Reflexões da pandemia de COVID-19: a tomada de decisão médica na abordagem terapêutica pós-aborto em dois hospitais públicos do Distrito Federal / Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil / Reflexiones de la pandemia de COVID-19: toma de decisiones médicas en el abordaje terapéutico postaborto en dos hospitales públicos del Distrito Federal, Brasil

Objetivo: identificar possíveis alterações da tomada de decisão médica para esvaziamento uterino pós-aborto de primeiro trimestre no cenário da COVID-19em dois hospitais públicos do Distrito Federal. Metodologia: abordagem qualitativa, que usou dois procedimentos metodológicos­documental e entrevistas­,cuja coleta de dados ocorreu entre maio e junho de 2022. No hospital A, coletou-se, em 25 registros consecutivos do livro do centro cirúrgico, a técnica de esvaziamento uterino pós-aborto prevalecente em 2020. No hospital B, coletou-se o mesmo dado em 48 prontuários clínicos, 23 de 2019 e 25 de 2020. As entrevistas semiestruturadas foram realizadas com onze profissionais de saúde: três médicos, quatro enfermeiros e quatro técnicos de enfermagem, lotados na obstetrícia/centro cirúrgico de cada hospital. Resultados: ambos os hospitais, no recorte temporal do estudo de 2019 a 2020, dispuseram de insumos para a eleição por quaisquer das técnicas de esvaziamento uterino. No hospital A, em 2020, a tomada de decisão médica foi 100% pela aspiração manual intrauterina. Em2019, no hospital B, a eleição foi 100% pela dilatação e curetagem; em 2020, período da COVID-19, apesar da dilatação e curetagem manter-se prioritária em 78% dos casos, notabilizou redução em relação a 2019. Evidenciou-se, ainda, no hospital B um maior quantitativo de atendimentos e internações de mulheres em processo de pós-aborto, se comparado como período anterior à COVID-19. Conclusão: o fator determinante para a tomada de decisão médica em ambos os hospitais é a aptidão técnica do médico para a abordagem eleita.

Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.

Objetivo: identificar posibles cambios en la toma de decisiones médicas al elegir la técnica de evacuación endouterina después de un aborto en el primer trimestre en el escenario COVID-19en dos hospitales públicos del Distrito Federal. Metodología:enfoque cualitativo, que utilizó dos procedimientos metodológicos, documentos y entrevistas, cuya recolección de datos se realizó entre mayo y juniode 2022. En el hospital A se recogió la técnica de evacuación endouterina postaborto prevalente en el año 2020 en 25 registros consecutivos del libro del centro quirúrgico, en el hospital B se recogieron los mismos datos en 48 historias clínicas, 23 del 2019 y, 25 del año 2020. Se realizaron entrevistas semiestructuradas a once profesionales de la salud: tres médicos, cuatro enfermeras y cuatro técnicos de enfermería, trabajando en el centro obstetricia/quirúrgico de cada hospital. Resultados:ambos hospitales en el período de estudio, 2019 y 2020, contaron con insumos disponibles para elegir cualquiera de las técnicas de evacuación endouterina. En el hospital A, en 2020, la toma de decisiones médicas se basó en la aspiración intrauterina manual. En 2019, en el hospital B, la elección fue del 100% para dilatación y legrado; En 2020, durante el período COVID-19, a pesar de que la dilatación y el legrado siguieron siendo una prioridad en el 78% de los casos, hubo una reducción notable en relación a 2019. En el hospital B, también hubo un mayor número de consultas y hospitalizaciones de mujeres en proceso postaborto, en comparación con el período anterior al COVID-19. Conclusión: el factor determinante para la toma de decisiones médicas en ambos hospitales es la capacidad técnica para realizar la técnica elegida.

Actitudes hacia el aborto deseado en estudiantes de ciencias de la salud chilenos / Attitudes towards wanted abortion among Chilean health sciences students

Introducción: La interrupción del embarazo mediando principalmente la voluntad de la mujer, es decir, cuando una mujer desea abortar para terminar su embarazo por cualquier razón, es un procedimiento controversial. Las actitudes individuales de los profesionales de la salud hacia este procedimiento influirían sobre la aceptación o el rechazo de realizarlo y, por ende, afectarían su acceso en el sistema de salud. Objetivo: Relacionar actitudes hacia la interrupción del embarazo con características sociodemográficas y académicas de estudiantes chilenos de enfermería, medicina y obstetricia y puericultura. Método: Estudio cuantitativo con diseño observacional, transversal y descriptivo. Reclutamos estudiantes universitarios con un muestreo no probabilístico. Recolectamos datos mediante cuestionarios virtuales autoadministrados. Preguntamos por la intención de realizar o asistir un aborto médico o quirúrgico frente a 15 escenarios distintos y creamos un índice con estas respuestas. Calculamos estadísticas descriptivas básicas y creamos modelos de regresión lineal. Consideramos significancia estadística si p < 0,05. Resultados: Participaron 229, 306 y 233 estudiantes de enfermería, medicina y obstetricia y puericultura, respectivamente (en total, 768). En el modelo de regresión lineal múltiple, declararse cristiano (β = −0,248) y afirmar que la religión es muy o totalmente importante en la vida (β = −0,269) se asociaron más fuertemente y de manera inversa y significativa con el índice de intención de realizar o asistir un aborto médico o quirúrgico. Conclusiones: La religión es un factor que influiría decisivamente sobre las actitudes hacia la interrupción del embarazo. Los escenarios más positivamente valorados podrían explicarse considerando que las leyes reflejarían los valores predominantes de una sociedad.

