Efectos emocionales que causa el aborto espontáneo / Emotional effects caused by spontaneous abortion

Introducción: en el contexto mexicano la maternidad suele ser una de las prioridades de la mujer, por lo cual, cuando se interrumpe el proceso se desencadena un conjunto de emociones que le afectan de manera negativa, pudiendo limitar su actuar cotidiano. Objetivo: identificar las emociones que surgen a causa del aborto espontáneo en mujeres jóvenes. Metodología: estudio descriptivo y cualitativo. Se aplicó una escala de actitudes hacia el aborto y una entrevista semiestructurada validada por juicio de expertos. Resultados: los hallazgos evidencian tristeza, enojo y rabia, que mantienen a las participantes en estado de confusión, decepción, retraimiento, inseguridad y vacío existencial. Conclusiones: el aborto espontáneo trae como consecuencia la ruptura del ideal de la mujer, ya que esta se representa como procreadora, lo cual coincide con el perfil mexicano de la maternidad; por ende, ante un aborto ya no se cumple con la supuesta función principal de la mujer.

Introduction: In the Mexican context, motherhood is the reason for being of a woman, therefore, when the process is interrupted, a set of emotions are triggered that affect negatively, and can even limit her daily actions. Objective: To identify the emotions that arise due to spontaneous abortion in young women. Methodology: Descriptive and qualitative study. A semi-structured interview validated by expert judgment was applied. Results: The findings show sadness, anger and rage that keep the informants in a state of confusion, disappointment, withdrawal, insecurity and existential emptiness. Conclusions: Spontaneous abortion results in the rupture of the ideal of women, since this is represented as procreating, which coincides with the Mexican profile of motherhood; therefore, in the face of an abortion, the main function of the woman is no longer fulfilled.

Percepções e sentimentos sobre o bebê subsequente à perda gestacional / Perceptions and feelings about the baby after pregnancy loss

A perda gestacional (PG) pode repercutir na gestação subsequente e na maternidade. Neste estudo, objetivou-se identificar e compreender as percepções e os sentimentos maternos sobre a gestação e o bebê subsequente à PG. Trata-se de estudo qualitativo e transversal, com quatro mães com PG nos últimos cinco anos, cujos bebês subsequentes tinham de 6 a 21 meses. Foram aplicados o Questionário de Dado Sociodemográficos e Clínicos, o Questionário sobre Vivências de Perda, o Brief Symptom Inventory e a Entrevista sobre Vivência de Luto Materno e Experiência da Maternidade Atual. Os resultados mostraram repercussões da PG nos sentimentos maternos sobre a gestação, como: ambivalência, medo de nova PG e angústia frente ao parto e nascimento; e nas percepções e sentimentos sobre o bebê, como: idealização das características dele e da relação mãe-bebê, medo da morte do bebê e substituição do bebê falecido. Os achados apontam a importância de ações de prevenção de saúde mental do binômio mãe-bebê em casos de PG

Pesar no óbito fetal: luto sem voz / Grief after fetal death: a voiceless mourning / Pesar por la muerte fetal: duelo sin voz

Resumo O Ministério da Saúde orienta que a declaração de óbito não seja emitida em casos de óbito fetal com gestação inferior a 20 semanas ou feto com peso inferior a 500 g ou estatura menor que 25 cm, acrescentando que a legislação permite a emissão da declaração em casos em que a família deseje fazer o sepultamento do feto. Nesse contexto, são poucos os casos de aborto em que a declaração é feita. Este artigo realizou revisão integrativa que responde à pergunta: os rituais de fechamento, particularmente o sepultamento (possibilitado pela emissão da declaração de óbito) em caso de morte fetal inferior a 20 semanas de idade gestacional, ajudariam no processo de luto dos pais? A literatura consultada trouxe informações favoráveis à emissão da declaração de óbito e possibilitou discussão médica, jurídica e antropológica do tema.

