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Biomedical subjects

I C Chi

Publications and source records attributed to I C Chi.

At least 19 recordsLinked to original sources
PubMed1992

The progestin-only oral contraceptive--its place in postpartum contraception.

The progestin-only oral contraceptive (POC) is not a widely-used method of contraception, possibly due to competition from other contemporary contraceptive methods or misunderstanding and prejudices among clients and/or service providers. Because of its underuse, the POC, as a contraceptive method, is under-studied. This article evaluates the general merits of the POC and its disadvantages relative to combined oral contraceptives (COCs) and other contraceptive methods, specifically during the postpartum period and particularly for breastfeeding women. We find that the POC appears to be a safe and acceptable contraceptive method for postpartum women who are fully or nearly fully breastfeeding at six months postpartum or when menstruation returns. The POC could be considered for use at any time by non-breastfeeding postpartum women. The need for empirical studies of the POC is also discussed.

Contraception↗
PubMed1992

Immediate postpartum intrauterine device insertion--a report on the Chinese experience.

Immediate postplacental insertion (IPPI) of the intrauterine device (IUD) has been practiced in China for at least 17 years. This presentation reviews and integrates the clinical experiences of IPPIs at five Chinese centers. The stainless-steel ring IUD was the most commonly used device for this procedure. Our review indicates that: (a) IPPIs-both after vaginal delivery and at cesarean section-are medically safe and effective in preventing accidental pregnancies (given careful patient selection), and (b) the one-year life-table expulsion rates of IUDs inserted at cesarean section are lower than the rates for vaginal insertions after normal delivery. This review also discusses other issues, such as factors influencing expulsion rates. Generally, IPPIs, whether performed via vagina or cesarean section, seem to be a method of choice for postpartum contraception. Some findings are, however, tentative; thus, further studies are needed.

Adult↗
PubMed1992

Conducting a hospital-based case-control study of the relationship between vasectomy and cardiovascular disease in Korea--an experience in an Asian setting.

An increasing number of case-control studies are being performed in the developing world. This paper describes the difficulties and advantages the author has experienced in conducting a hospital-based case-control study in the Republic of Korea testing the hypothesis of whether vasectomy is associated with subsequent cardiovascular disease. This experience should provide a useful reference for researchers planning studies using a similar approach in an Asian setting.

Adult↗
PubMed1992

The multiload IUD--a U.S. researcher's evaluation of a European device.

This evaluative review focused on the performance and safety of the Dutch-made Multiload copper IUD, primarily the Multiload-375 (MLCu-375) model which has a longer life expectancy (5 or more years) than the Multiload-250 (MLCu-250) model, usually cited for a life expectancy for three years. This copper-medicated IUD differs from the copper-T IUDs in shape and insertion technique. The review shows that (a) the MLCu-375 IUD seems to be slightly less effective in preventing pregnancies than TCu-380A IUD. Its efficacy is comparable to that of the Nova-T by two to three years of use; (b) the MLCu-250 IUD is similarly effective to TCu-200 but may be slightly less effective than TCu-220C; (c) no consistent differences were detectable in expulsion rates or in removal rates for bleeding/pain between the Multiload IUDs and comparative Copper-T IUDs; (d) the Multiload IUDs may perform better in nulliparous women than the T-shaped devices; (e) no or a very low incidence of uterine perforation is associated with insertions of the Multiload IUD; (f) ectopic pregnancy risks are similarly low in Multiload IUD users as in Copper-T-380A users; and (g) pelvic inflammatory disease (PID) risks are similarly low in Multiload IUD users as in users of T-shaped copper IUDs.

Evaluation Studies as Topic↗
PubMed1992

Risk factors for copper T IUD expulsion: an epidemiologic analysis.

Little is known of the factors associated with expulsion of intrauterine devices (IUD). We conducted a nested case-control study to examine the risk factors for copper T IUD expulsion using data from a multicenter international clinical trial. We included 70 cases with expulsion and 1,536 controls, and we examined a variety of characteristics of the IUD wearers. The proportional hazards model showed that young maternal age, abnormal amount of menstrual flow and dysmenorrhea before IUD insertion are risk factors for copper T IUD expulsion. The risk of expulsion steadily increased as age decreased, and as the severity of dysmenorrhea increased.

