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We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.

VARIOUS electrocardiographic abnormalities have been described in patients with subarachnoid hemorrhage, meningitis, and other central nervous system processes.1,2We report a patient with a pathologically proved subarachnoid hemorrhage in whom the ECG changes were striking and included both complete heart block and pronounced abnormalities of the ST segment and T wave. Report of a Case A 65-year-old woman was admitted to the hospital with the abrupt onset of severe headache, diplopia, nausea, and vomiting. She gave a history of mild hypertension, controlled with thiazides, but no history of heart disease, angina, or stroke. On admission, her blood pressure was 200/100 mm Hg; pulse, 88 beats per minute; and temperature, 36.8 C (98.4 F) per rectum. The patient was somnolent, and she had moderate nuchal rigidity. Her heart sounds were normal; a grade 2 systolic ejection murmur was heard at the left sternal border and a fourth heart sound at