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The New England Journal of Medicine Jan 2021In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only copper IUDs for emergency contraception because data are lacking on the efficacy of the levonorgestrel IUD for this purpose.
METHODS
This randomized noninferiority trial, in which participants were unaware of the group assignments, was conducted at six clinics in Utah and included women who sought emergency contraception after at least one episode of unprotected intercourse within 5 days before presentation and agreed to placement of an IUD. We randomly assigned participants in a 1:1 ratio to receive a levonorgestrel 52-mg IUD or a copper T380A IUD. The primary outcome was a positive urine pregnancy test 1 month after IUD insertion. When a 1-month urine pregnancy test was unavailable, we used survey and health record data to determine pregnancy status. The prespecified noninferiority margin was 2.5 percentage points.
RESULTS
Among the 355 participants randomly assigned to receive levonorgestrel IUDs and 356 assigned to receive copper IUDs, 317 and 321, respectively, received the interventions and provided 1-month outcome data. Of these, 290 in the levonorgestrel group and 300 in the copper IUD group had a 1-month urine pregnancy test. In the modified intention-to-treat and per-protocol analyses, pregnancy rates were 1 in 317 (0.3%; 95% confidence interval [CI], 0.01 to 1.7) in the levonorgestrel group and 0 in 321 (0%; 95% CI, 0 to 1.1) in the copper IUD group; the between-group absolute difference in both analyses was 0.3 percentage points (95% CI, -0.9 to 1.8), consistent with the noninferiority of the levonorgestrel IUD to the copper IUD. Adverse events resulting in participants seeking medical care in the first month after IUD placement occurred in 5.2% of participants in the levonorgestrel IUD group and 4.9% of those in the copper IUD group.
CONCLUSIONS
The levonorgestrel IUD was noninferior to the copper IUD for emergency contraception. (Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT02175030.).
Topics: Adolescent; Adult; Contraception, Postcoital; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Levonorgestrel; Pregnancy; Pregnancy Rate; Pregnancy Tests; Unsafe Sex; Young Adult
PubMed: 33503342
DOI: 10.1056/NEJMoa2022141 -
BMJ Case Reports Apr 2017A 35-year-old woman presented to our institution with tender, right knee swelling. Radiological and pathological work-up revealed metastatic osteosarcoma. Prior to the...
A 35-year-old woman presented to our institution with tender, right knee swelling. Radiological and pathological work-up revealed metastatic osteosarcoma. Prior to the initiation of chemotherapy, she underwent a routine urine pregnancy test and was surprised with a positive result. Serum beta human chorionic gonadotropin (βhCG) levels were also consistently positive and rising. No gestational sac was seen at transvaginal ultrasound. The paraneoplastic ectopic secretion of βhCG has been well described in gestational trophoblastic and gonadal tumours but has very rarely been associated with other tumour types. This patient's βhCG level was reflective of osteosarcoma activity and normalised with response to chemotherapy. The prognostic implications of βhCG expression in more diverse tumours is unclear; however, where raised, it can be used to monitor disease activity.
Topics: Adult; Aftercare; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Knee; Osteosarcoma; Pain; Pregnancy Tests; Prognosis; Tibia; Treatment Outcome
PubMed: 28455292
DOI: 10.1136/bcr-2016-218438 -
Emergency Medicine Clinics of North... Aug 1999According to recent national studies, one in six women and one in 33 men will experience an attempted or completed rape during their lifetime. Although most rapes are... (Review)
Review
According to recent national studies, one in six women and one in 33 men will experience an attempted or completed rape during their lifetime. Although most rapes are never reported, victims that do report them often present to the emergency department for intervention. The emergency physician must be able to treat acute injuries, accurately collect and record evidence, offer STD and pregnancy prophylaxis, offer emotional support (with the social worker and rape crisis advocate), and provide appropriate referrals for follow-up care. The emergency physician can play a crucial role in easing the transition from victim to survivor with initial treatment. This article summarizes current recommendations for evaluation and treatment of sexual assault victims.
