Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience

To evaluate the acceptance of postpartum intrauterine contraceptive devices [PPIUCD] among the inhabitants of Assiut governorate, Egypt and to study the factors that influence this acceptance. Subjects and Contraceptive counseling was given to 3,541 clients: 1,880 and 1,661 during the antenatal visits and postpartum hospitalization, respectively. Acceptors during antenatal counseling were to receive IUCDs via postplacental insertion in the case of vaginal delivery or transcesarean insertion in case of abdominal delivery. The clients who refused PPIUCD and chose interval IUCD insertion were referred to the Family Planning Clinic after the end of puerperium. Among postpartum counselees, PPIUCD acceptors received predischarge insertion within 48 h of delivery and the interval IUCD were referred to have IUCD inserted after the end of puerperium. The acceptance rate of both PPIUCD and interval IUCD and the percentage of actual insertions were recorded. The causes of both acceptance and refusal were also recorded. Of the 3,541 clients, 1,024 [28.9%] accepted the use of IUCD after delivery. Acceptance was approximately the same during antenal and postpartum counseling: 26.4 and 31.8%, respectively. Verbal acceptance was higher among women with formal education than among illiterate women. Planning another pregnancy in the near future, preference for another contraceptive method, namely lactational infertility, and complications from previous use of IUCD were the most common reasons for refusing the use of IUCD. Of the 1,024 verbal acceptors, only 243 [23.7%] had the actual insertion of IUCD. Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. For these women, the only opportunity to receive information about contraceptives is during childbirth when they are in contact with medical personnel. Hence, it is suggested that family planning should be integrated with maternal and child-care services in order to effectively promote the use of contraceptive devices in these women who otherwise would not seek the use of such a device

use of specific opioid receptor antagonist [nalthrexone] in hypertensive pregnancy

Twenty pregnant patients induced hypertension in late pregnancy [30-36 weeks] were randomly allocated to either Nalthrexone [R Trexan], specific opioid receptor antagonist, or placebo treatment. Nalthrexone was given in the form of tablets, 50 mg/12 hours. Blood pressure was measured twice daily and measuring of proteinunria was done daily with observation of edema of the lower limbs. The serum levels of prolactin before, one week and 2 weeks after treatment, were measured by radioimmunoassay. This was done also to 51 normal pregnant women in the same gestational age. The results show normalization of blood pressure, subsidence of pretibial edema and minimal decrease in body weight. This was associated with decrease of serum proloctin from 148 +/- 12.8 to 23.4 +/- 4.76 ng/ml after treatment. All babies were delivered at term in a healthy condition. There was no effect on the initiation of lactation which was normal up to 3 months after delivery. The present results of potential value from the clinical and biological points of view are: Nalthrexone is an effective and safe drug to be used in PIH. Beta-endorphin may play a role in the pathogenesis of PIH through controlling the release of prolactin