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1.
Title: Intrauterine devices: an effective alternative to oral hormonal contraception.
Source: Prescrire International. 2009 Jun;18(101):125-30.
Abstract: (1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | IUD | CONTRACEPTIVE MODE OF ACTION | IUD COMPLICATIONS | IUD EXPULSION | INSERTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | UTERINE PERFORATION | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Pregnancy Complications | Diseases | Perforations
Document Number: 342301

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3.
Title: [Of office hysteroscopy for the removal of intrauterine device. Literature review] Histeroscopia de consultorio para la extraccion de dispositivo intrauterino.
Author: Alanis Fuentes J; Amoroso Hernandez MA
Source: Ginecologia Y Obstetricia De Mexico. 2009 Apr;77(4):197-201.
Abstract: OBJECTIVE: To review the literature related to the hysteroscopic techniques such as outpatient diagnostic and therapeutic tools for the extraction of foreign bodies in patients with intrauterine device. METHOD: We searched the main electronic databases were searched for those words: hysteroscopy and intrauterine device in articles related to the removal of intrauterine devices by hysteroscopy. RESULTS: The loss or translocation of IUD is a common problem resulting from the large number of women who have applied. The importance of early diagnosis is to avoid, such as the inappropriate position of the device promotes an unwanted pregnancy, genital bleeding and injury to adjacent organs such as bowel and bladder. The assessment by ultrasound or X-rays, or both, allowing the device to locate and determine the desirability or otherwise of outpatient hysteroscopy (in practice) without anesthesia and with low morbidity for the patient or, well, resorting to other methods, and laparoscopy in the operating room. CONCLUSIONS: Hysteroscopy is an effective procedure for recovering intrauterine foreign bodies or hidden in properly selected patients.
Language: Spanish
Keywords:
GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | HYSTEROSCOPY | IUD | CONTRACEPTIVE REMOVAL | CONTRACEPTIVE USE-EFFECTIVENESS | PROGRAM EFFECTIVENESS | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Treatment | Contraceptive Effectiveness | Program Evaluation | Programs | Organization and Administration
Document Number: 342313

Peer Reviewed

Title: Expanding access to intrauterine contraception.
Author: Allen RH; Goldberg AB; Grimes DA
Source: American Journal of Obstetrics and Gynecology. 2009 Jun 13;
Abstract: The intrauterine device is a safe, highly effective, long-lasting, yet reversible method of contraception. Expanding access to intrauterine contraception is an important measure to reduce the rate of unintended pregnancy in the United States. Clinicians should consider intrauterine contraception in appropriate candidates, including women who are nulliparous, adolescent, immediately postpartum or postabortal, and desiring emergency contraception, and as an alternative to permanent sterilization. Barriers to intrauterine contraception such as requiring cervical cancer screening before insertion, routine testing for gonorrhea and chlamydial infection in low-risk women, or scheduling insertion only during menses are unnecessary.
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | ADOLESCENTS, FEMALE | IUD | CONTRACEPTIVE AVAILABILITY | MISINFORMATION | CONTRAINDICATIONS | INSERTION | PAIN | IUD EXPULSION | NULLIPARITY | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Communication | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 341709

Title: Interventions for pain with intrauterine device insertion.
Author: Allen RH; Bartz D; Grimes DA; Hubacher D; O'Brien P
Source: Cochrane Database of Systematic Reviews. 2009;(3):CD007373.
Abstract: BACKGROUND: Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES: To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. SEARCH STRATEGY: We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. MAIN RESULTS: Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. AUTHORS' CONCLUSIONS: No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.
Language: English
Keywords:
UNITED STATES OF AMERICA | CHILE | DENMARK | SWEDEN | LITERATURE REVIEW | CLINICAL TRIALS | IUD | INSERTION | PAIN | DRUGS | ADMINISTRATION AND DOSAGE | MISOPROSTOL | Developed Countries | North America | Americas | Developing Countries | South America, Southern | South America | Latin America | Europe, Northern | Europe | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 342475

6.
Title: Emergency contraception: how does it work?
Author: Baird DT
Source: Reproductive Biomedicine Online. 2009;18 Suppl 1:32-6.
Abstract: Emergency (or post-coital) contraception is any substance or device that is used to prevent pregnancy after unprotected intercourse. Currently used hormonal methods of emergency contraception (high-dose combined oral contraceptive pill or levonorgestrel) prevent about 50-80% of pregnancies. Research has demonstrated that these methods inhibit the midcycle surge of LH from the pituitary and, if given at least 2 days before ovulation, ovulation is delayed or prevented. Ovulation still occurs if administration is delayed until ovulation is imminent. Biological data that suggest that the most likely mode of action is by preventing fertilization are supported by the clinical observation that the greater the interval between coitus and administration the greater the chance of pregnancy. There are no data supporting the view that levonorgestrel can impair the development of the embryo or prevent implantation. In contrast, other very effective methods of emergency contraception, such as mifepristone and intrauterine devices, can also inhibit implantation.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | EMERGENCY CONTRACEPTION | IUD | RU-486 | LEVONORGESTREL | CONTRACEPTIVE EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Contraception | Family Planning | Contraceptive Methods | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330739

