Profile of women admitted with a history of induced abortion at a tertiary government hospital from 2013 to 2017 / Philippine Journal of Obstetrics and Gynecology

Introduction@#Unsafe abortion is one of the major medical and public health problems in developing countries. However, there is a lack of up‑to‑date and reliable information on induced abortion distribution and its determinant factors in the country@*Objectives@#This study determined the sociodemographic and clinical profile of women admitted for abortion at a tertiary government hospital in Cebu city from 2013‑2017@*Methods@#This study reviewed the charts in medical records of women diagnosed with abortion admitted at a government tertiary hospital from January 2013 to December 2017 with key words “abortion” in the final diagnosis@*Results@#The results of this study showed that 86% of patients who had induced abortion discharged improved from this institution, 2 patients died due to medical complications and 12% were discharged against medical advice. Majority of abortions were within early ages of gestation. Primigravidas and primiparas had the highest incidence of induced abortion 20.44% and 27.73%respectively. Of the treatments employed, the major method of abortion employed was mechanical. Majority of induced abortions did not develop septic complications@*Conclusion@#The trend in admission of induced abortions from 2013 to 2017 showed a downward trend. This decrease in incidence may be attributed to improved access to family planning methods since the Reproductive Health Law was implemented in 2014 and the introduction of the Maternal Perinatal Statistics quarterly conferences headed by Department of Health (DOH) Region 7 and the different DOH‑retained hospitals as well as BEMONC/SEMONC facilities in Cebu Province. 17. These statistical events focuses the spotlight on the importance of health education and further improvement in the provision of health care in the local setting. Moreover, further improvement in post abortive care and adequate coverage should be provided to patients with abortion to reduce the incidence of complications and potential mortality

Experiencia vivida frente al aborto inducido en un grupo de mujeres en Bogotá, Colombia / Lived Experience with Induced Abortion of a Group of Women in Bogotá, Colombia / Experiência com o aborto provocado em um grupo de mulheres em Bogotá, Colômbia

Introducción: frente al aborto inducido se han establecido diferentes posturas que muchas veces se basan en perspectivas morales, filosóficas y religiosas, cuando deberían estar centradas en lo que implica esta situación de salud en la vida de las mujeres Metodología: se desarrolló una investigación fenomenológica para establecer los diálogos desde la perspectiva de las propias protagonistas sobre el aborto inducido con una participación de siete mujeres, mayores de 18 años en Bogotá. Resultados: las experiencias de las mujeres son variadas, pero se identificaron algunos aspectos similares o comunes. Sin embargo, cada vivencia es particular y tiene como marco el contexto en el que cada una habitaba en el momento del aborto. Se identificaron las siguientes categorías de análisis: aborto como consecuencia de un embarazo no deseado, aborto como experiencia frente a una decisión autónoma, aborto, culpa y pecado, cambios asociados a la experiencia, maternidad, materialización del deseo y aborto no debe ser considerado como un delito. Conclusiones: la vivencia del aborto no puede ser generalizable, y para su entendimiento debe tenerse en cuenta aspectos que solo atañen a la mujer como experta en su vida y en su situación. El aporte de la presente investigación fue recuperar la vivencia de las mujeres sobre el aborto para contribuir al cuidado de la salud en la población femenina

Introdução: sobre o aborto provocado têm-se estabelecido diferentes posturas, muitas vezes baseadas em perspectivas morais, filosóficas e religiosas, quando deveriam estar focadas no que implica essa situação de saúde na vida das mulheres. Metodologia: desenvolveu-se uma pesquisa fenomenológica para estabelecer os diálogos na perspectiva das próprias protagonistas sobre o aborto provocado com a participação de sete mulheres, maiores de 18 anos, em Bogotá. Resultados: as experiências das mulheres são variadas, mas alguns aspectos semelhantes ou comuns foram identificados. Porém, cada experiência é particular e se enquadra no contexto em que cada uma permanecia no momento do aborto. Foram identificadas as seguintes categorias de análise: aborto como consequência de uma gravidez indesejada, aborto como experiência diante de uma decisão autônoma, aborto, culpa e pecado, mudanças associadas à experiência, maternidade, materialização do desejo e aborto não deve ser considerado como um crime. Conclusões: a experiência do aborto não pode ser generalizável e, para sua compreensão, devem ser considerados aspectos que dizem respeito apenas à mulher como especialista em sua vida e em sua situação. A contribuição desta pesquisa foi resgatar as vivências de mulheres sobre o aborto para contribuir com a atenção à saúde da população feminina.

