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PubMedDate not supplied

Model-based approaches to studying fertility and contraceptive efficacy.

Statistical methods recently developed to aid in identifying environmental exposures with reproductive toxicity can also be applied to trials of interventions undertaken specifically to impair fertility, i.e. methods of contraception. Although only applicable in a trial that includes a reliable benchmark for identifying the day of ovulation, the proposed measures of contraceptive efficacy derived from such a trial offer certain interpretive advantages over the more traditional approaches of evaluating contraceptives. Extensions of the same models also allow one to evaluate efficacy under any assumed pattern of imperfect use. One can also evaluate methods based on biomarkers for the fertile phase of the cycle, such as hydration of the cervical mucus, that may prove to be enormously helpful to couples who wish to use periodic abstinence as their method. In prospective studies of fertility, couples who occasionally use a barrier method should not be excluded from the study, but can be retained, without biasing the estimates for fertility parameters.

Contraception↗
PubMed2002

Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases.

BACKGROUND: Ectopic pregnancy is still a major health problem among women of childbearing age in our community. The majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with previous induced abortion(s) and or pelvic inflammatory disease. It remains a major challenge to the reproductive performance of women worldwide. OBJECTIVE: The study is an analysis of the clinical profile of patients presenting with ectopic pregnancy, to investigate the current status of the incidence, predisposing risk factors and the management options available in Benin. MATERIALS AND METHODS: One hundred and fifty two cases of ectopic pregnancies managed at the University of Benin Teaching Hospital (UBTH) between January 1994 and December 1998 were analyzed. Clinical and socio-biological information were retrieved from patients' case notes, and supplemented by information from the operating theatre and ward registers. RESULTS: The incidence of ectopic pregnancy during this study period was 1. 68% of total births and 6.74% of and gynecologic admissions. Nulliparous patients were 49.3%, while the peak age of incidence was 20-25 years. 95/152 (62.5%) of the patients had previous induced abortion(s), while pelvic adhesions were noted in 62/152 (40.85 approximately %). 67.8% of the patients were not using any method of contraception, while 13.8% and 9.2% were using lUD and barrier methods, respectively. Abdominal pain, 2 degrees amenorrhoea and irregular vaginal bleeding (83.6%, 77.5% and 73.7%, respectively) were the most frequent presenting complaints. 75/152 of the patients (49.3%) were in a state of shock, and 80.3% had ruptured tubal pregnancy at presentation. All patients had laparotomy, 54.6% and 34.9% had right and left salpingectomy, respectively. 831/52 of the patients (54.6%) had autotransfusion during surgery. CONCLUSION: In Benin, the majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with history of previous induced abortion(s) and or pelvic inflammatory disease. Management option is limited to laparotomy and salpingectomy.

Abortion, Induced↗
PubMed2001

Arterial hypertension increases intracranial pressure in cat after opening of the blood-brain barrier.

BACKGROUND: Increased permeability for small solutes in brain capillaries means that a change in hydrostatic capillary pressure may influence transcapillary fluid exchange according to the Starling fluid equilibrium, and a high arterial pressure may cause transcapillary fluid filtration and raised intracranial pressure. This could be of clinical relevance in states of disrupted blood-brain barrier such as meningitis and after a severe head injury, especially since these patients quite often are spontaneously hypertensive, and hypertensive therapy is sometimes used to increase cerebral perfusion pressure. This study on cat investigated the long-term relation between arterial pressure and intracranial pressure in a state of disrupted blood-brain barrier. METHOD: Endotoxin was given intrathecally to open the blood-brain barrier and depress cerebral autoregulation. Arterial pressure was increased by about 30 mm Hg during 5 hours by dopamine and angiotensin II infusion. The immediate fall in intracranial pressure after normalization of blood pressure reflects the blood volume component of an intracranial pressure increase. RESULTS: Increased arterial pressure had no effect on intracranial pressure before endotoxin. Endotoxin infusion increased intracranial pressure from the normal value of 10 to 12 mm Hg. and at steady state by almost 10 mm Hg. Intracranial pressure increased further after the arterial pressure increase. At steady state (achieved within 5 hours), this increase was almost as great as the arterial pressure increase, and about 80% persisted when measured directly after normalization of the arterial pressure. CONCLUSION: Increased arterial pressure in a state of disrupted blood-brain barrier increases intracranial pressure, mainly because of brain edema. This stresses that arterial hypertension may be deleterious in conditions such as meningitis or after a brain trauma.

