The risk factor profile of women with secondary infertility: an unmatched case-control study in Kigali, Rwanda

<p>Abstract</p> <p>Background</p> <p>Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.</p> <p>Methods</p> <p>Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).</p> <p>Results</p> <p>Risk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or <it>Treponema pallidum </it>antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.</p> <p>Conclusions</p> <p>The main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.</p

Freqüência e critérios para indicar a episiotomia Frecuencia y criterios para indicar la episiotomía Frequency and criteria for the indication of episiotomy

Trata-se de estudo exploratório com o objetivo de identificar a freqüência, os tipos e os critérios adotados para indicar a episiotomia. Foram entrevistados 12 médicos e 12 enfermeiras que prestam assistência à parturiente no Hospital Universitário da Universidade de São Paulo. A episiotomia ocorreu em 76,2% dos partos normais; as indicações mais freqüentes foram: rigidez perineal (28,7%), primiparidade (23,7%), feto macrossômico (11,9%), prematuridade (10,2%). O tipo mais citado foi médio-lateral direito (92,0%), justificado por: aprendizado durante a formação acadêmica (25,9%), ser adotada rotineiramente (19,4%), menor chance de lesar o esfíncter anal (16,1%), menor risco de complicações (16,1%). É necessário rever as práticas de atendimento à parturiente, considerando as evidências científicas e condutas individualizadas.<br>Trata-se de estudo exploratório com o objetivo de identificar a freqüência, os tipos e os critérios adotados para indicar a episiotomia. Foram entrevistados 12 médicos e 12 enfermeiras que prestam assistência à parturiente no Hospital Universitário da Universidade de São Paulo. A episiotomia ocorreu em 76,2% dos partos normais; as indicações mais freqüentes foram: rigidez perineal (28,7%), primiparidade (23,7%), feto macrossômico (11,9%), prematuridade (10,2%). O tipo mais citado foi médio-lateral direito (92,0%), justificado por: aprendizado durante a formação acadêmica (25,9%), ser adotada rotineiramente (19,4%), menor chance de lesar o esfíncter anal (16,1%), menor risco de complicações (16,1%). É necessário rever as práticas de atendimento à parturiente, considerando as evidências científicas e condutas individualizadas.<br>This is an exploratory study aimed at identifying the frequency, the types and the criteria adopted to recommend episiotomy. Twelve doctors and 12 nurses who attend women giving birth at the University of São Paulo's Hospital Universitário were interviewed. Episiotomy was performed in 76.2 percent of the normal births; the most frequent indications were: perineal rigidity (28.7 percent), primiparity (23.7 percent), macrossomic infant (11.9 percent) and prematurity (10.2 percent). The most mentioned type was the right medium-lateral (92.0 percent), and the justifications were: it was learned during academic formation (25.9 percent); it is adopted routinely (19.4 percent); with it there is a lesser chance for causing lesions to the anal sphincter (16.1 percent); with it there is a lesser risk of complications (16.1 percent). The practices for attending women giving birth must be revised taking into account scientific evidences and individualized conducts