[Prevention in diabetics].
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Contraception↗
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Empowering women by preventing unwanted pregnancies.
Emergency (post-coital) contraception is a useful intervention to reduce unplanned pregnancies in women of all ages. In Australia, two methods of emergency contraception are commonly used: the combined oral contraception pill and the intra-uterine contraceptive device. Additional regimes are used in other countries. A description of the regimes and political and moral issues related to them are described in this paper as is the relevance and significance of knowledge about emergency contraception for nurses working with women in a variety of health care settings.
Australia↗
Delivery options for contraceptives.
Although a steady increase in contraceptive use has been observed in developed and less-developed countries, the contraceptive needs of a significant proportion of couples have not yet been met, resulting in an increase in unplanned pregnancies. Several new contraceptive products have reached the market during the past few years. Among these are new implants, a medicated intrauterine device, contraceptive vaginal rings, transdermal patches and several new regimen of combined oral contraceptives. These new or improved methods have been developed to expand the contraceptive choices available to women and men as well as to respond to the unmet need for contraceptives with long-term activity. New targets are being identified both in the ovary and the testes for a more specific non-hormonal contraception. This futuristic approach still keeps in mind the need for better access to existing contraceptive methods, as well as the discovery of new contraceptives that are simple to use, safe, reversible and inexpensive. In recent years, there has been great interest in agents that provide dual protection against pregnancy and sexually transmitted infections (STI), especially human immunodeficiency virus (HIV). A contraceptive method providing dual medical benefits might increase motivation for consistent use, thus reducing contraceptive failures and unwanted pregnancies.
Contraception↗
Effects of contraceptive agents on the biochemical and protein composition of human endometrium.
An analysis of the nucleic acid and protein composition of endometrial tissue was undertaken in normal women and in patients using either steroidal oral contraceptives or intrauterine contraceptive devices (IUCD). In the presence of an IUCD, endometrial RNA/DNA and protein/DNA ratios were elevated in the secretory phase of the menstrual cycle compared to values obtained in normal women. In the oral contraceptive group, endometrial RNA/DNA and protein/DNA ratios were below the normal range in the late proliferative phase of the cycle. Typical electrophoretic profiles in the oral contraceptive group were similar to the control group, although a quantitative analysis revealed that the concentrations of certain characteristic uterine proteins were reduced. In the IUCD group, there was a preferential appearance of two proteins with approximate molecular weights of 36,000 and 26,000 daltons. Another protein with a molecular weight of 48,000 daltons, which demonstrated a cyclic change during the normal menstrual cycle, was reduced in both study groups. The results suggest that both agents studied induce changes in the macromolecular composition of the human endometrium which may relate to their contraceptive effect.
Adult↗
[The progestagen-containing implant (Implanon); who is responsible for what?].
Implanon is a contraceptive device with a high reliability in the prevention of pregnancy. The insertion is a simple procedure but the physician must master this skill. A number of cases have been recorded in which the rod appeared to have disappeared, which sometimes led to an unwanted pregnancy and sometimes ended in claims for compensation. There are a number of tips the physician can use to make sure that the insertion is done properly. At present, training in the insertion of this device is only offered by the company that sells Implanon. The question arises whether the professional group of GP's or gynaecologists should take over this responsibility.
Contraceptive Agents, Female↗
Emergency contraception: methods and efficacy.
A number of effective and safe methods for emergency contraception are now available. High doses of oestrogens, although effective, are seldom used nowadays because of the high incidence of nausea and vomiting, and the need for administration for 5 days. The Yuzpe regimen, consisting of administration of two doses of combined oral contraceptive pills with a 12-h interval, can prevent more than 74% of expected pregnancies, but the incidence of side effects, mainly gastrointestinal side effects, is high. Levonorgestrel and mifepristone are more effective than the Yuzpe regimen and have a lower incidence of side effects. They can prevent about 85% of pregnancies. The efficacy of both the Yuzpe regimen and levonorgestrel decreased with increase in the intercourse-treatment interval. The dose of mifepristone can be reduced to 10 mg without loss of efficacy. Both levonorgestrel or mifepristone are not yet widely available, and the Yuzpe regimen remains the only hormonal method in many countries. The postcoital insertion of an intrauterine contraceptive device is also a highly effective method, which can prevent over 90% of pregnancies.
