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PubMedDate not supplied

[Post-abortion counseling].

Faced with the silence that follows an abortion, we have established an individual, post-abortion counseling program based on psychological interviews with women who have recently had an abortion. These interviews begin in the second week following the abortion when the woman returns to the hospital for a post-abortion medical examination. The point of these interviews is to listen to what has been experienced--notably a certain ambivalence that arises from the act of having the abortion, which is constructed as having been a decision freely taken. The aim of these sessions is to help the woman through the process of mourning. Whether due to the failure of a contraceptive or a failed relationship, the resulting sorrow is produced by an underlying wish to have children. The periodic interviews have, over the weeks, helped to restore a certain psychological balance.

Abortion, Legal↗
PubMedDate not supplied

Management of epilepsy and pregnancy.

Epilepsy is recognized as the commonest serious neurological disorder in the world. Women with epilepsy (WWE) experience several gender-related physical and social problems. They constitute high obstetric risk because of reduced fertility, risk of seizures during pregnancy and complications of pregnancy. Hormonal and other factors can alter the pharmacokinetics of antiepileptic drugs (AED) during pregnancy and puerperium. Antenatal exposure to AEDs, particularly at higher dosage and in polytherapy, increases the risk of fetal malformation. Recent reports raise the possibility of selective developmental language deficits and neurocognitive deficits with antenatal exposure to AEDs. There are concerns regarding the effect of traces of AEDs that pass to the infant during breast-feeding. The pre conception management is the cornerstone for epilepsy care in WWE. A careful reappraisal of each case should ascertain the diagnosis, the need for continued AED therapy, selection of appropriate AEDs, optimization of the dosage and prescription of folic acid. During pregnancy, the fetal status needs to be monitored with estimation of serum a-feto-protein and ultrasound screening for malformations. The dosage of AEDs can be adjusted according to clinical requirement and blood levels of AEDs. Several institutions recommend oral vitamin K toward the end of pregnancy when enzyme-inducing AEDs are prescribed because the latter may potentially predispose the new born to hemorrhagic disease, but recent reports indicate that such a risk is practically negligible. WWE who are using enzyme-inducing AEDs (phenobarbitone, primidone, phenytoin, carbamazepine and oxcarbazepine) need to know that these AEDs may lead to failure of oral contraception.

Anticonvulsants↗
PubMed1992

Oral contraception noncompliance: the extent of the problem.

Compliance has been defined as the extent to which a patient's behavior coincides with the clinical prescription. The lowest expected failure rate of oral contraceptive (OC) use has been suggested to be 0.1%; however, in typical users, the failure rate varies by age, race, and marital status. In some populations in the United States (eg, unmarried black adolescents), the failure rate is 18%; rates that factor in the occurrence of abortions suggest an overall failure rate of 6.2% during the first year of use. If the annual failure rate of 6.2% is assumed, long-term failure rates rapidly approach 25% to 50% (ie, the proportion of users who will experience an unintended pregnancy) over 10 years of use. The gap between the lowest expected failure rate and the failure rates seen in typical users is related in large part to problems of compliance. Compliance with OC use includes both correct daily use and continuing use. Factors that contribute to OC discontinuation include the experience of side effects, fears and misinformation about OC side effects fueled by negative media reports, and intermittent use. There are relatively few data regarding the issue of missed pills and correct use, but studies suggest that adolescents may miss an average of 3 pills a month, and at least 20% to 30% of individuals miss a pill every month. Patients may have difficulty in the transition from one packet of pills to the next, and missed pills that extend the hormone-free interval may contribute to the failure rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed2003

8-year follow-up in a randomized trial of one vs two transcervical insertions of quinacrine pellets for sterilization in Indonesia.

OBJECTIVE: To evaluate the efficacy of one vs two insertions of quinacrine and the long-term safety of quinacrine sterilization (QS) 8 years after the procedure in Indonesia. METHODS: Between March 1993 and September 1995, a randomized trial was conducted in 6 academic centers in Indonesia. In February 2003, a follow-up study was undertaken in Bandung, one of those centers. This survey required a home visit of each woman. A questionnaire was designed to elicit information regarding current general health status, method failure, pregnancy outcomes and other contraceptive methods now used by women who experienced failures. Among the 70 patients receiving a single insertion of quinacrine pellets, 14.3% had become pregnant. There were no pregnancies among the 30 who received 2 insertions. All the women were found to be in good health. No long-term side effects or complications were identified. CONCLUSION: The two-insertion protocol is unmistakably superior to the single insertion. This study provides further evidence that QS is a safe contraceptive method.

