contraception Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1998;20(6):309-313
DOI 10.1590/S0100-72031998000600003
Objective: to evaluate variations in body weight, arterial blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, Sgot, SGPT, GGT and bilirubin in women bearing a single subdermal Silastic implant containing 55 mg (+ 10%) of nomegestrol acetate during two years. Methods: eighteen healthy volunteers of reproductive age who desired to use anticonceptive drugs and who did not present contraindications to hormonal contraception participated in the study. All women were investigated before starting treatment and were followed-up for two years. At the end of the first year the capsules were inserted. Results: body weight increased from 54.9 + 1.5 kg at admission to 55.3 + 2.0 kg at 12 months of use (p<0.05) and from 56.0 + 2.7 kg at 24 months of use. There was a slight increase in arterial blood pressure, both systolic and diastolic, at month 12 (p<0.01). At month 24, the arterial blood pressure was not significantly different from the values at admission. All values were within the normal range. Insulin, HbA1C, LDL-C and GGT remained unchanged during the use of the implant. A significant decrease in total cholesterol (p<0.05) was observed in the third month and of HDL-C (p<0.01) in the sixth month. All lipoprotein alterations were inconsistent and values were within the normal range. Significant increases in fast glucose (p<0.05 and p<0.01) were observed in the third and sixth months, respectively. Significant SGOT decreases (p<0.05, p<0.01 and p<0.05) were observed in months 6, 18 and 24, respectively, and of SGPT (p<0.05) in month 18. Significant bilirubin increase (p<0.05) was observed only in the third month of implant use. All these variations remained within the normal range. Conclusions: these results show that, within the normal range, fasting glucose variations do not correlate with alterations in insulin levels. The slight serum lipoprotein, SGTO, SGPT and insulin alterations were transient. No clinical effects could be observed regarding lipoproteins, carbohydrate metabolism, insulin levels and liver function among the users during the two years.
Summary
Rev Bras Ginecol Obstet. 1998;20(6):309-313
DOI 10.1590/S0100-72031998000600003
Objective: to evaluate variations in body weight, arterial blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, Sgot, SGPT, GGT and bilirubin in women bearing a single subdermal Silastic implant containing 55 mg (+ 10%) of nomegestrol acetate during two years. Methods: eighteen healthy volunteers of reproductive age who desired to use anticonceptive drugs and who did not present contraindications to hormonal contraception participated in the study. All women were investigated before starting treatment and were followed-up for two years. At the end of the first year the capsules were inserted. Results: body weight increased from 54.9 + 1.5 kg at admission to 55.3 + 2.0 kg at 12 months of use (p<0.05) and from 56.0 + 2.7 kg at 24 months of use. There was a slight increase in arterial blood pressure, both systolic and diastolic, at month 12 (p<0.01). At month 24, the arterial blood pressure was not significantly different from the values at admission. All values were within the normal range. Insulin, HbA1C, LDL-C and GGT remained unchanged during the use of the implant. A significant decrease in total cholesterol (p<0.05) was observed in the third month and of HDL-C (p<0.01) in the sixth month. All lipoprotein alterations were inconsistent and values were within the normal range. Significant increases in fast glucose (p<0.05 and p<0.01) were observed in the third and sixth months, respectively. Significant SGOT decreases (p<0.05, p<0.01 and p<0.05) were observed in months 6, 18 and 24, respectively, and of SGPT (p<0.05) in month 18. Significant bilirubin increase (p<0.05) was observed only in the third month of implant use. All these variations remained within the normal range. Conclusions: these results show that, within the normal range, fasting glucose variations do not correlate with alterations in insulin levels. The slight serum lipoprotein, SGTO, SGPT and insulin alterations were transient. No clinical effects could be observed regarding lipoproteins, carbohydrate metabolism, insulin levels and liver function among the users during the two years.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):25-31
DOI 10.1590/S0100-72031999000100005
Purpose: This epidemiological census on health conditions of women ranging from 20 to 49 years of age was carried out at Vila Santos Dumont, Pelotas, RS, in order to quantify actions to reorganize the service developed at the local health center. Methods: Information was collected regarding age, level of education, if living with a partner, health service utilization, antenatal care characteristics, cervical cancer screening, physical breast examination and contraceptive methods used. Results: Among the 411 women, 343 (83.5%) had a medical visit during the last year. There were 18 (4.4%) pregnant women. Eighty percent of the women had a cervical smear in the past three years. We found that 47.4% of the women had their breast examined in the last year. Among the 279 women currently using some contraceptive method, 62.4% used the pill, 14.0% had performed surgical sterilization and 7.9% used IUD. Conclusions: This study was women's health diagnosis. It became possible to incorporate the epidemiological method in the health center care planning. We discuss some health actions developed to improve the community care.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):25-31
