Eduardo Maradiegue

Return of fertility after discontinuation of the once-a-month injectable contraceptive Cyclofem®

The objective of this study was to evaluate the return of fertility in women who used Cyclofem as a contraceptive method during the introductory studies conducted in Brazil, Chile, Colombia, and Peru. From these four cohorts, 101 women were eligible for the study. Thirty-one were not included in the study either because they refused to be interviewed, had initiated another contraceptive method the month after discontinuation, or were unable to be contacted. A total of 70 women were included in the study. Our results showed that the return to fertility rate after the discontinuation of Cyclofem was 1.4 per 100 women at the end of the first month and reached 82.9 at one year. More than 50% were pregnant at 6 months. Fifty-one (94.4%) pregnancies ended in a live birth, two were spontaneous first trimester abortions, and one was a hydatidiform mole. Return of fertility was not related to the womans age at the time of discontinuation, her weight, or the number of Cyclofem injections. In conclusion, fertility is restored by 1 month following Cyclofem discontinuation. Users and potential users should be counseled regarding the rapid return of fertility after discontinuing this method of contraception.

Endometrial histology in long-term users of the once-a-month injectable contraceptive Cyclofem.

This study evaluated endometrial histology in women using the once-a-month injectable contraceptive Cyclofem for one year or more. The study received IRB approval. Seventeen Cyclofem users accepted to be submitted to an endometrial biopsy. All the samples were collected with an endometrial suction curette (Z-Sampler, ZSI Gynecological Product, Chasworth, CA, USA) in an outpatient clinic, 27–33 days after the last injection. The material was fixed immediately in Bouin solution prior to wax embedding and screened as a routine histological examination by a senior pathologist. The pathologist did not know the bleeding status of each woman or the number of injections each woman had received before the biopsy. All women recorded bleeding and spotting for the last 60 days prior to the biopsy. The mean age of volunteers was 25.9 years (range 21–32) and the mean number of injections received was 24.8 (range 14–47). The results were: 4 out of 17 biopsies were found to be inadequate for diagnosis because they consisted of only blood and mucus. Two of these women were bleeding regularly and the other 2 had amenorrhea. Eight endometrial samples presented a proliferative pattern and, in this group, 3 women had amenorrhea and 5 were bleeding regularly. The other 5 biopsies were reported as secretory endometrium, and 4 of them showed pseudodecidual reaction compatible with the administration of progestin. All of these women were bleeding regularly. The results of the biopsies were not related to the number of injections received nor to the age of the women. In conclusion, long-term administration of the injectable contraceptive Cyclofem did not produce adverse alterations in the endometrium as hyperplasia.

Infecciones en gineco-obstetricia. Infecciones transmitidas sexualmente

Sexually transmitted infections are a group of diseases whose transmission is performed at the time of intercourse. We describe them according to their etiology, or those caused by viruses, bacteria, chlamydia, spirochetes, protozoa and fungi. There are parasites that are transmitted through body contact during sex, such as produced by pubic lice or pubic Phithirus acarosis by Sarcoptes scabiei variety hominis, which will not be described in this paper.

ABORTO COMO CAUSA DE MUERTE MATERNA

The author defines abortion as a controverted pathology due to the various non-biologic components. It has been used since remote times as a resource to regulate fecundity. But the serious complications are still important causes of maternal death, generally as a consequence of severe infection. More than 400 000 induced abortions have been indirectly estimated in Peru, responsible for an important number of deaths due to this cause. Main non-mortal complications of induced abortion are chronic pelvic pain, ectopic pregnancy, sterility and premature menopause due to oophorectomy. The severity of infection in induced abortion done in adverse conditions frequently causes multiple organic compromise, its therapy depending in the pregnant woman’s health and in the severity of the bacteria or bacteriae involved. Once septic abortion is diagnosed treatment should be in a hospital with resolution capacity, as late or inappropriate treatments can derive in septic shock with high probabilities of maternal death (20 to 50%). Consider infection is polymicrobial and requires intensive and wide spectrum antibiotics. Use intravenous therapy with ampicillin + gentamicin + chloramphenicol or metronidazole; the scheme may vary though depending on drug disposition. The antibiotic therapy has to be maintained until two days after fever disappears, with no need to continue with oral therapy. Aside from the antibiotic therapy, uterus has to be evacuated as soon as possible, either by curettage or hysterectomy, depending on the clinical status.

Mortalidad por aborto séptico en el Hospital Nacional Cayetano Heredia. 1985 - 1992

This is a retrospective epidemiological control case type study of twenty-four deaths caused by septic abortion attended at our Hospital from 1985 through 1992. Control group consisted of 72 pregnant women who survived.. Septic abortion mortality rate was 67,3 per 100000 live newborns. Highest rate, 176,6, occurred in 1991. Mortality rate factor were 5 or more pregnancies (OR=1,7), gestational age over 16 week (OR=5,0), time from abortion maneuvers over 5 days (OR=1,7), septic shock (OR=8,5), anemia (OR=3,4), acute renal failure (OR=17,0), uterine perforation (OR=3,4), disseminated intravascular coagulation (OR=60,0), pelvic thrombophlebitis (OR = 10,2), multisystemic failure (OR=6,5) and lung shock (OR = 6,5). Significant symptoms were yellowish foul odor discharge, jaundice, petechiae, disnea and muscular pain. Main medical and surgical treatment consisted in blood and plasma transfusions, cardiotonics and anticoagulation, and hysterectomy and bilateral salpingoophorectomy. Main causes of death, were septic shock, acute renal failure, multisystemic failure, disseminated intravascular coagulation and lung thromboembolism.