Access to postpartum tubal ligation services in Cape Town, South Africa - an observational study

Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

Da gestação à laqueadura: cartografia de uma mãe órfã vivenciada em um Consultório na Rua / De la gestación a la ligadura de trompas: cartografía de una madre huérfana vivida en un consultorio en la calle / From pregnancy to sterilization: a cartography of an orphan mother experienced in a Clinic at the Street

Este artigo buscou mapear os afetos em cenas que ocorreram em uma vivência em um Consultório na Rua (CnaR) por meio da realização de uma cartografia. Os territórios mapeados, junto com a intercessão da obra "Sandman" de Neil Gaiman, que foi utilizada como dispositivo cognitivo de discussão da fantasia-realidade, evidenciaram modos de viver que desafiam os métodos tradicionais de produzir cuidado, enquanto tornaram visíveis capturas micropolíticas que levaram à produção de controle e enquadramento. Diante disso, foi perceptível no CnaR uma potência de produção de outros modos de cuidado ao mesmo tempo que as capturas micropolíticas para controle do vivente da rua agem agressivamente maquinando a produção da necessidade de esterilizações e desmaternizações com o sequestro de bebês pelo Estado. (AU)

El objetivo de este artículo fue mapear los afectos en escenas ocurridas en una experiencia en un consultorio en la calle (en portugués, Consultório na Rua - CnaR) por medio de la realización de una cartografía. Los territorios mapeados, juntamente con la intercesión de la obra Sandman de Neil Gaiman utilizada como dispositivo cognitivo de discusión de la fantasía-realidad, pusieron en evidencia modos de vivir que desafían los métodos tradicionales de producir cuidado, puesto que dieron visibilidad a capturas micropolíticas que llevaron a la producción de control y encuadre. Ante esto, fue perceptible en el CnaR una potencia de producción de otros modos de cuidado, al mismo tiempo que las capturas micropolíticas para control de la persona que vive en la calle actúan agresivamente maquinando la producción de la necesidad de esterilizaciones y desmaternizaciones juntamente con el secuestro de bebés por parte del Estado. (AU)

This article aimed to map the affections in scenes that occurred in an experience in a Clinic at the Street (CnaR) through the realization of a cartography. Mapped territories, with the intercession of Neil Gaiman's Sandman used as a cognitive device for the discussion of reality-fantasy, have highlighted ways of life that challenge traditional methods of care production, while making visible micropolitical captures that led to production of control and framing. Therefore, it was noticeable in the CnaR a potency of production of new ways of care, but at the same time, there are micropolitical captures for the control of street dwellers, conspiring aggressively to produce needs of sterilization and de-motherhood as well as the kidnapping of babies by the State. (AU)

Factores sociodemográficos y obstétricos relacionados con aplicación del consentimiento informado en procedimientos de oclusión tubárica. Cartagena-Colombia / Sociodemographic and obstetric factors related to the application of informed consent in procedures of tubal occlusion. Cartagena-Colombia

Introducción: La forma como se aplica el consentimiento informado (CI) en algunas instituciones prestadoras de salud, donde se realizan procedimientos de oclusión tubárica bilateral (OTB) en Cartagena, podría verse influenciado por factores de tipo sociodemográfico y factores de tipo obstétrico, que al final determinan la forma como se aplica el Consentimiento informado y que este sea más que un requisito para desligar responsabilidades por parte de profesionales en su relación médico- paciente. Objetivo: Determinar la influencia de los factores sociodemográficos y obstétricos en la aplicación del consentimiento informado, en procedimientos de OTB, en centros de salud de Cartagena. Material y Métodos: Se realizó un estudio descriptivo transversal prospectivo. Las fuentes de información consultadas son fuentes primarias; se encuestaron 196 pacientes que se realizaron procedimientos de cesárea por urgencias más oclusión tubárica bilateral. Se efectuó análisis Univariado y Bivariado para establecer tendencia a la asociación mediante la prueba de Chi cuadrado. Resultados: Dentro de las características sociodemográficas y obstétricas asociadas estadísticamente con conocer lo que es el consentimiento informado están tener más de 24 años (p= 0,033); ser de procedencia urbana (p=0,046); vivir en estrato superior a estrato 1 y 2 (p=0,0001), tener estudios superiores a primaria (p=0,0001); no tener más de dos embarazos (p=0,029) y asistir a control prenatal (p=0,0001). Conclusiones: La mayoría de las pacientes poseen en términos generales desconocimiento sobre el CI. El estrato socioeconómico, el nivel de escolaridad y la procedencia influyen en el nivel de conocimiento que tienen del CI, lo mismo que algunos factores obstétricos(AU)