Introduction: Regarding induced abortion, different positions have been adopted, often based on moral, philosophical, and religious perspectives, when they should be focused on what this health situation implies for women's lives. Method: A phenomenological research was conducted to establish dialogues from the own protagonists' perspective of induced abortion, where seven women over 18 years of age in Bogotá participated. Results: Women's experiences are varied, but some similar or common aspects were identified. However, each experience is specific and is framed within the context where each woman lived at the time of the abortion. The following categories of analysis were identified: Abortion as a consequence of unwanted pregnancy, abortion as an experience versus an autonomous decision, abortion, guilt and sin, changes associated with the experience, maternity, desire materialization, and abortion should not be considered a crime. Conclusions: Abortion experience cannot be generalized, and for its understanding, aspects that only concern women as the experts on their lives and situations must be taken into account. This research contribution was to restore women's abortion experiences to advance female population health care

Self-administration of MTP Pills and its Complications: An Observational Study

Background: Medical termination of pregnancy (MTP) has been legalized in India since 1971. MTP pills are well effective inthe early weeks of gestation and safe only when used under medical supervision.Aims and Objectives: The aim of the study was to find out the clinical presentations and complications following selfadministration of MTP pills.Materials and Methods: This was a retrospective observational study conducted at SMGS Hospital, Government MedicalCollege Jammu from July 2018 to June 2019. Hundred patients were included in the study. Following factors were studied suchas chief complaints, complications, treatment given, and blood transfusion.Results: Majority (57%) of patients were aged between 30 and 39 years. About 66% were gravid three or more. Only 28% hadtaken the pill within prescribed gestational age limit for MTP, i.e., <7 weeks. Mid-trimester pill intake was encountered in 14%patients. About 41% presented with incomplete abortion. Anemia was present in majority of patients and blood transfusion wasdone in 38% patients. About 24% patients presented with life-threatening shock. Sepsis was present in 5% patients. Emergencylaparotomy was required in 4% cases. Hysterotomy was done in 2% cases. Continuation of pregnancy was noted in 6% patients.Unintended pregnancy and limiting family size were main reasons for abortion 62% and 32%, respectively.Conclusions: Unauthorized over-the-counter availability despite legal ban and ignorance of women have led to increasednumber of unsafe abortions. Increasing awareness among women regarding complications of unsupervised pill intake andeasily availability of safe contraceptive methods can help control this health hazard.

Health seeking behaviour of women with unwanted pregnancies: a tertiary care centre based study of eastern Uttar Pradesh, India

Background: Termination of an unwanted pregnancy is legal in India. Many women in this region are still not aware about safe abortion services and its consequences. Especially young, economically deprived and those without a supportive male partner are at higher risk of unsafe abortion. There is no clear and established evidence on this issue in our region. In the study, the aim was to explore the health seeking behaviour of women with unwanted pregnancies.Methods: Present cross-sectional study was conducted among 303 patients visiting to obstetrics and gynecology ward of BRD Medical College, Gorakhpur from April 2018 to September 2018. Their socio demographic profile, reasons for current termination of pregnancy and health seeking behaviour was explored.Results: Most common reason given for terminating the current pregnancy was completed family size 65.3%. Unmarried girls with pregnancy were 5.6 % who wanted termination of pregnancy. Majority (67.0%) took medication for termination of pregnancy from nearby medical store without an expert consultation 15.8% of women consulted to a local quack or local dai for termination of pregnancy. 12.9% of women tried a method as advised by family/friends for termination of pregnancy. About 4% of women 1st tried traditional and herbal medicines, drinking tea or juice for termination of pregnancy. Majority of women (84.5%) visited to medical college for management of complications of earlier tried method of termination of pregnancy.Conclusions: Completed family size was found most common reason for termination of pregnancy. Self medication without consultation of authorised doctor was found most common practice of abortion leading to complications.