Contraceptives, Oral, Combined↗
Technical failures in tubal ring sterilization: Incidence, perceived reasons, outcome, and risk factors.
Six centers participated in comparative studies of female sterilization conducted by the international Fertility Research Program. The incidence of technical failures (or failed attempts) was compared between patients sterilized with the tubal ring and those sterilized with other tubal occlusion techniques. The tubal ring was associated with a higher failure rate than electrocoagulation, the Rocket clip, or the modified Pomeroy technique. Of 1,035 tubal ring sterilizations, there were 38 technical failures. Reasons given by the operators for the failures, by frequency of occurrence, were surgical complications, conditions preexisting in the patients, and problems with the instruments. Most of these failures were remedied by changing to other techniques. In two patients, the procedure was completed by changing the approach from laparoscopy to laparotomy. In five others, sterilization was not completed. Case-control analysis was performed and three risk factors were delineated: obesity, prior use of an intrauterine contraceptive device and previous abdominal operations.
Abdomen↗
[Multiple image artifacts with linear sonic transducers].
The multielement arrays used nowadays for diagnostic purposes can, by means of digital signal processing, produce exact images with no problem. When physical limits were reached however, geometric image artifacts also became more evident, thereby making diagnosis more difficult or uncertain. Multiple images became especially evident during tests in the early stages of pregnancy, making it harder to differentiate between single and multiple pregnancies , particularly as dynamic processes such as the heart beat can be shown double at a certain phase in the pregnancy. Artifacts were also observed in the form of multiple echos during control checks on the position of intrauterine contraceptive devices and when investigating gynaecological tumors. These artifacts are ascribed to sonic behaviour at interfaces and are representable as a function of the sonic angle of incidence primarily in one plane--the cross section. They appear virtually symmetrical and can be wiped out by moving the sonic transducer. Although there is no problem in recognising the double phenomena as being artifacts in checks on the position of IUD's, all multiple structures should be clarified by suitable examination techniques especially during the early stages of pregnancy and with tumours.
Diagnosis, Differential↗
Prevalence of sexual activity and family-planning use among undergraduates in Southwest Nigeria.
OBJECTIVE: To assess the prevalence of sexual activity and family-planning use among undergraduates in a private tertiary institution in Nigeria. METHODS: A cross-sectional survey of 283 undergraduate students. RESULTS: Out of 283 students, 245 (86.6%) are sexually active in the last month. Out of these 245, 219 (89%) are currently using a family-planning method. In the study population, the percentages of awareness, ever use, and current users are 89%, 77%, and 75%, respectively. The most commonly known, ever used, and currently used contraceptive is condom followed in descending order by calendar method, oral pills, coitus interruptus, injectable contraception, emergency contraception, intrauterine contraceptive device, and diaphragm. Unmarried students and male gender show statistical significance with condom use. The reasons for preferring the current contraceptive method, among 219 current users, include safety, cost, ready availability, and partner's preference, among others. Most of the nonusers gave no reason for a failure to use a contraceptive, but others felt that contraceptives are dangerous, while a minority were ignorant of any method. Though many use a condom, this use is inconsistent. CONCLUSION: There is a high level of sexual activity among these undergraduates. Many are aware of family planning, and the condom is the most commonly known and used method, though not consistently. Reproductive-health education should be promoted among youths in Nigeria.
Adult↗
The pill and venereal disease.
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Contraceptive Devices↗
[Current status of the female condom in Africa].
The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
Africa↗
A clinicopathological study of IUD users with special reference to endometrial patterns and endometritis.
A group of 65 IUD users was studied during a period of 165 years of use, with a mean of 2.6 +/- 1.7 years per woman. The main complaint which differed significantly from the 120 controls was the occurrence of spotting in 33.8% of IUD users. Normal endometrial mucosae were found in 36.9% of IUD users and 38.7% of controls. Chronic endometritis was evidenced in 35.4% of IUD users versus 12.5% of controls; the former were asymptomatic in 25.0% of the cases. 39.1% of them had normal endometrial synchrony. Chronic endometritis occurred 2.2 +/- 1.3 years after insertion of the device. Endometritis was always symptomatic in controls; only 13.3% of them exhibited endometrial synchrony. The fundamental mechanism(s) responsible for the contraceptive efficiency of intrauterine contraceptive devices (IUD) remains a subject of controversy and a field of investigation. The most recent studies are essentially directed towards the biochemical analysis of uterine fluid [1]. Nevertheless, the presence of an inflammatory process, either morphologically or biochemically detectable, seems to be one of the fundamental modifications induced by the IUD. Since a certain reluctance to use IUDs has been observed in some countries, which has been ascribed mainly to contradictory reports on the risk of pelvic inflammatory disease (PID) in women wearing such devices [2], we found it interesting to intend to objectivate and reevaluate the influence of IUD on chronic aspecific endometritis, a possible precursor state of salpingitis and PID.
