Objective To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination.Design A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception.Setting An NHS regional centre for pregnancy termination.Sample All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002.Methods Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure.Main outcome measures Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet.Results Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76-1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type.Conclusions Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method.
Objective To identify any adverse effect on bone density in long term users of depot Design Cross-sectional measurement of bone density in users with amenorrhoea of more than one Setting Community Family Planning Clinics in Portsmouth and Manchester.Population One hundred and eighty-five women aged 17-52 years (mean 33.3 years) who had used DMPA for between 1 and 16 years and were attending the clinics for further injections, between August 1994 and August 1996. Methods Dual energy X-ray measurement of bone density of femoral neck and lumbar spine, and venous blood sample taken just prior to the next injection of DMPA.Main outcome measures Bone density of femoral neck and lumbar spine and serum oestradiol in relationship to years of DMPA use and duration of amenorrhoea.Results Most women (n = 153) had serum oestradiol levels < 150 pmolll. Despite this, the mean bone density of the lumbar spine compared with the population mean for women aged 20-59 years gave a Z score (950/0 CI) of -0.332 (-0,510 to -0.154). There was no significant difference in the mean density of the femoral neck from the normal population mean.Conclusion Despite amenorrhoea and low serum oestradiol, this sample of long term DMPA users had bone density only minimally below the normal population mean. We therefore found no clinically important adverse effect on bone density and therefore no reason to recommend bone conserving measures, such as add-back oestrogen.medroxyprogesterone acetate (DMPA) for contraception.year or any woman using DMPA for more than five years.
Implanon ® , a contraceptive implant, is increasingly being used because of its efficacy and nonuser-dependent nature. However, as for other steroid contraceptives, its efficacy can be reduced by enzyme-inducing drugs, such as antituberculous medication, resulting in unplanned pregnancy. We present the case of a 27-year-old para 1 + 0 referred to us for termination of a pregnancy that resulted from failure of Implanon during concomitant treatment with Rifinah ® (a rifampicin-isoniazid combination). All health care providers should be aware of the adverse effects of hepatic enzyme inducers on hormonal contraceptives, obtain details of current contraceptive methods from women of reproductive age, and refer them to contraceptive and reproductive health care professionals as appropriate for optimal management. This will ensure that such women do not experience the psychologic trauma of a termination of pregnancy.
On average, leaflets provided half the information possible about the risks and procedures of medical and surgical methods. In addition, readability was rated as difficult in over half the leaflets. It seems unlikely that these leaflets enable women to make informed choices between abortion methods and, therefore, do not meet the requirements of current guidelines.
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