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Biomedical subjects

H W Ory

Publications and source records attributed to H W Ory.

At least 37 records · Page 2Linked to original sources
PubMed1983

Deaths attributable to tubal sterilization in the United States, 1977 to 1981.

In 1979, the Centers for Disease Control began surveillance of deaths attributable to tubal sterilization in order to determine why they occur and what may be done to prevent them. Since that time, 29 such deaths have been identified as occurring in the United States from 1977 through 1981. Of these 29 deaths, 11 followed complications of general anesthesia, seven were due to sepsis, four were due to hemorrhage, three were due to myocardial infarction, and four deaths were related to other causes. Some of these deaths might have been prevented by use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, safer use of unipolar coagulation or use of alternative techniques, careful insertion of the needle and trocar for laparoscopy, and discontinuation of oral contraceptives before sterilization. Further surveillance may help to make tubal sterilization even safer.

Adult↗
PubMed1983

Ectopic pregnancy in the United States 1970 through 1978.

Trends of the incidence and mortality associated with ectopic pregnancy (EP) in the United States were examined for 1970 through 1978. The estimated number of EPs rose from 17,800 in 1970 to 42,400 in 1978, and the EP incidence rate rose from 4.5 per 1,000 reported pregnancies to 9.4 during the same time period. The risk of EP was higher for older women and nonwhite women. Over 2.5% of all reported pregnancies among nonwhite women aged 35 to 44 years were ectopic. The death-to-case rate for EP declined almost 75% during the study period but remained consistently higher for nonwhite women as compared with white women.

Abortion, Induced↗
PubMed1983

The safety and efficacy of tubal sterilization: an international overview.

This article presents a synthesis of some of the major published studies on the efficacy and safety of tubal sterilization. The conclusions of this overview are that tubal sterilization is a safe operation, long-term sequelae of tubal sterilization have not been well documented, and the risk of pregnancy following tubal sterilization is less than 1 in 100. Continued study is needed to determine how to make a safe and effective procedure even safer and more effective.

Female↗
PubMed1983

Agreement between women's histories of oral contraceptive use and physician records.

The histories of oral contraceptive (OC) use provided by women participating in a study of hepatocellular adenoma (HCA) were compared with records obtained from their physicians. In the HCA study two memory aids were used to assist women in their recall: a calendar of significant events during a woman's lifetime to which she might relate her use of OCs and a book of colour photographs of the 90 OC preparations available up to the time of the study. Using the number of months of a woman's history which could be checked against physician records (mean for all women of 33 months) as the denominator, the highest proportion of concordance was for month-specific duration of OC use (90%) with lower agreement for duration and brand (62%) and duration, brand, and dose (54%). Agreement was better for cases than for controls.

Adult↗
PubMed1983

Risk of wound and pelvic infection after laparoscopic tubal sterilization: instrument disinfection versus sterilization.

To determine if disinfection, rather than sterilization, of laparoscopic equipment leads to an increase in the risk of postlaparoscopy infection, the authors analyzed data from a multicenter prospective study conducted by the Centers for Disease Control on the safety of sterilizing operations. From September 1978 through July 1981, 3903 women underwent laparoscopic tubal sterilization procedures in which the equipment was sterilized with ethylene oxide (58%) or disinfected with glutaraldehyde (42%). The overall risk of wound infection in each group was 1.5 per 100 women. The relative risk of wound infection for disinfection versus sterilization of the equipment was 0.5 when adjusted for differences in the two groups. The corresponding relative risk of pelvic infection was 1.2. These results suggest that laparoscopy equipment disinfected with glutaraldehyde is not associated with an increased risk of wound or pelvic infection compared with equipment sterilized with ethylene oxide.

Adolescent↗
PubMed1983

Menstrual changes after tubal sterilization.

The authors used data from a multicenter prospective study of female sterilization surgery to study changes in menstrual function following tubal sterilization. Duration of menstrual bleeding, menstrual cycle length, cycle regularity, amount of menstrual bleeding, menstrual pain, and intermenstrual bleeding were examined. The authors followed 2456 women for two years after tubal sterilization surgery. Each woman served as her own control; her menstrual function at the two-year follow-up interview was compared with her menstrual function at the preoperative interview. Except for menstrual pain among women who underwent unipolar electrocoagulation procedures, there was no increase in the prevalence of adverse menstrual function after tubal sterilization. For all menstrual variables, 50% or more of women with adverse function preoperatively had an improvement by two years after tubal sterilization.

