[Recommendations for prescribing postcoital contraceptives].
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Biomedical subjects
Publications and source records attributed to V Unzeitig.
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OBJECTIVE: Prediction of complexion changes in users of triphasic oral contraceptive containing norgestimate. DESIGN: Analysis of data from a prospective multicentre open study. SETTING: Department of Obstetrics and Gynaecology, Charles University, Prague. METHODS: Acne severity was evaluated in users of a triphasic norgestimate-containing contraceptive within a six month period. Based on subjective evaluation of acne, three subgroups of patients were selected: A) users where acne improved or disappeared; B) users in whom acne deteriorated, C) users who newly developed acne. Differences between group A and the other groups were established in the proportion or distribution of parameters related to the etiology of acne: age, weight, weight changes during the study, presence of hirsutism, presence of a regular menstrual cycle prior to the start of hormonal contraception use, and smoking. RESULTS: The effect of the pill use on acne was assessed in a total of 3,990 women. Out of 1,201 women with acne before the start of the study, improvement or disappearance of acne during the study was reported by 940 users (subgroup A) (78.27%). In 221 women (18.40%), the extent of acne remained unaltered whereas it increased (subgroup B) in only 30 women (2.50%). Acne newly developed during the study in 49 women (subgroup C), i.e., in 1.2% of the whole group. Users showing deterioration of acne (subgroup B) were found to have hirsutism less frequently. The subgroup even showed a decrease in mean weight during the study. Users with newly developed acne were--compared with subgroup A--significantly older, had a lower weight at the start of the study, and showed a higher frequency of regular menstrual cycles prior to starting hormonal contraception. The differences in the incidence of clinical parameters in the subgroups reached only borderline statistical significance and, hence, are not relevant. CONCLUSION: An extensive multicentric study confirmed the beneficial effect of a triphasic norgestimate-containing contraceptive on complexion. The presence of clinical parameters related to the etiology of acne does not allow to predict the individual response of the skin to hormonal therapy.
OBJECTIVE: To assess the frequency of factor V Leiden in oral contraceptive users and to define possible anamnestic data that could predict the presence of factor V Leiden. METHODS: Between 1997 and 1998, 583 users of oral estrogen-progestin contraceptives with no history of thrombotic disease were examined. Factor V Leiden was assessed by PCR after isolating DNA from a peripheral venous blood sample. Among other factors, such things as a family history of thromboembolic disease, myocardial infarction and/or stroke in a first-degree relative were monitored. In 448 users cardiovascular complications were evaluated during six months of oral contraceptive use. The data were analyzed using a MS Excel program. P-values were assessed by pair-tests and chi-square tests. SETTING: 1st Department of Obstetrics and Gynecology of Medical Faculty, Masaryk University, Brno. RESULTS: Factor V Leiden frequency was 6.5% in the study group. There were no differences between carriers and others in age, body weight, body mass index and blood pressure. Carriers had significantly more frequently positive family histories of thromboembolic disease or myocardial infarction or stroke. There were no cardiovascular complications observed in a group of 448 users. The positive family histories of any of the above-mentioned conditions have high specificity (97-99%) and a negative predictive value (0.94) with a low sensitivity (2.6-15.8%) in predicting factor V Leiden presence. CONCLUSION: We found a relatively high incidence of Factor V Leiden among oral contraceptive users without a history of thrombotic disease. Through a positive family history of thromboembolic disease or myocardial infarction or stroke, we can predict a Factor V Leiden presence with high specificity but low sensitivity.
