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Biomedical subjects

Lorraine Tiezzi

Publications and source records attributed to Lorraine Tiezzi.

5 recordsLinked to original sources
PubMed2007

Depo Now: preventing unintended pregnancies among adolescents and young adults.

PURPOSE: We compared the immediate administration of DMPA (Depo Now) to the immediate use of short-term hormonal methods that served as a "bridge method" until later DMPA initiation. We examined whether Depo Now, as compared to initiating with a bridge method (pills, transdermal patch, or vaginal ring), resulted in greater DMPA continuation at six months. METHODS: Young women aged 14 to 26 years seeking to use DMPA were randomized (nonblinded) after meeting eligibility criteria to either the Depo Now (n = 101) or bridge method (n = 232) group. Depo Now subjects received their first injection of DMPA at the conclusion of their first visit provided each was medically suitable and had a negative urine pregnancy test regardless of menstrual cycle day. Those assigned to the bridge method group were allowed to choose their starting contraceptive method and it was provided at the first visit. All subjects were told to return to the clinic in 21 days to repeat the urine pregnancy test, and among those who were assigned to use a bridge method, to receive their first injection of DMPA. All subjects were followed to their third injection, or about 6 months later. RESULTS: Those randomized to a bridge method were 1.8 (1.1, 2.9) times more likely than Depo Now subjects to return for their 21-day repeat pregnancy test, but only 55% (n = 125) of these young women actually received their first DMPA injection. Continuation rates at the third injection were 29.7% (n = 30) for those in the Depo Now group and 21.1% (n = 49) for those assigned to the bridge method (p = .09). Three factors were significantly associated with adherence to the third injection: randomized to Depo Now group, knowing more women who use DMPA, and returning to clinic for the 21-day repeat pregnancy test visit. Finally, 28 pregnancies were diagnosed during the study period, and those in the bridge method group were almost 4.0 (1.2, 13.4) times more likely to be diagnosed with a pregnancy than those in the Depo Now group. CONCLUSIONS: Immediate administration of DMPA is associated with improved adherence to DMPA continuation and fewer pregnancies.

Adolescent↗
PubMed2005

A prospective study of immediate initiation of depo medroxyprogesterone acetate contraceptive injection.

Traditional protocols for depo medroxyprogesterone acetate (DMPA) initiation mandate that women start the method during the first 5-7 days of the menstrual cycle. Women who do not have their initial clinic visit during this time period are generally instructed to return to clinic during menses to begin DMPA, which often leaves them insufficiently protected from pregnancy. An alternative approach is to give women the injection immediately during the clinic visit, regardless of menstrual cycle day. In this prospective study, we evaluated a protocol for immediate DMPA initiation among 149 women who presented on cycle day 8 or later. Ninety-two percent (n = 137) of subjects returned for a follow-up pregnancy test, but half of all subjects required multiple reminders to return for the visit. There were three pregnancies. Forty-seven percent (n = 70) continued to a second DMPA injection or another contraceptive method within 14 weeks of their initial clinic visit. Factors associated with returning for repeat injection included satisfaction with DMPA, older age and finding it easy to return for the follow-up pregnancy test visit.

Adult↗
PubMed2004

Immediate monthly combination contraception to facilitate initiation of the depot medroxyprogesterone acetate contraceptive injection.

Conventional clinical protocols specify that women initiate depot medroxyprogesterone acetate (DMPA) within 7 days of the onset of menses, and product labeling specifies initiation within 5 days. Women outside of this window should wait until next menses to begin, often leaving them with inadequate interim contraceptive protection. An alternative is for women to initiate monthly hormonal contraception immediately, as a bridge to DMPA, with a scheduled follow-up appointment about 4 weeks later. We evaluated bridge preferences and DMPA initiation among 150 women requesting DMPA who were ineligible for their first injection at the time of clinic visit due to menstrual cycle day. Ninety-eight percent (n = 147) rejected the standard protocol of waiting with condoms or abstinence in favor of a hormonal bridge method. Ninety-seven percent follow-up (n = 146) showed that 86% were satisfied with their bridge method. There were no posttreatment pregnancies, and 55% (n = 81) of participants had initiated DMPA or another long-term contraceptive within 4 weeks of their initial clinic presentation.

Adolescent↗
PubMed2002

Quick start: novel oral contraceptive initiation method.

Conventional oral contraceptive (OC) starting instructions require waiting until menses to begin the OC. The conventional approach requires detailed patient education about when to begin and also may require the use of less effective or less acceptable interim contraceptive protection until menses. At our urban family planning clinic, we routinely offer patients starting the OC the option of taking the first tablet sooner. We prospectively evaluated predictors of short-term OC continuation among 250 OC requestors who were offered several approaches to OC initiation. Telephone follow-up of 91% of participants showed that women who swallowed the first OC in the clinic were more likely to continue the OC until the second package than women who planned to start the OC later (adjusted OR 2.8, 95% C.I. 1.1-7.3). Other factors associated with short-term continuation were: partner's knowledge of planned OC use, older age, and participant's agreement that she would be very unhappy about becoming pregnant in the next 6 months.

Abortion, Induced↗