RESUMEN

Precipitous delivery in the emergency department is a high-acuity, low-occurrence event that requires rapid recognition and interdepartment cooperation to prevent fetal and maternal morbidity and mortality. Prompt recognition of the peripartum state can be delayed by reported usage of long-acting contraception and concurrent distracting complaints. In this case report, a young female presented to the emergency department with epigastric abdominal pain in the setting of recent workup for biliary colic and multiple doses of long-acting, depot contraceptive agents. Early utilization of bedside ultrasound confirmed a full-term, intrauterine pregnancy as well as an impacted gallbladder stone, followed by a precipitous footling breech presentation that required an emergent cesarean section.

RESUMEN

OBJECTIVE: A pooled analysis of two randomized controlled trials (RCTs) suggested that increased bodyweight and body mass index (BMI) may be associated with a greater probability of pregnancy. To address this issue we investigated whether higher bodyweight and/or BMI negatively impacted the risk of pregnancy in women receiving LNG-EC (levonorgestrel - emergency contraception) after unprotected sexual intercourse in a pooled analysis of three large multinational RCTs conducted by the World Health Organization (WHO). METHODS: A pooled analysis of three double-blind, multinational RCTs conducted by the WHO to investigate the efficacy of LNG-EC in the general population. All analyses were done on the per-protocol set (PPS) which included 5812 women who received LNG-EC within 72 hours following unprotected sexual intercourse. The analysis was based on logistic regression, with pregnancy as the outcome. BMI and weight were represented in the same model. RESULTS: A total of 56 pregnancies were available for analysis in the PPS. Increasing bodyweight and BMI were not correlated with an increased risk of pregnancy in the studied population. A limitation of this study is that despite the large study population in the pooled analysis there were relatively small numbers of women in the high-BMI and high-bodyweight subgroups. CONCLUSION: LNG-EC is effective for preventing pregnancy after unprotected intercourse or contraceptive failure and no evidence was found to support the hypothesis of a loss of EC efficacy in subjects with high BMI or bodyweight. Therefore, access to LNG-EC should not be limited only to women of lower bodyweight or BMI.

Asunto(s)

RESUMEN

OBJECTIVE: In order to improve the understanding of hormonal contraceptive failures, this study evaluates the persistence of oral contraception and the use of emergency contraception (EC) during persistence incidents. We made the hypothesis of the existence of a strong link between the risk of unplanned pregnancies and these two parameters. In this study, we also evaluated women's perception of EC in order to elucidate the reasons of EC insufficient use. METHODS: One survey was carried out on Internet on a representative sample of women, aged 16-45. RESULTS: In this survey, 3775 French women were interviewed (source-population). We defined a target population of 2415 fertile women who had heterosexual intercourse during the last 12 months, and a population of 760 women at risk of unintended pregnancy who had unprotected sexual intercourse during the last 12 months(risk-population). A little more than 30% of the target population, meaning 20% of the source-population (n=745) stopped their contraceptive method temporarily for an average time of two months. Almost 60% of women had a risk of unwanted pregnancy during this period without contraception, which is 59% of the risk-population. Only 20% of women among the population at risk used EC. The main reasons given for EC insufficient use were the misperception of the risk of pregnancy, the lack of knowledge about EC and its way of use. CONCLUSION: For the first time, this survey shows that 13% of women (of the source population) decide to stop temporarily their contraceptive method for an average time of two months per year. Fifty-nine percent of unplanned pregnancy situations are due to this poor contraception persistence. Although there is a need to reduce the risk of women being at risk, it seems also highly desirable to overcome the consequences of this poor persistence. Giving information about EC and a systematic prescription during contraception consultations would lead to an increased use of EC.

