Ectopic pregnancy in women who use intrauterine contraceptive devices]

This study analyzes occurrence of ectopic pregnancies in women using intrauterine contraceptive devices. During a 5-year period, 1990-1994, 524 women with ectopic pregnancies underwent surgery at our Clinic, while 22 (4.2%) had intrauterine devices. At admission most patients had signs of heavy intraabdominal bleeding, so in 77.27% cases the diagnosis was made by punction of the Douglas area, and only in 9.09% by laparoscopy, that is other methods for early detection of diseases. Rupture of the fallopian tube occurred in 50% of patients, tubal abortions in 36.36% and ovarian pregnancies in 13.64%, whereas 18 salpingectomies and 4 adnexectomies were performed. Late diagnosis and impossibility of performing conservative operations on fallopian tubes are the consequence of disregarding the possibility of getting pregnant by the users of intrauterine devices themselves, as well as by physicians whose help is asked for after symptoms appear.     

The use of cervical caps at the university of California/Berkeley

A pilot project was conducted at the University of California Student Health Services on student women fitted with a cervical cap. Follow-up was obtained in 34 of 36 women who purchased caps between spring 1978 and summer 1979. On the initial visit, the woman was presented with information on the cervical cap and its use and was loaned a cap after proper fitting. After the trial period, the woman returned for follow-up where she could elect to purchase a cap and if so, was then given a questionnaire to be returned later. The group of 34 women were divided into regular and irregular users: of the 24 regular users, 7 became pregnant using the cap and 2 of the irregular users became pregnant. 9 of the 24 users had 1 or more unwanted pregnancies aborted prior to the use of the cap, and 4 of the 7 regular users who became pregnant while using the cap had a previous pregnancy. While users were initially motivated, some did not actually use the method properly and even with proper fit, some found the cap became dislodged. This study did not bear out the high hopes many had for the cap's convenience and effectiveness although 16 or 17 regular users who did not become pregnant did continue use. Cap use should probably be discouraged as a primary contraceptive but it is a useful contraceptive to have available as an alternative. The cap's use will be regulated under "Medical Devices; Procedures for Investigational Device Exemption."     

Desire for children and the practice of family planning

Of 1647 women in confinement (mean age 26years) and 185 students nurses (mean age 18 years), the majority wanted two children. 8% of the women in confinement and 2% of the student nurses had received no previous family planning information, whereas 38% of the women in confinement and 81% of the student nurses had practiced contraceptive methods with a Pearl-index of 3 or less (oral contraceptives, basal-temperature-method). 31% of the women in confinement had already had unplanned pregnancies (mean: 1.4 pregnancy per woman). The last pregnancy was not planned in 27% and in these 4 out of 5 pregnancies were caused by incorrect application of the contraceptive method. Faulty practices and unsatisfactory results, in spite of the availability of secure contraceptive methods, emphasize the necessity of intensifying family planning. Because programmes including personal counsel have yielded better results, these should be favoured and include a clinical post partum programme. The latter was considered necessary by 95% of the women attending such a programme in our hospital.     

Effect of oral contraceptives and vitamin B6 supplements on alanine and glycine metabolism

Plasma alanine or glycine concentrations and blood pyruvate were studied before and after oral administration of the two amino acids to women using estrogen-containing oral contraceptives and to a control group of women. Thirty oral contraceptive users and 14 controls received alanine loads (200 mg/kg of body weight). The two groups had similar fasting plasma alanine levels, but the fasting blood pyruvate was elevated in the contraceptive steroid-treated women. After alanine ingestion, the increases in plasma alanine were significantly lower in the oral contraceptive users. Both groups showed a rise in blood pyruvate; there were no differences in the increments above fasting values. Treatment with pyridoxine hydrochloride, 25 mg for 4 weeks, had not effect on the responses of 11 oral contraceptive users to alanine loading. Twenty-four oral contraceptive users and 14 controls were studied before and after a glycine load (140 mg/kg of body weight). The fasting plasma glycine levels were similar, but lesser increases after ingestion of the amino acid occurred in the oral contraceptive-treated group. Blood pyruvate concentrations in both oral contraceptive users and controls were unaffected by oral glycine loads.     

