The Influenceof Parallel Reporting SystemsonData Quality and Information Use in Northwest Ethiopia: Qualitative Study

Background:Ethiopia utilisesthedistrict health information systemfor health information management. However,the lower level health structure seems inaccurate in comparisonto theparallel reportingsystem, withlimited evidence on its effect ondata quality and information use.Therefore,the present study aimed to assess the influence of a parallel reporting system on data quality and information use at the lower level structuresof the Amhara region, Northwest Ethiopia.Methods:The study was conducted in five districts of the Amhara region using an explanatory case study design. Twenty respondents were interviewed from the 1st­30thApril 2021,usinga semi-structured key informant interview(KII)guide with multiple probes to explore relevant information. The data was transcribed into English and transferred to the Open-Code 4.02 software for analysis. Textual data werecoded, and themes were identified from the synthesis. Inductive thematic analysis was applied to identify the relationships among the emerging themes in order todraw a relevant conclusion. Results:Five themeswere emerged fromthe analysis, includingthe current practice of parallel reporting, a program area of parallel reporting, the influence of parallel reporting, reasonsfor parallel reporting,and means to avoid parallel reporting.Likewise, parallelreportingwasdone at the district level and at the point of service delivery. The respondents described maternal and child health programs often usingparallel reporting. Parallel reporting was described as havingundesirable impacts on routinely collected health data quality and use. Moreover, it increases the work burden; andaffects service quality,the the satisfactionlevelsof clients and staff, and the overall efficiency. The main reasons for practicingparallel reporting were:missing important data elements in DHIS2, single language, varying stakeholders' interests, and lack of conductinga partnerforum.Conclusion and implication:Against the national health information system'sguiding principlesand vision, parallelreporting is practicedat the lower health system levelsfor various programs. Therefore, a corrective measure should be taken to achieve the country's information revolution (IR) agenda. To avoid parallel reporting mechanisms, it is recommended that regular partner forums at the district level must be strengthened, important data elements should beincorporated into the DHIS 2, and additional language platforms should be be included in theDHIS2 system.

Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons / Aborto entre mulheres vivendo e não vivendo com HIV/AIDS usuárias de serviços públicos de saúde no município de São Paulo: prevalência, contextos e motivos

Abstract Objectives: we investigated the lifetime prevalence of abortion and life contexts and reasons reported for first abortion among women living (WLHA) and not living with HIV/AIDS(WNLHA). Methods: representative samples of 975 users of public health care reference network for HIV/AIDS and of 1,003 users of the primary care public services in São Paulo municipality were selected by cluster-stratified sampling and answered an electronic socio-behavioral questionnaire. Results: the prevalence of abortion was 11.9% (CI95%9.8-13.9) among WLHA and 3.0% (CI95%2.4-5.7) for WNLHA.Most abortions (128) among WLHA occurred before diagnosis and 28 after diagnosis or during pregnancy when diagnosis was given. The majority of women did not use any contraception at the time of the first abortion. The use of misoprostol was the most reported method. Having HIV was very important in deciding to abort for half of the WLHA. Absence of marital life and the lack of desire to have children were the most reported reasons by both groups. Conclusions: the similarity in contexts and reasons to abort among WLHA and WNLHA suggests that they share experiences molded by gender and social inequalities that affect their ability to access sexual and reproductive health resources and services.

Resumo Objetivos: investigou-se a prevalência de aborto provocado alguma vez na vida e os contextos de vida e motivos referidos para realização do primeiro aborto entre mulheres vivendo (MVHA) e não vivendo com HIV/AIDS (MNVHA). Métodos: amostras representativas de 975 usuárias da rede especializada em HIV/AIDS e de 1.003 usuárias da rede de atenção básica no município de São Paulo foram selecionadas por amostragem estratificada por conglomerados e responderam um questionário eletrônico sócio-comportamental. Resultados: a prevalência de aborto provocado foi de 11,9% (IC95%9,8-13,9) entre MVHA e de 3,0% (IC95%2,4-5,7) para MNVHA. A maioria dos abortos (128) entre MVHA ocorreu antes do diagnóstico e 28 após o diagnóstico ou na gravidez que este foi dado. A maioria das mulheres não fazia contracepção à época do primeiro aborto. O uso de miso-prostol foi o método mais referido. Ter HIV foi muito importante na decisão de abortar para metade das MVHA. Ausência de vida conjugal e o não desejo de ter filhos foram os motivos mais referidos por ambos os grupos. Conclusões: a semelhança nos contextos e motivos para a realização de aborto entre MVHA e MNVHA sugere que elas compartilham experiências moldadas por desigualdades sociais e de gênero que afetam suas possibilidades de acesso a recursos e serviços de saúde sexual e reprodutiva.