8.
Title: Contraception for women with epilepsy.
Author: Burakgazi E; Harden C; Kelly JJ
Source: Reviews in Neurological Diseases. 2009 Spring;6(2):E62-7.
Abstract: The choice of a contraceptive drug can be challenging for women with epilepsy due to possible interactions between antiepileptic drugs (AEDs) and hormonal contraception. Enzyme-inducing AEDs can cause hormonal contraception to fail and can increase the risk of teratogenicity. Higher doses of oral contraceptives can overcome pharmacologic failure but may create additional risks. The effects of reproductive hormones on individual AEDs have recently been clarified, providing helpful guidelines for physicians and patients. Studies show that lamotrigine has a significantly increased clearance (> 50%) when used with combined oral contraceptives, which results in an increased seizure frequency in most patients. Useful alternatives to oral contraceptives include depot injections and intrauterine devices. Subdermal implants may increase the risk of pregnancy in women with epilepsy on enzyme-inducing AEDs. Depot medroxyprogesterone acetate is effective but can increase side effects. Intrauterine devices arean alternative to pharmacologic approaches because they lack drug-drug interactions and side effects.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | ORAL CONTRACEPTIVES | IUD | INJECTABLES | NEUROLOGIC EFFECTS | DRUGS | DRUG INTERACTIONS | TREATMENT | SIDE EFFECTS | Developed Countries | North America | Americas | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341913

Peer Reviewed

Title: Contraception and gynaecological care.
Author: Cameron S
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):211-220.
Abstract: Hormonal contraception, through suppression of ovarian activity or endometrial proliferation, can be used to treat and prevent a range of gynaecological disorders. There is evidence to support the effectiveness of the levonorgestrel intra-uterine system (LNG-IUS), combined oral contraceptive pill (COC) and progestogen-only injectable depot-medroxyprogesterone acetate for treating heavy menstrual bleeding and dysmenorrhoea. COCs are also an effective treatment for acne and hirsuitism, and may lessen the symptoms of premenstrual syndrome. There is good evidence that COCs can significantly reduce the risk of both ovarian and endometrial cancer. There is also some evidence that COCs may prevent ovarian cysts, endometrial hyperplasia and fibroids. The LNG-IUS may be used as endometrial protection in women using hormone replacement therapy or tamoxifen. This chapter will deal with the evidence for both treatment and prevention of a range of gynaecological disorders of different hormonal contraceptive methods.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | ORAL CONTRACEPTIVES | IUD | GYNECOLOGY | IUD, HORMONE RELEASING | Developed Countries | Europe, Western | Europe | Contraceptive Methods | Contraception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 329666

10.

Peer Reviewed

Title: Post abortion family planning counseling as a tool to increase contraception use.
Author: Ceylan A; Ertem M; Saka G; Akdeniz N
Source: BMC Public Health. 2009 Jan 15;9(20):[16] p.
Abstract: Background: To describe the impact of the post-abortion family planning counseling in bringing about the contraceptive usage in women who had induced abortion in a family planning clinic. Method: The Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and nongovernmental organization which runs a family planning clinic to serve the lower socio-economic populations, in Diyarbakir-Turkey. Post abortion counseling is introduced by using proper communication skills and with using appropriate methods to women. In this study we introduced contraceptive usage of women who had induced abortion one year ago and followed by DTFPA's clinic. Results: 55.3% of our clients were not using contraceptive methods before abortion. At the end of the one year, 75.9% of our followed-up clients revealed that they were using one of the modern contraceptive methods. There was no woman with IUD before induced abortion. At the end of one year 124 (52.3%) women had IUD. "A modern method was introduced immediately after abortion" was the most important factor increasing modern method usage. Conclusion: Our results advocate that post-abortion counseling may be an effective tool to increase the usage of contraceptives. Improved and more qualified post-abortion family planning counseling should be an integral part of abortion services.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | WOMEN | CLIENTS | POSTABORTION CARE | ABORTION | FAMILY PLANNING | COUNSELING | CONTRACEPTIVE USAGE | IUD | HEALTH SERVICES | Developing Countries | Europe, Southeastern | Europe | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Delivery of Health Care | Health | Fertility Control, Postconception | Clinic Activities | Contraception | Contraceptive Methods
Document Number: 329531 Notification

11.

