Jessica Sanders - Academia.edu (original) (raw)
Papers by Jessica Sanders
Contraception, 2012
Women choosing no contraception, barrier methods or non-LARC hormonal contraception as their post... more Women choosing no contraception, barrier methods or non-LARC hormonal contraception as their postabortion contraceptive method were provided with emergency contraceptive pills (ECP) at time of discharge. Ulipristal acetate was provided initially; however, most women received levonorgestrel ECP due to availability issues. Participants were contacted at 3 and 6 months postabortion. ECP use was the primary outcome. Secondary outcomes included procurement of additional emergency contraception, current contraceptive use, new interval pregnancy and participant perspectives regarding ECP. Results: A convenience sample of 140 women was enrolled, with 127 eligible for follow-up. Of these, 79 women were contacted. Some 37 (46%) had used the advance provision ECP. At time of enrollment, most women had baseline knowledge of ECP (80%), and more than half of women noted prior ECP use. At the 3-month follow-up, the number of women using non-LARC hormonal contraception decreased from 23 (79%) to 13 (44%) among those who used ECP. Three participants switched to a LARC method in this time period. Most women who had not used ECP cited current contraceptive use, followed by abstinence from sexual activity. There were four self-reported new pregnancies. Conclusions: More women than anticipated used the advance provision ECP in the 6 months after first-trimester aspiration abortion. This supports continued provision at present, although the effect on repeat pregnancy is uncertain.
Obstetrics & Gynecology, May 1, 2020
Obstetrics & Gynecology, 2021
Personal or nonessential information may be redacted at the editor's discretion.
Family Planning Elevated (FPE) is a statewide contraceptive intiative in Utah. FPE expands access... more Family Planning Elevated (FPE) is a statewide contraceptive intiative in Utah. FPE expands access to contraceptive education, training, and services for Utah providers and patients, in an effort to improve the intended pregnancy rate across the state of Utah.
BMC Women's Health, 2021
Background This biomechanical analysis of hysterectomy specimens assesses the forces associated w... more Background This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound. Methods We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available produ...
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](Obstetrics & Gynecology, 2019
Women's Health Issues, 2018
Introduction: Contraceptives improve women's lives and public health, but many women discontinue ... more Introduction: Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were twofold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months. Methods: We enrolled 200 eligible family planning clients and collected data at baseline and at 1, 3, 6, and 12 months. Sexual acceptability measures included the Female Sexual Function Index-6, the New Sexual Satisfaction Scale, and participants' perceptions of whether their contraceptive method had had a neutral, positive, or negative effect on their sex life. Survival analysis and Cox regression with time-varying covariates related sexuality measures to method continuation over time while controlling for other relevant factors. Results: Among 193 women who received an IUD or implant, 20% selected the copper IUD, 46% the levonorgestrel IUD, and 34% the etonogestrel implant. Ten percent discontinued their method during the year. Although changes in Female Sexual Function Index-6 and New Sexual Satisfaction Scale scores were not associated with discontinuation, individuals who perceived that their method detracted from their sexual experience had significantly higher removal rates than those who reported no sexual changes or positive sexual changes (adjusted hazard ratio, 8.04; 95% CI, 1.53-42.24), even when controlling for method type, bleeding changes, and a variety of covariates and controls. Conclusions: Although limited by the small sample of discontinuers, we found that women's perceptions of how their method affects their sex life were associated with contraceptive continuation over time. Sexual acceptability should receive more attention in both contraceptive research and counseling.
American journal of public health, 2018
To describe a community-wide contraception initiative and assess changes in method use when cost ... more To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention ...
Contraception, 2018
To estimate the prevalence of sexual-minority women among clients in family planning centers and ... more To estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative. This survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior. Among 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusiv...
Contraception, Jan 17, 2018
To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important... more To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence ...
