[Mathew's clip, an alternative for removal of IUDs with no visible threads. Experience of Family Planning Service]. / Pinza de Mathew, una alternativa en retiro de dispositivos intrauterinos de hilos no visibles. Experiencia de un servicio de planificación familiar.

BACKGROUND: The absence of IUD visible threads in the cervix is a complication of the intrauterine device. The IUD withdrawal in these cases was performed with Novak cannula or curettage instrumented under anesthesia and surgery. Its extraction with Mathew clip is an alternative. OBJECTIVE: To demostrate the effectiveness of the Mathew's clip as an alternatively for removal of intrauterine devices not visible threads. MATERIAL AND METHODS: A cross-sectional, retrospective, descriptive study was conducted in from February 2012 to July 2014 at the Family Planning Service of Gynecology and Obstetrics of the General Hospital of Mexico "Dr. Eduardo Liceaga ". RESULTS: 106 patients (54%) had no visible threads; in 84 patients (81.5 %) it was removed with Novak, cannula; in 19 patients (18.4%) in which it was not possible, the removal was done with a Mathew's clip. DISCUSSION: Mathew' clip is an alternative in cases where it was not possible to remove the IUD with Novak cannula, 19 IUDs no visible threads were removed. CONCLUSIONS. Mathew clip for removal of intrauterine devices with no visible threads means less risk to the patient and a decrease in institutional costs.

[Complex location of a single rod contraceptive implant]. / Localización difícil de implante anticonceptivo subdérmico de varilla única.

BACKGROUND: The subdermic single-rod contraceptive implant is used for more than 2.5 million of womens around the world (in Mexico there are around 600 000 collocated implants). in a small number of cases an incorrect insertion procedure is caused by a complex localizaron.. METHODS: A clinical, retrospective, descriptive study was conducted in the period January 2011 to December 2013. the Family Planning Service of the General Hospital of Mexico Dr. Eduardo Liceaga. RESULTS: A total of 21 patients were included. In all cases the implant was not palpable in 20 patients and was located by ultrasound and removed. 10 implants were in Fatty tissue, 6 in muscle, 2 in fatty tissue and muscle and 2 were located in armpit. CONCLUSIONS: Due to simplitcity and accessibility, the ultrasound is the selected method for identifying deeply non-palpable implants.

[Contraception and breastfeeding. Spacing of pregnancies. Present concepts]. / Anticoncepción y lactancia. Espaciamiento de los embarazos. Conceptos actuales.

The risk of pregnancy in breastfeeding should be a concern of women. Family planning programs in the post natal period contraceptive choices offer high efficiency. Breastfeeding is a natural contraception method (LAM) as a contraceptive shield has 98% efficiency. Women should consider using an alternate contraceptive method when feeding requirements for this method to be effective are not met. Some of contraceptive alternatives in lactation include hormonal methods. According to the Medical Eligibility Criteria for Contraceptive Use WHO combined hormonal methods are contraindicated during breastfeeding, hormonal progestogen only methodo are considered only in Group 3 and Group 1 immediate postpartum after 6 weeks postpartum. There are modifications to these criteria by the CDC and the UK for the use of these hormones in early in lactation.

[Contraception and breast feeding. Spacing of pregnancies. Present concepts]. / Anticoncepción y lactancia. Espaciamiento de los embarazos. Conceptos actuales.

The risk of pregnancy in breastfeeding should be a concern of women. Family planning programs in the postnatal period contraceptive choices offer high efficiency. Breastfeeding is a natural contraception method (LAM) as a contraceptive shield has 98 % efficiency. Women should consider using an alternate contraceptive method when feeding requirements for this method to be effective are not met. Some of contraceptive alternatives in lactation include hormonal methods. According to the Medical Eligibility Criteria for Contraceptive Use WHO combined hormonal methods are contraindicated during breast feeding, hormonal progestogen only method are considered only in Group 3 and Group 1 immediate postpartum after 6 weeks postpartum. There are modifications to these criteria by the CDC and the UK for the use of these hormones in early in lactation.