Introduction: The way in which informed consent (IC) is applied in some healthcare institutions where bilateral tubal occlusion (OTB) procedures are performed in Cartagena could be influenced by sociodemographic and obstetric factors which ultimately determine the way at which informed consent is applied, being this more than a requirement for the professionals to be free of liability in their doctor-patient relationship. Objective: To determine the influence of sociodemographic and obstetric factors on the application of informed consent in OTB procedures in health centers in Cartagena. Material and Methods: A prospective cross-sectional descriptive study was carried out. Primary sources of information were consulted; a total of 196 patients who underwent cesarean section procedures for emergencies plus bilateral tubal occlusion were surveyed. Univariate and bivariate analyzes were performed to establish a tendency to association using the Chi-square test. Results: Some sociodemographic and obstetric characteristics statistically associated with knowledge about informed consent are to be over 24 years old (p=0.033); to be of urban origin (p=0.046); to live in stratum higher than stratum 1 and 2 (p=0.0001), to have higher education than primary (p=0.0001); not to have more than two pregnancies (p=0.029) and to attend prenatal care (p=0.0001), among others. Conclusions: Most patients are generally unaware of IC. The socioeconomic stratum, level of schooling, origin and some obstetric factors have an influence on their level of knowledge of IC(AU)

Results of the insertion of hysteroscopic sterilization devices in a brazilian public hospital / Resultados da inserção de dispositivos de esterilização histeroscópica em um hospital público brasileiro

Abstract Objective To evaluate the insertion of the hysteroscopic intratubal sterilization device for female sterilization concerning the technique and the feasibility. Methods Retrospective study with data collection of medical records of 904 patients who underwent device insertion between January and September 2016 in a public hospital in Rio de Janeiro (Brazil) with data analysis and descriptive statistics. Results In 85.8% of the cases, the uterine cavity was normal, and themost commonlydescribed findings upon hysteroscopy were synechiae (9.5%). The procedure lasted an average of 3.56minutes (range: 1 to 10minutes), and the pain was considered inexistent or mild in 58,6% of the cases, mild or moderate in 32,8%, and severe or agonizing in less than 1% (0.8%) of the cases, based on a verbal scale ranging from 0 to 10. The rate of successful insertions was of 85.0%, and successful tubal placement was achieved in 99.5% of the cases. There were no severe complications related to the procedure, but transient vasovagal reactions occurred in 5 women (0.6%). Conclusion Female sterilization performed by hysteroscopy is a safe, feasible, fast, and well-tolerated procedure. The rates of successful insertions and tubal placements were high. There were few and mild adverse effects during the procedure, and there were no severe complications on the short term.

Resumo Objetivo Avaliar a inserção de dispositivo intratubário de esterilização histeroscópica com relação à viabilidade e à técnica. Métodos Estudo retrospectivo com coleta de dados de prontuários das pacientes submetidas à inserção do dispositivo entre janeiro e setembro de 2016 emumhospital público do Rio de Janeiro, comanálise dos dados e realização de estatísticas descritivas. Resultados Foram incluídos 904 casos no estudo. Em 85,8% dos casos, a cavidade uterina estava normal, e os achados mais comumente descritos à histeroscopia foram as sinequias (9,5%). O tempomédio do procedimento foi de 3,56minutos (gama: de 1 a 10 minutos); a dor foi considerada de ausente a leve em 58,6% dos casos, de leve a moderada em32,8% dos casos, e de forte à pior dor possível emmenos de 1% dos casos (0,8%). A taxa de inserções bem-sucedidas foi de 85,0%, e a colocação tubária foi bemsucedida em 99,5% dos casos. Não foram identificadas complicações graves, mas reações vasovagais transitórias ocorreram em 5 mulheres (0,6%). Conclusão A esterilização feminina por histeroscopia é um procedimento seguro, viável, rápido, e bem tolerado. As taxas de inserção bem-sucedida e de colocação tubária foram altas. Houve poucos e leves efeitos colaterais durante o procedimento, e não foram observadas complicações graves no curto prazo.