Asunto(s)

RESUMEN

This study was conducted to evaluate a new and improved inserter (GyneFix) for the anchoring of the Frameless IUD in the uterine cavity. Previous studies conducted with a prototype inserter (Flexigard) did not show fully the advantages of the new anchoring concept because of the shortcomings of the Flexigard inserter and the complexity of the insertion technique. The GyneFix IUD was compared with the TCu380A IUD in six centers in China in approximately 300 women in each group. Only parous women were included in the study. The data from this 3-year, ongoing study demonstrate that the shortcomings of the inserter have been corrected, resulting in better performance and a much reduced rate of failed insertion/expulsion of the frameless and anchored device. The cumulative expulsion rate with the GyneFix IUD was 3.0 at 3 years (annual rates 2.67, 0.33, and 0.0, respectively) compared with a cumulative expulsion rate of 7.38 at 3 years with TCu380A (annual rates 4.63, 1.76, and 1.04, respectively). This difference is statistically significant. The majority of the expulsions with the anchored IUD occurred early in the study, indicating improper anchoring technique. The study also shows that both devices are highly efficacious. No pregnancies occurred with the GyneFix IUD (cumulative pregnancy rate 0.0 at 3 years) versus one pregnancy with TCu380A (cumulative pregnancy rate 0.34 at 3 years). The total use-related discontinuation rate at 3 years was significantly lower with the GyneFix IUD (8.34) than with the TCu380A IUD (14.13) and results in a higher rate of continuation with the GyneFix IUD compared to the TCu380A IUD (90.73 vs 85.25). Neither perforations nor pelvic inflammatory disease cases were encountered with either device in this study, demonstrating the safety of the anchoring system.

Asunto(s)

RESUMEN

OBJECTIVE: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. DESIGN: A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications. PATIENT(S): Women seeking tubal sterilization. INTERVENTION: Tubal sterilization. MAIN OUTCOME MEASURE(S): Effectiveness and long-term risks and benefits. RESULT(S): Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. CONCLUSION(S): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.

PIP: This paper examines the frequency, effectiveness, and clinical sequelae of tubal sterilization (TS) with a focus on the US experience. A review of US health care statistics and English-language literature, as well as bibliographies of key references and US government publications showed that half of the 700,000 annual bilateral TS are performed postpartum and half as ambulatory interval procedures. In addition, 11 million US women aged 15-44 years rely on TS for contraception. Failure rates vary by method with one-third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies reported higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. In conclusion, TS is a highly effective and safe method of contraception.

Asunto(s)

RESUMEN

A total of 265 women who had the Norplant system inserted were followed for 5 years. The present study is based on 11,435 women-months of use, describing the continuation rates and efficacy of Norplant among these women. The 5-year cumulative continuation rate was 45.7 per 100 continuing users. The continuation rates were age-dependent. The women > or = 35 years of age consistently maintained higher continuation rates at all time intervals as compared with those of younger women. During 5 years of follow-up, five women became pregnant. Three pregnancies occurred in year 2, one in year 3, and one in year 5. The 5-year cumulative pregnancy rate was 2.5 per 100 continuing users. The weight of the user did not influence the pregnancy rate. The continuation rates, as well as the pregnancy rates, are comparable to those reported from other countries in the region.

PIP: This article documents a 5-year follow-up of Norplant acceptors. The study was based on the medical records of 265 women who obtained Norplant from the Family Planning Association of Pakistan clinics in Lahore and Karachi during 1988-89 to examine the efficacy and continuation rates of Norplant in Pakistan. The studied sample participated in the introductory trial that were followed up for 5 years. Results revealed that the cumulative continuation rate during the 5-year period was 45.7 per 100 continuing users. The continuation rates were age-dependent, wherein women aged 35 years or older consistently maintained higher continuation rates at all time intervals as compared with younger women. During the 5-year follow-up, 5 women became pregnant (3 in year 2, 1 in year 3, and 1 in year 5). Furthermore, the 5-year cumulative pregnancy rate was 2.5 per 100 continuing users. The user¿s weight did not influence the pregnancy rate. Lastly, the continuation rates, as well as the pregnancy rates, were comparable to those reported from other countries in the region.

