O planejamento familiar e a mortalidade materna por aborto / Family planning and maternal mortality for abortion / La planificación familiar y la mortalidad materna por aborto

A mortalidade materna é considerada um excelente indicador de saúde, não apenas da mulher, mas da população como um todo. No Brasil, a morte materna configura-se como um problema de saúde pública. Segundo o Ministério da Saúde, as altas taxas de mortalidade materna compõem um quadro de violação dos direitos humanos de mulheres e de crianças, atingindo desigualmente aquelas das classes sociais com menor ingresso e acesso aos bens sociais nas várias regiões brasileiras. O planejamento familiar, quando oferecido de forma contínua e prolongada, pode contribuir para a redução do número de gestações indesejadas, de abortos ilegais e da mortalidade materna. Trata-se de estudo de revisão sistemática de literatura do tipo exploratória com abordagem qualitativa. Após a leitura seletiva das referências, teve início a fase analítica. Realizou-se o grupamento em duas categorias temáticas, a seguir discriminadas: (1) o homem no planejamento familiar; (2) contracepção pós-abortamento e redes de cuidado. No que tange ao aborto, a participação masculina é de extrema relevância, pois a não aceitação da gravidez ou o abandono do parceiro são alguns dos motivos que levam a mulher ao aborto provocado. O cuidado integral à saúde da mulher em situações de abortamento deve incluir, além do tratamento de emergência, o acesso universal ao planejamento reprodutivo, inclusive orientações para as mulheres que desejam uma nova gestação.

Maternal mortality is considered an excellent indicator of health, not only for women but also for the population as a whole. In Brazil, maternal death is a public health problem. According to the Ministry of Health, the high rates of maternal mortality constitute a framework of violation of human rights for women and children, unequally affecting those of the lower income classes and with less access to social assets in various Brazilian regions. Family planning, when provided on a continuous and protracted basis, can contribute to reducing the number of unwanted pregnancies and illegal abortions as well as maternal mortality rates. This is a systematic review of literature with a qualitative approach and exploratory nature. After selective reading of the references, the analytical phase began. The data were grouped into two thematic categories, as follows: (1) The man in family planning; (2) Post-abortion contraception and care networks. Regarding abortion, male participation is extremely relevant, and non-acceptance of pregnancy as well as partner abandonment were some of the reasons that lead women to abortion. Comprehensive care for women's health in abortion situations should include universal access to reproductive planning and guidelines for women seeking a new pregnancy, in addition to emergency treatment.

La mortalidad materna se considera un excelente indicador de salud no solo de la mujer, sino de la población como un todo. En Brasil, la muerte materna se configura como un problema de salud pública. Según el Ministerio de Salud, las altas tasas de mortalidad materna componen un cuadro de violación a los derechos humanos de mujeres y de niños, alcanzando desigualmente las clases sociales con menor ingresos y acceso a los bienes sociales, en las distintas regiones brasileñas. La planificación familiar, cuando se ofrece de forma continua y prolongada, puede contribuir a la reducción del número de embarazos no deseados y abortos ilegales, y de la mortalidad materna. Se trata de un estudio de revisión sistemática de literatura de tipo exploratorio, con abordaje cualitativo. Después de la lectura selectiva de las referencias, se inició la fase analítica. Se realizó el agrupamiento en dos categorías temáticas: (1) el hombre en la planificación familiar; (2) contracepción postaborto y redes de cuidado. En lo que se refiere al aborto, la participación masculina es de extrema relevancia, pues la no aceptación del embarazo o el abandono del compañero son algunos de los motivos que llevan a la mujer al aborto. El cuidado integral a la salud de la mujer en situaciones de aborto debe incluir, además del tratamiento de emergencia, el acceso universal a la planificación reproductiva, comprendiendo orientaciones para las mujeres que desean una nueva gestación.

