Knowledge And Attitudes Of Latin American Gynecologists Regarding Unplanned Pregnancy And Use Of Combined Oral Contraceptives.

Unintended pregnancy is a public health problem and unmet medical need worldwide. It is estimated that in the year 2012, almost 213 million pregnancies occurred, and the global pregnancy rate decreased only slightly from 2008 to 2012. It was also estimated that 85 million pregnancies (40% of all pregnancies) were unintended and that 38% ended in an unintended birth. To assess knowledge and attitudes of Latin American (LA) obstetricians and gynecologists (OBGYNs) regarding unintended pregnancies and aspects of combined oral contraceptive (COC) use. A survey was conducted during a scientific meeting about contraception in 2014, in which OBGYNs from 12 LA countries who provide attention in contraception were invited to respond to a multiple-choice questionnaire to assess their knowledge and attitudes regarding unplanned pregnancy and some aspects regarding COC use. A total of 210 OBGYNs participated in the study. Their knowledge regarding COC failure was low. The participants reported they believed that their patients habitually forgot to take a pill and that their patients did not know what to do in these situations. They were aware of the benefits of COC use; however, they were less prone to prescribe COCs for the purpose of protecting against ovarian and endometrial cancer, and one-quarter of them had doubts about the association between COC use and cancer risk. The interviewed LA OBGYNs showed some flaws in terms of knowledge of COC failure rates and the non-contraceptive benefits and risks of COCs. To adequately counsel their patients regarding COC intake, OBGYNs must be updated regarding all aspects of COC use.7485-49

Knowledge of Latin American Obstetricians and Gynecologists regarding Heavy Menstrual Bleeding

Background. Heavy menstrual bleeding (HMB) is a common gynecological complaint affecting quality of life. Objectives. To assess knowledge on diagnosis and treatments of HMB of Latin American (LA) obstetricians and gynecologists (OBGYNs). Methods. A survey was conducted during a scientific meeting, organized to provide updated information on topics of reproductive medicine to OBGYNs from 12 LA countries who were invited to respond to a multiple-choice questionnaire. Results. Of the 210 OBGYNs participating in the survey, from 169 (80.4%) to 203 (96.7%) answered the questions. Most respondents (80%) gave accurate answers regarding the amount of blood loss which defines HMB, underreported the proportion of women who consulted due to HMB, and were aware that the use of combined oral contraceptives (COCs) with ethynyl estradiol is not an adequate treatment in women with HMB. Female OBGYNs and those who worked in the private sector were more prone to report a higher possibility of improvement of HMB with a COC that contained estradiol valerate and dienogest or with a levonorgestrel-releasing intrauterine system. Conclusions. In general, the respondents were aware of the importance of HMB in gynecological practice and of the new medical treatments and underreported the proportion of women who consulted due to HMB

Maternal position during the first stage of labor: a systematic review

BACKGROUND: Policy makers and health professionals are progressively using evidence-based rationale to guide their decisions. There has long been controversy regarding which maternal position is more appropriate during the first stage of labor. This problem has been examined often and repeatedly and the optimal recommendation remains unclear. METHODS: This is a systematic review of the effect of maternal position during the first stage of labor. The main question addressed here is: Does encouraging women to adopt an upright position or to ambulate during the first stage of labor reduce the duration of this stage? All randomized controlled trials carried out to assess this effect were taken into consideration in this review. The following electronic databases were accessed to identify studies: MEDLINE, Popline, the Scientific Electronic Library On-line and the Latin American and Caribbean Health Science Information. Citation eligibility was independently assessed by two reviewers. The methodological quality of each trial was also evaluated independently by two reviewers and a trial under consideration was included only when consensus had been attained. Allocation concealment and screening for the occurrence of attrition, performance and detection biases were considered when studies were appraised. The decision whether to perform data pooling was based on the clinical similarity of studies. RESULTS: The search strategy resulted in 260 citations, of which 18 were assessed in full-text. Nine eligible randomized controlled trials were included in the systematic review. Randomization methods were not fully described in eight studies. The allocation concealment was considered adequate in four studies and unclear in five. The investigators pooled the data from seven studies in which the length of the first stage of labor and results were in favor of the intervention, but the high level of heterogeneity (I(2 )= 88.4%) impaired the meaning of this finding. The intervention did not affect other outcomes studied (mode of delivery, use of analgesia, labor augmentation and condition of the child at birth). CONCLUSION: Adoption of the upright position or ambulation during first stage of labor may be safe, but considering the available evidence and its consistency, it cannot be recommended as an effective intervention to reduce duration of the first stage of labor

Infertility care and the introduction of new reproductive technologies in poor resource settings

Background: The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family.Methods: This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost.Results: There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child.Conclusions: It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings121sem informaçã

Perspective of pregnant women regarding antenatal preparation : a qualitative study

Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions. Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education. A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling. All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation. The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth32655856

Long-term Follow-up Of Women And Men After Unsuccessful Ivf.

