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In young women who had not been previously infected with HPV-16 or HPV-18, those in the vaccine group had a significantly lower occurrence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 than did those in the placebo group. (ClinicalTrials.gov number, NCT00092534 [ClinicalTrials.gov].).

Objective To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose.Design National historical registry based cohort study. Setting Four registries in Denmark.Participants Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009. Main outcome measures Relative and absolute risks of first time venous thromboembolism.Results Within 8 010 290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10 000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year. ConclusionAfter adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or drospirenone were at least at twice the risk of venous thromboembolism compared with users of oral contraceptives with levonorgestrel. IntroductionThe influence of specific types of combined oral contraceptives on the risk of thrombotic events remains the most important safety issue for these products. Several studies have investigated the relation between combined oral contraceptives and venous thromboembolism, including newer large scale studies. [17][18][19] These new studies showed an increased risk of venous thromboembolism in current users of combined oral contraceptives and a decreasing risk by both time of use and decreasing oestrogen dose. RESEARCHResults on the significance of the type of progestogen differed. Ten studies reported an increased relative risk of venous thromboembolism among users of oral contraceptives with desogestrel or gestodene compared with those containing levonorgestrel, 1 2 4-7 9 13 17 18 a difference that was significant in eight of the...

To cite this article: Jacobsen AF, Skjeldestad FE, Sandset PM. Ante-and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 2008; 6: 905-12.Summary. Objective: To study ante-and postnatal risk factors of venous thrombosis (VT) in pregnancy. Methods: A hospital-based case-control study. Cases were women with objectively verified VT during pregnancy or postpartum. Two controls were selected for each case. Validated risk factors were analyzed using chi-square test and logistic regression. Results: In total 559 cases with no prior VT, 268 ante-and 291 postnatal cases were identified together with 1229 controls. Risk factors for antenatal VT were assisted reproduction technique (ART), antepartum immobilization, cigarette smoking, and slight weight gain (<7 kg). Conception after ART and multiple pregnancy had an additive effect, whereas antepartum immobilization and high body mass index (BMI) had a multiplicative effect on the risk for antepartum VT. No other interaction was found between risk factors for antepartum VT. Risk factors for postnatal VT were antepartum immobilization, cigarette smoking, intrauterine fetal growth restriction (IUGR), preeclampsia, emergency cesarean section, postpartum hemorrhage, infection, surgery, and age and parity. Antepartum immobilization, high BMI and reoperation on the indication of bleeding showed multiplicative effects on the risk of postnatal VT. Conclusions: Ante-and postpartum risk factors differed markedly. More attention should be paid to pregnant women of high BMI who are immobilized.

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Objective To evaluate the ability of a risk of malignancy index (RMI), based on a serum CA125 level, ultrasound findings and menopausal status, to discriminate a benign from a malignant pelvic mass and to discriminate early stage (Figo Stage I) from Stages II, III and IV of ovarian cancer. Design A prospective study. Setting Department of Gynaecology, Trondheim University Hospital, Trondheim, Norway. Participants One hundred and seventy‐three women, 30 years or older, consecutively admitted between February 1992 and February 1994 for primary laparotomy of a pelvic mass. Main outcome measures The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and menopausal status, separately and combined into the RMI, to diagnose ovarian cancer. Results The RMI was more accurate than any individual criterion in diagnosing cancer. Using a RMI cut‐off level of 200 to indicate malignancy, the RMI derived from this dataset gave a sensitivity of 80%, specificity of 92% and positive predictive value of 83%. Applying RMI criteria developed by others, the following test performance was found: sensitivity 71%, specificity 96% and positive predictive value 89%. For the Stages II, III and IV of ovarian cancer the sensitivity increased to approximately 90% without any substantial loss in specificity. Conclusions The risk of malignancy index is able to correctly discriminate between malignant and benign pelvic masses. It is a scoring system which can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery at an oncological unit.

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