Abordaje integral de la Interrupción Voluntaria del Embarazo: (segunda entrega) / Comprehensive approach to the voluntary interruption of pregnancy: (second issue)

La legalización de la interrupción voluntaria del embarazo ha transformado la práctica médica con respecto a la atención de las pacientes que desean interrumpir la gestación hasta la semana 14 en Argentina. En la primera entrega, el equipo PROFAM compartió su punto de vista a través de una adaptación de su material educativo destinado, sobre todo, a aclarar los aspectos legales que hacen a la práctica cotidiana. En esta entrega se desarrolla en detalle el procedimiento para realizar un aborto farmacológico con misoprostol y mifepristona, así como las generalidades del aspirado manual endouterino. (AU)

The legalization of voluntary termination of pregnancy has transformed medical practice regarding the care of patients who wish to terminate a pregnancy up to 14 weeks in Argentina. In the first issue, the PROFAM team shared its point of view through an adaptation of its educational material aimed, above all, at clarifying the legal aspects of daily practice. In this issue, the procedure to perform a pharmacological abortion with misoprostol and mifepristone is developed in detail, as well as the generalities of manual uterine aspiration technique. (AU)

Embarazo con implantación en histerorrafia de cesárea anterior: caso clínico poco frecuente / Pregnancy implanted in previous cesarean section scar: a rare clinical case

Introducción: el embarazo ectópico se produce cuando el embrión se implanta fuera de la cavidad uterina, y se ubica mayormente en las trompas de Falopio. Objetivo: presentar un caso clínico en el que la paciente desarrolló un embarazo ectópico en la cicatriz de una histerorrafia previa, fue diagnosticada cuando cursaba la sexta semana de gestación y se resistió ante la idea de perderlo irremediablemente, aunque su cuadro clínico es muy doloroso y se complica rápidamente. Presentación del caso: paciente de 27 años de edad, de color de piel negra, con antecedente de cesárea previa 9 meses atrás. Según reporte ecográfico se diagnostica embarazo de 8,6 semanas de gestación localizado en la zona de cicatriz de cesárea previa. Recibe tratamiento inicial con metotrexate y cloruro de potasio, para luego ser intervenida quirúrgicamente a través de legrado instrumental, se corrobora diagnóstico ecográfico y se logra extraer el embrión exitosamente. Conclusión: el manejo atendió a las características clínicas e individuales de la gestante y se respetó el principio de autonomía de la embarazada. La paciente pudo ser dada de alta con un estado de salud satisfactorio, conservó su capacidad de fecundidad(AU)

Introduction: Ectopic pregnancy occurs when the embryo is implanted outside the uterine cavity, mostly located in the fallopian tubes. Objective: To present a clinical case in which the patient developed an ectopic pregnancy over a previous cesarean section scar; the diagnosis was made when she was in the sixth week of her pregnancy and she could not withstand the idea of losing the baby, but the clinical picture worsened, she was very painful and became complicated quickly. Case report: Twenty-seven-year-old black patient with previous history of a cesarean section 9 months ago. According to ultrasound criteria, 8.6 weeks of pregnancy located in the area of a previous cesarean section scar is diagnosed. The patient receives initial treatment with methotrexate and potassium chloride to undergo a surgical procedure through instrumental intervention (curettage), confirming the diagnosis of the ultrasound and removing the embryo successfully. Conclusions: The management was based on the clinical and individual characteristics of the pregnant woman respecting the principle of autonomy. The patient was in good health at the moment of discharge, preserving her fertility capacity(AU)

Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased.Objective. To investigate four treatment methods, based on each patient's clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP.Methods. CSEP cases (N=30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage (n=12), embryo reduction with local methotrexate injection (n=12), laparoscopic excision (n=3) and excision through laparotomy (n=3). Serum levels of beta-human chorionic gonadotrophin (ß-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values.Results. There was a significant positive correlation between gestational age in weeks and the CSEP management strategy employed. ß-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later.No cases required a hysterectomy, and no maternal complications were reported in this study.Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of ß-hCG levels and ultrasonographic examinations, is recommended after CSEP management

Aspiración manual endouterina (AMEU): Revisión de la literatura y estudio de serie de casos / Manual vacuum aspiration (MVA): a literature review and a case series study