Angiotensin II↗
PubMed1990

[Do male and female physicians give the same contraception guidance?].

A questionnaire on their practice regarding ordination of contraceptive methods was answered by 239 (75%) of the general practitioners in the three northern most counties of Norway. The female doctors reported a higher frequency both of female patients and of consultations for birth control, and were more active in these consultations than their male colleagues. Female doctors suggested more methods to their patients, and had a more positive attitude to barrier methods. 61% of the male doctors and 27% of the female doctors had no experience of fitting diaphragms.

Adult↗
PubMed1984

Mortality among young black women using contraceptives.

Data on the risk of death associated with various contraceptive methods are incomplete. Therefore, we analyzed the mortality rates for young, black inner-city women who used one of four methods of contraception--oral contraceptives, depomedroxyprogesterone acetate, intrauterine (contraceptive) devices, and barrier methods. The subjects were 30,580 15- to 44-year-old women who enrolled at a family planning clinic between 1967 and 1972 and who were observed by monitoring death certificates through the end of 1977. Forty percent of the 218 deaths observed were from accidents and violence. Use of this family planning clinic greatly reduced the risk of death from childbearing; only two deaths were associated with pregnancy and childbirth, compared with the 24 deaths expected. Overall, users of the four methods died at similar, low rates. Given that this study involves considerable loss to follow-up, possible acute effects of contraceptives (eg, infections or thrombosis) are more accurately estimated than possible long-term effects (eg, cancer).

Adolescent↗
PubMed1994

Teenagers and sex: a suitable case for education.

Approximately 1:5 sexually active girls become pregnant by the age of 20, and one-third of these pregnancies end in termination. Low income and low social class are associated with high rates of contraceptive failure. Sexually active girls who have received sex education are significantly more likely to use an effective contraceptive method. Girls around the age of 18 are usually highly fertile. Barrier methods used over at least five years reduce the risk of cervical cancer. Mortality and morbidity rates are high in babies born to young teenage mothers.

Adolescent↗
PubMed1993

Diabetes mellitus and fertility control: contraception management issues.

The need to prevent complications in the woman and fetus mandates that pregnancies in diabetic women always be planned and that safe and effective contraceptives be used at all times until it is determined that pregnancy is a safe and desired option. Pregnancy may aggravate complications of diabetes such as retinopathy and coronary artery disease. A pregnant diabetic woman is also more likely to experience such complications as hypertension, urinary tract infection, polyhydramnios, and cesarean section. Her fetus is at increased risk for congenital malformations, prematurity, stillbirth, neonatal morbidity, and diabetes later in life. Good diabetic control must be maintained before and throughout the pregnancy to minimize the risk of these and other complications. Until such time as good control is achieved and the woman desires pregnancy, a reliable method of contraception should be used. Most recent research supports the use of barrier methods, low-dose monophasic or triphasic oral contraceptives, or progestin-only methods, at least for the short-term. Under some circumstances the intrauterine device may be an appropriate option. Long-term data regarding the use of these methods is lacking. The decision regarding which method of contraception is used should be made by the woman in consultation with her physician.

Contraception↗
PubMed2003

Economic analysis of contraceptives for women.

OBJECTIVE: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States. METHODS: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables. RESULTS: Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively. CONCLUSION: From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.

Adult↗
PubMed2002

Oves contraceptive cap: short-term acceptability, aspects of use and user satisfaction.

