Prevención de la reincidencia del embarazo en adolescentes

OBJECTIVE: to evaluate the effectiveness of an educational family planning program in preventing the recurrence of teen pregnancy. METHODS: this was a retrospective study conducted in the department of Family Planning of the Federal University of São Paulo. The sample consisted of 264 patients who had at least one pregnancy. RESULTS: participants reported an average age of menarche at 12.2 years old. Their first sexual intercourse occurred at 15 years old and their age at the first pregnancy was 16 years old. In addition, 73.5% of the participants reported more than one pregnancy. Following educational family planning program, use of condoms, and birth control pills were the most used contraceptives methods; 4.9% of teens had a recurrence of pregnancy. CONCLUSION: the findings of this study support the importance and effectiveness of an educational family planning program in preventing recurrence of teen pregnancy.OBJETIVO: evaluar los efectos de un programa educativo y asistencial frente a la reincidencia de embarazo en adolescentes. MÉTODOS: estudio descriptivo y retrospectivo, realizado en el sector de Planificación Familiar de la Universidad Federal de São Paulo a partir de datos recolectados en 264 historias clínicas de adolescentes que tenían como antecedente al menos un embarazo anterior a la matrícula. RESULTADOS: los datos revelan que la menarquia ocurrió, en promedio, a los 12,2 años, la primera relación a los 15 y el primer embarazo un año después. Al matricularse en el programa el 73,5% poseían una gestación y el 2% dos. El condón y las hormonas fueron los anticonceptivos más utilizados. La reincidencia de embarazo fue observada en el 4,9% de las adolescentes. CONCLUSIONES: los datos encontrados refuerzan la importancia del ofrecimiento de programas de planificación familiar que abarquen la educación y la asistencia con la oferta de métodos anticonceptivos volcados a las adolescentes.OBJETIVO: avaliar os efeitos de um programa educativo e assistencial frente a reincidência de gestação em adolescentes. MÉTODOS: estudo descritivo e retrospectivo, realizado no setor de Planejamento Familiar da Universidade Federal de São Paulo (UNIFESP) a partir de dados coletados em 264 prontuários de adolescentes que tinham como antecedente ao menos uma gravidez anterior a matrícula. RESULTADOS: os dados revelam que a menarca ocorreu, em média, aos 12,2 anos, a sexarca aos 15 e a primeira gravidez um ano após. Ao se matricularem no programa 73,5% possuíam uma gestação e 2% duas. O condom e os hormonais foram os contraceptivos mais utilizados. A reincidência de gravidez foi observada em 4,9% das adolescentes. CONCLUSÕES Os dados encontrados reforçam a importância do oferecimento de programas de planejamento familiar, que englobem a educação e a assistência com oferta do método contraceptivo, voltados a adolescentes.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de EnfermagemUniversidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaUniversidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUNIFESP, Depto. de EnfermagemUNIFESP, Depto. de ObstetríciaUNIFESP, Depto. de GinecologiaSciEL

Effects of low-dose oral hormonal contraceptive on intraerythrocytic folate levels