Introducción y objetivo El aborto es la pérdida del producto de la concepción antes de la viabilidad fetal y se considera la principal complicación del embarazo. El objetivo de nuestro trabajo es evaluar los resultados iniciales y en mediano plazo del manejo con Aspiración Manual Endouterina (AMEU) del aborto en el primer trimestre. Métodos Análisis estadístico de serie de casos de 53 pacientes sometidas a AMEU en el Hospital Carlos Van Buren, Valparaíso desde noviembre 2017 a junio 2018 por aborto del primer trimestre. El diagnóstico fue clínico y mediante ultrasonografía. Se efectuó un cuestionario de satisfacción posterior al procedimiento. Resultados Se analizaron 53 pacientes, cuya edad promedio es de 29 años, 19 nulíparas, 34 multíparas, con edad gestacional promedio de 8 semanas. Se analizaron 53 biopsias de contenido intrauterino que resultaron en 53 abortos, de éstos 39 retenidos y 14 incompletos. Se registró un 3% de complicaciones (1 caso de perforación uterina que sólo requirió manejo médico y 1 caso de evacuación incompleta). El cuestionario reveló en una mayoría, el alivio de los síntomas y satisfacción en relación al procedimiento. Conclusión La AMEU es una buena alternativa en el manejo del aborto debido a menores costos, baja tasa de complicaciones y alta eficacia. Los centros que disponen de diversas alternativas para el manejo del aborto deben asegurarse de que la mujer participe activamente en la elección en cuanto a su resolución.

ABSTRACT Introduction and objective Miscarriage is the loss of the product of conception before fetal viability and it is considered the main complication of pregnancy. The main objective of our study is to evaluate initial and midterm reports using Manual Vacuum Aspiration (MVA) as management of first trimester miscarriage. Methods Statistic analysis of a case series of 53 patients submitted to MVA at Hospital Carlos Van Buren, Valparaíso since November 2017 until June 2018 with first trimester miscarriage. The diagnosis was clinical and ultrasonographic. A post procedure satisfaction questionnaire was carried out. Results Fifty-three patients were analyzed, with mean age of 29 years, 19 were nulliparous, 34 multiparous, mean gestational age of 8 weeks. Fifty-three intrauterine biopsies were analyzed, of which 53 were miscarriage, 39 retained sacs and 14 incomplete. We had 3% of complications (1 case of uterine perforation requiring only medical treatment and 1 case incomplete vacuum). The questionnaire revealed in a majority, the relief of symptoms and satisfaction with the procedure. Conclusion MVA is a good alternative in the management of miscarriage due to less costs, low rate of complications and high efficacy. The centres with various alternatives for miscarriage management must ensure that the women actively participates in the election of the resolution.

Embarazo ectópico tubárico con feto vivo en una adulta joven / Ectopic tubal pregnancy with alive fetus in a young adult woman

Se describe el caso clínico de una paciente de 21 años de edad quien acudió al Cuerpo de Guardia del Hospital Ginecobstétrico Docente Tamara Bunke Bider de Santiago de Cuba por presentar dolor leve en bajo vientre y sangrado en forma de manchas luego de que le fuera realizado un legrado uterino por aspiración 8 días atrás. Se efectuó una ecografía ginecológica que mostró un embarazo ectópico tubárico de 11 semanas en el lado derecho, con el feto vivo, por lo cual se indicó laparotomía exploratoria de urgencia y salpingectomía parcial en la trompa derecha. La paciente evolucionó de manera satisfactoria

The case report of a 21 years patient who went to the emergency room of Tamara Bunke Bider Teaching Gynecological-Obstetrics Hospital in Santiago de Cuba is described. She presented a slight pain in low stomach and bledding in form of stains after a suction curettage 8 days earlier. A gynecological echography that showed an ectopic tubaric pregnancy of 11 weeks in the right side, with alive fetus was carried out, reason why an exploratory emergency laparotomy and partial salpingectomy in the right tube were indicated. The patient had a satisfactory clinical course

Recurrent hydatidiform mole with NLRP7 mutation: The first confirmed case in the Philippines / Philippine Journal of Obstetrics and Gynecology

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae. Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Recurrent hydatidiform mole with NLRP7 mutation: The first confirmed case in the Philippines / Philippine Journal of Obstetrics and Gynecology

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Curetaje como tratamiento de apoyo en la reducción de la enfermedad hipertensiva inducida por el embarazo / Curettage as supportive therapy in reducing hypertensive disease induced by pregnancy

