Immediate start of hormonal contraception may reduce unintended pregnancies and increase method continuation, but the evidence is limited, according to the findings of an intervention review conducted by the Cochrane Fertility Regulation Group.1
In the United States, 49% of all pregnancies and 80% of pregnancies in women 19 years or younger are unintended.2 It has been suggested that a simple way to help decrease the rate of unintended pregnancies and improve continuation of hormonal contraception is through immediate initiation, which was introduced with combined oral contraceptives (COCs) but has since expanded to other types of hormonal contraceptives. With this method, the patient begins using the contraceptive immediately, regardless of her menstrual cycle; to safeguard against pregnancy, backup contraception must be used for the first 7 days.
To avoid any potential risks of hormonal contraceptive use during an undetected pregnancy, many clinicians advise women to wait until the first day of their next menses to begin hormonal contraception. However, evidence has shown that combined hormonal contraceptives do not cause birth defects and that hormonal contraceptives do not increase the risk of miscarriage or fetal growth problems when used early in pregnancy.3 Appropriate use of urine pregnancy tests and consideration of emergency contraception, in addition to use of backup contraception for 7 days, are ways to manage concerns about an undetected pregnancy and the quick start method.
To determine whether quick start hormonal contraception is associated with any differences in effectiveness, continuation, and patient acceptability, researchers identified and analyzed data from 5 randomized controlled trials that compared immediate with conventional start of hormonal contraceptives or that compared immediate start with various hormonal contraceptives.1
Overall, discontinuation rates were similar between all study groups. In studies comparing quick start with conventional start, bleeding patterns and adverse effects were similar between groups. In a trial of immediate versus conventional start of depot medroxyprogesterone(Drug information on medroxyprogesterone) acetate (DMPA), fewer pregnancies occurred in and patient satisfaction was higher in the immediate start group. In a comparison of quick start COCs with quick start vaginal ring, the vaginal ring group had less prolonged bleeding, less frequent bleeding, fewer adverse effects, and higher satisfaction ratings.
Based on these results, there is little evidence that immediate initiation of hormonal contraceptives is associated with fewer pregnancies or with less continuation. However, immediate start of DMPA was associated with lower pregnancy rates than the conventional start method, and quick start vaginal ring was preferred over quick start COCs. The conclusion: more studies are needed.
Pertinent Points:
- Immediate start of specific types of hormonal contraceptives was associated with fewer unintended pregnancies and higher patient satisfaction ratings.
- The available evidence showing that quick start hormonal contraception is associated with fewer pregnancies and longer continuation than conventional start hormonal contraception is insufficient to claim one method superior to another.
TopicIndex
MedicaForums
Medica Forums -
6/17/13
First, Plan B was only available OTC to women age 17 and up. In April, a judge ordered that it be made available to women of all ages. Now, an appeals court judge has stayed an order that would make a one-dose version of the emergency contraception available to all ages, while allowing the two-dose drug to be sold OTC without restriction. What do you make of all this?
Medica Forums -
6/15/13
muscle pain relief in Hong kong
eToims is a non-invasive pain therapy treatment for individuals desiring general physical health maintenance and enhancement or relief from chronic pain.Back pain is often caused or aggravated by bad or worn-out mattresses. A new pressure-relieving mattress and pillow can make a huge difference. It can support your back, shoulders and neck where it needs it most and thereby help you sleep in a better position, relieving pressure points and back pain. For more information on pressure relieving mattresses and pillows click here.For more information visit us at- Email-info@etoims.com,Contact- +1 215-387-0550.
Medica Forums -
6/12/13
For the past few months, I have not received any posts on the listserv OB-GYN-L. I would get daily posts in my e-mail. Where has it gone, what has happened to it? What can I do to get back on the list?
