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Providing contraception and contraceptive counseling to adolescents: perspectives of residents from three specialties
Abstracts / Contraception 80 (2009) 194–226 (DMPA) were the most commonly discussed methods antenatally (37%, 30%, 26%) and postpartum (43%, 31%, 29%), respectively; 23% (39) of women would have elected immediate postplacental IUD placement if available. Of the 59 patients who responded 4–6 months after delivery 20%, 8% and 5% reported using OCP, DMPA and IUD; 22% (13) of the participants contacted at follow-up still desired an IUD, of which 62% would have elected for postplacental placement, if available. Conclusions: Prenatal visits and postpartum contact with providers create an opportunity to discuss family planning and contraception. Although most patients reported both antenatal and immediate postpartum contraceptive counseling, significantly fewer reported continued contraceptive use at 4–6 months postpartum. Initiation of postplacental IUD placement would increase contraceptive use at 6 months in this population. P29 TWO-WEEK POSTPARTUM IMPLANON INSERTION IS NOT EQUIVALENT TO IMMEDIATE POSTPARTUM LARC Tocce K University of Colorado at Denver, Aurora, CO, USA Python J, Sheeder J, Teal S
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or to receive DMPA alone. Bleeding calendars and questionnaires assessed bleeding, DMPA continuation and acceptability of the ring. An intention to treat analysis was performed and groups were compared using chi-square and Wilcoxon statistical tests in SAS 9.1. Results: Seventy-one participants enrolled and 69% (n=49) completed the first 90 days of follow-up. To date, data are available for 38 participants. Participants receiving vaginal estrogen had a median of 16 (range 3–61) bleeding or spotting days compared to 20 days (range 0–95) in the DMPA alone group. Eighty percent (n=16) in the vaginal ring group and 72% (n=13) in the DMPA alone group received a second injection (p=.57). Ninety percent (18/20) who used the vaginal ring were satisfied, 75% (15/20) would use the ring again, and 85% (17/20) would recommend the ring to a friend starting DMPA. Conclusions: The vaginal ring is highly acceptable in this population. Bleeding and continuation were similar between groups. These findings do not support routine use of this intervention during DMPA initiation. P31 PROVIDING CONTRACEPTION AND CONTRACEPTIVE COUNSELING TO ADOLESCENTS: PERSPECTIVES OF RESIDENTS FROM THREE SPECIALTIES Perriera L University of Pittsburgh, Pittsburgh, Pennsylvania, PA, USA
Objectives: Few adolescents resume intercourse within 2 weeks of delivery. Long-acting, reversible methods of contraception (LARC) initiation 2 weeks postpartum should be equivalent to immediate. This pilot study was conducted to see if 2-week postpartum Implanon insertion meets the goals of immediate postpartum LARC. Method: Over 6 months, 116 ethnically diverse teens in a comprehensive adolescent-pregnancy program reported 3rd trimester contraceptive plans. Those who expressed interest were to receive Implanon at one of the three routine visits within 2 weeks postpartum. Patients who desired an IUD were to receive it at 6 weeks postpartum. Results: Of the 116 participants, 38 (33%) stated an intent to use Implanon. Postpartum, 26 (68%) of these patients received Implanon, 14 (37%) within 14 days; all patients reported abstinence prior to Implanon insertion. By 3 months postpartum, 35 of 116 had Implanon placed. Of those placed later than 2 weeks postpartum, 14 (67%) reported abstinence prior to Implanon insertion. Thirtyseven participants stated their third trimester contraceptive intent was an IUD. Eighteen of these teens received an IUD; three were inserted by 8 weeks postpartum. Of the 18 IUD acceptors, 13 (72%) had resumed intercourse prior to IUD insertion. Conclusions: Attempts to provide Implanon insertion within 2 weeks of delivery resulted in a 37% success rate. While 60% of patients who received Implanon or an IUD were abstinent prior to initiation of LARC, there were no predictors of who would abstain. Immediate postpartum LARC insertion would eliminate this risk window. P30 PILOT STUDY OF VAGINAL ESTROGEN SUPPLEMENTATION DURING DMPA INITIATION Dempsey A Medical University of South Carolina, Charleston, SC, USA Westhoff C Objectives: Study objectives are to evaluate whether vaginal estrogen supplementation during the first 90 days of depot medroxyprogesterone acetate (DMPA) use decreases bleeding and increases continuation to a second injection and to describe acceptability of this intervention. Method: This prospective randomized, controlled 6-month trial enrolled English or Spanish-speaking women ≥18 years of age initiating DMPA. Participants were randomized to receive an estrogen vaginal ring for 90 days