Abstract The Ministry of Health advises that death certificates should not be issued in cases of fetal death for a pregnancy of less than 20 weeks or fetus weighing less than 500 g or shorter than 25 cm in height; however, the legislation allows the issuance of the certificate in cases where the family wishes to bury the fetus. Given this context, abortion cases in which the certificate is issued are few. This article presents an integrative review that answers the question: would the death ceremonies, particularly the burial (made possible by the issuance of the death certificate), in case of fetal death under 20 weeks of gestational age help in the parents' mourning process? The literature consulted presented favorable information for the issuance of the death certificate and enabled a medical, legal and anthropological discussion of the theme.

Resumen El Ministerio de Salud brasileño recomienda que no se debe emitir el certificado de defunción en los casos de muerte fetal de menos de 20 semanas de gestación, feto con peso inferior a 500 g o estatura inferior a 25 cm, pero agrega que se puede permitirlo cuando la familia opta por el entierro del feto. En este contexto, el certificado se emite en pocos casos de aborto. Este artículo realizó una revisión integradora a partir de la pregunta: ¿Ayudarían en el proceso de duelo de los padres los rituales de inhumación, sobre todo el entierro (habilitado mediante la emisión de un certificado de defunción) en caso de muerte fetal con menos de 20 semanas de edad gestacional? La literatura consultada aportó con informaciones favorables a la emisión del certificado de defunción y permitió fomentar la discusión médica, jurídica y antropológica del tema.

Construction of meaning in pregnancy loss: qualitative study with brazilian couples / Construção de significados na perda gestacional: estudo qualitativo com casais brasileiros / Construcción de significados en la pérdida gestacional: estudio cualitativo con parejas brasileñas

We investigated the process of meaning construction in pregnancy loss in 11 Brazilian couples. The reports were submitted to inductive and deductive thematic analysis using the categorization system from the integrative model of meaning construction in grief. Regarding the original dimensions of the model (Sense-making of death, benefit from the experience of loss, and identity change), there was a lack of meaning for death, perception of strengthened bonds within the couple as a benefit, and parenting as an identity project. We propose an additional dimension (Meaning-making process) that includes gender differences, lack of social recognition, and emotional intensity of the experience. As for coping strategies, spirituality and the search for peers were identified, especially in social media. After a pregnancy loss, the process of meaning construction proved similar to that of other types of loss, validating this experience. We discuss the implications of the category system used in this study. (AU)

Investigou-se o processo de construção de significados na perda gestacional em 11 casais brasileiros. Os relatos foram submetidos à análise temática indutiva e dedutiva, utilizando o sistema de categorização do modelo integrativo de construção de significado no luto. Em relação às dimensões originais do modelo (Sentido para a morte, benefício na experiência de perda e modificação da identidade), constatou-se falta de sentido para a morte, fortalecimento de vínculo do casal como benefício e parentalidade enquanto projeto identitário. Foi proposta uma dimensão adicional (Processo de construir significado) que incluiu diferenças de gênero, falta de reconhecimento social e intensidade emocional da experiência. Enquanto estratégias de enfrentamento, identificou-se espiritualidade e busca por iguais, especialmente nas mídias sociais. O processo de construir significados na perda gestacional mostrou-se semelhante ao de outros tipos de perdas, validando esta experiência. Foram discutidas as implicações do sistema de categorias utilizado. (AU)

Se investigó el proceso de construcción de significados en la pérdida gestacional en 11 parejas brasileñas. Los informes fueron sometidos a un análisis temático inductivo y deductivo, usando el sistema de categorización del modelo integrador de construcción de significado en el duelo. En cuanto a las dimensiones originales del modelo (Significado para la muerte, beneficio en la experiencia de pérdida, cambio de identidad), se encontró falta de significado para la muerte, fortificación de lazos de la pareja como un beneficio y la parentalidad como un proyecto de identidad. Se ha propuesto una dimensión adicional (Proceso de construcción de significado) que incluye diferencias de género, falta de reconocimiento social e intensidad emocional de la experiencia. Como estrategias de afrontamiento, se identificó la espiritualidad y la búsqueda de los iguales, especialmente en las redes sociales. El proceso de construir significado en la pérdida gestacional demostró ser similar al de los otros tipos de pérdida, validando esta experiencia. Son discutidas las implicaciones del sistema de categorías utilizado. (AU)