Unsafe abortion: the silent scourge

Background: Unsafe abortions continue to cause maternal morbidity and mortality in developing countries. The practice of unsafe abortions by quacks needs to be checked. Our study aims to emphasize upon the unmet needs of medical termination pregnancies (MTP) services in rural India and to recognize the complications due to it and the efficient management of such cases at tertiary care center.Methods: A two years retrospective study of septic abortions from December 2009 to November 2011.Results: Among 1080 abortions reported, 44 were septic-4.07%. More commonly in the age group of >20years (81.9%). 77.3% of them were multiparous and 22.7% were nulligravidae, with an increased incidence of unmarried nulliparous pregnancies. Greater numbers occurred during 1st trimester (77.2% versus 22.7%), with 54.5%-grade I, 29.5%-grade II, 15.9% grade III in severity. Majority of cases were due to evacuation by quacks (72.7%). Among the 44 cases, emergency laparotomy was done for 5 cases of grade III severity. The mortality rates due to septic abortion were 6.25% (3) among the total of 48 maternal deaths.Conclusions: Septic abortion is totally preventable. Majority of uneducated rural women are not aware of MTP services. The reproductive and child health (RCH) services should effectively reach the underprivileged population like slum dwellers and migrants.

Mayor mortalidad materna por aborto en Cuba que en Chile, 2000-2015 / Higher maternal mortality from abortion in Cuba than in Chile, 2000-2015

RESUMEN Antecedentes: La muerte materna por aborto inseguro es un severo problema de salud pública, países con leyes de aborto liberales tendrían menor riesgo de aborto inseguro y de mortalidad por aborto. Cuba tiene una legislación que no penaliza el aborto inducido, mientras en Chile es ilegal en todos los casos hasta su reciente despenalización en 3 causales. Objetivo: Se postula que Cuba tendría una menor mortalidad materna por aborto que Chile, por lo que se propone comparar la evolución de la razón de mortalidad materna por aborto entre ambos países, en el período 2000-2015. Material y Método: Los datos crudos de muertes asociadas al aborto y nacidos vivos se obtienen de las bases de datos de estadísticas vitales de ambos países. La oportunidad relativa de muerte se estima según Odds Ratio (OR) con intervalo de confianza del 95% (IC 95%) de las razones de mortalidad materna. Resultados: La razón de muerte materna asociada al aborto fue mayor en Cuba que en Chile (OR: 1,91; IC 95%: 1,331 a 2,739; p=0,0004). Se observa una tendencia al descenso en Cuba y mientras no se observan cambios en Chile. Conclusiones: Contrario a lo postulado basado en las diferentes legislaciones de ambos países, en el período 2000-2015, Cuba presentó mayor razón de mortalidad materna asociada al aborto que Chile. Se comentan posibles condicionantes de la diferencia encontrada.

ABSTRACT Background: Maternal death due to unsafe abortion is a severe public health problem; countries with liberal abortion laws would have a lower risk of unsafe abortion and abortion mortality. Cuba has a legislation that does not penalize induced abortion, while in Chile it is illegal in all cases until its recent decriminalization in 3 grounds. Objective: It is postulated that Cuba would have a lower maternal mortality due to abortion than Chile, for which purpose it is proposed to compare the evolution of the maternal mortality by abortion between both countries, in the period 2000-2015. Material and Method: Raw data on deaths associated with abortion and live births are obtained from the vital statistics databases of both countries. The relative chance of death is estimated according to the Odds Ratio (OR) with a 95% confidence interval (95% CI) of the maternal mortality. Results: The maternal death rate associated with abortion was higher in Cuba than in Chile (OR: 1.91, 95% CI: 1.331 to 2.739; p = 0.0004). A downward trend is observed in Cuba and without changes in Chile. Conclusions: Contrary to the postulate based on the different legislations of both countries, in the period 20002015, Cuba had a higher maternal mortality associated with abortion than Chile. Possible conditioning factors of the difference found are discussed.

