Jennifer Conti, MD, MS, MSc

All Publications

• Self-administered lidocaine gel for local anesthesia prior to osmotic dilator placement: a randomized trial. Contraception Schivone, G. B., Lerma, K., Montgomery, C., Wright, P., Conti, J. A., Blumenthal, P. D., Shaw, K. A. 2018

  Abstract

  OBJECTIVE(S): To compare pain scores during cervical dilator placement prior to dilation and evacuation (D&E) with patient-administered vaginal lidocaine gel versus lidocaine paracervical block (PCB).STUDY DESIGN: We conducted an unblinded randomized trial of women≥18years of age undergoing surgical abortion at≥16weeks gestation in two outpatient clinics. We randomized participants to receive self-administered lidocaine gel 2% 20mL intravaginally 15-30min before procedure initiation, or lidocaine 1% 12mL PCB immediately prior to dilator placement. Participants rated their pain at various time points using a visual analog scale (VAS), including anticipated and baseline pain, speculum insertion, tenaculum placement, cervical dilator placement (primary outcome), and speculum removal.RESULTS: We enrolled 72 women and analyzed data for 69 participants. Socio-demographic characteristics and VAS scores at all time points, except for anticipated pain, were similar between groups. The median pain score with dilator placement was 48mm in the gel group and 61mm in the PCB group (p=.23). Procedure times the gel group and PCB group were 3.7min and 5.2min, respectively (p<.01). Lidocaine gel was non-inferior to PCB for reported pain scores (VAS) with dilator placement with a difference in means of-8mm (95% CI -21,5), favoring the gel.CONCLUSIONS: Self-administration of lidocaine gel prior to placement of cervical dilators for D&E is non-inferior to paracervical lidocaine block for local anesthesia and is a potential alternative to PCB for pain management with osmotic dilator placement.IMPLICATIONS: Lidocaine gel and similar products represent non-invasive, non-painful methods of local anesthesia for a variety of outpatient gynecologic procedures. Given our non-inferiority findings, if gel anesthetics are available they should be considered as an alternative to paracervical block.

  View details for PubMedID 30500336

• Self-Administered Vaginal Lidocaine Gel for Pain Management with Intrauterine Device Insertion: A Blinded, Randomized Controlled Trial. American journal of obstetrics and gynecology Conti, J. A., Lerma, K., Schneyer, R., Hastings, C. V., Blumenthal, P. D., Shaw, K. A. 2018

  Abstract

  BACKGROUND: A major barrier to intrauterine device use is fear of pain during insertion. Trials exploring analgesic interventions for intrauterine device insertion have yielded mixed results, and no standardized pain management guidelines currently exist for this procedure. In an abortion-related study, self-administered lidocaine gel over a prolonged time interval showed promise as a method of pain control.OBJECTIVE(S): To assess pain control with intrauterine device insertion after patient-administered lidocaine gel compared to placebo.STUDY DESIGN: We conducted a randomized, blinded trial of women undergoing levonorgestrel or copper intrauterine device insertion in an outpatient gynecology clinic between July 2016 and April 2017. Participants self-administered either 20 mL of 2% lidocaine gel or placebo gel vaginally at least 15-minutes prior to intrauterine device insertion. No other analgesics were administered. The primary outcome was pain during intrauterine device insertion, measured on a 100-mm visual analog scale (VAS, 0 being "no pain" and 100 being "worst pain imaginable"). Secondary outcomes included anticipated and baseline pain and pain with speculum insertion and tenaculum placement. In a post-procedure questionnaire, participants reported acceptability of vaginal gel and willingness to wait for pain control. Median values were assessed due to the non-normal distribution of visual analog scale scores using the Mann-Whitney U test. Predictors of IUD insertion pain were assessed using a multiple linear regression.RESULTS: In total, 220 women were randomized and 215 were included in analysis (108 in lidocaine gel, 107 in placebo gel groups). Median (range) time from gel administration to speculum insertion was 21 (14-74) and 20 (12-43) minutes in the lidocaine and placebo groups, respectively (p=.13). The median pain scores during intrauterine device insertion were not significantly different: 65 (1-99) mm in the lidocaine group and 59 (5-100) mm in the placebo group (p=.09). Among secondary outcome time points, only median pain scores at speculum insertion were significantly different between the lidocaine and placebo groups (7 (0-81) mm versus 11 (0-80) mm, respectively; p=.046). Anticipated pain and menstrual pain were both predictors of pain with IUD insertion. The majority of women in both groups found the amount of vaginal leakage following gel insertion to be acceptable (>80%). Ninety-two percent (n= 194) of participants stated they would be willing to wait before intrauterine device placement for a potential analgesic effect.CONCLUSION(S): Self-administered lidocaine gel at least 15-minutes before intrauterine device insertion does not appear to reduce pain compared with placebo, but may help with speculum insertion. We found that women are willing to extend visit time to gain pain control. Self-administration of local anesthetic is acceptable to patients and should be considered in future research.

