Clinical Edge Journal Scan

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Over a 10-year period, an unexpected high prevalence of vitamin D overdosing was observed in patients with cystic fibrosis with odds of overdose higher in patients suffering from exocrine pancreatic insufficiency (EPI).

Major finding: Severe vitamin D overdose was observed in 5.3% of patients, with 2 patients developing clinical toxicity and presenting with severe hypercalcemia, hypercalciuria, and acute kidney injury necessitating hospitalization and monitoring. Patients experiencing vitamin D overdose were more likely to suffer from EPI or were homozygous for F508del.

Study details: Findings are from a retrospective review of 244 patients with a diagnosis of cystic fibrosis and at least 1 measure of serum 25(OH)D.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Planté-Bordeneuve T et al. Sci Rep. 2021 Apr 8. doi: 10.1038/s41598-021-87099-w.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: Overt exocrine insufficiency is rare in patients with pancreatic trauma but some asymptomatic patients may show biochemical exocrine insufficiencies on specific investigations, particularly after pancreatic resection.

Major finding: Severe pancreatic exocrine insufficiency (PEI) was seen in 4 patients (20%), of which 3 had undergone pancreatic resection (P = .7). Only 1 patient complained of steatorrhea. Patients undergoing pancreatic resection had lower fecal elastase than those who did not (median, 113 μg/g vs. 162.5 μg/g), although difference was not significant statistically (P = .7).

Study details: Findings are from analysis of 20 patients with grade 2-5 pancreatic injury (age, 18-65 years) who were admitted and managed at the division of Trauma Surgery and Critical Care. Patients either underwent partial pancreatic resection (n=12) or nonoperative management or operation without resection (n=8).

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Colney L et al. Eur J Trauma Emerg Surg. 2021 Mar 14. doi: 10.1007/s00068-021-01638-8.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

Key clinical point: During long-term follow-up, exocrine pancreatic insufficiency (EPI) was observed in more than half of the patients who underwent curative gastrectomy and had completed oncological treatment for gastric adenocarcinoma. Postoperative radiotherapy as an adjunct to adjuvant chemotherapy was a serious risk factor for EPI development.

Major finding: Fecal elastase-1 (FE-1) less than 200 μg/g, considered a measure of EPI, was present in 63.8% of patients. A higher proportion of patients with low FE-1 (less than 100 μg/g) received adjuvant chemoradiotherapy vs. those with moderate FE-1 (100-200 μg/g; P = .012) and normal FE-1 (less than 200 μg/g; P less than .001).

Study details: This study included 69 patients with gastric cancer who underwent total or subtotal curative gastrectomy with D2 lymphadenectomy and had long-term disease-free survival success. Patients were followed up for 16-120 months.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Surmelioglu A et al. Pancreatology. 2021 Apr 1. doi: 10.1016/j.pan.2021.03.019.

Key clinical point: The small number of invasive aspergillosis cases may contribute to the low specificity of several tests in children after stem cell transplants and should be interpreted with caution.

Major finding: The sensitivity and specificity for probable invasive aspergillosis and potential invasive fungal disease was 80% and 55% for (1→3)-β-D-glucan (BDG); 40% and 100% for galactomannan; and 60% (and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR.

Study details: The data come from 404 blood samples taken from 26 pediatric patients who underwent allogeneic hematopoietic stem cell transplantation between April 2016 and March 2018 at a single center.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Springer J et al. J Fungi (Basel). 2021 Mar 22. doi: 10.3390/jof7030238.

Key clinical point: The small number of invasive aspergillosis cases may contribute to the low specificity of several tests in children after stem cell transplants and should be interpreted with caution.

Major finding: The sensitivity and specificity for probable invasive aspergillosis and potential invasive fungal disease was 80% and 55% for (1→3)-β-D-glucan (BDG); 40% and 100% for galactomannan; and 60% (and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR.

Study details: The data come from 404 blood samples taken from 26 pediatric patients who underwent allogeneic hematopoietic stem cell transplantation between April 2016 and March 2018 at a single center.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Springer J et al. J Fungi (Basel). 2021 Mar 22. doi: 10.3390/jof7030238.

