| 1. Title: Use of the diaphragm without spermicides may be just as effective in preventing unwanted pregnancy. Source: WOMEN'S GLOBAL NETWORK FOR REPRODUCTIVE RIGHTS NEWSLETTER. 1994 Jan-Mar;(45):13-4. Abstract: Researchers are exploring ways of increasing the effectiveness and acceptability of the diaphragm. According to one Brazilian study, women tend to continue use of the diaphragm, with a higher rate of effectiveness, when it is used alone without spermicides. This may be due to convenience and cost. The retrospective study comparing 441 women who used diaphragms in conjunction with spermicides to 215 who used diaphragms alone demonstrated a significantly higher failure rate in the former group (9.8 per 100) than in the latter (2.8 per 100). There were also significantly more discontinuations for vaginal discharge and other medical reasons in the first group. The Coletivo Feminista Sexualidade e Saude in Sao Paulo, Brazil reports a high diaphragm acceptance rate with a high 1-year continuation rate (72%) among its clients. The clinic emphasizes adequate training of its clients in the use of the diaphragm, including follow up visits, which is important to the success of the method. Studies show that diaphragms used with spermicides also provide significant protection against sexually transmitted diseases. Women using this method are less likely (p < .05) to have cervical gonorrhea (relative risk = .32) or trichomoniasis (relative risk = .24), or to be hospitalized for pelvic inflammatory disease. Language: English Keywords: BRAZIL | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | VAGINAL DIAPHRAGM | SPERMICIDAL CONTRACEPTIVE AGENTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION FAILURE | CONTRACEPTION CONTINUATION | TRAINING PROGRAMS | SEXUALLY TRANSMITTED DISEASE PREVENTION | GONORRHEA | BACTERIAL AND FUNGAL DISEASES | PARASITIC DISEASES | ADNEXITIS | PREVENTION AND CONTROL | Developing Countries | South America, Eastern | South America | Latin America | Americas | Studies | Research Methodology | Vaginal Barrier Methods | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Contraceptive Usage | Education | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Pelvic Inflammatory Disease Document Number: 096770 |
| 2. Title: Vote of confidence for the IUD. Low rates of pelvic infection. Source: FAMILY PLANNING NEWS. 1994;10(1):2. Abstract: Although the IUD remains a subject of debate, Dr. Emily Bernardo from the Philippines suggests that it is of undoubted value in carefully chosen users. Her country is currently reporting a 36% unmet need for birth control and Dr. Bernardo stressed the need for more public and professional confidence in the IUD. In the region as a whole, some 13% of Asian women using contraceptives now choose the IUD. More might do so but for the fear of ectopic pregnancy and pelvic inflammatory disease (PID). Recent major analyses by Family Health International and the WHO show that any increased risk of PID is greatest soon after insertion of the device and thereafter in women exposed to sexually transmitted diseases. The current rate of PID among IUD users in the Philippines compares favorably with that reported by Family Health International--1.4 vs. 1.6 cases, respectively, per 1000 woman-years of use. WHO data indicate that women using the most widely prescribed IUDs have ectopic pregnancy rates of up to 1.5 per 1000 woman-years of use. Rates tend to vary in proportion to the surface area of copper on the device: the greater the area, the lower the ectopic rate. Dr. Bernardo said that such data only supports her contention that the IUD is both safe and effective. (full text) Language: English Keywords: PHILIPPINES | IUD | CONTRACEPTIVE METHOD ACCEPTABILITY | PREGNANCY, ECTOPIC | ADNEXITIS | CONTRACEPTIVE USE-EFFECTIVENESS | PELVIC INFECTIONS | Asia, Southeastern | Asia | Developing Countries | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Pregnancy Complications | Diseases | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Contraceptive Effectiveness Document Number: 095067 |
| 3. Title: Transcervical recanalization of strictures in the postoperative fallopian tube. Author: Lang EK; Dunaway HH Source: RADIOLOGY. 1994 May;191(2):507-12. Abstract: Transcervical tubal recanalization was performed in 19 patients in whom previous surgery had failed to reverse sterilization (n=7) or to reconstruct fallopian tubes obstructed from inflammatory disease (n=12). The patients were 25-41 years old, had been infertile for more than 18 months after the failed surgery and had no other clinical cause of infertility. 4 of the cases of failed reversal surgery had fistular tracts, and 1 also had a structure. The other 3 reversal patients and all 12 failed tuboplasty and tube reimplantation patients has strictures at the site of implantation or anastomosis. The standard technique for transcervical recanalization was followed. The transcervical recanalization only succeeded in 13/15 patients with stenoses. 3 of these became pregnant naturally 1-16 months after recanalization and 2 after in vitro fertilization and embryo transfer. Reocclusion occurred in 2 of 10 patients reexamined 6-36 months postoperatively. It was concluded that transcervical recanalization is a suitable alternative to repeat microsurgical reimplantation or to tuboplasty in cases such as these. Language: English Keywords: STERILIZATION REVERSAL | FALLOPIAN TUBES | SURGERY | ADNEXITIS | Reversible Sterilization | Sterilization, Sexual | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases Document Number: 096538 |
| 4. Peer Reviewed Title: Human immunodeficiency virus type 1 seroconversion in women with genital ulcers. Author: Plourde PJ; Pepin J; Agoki E; Ronald AR; Ombette J; Tyndall M; Cheang M; Ndinya-Achola JO; D'Costa LJ; Plummer FA Source: JOURNAL OF INFECTIOUS DISEASES. 1994 Aug;170(2):313-7. Abstract: Genital ulcers are implicated as a risk factor enhancing susceptibility to human immunodeficiency virus type 1 (HIV-1) infection. A prospective study to determine the incidence of and risk factors associated with acquisition of HIV-1 in women with genital ulcers was done. HIV-1-seronegative women with genital ulcers attending a clinic for sexually transmitted diseases in Nairobi were followed to HIV-1 seroconversion over a 6-month period. Of 81 women, 10 seroconverted to HIV-1. The crude 6-month incidence of HIV-1 infection was 12%. Risk factors associated with seroconversion included cervical ectopy (rate ratio [RR], 4.9; 95% confidence interval [CI], 1.5-15.6) and pelvic inflammatory disease (RR, 6.3; 95% CI, 1.9-20.4). Thus, cervical ectopy and pelvic inflammatory disease may increase susceptibility to HIV-1 in women with genital ulcers. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | LABORATORY EXAMINATIONS AND DIAGNOSES | HIV TRANSMISSION | RISK FACTORS | SEXUALLY TRANSMITTED DISEASES | PELVIC INFLAMMATORY DISEASE | GENITAL EFFECTS, FEMALE | ADNEXITIS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Examinations and Diagnoses | HIV Infections | Viral Diseases | Diseases | Biology | Reproductive Tract Infections | Infections | Genitalia, Female | Genitalia | Urogenital System | Physiology Document Number: 098868 |
