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  • 1.
    Envall, Niklas
    et al.
    Karolinska institutet.
    Graflund Lagercrantz, Helena
    Sunesson, Jessica
    Kopp Kallner, Helena
    Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial2019In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 99, no 6, p. 335-39Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: 

    To evaluate whether intrauterine mepivacaine instillation before intrauterine device (IUD) insertion decreases pain compared to placebo.

    STUDY DESIGN: 

    We performed a double-blind, randomized, controlled trial comparing mepivacaine 1% 10 mL versus 0.9% NaCl intrauterine instillation using a hydrosonography catheter 5 min before IUD insertion in women 18 years of age or older. Participants completed a series of 10-cm visual analogue scales (VAS) to report pain during the procedure. The primary outcome was the difference in VAS scores with IUD insertion between intervention group and placebo. Secondary outcomes included VAS before and after insertion and analgesia method acceptability.

    RESULTS: 

    We randomized 86 women in a 1:1 ratio; both groups had similar baseline characteristics. In the intention-to-treat analysis, the primary outcome, median VAS with IUD insertion, was 4.8 cm in the intervention group [n=41, interquartile range (IQR) =3.1-5.8] and 5.9 cm in the placebo group (n=40, IQR=3.3-7.5, p=.062). In the per-protocol analysis, the median VAS with IUD insertion was 4.8 cm (IQR=3.1-5.5) and 6.0 cm (IQR=3.4-7.6) for the intervention and placebo groups, respectively (p=.033). More women in the intervention group reported the procedure as easier than expected (n=26, 63.4% vs. n=15, 37.5%), and fewer reported it as worse than expected (n=3, 7.3% vs. n=14, 35%, p=.006).

    CONCLUSION: 

    Intrauterine mepivacaine instillation before IUD insertion modestly reduces pain, but the effect size may be clinically significant.

    IMPLICATIONS STATEMENT: 

    While the reduction in VAS pain scores did not meet our a priori difference of 1.3 points for clinical significance, participants' favorable subjective reaction suggests that this approach merits further study.

    Copyright © 2019 Elsevier Inc. All rights reserved.

    KEYWORDS: 

    Contraception; Intrauterine devices; Mepivacaine; Pain; VAS

  • 2.
    Sjöström, Susanne
    et al.
    Karolinska Institutet.
    Essen, Birgitta
    Uppsala Universitet.
    Syden, Filip
    Uppsala Universitet.
    Gemzell-Danielsson, Kristina
    Karolinska Institutet.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet; Karolinska Institutet.
    Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India2014In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 90, no 1, p. 42-46Article in journal (Refereed)
    Abstract [en]

    Introduction: Although abortion care has been an established routine since decades in India, 8% of maternal mortality is attributed to unsafe abortion. Increased knowledge and improved attitudes among health care providers have a potential to reduce barriers to safe abortion care by reducing stigma and reluctance to provide abortion. Previous research has shown that medical students' attitudes can predict whether they will perform abortions. The objective of our study was to explore attitudes toward abortion among medical interns in Maharastra, India.

    Study Design: A cross-sectional survey was carried out among 1996 medical interns in Maharastra, India. Descriptive and analytical statistics were used to interpret the study instrument.

    Results: Almost one quarter of the respondents considered abortion to be morally wrong, one fifth did not find abortions for unmarried women acceptable and one quarter falsely believed that a woman needs her partner or spouse's approval to have an abortion. Most participants agreed that unsafe abortion is a serious health problem in India. A majority of the respondents rated their knowledge of sexual and reproductive health as good, but only 13% had any clinical practice in abortion care services.

    Conclusion: Disallowing attitudes toward abortion and misconceptions about the legal regulations were common among the surveyed medical students. Knowledge and attitudes toward abortion among future physicians could be improved by amendments to the medical education, potentially increasing the number of future providers delivering safe and legal abortion services.

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