Virus Zika y aborto por correspondencia, una realidad cercana a Chile / Zika virus and correspondence abortion, a reality close to Chile

Ante las evidencias de causalidad entre la infección prenatal de virus ZIKA y el desarrollo de microcefalia y otras anomalías cerebrales fetales, publicadas en el año 2016, en Latinoamérica ha surgido mucha incertidumbre sobre el acceso al aborto en mujeres embarazadas infectadas por el virus. Pese a que existe diversidad regulatoria en la región, hoy existen diferentes instancias que facilitan el aborto farmacológico a las mujeres, incluso en países donde está prohibido. Sin embargo esta realidad no se centra exclusivamente en el brote de virus ZIKA, sino que este hecho ha dejado en evidencia la forma como ONG's internacionales ingresan y facilitan el acceso del aborto farmacológico en diferentes países. Este escenario surgiere la interrogante de cómo enfrenta Chile el desarrollo de esta realidad, ante lo cual se muestra la incidencia de la ONG Women on Web en Chile luego de la alerta epidemiológica emitida por la OPS en noviembre de 2015 por virus ZIKA. Desde Chile se presentaron 442 peticiones de aborto farmacológico en 107 días después de emitida la alerta. Estos datos revelan que en Chile, pese a no estar afectado por virus ZIKA, de hecho se usan las plataformas web que proveen de un "aborto farmacológico por correspondencia". Esta evidencia muestra como hoy en Chile existe acceso al aborto farmacológico, tanto desde ONG's internacionales como la presentada, pero también en el comercio informal, todo promovido desde los alcances de las tecnologías de comunicación.

In lieu of the evidence of causality between prenatal ZIKA virus infection and the development of microcephaly and other fetal cerebral anomalies, published in 2016, there has been a surge of uncertainty in Latin America over the access to abortion in pregnant women infected by the virus. Even though diverse regulation exists in the region, today there are many different instances that facilitate women's to pharmacological abortion, even in countries where it is prohibited. However, this reality doesn't center exclusively in the ZIKA virus outbreak, rather this event has emphasized how international NGOs enter and facilitate access to pharmacological abortion in different countries. This scenario suggests the question of how Chile confronts the development of this reality, in which the marked incidence of the NGO Women on Web is shown in Chile after de epidemiology alert emitted by the PAHO in November of 2015 because of the ZIKA virus. Chile presented 442 petitions for pharmacological abortion in the 107 days following the alert notification. This data reveals that Chile, although unaffected by the ZIKA virus, has use of web platforms that provide a "pharmacological abortion by correspondence". This evidence demonstrates how access to pharmacological abortion exists today in Chile, not only from international NGO like the one mentioned, but even through informal commerce, promoted by the reach of communication technology.

Use of Medicinal Plants with Teratogenic and Abortive Effects by PregnantWomen in a City in Northeastern Brazil / Uso de Plantas Medicinais com Efeitos Teratogênicos e Abortivos por Gestantes em uma Cidade no Nordeste do Brasil

Purpose The purpose of this study is to verify the use ofmedicinal plants by pregnant women treated at four Basic Health Units and at a public maternity facility in Brazil s northeast. Methods This is a cross-sectional, quantitative study, performed between February and April 2014. The subjects were 178 pregnant women, aged 18 to 42 years. To collect data, a structured questionnaire with dichotomous and multiple choice questions was used. To verify the correlation between the variables, Pearson s chi-square test was used. Results The study showed that 30.9% of the pregnant women used medicinal plants, and boldo was the most cited (35.4%). All the plants utilized, except lemongrass, have toxic effects in pregnancy, according to Resolution SES/RJ N° 1757. There was no statistically significant correlation between social class and use of medicinal plants. Conclusion The health of the study participants and their unborn children is at risk due to the inappropriate use of medicinal plants.

Objetivo Verificar o perfil de uso de plantas medicinais por gestantes atendidas em quatro Unidades Básicas de Saúde da Família e em uma maternidade pública da cidade de Campina Grande - PB, na região Nordeste do Brasil. Métodos Estudo transversal, quantitativo, desenvolvido no período de Fevereiro a Abril de 2014. Foi incluída uma amostra com 178 gestantes com idade entre 18 e 42 anos. O instrumento de coleta foi um questionário estruturado com perguntas dicotômicas e de múltipla escolha. Para verificar a associação entre as variáveis estudadas, utilizou-se o teste Qui-quadrado de Pearson. Resultados Foi constatado que 30,9% das gestantes utilizavam plantas medicinais, sendo o boldo a mais citada (35,4%). Entre as plantas utilizadas com alta frequência pelas gestantes, todas, com exceção apenas da Erva-Cidreira (Melissa officinalis), apresentavam possíveis efeitos tóxicos para a gestação, segundo a Resolução SES/RJ N° 1757. Ao comparar a classe social e o uso de plantas medicinais, não observou-se relação significante. Conclusões A saúde das grávidas que fazem uso de plantas consideradas medicinais, assim como a de seus filhos, sofrem riscos devido ao uso inadequado destas plantas.

