Support Systems and Limitations in Therapeutic Abortion Care by the Gynecologist-Obstetrician of Public Hospitals in Peru / Sistemas de apoio e limitações na atenção ao aborto terapêutico pelo ginecologista-obstetra de hospitais públicos do Peru

Abstract Objective To identify the barriers to provide to women and adequately train physicians on therapeutic abortions in public hospitals in Peru. Methods Descriptive cross-sectional survey-based study. We invited 400 obstetrics and gynecology specialists from 7 academic public hospitals in Lima and 8 from other regions of Peru. Expert judges validated the survey. Results We collected survey results from 160 participants that met the inclusion criteria. Of those, 63.7% stated that the hospital where they work does not offer abortion training. Most of the participants consider that the position of the Peruvian government regarding therapeutic abortion is indifferent or deficient. The major limitations to provide therapeutic abortions included Peruvian law (53.8%), hospital policies (18.8%), and lack of experts (10.6%). Conclusion Most surveyed physicians supported therapeutic abortions and showed interest in improving their skills. However, not all hospitals offer training and education. The limited knowledge of the physicians regarding the law and institutional policies, as well as fear of ethical, legal, and religious repercussions, were the main barriers for providing abortions.

Resumo Objetivo Identificar as barreiras para oferecer às mulheres e capacitar adequadamente os médicos sobre abortos terapêuticos nos hospitais públicos do Peru. Métodos Estudo descritivo transversal baseado em inquérito. Convidamos 400 especialistas em obstetrícia e ginecologia de 7 hospitais públicos acadêmicos de Lima e 8 de outras regiões do Peru. Juízes especialistas validaram a pesquisa. Resultados Coletamos os resultados da pesquisa de 160 participantes que atenderam aos critérios de inclusão. Destes, 63,7% afirmaram que o hospital onde trabalham não oferece treinamento sobre aborto. A maioria dos participantes considera que a posição do governo peruano em relação ao aborto terapêutico é indiferente ou deficiente. As principais limitações para fornecer abortos terapêuticos incluem a lei peruana (53,8%), políticas hospitalares (18,8%) e falta de especialistas (10,6%). Conclusão A maioria dos médicos pesquisados apoiava o aborto terapêutico e demonstrava interesse em aprimorar suas habilidades. No entanto, nem todos os hospitais oferecem treinamento e educação. O conhecimento limitado dos médicos sobre a lei e as políticas institucionais, além do medo de repercussões éticas, legais e religiosas, foram as principais barreiras para a realização do aborto.

Caracterización clínica de las pacientes obstétricas con sospecha de la COVID-19 / Clinical characterization of obstetric patients with suspected COVID-19

Introducción: La pandemia por la COVID-19 ha causado más 350 000 muertes a nivel mundial. Objetivo: Caracterizar clínicamente a las pacientes obstétricas con sospecha de la COVID-19. Métodos: Se realizó un estudio retrospectivo, descriptivo, de corte transversal. Fueron incluidas todas las pacientes obstétricas que ingresaron en el Hospital Militar Central Dr. Luis Díaz Soto, entre el 12 de marzo y 20 de mayo de 2020. Se dividieron en dos grupos; en el I se incluyeron las que presentaron el PCR en tiempo real para SARS-CoV-2 negativo y en el grupo II, las que resultaron positivas. Las variables analizadas fueron la edad, antecedentes obstétricos, antecedentes patológicos personales, historia epidemiológica, cuadro clínico, complicaciones, ingreso en la unidad de terapia intensiva y mortalidad materna. Resultados: Ingresaron 60 pacientes obstétricas y 6 (10 por ciento) resultaron positivas al SARS-CoV-2, de las provincias La Habana, Mayabeque y Artemisa. La edad promedio fue de 25 años. Se encontraban en el primer trimestre del embarazo el 25,9 por ciento del grupo I y el 66,6 por ciento del grupo II. Presentó comorbilidad el 38,8 por ciento y 16,6 por ciento, del grupo I y grupo II respectivamente. Se encontraban asintomáticas 50 por ciento de las positivas. Se observó leucopenia en 10 (18,5 por ciento) del grupo I y en 5 (83,3 por ciento) del grupo II. Se presentó un aborto espontáneo en el grupo II. No hubo neumonía por la COVID-19, ni muertes maternas. Conclusiones: La COVID -19 se presentó con mayor frecuencia en las gestantes durante el primer trimestre, predominó la forma leve de la enfermedad, no existió neumonía por la COVID-19 ni muertes(AU)

