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Papers by S. Achilles

Research paper thumbnail of Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women

Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women

Obstetrics & Gynecology, 2014

ABSTRACT Despite their high efficacy, intrauterine device (IUD) use is limited among nulliparous ... more ABSTRACT Despite their high efficacy, intrauterine device (IUD) use is limited among nulliparous women, often as a result of fear of pain. Prior studies evaluating pain management during insertion usually include multiparous women and show no benefit. This study evaluates self-administered lidocaine gel before IUD insertion in nulliparous women. Nulliparous women seeking IUDs were randomly assigned to self-administer 1% lidocaine or placebo gel 5 minutes before IUD insertion. Women used a visual analog scale to report pain during insertion and reported overall satisfaction with insertion and the likelihood of recommending an IUD to a friend using a Likert scale. The median difference in pain between baseline and IUD insertion was 61 mm in the lidocaine group and 68 mm in the placebo (P=.133). Differences in pain score after speculum placement was 16 mm in the lidocaine group and 33 mm in the placebo group (P=.034) and scores for tenaculum placement were 32 mm in the lidocaine and 56 mm in the placebo group (P=.030). Seventy-seven percent of women were somewhat or very satisfied with their IUD placement, and 86% would probably or definitely recommend the IUD to a friend. Self-administered vaginal lidocaine significantly decreased pain after speculum and tenaculum placement but did not reduce pain with IUD placement. Self-insertion of vaginal lidocaine gel may be useful before a variety of gynecologic examinations and procedures. Despite pain during IUD insertion, nulliparous women were satisfied with the insertion and most would recommend an IUD to a friend.

Research paper thumbnail of Outcomes of medical abortion through 63 days in women with twin gestations

Contraception, 2008

Twin gestation is not considered a contraindication to medical abortion with mifepristone and mis... more Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days. We performed a secondary analysis of treatment efficacy and side effects using pooled data from two randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared. Of 2208 subjects, 24 (1.1%) women had twins. Treatment success was not statistically different for twin and singleton gestations (91% vs. 97%, p=.19). Perceived bleeding and pain were not significantly different between groups. Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.

Research paper thumbnail of Probing the stability of class I major histocompatibility complex (MHC) molecules on the surface of human cells

Research paper thumbnail of Randomizing women to intrauterine device type: a pilot study experience

Randomizing women to intrauterine device type: a pilot study experience

Contraception, 2012

Research paper thumbnail of Outcomes of medical abortion through 63 days in women with twin gestations

Contraception, 2008

Twin gestation is not considered a contraindication to medical abortion with mifepristone and mis... more Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days. We performed a secondary analysis of treatment efficacy and side effects using pooled data from two randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared. Of 2208 subjects, 24 (1.1%) women had twins. Treatment success was not statistically different for twin and singleton gestations (91% vs. 97%, p=.19). Perceived bleeding and pain were not significantly different between groups. Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.

Research paper thumbnail of Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women

Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women

Obstetrics & Gynecology, 2014

ABSTRACT Despite their high efficacy, intrauterine device (IUD) use is limited among nulliparous ... more ABSTRACT Despite their high efficacy, intrauterine device (IUD) use is limited among nulliparous women, often as a result of fear of pain. Prior studies evaluating pain management during insertion usually include multiparous women and show no benefit. This study evaluates self-administered lidocaine gel before IUD insertion in nulliparous women. Nulliparous women seeking IUDs were randomly assigned to self-administer 1% lidocaine or placebo gel 5 minutes before IUD insertion. Women used a visual analog scale to report pain during insertion and reported overall satisfaction with insertion and the likelihood of recommending an IUD to a friend using a Likert scale. The median difference in pain between baseline and IUD insertion was 61 mm in the lidocaine group and 68 mm in the placebo (P=.133). Differences in pain score after speculum placement was 16 mm in the lidocaine group and 33 mm in the placebo group (P=.034) and scores for tenaculum placement were 32 mm in the lidocaine and 56 mm in the placebo group (P=.030). Seventy-seven percent of women were somewhat or very satisfied with their IUD placement, and 86% would probably or definitely recommend the IUD to a friend. Self-administered vaginal lidocaine significantly decreased pain after speculum and tenaculum placement but did not reduce pain with IUD placement. Self-insertion of vaginal lidocaine gel may be useful before a variety of gynecologic examinations and procedures. Despite pain during IUD insertion, nulliparous women were satisfied with the insertion and most would recommend an IUD to a friend.

Research paper thumbnail of Outcomes of medical abortion through 63 days in women with twin gestations

Contraception, 2008

Twin gestation is not considered a contraindication to medical abortion with mifepristone and mis... more Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days. We performed a secondary analysis of treatment efficacy and side effects using pooled data from two randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared. Of 2208 subjects, 24 (1.1%) women had twins. Treatment success was not statistically different for twin and singleton gestations (91% vs. 97%, p=.19). Perceived bleeding and pain were not significantly different between groups. Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.

Research paper thumbnail of Probing the stability of class I major histocompatibility complex (MHC) molecules on the surface of human cells

Research paper thumbnail of Randomizing women to intrauterine device type: a pilot study experience

Randomizing women to intrauterine device type: a pilot study experience

Contraception, 2012

Research paper thumbnail of Outcomes of medical abortion through 63 days in women with twin gestations

Contraception, 2008

Twin gestation is not considered a contraindication to medical abortion with mifepristone and mis... more Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. We examined medical abortion outcomes for twin gestations through 63 days. We performed a secondary analysis of treatment efficacy and side effects using pooled data from two randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared. Of 2208 subjects, 24 (1.1%) women had twins. Treatment success was not statistically different for twin and singleton gestations (91% vs. 97%, p=.19). Perceived bleeding and pain were not significantly different between groups. Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the limited number of twins.

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