Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF).

The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.

[Gynecological management and follow-up in women with cystic fibrosis]. / Suivi et prise en charge gynécologique chez les femmes atteintes de mucoviscidose.

INTRODUCTION: Most women with cystic fibrosis reach adulthood and should have appropriate gynecological follow-up and contraception. BACKGROUND: There is no specific contra-indication to any contraception due to cystic fibrosis itself. Combined estrogen-progesterone contraception can be used in most cases (including transplanted women). In case of transplantation, intra-uterine devices should be used carefully (risk of pelvic inflammatory disease, potential risk of contraceptive failure with copper intra-uterine devices). Hormonal contraceptives may not be effective in women taking corrective treatments aiming to correct the maturation defect of the chloride channel. Screening for cervical cancer is recommended with a pap smear every three years for women aged 25-65, but yearly and starting at a younger age among transplanted women who are at higher risk for cervical dysplasia. Human Papillomavirus vaccination should be offered to all young women. OUTLOOK: Women with cystic fibrosis and health care providers should be better informed on screening and on sexual and reproductive health to avoid unplanned pregnancies, to take into account drug interactions and to prevent cervical disease. CONCLUSION: Regular and specific gynecological management is mandatory in cases of cystic fibrosis.

Update on the Essure System for Permanent Birth Control.

In 2002, the U.S. Food and Drug Administration approved the Essure system for permanent birth control. Implantation with this device offers a minimally invasive option for permanent female contraception that is placed during a brief office visit. Unlike laparoscopic tubal sterilization, the Essure procedure requires no hospitalization or general anesthesia, resulting in minimal recovery time. After a decade of stability in the report of adverse effects, the U.S. Food and Drug Administration noted a sharp increase in patient-reported adverse events, including chronic pelvic pain, irregular bleeding, allergic reactions, and autoimmune-like reactions. In response to this increase in complaints, the U.S. Food and Drug Administration issued updated guidelines for patient education and counseling. This article discusses those updates, as well as implications for nurses who provide health care to women seeking permanent contraception.

Teenage mothers.

BACKGROUND: Australia's teenage birth rate has fallen to historic lows, but teenage motherhood still occurs and can be challenging for mother and baby. OBJECTIVE: The aim of this article is to review current evidence on the epidemiology and clinical care of teenage pregnancy and parenting, and provide recommendations around management of these young people in Australia. DISCUSSION: Teenage mothers may have experienced family, sexual, and partner violence, family disruption, and socioeconomic disadvantage. Outcomes on a range of peripartum measures are worse for teenage mothers and their babies. Longer term risks for the mother include depression and rapid repeat pregnancy; for the child, intergenerational teenage parenthood; and for both, socioeconomic disadvantage. Teenage motherhood occurs more often within communities where poverty, Aboriginal and Torres Strait Islander status and rural/remote location intersect. General practitioners play a critical role in identification of at-risk teens, preventing unintended teenage pregnancy, clinical care of pregnant teens, and promoting the health and wellbeing of teenage mothers and their children.

[Post-partum: Guidelines for clinical practice--Short text]. / Post-partum: recommandations pour la pratique Clinique--Texte court.

OBJECTIVE: To determine the post-partum management of women and their newborn whatever the mode of delivery. MATERIAL AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus). In order to increase the rate of breastfeeding initiation and its duration, it is recommended that health professionals work closely with mothers in their project (grade A) and to promote breastfeeding on demand (grade B). There is no scientific evidence to recommend non-pharmacological measures of inhibition of lactation (Professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (Professional consensus). Because of potentially serious adverse effects, bromocriptin is contraindicated in inhibiting lactation (Professional consensus). For women aware of the risks of pharmacological treatment of inhibition of lactation, lisuride and cabergolin are the preferred drugs (Professional consensus). Whatever the mode of delivery, numeration blood count is not systematically recommended in a general population (Professional consensus). Anemia must be sought only in women with bleeding or symptoms of anemia (Professional consensus). The only treatment of post-dural puncture headache is the blood patch (EL2), it must not be carried out before 48 h (Professional consensus). Women vaccination status and their family is to be assessed in the early post-partum (Professional consensus). Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (Professional consensus). An analgesic multimodal protocol developed by the medical team should be available and oral way should be favored (Professional consensus) (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (Professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). Early postoperative rehabilitation is encouraged (Professional consensus). Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, after normal pregnancy and delivery (Professional consensus). Starting effective contraception later 21 days after delivery in women who do not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). According to the postpartum risk of venous thromboembolism, the combined hormonal contraceptive use before six postpartum weeks is not recommended (grade B). Rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long-term is not recommended (Expert consensus). Pelvic-floor rehabilitation using pelvic-floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C). Postpartum pelvic-floor rehabilitation is not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). The optimal time for maternity discharge for low risk newborn depends more on the organisation of the post-discharge follow up (Professional consensus). The months following the birth are a transitional period, and psychological alterations concern all parents (EL2). It is more difficult in case of psychosocial risk factors (EL2). In situations of proven psychological difficulties, the impact on the psycho-emotional development of children can be important (EL3). Among these difficulties, postpartum depression is the most common situation. However, the risk is generally higher in the perinatal period for all mental disorders (EL3). CONCLUSION: Postpartum is, for clinicians, a unique and privileged opportunity to address the physical, psychological, social and somatic health of their patients.