The experience of 92 couples, who had unsuccessfully undergone one or more IVF cycles at a university clinic, was evaluated 3-8 years following their last failed attempt. One member of each couple completed a telephone questionnaire regarding life events during their last IVF cycle performed at the clinic and at the time of the interview. Some couples had continued further treatment and some had not. Multivariate correspondence analysis was used to analyse the data. Regarding the long-term experience of couples who had undergone further treatment, for men the main experiences were psychological problems and having adopted a child. For women, the main experiences were related to problems of self-image, psychological problems, loss of hope, and having adopted a child. These women also presented a strong association with problems in their marital relationship and with adoption. For the group that did not undergo further treatment, the women showed a strong association with considering adoption, and a less intense association with psychological problems and loss of hope. The men presented psychological problems and having adopted a child as associated variables. Comparison between men and women showed that recognizing the impossibility of conceiving a child and giving up treatment were strongly associated. Men and women who had not continued with further treatment were more affected in the long term than those who had undergone further treatment after IVF failure.11458-6

Perceptions and actions of healthcare professionals regarding the mother-child relationship with premature babies in an intermediate neonatal intensive care unit: a qualitative study

Background: The mother-child interaction after delivery may be hampered when the newborn baby is hospitalized. The objective of the study was to understand perceptions and actions of healthcare professionals (HCPs), working in an intermediate neonatal intensive care unit (NICU), regarding mother-child relationship of hospitalized premature babies in the first weeks after delivery and the professionals' support for the development of this relationship within an NICU environment. The psychoanalytic concept of holding defined by Winnicott was used as the theoretical framework.Methods: A qualitative study was conducted with 20 HCPs (physicians, medical residents, nurses, and nurse technicians) working at an intermediate NICU of a referral hospital in Brazil. Semi-structured interviews were conducted, recorded and transcribed verbatim; and thematic analysis was performed.Results: The HCPs referred to the difficulty that these mothers had to develop the mother-child relationship within this environment. If they observed that the mother had initial inhibitions to interact with her baby, they tried to facilitate this process, since they were aware of the importance of early bonding for the child's well-being. They attributed the mothers' difficulty to the fragile appearance of the premature baby, the limited contact often imposed by the routine of the unit and the lack of participation in the decisions regarding the care given to her baby. HCPs tried to help women bond with her child by giving support and encouragement. Most of the physicians reported that the nurses represented a link between physicians and the mothers of the hospitalized babies.Conclusion: The HCPs reported attitudes and actions indicative of holding. A more in-depth understanding of the relationship between HCPs and mothers of premature babies at an NICU during the first days after delivery, and the needs of the mothers and her baby to be close to facilitate bonding should be part of the routine discussions of the NICU health team141COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação2011/23732-1

Características de homens e mulheres que buscam tratamento para infertilidade em serviço público de saúde

ResumoObjetivocaracterizar a população que busca tratamento para infertilidade em um serviço público de saúde.Métodoestudo descritivo com 101 homens e 101 mulheres que se consultavam pela primeira vez em ambulatório de reprodução humana de hospital universitário. Informações socioeconômicas e sobre a infertilidade foram coletadas por meio de entrevista única, com questionário estruturado.Resultadosa maior parte das pessoas tinha entre 25 e 35 anos, no máximo nível médio de escolaridade completo, renda per capita familiar entre um e três salários mínimos, declarou ser casada havia mais de cinco anos e que apresentava o problema de infertilidade havia dois anos ou mais. Um pouco menos da metade afirmou nunca ter feito tratamento para infertilidade. Houve diferença significativa entre homens e mulheres quanto a idade, união anterior, trabalho remunerado, tratamento anterior para engravidar, quem tinha o problema para engravidar e ter filhos de uma união anterior.Conclusõesas pessoas chegam ao serviço depois de um tempo relativamente longo de infertilidade. Especificamente as mulheres já chegam com idade que, muitas vezes, inviabiliza sua admissão para tratamento em vista das normas dos serviços. É preciso desenvolver estratégias para facilitar o acesso a esses serviços, para que sejam respeitados os direitos reprodutivos.AbstractObjectiveto characterize the population seeking infertility treatment at a public health service.Methodit was carried out a descriptive study with 101 men and 101 women who were consulting for the first time in a human reproduction outpatient clinic at an university hospital. A structured questionnaire was used to collect information on subjects’ socioeconomic characteristics and infertility problem.Resultsthe most of the subjects were 25-35 years old, have at most medium level of scholarship, familiar per capita income between one to three minimum salaries, they declared they were married for more than five years and that they had the infertility problem for two years or more. A little less than half said they had never had treatment for infertility. There was a significant difference between men and women regarding age, previous marriage, paid work, previous infertility treatment, who had the infertility problem, and have children from a previous union.Conclusionspeople come to the clinic after a long period of infertility. Specifically women are already at an age that often precludes admission for treatment in view of the standards of services. It is necessary to develop strategies to facilitate access to these services for reproductive rights

Knowledge of Latin American Obstetricians and Gynecologists regarding Heavy Menstrual Bleeding

Background. Heavy menstrual bleeding (HMB) is a common gynecological complaint affecting quality of life. Objectives. To assess knowledge on diagnosis and treatments of HMB of Latin American (LA) obstetricians and gynecologists (OBGYNs). Methods. A survey was conducted during a scientific meeting, organized to provide updated information on topics of reproductive medicine to OBGYNs from 12 LA countries who were invited to respond to a multiple-choice questionnaire. Results. Of the 210 OBGYNs participating in the survey, from 169 (80.4%) to 203 (96.7%) answered the questions. Most respondents (80%) gave accurate answers regarding the amount of blood loss which defines HMB, underreported the proportion of women who consulted due to HMB, and were aware that the use of combined oral contraceptives (COCs) with ethynyl estradiol is not an adequate treatment in women with HMB. Female OBGYNs and those who worked in the private sector were more prone to report a higher possibility of improvement of HMB with a COC that contained estradiol valerate and dienogest or with a levonorgestrel-releasing intrauterine system. Conclusions. In general, the respondents were aware of the importance of HMB in gynecological practice and of the new medical treatments and underreported the proportion of women who consulted due to HMB