[Posplacenta intrauterine device. Guide wires not visible]. / Dispositivo intrauterino posplacenta. Hilos guía no visibles.

BACKGROUND: Little information exists about the follow- up of the strings of intrauterine device (IUD) applied posplacenta. When the strings are of 10 cm in length are within the uterine cavity should be visible after postpartum involution. OBJECTIVE: To know the incidence of visible strings of intrauterine device (IUD) after posplacental insertion and to establish guidelines of follow-up when strings are not seen. METHODS: A prospective cohort study of 530 women with posplacental insertion of T Cu 380-A IUD with strings 10 cm long. Follow-up was at 6 weeks, 3, 6, 9 and 12 months after IUD insertion, at each visit women were questioned about IUD expulsion or removal and the cervix was inspected to visualize the strings of IUD. We analyzed the cumulative incidence of visible strings and procedures that were performed to locate the IUD when strings were not seen. RESULTS: At one year of follow-up the IUD was in situ in 398 women (75.1%), there were 44 expulsions (8.3%), 24 removals (4.5%) and 64 lost to follow up (12.1%). In women with IUDs in situ the strings were seen in 90.2% (n = 359) and were not seen in 9.8% (n = 39). In 65 women uterine cavity was probed identifying the IUD in situ in 64 cases, we performed 33 pelvic ultrasounds with IUDs in situ in 31 cases and in 2 cases with IUD in the cervical canal.. CONCLUSIONS: Strings of IUD after postplacental insertion was seen in most women at one year of follow up. When we are reasonably sure the woman is not pregnant, interventions for the location of the IUD should be avoided. A pelvic ultrasound should be the initial procedure and usually sufficient to locate IUDs whose strings are not visible.

Comparative pharmacokinetics and pharmacodynamics after subcutaneous and intramuscular administration of medroxyprogesterone acetate (25 mg) and estradiol cypionate (5 mg).

BACKGROUND: The efficacy of contraceptives is affected by its route and ease of administration. Herein, both pharmacokinetics and pharmacodynamics of the once-a-month combined injectable contraceptive medroxyprogesterone acetate (MPA) plus estradiol cypionate (E(2)-Cyp) were compared after intramuscular (IM) or subcutaneous (SC) injection in women of reproductive age. STUDY DESIGN: Thirty women were randomly assigned to the SC (n=15) or IM (n=15) route of MPA 25 mg+E(2)-Cyp 5 mg administration. Serum samples were obtained daily for 7 days and then three times a week for 40 days in order to quantify E(2), progesterone and MPA. In addition, three ultrasounds were performed on each subject to determine follicular development, and a daily record of the bleeding pattern and side effects was maintained. RESULTS: A comparative analysis showed that the main pharmacokinetic (peak serum concentration, peak serum time, area under the serum concentration vs. time curve, absorption half-life and elimination half-life) and pharmacodynamic parameters, such as follicular development and ovulation, were similar in the SC vs. IM groups. Complete suppression in ovarian function was present in all women. The bleeding patterns and side effects were similar in both groups. CONCLUSIONS: The results presented herein demonstrate that the injection of 25 mg of MPA plus 5 mg of E(2)-Cyp has similar efficacy and safety with either the SC or IM route of administration. The SC option can be considered a viable self-administered contraceptive option that might increase women's compliance to contraceptive use.

Complex localization of single-rod contraceptive implant. Report of two clinical cases.

BACKGROUND: The subdermal single-rod contraceptive implant is used by more than one million women worldwide. In México there are ~ 600,000 colocated implants. Cases of complex implant localization caused by a deep insertion procedure have been reported. CLINICAL CASES: Two clinical cases of implant with complex localization are presented. Case 1: we present a 21-year-old female. After the insertion procedure during the 12-, 24-, and 36-month revisions, the implant could not be located. Case 2: we present a 28-year-old female with subdermal single-rod contraceptive implant co-located in the external side of the left arm, partially palpable on the extreme distal area. Transverse cut of ultrasound showed the extreme distal area of the implant at 6 and 7 cm, respectively, at the site of insertion (scar). CONCLUSIONS: Due to simplicity and accessibility, ultrasound is the selected method for identifying deep nonpalpable implants.

