To evaluate pregnancy outcome in infertility patients with unrecognized exposure to a GnRH agonist in the first trimester.
Five women were given GnRH agonist before controlled ovarian ...hyperstimulation for in vitro fertilization cycles. The medication was administered in a dose of 0.5 mg/day, with drug exposure beginning on cycle day 21. The duration of exposure in all patients was 14-21 days. Thus, all five women received the medication at 3-6 weeks' estimated gestational age by menstrual dating. Pregnancy tests were not performed before the first injection of the GnRH agonist.
Three of the five pregnancies progressed to term without complication, and normal healthy infants were delivered. Missed abortion occurred in one pregnancy, and another ended in induced abortion at 13 weeks because of trisomy 18.
This experience suggests that despite manipulation of the hypothalamic-pituitary-ovarian axis by administration of GnRH agonist in the first trimester of pregnancy, normal pregnancies can result. Pregnancies in these patients should not be terminated because of drug exposure alone.
Endometriosis was detected in 42 cases out of 566 patients undergoing laparoscopic tubal sterilization. The presence of endometriosis was then correlated with previous contraception. Those patients ...using no contraception, or barrier contraception alone, were regarded as controls. Previous oral contraceptive use was associated with a lower incidence of endometriosis, although the difference was not significant. A significantly higher incidence (P less than .05) of endometriosis was present in former intrauterine device users, possibly because of retrograde flow of increased menses.
Laparoscopic tubal sterilization under local anesthesia with intravenous sedation has been shown to be a safe procedure. However, the use of laparoscopy in patients with cyanotic cardiovascular ...disease is controversial and is generally contraindicated. Five women were referred with uncorrectable cyanotic heart disease and pulmonary hypertension. The mean preoperative arterial oxygen pressure was 56.2 +/- 5 mmHg (N = 5). After cardiology and cardiovascular anesthesia consultation and clearance, the patients underwent laparoscopic sterilization with Silastic rings under local anesthesia using direct trocar entry. Continuous hemodynamic monitoring and pulse oximetry were employed. The patients were kept in the intensive care unit or the hospital for 24 hours for monitoring, and all did well. This hospital for 24 hours for monitoring, and all did well. This small retrospective series demonstrates that laparoscopic sterilization under local anesthesia is a sterilization technique that may be suitable and safe for such patients when appropriate monitoring is performed. Tubal sterilization may be the contraceptive method of choice in women with heart disease when pregnancy is contraindicated.
This article describes the status of HIV infection in an adolescent population attending publicly supported HIV testing clinics in Houston.
Records were reviewed of 4017 teenagers receiving HIV ...counseling and testing services over a period of three years (January 1990 to December 1992). We analyzed demographic characteristics, risk exposure groups, results of HIV antibody testing, and post-test counseling return rates.
An overall seroprevalence rate of 10.2 per 1000 was observed, with the majority of cases seen among black females. Forty-nine percent of teens with the virus failed to acknowledge a risk factor, but of those who did, male-to-male sexual contact was the most frequently reported. None who tested positive reported injected drug use. The majority of teens tested never returned to obtain their test results and post-test counseling.
In order to reinforce preventive behavior, institutional and other barriers should be examined and priority given to contacting both seropositive and high-risk clients who have sought testing. Interventions that encourage condom use or address sexual behavior may be more beneficial to teens than those that simply focus on drug use.
Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at ...improving their protective behaviors. Between 1999 and 2001, 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups, and multivariate analyses assessed associations between consisten t use and various characteristics. Among women who had used condoms consistently before starting on DMPA or the pill, 54% discontinued consistent use after taking these contraceptives. Overall, 20% of women consistently usedcondoms with their hormonal method, and such use did not vary significantly by contraceptive type. Seventy-five percent of women in nonmonogamous relationships were inconsistent users, though nearly a third had been consisten t users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner's positive opinion of condoms (odds ratio, 3.3) and the woman's strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). Many women at highest risk for disease have a decreased likelihood of using condoms, and disease prevention programs should be customized to target these women. Educational efforts focusing on women's attitudes and negotiation skills may be the best means of increasing dual method use.
