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Biomedical subjects

G L Rubin

Publications and source records attributed to G L Rubin.

At least 73 records · Page 4Linked to original sources
PubMed1984

Report of a high pregnancy rate after sterilization with the Bleier clip.

We investigated a report of a pregnancy rate of 7.3% after tubal sterilization procedures with the Bleier clip in one physician's practice. A review of ongoing clinical investigations of this method of tubal sterilization revealed a failure rate of 0.3%. Our investigation determined that misapplication of the clips was the most probable explanation for the high failure rate, though how the misapplications occurred is not known. The Bleier clip is probably an effective method of tubal occlusion, but close monitoring is needed to determine whether the high failure rate reported here is an isolated instance or a recurrent problem.

Evaluation Studies as Topic↗
PubMed1984

Tubal sterilizations performed in freestanding, ambulatory-care surgical facilities in the United States in 1980.

In 1981 the American Association of Gynecologic Laparoscopists and the Division of Reproductive Health, Centers for Disease Control, jointly conducted a study of tubal sterilizations performed in 141 freestanding, ambulatory-care surgical facilities in 1980 in the United States. Information was collected through mailed questionnaires and telephone interviews. Of 330 potential responding facilities, 141 we identified as freestanding, ambulatory-care surgical facilities. About 16,500 tubal sterilizations were performed in these facilities in 1980. The mean number of tubal sterilizations per freestanding, ambulatory-care surgical facility was 212. Sixty-seven percent of tubal sterilizations were performed in the south and west. General anesthesia was the anesthetic method used in 97% of the procedures. Nearly 91% of tubal sterilizations were done via laparoscopy, with bipolar electrocoagulation the tubal-occlusion method used most frequently. After tubal sterilization the patients were observed for an average of 2.4 hours before discharge. The average cost of laparoscopic tubal sterilization was $801; for nonlaparoscopic tubal sterilization it was $850.

Adult↗
PubMed1983

The impact of publicly funded perinatal care programs on neonatal outcome, Georgia, 1976-1978.

The State of Georgia administers three publicly funded perinatal care programs for medically high risk and/or low-income women: the High Risk Pregnancy Program, the Medicaid Program, and the Maternal and Infant Care Projects. To assess the impact of these programs on infant health, we compared the birth weight distribution and neonatal mortality rates of infants born to women in each program with those of infants of a nonfunded group of women with less than 12 years' education. Infants of women in publicly funded groups were more likely to weigh less than or equal to 2,500 gm at birth than those of women in the nonfunded group. Neonatal mortality rates for publicly funded groups were similar to those of the nonfunded group. The neonatal mortality rates for infants of birth weight less than or equal to 2,500 gm of publicly-funded women were significantly lower than those of the nonfunded women. There were no significant differences between groups for neonatal mortality rates for infants of birth weight greater than 2,500 gm. These findings suggest that publicly funded perinatal care programs may improve neonatal survival of infants of birth weight less than or equal to 2,500 gm of low-income mothers.

Adult↗
PubMed1983

Deaths attributable to tubal sterilization in the United States, 1977 to 1981.

In 1979, the Centers for Disease Control began surveillance of deaths attributable to tubal sterilization in order to determine why they occur and what may be done to prevent them. Since that time, 29 such deaths have been identified as occurring in the United States from 1977 through 1981. Of these 29 deaths, 11 followed complications of general anesthesia, seven were due to sepsis, four were due to hemorrhage, three were due to myocardial infarction, and four deaths were related to other causes. Some of these deaths might have been prevented by use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, safer use of unipolar coagulation or use of alternative techniques, careful insertion of the needle and trocar for laparoscopy, and discontinuation of oral contraceptives before sterilization. Further surveillance may help to make tubal sterilization even safer.

Adult↗
PubMed1983

Ectopic pregnancy in the United States 1970 through 1978.

Trends of the incidence and mortality associated with ectopic pregnancy (EP) in the United States were examined for 1970 through 1978. The estimated number of EPs rose from 17,800 in 1970 to 42,400 in 1978, and the EP incidence rate rose from 4.5 per 1,000 reported pregnancies to 9.4 during the same time period. The risk of EP was higher for older women and nonwhite women. Over 2.5% of all reported pregnancies among nonwhite women aged 35 to 44 years were ectopic. The death-to-case rate for EP declined almost 75% during the study period but remained consistently higher for nonwhite women as compared with white women.