| 5. Title: Three consecutive recurrent ectopic pregnancies. Author: Adelusi B; Al-Meshari A; Akande EO; Chowdhury N Source: East African Medical Journal. 1993 Sep;70(9):592-4. Abstract: Staff of the infertility clinic at King Khalid University Hospital in Riyadh, Saudi Arabia, cared for a Yemeni woman who had a poor obstetric history. She had had pelvic inflammatory disease. Her 1st pregnancy concluded in a full term vaginal delivery, but gastro-enteritis caused the infant's death at 4 months. She delivered her 2nd child at 32 weeks gestation and the infant died 3 days later. Her 3rd and 4th pregnancies occurred in the right tube. A laparotomy, conservative evacuation of the conceptus from the right tube, and peritoneal lavage were used to treat the ectopic pregnancies. She experienced spontaneous abortion of the 5th pregnancy at 10 weeks. The woman presented at the hospital's gynecology clinic at 40 days amenorrhea with low abdominal pain and a small amount of vaginal bleeding. She had not passed any clots or tissue. The general examination was normal. The pregnancy test was positive. Since she had past ectopic pregnancies, the physicians conducted an ultrasound, which revealed no intrauterine pregnancy and a heterogenous 4.5 cm x 5.5 cm mass near the left tube. Laparoscopy confirmed a normal size uterus, a mass on the left tube, and bleeding into the peritoneum. Laparotomy was performed to remove the unruptured left ampullary ectopic pregnancy in such a way as to preserve the patency of the tube and therefore fertility. The surgeons also conducted peritoneal lavage with dextran saline to remove the blood in the peritoneum. The surgeons lysed the adhesions they found between the omentum, abdominal wall, and the uterus. Both ovaries were in good condition. The right tube was in good condition. She did fine postoperatively and was released 7 days after operation. The physicians could not determine the patency of the left tube, because she was lost to follow up. This case shows that conservative management of the tubes to retain tubal patency was successful, since she was able to conceive, but recurrent ectopic pregnancies may damage the tubes. Language: English Keywords: SAUDI ARABIA | CASE STUDIES | PREGNANCY, ECTOPIC | INFERTILITY | SIGNS AND SYMPTOMS | ADNEXITIS | TUBAL EFFECTS | ADHESIONS | LAPAROTOMY | TREATMENT | PELVIC INFECTIONS | Developing Countries | Middle East | Studies | Research Methodology | Pregnancy Complications | Diseases | Reproduction | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Surgery Document Number: 093481 |
| 6. Title: Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Author: Blackwell AL; Thomas PD; Wareham K; Emery SJ Source: Lancet. 1993 Jul 24;342(8865):206-10. Abstract: Between October 1990 and March 1991, 401 women at Hill House Hospital in Swansea, Wales, undergoing an abortion enrolled in a study to determine the prevalence and sequelae of lower genital tract infection and to assess the costs and potential benefits of screening and of prophylaxis for the most common pathogens. The physicians administered 500 mg oxytetracycline for 10 days for women with uncomplicated chlamydia infection and for 14=21 days for those with chlamydia-related pelvic inflammatory disease (PID). A 5-day course of oral metronidazole (400 mg/2/times/day) treated anaerobic vaginosis and trichomonas infections. 51.7% had at least 1 lower genital tract infection, 28% had anaerobic vaginosis, 24% had candida infection and 32 women (8%) were infected with Chlamydia trachomatis. Some of these women also had anaerobic vaginosis, anaerobic vaginosis and candidosis, Escherichia coli infection, and candidosis (15, 1, 1, and 6 women, respectively). Anaerobic vaginosis was more likely to be present in women with chlamydia infection than in those without chlamydia infection (53% vs. 26%; p < .05). 19 of 30 women (63%) with chlamydia infection who could be followed postoperatively developed PID. 7 women had to be readmitted to the hospital. 9 males partners of 26 women also attended the Genito-Urinary Medicine clinic. 8 had not symptoms, but 3 had C. trachomatis infection and 1 had Neisseria gonorrhoea infection. The physicians estimated the costs of hospital admissions for pelvic infection to be 2.4 times more costly than providing routine prophylactic screening and treatment (16,800 vs. 6960 UK pounds). These results showed the need to be screen for chlamydia infection before termination of pregnancy and to provide prophylactic treatment for chlamydia infection and anaerobic vaginosis. The physicians also recommended tracing the male partners of chlamydia-infected women to prevent reinfections. Language: English Keywords: WALES | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ABORTION | SCREENING | VAGINITIS | CHLAMYDIA | CANDIDIASIS | GONORRHEA | ADNEXITIS | TREATMENT | ANTIBIOTICS | POSTABORTION | Developed Countries | United Kingdom | Europe, Western | Europe | Research Methodology | Studies | Fertility Control, Postconception | Family Planning | Examinations and Diagnoses | Vaginal Abnormalities | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Bacterial and Fungal Diseases | Pelvic Inflammatory Disease | Drugs | Reproduction Document Number: 084008 Notification |
| 7. Title: Pelvic inflammatory disease. Author: Brabin L Source: AFRICA HEALTH. 1993 Mar;15(3):15-7. Abstract: The real prevalence of pelvic inflammatory disease (PID) is unknown since many women are either asymptomatic or have atypical symptoms. It is often difficult to detect, manage, and prevent PID. Since PID has obstetric, gynecologic, and contraceptive-related causes, its prevalence is quite high. About 70% of PID hospital admissions in sub-Saharan Africa are a result of reproductive tract infections (RTIs) while this figure is 34% in Asia and 31% in developed countries. Only 10-20% of lower RTIs ascend into the upper genital tract and an even smaller percentage of women with PID develop chronic sequelae. Still, just 1 episode carries an increased risk of a tubal infertility, ectopic pregnancy, chronic pelvic pain, considerable pain during coitus, a new episode, and menstrual irregularities. Neisseria gonorrhoea and Chlamydia trachomatis are the most common causative organisms of PID. In Africa, the risk factors for PID are the same as they are for sexually transmitted diseases (STDs): multiple sex partners, young age at first intercourse, high frequency of coitus, and a high rate of acquiring new partners. The largest percentage of women with RTIs are monogamous women who are infected and constantly reinfected by their promiscuous husbands. The primary means to prevent PID are promotion of safer sexual behavior and condom usage. Secondary measures include accessible, acceptable, and effective STD services and education and counseling during case management. WHO suggests that STD treatment become part of the primary health care system. It has developed flow charts on syndromic diagnosis for urethral discharge in men and genital ulcer disease in women. Health workers should assume increased PID risk if the partner has had a history of urethral discharge and/or treatment for gonorrhea or nongonococcal urethritis. Partner notification is also needed for case management, but stigmatization in some countries poses a problem. WHO also recommends use of drugs which have a 95% STD cure rate. Language: English Keywords: DEVELOPING COUNTRIES | AFRICA, SUB SAHARAN | ADNEXITIS | RISK FACTORS | SEXUALLY TRANSMITTED DISEASES | RISK ASSESSMENT | RISK REDUCTION BEHAVIOR | WHO | REPRODUCTIVE HEALTH | PREVENTION AND CONTROL | WOMEN | Africa | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Biology | Evaluation | Behavior | UN | International Agencies | Organizations | Health | Demographic Factors | Population Document Number: 081373 |
| 8. Peer Reviewed Title: Chlamydia trachomatis, infertility, and population growth in Sub-Saharan Africa. Author: Brunham RC; Cheang M; McMaster J; Garnett G; Anderson R Source: Sexually Transmitted Diseases. 1993 May-Jun;20(3):168-73. Abstract: Researchers applied estimates of Chlamydia trachomatis transmission and disease parameters to a compartmental mathematical model of heterosexual, sexually transmitted disease (STD) transmission to determine the potential effect of chlamydia infection via its link to tubal infertility on population growth in sub-Saharan Africa. Epidemiologic parameters included transmission efficiency, salpingitis rate per cervical infection, tubal fertility rate per salpingitis episode, and average duration of infectivity. Sexual behavior parameters were sexual partner change and networks of sexual mixing. Demographic parameters consisted of a constant mortality rate (.02/year), a mean life expectancy (50 years), age of menarche (15 years), age of menopause (45 years), and maximum potential fertility rate. The mathematical model estimated that as the probability of infertility due to chlamydia infection increases, population growth falls almost linearly at various values of basic reproductive rates. In fact, 10% decline in population growth accompanies a 10% chlamydia prevalence. When the researchers applied estimates of gonorrhea transmission to the model, they learned that a 10% prevalence of gonorrhea results in a 30% reduction in population growth, indicating that gonorrhea has more of an effect on population growth than does chlamydia infection. Gonorrhea has higher transmissibility and shorter duration of infectivity than chlamydia infection, resulting in a higher incidence rate at any given prevalence of infection. Improved diagnosis and treatment of STDs as a result of AIDS prevention programs should result in considerable changes in the epidemiology of gonorrhea and chlamydia infection. These changes will likely speed up population growth unless STD control programs are integrated with effective family planning programs. Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | MATHEMATICAL MODEL | COMPARATIVE STUDIES | CHLAMYDIA | GONORRHEA | POPULATION GROWTH | INCIDENCE | PREVALENCE | EXAMINATIONS AND DIAGNOSES | AIDS PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | COMMUNICABLE DISEASE CONTROL | FAMILY PLANNING PROGRAMS | INTEGRATED PROGRAMS | ADNEXITIS | HETEROSEXUALS | SEX BEHAVIOR | TRANSMISSION | Africa | Developing Countries | Theoretical Models | Research Methodology | Studies | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Population Dynamics | Demographic Factors | Population | Measurement | AIDS | HIV Infections | Viral Diseases | Health Services | Delivery of Health Care | Health | Family Planning | Programs | Organization and Administration | Pelvic Inflammatory Disease | Behavior Document Number: 084303 |