Adolescent↗
PubMed1992

Performing tubal sterilizations during women's postpartum hospitalization: a review of the United States and international experiences.

A considerable number of tubal sterilizations have been performed while women are still in hospital after delivery in the United States as well as in other countries. There are few review papers exclusively on this sterilization modality. This paper provides a comprehensive review of results reported from recent studies of this approach, and answers the pertinent medical and related questions such as: To achieve maximum safety, what is the best time to perform the procedure during the women's postpartum hospitalization? Specifically, is it advisable for the procedure to be performed while the woman is still on the delivery table? What surgical approach and tubal occlusion technique are preferred? What are the risks that the women undergoing sterilization immediately or soon after delivery may incur the short- and long-term medical sequelae, and to conceive accidental pregnancy? What effect does sterilization have on lactation? And how should the women be screened and counseled to prevent poststerilization regret, generally thought to be more likely to occur in women after postpartum sterilization? Newly-developed mechanical tubal occlusion techniques have been included for consideration. Practical guidelines are given in this paper to help service providers achieve maximum safety and satisfaction for their patients with this convenient and low-cost method of postpartum sterilization.

Anesthesia↗
PubMed1991

The Nova-T IUD--a review of the literature.

The Nova-T IUD is being widely used in Western Europe, Canada, and some parts of Asia; numerous studies based on comparative trials with other types of IUDs have been reported. The results were consistent among most studies, but conflicting among others. This review paper revealed that, in general, the Nova-T IUD is a safe, effective, and acceptable device for contraception. However, more comparative studies with the other copper-releasing IUDs are needed to resolve some of the controversial findings on its long-term (e.g., five years or more) efficacy, especially with the TCu 380A which has the prospect of being used worldwide. The epidemiological (e.g., effects of age, parity, and lactating status of the women) and programmatic aspects (e.g., provider factors and timing of insertion) related to the performance of this device are also reviewed in this paper.

Adult↗
PubMed1991

An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs.

The levonorgestrel-releasing IUD (LNG-IUD-20), providing a daily dose of 20 ug, has recently been approved for marketing in Finland. The IUD's high efficacy in preventing accidental pregnancy and other numerous positive features make it a promising contraceptive device for worldwide use, just like the currently available T-shaped copper-releasing (TCu) IUDs. This paper reviews published reports comparing the LNG-IUD-20 and the currently used TCu IUDs. The merits and disadvantages of the steroid-releasing IUD are evaluated in terms of its performance and other special features relative to the TCu IUDs. Also, a number of future studies with medical and programmatic importance are proposed. A broader understanding about these two IUD families will facilitate their use in a complementary way for family planning programs.

Drug Evaluation↗
PubMed1991

Timing of postpartum tubal sterilization using the Filshie clips: an analysis of data from two developing-country centers.

Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.

Developing Countries↗
PubMed1991

Immediate postpartum IUD insertions in a Chinese hospital--a two year follow-up.

A data set consisting of 199 immediate postpartum IUD insertions performed at the Xuan Wu Hospital, Beijing, China was analysed in terms of insertion route, category of inserting personnel and device type. IUD expulsion and continuation of use were the outcome events of interest in this study. Based on our findings, the following hypotheses were derived for future confirmative studies: lower expulsion rates and hence, higher continuation rates of immediate postpartum IUD insertions are associated with (1) insertions through the abdominal incision wound for women who had a cesarean delivery as compared to immediate (less than 10 min) vaginal insertions in women with vaginal delivery; (2) obstetrician insertions, as compared to midwife insertions, and (3) use of the Delta T, as compared to that of the Delta Loop. For the derivation of the latter two hypotheses, only the vaginal insertions were studied.

Adult↗
PubMed1990

Do retroverted uteri adversely affect insertions and performance of IUDs?

