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Chest Dec 2017Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis was to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults.
METHODS
MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey were searched, and the bibliographies of relevant studies were reviewed. Two researchers independently selected studies that met the inclusion criteria and assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary receiver-operating characteristic curve and pooled diagnostic OR (DOR) were estimated by using a bivariate random effects analysis. Sources of heterogeneity were explored by using predefined subgroup analyses and bivariate meta-regression.
RESULTS
Nineteen studies involving 1,071 people were included in the study. For diaphragm thickening fraction, the area under the summary receiver-operating characteristic curve was 0.87, and DOR was 21 (95% CI, 11-40). Regarding diaphragmatic excursion, pooled sensitivity was 75% (95% CI, 65-85); pooled specificity, 75% (95% CI, 60-85); and DOR, 10 (95% CI, 4-24). For lung ultrasound, the area under the summary receiver-operating characteristic curve was 0.77, and DOR was 38 (95% CI, 7-198). Based on bivariate meta-regression analysis, a significantly higher specificity for diaphragm thickening fraction and higher sensitivity for diaphragmatic excursion was detected in studies with applicability concerns.
CONCLUSIONS
Lung and diaphragm ultrasound can help predict weaning outcome, but its accuracy may vary depending on the patient subpopulation.
Topics: Airway Extubation; Critical Illness; Diaphragm; Humans; Lung; Reproducibility of Results; Ultrasonography; Ventilator Weaning; Weaning
PubMed: 28864053
DOI: 10.1016/j.chest.2017.08.028 -
Anaesthesiology Intensive Therapy 2022Proper timing for discontinuation of mechanical ventilation is of great importance, especially in patients with previous weaning failures. Different indices obtained by... (Meta-Analysis)
Meta-Analysis Review
Proper timing for discontinuation of mechanical ventilation is of great importance, especially in patients with previous weaning failures. Different indices obtained by ultra-sonographic evaluation of the diaphragm muscle have improved determination of weaning success. The aim of the present systematic review was to evaluate and compare the accuracy of the diagnostic indices obtained by ultrasonographic examination, including diaphragm thickening fraction (DTF), diaphragmatic excursion (DE) and the rapid shallow breathing index (RSBI). A systematic literature search (Web of Science, MEDLINE, Embase and Google Scholar) was performed to identify original articles assessing diaphragm muscle features including excursion and thickening fraction. A total of 2738 citations were retrieved initially; available data of 19 cohort studies (1114 patients overall) were included in the meta-analysis, subdivided into groups based on the ultrasonographic examination type. Our results showed the superiority of the diagnostic accuracy of the DTF in comparison to the DE and the RSBI. Data on the combination of the different indices are limited. Diaphragmatic ultrasound is a cheap and feasible tool for diaphragm function evaluation. Moreover, DTF in the assessment of weaning outcome provides more promising outcomes, which should be evaluated more meti-culously in future randomised trials.
Topics: Diaphragm; Humans; Prospective Studies; Respiration, Artificial; Ultrasonography; Ventilator Weaning
PubMed: 35792111
DOI: 10.5114/ait.2022.117273 -
Contraception Dec 2016Women with medical conditions associated with increased risk for thrombosis generally should not use estrogen-containing contraceptives; however, less is known about... (Review)
Review
BACKGROUND
Women with medical conditions associated with increased risk for thrombosis generally should not use estrogen-containing contraceptives; however, less is known about progestin-only contraceptives (POCs) and thrombosis risk.
OBJECTIVES
The objective was to identify evidence regarding the risk of venous thromboembolism (VTE) or arterial thromboembolism [stroke or acute myocardial infarction (AMI)] among women using POCs.
METHODS
We searched the PubMed database for all articles published from database inception through January 2016 for studies examining thrombosis among women using POCs. We included studies which examined women with medical conditions associated with thrombosis risk, as well as studies of women in the general population (either without these conditions or who were not specified to have these conditions). Hormonal contraceptives of interest included progestin-only pills (POPs), injectables, implants and levonorgestrel-releasing intrauterine devices (LNG-IUDs). Outcomes of interest included VTE, stroke and AMI.
