Essential elements of postabortion care: origins, evolution and future directions.
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This article reviews the clinical experience with the GyneFix intrauterine implant system for interval, emergency and post-abortal contraception. The relatively high rate of unintended pregnancies and abortions in the world signifies that greater access to contraception is necessary. Unwanted pregnancies and abortions could be avoided by widening the range of effective and acceptable contraceptive methods for use in situations where current methods are far from optimal. High effectiveness, protection against sexual transmitted infections, long duration of action, reversibility and safety are some of the most important attributes of contraceptives valued by women. The development of the frameless intrauterine device is a response to the need to develop contraceptives with high user continuation rate. GyneFix has the lowest failure rate of all copper IUDs currently available. Its performance is further optimised by the atraumatic frameless design which minimises the side effects and discomfort experienced with conventional IUDs. GyneFix could, therefore, be a useful new contraceptive option in looking at ways to reduce the number of unwanted pregnacies and induced abortions.
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OBJECTIVE: To determine the causes that motivate acceptance or not-acceptance of contraceptiva methods in the immediate post abortion period. Material and methods. 191 questionnaires were applied to immediate post abortion patients, in the "Luis Castelazo Ayala" Gynecology and Obstetrics Hospital of the Instituto mexicano del Seguro Social. Patients were divided by two groups: acceptants (n = 75) and not-acceptants (n = 116). Both groups were compared with Student's t test and contrast of proportions. RESULTS: There were not significant differences in the general characteristics of both groups like age, age at menarche, beginning of sexual intercourse, age of marriage or free union, school grade, age at first pregnancy, number of pregnancies, gestational age of the last pregnancy that ended in abortion, previous use of contraceptiva methods and previous experience with them and whether or not they wanted a new pregnancy. The contraceptive method was offered to all patients in the acceptant group. Information was given to 45.33% of them and was considered satisfactory in 75.00%. In contrast, not-acceptants that received information were only 26.72% (p < 0.05) and all of them (100.00%) considered it inadequate (p < 0.05). In 20.68% of the women the method was not offered (p < 0.05). Medical contraindications were present in only 6.03%. The accepted methods were intrauterino device (64.00%), parentheral methods (16.00%), oral contraceptives (13.33%), surgical sterilization (5.33%) and condoms (1.33%). The contraceptive coverage of post abortion patients was 39.27% in this period. CONCLUSIONS: The use of contraceptive methods in post abortion patients can be increased if it is offered systematically to all patients who have had an abortion. Information given to patients must be understandable and sufficient to dissipate fears and ciarify doubts regarding the contraceptive method; contraceptive options must be offered according to the reproductive expectancies and using the informed consent to reinforce the acceptance of the chosen method.
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