In support of a compensation plan for vaccine-associated injuries. Infectious Diseases and Immunization Committee,Canadian Paediatric Society.

Between 1971 and 1973, 200 Dalkon Shield and 142 Gyne-T 200 intrauterine devices (IUDs) were inserted at the department of obstetrics and gynecology in a large urban hospital. In 1984 retrospective analysis of events associated with the use of these IUDs was done. Hospital and clinic charts were reviewed, and the women were contacted to obtain information on infertility and the outcome of pregnancy after discontinuation of IUD use. The rates of events leading to discontinuation of IUD use 2 years after insertion were similar in the two groups except for that of planned pregnancy, which was higher in the Dalkon Shield users (p less than 0.05). The rates of accidental pregnancy per 100 women were 3.8 for the Dalkon Shield users and 1 for the Gyne-T 200 users. The rates of pelvic inflammatory disease (PID) based on all cases of PID and follow-up information were similar in the two groups. There were no differences between the two groups in outcome of pregnancy with the IUD in situ or after expulsion or removal of the IUD because of planned pregnancy or other reasons. Infertility rates after discontinuation of IUD use were similar for the Dalkon Shield and Gyne-T 200 users. The results confirm the authors'' opinion that the Dalkon Shield and Gyne-T 200 IUDs are safe and effective methods of intrauterine contraception.     

Factors affecting the choice of contraceptive method by a group of OEO patients.

A method of discriminant analysis is described whereby a combination of personal characteristics is established which would best predict whether a woman would choose oral or IUD contraception. The study hypothesized that, at the time of choice, a higher level of motivation is necessary to accept an IUD rather than oral contraception. Approximately 450 patients at a Planned Parenthood clinic in Columbia, South Carolina, were studied between October and December 1970. At the 1% level of significance, it was found that pill users are younger, have fewer children, and are more likely to have used the pill in the last 2 years, compared to IUD users. Income is higher for pill users at the 10% level of significance. Educational levels did not differ between the 2 groups. Other factors were significant at varying levels. It would be possible to establish a combination of variables which would predict the separation between the 2 groups of women. There are problems in this approach. 1 problem is that Planned Parenthood has alw ays stressed the voluntary aspect of contraceptive acceptance.     

The mortality risk of voluntary surgical contraception

The mortality risk of voluntary surgical contraception (VSC) is compared to the mortality risk of other methods of fertility control, pregnancy and delivery, and selected nonreproductive-related events. After 1 year the rates per 100,000 are .1 for vasectomies, .3 for IUD use, 2.2 for legal abortion, 4.0 for female VSC in developed countries, and 18.7 for pregnancy and delivery. Rates for female VSC, pregnancy and delivery, and legal induced abortion were expressed as deaths per 100,000 procedures or live births and mortality risks for IUD use were presented as deaths per 100,000 women per year, per 5 years, and 10 years. After 10 years the mortality risks remain constant for single-exposure events but increase to 3.0/100,000 for IUD use, to 12/100,000 for the lowest risk category of OC users, and to much higher cumulative totals for higher risk pill users. Risks at 5 and 10 years after abortion and other pregnancy outcomes depend on the reproductive alternatives chosen; risks of barrier methods appear related to unintended pregnancy during use. In developed countries the mortality risks of smoking, driving, power boating, and drinking are higher than those for female VSC and vasectomy at 1 year. Mortality rates for all reproductive strategies in developing countries are estimated to be higher: the rate for female VSC in Bangladesh was recently estimated at 16.2/100,000 and of vasectomy at 19.0/100,000, although vasectomy death rate estimates as low as .1/100,000 have also been made for some developing countries. The risks of VSC in developing countries are considerably lower than those of a single pregnancy or delivery. The risk of VSC is concentrated in the 1st 6 weeks after the procedure and thereafter is related to pregnancy resulting from method failure.     