A large international multi-center IUD data set (N = 5520) coordinated by Family Health International was analysed to determine if the uterine position of a woman (anteverted, mid-positioned or retroverted) affects the ease of IUD insertion and if knowledge of uterine position would diminish insertion-related problems and improve IUD performance. Findings showed that insertion-related events were rare irrespective of uterine position. Women with retroverted uteri were not associated with higher termination rates for accidental pregnancy, expulsion or removal for bleeding and/or pain after 12 months of IUD use, as compared to the other two uterine position groups. All insertions in this data set were performed by experienced obstetricians/gynecologists, and our findings suggest that women with retroverted uteri should be equally good candidates for IUD contraception.

Adult↗
PubMed1990

Is the copper T 380A device associated with an increased risk of removal due to bleeding and/or pain? An analysis.

Previous studies have consistently shown that the family of the Copper T 380 devices is more effective in preventing accidental pregnancies than the inert, as well as most other, if not all, copper devices. However, a number of these studies also reported a higher removal rate due to bleeding and/or pain for the TCu 380A than for other devices. The programmatical importance of these findings prompted us to analyze the international multi-center randomized clinical trial datasets to examine this question on the new TCu 380A (ParaGard) recently marketed in the U.S. Our results, while confirming the inherent superior efficacy of the TCu 380A, did not reveal a significantly higher removal rate because of bleeding and/or pain among TCu 380A users than among users of the comparative devices, which included the Lippes Loop D, the TCu 200, the TCu 220 and the Multiload Cu 250 devices.

Adolescent↗
PubMed1990

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea.

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.

Adult↗
PubMed1990

Vasectomy and cardiovascular deaths in Korean men: a community-based case-control study.

This community-based case-control study was carried out in four cities in South Korea to examine whether vasectomy is associated with a long-term increased risk of cardiovascular death in Korean men. Our results coincide with those from epidemiological studies conducted in Western countries as well as the one study conducted in China and do not support the vasectomy--atherosclerosis hypothesis originating from animal research.

Adult↗
PubMed1989

Postpartum IUD contraception--a review of an international experience.

Postpartum insertion of intrauterine contraceptive devices (IUDs) performed while women are still in hospital has a number of advantages. Earlier reports, however, generally associated this procedure with high expulsion rates. Recent studies, on the other hand, have shown that if IUDs are inserted immediately (within 10 minutes) after placental delivery, it is safe and effective. In some experienced centers, fairly low expulsion rates are reported. In this paper the experiences with postplacental IUD insertions from international studies are reviewed, the lessons we have learned from these experiences summarized, and future research directions suggested.

Cross-Cultural Comparison↗
PubMed1989

Insertional pain and other IUD insertion-related rare events for breastfeeding and non-breastfeeding women--a decade's experience in developing countries.

The possible effect of breastfeeding on intrauterine device (IUD) insertion events was investigated. Analysis included a total of 6493 women who enrolled in multicenter IUD clinical trials over a ten-year period. Findings indicate that breastfeeding exerts a protective effect on the incidence of moderate to severe insertional pain and reduces the need for cervical dilatation to facilitate insertion. The pain protection effect was most evident in breastfeeding women who were still in lactational amenorrhea. Subjects with amenorrhea, both breastfeeding and non-breastfeeding, had a significantly lower incidence of pain at IUD insertion than the corresponding menstruating subjects. This effect may be related to a higher secretion of beta-endorphin in the breastfeeding and lactational amenorrheic subjects.

Breast Feeding↗
PubMed1989

Performance of the copper T-380A intrauterine device in breastfeeding women.

The effect of breastfeeding on performance of the TCu-380A IUD was evaluated using data derived from multicenter clinical trials. Insertion events for breastfeeding women (N = 559) and non-breastfeeding women (N = 590) were compared as well as discontinuations of IUD use through six months following insertion. Results indicate that breastfeeding women inserted with a TCu-380A are more likely than non-breastfeeding women to have a smooth, pain-free insertion, few postinsertion bleeding and pain problems, and a high rate of continuation of IUD use. There were no uterine perforations reported from either group of women.

Adult↗