Genital Bleeding Research Articles

2 cases of elderly women suspected of exhibiting genital bleeding due to ingestion of dozens of supplements

2 cases of elderly women suspected of exhibiting genital bleeding due to ingestion of dozens of supplements

Adult granulosa cell tumors of the ovary: a retrospective study of 30 cases with respect to the expression of steroid synthesis enzymes.

ObjectiveSome, but not all, granulosa cell tumors are characterized by estrogen production. This study was designed to determine whether there are clinical or pathological variations in granulosa cell tumors in relation to the expression of sex steroid synthesis enzymes.MethodsClinical symptoms, serum hormonal values, and histology of 30 granulosa cell tumor patients who underwent surgery between 2002 and 2014 were retrospectively reviewed.ResultsMost patients presented with abnormal genital bleeding including abnormal menstrual cycles. Eight of 16 patients older than 50 years had endometrial hyperplasia and one had endometrial cancer. Serum 17β-estradiol (E2) levels tended to be higher in patients over 50 years of age (p=0.081). Serum follicle-stimulating hormone (FSH) levels were low in all patients irrespective of serum E2 levels. Magnetic resonance imaging revealed a thicker endometrium in older as compared to younger patients (p<0.05). Tumor cells in the majority of cases were positive for inhibin α and P450 aromatase, irrespective of age and serum E2 levels. P450 17α-hydroxylase (P450c17) expression varied among cases. P450c17 was strongly positive in luteinized tumor cells and weakly positive in theca cells and fibroblasts. High E2 levels were associated with P450c17-positive cells in the tumor (p<0.05).ConclusionThe expression of hormone-synthesizing enzymes divides granulosa cell tumors into 2 distinct types; tumors with P450c17-positive cells show elevated serum E2 and related clinical symptoms, while tumors without these cells show symptoms related to FSH suppression by inhibin.

Cohort study of the incidence of spontaneous preterm birth and septic abortion referred by pathological examination in Gifu prefecture in Japan

AimsTo clarify the incidence of spontaneous preterm birth (PB) and septic abortion (sab) in Gifu prefecture in Japan. Study designThis prospective, population-based cohort study was approved by our hospital's Institutional Review Board. All 36 hospitals (100%) in Gifu prefecture offering obstetrical services participated in the study. Patient enrollment criteria were: sab and PB from 22 to <37weeks gestation (WG), excluding for maternal and fetal indications. Pathological examinations before 36 WG and associated factors for both PB and chorioamnionitis (CAM) stage 3 were analyzed by multiple logistic regression analysis judging from minimum daily clinical information in Gifu prefecture. ResultsThe sab rate per all deliveries was 29/16871 (0.17%) at 16.9±2.9 WG. The total spontaneous PB rate was 615/16871 (3.65%) at 34.5±2.7 WG, with birth weight (BW) 2267±557g. There were 26 (0.15%) PBs from 22+0 to 27+6 WG (weeks+days) at 25.2±1.5 WG, with BW 745±199g. Among 214 pathological examinations, CAM was detected in 80% (sab) and 63% (PB<36 WG), respectively. Funisitis were 14% and 17% respectively. Episodes of serial genital bleeding and/or hematoma at <12 WG were more frequent in sab and earlier PB (<28 WG) associated with CAM stage 3 (odds 1.9, P<0.0001). Combined factors such as bleeding and past history of CAM correlated with earlier delivery at 23.4±5.9 WG (P=0.0032). ConclusionIn Gifu prefecture, the incidence of sab was 0.17% (per all deliveries) and 3.65% of spontaneous PB. The combined risk of past CAM history and bleeding was associated with earlier delivery among total preterm birth.

Le prolapsus de la muqueuse urétrale chez la fillette: à propos de 12 cas et revue de la littérature

ObjectivesTo report on the epidemiological, diagnostic, and therapeutic aspects of urethral prolapse. Patients and methodsThe current study is a descriptive cross-sectional study over a period of 8 years (January 2006-December 2013). It was conducted on 12 patients aged under 16 and managed for urethral prolapse in the pediatric surgery department of the hospital Aristide Le Dantec. We studied the following variables: frequency, age, predisposing factors, clinical signs and investigations, treatment and evolution. ResultsOur annual incidence was 1.5 cases. The average age for our patients was 4.02 years. Genital hemorrhage (11 cases) was the main reason for consultation followed by dysuria (8 cases). Physical examination revealed a circular swelling below the clitoris with a cathétérisable opening in its center in all our patients. Urine analysis and culture performed in 10 patients revealed a germ in 2 cases. Surgical resection of the prolapsed mucosa was performed in all of our patients and was associated with a muco-cutaneous suture in 7 cases. The outcome was always favorable. ConclusionUrethral prolapse is a rare disease. Its diagnosis is clinical. Surgical excision is the radical treatment of urethral prolapse and is associated with a favorable outome.