Asunto(s)

RESUMEN

Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment, condom failure was reported by 16.6%, with failure rates of 2.1/100 episodes of condom usage (2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex). In separate multivariate models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a decreased per-condom failure rate and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for >80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. Safer sex counseling should particularly target men of lower socioeconomic status, promote proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use, especially amphetamines and alcohol, on condom failure.

PIP: Although the extent of condom use during anal intercourse has increased considerably among men who have sex with men (MSM) in response to the HIV/AIDS pandemic, condom failure through both slippage and breakage limits the effectiveness of such method use. Condom failure is associated with HIV seroconversion among MSM. 16.6% of the 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multi-site Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment reported condom failure. The overall failure rate was 2.1/100 episodes of condom use, with 2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex. Almost half of the men were aged 30 years or younger, 25% were non-White, 60.6% attended college, and 85.7% were employed either part- or full-time. Multivariate analysis of reported failures found more frequent condom use to be associated with a decreased per condom failure rate, and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for more than 80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. These findings suggest that safer sex counseling should therefore target men of lower socioeconomic status, promote the proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use upon condom failure.

Asunto(s)

RESUMEN

CONTEXT: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. METHODS: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. RESULTS: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. CONCLUSIONS: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.

PIP: This study estimated method-specific contraceptive failure rates in the US. Estimates were adjusted for underreporting of induced abortion in the main survey. The correction made a sizeable impact, as 25% of the 2,157,473 conceptions due to contraceptive failure were aborted. Data were obtained from the 1995 National Survey of Family Growth and the 1994-95 Abortion Patient Survey. Analysis was based on hazard models for failure in the first 6 and 12 months. Data include 7276 contraceptive use segments. The mean duration was 9.6 months. The pill and condom had the largest shares of use segments. The lowest failure rates were for implants and injectables (2-3%). Failure rates were as follows: oral pills (8%), diaphragm and cervical cap (12%), male condom (14%), periodic abstinence (21%), withdrawal (24%), and spermicides (26%). Failure rates were highest among cohabiting and other unmarried women; women with an annual family income below 200% of the federal poverty level; among Black and Hispanic women; and among adolescents and women in their 20s. The failure rate among low income women declined during 1988-95. Women above the 200% of poverty level had stable rates. Poverty continued to have a negative impact on effective contraceptive use. Four models were used to examine the effects of socioeconomic factors on contraceptive failure.

Asunto(s)

RESUMEN

CONTEXT: Half of all pregnancies in the United States are unintended. Of these, half occur to women who were practicing contraception in the month they conceived, and others occur when couples stop use because they find their method difficult or inconvenient to use. METHODS: Data from the 1995 National Survey of Family Growth were used to compute life-table probabilities of contraceptive failure for reversible methods of contraception, discontinuation of use for a method-related reason and resumption of contraceptive use. RESULTS: Within one year of starting to use a reversible method of contraception, 9% of women experience a contraceptive failure--7% of those using the pill, 9% of those relying on the male condom and 19% of those practicing withdrawal. During a lifetime of use of reversible methods, the typical woman will experience 1.8 contraceptive failures. Overall, 31% of women discontinue use of a reversible contraceptive for a method-related reason within six months of starting use, and 44% do so within 12 months; however, 68% resume use of a method within one month and 76% do so within three months. Multivariate analyses show that the risk of contraceptive failure is elevated among low-income women and Hispanic women. Low-income women are also less likely than other women to resume contraceptive use after discontinuation. CONCLUSIONS: The risks of pregnancy during typical use of reversible methods of contraception are considerably higher than risks of failure during clinical trials, reflecting imperfect use of these methods rather than lack of inherent efficacy. High rates of method-related discontinuation probably reflect dissatisfaction with available methods.

