Personal reflections 25 years after the International Conference on Population and Development in Cairo

In my postgraduate formation during the last years of the 80’s, we had close to thirty hospital beds in a pavilion called “sépticas” (1). In Colombia, where abortion was completely penalized, the pavilion was mostly filled with women with insecure, complicated abortions. The focus we received was technical: management of intensive care; performance of hysterectomies, colostomies, bowel resection, etc. In those times, some nurses were nuns and limited themselves to interrogating the patients to get them to “confess” what they had done to themselves in order to abort. It always disturbed me that the women who left alive, left without any advice or contraceptive method. Having asked a professor of mine, he responded with disdain: “This is a third level hospital, those things are done by nurses of the first level”. Seeing so much pain and death, I decided to talk to patients, and I began to understand their decision. I still remember so many deaths with sadness, but one case in particular pains me: it was a woman close to being fifty who arrived with a uterine perforation in a state of advanced sepsis. Despite the surgery and the intensive care, she passed away. I had talked to her, and she told me she was a widow, had two adult kids and had aborted because of “embarrassment towards them” because they were going to find out that she had an active sexual life. A few days after her passing, the pathology professor called me, surprised, to tell me that the uterus we had sent for pathological examination showed no pregnancy. She was a woman in a perimenopausal state with a pregnancy exam that gave a false positive due to the high levels of FSH/LH typical of her age. SHE WAS NOT PREGNANT!!! She didn’t have menstruation because she was premenopausal and a false positive led her to an unsafe abortion. Of course, the injuries caused in the attempted abortion caused the fatal conclusion, but the real underlying cause was the social taboo in respect to sexuality. I had to watch many adolescents and young women leave the hospital alive, but without a uterus, sometime without ovaries and with colostomies, to be looked down on by a society that blamed them for deciding to not be mothers. I had to see situation of women that arrived with their intestines protruding from their vaginas because of unsafe abortions. I saw women, who in their despair, self-inflicted injuries attempting to abort with elements such as stick, branches, onion wedges, alum bars and clothing hooks among others. Among so many deaths, it was hard not having at least one woman per day in the morgue due to an unsafe abortion. During those time, healthcare was not handled from the biopsychosocial, but only from the technical (2); nonetheless, in the academic evaluations that were performed, when asked about the definition of health, we had to recite the text from the International Organization of Health that included these three aspects. How contradictory! To give response to the health need of women and guarantee their right when I was already a professor, I began an obstetric contraceptive service in that third level hospital. There was resistance from the directors, but fortunately I was able to acquire international donations for the institution, which facilitated its acceptance. I decided to undertake a teaching career with the hope of being able to sensitize health professionals towards an integral focus of health and illness. When the International Conference of Population and Development (ICPD) was held in Cairo in 1994, I had already spent various years in teaching, and when I read their Action Program, I found a name for what I was working on: Sexual and Reproductive Rights. I began to incorporate the tools given by this document into my professional and teaching life. I was able to sensitize people at my countries Health Ministry, and we worked together moving it to an approach of human rights in areas of sexual and reproductive health (SRH). This new viewpoint, in addition to being integral, sought to give answers to old problems like maternal mortality, adolescent pregnancy, low contraceptive prevalence, unplanned or unwanted pregnancy or violence against women. With other sensitized people, we began with these SRH issues to permeate the Colombian Society of Obstetrics and Gynecology, some universities, and university hospitals. We are still fighting in a country that despite many difficulties has improved its indicators of SRH. With the experience of having labored in all sphere of these topics, we manage to create, with a handful of colleagues and friend at the Universidad El Bosque, a Master’s Program in Sexual and Reproductive Health, open to all professions, in which we broke several paradigms. A program was initiated in which the qualitative and quantitative investigation had the same weight, and some alumni of the program are now in positions of leadership in governmental and international institutions, replicating integral models. In the Latin American Federation of Obstetrics and Gynecology (FLASOG, English acronym) and in the International Federation of Obstetrics and Gynecology (FIGO), I was able to apply my experience for many years in the SRH committees of these association to benefit women and girls in the regional and global environments. When I think of who has inspired me in these fights, I should highlight the great feminist who have taught me and been with me in so many fights. I cannot mention them all, but I have admired the story of the life of Margaret Sanger with her persistence and visionary outlook. She fought throughout her whole life to help the women of the 20th century to be able to obtain the right to decide when and whether or not they wanted to have children (3). Of current feminist, I have had the privilege of sharing experiences with Carmen Barroso, Giselle Carino, Debora Diniz and Alejandra Meglioli, leaders of the International Planned Parenthood Federation – Western Hemisphere Region (IPPF-RHO). From my country, I want to mention my countrywoman Florence Thomas, psychologist, columnist, writer and Colombo-French feminist. She is one of the most influential and important voices in the movement for women rights in Colombia and the region. She arrived from France in the 1960’s, in the