| 9. Title: Lost IUD thread as a possible cause of infertility [letter] Author: Caspi B; Weissman A; Elchalal U Source: International Journal of Gynecology and Obstetrics. 1993 Oct;43(1):65-6. Abstract: In Israel, an unusual finding on pelvic ultrasonography necessitated hospitalization for a 41-year old female patient at Kaplan Hospital, in the Rehovot. During her 1st marriage, she had undergone 4 abortions. During her 2nd marriage, she delivered a healthy infant who was 10 years old at the time of hospitalization. A physician had inserted a Lippes Loop IUD 1 month postpartum. 6 years after its insertion, she suffered from a difficult IUD removal and subsequently developed some episodes of sever pelvic inflammatory disease at which time she was hospitalized and received iv antibiotics. She did not conceive throughout the 4 years after IUD removal. Gynecologists at Kaplan Hospital used diagnostic hysteroscopy to identify the intense intrauterine echoes earlier detected (echogenicity was like that of an IUD) by ultrasound. They found and removed a calcified 3 cm long IUD string in the uterine cavity. The woman was a tourist to Israel so the physicians could not determine her subsequent fertility, however. Nevertheless, they believed that the polyethylene thread had the same effect as an inert IUD, therefore making it responsible for her secondary infertility. This case study reinforces the importance of completely removing a IUD. Language: English Keywords: ISRAEL | CASE STUDIES | INFERTILITY | IUD, UNMEDICATED | ADNEXITIS | ULTRASONICS | SIDE EFFECTS | IUD SIDE EFFECTS | Middle East | Developed Countries | Studies | Research Methodology | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Treatment Document Number: 090568 |
| 10. Title: The pathophysiology and epidemiology of sexually transmitted diseases in relation to pelvic inflammatory disease and infertility. Author: Cates W; Rolfs RT; Aral SO Source: In: Biomedical and demographic determinants of reproduction, edited by Ronald Gray, Henri Leridon, and Alfred Spira. Oxford, England, Clarendon Press, 1993. :101-25. Abstract: Chlamydia trachomatis, Neisseria gonorrhoeae, and different anerobic and aerobic bacteria are the leading etiologic factors of pelvic inflammatory disease (PID) in the US. The microbes ascend from the cervix into the uterus and fallopian tubes, especially during menses, in women with gonorrhea and/or chlamydia. Sexual activity in teenagers, IUD insertion, and previous episodes of gonococcal PID are strongly associated with PID. Barrier contraceptive methods reduce the risk of PID. 15-24 year old women experience less tubal damage than older women. Health professionals do not agree on the definitions of sexually transmitted disease (STD)/PID and infertility, which results in inaccurate incidences and prevalences. For example, they use 3 different databases: estimates based on STD occurrence, PID occurrence, and infertility occurrence. Nevertheless, various studies indicate that the incidence of STD-related infertility lies between 75,000 and 225,000 cases per year. All studies so far have identified a significant link between STD/PID and infertility (especially tubal infertility), regardless of parity. C. trachomatis produces more severe subclinical tubal inflammation and tubal damage than other etiologic agents, probably because it is more chronic. Bilateral intratubal adhesions form as part of the healing process and block sperm transport. Cinical evidence of symptomatic PID is not always a requisite for development of tubal infertility. Yet the more previous PID episodes a woman has, the more likely that she will develop tubal occlusion. Antibiotics used for treatment regimens for PID do not reduce the likelihood of infertility. Thus, the medical community must make considerable investments in preventing lower genital tract STDs to reduce consequent upper genital tract PID and subsequent infertility. Language: English Keywords: UNITED STATES OF AMERICA | EPIDEMIOLOGIC METHODS | SEXUALLY TRANSMITTED DISEASES | ADNEXITIS | INFERTILITY | LITERATURE REVIEW | PHYSICAL EXAMINATIONS AND DIAGNOSES | LABORATORY EXAMINATIONS AND DIAGNOSES | RISK FACTORS | SIGNS AND SYMPTOMS | Developed Countries | North America | Americas | Research Methodology | Reproductive Tract Infections | Infections | Diseases | Pelvic Inflammatory Disease | Reproduction | Examinations and Diagnoses | Biology Document Number: 084494 |
| 11. Peer Reviewed Title: What we have learned from recent IUD studies: a researcher's perspective. Author: Chi IC Source: CONTRACEPTION. 1993 Aug;48(2):81-108. Abstract: Many studies published on IUDs during the last 2 years have consistently reported findings in favor of IUD use. Notable among these findings are: IUDs are not abortifacients; newly developed IUDs are highly effective and the efficacy is long lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpartum insertion. Most importantly, in apparent contrast to results often reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associated with an increased risk of pelvic inflammatory disease (PID), nor are they associated with an increased risk of ectopic pregnancy or subsequent infertility. there are still issues concerning IUD use that are controversial in spite of numerous studies. Should some of the contraindications currently listed for IUD use be modified according to the newer findings? Is the risk of uterine perforation increased when the IUD is inserted in lactating women? Do IUD tails increase the risk of PID? Does oral use of antibiotics at IUD insertion helps prevent postinsertion PID? There are also issued that have not been sufficiently addressed, and more information from empirical studies needed. These include: the effect of the insertor's skill on IUD performance: IUD use in nulliparous as well as in older women; the relationship between IUD use and chlamydia infection; and longterm IUD use and safety, including actinomycosis, etc. Answers are also needed by administrators facing difficult programmatic decisions. For instance, should programs involving massive IUD removal be implemented as many IUD-wearing women are approaching or passing menopause? Similarly, are large programs to remove less effective devices and replace them with newer and more effective IUDs advisable? This article reviews the state-of-the-art findings from recent IUD studies on the above issues. (author's) Language: English Keywords: LITERATURE REVIEW | IUD | CONTRACEPTION RESEARCH | CONTRACEPTIVE USE-EFFECTIVENESS | CONTRACEPTION TERMINATION | ADNEXITIS | PREGNANCY, ECTOPIC | INFERTILITY | LACTATION | POSTPARTUM WOMEN | UTERINE PERFORATION | RISK FACTORS | INSERTION | AGE FACTORS | LONGTERM EFFECTS | CHLAMYDIA | CONTRACEPTIVE METHOD ACCEPTABILITY | Contraceptive Methods | Contraception | Family Planning | Contraceptive Effectiveness | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Pregnancy Complications | Reproduction | Maternal Physiology | Physiology | Biology | Puerperium | Perforations | Treatment | Population Characteristics | Demographic Factors | Population | Time Factors | Population Dynamics | Sexually Transmitted Diseases | Contraceptive Usage Document Number: 084735 |