OBJECTIVE: To evaluate maternal morbidity and mortality of women suffering from coarctation of the aorta as well as the perinatal mortality of babies delivered by women with this anomaly of the aorta. According to our experience we recommend a suitable form of a follow up and suggest an optimal mode of delivery for these patients. DESIGN: Original paper. SETTING: 1st and 2nd Department of Gynecology and Obstetrics of the Masaryk University of Brno--Maternity Hospital, Obilní Trh 11, 602 00 Brno, Czech Republic. METHODS: Our set consists of 34 pregnant women with coarctation of the aorta. These patients were followed up during the pregnancy in the years 1964-1998 by the Centre for Cardiovascular Diseases in Pregnancy in the Maternity Hospital in Brno. Seven women who were not operated on for the coarctation of the aorta (group A) were pregnant 14 times. Twenty seven women who were operated on for the coarctation (group B) had 50 pregnancies. RESULTS: There were no maternal deaths in our set. From the 12 delivered babies of women with non operated coarctation of the aorta one child was SGA (small for gestational age). From 42 babies born by women who underwent an radical operation of the coarctation of the aorta previously we had to face one death of a newborn who was SGA as well. CONCLUSION: The radical operation of the aorta should be carried out during the first year of age if possible, between the 9th to 12th month, at best. With women who were not operated on there is a greater risk of rupture of the aneurysm of the aorta and aneurysm of the cerebral arteries in the 2nd and 3rd trimester, during the labor and in the early puerperium. We would advise therefore a through follow up during the whole pregnancy. The high BP should be lowered medicamentally. As to the mode of delivery Caesarean section is preferred. With women who were successfully operated on in their early infancy and whose BP is normal or the systolic BP does not exceed 160 mmHg the Caesarean section is not mandatory but elective. We would mostly advise a spontaneous delivery with shortening of the 2nd stage of the labor by forceps or vacuumextraction--the delivery by Caesarean section in accordance with usual obstetrical practice.
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OBJECTIVE: To run a screening for genital chlamydiosis in adolescents living in the town Brno as the first action of this type in the Czech Republic and to use the results of the screening for the elaboration of recommendations for running similar actions on the national scale. DESIGN: Prospective epidemiological study. SETTING: Veterinary Research Institute, Brno; Institute of Clinical Biochemistry, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague; Section of Public Health, Municipal Authorities of Brno; Bioplus Ltd., Brno; Regional Hygienic Services, Brno; Faculty Hospital Brno; with technical assistance of teachers and students of two Medical Assistant Schools in Brno. METHODS: Students (337 females and 15 males) of two Medical Assistant Schools, older than 18 years, were used as probands within the study. Sediments of the first portions of urine collected from the individual probands were tested for the presence of Chlamydia trachomatis using the direct fluorescent test, ELISA, and the ligase chain reaction. RESULTS: Positive reactions in any of the three tests were found in 31 of the 352 probands (8.8%). Positive and doubtful reactions in the direct fluorescent antibody test were obtained in 11 (35.5%) and 3 (9.6%) of the 31 reactors, respectively. The corresponding values for ELISA were 9 (23.0%) and 8 (25.8%), respectively, and those for the ligase chain reaction 3 (16.6%) and 3 (16.6%), respectively. The overall prevalence of 8.8% is higher than the European mean. CONCLUSIONS: The first limited screening for genital Chlamydia infections in the Czech Republic was run in Brno. Urinary samples were collected from 337 females and 15 males aged approximately 18 years. The presence of Chlamydia trachomatis in the urinary sediment was demonstrated by the direct fluorescent test, ELISA, and the ligase chain reaction. The established prevalence of 8.8% exceeded the European mean (3.9%).
OBJECTIVE: To evaluate serum levels of liver enzymes and bilirubin before and after six cycles of use of a triphasic oral contraceptive containing 35 micrograms of ethinylestradiol and 180/215/250 micrograms of norgestimate (Pramino, Janssen-Cilag). DESIGN: A prospective, open-label, non-comparative, multicentric phase IV study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University, Prague. METHOD: Before the start and after six cycles of Pramino use, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GMT), and bilirubin were determined in women. As the analyses were performed in different laboratories, the evaluation involved: 1. Subgroups of women examined in laboratories with the same reference range; 2. A group of women examined in laboratories with the upper reference range within the mean +/- SD interval; 3. Percentage variations of the measured values from a concrete upper reference limit. RESULTS: When evaluating subgroups of women from laboratories with the same standards, significant decreases in AST and bilirubin were seen in some subgroups, a rise in GMT in one subgroup; the other changes were non-significant. When assessing the entire group and percentage variations from standard, a mild rise in GMT was again seen; however, the values remain deep within the normal range. Values above the upper reference limit at the start of the study either do not change significantly throughout the study, or they normalize spontaneously. CONCLUSION: No clinically significant changes in liver function tests occurred in users of a triphasic oral contraceptive containing norgestimate along with 35 micrograms EE over a period of six cycles of use. The results, as judged by their dynamics, suggest liver function tests are not a useful tool for routine monitoring a healthy combined oral contraceptive user.
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During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.