Key clinical point: The small number of invasive aspergillosis cases may contribute to the low specificity of several tests in children after stem cell transplants and should be interpreted with caution.

Major finding: The sensitivity and specificity for probable invasive aspergillosis and potential invasive fungal disease was 80% and 55% for (1→3)-β-D-glucan (BDG); 40% and 100% for galactomannan; and 60% (and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR.

Study details: The data come from 404 blood samples taken from 26 pediatric patients who underwent allogeneic hematopoietic stem cell transplantation between April 2016 and March 2018 at a single center.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Source: Springer J et al. J Fungi (Basel). 2021 Mar 22. doi: 10.3390/jof7030238.

Key clinical point: Patients with severe COVID-19 and secondary coinfections had higher mortality rates and longer hospital stays compared to patients without secondary infections.

Major finding: The overall mortality rate was approximately 50%, but 83.14% of the patients with fungal or bacterial isolation died. The risk of death was significantly higher in patients with bacterial and fungal coinfections (odds ratios 11.28 and 5.97, respectively).

Study details: The data come from an analysis of 212 severely ill patients with COVID-19; 89 of these had fungal or bacterial secondary coinfections.

Disclosures: The study was supported by the Fundação de Amparo a Pesquisa do Estado de Minas Gerais - FAPEMIG and the Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq and Brazilian Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Silva DL et al. J Hosp Infect. 2021 Apr 11. doi: 10.1016/j.jhin.2021.04.001.

Key clinical point: Patients with severe COVID-19 and secondary coinfections had higher mortality rates and longer hospital stays compared to patients without secondary infections.

Major finding: The overall mortality rate was approximately 50%, but 83.14% of the patients with fungal or bacterial isolation died. The risk of death was significantly higher in patients with bacterial and fungal coinfections (odds ratios 11.28 and 5.97, respectively).

Study details: The data come from an analysis of 212 severely ill patients with COVID-19; 89 of these had fungal or bacterial secondary coinfections.

Disclosures: The study was supported by the Fundação de Amparo a Pesquisa do Estado de Minas Gerais - FAPEMIG and the Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq and Brazilian Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Silva DL et al. J Hosp Infect. 2021 Apr 11. doi: 10.1016/j.jhin.2021.04.001.

Key clinical point: Patients with severe COVID-19 and secondary coinfections had higher mortality rates and longer hospital stays compared to patients without secondary infections.

Major finding: The overall mortality rate was approximately 50%, but 83.14% of the patients with fungal or bacterial isolation died. The risk of death was significantly higher in patients with bacterial and fungal coinfections (odds ratios 11.28 and 5.97, respectively).

Study details: The data come from an analysis of 212 severely ill patients with COVID-19; 89 of these had fungal or bacterial secondary coinfections.

Disclosures: The study was supported by the Fundação de Amparo a Pesquisa do Estado de Minas Gerais - FAPEMIG and the Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq and Brazilian Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Silva DL et al. J Hosp Infect. 2021 Apr 11. doi: 10.1016/j.jhin.2021.04.001.

Key clinical point: Triazole antifungal agents, as well as amphotericin B and caspofungin, reduced rates of invasive fungal infections in patients with hematological malginancies; notably, posaconazole also was more effective at reducing all-cause mortality and adverse events compared with other triazoles.

Major finding: Posaconazole was superior to fluconazole (odds ratio 0.30), itraconazole (OR 0.40), and amphotericin B (OR 4.97) in reducing the incidence of both suspected and confirmed invasive fungal infections.

Study details: The data come from a meta-analysis of 35 studies including 37 randomized, controlled trials of the effectiveness of triazoles, polyene, and echinocandin antifungals for infection control in patients with hematological malignancies.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Zeng H et al. BMC Cancer. 2021 Apr 14. doi: 10.1186/s12885-021-07973-8.

Key clinical point: Triazole antifungal agents, as well as amphotericin B and caspofungin, reduced rates of invasive fungal infections in patients with hematological malginancies; notably, posaconazole also was more effective at reducing all-cause mortality and adverse events compared with other triazoles.