Topics: Aftercare; Emergency Treatment; Female; Forensic Medicine; Humans; Male; Medical History Taking; Physical Examination; Pregnancy; Pregnancy Tests; Rape; Risk Factors; Sexually Transmitted Diseases
PubMed: 10516847
DOI: 10.1016/s0733-8627(05)70091-2 -
Embryonic development and pregnancy test sensitivity: the importance of earlier pregnancy detection.Women's Health (London, England) Nov 2009Embryogenesis research provides information on a time of heightened vulnerability in embryo development: the time from conception to the day a woman misses her menstrual... (Review)
Review
Embryogenesis research provides information on a time of heightened vulnerability in embryo development: the time from conception to the day a woman misses her menstrual period. During this period, it is vital for the woman to be aware of exposures, behaviors and nutritional factors that could negatively impact the developing embryo. This article discusses this critical, often-overlooked window of development and will review the various types of teratogens that affect pregnancy. Over-the-counter pregnancy tests are widely used to determine pregnancy status. Earlier test models detected only the pregnancy hormone human chorionic gonadotropin in the urine, but it is now known that there are other key forms of human chorionic gonadotropin that are relevant when determining pregnancy status. This article will explain why early knowledge of pregnancy status is important for both woman and embryo, and the role that patient education and pregnancy test choice can have on normal embryonic development.
Topics: Chronic Disease; Counseling; Drug-Related Side Effects and Adverse Reactions; Embryonic Development; Female; Humans; Maternal Exposure; Patient Education as Topic; Pregnancy; Pregnancy Complications; Pregnancy Tests; Prenatal Exposure Delayed Effects; Sensitivity and Specificity; Substance-Related Disorders; Teratogens; Time Factors
PubMed: 19863469
DOI: 10.2217/whe.09.61 -
The Veterinary Clinics of North... Mar 2016The first part of this article defines the attributes of the ideal pregnancy test and describes the direct and indirect methods for pregnancy diagnosis in dairy cows... (Review)
Review
The first part of this article defines the attributes of the ideal pregnancy test and describes the direct and indirect methods for pregnancy diagnosis in dairy cows that are currently available that have the potential to replace transrectal palpation. Second, this new technology must be practically integrated into a systematic on-farm reproductive management strategy and empirically demonstrated to exceed the status quo of the industry in reproductive performance. Finally a future direction for research and technology in the area of early pregnancy diagnosis in dairy cows is presented, and the overall conclusions of the ideas presented herein are drawn.
Topics: Animals; Cattle; Dairying; Female; Insemination, Artificial; Pregnancy; Pregnancy Tests; Pregnancy, Animal; Reproduction; Ultrasonography, Prenatal; Uterus
PubMed: 26922118
DOI: 10.1016/j.cvfa.2015.09.006 -
Academic Emergency Medicine : Official... Jun 2015
Topics: Emergency Service, Hospital; Female; Humans; Pregnancy; Pregnancy Tests; Prescription Drugs; Teratogens
PubMed: 25996558
DOI: 10.1111/acem.12690 -
Frontiers in Endocrinology 2023Progesterone (P4) is essential for pregnancy. A controlled ovarian stimulation (COS) leads to a iatrogenic luteal defect that indicates a luteal phase support (LPS) at...
Progesterone (P4) is essential for pregnancy. A controlled ovarian stimulation (COS) leads to a iatrogenic luteal defect that indicates a luteal phase support (LPS) at least until pregnancy test day. Some clinicians continue the LPS until week 8 or later, when P4 is mainly secreted by syncytiotrophoblast cells.Measuring serum P4 on pregnancy test day after a fresh embryo transfer could help to identify women who might benefit from prolonged LPS. In women with LPS based on P4 administered by the rectal route, P4 concentration on pregnancy test day was significantly higher in patients with ongoing pregnancy than in patients with abnormal pregnancy.This monocentric retrospective study used data on 99 consecutive cycles of COS, triggered with human chorionic gonadotropin, followed by fresh embryo transfer resulting in a positive pregnancy test (>100 IU/L) (from November 2020 to November 2022). Patients undergoing preimplantation genetic screening or with ectopic pregnancy were excluded. All patients received standard luteal phase support (i.e. micronized vaginal progesterone 600 mg per day for 15 days). The primary endpoint was P4 concentration at day 15 after oocyte retrieval (pregnancy test day) in women with ongoing pregnancy for >12 weeks and in patients with miscarriage before week 12 of pregnancy.The median P4 concentration [range] at pregnancy test day was higher in women with ongoing pregnancy than in women with miscarriage (55.9 ng/mL [11.6; 290.6] versus 18.1 ng/mL [8.3; 140.9], p = 0.002). A P4 concentration ≥16.5 ng/mL at pregnancy test day was associated with higher ongoing pregnancy rate (OR = 12.5, 95% CI 3.61 - 43.33, p <0.001). A P4 concentration ≥16.5 ng/mL at pregnancy test day was significantly associated with higher live birth rate (OR = 11.88, 95% CI 3.30-42.71, p <0.001).After COS and fresh embryo transfer, the risk of miscarriage is higher in women who discontinue luteal support after 15 days, as recommended, but with P4 concentration <16.5 ng/mL. The benefit of individualized prolonged luteal phase support should be evaluated.