Introduction: The COVID-19 pandemic has caused more than 350,000 deaths worldwide. Objective: To clinically characterize obstetric patients with suspected COVID-19. Methods: A retrospective, descriptive, cross-sectional study was performed. All obstetric patients admitted to the Hospital Militar Central "Dr. Luis Díaz Soto" between March 12 and May 20, 2020. They were divided into two groups; Group I included those with negative RT-PCR for SARS-CoV-2 and group II with positive results. The variables analyzed were age, obstetric history, personal pathological history, epidemiological history, clinical picture, complications, admission to the intensive care unit and maternal mortality. Results: 60 obstetric patients were admitted and 6 (10 percent) were positive for SARS-CoV-2, from the provinces of Havana, Mayabeque and Artemisa. The average age was 25 years. 25.9 percent of group I and 66.6 percent of group II were in the 1st trimester of pregnancy. 38.8 percent and 16.6 percent, of group I and group II, respectively, presented comorbidity. 50 percent of the positives were asymptomatic. Leukopenia was observed in 10 (18.5 percent) cases in group I and in 5 (83.3 percent) in group II. Spontaneous abortion occurred in group II. There was no COVID-19 pneumonia, nor maternal death. Conclusions: COVID-19 occurred more frequently in pregnant women during the first trimester, the mild form of the disease prevailed, with no COVID-19 pneumonia or deaths from this disease(AU)

[Effectiveness of Misoprostol for induction of first-trimester miscarriages; experience at a single tertiary care centre in Oman]

Objectives: Non-invasive methods of inducing a miscarriage are now considered an effective alternative to surgical evacuation [dilatation and curettage]. This study aimed to evaluate the effectiveness of misoprostol in the termination of first-trimester miscarriages

Methods: This prospective study was conducted between October 2009 and September 2010 and assessed all patients admitted to the Royal Hospital in Muscat, Oman, for the termination of first-trimester miscarriages during the study period. All patients received misoprostol and the rates of successful termination were measured. Patient satisfaction was assessed using a short questionnaire

Results: A total of 290 women were included in the study. Termination with misoprostol was successful in 61.38% of the subjects. Of the remaining subjects requiring additional surgical evacuation [n = 112], 58.93% required evacuation due to failed termination with misoprostol and 65.18% underwent early evacuation [

Conclusion: Misoprostol was a well-tolerated drug which reduced the rate of surgical evacuation among the study subjects. This medication can therefore be used safely in the management of incomplete miscarriage

Evaluation of Misoprostol in the Medical Management of Abortion.

The present study was carried out to compare the safety and efficacy of Misoprostol with Surgical Evacuation in the management of abortion. 100 women as specified by the inclusion and exclusion criteria were recruited for this prospective observational study. 50 subjects (Group A) were managed medically by Misoprostol and 50 subjects (Group B) underwent Surgical Evacuation. Clinical outcome, time taken for expulsion, number of doses required, mean duration of hospital stay, mean analgesic requirement, mean blood loss and side effects were compared between the two groups. It was concluded that vaginal administration of Misoprostol is a safe, effective and cheap alternative to surgical evacuation. No serious adverse effects were observed with Misoprostol.

Factores clínicos y demográficos predictores de éxito del misoprostol en el tratamiento médico del aborto espontáneo / Predictors of success of misoprostol in the treatment of first trimester spontaneous abortion