| 12. Title: The new intrauterine contraceptive devices: safe and effective. Author: Edelman DA; Porter CW Jr Source: ADVANCES IN CONTRACEPTION. 1993 Mar;9(1):83-91. Abstract: Early studies indicated an increased risk of IUD-related complications, thus physicians began to advise IUD removal in pregnant women who had an IUD to preclude septic spontaneous abortion. They also began to not insert IUDs in women at high risk of pelvic inflammatory disease (PID). These changes in clinical practice reduced the incidence of IUD-related septic spontaneous abortions and PID. These early studies tended to include IUDs that are no longer used. Thus, any assessments of IUD safety today should use current data (post-1979) which consists of data almost exclusively on the Multiload 375 (MLCu375) and Copper T 380 (TCu380) IUDs, the 2 most commonly used IUDs in the world. Aggregate data from MLCu375 and TCu380 studies reveals that the first-year pregnancy rates are 0.7% and 0.4%, respectively. Corresponding expulsion rates are 2.7% and 5.1%. A 5-year study of MLCu375 shows the 5-year pregnancy rate to be 2.9% (expulsion rate - 5.4%). The TCu380 pregnancy rate for 2 5-year studies is 1.4% (expulsion rates = 7.4% and 8.2%). Their pregnancy rates correspond to those of Norplant. Their ectopic pregnancy rates are lower than those of other copper-releasing IUDs and of Norplant (.04-.06% vs. .07-.14% and .13%, respectively). No cervical or uterine perforations have occurred in 5617 interval insertions of the MLCu375. For TCu380, 2 perforations in 5115 interval insertions (0.4/1000 insertions) have occurred. Since physicians tend to not insert IUDs in women at risk of PID, the risk of PID has fallen significantly in women whose IUD was inserted after 1980. Fertility returns in 75-90% of former IUD users within 1 year of removal. This literature review confirms that changes in clinical practice have reduced the risk of complications. Further, MLCu375 and TCu380 IUDs effectively prevent pregnancy. Thus, the medical community needs to reconsider its opinion about IUDs. Language: English Keywords: LITERATURE REVIEW | IUD, COPPER RELEASING | CONTRACEPTIVE EFFECTIVENESS | UTERINE PERFORATION | ADNEXITIS | REVERSIBILITY | SIDE EFFECTS | IUD SIDE EFFECTS | IUD | Contraceptive Methods | Contraception | Family Planning | Perforations | Diseases | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Treatment Document Number: 083115 |
| 13. Title: Actinomyces israelii in the female genital tract: a review. Author: Evans DT Source: GENITOURINARY MEDICINE. 1993 Feb;69(1):54-9. Abstract: Actinomyces israelii (a gram-positive, branching, anaerobic or microaerophilic bacterium) infects 1.6-11.6% of IUD users worldwide. Physicians must decide whether to treat A. israelii infection with antibiotics, remove the IUD, or refer the patient to the family planning clinic. Culture techniques tend to be inadequate, so many US health professionals use a microscope to identify A. israelii and often confirm the microscopy findings with direct immunofluorescent techniques. A sophisticated culture from pelvic infection or abscesses is needed. It appears that A. israelii infection is more common in women with plastic IUDs than those with copper IUDs and in women who have had an IUD for more than 4 years. Pelvic actinomycotic disease occurs infrequently, but when it does this condition the right ovary and fallopian tube are generally involved; this condition can be life threatening. It is indistinguishable from other forms of pelvic inflammatory disease. Evidence suggests that there is a cause-and-effect relationship between IUD use and pelvic actinomycosis. It is difficult to predict which IUD users harboring A. israelii will develop subsequent serious pelvic infection. Nevertheless, Pap smears can detect A. israelii infection early so physicians can prophylactically treat it before it spreads. Prophylactic treatment in IUD users may consist of changing the IUD every 4 years of long term penicillin or doxycycline treatment. Combinations of various antibiotics used to treat actinomyces infection are penicillin, aminoglycoside, chloramphenicol, amoxycillin, metronidazole, and doxycycline. In the case of tubo-ovarian abscesses larger than 8 cm in diameter, however, surgical treatment is warranted. Language: English Keywords: LITERATURE REVIEW | BACTERIAL AND FUNGAL DISEASES | ADNEXITIS | IUD COMPLICATIONS | RISK FACTORS | ANTIBIOTICS | LABORATORY EXAMINATIONS AND DIAGNOSES | SCREENING | PREVENTION AND CONTROL | COMPLICATIONS | Infections | Diseases | Pelvic Inflammatory Disease | Reproductive Tract Infections | IUD | Contraceptive Methods | Contraception | Family Planning | Biology | Drugs | Treatment | Examinations and Diagnoses Document Number: 083550 |
| 14. Title: Today's IUDs offer safe, effective contraception. Author: Finger WR Source: NETWORK. 1993 Mar;13(3):12-5. Abstract: Even though IUDs are safe and effective when correctly inserted in women in monogamous relationships, both providers and users hold misperceptions about the safety of IUD, thereby restricting womens access to IUDs. Such practices include providers requiring numerous follow-up pelvic examinations and restrictions on who may insert IUDs. Yet research shows that follow-up pelvic examinations are not cost effective and do not necessarily improve the quality of care. Instead, providers should inform women of what symptoms and side effects warrant a follow-up examination, (e.g. irregular or excessive bleeding). Nurses, midwives, assistant midwives as well as physicians who have undergone competency-based training, including 10 to 15 correct insertions under supervision, can safely insert IUDs. Still, some countries restrict IUD insertions to just physicians, e.g., Egypt. On the other hand, midwives and assistant midwives can insert IUDs in Indonesia. The leading medical barrier is the belief that IUDs increase the risk of pelvic inflammatory disease (PID), especially in countries where IUD use is low. Providers inserted the first generation of IUDs in women at high risk of sexually transmitted diseases (STD); thus, many people attributed PID to the IUD rather than to the STDs. Studies showing an association between the Dalkon Shield and PID also fueled the fear. Research indicates that women are at an increased risk of PID, only during the first 4 to 6 weeks after IUD insertion, but thereafter no risk exists for women in monogamous relationships. Other obstacles are cost (e.g., US private physicians, US $1609-400), no promotional campaigns to improve the image of the IUD, and rumors (e.g., IUD migrates to the stomach or heart). Today most providers insert the copper-releasing IUDs, the second generation IUDs. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | IUD | IUD, COPPER RELEASING | FAMILY PLANNING PERSONNEL | INSERTION | PHYSICAL EXAMINATIONS AND DIAGNOSES | OBSTACLES | STAFF ATTITUDE | FAMILY PLANNING TRAINING | ADNEXITIS | Contraceptive Methods | Contraception | Family Planning | Family Planning Programs | Treatment | Examinations and Diagnoses | Organization and Administration | Attitudes | Psychological Factors | Behavior | Training Programs | Education | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases Document Number: 081443 |
| 15. Title: Fertility following contraceptive use. Author: Huggins GR Source: In: Biomedical and demographic determinants of reproduction, edited by Ronald Gray, Henri Leridon, and Alfred Spira. Oxford, England, Clarendon Press, 1993. :157-69. Abstract: In the US few women experience infection after undergoing a first-trimester abortion. But more and more women are having repeat abortions. Each repeat abortion increases the risk for pelvic infection. First-trimester abortions do not bring about an increase in cervical incompetence and subsequent prematurity or surgical infertility. Some women suffer from intrauterine adhesions (Asherman's syndrome) which cause infertility, habitual abortion, and menstrual irregularities. These adhesions often arise after an aseptic abortion. Women who have discontinued oral contraceptives (OCs) tend to experience spontaneous resumption of menses between 6 and 10 weeks after taking their last contraceptive pill. Fertility of former OC users may be temporarily delayed, but it returns by 1 year. In fact, the incidence of post-OC amenorrrhea lasting more than 6 months is less than 1%. Neither duration of use or type of OC are associated with post-OC amenorrhea. Any woman can suffer post-OC amenorrhea, regardless of pre-OC use menstruation status. Clomiphene successfully brings on resumption of menses and ovulation in women with normal estrogen and gonadotropin levels. Yet the pregnancy rate of such women is significantly