Introduction: Termination of pregnancy mediated primarily by the womans will, i.e., when a woman wishes to have an abortion to terminate her pregnancy for any reason, is a controversial procedure. The individual attitudes of health professionals towards this procedure would affect the degree of acceptance or rejection of performing this procedure and, therefore, would affect its accessibility in the health system. Objective: To relate attitudes towards abortion with sociodemographic and academic characteristics of Chilean nursing, medicine and midwifery students. Method: Quantitative study with observational, cross-sectional and descriptive design. We recruited university students with non-probabilistic sampling. We collected data through self-administered virtual questionnaires. We asked about the intention to perform an abortion in 15 different scenarios and created an index with these responses. We calculated basic descriptive statistics and created linear regression models. We considered statistical significance if p < 0.05. Results: 229, 306 and 233 students from nursing, medicine and midwifery participated, respectively (total: 768). In the multiple linear regression model, declaring oneself a Christian (β = −0.248) and stating that religion is very or totally important in life (β = −0.269) were inversely and significantly associated with the index of intention to perform an abortion. Conclusions: Religion is a factor that would decisively influence attitudes toward termination of pregnancy. The more positively valued scenarios could be explained by considering that laws would reflect the predominant values of a society.

Conocimientos sobre el aborto inducido y opiniones sobre el uso del misoprostol en Aguascalientes / Knowledge about induced abortion and opinions about the use of misoprostol in Aguascalientes

Resumen Antecedentes: El misoprostol es un medicamento de fácil acceso con el que se puede tener un aborto seguro. Objetivo: Explorar los conocimientos sobre la situación legal del aborto en el Estado de Aguascalientes, en donde el aborto está penalizado, así como los conocimientos y opiniones sobre el misoprostol. Método: Se aplicó un cuestionario en línea a 208 adultos. Resultados: La mayoría de las participantes no conocía la situación legal del aborto ni del Estado de Aguascalientes ni del país. Cerca de la mitad conocía el misoprostol, y sus principales fuentes de información fueron Internet y redes sociales. Aproximadamente la mitad de estos participantes no supo qué complicaciones puede ocasionar que requieran atención médica. Conclusión: El conocimiento sobre la situación legal del aborto y sobre el uso del misoprostol como método abortivo es limitado. Existe consciencia de la importancia de la supervisión médica cuando se usa, aunque esta se dificulta debido a la ilegalidad del aborto en Aguascalientes.

Abstract Background: Misoprostol is an easily accessible medication with which to have a safe abortion. Objective: To explore knowledge about the legal situation of abortion in the state of Aguascalientes, where abortion is criminalized, as well as knowledge and opinions about misoprostol. Method: An online questionnaire was administered to 208 adults. Results: Most of the participants did not know the legal situation of abortion neither in the state of Aguascalientes nor in the country. Almost half of them knew about misoprostol, and their main sources of information were the Internet and social networks. About half of these participants did not know which are the complications that misoprostol may cause that require medical attention. Conclusion: Knowledge about the legal situation of abortion and about the use of misoprostol as an abortion method is limited. There is awareness of the importance of medical supervision when misoprostol is used, but obtaining this supervision is difficult due to the illegality of abortion in Aguascalientes.

Characterizing two models for abortion care in Argentina pre-Law 27.610: 2016-2019 / Utilización de dos modelos en la atención al aborto en Argentina pre-Ley 27.610: 2016-2019

ABSTRACT OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

RESUMEN OBJETIVO Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016-2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba chi-cuadrado. RESULTADOS En el 2016, 37 personas por cada 100,000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100,000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100,000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0.2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas.

