Articles: disease.
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Sexual, reproductive and contraceptive risk factors were investigated in a matched community-based case-control study of carcinoma-in-situ of the uterine cervix in Sydney. The risk was related strongly to the number of sexual partners: women who had had seven or more sexual partners in a lifetime had a six-fold increased risk compared with those with one or no partner. Early age at first sexual intercourse was also a risk factor, but this effect was reduced substantially after adjustment for the number of partners, with only a two-fold excess risk persisting for those with first intercourse before the age of 16 years as compared with those whose first sexual intercourse was at the age of 25 years or later. ⋯ The risk increased with the number of induced abortions that had been undergone (relative risk, 2.2 for two or more abortions), but this effect was not statistically significant. A protective effect was found for women who had had a tubal ligation, for those who practised the rhythm method of birth control, and for women who breastfed. It is possible that these reduced risks may relate to unmeasured variables of life-style.
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Am. J. Obstet. Gynecol. · Feb 1989
Management of the third stage of labor in pregnancies terminated by prostaglandin E2.
In the management of second-trimester medical terminations of pregnancy, it is a commonly accepted practice to allow 2 hours for the third stage of labor. This practice is based on data from terminations with saline solution as the abortifacient. Herein we report our experience with the use of prostaglandin E2 vaginal suppositories for midtrimester terminations, with particular regard to placental delivery rates and associated complications. ⋯ This was based on an unacceptable complication rate of greater than 4% beyond 2 hours. The present study of the use of prostaglandin E2 suppositories for a variety of indications demonstrated a similar complication rate of 4% at 30 minutes. These findings suggest expectant management beyond this time limit may produce unacceptably high complication rates.
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The evidence for and against the association of oral contraceptives (OCs) with vascular disease is reviewed, along with the possible pathophysiologic mechanisms for such an association, including effects on coagulation, circulating lipoproteins, and glucose metabolism. The new, low-dose estrogen OCs appear to affect coagulation minimally, and anticoagulant as well as procoagulant effects have been documented. Such concomitant factors as cigarette smoking, obesity, a family history of thrombosis, lack of physical activity, and blood type influence coagulation more strongly. ⋯ However, educating patients in the management of breakthrough bleeding can help reduce the number of women who must be switched to higher-dose OCs. Epidemiologic evidence confirms the safety of low-dose OCs. By selecting patients carefully, the risk of vascular disease from oral contraception can be reduced to very low levels.
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Review
Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects.
Over the past three decades, much of the research on oral contraceptives has focused on cardiovascular and neoplastic effects. Results of recent United States studies have shown no increased risk of death among users of oral contraceptives, although an increased risk of idiopathic venous thromboembolism has been a consistent finding. ⋯ In addition, no clear association has been found between oral contraceptive use and breast cancer or cervical cancer. Data on hepatocellular carcinoma and malignant melanoma are inconclusive.