[Summary of the Dutch College of General Practitioners' practice guideline 'Contraception']. / Samenvatting van de NHG-standaard 'Anticonceptie'.

The choice of a method of contraception is individual, based on factors including good advice from the general practitioner. There are various reliable forms of contraception available, such as the contraceptive pill, the copper or hormone-containing coil (intrauterine device), the vaginal ring, the contraceptive patch, the contraceptive injection, contraceptive implants, and male sterilization (vasectomy) or female sterilization. When choosing for a combined hormonal preparation the preference is for a pill containing levonorgestrel and ethinylestradiol 30 µg. Women aged ≥ 35 years who smoke and are not prepared to stop are advised against taking combined preparations. Only liver-enzyme inducing drugs have been proven to have relevant interaction with hormonal contraceptives; this has not been proven in the case of antibiotics. A transvaginal ultrasound is not necessary following an uncomplicated insertion of an intrauterine device.

Conocimientos y utilización de la anticoncepción en parejas adolescentes que acuden a consulta de regulación menstrual / Knowledge and use of contraception in adolescent couples attending menstrual regulation consultation

Cuando los adolescentes tienen acceso a información y servicios de apoyo adecuados, también están dispuestos a retrasar la edad de inicio sexual y se aseguran de evitar riesgos cuando deciden comenzar su vida sexual. Objetivo: determinar el nivel de conocimientos y la utilización de la anticoncepción en adolescentes. Método: estudio descriptivo transversal con las adolescentes que acudieron al servicio de Regulación Menstrual del Policlínico Universitario Docente XX Aniversario de Santa Clara Villa Clara, para realizarse este proceder en el período de enero del 2011 hasta junio del 2012...

Biological evaluation of a novel copper-containing composite for contraception.

OBJECTIVE: To investigate the biocompatibility of a novel copper-containing composite to provide preclinical data for clinical application of intrauterine device (IUD) or intra-vas device (IVD). DESIGN: Prospective experimental study. SETTING: Good laboratory practices laboratories. ANIMALS: Twenty healthy adult mice (SPF grade Kunming white mice, animal code SCXK 2003-0005). INTERVENTION(S): Cytotoxicity tests in vitro were conducted to evaluate the influence of the materials on the morphology, growth, and proliferation of cultured L929 mouse fibroblasts. Acute systemic toxicity tests were conducted to investigate the acute systemic toxic reaction with mice, and then the materials were implanted into the spinal muscle of rabbits (n = 15). The rabbits were sacrificed for pathologic examination at 1, 4, and 12 weeks after surgery. MAIN OUTCOME MEASURE(S): Evaluation of cytotoxicity by MTT assay, cytotoxicity test by direct contact assay, acute systemic toxicity test, and material implantation test. RESULT(S): The cytotoxicity grade of the copper-containing composite was 0-1, suggesting that the material was free of cytotoxicity; no acute systemic toxicity was found in any mice; mild inflammatory reaction was observed in the surrounding tissues of the implanted material in the early implantation stage, which was similar to that of the sham-operated sides. Twelve weeks after implantation, the inflammatory reaction was completely disappeared in the implanted tissue, similarly to the sham-operated sides. The fibrosis membrane surrounding the material became stable gradually over time. CONCLUSION: The copper-containing composite has excellent biocompatibility, which is feasible and safe for the clinical application as a novel contraceptive material.

Provision of contraception: a survey among primary care physicians in Finland.