OBJECTIVE: To assess the short-term acceptability, aspects of use and user satisfaction with the Oves cap. DESIGN, SETTING AND SUBJECTS: A multicentre observational study, commissioned by Veos Ltd, manufacturers of the Oves cap, was carried out by the UK Family Planning and Reproductive Health Research Network in collaboration with the Institute of Population Studies, University of Exeter, Exeter, UK. Women from ten Network centres and one collaborating centre were invited to participate. Following an assessment by vaginal examination women were fitted with the cap and taught self-fitting by a doctor. The women were asked to use the cap six times in 8 weeks. Participants were asked to complete four questionnaires on various aspects of cap use including Likert-type measures and open-ended questions on experiences with the cap. Doctors were asked to complete a first visit and follow-up questionnaires. Women were self-selected clients in the participating centres. Women aged 18 years and over, gynaecologically healthy, using hormonal contraception or sterilised were eligible for the study. Thirty-five women were enrolled and fitted with the cap; 20 chose to participate in the study. MAIN OUTCOME MEASURES: Ease of fitting and removal of the cap expressed in structured and open-ended questions by both cap users and doctors; satisfaction of women and partners with the cap, measured by desire to use the cap in the future and by premature withdrawal from the trial. RESULTS: Twenty women used the cap on a total of 84 occasions. Four women completed the trial of six uses. While most doctors did not have difficulty with fittings or removals, 10/20 Oves cap users reported some difficulty in fitting it over the cervix and 12 reported some difficulty removing it in the first three uses. Fewer women had difficulty in fitting in uses 4-6 but nearly half continued to have some difficulty with removals. CONCLUSIONS: Few women indicated that they would use the cap in the future. However, most women were satisfied with their current method of contraception. The study raises the question whether women using non-barrier methods of contraception and satisfied with their current method of contraception are the appropriate target recruits for a trial such as this, even in the absence of robust efficacy data.

Adult↗
PubMed2006

[Effect of 1, 2-dichloroethane on blood brain barrier].

OBJECTIVE: To investigate the effect of 1, 2-dichloroethane (1, 2-DCE) on blood brain barrier. METHODS: Acute toxic encephalopathy model was copied with the consecutive static inhalation of 1, 2-DCE. The water content of brain tissue was measured, and the blood brain barrier permeability was detected with lanthanum nitrate. The brain microvascular endothelial cells and neuroglial cells were cultured in vitro, which were administrated with 1, 2-DCE. The cell morphologic structures were observed under light microscope and electron microscope. RESULTS: (1) The extracellular edema was most found in the cerebral tissue and the leakage of lanthanum particles through the barrier were found with the lanthanum tracking method. (2) The water content in cerebral cortex in the moderate and high dose groups was significantly higher than that in the control group and became severer with the increases of the intoxicated time. The water content in cerebral medulla was significantly increased only at 6 hours after the intoxication. (3) The normal morphological structure of brain microvascular endothelial cells and neuroglial cells could be injured by 1, 2-DCE, and the injury to neuroglial cells caused by 1, 2-DCE occurred earlier and severer than that to brain microvascular endothelial cells. CONCLUSION: 1, 2-DCE can damage blood brain barrier and induce cerebral edema.

Administration, Inhalation↗
PubMed2000

Characterization of graft-versus-host disease in SCID mice and prevention by physicochemical stressors.

BACKGROUND: Graft versus host disease (GVHD) prevents potentially curative allogeneic stem cell transplantation from being offered to cancer patients who lack a suitably matched donor. New methods to prevent GVHD are required to allow successful transplants across major histocompatibility complex barriers. METHODS: A model of GVHD in C.B-17 SCID mice was developed to allow the study of allo-activated donor T cells without confounding effects of host lymphocytes. The abilities of cyclosporin-A, anticytokine antibodies, and oxidative stress to prevent GVHD in this model was studied. RESULTS: T cells from major histocompatibility-mismatched donor mice caused severe GVHD in sublethally irradiated SCID hosts that could be ameliorated by coadministration of donor bone marrow but not by cyclosporine-A or anticytokine antibodies. In contrast, three-log more T cells could be injected without clinical consequences if they had been pretreated with a combination of heat, ultraviolet light, and oxygenation. The effect was not the trivial result of donor T cell destruction because T cell reconstitution, although delayed, recovered to normal levels within 2 weeks. Protection from GVHD required oxygenation and was associated with normalization of the CD4/CD8 donor T cell ratio, recovery of host hematopoiesis, and decreased inflammatory cytokine production. CONCLUSION: Pretreatment of donor T cells with a combination of physicochemical stressors effectively prevents GVHD caused by major major histocompatibility disparities and may facilitate the safe transplantation of patients without HLA-identical donors.

Animals↗
PubMed1994

Contraceptive efficacy and acceptability of the female condom.