Conocimientos y actitudes sobre interrupción voluntaria del embarazo en estudiantes de una Universidad de Cartagena (Colombia) / Knowledge and attitudes regarding interruption of pregnancy in students of a University in Cartagena (Colombia)

Introducción: La interrupción voluntaria del embarazo es un asunto político que polariza las opiniones y genera controversias entre el sector salud, social, económico y cultural. Objetivo: Determinar el nivel de conocimiento y actitudes sobre la interrupción voluntaria del embarazo en estudiantes de dos programas de Ciencias de la Salud de Cartagena. Materiales y métodos: Estudio descriptivo transversal, se aplicó el cuestionario adaptado por Marceliano y Medrano a 231 estudiantes de Enfermería y Medicina, los datos se analizaron obteniendo frecuencias relativas y absolutas. Resultados: El nivel de conocimiento de los estudiantes fue alto con 92,20% (213). Sin embargo, el 37,2% (86) no sabía cuáles eran las tres causales para que el aborto no se considere un delito. El 56,7% asume actitudes negativas hacia firmar una petición para legalizar el aborto y el 18,8% considera que si una mujer se realiza un aborto debe ir a la cárcel. Conclusión: El nivel de conocimiento de los estudiantes de medicina y enfermería es alto, sin embargo, los patrones muestran desconocimiento sobre las causales de legalización del aborto de acuerdo con la norma vigente y una variabilidad de actitudes positivas y negativas ante la interrupción voluntaria del embarazo.

Introduction: Voluntary interruption of pregnancy is a political issue that polarizes opinions and generates controversy within the health, social, economic, and cultural sectors. Objective: To determine the level of knowledge and attitudes regarding voluntary interruption of pregnancy in university students from two Health Sciences programs of Cartagena. Materials and methods: A descriptive cross-sectional study; the questionnaire adapted by Marceliano and Medrano was given to 231 students within the Nursing and Medical programs; the data was analyzed through relative and absolute frequencies. Results: The level of knowledge of the students was high with a 92.20% (213). Yet, a 37.2% (86) did not know the three reasons why abortion is not considered a crime. 56.7% have negative attitudes regarding signing a petition to legalize abortion and an 18.8% believe that a woman who has an abortion should go to jail. Conclusion: The level of knowledge in medical and nursing students is high, yet the patterns show lack of knowledge of the reasons for legalization of abortion according to the current laws and a variety of positive and negative attitudes regarding the voluntary interruption of pregnancy.

Analysis of induced abortion among adolescents in Guangzhou from 2015 to 2019 / 中国学校卫生

Objective@#To explore trends of adolescent induced abortion in Guangzhou, and to provide a reference for female adolescents induced abortion prevention and reproductive health promotion.@*Methods@#A retrospective survey was conducted to collect information regarding basic characteristics, frequency of induced abortion and risk factors of 7 648 adolescents aged 12-24 years who received induced abortion in one maternal and child health care hospital during 2015 to 2019. Chi square test and trend analysis were carried out for data analysis.@*Results@#Adolescents with first pregnancy, nulliparity and first abortion accounted for 61.28 %, 81.63%, 71.82%, respectively; a total of 1 251 adolescents aged 12-19 had induced abortion, accounting for 16.36%, and 6 397 adolescents aged 20-24 had induced abortion, accounting for 83.64%, the number of pregnancy, parity, and induced abortion in aged 20-24 was higher than that in the aged 12-19, and the differences were statistically significant ( P ＜0.05). The proportion of the aged 12-19 showed an overall downward trend in each year, while that of aged 20-24 showed an overall upward trend, and there was a statistically significant difference between the two groups ( χ 2 trend =22.99, P <0.01); the first pregnancy accounted for 61.28 %, and the number of pregnancies showed an overall upward trend ( χ 2 trend =9.06, P <0.05). The proportion of repeated abortion did not increase significantly, but the proportion of recurrent repeated abortion (within one year) showed an upward trend ( χ 2 trend = 6.69, P <0.05). The proportion of adolescents with reproductive tract infection showed a downward trend ( χ 2 trend =4.91, P < 0.01 ).@*Conclusion@#The proportion of induced abortion in first pregnancy and nulliparrous female adolescents is relatively high and showed an upward trend, which may be related to insufficient reproductive health knowledge and the lack of reproductive health education from society, school and family. Necessary resources should be devoted to adolescents with recurrent repeated abortion, as well as adolescent reproductive health education, post abortion and medical care, the decrease in the rate of reproductive tract infection in adolescents suggests that the awareness of reproductive tract infection prevention has been improved.

