[Can the action of the social worker lead to child abuse?]. / L'aide sociale peut-elle induire les mauvais traitements a l'enfant?

The authors report a case where the interference of a health worker led to child abuse in a family for which he had charge. They examine the interactions existing between the concerned team and the high-risk family. They notice that violent situations are often maintained by the higher number of psychosocial interventions and by the intrusive and rigid attitudes of the health workers. A real change in the parental situation can only be obtained by a systematic approach to the families involved, centered not only on the interactions between the child and its parents but also on the interactions between the health system and the family.

Institutional abuse: tubal sterilization in a population at risk of ill-treating their children.

Among the 145 patients at risk of child abuse and neglect who were seen in 1980 in our institution in the prevention of child abuse and neglect prenatal clinic, 19 were sterilized after giving birth. The criteria applied to these 19 patients were compared to the common criteria applied to our general maternity population. We were able to prove that these common criteria were systematically disregarded in the case of a mother at risk of ill-treating her child. We further studied our approach from the angle of the conflict which could exist for health care professionals between the choice of leaving these women with the right to reproduce or putting an end to a history of ill-treatment of children.

PIP: Among the 145 patients at risk of child abuse and neglect who were seen in 1980 in the authors' institution in the prevention of child abuse and neglect prenatal clinic, 19 were sterilized after giving birth. The criteria applied to these 19 patients were compared to the common criteria applied to the general maternity population. It was possible to prove that these common criteria were systematically disregarded in the case of a mother at risk of ill-treating her child. The authors further studied the approach from the angle of the conflict which could exist for health care professionals between the choice of leaving these women with the right to reproduce and or putting an end to a history of ill-treatment of children.

[Treatment of non-specific menometrorrhagia with naftazone]. / Traitement des ménométrorragies non spécifiques par la naftazone.

The authors carried out a double blind study of the action of naftazone in non-specific menometrorrhagias caused by a uterine device, the oral contraceptive and medroxyprogesterone, in 25 patients. They show a great improvement with the periods becoming normal and metrorrhagia disappearing in 12 out of 13 cases where naftazone was used and in only 1 out of 12 cases where the placebo was used.

Failures of laparoscopic sterilization by Hulka-Clemens clips.

PIP: The reasons for failure in a series of 544 laparoscopic sterilizations by Hulka-Clemens clips are analyzed. Patients were divided into 2 groups: 1) 327 women sterilized by clips, and 2) 217 women sterilized with clips simultaneous to suction abortion. Most patients were 31-41 years of age. 10 pregnancies were observed in the 4-12 month follow-up, most of which occurred 2-4 months after clip application. None of the pregnancies were ectopic. The higher failure rate in group 2 (7%) compared to group 1 (1.83%) is due to the larger uterine size in the pregnant women. Most failures were attributable to a lack of technical training on the part of operators. In most cases, the clips were applied to a structure other than the tube: round ligament (3 cases), fimbriae (2 cases), utero-ovarian ligament (1 case), twisted spring (3 cases). The cause for failure remains unknown in 1 case. Compared with other sterilization methods (e.g., diathermic coagulation, Yoon ring), the Hulka-Clemens clip procedure has a low rate of method failure. Other studies have noted the following reasons for failure: material, application in already pregnant patients, incomplete nipping of the tubal lumen, application on another structure, and decrease of pressure on the jaws of the clip. Subsequent pregnancies with this method can be avoided by attention to optimal presentation of the uterus during the procedure to facilitate tubal cupping, and adequate supervision when the procedure is done by an inexperienced operator.^ieng

[Contraception in teenagers (author's transl)]. / Problematique de la contraception chez les adolescentes.

PIP: The age at which adolescents start a sexual life is becoming younger and younger, and it is usually not accompanied by any correct knowledge of contraceptive methods. This particular group is more at risk of unwanted pregnancy; since a contraceptive method which is totally effective and totally reversible is not yet at hand. Several methods can be recommended to adolescents and include: 1) barrier contraception with condom and spermicidal agents, in those cases in which the couple has only occasional contacts; 2) low dose progestational oral contraception when the couple has a regular sex life; and 3) postcoital contraception only in cases of incest or rape, to be administered not later than 12 hours after coitus. While recent studies have demonstrated that low dose hormonal contraception is not harmful to the menstrual patterns and to the genetic patrimony of adolescent girls, the use of an IUD can eventually cause an infection leading to a future tubal sterility.^ieng

A coordinated attempt for prevention of child abuse at the antenatal care level.

