Outcome of pregnancy in women using different methods of contraception.

During the years 1968-74, 17,032 women were recruited to the Oxford Family Planning Association prospective study of the effects of different methods of contraception. The present analysis, which concerns 5700 pregnancies experienced by the participants in the investigation, adds to the evidence that ex-users of oral contraceptives and intrauterine devices suffer no delecterious effects on the outcome of pregnancy in terms of miscarriage, ectopic gestation, stillbirth, congenital malformation, alteration in the sex ratio or reduction in birth weight. Accidental pregnancies in women taking oral contraceptives were few in the present study (66 in all), but it seems likely that harmful effects of exposure of the fetus to the pill in utero, if any, occur infrequently. Women experiencing an accidental pregnancy with an intrauterine device in situ are at a markedly increased risk of miscarriage and ectopic gestation and are more likely to give birth to an underweight infant than other women.     

Bacterial flora of the cervix from 100 prehysterectomy patients.

Although anaerobic bacteria are being reported more frequently as causes of pelvic infections, few investigators have carefully studied these organisms in the normal female genital flora. This study describes the aerobic and anaerobic flora of 100 women prior to their undergoing hysterectomy. Anaerobic organisms were isolated from 86 per cent of the cultures in combination with aerobic organisms. Of the anaerobes the gram-positive cocci were the most common isolates (154 isolates in 74 cultures). The anerobic gram-positive rods (41 isolates in 38 cultures) were second, followed by the anerobic gram-negative rods (32 isolates in 29 cultures) and the anerobic gram-negative cocci (16 isolates in 15 cultures). The gram-positive cocci were most prevalent aerobic organisms isolated (149 isolates in 85 cultures).     

Analysis of bacterial flora in the uterine cervix in women during preterm labor

The aim of this study was to estimate type and frequency the bacterial flora of uterine cervix of female in case of preterm labor. There were analyzed 153 uterine cervix swabs of women before 37 weeks of pregnancy. It has been shown that the main etiologic factors of infestations were Escherichia coli and Staphylococcus epidermidis. Positive results of bacterial investigation has been occurred more frequently in multiparas with precocious ammonirrhea.     

Tubal pregnancies in women using progestagen-only contraception

Previously, 10 cases of tubal pregnancy in women using progestagen-only contraception have been reported in medical journals and mention has been made of 13 unpublished cases. 9 women who had ectopic pregnancies while taking progestagen-only pills (norethisterone .3 mg) for contraception can now be added to the list. These cases were found in 4 hospitals in 3 well-defined regions in the eastern, southeastern, and western parts of Norway in less than 2 years. Statistically, 2.5 ectopic pregnancies would be expected among minipill users instead of the 9 observed in this period. It is suggested that altered tubal motility is responsible for the high incidence of ectopic pregnancies among minipill users. The hypothesis that the minipill prevents intrauterine but not extrauterine pregnancies is a possibility that is difficult to prove.     

Bacterial flora and mycosis of the vagina in women with symptoms of vaginal inflammation

OBJECTIVES: To estimate the microbiological profile of vaginal flora in 30 women with gynecologic problems and 20 pregnant women complaining about pathological symptoms {pruritus, burning, vaginal discharge}. MATERIALS AND METHODS: The discharge from posterior vaginal vault was examined microbiologically on the Columbia Agar with sheep blood, MacConkey and Sabourand cultures incubated of 48 hours in the temperature of 37 degrees C. RESULTS: Bacterial infections were detected in 33 cases (66%), 12 of these women (24%) lived in urban, 21 (42%) in rural environment. From bacteria isolated from the vagina, most often because at 14 women stepped out Streptococcus agalactiae, at 11 Enterococcus faecalis at 8 Escherichia coli. In 5 cases bacterial inflammation was caused by two kinds of bacterium. At two women stepped out both Enterococcus faecalis and Escherichia coli. In single cases it was Klebsiella pneumoniae and Proteus vulgaris, Escherichia coli and Streptococcus agalactiae. In all cases of inflammation mycosis was called out by from Candida albicans. One ascertained it at 14 among all given an examination women. Mixed inflammations called out both by mycosis and bacterial stepped out in 3 cases in age of 21-30. At two women it was Candida albicans and Streptococcus agalactiae, at one inflammation mycosis accompanied Enterococcus faecalis. CONCLUSIONS: The common reason of vaginitis are bacterial infections caused by Streptococcus agalactiae, Enterococcus faecalis, E coli. Both, place of living and women' s age influence the type of etiological factor.     

Bacterial flora in infections of the urinary system system in pregnant women with pre-gestational diabetes

Urinary tract infections are accounted to serious complications, particularly in pregnancy complicated by diabetes. In this paper, cases of pregnancy have been analysed, affected by diabetes of type 1 and type 2, according to status of metabolic control and the type of urinary tract infection. In a group of 217 diabetic pregnant women, the incidence of urinary tract infections was 26.7%, 19.0% of them being recurrent. In the group with bad metabolic control, infections were statistically more frequent (17.4% vs. 37.3%, p = 0.001); bacteriuria without clinical demonstrations 10.4% vs. 19.6% (p > 0.05), pyelonephritis (7.0% vs. 17.7%, p = 0.001). The following types of pathogenic bacteria were found: E. coli--44.4%, Staphylococcous--28.9%, Enterococcocus--18.7%. A high frequency of Gram (+) bacteria was observed. A good metabolic control without chronic diabetic complications correlated with less frequent infections of the urinary tract.     

