Angela Dempsey

Objective: In this study, we explored associations of trust in the healthcare system, health locus of control, and patient factors with choice of effective postpartum contraception. Methods: For this observational study, we measured trust in the healthcare system and health locus of control using validated scales. The primary outcome was postpartum contraceptive choice. We defined effective contraception as methods with failure rate ≤ 10%. We used bivariate and multivariate analyses to determine associated variables. Results: Neither trust in the healthcare system nor health locus of control were associated with effective contraceptive choice. Black women were more likely to report choice of effective contraception compared to white women (OR = 4.26, 95% CI 1.43, 12.68). Choice of effective contraception did not differ between women who intended to become pregnant again in less than 2 years versus greater than 2 years although women with no desire for future pregnancy were more likely to choose effective methods (OR = 4.78, 95% CI 1.56, 14.64). Conclusions: Neither trust nor health locus of control were associated with choice of effective postpartum contraception. The increased likelihood of effective post-partum contraception in black women suggests coercion and bias in counseling and provision.

Purpose: To characterise the frequency of and predictors of contraceptive implant discontinuation within 12 months of insertion in our clinical setting. Materials and methods: This retrospective cohort study included women receiving the etonogestrel contraceptive implant at our hospital between May 2007 and May 2012. We abstracted data from charts including implant removal date, bleeding complaints, reproductive and demographic characteristics, prior contraceptive use, tobacco use and implant insertion timing. Our primary outcome was implant discontinuation within 12 months following insertion. SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was used to generate frequencies, bivariate analyses and multivariate logistic regression models. Results: Implant discontinuation was documented in 16% of implant users prior to 12 months (89/544). Women with documented bleeding complaints in the medical record were more likely to discontinue within 12 months (OR: 4.36, CI: 2.71, 7.00). No other demographic or clinical characteristics were associated with premature discontinuation. Having less than two prior pregnancies and tobacco use were associated with documented bleeding complaints. Conclusions: Discontinuation of the implant is associated with bleeding complaints. Women with lower parity and tobacco users may be more likely to experience bleeding or to find it intolerable.

Though serious infection after induced abortion is rare, infections account for one third of abortion-related deaths in the United States. Most fatal cases of infection after induced medical abortion have involved clostridial species. These reported cases share important clinical features that may guide clinicians to earlier recognition and institution of therapy. This article reviews our current knowledge regarding serious clostridial infections postabortion including the typical clinical presentation, pathophysiology, modes of diagnosis, and available treatment.