Ectopic pregnancies associated with low dose progestagen-releasing IUDs

Dimethyl-polysiloxane capsules containing pure progestagens were attached to Tatum's T IUDs and tested in 594 fertile women for contraceptive performance. The control group was represented by 71 women who received identical devices containing barium sulphate instead of steroid and 100 women who received a Copper T-200. The progestagens and the doses tested were megestrol acetate (4.8, 19.2, 26 and 32 micrograms/day; levonorgestrel (2.1, 3.4 and 8.5 micrograms/day); norethindrone (18 micrograms/day); R2323 (28.6 and 45 micrograms/day); and norgestrienone (26 micrograms/day). Twelve pregnancies were diagnosed during 5201 woman-months of exposure accumulated within the first year of use among users of the steroid-bearing IUDs. Five of these were ectopic gestations. Ten pregnancies, all uterine, were detected during 1701 woman-months of exposure in the control group. Intrauterine delivery of progestagens by means of a carrier IUD is effective in decreasing the pregnancy rate but it might effect postovulatory events in a way which increases the rate of tubal implantation. Because of this property, progestagen-releasing IUDs should be limited to doses that assure maximal effectiveness to avoid increasing the risk of ectopic pregnancy.     

Sterilization in Finland: from eugenics to contraception

The purpose of this paper was to describe the transition of sterilization in Finland from an eugenic tool to a contraceptive. Historical data were drawn from earlier reports in Finnish. Numbers of and reasons for sterilizations since 1950 were collected from nationwide sterilization statistics. Prevalence, characteristics of sterilized women, and women's satisfaction with sterilizations were studied from a 1994 nationwide survey (74% response rate). Logistic regression was used for adjustments. In the first half of the 20th century, eugenic ideology had influence in Finland as in other parts of Europe, and the 1935 and 1950 sterilization laws had an eugenic spirit. Regardless of this, the numbers of eugenic sterilizations remained low, and in practice, family planning was the main reason for sterilization. Nonetheless, prior to 1970 not all sterilizations were freely chosen, because sterilizations were sometimes used as a precondition for abortion. Female sterilizations showed remarkable fluctuation over time. Male sterilizations have been rare. The reasons stipulated by the law did not explain the numbers of sterilizations. In a 1994 survey, 9% of Finnish women reported they were using sterilization as their current contraceptive method (n = 189). Compared to women using other contraceptive methods, sterilized women were older, had had more births and pregnancies, and came from lower social classes. Sterilized women were satisfied with their sterilization, but there were women (8.5%) who regretted it. In conclusion, sterilizations have been and are likely to continue to be an important family planning method in Finland. The extreme gender ratio suggests a need for promoting male sterilizations, and women's expressed regrets suggest consideration of a higher age limit.     

Trends in contraceptive use in the United States: 1982-1995

CONTEXT: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS: Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS: The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS: The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women.     

Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

OBJECTIVES: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy. DESIGN: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents. SETTING: Postnatal wards of Harare Maternity Hospital. SUBJECTS: 923 mothers following delivery. MAIN OUTCOME MEASURES: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge. RESULTS: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy. CONCLUSION: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.     

Changes of exploratory behaviour and its habituation in rats neonatally treated with monosodium glutamate

BACKGROUND: Because of the ban on oral contraceptive use in Japan, only high-dose combined pills (HDCP), permitted as treatment for menstrual disorders, can be used as a contraceptive. We determined the prevalence of the use of such preparations in a community in Japan and assessed the health characteristics of the users. METHODS: A total of 18,435 female residents age 35 years and over in a city of Gifu Prefecture, Japan, responded in 1992 to a health questionnaire that included questions on the use of HDCP, lifestyle, and dietary habits. The response rate was 92%. RESULTS: The rates of current and past HDCP use were 1.3 and 7.1%, respectively, among women ages 35-49 years, and 2.2% of the women had used HDCP for longer than any other method of contraception. Current HDCP users were more likely to be smokers. They had lower intakes of carotene, fiber, and vitamins C and E and a lower polyunsaturated/saturated fat ratio than never-users. CONCLUSIONS: The prevalence of HDCP use was 1.3% among Japanese women ages 35-49 years. Potential risk factors for cardiovascular diseases, such as smoking and a diet with lower intakes of antioxidants, were prevalent among current HDCP users.     

