Contraceptive delivery systems最新文献

Zipper has more than adequately demonstrated that quinacrine, when placed in the uterine cavity, has a sclerosing effect on the tubal ostia, resulting in chemical sterilization of the fallopian tubes. His technique involves the use of 3 monthly instillations of 250 mg of pellets into the uterine cavity. With the hope of reducing the total dosage and making it a 1-insertion technique, quinacrine has been mixed with polyethylene oxide and place on the arms of various IUDs. It is hoped that the material is directed at the tubal ostia. Studies to date have occurred in women awaiting hysterectomy with careful pathologic examination of the intramural portion of the tube. The results thus far are most encouraging and once the best vector is identified, it is hoped that this will become an acceptable means of female sterilization.

After the development of postcoital hormonal interception, the postcoital use of IUDs to prevent pregnancy was proposed by Tatum. The major advantage of this treatment is that it avoids the use of the usual massive dose of estrogens (a very effective postcoital method) which is associated with nausea and vomiting. This is the 1st method to be effective up to 5 days after exposure, 3 days more than the estrogen treatment. It may also provide long-term contraception in women who wish to continue using the IUD. A major disadvantage of postcoital IUD use is that IUD insertion can produce serious complications if a patient has a vaginal or venereal infection or an asymptomatic cervicitis or even pelvic inflammatory disease (PID). After proper physical examination, suitable patients are selected from those requesting postcoital treatment. Cases involving rape are mostly excluded from these services; but, if they present early, proper work up and treatment can be performed within the time span of 5 days available for this method and it will still be possible to fit a postcoital IUD. The potential risk of future infertility should be considered as PID rates in nulliparous IUD users are up to 7 times higher than in nonusers. Young nulliparous, sexually active women--especially of the lower socioeconomic strata--are identified as high-risk patients. Over 70% of women requesting interception are nulliparous. Clients asking for postcoital insertion should be informed of its potential risk, as women under 25 years of age are more prone to infection. The risk of septic abortion exists if an IUD is inserted into a gravid uterus due to pregnancy resulting from unreported previous sexual intercourse. Septic abortion is a life-threatening condition. Out of several series, no pregnancies are reported in the month of treatment. The IUD preferred is the Multiload copper IUD or the copper T; the highest expulsion rate proved the Copper-7 Gravigard (Cu-7) inefficient. In suitable circumstances, the IUD can be the 1st choice in postcoital interception.

A total of 254 women were enrolled in the study of the intrauterine progesterone system, Progestasert, and some of the subjects have been followed into the 8th year of use of the device. Clinical experience on 192 women in their 1st year of use of the device was reported in 1977. This follow-up study reports on 110 patients who had at least 2 insertions of the Progestasert for continuous use of 13 months, to a maximum of 8 insertions for continuous use of up to 86 months, for a total of 3808 months. 60% of subjects were nulliparous women who tolerated the device as well as the multiparous. The expulsion rate was low (3.5/100 women-years) noting that 82% of expulsions occurred within 2 months postinsertion or exchange of the device. A total of 7 pregnancies were observed; the pregnancy rate was 2.2/100 women-years. 2 of these 7 pregnancies were ectopic. No uterine or cervical perforations and no serious infections were observed.