Contraceptive practices and fertility among Southeast Asian, black, and white mothers attending a maternal infant care program

The purpose of this analysis was to determine if there were differences in selected fertility characteristics including parity, pregnancy spacing, age at 1st pregnancy, age of menarche, breastfeeding postpartum, and contraceptive practices among white, black, Hmong, and other Southeast Asian mothers attending a maternal infant care program in Minneapolis, Minnesota, during 1980-1982. White and black mothers were younger than the Hmong and other Asian mothers. The lowest mean age of 1st pregnancy was among blacks. Ages of 1st pregnancy were similar for whites, Hmong, and other Asians, although the mean age of menarche was approximately 2 years later for Hmong and other Southeast Asian mothers compared to the white and black mothers. Based on self reports at the 1st postpartum visit 1 month after delivery, 39% of the whites and 25% of the blacks were breastfeeding. In comparison 8.7% of the Hmong and 17% of the other southeast Asian mothers were breastfeeding. Maternal aged age at 1st pregnancy were significant predictors of parity for whites, blacks, Hmong, and other Southeast Asians. Ever-use of contraception was significant predictor of parity only for Hmong. The highest proportion of ever-users of contraception was among the white mothers (80%) followed by the blacks (69.3%) and other Asian mothers (34.85). Hmong mothers had the lowest proportion having used contraception (17.1%).     

Family planning method change and dropouts in the Philippines

Pregnancy prevention techniques are classified into 2 general categories as the coitus-connected and coitus-independent. The former include rhythm, withdrawal, condom, and foam while the latter include such methods as oral contraception, IUDs, and male and female sterilization. The use of contraception hinges on motivation and the acceptability of the method. This article is a report on 1 particular study where data was collected in 1971-1972 through 1321 interviews resulting from a series of audits of family planning clinics with the purpose of determining the accuracy of information reported in clinic records and ascertaining the number of acceptors who had discontinued use of a family planning method or moved from the area served by the clinic. The findings revealed that: 1) Coitus-independent methods are more effective in the prevention of pregnancy that coitus-dependent ones, 2) Women who change from a coitus-dependent method are more likely to change to a coitus-independent method, while the changes from the latter method are usually to a method in the same general category, 3) In this population the IUD provides the maximum protection from conception with the minimum likelihood of program dropout.     

The copper-7 intrauterine contraceptive device: 5-year evaluation.

Over a 5-year period a family practitioner inserted copper-7 (Cu-7 intrauterine contraceptive devices (IUDs) in 134 women. The rates of continued use after 2 years, 53.0% for the women''s first IUD and 63.9% for all their IUDs, and of accidental pregnancy, 2.4%, are comparable to those in the literature. However, in this series the rate of expulsion was 0.8%, much lower than that in the literature. Fertility did not appear to be reduced in women who planned to have pregnancies after the device was removed. A carefully scrutinized technique of insertion and conscientious follow-up make the Cu-7 IUD an acceptable form of contraception for many patients in a family practice.     

Birth spacing in Pakistan

Life table analysis was applied to data from the 1975 Pakistan Fertility Survey to identify child spacing differentials between population subgroups. Women in urban areas had shorter birth intervals than their rural counterparts from parities 1-6; only after parity 7 was this differential reversed. Similarly, women with some education had shorter birth intervals at the earlier parities than uneducated women. While overall family size is relatively homogeneous in Pakistan, women of more modern backgrounds seem to space their children more closely than traditional women. Age at marriage appears to play an important role not only in determining the length of the 1st interval, but also that of subsequent intervals. An unexpected finding was that ever users of contraception had distinctly more rapid spacing of their births than never users. The median interval to 1st birth was shortest in North West Frontier Province, but similar in Punjab and Sind. Multiple classification analysis revealed that some differentials in child spacing by education, residence, and province persisted even after other variables were controlled. Cohort of mother had an independent effect, with younger cohorts having shorter birth intervals. However, the variable that had the strongest effect on length of interval (aside from the 1st interval) was breastfeeding duration. It is likely that increasing urbanization and improved levels of education among women will lead to high levels of marital fertility associated with shorter birth intervals. Even though these trends tend to increase the age at marriage, they are associated with shorter durations of breastfeeding. In the longer term, greater use of contraception among women in the modern sector may partially counteract the fertility increasing effect of reduced birth intervals.     