PIP: This study computed life table probabilities of contraceptive failure, discontinuation of use, and return to contraceptive use in the US. Data were obtained from the 1995 National Survey of Family Growth (NSFG) among a nationally representative sample of 6867 contraceptive use intervals contributed by women 15-45 years old who began use or resumed use after discontinuation during 1991-95. Analysis was based on Kaplan-Meier product-limit single decrement life table probability methods. Findings indicate that the risk of failure during typical use of reversible methods was 9% within 1 year of starting. Women with continuous lifetime use will experience 1.8 contraceptive failures. Failure rates were 7% for the pill, 9% for the male condom, 8% for the diaphragm, 20% for periodic abstinence, and 15% for spermicides. Failure rates reflect imperfect use. 31% of women discontinued use within 6 months of starting use. 44% discontinued within 12 months. Women using reversible methods continuously will discontinue use nearly 10 times during the reproductive period. Most women resumed use shortly after discontinuation. Low income women had higher risk of unintended pregnancy for all methods and the pill and lower risk of resumption after discontinuation. Hispanics had a higher risk of contraceptive failure for all methods and the condom. Black women had a higher risk of discontinuation of oral pills and condoms.

Asunto(s)

RESUMEN

CONTEXT: Condoms made of latex are not comfortable or appropriate for all consumers. Polyurethane condoms may provide a needed alternative. METHODS: In a double-masked study, 805 monogamous couples were randomized to use either the polyurethane condom or the latex condom for six months. Couples recorded the frequency of intercourse, of condom use and of breakage and slippage throughout the trial in coital diaries and in detailed reports on the first five uses. Breakage and slippage rates were determined, and typical-use and consistent-use pregnancy rates were calculated using life-table analysis, adjusted for use of emergency contraception. RESULTS: The six-month pregnancy rate during typical use (adjusted for use of emergency contraception) was 4.8% for the polyurethane condom and 6.3% for the latex condom. Similarly adjusted pregnancy rates during consistent use over six completed menstrual cycles--2.4% for the polyurethane condom and 1.1% for the latex condom--did not differ significantly. Clinical failure rates (including breakage and slippage occurring during either intercourse or withdrawal) were 8.5% for the polyurethane condom and 1.6% for the latex condom. In general, male participants were more satisfied with the latex condom, and users of latex were significantly less likely to drop out of the study for condom-related reasons than were users of polyurethane. CONCLUSIONS: Although polyurethane and latex condoms provide equivalent levels of contraceptive protection, the polyurethane condom's higher frequency of breakage and slippage suggests that this condom may confer less protection from sexually transmitted infections than does the latex condom.

PIP: Latex condoms are neither comfortable nor appropriate for all condom users. In a double-blinded study, 805 monogamous heterosexual couples aged 18-45 years were randomized to use either a polyurethane condom or the Ramses Sensitol latex condom for 6 months. The polyurethane condom had specifications similar to those of the commercially available Avanti condom. While both condoms are 180 mm long, with an open end diameter of 33 mm, when laid flat, the polyurethane and latex condoms are 64 and 52 mm wide, respectively. Recruited from Los Angeles, California, study participants were of mean age 27 years; 66% non-Hispanic Whites, 16% Hispanic, 6% Black, and 6% Asian; and with an average of 15 years education. Approximately 75% of the men were circumcised, and according to participants' measurements, the erect penis averaged 131 mm in midshaft circumference and 159 mm in length. 89% were using condoms as their contraceptive method at the start of the study. The 6-month pregnancy rate during typical use, adjusted for the use of emergency contraception, was 4.8% for the polyurethane condom and 6.3% for the latex condom. Similarly adjusted pregnancy rates during consistent use over 6 completed menstrual cycles were 2.4% for the polyurethane condom and 1.1% for the latex condom. Clinical failure rates, including breakage and slippage occurring during either intercourse or withdrawal were 8.5% for the polyurethane condom and 1.6% for the latex condom. Male participants were generally more satisfied with the latex condom, and users of latex were significantly less likely to drop out of the study for condom-related reasons than were polyurethane condom users.