Contraception, 2014
Objectives: Prostate specific antigen (PSA) is a biomarker of semen exposure within 48 h of unpro... more Objectives: Prostate specific antigen (PSA) is a biomarker of semen exposure within 48 h of unprotected intercourse. This study investigated PSA testing as an objective measure of semen exposure after self-reported unprotected/underprotected intercourse (UPI) among participants in a study on IUD use for emergency contraception (EC). Methods: Women enrolling in a prospective trial of IUD for EC had a vaginal swab for qualitative PSA (positive ≥4 ng/mL) at the initial EC visit. Participants reported demographic information, self-reported time since last intercourse and whether the need for EC was because of a lack of contraceptive use or method failure. Results: Among study participants, 62/93 (67%) tested positive for PSA. Demographic factors did not differ by PSA result. More positive PSA tests were seen among participants who reported last sexual intercourse within 48 h than among those who presented more than 48 h after last intercourse (57/79 (72%) vs. 5/14 (36%); pb.001). Common reasons given for requesting EC were no use of an anticipatory contraceptive method (41/90), withdrawal failure (35/90), and condom breakage or slippage (8/90). Among the participants reporting withdrawal failure, 25 of 35 had a positive PSA, six of eight participants reporting condom failure had a positive PSA, and 25 of 41 women using no method had a positive PSA. Conclusions: IUD for EC study participants are at risk for pregnancy; two thirds had a positive PSA test indicating semen exposure in the last 48 h.
American Journal of Obstetrics and Gynecology, 2017
BACKGROUND: Immediate postpartum levonorgestrel intrauterine device insertion is increasing in fr... more BACKGROUND: Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. OBJECTIVE: This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes.
Contraception, 2016
We assessed intrauterine device (IUD) preference among women presenting for emergency contracepti... more We assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users. We offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion. One hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0-5.1%). The only positive pregnancy test after treatment occurred in a ...
Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 25, 2017
The extent that state-mandated informed consent scripts affect women's knowledge about aborti... more The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given b...
American journal of obstetrics and gynecology, Jan 8, 2017
As the popularity of long-acting reversible contraception increases, so does the need for accurat... more As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined two-year continuation rates for the levonorgestrel 52mg intrauterine device, the copper T380A intrauterine device, and the 68mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. To examine the proportion and characteristics of women who continue IUD and implant use to two years and relate continuation to device type when controlling for patient characteristics. This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004 and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence ...
Journal of Women's Health, 2016
Objectives: To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pr... more Objectives: To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies. Study Design: In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, ''trying hard not to get pregnant''; 10, ''trying hard to get pregnant'') and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups. Results: Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD-1.60; LNG group: 0.68, SD-1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80). Conclusions: Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan. Clinical Trial Registration Number: Clinicaltrials.gov identifier NCT00966771.
Obstetrics & Gynecology, 2016
INTRODUCTION: In-hospital placement of long-acting reversible contraception (LARC) is increasingl... more INTRODUCTION: In-hospital placement of long-acting reversible contraception (LARC) is increasingly popular after vaginal and cesarean delivery and responds to maternal motivation for highly effective postpartum contraception. The present study assessed in-hospital provision and expulsion of immediate postpartum copper T380 IUD (Cu IUD), levonorgestrel (LNG) IUDs, and contraceptive implants. METHODS: Women presenting to the University of Utah Labor and Delivery Unit between October 2013 and March 2015 who requested an IUD or implant were offered enrollment in this prospective observational trial. Eligible patients received devices through the Ryan Residency Training LARC program. Data on expulsions and discontinuations at 3 months was obtained via patient report and supplemented with chart abstraction. Predictors of IUD expulsion were assessed. RESULTS: During the study period, 404 patients requested a postpartum IUD or implant during prenatal care and 358 devices were placed (88% uptake) prior to discharge from the hospital. A total of 246 women enrolled in the prospective observational outcome study: 73 (30%) Cu IUD users, 93 (38%) LNG IUD users, and 80 (33%) implant users. To date, 85% (n=209) have reached 3 months postpartum and 89% (n=185) have completed follow-up. Three months postpartum, 15/67 (22%) of the LNG IUD users and 3/60 (5%) of the Cu IUD users had an expulsion (P<.01). Among LNG IUD users, primiparity and vaginal delivery were predictors of expulsion (P<.05). CONCLUSION: Immediate postpartum LNG IUD users have higher expulsion rates than Cu IUD users. LNG IUD expulsion rates are highest for primiparous women having a vaginal delivery.