Title: Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess.
Author: Charonis G; Larsson PG
Source: Acta Obstetricia Et Gynecologica Scandinavica. 2009;88(6):680-684.
Abstract: Objective. The intrauterine contraceptive device (IUCD) is the most preferred method of reversible contraception in the world today. The Swedish Medical Products Agency currently recommends that women who had a copper IUCD inserted around age 40 do not need to have it extracted until one year after the menopause. Design. Retrospective study. Setting. Skovde Central Hospital, Sweden. Population. All 114 women receiving in-patient treatment for pelvic inflammatory disease (PID) over five years between January 2001 and December 2005. Methods. Comparison between cases of tubo-ovarian abscesses and salpingitis with focus on the effects of IUCDs used continually for >5 years after insertion. Main outcome measures. Age-adjusted risk of PID within or after five years of use, microbiological findings in blood, intraabdominal pus, cervical secretions or on extracted IUCDs. Results. There were 31 cases of tubo-ovarian abscesses, 63 of salpingitis, four of endometritis, and 16 of mild genital infection. When comparing women with the same IUCD>5 years to women having the same IUCDLanguage: English
Keywords:
SWEDEN | RESEARCH REPORT | WOMEN | PELVIC INFLAMMATORY DISEASE | IUD | GENITAL EFFECTS, FEMALE | RISK FACTORS | Developed Countries | Europe, Northern | Europe | Demographic Factors | Population | Reproductive Tract Infections | Infections | Diseases | Contraceptive Methods | Contraception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Health
Document Number: 341046

12.

Peer Reviewed

Title: Intrauterine devices for adolescents: a systematic review.
Author: Deans EI; Grimes DA
Source: Contraception. 2009 Jun;79(6):418-23.
Abstract: BACKGROUND: The appropriateness of IUDs for adolescents remains unsettled, as does the definition of the term adolescent. Unplanned pregnancy among teenagers remains epidemic, and long-acting methods, such as IUDs, offer the promise of top-tier effectiveness. STUDY DESIGN: We conducted a systematic review of the literature concerning IUD use in adolescents using MEDLINE, Popline, EMBASE and CINAHL databases. RESULTS: Six cohort studies and seven case-series reports met our inclusion criteria; none included IUDs in current use in the United States. Overall, continuation rates were high and cumulative pregnancy rates low, ranging from 2% at 6 months to 11% at 48 months. Compared with combined oral contraceptives, IUDs had similar or better continuation rates; pregnancy rates were similar at 2 years. IUD expulsion rates may be inversely related to age. CONCLUSIONS: The literature on IUD use among adolescents is scanty and obsolete. Nevertheless, published reports were generally reassuring. Randomized controlled trials and cohort studies comparing contemporary IUDs with other methods are urgently needed.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | COHORT ANALYSIS | ADOLESCENTS | CONTRACEPTION | IUD | PREGNANCY RATE | CONTRACEPTIVE METHODS CHOSEN | Developed Countries | North America | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Planning | Contraceptive Methods | Fertility Measurements | Fertility | Population Dynamics | Contraceptive Usage
Document Number: 342601

13.

Title: Use of oral contraceptives, intrauterine devices and tubal sterilization and cancer risk in a large prospective study, from 1996 to 2006.
Author: Dorjgochoo T; Shu XO; Li HL; Qian HZ; Yang G; Cai H; Gao YT; Zheng W
Source: International Journal of Cancer. 2009;124(10):2442-2449.
Abstract: The association of contraceptive methods, including oral contraceptives (OC), intrauterine devices (IUD) and tubal sterilization (TS), with overall and site-specific cancer were prospectively investigated in a cohort of 66,661 Chinese women in Shanghai, 76.7% of whom used contraception. During a median follow-up time of 7.5 years, 2,250 women were diagnosed with cancer. Ever-use of any contraceptive method was not associated with overall cancer risk [adjusted hazard ratio (HR(adj)) = 1.02, 95% CI, 0.92-1.12]. Use of any contraceptive method was associated with increased risk of rectal cancer (HR(adj) = 1.68, 95% CI, 1.08-2.62) and reduced risk of thyroid cancer (HR(adj) = 0.63, 95% CI, 0.38-1.04). Risk of gallbladder cancer increased with ever use of OC (HR(adj) = 2.38, 95% CI, 1.26-4.49). IUD use was associated with a possible reduced risk of thyroid cancer (HR(adj) = 0.64, 95% CI, 0.38-1.07). Longer duration of IUD use decreased risk for breast, thyroid and lung cancers. Ever having a TS was associated with increased uterine body cancer (HR(adj) = 2.50, 95% CI, 1.47-4.25) and decreased risk of stomach cancer (HR(adj) = 0.59, 95% CI, 0.39-0.91). We did not find any contraceptive method to be related to the risk of ovarian cancer but the analyses were based on few events. Although chance findings are a likely explanation for some of the associations found in our study, these findings suggest that various contraceptive methods or reproductive patterns may play a role in the etiology of cancer. (c) 2008 Wiley-Liss, Inc.
Language: English
Keywords:
UNITED STATES OF AMERICA | CHINA | RESEARCH REPORT | WOMEN | ORAL CONTRACEPTIVES | IUD | NEOPLASMS | FEMALE STERILIZATION | TUBAL LIGATION | Developed Countries | North America | Americas | Asia, Eastern | Asia | Developing Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Diseases | Sterilization, Sexual
Document Number: 329657

15.

