[Cardiac disease and pregnancy. 2. Pregnancy in the cardiac patient. 185 cases studied at the Boucicaut maternity hospital].
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Following persistent publicity about the possible side effects of hormonal contraceptives, intrauterine devices, and even sterilisation, many women contemplate the use of a diaphragm as their possible chosen method of contraception. In this article the practical aspects of fitting a diaphragm are described.
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In 1988 a survey** was conducted in 1,033 women living in Denmark, whose ages ranged from 15 to 44 years. The main aims of the study were to identify the influence, if any, of demographic and socioeconomic factors on contraceptive use and to assess the women's knowledge of selected facts concerning their own fertility. The study's additional objectives were to gain insight into factors influencing communication on the subject of contraception, such as advice obtained from professional counsellors, general information dissemination and discussion between partners, and to investigate women's attitudes and opinions regarding contraceptive methods and their use. The results are discussed in relation to the findings of other studies on the use of contraceptives both worldwide and in a number of European countries. The Danish findings are also examined in the context of possible action to reduce the relatively high rate of legally induced abortions in Denmark.
A retrospective study of 1,311 women making initial family planning visits to metropolitan-area health department clinics found that many women switch methods or discontinue use in the first year following the clinic visits. Among a subgroup of women, most of whom selected the pill as their primary method and who used the pill for at least one of the months in the study period, almost half either changed methods or used no method at some point during a follow-up period averaging eight months. This includes 13 percent of women who made two or more changes. In addition, only 42 percent said they took a pill every day, and only half of these said they always took their pill at about the same time every day. Despite such irregularities, pill users were approximately one-third as likely to get pregnant during the study period as women making an initial family planning visit to a health department clinic who did not use the pill at all.
The best available prevention against sexually transmitted diseases is limited to a consistent and correct use of a condom by the male. A new barrier method has been developed for the female. As it can be inserted into the vagina before sexual intercourse starts, and as it covers the entrance of the vagina, the opening of the urethra and the root of the penis, it is presumed to give a high degree of protection against sexually transmitted diseases and unwanted pregnancy. The preliminary results concerning acceptability are promising, and further investigations concerning acceptability and efficacy are in progress or completed in several countries. The method should be regarded as one aspect in the pattern of protection, particularly suitable for females with sexual risk behavior.
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Gynaeseal is a re-usable diaphragm tampon made from latex which forms a unique cervico-vaginal seal and isolates menstrual loss. In a prospective study involving 80 women, Gynaeseal was offered in combination with the Billings Ovulation Method in an advised birth control system. This system included: use of the diaphragm tampon during the menstruation-fertile phase interphase; periodic abstinence during the overtly fertile phase of the cycle; and if extreme reliability was required, for a further 2 days after the Billings method 'rules' allow resumption of intercourse. The diaphragm tampon successfully complemented the Billings Ovulation Method with 44 women (60.4%) assessing the GOM System as being as good, or better than, currently available reversible methods. It functioned effectively as a tampon with 50% (31 women) stating that they used the product as a contraceptive. One woman claimed an unplanned pregnancy. No significant medical complications were recorded. The product has major advantages as a tampon: it is easily and accurately inserted because of the efficient applicator; it isolated menstrual loss within a collection chamber; it protects the cervix; and it facilitates sexual activity. Based on a minimum effective diameter (62mm), the diaphragm tampon does not interfere with the normal physiology of the vagina. There appeared to be no significant distortion of normal adult pelvic anatomy, and properly placed, no sensation of the diaphragm tampon's presence. Regarding insertion of the diaphragm tampon using the spiral-curved applicator: 31 women (42.5%) had little or no difficulty; 29 (39.7%) moderate difficulty; 13 (17.8%) experienced serious difficulty; and 7 (8.7%) were unable to use the product.
In a large prospective study, set up to determine whether reproductive outcomes are affected by prior contraceptive use, 34,344 women were recruited at their first antenatal visit and followed until pregnancy termination. This paper summarizes the study methods and describes the demographic differences between subjects who used various contraceptives shortly before conception, and those who experienced contraceptive failures. Thirty percent of the women had used oral contraceptives (OCs) during the 5 months prior to conception and 2.4% had continued using them after their LMP. IUDs had been used by 5.8% of women before conception and 1.1% after. If these rates are also true for the whole population of the U.S., they indicate that approximately 70,000 babies are born each year following pill-failures and 30,000 following failures of IUD's. Exposure to other fetal hazards was common, with 48% of pregnant women drinking alcohol, 28% smoking, and 15% receiving diagnostic X-rays. OC use was more common among smokers and drinkers, and OC failures were significantly associated with the use of anti-epileptics, aspirin, and with exposure to radiation.
We conducted a case-control study to examine the associations between various behavioral risk factors and urinary tract infection among college-aged women. Cases were collected from a University Health Service, and were compared to Health Service controls and to a population-based control group. Sexual intercourse, diaphragm use, and urinating after sexual intercourse were each associated with urinary tract infection (UTI). The magnitude of the association of diaphragm use with UTI was reduced when urination habits around sexual intercourse were considered.
Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.
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This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.