Asunto(s)

RESUMEN

PIP: A Norwegian investigation from 1987-88 indicated that 25% of the women who were interviewed at a maternity ward stated that their pregnancy had not been planned. That means that 15,000 of the annual total of 60,000 births in Norway are not planned. This is roughly the same figure as the number of abortions (14,000 per year). 93% of women who carry out an unplanned pregnancy have not used contraception according to a 1991 study, but even a 1999 study showed that half of women seeking abortion had not used contraception. A 1994 investigation revealed that only 8% of women in the 20-24 age group did not use contraception and 5% used unsafe methods (coitus interruptus, safe periods, spermicides), while the rest used effective contraceptives (60% used OCs). There are 144,000 women in this age group in Norway, of which 12,000 give birth within a year. In theory the remaining 132,000 would have 2600 pregnancies. In 1996 there were 3883 abortions in this same age group; half of them would originate from that 8% of women who did not use contraception and the other half owing to contraceptive failure. Two studies among students in Oslo in 1997 demonstrated that even if a young woman started using OCs it did not mean that she would continue using them. A number of them discontinued because their relationship with their partner ended, they neglected to visit their doctor, forgot to take their pills, or thought that they could not get pregnant right after stopping OC use.^ieng

Asunto(s)

RESUMEN

To make an informed decision when choosing a contraceptive, women and couples need to know how effective different methods are when used perfectly, where perfect use is defined as following the directions for use. In this article, we show that unbiased estimates of pregnancy rates during perfect use can be guaranteed only if information on consistency and correctness of use is available for each menstrual cycle. The estimated probability of pregnancy during a year of perfect use among the subset of women who always used a method perfectly will be biased upward.

Asunto(s)

RESUMEN

CONTEXT: The incidence of unintended pregnancy has long been used as a primary indicator of the state of reproductive health. However, the definition--and therefore the measurement--of this indicator has been elusive. METHODS: Data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions--the standard definition based on women's reports of contraceptive failure, and the NSFG definition based on pregnancy timing (wanted then, wanted later, or not wanted then or in the future). An attitudinal scale was used to examine women's feelings about their unintended pregnancy. RESULTS: Of pregnancies classified as contraceptive failures under the standard definition, only 68% were unintended pregnancies--94% of those ending in abortion and 60% of those ending in birth. Just 59% of women with a contraceptive failure classified as an unintended pregnancy reported feeling unhappy or very unhappy about their pregnancy, while 90% of those with a failure classified as an intended pregnancy reported being happy or very happy. CONCLUSIONS: Measures of wantedness based on women's feelings about their pregnancy may correlate more closely with important pregnancy outcomes than do traditional measures of intendedness.

PIP: This study examines the alternative implications of the measurements of unintended pregnancy during contraceptive failure in the US. The data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions: the standard definition based on women's report of contraceptive failure; and the NSFG definition based on pregnancy timing. An attitudinal scale was used to examine women's feeling about their unintended pregnancy. The results of the analysis revealed 68% were unintended pregnancies under the classification of standard definition, while 59% of women with contraceptive failure classified under NSFG definition and reported feeling unhappy or very unhappy about their pregnancy. About 90% of those with contraceptive failure classified as an intended pregnancy reported feeling happy or very happy. Although these results were consistent with one another, it is still unclear why these women feeling happy about their unintended pregnancy are practicing contraception.

Asunto(s)

RESUMEN

PIP: This is a comment on the models created by researchers concerning contraceptive failure and unintended pregnancy. Human behavior refuses to conform to the models due to the occurrence of some unusual events. Thus, the models should be used with caution. Both unintended pregnancies and contraceptive failures are more complex than they appear at first glance. Part of the problem resides in the history of the instrument used to measure unintended pregnancy. Becoming accidentally pregnant presents people the oppressing responsibility of having to decide whether to enter into parenthood or not. The choices about parenthood are problem-filled in this country. As a consequence, the processes that determine the intimate lives of couples and in the culture as a whole should be studied. Otherwise, the industrialized world will have to put up with contraceptive "accidents", while political movements will continually promise to resolve these complexities.^ieng

Asunto(s)

