Ruptured uterus at Sagamu, Nigeria

Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.

Decision-intervention interval in ruptured uteri in Ile-Ife, Nigeria

OBJECTIVE

To determine the decision-intervention interval in ruptured uterus with a view of overhauling the management strategy thereby improving the maternal and perinatal outcome.

DESIGN

Cross-sectional survey based on secondary data done between 1990-1999.

SETTING

Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.

SUBJECTS

One hundred and two consecutive women who had uterine rupture.

RESULTS

The decision-surgical intervention interval ranged from 30 minutes to 4.5 hours. The major reason for delay was unavailability of compatible blood (88.2%), followed by lack of electricity (4.9%), unsterile instruments (3.9%), waiting for ambulance to get senior obstetricians (2.9%), delay in arrival of anaesthetist (1.9%) and neonatologists (1.9%). The peri-natal mortality rate (PNMR) was 843 per 1000 total births and maternal mortality rate (MMR) 4902 per 100,000 births.

CONCLUSION

The maternal and perinatal outcome in uterine rupture would be improved by early diagnosis and avoidance of preoperative delay through availability of essential obstetric services.

[Relationship of bilateral tubal occlusion with functional ovarian cysts]

The purpose was to determine the relation between functional ovary cysts (FOC) in patients with bilateral tubal occlusion (BTO) compared against a group of patients without the occlusion. Retrospective study, transversal and comparative in which 1,060 cases of patients that had pelvic ultrasounds were studied. 2 groups were formed: Group 1 with 356 patients with BTO, Group 2 without surgical sterilization history. In patients with BTO the FOC frequency was of 25.0% against a 15.7% detected in those without previous surgery. The frequency of FOC predominates in nulliparous patients without BTO (28.8%). On the age relation it is seen that en patients with BTO, the higher peak were functional cysts showed is on the 26 to 32 years old group. In patients without BTO the distribution is similar along the reproductive life with no domain of any age subgroup. The Xi'2 test showed that the difference of FOC in patients with BTO had a significant P < 0.05. BTO as antecedent is a factor that favors FOC and a cause-effect correlation exists. In women without. BTO age doesn't influence the incidence of FOC, and regarding the parity, FOC were observed more often in nulliparous patients with less that 30 years old. FOC can be related to other symptoms like an ovulation menstrual disorders, and pelvic ache. After this finding we must think about long-term complications resulted from bilateral tubal occlusion brings. We should also re-assess the surgical technique used since it can modify the living quality of the operated patients. BTO as a chosen procedure through informed consent, 0 offers in most of the cases more benefits than risks, nonetheless, there is the chance of consequence and long term symptoms and this should be informed to the patient.

Population, public health and tubal ligation in Vanuatu

The association between population growth and public health is often neglected. Between 1989 and 1999 Vanuatu's population grew by 30%. Unless this growth slows existing public health problems will worsen. To gain insight into family planning habits 111 ni-Vanuatu women undergoing tubal ligation were surveyed. 85% had 4, or more, children. Women resident on the outer islands had more children than those on the island containing the nation's capital. The implication is that ni-Vanuatu women perceive 4 children as desirable. With approximately half the population entering their reproductive years in the next decade this is too many to avoid a population explosion in Vanuatu. Public health campaigns must promote the benefits of a small family. Urgent education and widespread provision of effective family planning is required to avoid a future public health crisis. Aid donors need to be made aware of this as an absolute priority.

Female sterilisation through mini-laparotomy at Gondar College of Medical Sciences

OBJECTIVES

To describe the socio-demographic characteristics and clinical course and follow up of clients who have undergone voluntary surgical contraception (VSC) through minilaparotomy (mini-lap) under local anaesthesia (LA). Also, to evaluate the safety and method satisfaction, so as to forward recommendations for method utilisation in the Ethiopian context.

DESIGN

A case series design where pre- and post-operative conditions of clients coming for voluntary surgical contraception via mini-laparotomy were systematically analysed.

SETTING

Department of Obstetrics and Gynaecology, Gondar College of Medical Sciences, Gondar, Ethiopia.