If anybody has any information, send me a note at: dean@thehuffpeople.net Dean Huffman
Medica Forums -
6/6/13
Pregnant woman and the newborn infant in breast feeding both of them need safety. So, caution in use of drugs in pregnancy and during lactation is mandatory. The knowledge of risk-benefit ratio of different drugs should be in mind of the doctor while prescribing a pregnant or lactating lady.Definitions of Pregnancy categories of drugs and a table showing pregnancy categories of drugs and safety of drugs in lactation are given here.
Definitions of Pregnancy categories of drugs: On the basis of the potentiality for producing birth defects drugs in pregnancy are grouped into 1 of 5 categories which are A,B, C, D and X. Drugs of class A and B are considered safe and can be used routinely. Pregnancy Category A : Controlled studies in pregnant women fail to detect risk to the fetus in the first trimester and no evidence of risk in later trimesters. The possibility of harm to the fetus appears remote by using the drugs of pregnancy category A. Pregnancy Category B : Presumed safety on the basis of animal studies, with no controlled study in pregnant women, or animal studies have shown an adverse effect which was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk to the fetus in later trimesters. Pregnancy Category C : Studies in women and animals are not available or studies in animals have shown adverse effects on the fetus and there is no controlled study in women. Drugs should be given in pregnancy only if the potential benefits justify the potential risk to the fetus. Pregnancy Category D : There is positive evidence of risk to the human fetus (unsafe), however in a life-threatening illness the potential risk may be justified if there are no other alternatives. Pregnancy Category X : Highly unsafe: risk of use outweighs any potential benefit. Drugs in this category are contraindicated in pregnant women or in a woman who may become pregnant. To get more please visit - http://medicalforall.net/drugs-pregnancy-lactation/
Medica Forums -
6/1/13
Recently, I had the occasion to review a case of a term primigravida with PROM in a private hospital (no housestaff or in house obstetricians). She was seen by an obstetrician soon after arrival, evaluated, and pitocin induction begun.
She did not deliver for around 29 hours after admission, and the delivering obstetrician (a different physician) was physically present during the last 2 hours of labor prior to delivery. Simply put, while the two involved obstetricians were in communication by phone with the nursing staff throughout labor (separately as their "shifts" did not overlap), no one actually came to the bedside and wrote a note) from admission until around 2 hours before delivery. Medical staff bylaws call for a daily progress note; this bylaw was easily met. In reviewing the case, it did not "feel good" that no one came to the bedside. My questions: 1. Does anyone have or know of any guidelines to mandate such bedside attendance? Of course, we all hope that the involved physicians would not need said guidelines. 2. Does anyone have a suggestion of hospital/nursing protocols? Simply, in this case I would like to have had a charge nurse or bedside nurse simply say, "Hey, no one has been by for a while. What's up?" Garry
Medica Forums -
6/1/13
Reviews Of Progress is a weekly peer-reviewed scientific journal that covers original research and reviews. It publishes all articles under the guidance of the editorial team. The current Editor-in-Chief is Pindipol S.I, the editorial office is in Solapur.
Medica Forums -
5/27/13
I helped another physician with removal of a retained placenta last night, we were unsuccessful in removing it vaginally, her cervix was too closed to allow manual removal and we could only get a few pieces out with ring forceps and a large curette, so we did a laparotomy/hysterotomy and were able to preserve the uterus. The placenta turned out not to be an accreta and it was easily removed via that route through a low vertical incision on the uterus. Any thoughts on the appropriate CPT code would be appreciated. The patient came in through the ER five days after home delivery by her husband. She was severely anemic, rcvd 7 units of blood and is still quite ill and in the ICU but improving.
Ronald E. Ainsworth, MD, FACOG
Medica Forums -
5/23/13
Hello,
Has anyone tried FetalGrowth app (App Store for iPhone/iPad) ? I'm interested in using a simple and handy tool to calculate fetal percentiles, and I came across this app, which seems it does the job (plots growth charts, as well). I haven't seen anything else, besides this app, so I was wondering if there are people who have already tried it. Thanks !