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)

Embryonic mortality and abortion in goats caused by ingestion of Poincianella pyramidalis / Mortalidade embrionária e aborto em caprinos causados pela ingestão de Poincianella pyramidalis

This study aimed to characterize the embryotoxic, teratogenic and abortifacient effect of Poincianella pyramidalis in goats. Twenty pregnant goats with 18 days of gestation were divided into five groups of four animals each. After collection, the leaves of P. pyramidalis were dried in the shade and crushed. The daily feed provided to the goats was equivalent to 3% of their body weight, being 1% concentrated feed and 2% roughage. In Group 1 (control), the provided roughage was Cynodon dactylon (Tifton) hay; in Groups 2, 3 and 4, 10%, 20% and 80% of the C. dactylon roughage was replaced by dry and ground P. pyramidalis, respectively. In Group 5, all the roughage was replaced by green P. pyramidalis ad libitum, collected daily. Ultrasonographic examination was performed twice a week throughout the pregnancy. Goats in Groups 1, 2 and 3, delivered normal kids. Two goats in Group 4 aborted at 127 and 90 days of gestation. In group 5, three goats showed embryonic death at 25, 30 and 31 days of gestation and the other goat aborted at 39 days of pregnancy. Malformations were not observed. It is suggested that P. pyramidalis, which is very common in the semiarid region of northeastern Brazil, should be considered as an important cause of reproductive losses in this area. Due to its high palatability, it is important to avoid the ingestion of P. pyramidalis by pregnant and mating goats.(AU)

O objetivo deste trabalho foi estudar o potencial embriotóxico, abortivo e teratogênico da Poincianella pyramidalis em caprinos. Para tanto foram utilizadas 20 cabras prenhes com 18 dias de gestação, divididas em cinco grupos de quatro animais. Depois da coleta, as folhas de P. pyramidalis era secas a sombra e trituradas. A alimentação diária fornecida aos caprinos foi proporcional a 3% do seu peso vivo, sendo 1% de alimento concentrado e 2% de volumoso. No Grupo 1 (controle), o volumoso fornecido foi apenas feno de Cynodon dactylon (Tifton). Já nos Grupos 2, 3 e 4, 10%, 20% e 80% do volumoso foi substituído por folhas secas e trituradas de P. pyramidalis, respectivamente. No Grupo 5, todo o volumoso foi constituído por P. pyramidalis verde ad libitum, coletadas diariamente. Para o acompanhamento das gestações, exames ultrassonográficos foram realizados duas vezes por semana, durante toda a gestação. As cabras dos Grupos 1, 2 e 3 pariram cabritos normais. Duas cabras no Grupo 4 abortaram, sendo uma com 127 dias de gestação e outra com 90 dias. No grupo 5, três cabras apresentaram morte embrionária no 25º, 30º e 31º dia de gestação e uma cabra abortou no 39º dia de gestação. No presente estudo não foi observada nenhuma malformação. Com esses resultados e considerando a ampla difusão de P. pyramidalis na região semiárida do nordeste Brasileiro sugere-se que esta planta é uma importante causa de perdas reprodutivas na região. Devido a sua alta palatabilidade, recomenda-se evitar a permanência de cabras prenhes em áreas onde ocorre P. pyramidalis.(AU)

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 in the structure of causes of maternal mortality / Aborto na estrutura das causas da mortalidade materna

Abstract Objective To study the structure ofmaternalmortality caused by abortion in the Tula region. Methods The medical records of deceased pregnant women, childbirth, and postpartum from January 01, 2001, to December 31, 2015, were analyzed. Results Overall, 204,095 abortion cases were recorded in the Tula region for over 15 years. The frequency of abortion was reduced 4-fold, with 18,200 in 2001 to 4,538 in 2015. The rate of abortions per 1,000 women (age 15-44 years) for 15 years decreased by 40.5%, that is, from 46.53 (2001) to 18.84 (2015), and that of abortions per 100 live births and stillbirths was 29.5%, that is, from 161.7 (2001) to 41.5 (2015). Five women died from abortion complications that began outside of the hospital, which accounted for 0.01% of the total number. In the structure of causes of maternal mortality for 15 years, abortion represented 14.3% of the cases. Lethality mainly occurred in the period from 2001 to 2005 (4 cases). Among thematernal deaths, many women died in rural areas after pregnancy termination at 18 to 20 weeks of gestation (n = 4). In addition, three women died from sepsis and two from bleeding. Conclusion The introduction of modern, effective technologies of family planning has reduced maternal mortality due to abortion.

