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PubMed1980

Preliminary testing of the contraceptive collagen sponge.

The results of 3 years of developing the collagen sponge as an intravaginal contraceptive are presented. Postcoital tests were used to evaluate the efficacy of the sponge as a mechanical barrier. Results with the collagen sponge alone were compared to those of the sponge with spermicidal cream or spermicidal solution (acid buffer and zinc) and of spermicidal cream alone. The presence of any motile spermatozoa in the cervical mucus was considered a failure of the barrier method. The collagen sponge alone or with acid and zinc and spermicidal cream alone had failure rates of 22, 20, and 14%, respectively, whereas the collagen sponge with spermicidal cream had a 6% failure rate. The authors conclude that the combination of a mechanical and a chemical barrier is a more effective contraceptive method than a mechanical barrier or chemical agent alone.

Adolescent↗
PubMed2002

Techniques for the interruption of tubal patency for female sterilisation.

BACKGROUND: Female sterilization is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated. OBJECTIVES: To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties and women's and surgeons' views. SEARCH STRATEGY: The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using an Internet search service Pub Med. SELECTION CRITERIA: All randomized controlled trials comparing different techniques for tubal sterilization, regardless of the way of entry in the abdominal cavity or the method of anesthesia. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes. MAIN RESULTS: Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76). Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than with electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10). Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported. Pomeroy versus Filshie clip: In the trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months. No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices (Toplis 1988). REVIEWER'S CONCLUSIONS: Electrocoagulation was associated with less morbidity when compared with tubal ring and other methods. However the risk of burns to the small bowel might be a serious criticism of the approach. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.

Female↗
PubMed1993

Comments by the 'Information by Phone' Department of the Sex Medical Institute on the telephone calls related to sexuality and contraception.

The present study which was carried out by the Sex Medical Institute has been based on 5252 telephone calls related to sexual or contraception matters, which were received in the period February 1989 to July 1991. Of the calls, 58.8% came from men and 41.2% from women. The main topics of the questions concerned masturbation (frequency, guilts), anatomy of the genital system (anxiety and concern on the length of the penis, virility, femininity), the first sexual experience (fear, anxiety of failure).

Academies and Institutes↗
PubMed1987

Postcoital contraception with dl-norgestrel/ethinyl estradiol combination: six years experience in a student medical clinic.

Postcoital contraception with ethinyl estradiol/dl-norgestrel in combination has been available to women students attending the University of British Columbia since 1974. This paper reports on the side effects, cycle control and efficacy, for a six-year period (1979-1985). In this sample of women 50% reported side effects of nausea alone or nausea with vomiting. Length of the menstrual cycle was shortened in women who took the medication prior to the expected day of ovulation. The number of pregnancies reported was significantly (p less than 0.002) less than the number expected had the medication not been taken. Some women took the medication even though there was a possibility of conception earlier in the cycle and this might account for four of the failures. The mode of action of the postcoital medication remains unsolved making it difficult to understand possible reasons for the other 14 failures.

Adult↗
PubMed2002

Intrauterine devices.

The aim of this chapter is to review the worldwide use of intrauterine devices (IUDs) for contraception and the long-term contraceptive efficacy and safety of copper-bearing IUDs. The TCu380A and Multiload Cu375 have a very low failure rate (0.2-0.5%) over 10 years. The main concerns of the use of IUDs are risk of pelvic inflammatory diseases and increased menstrual blood loss and irregular bleeding. Factors associated with an increase in risk of pelvic inflammatory diseases are discussed. Preventive measures can be taken with careful screening of eligible IUD users, technical training and adequate service facilities for provision of IUDs. Levonorgestrel-releasing IUDs have the benefit of reducing menstrual blood loss in addition to high contraceptive efficacy. The copper IUD is the most effective method for emergency contraception. It can prevent over 95% of unwanted pregnancies within 5 days of unprotected intercourse.

Contraceptives, Postcoital↗
PubMed1991

Hepatic vein thrombosis in a teenager: a case report.

Hepatic vein thrombosis or the Budd-Chiari syndrome is an uncommon condition which rarely occurs in teenagers. The condition involves obstruction of blood flow from the liver with progressive congestion and hepatic failure. The etiology is often idiopathic but may involve conditions that increase thrombogenic tendencies. Oral contraceptives are known to increase the risk of a number of thrombotic conditions and have been associated with the Budd-Chiari syndrome. Although millions of teenagers have used oral contraceptives without incident, occasionally we are reminded of their potential serious complications. The case of a 19-year-old who developed hepatic vein thrombosis while using oral contraceptives is presented.

Adult↗
PubMedDate not supplied

Toxic shock syndrome: an opportunity for nursing intervention.

