Research roundup: May 2020 edition

Support for the integration of reproductive health care in the primary care setting, noncontraceptive benefits of hormonal contraception, use of patient decision aids in shared decision making in obstetrics and gynecology care, and more.

by Colleen Denny, MD and Emma Gilmore, MD

published 05/29/20

1. Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology (meta-analysis)

In shared decision making providers and patients discuss treatment choices and make a decision together with a shared understanding of the patient’s life situation and priorities. A variety of patient decision aids, from mobile apps to pamphlets, exist to facilitate shared decision making. Researchers performed a systematic review and meta-analysis to assess the utility of these aids in the shared decision making process in obstetrics and gynecology. They found moderate to high evidence to support the use of patient decision aids in the context of shared decision making, but further research is needed to better understand potential costs and the use of appointment time. Overall, this study encourages the use of patient decision aids in shared decision making in obstetrics and gynecology care.

2. Women's Perspectives on Reproductive Health Services in Primary Care.

The primary care setting is an important site for increasing access to reproductive health care services such as contraceptive counseling, pre-conception care, and basic infertility care. Accessing these services as well as referrals to the full spectrum of reproductive care within primary care settings may become increasingly important as state and federal regulations limit access to these services. For this study, researchers surveyed patients from a variety of settings in New York State through focus groups and in-depth interviews on their thoughts about exploring reproductive health-related topics in the primary care setting. Overall patients were open to discussions about reproductive health and desired care that utilized a model of shared decision-making. These findings support integration of reproductive health care into the primary care setting and should encourage providers to include these topics in their counseling and care.

3. Expulsion of Intrauterine Devices After Postpartum Placement by Timing of Placement, Delivery Type, and IUD Type: A Systematic Review and Meta-analysis.

Postpartum IUD placement provides effective and long-acting contraception for patients who desire them but has previously been associated with increased risk of expulsion. In this systematic review and meta-analysis, the authors examine how timing of IUD placement, type of delivery, and type of IUD all affect expulsion rates. The authors found that immediate postpartum IUD placement (within 10 minutes of delivery) and early inpatient (more than 10 minutes but less than 72 hours after delivery) both had higher rates of expulsion than early outpatient (more than 72 hours but less than 4 weeks after delivery) or interval (after 4 weeks), with 10% for immediate, 13% for early inpatient, 0% for early outpatient, and 2% for interval. Immediate placement after vaginal delivery had higher expulsion rates than immediate placement at time of C-section, and LNG IUDs had higher expulsion rates than copper IUDs after vaginal deliveries. Providers can use these numbers in shared decision-making conversations with patients about the timing of postpartum IUD placement, but IUDs can be placed at any time postpartum that a patient desires.

4. Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women.

Estrogen and progestin-containing birth control methods are a cornerstone for contraception around the world. While many providers may be aware of the non-contraceptive benefits of these methods, they may not have easy access to a comprehensive list, or to the data behind the benefits. This informative article provides a summary of the mechanisms of hormonal birth control methods and a subsequent literature review encompassing both gynecologic and non-gynecologic benefits. These include cancer prevention (both ovarian and endometrial), as well as decreased endometriosis, hirsutism, acne, and migraine headaches. This is useful reading for providers, both to refresh their knowledge of the available data, and to better inform their reproductive health counseling with patients.

5. Abortion during the Covid-19 Pandemic — Ensuring Access to an Essential Health Service

This perspective piece in the New England Journal of Medicine calls for state governors and other politicians to lift abortion restrictions recently placed due to COVID-19. Arguing that abortion should not be considered an elective procedure, terming it a “historical misclassification.” The authors also call for “all medical professionals to stand in solidarity with ACOG [American College of Obstetricians and Gynecologists] and the AMA [American Medical Association], with the women and couples who need the option of pregnancy termination, and with their colleagues who serve these patients.”

6. Call to Action: Preserving and Advocating for Essential Care for Women During the COVID-19 Pandemic

This perspective piece in the Gray Journal, calls to action OBGYNs and other providers to stand with their patients and advocate for their right to access “the full spectrum” of sexual and reproductive health services, including abortion. They also suggest supporting local, state, and national policies that aim to expand care, such as expanding Medicaid pregnancy and postpartum coverage.

Colleen Denny, MD, is an attending ObGyn at Bellevue Hospital in New York City, where she is the Medical Director of the Women's Clinic, and a clinical assistant professor with the NYU School of Medicine. She enjoys providing care for patients in all phases of life and is especially interested in issues related to contraception access and public health. Outside of work, she’s a runner, a dancer, and a bit of a crossword puzzle nerd.
Emma Gilmore is a fellow in Complex Family Planning at the University of Pennsylvania. She completed her residency in Obstetrics and Gynecology at New York University. She's passionate about reproductive rights, medical education, and combating health care disparities, particularly in sexual and reproductive health. In her free time, she can be found taking her dog on walks around the beautiful parks in and around Philadelphia.
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