  View details for PubMedID 30444982

• Abortion in the media. Current opinion in obstetrics & gynecology Conti, J. A., Cahill, E. n. 2017; 29 (6): 427–30

  Abstract

  To review updates in how abortion care is depicted and analysed though various media outlets: news, television, film, and social media.A surge in recent media-related abortion research has recognized several notable and emerging themes: abortion in the news media is often inappropriately sourced and politically motivated; abortion portrayal in US film and television is frequently misrepresented; and social media has a new and significant role in abortion advocacy.The portrayal of abortion onscreen, in the news, and online through social media has a significant impact on cultural, personal, and political beliefs in the United States. This is an emerging field of research with wide spread potential impact across several arenas: medicine, policy, public health.

  View details for PubMedID 28915157

• Update on abortion policy. Current opinion in obstetrics & gynecology Conti, J. A., Brant, A. R., Shumaker, H. D., Reeves, M. F. 2016; 28 (6): 517-521

  Abstract

  To review the status of antiabortion restrictions enacted over the last 5 years in the United States and their impact on abortion services.In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently.Liberalization of abortion laws saves women's lives. The rising number of antiabortion restrictions will ultimately harm women and their families.

  View details for PubMedID 27805969

• Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial. Obstetrics and gynecology Conti, J. A., Lerma, K., Shaw, K. A., Blumenthal, P. D. 2016; 128 (2): 297-303

  Abstract

  To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block.We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively.From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured.Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion.ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.

  View details for DOI 10.1097/AOG.0000000000001532

  View details for PubMedID 27400015

• Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion OBSTETRICS AND GYNECOLOGY Conti, J. A., Lerma, K., Shaw, K. A., Blumenthal, P. D. 2016; 128 (2): 297-303

  Abstract

  To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block.We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively.From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured.Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion.ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.

  View details for DOI 10.1097/AOG.0000000000001532

  View details for Web of Science ID 000380918500013

• Update on long-acting reversible methods. Current opinion in obstetrics & gynecology Conti, J., Shaw, K. 2015; 27 (6): 471-475

  Abstract

  The last several years have seen a number of important clinical and academic advances in long-acting reversible contraceptive (LARC) methods, such that many professional medical organizations now recommend these methods as first-line contraception for all women.Recent data support the use of LARC in a variety of special circumstances including adolescents, nulliparous women and immediately postpartum and postabortion. Evidence also shows that traditional methods of pain control with intrauterine device (IUD) insertion and cervical preparation prior to insertion may not be warranted. Further, the extended use of IUDs is safer and more effective than previously realized.The rising uptake of LARC methods in the United States has the potential to dramatically decrease undesired pregnancies and abortion rates, and should be considered an effective option in the majority of women.

  View details for DOI 10.1097/GCO.0000000000000227

  View details for PubMedID 26536210

• Leading the Way in Women's Health ... Through Journalism OBSTETRICS AND GYNECOLOGY Conti, J. A. 2013; 122 (4): 901-901

  View details for Web of Science ID 000330446900024

  View details for PubMedID 24051935

• Postcoital Vaginal Rupture in a Young Woman with No Prior Pelvic Surgery JOURNAL OF SEXUAL MEDICINE Austin, J. M., Cooksey, C. M., Minikel, L. L., Zaritsky, E. F. 2013; 10 (8): 2121-2124

  Abstract

  Reports of postcoital vaginal rupture in the literature are limited to cases involving women who are postmenopausal, have recently undergone pelvic surgery, or have suffered genitourinary trauma.We report a case of postcoital vaginal rupture in a 23-year-old woman with no prior surgical history who complained of acute onset, severe vaginal pain after consensual intercourse.Examination under anesthesia revealed a 6-cm laceration of the posterior fornix, which extended into the abdominal cavity. The laceration was repaired using a combined vaginal and laparoscopic approach.Coitus-induced vaginal rupture in a reproductive aged woman with no prior pelvic surgery or other risk factors is a rare clinical presentation. Prior reports of rupture in premenopausal women have recommended repair via laparotomy. This case documents successful transvaginal and laparoscopic repair, and reviews the etiological mechanisms for coitus-induced injury.

  View details for DOI 10.1111/j.1743-6109.2012.02682.x

  View details for Web of Science ID 000322585400027

  View details for PubMedID 22429501