Abortion, Induced↗
PubMed1983

Agreement between women's histories of oral contraceptive use and physician records.

The histories of oral contraceptive (OC) use provided by women participating in a study of hepatocellular adenoma (HCA) were compared with records obtained from their physicians. In the HCA study two memory aids were used to assist women in their recall: a calendar of significant events during a woman's lifetime to which she might relate her use of OCs and a book of colour photographs of the 90 OC preparations available up to the time of the study. Using the number of months of a woman's history which could be checked against physician records (mean for all women of 33 months) as the denominator, the highest proportion of concordance was for month-specific duration of OC use (90%) with lower agreement for duration and brand (62%) and duration, brand, and dose (54%). Agreement was better for cases than for controls.

Adult↗
PubMed1983

Complications of interval laparoscopic tubal sterilization.

In 1978, the Centers for Disease Control initiated a multicenter prospective study to assess the safety of the various female sterilizing operations and the ways in which they could be made safer. During the first 31 months, 3500 women who underwent interval laparoscopic tubal sterilization by electrocoagulation or Silastic banding without other concurrent operations were enrolled in the study. When a standard definition of complications was used, the overall rate of an intraoperative or postoperative complication was 1.7 per 100 women. Several patients factors increased the risk of complications twofold or more: diabetes mellitus, previous abdominal or pelvic surgery, lung disease, a history of pelvic inflammatory disease, and obesity. There was a fivefold difference in complication rates between procedures performed under general anesthesia and those done under local anesthesia.

Adolescent↗
PubMed1983

Risk of wound and pelvic infection after laparoscopic tubal sterilization: instrument disinfection versus sterilization.

To determine if disinfection, rather than sterilization, of laparoscopic equipment leads to an increase in the risk of postlaparoscopy infection, the authors analyzed data from a multicenter prospective study conducted by the Centers for Disease Control on the safety of sterilizing operations. From September 1978 through July 1981, 3903 women underwent laparoscopic tubal sterilization procedures in which the equipment was sterilized with ethylene oxide (58%) or disinfected with glutaraldehyde (42%). The overall risk of wound infection in each group was 1.5 per 100 women. The relative risk of wound infection for disinfection versus sterilization of the equipment was 0.5 when adjusted for differences in the two groups. The corresponding relative risk of pelvic infection was 1.2. These results suggest that laparoscopy equipment disinfected with glutaraldehyde is not associated with an increased risk of wound or pelvic infection compared with equipment sterilized with ethylene oxide.

Adolescent↗
PubMed1983

Menstrual changes after tubal sterilization.

The authors used data from a multicenter prospective study of female sterilization surgery to study changes in menstrual function following tubal sterilization. Duration of menstrual bleeding, menstrual cycle length, cycle regularity, amount of menstrual bleeding, menstrual pain, and intermenstrual bleeding were examined. The authors followed 2456 women for two years after tubal sterilization surgery. Each woman served as her own control; her menstrual function at the two-year follow-up interview was compared with her menstrual function at the preoperative interview. Except for menstrual pain among women who underwent unipolar electrocoagulation procedures, there was no increase in the prevalence of adverse menstrual function after tubal sterilization. For all menstrual variables, 50% or more of women with adverse function preoperatively had an improvement by two years after tubal sterilization.

Adolescent↗
PubMed1983

Type of intrauterine device and the risk of pelvic inflammatory disease.

To study the association of pelvic inflammatory disease and various types of intrauterine devices (IUDs), data from the Women's Health Study were analyzed. The analysis included data from interviews of 622 women hospitalized with an initial episode of pelvic inflammatory disease and 2369 hospitalized control subjects reporting no history of pelvic inflammatory disease. Compared to the risk in women using no contraception, the relative risk of pelvic inflammatory disease in women currently using the Dalkon Shield was 8.3 (95% confidence limits 4.7 to 14.5). This represented a fivefold increase in risk compared to women currently using other types of IUDs. In this study, only 10% of women wearing an IUD were using the Dalkon Shield, yet they accounted for almost 20% of the excess risk of pelvic inflammatory disease occurring among all the IUD users. Most of the increased risk of pelvic inflammatory disease for women currently using other IUDs (excluding the Dalkon Shield) occurred in the first four months after insertion. These associations were not explained by differences between cases and controls in demographic variables, level of sexual activity, or medical history. The authors recommend that women still using a Dalkon Shield have it removed.