Abortion: a look from the perspectives of public health, rights and social justice / El aborto: una mirada desde la salud pública, los derechos y la justicia social

ABSTRACT Unsafe abortion is a problem of public health, rights and social justice, particularly so for women living in developing countries. Consequently, public health is called upon to protect dignity, promote the exercise of rights and create the right conditions to ensure that women can have control over their own reproductive autonomy. The article analyses three schools of distributive justice, examines their strengths and contradictions, and concludes that capability building, with its resulting social justice, that derives from these, would be the ideal approach to the issue of abortion in medium and low income countries; and that, for a public health system intent of achieving the highest degree of health and wellbeing, it secures the basic material conditions required for capabilities to flourish becoming the best alternative for greater participation in the construction of individual life projects; it would consider the reality of the people in their sociocultural environments and would allow to pull the female world out of the private realm to allow a public debate on these matters and prevent them from being considered as "natural" unchangeable aspects of human relations. This would ensure greater relevance in terms of meeting the needs of each population. The article also highlights that the social justice that characterises this approach will not come from the top, from the State, but requires collective participation, where movements that oppose hegemony play a very important role and are active in building their own capabilities.

RESUMEN El aborto inseguro se considera un problema de salud pública, de derechos y de justicia social. Esto es particularmente certero para las mujeres que viven en países en vías de desarrollo, por lo que se requiere de una salud pública que defienda la dignidad, fomente el ejercicio de los derechos y genere las condiciones necesarias para que las mujeres sean dueñas de su autonomía reproductiva. El artículo tiene como objetivo analizar tres corrientes de justicia distributiva, examina sus fortalezas y contradicciones, y concluye que el desarrollo de capacidades y la justicia social que de este se derivan sería ideal para afrontar de mejor manera el tema del aborto en los países de medianos y bajos ingresos, y, para una salud pública que pretende el mayor grado de salud y bienestar posibles, asegura la satisfacción de todas las condiciones materiales básicas para el florecimiento de las capacidades y, por ende, sería la mejor alternativa para una mayor participación en la construcción de vidas propias; tendría presente la realidad que viven las personas en sus entornos socioculturales, y posibilitaría sacar del espacio privado el mundo femenino, permitir el debate público sobre dichas cuestiones e impedir que sigan siendo consideradas como cuestiones "naturales" e inmutables de las relaciones humanas, lo que garantizaría una mayor pertinencia en la satisfacción de las necesidades de cada población. También recalca que la justicia social que caracteriza a este enfoque no llegará de arriba, del Estado, sino que requiere de una construcción colectiva, donde los movimientos contrahegemónicos juegan un papel muy importante y hacen parte de la propia construcción de capacidades.

Contraceptive Practice of Clients Attending the Family Planning Clinic of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

Aim: To examine the socio-demographic characteristics, main source of information about family planning and contraceptive choices of women attending the family planning clinic of a tertiary hospital in Southwest Nigeria. Study Design: A retrospective descriptive analysis of the case records of all new clients. Place and Duration: Family planning clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between 1st January 2006 and 31st December 2011. Methods: This study was carried out on 733 new clients seeking contraceptive services within the study period. The age, marital status, parity, occupation, religion, ethnicity and educational level completed; source of information about family planning, interval between last confinement and first visit, and the intention of the clients were obtained. Results: A total of 733 new clients attended the family planning clinic during the period of review. There were 4145 new gynaecological consultations during the period and the contraceptive prevalence represented 17.6% of the total gynaecological consultations. The age of the clients ranged between 17 and 48 years with a mean of 32.5±5.5 years. There was a low patronage of family planning clinic by the teenagers and unmarried women as they accounted for only 0.3% and 2.9% respectively of all clients seen during the period. The source of information about family planning services was mainly from health personnel 516, (70.5%). IUCD and injectables were the most frequently selected methods irrespective of the socio-demographic characteristics of the clients, their intention for family planning uptake; and interval between last confinement and commencement of family planning. Conclusion: This study showed that unmarried females and teenagers had a poor patronage of conventional family planning centers. Instead of the health personnel, the mass media should play a pivotal and leading role in information dissemination so that awareness on the use and utilization of contraception will be higher than what it is presently.

A case report: Unsafe abortion.

Unsafe Abortion constitutes a major cause of maternal morbidity and mortality in developing countries. It is randomly practiced though exact statistics is not available due to lack of cooperation from concerned parties. Complications occur in a large portion of these cases which ultimately require tertiary care. This case report of complications associated with an unsafe abortion highlights the need for raising the awareness among women and healthcare providers regarding education on contraception and availability of safe and legal abortions with better access to abortion and post abortion services.

Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review / Determinantes sociodemográficas de abortos inseguros complicados en un poblado semiurbano de Nigeria: una revisión de cuatro anos

BACKGROUND: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70 000 women die globally as a result, with the majority occurring in the developing world. This study aims to determine the sociodemographic factors involved in complicated unsafe abortions. SUBJECTS AND METHODS: The study is a four-year retrospective evaluation of all cases of complicated unsafe abortions managed at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria between January 1, 2007 and December 31, 2010. RESULTS: The incidence of unsafe complicated abortions over the study period was 4.10% of total deliveries and contributed 14.0% of gynaecological admissions: 34.92% occurred in adolescents less than 20 years of age, of which the majority (55.55%) were secondary school students. There were 55.45% of patients who were nulliparae, 60.32% were unemployed and 69.80% were unmarried. A total of 87.30% had never used any form of contraceptive. Abortion mortality rate was 256/100 000 deliveries and the case fatality was 4.76%. It constituted 30.0% of all gynaecological deaths and 17.64% of maternal deaths during the study period. The commonest cause of death was septicaemia (66.66%). CONCLUSION: Unfavourable sociodemographic factors are major determinants of the high incidence of unsafe abortion in the Niger Delta despite strict abortion laws. Concrete measures must be put in place to address these, as unsafe abortion and its complications are a major cause ofmaternal morbidity and mortality in the environment.

ANTECEDENTES: Los abortos realizados por personas que no poseen las habilidades requeridas o en circunstancias en las quefaltan las normas médicas mínimas, o ambas, son considerados inseguros. Se estima que se realizan encima de 20 millones de abortos inseguros anualmente y aproximadamente 70 000 mujeres mueren globalmente como resultado, presentándose la mayoría de estos casos en el mundo en vías de desarrollo. Este estudio se propone determinar los factores sociodemográficos involucrados en los abortos inseguros complicados. SUJETOS Y MÉTODOS: El estudio es una evaluación retrospectiva de cuatro anos de todos los casos de abortos inseguros complicados tratados en el Hospital Docente Universitario de Niger Delta, Okolobiri, estado de Bayelsa, Nigeria, entre el 1ero de enero de 2007y el 31 de diciembre de 2010. RESULTADOS: La incidencia a lo largo del periodo de estudio fue 4.10% y contribuyó el 14.0% de los ingresos ginecológicos: 34.92% ocurrieron en los adolescentes de menos de 20 anos de edad, de los cuales la mayor parte (55.55%) eran estudiantes de escuela secundaria. Hubo 55.45% pacientes nulí-paras, 60.32% desempleadas y 69.80% solteras. Un total de 87.30% nunca había usado contraceptivo alguno. La mortalidad por aborto fue 256/100 000 partos, y la fatalidad de casos fue 4.76%. Ello constituyó el 30.0% de todas las muertes ginecológicas. La causa más común de las muertefue la septicemia (66.66%). CONCLUSIÓN: Los factores sociodemográficos desventajosos constituyen determinantes principales de la alta incidencia del aborto inseguro en Niger Delta, a pesar de sus estrictas leyes en contra del aborto. Deben tomarse medidas concretas para abordarlos, ya que el aborto inseguro y sus complicaciones constituyen una de las mayores causas de morbosidad maternal y mortalidad en el ambiente.

Prevalência e características de mulheres com aborto provocado - Favela México 70, São Vicente - São Paulo / Prevalence and characteristics of women with induced abortion - Favela México 70, São Vicente - São Paulo

No Brasil, o aborto está entre as principais causas de mortalidade materna. Pesquisas mostram que o aborto é praticado clandestinamente por mulheres de todas as classes sociais; no entanto, tem consequências desiguais, dependendo da inserção social, produzindo riscos à vida de mulheres pobres. Embora o tema venha sendo amplamente explorado nos últimos 20 anos, observou-se escassez de dados sobre mulheres de baixa renda. Desta forma, o presente estudo tem por objetivo estimar a prevalência de mulheres com aborto provocado. Arrolaram-se mulheres por inquérito domiciliar de base populacional em setores de baixa renda de São Vicente, São Paulo. Eram elegíveis as mulheres em idade fértil de 15 a 49 anos. A avaliação das razões de prevalência de mulheres com aborto provocado foi realizada por meio de modelos lineares generalizados, usando-se a regressão de Poisson com função de ligação logarítmica e variância robusta para aproximar a binomial. As variáveis que demonstraram ter maior influência no relato de aborto foram: "aceitar sempre esta prática" (IC95 por cento 2,98 - 11,02), seguida de "não ter filho nascido vivo" (IC95 por cento 1,35 - 19,78), ter de "dois a cinco nascidos vivos" (IC95 por cento 1,42 - 14,40) e ter de "seis ou mais nascidos vivos" (IC 95 por cento 1,35 - 19,78), "idade no momento da entrevista" (IC 95 por cento 1,01 - 1,07) e "renda" < R$ 484,97 (IC 95 por cento 1,04 - 2,96). É necessário campanha de grande abrangência sobre a prática do aborto, que consiga sensibilizar para esta causa todas as mulheres, sobretudo as de baixa renda, evitando assim mortes desnecessárias.