RESUMEN

AIMS: To document predisposing factors in 769 women who had inadvertently conceived while taking oral contraceptive pills reliably. METHODS: Over a 14-year period, 1981-1995, two questionnaires were administered, one for women using the combined oral contraceptive pill (COC) and one for women using the progestogen only pill (POP). RESULTS: More than one predisposing factor was usually present, the most common being diarrhoea and/or vomiting in 39.0%. Antibiotics had been prescribed in 20.5%. COC failure was associated with a high incidence of menstrual disturbance (37.1%). A history of a previous pill failure was obtained in 27.8%. Smoking was a risk factor for women on the COC. Only 6.0% became pregnant during the first month of pill use. As expected, POP users experienced a higher number of pill failures in proportion to the market share, but excess weight and time of taking did not appear to be risk factors. Most COCs failed according to the numbers expected from the market share. CONCLUSIONS: Many pill failures could be averted by better information about known or suspected risk factors, especially gastrointestinal upset and interacting medications. Pill failure is one more reason to discourage smoking in COC users.

PIP: Predisposing factors to oral contraceptive (OC) failure in reliable pill takers were investigated in a survey of 769 women who presented to Wellington (New Zealand) Hospital in 1981-95 for induced abortion. More than one predisposing factor was found in the majority of cases of pill failure. The highest percentage (37%) of pill failures occurred in women 20-24 years of age. The most common risk factor was diarrhea and/or vomiting, present around the time of conception in 39% of women. Another 21% took antibiotics during this period. Menstrual disturbance prior to the pregnancy occurred in 37.1%--a rate higher than that expected from studies of pill use. A history of previous pill failure was present in 27.8%. Smoking was a risk factor in users of combined OCs. 33.7% of women using the progestogen-only pill and 34.2% of combined OC users were under severe stress at the time pregnancy occurred. As expected, progestogen-only pill users experienced a higher rate of failure relative to the market share, but excess weight and the time of pill taking were not risk factors. These findings suggest a need for careful counseling about the potential of gastrointestinal illness and interacting medications to compromise pill effectiveness.

Asunto(s)

RESUMEN

PIP: The British Department of Health has issued a warning that the contraceptive device Persona may be an unreliable method of fertility control. This method tests hormone levels in urine to enable women to avoid unprotected intercourse during the fertile phase of the menstrual cycle. A pre-marketing clinical trial conducted by Upipath, the manufacturer of Persona, claimed a 94% reliability rate. However, the Medical Devices Agency has been unable to substantiate this claim and received numerous complaints from users, general practitioners, and trading standards officers. The warning letter advises physicians that, although Persona is basically a test-based form of the rhythm method, its technological basis may raise user expectations of accuracy. The letter notes that users should be aware a 94% reliability may also be expressed as a risk of 1 in 17 users becoming pregnant per 12 months of use. Persona is not considered suitable for women whose menstrual cycles do not fall into the 23-35 day range, those who have recently given birth or are breast feeding, and users of hormonal contraception.^ieng

Asunto(s)

RESUMEN

PIP: This study examined sociodemographic and contraceptive use factors that affect contraceptive failure (CF) during the first 8.5 years of contraceptive use and pregnancy outcomes in China. Data were obtained from complete fertility and contraceptive histories among 17,887 currently married women, aged 15-57 years, included in the 1988 Two-per-Thousand Fertility Survey. 4053 contraceptive use periods during 1980-88 ended in failure. The methods of Trussel and Hammerslough (1983) were used to estimate method-specific hazard models of CF. Findings of relative risk indicate that for male and female sterilization, duration of use and number of living children were determinants of CF among only rural couples. The rate of CF was greatest in the first few months and declined to almost zero after 36 months. Rural women with 3 or more children had a significantly higher rate of CF. The effect of female sterilization had a smaller effect on duration. Significant determinants of CF for mixed methods were duration of use, age at start of use, and number of living children. Risk of CF, after 1984, was lower by 18-32% depending upon method. 61.7% and 62.4% of CFs for male and female sterilization, respectively, resulted in live births. 45.0% of IUD CFs and under 25.0% of reversible method CFs resulted in live births. Number of living children was a significant determinant of a live birth outcome. More children was related to a greater risk of a live birth. The demographic impact of CFs varied by method and area of residence.^ieng