lower than that of women whose menses return spontaneously. IUD users, especially Dalkon Shield users, are more likely to develop pelvic inflammatory disease (PID) than are OC users and barrier contraceptive users. Copper releasing IUDs have the lowest PID risk. Scientists find it difficult to determine the effect IUDs have on development of pelvic adhesions which often cause infertility. Nevertheless, recent studies do show that IUDs carry an increased risk of tubal infertility. Overall, the risk of impaired future fertility from use of medical contraceptive methods is low. Physicians should identify patients who may develop such an impairment, such as women who menstruate infrequently or have a history of PID, so they can recommend a contraceptive method which likely does not pose a threat to future fertility. Language: English Keywords: UNITED STATES OF AMERICA | CONTRACEPTIVE USAGE | FERTILITY | ORAL CONTRACEPTIVES | ABORTION | IUD | MULTIPLE PARTNERS | ADNEXITIS | PREGNANCY RATE | ADHESIONS | MENSTRUATION DISORDERS | OVULATION | LITERATURE REVIEW | North America | Americas | Developed Countries | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Fertility Control, Postconception | Sexual Partners | Sex Behavior | Behavior | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Fertility Measurements | Signs and Symptoms | Reproduction Document Number: 084496 Notification |
| 16. Title: Acute pelvic infection following hysterosalpingography at the Kenyatta National Hospital, Nairobi. Author: Lema VM; Majinge CR Source: East African Medical Journal. 1993 Sep;70(9):551-5. Abstract: Between September 1988 and January 1989 in Kenya, health care providers recruited 150 infertile women, 15-39 years old, who had gone to a gynecological outpatient clinic at Kenyatta National Hospital in Nairobi to undergo hysterosalpingography to determine the condition of the uterus and fallopian tubes. The aim of the study was to determine whether there was an association between hysterosalpingography and pelvic inflammatory disease (PID) and the determinants for PID. Most women were between 20-29 years old, married, and had a primary education (67.3%, 90.7%, and 55.3%, respectively). One week after hysterosalpingography, 44% developed acute PID, defined as having at least 2 of the following signs or symptoms: lower abdominal pain, rebound tenderness, cervical/adnexal tenderness, foul smelling vaginal discharge, adnexal mass(es), and fever of at least 38 degrees Celsius. The most frequent signs and symptoms were lower abdominal pain and tenderness. Married women were more likely to have PID than unmarried women (47.1% vs. 14.3%). The small numbers of unmarried women made it difficult to determine the significance of the difference, however. Sexual intercourse within the 1st week after hysterosalpingography was not associated with PID (45.2% for PID cases vs. 42.1% for non-PID cases). The researchers believed that hysterosalpingography pushed existing pathogens in the vagina into the uterus, or the women already had asymptomatic PID. They recommended further studies to determine whether physicians should administer prophylactic antibiotic therapy to all women undergoing hysterosalpingography. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | ADNEXITIS | HYSTEROSALPINGOGRAPHY | SIGNS AND SYMPTOMS | PELVIC INFECTIONS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Physical Examinations and Diagnoses | Examinations and Diagnoses Document Number: 093479 |
| 17. Peer Reviewed Title: HIV infection among patients with acute pelvic inflammatory disease at the Kenyatta National Hospital, Nairobi, Kenya. Author: Ojwang AW; Lema VM; Wanjala SH Source: East African Medical Journal. 1993 Aug;70(8):506-11. Abstract: AIDS continues to exert considerable strain on the economy, as well as social aspects of our lives. Previous studies have identified the categories of people most at risk of contracting and developing HIV infection and AIDS. In this study, 20.9% of women with acute pelvic infection at the Kenyatta National Hospital, were found to be seropositive for HIV, much higher than the general population in Kenya. Though there was no direct correlation between one's age and serological status, most of the women with pelvic inflammatory disease (PID) were young, quite sexually active, and involved with several partners. 49.0% of the entire group and 53.7% of the women who were seropositive were married. This underlies the fact that marital status does not appear to offer any protection against HIV infection. The fact that the majority of these women had started coitus quite early, that they were not using any protective measure against STDs or HIV infection, and they were involved with several partners, indicate that we are very far from winning the fight against HIV infection and AIDS. There is need to revise the currently operative programs with a view to making them more effective in preventing transmission and spread of HIV infection. (author's) Language: English Keywords: KENYA | ADNEXITIS | HIV INFECTIONS | INCIDENCE | SEX BEHAVIOR | PELVIC INFECTIONS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Measurement | Research Methodology | Behavior Document Number: 092914 |
| 18. Title: Predisposing factors for pelvic inflammatory disease. Identifying and educating women at risk may reduce the incidence of PID. Author: Roddy RE Source: JOURNAL OF THE AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS. 1993 Jan;6(1):42-7. Abstract: A 1988 study shows that 11% women of reproductive age have had at least 1 episode of pelvic inflammatory disease (PID) and 30% of these women have had to be hospitalized. 30% of women with acute PID and more than 90% of women with chronic PID need surgery, especially hysterectomies. As the number of PID episodes increase, so does the risk of infertility (10% for 1, 30% for 2, and 75% for 3 or more). Clinicians should consider the demographic characteristics of women with PID, patterns of sexual behavior, the physiology of the genital tract, and the microbiology of gynecologic infections when they evaluate, diagnose, and treat these women. They should recognize and treat acute PID as soon as possible, especially chlamydia-associated PID, as well as treat the partners at the same time. They should advise patients to use condoms, even if they are using another contraceptive method. Demographic risk indicators of PID include: young age (especially 15-20 years), due to its high risk of sexually transmitted diseases (STDs) and a less viscous and easier to penetrate cervical mucus; non-Whites race; low level of education and low income; multiple sex partners; a lower incidence of seeking health care; cohabitation or single status; and urban residence. Frequent sexual intercourse is a risk factor, independent of number of sexual partners or the presence of an STD. Other PID risk factors are STDs (especially those caused by cervical and vaginal pathogens), HIV infection, and nonuse of barrier or oral contraceptives (OCs). It appears that vaginal douching and cigarette smoking are both risk indicators and factors. Physiologic determinants of PID are menses, cervical ectopia, motile spermatozoa, medical procedures breaking the cervical barrier (e.g., IUD insertion), and induced abortion. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | ADNEXITIS | RISK FACTORS | PELVIC INFECTIONS | Developed Countries | North America | Americas | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Biology Document Number: 092755 |