Introducción: el estado hipertensivo del embarazo es uno de los problemas obstétricos no resueltos más importante. El embarazo puede inducir elevación tensional y daño renal específico. Se han realizado algunos estudios que describen los cambios de la presión arterial durante todo el embarazo. En países donde el control prenatal no es adecuado, la preeclampsia provoca entre 40 y 80 por ciento de las muertes maternas. Se estima un total de 50 000 muertes por año. Objetivo: evaluar cómo se presenta la evolución de la presión arterial en el puerperio inmediato en pacientes con enfermedad hipertensiva inducida por el embarazo, sometidas a procedimiento de curetaje. Métodos: es un estudio comparativo con un grupo de intervención y un grupo control en el Hospital Universitario Dr. Joaquín del Valle Sánchez, Torreón. Coahuila, México. La intervención consistió en la realización del procedimiento de curetaje transcesárea en las pacientes con enfermedad hipertensiva inducida por el embarazo. Las mediciones principales fueron: el análisis de expediente clínico, perfil bioquímico completo, cifras tensionales. Resultado: la mayoría de las pacientes que acuden al Servicio de Ginecología y Obstetricia son adolescentes entre 14 y 20 años. Hubo una mejora significativa en la presión arterial sistólica a las 8 y 16 h, y una disminución a las 24 h de la presión sistólica y diastólica en pacientes sometidas al procedimiento de curetaje. Conclusiones: el uso del procedimiento de curetaje transcesárea en pacientes con enfermedad hipertensiva inducida por el embarazo disminuye considerablemente la presión arterial. Se sugiere el uso de este procedimiento en pacientes sometidas a cesárea en el Hospital Universitario Dr. Joaquín del Valle Sánchez y otros centros de salud(AU)

Introduction: Hypertensive pregnancy status is one of the obstetrical most important unsolved problems. Pregnancy can induce specific tensional elevation and kidney damage. There have been some studies describing changes in blood pressure throughout pregnancy. In countries where prenatal care is not adequate, preeclampsia causes 40 and 80 percent of maternal deaths. 50 000 deaths per year are estimated. Objective: Evaluate how the evolution of blood pressure in the immediate postpartum period in patients undergoing curettage procedure is presented due to pregnancy-induced hypertensive disease. Methods: A comparative study with an intervention group and a control group was conductedat Dr. Sanchez Joaquin Valley University Hospital, in Torreon, Coahuila, Mexico. The intervention consisted of carrying out the process of trans-cesarean curettage in patients with pregnancy-induced hypertensive disease. The main readings were the analysis of medical records, complete biochemical profile, and pressure figures. Result: Most patients who come to the service of Gynecology and Obstetrics are teenagers 14-20 years. There was significant improvement in systolic blood pressure at 8 and 16 h, and decreased to 24 in systolic and diastolic blood pressure in patients undergoing the procedure of curettage. Conclusions: The use of curettage procedure after cesarean section in patients with hypertensive disease induced by pregnancy significantly lowers blood pressure. The use of this procedure is suggested in patients undergoing cesarean section at suggested Dr. Joaquín del Valle Sánchez University Hospital and other health centers(AU)

Manual vacuum aspiration [MVA]: a safe and effective alternative for the surgical management of early pregnancy loss

Objective: To assess and document safety, efficacy and patient acceptability of Manual vacuum aspiration [MVA] in the management of early pregnancy loss [EPL], performed in the treatment room setting

Study Design: Quasi-experimental, [clinical trial]

Place and Duration of Study: Treatment Room, OBGYN department, PNS Shifa from Nov 2010 to 31[st] Mar 2013

Material and Methods: Single centre prospective study conducted at Obstetric and Gynecology department, PNS Shifa from Nov 2010 to Mar 2013. A total of 414 women with EPL consented for MVA in the treatment room under local anesthesia, out of which 400 women underwent MVA

Results: Overall MVA was 94.5% effective in treating pregnancies through 13 weeks of gestation. There were no major complications. Minor complications: retained products of conception and endometeritis were treated easily

Conclusion: MVA is safe, effective and economical alternative to conventional dilatation and curettage for the treatment of EPL. Treatment in the outpatient setting allows better post-procedure physical and emotional quality of life; avoids general anesthesia, has immense potential in primary health care setting

Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiracion manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013 / Remifentanil as complementary analgesia in paracervical blocking for endouterine manual aspiration. Hospital Vicente Corral Moscoso. Cuenca, 2013

