Ultrasound-guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study.

OBJECTIVE: To describe the feasibility of an ultrasound-guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. METHODS: This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6-month follow-up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. RESULTS: We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound-guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow-up. No uterine perforation or infection-related complications occurred within 6 months of the procedure. CONCLUSION: The ultrasound-guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Estratégias para melhorar conhecimentos, atitudes e práticas quanto às medidas de controle e prevenção da COVID-19: uma revisão sistemática / Strategies to improve knowledge, attitude, and practice in COVID-19 prevention and control measures: a systematic review

Objetivos: Identificar estratégias para melhorar conhecimentos, atitudes e práticas (CAP) sobre medidas de prevenção e controle da COVID-19 no mundo.Métodos: Foi realizada uma revisão sistemática de evidência quantitativa e qualitativa com busca nas bases de dados PubMed, LILACS e Scopus. A qualidade do relato e da metodologia dos estudos incluídos foi avaliada por meio da ferramenta do Joanna Briggs Institute.Resultados: De 2.196 registros identificados na busca, 12 estudos foram incluídos. A maioria avaliou estratégias educacionais (n=10), principalmente treinamentos baseados em simulação (n=6) para profissionais de saúde (n=9). Independente da estratégia ou público, todos os estudos identificaram melhorias em conhecimento (n=7), prática (n=7) e atitude (n=4). Entretanto, todos os estudos apresentaram pelo menos uma limitação de qualidade.Conclusões: Estratégias efetivas foram identificadas para melhorar CAP na prevenção e controle da COVID-19, especialmente para profissionais de saúde com treinamento baseado em simulação (baixa qualidade). (AU)

Objectives: To identify strategies to improve knowledge, attitude, and practice (KAP) about prevention and control measures of COVID-19 in the world.Method: A systematic review of quantitative and qualitative evidence was conducted, searching PubMed, LILACS and Scopus databases. Reporting and methodological quality of the included studies was assessed using the Joanna Briggs Institute tool.Results: Of 2,196 records identified in the search, 12 studies were included. Most studies evaluated educational strategies (n=10), mainly training based on simulation (n=6) for health professionals (n=9). Regardless of strategy or audience, all studies identified improvements in knowledge (n=7), practice (n=7), and attitude (n=4). However, all studies presented at least one quality limitation.Conclusions: Effective strategies have been identified to improve CAP in the prevention and control of COVID-19, especially aimed at healthcare professionals with simulation-based training (low quality). (AU)

Clomiphene citrate and letrozole to reduce follicle-stimulating hormone consumption during ovarian stimulation: systematic review and meta-analysis.

OBJECTIVE: To assess the available evidence comparing effectiveness of ovarian stimulation (OS) using clomiphene citrate (CC) and/or letrozole (LTZ) to reduce follicle-stimulating hormone (FSH) consumption compared with standard OS. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials that compared reproductive outcomes following in-vitro fertilization. We searched 11 electronic databases and hand-searched the reference lists of included studies and related reviews. We stratified the results, separating studies according to the oral agent used (CC or LTZ) and the characteristics of the included women (expected poor ovarian response or other women). When combining the results of the included studies, we assessed the relative risk (RR) for live birth, clinical pregnancy, miscarriage and cycle cancelation, the Peto odds ratio (OR) for ovarian hyperstimulation syndrome (OHSS) and mean difference (MD) for the number of oocytes retrieved and FSH consumption. RESULTS: A total of 22 studies were included in the review. Considering women with expected poor ovarian response, the available evidence suggested that using CC to reduce FSH consumption during OS provided similar rates of live birth (RR, 0.9 (95% CI, 0.6-1.2), moderate-quality evidence) and clinical pregnancy (RR, 1.0 (95% CI, 0.8-1.4), moderate-quality evidence); the use of LTZ did not cause a relevant change in the number of oocytes retrieved (MD, -0.4 (95% CI, -0.9 to 0.1), high-quality evidence). Considering the studies evaluating other women, the available evidence suggested that using CC to reduce FSH consumption during OS reduced the number of oocytes retrieved (MD, -4.6 (95% CI, -6.1 to -3.0), high-quality evidence) and risk of OHSS (Peto OR, 0.2 (95% CI, 0.1-0.3), moderate-quality evidence), while results were similar for rates of live birth (RR, 0.9 (95% CI, 0.7-1.1), moderate-quality evidence) and clinical pregnancy (RR, 1.0 (95% CI, 0.8-1.1), high-quality evidence). The quality of the evidence was low or very low for other outcomes. CONCLUSION: The use of CC to reduce FSH consumption in women with expected poor ovarian response has the advantage of providing similar reproductive outcomes with reduced costs. For the other women, the use of CC for reducing FSH consumption has the additional advantage of reducing OHSS, but also reduces the total number of oocytes retrieved. More studies are needed to evaluate the effect of LTZ for the same purpose. Future studies should focus on cumulative pregnancy per oocyte retrieval, patient dissatisfaction and agreement to repeat the cycle if not pregnant, which are important outcomes for clinical decisions. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.