[No-scalpel vasectomy. Profile of acceptance and results]. / Vasectomía sin bisturí. Perfil del usuario y resultados.

BACKGROUND: Men have few effective methods for birth control. The surgical method vasectomy is highly safe and effective, although in Mexico represents only 2.4% of all contraceptive methods used. OBJECTIVE: To determine the characteristics, complications and results of the men who requested and underwent no-scalpel vasectomy in the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, in México. MATERIAL AND METHOD: Retrospective cohort study with data of clinical records of men who underwent no-scalpel vasectomy from 2003 to 2007. Sociodemographic and clinical variables, and complications reported as well as espermatobioscopy data were included. Descriptive analysis was performed of different variables and chi squared test between proportions. RESULTS: A total of 596 no-scalpel vasectomies were performed. The average age was 36.5 years and 13.4 of schooling, 86.9% were married with 9.6 years of union. Socioeconomic status was as follows: medium (25%), middle high (20.1%), and high (24.7%). The 94.3% of men requested the no-scalpel vasectomy because of satisfied fertility and 5.7% by morbidity in his couple. The complications were as follows: epididymitis (2.2%), mild haematoma (1.5%) and contact dermatitis (0.2%). The surgical complications were significantly more frequent for the group with varicocele compared with the normal men group (p < 0.05). Azoospermia was achieved in 99.1% of men at 18 weeks after the no-scalpel vasectomy. Early recanalization occurred in 0.5% of men. There were no pregnancies. CONCLUSIONS: The profile of men who requested no-scalpel vasectomy was in a great proportion healthy, in the fourth decade of life, with high school or greater, satisfied fertility and high socioeconomic status. No-scalpel vasectomy is a method of fertility planning very effective with low morbidity.

[Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period]. / Estudio comparativo al azar entre los dispositivos intrauterinos Multiload Cu375 y TCu 380A, colocados durante el posparto.

OBJECTIVE: To evaluate safety and effectiveness of the intrauterine device Multiload Cu375 compared with the TCu 380A inserted in the postpartum period. PATIENTS AND METHODS: In a randomized comparative study carried out in the National Perinatology Institute, intrauterine devices MLCu 375 and Tcu 380A were inserted to 157 patients who voluntary accepted, and previously signed informed consent. There were four instances for the intrauterine devices insertion: within 10 minutes after vaginal delivery, during cesarean section (immediate postplacental insertion) and postpartum-postcesarean insertion (in the time range of 10 min to 48 h). All insertions were made with ring forceps. From 1 h to 24 h later, abdominal ultrasound examinations were performed to assess the distances between the upper part of the device to the fundus of uterine cavity. Follow up visits were scheduled at 3, 6, 9 and 12 months. Net cumulative life table event rates of discontinuations were estimated at one year. RESULTS: The expulsion rates were 10.4 for the MLCu 375 and 7.7 for the TCu 380A and they were not influenced by the moment of the intrauterine device insertion, not by the cervical dilatation, neither by the distance of the intrauterine device to the fundus of uterine cavity. The removal rates for bleeding and pain were 4.9 and 4.8, the removal rates for non medical reasons were 3.7 and 4.9 respectively. There was one case of genital infection in the MLCu 375 group. There were no pregnancies, nor uterine perforation. The one year continuation rates were 77.1 and 82.6 respectively. There were no statistical significant differences in the comparative rates. CONCLUSIONS: The intrauterine device MLCu 375 is as safe and effective as the TCu380A when they are inserted in the postpartum period.

