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Biomedical subjects

I C Chi

Publications and source records attributed to I C Chi.

At least 55 records · Page 3Linked to original sources
PubMed1987

Cervical dilatation in interval insertion of an IUD. Who requires it and does it lead to a high expulsion rate?

Cervical dilatation is occasionally performed to facilitate IUD insertions in difficult-to-insert cases. Patient characteristics associated with the need for dilation and whether dilation is associated with an increased risk of early expulsion of the IUD have rarely been studied. This analysis, using the extensive international IUD data base developed and maintained by Family Health International, is intended to answer these questions. This case-control analysis revealed that nulliparous women as well as women who had used oral contraceptives or an IUD in the previous month were more likely to require cervical dilatation at IUD insertion. Breastfeeding women, on the other hand, were less likely to require cervical dilatation to facilitate IUD insertion. Hypotheses are generated from this analysis that need to be tested in future studies. The six- and 12-month gross cumulative life-table expulsion rates and other pertinent termination event rates (e.g., accidental pregnancies and removals due to bleeding and pain) were not found to be higher for women with cervical dilatation than for women without.

Age Factors↗
PubMed1987

Pregnancy following minilaparotomy tubal sterilization--an update of an international data set.

Seventeen pregnancies were reported from an international tubal sterilization data set comprising 1,862 minilaparotomy cases between 1978 and 1984. Of these 17, seven (41.2%) were diagnosed as luteal phase pregnancies. Of the 10 pregnancies due to sterilization failure, one was an ectopic pregnancy which occurred much later (20 months poststerilization) than the intrauterine pregnancies (10 months or less). Poststerilization pregnancy risk was greater among gravid women (those undergoing sterilization at the time of abortion or soon after childbirth) than among non-gravid women (those undergoing interval sterilization). These findings are, in general, consistent with those of previous studies using a much larger data set of primarily laparoscopic sterilizations. Pregnancies occurred with every type of mechanical tubal occlusion techniques included for study (the tubal ring, the Rocket Clip, the Secuclip and the Filshie Clip), and a frequently reported reason for failure was incorrect placement of the device. No pregnancies occurred in women sterilized with the non-mechanical Pomeroy/modified Pomeroy techniques. Findings of this analysis suggest that in minilaparotomy sterilization, for the mechanical tubal occlusion techniques to be as effective as the Pomeroy/modified Pomeroy techniques, more care and skill are required for the operator.

Adult↗
PubMed1986

IUD insertion at cesarean section--the Chinese experience.

This review reports the experience of nine studies in Chinese maternity hospitals with insertions of an intrauterine device (IUD) at the time of cesarean section. In contrast to the usually high expulsion rates associated with immediate postpartum vaginal insertions, all nine studies reported low expulsion rates, thus resulting in high continuation rates with this procedure, comparable to those with interval insertions. This immediate post-cesarean section insertion procedure was also found to be safe. These findings are of programmatic importance for postpartum family planning delivery services and may eventually lead to an understanding of the expulsion mechanism in postpartum IUD contraception. Results of these reports have been synthesized in this review. Seven of these nine reports were originally in Chinese and were translated into English for the benefit of a broad international audience. Future research directions on this insertion procedure are also discussed.

Adult↗
PubMed1986

Severe pain at interval IUD insertion: a case-control analysis of patient risk factors.

This investigation, using a case-control analysis approach on an IUD data set from a less-developed country center, delineated four risk factors in patient characteristics that are associated with severe pain at interval IUD insertion. They are: higher education (greater than or equal to seven years), low-parity (1-2 live births), longer open interval (greater than or equal to 13 months) between the end of the last pregnancy and insertion, and non-breastfeeding at the time of insertion. Adjusted relative risks estimated by odds ratios are 2.1, 2.7, 2.7 and 5.0, respectively. For women with a combination of the above risk factors, they have a further increased (additive in nature) risk of suffering severe insertion pain. Similar analysis was also performed on a developed country center data set for which only the effect of education and parity could be studied; an odds ratio of 5.0 for nulliparity was obtained. The plausibility of these findings as well as their clinical and programmatic implications are discussed.

Breast Feeding↗
PubMed1986

Do insertion-related problems affect subsequent IUD performance?

This investigation compares the IUD performance of 372 women who had an insertion-related problem (most with moderate or severe pain) and 372 matched women who had no such problem; all women had interval insertion. A woman in the Problem Cohort and her matched counterpart in the Comparison Cohort were inserted with the same IUD type by the same insertor on the same day or on close dates. The six IUD types used by these women were Lippes Loop D, Copper-7, Copper T-200, Copper T-380 Ag, Multiload Copper 250 and Multiload Copper 375. Cumulative gross life-table rates of the pertinent events (accidental pregnancy, expulsion and medical removal for bleeding and pain), adjusted for age and parity, were calculated. Between the Problem Cohort and the Comparison Cohort, no differences were detected in the event rates that were of either statistical or practical significance. Results from this preliminary study suggest that the insertion-related problems usually encountered during interval insertion such as insertion pain, syncope and/or mild cervical laceration are not associated with an increased risk of IUD discontinuation due to pertinent events.

Adult↗
PubMed1986

Technical failures in female sterilization using the tubal ring: a case-control analysis.

To delineate characteristics of women predisposing to sterilization technical failures, we performed an analysis of 20 technical failures that occurred during tubal ring procedures and 80 control ring procedures matched on planned surgical approach and study site. None of the women had recently been pregnant (interval procedures). The odds ratios (ORs) were elevated for women wearing an IUD in the three months prior to sterilization (OR = 5.0, 90% confidence interval [CI] 2.2, 11.2) and for women with a history of spontaneous abortion (OR = 4.3, 90% CI 1.8, 9.8). A history of pelvic inflammatory disease (PID) and/or current evidence of PID was strongly associated with technical failure (X2 = 25.0, p less than 0.001). The combined effect of any two of these three factors increased the risk synergistically. We examined these factors prospectively and confirmed the elevated risks (relative risk [RR] = 5.0, 5.5 and 22.7 for recent IUD wearing, spontaneous abortion history and history/evidence of PID, respectively). The prospective analysis also found that previous abdominal surgery is associated with technical failure (RR = 6.7).

Abdomen↗
PubMed1986

Syncope and other vasovagal reactions at interval insertion of Lippes Loop D--who is most vulnerable?

Syncope and other vasovagal reactions occasionally occur at or immediately after IUD insertion. This analysis, using an international data set comprised of interval insertions of Lippes Loop D, found that women who are primiparous (as compared to those who are multiparous), and/or those who want more children are at higher risk for vasovagal reactions and deserve more careful counseling and gentler cervical manipulation. Moderate to severe pelvic pain at insertion is closely associated with the development of vasovagal reaction. Measures to alleviate or prevent pain at insertion could reduce the incidence of vasovagal reactions.

Adult↗
PubMed1986

In-hospital maternal mortality risk by cesarean and vaginal deliveries in two less developed countries--a descriptive study.

Cesarean deliveries are increasing in both developed countries and less developed countries (LDCs). Recent studies in the U.S. have revealed a significantly higher mortality risk for women who delivered abdominally than for those who delivered vaginally, even when the effect of the conditions which necessitated cesarean delivery was taken into account. We chose for study from an international maternity monitoring network, five centers from two LDCs that reported an in-hospital maternal mortality rate (MMR) of around 10 per 1000 parturient women. The pooled data revealed an MMR of 5.1 per 1000 women with vaginal deliveries. For women with cesarean delivery, the total MMR was 36.2 and the MMR attributable to cesarean section was estimated to be 12.8; both rates were per 1000 procedures. The leading cause of death was eclampsia for the vaginal deliveries and sepsis for the cesarean deliveries. The risk of maternal mortality inherent with the cesarean section procedure per se (not counting the risk associated with the labor and delivery complications that necessitated cesarean section) as well as the practical avoidability of maternal deaths for either mode of delivery in these LDC hospitals are discussed.

Anesthesia, Obstetrical↗
PubMed1986

Rare events associated with tubal sterilizations: an international experience.

The results from previous analyses of an international data set collected by Family Health International are reviewed in relation to the incidence, severity, risk factors, and outcomes of rare events associated with tubal sterilization. The rare events included for review, by sequence of their relationship to the tubal sterilization procedure are: luteal phase pregnancy, intraoperative complications (uterine perforation, unintended laparotomy required for completion of the laparoscopic procedure, and technical failure in tubal ring sterilization), deaths, early readmission following laparoscopic sterilization, hysterectomy after laparoscopic sterilization, and pregnancy (intrauterine and ectopic) conceived after tubal sterilization. The widespread use of this method of contraception has important public health implications, and awareness of these events will help clinicians minimize such incidences and better deal with them when they arise.