Resumo Objetivos Estudar a estrutura damortalidadematerna causada pelo aborto na região de Tula. Métodos Os registros médicos de mulheres grávidas falecidas, de parto e de pósparto, de 01 de janeiro de 2001 a 31 de dezembro de 2015, foram analisados. Resultados No geral, 204.095 casos de aborto foram registrados na região de Tula, em um período de 15 anos. A frequência de aborto foi reduzida a 1/4, passando de 18.200 abortos em2001 para 4.538 em 2015. A taxa de abortos a cada 1.000 mulheres (com idades entre 15 e 44 anos) diminuiu 40,5% em 15 anos, isto é, de 46,53 (2001) para 18,84 (2015), e a taxa de abortos a cada 100 nascidos vivos e natimortos foi de 29,5%, isto é, de 161,7 (2001) para 41,5 (2015). Cinco mulheres morreram de complicações do aborto que começaram fora do hospital, o que representou 0,01% do número total. No quadro geral de causas de mortalidade materna neste período de 15 anos, o aborto representou 14,3% dos casos. A letalidade ocorreu, principalmente, no período de 2001 a 2005 (4 casos). Entre as mortes maternas, muitas mulheres morreram em áreas rurais após a interrupção da gravidez, com 18 a 20 semanas de gestação (n= 4). Além disso, três mulheres morreram por sepse, e duas, por sangramento. Conclusão Com a introdução de tecnologias de planejamento familiar modernas e eficazes, a mortalidade materna devido ao aborto vem sendo reduzida.

Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas / Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals

Resumo O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos - fetais e neonatais - em maternidades públicas nas cidades de São Paulo, Rio de Janeiro e Niterói (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um óbito materno, 498 abortos, 65 óbitos fetais, 44 óbitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuário, cartão da gestante e no Sistema de Informações sobre Mortalidade (SIM). Foi descrita a população de estudo e estimados a concordância da causa básica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratórios e fatores maternos foram as principais causas entre óbitos fetais e neonatais. Sífilis congênita, diabetes e causas de morte fetal não especificada foram subdeclaradas no SIM. Os coeficientes kappa por capítulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistência de boa qualidade no planejamento reprodutivo, pré-natal, durante o parto e nascimento resultará na prevenção das mortes.

Abstract The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

Abortion procurement and post-abortion care services: experiences of nigerian adolescents

Introduction: The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, Nigerian adolescents are often unable to obtain adequate post-abortion care services due to numerous challenges and barriers. This study attempted to explore experiences with abortion and post abortion care services from the adolescents' perspective which is the first step in enhancing optimal utilization of adolescents' PAC services. Methods: A qualitative exploratory research design was used. Twenty semi-structured interviews were conducted with adolescent patients during hospitalization. The adolescent patients were duly counseled and informed consent obtained prior to the in-depth interview. Semi-structured interview guide was used for data collection and the data were analyzed using content analysis. Results: Findings from the interviews revealed that adolescents found it difficult to discuss issues of pregnancy and abortion with their parents or guardians due to fear, stigmatization or rejection. The adolescents experienced negligence of care, shame and stigma due to failure of health care providers to ensure privacy, as well as delay in treatment due to hospital protocol and non availability of prescribed drugs which significantly affected the PAC care services they received. Conclusion: The adolescents experienced fear, shame, and stigmatization, negligence of care and lack of access to adequate PAC services. These findings highlight the need to review health actions directed towards adolescents with abortion complications and plan interventions aim at improving provision of adolescents' friendly PAC services, in order to meet the reproductive health needs of these adolescents

Aborto, ¿es un problema de salud pública en Chile en el campo de la salud materno-perinatal? / Is abortion a serious public health problem in Chile in the field of maternal-perinatal health?

Background: The World Health Organization, by 2014, estimates that approximately 22 million unsafe abortions take place every year in the world, almost all of them in developing countries. The Millennium Goals, as part of the fifth compendium, focused on maternal health by proposing that member states should reduce maternal mortality to 75% by 2015. Aim: To determine, using maternal health indicators, if abortion in Chile is a priority health problem. Material and Methods: Data about maternal mortality and its causes between 1982 and 2014, was obtained from the databases available at the Chilean Ministry of Health. Trend analyzes were carried out using linear autoregressive models. Results: Between 1982 and 2012, maternal mortality rates decreased from 51.8 to 18.3 per 100,000 live births. Complications of pregnancy, childbirth and puerperium were the first three causes and the last one is abortion. The proportion of abortions due to unspecified causes, including induced abortion, decreased from 36.6% to 26.1% between 2001 and 2012. Conclusions: Abortion is not a public health problem in Chile. To continue reducing maternal mortality, programs for the early detection of risks such as diabetes, obesity and hypertension should be implemented.