Topics: Pregnancy; Humans; Female; Progesterone; Abortion, Spontaneous; Fertilization in Vitro; Retrospective Studies; Lipopolysaccharides; Embryo Transfer; Pregnancy Tests; Ovulation Induction
PubMed: 37455896
DOI: 10.3389/fendo.2023.1191648 -
Clinical Chemistry and Laboratory... Dec 2020
Topics: Chorionic Gonadotropin; Female; Humans; Pregnancy; Pregnancy Tests
PubMed: 33554533
DOI: 10.1515/cclm-2020-1797 -
PLOS Global Public Health 2023Early detection of pregnancy status may help women initiate earlier antenatal care and healthy pregnancy behaviors, which could lead to healthier mothers and infants....
Early detection of pregnancy status may help women initiate earlier antenatal care and healthy pregnancy behaviors, which could lead to healthier mothers and infants. Pregnancy tests are inexpensive and easy to use; meanwhile, little attention has been given to understanding women's knowledge and use of home pregnancy tests, especially in developing countries. We analyze cross-sectional data collected from 1,008 women ages 18-35, living in Northern Uganda in 2019, who are most likely to be uncertain about their pregnancy status. The survey asked women if they had knowledge of or had ever used a home pregnancy test kit, and barriers to purchasing a home pregnancy test kit. Among the 1,008 women, 65 percent report knowledge of home pregnancy test kits, and 29 percent report having ever used a test kit. Women who have heard of pregnancy test kits have higher levels of education, are in higher wealth quintiles, are more likely to have a salaried occupation and live closer to a health facility. Among women who report knowledge of home pregnancy test kits (N = 657), 90 percent report needing to ask their husband or partner for money to purchase a test kit, seven percent report they would hide the purchase, and 31 percent report that their husband or partner would not support the purchase. Women who report a lack of support from their husband or partner tend to be older, are more likely to have had prior pregnancies, are less likely to have a salaried occupation, are less likely to want a/another child, and are more likely to have a husband or partner desiring more children than herself. Future research aimed at understanding how and whether these barriers affect the utilization of home pregnancy test kits could help inform policymakers on how to increase the use of home pregnancy test kits. Trial registration: NCT03975933. Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933.
PubMed: 37440465
DOI: 10.1371/journal.pgph.0002165 -
EJIFCC Aug 2016Several emerging or disruptive technologies can be identified that might, at some point in the future, displace established laboratory medicine technologies and...
Several emerging or disruptive technologies can be identified that might, at some point in the future, displace established laboratory medicine technologies and practices. These include increased automation in the form of robots, 3-D printing, technology convergence (e.g., plug-in glucose meters for smart phones), new point-of-care technologies (e.g., contact lenses with sensors, digital and wireless enabled pregnancy tests) and testing locations (e.g., Retail Health Clinics, new at-home testing formats), new types of specimens (e.g., cell free DNA), big biology/data (e.g., million genome projects), and new regulations (e.g., for laboratory developed tests). In addition, there are many emerging technologies (e.g., planar arrays, mass spectrometry) that might find even broader application in the future and therefore also disrupt current practice. One interesting source of disruptive technology may prove to be the Qualcomm Tricorder XPrize, currently in its final stages.
PubMed: 27683538
DOI: No ID Found