Peer Reviewed

Title: Cost savings from the provision of specific methods of contraception in a publicly funded program.
Author: Foster DG; Rostovtseva DP; Brindis CD; Biggs MA; Hulett D; Darney PD
Source: American Journal of Public Health. 2009 Mar;99(3):446-51.
Abstract: OBJECTIVES: We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955,000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. METHODS: We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. RESULTS: More than half of the 178,000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. CONCLUSIONS: All contraceptive methods were cost-effective-they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | COST EFFECTIVENESS | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | INJECTABLES | BARRIER METHODS | IUD | CONTRACEPTIVE IMPLANTS | Developed Countries | North America | Americas | Evaluation Indexes | Quantitative Evaluation | Evaluation | Contraception | Family Planning
Document Number: 330488

16.

Peer Reviewed

Title: Pregnancy outcome in women with an intrauterine contraceptive device.
Author: Ganer H; Levy A; Ohel I; Sheiner E
Source: American Journal of Obstetrics and Gynecology. 2009 Aug 27;
Abstract: OBJECTIVE: To investigate pregnancy outcome in patients who conceived with an intrauterine contraceptive device. STUDY DESIGN: A retrospective study comparing the pregnancy outcome of women with retained intrauterine device (n = 98), patients after intrauterine device removal in early pregnancy (n = 194), and pregnancies without an intrauterine device (n = 141,191) was performed. RESULTS: A significant linear association was documented among the 3 groups and adverse outcomes such as preterm delivery (18.4% in the retained intrauterine device, 14.4 % in removed intrauterine device, and 7.3% in the no-intrauterine device group; P < .001) and chorioamnionitis (7.1% in the retained intrauterine device, 4.1% in removed intrauterine device and 0.7% in the no-intrauterine device group; P < .001). The presence of retained or removed intrauterine device was found as an independent risk factor for both preterm delivery and chorioamnionitis in multivariable models. CONCLUSION: Women conceiving with an intrauterine device are at increased risk for adverse obstetric outcomes, whereas the risk is higher for pregnancies with retained intrauterine device compared with early intrauterine device removal.
Language: English
Keywords:
GLOBAL | ISRAEL | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | PREGNANT WOMEN | PREGNANCY OUTCOMES | IUD | PREGNANCY | LOW BIRTH WEIGHT | PREMATURE BIRTH | Developed Countries | Middle East | Studies | Research Methodology | Demographic Factors | Population | Population Characteristics | Reproduction | Contraceptive Methods | Contraception | Family Planning | Birth Weight | Body Weight | Physiology | Biology
Document Number: 342708

17.

Title: [Descriptive study on contraceptive requirements for clinical trials in Spain. Do we need a debate?] Estudio descriptivo de las recomendaciones anticonceptivas en los ensayos
Author: Gastaminza Lasarte G; Algorta Pineda J
Source: Medicina Clinica. 2009 Jan 24;132(2):70-4.
Abstract: Among the measures that seek to avoid the toxic effects on reproduction (teratogenic, embryotoxic, fetotoxic or otherwise) include the obligation to conduct preclinical tests to investigate this aspect in different animal species before marketing a new drug, although its application in time differs Europe-European Medicines Agency (EMEA) and US-Food and Drug Administration (FDA). In Europe requires that prior to including women in phase I of clinical trials have been completed preclinical studies on embryo-fetal development, without any mention of contraception. In contrast, U.S. can include women in the fertile clinical trials have not completed initial pre-clinical tests on the safety play, if they practice a pregnancy test before participation in contraception and take some action "highly effective". Are considered "highly effective" (by both the FDA and the EMEA, to be included in a document of the International Conference on Harmonization) methods with low failure rate (<1% per year) when used properly, such as implants, injectables, combined oral, some intrauterine devices (IUDs), sexual abstinence or a vasectomy for the partner. (excerpt)
Language: Spanish
Keywords:
SPAIN | RESEARCH REPORT | CLINICAL TRIALS | PREGNANCY TESTS | ORAL CONTRACEPTIVES, COMBINED | IUD | INJECTABLES | CONTRACEPTIVE IMPLANTS | VASECTOMY | Europe, Southwestern | Europe | Developed Countries | Clinical Research | Research Methodology | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Male Sterilization | Sterilization, Sexual
Document Number: 329576

18.

Title: Migration of an intrauterine contraceptive device during the course of pregnancy: a case report.
Author: Glass T; Baker T; Kauffman RP
Source: Journal of Minimally Invasive Gynecology. 2009 Jan-Feb;16(1):81-3.
Abstract: Uterine perforation by a contraceptive intrauterine device (IUD) is a relatively rare event. These events may result secondary to mechanical force applied during placement (primary perforation) or migration by uterine contractions or surgical manipulation after placement (secondary perforation). A 33-year-old woman with an IUD placed 9 years before admission visited the emergency department with an early pregnancy and a 3-day history of vaginal bleeding. Vaginal examination revealed IUD strings visible at the cervical os, and transvaginal ultrasound confirmed the presence of an IUD in the lower uterine segment and upper cervix. The IUD migrated spontaneously to the fundal myometrium at 15 weeks' gestation. Premature rupture of membranes ensued at 20 weeks' gestation, and, at delivery, the IUD could not be retrieved. Subsequent computed tomography confirmed that the IUD was incompletely embedded in the fundal myometrium and partially extending into the peritoneal cavity. At laparoscopic sterilization 6 weeks later, the IUD had perforated the small bowel, and the device was removed with concomitant bowel repair. This case documents spontaneous migration of a copper IUD from the lower uterine segment through the fundus during early pregnancy and supports removal of asymptomatic ectopic IUDs whenever possible.
Language: English
Keywords:
UNITED STATES OF AMERICA | TEXAS | RESEARCH REPORT | CASE STUDIES | WOMEN | PREGNANCY | IUD | CONTRACEPTION FAILURE | UTERINE PERFORATION | LAPAROSCOPY | IUD MIGRATION | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Perforations | Diseases | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330821

19.

