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Objectives Given new research on postpartum placement of levonorgestrel and copper intrauterine devices (IUDs), our objective was to update a prior systematic review of the safety and expulsion rates of postpartum IUDs. Methods We searched MEDLINE, CENTRAL, LILACS, POPLINE, Web of Science, and ClinicalTrials.gov databases for articles between the database inception until July 2013. We included studies that compared IUD insertion time intervals and routes during the postpartum period. We used standard abstract forms and the United States Preventive Services Task Force grading system to summarise and assess the quality of the evidence. Results We included 18 articles. New evidence suggests that a levonorgestrel releasing-intrauterine system (LNG-IUS) insertion within 48 hours of delivery is safe. Postplacental insertion and insertion between 10 minutes and 48 hours after delivery result in higher expulsion rates than insertion 4 to 6 weeks postpartum, or non-postpartum insertion. Insertion at the time of caesarean section is associated with lower expulsion rates than postplacental insertion at the time of vaginal delivery. Conclusions This review supports the evidence that insertion of an intrauterine contraceptive within the first 48 hours of vaginal or caesarean delivery is safe. Expulsion rates should be further studied in larger randomised controlled trials. [ABSTRACT FROM AUTHOR]

Objectives To assess HIV knowledge, attitudes, sexual practices and sexual and reproductive health (SRH) service delivery in border areas of Tanzania, with a view to support the prioritisation of SRH interventions in border areas. Methods The target sample comprised randomly selected people living near the border, aged 15 to 49 years. To gather information, we utilised: (i) a standardised questionnaire ( n = 86; 42 men and 44 women) previously used in national household surveys conducted by the Tanzanian government; (ii) focus group discussions (ten male groups, n = 47; ten female groups, n = 51); and (iii) semi-structured interviews with service providers ( n = 37). Results The mean number of sexual partners, frequency of multiple concurrent partnerships and engagement in transactional sex were significantly higher in the border community than in the national population. Knowledge about HIV was comparable with that in the general population. Access to SRH services was limited in the border areas. Conclusion Efforts to reduce HIV transmission and to improve SRH in the border areas should focus on gaps in service delivery rather than education and information activities alone. In addition, multi-sectorial efforts spanning the health, social, legal and private sectors addressing gender imbalances and poverty alleviation are imperative for reducing poverty-driven unsafe transactional sex. [ABSTRACT FROM AUTHOR]

Objectives To estimate (i) lifetime prevalence of physical and sexual intimate partner violence (IPV) and (ii) associations of development of complications around delivery and IPV. Methods We used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 2001 currently married women having a child younger than five years. Exposure was determined from maternal reports of physical and sexual IPV. Experience of complications around delivery was the main outcome variable of interest. Results More than half (53%) of the women had experienced IPV. IPV of any type (adjusted odds ratio [AOR]: 1.86; 95% confidence interval [CI]: 1.35-2.56) was associated with development of complications, as was physical IPV only (AOR: 1.63; 95% CI: 1.14-2.33), sexual IPV only (AOR: 2.0; 95% CI: 1.01-3.99), and both types of IPV (AOR: 2.43; 95% CI: 1.55-3.79). There was a dose-response relationship between the number of varieties of physical IPV suffered and complications developing. Conclusions Experience of IPV is an important risk marker for the development of complications around delivery. Our findings underscore the calls for protecting women from all forms of physical and sexual violence from their husbands as part of the interventions to reduce the risk of complications supervening around delivery. They should be considered a public health research priority. [ABSTRACT FROM AUTHOR]

Objective To examine the effects of women employment on maternity care and pregnancy outcome in Al-Hassa, Saudi Arabia. Study design Two groups of highly educated employed (144 teachers and health care workers) and 162 non-employed mothers, all of Saudi nationality, were compared. Data were collected from family files kept at primary health care centres as well as by direct interview with mothers, two months after delivery. Results Working mothers initiated care late in pregnancy and subsequently attended fewer visits. They had more caesarean sections, preterm deliveries and low birth weight infants in the index pregnancy. These adverse effects were more prominent with unfavourable working conditions. Conclusion Maternal employment, especially with unfavourable working conditions, is associated with inadequate antenatal care and poorer pregnancy outcome, compared to housewives of the same high educational level. Maternity care providers need training in occupational medicine to promote the health of working mothers. [ABSTRACT FROM AUTHOR]

Objective To determine the level of Unmet need for Contraception among women in the first year post-delivery in Ile-Ife, Nigeria. Methods A prospective study of 256 women attending antenatal clinic of the OAUTHC, Ile-Ife, Nigeria was carried out 9–10 months post-delivery. Using a semi-structured questionnaire, the respondents were interviewed for socio-demographic characteristics; obstetric, sexual, and contraception history were also taken. The data were analyzed using descriptive and inferential statistical methods. Results There was a high level of unmet need (59.4%) in the sample of Nigerian women despite a high level of awareness of common methods of contraception. Education and parity had no significant effect on usage of contraception (p > 0.05). No reason was given for non-usage in the largest proportion (30.3%) of the non-users. Only one-third of the respondents could correctly report the ‘at-risk’ period for getting pregnant in the post-partum period. Conclusion There is a need to study in more detail the social and cultural factors that determine contraceptive utilization before success can be achieved in closing the gap of unmet need, as it has become evident that increasing the awareness and knowledge of contraception is not enough to achieve the objectives of family-planning programs. [ABSTRACT FROM AUTHOR]

The aim of the study was to audit the clinical experience of insertion of the Mirena® intrauterine system at the time of a caesarean section. The Mirena apparatus was inserted into the fundus of the uterus after delivery of the foetus and placenta. Thirty-three patients were analysed in private practice over 32 woman-years. The audit revealed the device was extremely well tolerated. There were no contraceptive failures, no complications and no expulsions of the intrauterine device. Patient satisfaction was extremely high. At the conclusion of the audit, only one device had been removed; this descriptive study showed that the Mirena intrauterine device can be inserted into the uterus at caesarean section to provide an immediate, reliable and reversible contraceptive. [ABSTRACT FROM AUTHOR]

Objectives: There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993.Methods: A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor.Results and Conclusions: It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment. [ABSTRACT FROM AUTHOR]

The article presents an editorial on gynaecologists, who accompany the grown-up girl till their pregnancies, deliveries and postpartum. Topics discussed include somatic and endocrine changes causing symptoms and individual suffering in women, impact of trusted gynaecologist in providing treatment and possibly palliative care to women and gynaecological oncology as a comprehensive concept.