American Journal of Obstetrics and Gynecology, 2016
Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the... more Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the highest incidence during the reproductive years. IBD and its treatments increase the risk of sexual dysfunction for both men and women with these diseases. Women with IBD often seek care from their gynecologist and may preferentially discuss sexual experiences with them over other providers. An understanding of IBD and its impact on sexual functioning and satisfaction will improve screening, evaluation, and management for these patients. Identifying interdisciplinary providers for referrals, such as pelvic floor physical therapists and health psychologists, is a key component to long-term improvements in sexual satisfaction for women with IBD.
Inflammatory Bowel Diseases, 2016
Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk... more Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk for adverse pregnancy outcomes. Pregnancy outcomes for these conditions are best during stable disease remission. Unfortunately, women with inflammatory bowel disease are equally as likely as the general population to have unintended pregnancies. Patients look to their gastroenterologist for contraceptive counseling; however, the current standards for disease management do not prioritize this topic. Guidelines based on available evidence and expert opinion, such as the Centers for Disease Control U.S. Medical Eligibility Criteria for Contraceptive Use, exist to help practitioners provide safe and effective contraception to women with chronic medical conditions. If health care providers were to educate themselves and screen women with inflammatory bowel disease for risk of unintended pregnancy, there would be a reduction in the number of unintended pregnancies and subsequent adverse neonatal and maternal outcomes. Keywords inflammatory bowel diseases; contraception; reproductive health; women Pregnancy planning and preconception counseling are imperative for healthy pregnancy outcomes; however, over half of all pregnancies in the United States are unintended. 1 Approximately 3.1 million pregnancies are unwanted or mistimed annually of which 4 in 10 end in abortion. 2 Pregnancy intention is a marker for adverse pregnancy outcomes, and unintended pregnancy is associated with significantly increased risk for delayed prenatal care, preterm delivery, low birth weight, and adverse developmental outcomes in the child.
Contraception, 2012
Women choosing no contraception, barrier methods or non-LARC hormonal contraception as their post... more Women choosing no contraception, barrier methods or non-LARC hormonal contraception as their postabortion contraceptive method were provided with emergency contraceptive pills (ECP) at time of discharge. Ulipristal acetate was provided initially; however, most women received levonorgestrel ECP due to availability issues. Participants were contacted at 3 and 6 months postabortion. ECP use was the primary outcome. Secondary outcomes included procurement of additional emergency contraception, current contraceptive use, new interval pregnancy and participant perspectives regarding ECP. Results: A convenience sample of 140 women was enrolled, with 127 eligible for follow-up. Of these, 79 women were contacted. Some 37 (46%) had used the advance provision ECP. At time of enrollment, most women had baseline knowledge of ECP (80%), and more than half of women noted prior ECP use. At the 3-month follow-up, the number of women using non-LARC hormonal contraception decreased from 23 (79%) to 13 (44%) among those who used ECP. Three participants switched to a LARC method in this time period. Most women who had not used ECP cited current contraceptive use, followed by abstinence from sexual activity. There were four self-reported new pregnancies. Conclusions: More women than anticipated used the advance provision ECP in the 6 months after first-trimester aspiration abortion. This supports continued provision at present, although the effect on repeat pregnancy is uncertain.
Obstetrics & Gynecology, May 1, 2020
Obstetrics & Gynecology, 2021
Personal or nonessential information may be redacted at the editor's discretion.
Family Planning Elevated (FPE) is a statewide contraceptive intiative in Utah. FPE expands access... more Family Planning Elevated (FPE) is a statewide contraceptive intiative in Utah. FPE expands access to contraceptive education, training, and services for Utah providers and patients, in an effort to improve the intended pregnancy rate across the state of Utah.
BMC Women's Health, 2021
Background This biomechanical analysis of hysterectomy specimens assesses the forces associated w... more Background This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound. Methods We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available produ...