Peer Reviewed

Title: Profile of long-acting reversible contraception users in Europe.
Author: Haimovich S
Source: European Journal of Contraception and Reproductive Health Care. 2009 Jun;14(3):187-95.
Abstract: OBJECTIVES: To assess the profile of long-acting reversible contraceptives (LARCs) users in Europe. METHODS: A random sample of women aged 15-49 years in 14 European countries (Germany, France, UK, Spain, Italy, Russian Federation, Estonia, Latvia, Lithuania, Austria, Czech Republic, Denmark, Norway, and Sweden) underwent web-based or computer-aided face-to-face interviews in June 2006. In this paper data pertaining to a subgroup of women using LARCs are presented. RESULTS: A total of 11,490 women participated in the full study. Of these, 1,188 (10%) women were LARC (hormonal implant, injectables, levonorgestrel-releasing intrauterine system [LNG-IUS], copper intrauterine device [Cu-IUD]) users. The age of the LARC users exceeded 30 years for 57-91% of them. Furthermore, more than half of them found convenience an extremely important factor when selecting the LARC as a contraceptive method. As compared to those wearing a Cu-IUD, women using hormonal LARCs experienced fewer physical and emotional symptoms that appeared or worsened during menstruation. CONCLUSIONS: LARCs have their place in the contraceptive market in Europe. The most popular LARCs among European women were the LNG-IUS and the Cu-IUD; both were mainly used by women who had children and had no wish to have more in the future.
Language: English
Keywords:
EUROPE | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | CONTRACEPTIVE USAGE | CONTRACEPTIVE IMPLANTS | INJECTABLES | IUD | CONTRACEPTIVE METHODS CHOSEN | AGE FACTORS | PARITY | SATISFACTION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Methods | Population Characteristics | Fertility Measurements | Fertility | Population Dynamics | Psychological Factors | Behavior | Contraceptive Agents
Document Number: 341802

20.

21.

Peer Reviewed

Title: What is the fate of the missing intrauterine contraceptive device?
Author: Ibitoye BO; Aremu AA; Onuwaje MA; Ayoola OO
Source: Tropical Doctor. 2009 Oct;39(4):221-3.
Abstract: An intrauterine contraceptive device (IUCD) is one of the most common forms of contraception in use worldwide today. It is associated with a myriad of problems and complications, one of which is the missing IUCD. It is a known fact that IUCDs can perforate the uterus resulting in its subsequent relocation in other organs within the pelvis and the abdomen. This study showed that more than 50% of clinically diagnosed cases of a missing IUCD are still located within the endometrial cavity. It is therefore being proposed that a clinical diagnosis of 'missing string' be made until adequate radiological investigations, such as ultrasonography, plain X-rays and computerized tomography, have been carried out.
Language: English
Keywords:
GLOBAL | NIGERIA | RESEARCH REPORT | INCIDENCE | WOMEN | IUD | IUD COMPLICATIONS | IUD MIGRATION | EXAMINATIONS AND DIAGNOSES | ULTRASONICS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342764

22.

Peer Reviewed

Title: Risk of urinary incontinence symptoms in oral contraceptive users: a national cohort study from the Swedish Twin Register.
Author: Iliadou A; Milsom I; Pedersen NL; Altman D
Source: Fertility and Sterility. 2009 Aug;92(2):428-33.
Abstract: OBJECTIVE: To assess the impact of oral contraceptives on lower urinary tract dysfunction in premenopausal women. DESIGN: Nationwide cohort study. SETTING: National registry. PATIENT(S): A total of 10,791 women (born 1959-1985) from the population- based Swedish Twin Registry who participated in a web-based survey of common diseases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Symptoms of urinary incontinence. RESULT(S): For users of oral contraception there was a significantly reduced risk for symptoms of stress urinary incontinence, mixed urinary incontinence, and urgency urinary incontinence. The reduction remained significant when adjusting for age, body mass index, and pregnancy history. A reduced prevalence of symptoms of overactive bladder in oral contraceptive users was also observed although the association was nonsignificant. There were no significant associations between lower urinary tract symptoms and women using a levonorgestrel-releasing intrauterine device compared with noncontraceptive users, with the exception of nocturia. CONCLUSION(S): Oral contraceptive use reduces the overall risk for symptoms of urinary incontinence.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | COHORT ANALYSIS | CONTRACEPTION | ORAL CONTRACEPTIVES | IUD | IUD SIDE EFFECTS | GENITAL EFFECTS, FEMALE | Developed Countries | Europe, Northern | Europe | Research Methodology | Family Planning | Contraceptive Methods | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 342587

