Multidisciplinary Experience In The Selection Of Patients For Tubal Sterilization.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.113171572

Effect of the postural challenge on the dependence of the cardiovascular control complexity on age

Short-term complexity of heart period (HP) and systolic arterial pressure (SAP) was computed to detect age and gender influences over cardiovascular control in resting supine condition (REST) and during standing (STAND). Healthy subjects (n = 110, men = 55) were equally divided into five groups (21-30; 31-40; 41-50; 51-60; and 61-70 years of age). HP and SAP series were recorded for 15 min at REST and during STAND. A normalized complexity index (NCI) based on conditional entropy was assessed. At REST we found that both NCIHP and NCISAP decreased with age in the overall population, but only women were responsible for this trend. During STAND we observed that both NCIHP and NCISAP were unrelated to age in the overall population, even when divided by gender. When the variation of NCI in response to STAND (\u394NCI = NCI at REST-NCI during STAND) was computed individually, we found that \u394NCIHP progressively decreased with age in the overall population, and women were again responsible for this trend. Conversely, \u394NCISAP was unrelated to age and gender. This study stresses that the complexity of cardiovascular control and its ability to respond to stressors are more importantly lost with age in women than in men

A Comparison Of The Performance Of Endometrial Biopsy With The Pipelle® By Nurses And Physicians

[No abstract available]452164165Stovall, Ling, Morgan, A prospective, randomized comparison of the Pipelle endometrial sampling device with the Novak curette (1991) American Journal of Obstetrics and Gynecology, 156, p. 1287Cornier, The Pipelle: A disposable device for endometrial biopsy (1984) Am J Obstet Gynecol, 148, p. 109Diaz, Faúndes, Marchi, Espejo, Comparación del desempeño del DIU T-Cu 200B insertado por médicos o enfermeras (1992) Rev. Iberoamericana de Fertilidad, 9, p. 53Armitage, (1971) Statistical Methods in Medical Research, , Blackwell Scientific Publications, Oxfor

Management Of Missing Strings In Users Of Intrauterine Contraceptives

Background: A common question among health care professionals is how to manage nonvisible strings in users of intrauterine contraceptives (IUCs) at repeat follow-up visits. This study assessed the position of the IUCs in women who consulted repeatedly with nonvisible IUC strings. Study Design: The medical records of the clinic were reviewed to identify new acceptors and switchers who had an IUC inserted between 1990 and 2009. All women were identified whose IUC string could not be visualized at the external os of the cervix by the health care professional at any given follow-up visit, even after attempting a standard maneuver of sweeping the strings from the cervical canal using a cervical brush or trying to visualize the strings in the cervical canal using colposcopy. Data were also retrieved on the use of ultrasonography and/or pelvic X-ray to assess IUC position, as well as data from any subsequent visits at which the IUC strings were nonvisible. Results: The medical charts of 14,935 patients using an IUC were reviewed, and 750 women (5.0%) presenting for the first time with missing IUC strings at any follow-up visit were identified. Ultrasound scans showed the IUC to be in situ in 735 cases (98.0%), while 9 women (1.2%) had expelled the device and, in 5 cases (0.7%), the device was found in the pelvis following uterine perforation. IUC strings were missing on a second occasion in 297 cases. The device was found to be in situ in 295 cases (99.3%) and had been expelled in 2 (0.7%). At subsequent consultations, (between 1 and 18 years after the first consultation), strings were missing in 113, 55, 19 and 5 cases. In 111 (98.2%), 54 (98.2%), 18 (94.7%) and 5 (100%) of these cases, respectively, the IUC was found to be in situ, while in the remaining cases, the device had been expelled. Conclusions: Missing IUC strings are an uncommon finding, and ultrasonography confirmed that the device was in situ in the majority of these cases. For women with persistent missing IUC strings after one ultrasound scan that has verified appropriate intrauterine position, given the 2.4% likelihood that expulsion may have occurred at the time of subsequent visits, repeating the ultrasound (if available) should be considered for at least one (and possibly two) additional women's visit. © 2012 Elsevier Inc. 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(2003) Contraception, 67, pp. 53-56Chi, I., What we have learned from recent IUD studies: A researcher's perspective (1993) Contraception, 48, pp. 81-108Zhou, L., Harrison-Woolrych, M., Coulter, D.M., Use of the New Zealand Intensive Medicines Monitoring Programme to study the levonorgestrel-releasing intrauterine device (Mirena) (2003) Pharmacoepidemiol Drug Saf, 12, pp. 371-377Van Houdenhoven, K., Van Kaam, K.J., Van Grootheest, A.C., Salemans, T.H., Dunselman, G.A., Uterine perforation in women using a levonorgestrel-releasing intrauterine system (2006) Contraception, 73, pp. 257-26