Pouru P. Bhiwandiwala

A comparison of different laparoscopic sterilization occlusion techniques in 24,439 procedures

This investigation assessed the safety and efficacy of five laparoscopic tubal occlusion techniques for female sterilization: electrocoagulation, the tubal ring via conventional and open laparoscopy, the prototype spring-loaded clip, and the Rocket clip. The 24,439 cases make up a data set collected by collaborating staffs at 64 institutions in 27 countries. The five techniques were compared with respect to six commonly evaluated parameters. Rates of surgical difficulties ranged from 2.4% to 12.5% (5.1% overall); rates of surgical complications, from 0.7% to 2.7% (1.7% overall); and rates of technical failures, from 0.6% to 1.0% (0.8% overall). Twelve-month life-table pregnancy rates were less than one per 100 women years. Prospective data on six menstrual parameters revealed that the menstrual cycles of the majority of women were unchanged after sterilization; for those who reported a change, approximately half experienced a change in one direction and half in the other direction. For example, one half reported an increase in the amount of menstrual flow, and one half reported a decrease in the amount of flow. The reported incidence of subsequent pelvic operations was less than 1% at each long-term follow-up. These data indicate that laparoscopic sterilization is safe and effective and that none of the studied techniques has a distinct advantage.

Menstrual pattern changes following laparoscopic sterilization with different occlusion techniques: A review of 10,004 cases

A comparison is made of menstrual pattern changes reported by 10,004 women undergoing interval and postabortion sterilization by the laparoscopic occlusive techniques of unipolar electrocoagulation, the tubal ring, the prototype spring-loaded clip, and the Rocket clip. Controlling for prior contraceptive use, the menstrual patterns in these women sterilized by the four techniques were compared with respect to six parameters: cycle regularity, cycle length, menstrual flow duration, amount of flow, dysmenorrhea, and intermenstrual bleeding. The majority of women reported no menstrual changes subsequent to sterilization. When changes were experienced, they occurred in equal proportions in opposite directions. Depending on the parameter, from 15% to 79% of the menstrual pattern changes seen within 6 months after sterilization in women who were using oral contraceptives or intrauterine contraceptive devices at the time of sterilization could be attributed to the discontinuation of those methods of contraception. There were no significant differences between the several occlusion technique groups with respect to the proportion of women who reported changes in their menstrual patterns after sterilization.

Breast-feeding and the return to ovulation in Durango, Mexico *

Twenty-nine breast-feeding mothers and 10 non-breast-feeding postpartum comparison mothers from a rural area of Mexico were followed longitudinally until ovulation resumed. A simple set of guidelines is described involving three obvious milestones for the breast-feeding mother to safely use the natural contraceptive benefit of breast-feeding. Those milestones are: the first vaginal bleeding episode, the initiation of supplementation, and the childs monthly birthday. In the absence of bleeding and supplementation, 100% of breast-feeding mothers remained anovular for 3 months postpartum, 96% for 4 months, 96% for 5 months, and 96% for 6 months. This suggests that, if a mother understands these three conditions, she can use breast-feeding alone as effectively as modern family planning methods for the prevention of pregnancy.

Preliminary observations on the return of ovarian function among breast-feeding and post-partum non-breast-feeding women in a rural area of Mexico

The relationship between the return of menstruation and ovulation and the pattern of breastfeeding was studied in a group of 29 women in a rural area of Mexico; 8 non-breast feeding post-partum women were also studied. The return of ovulation was assessed by weekly determinations of urinary pregnanediol. The number of suckling episodes and supplementary feeds was recorded. The cumulative probability of resumption of menses for the breastfeeders was 28% and 52% at 3 and 6 months respectively and for the non-breastfeeders was 75% and 88%. The cumulative probability of ovulation for the breastfeeders was 28% 66% 69% and 72% at 3 6 9 and 12 months respectively and for the non-breastfeeders was 50% and 100% at 3 and 6 months. The earlier the introduction of supplements the earlier the return of ovulation. The non-ovulatory subjects maintained a higher frequency of suckling episodes than did the ovulatory subjects. The cumulative probability of pregnancy for the breast-feeders was 3% 7% 7% and 10% at 3 6 9 and 12 months respectively and for the non-breast-feeders was 13% 38% and 50% at 3 6 and 9 months. (authors modified)

A comparative study of intra-amniotic saline and two prostaglandin F2α dose schedules for midtrimester abortion

The efficacy, side effects, and complications of two intra-amniotic PGF2alpha dose schedules and the unaugmented intra-amniotic instillation of saline are compared. All three methods resulted in satisfactory rates of abortion within a relatively short period of time and within clinically acceptable rates of complications. Each method has its advantages and disadvantages. Further large comparative studies were needed.

Menstrual therapies in Commonwealth Asian law.

Under English law, acting with the intention to procure an abortion whether a woman is pregnant or not is a crime. Laws in Commonwealth Asia governing abortion apply only in cases where a woman is clearly pregnant. Accordingly, menstrual therapies are available without violating abortion laws, or having to comply to their conditions. This permits doctors under such laws to exercise considerable discretion in recourse to menstrual therapies.

Mortality associated with sterilization: Preliminary results of an international collaborative observational study

Sterilization is the contraceptive method most widely used worldwide, yet the case‐fatality rate of deaths attributable to sterilization is not known. We used data collected from 1971–1979 from 28 countries by Family Health International to estimate case‐fatality rates. We adjusted these rates for individuals lost to follow‐up.

Menstrual pattern changes following minilap/Pomeroy, minilap/ring and laparoscopy/ring sterilization: a review of 5982 cases.

Menstrual pattern changes experienced by 5982 women subsequent to sterilization by the techniques of minilap/Pomeroy, minilap/tubal ring and laparoscopy/tubal ring were tabulated. Controlling for prior contraceptive use, we examined data on the following six menstrual parameters at the time of sterilization compared to reports at follow‐up visits 6 and 12 months after surgery: cycle regularity, cycle length, menstrual flow duration, amount of flow, dysmenorrhea and intermenstrual bleeding. Our findings suggest that minilap sterilization does not cause menstrual pattern changes.