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Objective: This study was undertaken to determine how consistently indigent, predominantly Hispanic women who had previously selected male condoms as their contraceptive method had used condoms and emergency contraception (EC) during the 2 weeks before their family planning clinic visit and reasons for any nonuse. Study design: Cross-sectional survey with no personal identifiers collected. Results: Two hundred forty-eight women were surveyed. Overall, 43.8% of sexually active women reported inconsistent condom use during the prior 14 days. Only 39% of women who had not used condoms consistently used EC at least once. The most common reason for nonuse of both condoms (44%) and EC (41%) was that the woman did not perceive that she was at risk. Conclusion: Inconsistent use of condoms and low use of EC are very frequent, even in a short-time frame. Patients may be reluctant to volunteer to clinicians their real contraceptive choices. Risk taking occurs at high rates, even among couples provided ready and free access to male condoms and EC. [ABSTRACT FROM AUTHOR]

Women who want safe, effective contraception have many more options than they did only a few years ago. Each option must be weighed carefully according to the needs and lifestyle of each particular woman. One method that provides long-term convenience with a side-effect profile that is comparable to that of oral contraceptives is the once-a-month injectable contraceptive containing 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate. Another option is the levonorgestrel-releasing intrauterine contraceptive system that offers pregnancy prevention for 5 years. Finally, hormonal implants that release low doses of progestins have been used for more than 30 years by a total of 10 million women, and easier-to-use implants will soon be available. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was undertaken to evaluate the outcomes of indigent women with possible ectopic pregnancy who were cared for in a public teaching hospital outpatient clinic by multiple residents. STUDY DESIGN: Retrospective review of patients seen in the Obstetric-Gynecologic Urgent Care Center at Harbor-UCLA Medical Center from September 1, 2000, through August 30, 2001, was performed. RESULTS: Of the 243 women being evaluated for possible ectopic pregnancy, 4 required surgical intervention during their diagnostic workup and 58 were lost to follow-up. Of the 31 women given methotrexate therapy, 25 successfully completed therapy, 2 required surgery, and 4 were lost to follow-up. Substantial investment was needed to contact patients who missed appointments. CONCLUSION: It is feasible to manage women with possible ectopic pregnancies on an ambulatory basis in a public teaching hospital, but close oversight is needed and both staff and patients must commit to significant follow-up. Local protocols can be modified to reduce the numbers of visits required. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify the impact on breast-feeding patterns of early postpartum initiation of progestin-only birth control methods compared with nonhormonal methods.Study Design: A prospective, nonrandomized trial was performed comparing progestin-only contraceptive methods administered before hospital discharge with nonhormonal methods on breast-feeding continuation rates, exclusive breast-feeding, and supplementation at 2, 4, and 6 weeks after delivery.Results: Three hundred nineteen women provided complete data until hospital discharge. The hormonal group had higher risk factors for not breast-feeding, but there was no difference among any of the subgroups in breast-feeding continuation rates except at week 4. Supplementation or perception of insufficient milk production did not differ between groups. By week 6, 23.5% of women discontinued breast-feeding, and 64.5% of those breast-feeding were supplementing.Conclusion: This study demonstrates that there is no detectable adverse impact on breast-feeding attributable to progestin-only contraceptive methods initiated within the first 3 days post partum. [ABSTRACT FROM AUTHOR]

Examines the feasibility of ultrasonographically guided transrectal aspiration of gynecologic pelvic abscesses in California. Treatment of patients with failure in intravenous antibiotic therapies; Characterization of pelvic abscesses through transvaginal ultrasonographic imaging; Effectiveness and safety of the procedure.

Objective: Our purpose was to describe the techniques we have developed to remove nonpalpable subcutaneous and intramuscular Norplant capsules with the patient under local anesthesia and with use of real-time ultrasonographic guidance in an office setting.Study Design: This was a noncomparative, descriptive study of our experiences with 27 women with 64 deep Norplant capsules.Results: Twenty-four women had all their nonpalpable and intramuscular implants removed under real-time ultrasonographic guidance with no complications. One woman was not a candidate, one was lost to follow-up, and another elected to retain her last implant.Conclusion: Real-time ultrasonographically guided procedures can be performed with the patient under local anesthesia in an office setting and can reduce the number of operative procedures necessary to remove nonpalpable and intramuscular Norplant capsules. [ABSTRACT FROM AUTHOR]

Presents a study on the impact of contraceptive methods on the onset of symptomatic vulvovaginal candidiasis within the menstrual cycle. Background information on vulvovaginal candidiasis; Purpose of study; Participants and methodology used to conduct study; Results of study in relation to onset of symptoms; Conclusions made due to study; Indepth look at study.

Assesses the ability of endovaginal ultrasonographically directed transvaginal drainage of pelvic abscesses to treat patients who failed intravenous antibiotic therapies and whose abscesses were not amenable to percutaneous or colpotomy drainage. Aspiration of purulent material; Subjects without problems; Subjects with sequelae related to pelvic infection.