Adult↗
PubMed2001

Emergency contraception: Who are the users?

CONTEXT: Data collected from two community family planning services are used to discuss the characteristics of users of emergency contraception (EC). OBJECTIVE: To investigate the characteristics of women attending for emergency contraception. DESIGN: A descriptive survey design was used to collect data. Questionnaires were completed over a 4-week period. Data were analysed using SPSS. SETTING: Community family planning services in South West Surrey and Newham, East London. PARTICIPANTS: Consenting women aged 14-44 years attending for emergency contraception (n = 171). MAIN OUTCOME MEASURES: Description of the users, the current episode and contact with contraceptive services were analysed by age. RESULTS: The age range was 14-37 years (mean 20.2 years). A majority were smokers. Of the women, 97.7% attended the clinic within the 72-hour time frame for issuing oral EC, however only 4% came within 12 hours of intercourse; 55% said that they had used contraception. Condom breakage was the commonest reason for failure. Reasons for not using contraception included getting 'carried away' (35%), not having condoms available (22%) and having drunk alcohol (13%). Of the sample 55.6% were previous users of EC. DISCUSSION: The study demonstrates a high incidence of sexual risk taking and need for EC, especially amongst smokers and drinkers. The message that soonest is best still requires promotion. Providers of EC must co-ordinate their services to ensure access within the 12-hour time frame in a local area. CONCLUSION: Health professionals need to ensure that clients have appropriate information about EC and regular contraceptive methods and that user friendly provision is widely available.

Adolescent↗
PubMed1985

Sterilization failures and their causes.

To say that a sterilization failure rate is expected does not answer why. Forty-seven cases of repeat sterilization have undergone such surgical and pathologic scrutiny. Resection methods failed most frequently because of spontaneous reanastomosis or fistula formation. Fimbriectomy was particularly vulnerable to reanastomosis because the fimbria ovarica was not removed. Mechanical devices failed when the device was defective, placed improperly, or placed in an improper location. Tissue damage was evident but incomplete when the bipolar electrocoagulation method failures were reviewed, and the endosalpinx remained viable. Unipolar method injuries, in contrast, were complete; they failed by fistula formation. Thus bipolar method failures may occur because of the limited range of electrical power available when using bipolar generators. Some sterilization failures are preventable, but many are not. When medicolegal questions arise, these findings may help answer the question, Why?

Contraceptive Devices, Female↗
PubMed2000

Economic analysis of long-term reversible contraceptives. Focus on Implanon.

OBJECTIVE: To examine the economic impact of a new implantable contraceptive, Implanon, in comparison with other available contraceptive methods. DESIGN: This was a modelling study using cost data derived from national published sources and effectiveness data from either controlled clinical trials (Implanon) or reports in the literature (other contraceptives). In the baseline analysis, Implanon was compared with 2 long term reversible contraceptives, Norplant and Mirena. Further analyses were then carried out comparing Implanon with Depo-Provera and with combined oral contraceptives. SETTING: The study concentrated on the UK, but also made reference to several other European countries. MAIN OUTCOME MEASURES AND RESULTS: The baseline analysis showed that all 3 long term reversible contraceptives produce very good rates of return, with Implanon providing the best rate of return (both average and internal) of the 3 methods. The payback period for Implanon was calculated as 146 days, compared with 339 and 368 days for Norplant and Mirena, respectively. In terms of cost effectiveness, the cost per protected year for Implanon was 95 Pounds, compared with 146 Pounds and 168 Pounds for Norplant and Mirena, respectively. In comparison with Depo-Provera (an injectable contraceptive), Implanon was both less costly and more effective, the cost per protected year for Depo-Provera being 131 Pounds. The threshold beyond which Implanon delivers cost savings compared with combined oral contraceptives was at a failure rate of 4.9% for the combined pill. CONCLUSIONS: Reversible long term approaches to contraception provide an effective and efficient use of healthcare resources and generate an excellent return on public investment. Implanon produces better rates of return than both Norplant and Mirena, and is also more cost effective in terms of cost per pregnancy avoided and cost per protected year than Norplant, Mirena, Depo-Provera and oral contraceptives.