OBJETIVO:Disminuir el dolor producido por la Aspira-ción Manual Endouterina (AMEU) en pa-cientes que se intervienen bajo bloqueo paracervical. MATERIALES Y MÉTODOS:Con un diseño clínico controlado aleato-rizado ciego, se incluyó, 80 pacientes (en dos grupos de 40) seleccionadas para tra-tamiento de aborto incompleto mediante Aspiración Manual Endouterina, en el De-partamento de Gineco-Obstetricia del Hospital Vicente Corral Moscoso. El grupo "A" (n = 40), recibió adicional al bloqueo para-cervical 1 mcg/kg de peso de remifentanil endovenoso como dosis inicial seguida de bolos de 0,5 mcg/kg de peso cada 4 minu-tos y al grupo "B" (n = 40), se realizó el proce-dimiento bajo bloqueo paracervical única-mente; Se determinó la intensidad del dolor mediante la escala visual análoga de 10 puntos, cambios hemodinámicos y efectos secundarios.RESULTADOS:No hay diferencia significativa en los grupos de estudio tanto en edad (p = 0,118), peso (p = 0,522), talla (p = 0,114), IMC (p = 0,668), nivel de instrucción (p = 0,699). La adición de remifentanil, disminuyó el dolor según la EVA de 7,58 grupo "B" con respecto a 2,98 del grupo "A", (p = 0,000); no se tuvo cambios significativos en cuanto a tensión arte-rial media y frecuencia cardiaca (p > 0,05); el efecto secundario que se presentó con diferencia estadísticamente significativa (p = 0,001) es la náusea que es mayor en el gru-po "B".DISCUSIÓN:La adición de remifentanil al bloqueo para-cervical, disminuyó el dolor mediante EVA en un 46%, sin mayor cambio en la hemo-dinamia y con menos efectos secundarios que los que presenta el grupo control (náu-sea 92,3% con p de 0,001).

OBJECTIVE:To reduce the pain of manual vacuum aspi-ration (MVA) in patients involved under pa-racervical block. MATERIALS AND METHODS:In a clinical randomized controlled blind design, 80 patients were included (in two groups of 40) selected for an incomplete treatment of abortion with manual vacuum aspiration, in the Gynecology and Obstetrics Department of the Vicente Corral Moscoso Hospital. The group "A" (n = 40) received ad-ditional to the paracervical block 1 mcg / kg intravenous remifentanil as an initial dose fo-llowed by 0.5 mcg / kg every 4 minutes and the group "B" (n = 40), the procedure was performed only under paracervical. Pain in-tensity was determined by visual analog sca-le of 10 points, hemodynamic changes and side effects. RESULTS:There is no a significant difference in the study groups in both age (p = 0.118), weight (p = 0.522), height (p = 0.114), BMI (p = 0.668), educational level (p = 0.699). The addition of remifentanil, reduced pain according to the EVA of 7.58 group "B" with respect to 2.98 group "A", (p = 0.000); it had no significant changes in arterial pressure and heart rate (p> 0.05); the side effect was presented with statistically significant difference (p = 0.001) it is nausea which is higher in group "B". DISCUSSION:The addition of remifentanil to paracervical block, decreased the pain through EVA by 46%, without much change in hemodyna-mics and with fewer side effects than has the control group (92.3% nausea with p 0.001).

[Suction evacuation with Methotrexate as a successful treatment modality for caesarean scar pregnancies; case series]

Pregnancy resulting from the implantation of an embryo within a scar of a previous Caesarean section is extremely rare. The diagnosis and treatment of Caesarean scar pregnancies [CSPs] are challenging and the optimal course of treatment is still to be determined. We report a case series of six patients with CSPs who presented to the Royal Hospital in Muscat, Oman, between October 2012 and April 2014. All of the patients were successfully treated with systemic methotrexate and five patients underwent suction evacuation either before or after the methotrexate administration. The patients were followed up for a period of 6-9 weeks after treatment and recovered completely without any significant complications. Suction evacuation with methotrexate can therefore be considered an effective treatment option with good maternal outcomes

Complicações clínicas da gravidez molar / Clinical complications of hydatidiform mole

