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Biomedical subjects

M J Sparrow

Publications and source records attributed to M J Sparrow.

At least 19 recordsLinked to original sources
PubMed1999

Condom failures in women presenting for abortion.

AIMS: To document the main reasons for condom failure in women presenting for first trimester termination of pregnancy. METHODS: From 1990-97 an audit was carried out, on the 3283 cases personally operated on by the author, using the information routinely obtained during pre-operative counselling. RESULTS: Two sets of figures were obtained. The first (minimum figures) were restricted to those who used condoms on every occasion of coitus (746 or 22.7% of all women seen). The second (maximum figures) included all of these plus those who did not use condoms on every occasion or who used condoms in conjunction with another method (1494 or 45.5% of all women seen). In this expanded group, there was no obvious cause for the failure in 446 (29.9% of condom users). The main reason for failure was not using condoms every time (736 or 49.3% of condom failures). Leakage of semen occurred in 321 cases (21.5% of condom failures) and 104 of these had used emergency contraception which had also failed (7.0% of condom failures). Condoms failed more often in women under 25 years of age. CONCLUSIONS: There is a need for better education on correct condom use and improved availability of emergency contraception. There is also a need for greater standardisation in reporting contraceptive failure.

Abortion, Legal↗
PubMed1998

Pill method failures in women seeking abortion: fourteen years experience.

AIMS: To document predisposing factors in 769 women who had inadvertently conceived while taking oral contraceptive pills reliably. METHODS: Over a 14-year period, 1981-1995, two questionnaires were administered, one for women using the combined oral contraceptive pill (COC) and one for women using the progestogen only pill (POP). RESULTS: More than one predisposing factor was usually present, the most common being diarrhoea and/or vomiting in 39.0%. Antibiotics had been prescribed in 20.5%. COC failure was associated with a high incidence of menstrual disturbance (37.1%). A history of a previous pill failure was obtained in 27.8%. Smoking was a risk factor for women on the COC. Only 6.0% became pregnant during the first month of pill use. As expected, POP users experienced a higher number of pill failures in proportion to the market share, but excess weight and time of taking did not appear to be risk factors. Most COCs failed according to the numbers expected from the market share. CONCLUSIONS: Many pill failures could be averted by better information about known or suspected risk factors, especially gastrointestinal upset and interacting medications. Pill failure is one more reason to discourage smoking in COC users.

Abortion, Induced↗
PubMed1998

Vaginal dinoprostone versus oral misoprostol for predilatation of the cervix in first trimester surgical abortion.

Prostaglandins are effective in predilatation of the cervix prior to first trimester surgical termination of pregnancy under local analgesia. Arandomized open comparative trial was devised to compare the effectiveness and acceptability of vaginal dinoprostone with oral misoprostol. Two groups were randomized to control for age, parity and ethnicity. The operation was easier and less painful in older, parous, and Polynesian women. Both methods were effective with respect to ease of dilatation. Both were acceptable and equal with respect to the level of pain experienced by the woman during the operation. Vaginal dinoprostone is more gradual in its action, but it is more expensive, has to be refrigerated and self-insertion may sometimes cause problems. Oral misoprostol is considerably cheaper and does not require refrigeration, but it was associated with more preoperative nausea, cramping and occasional heavy bleeding.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

The use of behavioral methods of contraception in women seeking abortion.

AIMS: To determine the extent to which behavioural methods, used alone or with other methods of contraception, contribute to contraceptive failure in women seeking termination of pregnancy. METHOD: A clinical audit was conducted of the use of behavioural methods of contraception, in 1342 women attending the Parkview Clinic for termination of pregnancy, over a four year period 1992-6. The information was obtained through standard interview and patient records. RESULTS: The women seen were representative of New Zealand women undergoing termination of pregnancy. Approximately one third of women (34.9%) used one or more behavioural methods in the month prior to conception. The two most common methods were periodic abstinence and coitus interruptus, both used by approximately 17%. Other methods used less frequently and not solely for contraceptive purposes, were cleansing of the vagina and breastfeeding. Pacific Island and Asian women were more likely to use behavioural methods than European and Maori women. Many women (45.6%) using behavioural methods also used other methods of contraception, especially the condom. CONCLUSIONS: Behavioural methods were found more commonly than previously reported. Greater understanding of the use of behavioural methods will assist in the implementation of preventive programmes to reduce the number of terminations.

