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PubMed2001

Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence.

OBJECTIVE: Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion. DESIGN: Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators. POPULATION: Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion. METHODS: Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze-Potter gross life table probabilities with denominators of person-time of exposure. MAIN OUTCOME MEASURES: Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation. RESULTS: Complication rates for immediate post-abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1,000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates. CONCLUSIONS: Post-abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.

Abortion, Induced↗
PubMed1989

[Demographic trends: birth spacing].

Two studies to measure children spacing in western metropolitan Santiago are compared. The first (1984-85) surveyed a sample of 687 mothers and the second 1,000. Deliveries took place at San Juan de Dios and Félix Bulnes hospitals (both state-finance) which provide medical care for medium and low income groups. Long spacing (5 years or more) accounted for the highest proportion of non-first born children (33.8% in 1984-85 with a significant increase to 40.1% in 1988) while short spacing (under 2 years) accounted for 19.2% in 1984-85 and 21.8% in 1988 (not significant). Mean birth weights were over 3,200 g in every spacing group. Despite the low illiteracy rate, predominant urban origin and having at least one child born before, high proportions of children were conceived despite the use of contraceptive measures (19.7% in 1984-85 and 22.5% in 1988). This contraceptive failure was less frequent among children born after longer spacings.

Birth Intervals↗
PubMed2002

Living conditions, contraceptive use and the choice of induced abortion among pregnant women in Denmark.

AIMS: This study describes women with induced abortion and thereby elucidates how living conditions and contraceptive failure are associated with the choice of induced abortion in a population of Danish pregnant women. METHODS: The study population consisted of pregnant women attending Odense University Hospital. They were categorized in two groups: women with induced abortion (n = 373) and a reference group consisting of women with spontaneous abortion and antenatal care attendees (n = 2,176). The two groups were compared by use of a case-referent design. The variables studied comprise age, number of children, partner relationship, education, occupation, economical situation, and contraceptive use. RESULTS: Being single, aged 15-24 or 35 and above, having either no children or two or more children, and the experience of contraceptive failure were parameters which were associated with the choice of induced abortion. Among married/cohabiting women aged 20-39 with fewer than two children, being under education, unemployed, on leave, or willing to invest effort in obtaining a more satisfying job influenced the choice of induced abortion. CONCLUSIONS: To reduce the number of induced abortions, it should be recognized that many women both want to establish a family with the number of children they wish for and to have a satisfying job with influence and challenge.

Abortion, Induced↗
PubMed1994

Epidemiology of unintended pregnancy and contraceptive use.

Almost all women are at risk for unintended pregnancy throughout their reproductive years. However, adolescents, formerly married women, and women of low socioeconomic status are at greater risk for contraceptive nonuse and for contraceptive failure; thus they are also at greater risk for unintended conceptions. Of the 6.4 million pregnancies occurring in the United States in 1988, more than half (56%) were unintended. An equal proportion of unintended pregnancies end in abortion (44%) as with birth (43%), and both options have great personal and social consequences. The level of unintended pregnancy appears to have increased during the last decade after consistent decreases since the early 1960s. Decreasing both the periods of contraceptive nonuse and contraceptive misuse will help lower the rate of unintended pregnancy in this country.

Adolescent↗
PubMed2000

Tubal sterilization: focus on the U.S. experience.

OBJECTIVE: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. DESIGN: A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications. PATIENT(S): Women seeking tubal sterilization. INTERVENTION: Tubal sterilization. MAIN OUTCOME MEASURE(S): Effectiveness and long-term risks and benefits. RESULT(S): Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. CONCLUSION(S): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.

Adolescent↗
PubMed2004

Unintended pregnancy among newly married couples in Shanghai.

CONTEXT: Though contraceptive failure and induced abortion in China have both attracted research attention, the somewhat broader topic of unintended pregnancy has been neglected. METHODS: A total of 7,872 newly married couples, enrolled between 1987 and 1988, were followed up until 1994-1995; only 2% were lost to follow-up. During face-to-face interviews, background and fertility-related data were collected. Chi-square tests and logistic regression were used to assess associations with unintended pregnancy. RESULTS: By three months after marriage, 461 couples had conceived; 57% of nonpregnant wives said that their preferred interval between marriage and conception was no more than three months. Twenty-one percent of pregnancies occurring between marriage and first birth were reported as unintended; 81% of these resulted from contraceptive failure. The majority of unintended pregnancies were carried to term; 13% were aborted. The younger the wife and the greater her desired interval between marriage and conception, the greater the likelihood that a pregnancy occurring before first birth was unintended. After first birth, 43% of couples experienced one or more unintended pregnancies, 98% of which were aborted in accordance with the one-child policy. The majority of these pregnancies occurred in the 12 months after first birth, when couples tend to rely on ineffective methods of contraception. The odds of having an unintended pregnancy after first birth were slightly elevated if at least one spouse desired a second child. CONCLUSIONS: Unintended pregnancies are common among married couples in Shanghai. Policies to reduce unintended pregnancies, and abortions, should focus particularly on postpartum contraception.

