Biomedical subjects

A Faúndes

Publications and source records attributed to A Faúndes.

At least 19 recordsLinked to original sources

PubMed2006

A risk reduction strategy to prevent maternal deaths associated with unsafe abortion.

INTRODUCTION: Worldwide, 13% of maternal deaths are caused by complications of spontaneous or induced abortion, 29% in Uruguay and nearly half (48%) in the Pereira Rossell Hospital. PURPOSE: This paper describes a risk reduction strategy for unsafe abortions in Montevideo, Uruguay, where over one-fourth of maternal deaths are caused by unsafe abortion. METHODS: Although abortion is not legal in Uruguay, women desiring abortions can be counseled before and immediately after to reduce the risk of injury. Women contemplating abortion were invited to attend a "before-abortion" and an "after-abortion" visit at a reproductive health polyclinic. At the "before-abortion" visit, gestational age, condition of the fetus and pathologies were diagnosed and the risks associated with the use of different abortion methods (based on the best available scientific evidence) were described. The "after-abortion" visit allowed for checking for possible complications and offering contraception. RESULTS: From March 2004 through June 2005, 675 women attended the "before-abortion" and 495 the "after-abortion" visit, the number increasing over time. Some women (3.5%) decided not to abort, others were either not pregnant, the fetus/embryo was dead or the woman had a condition that permitted legal termination of pregnancy in the hospital (7.5%). Most women, however, aborted. All women used vaginal misoprostol in the doses recommended in the medical literature. There were no serious complications (one mild infection and two hemorrhages not requiring transfusion). CONCLUSION: The strategy is effective in reducing unsafe abortions and their health consequences.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Does meloxicam increase the incidence of anovulation induced by single administration of levonorgestrel in emergency contraception? A pilot study.

BACKGROUND: Levonorgestrel (LNG) consistently prevents follicular rupture only when it is given before the onset of the ovulatory stimulus. As locally synthesized prostaglandin (PG) plays a crucial role in follicular rupture and cyclooxygenase-2 (cox-2) catalyses the final step of PG synthesis, we reasoned that adding a cox-2 inhibitor to LNG would prevent follicular rupture even after the ovulatory process had been triggered by the gonadotrophin surge. METHODS: Forty-one women were divided into two groups. One was treated when the size of the leading follicle was 15-17 mm (n=10) and the other when it was >or=18 mm (n=31). Each woman contributed with one cycle treated with LNG 1.5 mg single dose plus placebo and another treated with LNG + meloxicam (Melox) 15 mg, in a randomized order. Serial blood sampling for the assay of LH and follicular monitoring by transvaginal ultrasound were performed before and after treatment. RESULTS: Follicular rupture failed to occur within the 5-day period that followed treatment in 50 and 70% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the 15-17 mm group (P=0.15) and in 16 and 39% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the >or=18 mm group (P < 0.052). The overall proportion of cycles with no follicular rupture or ovulatory dysfunction increased significantly by the addition of Melox to LNG (66 versus 88%, P < 0.012; n=41-matched pairs). CONCLUSIONS: The trend towards increased incidence of no follicular rupture when Melox was combined with LNG suggests that the addition of a cox-2 inhibitor has the potential to improve the contraceptive efficacy of LNG by a pre-fertilization effect.

Adolescent↗

PubMed2005

[Cesarean section in Brazil: incidence, trends, causes, consequences and suggestions for change].

The authors analyse the current cesarean section situation in Brazil. In the last decade it has reached extremely high levels of incidence, higher than any other country. Social-economic and regional differences are established through the available national data on the cesarean section incidence. There is a higher incidence on wealthier regions and women. The factors influencing this high incidence, including socio-cultural, obstetric care organization, legal and institutional ones are also considered. Special attention is given to the problem of female surgical sterilization which is forbidden in the country and is performed through inadequate indication of a cesarean section. Consequences for maternal and perinatal morbidity and mortality, the effects on population fertility and extra public expenses are considered. Interventions and attitude changes are proposed at several levels to reverse this increasing tendency of cesarean section incidence in the country.

English Abstract↗

PubMed2004

[Women's opinions on circumstances under which hospitals should perform abortions].

Little is known about the opinion of Brazilian women on induced abortion. One objective of a study carried out in the region of Campinas, São Paulo State, was to learn whether women agreed as to specific circumstances under which hospitals should provide abortions. A total of 1838 women of childbearing age and who had been pregnant at least once were interviewed. Single women and those who had had at least one induced abortion were the ones who most agreed with hospitals performing abortions under the circumstances presented. The circumstances most accepted were rape, the woman's life being at risk, and fetal malformation. A smaller percentage of women were in favor of abortion when the reasons affected the woman but could not be observed in a direct and objective way by others.