| 19. Title: Intrauterine contraceptive devices [letter] Author: Rowlands S Source: BRITISH JOURNAL OF GENERAL PRACTICE. 1993 Apr;43(369):175. Abstract: A physician in Bedfordshire, England, believes that inert IUDs should not be reintroduced into the market place. He acknowledges that larger IUDs, but women who use them have a high incidence of pain and bleeding problems. The new copper-releasing IUDs have a better efficacy rate than inert IUDs. The lowest failure rate of any IUD is the levonorgestrel-releasing IUD and its efficacy is almost as good as that of the combined oral contraceptive. Medicated IUDs sometimes require periodic reinsertions, but this is insignificant when compared with the reduced pain and bleeding associated with their use, especially among low parity women. An Israeli study shows that 63% of inert IUD users suffered pain, bleeding, or discharge and more than 50% of them wanted the IUD removed. The availability of better IUDs makes this high rate unacceptable. Copper releasing IUDs remain effective and safe for as long as 8 years. Some physicians suggest that women of at least 40 years of age can use them indefinitely. Published reports show that the incidence of pelvic inflammatory disease (PID) is essentially the same for both inert IUDs and copper IUDs, e.g., 2 studies examining infertility reveal that the risks of tubal blockage are lower with copper IUDs than with inert IUDs. Besides the insertion process and background risk of sexually transmitted diseases are linked to PID and not the inherent property of the IUD. One 3-year study finds that a levonorgestrel releasing IUDs have a protective effect against PID. In the practice of the Bedfordshire physician, just 8 of 98 current IUD users use the inert IUD. He allows them to continue using their IUDs as long as they are satisfied and their hemoglobin levels remain stable. He proposes that clinicians should discard any remaining stock of inert IUDs and use only medicated IUDs. Language: English Keywords: UNITED KINGDOM | CRITIQUE | IUD, UNMEDICATED | IUD, HORMONE RELEASING | IUD, COPPER RELEASING | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION FAILURE | ADNEXITIS | SIDE EFFECTS | IUD SIDE EFFECTS | United Kingdom | Europe, Western | Europe | Developed Countries | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Treatment Document Number: 090562 |
| 20. Title: Emergency medicine, abortion and the healing tradition [editorial] Author: VanTassell VJ Source: JOURNAL OF EMERGENCY MEDICINE. 1993 Jan-Feb;11(1):94-5. Abstract: A male emergency medicine resident at the Maricopa Center in Phoenix, Arizona, in the US, disapproves of colleagues who perform or support abortion. He asks emergency physicians who are distressed that more than 1.3 million legal abortions occur each year in the US to disclose their beliefs. In the Journal of Emergency Medicine, authors of an article on the complications of self-induced abortion claim that financial barriers (i.e., lack of government funding) limit access to safe abortions. The antiabortion physician asserts that this argument implies that abortion on demand needs to be even more accessible and that using government funding to remove all barriers to abortion, would prevent abortion complications. Yet, he contends that 1.3 million women would claim that abortion is already too easily accessible. In 1974, 87% of women experienced an abortion for the first time, while, in 1987, just 55% did. In fact, 25% underwent a second abortion, 9.6% a third, and 4.7% at least a fourth abortion, suggesting that women now use abortion for birth control. Abortion on demand will not prevent self-induced abortions. According to the antiabortion physician, legalizing abortion exposed more women to a very dangerous, but legal, operation. For example, 10.9% of women suffer from pelvic inflammatory disease after abortion. 19.8 of 1000 dilation and evacuation cases experience uterine perforation. Between 1972 and 1985, 213 women in the US died from legal abortions. A 1987 Swedish study shows that 6.1% of almost 6000 consecutive first trimester abortions had complications with hospitalization averaging 5.3 days. This translates into 80,000 US women at risk each year from abortion complications. The antiabortion physician concludes that some physicians rationalize mistreatment of the unborn and unfit by making judgments on quality, social work, and costs of their lives. Language: English Keywords: UNITED STATES OF AMERICA | ARIZONA | CRITIQUE | ABORTION | PHYSICIANS | CONTRACEPTIVE AVAILABILITY | ADNEXITIS | UTERINE PERFORATION | MATERNAL MORTALITY | ETHICS | North America | Americas | Developed Countries | Fertility Control, Postconception | Family Planning | Health Personnel | Delivery of Health Care | Health | Contraception | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Perforations | Mortality | Population Dynamics | Demographic Factors | Population | Interest Groups | Political Factors Document Number: 083608 Notification |
| 21. Title: [Relationship between the incidence of ectopic pregnancy and the use of intrauterine devices (IUDs)] Author: Wang P; Fei MD Source: CHUNG-HUA FU CHAN KO TSA CHIH [CHINESE JOURNAL OF OBSTETRICS AND GYNECOLOGY]. 1993 Feb;28(2):94-6, 123. Abstract: The relationship between the incidence of ectopic pregnancy (EP) and the use of IUD was examined by the method of analytical epidemiological study. 10,843 women of childbearing age from the western district of Beijing were investigated and the following conclusions were reached: 1) The incidence of EP in IUD users was 0.91 per 1000 women per year; and the EP incidence in women not using any contraceptives was 2.23 per 1000 women per year; 2) the incidence of EP in women who had been using an IUD for 2 years was significantly higher than that in women who had been using an IUD for more than 2 years (5.64 per 1000 women per year and 0.47 per 1000 women per year, respectively); 3) the probability of suffering from EP for accidental pregnancy in IUD users was 4.84%, which was much higher than that of women who were not using a contraceptives (0.20%); 4) the risk of EP in IUD users with pelvic inflammatory disease (PID) was 6.64 times as compared to those without PID; 5) EP was not related to any previous Cesarean section or induced abortion. (author's modified) (summaries in ENG, CHI) Language: Chinese Keywords: CHINA | PREGNANCY, ECTOPIC | INCIDENCE | IUD | EPIDEMIOLOGIC METHODS | ADNEXITIS | PELVIC INFECTIONS | Developing Countries | Asia, Eastern | Asia | Pregnancy Complications | Diseases | Measurement | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections Document Number: 094794 |
| 22. Title: Sexually transmitted diseases in the age of AIDS. Author: Wimalawansa SJ Source: CEYLON MEDICAL JOURNAL. 1993 Mar;38(1):12-4. Abstract: WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year. STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection. HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs. PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache. STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections. Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission. HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus. Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection. Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections. Tourists are responsible for introducing HIV infection into many countries. Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries. Health resources are not keeping up with the spread of STDs and HIV. Governments should embark on health education campaigns to stem the spread of HIV. They should also integrate AIDS prevention with the control of other STDs. Language: English Keywords: GLOBAL | SEXUALLY TRANSMITTED DISEASES | AIDS | HIV INFECTIONS | ADNEXITIS | PREGNANCY | HEALTH EDUCATION | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Pelvic Inflammatory Disease | Reproduction | Education Document Number: 090330 |
| 23. Title: Does infection occur with modern intrauterine devices? [editorial] Source: Lancet. 1992 Mar 28;339(8796):783-4. Abstract: It is difficult to determine if the IUD increases the risk of pelvic inflammatory disease (PID) because simple clinical features are not consistently predictive and can have low specificity and sensitivity. The C-reactive protein and the erythrocyte sedimentation rate tests help with PID diagnosis, but only a laparoscopy can determine tubal involvement. In 1970, WHO's Cooperative Statistical Programme found 2-year combined PID rates to range from 3.8 to 5.2/100 women with an IUD. Then WHO and various US organizations agreed IUD use did not necessarily cause PID. During the 1970s, however, a large rise in sexually transmitted diseases (STDs), especially chlamydia and gonorrhea, occurred and were associated with PID incidence. Many believed the growing rate of PID was attributable to the increasing use of IUDs. Many studies were biased because of overdiagnosis of PID. A 1990 review of 28 articles revealed that the overall PID rate was 1.49/100 woman years (lower than what many believed earlier). Some researchers used multicountry data on 22, 908 IUD insertions from WHO's data base for IUD studies to determine PID risk in IUD users. This risk was somewhat high during the 1st 20 days postinsertion which may be related to insertion, but PID rates in IUD users corresponded with those from the general population. PID rates did increase with age, however, and they did vary with geographical area. In addition, rates were 62% lower in women whose IUD was inserted after 1980. The PID rate was associated with background risk of STDs. These results and those of other studies suggest that health staff must adequately assess all patients before fitting the IUD and insert it only under strict aseptic conditions. IUDs that release copper and levonorgestrel pose a lower risk of PID than nonmedicated IUDs. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | LITERATURE REVIEW | IUD, UNMEDICATED | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | PELVIC INFECTIONS | PHYSICAL EXAMINATIONS AND DIAGNOSES | SEXUALLY TRANSMITTED DISEASES | WHO | ADNEXITIS | Developed Countries | North America | Americas | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Examinations and Diagnoses | Reproductive Tract Infections | UN | International Agencies | Organizations | Pelvic Inflammatory Disease Document Number: 071775 |