Toxic Shock Syndrome (TSS) is a potentially fatal illness caused by a particular strain of Staphylococcus aureus. The clinical presentation is similar to that of septic shock. The incidence of TSS peaked in the late 1970s and early 1980s, probably as a result of availability of super absorbent tampons. Although most commonly associated with menstruation, the overall incidence of menstrual and nonmenstrual TSS in men and women ranges from 1 to 3 per 100,000. There are almost equal numbers of menstrual and nonmenstrual cases of TSS identified annually. S aureus, the causative microorganism in cases of TSS, has been isolated from many body tissues. Toxic shock syndrome presents as a flu-like illness with high fever, vomiting, diarrhea, general malaise, and muscle weakness. Nursing and medical management focus on controlling or preventing potentially serious complications, such as adult respiratory distress syndrome, renal failure, electrolyte imbalances, disseminated intravascular coagulation, encephalopathy, and cardiomyopathy. Judicious use of tampons and barrier contraceptive devices may decrease the risk of developing TSS.

Adult↗
PubMed1997

Tricuspid valve endocarditis in a non-drug addict associated with peliosis hepatis.

A 31-year-old woman was admitted because of persistent remittent fever. Tricuspid valve endocarditis due to Staphylococcus aureus was identified as the cause of fever. The patient had no history of intravenous drug abuse, oral contraceptives or predisposing cardiac disease. Huge hepatomegaly was found without any signs of congestive heart failure. Liver enzyme abnormalities were not detected throughout the entire course of therapy. The liver biopsy specimen revealed peliosis hepatis. Treatment with panipenem/betamipron was successful, although recurrent septic pulmonary embolism occurred. The cause of the huge hepatomegaly encountered in the present case may be attributable to peliosis due to severe infection.

Adult↗
PubMed1994

[The 1st phase of a prospective study of the effectiveness of natural family planning conducted in French-speaking Belgium].

UNLABELLED: The aim of this pilot-study is to check the practical efficiency and the acceptability of a recent NFP method in Western Europe. MATERIAL AND METHODS: In a first stage, 58 participants, aged 18 to 49, provided 940 cycles (78 woman-years) being with an average of 16 cycles each, all well-documented (sympto-thermal chart and supporting card). The average age of the women was 32 years. 53% of them have chosen NFP after giving up another contraceptive method. The applied NFP method uses a double check to accurately define the beginning as well as the end of the fertile phase of the menstrual cycle. The indicators of the beginning of the fertile phase were: the first sign of cervical mucus and a calendar calculation. The indicators of the end of the fertile period were: the third morning of high temperature and the evening of the fourth day after the peak mucus or the peak cervix. Four participants out of five regularly uses the cervix index. RESULTS: No method failure was seen. One unplanned pregnancy (user failure) was recorded. Pearl-Index (practical effectiveness of the method) was: 1.75. Pure NFP (i.e. no additional contraceptive means during the fertile phase) was applied in 85% of the cycles. Moreover unprotected sexual intercourse during the fertile phase occurred in 17% of the cycles. So in 71% of the cycles, couples had accepted periodic abstinence. CONCLUSIONS: After more than 78 years of use, it appears that an accurate and thoroughly taught sympto-thermal method of NFP shows a use-effectiveness which can be compared to that of the up-to-date contraceptive methods. The acceptance of the method proved to be excellent. The acceptability turns out to be very good.

Adolescent↗
PubMedDate not supplied

Effects of hormonal contraceptives on breast milk composition and infant growth. World Health Organization (WHO) Task Force on Oral Contraceptives.

Breast milk volume and composition and infant growth were measured at three- and four-week intervals, up to six months, in a multicenter randomized double-blind trial comparing a low-dose combined oral contraceptive (OC) with a progestogen-only OC. A nonrandom group using nonhormonal methods was also studied in the three centers: Szeged, Hungary; Bangkok, Thailand; and Khon Kaen, Thailand. A fourth group, users of depot-medroxyprogesterone acetate (DMPA) was included in the two Thai centers. Altogether, 341 women were recruited into the study. Combined OCs caused a significant decrease in milk output and total energy content as well as widespread changes in milk constituents. In the DMPA group, no significant changes were observed in milk volume, and only minor shifts occurred in milk composition, which varied between centers. No differences were found between the progestogen-only pill and DMPA. No hormonal contraceptive was associated with any significant difference in infant weight or fat fold, nor in the rate of discontinuation for failure to gain weight. This study reiterates the need to avoid combined OCs during the first few weeks or months of lactation. Both norgestrel and DMPA appear to be safe for use in both developing and developed countries, at least when the nutritional status of the mother and infant are adequate, but further research is needed on the safety of these contraceptives in populations with malnutrition.

Breast Feeding↗
PubMed1986

Unplanned pregnancies in the United States.

