Clifford R. Kay

The effect of induced abortion on subsequent pregnancy outcome

Objective— To investigate the effect of induced abortion on the outcome of the next pregnancy.

Combined oral contraceptives and liver disease

Although some information is available about the risk of liver tumors associated with combined oral contraceptive use, little is known about the relationship with other hepatic problems. Data from two large long-term observational studies, the Royal College of General Practitioners (RCGP) Oral Contraception Study and the Oxford-Family Planning Association (Oxford-FPA) Study, were used to examine this issue. Observations accumulated over a period of up to 27 years were available for each study. The incidence of liver disease in each study was low. There was no evidence of an increased risk of serious liver disease overall among current or former pill users. The RCGP study found a modest increased risk of mild liver disease associated with oral contraceptive use which declined after four years of use and after cessation of use. This increased risk occurred in women who had used oral contraceptives containing more than 50 micrograms of estrogen.

Outcome of pregnancy following induced abortion Report from the joint study of the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists

Summary. A total of 1590 general practitioners and 795 gynaecologists in England. Scotland and Wales are participating in a long‐term, prospective study concerning the sequelae of induced abortion. In the present report a comparison is made between the outcome of the first post‐index pregnancy in 745 women whose index pregnancy ended in an induced abortion (cases) and that in 1339 women who had an unplanned index pregnancy but were not referred f o r induced abortion (controls). There were no statistically significant differences between cases and controls. The increased relative risk which was found amongst the induced abortion group of non‐viable outcome, low birthweight and shortened gestation, could have arisen by chance. Further analysis of a larger number of pregnancies is required to permit confident interpretation of these observations. The present data provide no reason for alterations in the current management of induced abortion, or the subsequent pregnancy.

Third generation oral contraceptive pills

Is the scare over the increased risk of thrombosis justified? Britains Committee on Safety of Medicines has issued a recommendation that combined oral contraceptives containing the so called third generation progestogens, desogestrel and gestodene, should no longer be routinely prescribed. The committee came to this conclusion after examining the data from three unpublished studies, two of which have not been completed. These studies--an international study organised by the World Health Organisation; the European transnational study of oral contraceptives, which is funded by the pharmaceutical company Schering AG; and a study of data from the United Kingdom general practice research database (formerly known as VAMP)--were designed to examine whether the risk of vascular disease in women taking the newer oral contraceptive pills differed from that in women taking the slightly older pills containing predominantly the progestogen levonorgestrel. …

Oral contraceptives and benign liver tumours.

An oral contraceptive study by the Royal College of General Practitioners recorded 216000 woman-years of observation. 116000 of these were related to takers or ex-takers of oral contraceptives. No case of liver tumor was found in women of childbearing age. The Oxford Family Planning Association follow-up study of women using different methods of contraception recorded 83000 woman-years of observation of which 40% related to oral contraceptive users. No case of liver tumor was identified. The Oxford Linkage study for the years 1970-1975 found no benign liver tumors in women of childbearing age in a population of over a million. The Scottish National Diagnostic Index for the years 1968-1974 recorded no liver tumors in women of childbearing age. However 1 consultant recalled seeing 1 such case which had been improperly recorded as a hematoma. Thus the authors have identified only 1 case of benign liver tumor in a woman of childbearing age. Therefore benign tumors of the liver are considered to be rare in both users and nonusers of oral contraceptives. Some reports have indicated that the risk of such tumors has increased with the duration of use of oral contraceptives.

The effect of induced abortion on subsequent fertility

Objective To investigate the effect of induced abortion on subsequent fertility.

Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study.

Summary. In a prospective cohort study of the long‐term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post‐recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy‐related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post‐index pregnancy in the cases there was an increased relative risk (RR 2·26) of the occurrence of urinary tract infection and a decreased risk (RR 0·25) of pregnancy‐related anaemia.

Comparison of cause of death coding on death certificates with coding in the Royal College of General Practitioners Oral Contraception Study.

A comparison has been made between the coding of the cause of death by (a) the Royal College of General Practitioners (RCGP) during the Oral Contraception Study and (b) the Office of Population Censuses and Surveys (OPCS) or the General Register Office for Scotland (GRO) on death certificates for the same subjects. Broad grouping of the International Classification of Diseases (ICD) showed close agreement between RCGP and OPCS or GRO coding for all deaths which occurred from the start of the Oral Contraception Study in 1968 up to December 1978. Moreover, where discrepancies occurred there were no systematic differences between ever-users of oral contraceptive and non-users. Detailed examinations of discrepancies in the coding of the causes of those deaths included in the RCGP publication of October 1977 shows that our previous estimate of mortality risk associated with oral contraceptives would not be materially altered by the use of death certificate information.