Pregnancy Reasonably Excluded Guide (PREG) Evaluation of Pregnancy Status Before Contraceptive Procedures: Improved Availability of Same-Day Insertion

Abstract

Objective: To determine whether implementation of the Pregnancy Reasonably Excluded Guide (PREG) in a primary care gynecology clinic improves access to contraceptive procedures and affects the number of urine human chorionic gonadotropin (hCG) tests. Patients and Methods: PREG was administered to 981 women aged 18 to 50 years (1012 visits) who were seen in a primary care gynecology clinic for contraceptive procedures from September 30, 2015, through April 30, 2018. Contraceptive procedures included insertion of an intrauterine contraceptive (IUC) or subdermal contraceptive implant. After PREG review and patient discussion, health care professional decided to perform the procedure with or without hCG measurement or to reschedule if the patient's pregnancy status was uncertain. We collected data on the rate of same-day contraceptive procedures and the rate of hCG testing. Data from the PREG implementation period were compared with historical data from 185 women undergoing contraceptive procedures before PREG implementation. Results: Measurement of hCG was performed in 53% of women before and 24.1% (224 of 1,012 visits) after PREG implementation in the primary care setting. After PREG implementation, 974 0f 1012 patients (96.2%) were eligible for a same-day contraceptive procedure. If traditional criteria, current menses, or a preexisting IUC or implant in place were required for IUC or implant insertion, only 594 patients (58.7%) would have qualified for a same-day procedure. No contraceptive procedures occurred in pregnant women. Conclusion: PREG implementation allowed for same-day IUC or implant insertion in 974 women (96.2%) seen for a contraceptive procedure. Most of the women (75.9%) did not require preprocedure hCG measurement.

Experiencia con el implante subdérmico en adolescentes en la Catedra y Servicio de Ginecología y Obstetricia

“…La inserción es rápida y no requiere exámenes pélvicos ni pruebas de laboratorio. Las complicaciones son raras (aunque pueden incluir infección en el sitio de inserción, expulsión o extracción difícil) y, una vez insertados, los implantes no requieren una acción regular por parte del usuario o del sistema de salud (15). En la muestra los efectos adversos fueron poco frecuentes en esta muestra de pacientes, puesto que 5,4 % reporta cefalea y 4 % dolor en la zona, la cefalea debe tomarse con precaución, puesto que esta puede ser por diferentes motivos, no solo por el implante.…”