La contracepción definitiva en la mujer es el método de anticoncepción más extendido en todo el mundo. Los procedimientos transcervicales fueron introducidos en la década de los años 70 para evitar el acto quirúrgico y la anestesia general. Sin embargo, sus fallos y efectos secundarios han impedido hasta ahora su implantación.En Octubre de 2001, la Comunidad Económica Europea, Australia, Canadá y Singapur aprueban la aplicación clínica de Essure®. Este método consigue la obstrucción de la luz tubárica mediante la colocación de un dispositivo de titanio por vía histeroscópica. A priori parece reunir todas las características necesarias para sustituir a la ligadura tubárica. Así, Essure® representa una técnica que aporta eficacia y seguridad sin necesidad de intervención quirúrgica, incisiones cutáneas, ingreso hospitalario o recuperación domiciliaria. Los dos primeros estudios multicéntricos publican sus resultados en 2003. Las tasas de éxito en la colocación se sitúan alrededor del 92%, pero considerando necesaria la administración de anestesia local o general. Refieren efectos secundarios como la perforación uterina o tubárica y la expulsión inadvertida de los dispositivos hasta en un 7% de los casos, sin consecuencias graves para las pacientes. El seguimiento se realiza mediante HSG, la cual demuestra la obstrucción a los tres meses de la inserción. La eficacia contraceptiva resulta ser absoluta durante el tiempo de seguimiento medio, alrededor de tres años. Tras la experiencia en el seguimiento se decide simplificar el control de la HSG por una radiografía simple de pelvis.En Julio de 2002 se introdujo la técnica en el Instituto Universitario Dexeus bajo la premisa de no administración de anestesia y reducción de los criterios de selección. Tras dos años de experiencia con una serie de 124 pacientes, nuestras conclusiones han sido las siguientes:1- El método Essure® es un procedimiento de oclusión tubárica por vía histeroscópica de alta seguridad. No ha habido ninguna complicación ni ningún efecto secundario adverso severo en nuestra serie. 2- Hemos restringido los criterios de inclusión y exclusión para el método Essure® propuestos inicialmente, sin que ello haya supuesto menor eficacia, menor seguridad o efectos secundarios adversos intra ni postoperatorios, a corto o medio plazo, en las mujeres de nuestra serie.3- La tasa de colocación exitosa del dispositivo intratubárico Essure® ha sido de un 97.6%.4- La experiencia en histeroscopia diagnóstica desde 1980 y, especialmente, en el abordaje mediante vaginohisteroscopia desde 1997 han sido los dos pilares para la consecución de nuestros resultados con el método Essure®. 5- La duración media del procedimiento Essure® en nuestras manos ha sido un 50% inferior respecto a la media global de otros centros y ha disminuido de forma estadísticamente significativa a partir de las primeras 40 pacientes.6- El tiempo medio de recuperación tras el método Essure® en nuestras pacientes ha sido de 20 minutos, un 80% inferior a la media mundial obtenida de los datos publicados en la literatura. 7- Excepto en tres mujeres, no se aplicó anestesia local ni general. La premedicación oral con dosis únicas de un ansiolítico y un analgésico fue el único tratamiento que se ofreció a las pacientes, quienes refirieron una satisfacción "buena" o "muy buena" al procedimiento en el 95% de los casos.8- Los cuatro fallos de inserción de los dispositivos en nuestra población se dieron en las primeras 51 pacientes. A partir del caso número 52, la tasa de colocación ha sido del 100%. / Permanent contraception is the most common method for female sterilization worldwide. During the 70's decade transcervical approaches were introduced with the aim of avoiding both surgery and general anesthesia. However, failures and side effects prevented them from becoming truly spread. In October 2001 the European Economic Community, Australia, Canada and Singapur approved the clinical application of the Essure procedure. This device consists of a double expanding microcoil made of titanium and stainless steel with causes tissue ingrowth, fibrosis and late occlusion of the tubal lumen. The method is performed hysteroscopically and can be carried out in an outpatient setting. It gathers high effectiveness and safety without the need of surgery, skin incisions, hospitalization or home recovery.Two multicentre, prospective studies published their results in 2003. Rates of successful placement