Mechanism of action of the intrauterine contraceptive device: evidence for a specific biochemical deficiency in the endometrium

The precise mechanism of action of the intrauterine contraceptive device (IUCD) is uncertain. In this study we compared the circulating concentrations of a specific endometrial protein, placental protein 14 (PP14), in 62 women with an IUCD and 16 controls. The concentrations of PP14 were substantially lower in IUCD users. There was no difference in the concentrations of another and less specific endometrial protein, insulin-like growth factor binding protein-1 (IGFBP-1). There was no difference in PP14 concentrations between those women with and without intermenstrual bleeding. We conclude that the reduced concentrations of PP14 in IUCD users reflect defective endometrial function in these women, probably related to the contraceptive effect. We propose that the measurement of PP14 might be a means of comparing the efficiency of different devices.     

The copper-7 intrauterine contraceptive device: 5-year evaluation

Over a 5-year period a family practitioner inserted copper-7 (Cu-7 intrauterine contraceptive devices (IUDs) in 134 women. The rates of continued use after 2 years, 53.0% for the women's first IUD and 63.9% for all their IUDs, and of accidental pregnancy, 2.4%, are comparable to those in the literature. However, in this series the rate of expulsion was 0.8%, much lower than that in the literature. Fertility did not appear to be reduced in women who planned to have pregnancies after the device was removed. A carefully scrutinized technique of insertion and conscientious follow-up make the Cu-7 IUD an acceptable form of contraception for many patients in a family practice.     

Kinetics of interaction of HLA-C ligands with natural killer cell inhibitory receptors

OBJECTIVE: To measure effectiveness, adverse event experience, and acceptability of the Food and Drug Administration-approved variant of levonorgestrel capsule implants in the United States through 5 years and to examine determinants of these outcomes. METHODS: In a prospective, multicenter study, 511 sexually active women selecting contraceptive implants were monitored four times in the 1st year, then semiannually through 5 years. Adverse events were elicited by query and physical examination, and their incidence was measured. Lifetable analyses computed pregnancy and other discontinuation rates. Cox regression models examined effects of age, parity, and preadmission desire for more children on continuation. Removal times were analyzed by analysis of variance. RESULTS: Three pregnancies occurred, yielding a 5-year cumulative rate of 1.3+/-0.8 per 100 users, an average annual rate of three per 1000 women, and an ectopic pregnancy rate of 0.6 per 1000 woman years. No pregnancies occurred to women weighing less than 79 kg. Prolonged or irregular menstrual bleeding, followed distantly by headache, weight gain, and mood changes, was the most frequent medical conditions leading to removal. Weight gain averaged 1 kg per year. Each annual continuation rate was above 80 per 100, for a cumulative 5-year rate of 39 per 100. Continuation was age-dependent, with younger women (younger than 25 years at entry) having lower 5-year continuation rates than older subjects (P < .01). Tissue trauma from deeply placed or poorly aligned implants or severe reactions to local anesthetic affected subjects in 3.1% of removals (nine cases). CONCLUSION: As measured by annual continuation rates of 80 per 100 or higher and annual pregnancy rates below one per 100, implant contraception in the United States was found to be highly acceptable and effective, year after year, regardless of the woman's age or family formation status. The cumulative 5-year pregnancy rate, 1.3 per 100, is comparable to that of tubal ligation.     

Epidemiology of cervix carcinoma in pregnancy

It is reported about the prevalence-rate of the precancerous and invasive cancers ofthe cervix uteri with 22,450 pregnant women at the age-groups from the 13th to 48th year, which are registrated by help of the cytological and expanded colposcopical examination from 1968 to 1974. There were found 57 heavy dysplasies (= 0,25%; sp = +/- 0,133), 42 carcinomas in situ (0,18%; sp = +/- 0,113) and 12 invasive cancers of the cervix uteri (= 0,053%; sp = +/- 0,061). It seems to be, that the prevalence-rate of the precancerous and cancers of the cervix uteri is the same at pregnant and non-pregnant women in the generative age.     

