Edith Guilbert

Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec

OBJECTIVE 1) To determine the likelihood of sterilization reversal and of subsequent sterilization after sterilization reversal among men and women and 2) to examine the likelihood of pregnancy after sterilization (contraceptive failure) and of pregnancy after sterilization reversal. METHODS Payment data from the Quebec provincial health insurance system were obtained for each person undergoing vasectomy or female sterilization from January 1, 1980 to December 31, 1999 and linked through a unique identifying number for each person. Using standard techniques of survival analysis, we computed the cumulative probability of experiencing each of six events. RESULTS Among women, 0.9% (of 311,960) experienced a pregnancy after sterilization, 1.8% (of 321,929) obtained a reversal after sterilization, 61% (of 4369) achieved a pregnancy after sterilization reversal and 48% achieved a delivery; 23% (of 4677) obtained a subsequent sterilization after reversal. Among men, 2.4% (of 310,827) obtained a reversal after vasectomy and 18% (of 6694) obtained a subsequent vasectomy after reversal. All of these risks were much higher among those in the youngest age groups. CONCLUSION Sterilization reversal and pregnancy after sterilization are not rare. Relatively high rates of reversal among the youngest age groups suggest a need for better counseling about alternative contraceptive strategies

Comparison of Abortions Induced by Methotrexate or Mifepristone Followed by Misoprostol

OBJECTIVE To compare the effectiveness, side effects, and acceptability of medical abortions induced by methotrexate and misoprostol with abortions induced by mifepristone and misoprostol. METHODS This was a multicenter, randomized, non‐blinded, controlled trial comparing 50 mg/m2 of methotrexate followed 4–6 days later by 800 μg of vaginal misoprostol with 600 mg of oral mifepristone followed 36–48 hours by 400 μg of oral misoprostol. RESULTS There were 518 women in the methotrexate group and 524 women in the mifepristone group. In the methotrexate group, 21 women required suction curretage, two for continuing pregnancy, eight because of physician request (usually for excessive bleeding), and 11 because of patient request. In the mifepristone group, 22 women needed surgical termination, 17 because of physician request, and five because of patient request. By day 8, only 386 (74.5%) in the methotrexate group had completed the abortion compared with 474 (90.5%) in the mifepristone group, and the mean number of days from beginning to completion was 7.1 for methotrexate and 3.3 for mifepristone (P ≤ .001). There were no differences in complications, and side effects were similar. Acceptance was slightly higher with mifepristone (88.0%) than with methotrexate (83.2%). CONCLUSION Abortions induced with mifepristone completed faster than those induced with methotrexate, but the overall success rates, side effects, and complications were similar. Acceptance rates were slightly higher with mifepristone than methotrexate (P = .03).

Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception, 2007

Abstract Objective To serve as a guideline for health care providers on the use of continuous and extended combined hormonal contraception regimens, to prevent pregnancy, and to delay menses that affect health-related quality of life. Options All combined hormonal contraceptive methods available in Canada that may be used in a continuous or extended regimen are reviewed, and the implications are discussed. Outcomes Efficacy of cited regimens and assessment of their side effects, patient safety, medical usage and non-contraceptive benefits, cost-effectiveness, and availability in Canada. Indications for patient counselling are also provided Evidence Medline, PubMed, and Cochrane Database were searched for articles published in English between 1977 and May 2007. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. Values The quality of evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs The guideline is intended to help reduce unintended pregnancies and improve health-related quality of life in women who find their menses problematic. Increased awareness and empowerment of women, their partners, and health care professionals will improve their ability to make appropriate choices between continuous or extended and cyclic usage of these regimens. Sponsors The development of this guideline has been supported by unrestricted grants from Bayer HealthCare Pharmaceuticals, Janssen Ortho, Organon Canada Ltd., Paladin Labs Inc., Pfizer Canada Inc., and Wyeth Pharmaceuticals.

Cost savings from Emergency contraceptive pills in Canada

Objective To estimate cost savings from emergency contraceptive pills in Canada. Methods We modeled cost savings when a single emergency contraceptive treatment was provided after unprotected intercourse and when women were provided emergency contraceptive pills in advance. Results Each dollar spent on a single treatment saved

Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial

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Assessment of Satisfaction With Induced Abortion Procedure

2.35 (in Canadian currency), depending on the regimen and on assumptions about savings from costs avoided by preventing mistimed births. The dedicated products Preven (Shire Canada, Inc., Oakville, Ontario) and Plan B (Paladin Labs, Inc., Montreal) were cost-saving even under the least favorable assumption that mistimed births prevented today occur 2 years later. Each dollar spent on advance provision of Preven saved

A fatal case of Clostridium sordellii septic shock syndrome associated with medical abortion.

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Cycle control on low-dose oral contraceptives: A comparative trial

12.23, depending on the regular contraception method, on how consistently emergency contraception was used when needed, and on whether mistimed births were averted forever or simply delayed. Plan B was almost always cost-saving, although less so. Conclusion Emergency contraception was cost-saving whether provided when the emergency occurred or in advance to be used as needed. More extensive use of emergency contraception could save considerable medical costs by reducing unintended pregnancies.

Missed Hormonal Contraceptives: New Recommendations

Objective  To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion.

Contraceptive application of The Bioself fertility indicator

This study was designed to assess womens satisfaction with the abortion procedure at a family planning clinic in Quebec City. Overall satisfaction was quite high, especially for women who brought someone with them for social support. Preparation was a key element of satisfaction for all women. However, other factors underlying satisfaction were different for women who were accompanied and those who came alone. The results of this study may give clinic personnel incentives and ideas to improve the quality of care and to answer specific needs of their clientele.