[Reversible long-duration contraceptives: an efficient strategy to reduce non-planned pregnancies]. / Anticonceptivos de larga duración reversibles: una estrategia eficaz para la reducción de los embarazos no planeados.

Long-term contraception, reversible, have shown high rates of effectiveness and long-term compliance, with few contraindications. However, despite that Mexico has a variety of reversible contraception, most women still using less effective options. The resulting health benefits of contraception are important because they prevent unintended pregnancy, reduce the number of abortions and the incidence of death and disability related to pregnancy and childbirth complications. The Committee for Reproductive Health and Sexual Rights of the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG) conducted a literature review to evaluate the use of long-term contraception reversible as an effective and accessible tool to reduce the incidence unintended pregnancy and its consequences.

[Posplacenta intrauterine device. Guide wires not visible]. / Dispositivo intrauterino posplacenta. Hilos guía no visibles.

BACKGROUND: Little information exists about the follow- up of the strings of intrauterine device (IUD) applied posplacenta. When the strings are of 10 cm in length are within the uterine cavity should be visible after postpartum involution. OBJECTIVE: To know the incidence of visible strings of intrauterine device (IUD) after posplacental insertion and to establish guidelines of follow-up when strings are not seen. METHODS: A prospective cohort study of 530 women with posplacental insertion of T Cu 380-A IUD with strings 10 cm long. Follow-up was at 6 weeks, 3, 6, 9 and 12 months after IUD insertion, at each visit women were questioned about IUD expulsion or removal and the cervix was inspected to visualize the strings of IUD. We analyzed the cumulative incidence of visible strings and procedures that were performed to locate the IUD when strings were not seen. RESULTS: At one year of follow-up the IUD was in situ in 398 women (75.1%), there were 44 expulsions (8.3%), 24 removals (4.5%) and 64 lost to follow up (12.1%). In women with IUDs in situ the strings were seen in 90.2% (n = 359) and were not seen in 9.8% (n = 39). In 65 women uterine cavity was probed identifying the IUD in situ in 64 cases, we performed 33 pelvic ultrasounds with IUDs in situ in 31 cases and in 2 cases with IUD in the cervical canal.. CONCLUSIONS: Strings of IUD after postplacental insertion was seen in most women at one year of follow up. When we are reasonably sure the woman is not pregnant, interventions for the location of the IUD should be avoided. A pelvic ultrasound should be the initial procedure and usually sufficient to locate IUDs whose strings are not visible.

[No-scalpel vasectomy. Profile of acceptance and results]. / Vasectomía sin bisturí. Perfil del usuario y resultados.

BACKGROUND: Men have few effective methods for birth control. The surgical method vasectomy is highly safe and effective, although in Mexico represents only 2.4% of all contraceptive methods used. OBJECTIVE: To determine the characteristics, complications and results of the men who requested and underwent no-scalpel vasectomy in the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, in México. MATERIAL AND METHOD: Retrospective cohort study with data of clinical records of men who underwent no-scalpel vasectomy from 2003 to 2007. Sociodemographic and clinical variables, and complications reported as well as espermatobioscopy data were included. Descriptive analysis was performed of different variables and chi squared test between proportions. RESULTS: A total of 596 no-scalpel vasectomies were performed. The average age was 36.5 years and 13.4 of schooling, 86.9% were married with 9.6 years of union. Socioeconomic status was as follows: medium (25%), middle high (20.1%), and high (24.7%). The 94.3% of men requested the no-scalpel vasectomy because of satisfied fertility and 5.7% by morbidity in his couple. The complications were as follows: epididymitis (2.2%), mild haematoma (1.5%) and contact dermatitis (0.2%). The surgical complications were significantly more frequent for the group with varicocele compared with the normal men group (p < 0.05). Azoospermia was achieved in 99.1% of men at 18 weeks after the no-scalpel vasectomy. Early recanalization occurred in 0.5% of men. There were no pregnancies. CONCLUSIONS: The profile of men who requested no-scalpel vasectomy was in a great proportion healthy, in the fourth decade of life, with high school or greater, satisfied fertility and high socioeconomic status. No-scalpel vasectomy is a method of fertility planning very effective with low morbidity.

Pregnancy in teenagers with heart disease.