A gravidez molar, espectro benigno da doença trofoblástica gestacional, representa uma complicação obstétrica da primeira metade da gestação. De maneira geral, cursa com sintomatologia exuberante: hemorragia, útero aumento para a idade gestacional, cistose ovariana e pré-eclâmpsia precoce; chegando mesmo a graves situações clínicas de hipertireoidismo e insuficiência respiratória.Todavia, devido ao diagnóstico precoce da mola hidatiforme, ainda no primeiro trimestre, mercê da ultrassonografia, houve uma importante redução na ocorrência desses sintomas; contribuindo para que a condução desses casos excepcionais ficasse confinada aos Centros de Referência. É objetivo desse artigo apresentar ao obstetra brasileiro uma revisão das complicações clínicas da gravidez molar, atualizando-o no diagnóstico precoce e tratamento dessas condições clínicas que podem ser potencialmente ameaçadoras à vida da gestante e de seu concepto.(AU)

The molar pregnancy, in the benign gestational trophoblastic disease spectrum, represents an obstetric complication of first half of gestation. In general, runs with exuberant symptoms: bleeding, uterus increase for gestational age, ovarian cistose and early preeclampsia; even serious clinical situations of hyperthyroidism and respiratory failure. However, due to the early diagnosis of hydatidiform mole, still in the first trimester, through ultrasound, there was a significant reduction in the occurrence of these symptoms; contributing so that the conduct of these exceptional cases could be confined to the centers of reference. The purpose of this article is to present to the Brazilian obstetrician a review of clinical complications of molar pregnancy, updating it in the early diagnosis and treatment of clinical conditions that can be potentially threatening to the life of the pregnant woman and her fetus.(AU)

Comparison of manual vaccum aspiration and sharp curettage in the treatment of first trimester abortions

To compare the safety and efficacy of manual vaccum aspiration and sharp curettage in the treatment of first trimester abortions. Randomized controlled trial. Department of gynecology, Social Security Hospital Shahdra Lahore in collaboration with Family Health Hospital Johar Town Lahore, from May 2007 to May 20102. Six hundred women admitted with the diagnosis of first trimester less than or equal to 12 weeks abortions were randomly assigned, 300 to manual vacuum aspiration [MVA] and 300 to traditional sharp curettage. Diagnosis of abortion was confirmed by last menstrual period, physical examination and ultrasonography. In total of 600 patients, 300 randomly assigned to MVA and another 300 patients assigned to sharp curettage managemet were having mean age of 31.8 and 33 yrs respectively. mean parity was in both groups, mean gestational age 8.9 and 8.2 weeks, mean duration of procedure was 6.4 and 5.8 minutes, duration of hospital stay was 4 and 40 hrs, missed abortion in 47% and 43% patients, incomplete abortion in 53% and 57% patients, cervical dilatation was needed in 1% against 53%, 10% against 8% experienced mild pain in both groups, no patient of incomplete evacuation against 0.6%, uterine perforation in none against 0.3%, excessive bleeding was experienced by 0.3% against 0.6% patients in both groups, and patient satisfaction rate was 99% against 99.4% in the two groups respectively. in the management of first trimester pregnancy loss, MVA offers a quick solution to the problem with reduced hospital stay and lower rate of complications

Aspiración manual endouterina en el tratamiento ambulatorio del aborto espontáneo del primer trimestre / Manual vacuum aspiration in the outpatient treatment of spontaneous abortion in the first trimester

Introducción: A pesar de que en la mayoría de países desarrollados el aborto espontáneo del primer trimestre es manejado en forma ambulatoria con la técnica de Aspiración Manual Endouterina (AMEU) debido a la seguridad y eficacia demostrada a lo largo de décadas; todavía en nuestro país se utiliza el legrado uterino como técnica convencional requiriendo para ello hospitalización previa, generando malestar en las pacientes y mayor costo a los hospitales por la estancia prolongada. Objetivo: El objetivo fue describir los resultados del manejo de la Aspiración Manual Endouterina (AMEU) en el manejo ambulatorio del aborto espontáneo del primer trimestre. Materiales y Métodos: Se realizó un estudio transversal descriptivo y retrospectivo. De acuerdo a los criterios de inclusión y exclusión, se revisaron las historias clínicas de 93 pacientes entre 15 y 45 años atendidas en el Hospital de Andahuaylas en el periodo enero a diciembre del 2012 con diagnóstico de aborto espontáneo del primer trimestre (aborto incompleto, gestación anembrionaria, gestación no evolutiva). Resultados: La edad media de las 93 pacientes fue de 31,37 años. El tiempo promedio de duración del procedimiento fue de 7,19 mino El 82 por ciento de pacientes se recuperó en menos de dos horas la mayoría entre los 70 a 90 minutos. Dos pacientes tuvieron evacuación uterina incompleta pero sólo una requirió repetición del procedimiento con legrado uterino mientras que el otro fue manejado con misoprostol. No se encontraron casos de perforación uterina ni sangrado vaginal excesivo durante el procedimiento. La mayor dilatación cervical obtenida con misoprostol fue de 8 y 7mm en 45 por ciento y 25 por ciento respectivamente. Los efectos adversos predominantes con el uso de misoprostol fueron: cólico abdominal y hemorragia vaginal en un 33 por ciento y 25 por ciento respectivamente. El 73 por ciento de pacientes fueron atendidas y dadas de alta en menos de 12 horas desde el ingreso al hospital. El...