Adult↗
PubMed1989

Postcoital contraception: a family planning study.

The New Zealand Family Planning Association undertook a prospective study of Yuzpe's postcoital method of contraception (0.1 mg ethinyloestradiol and 1 mg d1-norgestrel taken within 72 hours of unprotected intercourse and repeated 12 hours later). The study also used pills containing levonorgestrel. Both pill formulations were equally effective. All participants were drawn from six family planning branches throughout the country. The study covered a period of one year. There were 909 participants with 8% lost to follow up. Strict criteria excluded women on medication or hormone therapy. The ages ranged from 11 to 43 years with 92% aged 19 years and under. Results revealed an overall failure rate of 2.3% and a significantly higher failure rate (4.49%) if the method was taken after 48 hours of unprotected intercourse and a significantly lower failure rate (1.22%) if taken before 12 hours of unprotected intercourse. Vomiting occurred in 17% but it did not affect the failure rate.

Adolescent↗
PubMed1992

Contraception after thirty-five.

Our knowledge about the safety, the incidence of side effects, and the effectiveness of contraceptive methods for women in premenopause, or during the last decade of their reproductive life, has not been a primary interest for research and development in fertility control. The main purpose of trials for the evaluation of new contraceptive methods is to test their effectiveness, and therefore only women below 38 years of age are accepted. Furthermore, when new methods are being tested, only healthy women are accepted, and those having health problems of almost any kind are excluded. Therefore our knowledge about the contraceptive methods in women over 40 years of age is scanty and comes from trials with a long-lasting follow-up on healthy women who can use the method without problems until they are 45 or reach menopause. We have very limited reported information on the use of contraceptives by women who have cardiovascular disease, diabetes, liver problems, etc. Therefore the main body of experience in this review comes from healthy women between 35 and 44. On the other hand, one should remember that these women have a high motivation to use contraceptive methods and therefore the continuation rate in the trials is high. This compensates for the relatively small number of acceptors by giving more women-years in follow-up. Continuation rate and the proper use of methods are directly correlated to increase in age, socioeconomical status, and to education of users. Highly educated women in this age group have very low failure rate with almost any method.

Adult↗
PubMed1988

[Vasectomy: criteria of choice or protocol?].

The authors describe the experience of a medical staff specialized in welcoming, advising and realizing vasectomies on patients, and this according to a particular method in which traditional preliminary criteria of age, fatherhood and autoconservation are substituted by a continuous effort to listen and advise patients over a long period of time. 1385 cases have been selected over a period of one to ten years. The socio-demographic analysis defines an "ideal-type candidate": he is a middle or upper white collar; aged 37; married; he has fathered more children than the average and at a younger age than the average; and he has used up every well-tried means of contraception. The only technical variation observed was the length of the resected canal. The more widely defined failure rate can be evaluated at 2.3% of the 1426 cases. This failure rate appears to be linked with the size of the resection, too small (less than 5 mm) during two years. This caused the repermeabilization through granulomas, histologically authentified, of half of the observed cases that failed over a period of twelve years. The psychosexual consequences, analyzed through questionnaires, are judged satisfactory and confirm the possibility for the authors to accept vasectomy demands in a humanistic perspective, conciliating individual autonomy and safety in selecting candidates.

Adult↗
PubMed1996

The male polyurethane condom: a review of current knowledge.

