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1.
Enferm. foco (Brasília) ; 12(7, supl 1): 99-104, out. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1337774

RESUMO

Objetivo: descrever a vivência de enfermeiros na implementação do serviço de inserção de dispositivo intrauterino de cobre na Atenção Primária à Saúde de Florianópolis, Santa Catarina. Método: relato de experiência apresentando as seguintes etapas: (a) elaboração de material teórico-prático; (b) formação de enfermeiros facilitadores; e (c) monitoramento e avaliação do processo. Resultados: no total, foram habilitados 115 enfermeiros, entre profissionais efetivos e residentes. Quanto à ampliação do acesso ao método contraceptivo, foi registrado um quantitativo de 2.024 inserções de dispositivo intrauterino por enfermeiros desde a implantação da prática, em pouco mais de três anos (390 inserções em 2018; 728 em 2019; 547 em 2020 e 359 inserções até maio de 2021). Esses dados refletem no incremento de 60% no acesso e oferta do método às mulheres. Conclusão: o enfermeiro, ao oferecer a inserção do dispositivo de forma responsável e baseado na cientificidade, tem contribuído para a desburocratização do acesso ao método. Neste sentido, o processo de capacitação influencia positivamente a qualificação da assistência e, a prática relatada, tem demonstrado eficácia e segurança, além de ultrapassar modelos, até então hegemônicos e centrados na figura do médico. (AU)


Objective: To describe nurses' experience in implementing the copper Intrauterine Device (IUD) insertion service in Primary Health Care (PHC) in Florianópolis, SC. Methods: Experience report presenting the following steps: (a) Theoretical-Practical Material elaboration (b) Nurse facilitators training; and (c) process monitoring and evaluation. Results: In total, 115 nurses were trained, including permanent professionals and residents. Regarding the expansion of access to the contraceptive method, a quantity of 2,024 IUD insertions by nurses was recorded since the implementation of the practice, in just over 3 years (390 insertions in 2018; 728 in 2019; 547 in 2020 and 359 insertions until May of 2021). These data reflect a 60% increase in access to the method to women. Conclusion: The nurse, by offering the insertion of the IUD in the PHC responsibly and based on scientificity, has contributed to reducing bureaucracy in access to the method. In this sense, the training process positively influences the qualification of care, and the reported practice has demonstrated efficacy and safety, in addition to surpassing models, which until then were hegemonic and centered on the doctor. (AU)


Objetivo: Describir la experiencia de enfermeras en la implementación del servicio de inserción de Dispositivo Intrauterino (DIU) de cobre en Atención Primaria de Salud (APS) en Florianópolis, SC. Métodos: Relato de experiencia presentando los siguientes pasos: (a) elaboración de Material Teórico-Práctico; (b) formación de enfermeras facilitadoras; y (c) seguimiento y evaluación del proceso. Resultados: En total se capacitaron 115 enfermeros, entre profesionales permanentes y residentes. En cuanto a la expansión del acceso al método anticonceptivo, se registró una cantidad de 2.024 inserciones de DIU por enfermeras desde la implementación de la práctica, en poco más de 3 años (390 inserciones en 2018; 728 en 2019; 547 en 2020 y 359 inserciones hasta mayo de 2021). Estos datos reflejan un aumento del 60% en el acceso y la oferta del método a las mujeres. Conclusión: La enfermera, al ofrecer la inserción del DIU en la APS de manera responsable y basada en la cientificidad, ha contribuido a reducir la burocracia en el acceso al método. En este sentido, el proceso de formación influye positivamente en la calificación de la atención, y la práctica reportada ha demostrado eficacia y seguridad, además de superar modelos, que hasta entonces eran hegemónicos y centrados en el médico. (AU)


Assuntos
Dispositivos Intrauterinos , Atenção Primária à Saúde , Enfermagem , Prática Avançada de Enfermagem , Acesso aos Serviços de Saúde
2.
MSMR ; 28(7): 2-10, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542257