RESULTS
There were 26 articles of good to poor quality that met inclusion criteria; 9 studies examined women with medical conditions and 20 examined women in the general population. Two studies found that, among smokers and women with certain thrombogenic mutations, use of depot medroxyprogesterone acetate (DMPA) had elevated odds of VTE compared with nonsmokers or those without mutations, although confidence intervals were wide and overlapped with odds among nonusers. One study found that, among women with previous VTE, use of POCs (including DMPA) was associated with a nonsignificant increased odds of recurrent VTE (all of which were among DMPA users); two other studies that examined POCs other than DMPA did not observe an association with recurrent VTE. Two studies found that use of DMPA among healthy women was also associated with increased odds of VTE. Two studies found that use of POCs for therapeutic indications was associated with increased odds of VTE. Studies did not find increased odds of VTE with POPs for contraceptive purposes, implants or LNG-IUDs nor were there increased odds of stroke or AMI with any POCs.
CONCLUSION
The majority of evidence identified by this systematic review did not suggest an increase in odds for venous or arterial events with use of most POCs. Limited evidence suggested increased odds of VTE with use of injectables (three studies) and use of POCs for therapeutic indications (two studies, one with POCs unspecified and the other with POPs). Any increase in risk likely translates to a small increase in absolute numbers of thrombotic events at the population level.
Topics: Contraception; Female; Humans; Myocardial Infarction; Progestins; Risk Assessment; Stroke; Venous Thromboembolism; Weight Gain
PubMed: 27153743
DOI: 10.1016/j.contraception.2016.04.014 -
Critical Care (London, England) May 2023Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years, diaphragmatic ultrasound has been used for this purpose. We conducted a systematic review and meta-analysis to evaluate the effectiveness of diaphragmatic ultrasound in predicting the success of weaning from mechanical ventilation.
METHODS
Two investigators independently searched PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, and LILACS for articles published between January 2016 and July 2022. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool; additionally, the certainty of the evidence is evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Sensitivity and specificity analysis was performed for diaphragmatic excursion and diaphragmatic thickening fraction; positive and negative likelihood ratios and diagnostic odds ratios (DOR) with their confidence intervals (95% CI) were calculated by random effects analysis, summary receiver operating characteristic curve was estimated. Sources of heterogeneity were explored by subgroup analysis and bivariate meta-regression.
RESULTS
Twenty-six studies were included, of which 19 were included in the meta-analysis (1204 patients). For diaphragmatic excursion, sensitivity was 0.80 (95% CI 0.77-0.83), specificity 0.80 (95% CI 0.75-0.84), area under the summary receiver operating characteristic curve 0.87 and DOR 17.1 (95% CI 10.2-28.6). For the thickening fraction, sensitivity was 0.85 (95% CI 0.82-0.87), specificity 0.75 (95% CI 0.69-0.80), area under the summary receiver operating characteristic curve 0.87 and DOR 17.2 (95% CI 9.16-32.3). There was heterogeneity among the included studies. When performing a subgroup analysis and excluding studies with atypical cutoff values, sensitivity and specificity increased for diaphragmatic thickening fraction; sensitivity increased and specificity decreased for diaphragmatic excursion; when comparing studies using pressure support (PS) versus T-tube, there was no significant difference in sensitivity and specificity; bivariate meta-regression analysis shows that patient position at the time of testing was a factor of heterogeneity in the included studies.
CONCLUSIONS
Measurement of diaphragmatic excursion and diaphragmatic thickening fraction predict the probability of successful weaning from mechanical ventilation with satisfactory diagnostic accuracy; however, significant heterogeneity was evident in the different included studies. Studies of high methodological quality in specific subgroups of patients in intensive care units are needed to evaluate the role of diaphragmatic ultrasound as a predictor of weaning from mechanical ventilation.
Topics: Humans; Respiration, Artificial; Ventilator Weaning; Sensitivity and Specificity; ROC Curve; Intensive Care Units; Diaphragm; Ultrasonography
PubMed: 37147688
DOI: 10.1186/s13054-023-04430-9 -
JBI Database of Systematic Reviews and... Sep 2019The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.
OBJECTIVE
The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.
INTRODUCTION
Stress has reached epidemic proportions globally. Unidentified sequela of physiological and psychological stress can result in anxiety, depression, heart disease, cancer, immunologic conditions and death. There is a high cost associated with the treatment of stress related health conditions in the United States and worldwide. Many treatments are pharmacologic and cannot be self-initiated. Therefore, it is critical to identify evidence-based, low-cost, non-pharmacologic, self-administered interventions that can mitigate physiological and psychological stress.