Abortificient effect of mulberry white root in mice

Background and Objective: Due to an increase in spontaneous abortions finding a safe and secure method is inevitable. Some medicinal herbs have abortifacient properties. This study was done to determine the effect of abortifacient effect of mulberry white root in mice

Methods: In this experimental study, 50 mice dams were randomly allocated into five groups including control, sham and experimental group 1, 2 and 3. Animals in control group did not receive any substance. Animals in sham group were received normal saline, intraperitoneally. Animals in experimental group 1, 2 and 3 were received doses of 50, 70 and 90 mg/kg/bw of the alcoholic extract of root of mulberry white during the 7th to 12th days of pregnancies, intraperitoneally, respectively. At the 16th day of the pregnancy the uterine tubes of mice were removed and the absorbed fetuses were recorded

Results: The mean of absorb fetuses was 7.4, 7.6, 1.8 and 3.1 in the experimental group 1, 2, 3 and sham, respectively. There was a significant relation between the mean number of aborted fetuses and concentration of strawberry root [P<0.05]. The apparent anomaly in fetus was not recorded

Conclusion: Root of mulberry white has abortifacient effect with dose-dependent manner

Píldora del día después ¿Anticonceptivo o abortivo? Papel del farmacéutico en el área asistencia / Morning after pill Contraceptive or abortifacient? role of the pharmacist in the healthcare area

Este presente artículo aborda la problemática de la labor y el papel del farmacéutico referido al área asistencial en la comercialización de la llamada píldora del día después. La problemática se origina en una diferencia de opiniones respecto al estado de embarazo algunos la definen como el proceso que va desde el momento de la anidación del embrión hasta el nacimiento; otros, en cambio, dan argumentos científicos de peso defendiendo que este proceso comienza con la fecundación. Sea como fuere el problema, es evidente que el desafío asumido influirá en la consideración de la píldora del día después como anticonceptivo o como abortivo; de igual manera, determinará las condiciones exigibles para su entrada en el mercado; y también repercutirá en la valoración ética del trabajo del farmacéutico en este ámbito. En fin, se clasifican las distintas píldoras del día siguiente y sus mecanismos de acción, Esta parte es imprescindible para entender la motivación que ha llevado al farmacéutico a plantearse un problema de conciencia ante su dispensación. Por lo cual se realizaron revisiones bibliográficas que afirmaron que el efecto de la píldora del día después tiene acción antiimplantatoria. Así, para aquéllos que opinan que el embarazo comienza en la anidación, se trata de meros anticonceptivos. Pero ante la firme convicción científicamente fundamentada de que la gestación se inicia en el momento de la fecundación, se trata de fármacos netamente abortivos. De este modo queda justificada la actitud del farmacéutico que trata de eludir la colaboración con un acto abortivo, aunque sea meramente material e indirecta. En base toda la información obtenida y revisada se llegó a la conclusión que el químico farmacéutico debería informar al usuario sobre la píldora del día después o en otros casos eludir las dispensaciones y su comercialización. Ya que tienen efectos abortivos que de alguna manera dañan a la salud humana.

The present article deals with the problem of the work and role of pharmacist care area referred to in the marketing of the morning after pill. The problem stems from a difference of opinion regarding the status of pregnancy some define as the process from the time of implantation of the embryo until birth, others, however, give weight scientific arguments defending this process begins with fertilization. Anyway the problem, it is clear that the challenge assumed influence the consideration of the morning after pill as a contraceptive or abortifacient likewise, determine the conditions required for its entry into the market, and also impact the ethical evaluation pharmacist's work in this area. In order to be classified the different morning after pills and their mechanisms of action. This part is essential to understand the motivation that has led to the pharmacist to be an issue of conscience before dispensing. Wherefore were conducted literature reviews that said the effect of the morning after pill has antiimplantatoria action. So, for those who believe that pregnancy begins at implantation, it is mere contraceptives. But with the firm conviction that scientifically based pregnancy begins at the moment of fertilization, it is clearly abortifacient drugs. This attitude is justified pharmacist collaboration seeks to avoid an abortive act, albeit merely material and indirect. Based on all the information obtained and reviewed it concluded that a pharmacist should inform the user about the morning after pill or in other cases evade the dispensations and marketing. Since abortive effects are somehow harm human health.

Effects of post-coital administration of alkaloids from senna alata [linn. roxb] leaves on some fetal and maternal outcomes of pregnant rats

The abortifacient claim of Senna alata [S. alata] was scientifically validated recently with alkaloids speculated to be the bioactive agent. This speculation is yet to be substantiated or refuted by scientific evidence. The present study was aimed to investigate the pregnancy terminating effects of the alkaloids from S. alata leaves. Twenty four Pregnant rats [143.99 +/- 1.21 g] allocated randomly to four groups: A, B, C and D respectively received, 0.5 ml of distilled water, 250, 500 and 1000 mg/kg body weight of the S. alata extracted alkaloids orally, once daily from day 10 until day 18 post-coitum. The indices of abortifacient were evaluated at the end of the exposure period. The results were analyzed by both the analysis of variance and Duncan's multiple range test and p<0.05 was considered as statistically significant. Thin-layer chromatographic separation produced five spots with Rf values of 0.28, 0.33, 0.39, 0.47 and 0.55 which gave positive reaction with Meyer's and Wagner's reagents, respectively. The number of implantation sites and corpora lutea, as well as the concentrations of FSH, LH, progesterone, weight of uterus, uterine/body weight ratio, glucose and cholesterol decreased significantly [p<0.05] whereas the resorption index, pre- and post-implantation losses, uterine protein content and alkaline phosphatase activity increased significantly. None of the alkaloid treated animals presented with provoked vaginal opening or bleeding except fetal deaths. The alkaloid decreased the maternal weight gain, as well as feed and water intake. Overall, the alkaloids from S. alata leaves exhibited anti-implantation, anti-gonadotropic, anti-progesteronic, embryonic resorptive, feto-maternal toxic activities but not complete abortifacient. The alkaloids alone may not be the sole abortifacient bioactive agent in the leaf extract

