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PubMed1983

[Infections in gynecology].

After the author had reviewed present ideas about infections he outlined the specific character and the role of the normal flora to be found in the cervix and in the vagina, as well as the common characteristics of sexually transmitted diseases. The pathogenic role of bacteria that were previously considered to be "innocent" (type B streptococci, staphylococcus aureus, Gardnerella vaginalis) and Chlamydiae and mycoplasmas make it easier to understand the pathogenesis of basal gynaecological infections and of the urethral syndrome. The author then studies the aetiology of acute salpingitis that can be classified according to a number of responsible organisms: monomicrobial salpingitis (due to gonococci, Chlamydia, and microplasmas) or polymicrobacterial, the nature (endogenous or exogenous) of the infecting agents and the role of iatrogenic factors (such as intra-uterine contraceptive devices, terminations of pregnancies and so on). The diagnosis and the risks of gynaecological infections occurring are pointed out as well as the different problems associated with preventing these infections.

Adult↗
PubMed1999

Peripartum cardiomyopathy: summary of an international survey on peripartum cardiomyopathy.

OBJECTIVE: The aim of this survey was to assess the evaluation, management, and future recommendations of patients with the diagnosis of peripartum cardiomyopathy and to evaluate the interest in the creation of a prospective database regarding this rare disorder. STUDY DESIGN: A total of 116 surveys were sent to major teaching institutions in the United States (including Puerto Rico), Canada, Crete, and South Korea after a national conference held at the National Institutes of Health regarding peripartum cardiomyopathy. This was an open-ended survey containing 17 specific questions regarding this disorder and its management. RESULTS: A total of 78 (67%) maternal-fetal specialists responded to the survey. Diuretics and digoxin were used as first-line treatment for this disorder. Only 6% used angiotensin-converting enzyme inhibitors during pregnancy. Fifty-eight percent of the perinatologists (58%) recommended either intrauterine contraceptive devices or foam and condoms, whereas oral contraceptives (progesterone-only pill or estrogen-progesterone mix) were recommended in 23% and 41%, respectively. Sixty-six percent (66%) of the respondents would recommend future pregnancy if ventricular function returned to normal. CONCLUSIONS: Fundamental clinical and basic research is lacking regarding this rare but potentially devastating disorder. Major teaching institutions do not have significant numbers of patients with this disorder to provide concrete recommendations, and starting a database will be useful in the gathering of important epidemiologic information. A secondary aim of such a registry would be to establish a repository for tissue and blood samples to answer basic mechanistic questions about this disorder.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Prevalence and determinants of contraceptive practice in a defined Nigerian population.

This study investigates the prevalence and determinants of contraceptive practice in Ile-Ife, Nigeria. A prospective study of 500 rural women in the reproductive age group was conducted between April to June 1999 in the Igboya health district of Ife central local government area of Osun State. A comprehensive contraceptive promotion and distribution had been carried out in this area by the University Teaching Hospital, the State Ministry of Health and many non-governmental organisations in the past 10 years. It is therefore expected that the contraceptive awareness and use in this environment would be high. Unfortunately, although all the respondents (100%) were aware of contraception and 78% were sexually active, only 18.8% used contraception. A majority of the non-users gave no reasons for failure to use contraception. Among reasons given by others include fear of side effects, no need for contraception, not married, religion, need for more children and student status. The most common contraceptive method among users was intrauterine contraceptive device followed by pills, condoms and injectable contraceptives. Factors which were significantly associated with utilisation of contraception were availability of family planning services, parity, knowledge of contraception and child spacing (P < 0.05). Religion, literacy level, attitudes of family planning providers and distance to family planning services were not found to be significant (P > 0.05). Recommendations that will improve wide contraceptive usage are preferred.

Adolescent↗
PubMed2001

[Intrauterine device migrating to the bladder].

Transuterine migration of an intrauterine contraceptive device (IUCD) is a rare complication. The authors report a case of IUCD which migrated into the bladder and subsequently became calcified. This 34-year-old woman had been fitted with an IUCD for 4 years. She presented an unwanted pregnancy and signs of disabling cystitis at the end of pregnancy. The diagnosis of migration of the IUCD into the bladder with secondary calcification was suggested on the plain abdominal x-ray and on ultrasound and was confirmed by cystoscopy. Ballistic lithotripsy of the bladder stone with endoscopic extraction of the IUCD was then performed.

Adult↗
PubMed1978

Unilateral ovarian abscess associated with the intrauterine device.

Four cases of primary ovarian abscess associated with intrauterine contraceptive devices are presented. It is proposed that both their unilaterality and the fact that they were primary in the ovary rather than tuboovarian are due to the fact that bacteria from the intrauterine device are shed continuously through the fallopian tubes, resulting in the inoculation of the corpus luteum, a unilateral structure. Removal of the ovarian abscess without additional surgical therapy is sufficient for a patient with this type of pelvic infection.

Abscess↗
PubMed1995

[The morphologic changes of endometrial hematostatic reaction in intrauterine devices induced menorrhagia].

