Contraception
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Publication bias is the selective publishing of favorable or statistically significant results. This practice, over time, distorts the medical literature by depicting inordinately optimistic outcomes for treatments and interventions. ⋯ Mandatory trial registration, as instituted by the International Committe of Medical Journal Editors (ICMJE), should reduce publication bias by improving the ability to identify all trials pertaining to a specific intervention. Contraception endorses the views of the ICMJE and will now require registration of all prospective trials.
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Case Reports
Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.
Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. ⋯ Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.
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Practice Guideline
Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation). SFP Guideline 20071.
First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. ⋯ There are insufficient data evaluating how cervical priming affects women's quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider cervical priming only for women who may be at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be difficult due to either patient factors or provider experience.
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The objective of this study was to examine factors associated with willingness to use the contraceptive vaginal ring among college students. ⋯ Busy lifestyle and acceptance of its characteristics were associated with willingness to use the contraceptive vaginal ring. Counseling should focus on addressing women's concerns about vaginal administration and side effects.
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This report is a review of the medical literature on the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with endometriosis, adenomyosis, cyclic pelvic pain and dysmenorrhea. ⋯ The use of LNG-IUS is an alternative for the medical treatment of women suffering from endometriosis, adenomyosis, chronic pelvic pain or dysmenorrhea, but experience is limited and long-term studies are necessary to reach definitive conclusions. However, for women who do not wish to become pregnant, this device offers the possibility of at least 5 years of treatment following one single intervention.