Major finding: Posaconazole was superior to fluconazole (odds ratio 0.30), itraconazole (OR 0.40), and amphotericin B (OR 4.97) in reducing the incidence of both suspected and confirmed invasive fungal infections.

Study details: The data come from a meta-analysis of 35 studies including 37 randomized, controlled trials of the effectiveness of triazoles, polyene, and echinocandin antifungals for infection control in patients with hematological malignancies.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Zeng H et al. BMC Cancer. 2021 Apr 14. doi: 10.1186/s12885-021-07973-8.

Key clinical point: Triazole antifungal agents, as well as amphotericin B and caspofungin, reduced rates of invasive fungal infections in patients with hematological malginancies; notably, posaconazole also was more effective at reducing all-cause mortality and adverse events compared with other triazoles.

Major finding: Posaconazole was superior to fluconazole (odds ratio 0.30), itraconazole (OR 0.40), and amphotericin B (OR 4.97) in reducing the incidence of both suspected and confirmed invasive fungal infections.

Study details: The data come from a meta-analysis of 35 studies including 37 randomized, controlled trials of the effectiveness of triazoles, polyene, and echinocandin antifungals for infection control in patients with hematological malignancies.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Zeng H et al. BMC Cancer. 2021 Apr 14. doi: 10.1186/s12885-021-07973-8.

Key clinical point: Concentrations of echinocandin penetration into wound secretions may be sub-therapeutic in some patients, and the relevance to clinical outcomes in patients with severe invasive candidiasis infections remains unclear.

Major finding: Concentrations of echinocandins in wound secretions were significantly lower than simultaneous plasma concentrations, and measured less than 0.025 mg/L-2.25 mg/L for anidulafungin; 0.025 mg/L-2.53 mg/L for micafungin; and 0.18 mg/L-4.04 mg/L for caspofungin.

Study details: The data come from 21 critically ill adults with suspected or confirmed invasive fungal infections who were treated with an echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS); concentrations in wound secretion were measured using liquid chromatography or tandem mass spectrometry detection.

Disclosures: The study was supported by the University of Innsbruck and Medical University of Innsbruck, and by the Austrian Science Fund. The researchers had no financial conflicts to disclose.

Source: Gasperetti T et al. Infection. 2021 Apr 20. doi: 10.1007/s15010-021-01604-x.

Key clinical point: Concentrations of echinocandin penetration into wound secretions may be sub-therapeutic in some patients, and the relevance to clinical outcomes in patients with severe invasive candidiasis infections remains unclear.

Major finding: Concentrations of echinocandins in wound secretions were significantly lower than simultaneous plasma concentrations, and measured less than 0.025 mg/L-2.25 mg/L for anidulafungin; 0.025 mg/L-2.53 mg/L for micafungin; and 0.18 mg/L-4.04 mg/L for caspofungin.

Study details: The data come from 21 critically ill adults with suspected or confirmed invasive fungal infections who were treated with an echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS); concentrations in wound secretion were measured using liquid chromatography or tandem mass spectrometry detection.

Disclosures: The study was supported by the University of Innsbruck and Medical University of Innsbruck, and by the Austrian Science Fund. The researchers had no financial conflicts to disclose.

Source: Gasperetti T et al. Infection. 2021 Apr 20. doi: 10.1007/s15010-021-01604-x.

Key clinical point: Concentrations of echinocandin penetration into wound secretions may be sub-therapeutic in some patients, and the relevance to clinical outcomes in patients with severe invasive candidiasis infections remains unclear.

Major finding: Concentrations of echinocandins in wound secretions were significantly lower than simultaneous plasma concentrations, and measured less than 0.025 mg/L-2.25 mg/L for anidulafungin; 0.025 mg/L-2.53 mg/L for micafungin; and 0.18 mg/L-4.04 mg/L for caspofungin.

Study details: The data come from 21 critically ill adults with suspected or confirmed invasive fungal infections who were treated with an echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS); concentrations in wound secretion were measured using liquid chromatography or tandem mass spectrometry detection.