Hipotiroidismo subclínico y pérdida de embarazo: una revisión de la literatura / Subclinical Hypothyroidism and Pregnancy Loss: A Literature Review

Existe una alta prevalencia de hipotiroidismo subclínico (SCH) en el embarazo. Está vinculado a una importante morbilidad y mortalidad materna y fetal. Los efectos de SCH sobre el embarazo incluyen mayores riesgos de hipertensión gestacional y ruptura prematura de membranas (PROM). Sus fetos y bebés tenían más probabilidades de sufrir de bajo peso al nacer (LBW) y retraso del crecimiento intrauterino (IUGR). El riesgo de aborto espontáneo se informa alto en varios estudios para SCH no tratado. SCH se asocia directamente con una mayor presencia de anti -cuerpos anti TPO en suero materno. La detección temprana y el tratamiento de SCH han sido testigos de mejores resultados en términos de resultado del embarazo. Esta revisión se centra para establecer la relación de una mayor prevalencia de SCH en los países en desarrollo, así como su asociación con el aumento de los cuerpos anti TPO en suero materna y sacar una conclusión que puede ayudar a reducir las razones y proporcionar una solución. Este estudio concluyó que SCH es más frecuente en los países en desarrollo, ya sea debido a la deficiencia de yodo, una disminución de la conciencia sobre este problema o menos acceso a las instalaciones médicas. Por lo tanto, se sugiere que las hembras con antecedentes de partos prematuros, IUGR anteriores o abortos involuntarios deben someterse a una detección de hipotiroidismo subclínico y niveles de anticuerpos anti TPO durante sus visitas prenatales

There is a high prevalence of subclinical hypothyroidism (SCH) in pregnancy. It is linked to significant maternal and fetal morbidity and mortality. SCH's effects on pregnancy include increased risks of gestational hypertension and premature rupture of membranes (PROM). Their fetuses and infants had been more likely to suffer from low birth weight (LBW) and intrauterine growth retardation (IUGR). The risk of miscarriage is reported high in various studies for untreated SCH. SCH is directly associated with increased presence of anti TPO anti bodies in maternal serum. Early detection and treatment of SCH have witnessed better results in terms of pregnancy outcome. This review focuses to establish the relationship of increased prevalence of SCH in the developing countries as well as its association with increased anti TPO anti bodies in maternal serum and draw a conclusion which can help narrow down the reasons and provide solution. This study concluded that SCH is more prevalent in developing countries, either due to iodine deficiency, decreased awareness about this problem or less access to medical facilities. Therefore, it is suggested that females with history of preterm deliveries, previous IUGRs, or miscarriages should undergo screening for subclinical hypothyroidism and Anti TPO antibody levels during their antenatal visits.

Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis / Tratamiento médico en gestantes con hipotiroidismo subclínico: revisión sistemática y meta-análisis

Abstract Objectives: to determine the effectiveness of medical therapy in reducing complications associated with subclinical hypothyroidism during pregnancy. Methods: in 2021, a systematic review of available cohort studies was carried out in three databases, with no publication date limit. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was performed, and odds ratios were calculated, with the corresponding 95% confidence intervals. Cohort risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The certainty of the evidence was assessed using the GRADE methodology. Results: five studies were included for qualitative and quantitative synthesis. A statistically significant relationship was found between medical treatment in pregnant women with subclinical hypothyroidism with respect to spontaneous abortion (p=0.03; OR=0.77; CI95%=0.61-0.97), and no statistically significant relationship was found for delivery preterm (p=0.46; OR=1.11; CI95%=0.85-1.44), nor for abrupt placentae (p=0.56; OR=1.60; CI95%=0.33-7.66). Three studies were at moderate risk of bias, and two were at low risk of bias. In all the results the certainty was very low. Conclusions: medical treatment of subclinical hypothyroidism during pregnancy can have a beneficial effect in reducing cases of spontaneous abortion.

