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)

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.

Ruta crítica para la realización de ligadura tubaria: estudio en un hospital público en la ciudad de Buenos Aires / Critical route for the realization of tubal ligation: study at a public hospital in the city of Buenos Aires

La existencia de brechas entre el marco legal en salud sexual y reproductiva y la puesta en práctica en las realidades sanitarias locales de las políticas públicas relativas a la ligadura tubaria en particular constituye un tema crucial para la Salud Pública de la Argentina. Objetivo general: describir los factores que impulsaron u obstaculizaron la ruta crítica que realizaron las mujeres gran multíparas para ejercer el derecho a solicitar la ligadura tubaria. Material y métodos: el diseño fue exploratorio descriptivo. Se realizaron entrevistas en profundidad y se administró un cuestionario sociodemográfico a una muestra intencional de 30 usuarias gran multíparas que solicitaron la anticoncepción quirúrgica durante el período: agosto de 2009 - enero de 2010, en el Área de Salud Sexual y Reproductiva del Hospital Materno Infantil Ramón Sardá de la Ciudad Autónoma de Buenos Aires. Resultados: 17 de las entrevistadas había solicitado la ligadura tubaria previamente. Del total, 22 entrevistadas iniciaron el recorrido cursando un embarazo no deseado y 9 pensaron en recurrir a un aborto inseguro, entre las cuales 5 averiguaron al respecto y 1 lo intentó. Conclusiones: Se espera que los resultados sean de utilidad para el diseño de estrategias intersectoriales efectivas que permitan monitorear el cumplimiento de la ley nacional Nº 26.130 con el fin de garantizar el acceso oportuno a la ligadura tubaria, y disminuir las iniquidades relativas a brechas territoriales, institucionales y obstáculos simbólicos y epistemológicos, a nivel sanitario, en la Argentina.

The existence of great gaps between the legal frame of the sexual and reproductive health system and the implementation of public policies in relation to tubal sterilization within the reality of local health institutions is a matter of crucial issue for Public Health of Argentina. General objective: To describe the factors that motivate or prevent the beginning of the critical path that grand multiparous women took in order to excercise their right to petition tubal sterilization. Methods and materials: The design was descriptive exploratory. Interviews in depth were conducted and a sociodemographic questionnaire was used over an in tentional sample of thirty grand multiparous women who arrived to the Reproductive and Sexual Health Area of the Ramón Sardá Hospital in the City of Buenos Aires asking for tubal sterilization during August 2009-January 2010. Results: 17 women had preaviously asked for tubal sterilization, and 22 out of the total number initiated the whole process with an unwanted pregnancy; and 9 women considered an unsafe abortion, 5 of them did research about it and 1 tried it. Conclusions: It is expected that the results shall be useful for the design and implementation of effective strategies that allow to monitor the enforcement of the national law N° 26.130 for the purpose of guaranteeing access to tubal sterilization, and to decrease inequality in relation to territorial and institutional gaps, as well as symbolic obstacles in Argentina.

Motivos de solicitud de la ligadura tubaria: estudio exploratorio desde la perspectiva de las usuarias gran multíparas que asisten a un hospital público de la Ciudad de Buenos Aires / Motives of request of the tubal ligation: exploratory study from the perspectives of the users great multiparous that they are present at a public hospital of the Buenos Aires City

En la Argentina, desde agosto de 2006 está vigente la Ley Nacional Nº 26.130 que garantiza el derecho a las mujeres mayores de edad, que no desean tener más hijos, a acceder en forma gratuita a la ligadura tubaria. Objetivo: Describir los motivos que explicitan las mujeres gran multíparas para solicitar la ligadura tubaria. Material y métodos: El diseño fue exploratorio-descriptivo y la metodología cualitativa. Se realizaron entrevistas en profundidad a una muestra intencional de 30 usuarias gran multíparas (> 5 partos) que solicitaron la anticoncepción quirúrgica en el Área de Salud Sexual y Reproductiva del HMI Ramón Sardá de la Ciudad Autónoma de Buenos Aires, y a 10 profesionales de la salud, considerados informantes clave. Resultados: La mitad de las mujeres entrevistadas había solicitado la ligadura tubaria previamente y 22 de 26 mujeres (84,6 por ciento) que estaban embarazadas al momento de solicitar la práctica, señalaron que su embarazo no era deseado. Entre algunos resultados, la mayoría era argentina y la edad promedio fue de 34,6 años. El temor a sufrir complicaciones en la salud en caso de un nuevo embarazo y la situación de un embarazo inesperado, aparecen como motivos determinantes para la solicitud de la práctica. Conclusiones: Si bien la sanción de la ley es muy reciente y su implementación está sujeta a diversas barreras, depende de la voluntad de los actores sociales para que dichos obstáculos sean visibilizados, a fin de optimizar la calidad de atención de las beneficiarias de los Programas de Salud Sexual y Reproductiva de la Argentina.

In Argentina, a National Law 26.130 was passed in August, 2006. This law gives the right to women over 21 years old who do not want to have more children to ask for the tubal sterilization without having to pay for the practice. Objective: Describe the reasons that grand multiparous women give to petition for a tubal sterilization. Material and methods: The design was descriptive exploratory and the methodology was qualitative. Interviews in depth were conducted to an intentional sample of thirty grand multiparous women (>5 partos) who arrive to the Reproductive and Sexual Health Area of the Ramón Sardá Hospital in the City of Buenos Aires asking for tubal sterilization, plus ten professionals in the health field, considered key informants. Results: Half of the women interviewed had already asked for the practice previously, and 22 of 26 women (84,6 per cent) that were pregnant talked that this pregnancy was unwanted. So me results establishes that most of them were argentinians and the average age was 34,6 years old. Conclusions: The fear of suffering health complications in the case of a new pregnancy or a new unwanted pregnancy appear to be the most important reasons to ask for the tubal sterilization. The visualization of the obstacles mentioned before depends on the willingness of the social actors. They will optimize the quality of the service offered to the patients of the reproductive and Sexual Health Program of Argentina.