| 24. Title: IUDs safe and effective at nine years of continuous use. Source: PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1992;(22):2-3. Abstract: The WHO Special Programme of Research, Development and Research Training in Human Reproduction has conducted long term studies on 2 copper releasing IUDs (TCu220C and TCu380A) in almost 2800 women which show that they are effective for 9 years. The pregnancy rates for TCu220C at 7 and 9 years are 4.9 and 5.4/1000 woman years respectively. Thus the annual risk of pregnancy is about 1%. The pregnancy rates for TCu380A are even lower (1.7 and 2.1 respectively), an annual rate of less than 0.5%. As a result of these studies, the US Food and Drug Administration sanctioned TCu380A use for 8 years up from 6 years. More than 80 million women worldwide, especially in developing countries (e.g., about 74 million in China), use the IUD. Researchers have analyzed data on 22,908 insertions from 12 trials to see whether IUD use is related to pelvic inflammatory disease (PID) and whether long term use causes more severe PID. They learned that the overall PID rate is 1.6/1000 woman years. The first 20 days after insertion carry a 7 times higher risk of PID, but the risk falls considerably thereafter and stays low for at least 8 years. Further, duration of IUD use does not increase the severity of PID. WHO is supporting research at 28 centers which are evaluating a new IUD which has copper sleeves hanging from a nylon suture (frameless IUD). During insertion, the clinician embeds the suture superficially into the top of the uterus so the IUD and the copper sleeves are suspended. WHO is also supporting research at up to 6 centers on 2 modified frameless IUDs designed to be inserted after delivery. The research want to determine whether the high expulsion rate of IUDs inserted during the postpartum period can be reduced. Language: English Keywords: GLOBAL | IUD, COPPER RELEASING | CONTRACEPTIVE USAGE | CONTRACEPTIVE EFFECTIVENESS | CLINICAL TRIALS | ADNEXITIS | GOVERNMENT AGENCIES | WHO | IUD | Contraceptive Methods | Contraception | Family Planning | Clinical Research | Research Methodology | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Organizations | UN | International Agencies Document Number: 079125 |
| 25. Title: Understanding PID. Source: PATIENT CARE. 1992 Mar 30;26(6):55-6. Abstract: Bacteria can migrate up from the vagina and cervix to infect the uterus, ovaries, and the Fallopian tubes and, if left untreated, the infection causes pelvic inflammatory disease (PID). Sometimes women have PID and no obvious symptoms. Cysts may become larger on the tubes or ovaries and eventually burst spilling bacteria into the abdomen and the blood stream. Once the infection has entered the blood stream, the woman's life is in danger. Another consequence of untreated PID is infertility caused by scars in the tubes. The scars either prevent the egg from being fertilized or a fertilized egg from reaching the uterus. Antibiotics treat PID and are administered either at home or in the hospital. The PID patient must abide by the physician's instructions to thwart more serious infection, e.g., septicemia. The physician must emphasize that the patient must take the antibiotics every day for the prescribed length of time, even after the patient feels fine. A home-based patient must return to the physician's office within 3 days after treatment begins and then 2 weeks later. A patient released from the hospital should visit the physician 2 weeks after discharge. At these visits, the physician should encourage the patient to have her sexual partner undergo testing for sexually transmitted disease (STDs). If indeed the partner is infected, the patient should not have sexual intercourse with him or anyone else who has a genital infection. If a patient does choose to have sexual intercourse with an infected person, she should insist on condom use, especially in conjunction with spermicides. They offer the best protection against STDs and PID, as well as pregnancy. Diaphragms and spermicides provide less protection than do condoms and spermicides. Other contraceptives just prevent pregnancy. Language: English Keywords: RECOMMENDATIONS | ADNEXITIS | UTERUS | FALLOPIAN TUBES | OVARY | ANTIBIOTICS | INFERTILITY | SEXUALLY TRANSMITTED DISEASES | CONDOMS | VAGINAL SPERMICIDES | VAGINAL DIAPHRAGM | PREVENTION AND CONTROL | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Drugs | Treatment | Reproduction | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Vaginal Barrier Methods Document Number: 080593 |
| 26. Title: Perihepatic adhesions: not necessarily pathognomonic of pelvic infection. Author: Amin-Hanjani S; Neely T; Chatwani A Source: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. 1992 Jul;167(1):115-6. Abstract: 100 consecutive patients undergoing elective laparoscopic tubal ligation were enrolled in a study aimed at investigating the association between perihepatic adhesions and pelvic inflammatory disease (PID). Perihepatic adhesions were identified in 17 of these patients on the basis of evaluation of the liver capsule and anterior abdominal wall. 2 patients (12%) in the adhesions group and 12 (15%) in the no-adhesions group reported a history of sexually transmitted diseases (STDs). No patient with adhesions had a documented PID episode in her history compared with 2 (2%) in the no-adhesions group. 4 patients with adhesions (24%) and 5 (6%) of those with no adhesions had clinical evidence of old pelvic infection. 2 women with a history of STD and adhesions had evidence of chronic pelvic infection. All patients had a negative gonorrhea culture, and all were clinically asymptomatic. The finding that 13 of the 17 patients with perihepatic adhesions had no evidence of prior infection of the pelvis was unexpected and suggests a need for a larger study to define the causes of these adhesions. Also suggested by these findings is the lack of association between perihepatic adhesions and infertility, since all patients were fertile women undergoing interval sterilization. Language: English Keywords: CORRELATION STUDIES | ADNEXITIS | SEXUALLY TRANSMITTED DISEASES | HEPATIC EFFECTS | INFERTILITY | ADHESIONS | ADNEXAL EFFECTS | WOMEN | Statistical Studies | Studies | Research Methodology | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Physiology | Biology | Reproduction | Signs and Symptoms | Genital Effects, Female | Genitalia, Female | Genitalia | Urogenital System | Demographic Factors | Population Document Number: 074713 |