Laparoscopic tubal sterilization has been performed under local anesthesia in the United States since 1971. Pilot studies suggested that local anesthesia was as adequate and as safe as general ...anesthesia. Since 1980, the senior author has performed more than 3000 outpatient laparoscopic tubal sterilizations with the silastic ring under local anesthesia. A retrospective descriptive study was conducted on 2827 cases. The technical failure rate was 0.14%. There were no unintended laparotomies due to complications. The mean operative time was 10.0 +/- 5.1 minutes. The mean anesthesia time was 23.3 +/- 6.9 minutes. The hospital cost for the patient was reduced by 68-85%. This study demonstrates that laparoscopic tubal sterilization can be performed adequately, safely, and quickly under local anesthesia.
To compare surgical outcomes of vaginal hysterectomy between women who have had one or more cesarean deliveries and those who have not.
A retrospective, chart review study was performed on women ...undergoing vaginal hysterectomy during a four-year period. Of 275 women who met the study criteria, 104 had a history of previous cesarean deliveries, and 171 did not. The groups were compared for indications for surgery, operative time, length of hospitalization and surgical complications.
Previous cesarean delivery did not affect hemoglobin loss, hospital stay or operative time among women undergoing vaginal hysterectomy. The complication rate (either operative or postoperative) was 12.3% among women without a history of cesarean section, 6.8% among those with one, 3.7% among those with two and 11.1% among those with three or more (chi 2 = 2.8, P = .4). The odds for surgical complications were not significantly different between women with one or more prior cesarean deliveries as compared to those without after adjustment for possible confounders.
Surgical complications with vaginal hysterectomy do not appear to be higher among women with a prior cesarean section as compared to those without a history of such operation.
The present study was undertaken to evaluate the effectiveness of Advantage 24
® to inhibit sperm transport and survival when applied at 24 hours, 12 hours, and 15–30 minutes prior to a single act of ...intercourse. Conceptrol
®, applied at 15–30 minutes before intercourse, was employed as the comparative spermicide. One-hundred-thirty-nine women, aged 22 to 45 years, were enrolled into the study and 111 completed the trial. The ability of the spermicides to immobilize sperm was assessed by postcoital testing (PCT) and by examining the proportion of sperm immobilization failure (SIF) rates. SIF was a postcoital test result with ≥10 sperm with progressive motility (either sluggish or rapid) per ×400 power field. Conceptrol and Advantage 24 used at 15–30 minutes were similar with respect to their ability to inactivate sperm (0% and 2% SIF, respectively, p = 0.5). At longer intervals between spermicidal application and intercourse, less inhibition of sperm motility was noted (9% and 14% SIF for 12 and 24 hours, respectively). The present study indicates that Advantage 24 is an effective agent to immobilize sperm. The action of Advantage 24 may decrease if it is applied earlier than 15–30 minutes before intercourse.
Fifty-five patients with a history of two or more cesarean sections underwent a trial of labor. Forty-two had had previous uterine incisions of unknown type, 11 had had low cervical transverse ...incisions, and two had had low vertical incisions. Twenty-five women (45%) had successful vaginal deliveries, and 30 (55%) received oxytocin augmentation of labor. The incidence of vaginal delivery was significantly lower in patients who required oxytocin augmentation (30 versus 64%, P less than .01). Three of the 55 patients had scar separation detected at the time of delivery. Two patients underwent hysterectomy. There were no maternal or neonatal deaths. A history of multiple cesarean sections need not exclude the patient from the option of trial of labor.
A cross-sectional survey of 3,136 women attending family planning clinics in Texas was conducted to examine past use of and future plans for use of condoms by partners during sexual intercourse for ...disease prevention in conjunction with other contraceptive methods. Following the receipt of clinical services, including counseling about family planning and disease prevention, both contraceptive and planned condom use reporting increased for the majority of subjects. However 22% of the sample indicated that they intended to reduce condom use in the future and instead use a contraceptive which protects from pregnancy but not from disease. Condom use was indicated more frequently for those who reported at least one risk faclor for HIV, but 17% of those at risk indicated lower future condom use than past use. This suggests that without changes in risk behavior, these women will be at increased risk of HIV or another sexually transmitted discase.