Adult↗
PubMedDate not supplied

Building a family: unplanned events.

Couples in developed societies are often unsuccessful in achieving precise family building goals despite the widespread use of birth control. Unplanned events that frustrate reproductive intentions to varying degrees include contraceptive failure, sterility, miscarriage, prolonged conception delay, undesired sex combination of offspring, divorce, and the death of a spouse or a child. This paper reviews the probability of the occurrence of these events using US data. It is concluded that the large majority of newlyweds will experience at least one unplanned event during the family building phase of the life cycle.

Congenital Abnormalities↗
PubMed1976

Pregnancies in the presence of copper intra-uterine devices. Hysterosalpingographic studies.

Two copper-bearing intrauterine devices--the Cu-7 and Cu-T-200--were investigated to determine why contraceptive failures occur with these devices. For this investigation, 155 multiparous women were followed up for at least 24 months after IUD insertion (T-Cu-200 in 75 cases and the Cu-7 in 80 cases). Three women using the T-Cu-200 and 5 women using the Cu-7 became pregnant during the first year. Hysterosalpingographic findings are presented for 8 of these cases and for 2 additional cases (one with each device) who became pregnant during the second year of follow-up. These indicate that uterine abnormalities and disproportions between the uterine cavity's shape and size and that of the device are the primary reasons for device displacement and partial fundal coverage leading to contraceptive failures.

Copper↗
PubMed1982

Vaginal spermicides and outcome of pregnancy: findings in a large cohort study.

By the end of 1980, 5729 singleton planned pregnancies, 1552 singleton unplanned pregnancies, and 81 multiple pregnancies had been observed among the 17032 participants in the Oxford-Family Planning Association contraceptive study. The outcome of these pregnancies was investigated in relation to the use of vaginal spermicides. There was some suggestion that spermicide use might have a small adverse effect on the risk of congenital malformations, especially among infants conceived as a result of contraceptive failure. There was not, however, any evidence of any other adverse effect of spermicide use. In particular, the results provide strong evidence against the hypothesis that spermicide use has any appreciable effect on the risk of spontaneous abortion.

Abnormalities, Drug-Induced↗
PubMed2006

[Study on the risk factors of repeated abortion among unmarried adolescents].

OBJECTIVE: To find out the rate of repeated induced abortion among unmarried abortion women and to study the relevant risk factors. METHODS: From July to September 2005, we used the method of hospital based descriptive epidemiological study to investigate 2295 abortion women below 25 years of age in Beijing, Shanghai and Zhengzhou. Case-control study was used as the method. We considered the women with history of repeated abortion as case group (736 women) and considered the women without history of repeated abortion as control group (1559 women). RESULTS: The mean age of respondents was 21.92 years with minimal age as 15 years. 17.2 % aborted women aged below 20 years with 32. 1% of them were ever having a history of previous induced abortion. Among 736 women with repeated abortion, 75.3 % of them had one time of induced abortion previously, 18.1% having two times, 4.2% having 3 times, 13 women having 4 times and 4 women having 5 times and one even with the maximum of having 8 times of previous abortion. In comparison with control group, the case group had higher rate among women whose first sex was below 18 years (16.2% vs. 9.4% , P<0.01). There were higher rates of women under following conditions: having exposed to sexual behavior for more than 3 years (33.6% vs. 6.6 % , P<0.01), having cohabited with male partner for over 1 year (64.6% vs. 23.9%, P <0.01), having regular sexual life (48.5 % vs. 37. 1%, P < 0.05), having multiple sexual partners (36.0% vs. 15.0%,P<0.01) having unwanted sex (6.0% vs. 3.9%, P<0.05), whose current pregnancy resulted from contraceptive failure (39.3% vs. 31.6%, P< 0.01), having a history of high-risk abortion (30.8% vs. 3.1%, P< 0.01) etc. In comparison with the control group, the case group showed higher rates of male partners not supporting this induced abortion, male partner not participating in decision-making on abortion and male partner not accompanying the female partners to seek for abortion service (rates of the three major factors in case group and in control group were 10.3% vs. 5.9%, P< 0.01, 30.3% vs. 24.0%, and 27.5% vs. 23.5%, P<0.01, respectively). CONCLUSION: The rate of repeated induced abortion among unmarried abortion women was relatively high. The risk factors for females would include: younger age of sex debut, longer duration from the beginning of first sex to the current abortion, cohabitation, regular sexual life, multiple sexual partners, unwanted sex, contraceptive failure and high risk induced abortion. Meanwhile, unmarried but repeated abortion was related to the differences of gender between males and females and male partner's concern on induced abortion.