Direct Oral Anticoagulants and Women.

Direct oral anticoagulants (DOACs) provide an effective, safe, and convenient therapeutic alternative to warfarin and other vitamin K antagonists (VKAs), and are now established for a wide range of indications. The use of DOACs in women merits special consideration due to two main situations: first, in relation to fertility, pregnancy, and lactation in women of reproductive age; second, because of their bleeding risk, leading to abnormal uterine and/or other genital tract bleeding. This review focuses on these two clinical situations, including approaches to management in the context of available information.

Prior uterine bleeding is associated with low visibility due to discolored amniotic fluid on fetoscopic laser photocoagulation.

To investigate the association between uterine bleeding preceding fetoscopic laser photocoagulation (FLP) and the presence of discolored amniotic fluid that impedes FLP. A retrospective review of all multiple gestations requiring FLP at the present institution was conducted. The rate of low visibility because of discolored amniotic fluid at the beginning of FLP was compared between patients with and without a history of uterine bleeding, defined as either genital bleeding or ultrasonographically detected subchorionic hematoma. The prevalence of low visibility because of discolored amniotic fluid was 4.5% (seven in 156 patients). Two of the seven cases of low visibility resulted in double fetal death. The incidence of low visibility was significantly higher in the group with uterine bleeding before surgery compared with that without bleeding (28.6% vs 0.74%, P < 0.001). Patients with a history of uterine bleeding prior to FLP may encounter more technical difficulties owing to discolored amniotic fluid during FLP.

Urethral Mucosal Prolapse in girls in Abidjan (Cote d’Ivoire)

Objective Urethral Mucosal Prolapse is a benign condition that is observed particularly in black girls. The benign nature of this disease contrasts with the anxiety of parents who attribute it to sexual abuse. This survey reported exclusively results of medical management of Urethral Mucosal Prolapse. Patients and Methods This retrospective study was conducted in CHU of Yopougon during 15 years from January 1998 to December 2012. All the patients in whom the surgical treatment was indicated at the outset of the disease were excluded from the study. The treatment consisted of the daily application of a dose of estrogen cream on the lump about the size of a hazelnut at the hypogastric region combined with a local antiseptic treatment as well as an antibiotic and a non-steroidal anti-inflammatory coverage. Results The patients were black Ivorian in 52 cases. They mean age was 4 years 8 months (1-11 years). In 87% of cases, genital hemorrhage was the telltale sign. In 36 patients the PMU was grade 4 (40.7%). The diagnosis was confirmed by clinical examination in all cases. Five cases were formally attributed to a rape. The total regression was observed before one month in 37 patients (68.5%). The average duration of treatment was 21 days (15-45 days). Two recurrences after early discontinuation of the hormonal treatment and 3 failures were identified; with a persisting residue of non-inflammatory ridge. The proposed surgical indication was rejected by parents in these 3 cases.

MODERN TRANSARTERIAL CHEMOEMBOLIZATION AS A STEP TOWARDS THE TREATMENT OF MALIGNANTTUMORS OF THE UTERI AND CERVIX

Introduction: Advanced cases of carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients. One method of stoped bleeding is transarterial chemoembolization, which has been studied. Methods: Seven women with advanced uterine and cervix cancer or the pelvic locoregional recurrence withgenital massive bleeding were treated using an endovascular therapy (transarterial chemoembolization (TACE) using cisplatin or doxorubicin or gemcitabine). Ware used HepaSphere (Bioshere Medical, France) filled with saturated 50 mg doxorubicin or 500 mg gemcitabine or 50 mg cisplatin. Results: On average, the total operative time for the procedure was 52 minutes. In all cases, the achieved control bleeding. By the 7th day were signs of reduction in tumor size, 1/3 of its original size. The maximum effect on the tumor size was achieved within 14-20 days. In 2 cases, chemoembolization performed twice at an interval of 21 to 28 days, due to a good picture of the ultrasound tumor vascularization. All operations are carried out under the I/V anesthesia and we had no adverse reactions or complications. Conclusions: Arterial chemoembolization dominant vessels tumor is a reliable method of stopping the genital bleeding at any time during of the planned treatment. It is to improve the quality of life of patients. Antitumor efficacy of drug has a lasting effect. The method is applicable as a minimally invasive, effective for treatment of cancer patients.