Adult↗
Validity of contraceptive histories in a rural community in Kenya.
To determine the validity of self-reported contraceptive histories obtained from rural Kenyan women, we interviewed 122 women participants in a long-term study during which their contraceptive use had been recorded regularly at clinics. Interview information was compared with each woman's clinic record. In all 71 women (58%) reported ever use of oral contraceptives, while 76 (62%) of the clinic records documented ever use. The agreement between the records and interview was reasonable (Kappa = 0.54, P < 0.001). The sensitivity of self-report of use compared to clinic records was 79%, specificity was 76%, positive and negative predictive values were 85% and 69% respectively. Ever use of injectable contraceptives (Depo-Provera) was reported by 78 (63%) women while the records showed use by 80 (65%) women (Kappa = 0.87, P < 0.001). The sensitivity, specificity, positive and negative predictive values were 94%, 93%, 96%, and 89% respectively. For the intrauterine contraceptive device, ever use was reported by 18 (14.8%) women while the records showed 19 (15.6%) (Kappa = 0.90, P < 0.001). The associated sensitivity, specificity, positive and negative predictive values were 90%, 99%, 94% and 98% respectively. The validity of reported duration of use of each method showed a similar pattern to that of the history of ever use. The Spearman's rank correlations for the duration of use calculated from interview compared with the clinic records were for oral contraceptives r = 0.68 (P < 0.001), injectables r = 0.81 (P < 0.001) and intrauterine devices r = 0.82 (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Mortality associated with use of IUDs.
Five deaths associated with the use of an intrauterine contraceptive device (IUD) were reported during the first half of 1973 through a nationwide mail survey of physicians whose practices were likely to be involved with intrauterine contraception. Four of the five reported deaths involved serious infections, and two of these four occurred in relation to a pregnancy. Use of an IUD prior to death ranged from seven months to 3 1/2 years. The mortality attributable to IUDs is estimated to be lower than that attributable to combination oral contraceptives.
Adolescent↗
[Contraceptives].
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Contraceptive Devices↗
An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs.
The levonorgestrel-releasing IUD (LNG-IUD-20), providing a daily dose of 20 ug, has recently been approved for marketing in Finland. The IUD's high efficacy in preventing accidental pregnancy and other numerous positive features make it a promising contraceptive device for worldwide use, just like the currently available T-shaped copper-releasing (TCu) IUDs. This paper reviews published reports comparing the LNG-IUD-20 and the currently used TCu IUDs. The merits and disadvantages of the steroid-releasing IUD are evaluated in terms of its performance and other special features relative to the TCu IUDs. Also, a number of future studies with medical and programmatic importance are proposed. A broader understanding about these two IUD families will facilitate their use in a complementary way for family planning programs.
Drug Evaluation↗
Abdominal wall actinomycosis associated with an IUD. A case report.
Abdominal wall actinomycosis without pelvic organ involvement in users of intrauterine contraceptive devices (IUDs) has not been reported on previously. We encountered one such patient, whose uterine cervix was colonized superficially with Actinomyces. We suggest that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Papanicolaou smears or in endocervical curettings. Such patients should be treated with appropriate antibiotic therapy, especially prior to any surgical intervention.
Abdominal Muscles↗
[Contraception a year after voluntary interruption of pregnancy].
At the time of conception leading to a RLA, 94 percent of the women were not using medical contraception (intra-uterine contraceptive device or estroprogestin drug). One year after the RLA, only 12 percent of the patients were found not to be using medical contraceptives. Thus, RLA is an event which modifies considerably the contraceptive habits of the patients. It is remarkable that one year after a RLA, 3/4 of the patients continue to use the contraceptive prescribed immediately after RLA.
Abortion, Legal↗