The changing pattern of contraception in Lahore, Pakistan: 1963-80

This paper attempts to test the dictum that social change begins in better educated, economically well-off and relatively less tradition-bound strata of the urban society and that it then spreads to the lower social strata and eventually affects the rural populations also. It analyzes temporal changes in the prevalence of contraception as reported by female respondents in 2 sample surveys conducted in the city of Lahore during 1963 and 1980. Altogether 1960 ever-married females aged over 15 were interviewed in the 1963 survey and 993 in the 1980 survey. Compared to 1980 respondents, those in the 1963 survey were older, educated and belonged to a medium or high socioeconomic status category. In 1963, 18% of the respondents were not aware of any method of contraception; by 1980 this proportion was reduced to 11%. The most spectacular change was observed in the prortion of respondents who were practising family planning. In 1963, only 7% of the respondents had ever used any method of contraception; this proportion increased to 48% in 1980. Moreover, substantial differences were noted with regard to the methods of contraception used. The use of condoms seems to have declined while that of the IUD the pill, sterilization and withdrawal seems to have increased. It is interesting that abstinence remained an important method of contraception. Use of contraception is found to vary with age, education and socioeconomic status of respondents. The degree of association between these 3 characteristics and contraceptive usage increased substantially from 1963 to 1980. 1980 survey results indicate that current as well as ever use of contraception show an inverted V-shaped pattern with age and parity. The prevalence of contraception increases with age, reaching a maximum of 41% for current users and 63% for ever users in the age group 35-39. A similar pattern is observed in relation to the parity of respondents with a maximum amongst women who had borne 6 children. Education shows a positive association with both the current and ever use of contraception. The pattern of current methods used is very similar to that noted for methods ever used. The only major differences relate to the condom and abstinence which show higher prevalence as current methods. In the 1963 survey religion was the main reason given by those expressing an unfavorable attitude toward family planning. In the 1980 survey questions were asked about the specific reasons of the respondents for never using any method of contraception. The desire for more children was the most commonly given reason and recent marriage was the 2nd most common. The strength of religious opposition to contraception seems to have declined substantially in the 1980 survey.     

Factors affecting the choice of nonpermanent contraceptive methods among married women

Data from the 1976 US National Survey of Family Growth were used to examine the effect of sociodemographic factors on choice of nonpermanent contraceptive methods among white, fecund, married women aged 15-44 who intend no additional births. A multivariate analysis revealed that age of the respondent had a strong negative relationship to the effectiveness of contraceptive chosen. Being Catholic had a negative effect on the effectiveness of contraceptive chosen, but significant interaction occurred between age and parity and between age and education. 1 explanation may be that increased age may result in reduced perception of risk that an unwanted birth will occur. Another explanation is that concerns about health risks associated with the pill or IUD use may lead to use of other methods among older women. The most probable explanation of the observed relationship is a cohort effect. Older women who began marital contraception at an earlier point in time have continued to use the same methods as were initially available early in their marriage. The lack of a significant association between parity and the effectiveness of contraceptive method chosen based on multivariate analysis is most likely due to the high correlation between parity and age. The lack of a significant effect of education on choice of method may be explained by the nearly universal access to all methods of contraception for married women. Further research on the same lines is strongly urged to shed light on current behavior patterns.     

Continuation of contraception following menstrual regulation--a Bangladesh experience

The study compares the 3 years of birth control practice of 1172 women who underwent early menstrual regulation (MR) and 499 others who accepted contraceptives only (nonMR) from an urban clinic in Bangladesh. About 60% of the women in the sample were followed-up and their all-method continuation rate was analyzed by life-table technique. The 3-year overall continuation rate in the MR group (64%) did not differ from that of the nonMR group (62%). In the age groups 25 and over, the continuation rate was higher in the MR group. Among the women who did not desire any more children, the continuation rate in the MR group was significantly higher than that of the nonMR group (80% versus 68%, P0.05). Of women with parity greater than 2, the MR group had significantly higher continuation rates than the nonMR group. The MR group had higher extended use-effectiveness for IUDs, conventional contraceptives (condom and foam), injectables, and oral contraceptives than the nonMR group. These findings indicated effective contraceptive practice following MR for this urban population. Easy availability of a multimethod service after MR seemed to be important in promoting effective contraception.     

胎次、性别对成年小鼠海马齿状回神经发生及学习记忆的影响

目的探讨胎次、性别是否对成年小鼠海马齿状回神经发生及学习记忆产生影响。方法运用Morris水迷宫系统检测第1～3胎成年小鼠的学习记忆能力,腹腔注射BrdU,标记神经干细胞,检测不同胎次、性别小鼠海马齿状回中的神经发生的差异。结果 （1）在同性别、不同胎次成年小鼠间,第2胎的学习记忆能力（LMA）均显著地高于第1、3胎的,其影响规律为LMA2〉LMA1〉LMA3,且P〈0.05;在同胎次、不同性别成年小鼠间,雌性小鼠的LMA均高于雄性小鼠的,但其差异无显著性（P〉0.05）。（2）在同性别、不同胎次成年小鼠间,第2胎海马DG新生神经细胞的数量（N）均高于第1、3胎的,其影响规律分别为NF2〉NF3〉NF1和NM2〉NM1〉NM3,但其差异无显著性（P〉0.05）;在同胎次、不同性别成年小鼠间,雌性小鼠的N均高于雄性小鼠的,但其差异无显著性（P〉0.05）。结论胎次、性别对实验动物神经发生及学习记忆等方面产生的影响是肯定的。因此,在使用实验动物时,应予以充分考虑,尽量使用胎次、性别相同的。     