Obstetrics & Gynecology, 2019
Women's Health Issues, 2018
Introduction: Contraceptives improve women's lives and public health, but many women discontinue ... more Introduction: Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were twofold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months. Methods: We enrolled 200 eligible family planning clients and collected data at baseline and at 1, 3, 6, and 12 months. Sexual acceptability measures included the Female Sexual Function Index-6, the New Sexual Satisfaction Scale, and participants' perceptions of whether their contraceptive method had had a neutral, positive, or negative effect on their sex life. Survival analysis and Cox regression with time-varying covariates related sexuality measures to method continuation over time while controlling for other relevant factors. Results: Among 193 women who received an IUD or implant, 20% selected the copper IUD, 46% the levonorgestrel IUD, and 34% the etonogestrel implant. Ten percent discontinued their method during the year. Although changes in Female Sexual Function Index-6 and New Sexual Satisfaction Scale scores were not associated with discontinuation, individuals who perceived that their method detracted from their sexual experience had significantly higher removal rates than those who reported no sexual changes or positive sexual changes (adjusted hazard ratio, 8.04; 95% CI, 1.53-42.24), even when controlling for method type, bleeding changes, and a variety of covariates and controls. Conclusions: Although limited by the small sample of discontinuers, we found that women's perceptions of how their method affects their sex life were associated with contraceptive continuation over time. Sexual acceptability should receive more attention in both contraceptive research and counseling.
American journal of public health, 2018
To describe a community-wide contraception initiative and assess changes in method use when cost ... more To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention ...
Contraception, 2018
To estimate the prevalence of sexual-minority women among clients in family planning centers and ... more To estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative. This survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior. Among 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusiv...
Contraception, Jan 17, 2018
To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important... more To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence ...
Contraception, 2014
Objectives: Prostate specific antigen (PSA) is a biomarker of semen exposure within 48 h of unpro... more Objectives: Prostate specific antigen (PSA) is a biomarker of semen exposure within 48 h of unprotected intercourse. This study investigated PSA testing as an objective measure of semen exposure after self-reported unprotected/underprotected intercourse (UPI) among participants in a study on IUD use for emergency contraception (EC). Methods: Women enrolling in a prospective trial of IUD for EC had a vaginal swab for qualitative PSA (positive ≥4 ng/mL) at the initial EC visit. Participants reported demographic information, self-reported time since last intercourse and whether the need for EC was because of a lack of contraceptive use or method failure. Results: Among study participants, 62/93 (67%) tested positive for PSA. Demographic factors did not differ by PSA result. More positive PSA tests were seen among participants who reported last sexual intercourse within 48 h than among those who presented more than 48 h after last intercourse (57/79 (72%) vs. 5/14 (36%); pb.001). Common reasons given for requesting EC were no use of an anticipatory contraceptive method (41/90), withdrawal failure (35/90), and condom breakage or slippage (8/90). Among the participants reporting withdrawal failure, 25 of 35 had a positive PSA, six of eight participants reporting condom failure had a positive PSA, and 25 of 41 women using no method had a positive PSA. Conclusions: IUD for EC study participants are at risk for pregnancy; two thirds had a positive PSA test indicating semen exposure in the last 48 h.
American Journal of Obstetrics and Gynecology, 2017
BACKGROUND: Immediate postpartum levonorgestrel intrauterine device insertion is increasing in fr... more BACKGROUND: Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. OBJECTIVE: This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes.
Contraception, 2016
We assessed intrauterine device (IUD) preference among women presenting for emergency contracepti... more We assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users. We offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion. One hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0-5.1%). The only positive pregnancy test after treatment occurred in a ...
Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 25, 2017
The extent that state-mandated informed consent scripts affect women's knowledge about aborti... more The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given b...
American journal of obstetrics and gynecology, Jan 8, 2017
As the popularity of long-acting reversible contraception increases, so does the need for accurat... more As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined two-year continuation rates for the levonorgestrel 52mg intrauterine device, the copper T380A intrauterine device, and the 68mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. To examine the proportion and characteristics of women who continue IUD and implant use to two years and relate continuation to device type when controlling for patient characteristics. This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004 and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence ...