A new oral contraceptive based on the normophasic method

62 women were treated for 554 cycles with normophasic oral contraceptive Fisioquens. A treatment cycle consists of 7 tablets of 0.05 mg ethinyloestradiol, followed by 15 tablets with a combination of 0.05 mg ethinyl-oestradiol and 1 mg lynestrenol. No pregnancies occurred. Both tolerance of the preparation and cycle control were good. Irregular bleeding occurred sporadically. Various side-effects diminished during treatment and even disappeared completely. Fisioquens appears to be a reliable contraceptive with a minimum of side-effects.     

Haiti: unions, fertility and the quest for survival

This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.     

Menstrual and child-bearing functions of women using mechanical and hormonal contraceptives

The authors have studied the influence of mechanical and hormonal contraceptives on the organism of women, more specifically on their menstrual and child-bearing function. The studied women were divided into 2 groups: in the 1st group were 1532 women wearing intrauterine devices and 200 women examined in the remote period. The 2nd group consisted of 218 women using Infecundin for contraceptive purposes. The length of the observation period varied from 1 to 7 years. All women observed were healthy and of reproductive age. They were between 20 and 45 years of age. They all had a 2-phase menstrual cycle until they started to use a contraceptive. The women wearing IUD's had been using them for 6 months to 5 years. 93.4% did not show any sign of complication; 7.9% were experiencing various complications such as menstrual disorders, acute inflammations of the sexual organs; 38 women became pregnant; there was one case of spontaneous abortion; and 2 cases of extra-uterine pregnancy. 23 pregnancies went to term normally and 12 cases necessitated an induced abortion. The women from the 2nd group had been taking Infecundin for 3 months, 6 months, 12 months and over 1 year. 17 of these women were complaining of side effects such as nausea, vomiting, cardiac pain, swelling of the mammary glands, weight gain, headaches and hepatic disorders. Some histological examinations of the endometrium showed signs of endometritis. 10 women discontinued the use of Infecundin. On the whole, hormonal and mechanical contraceptives are of satisfying efficiency. They do not appear to provoke any significant complications in the menstrual and child-bearing functions of the woman. However the use of oral contraceptives tends to provoke a pronounced atrophy of the mucous membrane in the uterus. Therefore it is advisable to prescribe oral contraceptives in cycles separated by 2 to 3 month interruptions.     

Intrauterine devices and acute pelvic inflammatory disease

One of the most serious problems among women using the intrauterine device (IUD) has been pelvic inflammatory disease (PID). Subjects for the present investigation were chosen from 15- to 44-year-old women seeking emergency medical attention at a large city hospital. Febrile and afebrile patients with PID and appropriate controls were asked to complete a self-administered questionnaire concerning their demographic, reproductive, and contraceptive histories. Results showed a significantly higher proportion of IUD users among febrile cases of PID (38%) than among controls (11%). This implies that febrile PID is five times as likely to develop in an IUD user as in a nonuser.     

The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study

A new contraceptive (LNG rod implants, Jadelle, Leiras Oy's registered trademark for rod implants) was prospectively evaluated in randomized 5 year comparison with Norplant (Population Council's registered trademark for contraceptive implants releasing levonorgestrel) capsule implants. The study involved 1198 women at seven centres. No pregnancies occurred in the first 4 years. At 5 years, the cumulative pregnancy rate was 1 per 100 users or less for each regimen. Annual discontinuation rates averaged 11-12 per 100 users (P > 0.05), corresponding to 5 year continuation rates of 55.1 for rods and 53.0 per 100 for capsules. Mean annual discontinuation rates for menstrual disturbances were 3.5 and 4.2 per 100 for rod and capsule implants respectively (P > 0.05), and mean annual removal rates for medical problems were 3.5 and 3.0 per 100 (P > 0.05) respectively. Apart from menstrual problems, headache, weight gain and acne were the principal medical reasons for removal. In proportional hazard analyses, family formation variables, age, parity and desire/non desire for another child, recorded at admission, significantly affected discontinuation rates for major decrement categories and for all reasons combined. Mean rod removal time was half that of Norplant (P < 0.01); complications of rod removal were at a lower rate. With these contraceptives indistinguishable in performance except for ease and speed of removal, LNG rod implants appear to be preferable to Norplant for use through 5 years by virtue of relative ease of removal.