BACKGROUND: Physical therapists provide treatment for pain and other common complaints for women in the postpartum period, thereby contributing to the improvement of their functioning. However, before applying any interventions, physical therapists should assess their patients to identify the desired therapeutic goals. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for documenting functioning data and operationalizing collaborative goal setting.
OBJECTIVE: To identify ICF categories and the respective domains that should be considered in the evaluation of women postpartum.
METHODS: A consensus-building, three-round e-mail survey was conducted using the Delphi method. The sample included Brazilian physical therapists with expertise in women\'s health. Meaningful content was analyzed in accordance to the ICF linking rules. The kappa coefficient and content validity index (CVI) were calculated.
RESULTS: The panel consisted of 45 participants with a median age of 33 years and more than 10 years of experience in women\'s health. A total of 1261 meaningful contents were identified from the responses in the first round. After consensus was achieved, a final list of 62 items was prepared, including 53 categories (11 were on structures; 15 on body functions; 12 on activities and participation; 15 on environmental factors) and nine personal factors (CVI=0.89).
CONCLUSIONS: From the perception of physical therapists, an ICF-based postpartum assessment to describe functioning and disability must comprise 53 ICF categories and nine personal factors.

OBJECTIVE: Pregnancy and puerperium are considered a risk situation in women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Therefore, specialized assessment is essential both preconception and during pregnancy and the puerperium. Likewise, it is very important that different specialists in autoimmune diseases and high-risk pregnancies participate in the follow-up of these patients in a coordinated manner. The Spanish Society of Gynaecology and Obstetrics, the Spanish Society of Internal Medicine, and the Spanish Society of Rheumatology have set up a working group for the preparation of three consensus documents.
METHODS: The stages of the work were: distribution of work in three groups corresponding to the three periods related to pregnancy (preconception, during pregnancy and childbirth and puerperium), identification of key areas, exhaustive review of the literature and formulation of recommendations.
RESULTS: This first document includes the 48 recommendations that address aspects related to infertility, the need for and treatments for gonadal preservation and preconception assessment.
CONCLUSIONS: These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with SLE/APS during pregnancy.

Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence-based methodology.
We followed the Grading of Recommendations, Assessment, Development and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews and writing recommendations based on the quality of available scientific evidence.
We suggest using magnetic resonance or computed tomographic angiography for confirming the diagnosis of CVT and not routinely screening patients with CVT for thrombophilia or cancer. We recommend parenteral anticoagulation in acute CVT and decompressive surgery to prevent death due to brain herniation. We suggest preferentially using low-molecular-weight heparin in the acute phase and not direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that, in women who have suffered a previous CVT, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular-weight heparin should be considered throughout pregnancy and puerperium.
Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT.

Elective surgical sterilization, while an alternative to traditional contraceptive methods, is a serious matter to be approached with complete information. Too often patients, particularly poor black patients, are pressured into accepting sterilization without full knowledge of its irreversible nature. 2 factors apparently have contributed toward violations of poor patient\'s rights. The first is that surgery specialty and subspecialty boards encourage operations by stipulating the number of operations at which candidates must assist or perform. Second, surgical teaching programs are having increasing difficulties finding subjects to learn on. As a consequence, residents in many city hospitals have resorted to considerable pushing and hard-selling of elective sterilization to women. Fortunately, the courts have begun to require greater disclosure of the benefits, risks, and alternatives to sterilization than has been the practice at many hospitals. Following are some guidelines a woman should consider before consenting to sterilization: 1) all such operations should be considered nonreversible; 2) women under 30 are more likely to regret sterilization than those over 30; 3) one should try other contraceptive methods first; 4) one should beware of doctors pushing sterilization; 5) sterilization is not a completely safe, problem-free method of birth control; 6) do not be hasty.

We have recorded the duration of lactational anovulation and amenorrhoea in a well-nourished group of Australian women who breastfed their babies throughout the study. The data enabled us to compare the theoretical cumulative probability of conception among breastfeeding women who had unprotected intercourse irrespective of their menstrual status with that of those who had unprotected intercourse only during lactational amenorrhoea. Breastfeeding alone is not an effective form of contraception, since all the women in our study resumed normal ovulation while still breastfeeding. However, among women who have unprotected intercourse only during lactational amenorrhoea but adopt other contraceptive measures when they resume menstruation, only 1.7% would have become pregnant during the first 6 months of amenorrhoea, only 7% after 12 months, and only 13% after 24 months. Thus for our women it would be possible to extend the Bellagio Consensus Conference guidelines which stated that lactational amenorrhoea can only be relied on as a contraceptive for the first 6 months post-partum in women who are fully or almost fully breastfeeding. The lactational amenorrhoea method can be relied on for excellent contraceptive protection in the first 6 months of breastfeeding, irrespective of when supplements are introduced into the baby\'s diet; for women who continue to breastfeed the method can also give good protection for up to 12 months post partum. Once menstruation has returned, other forms of contraception are essential to prevent pregnancy.
The Bellagio Consensus Conference on breast feeding as a family planning method determined that a mother who is breast feeding and remains amenorrheic has a 98% rate of protection from pregnancy for 6 months postpartum. A prospective study of the duration of lactational anovulation and amenorrhea was conducted by recruiting 101 breast- feeding women before their infants were 6 weeks old. Salivary progesterone (2-4 times a week) and in a subgroup urinary estrogen and pregnanediol excretion rates 1 mg/24 hours indicated ovulation) were determined to check ovarian activity. The mean duration of amenorrhea was 9.5 months in 101 women, and anovulation lasted 10.6 months in 89 women. The mean age of infants was 5.3 months at the start of supplementary feeding. The probability of pregnancy was less than 3 months for 50% of nonlactating women, and 6 months for 85%. In contrast, the probability was 12 months postpartum for 50% of breast- feeding women. Thus, breast feeding was not a reliable form of contraception. Only 1.7% of breast-feeding women using contraception were likely to get pregnant by 6 months, 7% by 12 months, and 13% by the end of 2 years. The results were calculated from the incidence of potentially fertile ovulations prior to the 1st menses over 2-month (1- 12 months) or 3-month (13-24 months) intervals by proportional hazards modeling. In this sample of well-nourished women longer breast feeding could induce prolonged lactational amenorrhea with a major contraceptive effect for up to 12 months or more even after supplements were introduced. The lactational amenorrhea method is appropriate for women in traditional societies who tend to breast feed longer. It helps attain a 2-year birth interval, reduces the risk of maternal breast cancer, and the risk of gastrointestinal infections in infants.