Introduction: Although in most developed countries the management of spontaneous first trimester abortion is performed on an outpatient basis with the technique of manual vacuum aspiration (MVA) due to safety and efficacy proven over decades, in our country uterine curettage is still used as a conventional technique requiring hospitalization prior to this, causing discomfort in patients and higher cost to hospitals for the prolonged stay. Objective: The objective was to describe the results of the management of manual vacuum aspiration (MVA) in the outpatient management of spontaneous first trimester abortion. Materials and Methods: A descriptive, retrospective cross-sectional study. According to the inclusion and exclusion criteria, the medical records of 93 patients between 15 and 45 years treated at the Hospital of Andahuaylas in the period January to December 2012 with a diagnosis of spontaneous abortion in the first trimester (incomplete abortion, anembryonic pregnancy and blighted ovum). Results: The mean age of the 93 patients was 31.37 years. The mean duration of the procedure was 7.19 min. 82 per cent of patients recovered in less than two hours most between 70 to 90 minutes. Two patients had incomplete uterine evacuation but only one required repeat curettage procedure while the other was managed with misoprostol. No cases of uterine perforation or excessive vaginal bleeding were found during the procedure. Most cervical dilation obtained with misoprostol was 8 and 7mm for 45 per cent and 25 per cent respectively. The predominant adverse effects with the use of misoprostol were abdominal cramping and vaginal bleeding in 33 per cent and 25 per cent respectively. 73 per cent of patients were treated and discharged within 12 hours of hospital admission. 90 per cent of control patients attended within 7 days of the procedure finding a case of pelvic inflammatory disease who received outpatient treatment. Discussion: The results described in this study...

Comportamiento de la regulación menstrual en la adolescencia / Behavior of menstrual regulation in adolescence

Introducción: la práctica del aborto es uno de los temas de mayor controversia a finales del siglo xx y comienzos del XXI, pero no constituye nada nuevo, ha existido en cada cultura conocida, con o sin alfabeto escrito, primitiva o moderna. En los últimos años se reconoce el valor que tiene la evacuación del útero en el embarazo temprano mediante el método de regulación menstrual. Objetivo: describir el comportamiento de la regulación menstrual en la adolescencia del área de salud de Párraga. Métodos: estudio observacional descriptivo transversal. El universo estuvo constituido por un total de 370 adolescentes que acudieron a la consulta de Regulación Menstrual del Policlínico Párraga. La muestra fue de 360 pacientes; a todas se les aplicó el método de aspiración endometrial. Estas pacientes fueron seguidas en consulta evolutivamente a los siete días. Se analizaron las variables: edad, escolaridad, estado civil, antecedentes obstétricos, uso de método anticonceptivo previo y complicaciones inmediatas. Resultados: predominó el grupo de la adolescencia tardía con 220 casos. La edad de inicio de las relaciones sexuales fue de 14 a los 17 años con 249 (69,1 porciento) adolescentes y el motivo por el cual no usaban los métodos anticonceptivos fue por olvido en 183 (50,8 porciento) casos. Las complicaciones que más se presentaron fueron las reacciones vagales en 54 (15,0 porciento) pacientes. Conclusiones: gran número de adolescentes hacen uso de la regulación menstrual por ser menos peligrosa que el aborto, más rápido, prescindir de anestesia y de otras complicaciones