RESUMO

Long-acting reversible contraceptives (LARCs) are highly effective means of birth control that can improve service women's overall health and readiness. This report expands upon prior data and summarizes the annual prevalence (overall and by demographics) of LARC use from 2016 through 2020 among active component U.S. service women, compares LARC prevalence to the prevalence of short-acting reversible contraceptives (SARCs), and evaluates the probability of continued use of LARCs by type. LARC use increased from 21.9% to 23.9% from 2016 through 2019 while SARC use decreased from 28.3% to 24.9%. Both SARC and LARC use decreased in 2020 which may have been related to the coronavirus disease 2019 (COVID-19) pandemic. The prevalence of intrauterine devices (IUDs) was greater than implants, and IUDs also had a higher probability of continuation than implants. At 12 months, the continuation for IUDs was 81% compared to 73% for implants. At 24 months, the probabilities of continuation were 70% for IUDs and 54% for implants. Probabilities of continuation were similar across outsourced care and direct care settings. The increased use of LARCs along with their high frequency of continuation in U.S. service women may have a positive impact on overall health and readiness.


Assuntos
Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Militares/estatística & dados numéricos , Adolescente , Adulto , COVID-19/epidemiologia , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Pessoa de Meia-Idade , Militares/psicologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
3.
Br J Nurs ; 30(16): S32-S37, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34514833

RESUMO

Actinomycosis is a rare bacterial condition that is seen infrequently and no studies have examined its prevalence or incidence globally. The author, a stoma care clinical nurse specialist (CNS), found herself caring for two such patients 3 weeks apart, both of whom were diagnosed with pelvic actinomycosis. Both patients had been fitted with copper intrauterine devices (IUDs) 10 years previously and were not aware that leaving IUDs in situ for a prolonged period increased their risk of infection. This article gives an overview of the condition, with discussion around the two patients the author cared for within her own specialty; not all aspects of the condition are included as the she has no clinical experience in microbiology and is not a gynaecological CNS. The case studies show how both women presented and were treated, with interventions including emergency surgery, long-term antibiotic therapy and stoma formation. Pelvic actinomycosis is often associated with the use of an IUD, and greater awareness about the risk of leaving IUDs in situ for prolonged periods is needed among gastrointestinal, colorectal and gynaecological practitioners.


Assuntos
Actinomicose , Dispositivos Intrauterinos , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Antibacterianos/uso terapêutico , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos
4.
Ned Tijdschr Geneeskd ; 1652021 08 12.
Artigo em Holandês | MEDLINE | ID: mdl-34523830

RESUMO

BACKGROUND: A rare cause of nonspecific, chronic abdominal pain is actinomycosis. Extensive disease can cause chronic peritonitis mimicking malignancy. CASE DESCRIPTION: A 59-year-old women presented with aspecific chronic abdominal pain, after 23 years of IUD use. Imaging showed two solid masses in the abdomen suggestive of malignant disease. Additional diagnostic procedures did not prove malignancy and biopsies showed chronic inflammation. In the absence of proof of malignancy and with regard to the long-term IUD use, actinomycosis was considered. A Pap smear showed Actinomyces 5 years earlier. Antibiotic treatment was instituted and remission of the intra-abdominal masses was seen after six months of treatment. CONCLUSION: Consider actinomycosis in a patient presenting with abdominal pain and (long-term) IUD use. Diagnosis is challenging and frequently impossible to confirm before treatment. This diagnosis should be considered after thorough workup for other diseases, especially malignancy. After such analysis, starting antibiotic therapy could prevent secondary complications and invasive procedures.


Assuntos
Actinomicose , Dispositivos Intrauterinos , Abdome , Dor Abdominal/etiologia , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/etiologia , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Radiografia
5.
Lancet Glob Health ; 9(10): e1431-e1441, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34474001