Abortion, Legal↗
PubMed1997

A trial of two methods of taking cervical smears: the Aylesbury spatula plus cytology brush compared to the Cervex broom.

AIMS: To compare the adequacy of cervical smear taking, using the Aylesbury spatula plus cytology brush with the Cervex broom. METHODS: Two cervical smears were taken at the same visit, the women acting as their own controls. In Group 1 comprising 81 women, the first smear was taken using the Cervex broom. In Group 2 comprising 97 women, the first smear was taken using the Aylesbury spatula followed by the cytology brush. The tips of the samplers were sent to the laboratory in a cytology container with 30% ethyl alcohol in saline, for analysis of residual cells. RESULTS: It took experienced staff two or three smears before they were adept at taking an adequate Cervex broom sample as defined by the presence of endocervical cells. Both techniques were equally good at detecting significant abnormalities. When the Cervex broom was used first there were more smears with no blood present but when bleeding occurred there was no significant difference between the two groups. Both techniques were well accepted by the women. CONCLUSIONS: Although it is more expensive than the Aylesbury spatula and the cytology brush the Cervex broom has the advantage of allowing a simple one step procedure, thereby reducing the potential for air drying.

Female↗
PubMed1994

Breakage and slippage of condoms in family planning clients.

Information was obtained from 540 clients on the 3,754 occasions when condoms were used over a one-month period. One or more major problems, breakage, slippage, leakage or a combination of these, occurred in 410 (10.9%) events, involving 217 (40.2%) clients. Breakage occurred in 209 (5.6%) events and slippage in 243 (6.5%). Leakage was almost always associated with breakage or slippage. There was a small group of accident prone clients. Breakage was more common in younger and inexperienced clients and in those who had previously experienced breakage. There were some differences in breakage rates between brands of condoms. Poor fitting condoms and non-spermicidal condoms were associated with more breaks. Other contributing factors included vigorous sex, dryness and tearing with fingernails. Additional lubrication did not protect from breaks and saliva was associated with more breaks than expected. Oil-based lubricants were associated with less breaks than expected. On many occasions (66.0%), clients were aware of the break before ejaculation occurred. Slippage was more common in the inexperienced and in those who had previously experienced slippage. There was no association between brand of condom and slippage but poor fitting condoms were associated with more slips. The most common reason for slippage was the condom being left on too long. Additional lubrication did not affect slippage.

Adolescent↗
PubMed1992

Prevalence of genital human papillomavirus infection in Wellington women.

OBJECTIVES: To determine prevalence of human papillomavirus (HPV) in Wellington women, to identify risk factors for HPV infection, to correlate presence of HPV with cervical cytology, and to identify characteristics of women infected with HPV but with normal cytology. DESIGN: Demographic, social, personal and clinical data were collected by a confidential self-administered coded questionnaire. The presence of DNA from HPV types 6/11, 16 + 18 and 31 + 33 in cervical scrapes was determined by dot-blot DNA hybridisation. All data were correlated with cervical cytology results. SETTING AND SUBJECTS: Two thousand and twenty one women attending family planning clinics in the Wellington region participated in the study. The mean age of participants was 26 years, 33.3% currently smoked, 72.3% used hormonal contraceptives, 31.4% were married, and 91.4% were of European origin. RESULTS: We found 10.9% of the study group infected with HPV. HPV types 16 and/or 18 predominated, being detected in 71.5% of HPV-positive women either alone or with other types. Of those infected 26.2% had multiple infections. Dysplasia (n = 87) or atypia (n = 84) were observed in 26.7% of infected women (n = 221) and 6.25% of uninfected women (n = 1792). Over 8% of women with normal smears were HPV positive, and types 16/18 were most common in these women. CONCLUSIONS: Women with cervical dysplasia or atypia were six times more likely to have HPV infection than other women. The main risk factor for HPV infection, particularly with types 16 and/or 18, was multiple (> 5) sexual partners in the last year independent of other variables. Multivariate analysis of data showed no independent association between HPV infection and ethnicity, educational background, smoking history, marital status, contraceptive use, age at first sexual intercourse, or number of lifetime sexual partners.

