Articles: disease.
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Recent concern about the safety of combined oral contraceptives (OCs) with third-generation progestagens prompted an examination of data from a population-based case-control study (Leiden Thrombophilia Study). We compared the risk of deep-vein thrombosis (DVT) during use of the newest OCs, containing a third-generation progestagen, with the risk of "older" products. We also investigated the influence of family history of thrombosis, previous pregnancy, age, and the thrombogenic factor V Leiden mutation. ⋯ Use of low-dose OCs with a third-generation progestagen carries a higher risk of DVT than the previous generation of OCs. The absolute risk of DVT associated with these OCs seems to be especially high among carriers of the factor V Leiden mutation and among women with a family history of thrombosis. However, the higher risk associated with OC with a third-generation progestagen compared with previous generations was also present in women without factor V Leiden and with no family history.
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Two hundred and twelve patients were admitted because of complications of induced abortions. 58% of those abortions had been performed outside designated health institutions despite the liberalisation of the abortion law in Ghana about ten years ago. Ghanaian society still seems to perceive abortions as illegal or unethical and hence to be procured clandestinely. The overall mortality rate was 2.4% whilst the case fatality rate for septic abortions was over three times this rate. ⋯ Suspicion of ectopic pregnancy must always be borne in mind if undue delay in their management is to be avoided in all cases of complicated induced abortions especially when the patients have risk factors. None of the patients used a modern contraceptive method over the three months preceding the index pregnancy and post-arbortal contraceptive counselling was infrequent. Effective and widespread contraceptive use and continuing education of doctors remain pivotal if the incidence of abortions and their complications are to be reduced.