Introduction: abortion is one of the most controversial topics at the end of the 20th century and at the beginning of the 21st century. However, this is not a new situation since it has existed in every recognized culture, either primitive or modern, with or without written alphabet. In the last few years, the role of the menstrual regulation to empty the uterus in the early pregnancy has been recognized. Objective: to describe the behavior of the menstrual regulation method in adolescents from the health area of Parraga neighborhood. Methods: an observational, cross-sectional and descriptive study was conducted. The universe of study was 370 female adolescents, who went to the Menstrual Regulation Service in Parraga polyclinics. The final sample was made up of 360 patients who were performed the endometrial aspiration method. These patients were followed up for 7 days to observe their recovery. The following variables were under analysis: age, schooling, marital status, obstetric history, use of contraceptive methods and immediate complications. Results: the group of late adolescents with 220 cases predominated. The age of onset of sexual relations was 14 to 17 years, with 249 (69.1 percent) adolescents, and the main reason for not using some contraceptive method was they forgot to do it in 183 (50.8 percent) cases in this sample. The most frequent complications sere vagal reactions in 54 (15.0 percent) patients. Conclusions: a large number of female adolescents turn to menstrual regulation because it is a quicker, safer method than abortion, does not require anesthesia and has no further complications

Aborto inducido en Cartagena, Colombia: estimación mediante la "Metodología de Complicaciones de Aborto Inducido" / Induced abortion in Cartagena, Colombia: estimation using Abortion Incidence Complications Methodology

Objetivo Estimar la incidencia de aborto inducido en un hospital de referencia y en la ciudad de Cartagena, Bolívar, Colombia. Métodos Estudio ecológico que uso la "Metodología de Complicaciones de Aborto Inducido" (MCAI). Se usaron datos de la Clínica Maternidad Rafael Calvo (CMRC) para estimar las atenciones pos-aborto en la ciudad. A partir de esos datos y el modelo MCAI, se obtuvieron razones y tasas de la incidencia de aborto inducido en CMRC y en la ciudad de Cartagena. Resultados La razón estimada de abortos inducidos en la ciudad de Cartagena fue de 261/1 000 nacimientos en 2005, 244 en 2006, y 259 en 2007. La tasa estimada de abortos inducidos por 1 000 mujeres de 15-44 años fue de 22 en 2005, 22 en 2006, y 21 en 2007. Conclusiones La tasa estimada es similar a la encontrada en la estimación realizada en la población colombiana con datos publicados previamente en 1989. Se recomiendan medidas de salud pública enfocadas a disminuir la presencia del embarazo no deseado.

Objective Estimating induced abortion incidence in a reference hospital and the city of Cartagena, Colombia. Methodology This was an ecological study that used Abortion Incidence Complications Methodology (AICM). Data from the Rafael Calvo Maternity Clinic (CMRC) was used for estimating post-abortion attention in Cartagena, Colombia. Induced abortion rates and ratios were estimated in the CMRC and the city of Cartagena from CMRC data using the AICM model. Results The estimated induced abortion ratio in Cartagena was 261/1,000 births in 2005, 244 in 2006 and 259 in 2007. The estimated rate per 1,000 females aged 15-44 for induced abortion was 22 in 2005, 22 in 2006 and 21 in 2007. Conclusions The estimated rate was similar to the rate found in previous research using Colombian data from 1989. Public health measures should be focused on reducing unwanted pregnancies and thereby reduce induced abortion rates.

Nuliparidad como factor asociado al dolor operatorio severo, durante el tratamiento del aborto incompleto mediante aspiración manual endouterina: Hospital Nacional Dos de Mayo 2008 / Parity as factor associated to the severe pain postoperative, during the treatment of the incomplete abortion by manual aspiration endouterine: National Hospital Two of May 2008

Objetivo: Determinar si la nuliparidad está asociada al dolor pélvico intraoperatorio severo, durante la aspiración manual endouterina por aborto incompleto. Metodología: Estudio observacional de corte transversal y prospectivo, incluyendo pacientes con aborto incompleto operadas mediante la aspiración manual endouterina (AMEU). El dolor pélvico fue cuantificado utilizando la Escala Visual Numérica. Para el análisis de los datos, se usó la prueba Chi cuadrado, OR y análisis multivariado. Resultados: De 272 pacientes con aborto incompleto operadas mediante la AMEU, entre julio 2008 y marzo 2009, 191 (70.2 por ciento) fueron incluidas y 81 (29.8 por ciento) excluidas. El 67.5 por ciento de las pacientes incluidas tuvieron entre 20 y 34 años, 40.8 por ciento procedían de los distritos La Victoria y El Cercado, 72.2 por ciento eran casadas o convivientes, y el 82.7 por ciento pertenecían al nivel socioeconómico C, D y E. Las nulíparas representaron el 50.8 por ciento y las no nulíparas el 49.2 por ciento. El 66.0 por ciento de las nulíparas y el 56.4 por ciento de las no nulíparas tuvieron dolor pélvico intraoperatorio severo, siendo la diferencia no significativa (p=0.168; OR=1.656, lC: 0.809-3.389). El promedio del dolor pélvico intraoperatorio (6.82±2.20 puntos) fue significativamente mayor que el dolor preoperatorio (2.81±1.87), (p=0.00). Conclusión: La nuliparidad no estuvo asociada significativamente al dolor pélvico intraoperatorio severo, durante la AMEU por aborto incompleto.

