Advances in contraception : the official journal of the Society for the Advancement of Contraception最新文献

In recent years, the development of improved intrauterine devices has focused on finding methods to reduce expulsion and the need for medical removal for better intrauterine retention and devices. Efforts also have been directed towards developing intracervical devices. Some of the more recent developments in intrauterine and intracervical devices are discussed.

Insertion of IUDs by trained non-physicians is increasing. This secondary analysis of TCu380A IUD acceptors collected at clinics in Nigeria, Turkey and Mexico involved 367 women; 193 insertions were performed by physicians and 174 by non-physicians. Women having their IUD inserted by a non-physician were more likely to experience a pain-free insertion, but also likelier to have the IUD removed for bleeding and pain or to experience an expulsion than women who had their IUD inserted by a physician. Early discontinuation rates were similar between the two groups. Overall continuation rates were statistically higher for IUDs inserted by physicians only at the Mexico site. Trained non-physicians can probably safely insert the TCu380A IUD. Appropriate competency-based training is required to limit the number of expulsions and removals for bleeding and pain by non-physicians.

There is good evidence that lactational amenorrhea (LAM) is an effective method of fertility regulation during the first 6 months postpartum, provided no other food is given to the baby and the mother remains amenorrheic. However, although breast-feeding is strongly promoted in many maternity hospitals that also run postpartum family planning programs, LAM is rarely included among the contraceptive options being offered. This paper presents the results of an operational study which compared the prevalence of contraceptive use and the cumulative pregnancy rate at 12-months postpartum among 350 women observed before and 348 women studied after introducing LAM as an alternative contraceptive option offered to women following delivery at the Instituto Materno Infantil de Pernambuco (IMIP), in Recife, Brazil. The percentage of women not using any contraceptive method was significantly lower (p<0.0001) after the intervention (7.4%) than before (17.7%). This difference remained statistically significant after controlling for age, number of living children, marital status and years of schooling. The proportion pregnant one year postpartum was also significantly lower (p<0.0001) after the introduction of LAM (7.4%) than before (14.3%), but the difference was no longer significant after controlling for the same variables. It is concluded that LAM is a useful addition to family planning postpartum programs.

Contraceptive implants are increasingly being used for fertility regulation all over the world. Reversible long-term use is their most appealing feature for many users. They have the practical advantage of overcoming the risks of user failure and low continuation rates associated with other methods that require continuous attention or motivation. Disruption of menstruation, complications of insertion and removal, and infection at implant site, constitute the majority of adverse effects associated with contraceptive implants. This article reviews these various common adverse effects associated with contraceptive implants and their possible management and prevention. In addition, we also discuss very rare events, like psychiatric disorders, pseudotumor cerebri, thrombotic, thrombocytopenic purpura and thrombocytopenia, that have been reported by some researchers. Further surveillance and research is necessary to determine if these rare adverse events are causally related to contraceptive implants. Until such a time, providers of contraceptive implants should be more selective in prescribing the contraceptive implants, especially in women with a history of and/or risk factors for stroke, cerebral and coronary heart disease, thrombocytopenia and pseudotumor cerebri.

This study was conducted to assess providers' attitudes toward the provision of long-term methods of contraception, in particular the IUD, and provider concerns about human immunodeficiency virus (HIV) in the context of family planning (FP) services. The data were collected using self-administered structured questionnaires. Between 65% and 80% of the public and private providers thought that the IUD is a good contraceptive method for Zimbabwean women. In addition, the majority of these two provider groups felt that neither the IUD nor tubal sterilization (TL) posed much risk of HIV infection to the client. A significant number of providers (especially the public nurses), however, thought that the provision of TL put the provider at high risk of HIV infection and a significant proportion of public nurses were also concerned about provider risk associated with providing IUD and injectables. To address such concerns, future training interventions should emphasize appropriate infection prevention practices associated with surgical FP method provision. Nurses, in particular, should be informed about the magnitude of risk associated with FP service provision and ways to protect themselves. Logistic activities also need to be strengthened so that legitimate concerns among providers regarding lack of adequate infection prevention supplies (e.g. gloves) in the field can be addressed.