OBJECTIVES: The purpose of the study was to determine the contraceptive efficacy of the female condom and to provide data about the device to the US Food and Drug Administration. METHODS: The clinical trial was conducted at six US sites and three sites in Latin America. Eligible subjects were in mutually monogamous relationships and agreed to use the female condom as their only means of contraception for 6 months. RESULTS: A total of 328 subjects contributed to the analysis of contraceptive efficacy. Twenty-two US subjects and 17 Latin American subjects became pregnant, yielding 6-month gross cumulative accidental pregnancy rates of 12.4 and 22.2, respectively. During perfect (consistent and correct) use of the method, the 6-month accidental pregnancy rates were 2.6 and 9.5 for the US and Latin American centers, respectively. There were no serious adverse events related to the use of the method. CONCLUSIONS: The female condom provides contraceptive efficacy in the same range as other barrier methods, particularly when used consistently and correctly, and has the added advantage of helping protect against sexually transmitted diseases.

Adult↗
PubMed1994

[Prevention of conception in adolescence].

The adolescent girl needs affection and understanding for all of her problems. She often does not find a satisfying measure of both in her familiar surroundings. Very often sex instruction is faulty, although the AIDS campaigns have led to remarkable improvements (condoms). Instructions for sexual behaviour should take place at home or at school, but not in the street. Nevertheless, the first intercourse occurs mostly unprotected. Teenage pregnancies present not only physical but also psychological problems. Termination of pregnancy means an especially difficult decision for the adolescent girl, often causes crisis and occasionally leads to negative consequences for later fertility. The choice of appropriate contraceptive methods for girls under 16 years of age may also have legal problems. Condoms and barrier methods are possible alternatives to the much safer hormonal contraception with the combination, sequence or minipill. Under certain circumstances, a progestin injection every three months or the 'morning-after pill' as postcoital contraception or, in the case of an abortion or of pregnancy termination, even an intrauterine device can be an alternative for adolescent girls under those exceptional circumstances.

Abortion, Induced↗
PubMed1996

Use of adhesion prevention barriers in ovarian surgery, tubalplasty, ectopic pregnancy, endometriosis, adhesiolysis, and myomectomy.

Intraperitoneal barriers reduce adhesion by preventing the formation of fibrin bridges between healing tissues. Although barriers were shown to be safe and effective in all human clinical trials, their use did not eliminate adhesions in all patients. Although barrier methods are the most effective technique for the prevention of adhesion reformation, efficacy of the barriers is limited to surgical situations where the area in question can be covered completely. Acceptance by physicians is constrained by technical difficulties including the need for hemostasis and removal of excess peritoneal fluid as well as concerns regarding fixation techniques and subsequent removal of the barrier.

Adnexal Diseases↗
PubMed1996

Contraceptive Options for Perimenopausal Women.

A number of safe and effective contraceptive choices exist for the perimenopausal woman. With increasing experience, we have learned that hormonal methods are safer than initially thought, particularly with the lower-dose formulations currently prescribed. Furthermore, the pill offers many noncontraceptive health benefits. And while progestins, in contraceptive doses, have a slight adverse impact on the lipoprotein profile, there has been no parallel increase in clinical cardiovascular disease. Since elimination of the Dalkon shield, the IUD has been recognized as a very safe and effective method of contraception; the risk of associated infection seems primarily related to the insertion procedure. Barrier methods provide somewhat reliable contraception, with varying degrees of added protection against STD. The decreased fertility rate among perimenopausal women allows some latitude when contraceptive methods with suboptimal efficacies are selected; however, unintended pregnancy is a significant problem for women older than 40 years, should it occur. Surgical sterilization remains the most popular form of contraception among perimenopausal-aged couples. Natural family planning techniques are safe and somewhat underutilized. All women should be counseled about the availability of postcoital contraceptive methods.

Journal Article↗
PubMed2005

Combination injectable contraceptives for contraception.