A case of gradually manifesting McCune-Albright syndrome with a 10-year follow-up.

McCune-Albright syndrome (MAS) is characterized by fibrous dysplasia (FD) of bone, café-au-lait skin pigmentation, and precocious puberty. Here we report a case of a 12-year-old girl with MAS presenting sexual precocity as initial signs, followed by FD of bone with her growth. She was referred to our hospital because of breast budding and abnormal genital bleeding at the age of 2.8 years. On physical examination, her height and weight were greater than two standard deviations of the mean ranges. Hormonal analysis revealed an elevated serum estradiol and suppressed luteinizing hormone and follicle-stimulating hormone production. Her bone age had advanced, and a 16-mm monocystic lesion was observed on her right ovary by pelvic ultrasonography. Considering the clinical and paraclinical findings, precocious pseudopuberty was suspected and periodic observations were started. Her estrogen "flare up" was transient and she had repeated similar episodes three times in the following 7 years. She complained of pain in her right hip at the age of 9.6 years, which was diagnosed as FD of bone by fluorodeoxyglucose-positron emission tomography. Although no café-au-lait skin pigmentation was observed, we made a preliminary diagnosis of MAS. Because clinical evidence for MAS can appear later in the course of recurrent autonomous cysts, careful observation and periodical assessments of patients with suspected MAS is necessary.

Magnetic resonance imaging findings and prognosis of gastric-type mucinous adenocarcinoma (minimal deviation adenocarcinoma or adenoma malignum) of the uterine corpus: Two case reports.

Our group previously documented the first, very rare case of primary gastric-type mucinous adenocarcinoma of the uterine corpus. Although this type of endometrial cancer appears to be similar to the gastric-type adenocarcinoma of the uterine cervix, its main symptoms, appearance on magnetic resonance imaging (MRI) and prognosis have not been fully elucidated due to its rarity. We herein describe an additional case of gastric-type mucinous adenocarcinoma of the endometrium and review the relevant literature. The two cases at our institution (Kyoto University Hospital, Kyoto, Japan) involved postmenopausal women with a primary complaint of abnormal genital bleeding. Microscopic examination of the hysterectomy specimens indicated a highly differentiated mucinous adenocarcinoma with a desmoplastic stromal reaction. Immunohistochemistry for HIK1083 and/or MUC6 was positive in both cases, suggesting a gastric phenotype. Both patients were diagnosed at an advanced stage, they relapsed or recurred immediately after adjuvant chemotherapy, and eventually succumbed to the disease. The main symptom of gastric-type mucinous adenocarcinoma of the uterine cervix is watery discharge, whereas abnormal genital bleeding in addition to watery discharge is mainly observed in the mucinous type of endometrial adenocarcinoma. Cystic cavities in the tumor are present on MRI in cases of endometrial origin, and prognosis is very poor due to resistance to chemotherapy. Thus, gastric-type mucinous adenocarcinoma of the uterine endometrium exhibits a clinical behavior that is similar to tumors originating from the uterine cervix, but is associated with distinguishing clinical symptoms. The incidence of gastric-type endometrial adenocarcinoma may be higher than expected.

