Asunto(s)
Antiinfecciosos Locales/efectos adversos , Hipotiroidismo Congénito/inducido químicamente , Endometritis/prevención & control , Povidona Yodada/efectos adversos , Premedicación , Administración Intravaginal , Antiinfecciosos Locales/administración & dosificación , Cesárea/efectos adversos , Endometritis/etiología , Femenino , Humanos , Recién Nacido , Povidona Yodada/administración & dosificación , EmbarazoRESUMEN
Objective: The study was designed to evaluate the experience and acceptability of emergency hormonal contraception service for inner-city women in Planned Parenthood clinics.Methods: In 1995, emergency hormonal contraception was introduced as a new service in three clinics of New York City's Planned Parenthood that served low-income women. Shortly after inception of this service, the agency undertook a survey to investigate patient experience and acceptability of the service. The survey addressed side effects and patients attitudes about emergency hormonal contraception. It also addressed suggestions for improving the service.The indication for the use of this method was unprotected intercourse within the previous 72 hours of first dosage of certain birth control pills. We used Lo/Ovral (norgestrel 0.3 mg + ethinyl estradiol 30 µg) 4 tablets given stat and second dose 12 hours later.Results: There were 118 patients who responded to the survey. The average patient age was 25 years. Approximately half of the women were white and half were other. The majority were nulliparous, and 42% had one or more abortions in the past. Side effects such as nausea, vomiting, and fatigue and their prevalence were noted. Two women reported method failure. Both patients elected abortion. The vast majority (92%) stated that they would use the method again. Patients also made several recommendations for enhancing the service.Conclusion: As a result of this survey, Planned Parenthood of New York City completely revised its emergency hormonal contraception protocols in order to increase patient satisfaction while maintaining high medical standards to ensure lower method failure and drug side effects in more than 1,000 patients so far.
RESUMEN
Planned Parenthood of New York City established a physician education program in first-trimester abortion using local anesthesia at its three clinics. This paper describes the program's technical and counseling skills curricula, individualized instruction, quality-assurance procedures, obstacles encountered, and solutions implemented. Major obstacles were slow initial recruitment, disincentives of off-site education, and scheduling difficulties. Solutions included grand rounds presentations at local hospitals to recruit residents, considerable flexibility in rotational scheduling, and expansion of instructional staff to include academic physicians as teachers. Since its inception in July 1993, 53 residents and attending physicians have been taught to perform induced abortions at Planned Parenthood, and 25 who completed the program are currently providing abortions around the nation. Planned Parenthood's experience in teaching residents from local hospitals to perform first-trimester abortion using local anesthesia may be valuable for those who wish to implement similar collaborative off-site educational programs.
Asunto(s)
Aborto Inducido , Internado y Residencia , Aborto Inducido/normas , Curriculum , Educación Médica Continua/métodos , Educación Médica Continua/organización & administración , Femenino , Humanos , Ciudad de Nueva York , Embarazo , Primer Trimestre del Embarazo , Calidad de la Atención de SaludRESUMEN
PIP: The obstetrician-gynecologist clinic should provide easy access for the disabled patient such as a hydraulic pelvic examination table. In most cases, disability does not affect sexuality, menstruation, or fertility but may change the level of interest and activity. Thus the physician should include sexual counseling even for abled patients with disabled partners. He/she should document the informed consent process to make sure it is legal and ethical. He/she must do a thorough evaluation of each disabled patient and her needs and develop a special protocol for each patient. The physician must know those disabled conditions that limit pelvic examination ability an contraindicate some contraceptives. Oral contraceptives (OCs) and progestin implants are contraindicated in women with spinal cord injury (SCI), disabled by a stroke, and with neurologic disorders that inhibit mobility in the lower extremities and cause circulatory disorders. Depending on individual circumstances, physicians should not advise OC use for women who are mentally retarded, mentally ill, or are drug abusers since they either do not understand, cannot remember, or are not motivated to take OCs regularly. Progestin implants may be a viable option for drug abusers, the mentally ill, and mentally retarded women. Once the US Food and Drug Administration approves injectable progestational agents, they could be another option for these women. The IUD is contraindicated in women who have no sensory capabilities and could not notice an ectopic pregnancy and pelvic infection. This may include women with some neurologic disorders, stroke, SCI, and multiple sclerosis. It is also contraindicated in women who have a blood disease, use anticoagulants, or have AIDS. Barrier methods could be used if a disabled patient or a partner is able to put them in place. In some cases, sterilization may be justified on medical grounds.^ieng
Asunto(s)
Sistema Nervioso Central , Circulación Cerebrovascular , Enfermedad Crónica , Anticoncepción , Consejo , Personas con Discapacidad , Estudios de Evaluación como Asunto , Necesidades y Demandas de Servicios de Salud , Consentimiento Informado , Discapacidad Intelectual , Trastornos Mentales , Médicos , Trastornos Relacionados con Sustancias , Instituciones de Atención Ambulatoria , Américas , Conducta , Biología , Atención a la Salud , Demografía , Países Desarrollados , Enfermedad , Economía , Servicios de Planificación Familiar , Salud , Personal de Salud , Planificación en Salud , Inteligencia , América del Norte , Organización y Administración , Personalidad , Fisiología , Población , Características de la Población , Psicología , Estados UnidosRESUMEN
One hundred seventy thousand first-trimester abortions were performed in three free-standing clinics of Planned Parenthood of New York City from 1971-1987. Seventy percent of the procedures were done under local anesthesia; the remainder under intravenous methohexital. No preoperative medications or routine postoperative antibiotics were given. High-risk patients were referred to a hospital. The clinics operated under uniform written guidelines. Experienced physicians performed the procedures. There were no deaths in this series of patients. One hundred twenty-one patients were hospitalized (0.71 per 1000) for suspected perforation, ectopic pregnancy, hemorrhage, sepsis, or recognized incomplete abortion. There was no major extirpative surgery performed. There were an additional 1438 minor complications (8.46 per 1000). Overall, there were 9.05 complications per 1000 abortions. The complication rates for procedures done under general anesthesia and local anesthesia were similar. We conclude that outpatient abortion on selected patients to the 14th week from the last menstrual period is a safe procedure.
Asunto(s)
Aborto Inducido/efectos adversos , Cuello del Útero/lesiones , Femenino , Hospitalización , Humanos , Incidencia , Embarazo , Primer Trimestre del Embarazo , Cervicitis Uterina/epidemiología , Heridas Penetrantes/epidemiologíaAsunto(s)
Obstetricia , Perinatología , Femenino , Humanos , Recién Nacido , Satisfacción en el Trabajo , EmbarazoAsunto(s)
Quiste Dermoide/terapia , Laparoscopía , Quistes Ováricos/terapia , Femenino , Humanos , Tiempo de InternaciónRESUMEN
In the differential diagnosis of postabortal amenorrhea, the entity of cervical agglutination-stenosis without uterine synechiae should be included. Nine such cases are reported with discussion of its possible etiology, diagnosis, and management. Other clinics are urged to report this complication of first trimester abortion.