DOI 10.1590/S0100-72031999000100005
Purpose: This epidemiological census on health conditions of women ranging from 20 to 49 years of age was carried out at Vila Santos Dumont, Pelotas, RS, in order to quantify actions to reorganize the service developed at the local health center. Methods: Information was collected regarding age, level of education, if living with a partner, health service utilization, antenatal care characteristics, cervical cancer screening, physical breast examination and contraceptive methods used. Results: Among the 411 women, 343 (83.5%) had a medical visit during the last year. There were 18 (4.4%) pregnant women. Eighty percent of the women had a cervical smear in the past three years. We found that 47.4% of the women had their breast examined in the last year. Among the 279 women currently using some contraceptive method, 62.4% used the pill, 14.0% had performed surgical sterilization and 7.9% used IUD. Conclusions: This study was women's health diagnosis. It became possible to incorporate the epidemiological method in the health center care planning. We discuss some health actions developed to improve the community care.
Summary
Rev Bras Ginecol Obstet. 2006;28(11):680-684
DOI 10.1590/S0100-72032006001100008
There is much controversy regarding the realtionship between the use of hormonal contraceptives and the risk of acquiring human immunodeficiency virus (HIV), and little is known about the effects of hormonal contraception in HIV-infected women (adverse events, menstrual disorders, disease progression, antiretroviral therapy interactions). The aim of the present study was to review available data regarding HIV vulnerability and transmission associated with hormonal contraceptives and the use of these contraceptives by women on antiretroviral therapy, with emphasis on drug interactions. In conclusion, it was not possible to offer evidence-based recommendations for the use of hormonal contraceptives among HIV-infected women under antiretroviral therapy. Infectious disease specialists and gynecologists providing care should be cautious about potential drug interaction leading to increase in adverse events, individualizing contraceptive drugs, route, and dosage, according to the antiretroviral therapy under use.
Summary
Rev Bras Ginecol Obstet. 2006;28(11):680-684
DOI 10.1590/S0100-72032006001100008
There is much controversy regarding the realtionship between the use of hormonal contraceptives and the risk of acquiring human immunodeficiency virus (HIV), and little is known about the effects of hormonal contraception in HIV-infected women (adverse events, menstrual disorders, disease progression, antiretroviral therapy interactions). The aim of the present study was to review available data regarding HIV vulnerability and transmission associated with hormonal contraceptives and the use of these contraceptives by women on antiretroviral therapy, with emphasis on drug interactions. In conclusion, it was not possible to offer evidence-based recommendations for the use of hormonal contraceptives among HIV-infected women under antiretroviral therapy. Infectious disease specialists and gynecologists providing care should be cautious about potential drug interaction leading to increase in adverse events, individualizing contraceptive drugs, route, and dosage, according to the antiretroviral therapy under use.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):403-409
DOI 10.1590/S0100-72032006000700005
PURPOSE: to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). METHODS: the analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p<0,05 as significant, and also standard cost. RESULTS: Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p<0,05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p<0,05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p <0,05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p<0,05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p<0,05) and better esthetic effect as compared to Gminil (p <0,05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. CONCLUSIONS: tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):403-409
DOI 10.1590/S0100-72032006000700005
PURPOSE: to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). METHODS: the analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p<0,05 as significant, and also standard cost. RESULTS: Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p<0,05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p<0,05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p <0,05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p<0,05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p<0,05) and better esthetic effect as compared to Gminil (p <0,05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. CONCLUSIONS: tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):388-396
DOI 10.1590/S0100-72032006000700003