Decidualização Ectópica: Uma Entidade Esquecida

&lt;strong&gt;Introduction:&lt;/strong&gt; Although ectopic decidualization is an entity often underdiagnosed, it may have adverse clinical impact on maternal-fetal morbimortality. The objective of this study was to review the scientific evidence regarding the etiology, clinical features, diagnosis and therapeutic approach on this issue.&lt;br /&gt;&lt;strong&gt;Material and Methods:&lt;/strong&gt; The search for this literature review was conducted in PubMed, Web of Science and Scopus, through the query (‘deciduosis’ OR ‘ectopic decidualization’ OR ‘ectopic decidua’ OR ‘ectopic decidua reaction’), considering articles of all evidence levels published up to 31/06/2014.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; Ectopic decidualization is, usually, a benign condition, asymptomatic and does not require therapeutic intervention. It occurs mostly during pregnancy, with complete regression in the postpartum period. The frequency of the diagnosis depends on the clinical suspicion and its location, being the omentum and the ovary the most common sites. When symptomatic, the main clinical manifestations are genital bleeding and hemoperitoneum. Differential diagnosis includes malignant disease and histopathological confirmation is essential in these situations. The low index of suspicion may lead to a biopsy, which can have serious adverse outcomes due to the high friability of these lesions.&lt;br /&gt;&lt;strong&gt;Discussion and Conclusion:&lt;/strong&gt; The recognition of this entity and its clinical features are essential for the management of these patients. On one side this allows an early and proper medical approach in severe cases, on the other side (the majority of cases) maintaining an expectant attitude avoiding iatrogeny, does not compromise, in most cases, the favorable outcome of ectopic decidualization.

Ectopic Decidualization: A Forgotten Entity

Although ectopic decidualization is an entity often underdiagnosed, it may have adverse clinical impact on maternal-fetal morbimortality. The objective of this study was to review the scientific evidence regarding the etiology, clinical features, diagnosis and therapeutic approach on this issue. The search for this literature review was conducted in PubMed, Web of Science and Scopus, through the query ('deciduosis' OR 'ectopic decidualization' OR 'ectopic decidua' OR 'ectopic decidua reaction'), considering articles of all evidence levels published up to 31/06/2014. Ectopic decidualization is, usually, a benign condition, asymptomatic and does not require therapeutic intervention. It occurs mostly during pregnancy, with complete regression in the postpartum period. The frequency of the diagnosis depends on the clinical suspicion and its location, being the omentum and the ovary the most common sites. When symptomatic, the main clinical manifestations are genital bleeding and hemoperitoneum. Differential diagnosis includes malignant disease and histopathological confirmation is essential in these situations. The low index of suspicion may lead to a biopsy, which can have serious adverse outcomes due to the high friability of these lesions. The recognition of this entity and its clinical features are essential for the management of these patients. On one side this allows an early and proper medical approach in severe cases, on the other side (the majority of cases) maintaining an expectant attitude avoiding iatrogeny, does not compromise, in most cases, the favorable outcome of ectopic decidualization.

Klippel-Trenaunay Syndrome: A Rare Cause of Vaginal Bleeding in the Prepubescent Girl

Klippel-Trenaunay syndrome (KTS) is an uncommon congenital disorder with unknown etiology that consists of mixed vascular malformations. Visceral organs may also be involved leading to a variety of manifestations. Although seemingly uncommon, genital tract involvement can occur and be a source of significant morbidity. We hereby describe a case of KTS of a 7-year-old female patient presenting with genital bleeding, large venous and capillary malformations and soft tissue hypertrophy of right limb. Patient was treated conservatively and asked to follow-up regularly. KTS should be kept on mind as a cause of vaginal bleeding in preteen girls especially those with suggestive clinical features. Management of this complex condition is challenging because of its progressive nature and wide range of disease severity.

Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review.

The objective of this paper is to propose minilaparotomy hysterectomy as the suitable choice for large uterus on the basis of our experienced case of performed minilaparotomy hysterectomy to 4,500 g myoma uteri and review published cases about this clinical condition. We presented a 44-year-old woman (gravida 0, virgin) who consulted our hospital because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel. Her tumor was an indication of surgery; to do minilaparotomy hysterectomy with laparoscope was decided because her informed consent was obtained. A 6 cm transverse incision (Maylard incision) was made to the skin above the pubic hairline. At the end of surgery, the length of abdominal wound was 8.5 cm, operating time was 128 min, weight of resected myoma uteri was 4,500 g, and intraoperative blood loss was 895 mL. Blood transfusion was not done; postsurgical course was not a problem without anemia. We propose that a large uterine case in which it is difficult to perform vaginal or laparoscopic hysterectomy should be considered in order to select minilaparotomy hysterectomy up to around 5 kg weight of uterus, and the length of skin incision in minilaparotomy hysterectomy is necessarily <9 cm particularly in large uterus.