Alteration in the in vitro activity of milk leukocytes during different parity in high yielding cross-bred cows

In vitro activity of milk leukocytes (viz. neutrophils, lymphocytes and macrophages) was evaluated in forty-eight (48) clinically healthy high-yielding cross-bred cows of mid-lactation stage (100–200 days of lactation), divided into four groups namely 1st parity (n = 12), 2nd parity (n = 12), 3rd parity (n = 12) and 4th and above parity (n = 12). Milk samples were taken (250 ml/cow) were taken. Milk somatic cell counts (SCC) and differential leukocyte counts (DLC) were performed microscopically. In vitro phagocytic index (PI) of milk neutrophils and macrophages was evaluated by colorimetric nitro blue tetrazolium reductive assay. Mitogen-induced milk lymphocyte blastogenic response was measured by colorimetric MTT (tetrazolium) assay after isolation of the milk leukocytes by density gradient centrifugation. Milk SCC differed significantly (p < 0.01) between different parity. Cows of 4 and above parity showed significantly (p < 0.01) higher milk SCC compared to primiparous cows. There was no significant difference in milk DLC during different parities in high-yielding cross-bred cows. There was a significant (p < 0.01) variation in lymphocyte blastogenesis amongst parity. The highest value of lymphocyte blastogenesis was seen at 3rd parity, whereas lowest value was obtained in the cows of both 1st and 4th or above parity. PI of milk neutrophils did not differ significantly between parity. PI of milk macrophages was significantly (p < 0.01) higher in 3rd parity and lower (p < 0.01) in 1st and 4th parities. The study indicated that depressed activity of milk lymphocytes and macropages was lower and SCC was higher in the cows of 4th and above parity indicating more mammary stress and hence susceptible to udder infection and mastitis. Therefore, better care and managemental interventions should be taken around these periods.     

Fertility of couples following cessation of contraception

A retrospective study of the delay in conception after stopping different methods of contraception is undertaken among 5108 pregnant women residing in a departement in the Paris region. Particular attention is paid to the delay that sometimes separates the cessation of contraception and the beginning of intercourse without precautions. The counfounding factors considered are: the observation of a waiting period following cessation of contraception; the existence of a strategy, i.e., a coital pattern adopted by certain couples who have intercourse more often during the middle of the cycle, hoping to conceive more rapidly; the regularity of the menstrual cycle and the woman's age at the beginning of unprotected intercourse. The statistical techniques include chi-square analysis, analysis of variance correlation, partial multiple regression and actuarial rates of infecundity. The mean age of women at their last period was 26.3 years; 37.6% were primagravida; 87.3% worked outside the home and 36.6% were smokers. 72% of the women used oral contraceptives; 14% the IUD, and 14% other methods. Among all factors studied, 4 are strongly related both to fertility and to mode of contraception: the waiting period, coital strategy, regularity of the menstrual cycle and the woman's age. Shorter average time required to conceive (TRC) and greater fecundability are associated with the observation of a waiting period, no coital strategy, and regular cycles. The woman's age at the time of unprotected intercourse shows no correlation with TRC; it does, however, show a correlation with fecundability, which increases with age to reach a maximum in the age group 25-29 and then decreases progressively. These 4 factors are also related to the mode of contraception. Those using hormonal contraception were more likely to observe a waiting period. However, they report a coital strategy less frequently, their usual cycle is more often irregular and they are younger than IUD or other method users. Results demonstrate a decreased fertility for couples after the pill and, to a lesser degree, after IUD use, but only among those who did not take other precautions (waiting period). For couples observing a waiting period, there is no decrease of fertility following the initial exposure to the risk of conception. This comparison of return of fertility following cessation of different contraceptive methods shows that raw data must be interpreted with caution. It is essential to take into account the possibility of delay in becoming exposed to the risk of conception while various confounding factors must also be considerd.     