The prevalence of pregnancy in adolescent women is high in Mexico and represents a public health problem. The pregnant teenager with heart disease has a high probability of complications during pregnancy and the delivery, which carries a risk of death of both the mother and the product. In many cases the pregnancy should have been avoided, planned or interrupted, however the majority at this age is vulnerable and although certain cases must be interrupted by their high risk of maternal-fetal death, prevention and legal aspects should be considered. In some cases the woman wants a pregnancy although her health condition does not allow it, but there are options of adoption or recourse to a surrogate belly. In response to this growing social problem, the National Cardiology Institute Ignacio Chávez and National Institute of Perinatology, with the coordination of Ministry of Health in Mexico, started a pregnancy prevention module within a clinic of follow-up of cardiopathy and pregnancy. This review raises the global problem in our country that occupies the first place in pregnancies in adolescents, with more than 400,000 pregnancies a year and the form of immediate response in a multidisciplinary way.

La prevalencia de embarazo en mujeres adolescentes es muy alta en México, y representa un problema de salud pública. La adolescente embarazada con cardiopatía tiene altas posibilidades de complicaciones durante el embarazo y su resolución, lo que pone en riesgo la vida tanto de la madre como del producto. En muchos casos el embarazo debió ser evitado, planeado o interrumpido, sin embargo la mayoría a esta edad es vulnerable y si bien ciertos casos deben ser interrumpidos por su alto riesgo de muerte materno-fetal, es fundamental considerar la prevención y los aspectos legales. En algunos casos la mujer desea un embarazo aunque su condición de salud no se lo permite, pero existen opciones de adopción o recurrir a un vientre subrogado. Atendiendo este problema social cada vez más creciente, el Instituto Nacional de Cardiología Ignacio Chávez, en coordinación con la Comisión Coordinadora de la Secretaría de Salud y el Instituto Nacional de Perinatología, echaron a andar un módulo de prevención de embarazo dentro de una clínica de seguimiento de cardiopatía y embarazo. Esta revisión plantea el problema global en nuestro país, que ocupa el primer lugar en embarazos en adolescentes, con más de 400 mil embarazos al año y la forma de dar respuesta inmediata de manera multidisciplinaria.

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations.

STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.

[Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period]. / Estudio comparativo al azar entre los dispositivos intrauterinos Multiload Cu375 y TCu 380A, colocados durante el posparto.

OBJECTIVE: To evaluate safety and effectiveness of the intrauterine device Multiload Cu375 compared with the TCu 380A inserted in the postpartum period. PATIENTS AND METHODS: In a randomized comparative study carried out in the National Perinatology Institute, intrauterine devices MLCu 375 and Tcu 380A were inserted to 157 patients who voluntary accepted, and previously signed informed consent. There were four instances for the intrauterine devices insertion: within 10 minutes after vaginal delivery, during cesarean section (immediate postplacental insertion) and postpartum-postcesarean insertion (in the time range of 10 min to 48 h). All insertions were made with ring forceps. From 1 h to 24 h later, abdominal ultrasound examinations were performed to assess the distances between the upper part of the device to the fundus of uterine cavity. Follow up visits were scheduled at 3, 6, 9 and 12 months. Net cumulative life table event rates of discontinuations were estimated at one year. RESULTS: The expulsion rates were 10.4 for the MLCu 375 and 7.7 for the TCu 380A and they were not influenced by the moment of the intrauterine device insertion, not by the cervical dilatation, neither by the distance of the intrauterine device to the fundus of uterine cavity. The removal rates for bleeding and pain were 4.9 and 4.8, the removal rates for non medical reasons were 3.7 and 4.9 respectively. There was one case of genital infection in the MLCu 375 group. There were no pregnancies, nor uterine perforation. The one year continuation rates were 77.1 and 82.6 respectively. There were no statistical significant differences in the comparative rates. CONCLUSIONS: The intrauterine device MLCu 375 is as safe and effective as the TCu380A when they are inserted in the postpartum period.

Pregnancy in teenagers with heart disease / Embarazo en pacientes adolescentes con cardiopatía

Abstract The prevalence of pregnancy in adolescent women is high in Mexico and represents a public health problem. The pregnant teenager with heart disease has a high probability of complications during pregnancy and the delivery, which carries a risk of death of both the mother and the product. In many cases the pregnancy should have been avoided, planned or interrupted, however the majority at this age is vulnerable and although certain cases must be interrupted by their high risk of maternal-fetal death, prevention and legal aspects should be considered. In some cases the woman wants a pregnancy although her health condition does not allow it, but there are options of adoption or recourse to a surrogate belly. In response to this growing social problem, the National Cardiology Institute Ignacio Chávez and National Institute of Perinatology, with the coordination of Ministry of Health in Mexico, started a pregnancy prevention module within a clinic of follow-up of cardiopathy and pregnancy. This review raises the global problem in our country that occupies the first place in pregnancies in adolescents, with more than 400,000 pregnancies a year and the form of immediate response in a multidisciplinary way.

