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1.
Eur J Contracept Reprod Health Care ; 26(6): 499-502, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34219584

RESUMO

BACKGROUND AND OBJECTIVES: Lack of information and myths or inadequate training of health care providers in the guidance and management of contraceptives could negatively affect choice and eventually continuation rates. Our objectives were to evaluate the impact of clinical and theoretical training of health care professionals on insertion and removal of etonogestrel (ENG)-implant regarding this contraceptive, including pre- and post-training knowledge about insertion and removal techniques, clinical characteristics, side effects and outcomes. MATERIAL AND METHODS: We conducted a cross-sectional study in which a questionnaire was sent to health care providers after they received clinical training in the management of ENG-implant. RESULTS: After training, 78.2% of the 139 participants initiated to offer and inserted up to 5 implants/month and 17.6% between 6 to 10/month. None of the interviewees reported having difficulty with insertions after training, and 87.9% reported feeling very confident for removal. CONCLUSION: Theoretical and practical training appeared important to prepare health care professionals, clarify doubts and promote higher rates of use of contraceptive implants in Brazil, contributing to reduce the rates of unintended pregnancies.


Assuntos
Anticoncepcionais Femininos , Brasil , Estudos Transversais , Implantes de Medicamento , Feminino , Pessoal de Saúde , Humanos , Gravidez
2.
Am J Obstet Gynecol ; 222(3): 245.e1-245.e10, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31541635

RESUMO

BACKGROUND: Fear of pain during the insertion of intrauterine contraceptives is a barrier to using these methods, especially for nulligravidas. An intracervical block may be easier and more reproducible than a paracervical block; however, this intervention has not been evaluated in nulligravid women to reduce pain with intrauterine contraceptive insertion. OBJECTIVE: To evaluate whether a 3.6-mL 2% lidocaine intracervical block reduces pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion among nulligravidas; and, in addition, to assess whether the intracervical block has any effect on the ease of device insertion and on the overall experience with the procedure. MATERIALS AND METHODS: In this randomized double-blind controlled trial, nulligravidas were block-randomized to 1 of 3 arms prior to 52-mg levonorgestrel-releasing intrauterine system insertion: 3.6-mL 2%-lidocaine intracervical block, sham injection (intracervical dry-needling), or no intervention. The primary outcome was pain at levonorgestrel-releasing intrauterine system insertion. Secondary outcomes were pain at tenaculum placement, ease of insertion (assessed by healthcare providers), and the overall experience with the procedure (pain with levonorgestrel-releasing intrauterine system insertion compared with expectations, discomfort level, wish to undergo another device insertion in the future, and recommendation of the procedure to others). Participants' pain was measured with a 10-cm visual analogue scale and a 5-point Faces Pain Scale. Pain was summarized into categories (none, mild, moderate, severe) and also analyzed as a continuous variable (mean and 95% confidence interval). Our sample size had 80% power (α = 0.05) to detect a 15% difference in pain score measured by visual analogue scale (mean [standard deviation] visual analogue scale score = 5.9 [2.0] cm) and an absolute difference of 20% in the proportion of women reporting severe pain at levonorgestrel-releasing intrauterine system insertion among groups. We used a χ2 test and a mixed-effects linear regression model. We calculated the number needed to treat for the intracervical block to avert severe pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion. RESULTS: A total of 302 women were randomized (99 to the intracervical block, 101 to the intracervical sham, and 102 to no intervention), and 300 had a successful device insertion. The intracervical block group had fewer women reporting severe pain than the other groups, both at tenaculum placement (intracervical block: 2% vs sham: 30.2% vs no intervention: 15.2%, P < .0001) and at levonorgestrel-releasing intrauterine system insertion (intracervical block: 26.5% vs sham: 59.4% vs no intervention: 50.5%, P < .0001). The mean (95% confidence interval) pain score reported at levonorgestrel-releasing intrauterine system insertion was lower in the intracervical block group than in the other groups (intracervical block: 4.3 [3.8-4.9] vs sham: 6.6 [6.2-7.0], P < .0001; intracervical block: 4.3 [3.8-4.9] vs no intervention: 5.8 [5.3-6.4], P < .0001). Women from the intracervical block group reported less pain than expected (P < .0001), rated the insertion as less uncomfortable (P < .0001), and were more willing to undergo another device insertion in the future (P < .01) than women in the other groups. The ease of insertion were similar among groups. The number needed to treat for the intracervical block to avert severe pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion was 2 and 4, respectively. CONCLUSION: A 3.6-mL 2% lidocaine intracervical block decreased pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion among nulligravidas. It also provided a better overall experience during the procedure.


Assuntos
Anestésicos Locais/administração & dosagem , Dispositivos Intrauterinos Medicados , Lidocaína/administração & dosagem , Dor/prevenção & controle , Adulto , Anticoncepcionais Femininos/administração & dosagem , Método Duplo-Cego , Feminino , Número de Gestações , Humanos , Levanogestrel/administração & dosagem , Dor/etiologia , Escala Visual Analógica
3.
Rev. bras. ginecol. obstet ; 15(3): 114-8, maio-jun. 1993. tab
Artigo em Português | LILACS | ID: lil-173509

RESUMO

A laqueadura tubária é bastante difundida como método anticoncepcional. Existe uma tendência de realizar-se este procedimento durante a operaçao cesariana, com aumento do risco de complicaçoes, tanto para a gestante como para o recém-nascido. Este trabalho, realizado no Departamento de Tocoginecologia do Centro de Atençao Integral à Saúde da Mulher-Unicamp, revisou 340 casos de laqueadura fora do ciclo gravídico-puerperal ocorridos no período de novembro de 1989 a julho de 1991. Foram comparadas as vias vaginal e abdominal quanto à idade, paridade, indicaçao de laqueadura, antecedentes cirúrgicos, operaçoes concomitantes, tempo da cirurgia e da internaçao e complicaçoes no intra e pós-operatório imediato. A via vaginal mostrou-se mais vantajosa quando analisados o tempo cirúrgico e o de internaçao. Os autores concluem que se deve dar preferência à via vaginal quando nao houver contra-indicaçao e quando for necessária a realizaçao de outra cirurgia vaginal concomitante.


Assuntos
Humanos , Feminino , Adulto , Abdome , Esterilização Tubária/métodos , Vagina , Fatores Etários , Tempo de Internação , Paridade , Complicações Pós-Operatórias , Fatores de Tempo
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