| 27. Title: Reversible contraception for the woman over 35 years of age. Author: Archer DF Source: CURRENT OPINION IN OBSTETRICS AND GYNECOLOGY. 1992 Dec;4(6):891-6. Abstract: US women over 35 years old continue to need reversible contraception. Most women in this age group who need reversible contraception use the condom, diaphragm, spermicides, IUDs, or oral contraceptives (OCs). The most effective reversible contraceptives are OCs, the IUD, and the systemic contraceptive, Norplant. Healthy women older than 35 who do not smoke and have no coronary artery disease risk factors can safely use low-dose OCs. OCs do not increase the incidence of breast cancer. They appear to protect from epithelial ovarian neoplasm and functional ovarian cysts. Further, they reduce the amount and duration of vaginal bleeding. IUD use has fallen in the US due to the negative publicity of increased risk of pelvic inflammatory disease (PID). Studies have shown, however, that older women who are in a stable monogamous relationship can use an IUD without increasing their risk of PID. The only 2 IUDs available in the US are Progestasert, which releases progesterone, and Paragard T380A, which releases copper. Progestasert reduces the amount of bleeding often associated with IUD use. The risk of ectopic pregnancy is slightly increased in IUD users. Older women can choose the subdermal implant, Norplant, which is effective for 5 years. Its major disadvantage is irregular vaginal spotting or bleeding, but administration of oral estrogen controls this effect. Norplant suppresses ovulation and alters cervical mucus. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | CONTRACEPTION | REVERSIBILITY | AGE FACTORS | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | CONTRACEPTIVE IMPLANTS | ORAL CONTRACEPTIVES, LOW-DOSE | BREAST CANCER | OVARIAN CANCER | OVARIAN CYSTS | ADNEXITIS | OVULATION SUPPRESSION | CERVICAL MUCUS | MENSTRUATION DISORDERS | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Family Planning | Population Characteristics | Demographic Factors | Population | IUD | Contraceptive Methods | Oral Contraceptives | Cancer | Neoplasms | Diseases | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Contraceptive Mode of Action | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 084644 |
| 28. Title: Update on the intrauterine contraceptive device [editorial] Author: Bergsjo P Source: Acta Obstetrica et Gynecologica Scandinavica. 1992 Apr;71(3):163-5. Abstract: About 84 million women in the world, 86% of whom live in China, use IUDs. 2-4% of fertile women in the US, Canada, Australia, and New Zealand use them, while 31% do in Norway. IUD use is also popular in other Scandinavian countries. The Dalkon Shield was linked to pelvic inflammatory disease (PID), presumably due to its multifilamentous thread, and many US women sought economic compensation. This litigation and the fear that using other IUDs also increases the risk of PID caused many manufacturers to withdraw IUDs from the US market. Between 1982 and 1988, IUD use fell 66% in the US. Yet, a meta-analysis of 12 studies with up to 10 years observation time reveals that the overall PID rate is low (1.6 cases/1000 woman years of use). Women were at least 6 times more likely to develop PID during the 20 days after insertion. After 20 days the risk was low. Physicians thus should test for gonococci and chlamydiae before insertion and administer antibiotics 2 weeks after insertion if they detect infection. Many people in predominantly Catholic countries consider IUDs to be abortifacients so IUD use is low. Yet, around 10% of women in Mexico use the IUD. Further, more and more people in Brazil are starting to accept the IUD. IUDs' benefits include user independence, reversibility, and effectiveness, which contribute to their high continuation rates. When the smaller copper releasing IUDs emerged, practitioners correctly believed they had fewer side effects than other IUDs, but they assumed they needed to be changed every 1-2 years. This erroneous belief resulted in greater sales, but also greater user anxiety and physician workload. Longterm follow-up studies, largely supported by WHO, indicate, however, that some copper releasing IUDs, e.g.m, TCu380A, can be effectively used for up to 8 years at least. Indeed, the TCu380A is perhaps the most effective IUD. Language: English Keywords: CHINA | UNITED STATES OF AMERICA | CANADA | AUSTRALIA | NEW ZEALAND | NORWAY | LITERATURE REVIEW | IUD | IUD SIDE EFFECTS | IUD, COPPER RELEASING | ADNEXITIS | CATHOLICISM | CONTRACEPTIVE METHOD ACCEPTABILITY | LITIGATION | CONTRACEPTIVE EFFECTIVENESS | SIDE EFFECTS | Developing Countries | Asia, Eastern | Asia | Developed Countries | North America | Americas | North America, Northern | Oceania | Europe, Northern | Europe | Contraceptive Methods | Contraception | Family Planning | Pelvic Inflammatory Disease | Reproductive Tract Infections | Infections | Diseases | Christianity | Religion | Contraceptive Usage | Treatment Document Number: 079373 |
| 29. Title: [Morbidity after induced abortions in 1989] Morbidita po miniinterrupcich v roce 1989. Author: Bilina T; Kobilkova J Source: CESKOSLOVENSKA GYNEKOLOGIE. 1992 Feb;57(1):33-7. Abstract: All the women who underwent a mini-abortion in 1989 at the 2nd clinic of obstetrics and gynecology of Prague were followed-up in order to ascertain the relationship of complications after a mini-abortion to parity; the amount of time that elapsed before the manifestation of difficulty; the clinical symptoms of readmission after abortion; the week of gestation when ultrasound was performed for the diagnosis of the causes of difficulty; and the role of treatment. 1769 mini-abortions were carried out in 1989. 90 (5.08%) women were hospitalized for complications. The youngest patient was 16 years old, the oldest 42 years old. 6.66% of the affected women were under 18 years old, 10% were in the 18-20 age group, 20% were under 25 years old, and 12.22% were under 30 years old. 24.44% were 35 years old, and 17.77% were over 35 years of age. 25 (25.55%) women were primigravida, and 68.88% were multiparous with at least 1 birth. 5.55% of women had an abortion or mini-abortion in their anamnesis. The complication in 10 clinic readmission cases occurred 2 days after induced abortion in 11.11%, 4 days later in 38.88%, 6 days later in 22.22%, 8 days later in 10%, and 10 days later in 3.33%. 18.14% of women were hospitalized longer than 10 days. The most frequent cause of admitting patients was suspicion of inflammation in 50%, residue in 22.22% and endometritis in 13.5%. 7.77% of the women were admitted for bleeding, 5.55% for endometritis and adnexitis, and 1.11% for parametritis and adnexitis. Ultrasound investigation was performed for every women admitted for complications. In 58.9% there were no findings, the fetal remains had been eliminated from the uterine cavity. The association of morbidity with the length of pregnancy was demonstrated by the fact that in 6.66% the abortion was performed in the 5th week of gestation, in 23.33% in the 6th week, in 47.77% in the 7th week, and in 22.22% in the 8th week. 73 patients (81%) were treated with antibiotics. Only in 19% was the treatment limited to uterotonic hormones. Language: Czech Keywords: CZECHOSLOVAKIA | FOLLOW-UP STUDIES | ABORTION | POSTABORTION | EXAMINATIONS AND DIAGNOSES | AGE DISTRIBUTION | BLEEDING | ENDOMETRITIS | ADNEXITIS | Europe, Central | Europe | Developing Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Reproduction | Age Factors | Population Characteristics | Demographic Factors | Population | Signs and Symptoms | Diseases | Reproductive Tract Infections | Infections | Pelvic Inflammatory Disease Document Number: 079038 Notification |
30.  Title: Potential endocervical pathogens before termination [letter] Author: Blackwell AL; Wareham K; Lemery S; Thomas PD Source: BMJ. British Medical Journal. 1992 Jul 18;305(6846):179. Abstract: We believe Mike Cohn and Peter Stewart's short report recommending that all patients requesting termination of pregnancy should be screened for endocervical pathogens has a major omission. Anerobic bacteria, which are isolated in large numbers from the vaginal secretions of women with anerobic (bacterial) vaginosis, have long been associated with pelvic inflammatory diseases, and surgical termination of pregnancy could lead to spread of these organisms to the upper genital tract. In addition, Larsson et al have shown that anerobic vaginosis and chlamydia are independent risk factors for pelvic inflammatory disease after abortion and that treatment of anerobic vaginosis leads to a reduction in complications after abortion. It therefore seems appropriate to screen patients attending for termination of pregnancy for both endocervical and vaginal infections, particularly anerobic vaginosis. (full text) (3 references cited in original document) Language: English Keywords: UNITED KINGDOM | ABORTION | SCREENING | ENDOMETRIAL EFFECTS | INFECTIONS | RISK FACTORS | ADNEXITIS | Developed Countries | Europe, Western | Europe | Fertility Control, Postconception | Family Planning | Examinations and Diagnoses | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Diseases | Pelvic Inflammatory Disease | Reproductive Tract Infections Document Number: 074596 Notification |
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