Anibal Faúndes

Induction of labor with intravaginal misoprostol in intrauterine fetal death

OBJECTIVEnOur purpose was to evaluate the effectiveness and safety of intravaginal misoprostol for the induction of labor in intrauterine fetal death.nnnSTUDY DESIGNnSeventy-two women at 18 to 40 weeks of pregnancy with intrauterine fetal death, without abdominal scars, were treated with 100 micrograms of intravaginal misoprostol. The dose was repeated every 12 hours until effective uterine contractions and cervical dilatation were obtained, for up to 48 hours.nnnRESULTSnThe mean time from induction to delivery was 12.6 hours, and only six patients (8%) required between 24 and 48 hours, at the end of which all patients had been delivered. Only the Bishops score was significantly associated with time from first dose to expulsion. No surgical procedure was required. Hypercontractility, sweating, fever, diarrhea, or other gastrointestinal effects were not detected. There was no need for analgesics.nnnCONCLUSIONSnIntravaginal misoprostol at the dose of 100 micrograms every 12 hours appears to be a safe, effective, practical, and inexpensive new method for induction of labor in intrauterine fetal death.

Evaluation of the clinical performance of a levonorgestrel-releasing IUD, up to seven years of use, in Campinas, Brazil

The clinical performance of a levonorgestrel IUD, releasing 20 mcg/day, used by 293 women at the Family Planning Clinic of the State University of Campinas, was evaluated up to the end of the seventh year of use. No pregnancies occurred in 899 women-years of observation. The cumulative removal rate for amenorrhea or severe hypomenorrhea was 15.7 per 100 women at seven years. The expulsion rate was within ranges observed with copper IUDs in the same clinic. The continuation rate was 49.5% at three years and 23.7 at seven years. The cumulative loss to follow-up rate was 13.7% at seven years. The effectiveness, good continuation rate, and reduction of the amount of blood loss make this device appropriate to be offered to Brazilian women, as an additional contraceptive option.

Low-dose vaginal misoprostol for induction of labor with a live fetus

Objective: To test the effectiveness and safety of low‐dose vaginal misoprostol for induction of labor with a live fetus. Methods: Labor was induced in 666 pregnant women with a live fetus in the cephalic position, who had no medical complications and no history of uterine surgery. One‐fourth of a 200‐μg tablet of misoprostol (50 μg) was placed in the posterior vaginal fornix every 12 h for a maximum of four doses or until active labor commenced. Time from induction to delivery, side effects and neonatal outcome were evaluated. Results: Labor was successfully induced in all cases. The mean time from induction to delivery was 10.4 h. The cesarean section rate was 7.8%. There were eight perinatal deaths, six of which occurred in low birth weight fetuses. There was one case of abruptio placenta, which was less than that expected in the study population. Conclusion: Vaginal misoprostol, in very low doses, was a remarkably efficient and safe method for induction of labor with a live fetus.

Effectiveness of the diaphragm used continuously without spermicide.

The experience of 670 diaphragm users from three Brazilian clinics was retrospectively reviewed. Most of the subjects (441) followed the traditional method (TM) of using the diaphragm, only at the time of sexual intercourse and with spermicide. One third (215) used the diaphragm continuously (CU), without spermicide, removing it only at the time of their daily shower to wash it, with immediate re-insertion. The total pregnancy rate was 7.0 per 100 women-years for the whole group. Patient and total failure rate were significantly lower in the CU (0.6 and 2.8), in comparison with the TM sub-group (6.5 and 9.8). The discontinuation rate for urinary infection or other medical reasons was not greater in the CU group. Logistic regression analysis, including age, parity, number of abortions and of living children, years of schooling, whether living with a partner, presence of mild cystocele or retroverted uterus, and form of use of diaphragm (TM or CU), showed that only the TM of diaphragm use was positively associated to patients and total failure rate.

Bleeding complaints during the first year of Norplant® implants use and their impact on removal rate

The frequency of bleeding complaints during the first year of use and their influence on removal rate were analyzed in a retrospective cohort study of 491 Norplant implants acceptors. Removal rates were significantly higher in women having menstrual complaints (1.98% and 29.23% in the first and fourth trimester) than in those who did not mention them (0.79 and 5.07% in the same periods). In all periods of observation, most women who mentioned menstrual problems decided to continue using the method. Two possible explanations for this are that 1) the complaints did not persist for very long, and 2) the most frequent complaint mentioned was bleeding irregularity, which was not as strongly associated with removals as increased or decreased bleeding. The authors conclude that bleeding problems are the most important factor limiting the acceptability of Norplant implants, either being the main reason for removal (3.9 per 100 women) or influencing the rate of removal for other reasons. Adequate counseling appears to be critical for reducing the impact of bleeding problems on removal rates, and thereby increasing the acceptability of the method. The importance of research aimed at preventing or treating menstrual problems to improve the acceptability of the method is emphasized.

Unwanted pregnancy: challenges for health policy

In Latin America, governments fail to recognize that information and services for sexuality, reproduction and contraception are essential to womens health. Governments should adopt comprehensive womens health policies and programs to help women avoid unwanted pregnancies that lead to dangerous illegal abortions. This includes sex education, especially for adolescents; contraceptive choices; accessible services; decriminalization of abortion and removal of obstacles to legal abortion services; and support for women who wish to carry their pregnancies to term.

Commentary on women's reproductive health: means or end?

The nature and extent of women’s reproductive health problems and ihe actions needed to improve their situation have been the subject of extensive review in recent years. Mthouah the demand for a oolitical commitment to implement those actions has been made repeatedly, very little has been done. The intention of this paper is to analyze the reasons behind the lack of action and to propose a rationale and a strategy for moving forward.

Comparison of local signs and symptoms after the insertion of NORPLANT® implants with and without a scalpel

The study compares NORPLANT subdermal implants acceptors enrolled randomly for two different insertion procedures. One group (420 women) received the implants with the use of a scalpel according to the manufacturers instructions. The other group (423 women) received the implant without an incision, directly through a sharpened trocar. The local signs and symptoms were observed at 7 and 30 days after insertion. Pain, tenderness, edema/swelling, ecchymosis and defective scar were considered. Complication rates were low and no significant differences were found between the two procedures. Based on the data of this study, we recommend inserting NORPLANT implants without the use of a scalpel.

Score prognosis for the infertile couple based on historical factors and sperm analysis

Objective: To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. Methods: The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. Results: Six variables had a predictive value: sperm morphology, the womans age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. Conclusions: The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger womans age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.