OBJECTIVE: To investigate self-reported practices of contraceptive provision among primary care physicians. DESIGN: A cross-sectional questionnaire study. SETTING: All community health centers (n = 63) in an university hospital area in Western Finland. SAMPLE AND METHODS: A total of 122 health center physicians involved in contraceptive counseling (CC) were invited to participate in self-administered survey. Data were obtained on initiation of contraceptive methods and the limits and contraindications applied when prescribing combined hormonal contraception (CHC), and they were assessed against Finnish and WHO guidelines. MAIN OUTCOME MEASURES: Distribution of initiated contraceptive methods and of examinations and tests included, application of limits and contraindications in relation to age, smoking, body mass index or weight, blood pressure (BP) and migraine with aura when prescribing CHC (combined oral contraceptives (COCs), vaginal ring and contraceptive patch). RESULTS: Responded physicians (n = 83.68%) said they most frequently prescribed the COC pill. Progestin-only pills, levonorgestrel-releasing intrauterine system and copper-releasing intrauterine device were also provided regularly. Most of the respondents routinely took numerous examinations and tests when initiating contraception, including also unnecessary ones. There were gaps in their knowledge about the limits and contraindications for CHC. For example, 41% of the respondents did not recognize migraine with aura as a contraindication and only 19% reported applying the recommended BP limit of 140/90 mmHg. CONCLUSIONS: The range of contraceptives available and examinations and tests offered were comprehensive. However, the inadequate procedures regarding assessment of contraindications for CHC suggests that updating CC practices is challenging in primary care.

Assessment of the contraceptive efficacy of the aqueous extract of Aegle marmelos Corr. leaves in male albino rats.

The present study was conducted to evaluate the contraceptive effect of an aqueous extract from the leaves of Aegle marmelos (AMLAq) on the reproductive organs of male rats with an emphasis on reversibility. Adult male rats were treated daily with different doses of AMLAq, i.e., 150, 300 and 600 mg/kg bw/day for 60 days. The data presented in this study demonstrate that the weight of the reproductive organs was reduced significantly in all the treatment groups. AMLAq induced a significant decrease in the sperm motility and sperm density of the Cauda epididymis and testes. The reduction in fertility was 50%, 85% and 100%, respectively, in the treatment groups. The testosterone level also significantly declined. Biochemical analysis of the reproductive tissues for sialic acid, protein, glycogen, fructose, ascorbic acid, acid and alkaline phosphatase indicated a significant decrease whereas testicular cholesterol level significantly increased indicating alterations in the biochemical milieu of the genital organs. Fertility and other effects gradually returned to control levels 120 days after cessation of treatment. No clinical signs of side effects on general metabolism were detected throughout the treatment, and after withdrawal, body weight gain was similar in all groups together with no alterations in the weight of vital organs', hematological and serological parameters.

The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health.

BACKGROUND: In the fall of 2007, the controversy about the contraceptive use of depot-medroxyprogesterone acetate (DMPA) and its potential impact on skeletal health reached the media in the province of Quebec, Canada, thereby becoming a matter of concern for the lay public and physicians. In order to discuss this subject openly, the National Institute of Public Health of Quebec (INSPQ) organized a scientific meeting on February 15, 2008, with targeted physicians delegated by their medical associations in the fields of general practice, obstetrics and gynaecology, rheumatology, orthopaedic surgery, physiatry and endocrinology. STUDY DESIGN: Participants reviewed the scientific literature using the study classification method according to the level of evidence, reviewed published guidelines of medical societies and organizations on the subject and reached a consensus position. This manuscript presents a review of the literature and describes the consensus position of the targeted medical associations. RESULTS: The consensus position adopted by all the targeted medical associations determined that DMPA was a cost-effective contraceptive option that must be considered in the light of the clinical situation and preference of each woman. Candidates for injectable contraception should be informed that the use of DMPA is associated with a slight decrease in bone mineral density (BMD), which is largely, if not completely, reversible. There should not be an absolute limit to the length of time that the DMPA contraceptive is used, regardless of the woman's age. Monitoring BMD is not recommended among users of DMPA for contraceptive purposes. Finally, the consensus statement declared that, although supplements of calcium and vitamin D are beneficial for skeletal health for women in general, such supplementation should not be recommended solely based on a woman's use of DMPA. CONCLUSION: Given the scientific evidences, DMPA use remains a valid contraceptive option for women. Its potential impact on BMD must be balanced against the significant individual, familial and social consequences of unintended pregnancy.

Norma y protocolo de planificacion familiar

La presente NORMA Y PROTOCOLO DE PLANIFICACIÓN FAMILIAR está dirigida a todas y todos los trabajadores de la salud, en los diferentes niveles de atención, con el propósito de poner en práctica una serie de acciones que permitan mejorar la calidad de atención y garantizar la seguridad de las usuarias que demandan los servicios. Asi como contribuir a la actualización de los conocimientos científicos y la homogenización del manejo de la atención de planificación familiar, con el fin de identificar factores de riesgo en los cuales podemos incidir, para reducir las muertes en nuestro país...