Asunto(s)

RESUMEN

PIP: Persona, marketed by Unipath, is a new method of natural family planning which has been on the market since 1996. It works by measuring the hormone levels in a woman's urine and letting her know when she is not fertile and may have sex without using a barrier method of contraception. The British Pregnancy Advisory Service (BPAS) found that their surveyed clients who reported using Persona had 188 abortions in 3 months and concluded that there was a need for better information and more advice for couples who plan to use the method. The other major non-NHS abortion provider, Marie Stopes International, reported similar findings, with about 60 women per month visiting their clinics for abortions after having used the method. The BPAS survey also showed that 43% of the women who had an abortion after using Persona were aged 24 years or younger even though Persona is intended for use by women aged 25-40 years in stable relationships. A similar proportion also reported having sex on days when the method told them that they were most fertile. These latter women were not asked if they used another method of contraception on fertile days. An additional 13% reported ignoring the instructions to wait for 3 natural periods after terminating pill use before beginning to use Persona.^ieng

Asunto(s)

RESUMEN

PIP: This report presents findings from a family planning (FP) survey of the population in 2 counties in North Anhui province and 2 counties in South Jiangsu province, China. FP views differed between the older and younger generation. About 66% viewed FP as positive. One women noted the increase in women's status. Young women and men preferred the husband's role as breadwinner and wife's role in the home. Preference for a son as a first child was expressed by 13% of men and women in South Jiangsu and 25-30% in North Anhui. Respondents from North Anhui indicated that sons were valuable for old age support and as persons to carry on the family name. Some mothers reported pressure from mothers-in-law to bear a son. Over 33% in South Jiangsu desired a stronger FP role for men, expressed in their acceptance of vasectomy. Over 50% wanted men to use condoms. In North Anhui, 60% wanted more men to undergo vasectomy; 52% wanted men to use condoms. 97% in South Jiangsu and 91% in North Anhui used contraception. Nearly 82% of contraceptive users in South Jiangsu and 31% in North Anhui used the IUD. 29% of husbands in North Anhui and under 1% in South Jiangsu had obtained a vasectomy. Nearly 20% of women in South Jiangsu and 9% in North Anhui had had a pregnancy due to contraceptive failure. Fertility was 1.3 children/woman in South Jiangsu and 1.8 in North Anhui. After focus groups, researchers recommended improvements in quality of care and services to adolescents and youth, wider choices of methods, and promotion of the value of daughters.^ieng

Asunto(s)

RESUMEN

PIP: This article discusses new sterilization methods for tubal ligation, failure rates, and risks for ectopic pregnancy in the US. The Filshie clip, which was developed by Femcare, Ltd. in Nottingham, England, and is distributed by Avalon Medical Corp of Vermont, was approved by the US Food and Drug Administration in September 1996. The company has provided training sessions at major universities nationwide and exhibited at national professional association meetings. A training video and two more films will be available in 1998. The new clip is considered a more modern approach to a tubal occlusion method, which relies on newer materials and solves prior problems. Physicians usually used Falope rings, which had better failure rates than the Hulka clip and bipolar coagulation methods. There is a need for more long-term and large scale information exchange about the new Filshie clip. Some physicians still use the Falope ring because it is cost effective and well-studied. Physicians are warned to continue to advise women about the potential failure rates up to 10 years after sterilization and the 1 in 3 risk of ectopic pregnancy. Counseling about failure rates and the risk of ectopic pregnancy should target women under 30 years old, who have the highest failure rates, and women 30-34 years old. All sterilized women should be advised to seek a provider immediately if they have pregnancy symptoms following sterilization. Counseling should include the issue of "regrets," since it is a permanent method. All women should know about nonpermanent methods and experience a basic informed consent process. Young women and newly divorced women are particularly vulnerable to the "regrets" syndrome.^ieng

Asunto(s)