Abortion, Induced↗
PubMed1990

The interaction of phenytoin and carbamazepine with combined oral contraceptive steroids.

Patients taking oral contraceptive steroids (OCS) are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone, phenytoin and carbamazepine. We have studied the single dose kinetics of ethinyloestradiol (EE2); 50 micrograms, and levonorgestrel (Ng); 250 micrograms in groups of women before and 8-12 weeks after starting therapy with phenytoin (n = 6) and carbamazepine (n = 4). The area under the plasma concentration-time curve (AUC) was measured over a 24 h period for each steroid and significant reductions were seen with both anticonvulsants. Phenytoin reduced the AUC for EE2 from 806 +/- 50 (mean +/- s.d.) to 411 +/- 132 pg ml-1 h (P less than 0.05) and for Ng from 33.6 +/- 7.8 to 19.5 +/- 3.8 ng ml-1 h (P less than 0.05). Carbamazepine reduced the AUC for EE2 from 1163 +/- 466 to 672 +/- 211 pg ml-1 h (P less than 0.05) and for Ng from 22.9 +/- 9.4 to 13.8 +/- 5.8 ng ml-1 h (P less than 0.05). These changes are compatible with the known enzyme inducing effects of phenytoin and carbamazepine. Patients taking these anticonvulsants will need to be given increased doses of OCS (equivalent to 50-100 micrograms EE2 daily) to achieve adequate contraceptive effects.

Adolescent↗
PubMed1981

Intrauterine contraceptive devices: failure of unilateral intrauterine device in inducing luteolysis in rabbits, rats and mice.

Insertion of a unilateral intrauterine device (IUD) on day 1 pc in rabbits and rats or day 2 pc in mice is found to interrupt pregnancy in the device-bearing uterine horn, but does not affect blastocyst implantation or fetal development of the contralateral side. It is also evident that following surgical ablation of the ovary of the non-IUD side, the ovary of the IUD-bearing side can effectively maintain pregnancy and fetal growth as in controls. The possible mode of action of the IUD has been discussed.

Animals↗
PubMed1975

A clinical appraisal of patients following long-term contraception.

This study presents a clinical evaluation of private patients between the ages of 16 and 40 who have used contraceptive measures from January 1, 1961, through December 31, 1973. The clinical evaluation involves 3,746 private patients. The contraceptive methods of 641 patients (17 per cent) who have been bollowed for a total of 99,996 months (13 years each) are presented and analyzed. The patients are evaluated as to weight, blood pressure, pregnancy, pap smears. laboratory changes, pelvic surgery, breast surgery, incidence of cancer, contraceptive failures and changes in contraceptive practices over this span of time. This paper evaluates the role of such sociologic factors as education, religion, economic level, occupation, working status, changing marital status, age at the time of contraceptive choice, and the attitude of the husband with regard to long-term contraceptive therapy. Side effects have been well publicized. Safety has been questioned but essentially proved for the vast majority of the patients. Collected data enable some insight into the life style and motivation of the long-term contraceptive users.

Adolescent↗
PubMed1981

Failure of contraceptive steroids to modify human chorionic gonadotrophin secretion by hydatidiform mole tissue and choriocarcinoma cells in culture.

The effect of steroids contained in oral contraceptives, namely ethinylestradiol:17 alpha-ethinyl-1,3,5,(10)-estratriene-3, 17-diol (E) and norethindrone acetate:17 beta-acetoxy-17-ethinyl-4-estren-3-one (N), on cell replication and human chorionic gonadotropin (hCG) secretion by choriocarcinoma cells in monolayer culture and by hydatidiform mole tissue maintained in organ culture were studied. The steroids were added to the culture medium individually or in combination to achieve a range of concentrations (10-10 to 10-4), within and beyond the presumed concentration of these substances in the blood of women taking oral contraceptives. The effect of luteinizing hormone releasing hormone (LHRH) on hCG secretion by choriocarcinoma cells in monolayer culture also was investigated. The rate of hCG production by either choriocarcinoma cells in monolayer culture or by hydatidiform mole tissue maintained in organ culture was not affected by the hormones used in this study; indeed hCG secretion remained reasonably unchanged even with high concentrations of steroids (up to 10-4 M) or LHRH (up to 10-4 mg x ml-1). Cell replication, as measured by increase in amount of cellular protein and DNA, was not stimulated by either of these compounds.

Cell Division↗