Awareness of AIDS and use of condom among middle school students who have induced abortion in Yuyao City, 2016-2020 / 中国学校卫生

Objective@#To understand the use of condom among middle school students after outpatient abortion operation, so as to provide a basis for safe sex education and intervention.@*Methods@#The questionnaire survey on condom use was conducted among the middle school students who had abortion operation in obstetric and gynecologic out patient clinic of Yuyao People s Hospital from 2016 to 2020. Group differences were compared by using Chi square test.@*Results@#A total of 274 middle school students were investigated. The awareness rates on "AIDS can be transmitted through sexual contact" and "correct use of condoms can reduce the risk of AIDS through sexual transmission" were 93.80% and 91.24% respectively. The rate of condom s usage was 17.88% in the past 6 months, 5.47% of participants used condoms every time, 12.41% used condoms occasionally, and 82.12% never used condoms. About 18.37% of participants who used condoms every time or occasionally could use correctly. The top three reasons were "I don t think it s so coincidental to get pregnant once in a while" (16.44%), "I think it s very troublesome to use it" (14.67%), "I didn t expect to use it, let alone prevent diseases" (14.22%).@*Conclusion@#Yuyao City flow of students related AIDS knowledge awareness rate is high, and the condom utilization rate, the correct utilization rate is very low. According to the main reasons of not wearing condoms, do a good job of the correct use of condom publicity, through targeted sex education and intervention, to achieve the purpose of from "knowledge" to "faith" and ultimately to "practice".

Effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion / 中国基层医药

Objective:To investigate the effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion.Methods:A total of 260 women who underwent painless abortion under ultrasound surveillance in The Second Hospital of Jiaxing from January 2019 to January 2021 were included in the ultrasound group. An additional 260 women who underwent minimally invasive endoscopic visual abortion were included in the endoscopy group. Operation-related indexes were compared between the two groups. Menstrual re-fluid time, vaginal bleeding time, postoperative abdominal pain and the incidence of postoperative intrauterine adhesion were compared between the two groups.Results:Operative time in the endoscopy group was significantly shorter than that in the ultrasound group [(3.37 ± 0.84) minutes vs. (6.59 ± 2.03) minutes, t = 23.68, P < 0.001]. The amount of intraoperative blood loss in the endoscopy group was significantly less than that in the ultrasound group [(15.87 ± 5.65) mL vs. (33.04 ± 10.44) mL, t = 23.33, P < 0.001]. Postoperative vaginal bleeding time and menstrual re-fluid time in the endoscopy group were (3.16 ± 1.58) days and (30.37 ± 6.13) days, respectively, which were significantly shorter than those in the ultrasound group [(4.23 ± 1.83) days, (32.07 ± 4.25) days, t = 7.10, 3.69, P < 0.001]. There were no significant differences in the severity and duration of postoperative abdominal pain between the two groups (both P > 0.05). Complete abortion rate in the endoscopy group was significantly higher than that in the ultrasound group [98.85% vs. 96.15%, χ2 = 3.86, P < 0.05]. The incidence of complications in the endoscopy group was significantly lower than that in the ultrasound group (2.31% vs. 5.77%, χ2 = 4.01, P < 0.05). There was no significant difference in the incidence of postoperative intrauterine adhesion between the endoscopy and ultrasound groups (1.15% vs. 3.46%, P > 0.05). Conclusion:Both minimally invasive endoscopic visual abortion and B-ultrasound-guided painless abortion have painless effects. Minimally invasive endoscopic visual abortion produces less postoperative impact, leads to better postoperative recovery, and is safer than B-ultrasound-guided painless abortion.

Dilemas clínicos en la constitución de la tercera causal de la interrupción voluntaria del embarazo / Clinical dilemmas derived from the need to certify rape for voluntary pregnancy interruption

Since 2017, women in Chile are allowed to interrupt voluntarily a pregnancy on three grounds: 1) When a woman's life is at risk due to the pregnancy, 2) When there are fetal anomalies incompatible with life, or 3) When pregnancy is result of rape. Women who qualify for any of these three pregnancy interruption requirements are entitled to a psychosocial accompaniment program to promote an integrative approach. In this article we will discuss the role of the psychosocial team in cases of rape resulting pregnancy. Specifically, the clinical and ethical dilemmas posed by the need to certify the rape in a general hospital such as difficulties in assessment of the story's plausibility, clinician's dual role and the limits to confidentiality, are discussed.

Interrupción voluntaria del embarazo en Latinoamérica, superando barreras / Voluntary interruption of the pregnancy in Latin America, overcoming barriers

Resumen Introducción: El embarazo no planeado o no intencional y el aborto son situaciones que afectan la vida de mujeres a nivel mundial, sin distinción de etnia, edad, riqueza, o ubicación geográfica, sin embargo, tiene una mayor posibilidad de presentarse y generar consecuencias negativas en mujeres con ciertas determinantes sociales. Objetivo: Mostrar el estado actual de la interrupción voluntaria del embarazo en países de Latinoamérica y del Caribe con énfasis en el reciente avance de la legislación argentina sucedido durante diciembre del 2020. Metodología: Se realizó una búsqueda no estructurada de información sobre la legislación del aborto en países de Latinoamérica y del Caribe y se hizo una revisión de tema sobre aspectos actuales y relevantes de la interrupción voluntaria del embarazo. Conclusiones: Es necesario que prestadores de servicios de salud y sociedad latinoamericana repasen las lecciones aprendidas de diferentes países sobre las consecuencias negativas para la salud de las mujeres y sus familias debido a las restricciones para acceder al aborto seguro. El mejoramiento de la calidad y las capacidades de los sistemas de salud en los países de bajos y medianos recursos, con mayor inversión e investigación en temas de salud sexual y reproductiva, resultará en la eliminación de barreras e inequidades en la prestación de atención médica a las mujeres, respetando sus derechos y autonomía.