Fertility and family planning in Accra

A sample of 1000 currently married women aged 25-39 and living in 3 geographic areas of the Ghanaian capital were interviewed about their contraceptive knowledge and practice. Slightly over 90% of the respondents said that they had heard of ways to delay or prevent pregnancy. There was no difference between the 3 areas, but more of those aged 30-34 had heard about contraception. The chances that a respondent had heard about contraception increased with the level of education. Catholics were less likely to have heard of any contraceptive methods than Protestants. Also, women engaged in traditional informal occupations were the least likely to have heard of any contraceptive methods. Overall, education emerged as the most important differentiating factor. The pill, condom, and IUD were the best known methods. Regarding actual contraceptive practice, only 41% of the respondents were currently using some form of contraception, with about 19% using modern and 27% traditional methods. Results of contraceptive usage by user characteristics show that the majority of women in 2/3 of the areas rely on a mixture of traditional and modern methods; that the % of users (any method) increases with age up to 30-34 years, after which it decreases. The % of ever-users of any type of contraception in this study is highest for the highest education levels, at 84% for women with 2ndary and post 2ndary education. With the exception of the IUD, douche and folklore methods, better educated women have higher ever-use %s for both traditional and modern methods. While the %s of users increases with education for foam, diaphragm and withdrawal; the reverse is observed for the pill and IUD, probably due to fear of negative side effects. Overall, there are no significant variations in contraceptive use by migration status; but the % of non-users is highest among recent migrants who are also the least likely to have ever used modern methods. Fertility differentials across ethnic groups have been observed in Ghana. The Akan have the highest fertility, followed by the Ewe and Ga-Adangbe with moderate fertility, and the northern ethnic groups with the lowest fertility. The Akan also have the highest % of ever users of modern contraceptives, an inconsistency which may be explained by their recent recognition of the burdens of high fertility and their attempts to control it. Religious differences are pronounced, especially between the traditional category on the 1 hand, and Christians and Muslims on the other. Results of an analysis of variance suggests that family size is the strongest motivation for adopting modern contraception, and that it may be used for limiting rather than spacing births.     

Evaluation of intra-uterine contraception in selected mission hospitals in India

The follow-up records of the 4067 women accepting Lippes loops (27.5 and 30 mm) during 1967-1968 in 15 randomly selected member mission hospitals of the Family Planning Project of the Christian Medical Association of India were studied. 97.7% of the insertions were not postpartum. Median age was 29.8. The difference between the mean number of living children, 3.7, and the mean parity, 4.9, suggests that a relatively high rate of infant and child mortality is characteristic of IUD acceptors. Analysis of the responses of 1656 acceptors to 1 query showed attitude toward the loop was favorable by both husband and wife in 77.3% of these cases and by either husband or wife in 90.5% of these cases. Expulsions, removals, and pregnancies were unaffected in any significant way by age. Expulsion, removal, and pregnancy rates were higher, but nonsignificantly so, for the 27.5 mm than for the 30 mm loop. The 27.5 mm loop was associated with a significantly higher proportion (p less than .05) of prolonged and heavy bleeding than was the 30 mm loop. The average number of women months of use was 6.7 (very low in a follow-up study of 24 months) and more or less unrelated to age. Most removals were due to bleeding, symptoms associated with bleeding, or desire for planned pregnancy. Removal rate was more or less uniform for all parities. With increase in the duration of use up to 18 months the complaint rate appeared to decrease, but after 18 months it appeared to increase again suggesting that IUDs cause irritation of the endometrium after long periods of use. Women less than age 25 had a significantly greater (p less than .01) percentage of reinsertion than did women age 25 or greater. The cumulative net termination rate after 24 months was 53.9 (plus or minus 1.4) per 100 first insertions, a rate comparing well with similar Indian figures. Pregnancy rate was 2 per 100 first insertions. Of the 2 devices the 30 mm loop seems the more effective and ideally suited for fertility control.     