SUBJECTS AND METHODS

Eighty two clients (median age of 33 years, range 25-40) who decided to use tubal sterilisation method of contraception from April 1993 to May 1995 were included in the study. A format prepared and distributed to VSC providing sites in Ethiopia by the Family Guidance Association of Ethiopia (FGAE) was used in collecting the necessary information, including informed consent of every client.

MAIN OUTCOME MEASURES

Previous knowledge of contraceptive methods, decision making for tubal sterilisation, size of incision, advantages of use of local anaesthesia in the local setting, duration of hospital stay, conditions on follow up.

RESULTS

Eighty two (55.4%) women underwent tubal sterilisation through mini-lap. The mean number of the live children per client was 6.2 +/- 1.7, with parity ranging from two to eleven children. Mothers with five or more children were 70 (85.4%). Among 69 mothers (84.1%), the last pregnancy outcome were live births. The average length of the time since making a decision not to have any more children was 2.5 +/- 2 years (median of one year). The rationales given were economic, ill health and completed family size. Regarding the pattern of decision making, in 77 (91.9%) clients both the couples were involved in decision making. All except two underwent the procedure under LA and no complication was encountered during surgery. Follow-up attendance was 100% in one-year period and nothing serious was reported. All reported to be satisfied with the method.

CONCLUSION

The study showed that early decision making by involving both couples other than proper case selection minimises regrets. The authors believe that tubal sterilisation through mini-lap under LA is an ideal method in developing countries where access to family planning and other reproductive health services are not widely available and where there is population explosion, less than 10% contraceptive prevalence rate and high maternal mortality.

Changes in the rate of tubal ligation done after cesarean section

OBJECTIVE

We studied tubal ligations done after cesarean section in a Spanish hospital during a 20-year period, in order to analyze changes in patient characteristics and indications for cesarean delivery.

STUDY DESIGN

We reviewed the clinical records, for the period from 1978 to 1997, of 1996 cases of cesarean section followed by tubal ligation in 108776 births in which the fetus weighed 1000 g or more.

RESULTS

During the 20-year period of study, the proportion of cesarean sections relative to vaginal deliveries increased, as did the frequency of cesarean section followed by tubal ligation relative to cesarean and vaginal deliveries. The proportion of women who underwent tubal ligation after a second cesarean section decreased from 60% during 1978-1982 to 5.6% during 1993-1997. The most frequent maternal pathology associated with gestation was previous cesarean section (60.5%), although 50% of the women had no underlying pathology.

CONCLUSIONS

In our setting, the rate of cesarean section followed by tubal ligation has been increasing steadily since the early 1980s. The proportion of women who requested tubal sterilization and who had only one living child, or who had had a previous cesarean birth, also increased.

Tubal sterilization in the United States, 1994-1996

CONTEXT

Although the number and rate of tubal sterilizations, the settings in which they are performed and the characteristics of women obtaining sterilization procedures provide important information on contraceptive practice and trends in the United States, such data have not been collected and tabulated for manyyears.

METHODS

Information on tubal sterilizations from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery was analyzed to estimate the number and characteristics of women having a tubal sterilization procedure in the United States during the period 1994-1996 and the resulting rates of tubal sterilization. These results were compared with those of previous studies to examine trends in clinical setting, in the timing of the procedure and in patient characteristics.

RESULTS

In 1994-1996, more than two million tubal sterilizations were performed, for an average annual rate of 1 1.5 per 1,000 women; half were performed postpartum and half were interval procedures (i. e., were unrelated by timing to a pregnancy). All postpartum procedures were performed during inpatient hospital stays, while 96% of interval procedures were outpatient procedures. Postpartum sterilization rates were higher than interval sterilization rates among women 20-29 years of age; interval sterilization procedures were more common than postpartum procedures at ages 35-49. Sterilization rates were highest in the South. For postpartum procedures, private insurance was the expectedprimary source of payment for 48% and Medicaid was expected to pay for 41 %; for interval sterilization procedures, private insurance was the expected primary source of payment for 68% and Medicaid for 24%.

CONCLUSIONS

Outpatient tubal sterilizations andprocedures using laparoscopy have increased substantially since the last comprehensive analysis of tubal sterilization in 1987, an indication of the effect of technical advances on the provision of this service. Continued surveillance of both inpatient and outpatient procedures is necessary to monitor the role of tubal sterilization in contraceptive practice.