Causas múltiplas de mortalidade materna relacionada ao aborto no Estado de Minas Gerais, Brasil, 2000-2011 / Multiple causes of maternal mortality related to abortion in Minas Gerais State, Brazil, 2000-2011 / Causas múltiples de mortalidad materna relacionada con el aborto, en el Estado de Minas Gerais, Brasil, 2000-2011

Resumo: Este estudo objetivou analisar a evolução da mortalidade materna por aborto em Minas Gerais, Brasil, no período de 2000 a 2011, sob o enfoque das causas múltiplas de morte. Estudou-se as características sociodemográficas das mulheres, ano, local e causas básica e associada de óbito. Foi calculada a razão de morte materna (RMM) geral e específica por aborto em cada ano e o coeficiente de correlação de Spearman (p < 0,05), para avaliar a evolução das razões no período. Foram registrados 183 óbitos por aborto, 15% dos óbitos maternos, e a RMM por aborto manteve-se estável. A razão causa múltipla e causa básica de óbito por aborto foi de 1,38. O uso do método de análise de causas múltiplas mostrou-se eficaz para dar maior visibilidade ao aborto. Os problemas oriundos da ilegalidade da prática de abortos favorecem o aparecimento de causas que mascaram mortes maternas e a sua subnotificação. Assim, ações intersetoriais são necessárias para a definição de estratégias, a fim de reduzir as desigualdades sociais e melhorar a qualidade dos serviços de atenção à mulher.

This study aimed to analyze trends in maternal mortality from abortion in Minas Gerais State, Brazil, from 2000 to 2011, addressing multiple causes of death. The analysis focused on women's social and demographic characteristics, year, location, and underlying and associated causes of death. Maternal mortality ratio (MMR) and abortion-specific ratio were calculated for each year, as well as Spearman's correlation coefficient (p < 0.05), to assess the trend in ratios during the study period. One hundred and eighty-three deaths from abortion were recorded, accounting for 15% of maternal deaths, and MMR remained stable. The ratio between multiple causes and underlying cause of death from abortion was 1.38. Use of the multiple-causes method proved effective for lending greater visibility to abortion. Problems deriving from the illegality of abortion in Brazil favor the appearance of causes that mask maternal deaths, in addition to their underreporting. Inter-sector actions are thus necessary to define strategies for reducing social inequalities and improving the quality of services for women.

Resumen: Este estudio tuvo por objetivo analizar la evolución de la mortalidad materna por aborto en Minas Gerais, Brasil, durante el período de 2000 a 2011, desde el enfoque de las causas múltiples de muerte. Se estudiaron las características sociodemográficas de las mujeres, año, lugar y causas básicas y asociadas de óbito. Se calculó la razón de muerte materna (RMM) general y específica por aborto durante cada año y el coeficiente de correlación de Spearman (p < 0,05), para evaluar la evolución de las razones durante el período. Se registraron 183 óbitos por aborto, un 15% de los óbitos maternos, y la RMM por aborto se mantuvo estable. La razón causa múltiple y causa básica de óbito por aborto fue de 1,38. El uso del método de análisis de causas múltiples se mostró eficaz para dar mayor visibilidad al aborto. Los problemas provenientes de la ilegalidad de la práctica de abortos favorecen la aparición de causas que enmascaran muertes maternas y su subnotificación. Por ello, se necesitan acciones intersectoriales para la definición de estrategias, con el fin de reducir las desigualdades sociales y mejorar la calidad de los servicios de atención a la mujer.

Caracterización de un grupo de adolescentes que se realizan regulación menstrual en un área de salud / Characterization of a group of teenagers who perform menstrual regulation in an area of health

Se realizó un estudio en la población femenina adolescente que acude al Servicio de Regulación menstrual del Policlínico Universitario "XX ANIVERSARIO" de Santa Clara, para realizarse este proceder en el período comprendido entre enero a diciembre del 2011. Objetivo: obtener información acerca de comportamientos y causas que inciden en el aborto en la adolescencia en un grupo de adolescentes que acuden al Servicio de Regulación Menstrual del Policlínico Universitario...