Essure no Brasil: desvendando sentidos e usos sociais de um dispositivo biomédico que prometia esterilizar mulheres / Essure in Brazil: unveiling senses and social uses of a biomedical device that promised to sterilize women

Resumo Denúncias graves de efeitos colaterais sofridos por mulheres em vários países (Estados Unidos, nações da Europa e Brasil) desvelaram controvérsias na difusão de um dispositivo permanente para controle reprodutivo, designado Essure, pelo laboratório farmacêutico Bayer. Este trabalho busca compreender a circulação internacional e a introdução desse artefato biomédico no Brasil, a partir de pesquisa documental em sites de agências regulatórias, do laboratório farmacêutico e da divulgação pública feita por hospitais no país, associados ao Sistema Único de Saúde, para convocarem mulheres para o procedimento. Trata-se de primeira aproximação ao tema para se inquirir sobre as condições sociais da implantação do dispositivo em usuárias desses serviços de saúde no período em que ele esteve disponível no país, de 2009 a 2017. Apresentado como um dispositivo seguro, inócuo e de fácil manejo clínico, a promessa de um objeto permanente que impediria a gravidez sem necessidade de recorrer ao método cirúrgico foi vendida pela Bayer ao staff médico como solução simples, prática e moderna de controle reprodutivo. O percurso do dispositivo no Brasil evidencia certo entusiasmo médico com a nova técnica, não acompanhado de monitoramento clínico de longo prazo, principalmente quando as mulheres passaram a demandar a sua retirada em razão de muitas sequelas e efeitos colaterais dele decorrentes.

Abstract Recently, there have been serious reports of side effects suffered by women in various countries (United States, European countries and Brazil), revealing controversies surrounding Bayer's widespread use of a permanent reproductive control device over the last decade: Essure. This article analyzes the international circulation and the introduction of this biomedical artifact in Brazil. This documentary research investigated websites of regulatory agencies, the aforementioned pharmaceutical laboratory, public disclosure made by hospitals in the country, associated with the Brazilian National Health System. This is the first approach to the subject that questions the social conditions of the implementation of Essure in users of these health services when it was available in the country, from 2009 until 2017. This permanent contraceptive method was presented as a safe and easy-to-use clinical management device. The promise of a permanent object that would prevent pregnancy without surgery was sold by Bayer to medical staff as a simple, practical and modern reproductive control solution. Its circulation in Brazil shows medical enthusiasm for the new technique, which was not accompanied by long-term clinical monitoring, even as women began to demand its withdrawal due to the many sequelae and resulting side effects.

Factores asociados a la no realización de la esterilización quirúrgica en mujeres gran multíparas de la serranía peruana, 2017 / Factors associated with not performing surgical sterilization in great multiparous women of the Peruvian highlands, 2017

RESUMEN Objetivo: Determinar las características sociodemográficas, los antecedentes gíneco-obstétricos, la percepción y los conocimientos previos asociados a no realizarse la esterilización quirúrgica en mujeres gran multíparas internadas en un hospital de la provincia de Huancayo. Materiales y Métodos: Estudio de tipo cuantitativo, prospectivo y de corte transversal, que se realizó en las mujeres gran multíparas internadas en el Hospital Regional Docente Materno Infantil "El Carmen" de Huancayo; que cumplieran con los criterios de inclusión. Se aplicó un instrumento de recolección de tipo encuesta. Se realizó una estadística descriptiva, así como, el análisis bivariado y multivariado. Resultados: Un 73% de las mujeres encuestadas no se realizaría la esterilización quirúrgica a futuro, sin embargo, a un 90% le gustaría recibir más información al respecto. Los factores estadísticamente significativos asociados a no realizase la esterilización quirúrgica fueron: No haber utilizado ningún método anticonceptivo anteriormente (RPa: 1,35; IC 95%: 1,01-1,82; p: 0,042), no saber si desea tener más hijos (RPa: 1,58; IC 95%: 1,22-2,03; p <0,001), pensar que realizarse la esterilización quirúrgica iría en contra de sus derechos (RPa: 1,24; IC 95%:1,05-1,46; p: 0,008) y pensar que la esterilización quirúrgica produce alteraciones menstruales (RPa: 1,11; IC 95%:1,17-1,34; p: 0,027). Conclusiones: Muchas mujeres encuestadas no optarían por la esterilización quirúrgica a futuro, debido a diversos factores, muchos de ellos modificables con una adecuada capacitación e intervención del personal de salud.

ABSTRACT Objective: Determine sociodemographic characteristics, gynecological-obstetric history, perception and previous knowledge associated with not performing surgical sterilization in large multiparous women admitted to a hospital in the province of Huancayo. Materials and Methods: A quantitative, prospective and cross-sectional study, was carried out on large multiparous women hospitalized in the gynecology and obstetrics services of the Regional Maternal and Child Teaching Hospital "El Carmen" of Huancayo; that met the inclusion criteria. A survey-type collection instrument was applied. A descriptive statistic was carried out, as well as the bivariate and multivariate analysis. Results: 73% of the women surveyed would not undergo surgical sterilization in the future, however, 90% would like to receive more information about it. The statistically significant factors associated with not performing surgical sterilization were: Not having used any contraceptive method previously (RPa: 1.35, 95% CI: 1.01-1.82, p: 0.042), not knowing if you want having more children (RPa: 1.58, 95% CI: 1.22-2.03, p <0.001), thinking that performing surgical sterilization would be against their rights (RPa: 1.24, 95% CI: 1.05-1.46; p: 0.008) and to think that surgical sterilization produces menstrual alterations (RPa: 1.11, 95% CI: 1.17-1.34, p: 0.027). Conclusions: Many women surveyed would not opt for surgical sterilization in the future due to various factors, many of them modifiable with adequate training and intervention of health personnel.

