Medical-eligibility criteria for contraceptive use.

CDC created U.S. Medical Eligibility Criteria for Contraceptive Use 2010 from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta Georgia during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However some WHO recommendations were modified for use in the United States including recommendations about contraceptive use for women with venous thromboembolism valvular heart disease ovarian cancer and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis history of bariatric surgery peripartum cardiomyopathy endometrial hyperplasia inflammatory bowel disease and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women men and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.

U S. Medical Eligibility Criteria for Contraceptive Use 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use 4th edition.

Intrauterine device insertion during the postpartum period: a systematic review.

Background: Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications. Methods: We searched Medline, Lilacs and Cochrane Collaboration databases for articles in any language, between database inception until December 2008, which compared outcomes of postpartum IUD insertion time intervals. Search terms included postpartum, puerperium, postcesarean delivery, cesarean section, IUD(s), IUCD(s), intrauterine device(s) and insertion. Results: From 297 articles, we identified 15 for inclusion in this review: all studies examined the outcomes from copper IUD insertions within the postpartum time period compared to other time intervals or compared routes (vaginal or via hysterotomy) of postpartum insertion. No studies of levonorgestrel IUDs were identified. Immediate IUD insertion (within 10 min of placental delivery) was safe when compared with later postpartum time periods and interval insertion. Immediate postpartum IUD insertion demonstrated lower expulsion rates when compared with delayed postpartum insertion but with higher rates than interval insertion. Immediate insertion following cesarean delivery demonstrated lower expulsion rates than immediate insertion following vaginal delivery. Conclusion: Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications.

Review article Intrauterine device insertion during the postpartum period: a systematic review ☆,☆☆

unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception.

U.S. medical eligibility criteria for contraceptive use, 2010.

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

Background: The high-sensitivity C-reactive protein (hs-CRP) seems to be associated with the presence of atherosclerosis. The association between menopause-related changes in endogenous sex hormones and hs-CRP levels remains controversial. Objective: To compare the levels of hs-CRP in pre- and postmenopausal women and to evaluate the association of endogenous sex hormones, waist circumference (WC) and insulin resistance with the levels of hs-CRP. Methods: This cross-sectional study included 145 women (age range: 45–65 years), 56 premenopausal and 89 postmenopausal. Patients were evaluated for hormonal and lipid profile, HOMA-IR, hs-CRP and WC. Each variable was first assessed for correlation with log hs-CRP using a univariate model, and significant variables were then added to the multivariate regression model. A p value <0.05 was considered statistically significant. Results: The hs-CRP is higher in postmenopausal patients (3.6 ± 4.9 versus 2.6 ± 3.7, p = 0.004). The log hs-CRP was positively cor...

Laura Olinda Bregiero Fernandes Costa

Papers

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

Waist circumference and menopausal status are independent predictors of endothelial low-grade inflammation.