Anti-fertility effect of flower extracts of Tabernaemontana divaricata in rats / 中国天然药物

AIM@#To evaluate the anti-fertility effect of methanolic (MeTD) and aqueous (AqTD) flower extracts of Tabernaemontana divaricata in rats.@*METHODS@#The anti-fertility activity of the extracts was evaluated using two experimental animal models: 1) Estrogenic activity was carried out in immature female rats using ethinyl estradiol as standard. The evaluation parameters includes changes in uterine weight and histopathology of uterus. 2) Anti-implantation and early abortifacient activity was performed in female Wistar rats. The number of implants and resorbtions were compared to vehicle control.@*RESULTS@#Phytochemical analysis of MeTD and AqTD revealed the presence of carbohydrates, amino acids, steroids, glycosides, flavonoids, alkaloids and tannins. In estrogenic activity, the MeTD and AqTD were offered significant estrogen-like activity at 500 mg·kg(-1), p.o. by increasing the uterine weight compared to vehicle control group. In Anti-implantation and early abortifacient activity study, MeTD (500 mg·kg(-1), p.o.) showed significant effect and it was evident by decrease in the number of implants and increase in the number of resorbtions compared to vehicle control group.@*CONCLUSION@#The MeTD at 500 mg·kg(-1), p.o. possess significant estrogenic, anti-implantation and early abortifacient activity, while the AqTD at 500 mg·kg(-1), p.o. was found to possess significant estrogenic activity and the results are in consistent with the literature reports related to anti-fertility effect of flower extracts of Tabernaemontana divaricata.

O comércio de medicamentos de gênero na mídia impressa brasileira: misoprostol e mulheres / The illegal market for gender-related drugs as portrayed in the Brazilian news media: the case of misoprostol and women

Este artigo analisa como a mídia impressa brasileira noticia o comércio clandestino do misoprostol, o principal medicamento para aborto. Foram recuperadas 1.429 notícias, de 220 veículos de informação impressos e eletrônicos, entre 2004 e 2009. A análise foi realizada em 524 notícias de 62 veículos impressos regionais e nacionais. O misoprostol é pauta permanente, mas o enquadramento das notícias é policial, diverso do aborto como uma questão religiosa, política e de saúde pública que domina a mídia brasileira. O misoprostol está inserido no mercado ilegal de medicamentos de gênero, tais como os para emagrecimento, disfunção erétil ou anabolizantes. Sessenta e quatro (12 por cento) notícias impressas apresentam histórias de vida de mulheres que abortaram com o misoprostol. As mulheres têm de 13 a 46 anos e sua inserção de classe demarca diferentes experiências de aborto. Três personagens foram identificados nos itinerários de aborto: amigas, intermediários e médicos. As histórias de aborto tardio são confundidas com a tipificação penal do infanticídio e são casos-limite para a narrativa midiática.

This article analyzes how the Brazilian news media covers the illegal market for misoprostol, the main drug used to induce abortion. A total of 1,429 news stories were retrieved from 220 print and electronic media channels from 2004 to 2009. The analysis included 524 stories from 62 regional and national newspapers. Misoprostol appeared repeatedly in the news, but was usually approached from a criminal perspective, unlike abortion as a whole, which the Brazilian media routinely covers as a religious, political, and public health issue. Misoprostol is part of the illegal gender-related drug market, along with drugs for weight loss and erectile dysfunction and anabolic steroids. Sixty-four (12 percent) of the news stories told life histories of women who had aborted with misoprostol. The women's ages ranged from 13 to 46 years, and socioeconomic status was associated with different experiences with abortion. Three characters appeared in the women's abortion itineraries: girlfriends (confidantes), go-betweens, and physicians. Stories of late-stage abortion are confused with the criminal characterization of infanticide and provide the extreme cases in the media's narrative on abortion.

