Lack of symptoms in early-stageovarian cancer leads to a high mortality rate overall. Tests and therapy are discussed here, along with the symptom index.
Postcoital contraception can play an important role in the prevention of unwanted adolescent pregnancy in the US. Diethylstilbestrol (DES), 25 mg twice daily for 5 days within 24 to a maximum of 72 hours after unprotected sexual intercourse, received US Food and Drug Administration (FDA) approval for pregnancy prevention in 1973. In 1978, however, the manufacturer, Eli Lilly, included in its packaging instructions that DES should not be used for postcoital contraception given the development of clear-cell adenocarcinoma of the vagina or cervix in the daughters of women who took DES to prevent spontaneous abortion. The FDA had not withdrawn its approval of DES for this purpose. Other drugs that have been effectively used for postcoital contraception include 0.5 mg of norgestrel and 0.05 mg of ethinyl estradiol (2 tablets within 72 hours of unprotected intercourse and another 2 tablets 12 hours later) and conjugated estrogens. This approach to pregnancy prevention sidesteps many of the medical and moral complexities associated with use of the abortifacient RU-486. In fact, the Catholic bishops of Great Britain have approved the use of postcoital contraception in women who are victims of sexual assault.
A growing number of US women are delaying childbirth until their late 30s. Pregnant women 35 years old face various risks including genetic disorders, prenatal medical and obstetric complications, intrapartum complications, and perinatal and neonatal morbidity and mortality. With each passing year, the risk of chromosomal abnormality such as Down's syndrome increases. Physicians perform chorionic villus sampling (CVS) between 9-11 weeks gestation and amniocentesis between 16-18 weeks to detect chromosomal abnormalities. CVS carries the higher risk of spontaneous abortion (1-2%). 35-year old pregnant women are more likely to suffer from hypertension and gestational diabetes than younger women. Yet their incidence remains at an acceptable level. Older pregnant women tend to also be at risk of several antepartum obstetric complications such as gestational bleeding, abruptio placentae, and placenta previa. The likelihood of cesarean section and dysfunctional labor is greater among 35-year old pregnant women. Between 1974 and 1978, older mothers were 4 times more likely to die than young mothers, but by 1982 the overall maternal mortality rate fell by 50%. The main causes of death among older mothers were hemorrhage, embolism, and hypertensive conditions. Positive effects of advanced maternal age were less worry about and better adjustment to pregnancy, cautiousness, and more likely to consult their physicians. Advanced maternal age tends not to effect neonatal outcome other than chromosomal anomalies. Physicians should not allow the pregnancy of 35-year old mothers to go beyond 42 weeks' gestation. Despite the minimal increased risks, 35-year old women should not allow their advanced age to be an absolute barrier to reproductive decisions. Obstetricians should conduct thorough and appropriate antepartum testing and surveillance, however.
The obstetrician-gynecologist clinic should provide easy access for the disabled patient such as a hydraulic pelvic examination table. In most cases, disability does not affect sexuality, menstruation, or fertility but may change the level of interest and activity. Thus the physician should include sexual counseling even for abled patients with disabled partners. He/she should document the informed consent process to make sure it is legal and ethical. He/she must do a thorough evaluation of each disabled patient and her needs and develop a special protocol for each patient. The physician must know those disabled conditions that limit pelvic examination ability an contraindicate some contraceptives. Oral contraceptives (OCs) and progestin implants are contraindicated in women with spinal cord injury (SCI), disabled by a stroke, and with neurologic disorders that inhibit mobility in the lower extremities and cause circulatory disorders. Depending on individual circumstances, physicians should not advise OC use for women who are mentally retarded, mentally ill, or are drug abusers since they either do not understand, cannot remember, or are not motivated to take OCs regularly. Progestin implants may be a viable option for drug abusers, the mentally ill, and mentally retarded women. Once the US Food and Drug Administration approves injectable progestational agents, they could be another option for these women. The IUD is contraindicated in women who have no sensory capabilities and could not notice an ectopic pregnancy and pelvic infection. This may include women with some neurologic disorders, stroke, SCI, and multiple sclerosis. It is also contraindicated in women who have a blood disease, use anticoagulants, or have AIDS. Barrier methods could be used if a disabled patient or a partner is able to put them in place. In some cases, sterilization may be justified on medical grounds.
A less-publicized aspect of the famed Louisiana abortion bill would have outlawed the use of IUDs and oral contraceptives (OCs), a provision that ignores the difference between contraceptives and abortifacients. The bill, which was vetoed by Governor Buddy Roemer, stirred widespread controversy in its effort to sharply restrict abortion. Many of those involved in the discussion -- including the State Attorney General's office -- have contended that IUDs and OCs induce abortions by destroying fertilized eggs. But such statements disregard scientific studies that indicate that both contraceptive methods work by preventing fertilization. Research has shown that IUDs, especially copper-IUDs, restrict the transport of sperm, thereby preventing fertilization. One study revealed the presence of sperm in the fallopian tubes of non-IUD users 15-30 minutes after insemination, but found no sperm in the tubes of IUD users. Inhibiting ovulation, OCs work through a combination of estrogen and progestin. OCs prevent fertility by activating various mechanisms: they suppress the release of certain hormones, and cause a thickening of the cervical mucus which impairs sperm motility. Although neither IUDs nor OCs can be considered abortifacients, a small but vocal minority has succeeded in obscuring this fact. And it is the role of science to resolve the controversy by making the facts clear.