23.
Title: Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi.
Author: Irfan F; Karim SI; Hashmi S; Ali S; Ali SA
Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):235-40.
Abstract: OBJECTIVES: To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan. METHODS: A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teaching hospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception (EC) and attitudes towards its use, Ethical requirements of informed consent and confidentiality were ensured Data was entered into Epi data and analyzed in SPSS. RESULTS: Eighty-eight percent of women were not aware of EC. 83% were housewives. Only a small number (11.5%) ever used EC to prevent pregnancy, out of those, the correct timing of effectiveness of post-coital pill was known to only 40% of women while none of these women were aware of the existence of Intra Uteriune Contraceptive Device (IUCD) insertion as an option for EC About 50% of women identified general practitioners or family medicine clinics as their main sources of knowledge about EC. Increased advertising was considered desirable by 72% while 37% considered over the counter availability of EC pill desirable and only 36% of women were uncomfortable to use EC because of religious reasons. CONCLUSION: EC has a potential to offer women an important option for fertility control. Lack of women's knowledge about EC use and availability may account in part for its limited use. There is a need to improve women's education about EC. The primary health care providers can play a major role in informing their patients about emergency contraception.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | KNOWLEDGE | EMERGENCY CONTRACEPTION | ATTITUDES | TIME FACTORS | CONTRACEPTIVE USAGE | IUD | ADVERTISING | PHARMACY DISTRIBUTION | CONTRACEPTIVE AVAILABILITY | RELIGION | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Sociocultural Factors | Contraception | Family Planning | Psychological Factors | Behavior | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Promotion | Marketing | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 331281

24.
Title: The role of three-dimensional imaging in the investigation of IUD malposition.
Author: Kalmantis K; Daskalakis G; Lymberopoulos E; Stefanidis K; Papantoniou N; Antsaklis A
Source: Bratislavske Lekarske Listy. 2009;110(3):174-7.
Abstract: OBJECTIVES: The aim of this study was to present a systematic review of the use of three-dimensional ultrasound for the detection and evaluation of intrauterine device malposition in a patient of our department. BACKGROUND: Transvaginal sonography failed to detect IUD misplacement in about 9% of cases. Whereas the three-dimensional ultrasound (3D), a new emerging technology, that could provide precise evaluation of IUD malposition. METHODS: The data were extracted from the literature using computerised Medline system. The use-effectiveness and acceptance of three-dimensional imaging in the detection of IUD malposition was examined as an alternative method to two-dimensional ultrasound. RESULTS: Three-dimensional ultrasound was more accurate than two-dimensional for the identifying IUD device. Three-dimensional technique enables assessment of IUD length in the longitudinal section synchronically with imaging arms of the device. Examination with 2D ultrasound is limited to transverse views of the shaft. The arms or other smaller parts cannot be investigated completely because of the frontal view of an IUD is rarely presented. CONCLUSION: Three-dimensional ultrasound is a new and promising imaging tool which provides much better view of the endometrial cavity. This is especially useful in uterus examination and in the detection of IUDs because structures that are not located in one single plane can be imaged simultaneously. Three-dimensional ultrasound is considered to be more secure and safer diagnostic technique to determine the location of IUDs than hysteroscopic evaluation (Fig. 2, Ref. 17). Full Text (Free, PDF) www.bmj.sk.
Language: English
Keywords:
GREECE | RESEARCH REPORT | LITERATURE REVIEW | ULTRASONICS | IUD | INSERTION | IUD COMPLICATIONS | Europe, Southern | Europe | Developed Countries | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Treatment
Document Number: 342596

25.

Peer Reviewed

Title: Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis.
Author: Kaunitz AM; Meredith S; Inki P; Kubba A; Sanchez-Ramos L
Source: Obstetrics and Gynecology. 2009 May;113(5):1104-16.
Abstract: OBJECTIVE: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION: This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials that included 390 women (levonorgestrel intrauterine system, n=196; endometrial ablation, n=194) were retrieved. Three studies pertained to first-generation endometrial ablation (manual hysteroscopy) and three to second-generation endometrial ablation (thermal balloon). Study characteristics and quality were recorded for each study. Data on the effect of treatment on pictorial blood loss assessment chart scores were abstracted, integrated with meta-analysis techniques, and presented as weighted mean differences. Both treatment modalities were associated with similar reductions in menstrual blood loss after 6 months (weighted mean difference, -31.96 pictorial blood loss assessment chart score [95% confidence interval (CI), -65.96 to 2.04]), 12 months (weighted mean difference, 7.45 pictorial blood loss assessment chart score [95% CI, -12.37 to 27.26]), and 24 months (weighted mean difference, -26.70 pictorial blood loss assessment chart score [95% CI, -78.54 to 25.15]). In addition, both treatments were generally associated with similar improvements in quality of life in five studies that reported this as an outcome. No major complications occurred with either treatment modality in these small trials. CONCLUSION: Based on the meta-analysis of six randomized clinical trials, the efficacy of the levonorgestrel intrauterine system in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation up to 2 years after treatment.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | BLEEDING | LEVONORGESTREL | IUD | ENDOMETRIAL EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Usage | Contraceptive Effectiveness
Document Number: 341342

26.