Effect of plumbagin free alcohol extract of Plumbago zeylanica Linn. root on reproductive system of female Wistar rats

OBJECTIVE@#To assess the effect of plumbagin-free alcohol extract (PFAE) of Plumbago zeylanica Linn. (Plumbaginaceae) (P. zeylanica) root, on female reproductive system and fertility of adult female wistar rats.@*METHODS@#After the oral acute toxicity study, the PFAE was administered at two dose levels to perform the estrous cycle study, anti-implantation and abortifacient activity and hormonal analysis. However, the estrogenic/antiestrogenic activity was evaluated at only one most effective dose.@*RESULTS@#LD(50) cut-off was 5,000 mg/kg body weight. The extract exhibited significant anti-implantation and abortifacient activity at the tested dose levels (300 and 500 mg/kg, p.o.) (P<0.01). The extract dose-dependently decreased the levels of serum progesterone, follicle stimulating hormone and luteinizing hormone, while a dose-dependent increase was observed in the concentration of serum prolactin. The extract did not show any significant changes in structure and function of uterus when given alone, but when given along with ethinyl estradiol, it exhibited significant antiestrogenic activity in immature overiectomized female rats(P<0.001). Biochemical parameters in the serum/blood and haematological parameters did not show appreciable changes throughout and after the course of investigation. However, all the altered parameters returned to normalcy within 30 days following withdrawal of treatment.@*CONCLUSIONS@#All findings suggest that the antifertility activity of extract could possibly be through the changes in the implantation site, altered hormonal levels, prolonged estrous cycle and anti-estrogenic activity. Hence, the extract possesses reversible antifertility activity without adverse toxicity in female rats.

Efeito embriotóxico, teratogênico e abortivo de plantas medicinais / Embryotoxic, teratogenic and abortive effects of medicinal plants

O uso milenar de plantas medicinais mostrou ao longo dos anos, que determinadas plantas apresentam substâncias potencialmente perigosas. Do ponto de vista científico, algumas pesquisas mostraram que muitas dessas plantas possuem substâncias agressivas e por essa razão devem ser utilizadas com cuidado, respeitando seus riscos toxicológicos. Os efeitos mais preocupantes do uso indiscriminado de plantas medicinais são embriotóxico, teratogênico e abortivo, uma vez, que os constituintes da planta podem atravessar a placenta, chegar ao feto e gerar um desses efeitos. Este estudo objetiva fornecer uma listagem das principais plantas medicinais que tenham efeitos embriotóxicos, teratogênicos e abortivos comprovados, conhecendo as partes da planta utilizadas e seus respectivos nomes científicos, com a finalidade de alertar gestantes quanto aos riscos de seu uso. Realizou-se buscas nas bases eletrônicas de dados SciELO, PubMed, MEDLINE, LILACS, CAPES e Google acadêmico. Nos resultados encontrados, plantas como Arnica (Arnica montana), Artemísia (Artemisia vulgaris), Arruda (Ruta chalepensis/ Ruta graveolens), Barbatimão (Stryphnodendron polyphyllum), Boldo (Vernonia condensata) dentre outras, podem vir a gerar um desses efeitos. A partir deste estudo comprova-se que para a maioria das plantas medicinais não há dados a respeito da segurança de seu uso durante a gravidez.

The ancient use of medicinal plants has shown over the years that certain plants have potentially dangerous substances. From a scientific point of view, some studies have shown that many of these plants contain aggressive substances and therefore should be used with caution, respecting their toxicological risks. The most important effects of the indiscriminate use of medicinal plants are embryotoxic, teratogenic and abortifacient since the plant constituents can cross the placenta, reaching the fetus and leading to one of these effects. This study aimed to provide a list of the major medicinal plants that have proven embryotoxic, teratogenic and abortifacient effects, including the used plant parts and their respective scientific names, in order to warn pregnant women about the risks of its use. Searches were carried out in the electronic databases SciELO, PubMed, MEDLINE, LILACS, CAPES and Google Scholar. Results indicated that plants such as mountain arnica (Arnica montana), mugwort (Artemisia vulgaris), fringed rue (Ruta chalepensis / Ruta graveolens), "Barbatimão" (Stryphnodendron polyphyllum) and "Boldo" (Vernonia condensata) are likely to generate such an effect. This study shows that for most medicinal plants there are not data regarding the safety of their use during pregnancy.

unusual complication of unsafe abortion

Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity. Case Report: A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications

Aspectos clínico-epidemiológicos das mulheres pós- abortamento em hospital de referência / Profile clinical-epidemiologist of women after-abortion in reference`s hospital

Caracterizar os aspectos clínico-epidemiológicos e principais fatores determinantes do abortamento em mulheres internadas em um hospital de referência no Estado do Pará. Método: estudo transversal analítico; foram entrevistadas 160 pacientes em idade fértil, internadas por abortamento no Hospital Fundação Santa Casa de Misericórdia do Pará, período de dezembro de 2007 a dezembro de 2008. Resultados: após análise dos dados observou-se que das 160 entrevistadas, 78,12% abortaram espontaneamente e 21,88% tiveram a intenção de interromper a gestação; a faixa etária mais freqüente foi de 20 a 29 anos (60%); constatou-se que o estado conjugal foi um importante fator determinante para o abortamento eletivo, pois 82,85% das mulheres que provocaram o término da gestação eram solteiras; o misoprostol foi método de escolha para cessar a gravidez em 82,9% dos casos; a instabilidade financeira foi o motivo mais apontado entre as pacientes que provocaram o abortamento (48,57%). Conclusão: houve redução no número de abortamentos provocados , prevalecendo os de causa espontânea. Não se descarta a possibilidade de subnotificações das ocorrências, pois a ilegalidade da interrupção eletiva da gestação leva mulheres a mentirem ou omitirem tal ato, com medo das conseqüências legais. Por isso, é importante ampliar estudos a respeito do tema, divulgando-os, na tentativa de combater os danos psicológicos e físicos às mulheres que provocam o abortamento, consequentemente, reduzindo o ônus ao sistema público de saúde.