Adolescent↗
PubMed1991

Trends in the contraceptive practices of women seeking abortions in the 1980s.

The demographic features and contraceptive practices of 1000 women attending Parkview clinic of Wellington Hospital for termination of pregnancy were studied over an eight month period in 1988-9. Comparisons were made with a previous study at the same clinic in 1980-1. The overall abortion rate has increased from 6.8/1000 women in the Wellington statistical area in 1981 to 9.8 in 1989. The proportion of Pacific Island and Asian women presenting for abortions is high and has increased disproportionately between 1981 and 1989. The abortion rate has also increased in lower socioeconomic groups in 1989. The proportion of women using contraception at the time of conception increased from 50% in 1981 to 68.5% in 1989. The methods used by women presenting for abortion have changed significantly. There has been an increase in the proportion of women using condoms (from 13.3% to 36.2%) and the oral contraceptive pill from (14% to 21.4%).

Abortion Applicants↗
PubMed1990

Premenstrual syndromes defined by symptom-sets.

An analysis is made of the pattern of presenting premenstrual symptoms in randomly selected general practice patients from the Wellington region, New Zealand. Participants, 1826 healthy women 16-54 years old whose characteristics were reasonably representative of the adult female population, were asked about their general, obstetrical and gynaecological health. For the 1456 women who had menstruated within the last month or so, detailed questions were asked about the last menstrual cycle. Each woman was assigned to one of seven premenstrual symptom sets. Three groups had 'pure' symptoms, ie a predominant single symptom (breast tenderness, bloating or irritability). Three groups had 'mixed' symptom-sets. The largest of the 'mixed' groups was formed by the women who reported breast tenderness, bloating and irritability together with tension and depression. Women in this group were most likely to rate their symptomatology as severe. The last group contains a large number of women with miscellaneous symptoms. Characteristics of these groups are outlined. The study highlights the importance of distinguishing among premenstrual syndromes as this can foster more effective clinical management.

Adolescent↗
PubMed1989

Pregnancies in reliable pill takers.

This study is an extension of a previous study on oral contraceptive pill method failure in reliable pill takers. It documents 137 cases which presented during the 3 year period from December 1985 to December 1988. The most important new finding is that smoking is a significant risk factor in failure on the combined pill (67% were smokers, n = 118), but not on the progestagen-only pill, although the numbers in the latter group were small (n = 19). Diarrhoea and/or vomiting (46%) and drug interactions (33%) are confirmed as important predisposing factors. Systemic illness and/or severe psychological stress may also affect pill utilisation and such factors were found in 47%. Menstrual disturbances were found in 32% of women on the combined pill and 68% of these were smokers. Multiple factors were present in most cases (79%). Repeat failures occurred in 25%.

Adolescent↗
PubMed1989

Postcoital contraception: a family planning study.