Antithrombin 3 concentration in women using low-dosage progestogen for contraception

To determine antithrombin III levels in women using chlormadinone acetate, 59 women took 0.5 mg daily, while a control group (53) took no oral contraceptive. The single radial immuno diffusion method was used to determine amounts of antithrombin III in the serum and plasma. Results showed that the treated women had significantly higher levels of antithrombin III than the others, both in serum (7.64%) and plasma (10.63%). If age differences (mean of 2.57 years) had been corrected for the groups, the level of difference would have been even greater. The greater concentration of antithrombin III, as the result of chlormadinone acetate usage, may mean more protection against thromboembolic disease.     

Coagulation studies in Asian women using injectable progestogen for contraception

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.     

Detection of Chlamydia trachomatis by several methods in the uterine cervix of pregnant women

Most pregnant women who have Chlamydia trachomatis (C. trachomatis) in the uterine cervix are asymptomatic. Several ways of detecting C.trachomatis were tested on 331 pregnant women, as well as 146 female patients attending our STD clinic as a control. 1) The detection rates for C.trachomatis in the cervix of pregnant women were 5.1% using the cell culture method, 2.4% with Micro Trak, and 2.2% employing Chlamydiazyme. These rates were higher in those patients visiting the STD clinic. 2) In pregnant women, the positive rate of Chlamydiazyme was 66.7% in the cell culture-positive cervical specimens, whereas Micro Trak was positive in 33.3%. 3) The antibody-positive rate was 84.6% in cases with PID caused by C.trachomatis. The antibody was found in only 17.7% of the pregnant women. Additionally, no significant correlation was noted between the antibody titer and C.trachomatis colonization in specimens obtained from the cervix of pregnant women. Although Micro Trak, Chlamydiazyme and possibly the microplate immunofluorescence antibody technique can be substituted for a cell culture method for detecting C.trachomatis in cases of symptomatic infection, these tests are not considered to be useful for screening Chlamydia-positive pregnant women.     

Bone mineral density in women using depot medroxyprogesterone acetate for contraception

Objective: To evaluate the possible effects of depot medroxyprogesterone acetate injectable contraception on bone mineral density in reproductive-age women.Methods: We conducted a population-based cross-sectional comparison of bone mineral density levels in women using depot medroxyprogesterone acetate contraception and in women of similar age not using this method. The study recruited 457 nonpregnant women aged 18–39 years who were enrollees of a Washington state health maintenance organization. One hundred eighty-three women were receiving injections and 274 were not. Bone mineral density at several anatomic sites (spine, femoral neck, greater trochanter, and whole body) was measured using dual-energy x-ray absorptiometry. Data on other factors potentially related to bone density were collected through questionnaire and examination.Results: Overall, age-adjusted mean bone density levels were lower for users of this method than for nonusers at all anatomic sites: The mean difference was 2.5% for the spine (P = .03) and 2.2% for the femoral neck (P = .12). Exposure to depot medroxyprogesterone acetate continued to be significantly (P < .01) associated with decreased bone density at the femoral neck, spine, and trochanter after multivariate adjustment for other risk factors related to bone density. Age-specific comparisons indicated that the major differences in bone density between users and nonusers occurred in the youngest age group (women 18–21 years); the mean femoral neck bone density was 10.5% lower (P < .01) for the exposed women, and differences were consistent (P < .01) across all anatomic sites. We also noted a significant dose-response relation between longer use of depot medroxyprogesterone acetate and decreased bone density levels in this age group (P < .01 for all sites).Conclusion: These results provide evidence that contraception with depot medroxyprogesterone acetate, particularly long-term use, may adversely affect bone mineral density levels in young women aged 18–21 years. The implications for future bone health need further study.     

Barrier methods of contraception

Despite the problems associated with coitus-dependent methods of contraception, barrier methods have an important role. The fact that they work as contraceptives without systemic effects makes them particularly appropriate for women with medical conditions that prevent the use of hormonal contraception. In addition, condoms and perhaps all barrier methods provide protection from sexually transmitted infections, making them essential for sexually active women at risk for STDs. Their continued importance is evidenced by the ongoing research to develop and improve barrier methods of contraception.     

Evaluation of some coagulation tests in women using low dosage oral contraception

This study assessed the effects of 3 types of combined oral contraceptives (OCs) on blood coagulation. The OCs investigated were a monophasic (EE 30 mcg + DOG 150 mcg), another monophasic (EE 30 mcg + LNG 150 mcg), and a triphasic (EE 30 mcg + LNG 50 mcg, EE 40 mcg + LNG 75 mcg, EE 30 mcg + LNG 125 mcg). 60 women between the ages of 19-30 with no contraindications to OC use were randomly recruited and divided into 3 groups. A blood sample was collected at a baseline level, and after 3 and 6 months of use. The parameters examined were antithrombin III, prothrombin time, partial thromboplastin time, fibrinogen degradation products, and protamina sulphate testing. There were no significant changes in any of the coagulation tests during the treatment period with these 3 different OCs. Thus, these OC compounds appear to be equally safe for use. (author's modified)     

Experimental methods of contraception

While most new contraceptives currently in development incorporate existing contraceptive agents into new delivery systems, several types of contraceptives with novel mechanisms of action are making steady progress. The antiprogestin mifepristone (better known as RU 486) is being tested as an ovulation inhibitor, as a once-a-month pill, and as a postcoital contraceptive. An antiestrogen, Centchroman (Hindustan Latex, India), is in use in India as a once-a-week, nonsteroidal pill. The development of more potent pituitary gonadotropin antagonists has improved their potential to block ovulation in women and to inhibit spermatogenesis in men (which requires concurrent administration of testosterone). Another promising male contraceptive is an intraluminal vas occlusion plug tested extensively in China that can be removed with no apparent detriment to future fertility. Finally, several types of immunocontraceptives could become the most specific form of fertility control by directing an antibody response against the fertilized or unfertilized egg or against sperm.