To determine the profile physician-epidemiologist of the women after-abortion and the main influences factors of such act. Method: for this sample, they had been interviewed 160 patients in fertile age interned by abortion in an institution of reference in State of Pará, comtemplating the period of December of 2007 the December of 2008. Results: it was observed that the age with greater frequency of abortion, with was between 20 the 29 years (60%), the influence of the conjugal state with the type of abortion was evident, the induced were practiced for bachelors, they make use of misoprostol (82.9%), this method of choice for the interruption of the pregnancy, and this had as root cause the lack of financial condition (48,57). The studies abortions show, 78.12% had been spontaneous. Conclusion: this summary demonstrated the unfamiliarity on the treated subject, in the state of Pará, that suffers with this work demonstrated the unfamiliarity on boarded searched the subject treat/searched/boarded in the State to Pará, that it suffers with the great number of occurrence of spontaneous abortions. However, we evidence that the induced interruption of the pregnancy is a large Brazilian problem of public health and social justice, that exactly being illegal practical one and a crime foreseen in law, has its incidence in considerable degrees.

Comparison of combination of dinoprostone suppository and ethacridine and ethacridine alone for induction of mid term pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness and safety of using the combination of dinoprostone suppository and ethacridine and ethacridine alone for the induction of mid-term pregnancy.</p><p><b>METHODS</b>The clinical data of 96 patients at 16-27+6 gestational weeks in Peking Union Medical College Hospital from March 2008 to December 2009 were retrospectively analyzed. Patients were divided into combination group (n=54) and ethacridine alone group (n=42) based on their induction methods. The efficacy and side effect were compared between these two groups after the induction.</p><p><b>RESULTS</b>The effectiveness rate was 70.4% (38/54) in the combination group,which was significantly higher than that in ethacridine alone group (4.8%) (2/42) (P=0.001). The durations of the first and second,and total stage of labor were found to be significantly shorter in combination group [(287∓39) and (513∓39) min)] when compared with ethacridine alone group [(546∓84) and (661∓82) min] (P=0.01). The bleeding volume in the combination group was (69∓4) ml, which was significantly less than that in control group (96∓7) ml (P=0.02). The two groups had no significant differences in terms of in-labor duration (P=0.45), postpartum placenta remnants (P=0.91), and fetal membrane remnants (P=1.31).</p><p><b>CONCLUSION</b>The combination of dinoprostone suppositories and ethacridine is more effective and safer than ethacridine alone for induction of mid-term pregnancy.</p>

Medical abortion in primary care: pitfalls and benefits / Aborto medico en la atención primaria: riesgos y beneficios

We describe five pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained products in the uterus; repetition of misoprostol because of retained products in the uterus after two weeks and an allergic reaction to methotrexate. Despite these pitfalls, there are enough benefits to consider medical abortion with methotrexate and misoprostol as a safe method with a high success rate of more than 91% and a good alternative for surgical abortion. An invasive procedure is not necessary, there are no long-term complications and it can be performed at an earlier stage, which makes it more acceptable in society. In Curaçao, where abortion is legally restricted, medical abortion is performed with methotrexate and misoprostol. In countries where abortion is legal, mifepristone and misoprostol are the first choice.

Describimos cinco riesgos del aborto medico: el embrazo ectópico no terminado después de misoprostol, pero sin efectos secundarios negativos; la pérdida de sangre vaginal a largo plazo sin productos retenidos sospechosos que desaparecieron espontáneamente; una paciente con útero miomatoso con dolor severo y productos retenidos en el útero; repetición del misoprostol debido a productos retenidos en el útero después de dos semanas y una reacción alérgica al metotrexato. A pesar de estas dificultades, hay suficientes beneficios para considerar el aborto médico con metotrexato y misoprostol como un método seguro con una alta tasa de éxito superior al 91%, y como una buena alternativa al aborto quirúrgico. No se requiere un procedimiento invasivo, no hay complicaciones a largo plazo, y puede realizarse en una etapa más temprana, lo que resulta más aceptable para la sociedad. En Curazao, donde el aborto está legalmente restringido, el aborto médico se realiza con metotrexato y misoprostol. En países donde el aborto es legal, la mefepristona y el misoprostol son la primera elección.