The authors report the preliminary result of an integrated approach to the primary prevention of the child abuse syndrome. The problem has been approached through a new concept of prenatal and postnatal care, the obstetrical team working in close cooperation with the child psychiatrist of the department of pediatrics. The obstetrical team followed 91 patients during their pregnancy; they were all discussed at supervisory sessions. This permitted a gynaecologist and a social nurse to develop a therapeutic plan for 72 patients. For the 19 more problematic cases, the child psychiatrist intervened immediately in the surroundings of the antenatal clinic. Short, specific psychotherapeutic interventions based on the alleviation of a family crisis have remedied important stress situations. The favourable influence of this new methodology has led to: (1) reduction of a potentially high expected prematurity rate; (2) improved integration of out-patient and in-patient care; (3) improved adaptation of the health staff to this type of situation. A case example to illustrate the functioning of both teams is given.

[Pregnancy after celioscopic sterilization with Hulka-Clemens Clips (author's transl)]. / Grossesse apres sterilization coelioscopique par clips de Hulka-Clemens.

PIP: 544 women who had undergone voluntary tubal occlusion with Hulka-Clemens clips were reexamined 2-6 months after the procedure. 10 women were pregnant, or a sterilization failure of 1.83%. There were no ectopic pregnancies and failure of sterilization was clearly due in 6 cases to surgical error, in 3 cases to malfunction of the clip, and no reason was found for the remaining case. The operators had all been young doctors performing their 1st sterilization. According to the published literature, failure rates for female sterilization goes from 2-5.2/1000 for electrocoagulation, from 0.18% to 2-6/1000 with the Hulka clip, and it is about 0.33% with the Yoon ring. Causes for failure may be imperfect surgical equipment, procedure on a patient already pregnant, or surgical error. All surgical equipment must be carefully tested before all procedures, and young and yet unskilled operators must be checked during the procedure.^ieng

[The 'lost' intra-uterine contraceptive device (author's transl)]. / Le dispositif intra-utérin "disparu"

The authors report five cases of lost intra-uterine devices, which means that the threads were not visible at the external os of the cervix. This gives them an opportunity to review the literature and to conclude the following: 1. Ultra-sound is the treatment of choice to find the position of the IUD that has been lost, whether is is intra- or extra-uterine. 2. In doubtful cases an antero-posterior and a lateral hysterogram makes it possible to determine the relative position of the IUD to the uterine cavity. Laparoscopy gives useful complementary information. 3. If the IUD is intra-uterine, either totally so or partially, the treatment of choice is to remove it under hysteroscopic control. 4. Where perforation has occurred and the IUD has only entered incompletely into the pelvis, it is possible to pull it out under hysteroscopic control through the vagina if laparoscopy has demonstrated that there are no local adhesions attaching it to neighbouring organs. 5. Where perforation has been complete, laparotomy is preferable to laparoscopy as a technique to recover the lost IUD, in particular when this is a copper one. 6. Perforations occur particularly when the IUDs are inserted post-partum.

[A review of the effects of hormonal contraception on thyroid function (author's transl)]. / Revue des effets de la contraception hormonale sur la fonction thyroïdienne

PIP: It is well known that the absorption of estrogen and progestogen alters the thyroxine-binding globulin capacity of serum and thus affects the proteins that carry the thyroid hormones and, consequently, the tests that are in current use. However, the levels of free thyroid hormones are altered only slightly and the peripheral thyroid function remains unchanged.^ieng

[Technical, educational, and sociological problems of family planning]. / Problèmes techniques, éducatifs et sociologiques du planning familial.

PIP: This discussion covers the definition of the term "family planning", an overview of the points in the reproductive cycle that can be subject to fertility control, and the role of sexual education in the practice of a gynecologist. The positive term "family planning" replaced the negative "birth control" in the 1930's, although "family planning" has negative connotations when used for government programs or for the married only. Family planning should connote responsible parenthood, i.e., the freedom and responsibility of each couple to decide when to bring forth a child. The points in the reproductive cycle amenable to control are the hormonal feedback in follicular maturation, capacitation and fertilization (6-14 hour critical period for an egg), tubal transport (3 day critical period), implantation (5-13 days), initial embryonic development, and spermatogenesis. The medical profession is poorly prepared to take on the role of instructor and guide, rather than technician, in the whole complex of maternal, child and family health.^ieng