Tubal sterilization and risk of breast cancer mortality in US women

OBJECTIVE

To investigate the hypothesis that tubal sterilization is associated with a reduced risk of breast cancer.

METHODS

We examined this hypothesis in a large prospective study of US adults. After 14 years of mortality follow-up, 3837 deaths from breast cancer were observed in a cohort of 619,199 women who were cancer-free at study entry in 1982.

RESULTS

Cox proportional hazards models (adjusted for multiple breast cancer risk factors) showed a significant inverse association between tubal sterilization and breast cancer mortality (adjusted rate ratio (RR) = 0.82, 95% confidence interval (CI) 0.70-0.96). Women who were sterilized before age 35 had a lower risk (adjusted RR = 0.69, 95% CI 0.53-0.88) than women who were sterilized at 35 years of age or older (adjusted RR = 0.92, 95% CI 0.75-1.13). Also, sterilizations performed before 1975 resulted in a lower risk (RR = 0.75, 95% CI 0.62-0.91) than those performed during or after 1975 (RR = 0.98, 95% CI 0.74-1.29), possibly reflecting the likelihood of greater tissue damage with earlier procedures.

CONCLUSIONS

These results suggest that tubal sterilization may lower subsequent risk of breast cancer, especially among women who are sterilized at a relatively young age. Additional studies are needed to confirm or refute these findings.

Union status, marital history and female contraceptive sterilization in the United States

CONTEXT

Much of what is known about the choice of sterilization as a contraceptive method is based on data from married women or couples. Because of increasing rates of cohabitation, divorce and repartnering, however, the relationship context in which sterilization decisions are made has changed.

METHODS

The 1995 National Survey of Family Growth includes the complete birth and union histories of 10,277 white, black and Hispanic women. The distribution of union status and marital history at the time of tubal sterilization was estimated for these three racial and ethnic groups among the 799 women who had had a tubal ligation in 1990-1995 before age 40. Cox proportional hazard regression models were used to estimate the effects of union status and marital history on the risk of tubal sterilization. The analysis controlled for the woman's age, parity, race and ethnicity education, region, experience of an unwanted birth and calendar period.

RESULTS

Among women who obtained a tubal sterilization, most whites (79%) and Hispanics (66%) were married when they had the operation, compared with only 36% of black women. At the time of their sterilization, 46% of black women had never been married. Among all women, regardless of race and ethnicity and net of all controls, the probability of tubal sterilization is about 25% lower for single, never-married women than for cohabiting or married women. Cohabitation does not reduce the likelihood in comparison to marriage, however. Higher rates of tubal sterilization among Hispanic women are accounted for by their higher parity at each age; differences in parity or marriage by race only partially account for the relatively higher rates of tubal sterilization among black women.

CONCLUSIONS

Because women currently spend greater proportions of their lives outside of marriage or in less-stable cohabiting partnerships than they did in the past, they are increasingly likely to make the decision to seek sterilization on their own. As a result, the gender gap in contraceptive sterilization will likely increase. The possibility of partnership change is an important consideration in choosing sterilization as a contraceptive method.

Profile of Indian women requesting reversal of sterilisation

This is a prospective clinical study carried out on 96 tubectomised women referred for microsurgical reversal to the Pandit BDS Postgraduate Institute of Medical Sciences, Rohtak and LHMC and SSKH, New Delhi. It was concluded that in developing countries high perinatal and child mortality rates are responsible for increased demands for reversal of sterilisation. Proper pre-operative counselling, age of the women, assessment of marital stability, family size and age of children are important before advocating sterilisation as a method of contraception.