Unplanned pregnancies constitute an epidemic in the United States. Over 3 million unplanned pregnancies occur, and over 1.5 million induced abortions are performed each year. Women of minority races and those with less than 12 years of education are at high risk of having unwanted children. Fear of complications (not the complications themselves) is the most powerful deterrent to women's use of contraception. Much of this fear is due to bad press. Recent good news about contraception, such as protection against ovarian and endometrial cancer, protection against ectopic pregnancy, and absence of teratogenic effects, has not received appropriate media coverage. For healthy women younger than 35 years, failure to use fertility control is more dangerous than use of any method.

Abortion, Induced↗
PubMed1993

3-month contraceptive injection approved.

FDA has approved medroxyprogesterone acetate as Depo Provera Contraceptive Injection, effective for 3 months in preventing pregnancy in women. In clinical studies, the drug's failure rate was less than 1%. However, physicians must ensure that patients receive injections on schedule to prevent pregnancy. The recommended dose is 150 mg administered every 3 months by deep, intramuscular injection in the gluteal or deltoid muscle. Most women in clinical studies of Depo Provera experienced menstrual irregularities. As use continued, amenorrhea became common, reported by 57% of the women by the end of a year of treatment. Other side effects included weight gain, headache, nervousness, abdominal pain or discomfort, dizziness, and asthenia. Physicians should administer the drug only to women found not to be pregnant, because fetal exposure may lead to low birth weight and other problems. Recent data have demonstrated that longterm use may contribute to osteoporosis, and the drug's manufacturer, the Upjohn Company of Kalamazoo, Michigan, will conduct additional research to study this possible side effect. Contraindications are similar to those for other contraceptives and include undiagnosed vaginal bleeding, known or suspected malignancy of breast, thromboembolic disorders, cerebral vascular disease, and liver dysfunction. Depo Provera was developed in the 1960s and has been approved for contraception in many other countries. When FDA first reviewed data on the drug in the 1970s, animal studies raised questions about its potential to cause breast cancer. Since then, longterm controlled clinical studies in other countries have shown a risk of breast cancer comparable to oral contraceptives, and no increased risk for ovarian, liver, or cervical cancer. The studies also showed that the contraceptive injection reduced the risk of endometrial cancer. FDA approved the drug October 29, 1992.

Contraception↗
PubMed1996

Postcoital contraception: who uses the 'morning after pill'?

Postcoital contraception (PCC) is a safe and effective method of avoiding unwanted pregnancy after an occurrence of unprotected sex. It nevertheless represents an absence or failure of preventive strategies. Women engaging in unprotected sex may have been exposed to risks of sexually transmissible diseases (STDs) including HIV/AIDS. Family planning service providers have expressed concern at the number of women using this emergency measure as a form of contraception, sometimes repeatedly, but little is known about the sort of women they are and the context in which unprotected sex has occurred. This paper reports the sociodemographic characteristics of women requiring PCC in the two clinical sites of Family Planning Victoria. A self-administered questionnaire was completed by 206 women who required PCC during a 3-month period. The women were aged 14-43 years with an average age of 23 years. Over half the women had used PCC previously and more than a quarter of these women had used it more than twice before. Most of the women had had sex with a regular boyfriend, husband or partner at their own or their partner's home. The main reasons given for needing PCC were nonuse of condoms, condom breakage and missing an oral contraceptive pill.

Adolescent↗
PubMed2002

Perception of university students in Ghana about emergency contraception.

Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure, or incorrect use. There is growing worldwide acceptance and promotion of EC as a measure to reduce the level of unwanted pregnancies and, hence, unsafe abortions. The potential effect of EC in this regard could be most evident in sub-Saharan Africa. In Ghana, the Ministry of Health has since 1996 included EC in its reproductive health service policy and standards. The Planned Parenthood Association of Ghana is the only agency involved in the promotion of EC in the country. Very little is known about societal perception of EC. We undertook a study to assess knowledge and attitude toward EC among a sample of students at the University of Ghana. We used a two-page, self-administered questionnaire in a cross-sectional study among students chosen by random sampling. The aspects of EC assessed included level of knowledge, extent of use, common traditional methods of emergency contraception, as well as socially and culturally acceptable ways to promote EC in Ghana. We also assessed how the availability of EC could influence the use of condoms among male respondents. Less than half (43.2%) of the 194 respondents (88 males and 106 females) had heard of modern emergency contraceptive methods. Postinor-2, a dedicated emergency contraceptive product, which was already on the Ghanaian market, was known to 1.5% of respondents. Only 11.3% of respondents indicated correctly the recommended time within which emergency contraceptive pills (ECPs) are to be taken after unprotected sex. Taking concentrated sugar solutions, having an enema, and douching were commonly used traditional methods of EC. More than half (55.0%) of the male respondents indicated that they would either "certainly" or "probably" reduce how often they used condoms once they knew that EC was available. Almost all (97.4%) the respondents wanted to learn more about EC. The indications from this study are that the promotion of EC in Ghana is desired and must be encouraged. The fact that EC does not offer protection against sexually transmitted infections should always be emphasized.

Adult↗