RESUMO
OBJECTIVE: To determine the impact of intrauterine insemination on the management of subfertility in Jamaica. METHODS: The present study was a retrospective analysis of all intrauterine insemination cycles completed from May 1, 2002, to August 31, 2005, at the University of the West Indies, Mona, Jamaica. The cycle pregnancy rate (CPR), live-birth rate (LBR), and cumulative pregnancy rate were obtained and prognostic factors were reviewed. RESULTS: The CPR, LBR, and cumulative pregnancy rate were 10.1%, 8.8%, and 13.9%, respectively. Improved success was significantly associated with a shorter period of infertility (3.10 ± 1.43 years vs 5.22 ± 2.89 years; P = 0.01). Women younger than 40 years of age, men with increased post-preparation sperm counts, and couples undergoing 2-3 cycles had improved outcomes. CONCLUSION: Intrauterine insemination represents a safe and cost-effective option for mild male factor infertility or unexplained infertility, especially in resource-poor regions such as the Caribbean. Repeated failed cycles identify those who would probably benefit from early intervention with in vitro fertilization.
Assuntos
Infertilidade Masculina/terapia , Inseminação Artificial/economia , Inseminação Artificial/métodos , Adulto , Países em Desenvolvimento , Feminino , Custos de Cuidados de Saúde , Humanos , Jamaica , Masculino , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the risk factors for shoulder dystocia in Jamaica. METHODS: A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors. RESULTS: The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86-3.34), 1.89 (0.91-3.94), 2.78 (0.24-31.47), and 1.56 (0.77-3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age. CONCLUSION: Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity.