[Intrauterine devices].
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Report on a 33 year old gravida 3 para 2 which was referred at 24 weeks gestation by ultra-sound with an intra-uterine device in place. The patient was referred for therapeutic abortion ab 10 weeks gestation by dates. Since the pregnancy was in fact 24 weeks the risks were explained to the mother and continuation of the pregnancy recommended. At approximately 36 weeks gestation a healthy make infant 2600 grams was delivered by double footling breech spontaneous delivery. A cavernous hemangioma of the right knee was probably not due to the intra-uterine device but an incidental occurance. The Copper-T intra-uterine device was removed under general anesthesia fourteen weeks following delivery.
Data from the 1991 National Survey of Men indicate that about 12% of married men aged 20-39 have had a vasectomy and about 13% are married to a woman who is sterilized. Multivariate analyses indicate that the likelihood of sterilization rises with husband's age, wife's age, duration of marriage and number of children. Black couples are significantly less likely than white couples to rely on sterilization, and interracial couples are less likely than same-race couples to be sterilized. The likelihood of reliance on vasectomy rather than tubal ligation also rises with husband's age, while black men are significantly less likely than white men to elect male over female sterilization. Use of male sterilization is strongly associated with having had a recent contraceptive failure while using a male method.
A 28-year-old woman who was treated for vaginal candidiasis with Gyno-Daktarin vaginal capsules (miconazole nitrate) became pregnant because a condom used during intercourse had ruptured. Incubation in vitro with 400 and 1200 mg miconazole nitrate vaginal capsules (Gyno-Daktarin 3 and Gyno-Daktarin I), but not miconazole nitrate vaginal cream (20 mg/g), was shown to damage rubber condoms. Patients using vaginal medicines should be aware of a possible adverse effect on rubber condoms or contraceptive diaphragms and a subsequent increased risk of pregnancy or contagious diseases such as AIDS. Fatty excipients such as glycerin, paraffin, petrolatum or Witepsol may be involved.
Subdermal Norplant-2 implantation, developed for contraception based on sustained release of levonorgestrel, has already been conducted in many countries around the world. From October 1986 to November 1988, a total of 267 female volunteers were enrolled in Norplant studies at the National Taiwan University Hospital. After a follow-up of 36 months, only one of the 231 evaluable cases (0.4%) became pregnant. The continuation rate was 84.5%, 61.3%, and 52.0% at the end of 12, 24 and 36 months after insertion, respectively. Menstrual problems were the most common adverse effects and were also the main reason for discontinuation. In the 23 patients who wished to become pregnant, fertility occurred soon after removal of the Norplant implant. After insertion, serum total cholesterol and triglyceride levels significantly decreased and the hemoglobin concentrations were increased. No liver or renal toxicities were detected. The data suggest that Norplant-2 is a highly effective, safe and long-acting method of reversible contraception. It would be worthwhile to introduce this contraceptive system into Taiwan's family planning program.
According to a thorough follow-up investigation of 2,002 sterilized women with an unusually high response of 94.3%, sterilization is by far the most reliable method of contraception (failure rate about 1 per thousand), largely free from danger (mortality less than 1 per thousand), and associated with less morbidity (somatic 1.4%, psychosomatic 2.4%, psychic 1.4%, sexual 2.8%, familial 0.8% and multiple complications 0.7%) whose improvements of 30 to 70% contrast in the areas mentioned. Psychic and familial stabilizing impulses arise form a sexuality freed from anixiety, so that the earlier medical reserve is unjustified.
In a consecutive study of 100 women with the surgical diagnosis of ectopic pregnancy confirmed by histologic examination, 7 women were found to have had prior tubal sterilization surgery. In 3 of these cases the sterilization procedure was bilateral tubal fulguration. The diagnosis of ectopic pregnancy must be given careful consideration if patients conceive after a tubal sterilization procedure of any type.
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In a group of 159 women at Santiago du Chili, fertility control by means of chemical occlusion of the utero-tubular junction was assessed. Two transcervical intra-uterine insertions of 216 mg of quinacrine, carried out at an interval of one month and associated with 50 mg of intra-uterine diclofenac and 150 mg of intra-muscular diclofenac resulted in a pregnancy rate after 12 months of 2.1 per 100 women and a Pearl index of 1.63 at 27 months after the sterilization process. The complications and adverse events appear to be similar to those which occur during insertion of an IUD and were minor and transient, disappearing within a few hours or at most 2 days after the procedure.
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Reviewing literature the fate of 3027 pregnancies with intrauterine devices in situ, included 43 own cases, is reported. The data strongly suggest to remove the intrauterine devices as early as possible in pregnancy, because otherwise the rate of spontaneous abortion, premature birth and stillbirth is negatively affected. The known elevated risk of extrauterine pregnancies is corroberated. The ratio of 1:4 with the progesterone-T is higher than with other IUDs (1:31 to 1:24,5). The observations do not support the view that intrauterine devices cause malformations. From the results instructions for the management of pregnancies associated with intrauterine devices are set up.
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Contraceptive continuation rates-the rates at which people continue to use a particular contraceptive method-can be a great help in determining whether a family planning program is effective or whether new contraceptive methods should be introduced. Until now, very little systematic work has been done to study contraceptive continuation rates in Latin America. The present article reports the results of one of the few existing studies on this subject, which examined the IUD experiences of women admitted to a large family planning clinic in Guatemala City. The study showed that these experiences compared favorably with the IUD experience of groups previously studied in Costa Rica, Taiwan, and the United States.
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Universal ethical principles can be used to analyse problems in reproductive health. The principle of beneficence obligates people to strive to bring about more beneficial consequences than harmful ones. The principle known as respect for persons presumes that all human beings have dignity and are worthy of respect. Showing equal respect for women as persons means recognizing their autonomy and treating them as capable decision-makers and full participants in medical decisions. A third leading concern of bioethics is justice, which requires a fair distribution of family planning methods, including access to safe abortion in cases of contraceptive failure.
With the aid of the carbon dioxide hysteroscope, 152 patients underwent transuterine tubal sterilization. 106 women had high frequency current coagulations of the tubes. At follow-up examinations 62 tubes were occluded and 30 showed a unilateral tubal occlusion. These results did not improve by using the thermo coagulation method since only 10 out of 24 patients showed bilateral tubal occlusion and two unilateral tubal occlusions. Up to 20 months following the transuterine tubal sterilization, 28 of the 152 women became pregnant. Of these, 16 became pregnant in spite of hysterosalpingographic evidence of bilateral tubal occlusion. Two patients required emegency laparotomies because of small bowel injuries. Within the coagulation times and temperature ranges used in this series, the results of trans-uterine tubal sterilization are unsatisfactory. It is possible that other types of hysteroscopic tubal sterilizations which are now being developed will be more successful.