were around 92%, but anesthesia, either local o intravenous sedation, was considered to be necessary. Side effects as uterotubal perforation or vaginal expulsion were recorded in 0.8 to 7% of the cases, though no life-threatening events took place. Follow-up was assessed through hysterosalpingography at third month to show tubal obstruction and it was lately substituted for an abdominal simple X-ray. Efficacy in pregnancy prevention seemed to be absolute at the end of the studies. The Essure procedure was introduced in the Institut Universitari Dexeus innBarcelona (Spain) in July 2002 under the conditions of not giving anesthesia and reducing selection criteria. After a two-year experience and a series of 124 patients, our conclusions were the following:1- The Essure procedure is a safe method for tubal sterilization through hysteroscopy. No severe complications or side effects and no pregnancies have been recorded among our patients.2- Both inclusion and exclusion criteria were reduced from those proposed from multicentre studies with no decrease in effectiveness or safety, no adverse side effects, intra or postoperative, at short or medium term have taken place in our series.3- Rate of successful placement of the Essure microinsert reached 97.6%.4- The experience in diagnostic hysteroscopy since 1980 and especially vaginohysteroscopy from 1997 have shown to be of basic importance during the learning curve of the method.5- Mean operative time of the Essure procedure was 7.5 minutes, which represented 50% less than that referred by other groups and it statistically decreased since the first group of 40 patients.6- Mean recovery time after the Essure procedure was 20 minutes, which resulted to be 80% less than that referred by other groups.7- Except for three women, no general or local anesthesia was given to any patient. Oral premedication with a single dose of both anxiolytic and analgesic were the only drugs which were offered to the patients. Satisfaction was referred to be "good" or "excellent" in 95% of the procedures.8- There were four failed cases which took place among first 51 cases. From the case number 52 on, placement ate has been 100%.

Estudo transversal, abordagem quantitativa e caráter descritivo, que objetivou realizar diagnóstico situacional acerca do dispositivo intra-tubário de contracepção permanente (DIT), na perspectiva do conhecimento e satisfação das usuárias, bem como da segurança à saúde. A população foi composta por 32 mulheres, residentes em Palmas-TO e submetidas à inserção do DIT em serviço público de referência estadual. Os dados foram coletados de junho a outubro de 2017, utilizando entrevista semiestrutura e analisados no Programa Stata versão 14.0. As variáveis categóricas foram descritas por meio de proporção e as contínuas, por média e desvio padrão. Foram feitas análises de associações entre níveis de conhecimento ou satisfação de acordo com as variáveis independentes, sendo utilizado Teste de Fisher para testar as proporções e Teste Mann Whitney, para as médias. O perfil sociodemográfico mostrou mulheres com 35,2±2,9 anos de idade, maioria com parceria fixa e pardas, ensino médio como nível de escolaridade predominante e ocupavam funções variadas. A média do número de filhos foi de 2,8±1,1. A média do tempo de espera para a inserção do DIT foi de 2,5 meses. Todas as mulheres inseriram o DIT fora do período gravídico puerperal. A média de idade das mulheres à época do procedimento foi de 31,9±3 anos. A principal informação fornecida às mulheres foi sobre a definitividade do método e a liberdade de desistir a qualquer tempo antes de sua realização (96,9%). A maioria (96,9%) das mulheres participou de atividades educativas. As mulheres relataram acompanhamento por equipe multiprofissional. 96,9% realizaram o teste de gravidez. 