Analise da mortalidade materna no municipio de Governador Valadares, 2002-2004 / Analysis of maternal mortality in the municipality of Governador Valadares, 2002-2004 / Analisis de la mortalidad materna en el municipio de Governador Valadares, 2002-2004

Neste trabalho, busca-se conhecer a mortalidade materna e a qualidade das informações contidas nas Declarações de Óbito em Governador Valadares-MG. No estudo descritivo foram utilizados dados do Sistema de Informações em Mortalidade, do Sistema de Informações de Nascidos Vivos e registros de investigação do Comitê de Prevenção de Mortalidade Materna de Governador Valadares, em 2002-2004. Para a compreensão dos eventos (óbitos), foi construído o percurso da linha do cuidado utilizando o fluxograma analisador. Ao se recalcular a Razão de Mortalidade Materna no município, houve aumento da RMM de 24,2 por mil nascidos vivos para 36,2 óbitos por mil nascidos vivos. Dentre as causas encontradas, 80% foram causas diretas, destacando-se os abortos. Na análise da linha do cuidado, foram detectadas falhas no pré-natal, na assistência (diagnóstico tardio, não uso da tecnologia disponível), chamando atenção a evitabilidade e o sub-registro dos eventos.

This work aims to study the maternal mortality and the quality of the information contained in Death Certificates issued in Governador Valadares, Minas Gerais. This descriptive study used data of the System of Information in Mortality, of the Live Births Information System, and of the information records of the Committee for the Prevention of Maternal Mortality between 2002 and 2004. In order to understand the events (deaths), the care pathway was reconstructed,using the process flow chart analysis. When recalculating the Maternal Mortality Rate in the municipal district, we detected an increase of the MMR ratio from 24, 2 deaths per 1000 (one thousand) live births, to 36, 2 deaths per 1000(one thousand) live births. Among the causes of death, 80 percent was due to a direct cause, mainly abortions. The care pathway analysis detected flaws in antenatal and health assistance (late diagnosis, lack of use of available technology),calling attention the event’s avoidability and its underreporting.

El presente trabajo busca conocer la mortalidad materna y la calidad de la información contenida en las Partidas de Defunción de Governador Valadares, Minas Gerais. La investigación descriptiva utilizó datos del Sistema de Información en Mortalidad, Sistema de Información de Nacidos Vivos y registros de investigación del Comité de Prevención de Mortalidad Materna de Governador Valadares entre 2002 y 2004. Para la comprensión de los eventos (muertes), se trazó la línea de cuidado utilizando el diagrama de flujo analizador. Al recalcular la Razón de Mortalidad Materna en elmunicipio se constató aumento de la RMM de 24,2 por 1000 nacidos vivos para 36,2 muertes por 1000 nacidos vivos.Entre las causas encontradas el 80% se debe a causas directas, destacándose los abortos. En el análisis de la línea de cuidado se detectaron errores en el prenatal, en la asistencia (diagnóstico tardío, falta de uso de tecnología disponible),llamando la atención la prevención y el subregistro de las muertes.

El aborto en la región de Centro América / Abortion in the region of Central America

Introducción: la falta de información correcta y oportuna que los gerentes de programas de salud y los hacedores de polìticas tienen para conocer la magnitud del problema del aborto, es limitada en la región centroamericana. Solo con adecuada información se puede identificar el tipo de intervención que tendría que implementarse y determinar también los grupos mas vulnerables existentes. Finalmente esta información también es necesaria para evaluar las intervenciones existentes, si es que existen...

Pesquisa sobre o aborto no Brasil: avanços e desafios para o campo da saúde coletiva: [revisão] / Research on abortion in Brazil: gaps and challenges for the public health field: [review]

O texto apresenta um panorama dos estudos sobre aborto no país, no campo da Saúde Coletiva, apontando lacunas e desafios para a investigação. A maioria das pesquisas está concentrada em hospitais públicos, com mulheres admitidas para tratamento do aborto incompleto, restringindo-se portanto aos abortos que apresentaram complicações. Descrevem o perfil das mulheres, métodos e razões para o aborto e conseqüências imediatas para a saúde física. Entretanto, permanecem limites relacionados à necessidade de estudos para mensuração da incidência do aborto; para investigação das especificidades dos óbitos por aborto e casos de morbidade grave; para análise da relação do aborto com anticoncepção; para investigação das repercussões do aborto na saúde mental das mulheres e para incorporação da perspectiva masculina. É urgente o desenvolvimento de pesquisas de avaliação da atenção ao aborto nos serviços públicos. Os resultados dos estudos devem ser divulgados, contribuindo para superar a visão ideologizada da discussão do direito ao aborto no país.