Condoms are one of the oldest form of contraceptive and the best recognized form of protection against sexually transmitted diseases. Their use, however, is limited by both behavioral factors and device-related factors, including complaints about decreased sensitivity and sexual enjoyment. To address these limitations, a male condom made of polyurethane was developed. Polyurethane is a strong impermeable material with good heat transfer characteristics that is less susceptible to deterioration during storage than latex. Because little information is available comparing polyurethane and latex condoms in terms of consumer preferences as well as breakage and slippage, we reviewed four pre-marketing studies of polyurethane condoms, one of which included comparison to latex. No significant differences in slippage and breakage rates between latex and polyurethane condoms were reported in the study that included a latex comparator, and other studies of polyurethane condoms alone resulted in rates in the same range as published for latex condoms. Subjectively, consumers expressed significantly greater preference for the polyurethane condom over latex in regard to appearance, lack of smell, likelihood of slippage, comfort, sensitivity, natural look, natural feel, and overall. While additional testing is needed, these preliminary results suggest that the male polyurethane condom reviewed performed at least as well as latex condoms and is preferred by consumers. If preference translates to greater use, the male polyurethane condom may address important barriers that have been linked with inadequate condom use in the past. These results, however, may not be generalizable to other brands of polyurethane condom currently under development.

Condoms↗
PubMedDate not supplied

The quality of family planning services in rural China.

This article provides a preliminary analysis of three aspects of service quality in four rural counties in China--the availability of contraceptive methods, information given to users, and provider knowledge about methods. Contraceptive choice and characteristics of contraceptive use by women in the study areas are also examined. The data are derived from a survey carried out by the authors during 1987, under the auspices of China's State Family Planning Commission. The survey was conducted in four rural counties located in Fujian and Heilongjiang provinces. A total of 318 married women of reproductive age were randomly selected and interviewed. All family planning service sites serving the women were visited and a sample of service providers was interviewed. No shortage of contraceptives existed in any of the counties, but variations in community wealth and local procurement practices have resulted in the acquisition of an IUD with high failure rates. Although providers believe they inform women about method choices and side effects, women were poorly informed about the methods they selected. Not all providers who insert IUDs and distribute pills were knowledgeable about contraindications and side effects of the methods. Ever-use of contraception was nearly 100 percent, but most women, especially in Heilongjiang, have only used one method: the IUD or sterilization. Improvements in quality, especially in method mix, providers' level of knowledge, and the quality and quantity of information provided to users will likely improve contraceptive continuation, client satisfaction, and women's health.

China↗
PubMed1993

Information needs on emergency contraception not being met.

During the 1980s, there was 2 prominent changes in family planning: more women went to general practitioners (GPs) for contraceptive advice and there was an upturn in the use of condoms due to safer sex campaigns in the mid-80s. In this study of 769 women requesting a pregnancy termination, the author's found that the greater use of condoms had appeared to increase the need for information about emergency contraception, but this was not being met. Patients advised by their GPs seemed to have a lower level of knowledge than those who obtained their contraception from clinics. The study, carried out at St. James's University Hospital in 1991-92, is compared with several studies in the 1970s and 80s which look at contraceptive usage by women with unwanted pregnancies. Differences were found between those receiving contraceptive advice from different sources (i.e. GPs, clinics, no medical source). Failure of the pill was more frequent in the GP-advised group, but failure of the diaphragm was more frequent in the clinic-advised group. Failure of non-use of condoms did not differ according to the source of advice. Knowledge of and use of emergency contraception was low. Only 14.5% of those using no contraception or recognizing a condom failure attempted to use a secondary or emergency method. Condoms should be used as well as rather than instead of other methods of contraception, and knowledge and availability of emergency contraception should be increased and promoted, recommend the authors. They concluded that problems arising from family planning provision by untrained and uncommitted doctors should be addressed urgently. (Bromham and Cartmill, British Journal of Family Planning, vol. 19, 1993, pp179-183). Commenting on the study findings, FPA Medical Information Office Jane Urwin said: "This study has furthered our knowledge in this area. It also highlights the need for further study of risk-taking behavior in relation to contraceptive use's.

Ambulatory Care Facilities↗
PubMed1997

[Postcoital contraception. Dates based on a 5-year use in a private consultation service].