Evaluation of quality of life and subjective experience of the disease before and after vaginal hysterectomy among women admitted to the University Hospital in Brazzaville

Toute maladie est un mal en soi qu’il faut éradiquer car elle altère souvent de façon significative la qualité de la vie. L’hystérectomie vaginale est indiquée pour les patientes qui présentent certaines affections gynécologiques graves, elle est donc bénéfique mais, peut également avoir une répercussion néfaste sur la qualité de vie de la femme. Ainsi nous avons voulu explorer le vécu de la maladie et de l’hystérectomie vaginale (HV) des femmes avant et après l’intervention chirurgicale. Nous avons effectué une étude prospective qualitative, à recueil clinique sur une période de 12 mois; qui a concerné les femmes, ayant subi une hystérectomie vaginale. Celles n’ayant pas accepté de participer à l’étude, ou n’ayant pas de contact téléphonique n’ont pas été incluses. Pendant la maladie, le vécu des femmes a été: l’inconfort sexuel 26/40 (65%); les saignements génitaux 12/40 (30%); les douleurs pelviennes 13/40 (32,5%). En Post-opératoire, ont été noté les dyspareunies transitoires30/40 (75%) ; les céphalées secondaires à l’anesthésie 4/40 (10%). Le vécu psychologique a été dominé avant l’HV par la peur de la chirurgie chez toutes les patientes, les troubles du sommeil 38/40 (95%), l’angoisse 30 /40(75%), un sentiment de honte lié aux difficultés à accomplir l’acte sexuel en raison du prolapsus 26/40(65%) et/ ou en raison des saignements génitaux, dus au fibrome utérin 14/40(35%). Le sentiment de la perte de féminité était déclaré par 26/40 femmes porteuses de prolapsus utérin (65%), la modification de l’estime de soi 26/40 (65%). Ces appréciations subjectives ont été améliorées avec l’HV, contre balançant la perte de leur organe de reproduction. Aucune information n’a été donnée par les femmes à leurs proches et aux membres de la famille avant la chirurgie, traduisant ainsi leur sentiment de gène ou de honte. L’arrêt des symptômes a été observé dans tous les cas, même si dans un cas (1,25%) un nouveau signe au titre des complications (plaie rectale) a éténoté. Concernant l’activité sexuelle, tous les couples ont déclaré leur satisfaction après le traitement. Le vécu dramatique de la maladie et de l’hystérectomie vaginale avant, est nettement amélioré après l’intervention chirurgicale.

The Urethral Prolapse, a Rare Cause of Genital Bleeding in Girls: Report on Three Cases

Long considered a disease of elderly women, urethral prolapse is increasingly found in girls, mostly African. It is a rare disease which causes eversion of the urethral mucosa through the meatus. Such pathophysiology, still debated, contrasts with the purely clinical diagnosis in the presence of genital bleeding or vulva swelling more or less painful, and bleeding when touched. Surgical treatment gives excellent results. We hereby give details of our experience across three cases of urethral prolapse supported surgically with good results.

Risk Factors for Mortality of Newborn at Kolwezi Hospital

The WHO estimates that about 130 million children born each year worldwide, and about 4 million die during the neonatal period. Neonatal mortality remains until now a major public health problem in the world and is the socio-economic indicators of progress and health of a country by its frequency. This study aimed to identify risk factors of neonatal mortality through maternal and new-born characteristics susceptible to influence this last. We conducted a longitudinal study from January 1st to December 2014 based on data collected through a questionnaire developed for this purpose. This questionnaire was tested, standardized and administered in the maternity and neonatology service in the language spoken by the mother (Swahili or French). Results: Anemia and neonatal asphyxia were significantly associated with the occurrence of death with adjusted odds ratio of 34.570 respectively (CI: 5.633 to 212.149, 95%) and 7861 (CI: 2.017 to 30.644). The history of fetal deaths and HIV in mothers was also recognized as an explanatory factor for the occurrence of neonatal mortality. But it should be noted that the CPN followed and the history of genital bleeding in the first trimester of pregnancy have made protective factors for developing neonatal mortality with their respective adjusted OR of 0.169 (CI: 0.037 to 0.775, 95%) and 0.066 (CI: 0.005 to 0.906). Conclusion: To address this problem, the management of various risk factors that may influence the occurrence of neonatal mortality should be taken into account.

Postinfluenza Vaccination Idiopathic Thrombocytopenic Purpura in Three Elderly Patients.