years of counterculture, the Beatles, hippies, Simone de Beauvoir, and Jean-Paul Sartre, a time in which capitalism and consumer culture began to be criticized (4). It was then when they began to talk about the female body, female sexuality and when the contraceptive pill arrived like a total revolution for women. Upon its arrival in 1967, she experimented a shock because she had just assisted in a revolution and only found a country of mothers, not women (5). That was the only destiny for a woman, to be quiet and submissive. Then she realized that this could not continue, speaking of “revolutionary vanguards” in such a patriarchal environment. In 1986 with the North American and European feminism waves and with her academic team, they created the group “Mujer y Sociedad de la Universidad Nacional de Colombia”, incubator of great initiatives and achievements for the country (6). She has led great changes with her courage, the strength of her arguments, and a simultaneously passionate and agreeable discourse. Among her multiple books, I highlight “Conversaciones con Violeta” (7), motivated by the disdain towards feminism of some young women. She writes it as a dialogue with an imaginary daughter in which, in an intimate manner, she reconstructs the history of women throughout the centuries and gives new light of the fundamental role of feminism in the life of modern women. Another book that shows her bravery is “Había que decirlo” (8), in which she narrates the experience of her own abortion at age twenty-two in sixty’s France. My work experience in the IPPF-RHO has allowed me to meet leaders of all ages in diverse countries of the region, who with great mysticism and dedication, voluntarily, work to achieve a more equal and just society. I have been particularly impressed by the appropriation of the concept of sexual and reproductive rights by young people, and this has given me great hope for the future of the planet. We continue to have an incomplete agenda of the action plan of the ICPD of Cairo but seeing how the youth bravely confront the challenges motivates me to continue ahead and give my years of experience in an intergenerational work. In their policies and programs, the IPPF-RHO evidences great commitment for the rights and the SRH of adolescent, that are consistent with what the organization promotes, for example, 20% of the places for decision making are in hands of the young. Member organizations, that base their labor on volunteers, are true incubators of youth that will make that unassailable and necessary change of generations. In contrast to what many of us experienced, working in this complicated agenda of sexual and reproductive health without theoretical bases, today we see committed people with a solid formation to replace us. In the college of medicine at the Universidad Nacional de Colombia and the College of Nursing at the Universidad El Bosque, the new generations are more motivated and empowered, with great desire to change the strict underlying structures. Our great worry is the onslaught of the ultra-right, a lot of times better organized than us who do support rights, that supports anti-rights group and are truly pro-life (9). Faced with this scenario, we should organize ourselves better, giving battle to guarantee the rights of women in the local, regional, and global level, aggregating the efforts of all pro-right organizations. We are now committed to the Objectives of Sustainable Development (10), understood as those that satisfy the necessities of the current generation without jeopardizing the capacity of future generations to satisfy their own necessities. This new agenda is based on: - The unfinished work of the Millennium Development Goals - Pending commitments (international environmental conventions) - The emergent topics of the three dimensions of sustainable development: social, economic, and environmental. We now have 17 objectives of sustainable development and 169 goals (11). These goals mention “universal access to reproductive health” many times. In objective 3 of this list is included guaranteeing, before the year 2030, “universal access to sexual and reproductive health services, including those of family planning, information, and education.” Likewise, objective 5, “obtain gender equality and empower all women and girls”, establishes the goal of “assuring the universal access to sexual and reproductive health and reproductive rights in conformity with the action program of the International Conference on Population and Development, the Action Platform of Beijing”. It cannot be forgotten that the term universal access to sexual and reproductive health includes universal access to abortion and contraception. Currently, 830 women die every day through preventable maternal causes; of these deaths, 99% occur in developing countries, more than half in fragile environments and in humanitarian contexts (12). 216 million women cannot access modern contraception methods and the majority live in the nine poorest countries in the world and in a cultural environment proper to the decades of the seventies (13). This number only includes women from 15 to 49 years in any marital state, that is to say, the number that takes all women into account is much greater. Achieving the proposed objectives would entail preventing 67 million unwanted pregnancies and reducing maternal deaths by two thirds. We currently have a high, unsatisfied demand for modern contraceptives, with extremely low use of reversible, long term methods (intrauterine devices and subdermal implants) which are the most effect ones with best adherence (14). There is not a single objective among the 17 Objectives of Sustainable Development where contraception does not have a prominent role: from the first one that refers to ending poverty, going through the fifth one about gender equality, the tenth of inequality reduction among countries and within the same country, until the sixteenth related with peace and justice. If we want to change the world, we should procure universal access to contraception without myths or barriers. We have the moral obligation of achieving the irradiation of extreme poverty and advancing the construction of more equal, just, and happy societies. In emergency contraception (EC), we are very far from reaching expectations. If in reversible, long-term methods we have