Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates / Inserção de dispositivo intrauterino de cobre no pós-parto imediato em hospital universitário brasileiro: Taxas de expulsão e continuação

Abstract Objective To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. Materials and Methods In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. Results There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Conclusion Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Resumo Objetivo Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. Materiais e Métodos Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. Resultados Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. Conclusão Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo.

Expulsion rate of immediate versus early postpartum intrauterine device insertion after vaginal delivery: A cross sectional study / Philippine Journal of Obstetrics and Gynecology

Background@#Progressively increasing population of the country leads to unmet needs for responsible parenthood. This is reflective to reproductive age women with unplanned pregnancies which may consequently lead to maternal morbidity and mortality and adverse perinatal outcomes. Provision of family planning methods is implemented. One of the temporary methods of Long Acting Reversible Contraception (LARC) is Intrauterine Contraceptive Device (IUD). The effectiveness is similar to tubal sterilization with its perfect use. However, one of the drawbacks is dealing with its expulsion which affects its efficacy. @*Objective@#The study determined the expulsion rate between Immediate and Early postpartum IUD insertion after vaginal delivery. Expulsion rate was evaluated during the following periods: prior to discharge, after 4 weeks, after 12 weeks and 24 weeks post-insertion. @*Methodology@#This was an Observational Cross Sectional Study conducted for a year designed to collect data among patients who had IUD insertion after vaginal deliveries in a 6-month period of follow up. Sample size was computed using epi info 7.0. Finite Population Collection was derived to meet the population size available which resulted to 159 participants. Randomization was initiated to classify between immediate and early IUD insertion. Expulsion was observed during follow up at the family planning center of the institution @*Results@#This data showed no direct correlation in the expulsion rates between early and immediate postpartum IUD insertion. The expulsion rate was 6.25% for Immediate and 5.55% for Early IUD insertion respectively. There were no expulsion observed beyond 12 weeks post insertion. Relationship between early/immediate IUD insertion and expulsion rate was investigated using Chi square test. @*Conclusion@#Improved education and heightened awareness among reproductive aged women would initiate higher acceptance of IUD during postpartum period. Proper and improved technique of IUD insertion during postpartum period may decrease expulsion rate hence promoting better utilization of this family planning method.

Atención del parto y del puerperio inmediato con pertinencia intercultural / Care of childbirth and immediate puerperium

PROPÓSITO: Explorar los factores que influyen en la aplicación de la interculturalidad con respecto a la atención del parto y puerperio inmediato en personal médico y paramédico, comadronas y usuarias del Centro de Urgencias Médicas (CUM) de Tecpán, Chimaltenango, abril-mayo 2017. MATERIAL Y MÉTODOS: Estudio cualitativo con diseño etnográfico. Se realizaron entrevistas en profundidad al personal de salud y usuarias del CUM y grupos focales con comadronas. Se evaluó la infraestructura de las salas de parto y posparto. RESULTADOS: En el personal médico y paramédico se evidenciaron saberes limitados acerca de la pertinencia cultural, descrita en las Normas de Atención con Pertinencia Cultural. Se contó con el 65% de los elementos de infraestructura y equipo de la sala de partos culturalmente adecuada. Las comadronas percibieron una atención deficiente y refirieron poco interés y capacitación del personal del servicio de salud. Las usuarias opinaron que existe una buena relación con el personal de salud, sin embargo no se les brindó una atención con adecuación cultural. CONCLUSIONES: Los factores que influyen en la implementación de las prácticas interculturales son de índole económica principalmente, además de aspectos estructurales, organizaciones y socioculturales.

PURPOSE: To explore the factors that influence the implementation of interculturality in regards to care during childbirth and the immediate postpartum period, in medical and paramedical staff, traditional midwives and patients of the Center of Medical Urgencies (CUM), Tecpán, Chimaltenango, April-May 2017. MATERIALS AND METHODS: Qualitative study with an ethnographic design. In-depth interviews with medical staff and patients of the CUM were carried out in addition to focal groups with traditional midwives. The infrastructure of the birthing room and postpartum ward were evaluated. RESULTS: CONCLUSIONS: The medical and paramedical staff showed limited awareness of cultural pertinence, as described in the Norms of Attention with Cultural Pertinence. The birthing room satisfies 65% of the criteria of infrastructure and equipment of a culturally pertinent birthing room. The traditional midwives perceived deficient patient care and identified a lack of interest and training of the health staff. The patients experienced a good relationship with the health staff, but declared a lack of cultural adequacy in the attention. The factors that influence in the implementation of intercultural practices are principally of economic nature, in addition to structural, organizational and sociocultural aspects.