Objective The objective of the study was to analyze the behaviors of women that resulted in menstrually related severe anemia (hemoglobin <5 g/dL) from a single public hospital serving indigent women. Study Design This was a retrospective cohort study of all women identified as having been treated at Harbor-UCLA Medical Center for excessive menstruation ( International Classification of Diseases , ninth revision, codes 285.9, 6256.2) and hemoglobin values less than 5 g/dL in the 6 years from 2008 to 2013. Results Approvals were obtained from the Human Subjects and Research Committees. This search identified 271 women with those 2 diagnoses; 122 were excluded because their severe anemia had nonmenstrual causes. The remaining 149 women had 168 episodes with hemoglobin levels below 5 g/dL attributed to chronic excessive menstrual bleeding. Mean age was 41 years (range, 19–55 years). Mean body mass index was 28.9 kg/m 2 (range, 18–57 kg/m 2 ); 58.2% were actively bleeding at presentation, and 90.4% reported chronic excessive blood loss. Two thirds recognized heavy bleeding that had persisted for more than 6 months without seeking help. However, 7.8% described their bleeding as normal, and 40.5% had received at least 1 previous transfusion. Mean nadir hemoglobin was 4.15 g/dL (range, 1.6–4.9 g/dL). Mean corpuscular volume was 62.2 fL (range, 47.7–99.8 fL) and mean corpuscular hemoglobin concentration was 29.2 g/dL (range, 25.7–33.6 g/dL). Nearly a quarter had reactive thrombocytosis, which might have created a hypercoagulable state. Bleeding was ultimately attributed to leiomyoma in 47.9%; cancer was detected in 4.8%. A total of 33.9% were discharged without being offered any therapy to prevent subsequent bleeding; 3.0% declined any medical therapy; 35.1% were lost to follow-up prior to receiving effective therapy; and 26.8% had multiple subsequent transfusions before seeking/receiving definitive treatments. Conclusion Even when faced with potentially life-threatening anemia because of chronic, excessive menstrual blood loss, some women are not impressed with the serious nature of their problem. Women will benefit from recognizing the health consequences of chronic excessive blood loss. Chronic excessive blood loss should be treated as both an urgent and potentially recurrent problem; physicians should address this clinical concern proactively. [ABSTRACT FROM AUTHOR]

Objective: The objective of this investigation was to study short-term efficacy and feasibility of a new progestogen-only treatment for outpatient management of acute abnormal uterine bleeding. Study Design: This was a prospective, single-arm, pilot clinical trial of a progestogen-only bridging treatment for acute abnormal uterine bleeding in nonpregnant, premenopausal women in the Gynecologic Urgent Care Clinic at Harbor-UCLA Medical Center. Subjects were administered a depo-medroxyprogesterone acetate 150 mg intramuscular injection and given medroxyprogesterone acetate 20 mg to be taken orally every 8 hours for 3 days. The primary outcome measures included a percentage of women who stopped bleeding in 5 days, time to bleeding cessation, reduction in numbers of pads used, side effects, and patient satisfaction. Results: All 48 women stopped bleeding within 5 days; 4 women had spotting only at the time of their last contact during the 5 day follow-up. Mean time to bleeding cessation was 2.6 days. Side effects were infrequent and patient satisfaction was high. Conclusion: Injection of depo-medroxyprogesterone acetate 150 mg intramuscularly combined with 3 days of oral medroxyprogesterone acetate 20 mg every 8 hours for 9 doses is an effective outpatient therapy for acute abnormal uterine bleeding. [Copyright &y& Elsevier]

Objective: This study investigated the natural history of glucose tolerance by using modern definitions in women after delivery of a pregnancy complicated by gestational diabetes. The association between deterioration of glucose metabolism and contraceptive methods was also studied. Study Design: Retrospective chart review of 592 indigent, primarily Latina women who had been diagnosed with gestational diabetes, monitored for up to 24 months'' postpartum. Results: At the first postpartum visit, 230 women (40.2%) had prediabetes or diabetes. Within the first 12 months, 26.4% experienced deterioration. Of the 89 women monitored for 12-24 months, another 38.5% had prediabetes (n = 13) or diabetes (n = 11) develop. About 22% of women by using only nonhormonal contraception experienced worsening of their glucose status, whereas 35% of combined hormonal contraceptive users and 34% of progestin-only users worsened. Conclusion: Gestational diabetes is a sentinel event signaling the need for frequent testing postpartum. [Copyright &y& Elsevier]

Objective: One problem women have successfully using combined hormonal contraception is the limited supplies they are dispensed. Patients at the Women’s Health Care Clinic at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center have virtually no barriers to method switching, so it is possible to estimate the impacts that more generous prescribing policies have on short-term continuation rates. Study Design: Anonymous chart review of all women who initiated hormonal contraception between Jan. 1 and June 30, 2005. Results: Only 40.4% of women had documented use for at least 3 months. Women dispensed supplies for 3 or more cycles at the initial visit were more likely to continue use for 3 months (47.8%) than were women dispensed fewer cycles (31.9%) (P < .0001). Conclusion: More liberal dispensing policies may increase the wastage of combined hormonal contraceptive product, but they significantly increase at least intermediate term use of those methods. [Copyright &y& Elsevier]