The cervical cap: effectiveness, safety, and acceptability as a barrier contraceptive.

PIP: The experiences of 217 volunteers fitted with the cervical cap were analyzed to asses the cap's effectiveness. The cervical cap's a contraceptive barrier device used widely in Europe and currently under consideration by the Food and Drug Administration for release in the US. In 24 months of use, 43 pregnancies were reported among 39 women (4 became pregnant twice with the cap). The Pearl Index was 22.7 pregnancies/100 woman-years of use. Neither the characteristics of participants nor the characteristics of cap use affected the pregnancy rate significantly. However, the pregnancy rate was higher in participants reporting an average frequency of intercourse of 20 or more times/month and in those who observed cap displacement sometime during intercourse. Medical problems associated with cap use were minimal. Increased vaginal odor was the side effect reported most frequently. The majority of participants deemed the cap a positive contraceptive; 83% stated they would recommend it to friends.^ieng

Preabortion cervical dilatation with a low-dose prostaglandin suppository. A comparison of two analogs.

Vaginal administration of PGE2 and PGF2 alpha suppositories resulted in cervical changes that facilitated suction curettage termination of 46 first-trimester pregnancies. When 30 mg of 9-deoxo-16,16-dimethyl-9 methylene PGE2 was compared with 0.5 mg of 15(S)-methyl PGF2 alpha suppositories, the cervix-ripening properties of these two agents appeared to be equivalent. Within one to two hours of insertion, a mean dilatation increase of 3.3 and 3.1 mm was achieved for the PGE2 and PGF2 alpha groups, respectively, increasing the ease of suction abortion. Blood loss and gastrointestinal side effects were minimal for both groups. The rapid effectiveness of these suppositories for cervical priming permits a one-day hospital stay for abortion and may minimize long-term sequelae associated with forceful mechanical dilatation of the cervix.

Vasectomy and atherosclerosis in Macaca fascicularis. New findings in a controversial issue.

The influence of vasectomy on diet-induced atherosclerosis was studied in ten Macaca fascicularis monkeys. After a six-month control period the monkeys were divided into two groups and matched for cholesterol levels. Five monkeys were given vasectomies and five sham vasectomies, and all animals were placed on a high-cholesterol, atherogenic diet. The vasectomized monkeys showed a significant increase in sperm antibody formation as compared with the control group. Both groups developed similar high cholesterol levels. After ten months all monkeys were necropsied, and their vascular systems were carefully evaluated to determine the extent of atherosclerosis. There was no difference in the occurrence of atherosclerotic plaques between the study and control groups despite sperm antibody development in the study group. This finding is in contrast to those of previous animal studies in which it was theorized that vasectomy aggravated the development of atherosclerosis. This study, however, confirms the results of several human studies that have failed to find any increase in cardiovascular disease among men who have undergone vasectomy.

Reliability of antenatal testing: estriol levels versus nonstress testing.

During the third trimester of pregnancy, 334 high-risk patients were followed with antenatal fetal heart rate (FHR) evaluation and with serial determinations of unconjugated plasma estriol. The antenatal FHR tests included nonstress testing (NST) and investigation of beat-to-beat variability. Data indicate that the NST was more reliable than estriol analysis in assessing fetal compromise. While predictive values of negative test results did not differ statistically, the NST/beat-to-beat assessment was particularly accurate in identifying fetal jeopardy in more than 45.0% of the fetuses at risk, whereas only 22.8% cases of jeopardy were accurately predicted by abnormal estriol values. An abnormal NST with loss of beat-to-beat FHR variability should therefore take precedence over plasma estriol determinations during antenatal surveillance of high-risk obstetric patients.

Cervical priming prior to dilatation and evacuation: a comparison of methods.

Vaginal administration of prostaglandin analogues resulted in cervical changes that facilitated dilatation and evacuation in 80 patients in the late first trimester and the second trimester of pregnancy. When 0.5 mg and 1.0 mg of 15(S)-15-methyl-prostaglandin F2 alpha (15-ME-PGF2 alpha) was compared to 30 and 60 mg of 9-deoxo-16,16-dimethyl-9 methylene prostaglandin E2 (PGE2 analogue), the PGE2 analogue appeared to have more cervical ripening effect than did the 15-ME-PGF2 alpha. Overall, the 30 mg PGE2 vaginal suppository seemed to offer the most optimal combination of effectiveness, sufficient cervical dilatation, and minimal side effects. With the prostaglandins, maximal cervical effect was observed at 4 to 5 hours; this rapid effectiveness allows administration of the prostaglandin to accommodate a 1-day stay for surgical evacuation. The preoperative cervical priming results with the prostaglandins were compared to those obtained with the use of laminaria tents. Although the number of patients who needed further dilatation at the time of operation was less with the laminaria, the incidence of complications and the time for adequate dilatation were higher in that group.

A new iud insertion technique utilizing cervical priming with prostaglandin.

Cervical priming with the aid of a single 15-ME-PGF2a vaginal suppository prior to IUD insertion resulted in cervical changes which facilitated the procedure. A 0.5 mg 15(S)-15-prostaglandin F2a methyl ester vaginal suppository was administered one hour prior to the IUD insertion in all patients studied. The insertion was performed in all patients studied. The insertion was performed from seven to seventeen days following the LMP with the exception of four patients with prolonged amenorrhea. A mean increase in cervical dilatation of 2.14 mm was achieved with minimal side effects. The cervical ripening and dilatation produced by the suppository increased the ease of IUD insertion , and expanded the time frame in which an IUD insertion could be performed. The method was well tolerated by all patients and eliminated the nausea and syncope often associated with IUD insertion.