OBJECTIVE: To investigate the relationship between intrauterine contraceptive devices (IUD) induced menorrhagia and endometrial spiral arteriolar contractive function and endometrial superficial vessels thrombus formation function. METHODS: Sixty five subjects were admitted and divided into IUD bleeding group (25 cases), IUD non-bleeding group (20 cases) and IUD non-user group (20 cases). The samples were obtained by curettage within 24 hours prior to menstruation and observed under light and electron microscope. The morphologic changes of endometrial micro-vessels, spiral arterioles were observed and diameter of spiral arterioles were measured. RESULTS: Compared with IUD non-user group, the degenerative changes of spiral arteriolar wall were more severe and the dilatation of spiral arteriolar lumen was obvious especially in spongious layer. In IUD non-bleeding group, these changes were mild. The platelet and fibrin thrombus count was the highest in IUD non-bleeding group and the lowest in IUD bleeding group. CONCLUSIONS: These results suggested that IUD induced menorrhagia might correlated with poor contraction of spiral arterolars in spongious layer and poor thrombus formation. Mild degeneration and dilatation of spiral arterioles and a lot of thrombus were seen in IUD non-bleeding group, and this might be the cause that the mentrual blood loss in this group did not increase obviously.

Adult↗
PubMed1976

Comparison of continuation rates of intrauterine devices.

The validation of reports of the performance of intrauterine contraceptive devices (IUDs) is fraught with confounding factors such as different protocols, populations, and clinic environments. Two-year life table continuation rates from a comparative study of the Lippes loop, TCu-200, and Dalkon shield are reported from a single clinic in which 1626 insertions were performed by two obstetrician/gynecologists. The difference between the highest and lowest parity-standardized continuation rates for the three devices was only 3.7 percentage points after 2 years of use. The TCu-200 and Dalkon shield yielded significantly lower expulson rates than the Lippes loop. The more recently developed IUDs do not appear to have higher continuation rates than the Lippes loop.

Adolescent↗
PubMedDate not supplied

A comparison of satisfaction with types of diaphragms among women in a college population.

Since the 1940s diaphragms have been a popular contraceptive device used by women in the United States. This study compared three popular diaphragms and women's subjective comparisons of comfort, ease of insertion, and overall satisfaction. None of the three types, the wideseal, coil spring, or arcing spring, was found to be statistically more comfortable or easier to insert. For overall satisfaction, women were more pleased with the coil spring than the wideseal (p = .0416 at two to four weeks, p = .0759 at four to six months, and p = .0049 at one year). Women who used the arcing spring and wideseal were more pleased with the wideseal at two to four weeks (p = .0571). No significant difference was found at one year. The study results demonstrate that certain diaphragm styles may improve women's use of and satisfaction with the diaphragm.

Consumer Behavior↗
PubMed1987

Observations on the mode of action of an intratubal device, the P-block.

A hydrogelic intratubal device, called P-block, Mark 9, was inserted hysteroscopically with local anesthesia in the intramural part of the fallopian tube of 25 women referred for the procedure as an alternative to abdominal sterilization. Hysterosalpingography revealing bilateral oviductal patency was followed by hysteroscopic checkup verifying bilateral presence of P-blocks, except in three patients who had expulsion of the P-blocks on one side. All of the 22 patients had retention of the P-blocks 6 to 7 months after insertion. None became pregnant. Thus it is suggested that an intratubal device in the isthmic part of the human fallopian tube acts as an intrauterine contraceptive device, preventing intratubal and intrauterine pregnancies. Endeavors to explain the contraceptive effect of a nonocclusive intratubal device are discussed on the basis of our present knowledge of tubal physiology. Distension of part of the human isthmus is likely to disturb normal gamete transport through the isthmus.

Adult↗
PubMed1991

Evaluation of the effects of a female condom on the female lower genital tract.

The purposes of this study were to determine if use of the female condom (Reality) was traumatic to the vaginal mucosa and/or vulvar skin and to determine its effect on resident vaginal bacterial flora. Thirty subjects were randomly assigned to utilize the female condom or diaphragm during the study period. Initially and during 3 follow-up visits, each subject underwent colposcopic examination of the vagina, cervix, and vulva with photographic record, and qualitative fungal, aerobic and anaerobic cultures of the vagina. The two groups were compared with respect to the frequency of abnormal physical findings determined by both macroscopic and colposcopic examination. Visits were compared within each contraceptive group with respect to changes in resident vaginal flora. There was no evidence of significant trauma associated with the use of either contraceptive device during the study period. The resident vaginal flora did not significantly change during the three follow-up visits in patients using the female condom. In diaphragm users, lactobacilli were less frequently isolated at the third (14/15 vs 6/15, P = 0.008) and fourth (14/15 vs 7/15, P = 0.039) follow-up visits when compared to the initial visit. In addition, aerobic gram-negative rods were more frequently isolated during the fourth visit (1/15 vs 9/15, P = 0.021) when compared to the first visit. We conclude that neither the female condom (Reality) nor the diaphragm is associated with trauma to the lower genital tract. Subjects using the diaphragm undergo a significant change in vaginal bacterial flora, becoming more likely to be colonized with coliform microorganisms and less likely to maintain lactobacilli colonization.

