Thrombin impairs human endometrial endothelial angiogenesis; implications for progestin-only contraceptive-induced abnormal uterine bleeding Progestin-only contraceptives induce abnormal uterine bleeding, accompanied by pro-thrombin leakage from dilated endometrial microvessels and increased thrombin generation by human endometrial stromal cell (HESC)-expressed tissue factor. Initial studies of the thrombin-treated HESC secretome identified elevated levels of cleaved chondroitin sulfate proteoglycan 4 (CSPG4), impairing pericyte–endothelial interactions. Thus, we investigated direct and CSPG4-mediated effects of thrombin in eliciting abnormal uterine bleeding by disrupting endometrial angiogenesis.
Technique for bilateral salpingectomy at the time of Cesarean delivery: a case series The American Congress of Obstetricians and Gynecologists and the Society of Gynecologic Oncology endorse bilateral salpingectomy for ovarian cancer prevention. We describe a bilateral salpingectomy technique in 23 patients during Cesarean delivery. Operative time, hospital length of stay and complications are reported. Bilateral salpingectomy during Cesarean delivery appears feasible.
Contraceptive knowledge assessment: methodological issue on reliability analysis I was interested to read the paper by Haynes M.C. and colleagues published in the February 2017 issue of Contraception . The purpose of the authors was to create an evidence-based assessment tool and determine its validity and reliability for measuring contraceptive knowledge . They developed a 25-question multiple-choice tool entitled the Contraceptive Knowledge Assessment (CKA). They mentioned that repeat testing after 2–4 weeks evaluated test–retest reliability . Based on their report, there were no differences within patients' results with repeat testing over time (p=.667).
Removing barriers to contraception through use of criteria to assess pregnancy risk Safe initiation of many contraceptive methods requires an accurate assessment of whether a woman may already be pregnant. Upon initial thought, routine administration of pregnancy tests would seem to be the easiest way to assess pregnancy status. However, pregnancy tests may not be available in every setting, are associated with some cost and have limitations in detection, particularly for very early or recent pregnancies. The US Centers for Disease Control and Prevention (CDC) developed contraceptive guidance, adapted from that of the World Health Organization, which is intended to provide evidence-based guidance on contraceptive provision and reduce barriers to access and use of contraception.
Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section — reply to letter to the editor We appreciate the interest shown by Bahamondes and Monteiro in our recently published paper . We would like to thank the authors for their valuable comments that add much more to our own published findings. We agree with them that statistical significant difference is not necessarily means a clinical difference. However, the ease of insertion score (ES) is an assumed visual analog scale (VAS) from 0 to 10 for numerical measurement of the degree of the ease of insertion. It is not a standardized score unlike the VAS for pain, in which 2-cm difference on the 10-cm VAS have been considered to be a clinically significant difference in pain .
Revisiting contraceptive steroid hormone pharmacokinetics in obese women A recent commentary by Dr. William Jusko  supports the findings of our prior studies, and those by Westhoff et al., that demonstrate obesity changes the pharmacokinetics of contraceptive steroid hormones, namely levonorgestrel Cmax, half-life, and time to steady state [2–5]. However, his commentary highlights potential weaknesses in our efforts to understand what might be driving these changes (clearance or volume of distribution or both). Thus, we have re-analyzed our data  (analysis performed with WinNonLin software).
Does using the “pregnancy checklist” delay safe initiation of contraception? In the 2013 and 2016 Centers for Disease Control and Prevention (CDC) Selected Practice Recommendations (SPR) for Contraceptive Use, the term “reasonably certain” appears at least 40 times and indicates that a health care provider should be reasonably certain that the woman is not already pregnant before initiating a contraceptive [1,2]. The SPR state that “in most cases, a detailed history provides the most accurate assessment of pregnancy risk in a woman who is about to start using a contraceptive method” and that a provider can be “reasonably certain” if a woman has no signs or symptoms of pregnancy and passes the Pregnancy Checklist [1,2].
Endogenous thrombin potential changes during the first cycle of oral contraceptive use Venous thromboembolism (VTE) risk increases within months of combination oral contraceptive (COC) initiation. Because elevated endogenous thrombin potential (ETP) has been found in several studies to be a VTE risk factor, we evaluated the extent of ETP changes during the initial cycle of an ethinyl estradiol (EE) and levonorgestrel (LNG) COC. We also assessed the relationship between ETP changes and systemic EE and LNG concentrations.
Implications of dispensing self-administered hormonal contraceptives in a 1-year supply: a California case study On September 23, 2016, California became the sixth state to pass legislation requiring health plans and insurers to cover a 12-month supply of FDA-approved self-administered hormonal contraceptives such as contraceptive pills, patches and vaginal rings. This legislation is estimated to result in 38% of current contraceptive pill, patch, and ring users receiving a 12-month supply dispensed at one time. This shift in dispensing patterns was estimated to result in a reduction of 15,000 unintended pregnancies; 2000 fewer miscarriages; and 7000 fewer abortions in California decreasing total net health care expenditures by 0.03%.
Estimating systemic exposure to levonorgestrel from an oral contraceptive The gold standard for measuring oral contraceptive (OC) pharmacokinetics is the 24-h steady-state area under the curve (AUC). We conducted this study to assess whether limited sampling at steady state or measurements following use of one or two OCs could provide an adequate proxy in epidemiological studies for the progestin 24-h steady-state AUC of a particular OC.
Changes in body composition in women using long-acting reversible contraception Users of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users.
Immediate postpartum long-acting reversible contraception: the time is now Timely access to contraception is vitally important after childbirth. One third of US pregnancies are conceived less than 18 months after a prior birth . These short-interval pregnancies are often unintended and are associated with increased risk of adverse maternal and child health outcomes [2–8].
Proposed clinical guidance for excluding pregnancy prior to contraceptive initiation Current clinical guidance is unanimous in its recommendation that pregnancy should be ruled out prior to initiation of hormonal contraception and intrauterine devices (IUDs) [1–3]. As a result, screening for possible pregnancy constitutes a substantial part of the workload of family planning providers. The rationale for excluding pregnancy is simple: to avoid providing unnecessary contraception and, in the case of the IUD (including hormonal IUDs), to avoid possible harm to the pregnant woman or her fetus.
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