The New Zealand Family Planning Association undertook a prospective study of Yuzpe's postcoital method of contraception (0.1 mg ethinyloestradiol and 1 mg d1-norgestrel taken within 72 hours of unprotected intercourse and repeated 12 hours later). The study also used pills containing levonorgestrel. Both pill formulations were equally effective. All participants were drawn from six family planning branches throughout the country. The study covered a period of one year. There were 909 participants with 8% lost to follow up. Strict criteria excluded women on medication or hormone therapy. The ages ranged from 11 to 43 years with 92% aged 19 years and under. Results revealed an overall failure rate of 2.3% and a significantly higher failure rate (4.49%) if the method was taken after 48 hours of unprotected intercourse and a significantly lower failure rate (1.22%) if taken before 12 hours of unprotected intercourse. Vomiting occurred in 17% but it did not affect the failure rate.

Adolescent↗
PubMed1989

Treatment of premenstrual symptoms in Wellington women.

A survey of 1826 women in the Wellington region was carried out. Participants were asked about their general and gynaecological health, as well as detailed questions about their last menstrual cycle. The majority (1456) had had a menstrual period within the last month or so. Eighty five percent of these women noted premenstrual symptoms of some kind, and were asked about a variety of self-help measures, and medical help, for these, and whether the advice and/or treatment was in fact helpful. Nine hundred and ninety women had tried self-help while four hundred and sixteen had sought medical help. The most commonly tried self-help measures were exercise, rest and vitamin B6. Half the women had tried each of these. Overall, there was a marked placebo response, but exercise, rest and keeping a written diary of symptoms were all helpful in over eighty percent of those who tried them. Doctors offered a wide range of treatments, including vitamin B6, diuretics, oral contraceptives and mefanamic acid, but the effect of these was difficult to evaluate further. When the sample was subdivided into clusters of women who shared similar symptoms, significant differences in the effectiveness of different self help measures emerged. Four different premenstrual syndromes are suggested: PMS-breast, PMS-bloat, PMS-irritable and intolerant, and PMS-various.

Adolescent↗
PubMed1987

The prevalence of premenstrual symptoms in Wellington women.

A survey of 1826 women in the Wellington region was carried out. Participants were asked about their general and gynaecological health and their menstrual, contraceptive and obstetric history. Detailed questions were asked about the menstruating women's last menstrual cycle. Subjects were premenopausal women attending a random sample of general practice surgeries for any reason. The achieved sample is not intended as a cross-section of the Wellington community, but is nevertheless reasonably representative of the general adult female population aged 20 to 45. Most women volunteered one or more premenstrual symptoms; and about half of the women said these symptoms were such that they affected their lives.

Adolescent↗
PubMed1987

Pill method failures.

This is a study over a four year period from November 1981 to December 1985 documenting 163 cases of pill method failures in reliable pill takers. In over one third of these cases (36%) there were no predisposing factors. Significant factors which were associated with failure were diarrhoea and/or vomiting in 35%, and breakthrough bleeding on the combined pill in 21%. While there is controversy in the literature about the role of antibiotics in causing pill failure, this study found 23% of failures associated with antibiotic use. Two failures occurred on anticonvulsant medication. Recommendations are made for improved instructions to patients.

Abortion, Induced↗
PubMed1982

The contraceptive practice of one thousand abortion patients.

This is a report on the contraceptive practice of 1000 cases who attended the Parkview clinic for termination of pregnancy. Fifty percent were not using any method of contraception at the time of conception. The principal reasons for non-use were dissatisfaction with previous methods and risk taking behaviour. Fifty percent became pregnant while using contraception, and in 20 percent methods which are generally regarded as reliable had been used. Fourteen percent were using the pill at the time of failure and this group is studied in greater detail. Improvements in contraceptive practice are suggested.

Abortion Applicants↗
PubMed1980

The contraceptive practice of abortion patients.

An analysis is made of the contraceptive practice of 100 women prior to abortion. Half the women were not using any method during the month they became pregnant. Problems with the pill, risk-taking behaviour and fears of infertility, were the commonest reasons for non-use. In the 50 percent who were using a method, failure was most commonly due to human error and to the use of less reliable methods. Psychological and social factors were seen to be important determinants of behaviour. This study emphasises the need for remedial action.

Abortion, Induced↗