PURPOSE: to generate knowledge in order to allow of the determination the factors affecting the high incidence of caesarean section and its relation to sterilization. METHODS: the multicentric study on reproductive health in Brazil, carried out from 1998 to 2000, included the States of Rio Grande do Norte, Minas Gerais, São Paulo, and Rio Grande do Sul. It was characterized as a longitudinal study, where the women, proceeding from public as well as private health services, were interviewed at three moments: at the beginning of pregnancy (until the 22nd week of gestation), at the end of pregnancy (between 30 and 40 days before the probable date of childbirth) and after delivery (between 15 and 45 days after childbirth). The interviewed women complied with the following eligibility criteria: to have 18 to 40 years of age, to live in Natal and plan to deliver the baby in Natal. At the first moment, 433 women were interviewed, 380 at the second moment and 269 at the third moment. The data were submitted to the chi-square test, with the level of significance set at 0.05, just to assure the relation between the variable years of schooling (0 to 8 and 9 or +) and the representative variables for reproductive health. RESULTS: the result disclosed a statistically significant relationship (p<0.05) between the variables: years of schooling, parity, type of service used, social class, job status, and prenatal consultations. It was found that a higher educational level is predominant among those women who searched for private services, coming from higher social classes and large number of prenatal visits. Although without statistical significance, having a for the women coming from this type of service, a higher number of caesarean section5 was observed, probably due to an easy doctor-patient interaction, while the planned caesarean section was frustrated for 43% of those women coming from public health services, as well as the wish to have a tubal ligation at childbirth (57%). CONCLUSIONS: These results show up the great differentials between the private and public services, with a clear favoritism for the private sector, demonstrating clearly that the practical obstetrics in Brazil needs a change and an improvement both for those women with access to the private service, who obtain the accomplishment of the caesarean section without consistent medical indications, and those with access to the public service, who face difficulties in accomplishing this procedure, even with consistent medical indications, in order to provide equality in the reproductive rights of those women.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):388-396
DOI 10.1590/S0100-72032006000700003
PURPOSE: to generate knowledge in order to allow of the determination the factors affecting the high incidence of caesarean section and its relation to sterilization. METHODS: the multicentric study on reproductive health in Brazil, carried out from 1998 to 2000, included the States of Rio Grande do Norte, Minas Gerais, São Paulo, and Rio Grande do Sul. It was characterized as a longitudinal study, where the women, proceeding from public as well as private health services, were interviewed at three moments: at the beginning of pregnancy (until the 22nd week of gestation), at the end of pregnancy (between 30 and 40 days before the probable date of childbirth) and after delivery (between 15 and 45 days after childbirth). The interviewed women complied with the following eligibility criteria: to have 18 to 40 years of age, to live in Natal and plan to deliver the baby in Natal. At the first moment, 433 women were interviewed, 380 at the second moment and 269 at the third moment. The data were submitted to the chi-square test, with the level of significance set at 0.05, just to assure the relation between the variable years of schooling (0 to 8 and 9 or +) and the representative variables for reproductive health. RESULTS: the result disclosed a statistically significant relationship (p<0.05) between the variables: years of schooling, parity, type of service used, social class, job status, and prenatal consultations. It was found that a higher educational level is predominant among those women who searched for private services, coming from higher social classes and large number of prenatal visits. Although without statistical significance, having a for the women coming from this type of service, a higher number of caesarean section5 was observed, probably due to an easy doctor-patient interaction, while the planned caesarean section was frustrated for 43% of those women coming from public health services, as well as the wish to have a tubal ligation at childbirth (57%). CONCLUSIONS: These results show up the great differentials between the private and public services, with a clear favoritism for the private sector, demonstrating clearly that the practical obstetrics in Brazil needs a change and an improvement both for those women with access to the private service, who obtain the accomplishment of the caesarean section without consistent medical indications, and those with access to the public service, who face difficulties in accomplishing this procedure, even with consistent medical indications, in order to provide equality in the reproductive rights of those women.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):271-277
DOI 10.1590/S0100-72032006000500002
PURPOSE: to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. METHODS: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. RESULTS: most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. CONCLUSIONS: it was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use.