Implantes anticonceptivos / Contraceptives implants

El objetivo del presente trabajo es actualizar la información disponible sobre implantes subdérmicos como métodos anticonceptivos. Existen en uso clínico tres tipos de implantes: Norplant, desde 1985, consistente en seis cápsulas de dimetilpolisiloxano con levonorgestrel; Jadelle, desde 1995, utiliza dos barras de una mezcla del mismo polímero y misma progestina que Norplant; e Implanon, 1999, una sola varilla de acetato de etilenvinilo mezclado con etonogestrel. Se insertan bajo la piel del brazo con anestesia local; liberan la progestina a tasas constantes después del primer año y se usan por cinco y tres años, respectivamente. El principal mecanismo de acción de los dos primeros es la inhibición de la penetración espermática y del Implanon, la inhibición de la ovulación. Finalmente, se concluye que los implantes subdérmicos forman parte de los anticonceptivos más eficaces, ya que se producen 0.1 embarazos por 100 mujeres el 1er. año de uso. Alteran la menstruación en 70% de las mujeres. Como eventos más frecuentes provocan aumento de peso, cefalea y mastalgia, no obstante, las tasas de continuidad son cercanas a 90% en el primer año de uso.

The objective of this work it is to up date the information about implantable contraceptives. Description: There are three contraceptive implants in clinical practices: Norplant, since 1985, that consists of 6 capsules of polidimethylsiloxane containing levonorgestrel; Jadelle, since 1995, two rods of a mixture of the same polymer and progestin thet Norplant uses, and Implanon, since 1999, a single rod of ethylenevinyl acetate mixed with etonorgestrel; they are inserted subdermaly in the arm, under local anesthesia; they release the progestin at constant rates after the first year and have a life-span of 5 and 3 years, respectively. Both, Norplant and Jadelle make the cervical mucus impenetrable by spermatozoa. Implanon inhibits ovulation. Other implantable contraceptives under research-contain. Nomegestrol (Uniplant) and nestorone (Elcometrin) Conclusions: Implantable contraceptives are some of the most effective methods, only 0.1 pregnancies per 100 women in the first year of use. All of them produce vaginal bleeding disturbances in about 70% of users. Other events observed are weight increase, headache and breast tenderness. The continuation rates are about 90% in the first year of use.

The limited clinical usefulness of taking a history in the evaluation of women with tubal factor infertility.

OBJECTIVE: To evaluate whether patient histories of gynecological infections predict tubal pathology seen at laparoscopic exam in infertile women. DESIGN: Cross-sectional analysis from a subset of case-control subjects. SETTING: Tertiary-level public hospitals with infertility clinics, Mexico City. PATIENT(S): Three hundred twenty-one nulligravid infertile women seeking diagnostic workup. INTERVENTION(S): Interviews conducted before evaluation by laparoscopy. MAIN OUTCOME MEASURES(S): Sensitivity, specificity, and predictive values for correlating previous pelvic inflammatory disease symptoms, vaginal discharge, genital tract infections, and antibodies to Chlamydia trachomatis to confirmed diagnoses of tubal pathology and to severe tubal pathology. RESULT(S): Tubal pathology was found in 58% of participants (n = 185), and severe pathology was found in 29% (n = 92). None of the historical infection-related factors alone was a good overall predictor of tubal pathology; high sensitivity values (up to 73%) were offset by low specificity (down to 30%) and vice versa, for each factor. When considered simultaneously, the factors improved the overall predictive ability just slightly (84% sensitivity and 29% specificity) over the individual factors. The validity measures did not improve when examining severe tubal pathology alone. CONCLUSION(S): History taking related to past genital tract infections appears to be of little use in the evaluation of infertile women.

[Aspirated sperm activation from deferens in an ionic media similar to seminal plasma]. / Activación de espermatozoides aspirados del deferente con un medio iónico similar al plasma seminal.