Social inequalities in the use of contraceptives in adult women from Southern Brazil / Desigualdades sociais no uso de contraceptivos em mulheres adultas no Sul do Brasil

ABSTRACT OBJECTIVE: To describe the contraceptive methods used by adult women and the associated socioeconomic and demographic factors. METHODS: Population-based cross-sectional study with 20 to 49-year-old women from São Leopoldo, state of Rio Grande do Sul, in 2015. Three outcomes were considered to analyze the association with demographic and socioeconomic characteristics: use of oral contraceptive pills, tubal ligation and male condom. The crude prevalence ratios, stratified by age, and 95% confidence intervals (95%CI) were obtained using Poisson regression, taking the experimental error into account. RESULTS: A total of 736 women, aged from 20 to 49 years old, were evaluated. The prevalence of the use of oral contraceptive pills, tubal ligation and male condom were respectively 31.8% (95%CI 28.4-35.3), 11.1% (95%CI 9.0-13.6) and 10.9% (95%CI 8.7-13.3). In addition, 10.5% (n = 77) of the women reported making combined use of oral contraceptive pills and condom. In the stratified analysis, younger women with lower education level and from lower social classes reported less use of oral contraceptive pills. Tubal ligation was more prevalent among the lower social classes, but only in the age group from 30 to 39 years old. No differences were found in relation to male condom. CONCLUSIONS: The results indicated that differences persist in relation to contraception, which can be associated with both the difficulties of access to these inputs and the frailty of actions in reproductive health to achieve the needs and preferences of women who are more socially vulnerable.

RESUMO OBJETIVO: Descrever os métodos contraceptivos utilizados e fatores demográficos e socioeconômicos associados em mulheres adultas. MÉTODOS: Estudo transversal de base populacional com mulheres de 20 a 49 anos de São Leopoldo, RS, em 2015. Foram considerados três desfechos para analisar a associação com características demográficas e socioeconômicas: uso de anticoncepcional oral, ligadura tubária e uso de preservativo masculino. Foram obtidas razões de prevalências, brutas e estratificadas por idade, e intervalos de confiança de 95% (IC95%) por meio de regressão de Poisson, levando em conta o erro de delineamento. RESULTADOS: Foram avaliadas 736 mulheres com idades entre 20 e 49 anos. A prevalência de uso de anticoncepcional oral, de ligadura tubária e de uso de preservativo masculino foram, respectivamente, 31,8% (IC95% 28,4-35,3), 11,1% (IC95% 9,0-13,6) e 10,9% (IC95% 8,7-13,3). Além disso, 10,5% (n = 77) das mulheres relataram fazer uso combinado de anticoncepcional oral e preservativo masculino. Na análise estratificada, as mulheres mais jovens, de menor escolaridade e classe econômica mais baixa relataram menor uso de anticoncepcional oral. Já a ligadura tubária foi mais prevalente entre as de classe econômica mais baixa, mas apenas na faixa etária de 30 a 39 anos. Não foram encontradas diferenças quanto ao preservativo masculino. CONCLUSÕES: Os resultados indicaram que ainda persistem diferenças quanto à contracepção, o que pode se relacionar tanto a dificuldades no acesso a esses insumos como a fragilidades das ações em saúde reprodutiva para atingir as necessidades e preferências das mulheres em maior vulnerabilidade social.

Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes? / Qual modo e potência produzem a menor área de nãoobstrução nas tubas de Falópio?