Resumo Objetivos: determinar la efectividad de la terapia médica para disminuir las complicaciones asociadas al hipotiroidismo subclínico durante la gestación. Métodos: en el 2021 se realizó una revisión sistemática de estudios de cohortes disponibles en tres bases de datos, sin límite de fecha de publicación. La selección de estudios y extracción de datos se realizaron por duplicado. Se realizó metaanálisis de efectos aleatorios y se calcularon los Odds ratio, con los correspondientes intervalos de confanza al 95%. El riesgo de sesgo de las cohortes se evaluó mediante la escala de Newcastle-Ottawa (NOS). La certeza de la evidencia se evaluó con la metodología GRADE. Resultados: cinco estudios fueron incluidos para síntesis cualitativa y cuantitativa. Se encontró una relación estadísticamente significativa del tratamiento médico en gestantes con hipotiroidismo subclínico con respecto al aborto espontáneo (p=0,03; OR=0,77; IC95%=0,61-0.97), no se encontró relación estadísticamente significativa para parto pre término (p=0.46; OR=1,11; IC95%=0.85-1.44), ni para abrupto placentae (p=0.56; OR=1,60; IC95%=0.33-7.66). Tres estudios tenían riesgo moderado de sesgo, y dos tenían riesgo de sesgo bajo. En todos los resultados la certeza fue muy baja. Conclusiones: el tratamiento médico del hipotiroidismo subclínico durante la gestación puede tener un efecto beneficioso para reducir los casos de aborto espontaneo.

Complicaciones materno-fetales en embarazadas añosas. Centro de salud san jacinto de buena fe, 2020 / Maternal-fetal complications in elderly pregnant women. San Jacinto de Buena Fe Health Center, 2020

El embarazo añoso representa una problemática de salud pública debido a sus repercusiones en el binomio madre-hijo. Objetivo. Determinar las complicaciones materno-fetales en embarazadas añosas atendidas en el Centro de Salud Tipo C San Jacinto de Buena Fe durante el periodo enero y diciembre del 2020. Materiales y métodos. El diseño de investigación observacional, cuantitativo, retrospectivo, descriptivo de corte transversal con una muestra de 80 gestantes mayores de 35 años, como instrumento se empleó un formulario de recolección de datos que constó de 12 ítems validados por un juicio de expertos. Resultados. Las caracteristicas sociodemográficas de interés en las pacientes del estudio fueron: grupo etario de 35-37 años con el 67,2 %, unión libre con 52,5 %, grado de instrucción primario con el 46,3 % y procedencia rural en el 95 %; entre las complicaciones maternas: ruptura prematura de membranas con el 25 %, trastornos hipertensivos en el 16,2 % y aborto espontáneo con el 13,7 %; las complicaciones fetales: prematuridad con el 17,5 %, bajo peso al nacer con el 17,5 % y síndrome de dificultad respiratoria con el 11,2%. Conclusión. Fue posible establecer las características sociodemográficas de interés en la muestra de estudio, identificar algunos factores de riesgo de complicaciones y determinar las complicaciones que comprometen a la madre y al hijo/a en embarazos de edad avanzada.