OBJECTIVE: To compare motility on sperm obtained from the vas deferens and incubated in seminal plasma (PS), a ionic medium similar to seminal plasma (MA) and HTF-HEPES culture medium. MATERIAL AND METHOD: Aspirates from de proximal vas deferens were obtained in eight healthy men during vasectomy and separated in three aliquots (5-6 millions sperm/mL). Aliquots were incubated on PS, MA and HTF-HEPES. Quantitative and qualitative motility were assessed at one hour intervals. RESULTS: Sperm motility decreased 30% in the 1st hour but at the 3rd hour it increased 70% in aliquots incubated in PS and MA. Straight line velocity (VSL) also increased significatively at the 1st and 3rd hour only in aliquots incubated in PS and MA compared to aliquots incubated in HTF-HEPES (1st hour: p < 0.01; 3rd hour: p < 0.001). Curvilinear velocity (VCL) decreased at 3 hours in aliquots incubated in PS and MA compared to HTF-HEPES (P < 0.001). VCL was lower on aliquots incubated in PS compared to MA (p < 0.01). CONCLUSIONS: Sperm activation occurred in PS and MA at 3 hours. Incubation in HTF-HEPES culture medium resulted in a progressive decrease of sperm motility. This suggests that ionic/osmolar composition of PS is important for sperm activation of sperm obtained from the vas deferens.

Aspiración manual endouterina para el tratamiento del embarazo molar / Manual aspirative endouterine for the treatment of molar pregnancy

Se revisaron 36 casos de embarazo molar resueltos con Aspiración Manual Endouterina (AMEU), en el Instituto Nacional de Perinatología, en el periodo comprendido del 1o. de enero al 31 de octubre de 1998. La Incidencia del embarazo molar en la institutción fue de 2.3 por 1000 embarazos. Casi dos terceras partes de los casos ocurrieron en mujeres con edades comprendidas entre 20 y 30 años. El factor de riesgo más relevante fue el antecedente de embarazo molar, que estuvo presente en el 44.5 por ciento de los casos. El promedio de edad gestacional fue de 12.6 semanas. Dentro de las técnicas anestésicas, se utilizó bloqueo epidural lumbar en el 86.1 por ciento de los casos y en los restantes anestesia general. El procedimiento de la AMEU fue realizado por diferentes cirujanos siguiendo los lineamientos descritos para técnica; en 12 mujeres (33.3 por ciento) se practicó legrado uterino instrumental (LUI) como complemento de la AMEU. Tres mujeres presentaron hemorragia de 1000 ml o más ameritando transfusión sanguínea una de ellas. Dos mujeres tuvieron retención de restos ovulares. Siete casos evolucionaron a enfermedad trofoblástica persistente. En más de 90 por ciento de los casos el reporte de histopatología "molar hidatiforme completa". El método de planificación familiar más utilizado después de la resolución del embarazo molar fueron los anticonceptivos orales combinados en 66.7 por ciento de los casos. Se concluye que la AMEU es un método seguro y efectivo para la evacuación del embarazo molar

Aspiración manual endouterina para el tratamiento del aborto incompleto / Manual endouterine aspiration in the treatment of incomplete abortion

La aspiración manual endouterina (AMEU) es un procedimiento propuesto para el vaciamiento uterino, en casos de aborto incompleto, mediante una jeringa de plástico con la que se produce una presión negativa para realizar la aspiración. Con esta técnica, se efectuaron 122 tratamiento de aborto en sus diferentes variedades, en el Instituto Nacional de Perinatología, y los resultados obtenidos se compararon con los logrados en el mismo periodo en 126 mujeres tratadas, también por aborto, mediante legrado uterino instrumental (LUI). Las características sociodemográficas de ambos grupos de pacientes fueron similares; pero, en cuanto las variedades de aborto, la de aborto molar y la de aborto diferido predominaron en las pacientes tratadas con AMEU. Los procedimientos anestésicos usados fueron similares en ambos grupos, salvo en 10 casos tratados con AMEU, en que se empleó bloqueo paracervical. Sólo se observaron 4 complicaciones transoperatorias: dos casos de hemorragia, uno en AMEU y otro en LUI; y 2 en AMEU, en que la evacuación resultó insuficiente y obligó a LUI posterior. El estudio histopatológico con técnicas morfométricas mostró proporción relativa de tejidos fetales, vellosidades coriónicas, decidua, miometrio y coágulos, similar para ambos procedimientos. Los autores concluyen que la técnica de AMEU es igulamente eficaz y segura que el LUI, su práctica es fácil de realizar, evita complicaciones importantes y puede constituir una alternativa ventajosa en los casos de aborto molar

