Perioperative antibiotics to prevent infection after first-trimester abortion.

BACKGROUND: There are two main strategies for the prevention of post-abortal upper genital tract infection: antibiotics given around the time of surgery for all women; and 'screen-and-treat', in which all women presenting for abortion are screened for genital infections and those with positive results are treated. OBJECTIVES: To determine:1. the effectiveness of antibiotic prophylaxis in preventing post-abortal upper genital tract infection; 2. the most effective antibiotic regimen; 3. the most effective strategy. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, POPLINE and LILACS. The search was last updated in May 2011. SELECTION CRITERIA: Randomised controlled trials (RCTs) in any language including women undergoing induced first trimester surgical or medical abortion, comparing: 1) any antibiotic regimen to placebo, nothing, or another antibiotic; 2) screen-and-treat versus antibiotics. The primary outcome was the proportion of women diagnosed with post-abortal upper genital tract infection. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected references and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI). We used meta-analysis where appropriate and examined between trial heterogeneity using the I(2) statistic. In the presence of between trial heterogeneity we also estimated the 95% prediction interval (PI). MAIN RESULTS: A total of 703 unique items was identified. We included 19 RCTs. There was evidence of small study biases (Egger test, P = 0.002). In 15 placebo-controlled RCTs there was an effect of antibiotic prophylaxis (pooled RR 0.59, 95% CI 0.46 to 0.75, 95% PI 0.30 to 1.14, I(2) = 39%). There were insufficient data (three trials) to determine whether one regimen was superior to another. In one trial, the incidence of post-abortal upper genital tract infection was higher in women allocated to the screen-and-treat strategy (RR 1.53, 95% CI 0.99 to 2.36). AUTHORS' CONCLUSIONS: Antibiotic prophylaxis at the time of first trimester surgical abortion is effective in preventing post-abortal upper genital tract infection. Evidence of between trial heterogeneity suggests that the effect might not apply to all settings, population groups or interventions.This review did not determine the most effective antibiotic prophylaxis regimen. Antibiotic choice should take into account the local epidemiology of genital tract infections, including sexually transmitted infections.Further RCTs comparing different antibiotics or combinations of antibiotics with each other would be useful. Such trials could be done in low and middle income countries and where the prevalence of genital tract infections in women presenting for abortion is high.

Progestogen-only contraceptive use among breastfeeding women: a systematic review.

BACKGROUND: The use of progestogen-only contraceptives by breastfeeding women raises theoretical concerns regarding possible adverse effects on breastfeeding success, and infant health or growth. This review was conducted to determine from the literature whether use of progestogen-only contraceptives by breastfeeding women leads to adverse effects on lactation, or infant growth or health when compared to nonuse. STUDY DESIGN: We searched the Medline, Popline, Cochrane and LILACS databases for all articles published from database inception through May 2009. Studies were included if they investigated the use of progestogen-only methods in breastfeeding women and reported on clinical outcomes in either women or their infants. Standard data abstraction templates were used to systematically assess and summarize. Summary odds ratios were not calculated, given the heterogeneity of interventions, results and non-quantifiable outcomes reported. RESULTS: We identified 43 articles for this review. Overall, five randomized trials and 38 observational studies demonstrated no adverse effects of various progestogen-only methods of contraception on multiple measures of breastfeeding performance through 12 months in women using these methods in the postpartum period. Many of these studies also demonstrated no adverse effects of progestogen-only methods on infant growth, health or development from 6 months to 6 years of age. Additional studies demonstrated no effects on infant immunoglobulins or sex hormones of exposed male infants. A single study of a desogestrel pill reported two cases of gynecomastia in exposed infants. CONCLUSIONS: Evidence suggests that progestogen-only methods of contraception do not adversely affect breastfeeding performance when used during lactation. Evidence that progestogen-only contraception does not adversely affect infant growth, health, or development when used by breastfeeding women is consistent but methodologically limited.

Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease.

BACKGROUND: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy. STUDY DESIGN: We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated. RESULTS: Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies. CONCLUSIONS: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method.

The effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver: a systematic review.

BACKGROUND: This report evaluates the effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver. METHODS: PubMed and Cochrane databases were searched from inception to June 2008 for publications that examined the use of hormonal contraceptives among women with viral hepatitis or cirrhosis of the liver. RESULTS: Six studies met the inclusion criteria. In one study of acute hepatitis, combined oral contraceptive (COC) use did not affect duration of hospitalization or successful disease resolution. The remainder of the studies examined chronic hepatitis or its sequelae. Women recovered from hepatitis experienced transaminase elevation with COC use which resolved after 4 weeks in one study or increased slightly over 6 months in another study. Hepatitis B virus carriers using COCs had similar transaminase levels as nonusing carriers over 6 months. Studies of chronic hepatitis C infection demonstrated no influence of COC use on progression or severity of liver fibrosis or development of hepatocellular carcinoma. CONCLUSION: Data from one study suggest that COCs do not affect the course of acute hepatitis. Limited data from studies on chronic hepatitis or its sequelae suggest that COC use does not affect the rate of progression or severity of cirrhotic fibrosis, the risk of hepatocellular carcinoma in women with chronic hepatitis, or the risk of liver dysfunction in hepatitis B virus carriers.

Hormonal contraceptive use among women with liver tumors: a systematic review.

BACKGROUND: The review was conducted to evaluate from the literature the safety of hormonal methods of contraception in women with liver tumors, specifically in benign and malignant disease. STUDY DESIGN: We searched PubMed and Cochrane databases to find all articles published from database inception through July 2008 that were relevant to hormonal contraception use and liver tumors. RESULTS: Of 148 articles, three publications of two studies met the criteria for inclusion in this review; both investigated the use of hormonal contraception in women with the benign liver tumor focal nodular hyperplasia (FNH). In one small, retrospective case series, use of combined oral contraceptives (COCs) over a 4-year average follow-up was not associated with a change in either the number or size of hepatic lesions. In another case series, use of either COCs or progestogen-only contraceptives (POCs) after FNH diagnosis had no influence on disease progression or resolution. CONCLUSIONS: The studies identified examined oral contraceptive use among women with FNH. We did not identify any studies of hormonal contraceptive use among women with hepatocellular adenoma or with malignant liver tumors. Limited, poor-quality evidence suggests that for women with FNH, use of low-dose COCs or POCs does not appear to influence either liver lesion resolution or progression.

Prostate cancer and vasectomy: a hospital-based case-control study in China, Nepal and the Republic of Korea.

BACKGROUND: The study of a possible relationship between vasectomy and prostate cancer has yielded mixed results. Data from developing countries are limited. STUDY DESIGN: We conducted a hospital-based case-control study in China, Nepal and the Republic of Korea to evaluate the risk of prostate cancer after vasectomy. RESULTS: Prostate cancer in 294 cases (confirmed by independent pathologists) and 879 matched controls were included. The odds ratio of prostate cancer in men with a history of vasectomy was 1.21 [95% confidence interval (95% CI)=0.79, 1.87]. No significant trend was observed in risk by time since vasectomy or age at vasectomy. The odds ratio for localized disease was 1.02 (95% CI=0.53, 1.95); the odds ratio for later stages was 1.41 (95% CI=0.78, 2.53). No confounding factor was identified. The study illustrated differential misclassification of disease by vasectomy status; reference pathologists determined that 28% of men with a history of vasectomy, compared with 17% of men without a history of vasectomy, were misdiagnosed with prostate cancer by local pathologists. CONCLUSION: Vasectomy is not associated with an increased risk of prostate cancer in developing countries where the rate of the disease is low.