BACKGROUND: The aim of this 5-year retrospective study is to define the efficacy of oestro-progestinic interception. METHODS: An oestro-progestinic mixture (0.05 mg ethinyl estradiol and 0.250 mg dlnorgestrel) was prescribed to 6003 women attending the gynaecological outpatients clinic of AIED (Associazione Italiana per l'Educazione Demografica) in Genoa, Italy, without evidence of any previous contra-indications. The prescription was of two pills at once and two pills 12 hours after. Before examination, the doctor asked for personal and medical history (age, date of onset of menses, unprotected intercourse date and anticonceptional failure); patients were also asked to report the data of the following menses to the clinic. The largest age range was between 20 and 24 years, probably because of their inadequate knowledge of contraceptives. The reasons for post-coital contraception were: sexual intercourse without contraceptive, failure of coitus interruptus and of the condom. RESULTS: Post-coital interception efficacy (monthly oestro-progestinic contraception was 99.5%) according to retrospective statistical analysis, was according to Pearl index 92.9% vs 50% without any contraceptive. CONCLUSIONS: Finally, the efficacy of this method, together with its easy management and low frequency of severe contra-indications, allows us to indicate the "morning after pill" as one of the most useful outpatient strategies to avoid unwanted pregnancies.

Adult↗
PubMed1980

[Long-term experience in intrauterine contraception a comparison between Lippes' loop, Dalcon-shield and copper-t (author's transl)].

Three different models of intrauterine pessaries are compared with each other in respect of tolerance and safety. They were worn for different lengths of time, partly for up to ten years. The comparison shows that the Pearl index in its conventional form is not a suitable indicator. It does provide a pointer if the individual collectives are reduced to the same wearing period. The Life-Table method yields better results. It relates the events for a total of 100 women in each case to the same interval periods. This shows that the most favourable rate of complications and quota of failures is obtained with Cu-T 200. During the first three years this quota decreases steadily. Hence it is recommended to effect intrauterine contraception according to this model wherever suitable and to allow Cu-T to be retained in position for at least three years if it is well tolerated.

Adult↗
PubMedDate not supplied

Contraceptive efficacy of the diaphragm, the sponge and the cervical cap.

A reanalysis of data from two clinical studies--in which 1,439 women were randomly assigned to use either the contraceptive sponge or the diaphragm and 1,394 women were randomly assigned to use either the cervical cap or the diaphragm--found first-year probabilities of failure during typical use of 17% for the sponge, 18% for the cervical cap and 13-17% for the diaphragm. The first-year probabilities of failure during perfect use are 11-12% for the sponge, 10-13% for the cervical cap and 4-8% for the diaphragm. The probability of failure during perfect use is significantly higher among women who have given birth than among those who have not for users of the sponge (19-21% vs. 9-10%) and users of the cervical cap (26-27% vs. 8-10%), but not for users of the diaphragm.

Contraceptive Devices, Female↗
PubMed2006

Low-dose oral contraceptive to re-induce menstrual bleeding in amenorrheic women on DMPA treatment: a randomized clinical trial.

BACKGROUND: Depot medroxy progesterone acetate (DMPA) is one of the most reliable contraceptive methods with a failure rate less than 0.3 percent. It is injected every three months and Although it has many advantages over many other hormonal contraceptives, But a major disadvantage of it is bleeding disorders which comprise most of the discontinuance reasons. Our Aim was to study bleeding complications of DMPA when used as a contraceptive in Ardabil district and clinical trial of LD and Ethynil oestradiol in controlling these complications. MATERIAL/METHODS: All the 917 women who referred to ardabil's health centers for having a DMPA injection for the first time, were entered into a longitudinal study. Those complaining of menstrual cessation were entered into a double blinded randomized clinical trial. Data were collected by means of 9 questionnaires 7 of them used for descriptive and 2 for clinical trial study. Data was analyzed by SPSS statistical package. RESULTS: Those DMPA users with a cesarean section history had a higher chance of bleeding complications. Four hundred forty-four of the 917 women receiving the injection discontinued using it before the end of the study period. The main reason for discontinuation (in 70%) was irregular menstrual bleedings and menstrual cessation. In the clinical trial of women with bleeding cessation, 70% of those receiving the LD-OC pill experienced menstrual bleedings again, compared with only 22.7% in the placebo group. The discontinuation rate in the drug group was lower than in the placebo group as well (p < 0.05). CONCLUSIONS: Treating menstrual cessation caused by DMPA with LDs, improves the complication and decreases the discontinuance rate.

Adult↗