Journal of Women's Health, 2016
Objectives: To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pr... more Objectives: To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies. Study Design: In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, ''trying hard not to get pregnant''; 10, ''trying hard to get pregnant'') and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups. Results: Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD-1.60; LNG group: 0.68, SD-1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80). Conclusions: Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan. Clinical Trial Registration Number: Clinicaltrials.gov identifier NCT00966771.
Obstetrics & Gynecology, 2016
INTRODUCTION: In-hospital placement of long-acting reversible contraception (LARC) is increasingl... more INTRODUCTION: In-hospital placement of long-acting reversible contraception (LARC) is increasingly popular after vaginal and cesarean delivery and responds to maternal motivation for highly effective postpartum contraception. The present study assessed in-hospital provision and expulsion of immediate postpartum copper T380 IUD (Cu IUD), levonorgestrel (LNG) IUDs, and contraceptive implants. METHODS: Women presenting to the University of Utah Labor and Delivery Unit between October 2013 and March 2015 who requested an IUD or implant were offered enrollment in this prospective observational trial. Eligible patients received devices through the Ryan Residency Training LARC program. Data on expulsions and discontinuations at 3 months was obtained via patient report and supplemented with chart abstraction. Predictors of IUD expulsion were assessed. RESULTS: During the study period, 404 patients requested a postpartum IUD or implant during prenatal care and 358 devices were placed (88% uptake) prior to discharge from the hospital. A total of 246 women enrolled in the prospective observational outcome study: 73 (30%) Cu IUD users, 93 (38%) LNG IUD users, and 80 (33%) implant users. To date, 85% (n=209) have reached 3 months postpartum and 89% (n=185) have completed follow-up. Three months postpartum, 15/67 (22%) of the LNG IUD users and 3/60 (5%) of the Cu IUD users had an expulsion (P<.01). Among LNG IUD users, primiparity and vaginal delivery were predictors of expulsion (P<.05). CONCLUSION: Immediate postpartum LNG IUD users have higher expulsion rates than Cu IUD users. LNG IUD expulsion rates are highest for primiparous women having a vaginal delivery.
American Journal of Obstetrics and Gynecology, 2016
Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the... more Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the highest incidence during the reproductive years. IBD and its treatments increase the risk of sexual dysfunction for both men and women with these diseases. Women with IBD often seek care from their gynecologist and may preferentially discuss sexual experiences with them over other providers. An understanding of IBD and its impact on sexual functioning and satisfaction will improve screening, evaluation, and management for these patients. Identifying interdisciplinary providers for referrals, such as pelvic floor physical therapists and health psychologists, is a key component to long-term improvements in sexual satisfaction for women with IBD.
Inflammatory Bowel Diseases, 2016
Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk... more Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk for adverse pregnancy outcomes. Pregnancy outcomes for these conditions are best during stable disease remission. Unfortunately, women with inflammatory bowel disease are equally as likely as the general population to have unintended pregnancies. Patients look to their gastroenterologist for contraceptive counseling; however, the current standards for disease management do not prioritize this topic. Guidelines based on available evidence and expert opinion, such as the Centers for Disease Control U.S. Medical Eligibility Criteria for Contraceptive Use, exist to help practitioners provide safe and effective contraception to women with chronic medical conditions. If health care providers were to educate themselves and screen women with inflammatory bowel disease for risk of unintended pregnancy, there would be a reduction in the number of unintended pregnancies and subsequent adverse neonatal and maternal outcomes. Keywords inflammatory bowel diseases; contraception; reproductive health; women Pregnancy planning and preconception counseling are imperative for healthy pregnancy outcomes; however, over half of all pregnancies in the United States are unintended. 1 Approximately 3.1 million pregnancies are unwanted or mistimed annually of which 4 in 10 end in abortion. 2 Pregnancy intention is a marker for adverse pregnancy outcomes, and unintended pregnancy is associated with significantly increased risk for delayed prenatal care, preterm delivery, low birth weight, and adverse developmental outcomes in the child.