Resumen La prevalencia de embarazo en mujeres adolescentes es muy alta en México, y representa un problema de salud pública. La adolescente embarazada con cardiopatía tiene altas posibilidades de complicaciones durante el embarazo y su resolución, lo que pone en riesgo la vida tanto de la madre como del producto. En muchos casos el embarazo debió ser evitado, planeado o interrumpido, sin embargo la mayoría a esta edad es vulnerable y si bien ciertos casos deben ser interrumpidos por su alto riesgo de muerte materno-fetal, es fundamental considerar la prevención y los aspectos legales. En algunos casos la mujer desea un embarazo aunque su condición de salud no se lo permite, pero existen opciones de adopción o recurrir a un vientre subrogado. Atendiendo este problema social cada vez más creciente, el Instituto Nacional de Cardiología Ignacio Chávez, en coordinación con la Comisión Coordinadora de la Secretaría de Salud y el Instituto Nacional de Perinatología, echaron a andar un módulo de prevención de embarazo dentro de una clínica de seguimiento de cardiopatía y embarazo. Esta revisión plantea el problema global en nuestro país, que ocupa el primer lugar en embarazos en adolescentes, con más de 400 mil embarazos al año y la forma de dar respuesta inmediata de manera multidisciplinaria.

[Endometriosis and discouragement of immunology cytotoxic characteristics]. / Endometriosis y abatimiento de las características de la respuesta inmunológica citotóxica.

OBJECTIVE: To determine the immunology kind of response Th1 (cytotoxic) or Th2 (humoral) prevailing at peripheral and peritoneal environment at endometriosis women (ENW). STUDY DESIGN: Observational, transverse, analytical, retrospective, cases and controls. MATERIAL AND METHODS: Cooperative and cytotoxic lymphocytes obtained from peritoneal fluid (PF) and peripheral blood (PB) were used to determine IFN-gamma and IL-2 intracellular synthesis at ENW. IFN-gamma, IL-2, IL-4 and IL-10 concentration were determined at PF, PB at ENW and fertile women (FERW). Results were analyzed by ANOVA, t student and Mann-Whitney tests, accepting p < 0.05, as a statistic difference. RESULTS: Peritoneal environment of ENW shows a smaller intracellular synthesis of IFN-gamma and IL-2 at cooperative and cytotoxic T lymphocytes, as in the PF at ENW. The decrease is associated to a smaller percentage of activated, cooperative T lymphocytes and NK cells (p < 0.05, at all the variable), versus FERW. This phenomenon is observed more stressed at the III and IV pathology degree. CONCLUSIONS: ENW show a peritoneal environment with a smaller immunology cytotoxic capacity, versus FERW. The discouragement of the immunology cytotoxic capacity increases associated to the pathology intensity.

Comparative pharmacokinetics and pharmacodynamics after subcutaneous and intramuscular administration of medroxyprogesterone acetate (25 mg) and estradiol cypionate (5 mg).

BACKGROUND: The efficacy of contraceptives is affected by its route and ease of administration. Herein, both pharmacokinetics and pharmacodynamics of the once-a-month combined injectable contraceptive medroxyprogesterone acetate (MPA) plus estradiol cypionate (E(2)-Cyp) were compared after intramuscular (IM) or subcutaneous (SC) injection in women of reproductive age. STUDY DESIGN: Thirty women were randomly assigned to the SC (n=15) or IM (n=15) route of MPA 25 mg+E(2)-Cyp 5 mg administration. Serum samples were obtained daily for 7 days and then three times a week for 40 days in order to quantify E(2), progesterone and MPA. In addition, three ultrasounds were performed on each subject to determine follicular development, and a daily record of the bleeding pattern and side effects was maintained. RESULTS: A comparative analysis showed that the main pharmacokinetic (peak serum concentration, peak serum time, area under the serum concentration vs. time curve, absorption half-life and elimination half-life) and pharmacodynamic parameters, such as follicular development and ovulation, were similar in the SC vs. IM groups. Complete suppression in ovarian function was present in all women. The bleeding patterns and side effects were similar in both groups. CONCLUSIONS: The results presented herein demonstrate that the injection of 25 mg of MPA plus 5 mg of E(2)-Cyp has similar efficacy and safety with either the SC or IM route of administration. The SC option can be considered a viable self-administered contraceptive option that might increase women's compliance to contraceptive use.