low prevalence, in EC the situation gets worse. Not all faculties in the region look at this topic, and where it is looked at, there is no homogeneity in content, not even within the same country. There are still myths about their real action mechanisms. There are countries, like Honduras, where it is prohibited and there is no specific medicine, the same case as in Haiti. Where it is available, access is dismal, particularly among girls, adolescents, youth, migrants, afro-descendent, and indigenous. The multiple barriers for the effective use of emergency contraceptives must be knocked down, and to work toward that we have to destroy myths and erroneous perceptions, taboos and cultural norms; achieve changes in laws and restrictive rules within countries, achieve access without barriers to the EC; work in union with other sectors; train health personnel and the community. It is necessary to transform the attitude of health personal to a service above personal opinion. Reflecting on what has occurred after the ICPD in Cairo, their Action Program changed how we look at the dynamics of population from an emphasis on demographics to a focus on the people and human rights. The governments agreed that, in this new focus, success was the empowerment of women and the possibility of choice through expanded access to education, health, services, and employment among others. Nonetheless, there have been unequal advances and inequality persists in our region, all the goals were not met, the sexual and reproductive goals continue beyond the reach of many women (15). There is a long road ahead until women and girls of the world can claim their rights and liberty of deciding. Globally, maternal deaths have been reduced, there is more qualified assistance of births, more contraception prevalence, integral sexuality education, and access to SRH services for adolescents are now recognized rights with great advances, and additionally there have been concrete gains in terms of more favorable legal frameworks, particularly in our region; nonetheless, although it’s true that the access condition have improved, the restrictive laws of the region expose the most vulnerable women to insecure abortions. There are great challenges for governments to recognize SRH and the DSR as integral parts of health systems, there is an ample agenda against women. In that sense, access to SRH is threatened and oppressed, it requires multi-sector mobilization and litigation strategies, investigation and support for the support of women’s rights as a multi-sector agenda. Looking forward, we must make an effort to work more with youth to advance not only the Action Program of the ICPD, but also all social movements. They are one of the most vulnerable groups, and the biggest catalyzers for change. The young population still faces many challenges, especially women and girls; young girls are in particularly high risk due to lack of friendly and confidential services related with sexual and reproductive health, gender violence, and lack of access to services. In addition, access to abortion must be improved; it is the responsibility of states to guarantee the quality and security of this access. In our region there still exist countries with completely restrictive frameworks. New technologies facilitate self-care (16), which will allow expansion of universal access, but governments cannot detach themselves from their responsibility. Self-care is expanding in the world and can be strategic for reaching the most vulnerable populations. There are new challenges for the same problems, that require a re-interpretation of the measures necessary to guaranty the DSR of all people, in particular women, girls, and in general, marginalized and vulnerable populations. It is necessary to take into account migrations, climate change, the impact of digital media, the resurgence of hate discourse, oppression, violence, xenophobia, homo/transphobia, and other emergent problems, as SRH should be seen within a framework of justice, not isolated. We should demand accountability of the 179 governments that participate in the ICPD 25 years ago and the 193 countries that signed the Sustainable Development Objectives. They should reaffirm their commitments and expand their agenda to topics not considered at that time. Our region has given the world an example with the Agreement of Montevideo, that becomes a blueprint for achieving the action plan of the CIPD and we should not allow retreat. This agreement puts people at the center, especially women, and includes the topic of abortion, inviting the state to consider the possibility of legalizing it, which opens the doors for all governments of the world to recognize that women have the right to choose on maternity. This agreement is much more inclusive: Considering that the gaps in health continue to abound in the region and the average statistics hide the high levels of maternal mortality, of sexually transmitted diseases, of infection by HIV/AIDS, and the unsatisfied demand for contraception in the population that lives in poverty and rural areas, among indigenous communities, and afro-descendants and groups in conditions of vulnerability like women, adolescents and incapacitated people, it is agreed:  33- To promote, protect, and guarantee the health and the sexual and reproductive rights that contribute to the complete fulfillment of people and social justice in a society free of any form of discrimination and violence. 37- Guarantee universal access to quality sexual and reproductive health services, taking into consideration the specific needs of men and women, adolescents and young, LGBT people, older people and people with incapacity, paying particular attention to people in a condition of vulnerability and people who live in rural and remote zone, promoting citizen participation in the completing of these commitments. 42- To guarantee, in cases in which abortion is legal or decriminalized in the national legislation, the existence of safe and quality abortion for non-desired or non-accepted pregnancies and instigate the other States to consider the possibility of modifying public laws, norms, strategies, and public policy on the voluntary interruption of pregnancy to save the life and health of pregnant adolescent women, improving their quality of life and decreasing the number of abortions (17)

