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PubMed1982

Detection and prevalence of IUD-associated Actinomyces colonization and related morbidity. A prospective study of 69,925 cervical smears.

Cervical Papanicolaou smears from 69,925 women were screened prospectively for the presence of Actinomyces israelii. The organism was not identified in non-intrauterine (contraceptive) device (IUD)-wearers. The prevalence of A israelii among IUD wearers ranged from 1.6% (general population) to 5.3% (clinic population). Protracted IUD use seemed to predispose to a higher incidence of infection. Direct immunofluorescence proved to be a more accurate and specific method of identification when compared with conventional light microscopy and anaerobic culture. Two of 112 women with direct immunofluorescence-proved A israelii had significant clinical infections. It appears that in the vast majority of cases, IUD-associated Actinomyces colonization produces only a superficial infestation. Conservative management is suggested for asymptomatic patients with cytologically detected Actinomyces to include removal of the IUD and repeated Papanicolaou smear after the next menstrual period.

Actinomyces↗
PubMed1991

The intrauterine device and pelvic inflammatory disease: the Women's Health Study reanalyzed.

The Women's Health Study (WHS) was a large, widely accepted and influential case-control study of the relationship between the use of intrauterine contraceptive devices (IUDs) and pelvic inflammatory disease (PID). The data were collected at 16 hospitals in 9 cities across the U.S.A. from October 1976 through August 1978. The first paper on this research was published in 1981 and concluded that IUDs increase the risk of PID. The report cited an estimated RR (relative risk) of PID for current IUD users vs nonIUD users of 1.6 with a 95% confidence interval of (1.4, 1.9). However, careful examination of the report reveals that the data support conclusions antithetical to those at which the author arrived. When the second report on the WHS was published in 1983, it was anticipated that many of the shortcomings of the first report would be corrected, but they were not. In 1983 we undertook a complete reanalysis of the same WHS data using more appropriate criteria and the results were compared to the first two published reports. The reanalysis revealed an RR of 1.02 (0.86, 1.21) for current IUD users compared to noncontraceptors. The conclusion of the WHS should have been that IUDs do not increase the risk of PID.

Adult↗
PubMed1995

Attitudes and practice of couples regarding sexual relations during the menses and spotting.

To determine attitudes and practices regarding sexual relations during menstruation and vaginal spotting, a cross-sectional descriptive survey was performed at the Instituto de Investigaciones Materno Infantil, Universidad de Chile, Santiago, Chile. A total of 287 women and 206 men were randomly selected from an urban population. Attitudes, beliefs, and practices regarding sexual relations during vaginal bleeding were surveyed and stratified by educational level and other demographic characteristics. Overall, 70% of women and 72% of men were found to avoid sexual relations during menstruation. Fifty-four percent of women and 60% of men avoided sexual relations during vaginal spotting. Women with higher education (technical or university) were less likely to avoid sexual intercourse compared to those with a lower educational level (basic or secondary education) during menstruation (73% vs. 57%) and vaginal spotting (69% vs. 34%). Men with a higher educational level (university) avoided intercourse less frequently when their partner was spotting (48% vs. 64%). As many methods of contraception affect a woman's menstrual cycle, they therefore may affect the intimacy of a couple. Counseling and education regarding the menstrual cycle and expected alterations by a contraceptive method may reduce any negative impact of a contraceptive device on a couple's sexual life.

Adult↗
PubMed1995

Women's knowledge of taking oral contraceptive pills correctly and of emergency contraception: effect of providing information leaflets in general practice.

BACKGROUND: About one third of all pregnancies are unplanned and 20% of all pregnancies end in abortion. More than 170,000 legal abortions are performed in the United Kingdom annually. Nearly all general practitioners provide contraceptive advice; the most commonly used form of reversible contraception is the oral contraceptive pill. AIM: The aim of this study was to determine factors associated with women's knowledge of taking the contraceptive pill correctly and of emergency contraception, and to investigate if their knowledge could be improved in general practice by providing women with Family Planning Association information leaflets. METHOD: An uncontrolled intervention study was performed in one rural and one urban English general practice, using a self-completion questionnaire that was initially administered to women attending their general practitioner for oral contraception over six months from 1 October 1992. The questionnaire asked for: sociodemographic information; knowledge of how late women can be taking an oral contraceptive pill and still be protected against unplanned pregnancy; for how many days after being late with a pill they need to use other precautions; sources and methods of emergency contraception; and for how long the methods are effective after the primary contraceptive failure. After completing the questionnaire women were given two leaflets: one about how to take their prescribed contraceptive pill correctly and one about emergency contraception. Three to 12 months later the same questionnaire was administered in the same manner. RESULTS: Of 449 women completing the first questionnaire, 233 (52%) completed the second questionnaire. Initially 71% of 406 women taking an oestrogen/progestogen combined pill knew about the '12-hour rule' and 17% knew about the 'seven-day rule'; giving women information about the pill they were taking increased the extent of knowledge about these rules among 212 respondents to 82% (P < 0.01) and to 25% (P < 0.05), respectively. The proportion of respondents who knew that they could obtain emergency contraception from their own general practitioner, from any general practitioner and from family planning clinics all increased after they had received the leaflets (from 84% to 92%, from 34% to 47% and from 82% to 90%, respectively, all P < 0.01). There were significant improvements in the proportion of women knowing the duration of effectiveness of emergency contraception. However, after receiving the leaflet on emergency contraception the majority of women still did not know for how long after unprotected intercourse the high-dose combined pill and the intrauterine contraceptive device were effective (80% and 93% of 233 women, respectively). Improvements in knowledge depended upon women's social class, previous use of emergency contraception and with which practice they were registered. CONCLUSION: Providing women with leaflets about taking the contraceptive pill correctly and about emergency contraception appears to improve significantly their extent of such knowledge. If such practice was adopted elsewhere this increased knowledge might reduce the number of unplanned pregnancies in the UK. The effect of general practitioners personally providing such leaflets, with or without verbal instruction, warrants further study.