Abstract Introduction: Unplanned or unintended pregnancy and abortion are situations that affect the lives of women worldwide without distinction of ethnicity, age, economic level, or geographical location. However, they have a greater probability of occurring and negative consequences in women with certain social determinants. Objective: Our main objective is to show the current state of the Voluntary Interruption of Pregnancy in Latin American and Caribbean countries with special emphasis on the recent advance of the legislation of Argentina that occurred last December. Methodology: An unstructured search for information about Abortion Legislation in Latin American and Caribbean countries was carried out and a subject revision on current and relevant aspects of Voluntary Interruption of Pregnancy was made. Conclusions: It is necessary that as Health Service providers and as a Latin American Society, we review the lessons learned from different countries about the negative consequences on the health of women and their families due to the restrictions for accessing legal abortions. Improving the quality and capacity of the health system in low- and middle- income countries, in addition to greater investment and research in sexual and reproductive health issues, will derive a removal of barriers and inequity related to the provision of medical attention for women while respecting their rights and autonomy.

Clinical analysis of pregnancy termination in 167 pregnant women with cardiovascular disease during the first and second trimester / 中华妇产科杂志

Objective:To study the risk assessment, method selection and clinical management of pregnancy termination during the first and second trimester of pregnant women with cardiovascular disease.Methods:This study focused on pregnant women with cardiovascular diseases who were admitted to Beijing Anzhen Hospital during the first and second trimester of pregnancy from January 2016 to September 2019, to summarize their clinical characteristics, reasons and methods of pregnancy termination, management and outcomes.Results:Among 167 pregnant women, 119 cases (71.3%, 119/167) were in early pregnancy and 48 cases (28.7%, 48/167) were in middle pregnancy. The reasons for termination of pregnancy were cardiovascular disease (109 cases; 65.3%, 109/167), unwanted pregnancy (54 cases; 32.3%, 54/167) and other reasons (4 cases). Vacuum aspiration was performed in 98 cases and forceps curettage was performed in 19 cases, medical abortion was performed in 2 cases in early pregnancy. There was no change in cardiac function after pregnancy termination and all survived in early pregnancy. In the second trimester, 16 cases were induced by intraamniotic injection of ethacridine, 2 cases by water balloon, 1 case by oxytocin intravenous drip, and 29 cases by hysterotomy delivery. The ratio of patients with hysterotomy delivery with cardiac function grade Ⅲ-Ⅳ was significantly higher than that in the patients with vaginal labor induction in the second trimester [79% (23/29) vs 4/19; P<0.01]; the ratio of pregnancy risk grade Ⅳ-Ⅴ was also significantly higher [100% (29/29) vs 14/19; P=0.007]. The mean length of hospital stay of patients with hysterotomy delivery was significantly longer than that in the patients with vaginal labor induction [(7.1±3.4) vs (2.4±1.8) days; P<0.01]. Cardiac function was improved in 4 patients induced by ethacridine and rapid recovery without serious complications. Cardiac function decreased in 5 cases and 1 case died on the first day after hysterotomy delivery. Conclusions:Pregnancy risk assessment should be conducted as early as possible in patients with cardiovascular disease. If it is not suitable to continue the pregnancy, terminate pregnancy as early as possible to reduce the risk. Pregnancy termination methods and analgesic methods should be selected according to different gestational age and complications. The indications for hysterotomy delivery should not be relaxed at will, so as to minimize trauma and hemodynamic changes. After the termination of pregnancy, contraceptive measures should be implemented and the next treatment plan should be guided.

Efficacy and safety of naborphine versus dizocine in painless visual anesthetics induced abortion / 中国基层医药