Contraceptive efficacy, subject acceptability (cycle control, side-effects, acne score and weight gain) and blood pressure of a monophasic oral contraceptive containing 30 microg ethinyl estradiol plus 150 microg desogestrel (Marvelon) were assessed in an open-label 6-cycle multicenter study in Argentina (7 centers) and Venezuela (5 centers). Of the 407 participating women, 389 (95.6%) completed six cycles of treatment, providing data for a total of 2383 cycles. No pregnancies occurred during the course of the study, confirming the high contraceptive reliability of Marvelon. Cycle control was excellent; the duration of withdrawal bleeding decreased during consecutive treatment cycles and the incidence of spotting and breakthrough bleeding was low. The desogestrel/ethinyl estradiol combination was well tolerated and the incidence of minor side-effects, which was already low in the first treatment cycle, in most cases decreased during the subsequent cycles. The preparation was effective in reducing pre-existing acne, whereas it did not induce clinically relevant changes in blood pressure and body weight. Marvelon was shown to provide effective oral contraception, with good tolerance and excellent cycle control in Latin-American women.

The aim of this study was to evaluate the efficacy, safety and acceptability of two monthly transcervical applications of quinacrine 252 mg and ibuprofen 55.5 mg as pellets for non-surgical female sterilization. From August 1992 through October 1996, a prospective clinical study was conducted on 200 normal women seeking surgical sterilization voluntarily in the Family Planning Clinic of the Department of Obstetrics and Gynecology, Regency Hospital, Wonosobo, Central Java, Indonesia. Quinacrine 252 mg and ibuprofen 55.5 mg were inserted transcervically, as pellets, using a Copper T IUD insertor in the proliferative phase of two consecutive menstrual cycles. The women were followed up 6, 12, 24 and 48 months after insertion. There were no major complications during the insertion procedures, and side-effects which occurred during the use of the methods were transient. Cumulative life-table continuation rate per 100 women at four years was 0.91+/-0.02 (SE). The pregnancy failure rate was 0.04 or 4.3%. The results of this study indicate that intrauterine insertion of quinacrine pellets is a safe, acceptable and effective method of non-surgical female sterilization.

In this comparative study, the five-year continuity rate of 53.7% in the Norplant implants group was comparable to that of 52.7% in the copper IUD group. The difference was not statistically significant. Only one accidental pregnancy occurred during the five years of copper IUD use. Desire for future pregnancy was the main reason for removal in the Norplant implants group (35.9%) while expulsion of the IUD (13.2%) was the main reason for removal of the copper IUD. Menstrual disturbance was not a major side-effect in either group. The post-removal conception rates of 78.6% in the Norplant implants group and 75.0% in the copper IUD were good and comparable. Both the Norplant implants and copper IUD are acceptable and effective contraceptive methods in Singapore.

Users of natural family planning (NFP) practice periodic abstinence, leading many to reason that such couples should show increased anomalies in offspring as a result of fertilization involving aging gametes. In an effort to complement our NFP cohort study, we currently conducted a case-control study in the same region (South America) in which the largest number of cases have been recruited for our cohort NFP study. During 1992-94, 5324 case-control pairs of mothers were interviewed during the immediate postpartum period in 18 maternity hospitals participating in the Latin-American Collaborative Study of Congenital Malformations: ECLAMC (Spanish acronym for Latin-American Collaborative Study of Congenital Malformations). Natural family planning (NFP) usage was recorded in 6% of mothers in the ECLAMC sample studied (n = 10,648). Overall, no significant differences in frequency of NFP usage were observed between malformed cases (349/5324 = 6.6%) and normal controls (303/5324 = 5.7%) (chi 2 = 3.3; df = 1; p > 0.05). No significant differences in sex ratios were observed between children of NFP user and non-user mothers. Of special interest is the lack of association between NFP and Down syndrome, the sentinel phenotype for the hypothesis of delayed fertilization (aging gametes).

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.