Pain scores at the insertion of the 52 MG levonorgestrel-releasing intrauterine system among nulligravidas and parous women.

PURPOSE: This study aimed to assess the pain scores at the insertion of the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) among nulligravidas, parous women with previous vaginal delivery and parous women with elective caesarean-delivery without any previous labour or cervix dilation. MATERIALS AND METHODS: The present research is a prospective, single-cohort study that included 413 women aged 15-49 years who opted for LNG-IUS placement for contraception or treatment of heavy menstrual bleeding. Women who participated in the present study were not submitted to any pharmacological pain-relieving intervention to perform the procedure. Pain at insertion was evaluated by using a Visual Analogue Scale (VAS). Pain was classified as absent (0), mild (1-3), moderate (4-6), or severe (7-10). The women were divided as: (1) nulligravidas, (2) parous women with a previous vaginal delivery, or (3) parous women with elective caesarean-delivery without any previous labour or cervix dilation. RESULTS: Nulligravidas women presented a higher mean pain score, when compared to women with elective caesarean-delivery and women with previous vaginal delivery (6.6 ± 2.0 vs 5.5 ± 2.1 and 3.9 ± 2.4, respectively; p < 0.001). Nulligravidas and women with elective caesarean-delivery were more likely to have pain classified as moderate or severe (in relation to absent or mild) than women with previous vaginal delivery (p < 0.001). Multiple Linear Regression Analysis demonstrated that 29.5% of all variability of the pain score was explained by two predictor/independent variables: nulligravidas or women with elective caesarean and difficulty at IUD insertion. CONCLUSIONS: Women with previous vaginal delivery had lower pain scores at LNG-IUS insertion when compared to nulligravidas and women with elective caesarean-delivery without any previous labour.

Incidence of congenital syphilis in a metropolitan region of Rio de Janeiro state: social inequalities

Congenital syphilis remains a public health matter, with no perspective of reaching governmental reduction goals. There are few studies about social inequalities and its relation with this disease in Brazil. Objective: describe occurrence of congenital syphilis in a reference hospital in a Metropolitan Region of Rio de Janeiro State, according to socioeconomic and clinical-laboratorial variables as well. Methods: cross-sectional study, basedon interviews, review of medical records and prenatal cards. Population: all women admitted to a maternity ward during a trimester in 2011. Maternal variables: age, schooling, skin color, income, prenatal visits. Fetus/neonate variables: birth weight, gestational age, clinical and laboratory outcomes.Incidence of congenital syphilis (Brazilian Ministry of Health criteria) was calculated for all live births and for each social and economical variable.Results: there were 666 eligible women, comprehending 576 deliveries ? 558 live births and 18 stillbirths. We identified 22 CS cases: 18 live births, threefetal deaths and 1 abortion. One of the neonates died in the third day of life. The incidence of CS was of 39.4/1,000 live births. Socioeconomic variables - low education, low income and black skin - were related to a greater incidence. Only 13 out of 22 cases were identified in prenatal care. Conclusion: ourresults pointed to social inequalities in the congenital syphilis incidence. As prenatal care is also related to socioeconomic variables, investments in quality of maternal assistance should be directed to more vulnerable women.