Anticoncepción en el postparto

Los programas de anticoncepción quirúrgica voluntaria, han generado  un gran vacío en las mujeres que desean planificación  no definitiva, ya que usualmente la mayoría de hormonales  se contraindican en la lactancia y no  hay una amplia disponibilidad de progestágenos solos, que de todas formas se pueden utilizar desde las seis semanas del posparto. Por otra lo que usualmente se recomienda a las mujeres que deciden utilizar dispositivo intrauterino (DIU) es que regresen luego de 4 a 8 semanas; muchas mujeres no regresan o cuando lo hacen están nuevamente gestando. Con la paciente  que presenta un aborto sucede algo similar y rara vez abandona el Hospital can un método de anticoncepción. Revisaremos las opciones anticonceptivas para !a mujer lactante en el postparto

Uso del misoprostol en Obstetricia y Ginecología

101 p.Para la Federación Latinoamericana de Obstetricia y Ginecología – FLASOG, es preocupante el incremento de las tasas de morbi-mortalidad materna en nuestros países y, en particular, las complicaciones derivadas de la atención profesional a la mujer gestante y su impacto negativo sobre las posibilidades de acceso a los servicios de atención en salud de mediana y alta complejidad, principalmente aquellas provenientes de las comunidades más vulnerables donde los servicios esenciales como la salud pública integral se ven limitados en muchos escenarios en relación a la atención ginecológica y obstétrica. Con este panorama y preocupados por la situación epidemiológica de la región, FLASOG se permite actualizar y articular las mejores experiencias clínicas y de investigación en el desarrollo de esta nueva edición del Manual de uso de misoprostol en Obstetricia y Ginecología - 2013, la cual se espera contribuya notoriamente a las mejores prácticas clínicas en beneficio de nuestras mujeres latinoamericanas.Fil: Garello, Néstor César. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. II Cátedra de Clínica Ginecológica; Argentina.Fil: De Melo, Nilson Roberto. Federación Latinoamericana de Sociedades de Obstetricia y Ginecología; Brasil.Fil: Gómez Sánchez, Pío Iván. Federación Latinoamericana de Sociedades de Obstetricia y Ginecología; Colombia

Grades curriculares de saúde sexual e reprodutiva nos programas de ensino superior para a América Latina