Abstract Objective To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. Methods In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. Results Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). Conclusion The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

Resumo Objetivo Determinar em qual modo e potência, usando unidades geradoras modernas de eletrocoagulação, produz a menor área de não-obstrução das tubas de Falópio. Métodos Num estudo experimental, tubas uterinas derivadas de 48 histerectomias ou ligadura tubária foram avaliadas. As tubas foram alocadas aleatoriamente para um dos seguintes grupos: grupo A) 25 W x 5 segundos (n = 17); grupo B) 30 W x 5 segundos (n = 17); grupo C) 35 Wx 5 segundos (n = 18), grupo D) 40 W, 5 segundos (n = 20); grupo E) 40 W x 5 segundos inspeção visual (branqueia, incha e colapsa) (n = 16); grupo F) 50 Wx 5 segundos (n = 8). A eletrocoagulação bipolar foi usada nos grupos de A a E, e a eletrocoagulação monopolar, no grupo F. O modo de coagulação foi utilizado em todos os grupos. Cortes histológicos transversais do segmento ístmico das tubas de Falópio foram corados e fotografados digitalmente, e a percentagem da área luminal (mm2) não-obstruída foi medida com o software ImageJ (ImageJ, National Institutes of Health, Bethesda, MD, USA). O teste de Kruskal-Wallis ou ANOVA foram usados para a análise estatística. Resultados Noventa e seis cortes histológicos de tubas de Falópio foram analisados. A mediana da menor área não-obstruída (%; amplitude) da tuba de Falópio foi obtida no grupo 40 W com inspeção visual (8,3%; 0,9-40%), seguido do grupo 25 W (9,1%; 0- 35,9%), 40W(14,2; 0,9-43,2%), 30 W(14.2; 0,9-49,7%), 35 W(15,1; 3-46,4%) e 50 W (38,2; 3.1-51%). Não houve diferença significativa entre os grupos (p = 0,09, teste de Kruskal-Wallis). Conclusão A menor área não-obstruída foi obtida com a potência de 40 W com inspeção visual usando um gerador moderno de eletrocirurgia. Contudo, nenhuma diferença significativa na área não-obstruída foi observada entre os grupos usando esses modos e potências.

Esterilização tubária histeroscópica: uma atualização sobre o dispositivo Essure® / Hysteroscopic tubal sterilization: update on the Essure® device

No intuito de oferecer para a laqueadura tubária uma alternativa menos invasiva e com menos complicações, foi desenvolvido o dispositivo Essure®, aplicado ao método da esterilização histeroscópica, além de ter utilidade nos quadros de hidrossalpinge com indicação de fertilização in vitro (FIV). Este artigo, por meio de uma revisão de literatura, teve como objetivo reunir dados acerca do uso do Essure®, incluindo resultados obtidos com o dispositivo, bem como comparações em diversos aspectos com outras metodologias de esterilização. Foram utilizados os bancos de dados PubMed, Lilacs e Scielo, no período entre 1970 e 2016. Foram pesquisados os termos "hysteroscopic contraception"; "Essure"; "definitive tubal sterilization; "sterilization"; "contraception". A literatura demonstrou se tratar de um dispositivo de fácil e rápida inserção, e com bons resultados para anticoncepção. Porém, devido a complicações como perfuração tubária, implante peritoneal e aborto, bem como para avaliar seu custo financeiro ao sistema de Saúde, mais estudos prospectivos são necessários.(AU)

In order to provide a less invasive and harmful technique compared to the tubal ligation, the Essure® device was developed, applied to the hysteroscopic sterilization method. It is also used in cases of hydrosalpinus and indication of in vitro fertilization (IVF). This article, through a literature review, aimed to gather data about the use of Essure®, including results obtained with the device, comparing different aspects with other methods of sterilization. For this purpose, PubMed, Lilacs and Scielo databases were used, with results from 1970 to 2016. The keywords searched were "hysteroscopic contraception", "Essure", "definitive tubal sterilization". The literature has shown that it is a quickly and easily inserted device with good results for contraception. However, due to complications such as tubal perforation, peritoneal implantation and abortion, as well as to evaluate its financial cost to the health system, more prospective studies are needed.(AU)

A Quick and Easy Technique for Lateral Canthoplasty Using Reverse V-Y Advancement: A Case Report

Cosmetic lateral canthoplasty has become popular among Asians in the last few decades, but few techniques have withstood the test of time to be accepted as both effective and noninvasive, with minimal complications. Novel techniques have been developed, but are not free from complications. Moreover, these methods often have limited indications and may require a rather long learning curve to master. Herein, the authors present their experiences performing a simple lateral canthoplasty procedure in 61 patients using a slightly modified V-Y advancement flap, previously known as the Uchida method.

