[IUD insertion during cesarean section and its most frequent complications]. / DIU transcesárea y sus complicaciones más frecuentes.

A prospective and cooperative study was done in 152 patients that were submitted to cesarean section. Seventy eight patients received intrauterine device (IUD) T CU 220 during cesarean section, and the other 74 patients only got the cesarean section without IUD. The events that were analyzed during the puerperium were pain, bleeding and infection. We didn't find any difference in the results between both groups, these were analyzed with the help of the square chi (X2). These results suggest that with an adequate selection of the patients, the insertion of the IUD during the cesarean section is a secure and helpful method for the fertility control for patients with high risk of reproduction.

PIP: 78 women were fitted with copper T 220 IUDs during cesarean deliveries at a Mexican Institute of Social Security hospital in Cardenas, Tabasco, between August 1991 and December 1992 in a study of the suitability of IUD insertion during cesareans. A control group consisted of 74 women undergoing cesarean deliveries who did not have IUDs inserted. The average age was 20.6 years for IUD acceptors and 24.9 years for controls. The average number of pregnancies including the current one was 1.3 for the IUD group and 3.2 for the control group. Average gestational age at the time of delivery was 38.5 weeks for the IUD group and 40.1 weeks for the control group. The indication for cesarean was fetopelvic disproportion for 51.2% of the IUD group and 40.5% of controls. The volume of bleeding was normal for 98.7% of IUD acceptors and all in the control group. The IUD was vaginally removed two hours postpartum in the one IUD acceptor with postpartum hemorrhage. The average duration of bleeding was 23.8 days for the IUD group and 22.0 days for the control group. Pain during the postpartum period was described as light for 91.0% and moderate for 9.0% in the IUD group and as light for 93.2% and moderate for 6.8% in the control group. Four cases of endometritis (5.1%) were observed in the IUD group. Three cases of endometritis and one of abscess of the abdominal incision were observed in the control group, for an overall infection rate of 5.4%. One IUD expulsion occurred on the fifteenth postpartum day, for a rate of 1.28%. The strings could be seen in only 21.7% of cases at the six-week check-up. The IUD was visualized by X-ray for 71.7% at the control visit. IUD insertion did not significantly increase postoperative pain, hospital stay, the volume or duration of bleeding, or frequency of infection. The results suggest that IUD insertion during cesarean is a safe and effective method of fertility control for patients at high reproductive risk.

IPPF Brazil program confronts sterilization accusations.

PIP: Even though Brazil's BEMFAM program stopped providing sterilization services over a year ago, many sources hostile to BEMFAM in the Brazilian government are still accusing it of misconduct. BEMFAM is sponsored by the International Federation of PLANNED Parenthood and was investigated and cleared of any wrong doing by the Brazilian government. In Brazil it is against the law to perform sterilization for the purposes of birth control, yet it is estimated that there are between 6-20 million such operations each year. Over 65% of the births in Brazil are by Caesarian section and it is common for women to ask their doctors to perform a tubal ligation at the same time. Abortion is illegal in Brazil, but there are an estimated 1.4-2.4 million abortions each year. 56% of Brazilian women use contraceptives, with 90% using either the pill or illegal sterilization. 90% of those who use the pill obtain it over the counter at pharmacies with inadequate knowledge on how to use it. 80% of the people receive their health care from the Brazilian government.^ieng

[Post-cesarean ovarian transposition as a method of reversible sterilization: initial study]. / Transposición ovárica postcesárea como método de esterilización reversible: estudio inicial.

PIP: A reversible method of sterilization to be performed during cesarean section by moving the ovary through the mesosalpinx to the front of the tube is described. 22 patients at a Mexican Institute of Social Security Hospital who did not wish further pregnancies but did not want definitive sterilizations have undergone the procedure with no pregnancies to date. Most of the procedure is done with the fingers to avoid lesions to the ovary and tube; the steps are briefly described and diagrammed. 1 or 2 silk stitches hold the ovary in place. The surgical technique is simple and rapid, postoperative complications were absent and recovery was the same as that following any cesarean operation. After periods of up to 6 months no pregnancies have been reported. No menstrual or other alterations attributable to the procedure have been identified. It is expected that patients will be followed up for several years to demonstrate the safety and effectiveness of the procedure, as well as its reversibility if some patients desiring restored fertility undergo reversal operations and and achieve pregnancy.^ieng