Objetive: To identify if Latin-American and Caribbean higher education institutions include in their curriculum the sexual and reproductive health topics proposed by FLASOG in undergraduate and graduate programs. Methods: Descriptive, cross sectional study developed in the year 2017. A survey was sent to universities in Latin America and the Caribbean to evaluate if the sexual and reproductive health contents in the curriculum in undergraduate school (medicine) and graduate school (obstetrics and gynecology) correspond to the ones proposed by Ob & Gyn Latinamerican Federation. Results: 100% of assessed undergraduate programs include the following topics in their curriculum: birth control methods, abortion, maternal morbidity and mortality and 36.4% include sexual health in the elderly. 100% of graduate programs evaluated include: birth control methods, maternal morbidity and mortality, abortion, and healthy maternity and 55.6% include legal pregnancy termination and sexual health in the elderly. Conclusions: All the higher education programs evaluated have teachers for sexual and reproductive health, but the majority of institutions (76.9%) do not have a formal process for evaluation and feedback. All the universities include in their undergraduate programs the following topics: Abortion, birth control methods and maternal morbidity and mortality; these have high impact in sexual and reproductive health in women. However, topics such as legal termination of pregnancy are only included in 2 out of 3 universities evaluated, and sexual health in the elderly is rarely included in the curriculum.Objetivo: identificar la inclusión de la propuesta temática curricular de la Federación Latinoamericana de Obstetricia y Ginecología (FLASOG) sobre salud sexual y reproductiva en programas de pregrado (Medicina) y posgrado (Obstetricia y Ginecología) en un grupo de universidades e instituciones de educación superior de Latinoamérica y el Caribe. Método: estudio descriptivo de corte transversal en el cual se aplicó una encuesta a universidades de Latinoamérica y El Caribe durante el año 20 para determinar si los contenidos de los programas con relación a salud sexual y reproductiva corresponden a la propuesta temática de la FLASOG, tanto en pregrado (Medicina) como en posgrado (Obstetricia y Ginecología). Resultados: todos los programas de pregrado evaluados incluyen dentro del currículo los siguientes temas: métodos anticonceptivos, aborto y morbimortalidad materna y el 36,4 %contemplan salud sexual en la tercera edad. Todos los programas de posgrado evaluados estudian métodos anticonceptivos, anticoncepción en posparto y posaborto, morbimortalidad materna, aborto, y maternidad saludable. Solo el 55,6 % de ellos tienen temáticas relacionadas con interrupción voluntaria del embarazo y salud sexual en la tercera edad. Conclusiones: los programas evaluados cuentan con docentes dedicados a educación en salud sexual y reproductiva en sus programas, aunque en la mayoría de las instituciones (76,9 %) no existe un proceso formal de evaluación y retroalimentación. Todas las universidades que respondieron la encuesta trabajan tres temas en sus contenidos curriculares de pregrado: aborto, anticoncepción y morbimortalidad materna, tópicos que han sido considerados de alto impacto en la salud sexual y reproductiva de las mujeres. La interrupción voluntaria del embarazo se discute en dos de cada tres universidades que respondieron la encuesta. El tema de salud sexual en la tercera edad no se incluye en los programas.Objetivo: identificar a inclusão da proposta temática da Federação Latino-Americana de Obstetrícia e Ginecologia (FLASOG) em saúde sexual e reprodutiva nos programas de graduação (Medicina) e pós-graduação (Obstetrícia e Ginecologia) em um grupo de universidades e instituições de ensino superior da América Latina e do Caribe. Método: estudo descritivo transversal. Foi aplicado um questionário em programas de cursos de graduação e pós-graduação de universidades da América Latina e do Caribe em 2017, para determinar se o conteúdo dos programas relacionados à saúde sexual e reprodutiva cor respondem à proposta temática da FLASOG no nível de graduação (Medicina) e de pós-graduação (Obstetrícia e Ginecologia). Resultados: todos os programas de graduação avaliados incluíram os seguintes tópicos no cur r ículo: métodos contraceptivos, abor to e morbimortalidade materna; ainda, 36,4% dos programas abrangem temas relacionados à saúde sexual nos idosos. Todos osprogramas de pós-graduação avaliados estudam métodos contraceptivos, contracepção no pós-parto e pós-abor to, morbimor talidade materna, abor to e maternidade saudável. Apenas 55,6% desses programas têm tópicos relacionados à inter rupção voluntária da gravidez e sobre a saúde sexual em idosos. Conclusões: os programas avaliados têm professores enfocados na educação da saúde sexual e reprodutiva, embora na maioria das instituições (76,9%) não exista um processo formal de avaliaçãoe feedback. Todas as universidades que responderam à pesquisa trabalham com três tópicos em seu conteúdo cur ricular de graduação: abor to, contracepção e morbimor talidade materna, considerados de alto impacto na saúde sexual e reprodutiva das mulheres. A inter rupção voluntária da gravidez é discutida em uma proporção de duas em cada três universidades que responderam ao questionário. A saúde sexual em idosos não está incluída nos programas

Clinical practice guidelines for early detection of abnormalities during labor, care for normal and dystocic delivery