Risk factors for uterine fibroids among women undergoing tubal sterilization

Uterine leiomyomas are reported to be the most common benign gynecologic tumors affecting premenopausal women, and they are often associated with considerable morbidity. The purpose of this study was to identify risk factors for uterine fibroids among women undergoing tubal sterilization. Cases comprised women aged 17-44 years whose uterine fibroids were first visualized at the time of tubal sterilization (1978-1979 or 1985-1987) or who reported a history of uterine fibroids (n = 317). Controls were randomly selected from women with no laparoscopic evidence of or history of fibroids (n = 1,268). Adjusted odds ratios were estimated using unconditional logistic regression separately for White (n = 1,235) and African-American (n = 350) women. Risk factors for White women included: age 40-44 years (odds ratio (OR) = 6.3; 95% confidence interval (CI): 3.5, 11.6), > or =5 years since last delivery (OR = 1.9; 95% CI: 1.1, 3.1), lifetime cigarette smoking of > or =1 pack/day (OR = 1.6; 95% CI: 1.1, 2.3), menstrual cycle length of >30 days (OR = 1.6; 95% CI: 1.1, 3.3), and menstrual bleeding for > or =6 days (OR = 1.4; 95% CI: 1.0, 2.0). Parous women were at reduced risk compared with nulliparous women (OR = 0.2; 95% CI: 0.1, 0.3). Advancing age was the only significant risk factor for African-American women (ages 40-44 years, OR = 27.5; 95% CI: 5.6, 83.6). Current oral contraceptive use and elective abortion were not associated with fibroids.

Factors affecting the selection of a reversible or an irreversible contraceptive method in a developing country

OBJECTIVES

To evaluate the factors that may affect the selection of a reversible or an irreversible contraceptive method.

METHODS

In an urban area of a developing country, demographic characteristics, educational and income levels, and previously used contraceptive methods were retrospectively reviewed for 3 years from the files of women who had chosen reversible or irreversible contraceptive methods. Student's t test and the chi2 test were used to analyze the data obtained from the two groups of women.

RESULTS

Out of a total of 8078 women, 595 (7.4%) selected surgical sterilization, while 7483 (92.6%) preferred reversible methods such as intrauterine devices (38.1%), combined oral contraceptives (13.9%), condoms (40%) and Norplant (0.6%). Compared to those who preferred reversible methods, the women with surgical sterilization had a higher mean age (33.9 +/- 4.2 years versus 29.6 +/- 3.9 years), mean gravidity (3.8 +/- 0.9 versus 2.3 +/- 1.2) and mean number of living children (2.6 +/- 0.8 versus 2.1 +/- 1.1) (p < 0.01). These women had also higher rates of high-school education (37.3% versus 30.1%) and previous modern contraceptive use (78.1% versus 71.2%) (p < 0.01). None of the women with surgical sterilization, but 1770 (33.0%) of those who chose reversible methods, had fewer than two living children.

CONCLUSIONS

These data suggest that irreversible contraceptive methods tend to be chosen by older women with higher educational levels, who have decided that their family is complete and who have at least two children.

Tubal sterilization: focus on the U.S. experience

OBJECTIVE

To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience.

DESIGN

A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications.

PATIENT(S)

Women seeking tubal sterilization.

INTERVENTION

Tubal sterilization.

MAIN OUTCOME MEASURE(S)

Effectiveness and long-term risks and benefits.

RESULT(S)

Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women.

CONCLUSION(S)

Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.

Women, men, and contraceptive sterilization

OBJECTIVE

To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices.

DESIGN

Multinomial logit regression of sterilization.

PATIENT(S)

Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Tubal sterilization and vasectomy.

RESULT(S)

Surprisingly high proportions of recent tubal sterilizations were performed on unmarried women: 1 in 3 overall, 1 in 5 among white non-Hispanic women, and 2 in 3 among black women. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilizations to vasectomies is extremely low in the Western region of the United States.

CONCLUSION(S)

Analysis of sterilization decisions must be based on time since the completion of childbearing. The findings call attention to the need for measuring variables that mediate observed associations with sterilization outcomes.

[Women and contraception: knowledge and use of contraceptive methods]

This article analyzes knowledge and use of contraceptive methods in women ages 10 to 49 years residing in the southern region of the city of São Paulo in 1992. A total of 1,157 childbearing-age women were studied, focusing on variables that might define them as to: knowledge in the use of contraceptive methods and reasons for choosing a given method. We observed that 86% of the women referred knowledge of some contraceptive method, while the most common was the pill (95.3%), followed by condoms (92.6%). Meanwhile, 14% of the interviewees denied knowledge of any contraceptive method. Of the sexually active women (66.4%), 34.9% reported never having used contraceptive methods. Of those who had, 35.3% used the pill, while 42.9% had resorted to sterilization. Only 5.2% used condoms. Despite the high level of knowledge concerning contraceptive methods, especially oral contraceptives and condoms, we observed limited use of same as compared to the high sterilization rate around the age of 27, thus leaving contraception limited to the pill and female sterilization.