Objetivos: Determinar posibles predictores de éxito del misoprostol en el tratamiento del aborto espontáneo del primer trimestre. Método: Estudio observacional descriptivo y prospectivo, realizado entre febrero de 2009 y febrero de 2010. Inclusión consecutiva de 248 mujeres con diagnostico ecográfico de aborto espontáneo del primer trimestre con tratamiento médico o quirúrgico, siendo las pacientes las que eligieron la opción terapéutica de acuerdo a los criterios de inclusión para el manejo con misoprostol. En el grupo tratamiento médico se aplicó 800 mcg de misoprostol vaginal/24horas/2 dosis, considerándose como criterio de éxito un endometrio homogéneo con grosor <15 mm en la ecografía realizada al 8° día del tratamiento. Resultados: Influyen en la tasa de éxito del misoprostol la edad de las pacientes (mejor resultado cuanto más joven, p=0,025), número de embarazos (responden mejor las primigestas, p=0,024), existencia o no de abortos (p=0,05) o legrados previos (p=0,028) (la tasa de éxito del misoprostol es mayor en las mujeres que no tienen ningún aborto o legrado previo), y tipo de sangrado vaginal que aparece como efecto secundario del misoprostol (mejorando el pronóstico cuando dicho sangrado es igual o mayor que menstruación, p=0,041). Conclusiones: Hubo predictores de éxito del misoprostol que pueden orientar el manejo, sabiendo que hubo mejor resultado en pacientes jóvenes, primigestas, sin abortos ni legrados previos y con un sangrado vaginal igual o mayor que menstruación.

Objectives: To determine possible predictors of success of misoprostol in the treatment of first trimester spontaneous abortion. Methods: Descriptive observational study and prospectively from February 2009 to February 2010. It were included 248 women which were diagnosed by ultrasound of spontaneous abortion in the first trimester and received medical or surgical treatment, depending on the patient's own choice, provided that the established clinical conditions were present. The protocol applied in the medical treatment group was 800 mcg of vaginal misoprostol/24h/2 dose. It was considered as criteria of success, the presence of a homogeneous endometrium with a thickness <15 mm in the ultrasound examination performed on the 8 th day of treatment. Results: The following variables influence the success rate of misoprostol: patient age (the younger the better outcome, p = 0.025), number of pregnancies (primiparous respond better, p = 0.024), presence or absence of abortions ( p = 0.05) or previous curettage (p = 0.028) (the success rate of misoprostol is higher in women who have no previous abortion or curettage), and type of vaginal bleeding that occurs as a side effect of misoprostol (improving prognosis when bleeding is equal to or greater than the rule, p = 0.041). Conclusions: We found predictors of success of misoprostol, which can guide the management knowing that better results can get obtained in younger patients, primigravida, no previous abortions or curettage and with a vaginal bleeding equal to or greater than the rule.

Metodologia e tratamento do abortamento infectado / Methodology and treatment of infected abortion

Visa este estudo mostrar a metodologia empregada por 143 pacientes que provocaram o abortamento e que foram atendidas na Maternidade da Encruzilhada, Recife, de 1 de janeiro a 30 de junho de 1994. Todas as pacientes com abortamento atendidas no período referido eram submetidas a uma anamnese acurada quando se investigava se o abortamento fora provocado ou espontâneo. Nos casos de abortamento provocado, investigava-se o método utilizado. Nos casos simples sem infecçao, o tratamento de escolha era a curetagem uterina. Na presença de infecçao ou manuseio por sonda ou gotas cáusticas, associava-se um ou mais antibióticos, conforme a gravidade do caso. Os métodos mais utilizados pelas pacientes para provocar o abortamento foram: misoprostol 77 por cento, sonda só ou associada a gotas 17 por cento, chás diversos 11 por cento e injetáveis 5 por cento. Os seguintes métodos terapêuticos foram realizados: curetagem uterina 70 por cento, curetagem uterina e um antibiótico 16 por cento, curetagem uterina e dois antibióticos 7 por cento e curetagem uterina e três antibióticos 7 por cento. Nao houve complicaçoes sérias a registrar e o misoprostol foi o método mais freqüentemente utilizado para provocar o abortamento. Em 70 por cento das vezes, a curetagem uterina foi o tratamento único e em 30 por cento das oportunidades foi acrescido o antibiótico. Enfatiza-se, por fim, a grande importância do planejamento familiar como soluçao definitiva para o problema do abortamento provocado.

Antibiótico profilático em ginecologia e obstetrícia / Prophylactic antibiotics in gynecology and obstetrics

Os autores fazem uma revisäo sobre o emprego de antibióticos profiláticos em várias situaçöes clínicas de obstetrícia e ginecologia, tentando estabelecer condutas mais recomendadas