Medica Forums -
5/19/13
Had a case the other day with the above finding on a pap. She was age 36 and had a Mirena in place. How do people feel about the idea of trying to do an EMB with an IUD in place? If not, how do we proceed?
Medica Forums -
5/12/13
Welcome to the new ObGyn.net Forum!
To all the members of OB-GYN-L… Thank you for coming! I’m thrilled that you’ve decided to check out the new Forum site, and look forward to reading about what’s on your mind. If you’re new to the ObGyn.net community... welcome aboard! You’ve just joined an outstanding group of physicians and health care professionals who have been sharing information, answering questions, and building professional relationships via the site’s listserv for nearly 20 years. Feel free to poke around on the site to get a feel for things, or take a look at the Help Topics page for instructions on how to use the different features of the site. A few quick tips: For those of you who like getting new Forum messages delivered directly to your inbox, the first thing you’ll want to do is click on the ‘Follow this forum’ button on the main page. You’ll have the option of getting notifications immediately, as a daily digest, a weekly digest, or only when you’re not online (which is to say, if you’re on the site when someone posts a message, you won’t be notified of it). You won’t be able to post on the site just by replying to the email, but the message will contain a link that takes you directly to the message you’d like to reply to. You can also follow individual conversations without following the whole list by going into the topic and clicking the ‘Follow this topic’ button next to the title. Also, in ‘My Profile’ you can:
Happy posting! EducationalTutorialsEducational Tutorial: Complications of Laparoscopy
February 7, 2012 There are a variety of complications that can occur during laparoscopic surgery. In this tutorial learn some of the complications and tips to avoid them. Educational Tutorial: Low Molecular Weight Heparin in Recurrent Abortions
January 17, 2012 Review information on low molecular weight heparin in recurrent miscarriages in this educational tutorial. CaseStudiesFetal Abdomen with Gallbladder Calculi
Dr. Muktachand and Dr. Trupti , September 27, 2011
Sacrococcygeal Teratoma?
Dr. Jaydeep , September 14, 2011
Fetal Cardiac Anomalies
Joshua Abbott Copel, MD OBGYN.net Advisory Board Member , July 19, 2011
Single Umbilical Artery Color Doppler
Abana Cerekja , June 15, 2011
FromPhysiciansPracticeKey Differences between FQHCs and RHCs Chastity Werner, RHIT, June 13, 2013 FQHCs and RHCs take up a unique niche among physician practices. And that affects compensation and billing. Improving Care Coordination in Your Practice Susanne Madden, June 12, 2013 Practices are feverishly working to control the rising costs of healthcare - effective care coordination can help. Refunding Overpayments: Two Options for Medical Practices Ericka L. Adler, June 12, 2013 Medicare and Medicaid providers must return overpayments once identified. Here are two different refund approaches for practices to consider when necessary. Four Easy Ways to Boost Patient Time of Service Collections Aubrey Westgate, June 12, 2013 Simple ways your medical practice staff can increase the likelihood patients will pay when presenting for appointments. iPad Alternatives for Mobile Physicians Marisa Torrieri, June 11, 2013 As more physicians are seeing the merits of media tablets, the market is expanding, too.
MostPopular
MostPopular
MostPopular
SearchMedicaSearchResultFind peer-reviewed literature and websites for practicing medical professionals EventCalendar
|
|
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy
CancerNetwork |
ConsultantLive |
Diagnostic Imaging |
Musculoskeletal Network |
OBGYN.net |
PediatricsConsultantLive |
Physicians Practice | Psychiatric Times | SearchMedica | Medical Resources
Physicians Practice | Psychiatric Times | SearchMedica | Medical Resources
© 1996 - 2013 UBM Medica LLC, a
UBM company
Privacy Statement -
Terms of Service -
Advertising Information -
Editorial Policy Statement -
UBM Medica Network Privacy Policy