A cosmopolítica da gestação, do parto e do pós-parto: autoatenção e medicalização entre os índios Munduruku / The cosmopolitics of pregnancy, childbirth and postpartum: self-attention and medicalization among Munduruku Indians

A pesquisadora Raquel Paiva Dias-Scopel, do Instituto Leônidas e Maria Deane (ILMD/Fiocruz Amazônia), levanta questões sobre a valorização e respeito à diversidade étnica e cultural dos povos indígenas e a difícil interface com o processos de medicalização e do direito ao acesso aos serviços de saúde biomédicos. O livro é parte da Coleção Saúde dos Povos Indígenas, da Editora Fiocruz e partiu da tese de doutorado defendida em 2014 no Programa de Pós-Graduação em Antropologia Social da Universidade Federal de Santa Catarina (UFSC). Foi publicado pela primeira vez em 2015 pela Associação Brasileira de Antropologia com o título A Cosmopolítica da Gestação, Parto e Pós-Parto: práticas de autoatenção e processo de medicalização entre os índios Munduruku. No prefácio da primeira edição, sua orientadora, a doutora em antropologia e professora titular da UFSC, Esther Jean Langdon, ressalta que o conceito fundamental deste livro é da autoatenção, que aponta para o reconhecimento da autonomia e da criatividade da coletividade, principalmente da família, como núcleo que articula os diferentes modelos de atenção ou cuidado da saúde.

Satisfaction with the use of contraceptive methods among women from primary health care services in the city of São Paulo, Brazil / Satisfação com o uso de métodos contraceptivos entre usuárias de unidades básicas de saúde da cidade de São Paulo

Abstract Objectives: to assess satisfaction with the use of contraceptive methods among women attending primary health care services in São Paulo, Brazil. Methods: crosssectional study conducted with a sample of 668 women aged 1849 years, who were enrolled in 38 primary health care facilities in São Paulo city, Brazil, in 2015. Exclusion criteria were no sexual initiation, use of irreversible contraceptive methods for more than five years, pregnancy and no contraceptive method use. Data were analyzed using chisquare and multivariate logistic regression. Results: in general, women were satisfied with current contraceptive method (78.7%). The higher percentage of satisfaction was observed among IUD users (94.7%), and female and male sterilization users (93.5% and 91.7%, respectively). Withdrawal users were less satisfied (52.9%). Contraceptive method itself was the only factor associated with satisfaction. Barrier or traditional method users were less likely to be satisfied with their contraceptive methods than irreversible method users. Conclusions: long acting contraceptive method and irreversible method users were more satisfied with their contraceptive methods. Efforts should be undertaken in order to make these contraceptives available and accessible in primary health care facilities in Brazil.

Resumo Objetivos: avaliar a satisfação com o método contraceptivo em uso entre usuárias de unidades básicas de saúde da cidade de São Paulo/SP. Métodos: estudo transversal conduzido com 668 mulheres com idade entre 18 e 49 anos, usuárias de 38 unidades básicas de saúde da cidade de São Paulo, Brasil, em 2015. Foram excluídas mulheres que não haviam iniciado a vida sexual, tinham feito laqueadura/parceiro foi vasectomizado há mais de cinco anos, estavam grávidas e não usavam métodos contraceptivos. Dados foram analisados usando teste de diferença entre proporções pelo quiquadrado e regressão logística múltipla. Resultados: a maior parte das mulheres estava satisfeita com o método contraceptivo utilizado (78,7%). A maior satisfação foi observada entre usuárias do DIU (94,7%), da laqueadura (93,5%) e vasectomia (91,7%). A menor satisfação foi entre usuárias de coito interrompido (52,9%). O tipo de método foi o único aspecto associado à satisfação com o método contraceptivo. Mulheres que usavam métodos de barreira ou tradicionais tiveram menos chance de estar satisfeitas com o método usado, quando comparadas às mulheres queusavam métodos irreversíveis. Conclusões: usuárias de métodos contraceptivos de longa duração ou irreversíveis relataram estar mais satisfeitas. Esforços devem ser empreendidos para que esses métodos estejam disponíveis nas unidades básicas de saúde e o acesso a eles seja facilitado.

Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer: A case-control study / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma. OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomy METHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods. RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%. CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.

Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer: A case-control study / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma.OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomyMETHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods.RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%.CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.

Desencontros entre direitos e desejo da mulher e a decisão da equipe médica na prática da esterilização cirúrgica / Disagreements between women's rights and desires and the medical team decision in the practice of surgical sterilization

