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Failure of Implanon contraception in a patient taking carbamazepin for epilepsia.

Until now, no pregnancies have been reported in association with the implantable hormonal contraceptive Implanon (Organon, Roseland, NJ, USA), resulting in a pearl index of 0. We present a 24-year-old patient who conceived despite the correct application of Implanon for one and a half year. The patient was concurrently taking carbamazepin for epilepsia. Special care should be taken to patients demanding hormonal contraceptives while taking carbamezepin. Even Implanon seems to possibly fail in this combination.

Adult↗

Survey of 3,000 unwanted pregnancies.

A survey of 3,000 unwanted pregnancies disclosed two main populations differing in age, marital status, and contraceptive practice. Failure to use contraception accounted for two-thirds of the pregnancies. More than half of the patients were married women or single women in stable relationships, but many single women faced their predicament alone, without help from partner or parent.Some evidence is given of valid needs which could not be met by existing N.H.S. facilities.

Abortion, Legal↗

Failure in intrauterine contraception. Analysis of 137 cases of unfavourable outcome.

137 cases of unfavourable outcome in IUD insertion (i.e. early removal or expulsion because of complications) were investigated as regards age, parity, previous intrauterine contraception, previous induced abortion, type of device inserted, and type of complications observed. Moreover, this group was compared for each feature mentioned with a control group of 454 women who successfully concluded the prescribed period from the insertion. All the devices were inserted with a significantly higher rate of favourable outcome in pluriparous versus nulliparous patients; age probably didn't affect the outcome, but strongly conditioned the prevalence of particular complications such as PID and abnormal bleeding. Progesterone-loaded IUD didn't show a more favourable outcome than copper devices.

Adult↗

Female sterilisation: National Women's Hospital 1988-9.

AIM: To determine the failure rate of all female sterilisation procedures performed at National Women's Hospital in order to identify ways of improving the service. METHODS: A review was made of all sterilisation procedures performed at National Women's Hospital in 1988 and 1989. All patient notes and theatre records were examined. A consumer questionnaire was mailed to all patients monthly for 3 months. If there was no response efforts were made to contact these women via their last known general practitioner. Epsom Day Hospital where 95% of all terminations of pregnancy in Auckland are performed also examined their records. RESULTS: 1094 procedures were performed at National Women's Hospital in Auckland during 1988 and 1989. Failures were classified into two groups: those pregnant at the time of surgical procedure (administrative failures) and those pregnant after the procedure (surgical failure). There were 15 surgical failures (1.4%). Laparoscopy using Filshie clips was the most common method used and had a 1.2% surgical failure rate. Registrars had a 1.3% failure rate, consultants 1.9% and when both a consultant and registrar performed the procedure a failure rate of 0.7% was recorded. Eighty-six percent (6/7) of women who had a subsequent laparotomy after a failed sterilisation were found to have surgical misapplication of the occlusive device. There were 7 (0.6%) women who were pregnant at the time of the procedure. There were no patient or procedure-related factors which were associated with failures. CONCLUSION: Sterilisation is associated with a significant failure rate. Contraception counselling at the time of booking for the procedure needs to be improved. Preoperative pregnancy testing should be introduced to avoid sterilisation procedures in early pregnancy. Surgical misapplication of devices was a common cause of failure, not recanalisation as found elsewhere. From this review it would appear that the involvement of two surgeons lowers the failure rate.

Female↗

[Interactions between oral contraceptives and other drugs].

Failures of oral contraceptives are possible when combined with rifampicin or antiepileptics, especially phenobarbitone and phenytoin. The mode of action is shown by clinical trials to be due to induction of hepatic enzymes thus increasing the steroid metabolism. Failure or oral contraceptives has occurred with the concomitant use of antibiotics, i.e. ampicillin and sulfonamides. Clinical trials have focused upon the changes in the intestinal flora induced by antibiotics. This might influence the enterohepatic circulation of estrogen and thereby decrease reabsorption of estrogen, but this has not been definitely proved. The failures may be caused by individual pharmacokinetics of oral contraceptives. Oral contraceptives are able to influence the pharmacodynamics of various other drugs metabolized by oxidation or conjugation but besides an increased pharmacological effect of prednisolone and increased toxicity of imipramine the clinical importance is uncertain.

Anti-Bacterial Agents↗

Twice-failed tubal ligation: a case report.

The case is presented of a twice-failed tubal ligation in a woman with six previous children. The first failure followed laparoscopic tubal occlusion by silastic falope rings, while the second failure was subsequent to tubal ligation and division via minilaparotomy. No similar reports have been reported in the East African Literature. Possible reasons for failure are discussed.

Adult↗

[Use of a monthly calendar for collecting retrospective data on contraception: an evaluation of the experimental field studies of the Demographic and Health Surveys (DHS)].

A methodological experiment was conducted as part of the Demographic and Health Surveys (DHS) project to determine whether different approaches to measuring the same variables would yield similar results. The experiment consisted of the use of a new questionnaire, incorporating variants of many of the traditional approaches to the collection of demographic and health data. The experimental questionnaire was applied in 2 countries, Peru and the Dominican Republic at the same time as the standard survey. The most salient feature of this new questionnaire pregnancies, contraceptive practice, and postpartum, marriage, employment, and migration information. In this paper, the authors evaluate whether the use of the calendar in the experimental questionnaire improved the quality of the resulting information on contraception in the DHS surveys from the abovementioned countries. Specifically, the author determine whether the monthly calendar led to better estimates of contraceptive prevalence, failure, and discontinuation, and discuss the advantages and drawbacks of the calendar over the more standard approach. Results from this evaluation suggest that the major advantages of the calendar over the more standard questionnaire are 3-fold: it allows for more complete reports of use for periods prior to the survey; it allows for a detailed study of contraceptive use patterns; and it obtains information which is more internally consistent with other types of information. On the bases of these findings, the DHS project will include a calendar in the new standard questionnaire to be used in the 2nd round of surveys (DHS II).

Americas↗