PURPOSE: to study the effects of low-dose oral hormonal contraceptives (OHC) (<30 mg of ethynylestradiol) on the intraerythrocytic folate levels. METHODS: this was a prospective transversal study with 95 patients treated in the Family Planning Clinic of UNIFESP (Federal University of São Paulo). The control group (Condom group) consisted of patients using condom as their exclusive contraceptive method during the last 12 months, and the study groups consisted of patients using low-dose oral hormonal contraceptives, in the following way: OHC 3 group (three to six months of use), OHC 6 group (six to twelve months of use) and OHC 12 group (more than twelve months of use). Intraerythrocytic folate was determined by the ionic capture method. Analysis of variance and c² test were used for statistical analysis. RESULTS: the Condom group showed a rate of 44% of patients with folate lower than 186.0 ng/mL and the users of low-dose oral contraceptives showed a rate of 32% (OHC 3 group), 16% (OHC 6 group) and 31% (OHC 12 group). We did not find in the group using low-dose oral contraceptives a significant reduction in the average level of intraerythrocytic folate compared to the control group and there was no statistically significant difference (p=0.28) regarding time of use. CONCLUSION: we observed reduced levels of intraerythrocytic folate in a significant number (44%) of patients not using low-dose oral hormonal contraceptives. Their rates were similar to the lower limit considered to be normal by most authors, which points to a basal folate deficiency in the studied group. We did not observe any alteration in the level of intraerythrocytic folate in patients using low-dose oral hormonal contraceptives.OBJETIVO: identificar os efeitos do uso dos contraceptivos hormonais orais (ACHO) de baixa dosagem estrogênica (<30 mg de etinilestradiol) nas taxas intra-eritrocitárias de folatos. MÉTODOS: este foi estudo prospectivo transversal que incluiu 95 pacientes atendidas no Ambulatório de Planejamento Familiar da Escola Paulista de Medicina - UNIFESP. O grupo controle (grupo Condom) foi constituído por pacientes usuárias de condom como método contraceptivo exclusivo nos últimos doze meses e os grupos de estudo eram compostos por usuárias de ACHO de baixa dosagem agrupadas de acordo com o tempo de uso do método, quer seja, grupo ACHO 3 (três a seis meses de uso), grupo ACHO 6 (seis a doze meses de uso) e grupo ACHO 12 (mais de doze meses de uso). A dosagem de folatos intra-eritrocitários foi feita pelo método de captura iônica. A avaliação estatística dos resultados foi feita pela análise de variância e teste c². RESULTADOS: no grupo Condom observou-se que 44% das pacientes apresentaram níveis de folato intra-eritrocitárioreduzidos (<186,0 ng/mL), ao passo que nos grupos de usuárias de ACHO este índice foi de 32% (grupo ACHO 3), 16% (grupo ACHO 6) e 31% (grupo ACHO 12). Não se encontrou nos grupos de usuárias de ACHO de baixa dosagem estrogênica redução significativa na média das taxas de folato intra-eritrocitário em relação ao grupo controle, nem houve diferença dos resultados em função do tempo de uso do método. CONCLUSÕES: verificaram-se níveis reduzidos de folato intra-eritrocitário numa parcela significativa (44%) de pacientes não usuárias de ACHO, com valores próximos ao limite inferior do que é considerado normal pela maioria dos autores, traduzindo deficiência basal de folatos na população estudada. Não se observou influência do uso de ACHO de baixa dosagem estrogênica sobre as taxas de folato intra-eritrocitário.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Medicina FetalUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Obstetrícia FundamentalSecretaria de Saúde do Estado de São Paulo Instituto Adolfo LutzUNIFESP, EPM, Disciplina de Medicina FetalUNIFESP, EPM, Disciplina de Obstetrícia FundamentalSciEL

Iron deficiency anemia in pregnant adolescents: comparison between laboratory tests

PURPOSE: to evaluate, in pregnant adolescents, the incidence of iron deficiency, using the following blood tests: hemoglobin, ferritin, serum iron, transferrin saturation rate and serum transferrin receptor, and their relationships. METHODS: a total of 56 adolescents were included at the first prenatal evaluation between the 12th and the 20th week of gestation. The normal values for each test were: above 11 mg/dL for hemoglobin, 12 µg/dL for ferritin, 50 mg/L for serum iron, 16% for transferrin saturation rate and below 28.1 nmol/L for serum transferrin receptor. Each result was evaluated using percentages and the McNemar test was used to compare the results. RESULTS: incidence of anemia using the hemoglobin concentration test was 21.4%. All pregnant women presented mild anemia. In the present study, 21.4% of the patients had iron deficiency with a ferritin concentration <12 mug/dL. Serum iron concentration was reduced in 3.6% of the adolescents and transferrin saturation rate in 26.8% of the sample. The value obtained by the transferrin receptor test was unclear, due to the lack of international standardization regarding measure unit. Comparing the hemoglobin concentration test to the other iron deficiency tests, it was found that the latter do not show a better evaluation than the hemoglobin concentration test in patients with hypoferremia. CONCLUSIONS: the hemoglobin concentration test in patients with mild anemia was effective to identify iron deficiency.OBJETIVO: avaliar, em grávidas adolescentes, a incidência de redução do estoque de ferro, por meio de seus vários indicadores: hemoglobina, ferro sérico, ferritina, índice de saturação de transferrina e receptor de transferrina, e correlacionar os seus resultados. MÉTODOS: foram incluídas 56 adolescentes, que se encontravam na primeira consulta de pré-natal entre a 12ª e a 20ª semana de gestação. Foram consideradas pacientes normais aquelas que apresentavam valores superiores a: 11 mg/dl para a hemoglobina, 12 mig/dL para a ferritina, 50 mg/L para o ferro sérico, 16% para o índice de saturação de transferrina e inferior a 28,1 nmol/L para o receptor de transferrina. Cada marcador foi avaliado por porcentagem simples e para verificar discordâncias entre os valores obtidos utilizamos o teste de McNemar. RESULTADOS: a incidência de anemia dada pelo nível de hemoglobina foi de 21,4%, sendo essas gestantes anêmicas, portadoras de anemia de grau leve. A ferritina em níveis inferiores a 12 µg/dL apurou deficiência de ferro em 21,4% das gestantes. O ferro sérico encontrou-se diminuído em 3,6% das pacientes e o índice de saturação da transferrina em 26,8% da amostra. Não se pôde valorizar a interpretação do receptor de transferrina, pois não há padronização internacional quanto à unidade de medida de dosagem. Quando se comparou a hemoglobina com os outros parâmetros de avaliação de ferropenia, como a ferritina, o ferro sérico, o índice de saturação de transferrina e o receptor de transferrina, encontrou-se que esses índices não avaliaram melhor que a hemoglobina a deficiência de ferro. CONCLUSÕES: a dosagem de hemoglobina, em pacientes com anemia leve, foi suficiente para avaliação da ferropenia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaSciEL

Bleeding pattern and management of unexpected bleeding/spotting with an extended regimen of a combination of ethinylestradiol 20 mcg and drospirenone 3 mg

Objective: To compare the bleeding pattern in women using ethinylestradiol 20 mcg/ drospirenone 3 mg (EE 20 mcg/DRSP 3 mg) in a 24/4-day cyclic regimen with an extended regimen. Unexpected bleeding/spotting in the extended regimen group was managed by allowing a 4-day hormone-free interval (HFI). Methods: This was a randomized, prospective, open-label, multicenter study. Participants (N = 348) were randomized to receive EE 20 mcg/DRSP 3 mg in either an extended regimen (EE/DRSPes group) or a 24/4-day cyclic regimen (EE/DRSP24/4 group) and followed for 168 days. In the EE/DRSPes group, a 4-day HFI was allowed whenever unexpected bleeding/ spotting persisted for ≥7 consecutive days. The participants assessed their bleeding daily as “no bleeding,” “spotting,” or “light,” “moderate,” or “heavy” bleeding according to a predefined scale. Results: EE/DRSPes group experienced fewer days of bleeding than those using a 24/4 cyclic regimen (P < 0.001). After 168 days, 57.5% of women in the EE/DRSPes group achieved complete amenorrhea (i.e., neither bleeding nor spotting) and 73.9% achieved “no bleeding” (i.e., no bleeding with or without spotting) during the final 28-day interval of the study period. Women in the extended group who instituted the 4-day HFI experienced a 94.1% rate of successful management of unexpected bleeding/spotting. Conclusion: The use of EE 20 mcg/DRSP 3 mg in an extended regimen resulted in high rates of amenorrhea and “no bleeding”. Unexpected bleeding/spotting in the EE/DRSPes group could be managed effectively with a 4-day HFI

Study of triglyceride, total cholesterol and fractions (HDL-C, LDL-C) levels in long adolescent users of oral contraceptive

BV UNIFESP: Teses e dissertaçõe

The T 380A intrauterine device: a retrospective 5-year evaluation

Background: the undue resistance to intrauterine device (IUD) use seen in several settings does not seem to occur in the Family Planning Unit of UNIFESP-EPM (São Paulo Federal University, Brazil). in fact, the Copper T 380A IUD in this clinic has reached an outstanding importance and this motivated us to present our differing experience. the prevalence of this method in this clinic is as high as 40%. This contrasts to the low use in the rest of the country, where tubal ligation is by far the most used contraceptive method (40%) and where IUD is inexpressive (1.1%).Study Design: This is a retrospective study of the records of 118 users of Copper T 380A IUD inserted at the clinic and who were followed during 5 years.Results: the cumulative pregnancy rate was 0.8%. the main cause for discontinuation of the study was loss to follow-up (21.3%). Other reasons for the withdrawal of the device were personal option (13.6%), dislocation (11.7%) and pregnancy wish (3.4%). There was no withdrawal by pelvic inflammatory disease. Bleeding (0.8%) was not an important cause for withdrawal, and there were no withdrawals due to pain. the continuation rate at 5 years was 46.7%.The structured service and an adequate educative program perhaps could explain at least partially the good performance of IUD use in this clinic. There was an amazing prevalence of the components of the metabolic syndrome. This could represent contraindications for hormonal contraception, and, in consequence, it could influence the increased option for and continuation of the IUD.Conclusion: These data show a good performance of the IUD for long duration, in relation to other studies, and this should be considered as a reliable alternative to the high prevalence of female sterilization in this Country. Published by Elsevier Inc.Universidade Federal de São Paulo, Family Planning Unit, EPM, São Paulo, BrazilUniversidade Federal de São Paulo, Family Planning Unit, EPM, São Paulo, BrazilWeb of Scienc