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Emergency contraception and prevention of induced abortion in India.

OBJECTIVE: Induced abortion is associated with high morbidity and mortality in India. Use of regular contraception with emergency contraception (EC) as backup can reduce the incidence of induced abortion. The study aimed to assess women's knowledge, practice, preference and acceptance of different contraceptive methods with special reference to the causes of induced abortion, and their willingness to use hormonal EC. METHODS: The study comprised a structured questionnaire survey conducted in the family planning clinic of a tertiary teaching hospital in New Delhi, India. A total of 623 women and three men seeking contraceptive advice and/or termination of pregnancy were interviewed. The main outcome measures were knowledge of different contraceptive methods including EC and the reasons for unintended pregnancy. RESULTS: More than 99% of the respondents knew about most of the modern methods of contraception whereas only 37 (5.9%; 95% CI 4.0-7.8) of the respondents knew about EC and none of them had ever used it. Contraceptive method failure led to unintended pregnancy in 39.1% (95% CI 33.7-44.5) of abortion seekers. Correct use of EC could have prevented nearly 65.5% (95% CI 57.0-74.0) of induced abortions due to contraceptive method failure and 25.6% (95% CI 20.7-30.5) of all induced abortions. CONCLUSIONS: More efforts are required to generate awareness about the safety, efficacy and availability of EC, regular use of effective contraception and the health hazards of induced abortion.

Abortion, Induced↗

Effectiveness of the diaphragm, used continuously, without spermicide.

The experience of 670 diaphragm users from three Brazilian clinics was retrospectively reviewed. Most of the subjects (441) followed the traditional method (TM) of using the diaphragm, only at the time of sexual intercourse and with spermicide. One third (215) used the diaphragm continuously (CU), without spermicide, removing it only at the time of their daily shower to wash it, with immediate re-insertion. The total pregnancy rate was 7.0 per 100 women-years for the whole group. Patient and total failure rate were significantly lower in the CU (0.6 and 2.8), in comparison with the TM sub-group (6.5 and 9.8). The discontinuation rate for urinary infection or other medical reasons was not greater in the CU group. Logistic regression analysis, including age, parity, number of abortions and of living children, years of schooling, whether living with a partner, presence of mild cystocele or retroverted uterus, and form of use of diaphragm (TM or CU), showed that only the TM of diaphragm use was positively associated to patients' and total failure rate.

Adult↗

Sterilization failures with bipolar tubal cautery.

From a consecutive series of 105 patients undergoing bipolar tubal sterilization (BPS), ten pregnancies were reported, and a tubal patency rate of 16% was found at hysterosalpingography. There were no significant clinical variables separating the BPS failure patients from those with successful sterilization. Ninety percent of the BPS failures were intrauterine, and 90% occurred within three cycles of BPS. The results of this investigation suggest that (1) BPS tubal occlusion may be associated with an increased failure (pregnancy and tubal patency) rate; (2) the majority of BPS failures are intrauterine gestations; (3) delayed fibrosis, rather than immediate tubal destruction, may be the mechanism of BPS tubal occlusion; (4) for maximum effectiveness, patients undergoing BPS should use alternative contraception for two to three cycles; and (5) surgeons employing BPS require precise training in the application of this modality of female sterilization.

Cautery↗

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↗

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↗

Pill method failures.

This is a study over a four year period from November 1981 to December 1985 documenting 163 cases of pill method failures in reliable pill takers. In over one third of these cases (36%) there were no predisposing factors. Significant factors which were associated with failure were diarrhoea and/or vomiting in 35%, and breakthrough bleeding on the combined pill in 21%. While there is controversy in the literature about the role of antibiotics in causing pill failure, this study found 23% of failures associated with antibiotic use. Two failures occurred on anticonvulsant medication. Recommendations are made for improved instructions to patients.

Abortion, Induced↗

Non-surgical tubal occlusion.

Out of 151 women provided with chemical female sterilization with 3 insertions of 250 mg of quinacrine spaced 1 month apart, there were 7 pregnancies in 3 years. If these pregnancies were a result of failure to occlude the entrance to 1 or both fallopian tubes, birth events should decrease exponentially with time. Unexpectedly, the low failure rate has not decreased significantly over the 3-year observation period.

Acridines↗

Fatherhood without apparent spermatozoa after vasectomy.

Fatherhood after vasectomy is rare. We describe 6 cases of DNA-proven fatherhood after vasectomy in association with persistently negative semen examination. All vasectomy patients and their partners should be counselled about the small possibility of late failure, and warning of failure should be recorded.

Female↗

Chromosomal abnormalities in the Kaiser-Permanente Birth Defects Study, with special reference to contraceptive use around the time of conception.

Chromosomal abnormalities were studied in 33,551 abortions and births to women whose contraceptive histories had been recorded at their first antenatal visit in 1975-1977. Chromosome examinations were performed exclusively on clinical grounds. There were 45 de novo abnormalities detected (1.34/1,000); three of them were detected at amniocentesis. Trisomy 21 was observed in 27 cases (0.80/1,000), trisomy 18 in nine (0.27), other trisomies in three (0.09), and translocations or deletions in five (0.15). One case of triploidy and six cases of inherited abnormalities were detected. There were no significant racial variations. No increase in risk for chromosomal abnormalities was found among women who had used oral contraceptives prior to becoming pregnant or among women who experienced oral contraceptive breakthrough pregnancies. Two cases of trisomy 18 were observed among the 814 deliveries following oral contraceptive breakthrough conceptions (2.46/1,000), two cases of trisomy 21 occurred in 338 births following failures of rhythm contraception (5.92/1,000), and no cases of trisomy 21 or 18 among the 1,569 women using spermicides at the time of conception.

Abnormalities, Drug-Induced↗