Swanier B, Gold M, Akers A Objectives: To explore perspectives of residents in specialties that routinely care for adolescents regarding provision of contraception and contraceptive counseling to adolescents. Method: Between November 2008 and February 2009, resident physicians at the University of Pittsburgh Medical Center from Pediatrics, Obstetrics and Gynecology (Ob/Gyn) and Family Medicine residency programs participated in focus groups. Three focus groups were conducted in each specialty. Discussions explored resident comfort with counseling adolescents about contraceptive methods and assessed which methods are routinely offered. Each discussion lasted 60–80 min, was audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis. Results: Fifty-four residents (18 per specialty), representing all training years, participated. All residents denied having lectures or clinics focused on adolescent contraceptive counseling. Comfort with contraceptive counseling and method initiation differed by specialty. Ob/Gyn residents were comfortable offering adolescents all approved contraceptive methods except sterilization, especially long-acting methods. Pediatric and family medicine residents were most comfortable offering contraceptive pills and depomedroxyprogesterone acetate. They felt implants and intrauterine devices were less appropriate for adolescents and rarely provided these methods due to lack of familiarity. All specialties agreed condoms should be used for the prevention of sexually transmitted infections, not pregnancy prevention. Conclusions: Ob/Gyn residents have more experience and comfort providing long-acting reversible methods such as intrauterine devices and implants to adolescents. Additional clinical and didactic teaching is necessary to improve family medicine and pediatric residents' comfort with discussing and providing highly effective long-acting contraceptive methods to adolescents. P32 PREFERENCES FOR DECISION MAKING ABOUT CONTRACEPTION AMONG HEALTHY ADULT WOMEN Diedrich J University of California, San Francisco, San Francisco, CA, USA Tharayil M, Steinauer J, Drey E, Dehlendorf C
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or to receive DMPA alone. Bleeding calendars and questionnaires assessed bleeding, DMPA continuation and acceptability of the ring. An intention to treat analysis was performed and groups were compared using chi-square and Wilcoxon statistical tests in SAS 9.1. Results: Seventy-one participants enrolled and 69% (n=49) completed the first 90 days of follow-up. To date, data are available for 38 participants. Participants receiving vaginal estrogen had a median of 16 (range 3–61) bleeding or spotting days compared to 20 days (range 0–95) in the DMPA alone group. Eighty percent (n=16) in the vaginal ring group and 72% (n=13) in the DMPA alone group received a second injection (p=.57). Ninety percent (18/20) who used the vaginal ring were satisfied, 75% (15/20) would use the ring again, and 85% (17/20) would recommend the ring to a friend starting DMPA. Conclusions: The vaginal ring is highly acceptable in this population. Bleeding and continuation were similar between groups. These findings do not support routine use of this intervention during DMPA initiation. P31 PROVIDING CONTRACEPTION AND CONTRACEPTIVE COUNSELING TO ADOLESCENTS: PERSPECTIVES OF RESIDENTS FROM THREE SPECIALTIES Perriera L University of Pittsburgh, Pittsburgh, Pennsylvania, PA, USA