INCLUSION CRITERIA
This review considered adults 18 years and over engaged in diaphragmatic breathing as an isolated intervention to reduce physiological and psychological stress. There were no exclusions based on physical or psychological conditions. The comparator was no treatment or usual treatment, which may constitute ordinary breathing.
METHODS
The comprehensive literature search included published and unpublished studies in English from the beginning of the databases through January 2018. The databases searched included: PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, ProQuest Nursing and Allied Health and Health Source: Nursing/Academic Edition. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used.
RESULTS
Three studies met the criteria for review: one randomized controlled trial and two quasi-experimental studies. Statistical pooling was not possible due to clinical and methodological heterogeneity of interventions and outcome measures of the included studies. All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress.
CONCLUSIONS
The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. Given the benefits of diaphragmatic breathing on stress reduction, ongoing research is needed to continue to establish the evidence-base for this self-administered, low-cost, non-pharmacologic intervention.
Topics: Adult; Breathing Exercises; Clinical Trials as Topic; Diaphragm; Female; Humans; Male; Stress, Physiological; Stress, Psychological; Treatment Outcome
PubMed: 31436595
DOI: 10.11124/JBISRIR-2017-003848 -
Annals of Physical and Rehabilitation... Sep 2022Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poor-quality studies (PEDro score ≤4).
OBJECTIVES
With this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and medium-term in post-stroke.
METHODS
Databases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool.
RESULTS
Nine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27-1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17-1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71-1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43-1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03-1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term.
CONCLUSIONS
The meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone.
Topics: Breathing Exercises; Exercise Tolerance; Forced Expiratory Volume; Humans; Muscle Strength; Respiratory Muscles; Stroke
PubMed: 34687960
DOI: 10.1016/j.rehab.2021.101596 -
European Journal of Obstetrics,... Jun 2022To report the pregnancy outcomes of women with prior endometrial cancer and endometrial hyperplasia managed with fertility-sparing treatments. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To report the pregnancy outcomes of women with prior endometrial cancer and endometrial hyperplasia managed with fertility-sparing treatments.
METHODS
Medline and Embase databases were searched. Inclusion criteria were studies reporting the pregnancy outcomes of women who had undergone fertility-sparing treatments for endometrial hyperplasia or early endometrioid endometrial cancer. Outcomes explored were pregnancy, miscarriage and livebirth rates according to the type of progestin treatment used. Subgroup analyses according to the type of diagnostic follow-up were also performed. Meta-analyses of proportions using a random effects model were used to combine data.
RESULTS
Twenty-nine studies (1036 women) were included, and 82.8% [95% confidence interval (CI) 72.3-91.2] of women achieved complete remission. Pregnancy rates were 56.3% (95% CI 41.6-70.5) with megestrol (MA) or medroxyprogesterone acetate (MPA), 63.1% (95% CI 37.0-85.6) with levonorgestrel-releasing intrauterine device (LNG-IUD), 57.9% (95% CI 37.7-76.8) with MA or MPA and metformin, 59.8% (95% CI 48.3-70.7) with MPA and LNG-IUD, 15.4% (95% CI 4.3-42.2) with gonadotropin-releasing hormone analogue (GnRHa) combined with LNG-IUD or letrozole, and 40.7% (95% CI 24.5-59.3) with LNG-IUD and GnRHa. Miscarriage rates were 17.4% (95% CI 12.2-23.4), 14.3% (95% CI 6.4-24.7), 57.9% (95% CI 37.7-76.8), 26.9% (95% CI 14.6-39.3), 100% (95% CI 34.0-100) and 18.2% (95% CI 5.1-47.7), respectively, and livebirth rates were 68.8% (95% CI 56.0-80.3), 80.8% (95% CI 69.5-90.0), 69.9% (95% CI 56.1-82.0), 25.97 (95% CI 14.6-39.3), 0% (95% CI 0-66.0) and 81.8% (95% CI 52.3-94.8), respectively. Finally, stratifying the analysis considering the endometrial sampling method alone, the pregnancy rate was 68.6% (95% CI 51.2-83.6; 10 studies, I = 83.5%) in women who underwent hysteroscopy and 60.5% (95% CI 53.4-67.5; 13 studies, I = 39.8%) in women managed with dilatation and curettage biopsy; the miscarriage and livebirth rates were 13.2% (95% CI 8.0-19.5; I = 0%) and 81.2% (95% CI 67.4-91.8; I = 67.3%), respectively, for hysteroscopy, and 25.2% (95% CI 17.8-33.3; I = 15.5%) and 67.5% (95% CI 58.8-75.5; I = 0%), respectively, for dilatation and curettage biopsy.