RESUMO

BACKGROUND: 30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia. METHODS: We did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia. Eligible women were aged 18-49 years in Nigeria and 16-49 years in Zambia, had chosen to receive the hormonal intrauterine device, copper intrauterine device, or implant (either a 5-year levonorgestrel-releasing subdermal implant or a 3-year etonogestrel-releasing subdermal implant), and, in Nigeria only, had access to a telephone. Women were interviewed within 100 days of receiving their contraceptive method either via telephone in Nigeria or in person in Zambia, with follow-up surveys at 6 months and 12 months. The primary outcomes were method-specific, 12-month continuation rates-ie, continuation rates of the hormonal intrauterine device, copper intrauterine device, and implant across Nigeria and Zambia. We used Kaplan-Meier methods to estimate the cumulative probabilities of method-specific continuation and a log-rank test to compare contraceptive methods. We analysed self-reported satisfaction and experiences as a secondary outcome. FINDINGS: Between June 25 and Nov 22, 2018, we enrolled a total of 1542 women (n=860 in Nigeria and n=682 in Zambia) receiving a long-acting reversible contraceptive. In total, 835 women (266 [32%] hormonal intrauterine device users, 274 [33%] copper intrauterine device users, and 295 [35%] implant users) in Nigeria and 367 (140 [38%] hormonal intrauterine device users, 149 [40%] copper intrauterine device users, and 78 [21%] implant users) in Zambia were included in the study analysis. The 12-month cumulative continuation rates were 86·8% (95% CI 82·1-90·4) for the hormonal intrauterine device, 86·9% (82·1-90·4) for the copper intrauterine device, and 85·0% (80·2-88·7) for implants in Nigeria. In Zambia, the 12-month cumulative continuation rates were 94·7% (89·2-97·4) for the hormonal intrauterine device, 89·1% (82·3-93·4) for the copper intrauterine device, and 83·1% (72·2-90·1) for implants. At least 71% of respondents across the timepoints were very satisfied with their method, and at least 55 (79%) of 70 reported having recommended their contraceptive method to someone else. Across the methods, the most commonly self-reported positive aspect of long-acting reversible contraceptive use at 12 months was effectiveness in Nigeria (range 93-94%) and long-lasting duration in Zambia (48-60%). Between 124 (50%) of 248 and 136 (59%) of 230 Nigerian participants and 26 (42%) of 62 and 66 (57%) of 117 Zambian participants reported nothing negative about their contraceptive method. INTERPRETATION: Our study showed high continuation rates and satisfaction across long-acting reversible contraceptives, including the hormonal intrauterine device, a method that has been largely underused in sub-Saharan Africa. This finding supports the inclusion of the hormonal intrauterine device as a valuable addition to the mix of contraceptive methods in Nigeria and Zambia. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Anticoncepcionais Femininos , Dispositivos Intrauterinos de Cobre , Dispositivos Intrauterinos , Anticoncepção , Feminino , Humanos , Nigéria , Estudos Prospectivos , Zâmbia
7.
Eur J Obstet Gynecol Reprod Biol ; 265: 66-73, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34461384

RESUMO

OBJECTIVE: To compare the effect of a hysteroscopic niche resection with a Levonorgestrel-releasing intrauterine device (LNG-IUD, 52 mg) on postmenstrual spotting duration in patients with a symptomatic niche in the uterine cesarean scar. STUDY DESIGN: This prospective cohort study was conducted at the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, China. Patients with postmenstrual spotting symptomatic niches were allocated to hysteroscopy group or LNG-IUD group based on the shared medical decision-making approach, and were followed up for 1 year after treatment. MAIN OUTCOME MEASURES: The primary outcome was reduced postmenstrual spotting days at 6th month after treatment. Secondary outcomes were effectiveness rate (proportion of patients with spotting days reduced by at least 50% from baseline), menstrual characteristics, menstruation satisfaction, direct medical costs, complications and side effects. RESULTS: 78 out of the 82 eligible patients were included, 36 patients in both group finished 1-year follow-up. Reduced spotting days at the 6th month was 7 days in LNG-IUD group, significantly higher than 5 days in hysteroscopy group, P = 0.004; The effectiveness rate increased over time within 1 year after the insertion of LNG-IUD (63.89%, 83.33%, 88.89%, 88.89%, P for trend = 0.006), while no trend change was observed in hysteroscopy group (71.05%, 71.05%, 66.67%, 61.11%, P for trend = 0.77). The mean direct medical costs were 817[785,856] $ in the hysteroscopy group and 243[239,255] $ in the LNG-IUD group (p<0.001). 2 patients removed IUD and 2 patients reported weight gain of more than 5 kg and breast distended pain in LNG-IUD group; 2 patients got pregnant in hysteroscopy group. No serious complications were observed in both groups. CONCLUSIONS: LNG-IUD is more effective in the treatment of postmenstrual spotting from the 6th month onwards than a hysteroscopic niche resection in patients with a symptomatic niche at lower direct costs.