Objectives: Few adolescents resume intercourse within 2 weeks of delivery. Long-acting, reversible methods of contraception (LARC) initiation 2 weeks postpartum should be equivalent to immediate. This pilot study was conducted to see if 2-week postpartum Implanon insertion meets the goals of immediate postpartum LARC. Method: Over 6 months, 116 ethnically diverse teens in a comprehensive adolescent-pregnancy program reported 3rd trimester contraceptive plans. Those who expressed interest were to receive Implanon at one of the three routine visits within 2 weeks postpartum. Patients who desired an IUD were to receive it at 6 weeks postpartum. Results: Of the 116 participants, 38 (33%) stated an intent to use Implanon. Postpartum, 26 (68%) of these patients received Implanon, 14 (37%) within 14 days; all patients reported abstinence prior to Implanon insertion. By 3 months postpartum, 35 of 116 had Implanon placed. Of those placed later than 2 weeks postpartum, 14 (67%) reported abstinence prior to Implanon insertion. Thirtyseven participants stated their third trimester contraceptive intent was an IUD. Eighteen of these teens received an IUD; three were inserted by 8 weeks postpartum. Of the 18 IUD acceptors, 13 (72%) had resumed intercourse prior to IUD insertion. Conclusions: Attempts to provide Implanon insertion within 2 weeks of delivery resulted in a 37% success rate. While 60% of patients who received Implanon or an IUD were abstinent prior to initiation of LARC, there were no predictors of who would abstain. Immediate postpartum LARC insertion would eliminate this risk window. P30 PILOT STUDY OF VAGINAL ESTROGEN SUPPLEMENTATION DURING DMPA INITIATION Dempsey A Medical University of South Carolina, Charleston, SC, USA Westhoff C Objectives: Study objectives are to evaluate whether vaginal estrogen supplementation during the first 90 days of depot medroxyprogesterone acetate (DMPA) use decreases bleeding and increases continuation to a second injection and to describe acceptability of this intervention. Method: This prospective randomized, controlled 6-month trial enrolled English or Spanish-speaking women ≥18 years of age initiating DMPA. Participants were randomized to receive an estrogen vaginal ring for 90 days
Swanier B, Gold M, Akers A Objectives: To explore perspectives of residents in specialties that routinely care for adolescents regarding provision of contraception and contraceptive counseling to adolescents. Method: Between November 2008 and February 2009, resident physicians at the University of Pittsburgh Medical Center from Pediatrics, Obstetrics and Gynecology (Ob/Gyn) and Family Medicine residency programs participated in focus groups. Three focus groups were conducted in each specialty. Discussions explored resident comfort with counseling adolescents about contraceptive methods and assessed which methods are routinely offered. Each discussion lasted 60–80 min, was audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis. Results: Fifty-four residents (18 per specialty), representing all training years, participated. All residents denied having lectures or clinics focused on adolescent contraceptive counseling. Comfort with contraceptive counseling and method initiation differed by specialty. Ob/Gyn residents were comfortable offering adolescents all approved contraceptive methods except sterilization, especially long-acting methods. Pediatric and family medicine residents were most comfortable offering contraceptive pills and depomedroxyprogesterone acetate. They felt implants and intrauterine devices were less appropriate for adolescents and rarely provided these methods due to lack of familiarity. All specialties agreed condoms should be used for the prevention of sexually transmitted infections, not pregnancy prevention. Conclusions: Ob/Gyn residents have more experience and comfort providing long-acting reversible methods such as intrauterine devices and implants to adolescents. Additional clinical and didactic teaching is necessary to improve family medicine and pediatric residents' comfort with discussing and providing highly effective long-acting contraceptive methods to adolescents. P32 PREFERENCES FOR DECISION MAKING ABOUT CONTRACEPTION AMONG HEALTHY ADULT WOMEN Diedrich J University of California, San Francisco, San Francisco, CA, USA Tharayil M, Steinauer J, Drey E, Dehlendorf C