CONCLUSION
Fertility-sparing treatment in women with endometrial cancer or hyperplasia is associated with an overall good response to therapy, good chance of achieving pregnancy and a good livebirth rate. Diagnostic follow-up with hysteroscopy was associated with a higher pregnancy rate, although this requires confirmation in adequately powered randomized trials.
Topics: Abortion, Spontaneous; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Fertility Preservation; Humans; Hyperplasia; Intrauterine Devices, Medicated; Levonorgestrel; Medroxyprogesterone Acetate; Precancerous Conditions; Pregnancy; Pregnancy Outcome
PubMed: 35526471
DOI: 10.1016/j.ejogrb.2022.04.019 -
Journal of Obstetrics and Gynaecology... Sep 2020One barrier to the use of intrauterine devices (IUDs) as a contraceptive method is the experience of anxiety and pain during the insertion procedure. Previous reviews... (Review)
Review
One barrier to the use of intrauterine devices (IUDs) as a contraceptive method is the experience of anxiety and pain during the insertion procedure. Previous reviews have focused on pharmacological methods used to relieve pain during IUD insertion; however, few similar reviews have examined non-pharmacological methods to relieve pain or strategies to reduce anxiety. The objectives of this study were to identify and categorize strategies for reducing anxiety and pain with respect to IUD insertion and the ways in which anxiety and pain were assessed. In particular, the study aimed to identify non-pharmacological interventions and studies that included anxiety as a research outcome. A literature search was conducted of all English-language studies between inception and the week of July 29, 2018 from the following online databases: Medline, Embase, Cochrane Library, and PubMed. The search revealed 426 studies after removal of duplicates, 35 of which fulfilled the inclusion criteria. A total of 29 studies were identified as assessing pharmacological interventions for the management of pain, and six studies assessed non-pharmacological interventions. Only one study included a measurement of patient anxiety during the procedure as an outcome measure. Research on non-pharmacological interventions for the management of anxiety and pain during IUD insertion is lacking. This review found that evidence for the studied pharmacological interventions is conflicting, and there is very little evidence on understanding the effectiveness of strategies to manage anxiety during the IUD insertion procedure. Further high-quality research on non-pharmacological pain and anxiety management strategies is warranted.
Topics: Anxiety; Contraception; Female; Humans; Intrauterine Devices; Pain
PubMed: 31882291
DOI: 10.1016/j.jogc.2019.09.014 -
American Journal of Obstetrics and... Aug 2020To provide updated and more detailed pooled intrauterine device expulsion rates and expulsion risk estimates among women with postpartum intrauterine device placement by... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To provide updated and more detailed pooled intrauterine device expulsion rates and expulsion risk estimates among women with postpartum intrauterine device placement by timing of insertion, delivery type, and intrauterine device type to inform current intrauterine device insertion practices in the United States.
DATA SOURCES
We searched PubMed, Cochrane Library, and ClinicalTrials.gov through June 2019.
STUDY ELIGIBILITY CRITERIA
We included all studies, of any study design, that examined postpartum placement of Copper T380A (copper) or levonorgestrel-containing intrauterine devices that reported counts of expulsion.
STUDY APPRAISAL AND SYNTHESIS METHODS
We evaluated intrauterine device expulsion among women receiving postpartum intrauterine devices in the "immediate" (within 10 minutes), "early inpatient" (>10 minutes to <72 hours), "early outpatient" (72 hours to <4 weeks), and interval (≥4 weeks) time periods after delivery. We assessed study quality using the US Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of partial and complete intrauterine device expulsion separately and estimated adjusted relative risks by the timing of postpartum placement, delivery type, and intrauterine device type using log-binomial multivariable regression.