Assuntos
Dispositivos Intrauterinos Medicados , Dispositivos Intrauterinos , Criança , China , Cicatriz , Feminino , Humanos , Levanogestrel , Gravidez , Estudos Prospectivos
8.
BMC Womens Health ; 21(1): 301, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399735

RESUMO

BACKGROUND: Intrauterine devices (IUD) are widely used all over the world. One of the most serious complications is uterine perforation, and it is very rare for the IUD to penetrate the bladder after perforation. Here we report two cases of IUD migration into the bladder, and review the literature to analyze the possible causes and solutions of such complications. CASE PRESENTATION: Case NO. 1 is a 37-year-old female who presented lower urinary tract symptoms for a year. Cystoscopy showed that a strip of metal penetrated into the bladder, and the surface was covered with stones. The patient underwent cystotomy and foreign body removal under general anesthesia. Case NO. 2 is a 46-year-old woman who previously inserted an IUD in 1998, but she had an unexpected pregnancy in 1999. Her doctor believed that "the IUD had spontaneously expulsed" and a new IUD was inserted after her pregnancy was terminated. Her CT scan showed an IUD on the left side of the bladder and another IUD in the uterus. Her foreign body was removed by cystotomy. CONCLUSION: Patients with IUD should be suggested to check the device regularly, and those who with a missed IUD have to rule out the possibility of IUD migration. For patients with IUD combined with lower urinary tract symptoms, it is necessary to be aware of whether IUD perforation affects the bladder.


Assuntos
Dispositivos Intrauterinos , Perfuração Uterina , Adulto , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Gravidez , Tomografia Computadorizada por Raios X , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Perfuração Uterina/diagnóstico por imagem , Perfuração Uterina/etiologia , Perfuração Uterina/cirurgia
9.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34344746

RESUMO

BACKGROUND: Unintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%-10% in 3-month period. METHOD: A fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used. INTERVENTIONS: Daily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers. RESULT: The PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%-35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques. CONCLUSION: Sensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.


Assuntos
Anticoncepção , Serviços de Planejamento Familiar , Dispositivos Intrauterinos , Período Pós-Parto , Melhoria de Qualidade , Adulto , COVID-19 , Anticoncepção/estatística & dados numéricos , Aconselhamento , Feminino , Pessoal de Saúde , Humanos , Índia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Alta do Paciente , Gravidez
10.
Ann Palliat Med ; 10(6): 6804-6823, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237979

RESUMO

BACKGROUND: This research aims to study the efficacy of an integrated approach to prevent and treat the recurrence of intrauterine adhesions (IUA) after hysteroscopic adhesiolysis. METHODS: A total of 96 patients diagnosed with moderate-to-severe intrauterine adhesions (IUA) in Nantong Maternal and Child Health Hospital from January 2016 to December 2019 were included in this parallel, randomized and single-center trial. Moderate (48 cases) and severe (48 cases) patients were randomly divided into three groups by a computer random generator: Group A (IUD, n=16), Group B, (Foley1w+IUD, n=16) and Group C (Foley1m+IUD, n=16). All patients received sequential treatment of estrogen and progesterone on the day of operation. Follow-up was performed at 1 and 3 months after treatment of uterine cavity, endometrial thickness, menstruation and pregnancy. Surgeons who performed the second-look and third-look hysteroscopy and postsurgical assessors were blinded to the randomization. RESULTS: In total, 96 patients (48 cases in each degree) were included in the final analysis, with 16 cases in each group. No cases were lost to follow up. The primary outcome measure was AFS score, which was significantly lower in Group C than that of women in group A and Group B at 1 month (P<0.05). Similar results were observed at 3-month follow up. In patients with moderate adhesions, the pregnancy rate in Group C (Foley1m+IUD) was higher than that in Group A and Group B (P<0.05). However, in patients with severe adhesions, there was no significant difference in the pregnancy rate among the three groups (P>0.05). There was no statistical significance in infection indicators among the three groups of moderate and severe patients (P>0.05). Postoperative complications such as uterine perforation, severe bleeding, water poisoning and intrauterine infection were not observed. CONCLUSIONS: The effect of a Foley intrauterine balloon combined with IUD in preventing re-adhesion was better than that of an IUD alone. For patients with moderate adhesion, the prolongation of placement time could prevent intrauterine re-adhesion and significantly improve the pregnancy rate with strong safety. However, for patients with severe adhesions, the prolongation of intrauterine Foley balloon placement did not better prevent intrauterine re-adhesions, improve menstruation, or improve pregnancy rates. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100046945.