Introdução - A esterilização cirúrgica é o método contraceptivo mais utilizado no mundo, com diferenças significativas entre países de alta renda e de média e baixa renda. Em nosso país, os últimos dados de 2006 (PNDS) revelaram que a prevalência da esterilização feminina era de 29 por cento e da pílula anticoncepcional, de 21 por cento , sendo a esterilização o método contraceptivo mais utilizado. A regulamentação da Lei 9263/96 inseriu a esterilização cirúrgica como um direito e em condições de igualdade de livre escolha dentre todos os outros métodos contraceptivos. Entretanto, as imprecisões presentes no texto da lei e as diferentes interpretações, por parte de profissionais, como de usuários, podem implicar em desencontros entre direitos e desejo da mulher e decisão da equipe médica. Conhecer o contexto social, conjugal e reprodutivo em que ocorrem esses desencontros e as implicações de diferentes naturezas apresenta-se como importante tema de pesquisa em saúde pública. Objetivos - Analisar os desencontros entre o desejo da mulher pela esterilização cirúrgica e motivos da discordância da equipe médica na tomada de decisão em relação aos critérios da Lei 9263/96. Metodologia - A pesquisa foi de natureza qualitativa, baseada na técnica de depoimento oral e roteiro do tipo temático, foram entrevistadas dez mulheres que optaram pela esterilização cirúrgica, as quais tiveram aconselhamento da equipe médica contrário ao seu desejo. Na interpretação das narrativas, foi utilizada uma aproximação da Análise de Discurso. Resultados - Todas as dez candidatas a esterilização cirúrgica encontravam-se gestantes e apresentavam características de risco aumentado ao arrependimento, notadamente pela flexibilidade à mudança da situação conjugal, tais como: idade menor que 25, parceiros muito jovens, primeiro filho do companheiro atual, baixa paridade, apenas um filho e pouco tempo de união. Nos discursos das mulheres, a esterilização cirúrgica requerida estava dentro dos critérios previstos na lei em relação à idade, ao número de filhos e no momento do parto - o que fica evidente em seus discursos é a de que o segundo filho, que ainda está no ventre, é contabilizado como filho vivo. Nos discursos dos médicos, a decisão contrária estava fundamentada na ilicitude ética e legal, prescritos na lei, principalmente em relação à idade, número de filhos vivos e, no momento do parto, no quesito duas cesáreas consecutivas anteriores. Caso exemplar para resolver este desencontro com a intervenção do Poder Judiciário é ilustrado neste estudo. Conclusão - A questão nuclear dos desencontros entre direitos e desejo da mulher e a decisão da equipe médica na prática da esterilização residem nas distintas interpretações do texto da lei 9263/96 entre os sujeitos: as mulheres, a equipe médica e o Poder Judiciário. Na prática da esterilização cirúrgica com a legislação vigente, resta para as conformadas a resignação e, para as indignadas, buscar o seu direito no Poder Judiciário. Às resignadas e aos profissionais de saúde, resta esperar pelo aperfeiçoamento da lei com texto mais preciso e claro que atenda as mulheres em seus direitos e desejo e que propicie aos profissionais de saúde uma prática isenta de conflitos morais, éticos e legais

Introduction - Surgical sterilization is the most used contraceptive method in the world with significant differences between high, medium and low incomes countries. In Brazil, data from 2006 (PNDS) revealed that female sterilization prevalence was 29 per cent , whereas the use of oral contraceptive was 21 per cent , making sterilization the most used contraceptive method in our country. The federal law 9263/96 introduced surgical sterilization as a legal right and with equal conditions to all other contraceptive methods. However, the inaccuracies present in the law text and in the different interpretations by professionals, as well as users, may produce in disagreements between womens rights/desires and the medical team decision. The social, marital and reproductive context in which these disagreements occur and the implications of diverse natures, present themselves as an important topic research in public health. Objectives - To analyze the divergences between the woman\'s desire for surgical sterilization and the reasons of the medical teams disagreement in relation to the criteria of law 9263/96. Methodology - The research was qualitative and based on the oral testimony and thematic script technique. It included the interview with ten women who opted for surgical sterilization and had counseling of the medical team contrary to their desire. Discourse Analysis were used in the narratives interpretation. Results - All ten candidates for surgical sterilization were pregnant and presented high risk of repentance, especially due to the flexibility of changing the marital situation, such as younger than 25 years, very young partners, first child of the current partner, few children, an only child and short time of union. In the women\'s speeches, the required surgical sterilization was within the criteria defined by the law as much as by age, number of children; it was evident in their speeches, is that the second child who is still in the womb is considered a living son. In the doctors\' speeches, the contrary decision was based on ethical and unlawfulness prescribed by law, especially in relation to age, number of living children and at the time of delivery, in the case of two previous consecutive cesarean section. An exemplary case to solve this disagreement with the judiciary intervention is illustrated in this study. Conclusion - The core issue of disagreement between women\'s rights and desires and the decision of the medical team in the sterilization practice lies in the different interpretations of the law 9263/96 by social subjects: women, medical team and the judiciary. In the surgical sterilization practice with the current legislation, remains the resignation to the conformed and outraged women to look for their rights in the Judiciary System. To the resigned and to the health professionals, it remains to wait for the law improvement with more precise and clear text, able to uphold the womens rights and desires and that it gives a practice free of moral, ethical and legal conflicts to the health professionals

Analysis of surgeries performed after hysteroscopic sterilization as tabulated from 3,803 Essure patient experiences

OBJECTIVE: Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures. METHODS: This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement. RESULTS: In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal +“other” cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P<0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (P<0.01). CONCLUSION: This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.