RESULTS
We identified 48 level I to II-3 studies of poor to good quality that reported a total of 7661 intrauterine device placements. Complete intrauterine device expulsion rates varied by timing of placement as follows: 10.2% (range, 0.0-26.7) for immediate; 13.2% (3.5-46.7) for early inpatient; 0% for early outpatient; and 1.8% (0.0-4.8) for interval placements. Complete intrauterine device expulsion rates also varied by delivery type: 14.8% (range, 4.8-43.1) for vaginal and 3.8% (0.0-21.1) for cesarean deliveries. Among immediate postpartum vaginal placements, the expulsion rate for levonorgetrel intrauterine devices was 27.4% (range, 18.8-45.2) and 12.4% (4.8-43.1) for copper intrauterine devices. Compared with interval placement, immediate and early postpartum placements (inpatient and outpatient combined) were associated with greater risk of complete expulsion (adjusted risk ratio, 8.33; 95% confidence interval, 4.32-16.08, and adjusted risk ratio, 5.27; 95% confidence interval, 2.56-10.85, respectively). Among immediate postpartum placements, risk of expulsion was greater for placement after vaginal compared with cesarean deliveries (adjusted risk ratio, 4.57; 95% confidence interval, 3.49-5.99). Among immediate placements at the time of vaginal delivery, levonorgestrel intrauterine devices were associated with a greater risk of expulsion compared with copper intrauterine devices (adjusted risk ratio, 1.90; 95% confidence interval, 1.36-2.65).
CONCLUSION
Although intrauterine device expulsion rates vary by timing of placement, type, and mode of delivery, intrauterine device insertion can take place at any time. Understanding the risk of intrauterine device expulsion at each time period will enable women to make an informed choice about when to initiate use of an intrauterine device in the postpartum period based on their own goals and preferences.
Topics: Delivery, Obstetric; Female; Humans; Intrauterine Device Expulsion; Intrauterine Devices; Postpartum Period; Pregnancy; Risk Factors; Time Factors
PubMed: 32142826
DOI: 10.1016/j.ajog.2020.02.045 -
Reproductive Health Jan 2021Unintended pregnancies (UIP) have a significant impact on health of women and the health budget of countries. Contraception is an effective way to prevent UIPs. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Unintended pregnancies (UIP) have a significant impact on health of women and the health budget of countries. Contraception is an effective way to prevent UIPs. The study objective was to collate evidence on clinical effectiveness of etonogestrel subdermal implant (ESI), continuation rate and side effect profile among eligible women of reproductive age group, as compared to levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (Cu-IUD) and depot medroxy progesterone acetate injections; other types of contraceptive implants were excluded as comparators.
METHODS
The protocol of the systematic review was registered in Prospero (registration number: CRD42018116580). MEDLINE via PubMed, Cochrane library and web of science were the electronic databases searched. A search strategy was formulated and studies from 1998 to 2019 were included. Clinical trial registries and grey literature search was done. Critical assessment of included studies was done using appropriate tools. A qualitative synthesis of included studies was done and a meta-analysis was conducted in RevMan software for continuation rates of ESI as compared to other long acting reversible contraceptives (LARC) e.g. LNG IUS and Cu-IUD.
RESULTS
The search yielded 23,545 studies. After excluding 467 duplicates, 23,078 titles were screened and 51 studies were included for the review. Eight of the 15 studies reporting clinical effectiveness reported 100% effectiveness and overall pearl index ranged from 0 to 1.4. One-year continuation rates ranged from 57-97%; 44-95% at the end of second year and 25-78% by 3 years of use. Abnormal menstruation was the most commonly reported side effect. There was no significant difference in bone mineral density at 1 year follow-up. The meta-analyses showed that odds ratio (OR) of 1-year continuation rate was 1.55 (1.36, 1.76) for LNG-IUS vs. ESI and 1.34 (1.13, 1.58) for copper-IUD vs. ESI; showing that continuation rates at the end of one-year were higher in LNG-IUS and copper-IUD as compared to ESI.
CONCLUSION
ESI is clinically effective and safe contraceptive method to use, yet 1-year continuation rates are lower as compared to LNG-IUS and copper-IUD, mostly attributed to the disturbances in the menstruation.
Topics: Adolescent; Adult; Contraception Behavior; Contraceptive Agents, Female; Contraceptive Agents, Hormonal; Desogestrel; Female; Humans; Intrauterine Devices, Copper; Pregnancy; Treatment Outcome; Young Adult
PubMed: 33407632
DOI: 10.1186/s12978-020-01054-y