In Brazil, abortion is among the leading causes of maternal mortality. Research has shown that abortion is practiced clandestinely by women of all social classes, but has unequal consequences depending on social inclusion, producing risks to poor women. Although the issue has been widely explored in the past 20 years, there is a lack of data about low-income women. Thus, the present study aims to estimate the prevalence of women with induced abortion. Women from a population-based household survey in low-income sectors of São Vicente, São Paulo were recruited. Women of childbearing age from 15 to 49 years were eligible. The evaluation of the prevalence ratios for women with induced abortion was performed by using generalized linear models, with Poisson log-link function and robust variance to approximate the binomial. The most frequent variables that influenced reporting of abortion were: "always accept this practice" (95 percent CI 2.98 - 11.02), followed by "not having a child born alive" (95 percent CI 1.35 - 19.78), having "two to five live births" (95 percent CI 1.42 - 14.40 ), "having 'six or more live births" (95 percent CI 1.35 - 19.78), "age at interview" (95 percent CI 1.01 - 1.07) and "income" < R$ 484.97' (95 percent CI 1.04 - 2.96). A widespread campaign about the practice of abortion, which can raise awareness among women in favor of the cause, especially among those in low-income strata is necessary to prevent unnecessary deaths.

Costos de la atención postaborto en hospital es de Lima, Perú

Objetivos: Determinar el costo de atención de los abortos incompletos en los hospitales públicos y de abortos electivos en una institución privada. Diseño: Investigación prospectiva. Participantes: Mujeres con aborto incompleto. Metodología: En 120 mujeres con aborto incompleto complicado o no complicado en cuatro hospitales públicos de Lima y 40 mujeres en una clínica privada, se estableció el tiempo que demandó la atención, costo de personal, medicamentos, insumos, equipos y funcionamiento del hospital; igualmente el costo de bolsillo, transporte, cuidado de los niños y del hogar y el ingreso dejado de percibir. Todas firmaron un consentimiento informado. Principales medidas de resultados: Costos de atención. Resultados: La permanencia en tres hospitales, hasta el alta, por aborto incompleto no complicado fue alrededor de 6 horas, siendo mayor en uno de ellos por la normativa interna. En los cuatro hospitales, las complicaciones del aborto ameritaron una permanencia mayor. Las mujeres de aborto electivo requirieron la mitad del tiempo de aquellas con aborto incompleto no complicado en los hospitales. El costo total para la atención de abortos incompletos no complicados fue similar en los cuatro hospitales, entre US$ 110 y US$ 150; y para abortos complicados varió entre US$ 376 y US$ 858. El costo total de atención de los abortos electivos fue similar a la atención del aborto no complicado en los hospitales. Conclusiones: La permanencia de las mujeres con aborto no complicado fue relativamente corta en los hospitales. El costo de atención de los abortos complicados y no complicados demandó un monto importante para los hospitales y las propias mujeres. Los costos del aborto electivo estuvieron al alcance de las mujeres y ninguno de ellos evidenció complicación alguna.