Understanding the prevalence of female sterilization in rural south India

By analyzing the practice of female sterilization in rural Andhra Pradesh, in southern India, this article examines the role culture plays in demographic research. The popularity of female sterilization in rural Andhra Pradesh is shown to be intelligible if the symbolic value of a young mother's reproductive capacity is understood in terms of familial power relations. Through sterilization, young mothers can symbolically push their influential mothers-in-law toward old age, thus increasing their own relative prestige, and they can strive to control the ambiguity surrounding their reproductive functions. This study is based on 14 months of participant observation in three rural villages, a survey of 396 households, and unstructured interviews with 42 women and two men. It shows how demography and anthropology can be mutually supportive in their efforts to clarify population phenomena.

Sterilization and its consequences

The purpose of this review is to analyze critically the two techniques of sterilization (bilateral tubal ligation [BTL] and vasectomy) so that a physician may provide informed consent about methods of sterilization. A MEDLINE search and extensive review of published literature dating back to 1966 was undertaken to compare preoperative counseling, operative procedures, postoperative complications, procedure-related costs, psychosocial consequences, and feasibility of reversal between BTL and a vasectomy. Compared with a vasectomy, BTL is 20 times more likely to have major complications, 10 to 37 times more likely to fail, and cost three times as much. Moreover, the procedure-related mortality, although rare, is 12 times higher with sterilization of the woman than of the man. Despite these advantages, 300,000 more BTLs were done in 1987 than vasectomies. In 1987, there were 976,000 sterilizations (65 percent BTLs and 35 percent vasectomies) with an overall cost of $1.8 billion. Over $260 million could have been saved if equal numbers of vasectomies and BTLs had been performed, or more than $800 million if 80 percent had been vasectomies, as was the case in 1971. The safest, most efficacious, and least expensive method of sterilization is vasectomy. For these reasons, physicians should recommend vasectomy when providing counseling on sterilization, despite the popularity of BTL.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians

LEARNING OBJECTIVES

After completion of this article, the reader will be able to predict the failure rates and likelihood of successful reversal of tubal ligation and vasectomy; to recall the difference in cost between the two sterilization procedures, and to describe the short-term and long-term complications associated with each of the two methods of sterilization.

Hormone replacement therapy and risk of epithelial ovarian cancer

It has been suggested that oestrogen replacement therapy is associated with risk of epithelial ovarian cancer of the endometrioid type. Using data from an Australian population-based case-control study, the relation between unopposed oestrogen replacement therapy and epithelial ovarian cancer, both overall and according to histological type, was examined. A total of 793 eligible incident cases of epithelial ovarian cancer diagnosed from 1990 to 1993 among women living in Queensland, New South Wales and Victoria were identified. These were compared with 855 eligible female controls selected at random from the electoral roll, stratified by age and geographic region. Trained interviewers administered standard questionnaires to obtain detailed reproductive and contraceptive histories, as well as details about hormone replacement therapy and pelvic operations. No clear associations were observed between use of hormone replacement therapy overall and risk of ovarian cancer. Unopposed oestrogen replacement therapy was, however, associated with a significant increase in risk of endometrioid or clear cell epithelial ovarian tumours (odds ratio (OR) 2.56; 95% confidence interval (CI) 1.32-4.94). In addition, the risk associated with oestrogen replacement therapy was much larger in women with an intact genital tract (OR 3.00; 95% CI 1.54-5.85) than in those with a history of either hysterectomy or tubal ligation. Post-menopausal oestrogen replacement therapy may, therefore, be a risk factor associated with endometrioid and clear cell tumours in particular. Additionally, the risk may be increased predominantly in women with an intact genital tract. These associations could reflect a possible role of endometriosis in the development of endometrioid or clear cell ovarian tumours.