Assuntos
Dispositivos Intrauterinos , Doenças Uterinas , Criança , Feminino , Humanos , Histeroscopia , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Aderências Teciduais/prevenção & controle
11.
Clin J Gastroenterol ; 14(5): 1419-1425, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34255288

RESUMO

A 39-year-old previously healthy woman was referred to our emergency department by a primary care doctor on suspected to be acute enteritis, complaining of fever, anorexia, lower abdominal pain, and frequent diarrhea. The day after admission, although frequent diarrhea stopped, the abdominal distension worsened. An abdominal radiograph revealed several dilated loops of the small bowel, suggested that small bowel obstruction (SBO) had developed. White blood cell count and c-reactive protein were markedly increased, and abdominal contrast-enhanced computed tomography scan showed localized severely edematous bowel mucosa, increased adipose tissue concentration in the pelvis, and a beaded low absorption area in the uterus. Gynecological examination revealed the presence of a pus-filled plastic intrauterine device (IUD) in the uterus. The patient confided that she had sex with her husband 2 days before the onset of symptoms. A diagnosis of SBO due to pelvic peritonitis caused by IUD infection during sexual activity was made. The SBO was cleared in 12 days with fasting, peripheral parenteral nutrition, antibiotic treatment, and insertion of an ileus tube. This case reminds us that it needs to consider disorders associated with the uterine appendages, in women of reproductive age with lower abdominal pain.


Assuntos
Íleus , Obstrução Intestinal , Dispositivos Intrauterinos , Peritonite , Adulto , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Dispositivos Intrauterinos/efeitos adversos
12.
BMJ Glob Health ; 6(6)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34162627

RESUMO

BACKGROUND: Programmes promoting the postpartum intrauterine device (PPIUD) have proliferated throughout South Asia and sub-Saharan Africa in recent years, with proponents touting this long-acting reversible contraceptive (LARC) method's high efficacy and potential to meet contraceptive unmet need. While critiques of LARC-first programming abound in the Global North, there have been few studies of the impact of LARC-centric programmes on patient-centred outcomes in the Global South. METHODS: Here, we explore the impact of a PPIUD intervention at five Tanzanian hospitals and their surrounding satellite clinics on quality of contraceptive counselling and person-centred care using 20 qualitative in-depth interviews with pregnant women seeking antenatal care at one of those clinics. Using a modified version of the contraceptive counselling quality framework elaborated by Holt and colleagues, we blend deductive analysis with an inductive approach based on open coding and thematic analysis. RESULTS: Interpersonal aspects of relationship building during counselling were strong, but a mix of PPIUD intervention-related factors and structural issues rendered most other aspects of counselling quality low. The intervention led providers to emphasise the advantages of the IUD through biased counselling, and to de-emphasise the suitability of other contraceptive methods. Respondents reported being counselled only about the IUD and no other methods, while other respondents reported that other methods were mentioned but disparaged by providers in relation to the IUD. A lack of trained providers meant that most counselling took place in large groups, resulting in providers' inability to conduct needs assessments or tailor information to women's individual situations. DISCUSSION: As implemented, LARC-centric programmes like this PPIUD intervention may decrease access to person-centred contraceptive counselling and to accurate information about a broad range of contraceptive methods. A shift away from emphasising LARC methods to more comprehensive, person-centred contraceptive counselling is critical to promote contraceptive autonomy.