Objectives: To determine care costs of incomplete abortions at public hospitals and elective abortions at a private institution. Design: Prospective study. Participants: Women with incomplete abortion. Methods: In 120 women with either complicated or non-complicated incomplete abortion in four public hospitals and 40 women in a private hospital, time for attention, cost of personal, drugs, materials, equipments and hospital functioning were determined; also pocket cost, transportation, children and home care and non-perceived income. All women signed informed consent. Main outcome measures: Care costs. Results: Hospital stay at three hospitals for non-complicated incomplete abortion until discharge was about 6 hours, more in one hospital because of internal norms. Abortion complications at the four hospitals required longer stay. Women with elective abortion required half the time of those with non-complicated incomplete abortion at hospitals. Total cost for non-complicated incomplete abortions care was similar at the four hospitals, between US$ 110 and US$ 150, and for complicated abortions between US$ 376 and US$ 858. Elective abortions care total cost was similar to that of non-complicated abortions care at hospitals. Conclusions: Non-complicated abortion stay of women was relatively short at hospitals. Complicated and non-complicated abortions care demanded an important cost for hospitals and women themselves. Elective abortion costs were accesible to every woman and none had complications.

Estrategia FIGO para la prevención del aborto inseguro: experiencia en Colombia / Experience in Colombia regarding the FIGO strategy for preventing unsafe abortion

Objetivo: analizar la situación del aborto inseguro en Colombia para establecer: consecuencias, factores determinantes y calidad de la atención e identificar los puntos susceptibles de intervención, para elaborar un plan de acción tendiente a reducir los embarazos no deseados, abortos provocados y sus consecuencias. Materiales y métodos: estudio cualitativo con un componente de revisión de material bibliográfico y otro de consenso de expertos. Se llevó a cabo en dos fases. En la fase 1, de análisis situacional, se recolectó información mediante el formato elaborado por el grupo de trabajo de FIGO (Federación Internacional de Ginecología y Obstetricia). En la fase 2, de elaboración del plan de acción utilizando un marco lógico, se reunieron los representantes de OPS (Organización Panamericana de la Salud), UNFPA (Fondo de Población de las Naciones Unidas), filiales de IPPF (Federación Internacional de Planificación Familiar), ONG locales y agencias del gobierno. Resultados: el análisis situacional se resume en tres ejes: embarazo no deseado, intervenciones para su prevención y aborto. En el plan de acción se definieron cuatro objetivos específicos: mejorar el acceso a los servicios de salud sexual y reproductiva; facilitar el acceso a la interrupción voluntaria del embarazo acorde con la Sentencia C-355 de 2006; promover el acceso al misoprostol para usos ginecoobstétricos; y mejorar la información sobre tasas y complicaciones asociadas al aborto inseguro. Conclusión: a pesar del avance en Colombia con la Sentencia C-355 de 2006, aún persisten grandes retos, tales como reglamentar opciones de fácil acceso al servicio de interrupción voluntaria del embarazo para mujeres víctimas del conflicto armado, protocolos de investigación al interior de los tribunales de ética médica para los asuntos relacionados con objeción de conciencia, clarificar la autonomía y capacidad de menores de catorce años.

Objective: analyzing the situation regarding unsafe abortion in Colombia for establishing its consequences, determinant factors and the quality of attention as well as identifying susceptible intervention points for preparing a action plan aimed at reducing unwanted pregnancies, provoked abortions and their consequences. Materials and methods: this was a qualitative study, having a bibliographic material review component and another regarding expert consensus. It was carried out in two phases: 1. A situational analysis: information was compiled by using a form drawn up by the International Federation of Gynecology and Obstetrics (FIGO) working group; and 2. Preparing an action plan using a logical framework. A meeting was held with representatives from the Pan-American Health Organization (PAHO), the United Nations Population Fund (UNFPA), International Planned Parenthood Federation (IPPF) affiliates, local NGOs and government agencies. Results: the situational analysis revealed three areas of interest: unwanted pregnancy, prevention interventions and abortion. Four specific objectives were defined in the action plan: a) Improving access to sexual and reproductive health services; b) Facilitating access to voluntary interruption of pregnancy according to ruling C-355/2006; c) Promoting access to misoprostol for gynecobstetric use; and d) Improving information about unsafe abortion associated rates and complications. Conclusion: in spite of advances having been made in Colombia via ruling C-355/2006, there are still great challenges to be faced, such as establishing regulations for female victims of armed conflict, options for gaining easy access to the voluntary interruption of pregnancy service, research protocols within medical ethics’ tribunals for matters related to conscientious objection, clarifying the autonomy and ability of minors aged less than fourteen.

Uterine Perforation with Bowel Infarction in a case of Unsafe Abortion.

We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.