Adolescent↗
PubMed1983

Type of intrauterine device and the risk of pelvic inflammatory disease.

To study the association of pelvic inflammatory disease and various types of intrauterine devices (IUDs), data from the Women's Health Study were analyzed. The analysis included data from interviews of 622 women hospitalized with an initial episode of pelvic inflammatory disease and 2369 hospitalized control subjects reporting no history of pelvic inflammatory disease. Compared to the risk in women using no contraception, the relative risk of pelvic inflammatory disease in women currently using the Dalkon Shield was 8.3 (95% confidence limits 4.7 to 14.5). This represented a fivefold increase in risk compared to women currently using other types of IUDs. In this study, only 10% of women wearing an IUD were using the Dalkon Shield, yet they accounted for almost 20% of the excess risk of pelvic inflammatory disease occurring among all the IUD users. Most of the increased risk of pelvic inflammatory disease for women currently using other IUDs (excluding the Dalkon Shield) occurred in the first four months after insertion. These associations were not explained by differences between cases and controls in demographic variables, level of sexual activity, or medical history. The authors recommend that women still using a Dalkon Shield have it removed.

Female↗
PubMed1983

Risk factors for complications of interval tubal sterilization by laparotomy.

The complication rate among 282 women undergoing interval tubal sterilization by laparotomy was studied as part of the prospective multicenter Collaborative Review of Sterilization. Using a standard definition of major complications, the overall complication rate was 5.7 per 100 procedures. Women experiencing complications had a significantly lengthened postoperative recovery period before the resumption of normal activities. Important risk factors for complications included diabetes, cigarette smoking, previous abdominal or pelvic surgery, and a history of pelvic inflammatory disease. Women with an initial abdominal incision of 7 cm or longer had three times the complication rate of women with shorter incisions. These results provide objective evidence that, for tubal sterilizations, minilaparotomy (laparotomy with a small abdominal incision) is associated with lower morbidity than is conventional laparotomy.

Abdomen↗
PubMed1982

Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.

Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade, few recent studies have been conducted to determine the risk of complications. We examined data from the Collaborative Review of Sterilization, a prospective, multicenter, observational study coordinated by the Centers for Disease Control, to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches. Between September, 1978, and August, 1981, 1,851 women from nine institutions were included in the study. Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group. Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity, bleeding requiring transfusion, hospitalization, and convalescence than abdominal hysterectomy. Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinically appropriate.

Adolescent↗
PubMed1982

Oral contraceptives and pelvic inflammatory disease.

To study the association of the use of oral contraceptives and pelvic inflammatory disease (PID), we analyzed data from a large multicenter case-control study of contraceptive use and serious gynecologic disorders. The analysis included data from interviews of 648 women hospitalized with an initial episode of PID and 2,516 hospitalized control subjects. The risk of PID for women using oral contraceptives in the 3 months prior to interview was 0.5 (95% confidence limits, 0.4 to 0.6) relative to women using no contraceptive method during this period. This association was not explained by differences between case subjects and control subjects in demographic variables, level of sexual activity, or medical history. The protective effect of current oral contraceptive use against PID was restricted to women using oral contraceptives for more than 12 months; past use of oral contraceptives did not exert a protective effect against PID. Annually, an estimated 50,000 initial cases of PID are prevented by oral contraceptive use; 12,500 hospitalizations are also averted by oral contraceptive use. Consequently, protection against PID is one of the most important noncontraceptive benefits of oral contraception.

Adolescent↗
PubMed1982

Hysterectomy among women of reproductive age. Trends in the United States, 1970-1978.