Female↗
PubMed1985

Hospitalizations among black women using contraceptives.

We analyzed hospitalizations among 26,507 young black women who attended a large metropolitan family planning clinic between 1968 and 1976. Age-adjusted hospitalization rates were compared for women using oral contraceptives, intrauterine contraceptive devices, and depot medroxyprogesterone acetate. Overall, intrauterine contraceptive device and depot medroxyprogesterone acetate users were hospitalized at about the same rate, while women using oral contraceptives were hospitalized 30% less often. The oral contraceptive users were not hospitalized at a higher rate for circulatory disease. Compared to women using intrauterine contraceptive devices, users of oral contraceptives and depot medroxyprogesterone acetate were less likely to be hospitalized for benign breast disease (rate ratios = 0.5 and 0.2, respectively, with 95% confidence limits of 0.3 to 0.7 and 0.1 to 0.5) and for pelvic inflammatory disease. Women were four times as likely to be using depot medroxyprogesterone acetate when they were hospitalized with carcinoma in situ of the cervix, but depot medroxyprogesterone acetate users with at least 3 years of use were less likely to be hospitalized for carcinoma in situ than comparable groups of oral contraceptive and intrauterine contraceptive device users.

Adolescent↗
PubMed1985

Interval tubal sterilization in obese women--an assessment of risks.

Obesity is considered to be a complicating factor in most surgical procedures, but very few studies have investigated whether this is true for tubal sterilization. We used a large international data set to investigate the effect of obesity on tubal sterilization. Each of the 159 women delineated as obese (greater than 50% above the mean ideal weight) was matched with a woman of normal weight on important provider variables such as center, operator, and type of surgical procedure. Incidences of anesthesic, surgical, and early postsurgical complications were comparably low and of a mild nature for both the obese and the nonobese groups. Incidence of surgical difficulties was higher, and as a result, the technical failure rate was also higher and the surgical time longer for obese women than for nonobese women. However, none of these surgical difficulties or technical failures led to serious consequences. The difference in surgical times was small and is probably of little practical significance. It appears that the surgical difficulties of tubal sterilization in moderately obese women can be easily overcome.

Anesthesia↗
PubMed1985

Expulsions in immediate postpartum insertions of Lippes Loop D and Copper T IUDs and their counterpart Delta devices--an epidemiological analysis.

In this paper, an epidemiological analysis was performed, using an international data set, exclusively on the expulsion problem associated with postpartum IUD insertions. The inserter's experience in postplacental insertions is probably an important determining factor for IUD expulsions. Immediate insertions (within 10 minutes after placental delivery) are possibly associated with lower expulsion rates than later insertions (eg. two to 72 hours after placental delivery) during the woman's postpartum hospitalization. No significant differences were detected between the standard Lippes Loop D and Copper T IUDs and their counterpart Delta devices specifically designed for postpartum use, between the two types of Delta device or between the hand and inserter methods. A case-control analysis also did not detect any significant association between IUD expulsions and mild complications occurring or management performed during the third stage of labor and delivery. The practical implications of these findings, the methodologic problems of this analysis and future research strategies are also discussed.

Adult↗
PubMed1984

Interval insertion of intrauterine device in women with previous cesarean section.

The cesarean delivery rate is increasing worldwide. The effect of previous cesarean section on the performance of IUDs is considered in a group of 318 women with 1+ cesarean deliveries who were matched by center, device type, age and parity with 617 women with no history of cesarean section. All insertions were performed at least six weeks after termination of the woman's last pregnancy. No statistically significant differences in expulsion rates or other pertinent event rates were detected. Two delayed uterine perforations, one in each group, were identified. The findings are, in general, reassuring for the efficacy and safety of interval insertion of IUDs in women with previous cesarean section.

Adult↗
PubMed1984

Is lactation a risk factor of IUD- and sterilization-related uterine perforation? A hypothesis.

A recent article reported a high risk of IUD-related uterine perforation in lactating women in the U.S. This article prompted the authors to examine the large international datasets on IUDs and tubal sterilizations collected by Family Health International. The findings are somewhat suggestive of such a positive association in IUD users as well as in women undergoing laparoscopic or minilaparotomy sterilization. More definitive studies are urged.

Breast Feeding↗