English Abstract↗

PubMed2004

Reducing maternal mortality in Mozambique: challenges, failures, successes and lessons learned.

The aim of this paper is to describe different approaches to make emergency obstetric care (EmOC) accessible to women in Mozambique. The definitions of basic (BEmOC) and comprehensive EmOC (CEmOC), proposed by the UN agencies, were adopted by FIGO and by the Mozambican Ministry of Health as a general strategy to reduce maternal mortality. Four projects are presented: (1) José Macamo and (2) Mavalane Hospitals in Maputo city, (3) Manhiça District in Maputo Province and (4) Sofala Province. José Macamo was staffed by physicians 24 h a day; other hospitals by non-physicians trained in surgical and anesthesiology techniques, as well as nurse-midwives. José Macamo Hospital provided CEmOC to the city of Maputo and the southern area of Maputo Province. In 2001, this hospital attended 32% of deliveries and 38% of cesarean sections in the city, up from 14 and 2.5%, respectively, in 1998. The Mavalane Hospital failed to provide CEmOC; however, the number of deliveries per year almost doubled. The Manhiça hospital carried out 31% of the District's C-sections in 2001, up from 9% in 1998. In Sofala Province, one additional CEmOC and four BEmOCs were installed and case fatality rates decreased. In conclusion, the strategy for ensuring provision of EmOC is feasible even in countries with minimal resources and a scarcity of physicians, such as Mozambique.

Delivery of Health Care↗

PubMed2003

[The decision to abort: the process and feelings involved].

In Brazil, induced abortion is considered a crime in the majority of cases, the result being that there is little official data on the subject. Little is known about the conditions under which abortions are induced This research was designed to shed light on the characteristics of the women who had had an abortion and to study the reasons why and conditions under which it occurred. The sample consisted of all employees (7,359) and students (2,231) in a university program in S o Paulo who were mailed a self-administered survey. Accompanying the questionnaire was a letter and self-addressed stamped envelope. 27% of the employees and 42% of the students returned the questionnaires. Of these, 1,314 employees and 138 students had had at least one pregnancy. The results presented in this study show that 465 of the employees and students ar some point had thought of having an abortion. They were divided into two groups: those who had had an abortion and those who had nos. The objective was to analyze the association of some characteristics of the women with their decision to have/not have an abortion and how they felt when faced with this decision. The proportion of women who had had an abortion was significantly lower among married women than singles. A larger percentage of women who had talked with a friend and/or husband/partner/boyfriend had decided to have an abortion than those who had talked to a parent or had not talked to anyone. More women who said they were not prepared to raise/educate a child had had an abortion as compared to those giving other reasons. Almost half of the women undergoing an abortion said that they felt bad emotionally and physically afterwards. Among those who had not had an abortion, almost two-fifths reported that they felt good, were happy, relieved, and did not regret their decision. The conclusion drawn from the population studied was that emotional and social factors played a significant role in the decision-making process for women considering an abortion.

English Abstract↗

PubMed2003

The in vitro effect of levonorgestrel on the acrosome reaction of human spermatozoa from fertile men.

The objective of the study was to evaluate the effect of levonorgestrel (LNG) on the occurrence of acrosome reaction (AR) of capacitated spermatozoa from fertile men. A total of 20 semen samples from four fertile men were evaluated. The spermatozoa were separated by swim-up, and subsequently incubated for 20 h under capacitating conditions. Capacitated spermatozoa were exposed to three different concentrations of LNG (200, 400 and 800 ng/mL), follicular fluid (20% v/v), and ethanol or human tubal fluid medium (HTF) as a control. The AR rate and the ratio of live to dead spermatozoa were assessed after 15 and 30 min of incubation at 37 degrees C and 5% CO(2). The different treatments were compared with follicular fluid and HTF medium as positive and negative controls. The main results showed that the AR rate after 15 min of exposure was not affected by LNG and was significantly higher with follicular fluid than with all the other treatments. At 30 min of exposure, the three LNG concentrations induced a greater rate of AR than the HTF and a trend of higher AR rate with greater concentration was observed. Follicular fluid induced a significantly higher rate of AR than the other treatments. In conclusion, the addition of LNG in vitro to capacitated human spermatozoa is associated with a dose-dependent increased rate of AR, but such increase was not as great that induced by follicular fluid.

Acrosome↗

PubMed2003

Ectopic pregnancy and emergency care: ethical and legal issues.

