Trends in family planning and counselling for women with sickle cell disease in the UK over two decades
Trends in family planning and counselling for women with sickle cell disease in the UK over two decades
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DOI：
10.1136/jfprhc-2013-100763
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发表时间：
2015-04-01
影响因子：
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通讯作者：
Stott, Daniel
中科院分区：
文献类型：
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作者：
Eissa, Asma A.;Tuck, Susan M.;Stott, Daniel
镰状细胞病（SCD）孕妇的孕产妇和胎儿死亡率和发病率较高。考虑到这些妊娠相关的问题，SCD女性，关于妊娠计划和有效避孕的建议至关重要。本研究旨在发现SCD妇女使用的避孕方法，什么并发症的SCD妇女遇到避孕，和他们的经验，孕前咨询和怀孕计划，以及如何这些问题可能已经改变了在过去的20 decades.Method这项研究是一个多中心，访谈为基础的，横断面研究。在2010年期间，在伦敦北部和中部，对102名SCD女性进行了采访，内容涉及她们目前和以前的避孕方法使用情况、妊娠史、月经史以及她们收到的有关妊娠计划和避孕的建议。患者信息是匿名的，并获得了伦理批准。结果2010年非计划妊娠发生率从1993年的64%下降到2010年的53%，差异有统计学意义（P < 0. 05）。被建议不要怀孕的SCD妇女人数也从36%下降到15%。使用复方口服避孕药的妇女从1993年的45%下降到2010年的31%。相反，使用长效醋酸甲羟孕酮避孕药（DMPA）和左炔诺孕酮宫内节育系统（LNG-IUS）均increased.Conclusions显着变化的妇女SCD所使用的避孕方法证明在伦敦人口。此前尚未研究过LNG-IUS在SCD中的使用。患有SCD的妇女被建议不要怀孕的人数出现了令人鼓舞的下降，这可能反映了她们整体健康状况的改善。虽然计划外怀孕的数量有所下降，但仍然很高-强调SCD妇女继续需要获得有关怀孕相关问题和避孕的知情咨询。
Background Pregnancies in women with sickle cell disease (SCD) are known to have high rates of maternal and fetal mortality and morbidity. Given these pregnancy-associated problems for women with SCD, advice both about pregnancy planning and about effective contraception are of paramount importance. This study sought to discover the contraception methods used by women with SCD, what complications women with SCD encounter with contraception, and their experiences of pre-pregnancy counselling and pregnancy planning, and how such issues may have changed over the past two decades.Method The study was a multicentre, interview-based, cross-sectional study. Interviews were carried out with 102 women with SCD, in north and central London during 2010, concerning their current and previous contraceptive use, their pregnancy history, their menstrual history, and the advice they received concerning pregnancy planning and contraception. Patient information was anonymised and ethical approval was obtained. These data were compared with data from a similar study undertaken in 1993.Results There were significant differences in a number of key areas: the number of unplanned pregnancies decreased from 64% in 1993 to 53% in 2010. The number of women with SCD who were advised not to become pregnant also fell, from 36% to 15%. The use of combined oral contraceptive pills declined, from 45% of the women in 1993 to 31% in 2010. Conversely the use of depot medroxyprogesterone acetate contraception (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) both increased.Conclusions Significant changes in the contraceptive methods used by women with SCD are demonstrated in the London population. LNG-IUS use in SCD has not been investigated before. There has been an encouraging decrease in the number of women with SCD who are advised not to become pregnant, perhaps reflecting an improvement in their overall health. Although the number of unplanned pregnancies has fallen, it remains high - emphasising the continuing need for women with SCD to have access to informed advice about pregnancy-associated issues and contraception.