10 (31,3%) mulheres informaram não ter realizado o teste confirmatório do DIT. Não houve consulta de retorno para 43,9 % das mulheres, principalmente pelo fato do serviço não estar funcionando (42,9%). O relato das repercussões clínicas indicou a dor durante o procedimento (n=20) como a mais comum neste estudo. Outras repercussões também foram citadas. A maioria (93,8%) das mulheres apresentaram um nível de conhecimento satisfatório em relação às características do DIT. Houve associação entre a participação na atividade educativa e o nível de conhecimento satisfatório em relação ao DIT (p=0,000). A maioria (96,9%) das mulheres também obteve conhecimento satisfatório sobe o procedimento e mecanismo de ação do DIT e acerca das recomendações antes e após o procedimento. De todas as variáveis do conhecimento, as repercussões clínicas foram as menos conhecidas pelas mulheres, sendo a maioria (84,4%) classificada com nível insatisfatório. Houve associação estatisticamente significante entre o estado civil separada e o nível de conhecimento insatisfatório com relação às repercussões clínicas do DIT (p=0,000). Ter renda maior associou-se com conhecimento insatisfatório das mulheres sobre repercussões clínicas (2.843,18±2.243,73 p= 0,031). A maioria (78,1%) das mulheres está totalmente satisfeita com o método. Ficou evidente neste estudo o vazio assistencial ocasionado pelo fechamento do serviço de referência, além de fragilidades no aconselhamento pela equipe multiprofissional, incluindo a ineficiência das atividades educativas, percebida a partir do grande número de mulheres com conhecimento insatisfatório em variáveis indispensáveis ao processo de escolha livre e esclarecida, como repercussões clínicas e contraindicações do método. / A cross-sectional study, a quantitative approach and a descriptive character, aimed at performing a situational diagnosis about the intra-tubal device of permanent contraception (ITD), in the perspective of users' knowledge and satisfaction, as well as health security. The population was composed of 32 women, living in Palmas-TO and submitted to the insertion of the DIT into a state public reference service. The data were collected from June to October 2017, using a semistructure interview and analyzed in the Stata Program version 14.0. Categorical variables were described by means of proportion and the continuous variables, by mean and standard deviation. Analyzes were made of associations between levels of knowledge or satisfaction according to the independent variables, using Fisher's test to test the proportions and Mann Whitney test for the means. The sociodemographic profile showed women with 35.2 ± 2.9 years of age, majority with fixed partnership and browns, high school as predominant level of education and occupied varied functions. The mean number of children was 2.8 ± 1.1. The mean waiting time for insertion of the DIT was 2.5 months. All the women inserted the DIT outside the puerperal pregnancy period. The mean age of the women at the time of the procedure was 31.9 ± 3 years. The main information provided to women was about the definiteness of the method and the freedom to give up at any time before its completion (96.9%). The majority (96.9%) of the women participated in educational activities. The women reported follow-up by multiprofessional team. 96.9% performed the pregnancy test. 10 (31.3%) women reported not having performed the confirmatory DIT test. There was no return consultation for 43.9% of the women, mainly because the service was not functioning (42.9%). The report of the clinical repercussions indicated pain during the procedure (n = 20) as the most common in this study. Other repercussions were also cited. The majority (93.8%) of the women had a satisfactory level of knowledge regarding the characteristics of the ITD. There was an association between participation in the educational activity and the level of knowledge satisfactory in relation to ITD (p = 0.000). The majority (96.9%) of the women also obtained satisfactory knowledge on the procedure and mechanism of action of the ITD and on the recommendations before and after the procedure. Of all knowledge variables, the clinical repercussions were the least known among women, with the majority (84.4%) classified as unsatisfactory. There was a statistically significant association between the separate marital status and the unsatisfactory level of knowledge regarding the clinical repercussions of ITD (p = 0.000). Having higher income was associated with unsatisfactory knowledge of women on clinical repercussions (2,843.18 ± 2.243,73 p = 0.031). The majority (78.1%) of women are fully satisfied with the method. It was evident in this study the assistance gap caused by the closure of the reference service, as well as weaknesses in counseling by the multiprofessional team, including the inefficiency of educational activities, perceived from the large number of women with unsatisfactory knowledge in variables indispensable to the process of free choice and clarified, as clinical repercussions and contraindications of the method.