RESUMO
OBJECTIVE: The lactational amenorrhoea method (LAM) is an effective contraceptive option in developing countries. Post-partum, of the women who accept to apply LAM, many never do. Our aim was to determine the actual use of LAM. METHODS: A group of 326 post-partum women who accepted LAM use were recruited. After 6 months, they were asked if they actually had applied the method or not. In a logistic regression analysis, nine socio-demographic and clinical variables were studied as predictors of actual LAM use. An alpha level was set at 0.05. RESULTS: Overall, of the 326 women, only 61 (18.7%) actually applied LAM. The mean duration of LAM use was 4.3 +/- 0.2 months. The main reason for not applying LAM was that women thought the method was ineffective (66.0%). The variable time of menses resumption emerged as a predictor of LAM use (p = 0.001). CONCLUSIONS: Despite post-partum acceptance, most women did not actually apply LAM. In our setting as well as in other developing countries, regular contacts with a health care provider could improve LAM use.
Assuntos
Amenorreia , Aleitamento Materno , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Lactação , Período Pós-Parto , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Menstruação , México , Pessoa de Meia-Idade , Gravidez , Fatores de RiscoRESUMO
OBJECTIVES: The aim of the present study was to identify the reasons for the acceptance or rejection of contraceptive methods among postpartum women at the Hospital of Obstetrics and Gynecology in León, Mexico. METHODS: A prospective cross-sectional study of 1025 postpartum women was undertaken. Reasons for acceptance or refusal of contraceptives were registered in a written survey. Twelve sociodemographic variables were included as predictors in a logistic regression analysis; the acceptance or refusal was the dependent variable, and statistical significance was set at 0.05. RESULTS: There were 513 patients who accepted contraceptives (50.0%) and 512 (50.0%) who refused them. The main reasons for accepting contraceptives were definitive desire for no more children (17.0%) and satisfaction with previous contraceptive methods (21.5%). The main contraceptive methods chosen were intrauterine device (67.7%) and tubal sterilization (28.5%). Reasons for contraceptive refusal were husband's rejection (33.2%) and delaying contraceptive use until after finishing the postpartum period (31.8%). In the logistic regression model, the variables previous deliveries (p < 0.001), number of Cesarean sections (p < 0.001) and women's level of education (p < 0.02) were included as predictors of acceptance. CONCLUSIONS: Previous deliveries, previous Cesarean sections and women's level of education were significant in contraception acceptance. The rejection of contraceptives was mainly attributed to husbands.
Assuntos
Anticoncepção/normas , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Fatores Etários , Atitude Frente a Saúde , Anticoncepção/tendências , Anticoncepcionais/administração & dosagem , Estudos Transversais , Feminino , Maternidades , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Modelos Logísticos , México , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Parto , Probabilidade , Estudos Prospectivos , Fatores de Risco , Fatores SocioeconômicosRESUMO
Throughout a cross-section observational descriptive study, 1,010 postpartum patients were included. Data were collected directly with a survey, and women were divided into two groups: 507 (50.20%) women who accept postpartum contraceptive use and 503 (49.80%) women, which did not accept postpartum contraceptive use. Variables with statistical significance related with postpartum contraceptive acceptance or refusal were: patient age (P < 0.05), marital status (P < 0.001), pregnancies number (P < 0.001), parity (P < 0.01), cesarean section number (P < 0.001) and previous contraceptive use (P < 0.001). Postpartum contraceptives more accepted were: intrauterine device (67.85%), and tubal section (28.20%). Main reasons for postpartum contraceptive acceptance were: desire of no more children (27.02%), satisfaction with previous contraceptive methods (21.4%) and gynecologist counseling during prenatal care and delivery room (18.55%). Main reasons for postpartum contraceptive refusals were: husband's rejection of postpartum contraceptive use (33.6%), and delay in postpartum contraceptive use after finishing postpartum (32.0%). It was concluded that according to presence of significant differences between both groups in some variables, these variables should be kept in mind by physicians in promoting contraceptive methods in a personalized manner during prenatal care. Likewise, owing to husband's rejection of postpartum contraceptive use is needed to incorporate the husbands systematically to the prenatal care and to try convincing them of accepting postpartum contraceptive use.
Assuntos
Anticoncepção/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Período Pós-Parto , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
In order to evaluate the diagnostic accuracy of the Doppler ultrasonography profile in the assessment of fetal wellbeing in hypertensive pregnancies, 171 women at 36-42 week's gestation were included. A Doppler color ultrasound scanning was made and the score of the Doppler ultrasonography profile were correlated with the neonatal outcome, with one minute Apgar's score or admission to neonatal intensive care unit as main outcome. The Doppler ultrasonography profile includes: umbilical artery Doppler flow velocity waveforms, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. In 145 cases (84.7%) had gestational hypertension without proteinuria, 22 patients (12.9%) had chronic hypertension and only in 4 cases (2.4%) preeclampsia was found. In 101 patients (59%) a cesarean section was made, 66 cases delivered normally and 4 (2.4%) patients had complicated vaginal delivery. Scores of diagnostic tests were: sensitivity 44%, specificity 99%, positive predictive value 80% and negative predictive value 97%, with an average accuracy of 71.5%. The multiple logistic regression analysis with 5 parameters of the Doppler ultrasonography profile had a determination coefficient (R2 = 0.15125) P < 0.01, and umbilical artery Doppler flow velocity waveforms had a regression coefficient--31.3959 (P < 0.05). It was concluded that the Doppler ultrasonography profile is a test with high predictive values in assessing fetal wellbeing in hypertensive pregnancies and the umbilical artery Doppler flow velocity alone is a significant variable in the multiple logistic regression analysis.
Assuntos
Monitorização Fetal/métodos , Hipertensão/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Reologia/métodosRESUMO
In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.
Assuntos
Feto/irrigação sanguínea , Pescoço , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/diagnóstico por imagem , Adolescente , Adulto , Índice de Apgar , Peso ao Nascer , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Sofrimento Fetal/diagnóstico por imagem , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/etiologia , Humanos , Recém-Nascido , Mecônio , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Resistência VascularRESUMO
In order to measure the umbilical resistance and pulsatility Doppler indexes 60 pregnant women with low risk pregnancies were studied in a descriptive, observational and prospective study carried out at the Hospital de Gineco-Pediatria numero 48 del Instituto Mexicano del Seguro Social. Umbilical Doppler measurements were done of the fetal umbilical cord from the week 30 at the 40 of gestation. We carried out a total of 337 measurements and 178 (52.8%) corresponded to the resistance index and 159 (47.2%) to the pulsatility index. The average of the resistance index was 0.64 with a range average (average plus two standard deviations was 0.48-0.79) and the pulsatility index had an average value of 0.94 with an average range of 0.58-1.30. The percentil values of the resistance index were 0.52, 0.66 and 0.79 respectively in the percentil 5, 50 and 95 whereas the percentil values of the pulsatility index were 0.64, 0.94 and 1.28 respectively in the percentil 5, 50 and 95. The analysis of variance with the Bonferroni test for multiple comparisons showed that our found indexes can be applied from the week 31 to the 40 of gestation. Our findings are in according to reported by other authors and it should be kept in mind that the concept of normality of the Doppler velocimetry indexes is strictly statistical and that only its judicious use will offer the benefit to our pregnant patients to obtain products under good conditions of health.