Adolescent↗
PubMed1998

[Contraceptive use in female transplant recipients].

The choice of a good contraception is difficult in allograft recipient woman. Even if patients recovered a normal menstruation and fertility, the oral and the intra-uterine devices contraceptives are contraindicated. If pregnancy occur too soon after the transplantation, the survival graft is in danger. According to the literature, 50% allograft recipient have begun a pregnancy without medical concentration. In this article, we wanted to find the contraceptive method effective and appropriate in recent allograft recipient female according to the organ grafted. We discuss the new contraceptive methods and advise to avoid, in first instance a tubal ligature.

Contraception↗
PubMed1984

[IUD-deformation and unusual complications of intrauterine contraception].

Deformations of intrauterine contraceptive devices in the uterine cavity and their consequences are reported. In a period of 16 years we observed two partial perforations and two tuboovarian abscesses with this method of contraception in 3753 women. The value of IUD as a contraceptive of the second range is not degraded by these rare complications.

Abscess↗
PubMed2001

Intra-uterine implant (GyneFix) lost via intestinal route?

Uterine perforation has long been regarded as a complication of the insertion of an intra-uterine contraceptive device (IUD). The development of modern devices with sophisticated insertion systems as well as advanced training requirements seeks to minimise the risk of adverse insertion incidents for women choosing intra-uterine contraception. This case report highlights the continuing need for intra- and post-insertion vigilance as even recent advances in IUD technique and technology do not guarantee risk-free insertion.

Adult↗
PubMed1995

The influence of the Gyne-T 380S IUD on menstrual blood loss and iron status.

The influence of the Gyne-T 380S intrauterine contraceptive device (IUD) on menstrual blood loss (MBL) and iron status (hemoglobin, hematocrit, red cell count and indices, and serum ferritin) was evaluated. MBL was determined objectively by the alkaline hematin method in 18 women (mean age 37.1 +/- 1.6 yr, range 22-46 yr) before and 3, 6 and 12 months after insertion of a Gyne-T 380S IUD. MBL prior to IUD insertion was 59 +/- 8 ml and increased to 91 +/- 11 ml (p < 0.01) 3 months after insertion. MBL then remained largely unchanged during the remainder of the observation period (6 months, 94 +/- 12 ml; 12 months, 92 +/- 13 ml). The percentage increase in MBL at the respective measurement points ranged between 54 and 59% which is comparable with previous reports regarding the increase in MBL associated with the use of a copper IUD. There were no significant changes recorded in iron status parameters during the 12-month observation period following IUD insertion. Based on the results of the present study, women from developed countries apparently tolerate an increased MBL of approximately 55% without developing iron deficiency anemia. Iron stores were unchanged indicating an adequate adaptive increase in intestinal iron absorption.

Adult↗
PubMed1992

Ovarian actinomycosis presenting as acute peritonitis.

A patient with acute peritonitis due to ovarian actinomycosis and the association of this disease with the intrauterine contraceptive device is discussed. Because adequate treatment requires prolonged antibiotics the diagnosis should be sure. Unfortunately if antibiotics are given pre-operatively culture is usually unsuccessful and thus careful examination of all removed material is essential. As many of these women are of child bearing age surgical intervention should aim to preserve fertility wherever possible.

Abscess↗
PubMed1978

Ectopic pregnancy. Relationship to the preceding contraception.

The incidence of extrauterine pregnancies in all the deliveries in this clinic has increased from 1.3% in 1968 to 2.5% in 1976. Of 163 consecutive extrauterine pregnancies during a ten month period in 1976, 40% had an intrauterine contraceptive device in situ at the time of conception. 650 healthy women who had had an IUD inserted in 1973 were follow-up for an average of 3 years and all extrauterine and intrauterine pregnanices registered while the device was in situ. 27 intrauterine and 4 extrauterine pregnancies occurred over 1,572 women-years of use. From these data it was calculated that 99.5% of all possible intrauterine implantation and 93.5% of tubal implantations were inhibited by the device. This difference is apparently the reason for the increased risk of extrauterine pregnancies in IUCD users.

