Objective To analyze the profiles of women who accepted and who refused the insertion of the copper intrauterine device (IUD) postpartum and to learn the motivations related to the refusal of the method. Methods Cross-sectional study with 299 pregnant women. The women were informed about the possibility of inserting a copper IUD postpartum and were questioned about their interest in adopting or not this contraceptive. All participants answered a questionnaire with information relevant to the proposals of the present study. The sample size was limited to the number of devices available for the present study. Results A total of 560 women were invited to join the present study and 299 accepted. Out of the 299 women included in the present study, 175 accepted the copper IUD and 124 refused. As the number of pregnancies increased, the IUD acceptance rate raised (p = 0.002), especially between the groups with 1 and with ≥ 4 pregnancies (p = 0.013). Regarding the desire to have more children, the women who planned to have more children were more likely to refuse the method than the ones who did not (p < 0,001). Conclusion Women with multiple pregnancies and desire to not have more children were more likely to accept the copper IUD. The profile of those who refused was first pregnancy and desire to have more children. Among the three most frequent reasons reported for copper IUD rejection, two responses stood out: no specific justification and desire to have more children.

Objetivo: Apresentar um caso de melanoma de pele com metástase para o cólon expondo a evolução incomum da doença e os possíveis caminhos terapêuticos disponíveis. Descrição: Relato de caso de um paciente do sexo masculino, de 57 anos, que buscou o serviço da Santa Casa de São Paulo em 2015 com uma história prévia de melanoma em quirodactilo e antebraço ipsilaterais, foi então indicada e realizada a exérese da lesão e a biopsia identificou um melanoma acral, com margens livres. Foi então iniciado tratamento com Interferon. Nos dois anos seguintes, uma metástase pulmonar e uma recidiva na mão esquerda foram diagnosticados e ambas as biopsia confirmaram ser do melanoma.    Em 2018 uma tomografia de abdome evidenciou uma tumoração no cólon e a biopsia e imunohistoquímica confirmaram se tratar de melanoma. Foi então realizada uma cirurgia para retirada da parte afetada. Além disso, nesse mesmo ano, o paciente teve que ser submetido a amputação do braço esquerdo devido a nova recidiva local.  Em junho do ano seguinte, uma colonoscopia e uma tomografia de abdome apresentaram imagens compatível com recidiva em cólon, além de invasão gástrica e em contato com a cauda pancreática. Após reunião com a equipe de coloproctologia, foi contraindicado o procedimento cirúrgico. O paciente está recebendo cuidados paliativos da equipe da oncologia com tratamento medicamentoso.Comentários: o melanoma metastático em cólon é raro, sendo linfonodos, pulmões, fígado e cérebro os sítios mais comumente atingidos. Inúmeros trabalhos mostram o aumento da incidência mundial do melanoma. Cerca de 70% dos casos se originam de nevos melanocíticos pré-existentes, e os 30% restantes surgem de novo. Dada a agressividade do melanoma, a sobrevida depende de um diagnóstico e tratamento precoces. No entanto, em alguns casos, mesmo com o tratamento cirúrgico, quimioterápico e radioterápico adequados, a agressividade do câncer impede que tais tratamentos tenham resultados satisfatórios.Descritores: Melanoma, Neoplasias do colo, Neoplasias cutâneas, Metástase neoplásicaAbstract Objective: To present a case of metastatic skin melanoma in colon, exposing the unusual evolution of the disease and the therapeutic possibilities. Description: A report of a 57-year-old male patient that in 2015 came to Santa Casa with a previous history of ipsilateral chirodactyl and forearm melanoma. At the time it was indicated the excisional biopsy that identified acral melanoma with free margins. Interferon treatment was then started. Over the next two years, a pulmonary metastasis and a recurrence in the left hand were diagnosed and both biopsies confirmed to be melanoma. In 2018 an abdominal CT scan showed a tumor in the colon and biopsy and immunohistochemistry confirmed that it was melanoma. Surgery was then performed to remove the affected part. In addition, that same year, the patient had to undergo amputation of the left arm due to new local recurrence. In June of the following year, a colonoscopy and a CT scan showed images compatible with colon recurrence, as well as gastric invasion and contact with the pancreatic tail. After discussion with the coloproctology team, the surgical procedure was contraindicated. The patient is receiving palliative care from the oncology team using drug treatment. Comments: Metastatic melanoma in colon is quite rare, with lymph nodes, lungs, liver and brain being the most common sites of metastasis. Numerous studies show the increasing incidence of melanoma worldwide. About 70% originate from pre-existing melanocytic nevi, and the remaining 30% arise again. Given the aggressiveness of melanoma, survival depends on early diagnosis and treatment.Keywords: Melanoma, Colonic neoplasms, Skin neoplasm, Neoplasm Metastasis