Ectopic or tubal pregnancy presents a medical emergency that requires prompt treatment in order to contain risks of maternal death and morbidity, including loss of future fertility. Medical circumstances involving individual patients and resources of the prevailing health care system will determine the options and means of treatment. Termination of ectopic pregnancy does not constitute or directly implicate abortion. Any practice of deliberately delaying treatment of reliably diagnosed ectopic pregnancy, on non-clinical grounds, until rupture of the fallopian tube has occurred or is imminent, in order to justify termination of the ectopic pregnancy on grounds of saving the patient's life, is unethical and illegal. Those who undertake or counsel deliberate delay of medically-indicated treatment can be charged with criminal offences and civil (non-criminal) liability, and medical professional misconduct. On reliable diagnosis, prompt treatment to remove ectopic pregnancy is legally justified, and ethically and legally required.

Emergency Medical Services↗

PubMed2003

Emergency contraception--clinical and ethical aspects.

Emergency contraception (EC) consists of either 1.5 mg of levonorgestrel (LNG) in one or two doses, or a combination of LNG with ethinylestradiol, administered for up to 5 days after unprotected intercourse. Clinical studies indicate that LNG alone is more effective and has less side effects. Its effectiveness decreases the longer after coitus it is taken. EC is indicated when there is non-compliance or accidents with the use of regular methods of contraception, or when women have had voluntary or imposed unprotected intercourse. The ethics of providing EC has been questioned by some, arguing that it acts by preventing implantation. Scientific evidence does not support this concept, but shows that EC acts mostly before fertilization. Placing obstacles to the access of EC is unethical as it transgresses the ethical principles of autonomy, non-maleficence beneficence and justice. Far from inducing abortions, EC reduces unwanted pregnancies and prevents abortion.

Contraceptives, Oral, Synthetic↗

PubMed2002

Urodynamics in climacteric women with urinary incontinence: correlation with route of delivery.

The aim of this study was to compare the urodynamic findings among climacteric women complaining of urinary incontinence who had only vaginal deliveries with those who had only cesarean sections. The study group comprised 30 climacteric women with complaints of urinary incontinence consulting at the Menopause Outpatient Clinic, State University of Campinas, submitted to anamneses and complete urodynamic testing. Nineteen women had had only vaginal deliveries and 11 were delivered only by cesarean section. Vaginal delivery was significantly associated with a reduced normal and strong desire to void and maximum cystometric capacity compared to women who delivered only by Cesarean section. Detrusor instability was four to five times more frequent among women who had had only vaginal deliveries. There was no difference between the two groups concerning uroflowmetry parameters. Climacteric women with urinary incontinence who had had only vaginal deliveries are at a higher risk of urodynamic abnormalities.

Adult↗

PubMed2002

Sexual violence against women. The role of gynecology and obstetrics societies in Brazil.

Sexual violence is highly prevalent although barely visible in most countries. While its prevention is a task of the whole society, the care of the women who suffer sexual violence, from immediate assistance to treatment of its consequences, is a responsibility of obstetricians-gynecologists. One of the most severe consequences of rape is unwanted pregnancy, which frequently ends in abortion. Currently, even in countries where abortion following rape is accepted by the law, raped women do not have access to legal abortion. The role of obstetricians-gynecologists in solving this problem is described, giving as an example the work of the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO). After 5 years of work of a special FEBRASGO Committee, services for the comprehensive care of women victims of sexual violence exist in all mayor cities in Brazil and are rapidly expanding.

Abortion, Legal↗

PubMed2001

Post-partum bleeding and infection after post-placental IUD insertion.

The incidence of excessive bleeding and endometritis in 145 women who accepted post-placental insertion of a copper T380A intrauterine device (IUD) was compared with that of 157 subjects who did not accept the insertion of the IUD. The subjects delivered at the Maternidade da Encruzilhada, Recife, Brazil in the period from March 30, 1994, to December 15, 1995. A blood sample for hemoglobin was collected before placental expulsion and 10 days after labor. The IUD was inserted up to 10 min after the expulsion of the placenta. There was no difference between the groups in the incidence of excessive bleeding, neither regarding mean hemoglobin concentration before placental expulsion (t = 0.039; p = 0.83) nor at day 10 postpartum (t = 1.04; p = 0.29). There were 5 cases of clinically diagnosed endometritis among the 145 subjects with placental-IUD (3.4%) and 7 cases among the 157 women without IUD (4.6%) (p = 0.40). Post-placental insertion appears to be a convenient approach to IUD initiation, with no observed increase in the incidence of excessive bleeding or endometritis.

Adult↗

PubMed2001

The risk of urinary incontinence of parous women who delivered only by cesarean section.