Objective:To investigate the efficacy and safety of naborphine versus dezocine in painless visual anesthetics induced abortion. Methods:A total of 120 patients who underwent painless visual anesthetics induced abortion in Zhongshan City People's Hospital and Zhongshan Shaxi Longdu Hospital, China during January to September in 2020. They were randomly assigned to receive intravenous naborphine hydrochloride injection (0.15 mg/kg, naborphine group) or dezocine injection (5 mg, dezocine group), followed by intravenous propofol (2 mg/kg). When the eyelash reflex disappeared, surgery was initiated. If there were body movements, 30-50 mg propofol was added as appropriate. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, and heart rate before anesthesia (T 0), at 3 minutes after the beginning of surgery (T 1), and during recovery (T 2) were compared between the two groups. The time to regain consciousness, postoperative visual analogue pain score, propofol dose, operative time, and adverse reactions were determined in each group. Results:There were slight, but not significant, differences in systolic blood pressure and heart rate between the two groups at T 0, T 1 and T2 (all P > 0.05). There were no significant differences in time to regain consciousness, postoperative visual analogue pain score, propofol dose and operative time between the two groups (all P > 0.05). The incidence of nausea and vertigo in the naborphine group was 8.3% (5/60) and 11.6% (7/60), respectively, which was significantly lower than that in the dezocine group [30.0% (18/60), 31.6% (19/60), χ2 = 9.09, 7.07, both P < 0.05). Conclusion:Naborphine combined with propofol for painless visual anesthetics induced abortion exhibits good anesthetic effects and safety, with fewer intraoperative and postoperative adverse reactions than dezocine combined with propofol.

Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

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

Does Enoxaparin treatment have any effects on the placenta in women with unexplained histories of habitual abortion? A case control study

ABSTRACT BACKGROUND: It is very common to offer low molecular weight heparin (LMWH) medications to women with unexplained habitual abortion, to increase the livebirth rate. Although no benefit from LMWH has been clearly demonstrated, examination of the effects of enoxaparin on placental structure is lacking. OBJECTIVE: To assess placental structural changes in pregnancies treated with enoxaparin, compared with controls. DESIGN AND SETTING: Case-control study in an obstetrics and gynecology unit of a tertiary-level university hospital in Turkey. METHODS: Forty patients who had had term pregnancies and live births but also histories of habitual abortion were recruited for this study. Placentas were sampled using a systematic random sampling method. Tissue samples were obtained, embedded and sectioned for routine histological analyses. Hematoxylin and eosin staining was used. Surface area and length estimates from placental components were evaluated by using Image J. Cell proliferation and apoptosis were also assessed via immunohistochemistry. RESULTS: There were no significant differences between the groups regarding maternal age, abortion rate, birth weight or gestational age. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. We found that Bcl-2 was generally expressed at high levels in the enoxaparin group, while there was no difference in terms of Ki-67 between the groups. CONCLUSIONS: This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion.

Sedation and analgesia effect of intranasal drip with dexmedetomidine in induced abortion / 中国医师进修杂志

Objective To study the sedation and analgesia effect of intranasal drip with dexmedetomidine in induced abortion.Methods Three hundred patients scheduled underwent induced abortion from April 2014 to January 2015 in the Second Affiliated Hospital of Dalian Medical University were selected.The patients were divided into P group,DP group and SP group by random digits table method with 100 cases in each group.The patients of P group received 0.9％ sodium chloride intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of DP group received dexmedetomidine intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of SP group received 0.9％ sodium chloride intranasal drip and sufentanil and propofol intravenous injection.The operation time,oxytocin dose,recovery time,recovery to leave the operating bed time,recovery to discharge time,blood loss,quality of aspirated tissue,propofol additional dose,propofol total dose,uterine contraction pain score,adverse reactions,satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions were compared among 3 groups.Results There were no statistical differences in operation time,recovery time,recovery to leave the operating bed time,recovery to discharge time,quality of aspirated tissue and incidence of adverse reactions among 3 groups (P＞0.05).The blood loss,oxytocin dose,propofol additional dose and propofol total dose in DP group were significantly lower than those in P group and SP group:(5.0 ± 3.2) ml vs.(7.5 ± 3.8) and (10.0 ± 3.4) ml,(7.0 ± 3.3) U vs.(10.0 ± 3.1) and (12.0 ± 2.9) U,(0.52 ± 0.02) mg/kg vs.(0.81 ± 0.04) and (0.75 ± 0.02) mg/kg,(1.5 ± 0.3) mg/kg vs.(2.8 ± 0.4) and (2.6 ± 0.5) mg/kg,there were statistical differences (P＜0.05).The uterine contraction pain score immediate postoperative,postoperative 15 min and postoperative 30 min in DP group was significantly lower than that in P group and SP group:(3.1 ± 0.2) scores vs.(5.1 ± 0.9) and (3.9 ± 0.3) scores,(3.0 ± 0.6) scores vs.(5.0 ± 0.7) and (3.8 ± 0.8) scores,(2.8 ± 0.3) scores vs.(5.0 ± 0.5)and (3.3 ± 0.4) scores,the score in SP group was significantly lower than that in P group,and there were statistical differences (P＜0.05).The satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions in DP group were significantly higher than those in P group and SP group:95.0％ (95/100) vs.10.0％ (10/100) and 60.0％ (60/100),75.0％ (75/100) vs.15.0％ (15/100) and 65.0％ (65/100),90.0％ (90/100) vs.30.0％ (30/100) and 80.0％ (80/100),the satisfaction rates in SP were significantly higher than those in P group,and there were statistical differences (P＜0.05).Conclusions Sedation with intranasal drip dexmedetomidine (1 μg/kg) provides effective antianxiety,reduces dose of propofol and blood loss in induced abortion.Compared with propofol or propofol combined with sulfentanil,dexmedetomidine intranasal drip combined with propofol intravenous injection has higher satisfaction scores of patients and doctors,and no obvious adverse reactions.

