Family planning Archives - Revista Brasileira de Ginecologia e Obstetrícia
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Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(2):67-73
, , , , , To determine the prevalence of inadequate birth interval and its associated factors in the BRISA study.
Cross-sectional study using data from the BRISA cohort. Birth interval was categorized into “adequate” (≥ 2 years or < 5 years between births), “short interval” (< 2 years) and “long interval” (≥ 5 years). The analysis of the factors associated with short and long birth intervals used multinomial logistic regression.
The prevalence of adequate birth intervals was 48.3%, of long intervals, 34.6%, and of short intervals, 17.1%. Skin color, age, education level, economic status, type of delivery, number of prenatal visits, parity, blood pressure, diabetes, and anemia (p-value was < 0.2 in the univariate analysis) proceeded to the final model. The variable ≥ 3 births (odds ratio [OR] = 1.29; confidence interval [CI]: 1.01–1.65) was associated with short intervals. Age < 20 years old (OR = 0.48; CI: 0.02–0.12) or ≥ 35 years old (OR = 2.43; CI: 1.82–3.25), ≥ 6 prenatal visits (OR = 0.58; CI: 0.47–0.72), ≥ 3 births (OR = 0.59; CI: 0.49–0.73), and gestational diabetes (OR = 0.38; CI: 0.20–0.75) were associated with long intervals.
Older mothers were more likely to have long birth intervals, and higher parity increases the chances of short birth intervals. Furthermore, gestational diabetes and adequate prenatal care presented higher chances of having adequate birth intervals, indicating that health assistance during pregnancy is important to encourage an adequate interval between gestations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(2):67-73
, , , , , To determine the prevalence of inadequate birth interval and its associated factors in the BRISA study.
Cross-sectional study using data from the BRISA cohort. Birth interval was categorized into “adequate” (≥ 2 years or < 5 years between births), “short interval” (< 2 years) and “long interval” (≥ 5 years). The analysis of the factors associated with short and long birth intervals used multinomial logistic regression.
The prevalence of adequate birth intervals was 48.3%, of long intervals, 34.6%, and of short intervals, 17.1%. Skin color, age, education level, economic status, type of delivery, number of prenatal visits, parity, blood pressure, diabetes, and anemia (p-value was < 0.2 in the univariate analysis) proceeded to the final model. The variable ≥ 3 births (odds ratio [OR] = 1.29; confidence interval [CI]: 1.01–1.65) was associated with short intervals. Age < 20 years old (OR = 0.48; CI: 0.02–0.12) or ≥ 35 years old (OR = 2.43; CI: 1.82–3.25), ≥ 6 prenatal visits (OR = 0.58; CI: 0.47–0.72), ≥ 3 births (OR = 0.59; CI: 0.49–0.73), and gestational diabetes (OR = 0.38; CI: 0.20–0.75) were associated with long intervals.
Older mothers were more likely to have long birth intervals, and higher parity increases the chances of short birth intervals. Furthermore, gestational diabetes and adequate prenatal care presented higher chances of having adequate birth intervals, indicating that health assistance during pregnancy is important to encourage an adequate interval between gestations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):309-312
To study the structure ofmaternalmortality caused by abortion in the Tula region.
The medical records of deceased pregnant women, childbirth, and postpartum from January 01, 2001, to December 31, 2015, were analyzed.
Overall, 204,095 abortion cases were recorded in the Tula region for over 15 years. The frequency of abortion was reduced 4-fold, with 18,200 in 2001 to 4,538 in 2015. The rate of abortions per 1,000 women (age 15-44 years) for 15 years decreased by 40.5%, that is, from 46.53 (2001) to 18.84 (2015), and that of abortions per 100 live births and stillbirths was 29.5%, that is, from 161.7 (2001) to 41.5 (2015). Five women died from abortion complications that began outside of the hospital, which accounted for 0.01% of the total number. In the structure of causes of maternal mortality for 15 years, abortion represented 14.3% of the cases. Lethality mainly occurred in the period from 2001 to 2005 (4 cases). Among thematernal deaths, many women died in rural areas after pregnancy termination at 18 to 20 weeks of gestation (n = 4). In addition, three women died from sepsis and two from bleeding.
