaction with tenaculum grasp. Pain scores were analyzed with Wilcoxon rank sum test. Provider satisfaction was analyzed with Fisher’s Exact Test. Results: Some 33 women were randomized to each arm. Average pain score with slow placement was 44 (SD, 24.4) with median of 44 (IQR, 21–63). Average pain score with cough placement was 35.5 (SD, 23.9) with median of 32 (IQR, 19–54). Pain scores did not differ between methods of tenaculum placement (p=.16). Overall pain scores did not differ (p=.12). Provider satisfaction was not associated with one method over the other (p=1). Anxiety was significantly associated with pain at the time of tenaculum placement (p=.01). Conclusions: Providers should utilize the method of tenaculum placement of their choice since neither method significantly reduces pain or improves provider satisfaction. Pain with tenaculum use is significantly associated with anxiety. http://dx.doi.org/10.1016/j.contraception.2017.07.066
P38 Comic for contraceptive implant information: a pre–post test quasi-experimental study A Sridhar David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA AD Dragan Objectives: We aimed to develop an educational comic with structured information about the contraceptive implant. We conducted a quasiexperimental pre–post test among young adult women to assess the effect of the comic on their perceived knowledge about the implant. Methods: An implant comic based on health behavior theories was developed with an illustrator. We pilot tested the comic with five patients and providers. English-speaking 18–29-year-old women who had never used an implant were recruited to the quasi-experimental pre–post test study. The primary outcome was to assess subjective knowledge of the implant before and after exposure to the contraceptive implant comic. We planned to have a sample size of 30 for 80% power to detect an improvement in mean knowledge score of 1 assuming a standard deviation of the change in knowledge of 2.0, with a .050 two-sided significance level.