An estimated 3.5 million women aged 15 to 44 years in the United States underwent hysterectomy (excluding radical procedures) between 1970 and 1978. Data from the National Center for Health Statistics were used to study the influence of age, race, and geographic region on hysterectomy rates, surgical approach, and concurrent oophorectomy. The number and rate of hysterectomies increased between 1970 and 1972 but remained stable thereafter. Hysterectomy rates increased with age, and rates for black women slightly exceeded the rates for whites. Rates were consistently highest for women in the South and lowest for women in the Northeast. Women undergoing hysterectomy in the Northeast had the lowest percentage performed by a vaginal approach and the highest percentage performed in conjunction with bilateral oophorectomy. Women having a hysterectomy in the West had the highest percentage performed by a vaginal approach.

Adolescent↗
PubMed1982

Barrier-method contraceptives and pelvic inflammatory disease.

The protective effect of barrier-method contraception against pelvic inflammatory disease (PID) was examined by analyzing data from the Women's Health Study, a large multicenter case-control study. We compared the contraceptive methods used by 645 women hospitalized for initial episodes of PID with the contraceptive methods used by 2,509 control subjects reporting no history of PID. The risk of hospitalization for PID in women currently using barrier methods relative to women using all other methods and to women using no method of contraception was 0.6 (95% confidence limits, 0.5 to 0.9) for both comparisons. This protective effect was observed for both chemical and mechanical barrier methods, although it was not statistically significant for the former. The prevention of PID and its sequelae is one of the most important noncontraceptive benefits of barrier methods of contraception.

Adolescent↗
PubMed1982

Mortality risk associated with tubal sterilization in United States hospitals.

Despite the millions of women who have undergone tubal sterilization in United States hospitals, little has been published about the risk of death from these procedures. To estimate a case-fatality rate of tubal sterilization, we combined data from the Commission on Professional and Hospital Activities and the National Center for Health Statistics with a review of the clinical circumstances for each woman whose death was identified as being potentially sterilization attributable. Considering all deaths temporally associated with tubal sterilization, we estimate that the case-fatality rate is nearly 8/100,000 procedures. When only deaths determined to be attributable to the sterilization operation per se are considered, the case-fatality rate is approximately 4/100,000 procedures, making death attributable to tubal sterilization a rear event.

Epidemiologic Methods↗
PubMed1982

Cumulative prevalence rates and corrected incidence rates of surgical sterilization among women in the United States, 1971--1978.

The authors used data from the 1970 National Fertility Survey and Centers for Disease Control surveillance of surgical sterilizations to estimate the cumulative prevalences of hysterectomy and tubal sterilization among women of reproductive age in the United States between 1971 and 1978. In 1978, the cumulative prevalence rate of tubal sterilization was more than twice as high for women aged 15--44 years as it was in 1971 and at least three times as high for women under 30. Although the increase in the cumulative prevalence rate of hysterectomy was not as marked, by 1978, 19% of women aged 40--44 had undergone hysterectomy. The authors used the cumulative prevalence rate to estimate the population at risk for surgical sterilization, and calculated the corrected incidence rates for these procedures. While corrected incidence rates of tubal sterilization among women aged 15--44 doubled between 1971 and 1978, corrected hysterectomy rates remained stable. The largest age-specific increase in incidence rates of tubal sterilization was among women 40--44, with rates six times higher in 1978 than in 1971. These findings can be used to recompute incidence rates of endometrial and cervical cancers, abortions, and ectopic pregnancies, allowing more precise analysis of related trends.

Adolescent↗
PubMed1982

Demographic trends in tubal sterilization: United States, 1970-1978.

In the period 1970-1977, an estimated 4,236,000 women 15-44 years of age had tubal sterilization operations in United States hospitals. Both the number and the rate of tubal sterilizations increased each year from 1970-1977, but in 1978 both declined. Tubal sterilization rates for Black women were higher than for White women. Black women also tended to be younger at the time of tubal sterilization. For the nation as a whole, the mean age at the time of tubal sterilization remained constant at about 30 with the youngest age group having the highest proportion of never-married women.

Adolescent↗
PubMed1982

Death following puncture of the aorta during laparoscopic sterilization.

Lacerations of major vessels have been associated with use of the Veress needle and sharp trocar for laparoscopy. A death caused by puncture of the aorta during insertion of a Veress needle is reported. Deaths from major vessel laceration can be prevented by using proper technique for inserting the needle and trocar or choosing alternative methods of sterilization that do not require these instruments. Should major vessel laceration occur, prompt recognition and treatment may prevent death.

Adult↗