Disclosures: The study was supported by the University of Innsbruck and Medical University of Innsbruck, and by the Austrian Science Fund. The researchers had no financial conflicts to disclose.

Source: Gasperetti T et al. Infection. 2021 Apr 20. doi: 10.1007/s15010-021-01604-x.

Key clinical point: Invasive fungal infections, though rare, have been observed in multiple sclerosis patients using a range of disease-modifying treatments and should be suspected in patients presenting with signs of infection.

Major finding:  The overall occurrence of invasive fungal infections in patients with multiple sclerosis on disease-modifying treatments was low, but monoclonal antibodies were associated with higher rates of infection. The most common infection sources were Aspergillosis and cryptococcal meningitidis.

Study details: The data come from a meta-analysis of patients treated with rituximab, ocrelizumab, alemtuzumab, fingolimod, natalizumab, dimethyl fumarate, interferon, glatiramer acetate, cladribine, teriflunomide.

Disclosures: The study received no outside funding. Lead author Dr. Scotto had no financial conflicts to disclose; several coauthors disclosed relationships with companies including Almirall, Bayer, Biogen, Merck, Novartis, Roche, and Sanofi-Genzyme.

Source: Scotto R et al.  Expert Opin Drug Saf. 2021 Apr 21. doi: 10.1080/14740338.2021.1918673.

Key clinical point: Invasive fungal infections, though rare, have been observed in multiple sclerosis patients using a range of disease-modifying treatments and should be suspected in patients presenting with signs of infection.

Major finding:  The overall occurrence of invasive fungal infections in patients with multiple sclerosis on disease-modifying treatments was low, but monoclonal antibodies were associated with higher rates of infection. The most common infection sources were Aspergillosis and cryptococcal meningitidis.

Study details: The data come from a meta-analysis of patients treated with rituximab, ocrelizumab, alemtuzumab, fingolimod, natalizumab, dimethyl fumarate, interferon, glatiramer acetate, cladribine, teriflunomide.

Disclosures: The study received no outside funding. Lead author Dr. Scotto had no financial conflicts to disclose; several coauthors disclosed relationships with companies including Almirall, Bayer, Biogen, Merck, Novartis, Roche, and Sanofi-Genzyme.

Source: Scotto R et al.  Expert Opin Drug Saf. 2021 Apr 21. doi: 10.1080/14740338.2021.1918673.

Key clinical point: Invasive fungal infections, though rare, have been observed in multiple sclerosis patients using a range of disease-modifying treatments and should be suspected in patients presenting with signs of infection.

Major finding:  The overall occurrence of invasive fungal infections in patients with multiple sclerosis on disease-modifying treatments was low, but monoclonal antibodies were associated with higher rates of infection. The most common infection sources were Aspergillosis and cryptococcal meningitidis.

Study details: The data come from a meta-analysis of patients treated with rituximab, ocrelizumab, alemtuzumab, fingolimod, natalizumab, dimethyl fumarate, interferon, glatiramer acetate, cladribine, teriflunomide.

Disclosures: The study received no outside funding. Lead author Dr. Scotto had no financial conflicts to disclose; several coauthors disclosed relationships with companies including Almirall, Bayer, Biogen, Merck, Novartis, Roche, and Sanofi-Genzyme.

Source: Scotto R et al.  Expert Opin Drug Saf. 2021 Apr 21. doi: 10.1080/14740338.2021.1918673.

Patients receive the full range of contraception options when providers are educated on the proper use and spectrum of contraceptive options. When an educational intervention was introduced in three countries (Democratic Republic of Congo, Somalia, and Pakistan), aimed at training providers on counseling and provision of immediate postpartum LARC, a significant number of women opted for LARC. This was in comparison to countries that did not implement this educational intervention (Rwanda, Syria, Yemen). The rate of LARC adoption was 10.01% versus 0.77%, respectively in countries providing the educational intervention versus those that did not. 

