Willingness to Use Cannabis for Gynecological Conditions: A National Survey.

Objective: Expanded legal access to cannabis in the United States has led to its increased use for treating medical conditions. We assessed the use of and attitudes toward cannabis for treating gynecological conditions. Materials and Methods: We utilized Amazon.com Inc.'s Mechanic Turk platform to administer a survey to U.S. women 18 years and older about cannabis use for recreational and medicinal purposes and willingness to use cannabis to treat 17 gynecological conditions. We collected sociodemographic data and views about the legal status of cannabis. We used logistic regression to identify factors associated with willingness to use cannabis for gynecological conditions. Results: In our analytical sample (N = 995), women who reported ever using cannabis were more willing to use cannabis to treat a gynecological condition compared with never users (91.6% vs. 64.6%, p < 0.01). Women willing to use cannabis for gynecological conditions were most interested in using cannabis for treating gynecological pain (61.2% of never users vs. 90.0% of ever users; p < 0.001) compared with procedural pain (38.2% vs. 79.0%, respectively; p < 0.001) or other conditions (38.0% vs. 79.8%, respectively; p < 0.001). In multivariate analysis, willingness to use cannabis for a gynecological condition was associated only with a history of ever using cannabis and views that cannabis should be legal in some capacity and not by age, race, or education. Conclusions: The majority of women would consider using cannabis to treat gynecological conditions. Overall, respondents who had a history of cannabis use were more likely to report willingness to use cannabis for all gynecological conditions, but a large proportion of those who reported never using cannabis were also willing to use it.

Cannabinoids for Pain Control During Medical Abortion: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether prophylactic dronabinol, a synthetic tetrahydrocannabinol, reduces pain during medical abortion. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women undergoing medical abortion with mifepristone and misoprostol up through 70 days of gestation. All participants received 800 mg of ibuprofen and were randomized to either 5 mg of oral dronabinol or a placebo 30 minutes before misoprostol administration. Participants used a text messaging service to report pain on a numeric rating scale from 0 to 10 (0=no pain, 10=worst pain). The primary outcome was maximum pain experienced during the 24 hours after misoprostol administration. Secondary outcomes were pain scores at 0, 6, and 24 hours after misoprostol administration; maximum anxiety and nausea scores; use of additional pain medication; reported side effects; and satisfaction (yes or no). We needed 68 participants (34 per group) to have 80% power to detect a 2-point difference in maximum pain on a numeric rating scale. RESULTS: From November 2018 to May 2019, we randomized 70 women (dronabinol=35, placebo=35). Participants in the study arms had comparable baseline characteristics. We found no difference between groups in the median maximum pain score reported (dronabinol 7 [interquartile range 6-8], placebo 7 [interquartile range 5-8], P=.82) or median pain scores at any timepoint. Groups were also no different in mean maximum anxiety (dronabinol 3.33 [SD 3.06], placebo 3.23 [SD 2.53], P=.88) or nausea scores (dronabinol 2.21 [SD 2.32], placebo 2.72 [SD 2.64], P=.41). Most women were satisfied with their pain management (76% dronabinol, 82% placebo, P=.51). CONCLUSION: Dronabinol does not reduce the maximum level of pain experienced by women undergoing medical abortion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03604341.

Opioid Analgesia for Medical Abortion: A Randomized Controlled Trial.

OBJECTIVE: To estimate the effect of oral opioids on patient pain during first-trimester medical abortion. METHODS: We conducted a randomized, double-blind, placebo-controlled trial where patients up to 10 0/7 weeks of gestation undergoing a medical abortion with mifepristone and misoprostol took 10 mg oral oxycodone or placebo at onset of painful cramping. Additionally, all patients received 800-mg ibuprofen tablets, 4-mg ondansetron oral dissolving tablets, and a written prescription for adjunctive pain medication (six tablets oxycodone 5 mg). Participants used a text-messaging service to report pain scores on a numerical rating scale from 0 to 10 (0 being no pain, 10 being worst pain) for 24 hours at start of misoprostol dosing. The primary outcome was maximum pain experienced within 24 hours postmisoprostol. Our secondary outcomes were maximum pain stratified by gestational age (less than 7 weeks of gestation, 7-10 weeks of gestation), duration of maximum pain, use of adjunctive medication, presence of nausea or vomiting, and satisfaction. We needed at least 76 participants per group to differentiate a clinically important pain difference of 2 points on the numerical rating scale. RESULTS: From May 2017 to May 2018, we randomized 172 participants (placebo group with 86, oxycodone group with 86). The study groups had comparable baseline characteristics. We found no difference between groups in median maximum pain scores (placebo 8 [range 1-10], oxycodone 8 [range 2-10], P=.92) and the median duration of maximum pain (placebo 0.75 hours range 0.01-15 vs oxycodone 1 hour range 0.02-10, P=.39). Groups were also similar in the proportion obtaining (placebo 62%, oxycodone 49%, P=.09) and using (placebo 48%, oxycodone 40%, P=.28) adjunctive medication, experiencing nausea or vomiting (placebo 59%, oxycodone 65%, P=.43) and reported satisfaction with pain medications (placebo 62%, oxycodone 65%, P=.63). CONCLUSION: Oxycodone does not reduce the maximum level of pain experienced by women undergoing medical abortion up to 10 0/7 weeks of gestation or improve satisfaction. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03139240.