Abortion, Legal↗
PubMed1981

Incidence, trends, and risks of ectopic pregnancy in a population of women.

In a 20-year longitudinal study on ectopic pregnancy in a defined population of women aged 15-39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased from 5.8 during 1960-4 to 11.1 during 1975-9. The mean annual incidence of ectopic pregnancy per 1000 women increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed conceptions increased with increasing age of the women and were 4.1, in the teenage group 6.9, in women aged 20-29 years, and 12.9 in women aged 30-39. Among 20- to 29-year-old sexually active women at risk of pregnancy who had never had acute salpingitis the rates of ectopic pregnancy per 100 woman-years were the same in those who did not use contraceptives as in those using non-medicated or copper-medicated intrauterine contraceptive devices (IUCDs; 0.3/100 woman years). The risk of an ectopic pregnancy increased sevenfold after acute salpingitis. These findings confirm the increased risk of ectopic pregnancy after salpingitis and suggest that the increase in the incidence of ectopic pregnancy in Lund from 1960 to 1979 was partly accounted for by the use of IUCDs.

Adolescent↗
PubMed1975

An epidemiological study of recent trends in ectopic pregnancy.

Data from two independent sources in England and Wales, the first based upon persons discharged from hospital and the second upon general practitioner consultations, indicate that the incidence of ectopic pregnancy has been increasing since the late 1950s, with a particularly sharp increase since 1970. Time trends in the age and regional distribution of ectopic pregnancy suggest that the increasing use of intrauterine contraceptive devices may be a major factor contributing to this recent increase in extrauterine gestations. In contrast, recent age and regional trends in tubal infection appear to be unrelated to the trends in ectopic pregnancy. The possible contribution of progestogen-only contraceptives, induced abortion and tubal surgery to the recent increase in extrauterine pregnancy cannot be assessed from the available data.

Abortion, Induced↗
PubMed1990

[The outcome of continuing pregnancies in patients with intrauterine devices. A retrospective study from the Maternity Unit of the University Hospital Center at Caen during the period 1985-1988].

This study has been carried out to investigate whether the presence of an intra-uterine contraceptive device in pregnancy is a risk factor for the pregnancy, for the fetus and for the mother. We have concerned ourselves with pregnancies that led to a viable fetus. We wanted to know whether early removal of the device altered the bad effects of the device. The same types of pathology such as bleeding, threatened premature labour, premature rupture of the membranes and premature delivery occurred whether the device was removed or not; but the incidence of the various complications was increased if the device remained in place the whole pregnancy. It seems absolutely necessary for every woman who becomes pregnant with an intra-uterine device to have the pregnancy diagnosed as early as possible and for the device to be removed to lessen the risk of complications. When this is not done the pregnancy should be considered a high risk pregnancy.

Amnion↗
PubMed1985

Contraceptive use before tubal sterilization.

A woman's decision to undergo tubal sterilization may be affected by her experience with temporary contraception. To examine this issue we analyzed data from the Collaborative Review of Sterilization, a multicenter, prospective study of the health effects of sterilization operations on women aged 15-44 years. Data on contraceptive use by a comparison group of nonsterilized women were drawn from a random, population-based sample of women aged 20-44 years who were controls in a large study of cancer and steroid hormone use. Sterilized women reported ever using a higher average number of contraceptive methods than did nonsterilized women. As compared with nonsterilized women, a higher percentage of sterilized women reported ever using contraceptives (99% versus 91%), especially two types, barrier and rhythm or withdrawal. Prior to selecting sterilization as a permanent contraceptive method, the sterilized women had more extensive experience with temporary contraceptives, particularly the less effective ones, than did the comparable nonsterilized women.

Adult↗
PubMed1977

Progestational agents and blood coagulation. VIII. Effect of low-dose, alternate-day, estrogen-progestin combinations on blood coagulation factors in man, with a special note on the effect of freezing of blood samples.

Changes in the blood coagulation system were studied in three groups of 20 patients each. The first group received 0.5 mg. of norethindrone daily, plus 0.06 mg. of ethinyl estradiol on alternate days from cycle Day 5 through 25. The second group, all of whom had been fitted with an intrauterine contraceptive device (IUD), received no hormonal treatment and served as a control group. The third group received 0.5 mg. of norethindrone daily, combined with 0.045 mg. of ethinyl estradiol given on alternate days from cycle Day 5 through 25. Blood samples were drawn prior to the initiation of the study and after three months of treatment. Tests of the following parameters of the blood coagulation system were performed: direct platelet count; platelet adhesiveness; prothrombin time; thrombin time; fibrinogen; factor II assay; activity of factors V, VII, VIII, IX, and X; antithrombin III; and fibrin/fibrinogen degradation products. For a number of these factors, both fresh and frozen blood samples were examined. It was concluded that the two treatment regimens, with the use of alternate-day estrogen administration over a three-month period, had no clinically significant effect on the blood coagulation system.

Adolescent↗