Impact of PDCA cycle on contraceptive methods after induced abortion in female college students / 中国学校卫生

Objective@#To explore the effect of plan-do-check-act (PDCA) cycle on contraceptive methods after induced abortion in female college students.@*Methods@#A total of 456 unmarried female college students who underwent artificial abortion in Tongde Hospital of Zhejiang Province from January 2018 to May 2019 were selected. These students were randomly divided into control group (n=228) and intervention group(n=228). Students from the control group accepted Post Abortion Care (PAC) service, while the intervention group accepted the management of PDCA cycle on basis of PAC services.@*Results@#In the intervention group, the rate of highly effective contraception immediately after abortion and six months after abortion were 91.23% and 71.17% respectively, while in the control group were 82.89% and 60.00%, the intervention group was higher than the control group(χ2=7.03, 5.98, P<0.05). The rate of unsafe contraceptive in the intervention group six months after abortion was 3.60%, while in the control group was 20.00%, the intervention group was lower than the control group(χ2=28.35, P<0.05).@*Conclusion@#The PDCA cycle can effectively improve the utilization rate of high efficiency contraceptive methods after induced abortion in college students, reduce the rate of unsafe contraceptive six months after abortion, and it is helpful to reduce the incidence of short-term unplanned pregnancy after abortion.

Evaluation of the post-abortion care services for unmarried female college students’ reproductive health effect / 中国学校卫生

Objective@#To understand the influence of post-abortion care (PAC) on the reproductive health of unmarried female college students,and to provide scientific basis for reproductive health education.@*Methods@#A total of 486 unmarried female college students who received artificial abortion voluntarily due to unwanted pregnancy and had complete follow-up data were investigated by questionnaires before and six months after the operation from July 2017 to June 2018 in the Tongde hospital of Zhejiang Province.@*Results@#There were 248 patients with abortion history, including 15 patients with abortion frequency ≥3 times.72 cases of high-risk abortion, the high-risk factors were re-abortion within half a year and the number of abortion ≥3 times; After PAC intervention, the awareness rate on menstruation and ovulation knowledge, scientific contraceptive knowledge, prevention of sexually transmitted diseases knowledge(types of diseases,raltes of transmission and preventive measures), and the harm of abortion knowledge(short-term and longterm complications), was higher than before(χ2=21.42, 69.65, 71.09, 52.80, 63.25, 187.59, 356.02, P<0.05). Before intervention, only 53.7% (261/486) of female college students used medium and low efficiency contraceptive measures, only 0.4% (2/486) were high-efficiency contraceptive measures. After intervention, all of them used contraceptive measures, The rate of effective contraceptive measures in the immediate and six months after operation was 85.4% (415/486) and 68.3% (332/486) respectively, which was significantly higher than before(χ2=786.10, P<0.05).@*Conclusion@#PAC service for female college students can improve awareness rate of sexual and reproductive health, enhance effective contraceptive measures, reduce the risk of repeated abortion.

Clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion / 中国基层医药

Objective@#To explore the clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion.@*Methods@#From May 2016 to June 2017, 90 cases of vaginal bleeding after drug abortion in the People's Hospital of Dongping County were divided into the observation group and the control group according to the digital table, with 45 cases in each group.The two groups were all treated with drug abortion to terminate pregnancy, and the control group was treated with metronidazole tablets + carbazochrome tablets after the termination of pregnancy.The observation group was treated with Huoxue Qing Gong decoction on the basis of the control group.The effect of abortion, bleeding time and bleeding volume after drug abortion, the time of menstrual recovery and menstrual duration after treatment in the two groups were observed and compared.@*Results@#The total abortion rate in the observation group was 95.6%, which was significantly higher than that in the control group(84.4%), the difference was statistically significant(χ2=5.620, P<0.05). The proportion of bleeding time≤7d after abortion in the observation group was 37.8%, which was significantly higher than that in the control group(11.1%), the difference was statistically significant(χ2=5.628, P<0.05). The proportion of bleeding time 8~14d of the observation group was 60%, which was significantly lower than that of the control group(73.3%), the difference was statistically significant(χ2=6.571, P<0.05). The proportion of bleeding time more than 15d after drug abortion of the observation group was 2.2%, which was significantly lower than that of the control group(15.6%), the difference was statistically significant(χ2=5.028, P<0.05). The proportion of vaginal bleeding volume<previous menstrual volume after drug abortion of the observation group was 60.0%, which was significantly higher than that of the control group(28.9%), the difference was statistically significant(χ2=6.021, P<0.05). The proportion of amount of vaginal bleeding=previous menstrual volume after drug abortion in the observation group was 22.2%, which was significantly lower than that in the control group(26.7%), the difference was statistically significant (χ2=5.114, P<0.05). The proportion of vaginal bleeding volume>previous menstrual volume after drug abortion of the observation group was 17.8%, which was significantly lower than that of the control group(44.4%), the difference was statistically significant(χ2=6.375, P<0.05). The period of menstrual recovery of the observation group was (29.5±4.2)d, which was significantly shorter than that of the control group[(37.9±4.3)d](t=5.028, P<0.05). The duration of menstruation in the observation group was (5.0±1.1)d, which was significantly shorter than that in the control group[(6.9±1.2)d], the difference was statistically significant(t=3.229, P<0.05).@*Conclusion@#Huoxue Qing Gong decoction in the treatment of vaginal bleeding after drug abortion can significantly shorten the time of vaginal bleeding, reduce the amount of vaginal bleeding, improve the rate of complete abortion, and has no obvious effect on the first menstrual cycle and menstrual period after the drug flow.