Title: Update in adolescent contraception.
Author: Lara-Torre E
Source: Obstetrics and Gynecology Clinics of North America. 2009 Mar;36(1):119-28.
Abstract: Pregnancy rates in the United States seem to have stabilized in the past decade but continue to be higher than those in other industrialized nations. Although abstinence and barrier methods are available and efficient in preventing pregnancy, a comprehensive approach is a better choice when counseling patients on available options. The new approach to old contraceptive methods provides new alternatives to adolescents seeking safe and reliable methods. The availability and proved safety with longterm reversible contraceptive methods, such as the intrauterine system and subdermal implant, may allow adolescents to make better choices in preventing pregnancy. Future efforts in research should concentrate on finding the reasons why adolescents are at increased risk for unplanned pregnancy and solutions for this problem. Future contraceptive technology continues to focus on safety and convenience to facilitate the use of contraceptives in adolescents.
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | KAP SURVEYS | ADOLESCENTS | SEX BEHAVIOR | RISK BEHAVIOR | CONTRACEPTIVE USAGE | ABSTINENCE | BARRIER METHODS | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, PROGESTIN | EMERGENCY CONTRACEPTION | IUD | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Contraception | Family Planning | Family Planning, Behavioral Methods | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330954

27.

Title: Contraception and Induced Abortions for Women of Reproductive Age Married in Recent Years in Rural Areas of Shandong, China.
Author: Li H; Li DQ; Li HQ; Diao YT
Source: Gynecologic and Obstetric Investigation. 2009 Aug 6;68(3):174-180.
Abstract: Background: In 2001, the Chinese Government published the Population and Family Planning Law which gave citizens the right to know the facts about, and to choose, methods of birth control. Since then, the percentage use of different contraceptive methods has changed. More and more women have been using male condoms for birth control, which has resulted in an increasing prevalence of induced abortions of unintended pregnancies in recent years. Objective: To investigate the relationship between choice of contraception methods and rates of induced abortion in the rural areas of Shandong. Materials and Methods: A questionnaire-based survey on contraceptive methods and abortions in women of reproductive age who married between January 1, 2002, and August 31, 2005, was carried out in 8 sampling communities of rural areas in Shandong Province.Results: 7,159 of 8,520 women of childbearing age took part in the survey, which gave a response rate of 84.0%. The accumulative abortion rate was 2.39% for intrauterine device (IUD) use and 5.46% for male condom use during the period of survey. A longer duration of marriage and a longer time of male condom use increased the rate of induced abortions, while longer periods of IUD use decreased the rate of induced abortions. Conclusion: The results indicated that an integrated program for family planning, especially one that better educates condom users, must be initiated in the rural areas of Shandong Province, China.
Language: English
Keywords:
CHINA | RURAL AREAS | RESEARCH REPORT | SAMPLING STUDIES | CURRENTLY MARRIED | WOMEN | QUESTIONNAIRES | CONDOM USE | IUD | CONTRACEPTION FAILURE | ABORTION RATE | ABORTION | Asia, Eastern | Asia | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Marital Status | Nuptiality | Demographic Factors | Risk Reduction Behavior | Behavior | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Fertility Control, Postconception
Document Number: 342489 Notification

28.

Title: Involution of latent endometrial precancers by hormonal and nonhormonal mechanisms.
Author: Lin MC; Burkholder KA; Viswanathan AN; Neuberg D; Mutter GL
Source: Cancer. 2009 May 15;115(10):2111-8.
Abstract: BACKGROUND: Inactivation of the PTEN suppressor gene has been shown to occur in the majority of endometrial cancer cases. Somatic PTEN inactivation by deletion and/or mutation, the first detectible change of endometrial carcinogenesis, has been reported to occur at a high frequency in the endometrium of normal premenopausal women, although few of these cases progress to cancer. It was hypothesized that the 50% to 60% reduced cancer risk attributed to oral contraceptives (OCPs) and intrauterine devices (IUDs) occurred in part through their activity as negative selection factors for these subclinical mutated glands. METHODS: A total of 71 women with a history of OCP use and 80 with a history of IUD use were age matched with 191 and 119 controls, respectively. Endometrial biopsy specimens were immunostained for PTEN, and each was scored for the presence or absence of PTEN-null glands (latent precancer). RESULTS: The frequency of latent precancers was found to be significantly reduced in OCP-exposed (13%; odds ratio [OR], 0.19 [P < .001]) and IUD-exposed (18%; OR, 0.42 [P = .015]) women compared with respective matched controls (43% and 34%). The presence or absence of endometritis did not appear to be significantly correlated with PTEN status within the IUD-exposed group (P = .24). CONCLUSIONS: Normal-appearing PTEN mutated endometrial glands, which are highly prevalent in the normal population, may be targets of endometrial cancer risk-modulating exposures. Some exposures reported to diminish the incidence of endometrial cancer in epidemiologic outcome studies, including OCP and IUD use, are associated with a proportionate decline in the frequency of latent precancers. Involution of pre-existing endometrial latent precancers, as evaluated by PTEN analysis, may provide an accessible surrogate marker for long-term endometrial cancer risk.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | ENDOMETRIAL CANCER | RISK FACTORS | ENDOMETRITIS | HISTOLOGY | ORAL CONTRACEPTIVES | IUD | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Health | Reproductive Tract Infections | Infections | Biology | Contraceptive Methods | Contraception | Family Planning
Document Number: 341658