The copper IUD has long been utilized for emergency contraception, providing nearly 100% efficacy in pregnancy prevention, as well as long-acting, reversible contraception. Recently, the levonorgestrel (LNG) IUD was considered for similar use as emergency contraception. Turok et al studied the pregnancy rate of the LNG IUD compared the copper IUD and found that the LNG IUD was noninferior to the copper IUD when used for emergency contraception, with pregnancy rates of 1 in 317 (LNG) compared to 0 in 321 (copper). LNG IUDs are often more readily available in OBGYN offices and could improve access to higher efficacy emergency contraception compared to traditional emergency contraceptive pills.

When placing IUDs, providers have a range of devices to measure the length of the uterus for correct IUD placement, including endometrial biopsy pipelles, uterine sounds, both plastic and metal, as well as the device inserters. In a biomechanical ex vivo analysis, Duncan et al examined the maximum force generated for IUD placement with the levonorgestrel placement instrument, the copper IUD placement instrument, and a metal sound. Using their model, the investigators found that the metal sound caused uterine perforation, but the plastic IUD placement device did not. Although the study authors utilized the device inserters themselves, we recommend the use of plastic uterine sounds or biopsy pipelles over the device inserters in accordance with IUD packaging instructions.  IUD packaging should not be opened until both the ability to access the uterine cavity and appropriate uterine size are determined to avoid needing to discard the IUD.

Patients receive the full range of contraception options when providers are educated on the proper use and spectrum of contraceptive options. When an educational intervention was introduced in three countries (Democratic Republic of Congo, Somalia, and Pakistan), aimed at training providers on counseling and provision of immediate postpartum LARC, a significant number of women opted for LARC. This was in comparison to countries that did not implement this educational intervention (Rwanda, Syria, Yemen). The rate of LARC adoption was 10.01% versus 0.77%, respectively in countries providing the educational intervention versus those that did not. 

The copper IUD has long been utilized for emergency contraception, providing nearly 100% efficacy in pregnancy prevention, as well as long-acting, reversible contraception. Recently, the levonorgestrel (LNG) IUD was considered for similar use as emergency contraception. Turok et al studied the pregnancy rate of the LNG IUD compared the copper IUD and found that the LNG IUD was noninferior to the copper IUD when used for emergency contraception, with pregnancy rates of 1 in 317 (LNG) compared to 0 in 321 (copper). LNG IUDs are often more readily available in OBGYN offices and could improve access to higher efficacy emergency contraception compared to traditional emergency contraceptive pills.

When placing IUDs, providers have a range of devices to measure the length of the uterus for correct IUD placement, including endometrial biopsy pipelles, uterine sounds, both plastic and metal, as well as the device inserters. In a biomechanical ex vivo analysis, Duncan et al examined the maximum force generated for IUD placement with the levonorgestrel placement instrument, the copper IUD placement instrument, and a metal sound. Using their model, the investigators found that the metal sound caused uterine perforation, but the plastic IUD placement device did not. Although the study authors utilized the device inserters themselves, we recommend the use of plastic uterine sounds or biopsy pipelles over the device inserters in accordance with IUD packaging instructions.  IUD packaging should not be opened until both the ability to access the uterine cavity and appropriate uterine size are determined to avoid needing to discard the IUD.

Patients receive the full range of contraception options when providers are educated on the proper use and spectrum of contraceptive options. When an educational intervention was introduced in three countries (Democratic Republic of Congo, Somalia, and Pakistan), aimed at training providers on counseling and provision of immediate postpartum LARC, a significant number of women opted for LARC. This was in comparison to countries that did not implement this educational intervention (Rwanda, Syria, Yemen). The rate of LARC adoption was 10.01% versus 0.77%, respectively in countries providing the educational intervention versus those that did not. 

The copper IUD has long been utilized for emergency contraception, providing nearly 100% efficacy in pregnancy prevention, as well as long-acting, reversible contraception. Recently, the levonorgestrel (LNG) IUD was considered for similar use as emergency contraception. Turok et al studied the pregnancy rate of the LNG IUD compared the copper IUD and found that the LNG IUD was noninferior to the copper IUD when used for emergency contraception, with pregnancy rates of 1 in 317 (LNG) compared to 0 in 321 (copper). LNG IUDs are often more readily available in OBGYN offices and could improve access to higher efficacy emergency contraception compared to traditional emergency contraceptive pills.