Ru486: del aborto químico a la contracepción de emergencia / Ru486: from chemical abortion to emergency contraception

El uso del mifepriston (RU486), en combinación con análogos de las prostaglandinas, en la inducción del aborto químico requiere una específica reflexión en relación a los principales aspectos farmacológicos y toxicológicos. La actual dialéctica bioética y biopolítica, a menudo ideologizada, impone aún más un tratamiento riguroso basado en evidencias científicas, para aclarar sobre todo los mecanismos de acción y de los eventos adversos. Estos últimos a veces también subvalorados o minimizados. Considerada la iniquidad del aborto voluntario, el artículo se propone también el objetivo de aclarar cómo, a la luz de una reciente bibliografía, el recurso al RU486 representa un significativo riesgo para la salud de las mujeres. Una particular atención está reservada a la aclaración etiopatogenética de las hemorragias y de las sepsis, en las cuales se han evidenciado también distintos decesos. En el artículo están presentes, además, los más actuales desarrollos de la investigación con RU486 sea para el tratamiento experimental de patologías –ginecológicas y no– como para el uso de la molécula de la contracepción hormonal y la contracepción de emergencias.

The use of mifepristone (RU486), in combination with prostaglandin analogues, in chemical abortion requires a specific reflection on the main aspects in pharmacology and toxicology. The current debate in bioethics and bio-policies, often ideological, imposes a more rigorous treatment based on scientific evidence, especially clarification of the mechanisms of action and severe adverse events. The latter is sometimes underestimated or minimized. Considering the inequity of voluntary abortion, this article aims also to clarify how, in the light of the most recent literature; the use of RU486 represents a significant risk to women’s health. Particular attention is given to etiopathogenetic clarification of bleeding and sepsis, which have also involved several deaths. The article reports the latest developments in research with RU486, whether for experimental treatment of pathologies –gynaecological and others– and for the use of the hormonal contraception molecule and emergency contraception.

Intoxicação aguda e abortos em cobaias pelas favas de Enterolobium contortisiliquum (Leg. Mimosoideae) / Acute poisoning and abortions in guinea pigs by the pods of Enterolobium contortisiliquum (Leg. Mimosoideae)

Os objetivos deste trabalho foram determinar a toxicidade aguda e o efeito abortivo de favas de Enterolobium contortisiliquum. Em um experimento frutos da árvore foram administrados a 4 grupos de 3 cobaias cada. Outro grupo de 3 cobaias foi utilizado como controle. Para os Grupos 1 e 2 foram administradas 5 e 10g de favas por kg de peso vivo, respectivamente, em doses únicas. Para os Grupos 3 e 4 foram administradas 10 e 15g/kg, respectivamente, divididas em doses diárias de 5g/kg. Uma cobaia do Grupo 2 e uma do Grupo 4 morreram 12 e 18 horas após o final da administração da planta. As lesões macroscópicas consistiam hemorragias no estômago e intestinos delgado e grosso, fígado aumentado e vesícula biliar distendida. Histologicamente, o fígado apresentava severa vacuolização e necrose dos hepatócitos periportais. Em outro experimento, ração contendo 4% de favas de E. contortisiliquum foi administrada a dois grupos de 4 cobaias 35 dias após o acasalamento. Das 8 cobaias, 4 abortaram 6-15 dias após o início da ingestão. As outras 4 cobaias não estavam prenhes. Duas cobaias controle pariram normalmente. Todas as cobaias foram eutanasiadas no final do experimento. Histologicamente, as cobaias que ingeriram as favas apresentaram, no fígado, necrose hemorrágica periportal de moderada a severa. Todos os fetos apresentavam graus variáveis de autólise. Em 4 fetos que foram estudados histologicamente não foram observadas lesões significantes. As lesões agudas observadas nas cobaias são semelhantes às observadas na intoxicação por favas de E. contortisiliquum em bovinos e às da intoxicação experimental com saponinas da árvore.Os resultados do experimento em cobaias prenhes demostram o efeito abortivo de E. contortisiliquum e sugerem que esta espécie pode ser utilizada para estudar o efeito abortivo da planta ou de princípios ativos identificados na mesma.(AU)

The objective was to study the acute toxicity and the abortive properties of Enterolobium contortisiliquum pods in guinea pigs. Pods of E. contortisiliquum were administered orally to 4 groups of 3 guinea pigs each. Another group of 3 guinea-pigs was used as control. Group 1 and 2 were fed with one dose of 5 and 10g of pods for kg body weight, respectively. The guinea pigs of Group 3 and 4 received 10 and 15g/kg, respectively, divided into daily doses of 5g/kg. One guinea pig from Group 2 and one from Group 4 died 12 and 18 hours after the end of the administration. Gross lesions were hemorrhages of the stomach and of the large and small gut, enlarged liver, and dilated gall bladder. Histologically, the liver had severe vacuolation and necrosis of periportal hepatocytes. In another experiment a ration containing 4% of pods of E. contortisiliquum was fed to 2 groups of 4 guinea-pigs, 35 days after mating. Four of the 8 guinea pigs aborted 6-15 days after the beginning of ingestion. The other 4 guinea pigs were not pregnant. All guinea pigs were euthanized after abortion or at the end of the experiment. Histologically all animals had mild to severe periportal hemorrhagic necrosis. All fetuses had variable degree of autolysis. In 4 fetuses studied no significant histologic lesions were observed. The acute lesions observed in guinea-pigs are similar than those observed in the spontaneous poisoning by Enterolobium spp. in cattle. Similar lesions are observed in guinea-pigs poisoned experimentally with saponins from E. gummiferum. The results of the experiments in pregnant guinea pigs suggest that E. contortisiliquum can be used to study the abortive effect of its pods or its toxic compounds.(AU)