Parâmetros reprodutivos e produtivos em vacas leiteiras de manejo free stall / Productive and reproductive parameters of dairy cows in free stall

Avaliou-se parâmetros reprodutivos e produtivos em vacas da raça Holandês-PB no pós-parto imediato, manejadas em free stall . Utilizou-se 51 vacas entre primíparas e pluríparas. Os valores obtidos foram: escore de condição corporal ao parto 3,47±0,4; intervalos do parto à primeira ovulação 5,89±3,4 semanas; ao primeiro serviço 112,5±57,0 dias; a taxa de gestação ao primeiro serviço foi 43,6% e no período experimental 76,4%, não sendo observada diferença para ordens de parto (P>0,05). A produção de leite acumulada à concepção, produção diária leite até a concepção e produção de leite ajustado para 305 foi respectivamente, 3.335,6±1.488,4; 25,8±5,4 e 7.424,0±1.877,8 litros. Conclui-se que no manejo de Free stall , a detecção de estro, foi o principal fator limitante para alcançar melhor eficiência reprodutiva.

The reproductive and productive parameters in postpartum of 51 primiparous and pluriparous Holstein cows housed in free stall were obtained. The values measured were: body condition score at parturition (3.47±0.4), interval from parturition to first ovulation (5.89±3.4 weeks), interval parturition at first service (112.5±57.0 days), first-service pregnancy rate (43.6%) and during the experimental period (76.4%). No difference was found between parturition order (P>0.05). The accumulated milk production until conception time, daily production until conception time, and adjusted 305-day milk production was respectively 3,335.6±1,488.4; 25.8±5.4 and 7,424.0±1,877.8 liters. In free stall of this study the estrus detection was the most limiting factor to improve the reproductive efficiency.

prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital.

Background: In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section. Methods: A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions. Results: In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%. Conclusion: Immediate postpartum IUD insertion is a safe, convenient and effective method.

Comportamientos de cuidado del profesional de enfermería que percibe la gestante en trabajo de parto y parto en la clínica Palermo / Care behaviors of the nursing professional perceived by the pregnant woman in labor and delivery at the Palermo clinic

Con el propósito de determinar la percepción de los comportamientos de cuidado del profesional de enfermería por parte de las gestantes en trabajo de parto y parto que recibieron atención en la Clínica Palermo de Bogotá, se realizó un estudio mediante entrevistas utilizando el instrumento Inventario de Comportamientos de Cuidado de Wolf 1986, validado en español por Itza Camargo (2006) con un coeficiente alfa de Cronbach de 0,78. Para ello se utilizó un método descriptivo transversal cuantitativo el cual permitió la descripción de los comportamientos de cuidado por las cinco dimensiones del instrumento y por la puntación total del instrumento, así mismo se realizó análisis no paramétricos para establecer asociaciones entre los factores socio demográfico y las dimensiones del instrumento. Los resultados de este estudio mostraron que la percepción del cuidado recibido por las madres fue predominantemente favorable, pero al describir cada dimensión por separado se detectó una calificación alta preferentemente para los cuidados rutinarios, así mismo se evidenció menor percepción en los comportamientos de cuidado que tienen que ver con las interrelaciones enfermera mujer gestante. En los análisis de las relaciones entre los factores socio demográficos con la percepción de los comportamientos de cuidado se encontró relación con el estrato socioeconómico y la entidad prestadora de servicio de salud de donde fueron remitidas las gestantes. El estudio recomienda para que se pueda dar un mejor acercamiento de la enfermera con la mujer gestante en trabajo de parto se requiere contar con una relación de enfermeras-pacientes más alta, por otro lado se sugiere a las enfermeras motivarse a innovar en técnicas alternativas en el manejo del dolor y los síntomas desagradables de las mujeres en trabajo de parto y parto. (AU)

In order to determine the perception of the behaviors of professional nursing care by pregnant women in labor and delivery receiving care in Palermo Clinic in Bogota, a study was conducted through interviews using the instrument inventory Care behaviors Wolf 1986, validated in Spanish by Itza Camargo (2006) with a Cronbach's alpha of 0.78. We used a descriptive method which allowed cross quantitative description of caring behaviors by the five dimensions of the instrument and total value, likewise nonparametric analyzes were performed to establish associations between sociodemographic factors and dimensions of the instrument . The results of this study showed that the perception of care received by mothers was predominantly favorable, but to describe each separate dimension is preferably detected a high rating for routine care, also is evidenced in lower perceived caring behaviors that have to do with the interrelations nurse- pregnant women. In the analysis of the relationships between sociodemographic factors to the perception of caring behaviors was found with socioeconomic status and the entity providing health service where pregnant women were referred. The study recommends that to be able to better approach the nurse with the pregnant woman in labor is required to have a nurse-patient ratio higher, on the other hand it is suggested to motivate nurses to innovate alternative techniques pain management and the unpleasant symptoms of women in labor and delivery. (AU)