Assuntos
Dispositivos Intrauterinos , Anticoncepção , Feminino , Humanos , Período Pós-Parto , Gravidez , Qualidade da Assistência à Saúde , Tanzânia
13.
Eur J Contracept Reprod Health Care ; 26(5): 404-412, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34096440

RESUMO

PURPOSE: To evaluate the different techniques for Essure® microinserts removal and to assess the risk of fracture of the device and the intra- and post-operative complications in relation to surgical technique variants. METHODS: Electronic search in Medline, Scopus and Embase databases using the following keywords: Essure; Essure removal; Essure surgical technique. RESULTS: Out of 95 articles in the initial database, 17 studies were eligible for inclusion in our literature review. Several surgical techniques have been described in which the most frequent were laparoscopic salpingectomy (LS), laparoscopic cornuectomy (LC), laparoscopic or vaginal hysterectomy (LH, VH) with en-bloc salpingectomy. There were more fractures of the device with the LS procedure (6.25%) followed by the LC technique (2.77%), while there was no fracture with hysterectomy. However, peri-and post-operative complications were more severe and frequent with hysterectomy in comparison with the LC and LS procedures (respectively 8.1% Clavien Dindo grade 3 for the hysterectomy group, 1.11% for the LC procedure and 0.69% for the LS technique). CONCLUSION: Due to the lack of standardised surgical treatment guidelines, a system of care networks for symptomatic patients with adverse effects related to Essure® headed by specialised centres may offer a suitable and high-quality management with the appropriate removal techniques within two objectives: limiting the risk of fracture (with an en-bloc removal of the Essure® microinserts) and avoiding intra- and post-operative complications.


Assuntos
Remoção de Dispositivo/métodos , Histerectomia/efeitos adversos , Dispositivos Intrauterinos/efeitos adversos , Laparoscopia/efeitos adversos , Salpingectomia/efeitos adversos , Esterilização Tubária/efeitos adversos , Feminino , Humanos , Histerectomia/métodos , Complicações Pós-Operatórias , Salpingectomia/métodos , Esterilização Tubária/métodos , Inquéritos e Questionários , Resultado do Tratamento
14.
Eur J Contracept Reprod Health Care ; 26(5): 421-428, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34126830

RESUMO

OBJECTIVES: This study aims to assess pregnant women's intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. METHODS: The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. RESULTS: Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands' disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085-2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108-4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379-0.964), p = 0.03) and perception of IUD related myths (OR (95% CI) = 0.893 (0.836-0.955), p = 0.004) were the negative predictors of the intention to use IUD. CONCLUSION: The intention to use IUD is relatively low among pregnant women in rural Upper Egypt. Targeting pregnant women and their husbands with proper counselling regarding IUD use during antenatal care visits would greatly impact increasing their use of the method.


Assuntos
Intenção , Dispositivos Intrauterinos/estatística & dados numéricos , Gestantes/psicologia , População Rural , Adolescente , Adulto , Egito , Feminino , Humanos , Período Pós-Parto , Gravidez , Rede Social , Fatores Socioeconômicos , Adulto Jovem
16.
BMC Womens Health ; 21(1): 211, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016111