This paper provides a review of abortion studies produced in the field of public health in Brazil, highlighting current research gaps and challenges. Most studies focus on women admitted to public hospitals for treatment of incomplete abortion, so their scope is limited to abortions presenting complications. Women's profiles, abortion methods, motives, and immediate consequences for women's physical health are also included. However, there remains a need for studies on the following aspects: measuring abortion incidence; investigating cases of post-abortion complications and death; analyzing the relationship between abortion and contraception; investigating the impact of abortion on women's mental health; and incorporating men's perspectives. There is an urgent need for evaluative research on abortion care in public services. Research results should be disseminated widely, so as to help overcome any ideological bias in the current debate on abortion rights in the country.

Prevalence of induced abortion and associated complications in women attending hospitals in Isfahan

A high proportion of maternal deaths are caused by abortion, especially induced abortion. This cross-sectional study determined the prevalence of illegally-induced abortion prior to admittance and its associated risk factors in 8 maternity hospitals in Isfahan, Islamic Republic of Iran, during 2003-04. In confidential interviews with 417 women who attended the hospitals with abortion, 50 [12.0%] reported that it was illegally induced. These abortions had a significant correlation with fever, septic shock and septic abortion. Of all pregnancies, 35.0% were unwanted, and 27.1% of these were illegally-terminated by induced abortions. Unwanted pregnancy was one of the most important risk factors for induced abortion [OR = 8.84, 95% CI: 4.36-17.92]

Complications of induced abortions

To determine the complications developed due to induced abortions. Descriptive case series. Department of Obstetrics and Gynecology, Fatima hospital, Baqai medical University Karachi, from January to December 2005. Records of patients admitted with induced abortion were analyzed retrospectively. Their presentation and complications were noted. Patients presented within 40 days of induced abortion were included in the study. While patients with spontaneous abortions or who were admitted after 40 days of induced abortion were excluded. During study period, total number of patients admitted was 124. Out of them 96 spontaneous abortions, 13 induced and 15 were threatened. The frequency of induced abortion was 10.4%. Out of 13 cases, 9 [69.2%] were married and 4[30.7%] were unmarried under the age of 20 years. Regarding parity 7[53.8%] were having >5 children. Traditional Birth Attendants performed abortions in 11[84.6%] of patients. Sepsis was the main complication developed in 7[53.8%] patients followed by uterine perforation found in 3 [23%] patients. Hemorrhage occurred in 2[15.3%] patients. Induced abortion caused mortality in 1[7.60%] patient. Induced abortions are a major cause of maternal complications. Education of traditional birth attendants to recognize the severity of complications and availability of family planning services can help to reduces morbidities and mortalities

Use of Foley's catheter and prostaglandin F-2 alpha in second trimester termination of pregnancy

Termination of pregnancy [TOP] in the second trimester is associated with three to five times higher risk of maternal morbidity and mortality than termination during first trimester. The main concern of obstetrician is to provide the most effective and safest regimen which combines the shortest expulsion interval with least side effects. This study was undertaken to compare the use of Foley's catheter with extra-amniotic instillation of PGF2 alpha for second trimester TOP so that a choice of the safer and cost-effective method could be available. The study was conducted in Department of Obstetrics and Gynecology Unit 'B' at Ayub Teaching Hospital Abbottabad between August 2003 and July 2004. Sixty patients recommended for TOP [missed abortion or anencephalic fetus confirmed on ultrasonography] were randomly allocated into two groups. In group 'A', Foley's catheter alone was used while in group 'B' extra amniotic instillation of Prostaglandin F-2 alpha [PGF2 alpha] was done via a Foley's catheter. After expulsion of catheters in both cases oxytocin infusion containing 30 units were started till the expulsion of fetus, placenta and membranes. The mean induction to expulsion time and the mean induction to delivery time for both groups were noted as well as total cost of treatment. Difference in time interval with regard to induction to expulsion time of catheter and induction to delivery time between the two groups was significant being 3 hours and 5 hours respectively less in group 'B' [p < 0.001]; however only 25% of patients in group 'B' had a significant short induction to delivery time as compared to group 'A'. The difference in costs of treatment between the groups was also significant [p < 0.001]. Use of PGF 2 alpha is preferred, though for poor patients Foley's catheter may be used, but only in a tertiary care setting