The introduction of modern, effective technologies of family planning has reduced maternal mortality due to abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):309-312
To study the structure ofmaternalmortality caused by abortion in the Tula region.
The medical records of deceased pregnant women, childbirth, and postpartum from January 01, 2001, to December 31, 2015, were analyzed.
Overall, 204,095 abortion cases were recorded in the Tula region for over 15 years. The frequency of abortion was reduced 4-fold, with 18,200 in 2001 to 4,538 in 2015. The rate of abortions per 1,000 women (age 15-44 years) for 15 years decreased by 40.5%, that is, from 46.53 (2001) to 18.84 (2015), and that of abortions per 100 live births and stillbirths was 29.5%, that is, from 161.7 (2001) to 41.5 (2015). Five women died from abortion complications that began outside of the hospital, which accounted for 0.01% of the total number. In the structure of causes of maternal mortality for 15 years, abortion represented 14.3% of the cases. Lethality mainly occurred in the period from 2001 to 2005 (4 cases). Among thematernal deaths, many women died in rural areas after pregnancy termination at 18 to 20 weeks of gestation (n = 4). In addition, three women died from sepsis and two from bleeding.
The introduction of modern, effective technologies of family planning has reduced maternal mortality due to abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):132-139
To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs).
A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established.
When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4).
There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):132-139
To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs).
A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established.
When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4).
There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(7):143-149
DOI 10.1590/S0100-72032011000700005
PURPOSE: To determine the main contraceptive methods adopted by users of the public and private health sectors in the city of Aracaju (SE), Brazil, with a secondary focus on orientations for their use and reasons for interruption. METHODS: A cross-sectional study was conducted on 210 women, 110 from the public service and 100 from the private sector. The data were collected by applying a questionnaire to sexually active patients who agreed to sign a consent form. The software Statistical Package for Social Sciences (SPSS) version 15.0 was used for statistical analysis, with the 
test for categorical variables and the Student's t-test for independent samples. RESULTS: The overall prevalence of contraceptive use in this study was 83.3%. The main methods used in the public and private sectors, were the hormonal (41 and 24%, p=0.008) and permanent (20 and 26%, p=0.1) ones, respectively. The rate of condom use was 17.3% in the public sector and 12% in the private sector, with no significant difference (p=0.12). Medical orientation about the correct use of the method chosen and/or indicated was provided to 37.3% of users from the public sector and to 48% of users from the private sector. Discontinuation of the use of contraceptive methods was 14.5% in the public sector and 12.0% in the private sector, mainly because of side effects and the desire to become pregnant. CONCLUSIONS: The main contraceptive methods adopted by users of the public and private sectors were hormonal contraception and permanent contraception. It is important to highlights the low frequency of use of male condoms in the two groups studied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(7):143-149
DOI 10.1590/S0100-72032011000700005
PURPOSE: To determine the main contraceptive methods adopted by users of the public and private health sectors in the city of Aracaju (SE), Brazil, with a secondary focus on orientations for their use and reasons for interruption. METHODS: A cross-sectional study was conducted on 210 women, 110 from the public service and 100 from the private sector. The data were collected by applying a questionnaire to sexually active patients who agreed to sign a consent form. The software Statistical Package for Social Sciences (SPSS) version 15.0 was used for statistical analysis, with the test for categorical variables and the Student's t-test for independent samples. RESULTS: The overall prevalence of contraceptive use in this study was 83.3%. The main methods used in the public and private sectors, were the hormonal (41 and 24%, p=0.008) and permanent (20 and 26%, p=0.1) ones, respectively. The rate of condom use was 17.3% in the public sector and 12% in the private sector, with no significant difference (p=0.12). Medical orientation about the correct use of the method chosen and/or indicated was provided to 37.3% of users from the public sector and to 48% of users from the private sector. Discontinuation of the use of contraceptive methods was 14.5% in the public sector and 12.0% in the private sector, mainly because of side effects and the desire to become pregnant. CONCLUSIONS: The main contraceptive methods adopted by users of the public and private sectors were hormonal contraception and permanent contraception. It is important to highlights the low frequency of use of male condoms in the two groups studied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(5):235-240