Improving Staff Communication and Transitions of Care Between Obstetric Triage and Labor and Delivery.

OBJECTIVE: To improve staff perception of the quality of the patient admission process from obstetric triage to the labor and delivery unit through standardization. DESIGN: Preassessment and postassessment online surveys. SETTING: A 13-bed labor and delivery unit in a quaternary care, Magnet Recognition Program, academic medical center in Pennsylvania. PARTICIPANTS: Preintervention (n = 100), postintervention (n = 52), and 6-month follow-up survey respondents (n = 75) represented secretaries, registered nurses, surgical technicians, certified nurse-midwives, nurse practitioners, maternal-fetal medicine fellows, anesthesiologists, and obstetric and family medicine attending and resident physicians from triage and labor and delivery units. METHODS: We educated staff and implemented interventions, an admission huddle and safety time-out whiteboard, to standardize the admission process. Participants were evaluated with the use of preintervention, postintervention, and 6-month follow-up surveys about their perceptions regarding the admission process. Data tracked through the electronic medical record were used to determine compliance with the admission huddle and whiteboards. RESULTS: A 77% reduction (decrease of 49%) occurred in the perception of incomplete patient admission processes from baseline to 6-month follow-up after the intervention. Postintervention and 6-month follow-up survey results indicated that 100% of respondents responded strongly agree/agree/neutral that the new admission process improved communication surrounding care for patients. Data in the electronic medical record indicated that compliance with use of admission huddles and whiteboards increased from 50% to 80% by 6 months. CONCLUSION: The new patient admission process, including a huddle and safety time-out board, improved staff perception of the quality of admission from obstetric triage to the labor and delivery unit.

Six-week retention after postplacental copper intrauterine device placement.

OBJECTIVES: We sought to evaluate the 6-week clinical outcomes (intrauterine device [IUD] retention, recognized expulsions, ability to visualize or palpate strings, and need for ultrasound evaluation) in women who received a TCu380A postplacental IUD (PPIUD) after vaginal (VD) or cesarean delivery (CD). STUDY DESIGN: We conducted a retrospective cohort study to examine the 6-week retention of TCu380A IUDs placed within 10 min of placental delivery in VD (n=137) and CD (n=73). We used Student's t test and Wilcoxon rank sum tests for continuous data and Pearson χ2 test and Fisher's Exact Test for categorical data. RESULTS: Of the 169 women who had follow-up, 151 (89.3%) retained their IUD at 6 weeks (95% CI 84.7%-93.9%). All women who underwent CD retained their IUD at 6 weeks postpartum (56/56), whereas 95/113 (84% [95% CI 76.0%-90.3%]) who underwent VD retained their original IUD (p<.01). Strings were detected more frequently in women who had a VD (93.1% [95% CI 85.6-97.4]) compared to those who delivered by CD (44.2% [95% CI 30.5-58.7]; p<.01). Women who underwent CD had an ultrasound to evaluate IUD location more frequently (42.9% [95% CI 29.7-56.8]) compared to women who underwent VD (13.7% [95% CI 7.5-22.3]; p<.01). CONCLUSION: Women are more likely to retain a PPIUD after CD compared to a VD (p<.01); however, women who have a PPIUD placed after CD are more likely to have nonvisible strings with a pelvic exam (p<.01) and undergo pelvic ultrasound evaluation (p<.01) compared to a PPIUD placed at the time of a VD.