Objetivo: realizar recomendaciones para detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta Guía fue adaptada de la “Guía de práctica clínica sobre la atención del parto normal” (País Vasco - 2010) y actualizada por procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Esta guía y sus secciones hacen parte de un grupo de 25 GAI basadas en la evidencia que incorporan consideraciones económicas y de implementabilidad en el contexto del Sistema General de Seguridad Social en Salud colombiano, y que se desarrollaron por iniciativa del Ministerio de Salud y Protección Social y el Departamento de Ciencia, Tecnología e Innovación (Colciencias) en temas prioritarios y de alta prevalencia en el país mediante contrato otorgado a la Universidad Nacional de Colombia en el año 2010. Resultados: se presentan las recomendaciones para la asistencia del trabajo de parto y el parto asociadas con mayor probabilidad de obtener un resultado materno fetal exitoso durante la atención del parto. Conclusiones: se espera que las recomendaciones de esta GPC sean utilizadas por los profesionales de la salud de los programas de atención de la gestación con el fin de disminuir la morbilidad y mortalidad atribuibles a complicaciones del trabajo de parto y el parto.objective: To make recommendations for early detection of abnormalities during labor, and care of normal and dystocic delivery. materials and methods: The Guideline Developer Group (GDG) prepared this CPG during 2011-2012 in accordance with the Methodology Guideline for the development of Comprehensive Care Guidelines of the Colombian General System of Social Security, on the basis of the available scientific evidence, and with the active participation of patient groups, scientific societies and stakeholders. In particular, the evidence for this section was adapted from the “Clinical practice guideline for normal delivery care” (País Vasco – 2010) and adapted through systematic procedures for the search and assessment of the evidence as well as for the generation of recommendations. The level of evidence and the power of the recommendations were expressed using the Scottish Intercollegiate Guidelines Network (SIGN) system. results: We present the recommendations for labor and delivery care associated with the highest probability of a successful outcome for the mother and the baby. conclusions: It is expected that the recommendations contained in this CPG will be used by practitioners in pregnancy care programs in order to reduce morbidity and mortality attributable to labor and delivery complications

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Hemorragia uterina anormal en la mujer, enfoque básico

El síntoma de sangrado genital en la mujer constituye uno de los principales retos tanto para el personal de salud por la multiplicidad de etiologías orgánicas y funcionales que se pueden presentar desde la recién nacida hasta la mujer perimenopáusica. En este trabajo se revisan algunos conceptos del ciclo menstrual normal, definiciones y se hace un enfoque de la hemorragia uterina anormal por grupos etáreos, especificando las causas orgánicas y funcionales características de la recién nacida, prepúber, adolescente, mujer adulta, premenopáusica y postmenopáusica. Al final se propone un enfoque diagnóstico y terapéutic

Anticoncepción en el postparto

Los programas de anticoncepción quirúrgica voluntaria, han generado  un gran vacío en las mujeres que desean planificación  no definitiva, ya que usualmente la mayoría de hormonales  se contraindican en la lactancia y no  hay una amplia disponibilidad de progestágenos solos, que de todas formas se pueden utilizar desde las seis semanas del posparto. Por otra lo que usualmente se recomienda a las mujeres que deciden utilizar dispositivo intrauterino (DIU) es que regresen luego de 4 a 8 semanas; muchas mujeres no regresan o cuando lo hacen están nuevamente gestando. Con la paciente  que presenta un aborto sucede algo similar y rara vez abandona el Hospital can un método de anticoncepción. Revisaremos las opciones anticonceptivas para !a mujer lactante en el postparto

Experiencia con 1000 implantes subdérmicos de levonorgestrel en el Instituto Materno Infantil (I.M.I).

Colombian Family planning programs have increased modern methods like Norplant. The Instituto Materno Infantil, had Norplantprogram from1984 to 1986 but in 1992 with the support of the PHO began a new program. Now we have 1000 patients with Norplant. Objective: To evaluate Norplant efficiency, tolerance, acceptability and side effects. Results: Most of patients had between 16-33 years old and had between 1-3 children. Norplant efficiency was 98.6%. There were seven ectopic pregnancy (50% of failure). The main side effects were irregular menstrual bleeding and headache. 17% of implants have been removed. 91.9% were satisfied and continuity rate was 94% in the first year and 78% at the end of the fourth year. Conclusion: Norplant is a safe and effective hormonal method. Counseling is necessary before Norplant use. It is necessary to improve Not-plant knowledge in physicians in order to offer better medical counseling