Eficacia de consejería de enfermería en la disminución de la ansiedad en pacientes sometidas a la aspiración manual endouterina en el Servicio de Emergencia del Instituto Nacional Materno Perinatal 2010 / Effectiveness of the Department of nursing in the reduction of anxiety in patients undergoing the manual aspiration endouterine in the Service of Emergency of Perinatal Maternal National Institute 2010

El objetivo fue determinar la eficacia de la consejería de enfermería en la disminución de la ansiedad en las pacientes sometidas al AMEU en el servicio de emergencia del INMP. Material y Método: El estudio fue de tipo cuantitativo, nivel aplicativo, método cuasi experimental de corte transversal. La muestra estuvo conformada por 43 pacientes. La técnica fue la entrevista y el instrumento la Escala para la Ansiedad de Hamilton previo consentimiento informado. Resultados: Del 100 por ciento (43) antes de la aplicación de la consejería de enfermería; 93.1 por ciento (40) presentó un nivel de ansiedad severo/grave, 6.9 por ciento (3) moderado; luego de la consejería de enfermería (después); 51 por ciento (22) presentó un nivel de ansiedad moderado 46.7 por ciento (20) severo/grave y 2.3 por ciento (1) leve. Así también en el compnente componente somático y psiquico fue el primero que tuvo mayor disminución desde 14.6 a 9.7 mientras que en el componente psiquico se tuvo un promedio de 18.23 a 15.30. Para comprobar la hipótesis se aplicó la prueba t de student para datos pareados, el cual resulta ser significativo (p<0.05) la consejeria de enfermería en la disminución de la ansiedad. Conclusiones: La consejeria de enfermería resulta ser eficaz en la disminución de la ansiedad en las pacientes sometidas al AMEU...

The objective was to determine the effectiveness of the Department of nursing in the reduction of anxiety in patients undergoing the AMEU in emergency of the INMP. Materials and methods: The study was quantitative type, application level, quasi experimental of cross section method. The sample was made up by 43 patients. The technique was the interview and the instrument the scale for the Hamilton anxiety prior informed consent. Results: 100 per cent (43) before the implementation of the Department of nursing; 93.1 per cent (40) presented a serious/severe anxiety level, 6.9 per cent (3) moderate; After the Department of nursing (Iater); 51 per cent (22) presented a moderate level of anxiety 0.11 per cent (20) serious/severe and 2.3 per cent (1) light. So al so in the somatic component purposes and mental was the first which had greater decrease from 14.6 to 9.7 while mental component took an average of 18.23 to 15.30. To check the hypothesis test was applied for matched data student's t, which turns out to be significant (p<0.05) counseling of nursing in the decrease of anxiety. Conclusions: Counseling of nursing is to be effective in the de crease of anxiety in patients undergoing the AMEU...

Sublingual misoprostol: A better choice for cervical priming before manual vacuum aspiration.

Background: Misoprostol is effective for cervical priming before manual vacuum aspiration (MVA). Aim of study was to determine whether sublingual misoprostol with a shorter interval of 2 hours before MVA would be as effective as its standard vaginal administration. Study Design: This randomized control trial included 82 women randomly assigned to receive 400 mcg of misoprostol, either sublingually or vaginally. MVA was performed 2 hours and 3 hours after in sublingual and vaginal group, respectively. Results: Cervical dilatation of 8 mm was achieved within 2 hours in sublingual group. Mean time taken for procedure (14.4 ± 5.3: sublingual group and 16.2 ± 5.7: vaginal group), and blood loss was comparable (12.2 ± 9.7 ml in sublingual group and 13.7 ± 8.5 ml in vaginal group). Conclusion: 2 hour of cervical priming with 400 mcg of sublingual misoprostol before MVA was as good as 3 hours with vaginal administration of the same dose.