The etiologies of secondary idiopathic thrombocytopenic purpura (ITP) include infection, autoimmune disease, and immunodeficiency. We report the cases of three elderly patients who developed ITP after receiving influenza vaccinations. The platelet count of an 81-year-old woman fell to 27,000/μL after she received an influenza vaccination. A 75-year-old woman developed thrombocytopenia (5,000 platelets/μL) after receiving an influenza vaccination. An 87-year-old woman whose laboratory test values included a platelet count of 2,000/μL experienced genital bleeding after receiving an influenza vaccination. After Helicobacter pylori (HP) eradication or corticosteroid treatment, all of the patients' platelet counts increased. Influenza vaccination is an underlying etiology of ITP in elderly patients. HP eradication or corticosteroid treatment is effective for these patients. Clinicians should be aware of the association between ITP and influenza vaccinations.

Successful treatment of atypical cesarean scar defect using endoscopic surgery

BackgroundCesarean scar syndrome results from a postoperative defect of the uterine isthmus, also known as an isthmocele. Patients present with gynecological symptoms, such as abnormal genital bleeding or infertility, after cesarean delivery. Although the cesarean rate is increasing worldwide, this syndrome is not widely known.Case presentationA 43-year-old G2P1 Japanese woman with atypical cesarean scar syndrome had a 3-year history of secondary infertility and postmenstrual brown discharge. Laparoscopic and hysteroscopic exploration revealed a cesarean scar defect connected to a small cavity in the myometrium: this was not an endometrial cavity or a uterine diverticulum. After endoscopic excision of the cavity, the brown discharge resolved, and the patient achieved ongoing pregnancy on her third attempt at intrauterine insemination.ConclusionConsensus is still lacking regarding the diagnosis and treatment of cesarean scar defect. However, the gynecologists should be aware that cesarean scar syndrome can have scar defects forming cavities of unusual shapes and features. Surgical correction of these defects will often improve postmenstrual bleeding and subfertility in these cases.

Adesão à dupla contracepção entre mulheres infectadas pelo HIV

To determine adherence to dual contraception using depot-medroxyprogesterone acetate (DMPA) and condom among HIV-infected women. A cross-sectional study carried out from December 2013 to September 2014 at a local reference center, with application of questionnaire elaborated after Delphi panel and content validation to 114 HIV(+) women aged 15 to 49 years, using DMPA plus condom for contraception. Mean age was 33.2 ± 7.2 years, mean time since HIV detection was 8.1 ± 5.2 years, mean time of antiretroviral use was 6.8 ± 5 years and mean CD4 cells/mm3 count was 737.6 ± 341.1. Sexual HIV acquisition was reported by 98.2% (112/114), antiretroviral use by 85.9% (98/114), and 77.7% (84/114) had a CD4>500/mm3 count. Having a single sex partner was reported by 78.9% (90/114), with HIV serodiscordance in 41.2% (47/114) of couples, 21.9% did not know the serological status of their partner and in 37.7% of cases (43/114) the partner was unaware of the HIV(+) status of the woman. The last pregnancy was unplanned in 71.9% of cases (82/114) and 14.9% of the women had become pregnant the year before, with pregnancy being unplanned in 70.5% (12/17) of cases. Current use of DMPA was reported by 64.9% (74/114), with genital bleeding in 48.2% (55/114) and weight gain in 67.5% (77/114). Use of a male condom was reported by 62.2% of the subjects (71/114). Three reported that they always used a female condom and ten that they eventually used it. Unprotected vaginal sex was reported by 37.7% (43/114) and unprotected anal intercourse was reported by 32.4% (37/114). Partner resistance to use a condom occurred in 30.7% of cases (35/114). Dual contraception using DMPA with condom was reported by 42.9% (49/114). A partner who resisted wearing a condom was associated with poor adhesion (PR=0.3; 95%CI 0.2-0.7; p<0.001). A partner who was unaware that a woman was infected with HIV favored adherence (PR=1.8; 95%CI 1.2-2.7; p=0.013). The percentage of dual contraception using DMPA plus condom was 42.9%, maintaining unplanned pregnancies and unprotected sex. Resistance of partners to use a condom increased three times the chance of a woman not adhering to dual contraception, and the partner not knowing women's HIV infection almost doubled the chance to adhere to safe contraception. to offer new hormonal contraceptives and to involve the partners in contraception and serologic detection tests.