Biopsia endometrial por aspiración / Aspiration endometrial biopsy

Se evaluó la factibilidad y precisión diagnóstica de la biopsia endometrial por aspiración con cánula de karman, comparada con la toma de raspado con la cánula de Novak. Del 1o. de junio de 1993 al 15 de enero de 1994, se tomaron 230 biopsias de endometrio a igual número de pacientes, como parte del estudio que se efectúa a mujeres con trastorno de la fertilidad en las Clínicas de Reproducción Asistida y de Esterilidad del Instituto Nacional de perinatología. Las muestras se tomaron con cánula de Karman, Grupo I (n = 115) y con cánula de Novak, Grupo II (n= 115) y se compararon; tiempo del procedimiento, intensidad del dolor, cantidad y calidad de las muestras macro y microscópicamente. En 92.2 por ciento del grupo I se obtuvo tejido adecuado para diagnóstico en comparación con 84.4 por ciento del grupo II, asímismo, cuantitativamente y cualitativamente la muestra fue mejor en el grupo I y el tiempo empleado fue menor de 1 minuto en 90 por ciento del grupo I y 83 por ciento en el grupo II. De las mujeres en las que se usó cánula de Karman 26 por ciento manifestaron no haber tenido dolor y 0.9 por ciento en las que se usó la cánula de Novak. Este estudio permite afirmar que la aspiración endometrial con cánula de karman puede ser factible y confiable para el diagnóstico histopatológico funcional, permitiendo obtener muestras adecuadas en cantidad y calidad, ofreciendo como ventaja menor dolor y más seguridad a las pacientes

Aplicación posparto y transcesárea del dispositivo intrauterino en mujeres con riesgo obstétrico / Postpartum and transcesarean application of IUD in women with obstetric risk

En ninguno de los estudios publicados hasta la fecha se reporta aumento en el riesgo de complicaciones puerperales en mujeres a quienes sin presentar patología obstétrica se les aplicó un dispositivo intrauterino (DIU) en el periodo posparto. En el presente estudio se revisaron los resultados de 104 mujeres a las que se les aplicó el DIU posparto y 125 mujeres a quienes se les aplicó el DIU durante la cesárea, a través de la histerotomía y los eeventos de infección y sangrado se comparan con los presentados por 122 mujeres operadas de cesárea que sirvieron de testigo; todas ellas con algún factor de riesgo durante el embarazo y el parto. Estos factores fueron trabajo de parto entre 13 a 48 hrs., 211 casos; rotura de membranas entre 6 a 48 hrs., antes del parto, 86 casos; enfermedad hipertensiva aguda del embarazo, 41 casos; embarazo gemelar, 12 casos y placenta previa y desprendimieto prematuro de placenta normoinserta, 16 casos. El seguimiento se realizó a un mes. Las complicaciones observadas fueron: endometritis y hemorragia puerperal tardía, sin existir diferencias estadísticamente significativas entre los tres grupos, ni por factor de riesgo. No se observó ningún caso de endometritis en los grupos de cesárea, cuando se administraron antimicrobianos profilácticos. Se plantea la posibilidad de que el uso del DIU en mujeres con factores de riesgo obstétrico y del parto, no aumente la frecuencia de complicaciones puerperales infecciosas ni hemorrágicas.