[Impact of contraceptive methods on women's lives: the case of tubal ligation]

This study focused on the long-term consequences of tubal ligation on women's lives. Women 30 to 49 years old living in Campinas, State of São Paulo (Brazil), were interviewed: 236 sterilized at least five years prior to the interview and 236 non-sterilized women. Their experiences with the currently used contraceptive methods were compared with regard to satisfaction, benefits, and damage attributed to the method, feelings of regret, and perception of effects on their health, body, menstruation, sex, affective and family life, job, studies, economic status, and self-esteem. Scores were created to compare the groups in relation to self-esteem, well-being/quality of life, relationship with partner, and gender issues. Satisfaction with the currently used contraceptive method was significantly higher among sterilized women, although they more frequently reported having regretted being sterilized at some moment in time. Relatively more sterilized women felt that the contraceptive method had improved their sex lives and economic status, while producing a negative effect on their menstruation. No significant difference was observed between the groups with regard to the scores studied.

[Reproductive characteristics of women from 15 to 49 years of age: comparative studies and planning for actions]

INTRODUCTION

The availability of socioeconomic, demographic and reproductive health data about women at national, regional and municipal levels allows comparisons between regions and may offer background information for planning actions of the Program of Integrated Assistance for Women's Health.

METHODS

A population-based cross-sectional study was carried out in Southern Brazil. Three thousand and two women aged 15 to 49 years living in an urban area in Pelotas, were selected for inclusion in the study. A structured questionnaire was used to collect the socioeconomic, demographic and reproductive characteristics. The analysis included comparison of means and proportions. In the sterilization analysis the data were controlled for age.

RESULTS

Nearly 56% of the women were married/in union and 35% were single. A third of them were housewives and 50% were wage workers. The mean of schooling was 8.5 years. Almost, half of the adolescents (15 to 19 years old) have an active sexual life, and of those 33% had already been pregnant. A high percentage of unwanted pregnancy was reported, mainly among younger women. Near the end of their reproductive life (women aged 45 to 49 years) the mean of children per woman was 2.4. The most prevalent methods were pill and sterilization. Among married women or those living in consensual union, 15% had been sterilized. The sterilization rate increased with age and attained nearly 25% of women aged over 35 years; 29.6% of sterilized women had had a stillborn child and 18.3% a pre-term baby; 20% of husbands/partners did not accept the use of any contraceptive method.

CONCLUSIONS

The study results confirm the need for additional attention to and development of special programs for adolescents, improvements in the access to services, increase in the use of the contraceptive options already available and research and programatic actions related to the theme "men/reproductive health.

Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer

To evaluate patient compliance with Papanicolaou (Pap) smear screening after tubal ligation compared with other methods of birth control in patients who develop cervical cancer, a retrospective review of 262 women with cervical cancer diagnosed at age < or = 70 years was undertaken at the Albert Einstein College of Medicine from January 1987 to December 1995. Demographic data, stage of the disease, histologic type, history of smoking, history of sexually transmitted disease (STD), and birth control use were recorded. The Pap screening history was obtained from all the patients. Women who had a bilateral tubal ligation (BTL) were compared with those who did not have this form of birth control. The date and result of their last Pap test prior to their diagnosis of cervical cancer was noted. Two hundred fourteen women with cervical cancer were evaluable. The clinical stage, mean age, history of smoking, and history of STD were similar for both groups. Gravidity among the BTL group was higher than in the non-BTL group (p < 0.01). Forty-eight (22.4%) women had a previous BTL. Twenty-seven of these 48 patients (56.3%) did not have a Pap smear within 3 years prior to the diagnosis of cervical cancer. Of the 166 patients, 61 (36.7%) did not have a Pap test within 3 years (p < 0.05). Fourteen women (29.2%) in the tubal ligation group never returned for a Pap test following the BTL. An average of 6.2+/-5.9 years elapsed since the last Pap test in the BTL group, with 4.0+/-5.1 years in the nontubal ligation group (p < 0.05). There was a correlation between the number of years since BTL (14.2+/-7.7) to the number of years since the last Pap test (6.2+/-5.9) (p < 0.05). Women who have had a BTL should be considered high risk because of poor screening compliance. A Pap test every 3 years is not adequate in this high-risk population group. We advocate improved counseling regarding the importance of continued annual Pap screening for women who are considering tubal ligation.