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This document is one of two evidence-based cornerstones of the World Health Organization's (WHO) new initiative to develop and implement evidence-based guidelines for family planning. The first cornerstone, the Medical eligibility criteria for contraceptive use (third edition) published in 2004, provides guidance for who can use contraceptive methods safely. This document, the Selected practice recommendations for contraceptive use (second edition), provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. The recommendations contained in this document are the product of a process that culminated in an expert Working Group meeting held at the World Health Organization, Geneva, 13-16 April 2004.
Presents almost 100 common and uncommon gynecologic problems encountered in urgent and emergency settings with an emphasis on practical management.
Medical Eligibility Criteria for Contraceptive Use reviews the medical eligibility criteria for use of contraception, offering guidance on the safety and use of different methods for women and men with specific characteristics or known medical conditions. The recommendations are based on systematic reviews of available clinical and epidemiological research. It is a companion guideline to Selected Practice Recommendations for Contraceptive Use. Together, these documents are intended to be used by policy-makers, program managers, and the scientific community to support national programs in the preparation of service delivery guidelines. The fourth edition of this useful resource supersedes previous editions, and has been fully updated and expanded. It includes over 86 new recommendations and 165 updates to recommendations in the previous edition. Guidance for populations with special needs is now provided, and a new annex details evidence on drug interactions from concomitant use of antiretroviral therapies and hormonal contraceptives. To assist users familiar with the third edition, new and updated recommendations are highlighted. Everyone involved in providing family planning services and contraception should have the fourth edition of Medical Eligibility Criteria for Contraceptive Use at hand.
Intrauterine devices (IUDs) have an antifertility effect in every animal tested, but this effect is manifested differently among the species. 6-8 million women use the IUD with a pregnancy rate in the United States of from 1.5-3/100 women during the first year of use. These rates decline with use. 80% will continue with the device in the first year, 70% for the second, and about 50% by the fifth year. Adverse reactions include irregular bleeding and cramps for the first 2-3 months and this accounts for 60% of removal. Pelvic inflammatory disease has been reported to be about 2.5% the first year, 1.5% during the second. Highest incidence was in the first month after insertion. The Committee recommended more stringent standards for inserters and devices and more care in insertion. A survey of the Fellows of the American College of Obstetricians and Gynecologists disclosed 15 instances of intestinal obstruction following perforation of the uterus, 13 in which the closed type IUD was used. "The Committee is adverse to the use of currently available closed devices, except in very unusual circumstances." Monitoring women wearing IUDs for cancer in the same manner as for normal women was suggested. The mortality figure for IUDs was .2/10,000 insertions. The current legislation under consideration by the Food and Drug Administration for certain classes of devices secured or placed in the body was considered satisfactory, with means for confidential reporting of adverse reactions recommended. The Committee recommended areas for further research. Task force reports and a bibliography of clinical reports on IUDs in the English literature 1959-1967 were presented. The report includes a list of available IUDs and exhibits of labeling submitted by some manufacturers.
The "contraceptive revolution" of the 1960s and 1970s introduced totally new contraceptive options and launched an era of research and product development. Yet by the late 1980s, conditions had changed and improvements in contraceptive products, while very important in relation to improved oral contraceptives, IUDs, implants, and injectables, had become primarily incremental. Is it time for a second contraceptive revolution and how might it happen? Contraceptive Research and Development explores the frontiers of science where the contraceptives of the future are likely to be found and lays out criteria for deciding where to make the next R&D investments. The book comprehensively examines today's contraceptive needs, identifies "niches" in those needs that seem most readily translatable into market terms, and scrutinizes issues that shape the market: method side effects and contraceptive failure, the challenge of HIV/AIDS and other sexually transmitted diseases, and the implications of the "women's agenda." Contraceptive Research and Development analyzes the response of the pharmaceutical industry to current dynamics in regulation, liability, public opinion, and the economics of the health sector and offers an integrated set of recommendations for public- and private-sector action to meet a whole new generation of demand.