Summary
Rev Bras Ginecol Obstet. 2006;28(5):271-277
DOI 10.1590/S0100-72032006000500002
PURPOSE: to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. METHODS: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. RESULTS: most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. CONCLUSIONS: it was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):741-743
DOI 10.1590/S0100-72032004000900011
Ectopic pregnancy is the implantation and development of the ovum outside the uterine cavity; it needs a quick diagnosis and an urgent treatment. The presence of the corpus luteum in the ovary that is contralateral to the ectopic pregnancy is presumptive evidence for ovum transmigration, which may be the cause of ectopic pregnancy. In 1994, a multinational clinical trial proved the superiority of levonorgestrel over the existing emergency contraceptive products. In the present study, we describe the case of a 27-year-old woman with ectopic pregnancy and a contralateral corpus luteum after use of hormonal emergency contraception (levonorgestrel), because of failure of the used contraception method (condom). The patient was treated with laparoscopic surgery that was successful.
Summary
Rev Bras Ginecol Obstet. 2004;26(9):741-743
DOI 10.1590/S0100-72032004000900011
Ectopic pregnancy is the implantation and development of the ovum outside the uterine cavity; it needs a quick diagnosis and an urgent treatment. The presence of the corpus luteum in the ovary that is contralateral to the ectopic pregnancy is presumptive evidence for ovum transmigration, which may be the cause of ectopic pregnancy. In 1994, a multinational clinical trial proved the superiority of levonorgestrel over the existing emergency contraceptive products. In the present study, we describe the case of a 27-year-old woman with ectopic pregnancy and a contralateral corpus luteum after use of hormonal emergency contraception (levonorgestrel), because of failure of the used contraception method (condom). The patient was treated with laparoscopic surgery that was successful.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):389-395
DOI 10.1590/S0100-72032003000600002
PURPOSE: to evaluate acceptability, adhesion and experience with the use of female condom (FC) among HIV-infected women. METHODS: prospective descriptive study with 76 HIV-infected women under care at CAISM/UNICAMP and Centro Corsini, both in Campinas. After a screening interview and agreeing to participate, the volunteers received a diary to register their intercourses and correspondent use of male condom (MC). After 30 days, they returned to a training visit when the FC was inserted in a pelvic model, also bringing their diary related to the previous cycle, considered a control cycle. A structured questionnaire was used at 30, 60 and 90 days, also with the respective diary on sexual intercourse and use of MC and FC kept for posterior data entry. c², Fisher's exact, McNemar and Friedman tests were applied statistical analysis of paired samples. RESULTS: there was a predominance of young women, with low schooling, living with their partner. Rate of continuity was 52% after 90 days. The use of FC in half the intercourses for each time period remained stable over the 90-day interval. There was a significant reduction in unprotected intercourses (from 14 to 6%), without use of FC or MC, at the end of the period. The initial difficulties in handling the device were overcome. Serodiscordant couples had more protected intercourses than concordant couples, but the difference did not reach statistical significance. Women reporting consistent previous use of MC had more protected sex using FC. CONCLUSIONS: the offer of the female condom was able to reduce unprotected intercourses in HIV-infected women, which were highly motivated and receptive for the new method.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):389-395
DOI 10.1590/S0100-72032003000600002
PURPOSE: to evaluate acceptability, adhesion and experience with the use of female condom (FC) among HIV-infected women. METHODS: prospective descriptive study with 76 HIV-infected women under care at CAISM/UNICAMP and Centro Corsini, both in Campinas. After a screening interview and agreeing to participate, the volunteers received a diary to register their intercourses and correspondent use of male condom (MC). After 30 days, they returned to a training visit when the FC was inserted in a pelvic model, also bringing their diary related to the previous cycle, considered a control cycle. A structured questionnaire was used at 30, 60 and 90 days, also with the respective diary on sexual intercourse and use of MC and FC kept for posterior data entry. c², Fisher's exact, McNemar and Friedman tests were applied statistical analysis of paired samples. RESULTS: there was a predominance of young women, with low schooling, living with their partner. Rate of continuity was 52% after 90 days. The use of FC in half the intercourses for each time period remained stable over the 90-day interval. There was a significant reduction in unprotected intercourses (from 14 to 6%), without use of FC or MC, at the end of the period. The initial difficulties in handling the device were overcome. Serodiscordant couples had more protected intercourses than concordant couples, but the difference did not reach statistical significance. Women reporting consistent previous use of MC had more protected sex using FC. CONCLUSIONS: the offer of the female condom was able to reduce unprotected intercourses in HIV-infected women, which were highly motivated and receptive for the new method.