When placing IUDs, providers have a range of devices to measure the length of the uterus for correct IUD placement, including endometrial biopsy pipelles, uterine sounds, both plastic and metal, as well as the device inserters. In a biomechanical ex vivo analysis, Duncan et al examined the maximum force generated for IUD placement with the levonorgestrel placement instrument, the copper IUD placement instrument, and a metal sound. Using their model, the investigators found that the metal sound caused uterine perforation, but the plastic IUD placement device did not. Although the study authors utilized the device inserters themselves, we recommend the use of plastic uterine sounds or biopsy pipelles over the device inserters in accordance with IUD packaging instructions.  IUD packaging should not be opened until both the ability to access the uterine cavity and appropriate uterine size are determined to avoid needing to discard the IUD.

Key clinical point: Three countries that implemented an immediate postpartum family planning (IPPFP) intervention that focused on long-acting reversible contraception (LARC) showed a significant increase in the number of girls and women who opted for an IUD or implant within 48 hours of delivery. 

Major finding: The mean percentage of IPP LARC adoption among all deliveries in the countries that implemented the intervention programs was 10.01%, compared to 0.77% in countries providing standard postpartum care without the intervention.

Study details: The data come from a review of immediate postpartum long-acting reversible contraception (IPP LARC) from 2016 to 2019 in three countries that focused on LARC intervention (Democratic Republic of Congo, Somalia, and Pakistan) including training delivery-room providers on counseling and provision of IPPFP; and three countries the did not implement this intervention (Rwanda, Syria, and Yemen).

Disclosures: The study was supported by an anonymous foundation. The researchers had no financial conflicts to disclose.

Source: Gallagher MC et al. Front Glob Womens Health. 2021 Apr 6. doi: 10.3389/fgwh.2021.613338.

Key clinical point: Three countries that implemented an immediate postpartum family planning (IPPFP) intervention that focused on long-acting reversible contraception (LARC) showed a significant increase in the number of girls and women who opted for an IUD or implant within 48 hours of delivery. 

Major finding: The mean percentage of IPP LARC adoption among all deliveries in the countries that implemented the intervention programs was 10.01%, compared to 0.77% in countries providing standard postpartum care without the intervention.

Study details: The data come from a review of immediate postpartum long-acting reversible contraception (IPP LARC) from 2016 to 2019 in three countries that focused on LARC intervention (Democratic Republic of Congo, Somalia, and Pakistan) including training delivery-room providers on counseling and provision of IPPFP; and three countries the did not implement this intervention (Rwanda, Syria, and Yemen).

Disclosures: The study was supported by an anonymous foundation. The researchers had no financial conflicts to disclose.

Source: Gallagher MC et al. Front Glob Womens Health. 2021 Apr 6. doi: 10.3389/fgwh.2021.613338.

Key clinical point: Three countries that implemented an immediate postpartum family planning (IPPFP) intervention that focused on long-acting reversible contraception (LARC) showed a significant increase in the number of girls and women who opted for an IUD or implant within 48 hours of delivery. 

Major finding: The mean percentage of IPP LARC adoption among all deliveries in the countries that implemented the intervention programs was 10.01%, compared to 0.77% in countries providing standard postpartum care without the intervention.

Study details: The data come from a review of immediate postpartum long-acting reversible contraception (IPP LARC) from 2016 to 2019 in three countries that focused on LARC intervention (Democratic Republic of Congo, Somalia, and Pakistan) including training delivery-room providers on counseling and provision of IPPFP; and three countries the did not implement this intervention (Rwanda, Syria, and Yemen).

Disclosures: The study was supported by an anonymous foundation. The researchers had no financial conflicts to disclose.

Source: Gallagher MC et al. Front Glob Womens Health. 2021 Apr 6. doi: 10.3389/fgwh.2021.613338.