DOI 10.1590/S0100-72032009000500006
PURPOSE: to study infection prevalence by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), among adolescent and young women in a family planning outpatient clinic. METHODS: a total of 230 women up to 24 years old and history of up to four sexual partners have been followed-up for 48 months, with urine collection to search CT and NG, by the polymerase chain reaction method at the 1st, 12nd, 24th, 36th and 48th months. The variables studied were age group, schooling, marital status, number of gestations, abortions and children alive, age at the onset of sexual life, previous and present use of condom, previous use of intrauterine device, number of sexual partners in the previous six months and follow-up time. Bivariate analysis of variables according to positive tests for CT and NG, and multiple analyses by logistic regression were done. RESULTS: the ratio of infections by CT was 13.5% and by NG, 3%. Two women presented both tests as positive. The previous intrauterine device use was associated with positive tests for NG. CONCLUSIONS: the prevalence of infections by CT and NG was higher among the age group studied and the screening of young women must be taken into consideration in our services, to control the dissemination of sexually transmitted diseases and prevention of sequels.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(5):235-240
DOI 10.1590/S0100-72032009000500006
PURPOSE: to study infection prevalence by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), among adolescent and young women in a family planning outpatient clinic. METHODS: a total of 230 women up to 24 years old and history of up to four sexual partners have been followed-up for 48 months, with urine collection to search CT and NG, by the polymerase chain reaction method at the 1st, 12nd, 24th, 36th and 48th months. The variables studied were age group, schooling, marital status, number of gestations, abortions and children alive, age at the onset of sexual life, previous and present use of condom, previous use of intrauterine device, number of sexual partners in the previous six months and follow-up time. Bivariate analysis of variables according to positive tests for CT and NG, and multiple analyses by logistic regression were done. RESULTS: the ratio of infections by CT was 13.5% and by NG, 3%. Two women presented both tests as positive. The previous intrauterine device use was associated with positive tests for NG. CONCLUSIONS: the prevalence of infections by CT and NG was higher among the age group studied and the screening of young women must be taken into consideration in our services, to control the dissemination of sexually transmitted diseases and prevention of sequels.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):199-205
DOI 10.1590/S0100-72031998000400005
The purpose of the present study was to investigate the menstrual disturbances and the psychological effects of post-tubal sterilization - the so-called post-tubal sterilization syndrome. Does it exist? The authors followed-up prospectively 300 women from the Gynecological Endoscopy and Family Planning Section, Department of Obstetrics and Gynecology, Botucatu Medical School, Universidade Estadual Paulista (UNESP) during one, three and five years after tubal sterilization surgery. Different parameters such as menstrual cycle length, duration of menstrual flow, dysmenorrhea, pelvic pain, regret rates etc, after tubal ligation, were analyzed. Each woman served as her own control. In conclusion, our findings suggest that most women reported no menstrual changes subsequent to sterilization. These findings do not deny or diminish the importance or benefits of tubal sterilization, but serve as a focus for further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):199-205
DOI 10.1590/S0100-72031998000400005
