RESUMEN
BACKGROUND: Many women who intend to use long-acting, reversible contraceptives (LARCs) postpartum do not follow through with initiating use. The objectives of this study were to determine whether support from a contraceptive personal assistant could increase the uptake of LARCs by 3 months postpartum, and to identify risk factors for nonuptake of LARCs among women who planned LARC use. STUDY DESIGN: This is a randomized, controlled trial of 50 low-income postpartum women who desired LARC. The intervention group received telephone contact from a personal assistant who provided contraception education, facilitation of insurance coverage, appointment scheduling and assistance with childcare and transportation. The control group received routine follow up. Women were surveyed immediately and 3 months postpartum regarding contraceptive use and anticipated barriers to LARC use. RESULTS: A similar proportion of women in both groups received LARC [control 16/24 (67%), intervention 18/25 (72%), p=.76]. More primiparous (86.4%) than multiparous (55.5%) women obtained LARC (p=.04). In addition, women with more prenatal visits were more likely to have initiated LARC (odds ratio, 95% confidence interval for each increased visit: 1.50, 1.15-1.96). No other demographic factors were related to LARC uptake. CONCLUSIONS: Providing telephone assistance to help navigate barriers did not increase postpartum uptake of LARCs. A personal history of clinic visit no-shows and/or infrequent prenatal visits were related to poor uptake of LARCs postpartum.
Asunto(s)
Conducta Anticonceptiva , Anticonceptivos Femeninos , Dispositivos Intrauterinos , Atención Posnatal , Medicina de Precisión , Centros Médicos Académicos , Adulto , Anticonceptivos Femeninos/administración & dosificación , Implantes de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Oregon , Servicio Ambulatorio en Hospital , Paridad , Cooperación del Paciente , Educación del Paciente como Asunto , Embarazo , Atención Prenatal , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The objective of the study was to examine the impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. STUDY DESIGN: This was a retrospective cohort study of 532,088 women undergoing singleton births in California in 2006. Women were categorized into chronic hypertension, pregestational diabetes, both, or neither. Pregnancy outcomes were compared using the χ(2) test and multivariable logistic regression to control for potential confounders. RESULTS: We identified differences in perinatal outcomes between the groups. The rate of preterm birth in women with both conditions was 35.5% versus 25.5% in women with chronic hypertension versus 19.4% in women with pregestational diabetes (P < .001). The rate of small for gestational age was 18.2% in women with both versus 18.3% in women with chronic hypertension versus 9.7% in women with pregestational diabetes (P < .001). CONCLUSION: The impact of having both chronic hypertension and pregestational diabetes in pregnancy varies, depending on the outcome examined. Although some had an additive effect (eg, stillbirth), others did not (eg, preeclampsia).
Asunto(s)
Diabetes Mellitus/fisiopatología , Hipertensión/fisiopatología , Resultado del Embarazo , Embarazo en Diabéticas/fisiopatología , Adulto , California , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Nacimiento Prematuro , Estudios RetrospectivosRESUMEN
OBJECTIVES: Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications. METHODS: All UE venous duplex scans during a 12-month period were reviewed, selecting patients with isolated SVT or DVT and PICCs placed ≤30 days. All UE PICC procedures during the same period were identified from an electronic medical record query. PICC-associated DVTs, categorized by insertion site, were compared with all first-time UE PICCs to determine the rate of UE DVT and isolated UE SVT. Technical and clinical variables in patients with PICC-associated UE DVT also were compared with 172 patients who received a PICC without developing DVT (univariable and multivariable analysis). RESULTS: We identified 219 isolated UE SVTs and 154 UE DVTs, with 2056 first-time UE PICCs placed during the same period. A PICC was associated with 44 of 219 (20%) isolated UE SVTs and 54 of 154 UE DVTs (35%). The rates of PICC-associated symptomatic UE SVT were 1.9% for basilic, 7.2% for cephalic, and 0% for brachial vein PICCs. The rates of PICC-associated symptomatic UE DVT were 3.1% for basilic, 2.2% for brachial, and 0% for cephalic vein PICCs (χ(2)P < .001). Univariate analysis of technical and patient variables demonstrated that larger PICC diameter, noncephalic insertion, smoking, concurrent malignancy, diabetes, and older age were associated with UE DVT (P < .05). Multivariable analysis showed larger catheter diameter and malignancy were the only variables associated with UE DVT (P < .05). CONCLUSIONS: The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.