Empleo de Misoprostol para inducir el aborto hasta 9 semanas / Use of Misoprotol to induce abortion up to 9 weeks

Objetivo: evaluar la eficacia y seguridad de la auto-administración vaginal de 800 mg de Misoprostol, 1 dosis cada 8 horas hasta un máximo de 3 dosis y 2 ciclos en un período de 48 horas, para provocar el aborto en un grupo de 214 pacientes con menos de 63 días de embarazo. Métodos: se hizo un estudio clínico, descriptivo y prospectivo, cuyo universo de trabajo quedó constituido por todas las pacientes que acudieron a la consulta de planificación familiar del Hospital Universitario Ginecoobstétrico América Arias desde el 15 de enero de 2006 al 21 de noviembre de 2006. Resultados: el método se consideró eficaz cuando provocó el aborto completo sin requerir procedimientos quirúrgicos y esto ocurrió en 193 pacientes (90,2 E por ciento). La mayor efectividad se logró con el primer ciclo de tratamiento en 185 casos (86,4 por ciento). Se presentaron 21 fallos (9,8 por ciento), en 15 de ellos fue por fracaso del método después de administrada la 3ra dosis del 2do ciclo, en 4 por decisión médica y 2 por decisión de la paciente. Los efectos secundarios más significativos fueron los escalofríos (55,1 por ciento), las náuseas (32,7 por ciento), el dolor pélvico (73,8 por ciento) y el sangrado uterino mayor que el menstrual (63,1 por ciento). Conclusiones: los resultados obtenidos sugieren que la administración de una dosis de 800 mg de Misoprostol cada 8 horas por vía vaginal es un método adecuado para interrumpir el embarazo entre las 6 y 9 semanas de gestación.

Objective: to evaluate the efficiency and safety of self-vaginal administration of 800 µg of Misoprostol, one dose every 8 hours up to a maximum of 3 doses and 2 cycles in a period of 48 hours to induce abortion in a group of 214 patients with less than 63 days of gestation. Methods: a clinical, descriptive and prospective study was conducted. The universe consisted of all the patients that were seen at the familiy planning department of América Arias Gynecoobstetric University Hospital from January 15 2006 to November 21 2006. RESULTS: the method was considered efficient when the complete abortion was attained with no surgical procedures, which occurred in 193 patients (90,2 E percent). The highest effectiveness was obtained with the first cycle of treatment in 185 cases (86.4 percent). There were 21 fails (9.8 percent), 15 of them due to failure of the methods after the administration of the third dose of the second cycle, 4 for medical decision and 2 because of patient's decision. The most significant secondary effects were chills (55.1 percent), nausea (32.7 percent), pelvic pain (73.8 percent) and uterine bleeding above the menstrual bleeding (63.1 percent). Conclusions: the results suggest that the administration of a dose of 800 µg of Misoprostol every 8 hours by vaginal route is an adequate method to interrupt pregnancy between the 6 and 9 weeks of gestation.

O uso popular de plantas como emenagogas e abortivas / The use of plants as emmenagogue and abortifacient agents

O emprego de plantas para indução da menstruação e do aborto é amplamente difundido, e há uma grande diversidade de espécies vegetais utilizadas. Este trabalho revisa a literatura sobre o uso popular de plantas como emenagogas e abortivas, visando a contribuir com a divulgação de informações etnofolclóricas e dados experimentais a respeito das espécies vegetais mais utilizadas. Foram apresentados os dados sobre carrapichinho (Acanthospermum hispidum), cipó mil homens (Aristolochia triangularis), losna (Arthemisia absinthium), erva de santa maria(Chenopodium ambrosioides), buchinha do norte (Luffa operculata), pariparoba (Piper sp.) e arruda (Ruta graveolens). A ação das plantas deve-se à presença de substâncias estrogênicas, citotóxicas e/ou que estimulem a contratilidade uterina. Se o aborto não ocorrer, anomalias ou malformações podem ser produzidas. O uso de plantas para indução do aborto é comum, apesar dos riscos de intoxicação. Essa conduta deveria ser desestimulada por programas de saúde comunitária, com esclarecimento sobre os riscos à saúde da mulher e do feto e com acesso a métodos contraceptivos. Por outro lado, os produtos de origem vegetal devem ser considerados pela indústria farmacêutica como importante fonte na busca de agentes interceptivos e de medicamentos para o tratamento das desordens menstruais