Regression analysis of "current status" life tables on duration of breastfeeding in Sri Lanka

Provided that women report the dates of their children's births with reasonable accuracy, it is possible to derive good estimates of the duration of breastfeeding from women's breastfeeding status at the time of the interview. This paper illustrates the application of conventional regression techniques to the analysis of breastfeeding rates derived in this manner. Construction of current status rates is explained and a comparison between open interval, closed interval, and current status breastfeeding life tables is presented, indicating the extent of bias to which tables of the former types are open. Birth-weighted rates are used for WFS data from Sri Lanka; the variables entered into the regression equation include parity, educational level, residence, work experience since marriage and use of contraception since the birth. Contraception is not found to influence net breastfeeding rates in the 1st interval (1-16 months), although it is about as prevalent as in later intervals. The positive coefficients at intervals beyond the 1st also imply that contraceptive use is not a substitute for lactation in Sri Lanka or not a predominant one. Lifetime urban residence is associated with short durations of breastfeeding, and being an urban migrant is associated with intermediate durations relative to those of rural women. The effects of residence on breastfeeding are especially pronounced in the 1st interval. By parity as by contraception, differences in breastfeeding rates are not significant at short durations but become so with time as lower parity women reach pregnancy. Patterns by age are similar, but less sharp. Middle school attendance and work at home are both strongly associated with with lactation behavior, the former negatively and the latter to about an equal degree positively. Working outside the home seems not to influence breastfeeding to any great extent. In the multiple attribute regressions, middle schooling depresses breastfeeding durations about as strongly as lifetime urban residence relative to women who are rural and uneducated. Being at parity 5 or above or working at home almost as sharply increases durations. The use of contraception has slightly smaller positive effects. The patterns suggest that as Sri Lankan women become increasingly well educated and urban, and as family sizes decline, durations of breastfeeding will decline. Equally important however, even among better educated urban wives, breastfeeding continues longer than is typical of western countries.     

Compared to dinoprost tromethamine, cloprostenol sodium increased rates of estrus detection, conception and pregnancy in lactating dairy cows on a large commercial dairy

Using two PGF_2α treatments 14 days apart as a way to enhance estrus detection rate following the 2nd treatment is a reproductive management tool that continues to be used on large dairy farms. In one study, in cows with a functional CL and a dominant follicle, treatment with cloprostenol vs. dinoprost resulted in greater peripheral estradiol concentrations. The objective of the present study was to determine if cloprostenol could enhance pregnancy rates of cows in a large dairy herd using a PGF_2α program for 1st artificial insemination (AI). Lactating dairy cows (n = 4549) were randomly assigned to receive two treatments of either 500 μg cloprostenol or 25 mg dinoprost 14 days apart, with the 2nd treatment on the 1st day of the voluntary waiting period (57 DIM). Cows detected in estrus within 5 days after the 2nd treatment were inseminated. There was no effect of treatment on day of estrus detection, with 78% of cows inseminated on Days 3 or 4 following treatment. Cloprostenol increased (P < 0.01) estrus detection rates in 1st parity cows compared to dinoprost, 42.4 vs. 34.0%. In cows inseminated on Days 3 or 4 after treatment, cloprostenol increased (P = 0.05) conception rates compared to dinoprost, 38.3 vs. 34.4%. When treatments and parities were combined, conception rates increased (P < 0.02) with interval after treatment (27.0, 36.4, and 44.5% for Days 1 or 2, Days 3 or 4, and Day 5, respectively). Cloprostenol increased (P = 0.02) overall pregnancy rate compared to dinoprost, 14.4 vs. 12.2%. In summary, cloprostenol increased fertility in 1st parity cows inseminated on Days 3 or 4 following treatment and subsequently enhanced pregnancy rates of 1st parity lactating dairy cows compared to dinoprost. Fertility appeared greater in cows expected to have had a young antral ovarian follicle at treatment.     

Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion. METHODS: Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes. DISCUSSION: The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion.Trial registrationClinicalTrials.gov Identifier NCT01174225.     

Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic.

Women attending a family planning clinic were studied to determine the relation between cervical erosion and clinical and social characteristics. The appearance of the cervix was recorded without knowledge of the women''s symptoms. The prevalence of erosion increased with parity but, when the effects of other factors were controlled, decreased in women aged 35 and over. Erosion was significantly more common in women taking the "pill" and less common in women using barrier methods of contraception than in others. There was considerable variation between doctors in the reporting of erosion. No association was found between erosion and postcoital bleeding, dyspareunia, backache, or dysuria. There was a significant but modest association between erosion and vaginal discharge and a suggestion that erosion may sometimes be associated with nocturia and frequency of micturition. Vaginal flora was similar in women with and without erosion. Cervical erosion should not be regarded as pathological in asymptomatic women, nor should it be assumed necessarily to be the cause of symptoms in women with genitourinary complaints.