Female↗
PubMed1983

Risk factors for complications of interval tubal sterilization by laparotomy.

The complication rate among 282 women undergoing interval tubal sterilization by laparotomy was studied as part of the prospective multicenter Collaborative Review of Sterilization. Using a standard definition of major complications, the overall complication rate was 5.7 per 100 procedures. Women experiencing complications had a significantly lengthened postoperative recovery period before the resumption of normal activities. Important risk factors for complications included diabetes, cigarette smoking, previous abdominal or pelvic surgery, and a history of pelvic inflammatory disease. Women with an initial abdominal incision of 7 cm or longer had three times the complication rate of women with shorter incisions. These results provide objective evidence that, for tubal sterilizations, minilaparotomy (laparotomy with a small abdominal incision) is associated with lower morbidity than is conventional laparotomy.

Abdomen↗
PubMed1982

Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.

Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade, few recent studies have been conducted to determine the risk of complications. We examined data from the Collaborative Review of Sterilization, a prospective, multicenter, observational study coordinated by the Centers for Disease Control, to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches. Between September, 1978, and August, 1981, 1,851 women from nine institutions were included in the study. Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group. Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity, bleeding requiring transfusion, hospitalization, and convalescence than abdominal hysterectomy. Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinically appropriate.

Adolescent↗
PubMed1982

Oral contraceptives and pelvic inflammatory disease.

To study the association of the use of oral contraceptives and pelvic inflammatory disease (PID), we analyzed data from a large multicenter case-control study of contraceptive use and serious gynecologic disorders. The analysis included data from interviews of 648 women hospitalized with an initial episode of PID and 2,516 hospitalized control subjects. The risk of PID for women using oral contraceptives in the 3 months prior to interview was 0.5 (95% confidence limits, 0.4 to 0.6) relative to women using no contraceptive method during this period. This association was not explained by differences between case subjects and control subjects in demographic variables, level of sexual activity, or medical history. The protective effect of current oral contraceptive use against PID was restricted to women using oral contraceptives for more than 12 months; past use of oral contraceptives did not exert a protective effect against PID. Annually, an estimated 50,000 initial cases of PID are prevented by oral contraceptive use; 12,500 hospitalizations are also averted by oral contraceptive use. Consequently, protection against PID is one of the most important noncontraceptive benefits of oral contraception.

Adolescent↗
PubMed1982

Barrier-method contraceptives and pelvic inflammatory disease.

The protective effect of barrier-method contraception against pelvic inflammatory disease (PID) was examined by analyzing data from the Women's Health Study, a large multicenter case-control study. We compared the contraceptive methods used by 645 women hospitalized for initial episodes of PID with the contraceptive methods used by 2,509 control subjects reporting no history of PID. The risk of hospitalization for PID in women currently using barrier methods relative to women using all other methods and to women using no method of contraception was 0.6 (95% confidence limits, 0.5 to 0.9) for both comparisons. This protective effect was observed for both chemical and mechanical barrier methods, although it was not statistically significant for the former. The prevention of PID and its sequelae is one of the most important noncontraceptive benefits of barrier methods of contraception.

Adolescent↗
PubMed1982

Reproductive mortality in the United States.

Maternal mortality in the United States has declined by 50% during the last decade. This decline took place at the same time as changes in the availability and use of contraceptive measures, including temporary contraceptives and sterilization. To examine the impact of these changes on mortality we estimated the reproductive mortality rate, which includes pregnancy-related deaths as well as deaths from the side effects of contraceptive methods. The estimated reproductive mortality rate fell by 73% from 1955 to 1975. The decrease was greater for women younger than 35 years. The slower decline for women aged 35 years and older was due to oral-contraception-related deaths. By 1975, pregnancy prevention was responsible for nearly as many deaths as pregnancy itself. The reproductive mortality rate is more appropriate than the maternal mortality rate for evaluating the health risks of reproduction and contraception. We urge that national surveillance of maternal mortality should be expanded to include deaths associated with contraceptive methods.

Abortion, Induced↗