RESUMO

BACKGROUND: To study the effectiveness of an aromatase inhibitor (Anastrozole) associated with levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis. METHODS: Prospective, randomized clinical trial. SETTING: University Hospital (single center). Elegibility criteria: Endometriomas > 3 × 4 cm, CA-125 > 35 U/mL and endometriosis symptoms. PATIENTS: Thirty-one women randomized to anastrozole + Mirena® + Conservative Surgery(CS) (n = 8), anastrozole + Mirena® + transvaginal ultrasound-guided puncture-aspiration (TUGPA) (n = 7), Mirena® + CS (n = 9), or Mirena® + TUGPA (n = 7). INTERVENTIONS: Anastrozole 1 mg/day and/or only Mirena® for 6 months; CS (ovarian and fertility-sparing) or TUGPA of endometriomas one month after starting medical treatment. MAIN OUTCOME MEASURES: Visual analogic scale for symptoms, CA-125 levels, ultrasound findings of endometriomas and recurrences. RESULTS: A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2 years. It was more significant in patients including anastrozole in their treatment (51%, 95% CI 33.3-68.7). For CA-125, the most significant decrease was observed in patients not taking anastrozole (73.8%, 95% CI 64.2-83.4 vs. 53.8%, 95% CI 25.7-81.6 under Mirena® + anastrozole). After CS for endometriosis, a reduction of ultrasound findings of endometriomas and long-term recurrence occurred, with or without anastrozole. At 4.2 ± 1.7 years (95% CI 3.57-4.85), 88% of the patients who underwent CS were asymptomatic, without medication or reoperation, compared to only 21% if TUGPA was performed, with or without anastrozole (p = 0.019). CONCLUSIONS: Dosing anastrozole for 6 months, starting one month before CS of endometriosis, reduces significantly the painful symptoms and delays recurrence, but has no other significant advantages over the single insertion of LNG-IUD (Mirena®) during the same time. Anastrozole and/or only Mirena® associated with TUGPA are not effective. TRIAL REGISTRATION: Eudra CT System of the European Medicines Agency (London, 29-Sept-2008) Nº EudraCT: 2008-005744-17 (07/11/2008). Date of enrolment of first patient: 15/01/2009.


Assuntos
Anticoncepcionais Femininos , Endometriose , Dispositivos Intrauterinos Medicados , Dispositivos Intrauterinos , Anastrozol/uso terapêutico , Endometriose/diagnóstico por imagem , Endometriose/tratamento farmacológico , Feminino , Humanos , Levanogestrel/uso terapêutico , Londres , Estudos Prospectivos
17.
J Med Case Rep ; 15(1): 224, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33934716

RESUMO

BACKGROUND: Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy. CASE PRESENTATION: A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months' duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy. CONCLUSIONS: Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.


Assuntos
Actinomicose , Colo Transverso , Neoplasias do Colo , Dispositivos Intrauterinos , Actinomyces , Actinomicose/diagnóstico , Adulto , Colo Transverso/diagnóstico por imagem , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos
18.
Urologiia ; (2): 82-85, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-33960163

RESUMO

The article provides a rare observation of a 34-year-old woman who, 12 years before admission to a urological clinic, a gynecologist installed an intrauterine contraceptive device (IUD). The subject migrated into the abdominal cavity, and after 10 years the patient developed dysuria and hematuria. In October 2017, ultrasound and cystoscopy revealed the migration of IUD into the bladder. A foreign body was removed from the bladder - an IUD of a T-shape with the formation of a stone on it with a maximum size of 4.5 cm. During a follow-up examination after 2 years, pathology was not established.


Assuntos
Corpos Estranhos , Dispositivos Intrauterinos , Cálculos da Bexiga Urinária , Adulto , Cistoscopia , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos
19.
Clinics (Sao Paulo) ; 76: e1987, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33978070

RESUMO

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.


Assuntos
Dispositivos Intrauterinos , Doenças Uterinas , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Histeroscopia , Gravidez , Aderências Teciduais/prevenção & controle , Doenças Uterinas/prevenção & controle , Doenças Uterinas/cirurgia
20.
J Int Med Res ; 49(5): 3000605211015032, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34000871

RESUMO

Migration and embedding of an intrauterine contraceptive device (IUCD) in the urinary bladder wall is rare. We present such a case of a 30-year-old woman with complaints of persistent lower urinary tract symptoms and a history of IUCD placement 8 years earlier. The IUCD was successfully removed with cystoscopy alone. The patient recovered well and had her second baby after the surgery without complaints of new urinary symptoms.


Assuntos
Cistoscopia , Dispositivos Intrauterinos , Adulto , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
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