Control de la fecundidad: experiencia de 15 años de trabajo en un consultorio médico / Fertility control: experience of 15 years of work in a family phsycian's office

El modelo de salud cubano ha propiciado un desarrollo en la esfera de la salud que se expresa en los cambios ocurridos en los perfiles demográficos envejecimiento de la población y descenso de la fecundidad. Se realizó un estudio observacional descriptivo y retrospectivo de la población del Consultorio Médico # 3 del Policlínico Universitario Vedado, en el municipio Plaza, en el período comprendido desde 1990 a 2005, con el propósito de evaluar el comportamiento de la fecundidad en un consultorio durante 15 años de trabajo. Se aplicó el método estadístico porcentual, tasas y razones. Se concluyó que ocurrieron 78 nacimientos, y los años 1993 y 1995 alcanzaron las mayores tasas de natalidad y fecundidad. Predominaron los nacimientos del sexo masculino, y la razón de masculinidad fue de 1,3 por cada un nacimiento del sexo femenino. El 60,2 por ciento de las madres tienen nivel de preuniversitario y el 57,7 por ciento son trabajadoras. La mayor frecuencia de la fecundidad se establece en los grupos de edad de 25 a 29 años, seguidos por el de 20 a 24.

Twenty micrograms vs. >20 microg estrogen oral contraceptives for contraception: systematic review of randomized controlled trials.

Concern about estrogen-related adverse effects has led to progressive reductions in the estrogen dose in combination oral contraceptives (COCs). This review of randomized controlled trials tested the hypothesis that COCs containing 20 microg in terms of contraceptive effectiveness, bleeding patterns, discontinuation and side effects. Data from the 18 eligible trials conducted to date are inadequate for detecting possible differences in contraceptive effectiveness. Several COCs containing 20 microg EE resulted in higher rates of early trial discontinuation (overall and due to adverse events such as irregular bleeding) as well as increased risk of bleeding disturbances (both amenorrhea/infrequent bleeding and irregular, prolonged, frequent bleeding or breakthrough bleeding or spotting) than their higher-estrogen comparison pills. However, most trials compared COCs containing different progestin types, and changes in bleeding patterns could be related to progestin type as well as estrogen dose. While health care providers and women might select COCs containing 20 microg EE based on theoretical improvements in safety profile from the reduced dose of estrogen, no evidence is available to support this choice.

Salud reproductiva, hoy / Reproductive health today

La Salud Sexual y Reproductiva es considerada en la actualidad un Derecho Humano que debe ser garantizado por el Estado. En Argentina se han dictado leyes federales, provinciales y municipales para garantizar este derecho, a través de Programas que brindan información, consejería e implementación en el uso de métodos anticonceptivos; prevención, diagnóstico y tratamiento de las infecciones de transmisión sexual y patologías genitomamarias. Numerosas instituciones, incluyendo la Universidad Nacional de Córdoba, se han incorporado a estos Programas. Los métodos anticonceptivos tienen criterios de selección e indicación para su uso que son descriptos en esta publicación, a los efectos de precisar las indicaciones, contraindicaciones, ventajas y desventajas de cada uno de ellos. como también su mejor utilización en las tres etapas de la vida reproductiva: adolescencia. madurez sexual y premenopausia. Finalmente, se sintetizan los Criterios de Elegibilidad para uso de métodos anticonceptivos elaborados por la OMS en 1996.

Sexual and Reproductive Health are considered at present as a Human Right that must be guaranteed by the State. In Argentina some Federal, Provincial and Municipal Laws have been sanctioned in order to guarantee this right through programs that bring information, counselling and implementation in the use of contraceptive methods. prevention, diagnosis and treatment of sexually transmitted infections and genitomammary pathologies. Many Institutions, including Universidad Nacional de Córdoba, have been incorporated in these programs. Contraceptive methods have selection criteria and indication for its use that are described in this publication, for the purpose to explain indications, side-effects, advantages and disadvantages of each one of them; as well as their best usefulness in the three stages of reproductive life: adolescence, sexual maturity and premenopause Finally, the Eligibility Criteria were synthesized for the use of contraceptive methods, performed by the OMS in 1996.

Hormonal contraception: recent advances and controversies.

This document will outline new delivery systems and contraceptive formulations, summarize recent advances in emergency contraception, and review the effects of hormonal contraception on cancer risks, cardiovascular disease, and bone.