29.

Title: Emergency contraception: Knowledge, attitude and prescription practice among doctors in different specialties in Hong Kong.
Author: Lo SS; Kok WM; Fan SY
Source: Journal of Obstetrics and Gynaecology Research. 2009 Aug;35(4):767-74.
Abstract: Aim: Few studies have evaluated doctors' knowledge, attitudes and practices as regards emergency contraception (EC). Some studies have reported inadequate knowledge, bias and wrong prescriptions by doctors. This article compares the prescription pattern, attitude and knowledge of EC in Hong Kong doctors in different specialties. Methods: Questionnaires were mailed to family physicians, obstetrician-gynecologists and doctors working in family planning clinics to ascertain their attitudes to EC. Those who provided EC described the types of EC used, whether drugs were given in advance and answered a 12-question knowledge test. Those who did not provide EC stated why. Results: A total of 443 completed questionnaires were analyzed: 70.9% of doctors agreed that the benefits of EC outweigh its risks and 61.2% agreed that doctors should discuss it with clients. Advanced provision was supported by 54.2% of doctors but reduced to 32.5% if the target client was a girl aged 16 or below. Even fewer doctors (40.2%) supported the over-the-counter sales of EC pills. In the knowledge test, family planning doctors scored 10.45 out of 12 and obstetrician-gynecologists in private practice had the lowest score of 6.08. Family planning doctors used levonorgestrel pills while private family physicians and obstetrician-gynecologists used Yuzpe. Among 352 doctors who provided EC, only 21.7% of private family physicians and 15.9% of private obstetrician-gynecologists prescribed it in advance. Conclusions: Only doctors working in family planning clinics were competent in their knowledge of emergency contraception and up to date with current practice. Although half of the doctors supported advanced provision, few implemented it. Most doctors did not support advanced provision to young girls nor the over-the-counter sales of EC pills.
Language: English
Keywords:
HONG KONG | RESEARCH REPORT | KAP SURVEYS | PHYSICIANS | EMERGENCY CONTRACEPTION | PRESCRIPTIONS | CONTRACEPTIVE DISTRIBUTION | OBSTACLES | LEVONORGESTREL | ETHINYL ESTRADIOL | IUD | QUESTIONNAIRES | AGE FACTORS | Developed Countries | Asia, Eastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Family Planning | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Contraceptive Methods | Population Characteristics | Demographic Factors | Population
Document Number: 342776

30.

Title: Infection risk and intrauterine devices.
Author: Martinez F; Lopez-Arregui E
Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(3):246-50.
Abstract: For most women, intrauterine contraceptive devices (IUCD) are a safe option. Upper genital tract infections (pelvic inflammatory disease, PID) occur when pathogenic microorganisms ascend from the cervix and invade the endometrium and the fallopian tubes, causing an inflammatory reaction. Evidence-based recommendations regarding intrauterine contraception and risk of infection were presented at the Congress of the European Society of Contraception, in Prague, 2008: A clinical history (including sexual history) should be taken as part of the routine assessment for intrauterine contraception to identify women at high risk of sexually transmitted infections (STI); if appropriate a test should be offered; if symptoms or signs are present, appropriate diagnostic tests should be done, results awaited, necessary treatment completed, and IUCD insertion postponed until resolution. Prophylactic antibiotics are not recommended (evidence level II-3). STI screening is not routinely recommended. PID among IUCD users is most strongly related to the insertion process and to the background risk of STI (evidence level II-2). Conditions which represent an unacceptable health risk if an IUCD is inserted (WHO Medical Eligibility Criteria, MEC, Categories 3-4) are current PID, current purulent cervicitis, chlamydial or gonorrheal infection. For continuation as well as initiation, WHO MEC categories 3-4 are allotted to women with known pelvic tuberculosis, puerperal sepsis and septic abortion.
Language: English
Keywords:
SPAIN | RESEARCH REPORT | WOMEN | IUD | PELVIC INFLAMMATORY DISEASE | SEXUALLY TRANSMITTED DISEASES | RISK FACTORS | TUBERCULOSIS | GENITAL EFFECTS, FEMALE | Developed Countries | Europe, Southwestern | Europe | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Reproductive Tract Infections | Infections | Diseases | Health | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 330543


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