Regional and geographical variations in infertility: effects of environmental, cultural, and socioeconomic factors.

Fertility is affected by many different cultural, environmental, and socioeconomic factors, especially in developing countries where poverty and infections are commonplace. Environmental factors play a major role in infertility in Africa. One of the most important health problems in sub-Saharan Africa is the high rate of infertility and childlessness. The African society has a strong traditional heritage, and the study of the patterns of infertility in this part of the world would be incomplete without consideration of the sociocultural and environmental factors. The most cost-effective approach to solving the infertility problems in Africa is prevention and education. In Mexico, problems of reproductive health are associated with pregnancy in adolescents, sexually transmitted diseases and genitourinary neoplasms. Infertility affects 10% of couples, usually as a result of asymptomatic infection. Education, poverty, nutrition, and pollution are problems that must be tackled. The government has taken positive action in the State of São Paulo in Brazil, where gender discrimination is a major factor affecting women's health and reproductive outcomes. The implementation of new policies with adequate funding has resulted in marked improvements.

PIP: The impact of cultural, environmental, and socioeconomic factors on reproductive health and infertility are discussed in general terms. Conditions in sub-Saharan Africa, Kenya, Mexico, and Brazil are described. In Mexico, high levels of arsenic in drinking water pose a major environmental hazard affecting reproductive health. Chronic arsenic poisoning in Comarca Lagunera, Mexico, contributes to male infertility and birth defects. Additional problems are adolescent pregnancy, sexually transmitted diseases (STDs), congenital malformations, genitourinary neoplasms, malnourishment, and poverty. The example of Sao Paolo's investment in the well-being of women shows how effective government policy can accomplish rapid improvement in women's health. Infertility in Africa is around 30-40%. Infertility in the US is only 8%. The African cultural emphasis on women's status and childbearing makes infertility a major concern. African infertility is related to disease. In the Cameroon, over 50% of infertility is accounted for by pelvic inflammatory disease. Prevention programs should include improvement in diagnosis and treatment of sexually transmitted diseases (STDs), sex education for men and women, expanded family planning (FP) services, and better obstetric care. Infertility in Zaire, Cameroon, Gabon, and Uganda is high compared to other non-African countries. Infertility is geographically and ethnically variable within each country. Politics and government FP policy, traditional attitudes, polygamous relationships, and induced abortion all impact on infertility. Traditional practices, such as female genital mutilation, result in infections during the healing process; infections also occur during childbirth. Vesico-vaginal fistula and incontinence are problematic and can be corrected through surgical methods. Illegal abortions contribute to morbidity and mortality. STDs are a main cause of infertility in Kenya. Cultural beliefs place the blame on females. In both Africa and Mexico, men account for 30% of couple infertility.

[Interventions to reduce maternal mortality]. / Intervenções para a redução da mortalidade materna.

The authors comment a proposal to adopt measures to reduce maternal death and suggest four levels of action: 1) actions aimed at improving the knowledge about the number and factors associated to high risk maternal mortality during pregnancy, delivery and puerperium; they comment on the undernumeration of maternal death cases and propose an improvement in vital statistics, epidemiologic investigation and the creation of maternal mortality committees; 2) action to assist pregnancy, delivery and puerperium, to increase both the coverage and the quality of medical care, prenatal care, institutional care to delivery, and post-partum care; 3) action to prevent pregnancy in women with high risk of maternal mortality, improving diagnosis and treatment of diseases that increase maternal risk, and promoting contraception for these cases; 4) other actions aimed at reducing the risk of death brought about by induced abortion.

Vilosite placentaria. Correlacao anatomoclinica. / Placental villositis.Anatomo-clinical correlation

Foram analisadas 132 placentas tendo sido feito o diagnostico de vilosite em 32 (24%), sendo posteriormente revistas as fichas clinicas das maes e dos recem-nascidos. As vilosites foram classificadas em difusas (2l,8%) e focais (78,2%). O agente etiologico foi encontrado em cinco casos (quatro de toxoplasmose e um de doenca de Chagas), em dois houve suspeita de sifilis e na maioria dos casos (78,2%) nao se determinou a etiologia.A alteracao mais frequentemente associada a vilosite de causa desconhecida foi o RN de baixo peso (28%), sendo sua frequencia diretamente relacionada a intensidade do processo inflamatorio

O papel da percepçäo materna de movimentos fetais na avaliaçäo da vitalidade fetal / The role of maternal perception of fetal movements in fetal vitality evaluation

Gestantes com 32 semanas ou mais de amenorréia e algum fator de risco para a insuficiência útero-placentária foram instruídas para contar e registrar, em formulário específico, os movimentos fetais (MF), durante uma hora por dia, em posiçäo sentada e com uma mäo sobre o abdome. Oitenta e seis fizeram esse registro e tiveram seu parto na instituiçäo dentro da semana seguinte ao último registro. Em todos os casos também foi realizada a Cardiotocografia Anteparto de Repouso (CTG). Para estudar o valor diagnóstico e prognóstico do procedimento, foram utilizadas como variáveis indicativas de possível insuficiência placentária as seguintes: sofrimento fetal (SF), detectado eletronicamente no trabalho de parto e Prova de Pose positiva. Houve 21 casos com 6 ou menos de MF por hora no último registro e 65 com mais de 6 MF. A sensibilidade do método, com esta definiçäo de maus resultados fetais, foi de 37% e a especificidade de 76%. O valor preditivo negativo (bom prognóstico confirmado) foi de 92%. O valor preditivo positivo foi de 14%). A CTG mostrou resultados semelhantes aos do registro de MF. A presença de 6 ou mais MF corresponderia a CTG negativo em 93% dos casos. Conclue-se que a percepçäo materna de mais de 6 movimentos fetais em 1 hora de observaçäo por dia é um método eficiente para julgar boas condiçöes de vitalidade fetal, semelhante à CTG. O registro de 6 ou menos MF pode corresponder a más condiçöes fetais ou apenas à pouca sensibilidade da mäe paa a percepçäo dos movimentos ou à fisiologia fetal normal