O direito ao aborto no Brasil e a implicação da Atenção Primária à Saúde / The right to abortion in Brazil and the role of Primary Health Care / El derecho al aborto en Brasil y el rol de la Atención Primaria de Salud

Apesar dos importantes progressos ocorridos no âmbito da saúde pública no Brasil, as mortes maternas por abortos inseguros representam um desafio persistente. Por tratar-se de condição prevalente na população, a mulher que busca o serviço de saúde por questões relacionadas ao aborto deve encontrar no serviço de atenção primária uma porta de entrada segura e um espaço de diálogo aberto. Considerando que o contexto legal do Brasil é um dos mais restritivos do mundo em relação ao aborto, este texto apresenta ideias de como o(a) médico(a) de família e comunidade pode atuar frente a uma situação de gravidez indesejada, baseado na experiência de outros países, considerando os atributos da atenção primária e o código de ética médica. Por fim, a experiência do Fórum Aborto Legal RS é relatada, no intuito de compartilhar ações concretas visando à qualificação do atendimento às mulheres que recorrem a um aborto permitido por lei. Conclui-se que, no nosso meio, um primeiro passo para avançar no direito ao aborto é fazer cumprir a lei que garante a sua realização em situações específicas e que a atuação dos(as) profissionais da atenção primária na redução de danos parece ser uma estratégia chave para evitar abortos inseguros e, por consequência, reduzir a mortalidade materna

Despite important progress in public health in Brazil, maternal deaths from unsafe abortion remain a continuous challenge. Because it is a prevailing condition in the population, a woman who seeks health care for abortion-related issues must find in the primary care facility a safe doorway and an open space for dialogue. Considering that Brazil's legal context is one of the most restrictive in the world in relation to abortion, this text presents ideas on how the family physician can act in dealing with a situation of unwanted pregnancy, based on the experience of other countries and considering the primary care attributes and the medical ethics code. Finally, the experience of the Legal Abortion Forum in Rio Grande do Sul is reported, in order to share concrete actions aimed at the qualification of care for women who seek an abortion that is granted by law. In conclusion, in our country, a first step to acquire more significant progress on the right to abortion is to enforce the law that guarantees its fulfillment in specific situations. Moreover, the engagement of primary care professionals in harm reduction seems to be a key strategy to prevent unsafe abortion and, consequently, to reduce maternal mortality

A pesar de los importantes progresos ocurridos en el ámbito de la salud pública en Brasil, las muertes maternas por abortos inseguros representan un desafío persistente. Por tratarse de condición prevalente en la población, la mujer que busca el servicio de salud por cuestiones relacionadas al aborto debe encontrar en el servicio de atención primaria una puerta de entrada segura y un espacio de diálogo abierto. Considerando que el contexto legal de Brasil es uno de los más restrictivos del mundo en relación al aborto, este texto presenta ideas de cómo el (la) médico (a) de familia y comunidad puede actuar frente a una situación de embarazo no deseado, basado en la experiencia de otros países, considerando los atributos de la atención primaria y el código de ética médica. Por último, se comparte la experiencia del Foro Aborto Legal de Rio Grande do Sul, con el fin de proponer acciones concretas para la calificación de la atención a las mujeres que recurren a un aborto permitido por ley. Se concluye que, en nuestro contexto, un primer paso para avanzar en el derecho al aborto es hacer cumplir la ley que garantiza su realización en situaciones específicas y que la actuación de los profesionales de la atención primaria en la reducción de riesgos y daños parece ser una estrategia clave para evitar abortos inseguros y, por consiguiente, reducir la mortalidad materna.