Deaths from contraceptive sterilization in bangladesh: rates, causes, and prevention.

This report summarizes the second of 2 epidemiologic investigations of deaths attributable to sterilization in Bangladesh. All deaths resulting from sterilizations performed nationwide between September 16, 1980, and April 15, 1981, were investigated and analyzed. Nineteen deaths from tubal sterilization were attributed to 153,032 sterilization operations (both tubal sterilization and vasectomy), for an overall death-to-case rate of 12.4 deaths per 100,000 operations. This rate is lower than that (21.3) for operations performed in Dacca and Rajshahi Divisions from January 1, 1979, to March 31, 1980, although this difference is not statistically significant. Anesthesia overdosage, tetanus, and hemorrhage were the leading causes of death. Improvements in anesthesia management, surgical asepsis, and postoperative monitoring of vital signs should make sterilization operations even safer. Although tubal sterilizations performed in Bangladesh cost some lives, they avert far more maternal deaths. The net health impact is strongly favorable: For every 100,00 tubal sterilizations performed, approximately 100 deaths are prevented.

Effectiveness of various drugs in controlling bleeding after IUD insertion.

PIP: The National Research Institute of Family Planning of Pakistan in April 1967 initiated a study to determine what drugs and other variables might aid in reducing IUD postinsertion bleeding. 768 women were admitted to the study after the insertion of a polyethylene plastic Lippes loop. Each woman was given 1 of the following medications (double-blind test) in a packet: 1) Vitamin-K (10 mg tid for 21 days), 2) Vitamin-C (50 mg tid for 21 days), 3) ferrous sulfate (.3 mg tid for 21 days), 4) Lyndiol (2.5 mg daily for 21 days), and 5) placebo (glucose-filled gelatin capsules, 1 daily for 21 days). 623 (81%) of the patients returned for the first-month follow-up. Second- and third-month follow-ups had far fewer returns; data analysis was thus restricted to the first month only. 4% of the loops were removed for bleeding. 91.5% reported some degree of postinsertion bleeding. Bleeding was reported as minimal or spotting and slight bleeding (less than normal menstrual flow), normal menstrual flow, or heavy bleeding and clots (more than normal menstrual flow). More of the young clients (ages 25-29) returned than expected (249 vs. 222.3); fewer of the older clients (ages 40-44) returned than expected (31 vs. 52.7). Ferrous sulfate was most effective in shifting the control pattern of bleeding to a pattern skewed to lesser degrees of bleeding. The least bleeding was reported for insertion 1-3 months postpartum. With regard to the time since the onset of the last menstrual period, insertion during lactation amenorrhea gave the best results, and insertion prior to Day 13 was much better than insertion during the last half of the cycle.^ieng