BACKGROUND: Combination injectable contraceptives provide a highly effective, reversible method of preventing pregnancy, and they do not require daily administration or use at the time of coitus. Although they are used in many countries, their acceptability could be limited by method characteristics, such as the need to obtain a monthly injection or bleeding pattern changes. OBJECTIVES: To assess the contraceptive efficacy, bleeding patterns, discontinuation, user preferences, and side effects of combination injectable contraceptives. SEARCH STRATEGY: We searched computerized databases for randomized controlled trials of combination injectable contraceptives. SELECTION CRITERIA: Randomized controlled trials reported in any language were eligible if they compared a combination injectable with any other contraceptive method (e.g., a second combination injectable contraceptive, progestin-only injectable contraceptive, other hormonal contraceptive or barrier method) or placebo. We limited the review to currently marketed combination injectable contraceptives. DATA COLLECTION AND ANALYSIS: The primary reviewer evaluated all titles and abstracts from the literature searches to determine their eligibility. Two reviewers independently extracted data from the eligible trials. Data on contraceptive efficacy, bleeding patterns, continuation, and side effects were entered and analyzed with RevMan 4.2. MAIN RESULTS: Combination injectable contraceptives include depot medroxyprogesterone acetate (DMPA) 25 mg plus estradiol cypionate (E(2)C) 5 mg, as well as norethisterone enanthate (NET-EN) 50 mg plus estradiol valerate (E(2)V) 5 mg. These combination injectable contraceptives resulted in lower rates of early study discontinuation due to amenorrhea or other bleeding problems, but had higher rates of discontinuation due to other reasons than the progestin-only comparison contraceptives. Studies comparing two combination injectable contraceptives found that NET-EN 50 mg plus E(2)V 5 mg resulted in less overall early discontinuation and less discontinuation due to amenorrhea or prolonged bleeding than DMPA 25 mg plus E(2)C 5 mg. However, these differences were not detected in all trials making this comparison. The NET-EN plus E(2)V group also had more cyclical (regular) bleeding and fewer prolonged bleeding reference periods than the DMPA plus E(2)C group. The groups did not differ in their amenorrhea rates. AUTHORS' CONCLUSIONS: While discontinuation rates can be viewed as a measure of method acceptability, the findings should be interpreted with caution since discontinuation rates are dependent on many other factors. Future research should be directed toward interventions to improve the acceptability of combination injectable contraceptives, such as providing injections in settings more convenient than clinical sites, methods for women to administer their own injections, and counseling about possible bleeding pattern changes.

Algestone↗
PubMed2000

Effects of five different barrier materials on postsurgical adhesion formation in the rat.

Postsurgical adhesion formation is a significant clinical problem within every surgical specialism. Due to the problems that adhesions cause, a wide variety of adjunctive treatments to prevent the formation and reformation of adhesions have been proposed. One of the modalities that has been studied extensively and that has been showing the most promising results is the so-called barrier method. The purpose of the present study was to compare the efficacy of five of these barrier materials in the prevention of postsurgical adhesion formation in a standardized rat adhesion model. It was concluded that no beneficial effect of Ringer's lactate on adhesion formation was seen. Significant reductions (P < 0.0001) in adhesion percentages compared to control animals were seen with Polyactive((TM)), PRECLUDE Peritoneal Membrane((TM)), Seprafilm((TM)) and Tissucol((TM)), but only PRECLUDE Peritoneal Membrane and Seprafilm significantly reduced adhesions (P < 0.01) when the barrier-treated peritoneal defects were compared with contralateral control-side peritoneal defects. The results of our study suggest that Seprafilm and PRECLUDE Peritoneal Membrane are superior to Tissucol and Polyactive in preventing adhesion formation. When Polyactive was still attached to the site of application during the second laparotomy, similar results to Seprafilm and PRECLUDE Peritoneal Membrane were seen. Future studies on the efficacy of a material to decrease adhesion formation should always include a comparison of several control materials in the same model. Our study indicates that Seprafilm or PRECLUDE Peritoneal Membrane might be used as standards of control.

Analysis of Variance↗
PubMed1989

Fertility, menstrual characteristics, and contraceptive practices among white, black, and Southeast Asian refugee adolescents.

This study compares fertility and menstrual characteristics and contraceptive practices of white, black, and Southeast Asian refugee adolescents participating in the Minneapolis Health Department's Maternal and Infant Care Program between 1980 and 1982. Mean ages were similar among all racial groups; however, half the Hmong adolescents had a live birth as compared to less than 25% of the other racial groups. More than 75% of the Hmong and other Southeast Asian adolescents were married as compared to 11% of the whites and 8% of the blacks. Menarche was significantly later (2 years) for Hmong and other Southeast Asians, and the interval between menarche and first pregnancy was significantly shorter for the Hmong. While more than half of the whites and blacks previously used contraception, 14% of the Hmong and 29% of the other Southeast Asians had used contraception. Oral contraceptives were the most frequently used method for whites, blacks, and Southeast Asians; the Hmong were equally likely to choose oral contraceptives or barrier methods. The Hmong were less likely to choose contraception postpartum than were the other groups.

Adolescent↗