OBJECTIVE: To assess the efficacy, acceptability and safety of triphasic oral contraceptive pill containing norgestimate 180/215/250 micrograms and ethinylestradiol 35 micrograms. DESIGN AND SETTING: Prospective, open-label, non-comparative, multicenter study in 409 centers in the Czech Republic. METHODS: Body weight, blood pressure, bleeding pattern, headaches, nausea, breast tenderness, acne, pregnancies and side effects were monitored before the start of the treatment, after three and six cycles of oral contraceptive use. Liver function tests were carried out before and after the treatment. RESULTS: Evaluating 26,432 cycles in 4,720 women the theoretical Pearl index was 0.15. There were no significant changes in body weight (61.45 kg before vs 61.58 kg after the treatment). There were clinically significant changes neither in the blood pressure nor in the liver function tests. Evaluating the bleeding pattern there were similar incidences of irregular bleeding/spotting before the treatment and up to the third treatment cycle (16.15%, resp. 17.86%); then the incidence dropped down (8.41% after the third cycle). Amenorhea was very rare (0.41% resp. 0.35% up to, resp. after the third cycle). Decreasing incidences compared to pretreatment state were observed for headache, breast tenderness and acne. The effect on acne was remarkable (28.3% of women complaining of acne before the treatment vs 6.51% after the six treatment cycles). There were no serious adverse events observed during this study. CONCLUSION: Triphasic oral contraceptive pill containing norgestimate and ethinylestradiol proved in a large multicenter study high both efficacy and acceptability.
This article highlights health issues related to prostitution, with special reference to the situation in Europe. Strategies aimed at improving the health care of commercial sex workers, including programs for screening for sexually transmitted infections, are discussed. Problems related to failure to follow-up, particularly of mobile (migratory, international) commercial sex workers, are considered. Other topics covered include counselling on sexual risk reduction, including medical hotline telephone services and clinical outreach work. Counselling commercial sex workers on contraception, desired termination of pregnancy and hazards of illicit drug use are also highlighted. The public-health consequences of delivering poor health care to commercial sex workers are generally severely underestimated, particularly in societies where prostitution is illegal.
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UNLABELLED: Spasmolytics and spasmoanalgetic mixtures are administered to facilitate dilatation of the cervix during delivery and to shorten the first stage of labour. This medication is used in 70% deliveries at the 1st Dept. of Obstetrics and Gynaecology Masaryk University in Brno. The aim of the study was to analyze the spasmolytic effect on the process of cervix dilatation. The study comprises 108 uncomplicated deliveries (52 deliveries with spasmolytics and 56 deliveries without). We analyzed the effect of spasmolytics on the cervix, process of labour and outcome of delivery. Six kinds of spasmolytics were used, administered from once to four times during labour and most of them (85%) in the latent phase of the first stage of labour. In the group with spasmolytics there was statistically insignificant by prolonged active phase of the first stage of labour (126 vs 104 minutes) and more frequent administration of Oxytocin. Others parameters such as length of the second stage of labour, rate of birth injuries, the 1st minute Apgar score less than 7 and the necessity of neonatal resuscitation did not differ in the two groups. CONCLUSIONS: The application of spasmolytics did not significantly affect the process of delivery.
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OBJECTIVES: The survey was designed to study the attitudes of gynecologists from 11 European centers providing guidance in contraception to women at high risk and women with cardiovascular disease. METHODS: Attitudes were registered by means of a standard questionnaire. RESULTS: Most contributors reported that, in women with venous thrombosis (10/11), deep venous thrombosis (10/11), coagulation disorders (11/11) and stroke (8/11), they prefer to prescribe methods other than combined oral contraceptives (COCs). A history of myocardial infarction was considered a relative contraindication and some experts suggested that, in some cases, the use of third-generation COCs may be possible. COCs were not recommended in women with severe cardiovascular disease and in those over 35 years of age with light or moderate cardiovascular disease, heavy smokers (over 20 cigarettes per day), or those presenting with severe hyperlipidemia. CONCLUSION: The pill is not considered appropriate for women with clinically established cardiovascular diseases or in cases where more than two coronary risk factors exist. COCs may safely be given to women with elevated blood pressure as long as it is lower than 160/100 mmHg, in cases of light and moderate cardiovascular disease as long as the patient is less than 35 years of age, in women who are not heavy smokers, in the presence of a light or moderate degree of hyperlipidemia, and in uncomplicated diabetes mellitus provided that there are no additional risk factors. In these cases, third-generation COCs are preferred. The co-operation of the cardiologist is desirable in order to classify cardiovascular disease and for patient follow-up.