ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00947.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Potts M (International Fertility Research Program, Research Triangle Park, NC, USA). Perspectives on fertility control.Int J Gynaecol Obstet 16: 449–455, 1979The biologic, administrative and individual perspectives on fertility control are presented and discussed. The need to unite perspectives is demonstrated and the importance of adjusting human fertility to new physiologies and social demands is stressed.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00948.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Tietze C, Lewit S (The Population Council, New York, NY, USA). Life risks associated with reversible methods of fertility regulation.Int J Gynaecol Obstet 16: 456–459, 1979Based on a computer model, this report attempts to quantify the risk to life associated with reversible methods of fertility regulation, compared to those of uncontrolled childbearing. Outstanding findings are:1.Among young women under 30 years of age, with the exception of pill‐takers who smoke, the total risk to life associated with each of the major methods of fertility control used alone is about equal, on the order of 1–2 per 100 000 women per year, significantly lower than the birth‐related risk to life without fertility regulation. Pill‐takers who smoke approach that risk in their late 20s.2.Beyond age 30 the risk to life (which is almost entirely method‐related) increases rapidly for pill‐takers, especially those who smoke. After age 40, it is much higher in the latter group than the risk experienced by women using neither contraception nor abortion. For all other methods, the risk remains virtually constant or (in the case of those using barrier methods without abortion backup) increases moderately, but remains far below the level of mortality associated with complications of pregnancy and childbirth without fertility control.3.At all ages, the lowest level of mortality by far is achieved by a combined regimen, ie, use of barrier contraceptives with recourse to early abortion in case of failure.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00949.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Sivin I (The Population Council, Rockefeller University, New York, NY, USA). Measuring contraceptive efficacy and side effects.Int J Gynaecol Obstet 16: 460–465, 1979To assess effectiveness of contraceptives, one reports all pregnancies during use. Multiple and single decrement life‐table pregnancy rates computed from these reports constitute the fundamental measures of effectiveness in clinical trials. Minimally biased evaluation of a new method requires a randomized, double‐blind (or its nearest semblance), multicentered study of sexually active women. New contraceptives are studied in special, volunteer populations. Evaluation of marketed contraceptives implies broader‐gauged representation, larger numbers and longer time frames. Prospective studies, like clinical trials, should include several methods, and may use subsamples for case‐control analysis of risk. Well‐designed and executed multicentered, prospective studies, nevertheless, may represent specially selected populations. Risk‐benefit analyses based on findings from selected populations require careful scrutiny. Although the most persuasive estimates of effectiveness derive from national, representative samples, moderately large samples in the USA have not been able to distinguish among products within a class. Formidable problems of recall are present in household surveys. In the United Kingdom, Europe and North America, analysis of risks and benefits may be enriched by better utilization of the data collection and record linkage resources of national health statistics systems.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00950.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Kannel WB (Framingham Heart Study of the National Heart, Lung and Blood Institute, Framingham, MA, USA). Oral contraceptive hypertension and thromboembolism.Int J Gynaecol Obstet 16: 466–472, 1979Oral contraceptives (OCs) are a highly effective and widely accepted means of avoiding pregnancy, but they also worsen the major atherogenic cardiovascular risk factors to some degree in all women. Some OC users may suffer severe hypertensive episodes or massive hypertriglyceridemia with pancreatitis. Mild or severe adverse effects could eventually have serious consequences beyond the childbearing years. OC use would appear imprudent for women with a history of hypertension, gestational hypertension and a family history of hypertension. Special care is needed with blacks, diabetics and women with renal disease. OCs may also affect blood clotting, fibrinolysis and platelet adhesiveness. Also, histo‐chemical and anatomical changes in blood vessels have been noted. Both may precipitate thromboembolic events while the OC user is still at the childbearing age and may also contribute to accelerated atherogenesis in subsequent years. There is a need for more specific guidelines for monitoring women on OCs for a worsening of their cardiovascular risk profile and changes in blood coagulation. Indications and contraindications for OC use in relation to the hazard of thromboembolic sequelae need to be more explicitly defined.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00951.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Kirk ME (Depts of Pathology, McGill University and The Montreal General Hospital, Montreal, Canada). Tumorigenic aspects.Int J Gynaecol Obstet 16: 473–478, 1979This report presents a review of tumors, except those of pituitary, that have been reported to occur in women taking combined oral contraceptive preparations. Pathologic features, both gross and microscopic, and differential diagnosis are emphasized. Particular attention is given to tumors of the liver: focal nodular hyperplasia (hepatic hamartoma) and liver cell adenoma (benign hepatoma). The characteristic features of these usually distinctive lesions are illustrated, and an attempt is made to evaluate the significance of each with respect to oral contraceptives. Tumorigenic aspects relating to the uterus and the breast are briefly discussed.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00952.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Connell EB (Dept of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, IL, USA). Barrier methods of contraception: a reappraisal.Int J Gynaecol Obstet 16: 479–481, 1979In the last two years, there has been a gradual reawakening of interest in barrier methods and an increase in their usage by both men and women. This is in large part due to concern about the sometimes serious side effects reported for other contraceptive methods. The return to these techniques is particularly important, given the current epidemics of teenage pregnancy and venereal disease. One of the major problems in relation to barrier methods today is the accurate determination of their efficacy. There are very limited data with statistical validity available to judge the exact rate of effectiveness one might obtain using one of these techniques. The National Survey of Family Growth, conducted by the National Center for Health Statistics, showed a failure rate per 100 women of 16.7 for foam, cream or jelly and 15.9 for diaphragms (22). There is a great need for new and improved barrier methods of contraception. Numerous clinical studies are being set up to test spermicidal agents and vaginal sponges for the female, as well as such things as disposable condoms for males.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00953.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Mishell DR, Jr (Dept of Obstetrics and Gynaecology, School of Medicine, University of Southern California, Los Angeles, CA, USA). Intrauterine devices: medicated and nonmedicated.Int J Gynaecol Obstet 16: 482–487, 1979The main benefits of intrauterine devices (IUDs) are a lack of adverse systemic effects, excellent effectiveness, high continuation rates and the single act of motivation required for use. First year failure rates range from 2% to 3%, but decline steadily thereafter to a cumulative annual failure rate of less than 1% after six years. The risks of IUDs include increased blood loss, uterine perforation, pelvic infection and pregnancy‐related complications. The incidence of perforation of the uterine fundus ranges from 1:1000 to 1:2500 insertions, while that of cervical perforation with the copper devices ranges from 1:600 to 1:1000. IUD use is associated with about a three‐fold increased incidence of developing acute salpingitis in comparison with use of oral contraceptives and diaphragms. If pregnancy occurs with an IUD in place, there is a three‐fold increased risk of spontaneous abortion, a ten‐fold increased risk of ectopic pregnancy (5% of all IUD pregnancies) and a possible increased incidence of sepsis during the pregnancy.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00954.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Rioux JE (Dept of Gynecology and Obstetrics, Faculty of Medicine, Laval University, Laval University Hospital, Ste‐Foy, Quebec, Canada). Sterilization of women: benefits vs risks.Int J Gynaecol Obstet 16: 488–492, 1979Voluntary sterilization is the birth control method most widely practiced throughout the world. The last ten years have witnessed great improvements in techniques and perfection of innovations, explaining the important role that it now plays in the regulation of fertility. Different methods are examined and it is concluded that hysterectomy is the best, if medically indicated; conventional laparotomy is not justified unless required by concomitant intraabdominal pathology; minilaparotomy is mostly suitable postpartum; colpotomy is better left to specialists; laparoscopy is ideal for nonpregnant patients; culdoscopy is a relic of the past; and hysteroscopy, although still experimental, may be the way of the future. The advantages of voluntary sterilization lie in its remarkable and immediate efficiency, freedom from ongoing motivation, the convenience of a one‐time operation, the absence of side effects and the reduction of total costs. Its disadvantages are the complexity of any surgical intervention for a woman, its indisputable finality, its uncertain legality and the risks inherent in any operation. Hysterectomy and tubal ligation are practically never fatal, so this argument does not influence the choice of either method. However, incidence of morbidity is higher following hysterectomies, which must therefore be justified. The balance is clearly in favor of voluntary sterilization for the woman who is convinced that the size of her family is complete.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00955.x