Adult↗
PubMed1985

Correlation between the incrustation of intrauterine devices and the duration of their use.

The usefulness and side-effects of intrauterine contraceptive devices (IUDs) are evaluated on the basis of various aspects (e. g. effect of postabortal and post-partal insertion, expulsion of device, frequency of pregnancies, bleeding and inflammation, etc.) [1, 2, 3, 4]. However, the incrustation of the device has been ignored although the coating on the major part of the surface is easy to study. The rough surface coating is very likely to be associated with some side-effects [5]. In our report we have tried to find some links between the degree of incrustation and the duration of using the device.

Calcium Carbonate↗
PubMed2006

The intrauterine device in modern contraception: Still an actuality?

The intrauterine devices (IUD) is a contraceptive method largely used as an effective, safe and economic method of contraception; IUD efficacy is demonstrated to be about 97%, and copper IUD contraceptive failure frequency is about 0.8% for the first year of use, and this is about 0.1-0.2% for the progestin IUD. IUD benefits are different; it produces a well-defined contraceptive efficacy for long time, is useful for sexual activity and is rather free from common problems. However, IUD utilization is associated with an increasing risk of pelvic infection (0.5%) in the 8 years from initial use, and the common risk of pelvic inflammatory infection (PID) is about one to two cases per year; this risk, for copper IUD users, is 0.2-0.5% per year. The possible side effects of IUD use are: pelvic pain, irregular meshes, infections, bleeding and uterine perforation; we report a uterine perforation due to IUD migration in the Retzius space, diagnosed on transvaginal ultrasonography, confirmed on CT and removed by laparoscopy. In any case, the IUD remains the mainstay of family planning measures in developing countries but, unfortunately, its association with possible serious complications, change the cost-benefit link and restrict its utilization by a large part of the general population.

Adult↗
PubMed1998

User acceptability of a female condom (Reality) in Shanghai.

Thirty married couples evaluated the Reality female condom on questionnaires about its acceptability for 300 acts of coitus (10 per couple). An analysis of the summary questionnaires showed: 90% of couples considered the female condom an acceptable method and 87% felt it was a good contraceptive device; the majority of couples (87%) found it easy to use; and 80% of females and 73% of males reported that, in comparison with the male condom, the effect on sexual pleasure was either improved or no different. A little more than half of the couples (55%) preferred it to male condoms. To look at the learning curve effect, an additional analysis was completed by pooling the first 5 applications of each user and comparing the results with the pooled results of the second 5 uses. All the findings suggest that a certain proportion of couples of childbearing age will choose the Reality female condom for contraception if it enters into the Chinese market. As a new contraceptive barrier device, the female condom may require a certain amount of education and awareness before it will be fully recognized as an important option to help prevent pregnancy as well as sexually transmitted infections.

Adult↗
PubMed2005

Acceptability and feasibility of continuous diaphragm use among sex workers in Madagascar.

OBJECTIVES: The diaphragm, a woman controlled, reusable contraceptive device, might prevent some sexually transmitted infections (STIs). We assessed the acceptability and feasibility of use of silicone Wide-Seal Arcing Diaphragms (Milex Products, Chicago, IL, USA) by sex workers in Madagascar. METHODS: Over 8 weeks, we evaluated method acceptability by examining patterns of and problems with women's diaphragm use. We also evaluated several measures of study feasibility, including recruitment and follow up methods. RESULTS: 91 women from three cities (Antananarivo, Tamatave, and Mahajanga) participated, and 87 (96%) completed follow up. At enrolment, participants reported a median of six sex acts with five clients in the previous week. During the follow up period, participants reported a median of three sex acts with three clients during the previous 2 days, and self reported continuous diaphragm use during the previous day increased from 87% to 93%. Seven women became pregnant (incidence 53 pregnancies per 100 woman years). Self reported use of male condoms and diaphragms was fairly constant over the study period: women reported condom use in 61% to 70% of acts and diaphragms in 95% to 97% of acts. The number of participants reporting diaphragm problems decreased from 15 (16%) at the first visit to six (7%) at the final visit. 20 women (22%) needed replacement devices during follow up because their original diaphragms were lost, were the wrong size, or became seriously damaged. CONCLUSIONS: Given the high use and steady decrease in reported problems during the study, we believe diaphragms are acceptable and feasible in this resource poor, low education sex worker population.

Adolescent↗
PubMed1980

Post-coital intrauterine device insertion - a further evaluation.

A total of 191 patients have undergone post-coital insertion of an intrauterine contraceptive device up to ten days post-coitus. The majority of patients were nulliparous and underwent insertion of a standard Gravigard [Copper 7] device. The subsequent expulsion and medical removal rates were normal for this group of patients but the non-medical removal rates were higher. There was one possible post-coital contraceptive failure (0.6%) and one pregnancy at six months due to the device exhibiting a failure to conventional contraceptive action.

Coitus↗