Initial experience with hysteroscopic tubal occlusion (Essure®) / Experiência inicial com a oclusão tubária por via histeroscópica (Essure®)

ABSTRACT Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied.

RESUMO Objetivo Avaliar os resultados das primeiras oclusões tubárias realizadas pela via histeroscópica (Essure®). Métodos Estudo prospectivo com 38 pacientes, sendo 73,7% caucasianas, com média de idade de 34,5 anos, e com 3 gestações e 2,7 partos em média. Do total, 86,8% das pacientes fizeram preparo prévio do endométrio. Todos os procedimentos foram ambulatoriais e sem anestesia. Resultados A taxa de inserção do dispositivo foi de 100%, com tempo médio de 4 minutos e 50 segundos. Segundo a Escala Visual Analógica, a dor média obtida foi de três, e 55,3% das mulheres não referiram qualquer dor após o método. Ocorreu um caso de reflexo vagal e 89,5% das pacientes retornaram às atividades normais no mesmo dia. Após 3 meses, 89,5% das pacientes encontravam-se muito satisfeitas com o método. A radiografia simples da pelve evidenciou 92,1% de dispositivos tópicos, ocorrendo um caso de expulsão unilateral. Após 4 anos de seguimento, não houve falha do método. Conclusão A oclusão tubária por via histeroscópica em regime ambulatorial e sem anestesia foi um procedimento rápido, bem tolerado, isento de complicações graves e com alta taxa de sucesso e satisfação das pacientes.

Knowledge and factors determining choice of contraception among Singaporean women

<p><b>INTRODUCTION</b>The study aimed to assess the level of awareness and knowledge of contraception among women in Singapore, and identify the factors that influence contraception choice.</p><p><b>METHODS</b>We conducted a cross-sectional survey of 259 female patients, aged 21-49 years, who attended the Obstetrics and Gynaecology Clinic at National University Hospital, Singapore. An original questionnaire on nine contraceptive methods was used. Respondents who had ≥ 2 correct answers for a method (out of four questions) were considered to have good knowledge of the method. Participants were asked to rate factors known to influence contraceptive choice as important or not important.</p><p><b>RESULTS</b>Awareness of the following methods was high: condom (100.0%), oral contraception pill (89.2%), tubal ligation (73.0%) and copper intrauterine device (IUD) (72.2%). The women were least aware of hormonal IUD (24.3%). Women who were parous, had a previous abortion, had completed their family or used contraception previously were more likely to have a higher awareness of contraception. 89.2% of the women had good knowledge of the condom; among those aware of hormonal IUD, only 46.0% had good knowledge of it. Women who had used hormonal IUD and the condom were more likely to have good knowledge of them. Many rated efficacy (90.5%) and a healthcare professional's advice (90.1%) as important in contraceptive choice. Few considered peer influence (21.0%) and cultural practices (16.3%) to be important.</p><p><b>CONCLUSION</b>Women in Singapore have poor awareness and knowledge of contraception, especially long-acting reversible methods. More effective ways are needed to educate women about contraceptive methods.</p>

Fallopian Metaplastic Papillary Tumour: An Atypical Transdifferentiation of the Tubal Epithelium?

A metaplastic papillary tumor of the Fallopian tube is an extremely uncommon condition, with odd and confusing features that make it difficult to categorize as benign or borderline. Here, we summarize all the published cases to date and document the case of a 41-year-old woman diagnosed with this alteration after her last childbirth and ensuing tubal ligation. One of the tubes was bulky and filled with a caramel-like substance encircling a blurry spot. Light microscopy detailed a slender stalk covered by eosinophilic, columnar plump cells, showing atypical nuclei and focal budding. Mitotic figures were absent. The immunohistochemistry panel was positive for pan-cytokeratin, epithelial membrane antigen, cyclin D1, and hormone receptors. Additionally, a proliferation index of less than 5% was rated using Ki-67. The true nature of this tumor (reactive vs neoplastic) is uncertain. Nonetheless, its association with pregnancy suggests an adaptive change, likely similar to the atypical transdifferentiation proposed for Arias-Stella reaction.