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Ackman CFD, MacIsaac SG, Schual R (Dept of Surgery, McGill University, Montreal, Quebec, Canada). Vasectomy: benefits and risks.Int J Gynaecol Obstet 16: 493–496, 1979Bilateral occlusion of the vas deferens, vasectomy, is progressively becoming the method of choice for couples seeking permanent contraception at a younger age, with smaller families. They are apparently well‐informed and view the procedure as a natural step. Vasectomy is an inexpensively performed office procedure that causes minimal disruption of routine and has a high degree of community acceptance. The risks of significant hematoma, infection, discomfort and other sequelae are within acceptable limits. Improved techniques will continue to reduce the small failure rate. Antibodies observed in half of the patients have not been linked to systemic disease, although they are a hazard for the one patient in 500 returning for a vasovasostomy. Refinements in microsurgery and availability of artificial insemination enhance vasectomy as the method of choice. Evidently, extending the minimum time of sterility confirmation permits detection of occasional recanalization from technical failures. Adequate screening of the couple's motivation and expectations can prevent the rare psychologic disturbances, the greatest risk with this procedure and a problem associated with all options. For the male, there is no competitive technique at this time. In a world striving for equal rights, where the female still carries the burden of temporary contraception, the simplicity and popularity of vasectomy for permanent contraception add the desired undertones of social equilibrium.

ISSN:0020-6695    

DOI:10.1002/j.1879-3479.1979.tb00956.x

出版商:Wiley    

年代:2016

数据来源: WILEY