Embarazo ectópico y dispositivo intrauterino / Ectopic pregnancy and intrauterine device

Se estudiaron 418 casos de embarazo ectópico (EE) para conocer su posible relación con el uso del dispositivo intrauterino (DIU) y con otros factores considerados de riesgo para su producción. Los datos se compararon con los de 510 controles o testigos, mujeres de 15 a 44 años de edad, no embarazadas internadas por padecimientos agudos no ginecológicos en hospitales del Instituto Mexicano del Seguro Social, en el Valle de México. El grado de asociación se estableció a través del cálculo de riesgo relativo (RR) con intervalo de confianza de 95% (IC 95%). La proporción de usuarias del DIU fue similar en ambos grupos. El RR de desarrollar EE en las usuarias del DIU resultó de 0.4 con IC 95% de 0.3 a 0.6, significativamente menor que en las no usuarias del método anticonceptivos (p<0.001). No se encontró relación entre el tiempo de uso, ni el tipo de DIU. En las ex-usuarias del DIU el RR fué de 1.9, sin significancia estadística, con IC 95% de 1.0 a 3.5. Las mujeres solteras, las que tuvieron más de dos parejas sexuales y aquellas con antecedente de enfermedad inflamatoria pélvica presentaron RR de 2.4, 2.2 y 2.0 respectivamente, pero sin significancia estadística. El antecedente de EE resultó ser el único factor que se asoció con una elevación del riesgo de desarrollar EE, con RR de 6.0, IC 95% de 2.0 a 17.8 y p<0.001

Resultados con el uso del dispositivo intrauterino en mujeres adolescentes / Results of the use of intrauterine device among adolescent women

Se revisaron los eventos presentados por 600 mujeres adolescentes de 14 a 19 años de edad que voluntariamente aceptaron la inserción de un dispositivo intrauterino (DIU) como método de control de la fertilidad. Los datos de 1831 mujeres adultas (20 o más años) con el mismo método sirvieron de comparación. Los DIUs aplicados fueron "T" liberadoras de cobre en 58% de los casos. "T" liberadoras de progesterona en 37.8% y asa de Lippers en el 1.9%. Las tasas netas de eventos acumulados a un año por cien aceptantes por tipo de terminación y continuación para las adolescentes y adultas resultaron de: Embarazo 1.4, expulsión 2.0 y2.0 de retiros por causas médicas 3.2 y 3.1 respectivamente. Diferencias sin significancia estadística. En esta muestra de mujeres adolescentes, el uso del DIU mostró bajas tasas de abandono, similares a las presentadas por la muestra de mujeres adultas. No se encontraron casos de enfermedad inflamatoria pélvica, ni se presentaron perforaciónes uterinas. Su uso puede recomendarse porque la baja tasa de embarazos accidentales y la elevada tasa de continuidad garantizan una protección anticonceptiva eficaz

Anticonceptivos orales y morbilidad de enfermedades cardiovasculares / Oral contraceptives and cardiovascular diseases morbility

Se estudió asociación entre ciertas enfermedades cardiovasculares no reumáticas y el uso de anticonceptivos orales den mujeres de 20 a 44 años de edad hospitalizadas en unudades de segundo y tercer nivel de atención médica del Instituto Mexicano del Seguro Social en el Valle de México, de 1979 a 1984. Se analizaron los datos de 201 casos y 606 testigos apareados por edad, paridad y nivel de educación. Se encontró que el riesgo relativo de desarrollar cardiopatía isquémica, accidente cerebrovascular, tromboembolia pulmonar y trombosis venosa aumentó en forma estadísticamente significativa para las mujeres que estaban usando o habían usado alguna vez anticonceptivos orales. En el análisis conjunto de estas enfermedades, el riesgo se presenta desde los primeros meses de uso, con el empleo de anticonceptivos que contienen 40 µg o menos de estrógeno y se incrementa conforme es mayor la edad de la mujer