OBJECTIVES: To evaluate the association of route of delivery with prevalence of urinary incontinence. METHODS: Women with menopause who consulted at the Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, were interviewed and examined to detect urinary incontinence. Obstetrics history and other possible factors that could influence incontinence were also recorded. RESULTS: Urinary incontinence was diagnosed in 98 women (cases) while 91 were free of this problem. The risk of urinary incontinence was approximately five times higher among women with one or more pregnancies than among nulligravida, and 3.5 times higher among women who had had only cesarean sections than among nullipara. CONCLUSIONS: Women cannot prevent urinary incontinence by delivering exclusively by cesarean section.

Adult↗

PubMed2001

Misoprostol for prevention of postpartum hemorrhage.

OBJECTIVE: To compare the effectiveness of 400 microg rectal misoprostol in 5 cm(3) of saline with oxytocin 10 IU, i.m., in reducing bleeding during the third stage of labor. DESIGN: A double blind, randomized, clinical trial including 663 women with uncomplicated vaginal delivery who received misoprostol (n=324) or oxytocin (n=339). MAIN OUTCOME MEASURES: Changes in hemoglobin and hematocrit from before to 72 h postpartum; blood loss during the third stage; duration of the third stage of labor; need for additional oxytocic drug; frequency of requisition and of administration of blood; changes in blood pressure; and occurrence of side effects. RESULTS: No significant differences were observed between groups, before and 72 h postpartum, in mean hemoglobin and hematocrit, on volume of blood loss and duration of third stage of labor. The incidence of shivering and mean temperature (P<0.01) was significantly greater among women receiving misoprostol than oxytocin. CONCLUSIONS: Misoprostol administered as a micro-enema, 400 microg in 5 ml of saline during the third stage of labor, appears to be as effective as oxytocin 10 IU, i.m., but misoprostol produced more side effects than oxytocin.

Administration, Rectal↗

PubMed2001

[Urinary incontinence among climateric Brazilian women: household survey].

OBJECTIVE: To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. METHODS: A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). RESULTS: Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. CONCLUSION: Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.

Brazil↗

PubMed2001

The opinion of Brazilian women regarding vaginal labor and cesarean section.

OBJECTIVES: The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. METHODS: Six hundred and fifty-six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. RESULTS: Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C-section-only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). CONCLUSIONS: Apparently, pain and women's perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.

Brazil↗

PubMed2000

The effect upon the human vaginal histology of the long-term use of the injectable contraceptive Depo-Provera.

The objective of the study was to evaluate the effect of long-term use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) on human vaginal histology. Twenty premenopausal women currently using DMPA as a contraceptive method for two and three years were compared with 20 regularly menstruating women, who never used Depo-Provera and/or other kind of hormonal contraceptive in the last 6 months prior to the study. Subjects and controls were matched by age (+/-1 year), body mass index (kg/m2) (+/-1.0), number of pregnancies (+/-1), age at first intercourse (+/-1 year), years of sexual activity (+/-1 year), and number of partners during their life (+/-1). Vaginal biopsies were performed in users at 90+/-7 days after the last injection and in nonusers at day 20-25 of the menstrual cycle. In addition, at the day of the biopsy a blood sample was collected to measure estradiol (in all women) and DMPA in users. The level of serum estradiol was significant lower in Depo-Provera users than in controls (p < 0.001). The thickness of the vaginal epithelium was not smaller among DMPA users than among controls, the mean count of Langerhans cells per mm of epithelium were almost identical in both groups, and no significant differences were found on the vaginal maturation indices. In conclusion, the use of Depo-Provera between two and three years did not affect vaginal thinning of the epithelium, Langerhans cell count or maturation index.

Adult↗

PubMed2000

T-shaped IUDs accommodate in their position during the first 3 months after insertion.

The objective of this study was to observe the position dynamics of the T-shaped intrauterine device (IUD) in the uterine cavity, from insertion to 90 days of use. IUD position was evaluated in 214 women by vaginal ultrasound, measuring the IUD-endometrium, IUD-myometrium, and IUD-fundus distances. The 90th percentile of the IUD-endometrium distance was 5, 6, and 8 mm at time of insertion, 30 and 90 days of use; 7, 9, and 10 mm for IUD-myometrium distance; and 23, 24, and 27 mm for IUD-fundus distance, respectively. Seventeen IUDs were classified as misplaced at insertion by using the 90th percentile of the IUD-myometrium distance as standard. Of these, only 6 remained misplaced after 90 days of use. On the other hand, 21 IUDs were beyond the 90th percentile at the 90-day observation, only 6 of which were considered misplaced at insertion. We conclude that the T-shaped IUD accommodates its position in the uterine cavity during the first 3 months following insertion, and that ultrasound evaluation of its position is not a good predictor of future evaluation.

Adult↗