Margaret Polaneczky

The Use of Levonorgestrel Implants (Norplant) for Contraception in Adolescent Mothers

Background Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. Methods We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (±SD) of 15.5 ±2.9 months post partum. Results Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group an...

Depot Medroxyprogesterone Acetate or Oral Contraception in Postpartum Adolescents

Objective To compare rates of method continuation and repeat pregnancy among postpartum adolescents selecting depot medroxyprogesterone acetate or oral contraceptives (OCs). Methods A retrospective study of 161 adolescents aged 19 years and younger who gave birth at an urban teaching hospital between May 1,1994, and April 30,1995, returned to the hospitals family planning clinic within 14 weeks of delivery and chose depot medroxyprogesterone acetate (n = 111, 69%), or OC (n = 50, 31%) as their postpartum contraceptive method. Most subjects were black (99%), single (97%), and on medical assistance (85%). Data were gathered 12–18 months postpartum (mean ± standard deviation [SD] 14.5 ± 1.6 months) by telephone interview and medical record review. The main outcome measures were method continuation and repeat pregnancy. Results The mean (± SD) age at delivery was 17.8 ± 1.4 years. Variables differentiating subjects selecting depot medroxyprogesterone acetate or OC included multiparity (34% versus 12%, P < .05), mean age at first pregnancy (15.9 versus 16.6 years, P < .05), and mean age at first delivery (16.1 versus 16.9 years, P < .05), The survival curves for depot medroxyprogesterone acetate and OC continuation differed significantly (median duration of use 8.1 versus 5.4 months, respectively), but the continuation rates, at 12 months were similar (34% versus 32%). The survival curves for repeat pregnancy among subjects selecting depot medroxyprogesterone acetate differed significantly from curves of those choosing OC, with repeat pregnancy rates of 15% and 36% by 15 months. Postpartum selection of OC was the only variable entering a Cox regression model designed to predict repeat pregnancy (relative risk 3.0,95% confidence interval 1.4, 6.7). Conclusion Adolescent mothers choosing depot medroxy progesterone acetate or OC immediately postpartum face similarly high rates of method discontinuation and repeat pregnancy within 1 year.

Long-term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents

PURPOSEnTo determine Depo-Provera continuation rates and reasons for its discontinuation among adolescents.nnnSTUDY DESIGNnMedical record reviews and telephone interviews with 159 adolescents who initiated Depo-Provera use between 1 December 1992 and 31 December 1995 at two clinics in New York City. Depo-Provera continuation was measured using lifetable analysis.nnnRESULTSnThe mean age was 17.7 +/- 1.5 years, with a median of 1 pregnancy (range 0-11). Mean follow-up was 23.4 +/- 10.7 months. Depo-Provera continuation rates were 71% at 3 months, 48% at 6 months, and 27% at 12 months, and were not affected by age, race, pregnancy or contraceptive history, clinic, or foster care status. Forty-three subjects (37% of discontinuers) restarted Depo-Provera during the study period, with a mean time to restart of 8.4 months after the last Depo-Provera injection. Side effects were the main reported reason for Depo-Provera discontinuation, primarily menstrual irregularities (26%) and weight gain (18%). Seventy percent of those discontinuing Depo-Provera owing to irregular bleeding did so after only one injection. For 23%, the single reason for discontinuation was appointment noncompliance. Restart rates were lowest among those who reported irregular bleeding (15%), weight gain (9%), and hair loss (10%), and highest among those discontinuing owing to missed appointments (87%) (p < 0.05). Pregnancies occurred in 19% of Depo-Provera discontinuers.nnnCONCLUSIONnAlthough Depo-Provera continuation rates among adolescents are low, over a third of discontinuers may restart the method. Aggressive management of side effects and assistance with appointment follow-up may improve long-term use. High pregnancy rates warrant close follow-up after Depo-Provera discontinuation.

Simple test of pelvic muscle contraction during pelvic examination: correlation to surface electromyography.

The objective of this work was to evaluate the utility of a “Kegel” contraction test in a primary care setting. Fifty‐seven adult women completed a questionnaire, underwent pelvic examination, “Kegel” assessment, and measurement of same by vaginal sensor electromyography. Thirty‐seven underwent repeat evaluations within 4 weeks. Inter‐ and intra‐rater reliability of digital scale, intra‐rater reliability for sEMG measurement, correlation between raters and sEMG, and correlation between scale scores and sEMG with history and pelvic exam were determined. Fifty‐six percent were pre‐menopausal, 44% post‐menopausal. Urinary (62%) and rectal (37%) dysfunction were reported. Inter‐rater reliability, intra‐observer reproducibility for both raters and sEMG measurements, and correlation between raters and sEMG were significant (P< 0.05). Comparison of continence status and digital scores showed scores ≤4 were more frequently associated with reported urinary incontinence (P<0.05). sEMG data also correlated to hormonal status and parity (P < 0.05). This digital scale is a useful assessment of “Kegel” contraction, correlating well to sEMG vaginal sensor readings and self‐reported overall urinary continence status. Neurourol. Urodynam. 18:603–612, 1999.

State-mandated voluntary newborn human immunodeficiency virus screening in a New York City Hospital.

OBJECTIVEnTo report the experience with state-mandated voluntary newborn human immunodeficiency virus (HIV) screening in a large university hospital.nnnMETHODSnRetrospective analysis of delivery records and newborn HIV screening data for infants born between May 4, 1996, and January 31, 1997.nnnRESULTSnOf 3111 women, 40% had HIV testing during pregnancy, 28% had testing before pregnancy, 30% never had testing, and 2% gave no information. Most (91%) consented to postpartum newborn HIV testing, although rates varied by HIV counselor (range 81-96%, P < .001) and maternal HIV testing history (range 72-94%, P < .001). Maternal antepartum HIV testing rates varied by delivering physician (range 8-100%, P < .001) and by antepartum care site (clinics, 83%; faculty practices, 72%; private practices, 57%; P < .001). Fourteen HIV-exposed infants (0.46% of infants tested) were identified, 13 of whom were born to women known to be HIV positive before delivery. These women had received zidovudine prophylaxis according to Adult AIDS Clinical Trials Group 076 guidelines. All 14 infants subsequently tested negative for HIV. Human immunodeficiency virus-positive women were more likely than HIV-negative women to have received antepartum care in clinics (93% compared with 11%), have care paid by Medicaid (93% compared with 28%), and reside in high-risk areas (72% compared with 11%) (P < .001).nnnCONCLUSIONnNewborn HIV screening has little incremental impact in settings with aggressive antepartum screening and/or low HIV infection rates. Interventions to increase antepartum HIV screening in the private sector should be implemented.

The use of Levonorgestrel Implants (Norplant) for Contraception in Adolescent Mothers

BACKGROUNDnAlthough levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population.nnnMETHODSnWe studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum.nnnRESULTSnForty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use.nnnCONCLUSIONSnThe selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.