The purpose of the present study was to investigate the menstrual disturbances and the psychological effects of post-tubal sterilization - the so-called post-tubal sterilization syndrome. Does it exist? The authors followed-up prospectively 300 women from the Gynecological Endoscopy and Family Planning Section, Department of Obstetrics and Gynecology, Botucatu Medical School, Universidade Estadual Paulista (UNESP) during one, three and five years after tubal sterilization surgery. Different parameters such as menstrual cycle length, duration of menstrual flow, dysmenorrhea, pelvic pain, regret rates etc, after tubal ligation, were analyzed. Each woman served as her own control. In conclusion, our findings suggest that most women reported no menstrual changes subsequent to sterilization. These findings do not deny or diminish the importance or benefits of tubal sterilization, but serve as a focus for further investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):101-106
DOI 10.1590/S0100-72032002000200005
Purpose: to analyze the prevalence of gonorrhea, Chlamydia, syphilis and HIV among patients attending a family planning clinic regarding presence of STD symptoms and risk behaviors. Methods: women between the ages of 18 and 30 years who attended a public family planning clinic in Brazil were tested for gonorrhea and Chlamydia using the urine-based DNA amplification test (LCR, Abbott), and a blood test for syphilis (VDRL) and HIV. All participants were asked questions about their health care seeking behavior, the presence of STD symptoms, and about the STD risk behaviors. Results: Chlamydia was found in 11.4%, syphilis in 2%, gonorrhea in 0.5% and HIV was confirmed positive in 3%. Approximately 61% of the women who were infected with Chlamydia had no symptoms. Women who never used condoms had much higher risks for STD than women who used them always or most of the time. Although not statistically significant, there was a trend for women who never used any contraceptive to have a higher risk for STD than women who used some method of contraception (p=0.09). However, when examining separately each contraceptive, none of them alone offered protection against STD. Very few women reported problems related to the use of alcohol or illegal drugs. But among those who did report such use, the risk for STD was very high, particularly regarding marijuana use. Conclusions: the most significant findings in our study were the high STD rates among a population of women generally reporting low-risk health behaviors. Based upon our findings it is crucial to offer STD/HIV screening to all women under 30 years who visit public family planning clinics. Without screening all women, more than half of the infected women will never be identified or treated. Given the new sensitive and specific technology available to screen for Chlamydia, gonorrhea, and HIV, and the ease of collecting urine specimens for diagnosis, more efforts should be directed to surveillance of populations at risk, so that current clinical practice may reflect the true risk of the populations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):101-106
DOI 10.1590/S0100-72032002000200005
Purpose: to analyze the prevalence of gonorrhea, Chlamydia, syphilis and HIV among patients attending a family planning clinic regarding presence of STD symptoms and risk behaviors. Methods: women between the ages of 18 and 30 years who attended a public family planning clinic in Brazil were tested for gonorrhea and Chlamydia using the urine-based DNA amplification test (LCR, Abbott), and a blood test for syphilis (VDRL) and HIV. All participants were asked questions about their health care seeking behavior, the presence of STD symptoms, and about the STD risk behaviors. Results: Chlamydia was found in 11.4%, syphilis in 2%, gonorrhea in 0.5% and HIV was confirmed positive in 3%. Approximately 61% of the women who were infected with Chlamydia had no symptoms. Women who never used condoms had much higher risks for STD than women who used them always or most of the time. Although not statistically significant, there was a trend for women who never used any contraceptive to have a higher risk for STD than women who used some method of contraception (p=0.09). However, when examining separately each contraceptive, none of them alone offered protection against STD. Very few women reported problems related to the use of alcohol or illegal drugs. But among those who did report such use, the risk for STD was very high, particularly regarding marijuana use. Conclusions: the most significant findings in our study were the high STD rates among a population of women generally reporting low-risk health behaviors. Based upon our findings it is crucial to offer STD/HIV screening to all women under 30 years who visit public family planning clinics. Without screening all women, more than half of the infected women will never be identified or treated. Given the new sensitive and specific technology available to screen for Chlamydia, gonorrhea, and HIV, and the ease of collecting urine specimens for diagnosis, more efforts should be directed to surveillance of populations at risk, so that current clinical practice may reflect the true risk of the populations.