Elderly pregnancy represents a public health problem due to its repercussions on the mother-child binomial. Objective. To determine the maternal-fetal complications in elderly pregnant women treated at the San Jacinto de Buena Fe Type C Health Center during the period January and December 2020. Materials and methods. The observational, quantitative, retrospective, descriptive cross-sectional research design with a sample of 80 pregnant women over 35 years of age, as an instrument a data collection form that consisted of 12 items validated by an expert judgment was used. Results. The sociodemographic characteristics of interest in the study patients were age group 35-37 years with 67.2%, free union with 52.5%, grade of primary education with 46.3% and rural origin in 95 %; among maternal complications: premature rupture of membranes with 25%, hypertensive disorders in 16.2% and spontaneous abortion with 13.7%; fetal complications: prematurity with 17.5%, low birth weight with 17.5% and respiratory distress syndrome with 11.2%. Conclusion. It was possible to establish the sociodemographic characteristics of interest in the study sample, identify some risk factors for complications, and determine the complications that affect the mother and the child in older pregnancies(AU)

SOMEWHERE OVER THE RAINBOW: NARRATIVES OF RAINBOW CHILDREN’S MOTHERS / Somewhere over the rainbow: narrativas de mães de crianças arco-íris / Somewhere over the rainbow: narrativas de madres de niños arcoiris

RESUMO Visando a investigar a experiência emocional de mães que tiveram uma criança "arco-íris" após terem experienciado uma perda gestacional/neonatal, foram entrevistadas quatro mães de crianças arco-íris de até três anos de idade. As entrevistas foram mediadas por uma narrativa interativa e, após cada encontro, uma narrativa transferencial foi redigida pela entrevistadora. O material foi analisado psicanaliticamente, segundo a Teoria dos Campos. Observou-se que as participantes, atravessadas por um enlutamento complexo, culpabilizaram-se pela perda e por terem seguido adiante no cuidado materno com os filhos arco-íris, oscilando entre a superproteção e o afastamento. Nota-se a importância de uma intervenção junto a esse coletivo, que geralmente só é foco de atenção (quando o é) durante a gestação/puerpério subsequente à perda gestacional/neonatal.

ABSTRACT Aiming to investigate the emotional experience of mothers who had a "rainbow" child after experiencing a gestational/neonatal loss, four mothers of rainbow children up to three years old were interviewed. The interviews were mediated by an interactive narrative. After each meeting, a transferential narrative was written by the interviewer. The material was analyzed psychoanalytically, according to the Theory of Fields. It was observed that the participants blamed themselves for the loss and for having carried on with the maternal care of the rainbow children, oscillating between overprotection and withdrawal. We have noticed the importance of intervention within this group, which is usually the focus of attention (when it is) only during the pregnancy/puerperium following the gestational/neonatal loss.

RESUMEN Con el objetivo de investigar la experiencia emocional de madres que tuvieron un hijo "arcoiris" después de experimentar la pérdida gestacional/neonatal, se entrevistó a cuatro madres de niños arcoiris de hasta tres años de edad. Las entrevistas fueron mediadas por una narrativa interactiva. Después de cada encuentro, la entrevistadora redactó una narrativa transferencial. El material fue analizado psicoanalíticamente, según la Teoría de Campos. Se observó que las participantes se culpaban por la pérdida y por haber seguido adelante con los niños arcoíris, oscilando entre la sobreprotección y el retraimiento. Se señala la importancia de una intervención junto a este colectivo, a la que normalmente se dirige (cuando se lo hace) sólo durante el embarazo/puerperio tras la pérdida gestacional/neonatal.

Conjugalidade e parentalidade subsequentes à perda gestacional: revisão sistemática / Conjugality and parenthood after pregnancy loss: systematic review / Conyugalidad y parentalidad subsecuente a pérdida gestacional: revisión sistemática

RESUMO O objetivo deste estudo foi analisar a literatura científica no período de janeiro de 2006 a março de 2021 sobre as repercussões da perda gestacional na conjugalidade e na parentalidade. Trata-se de uma revisão sistemática que envolveu consulta às bases Pubmed, PsycNET e Portal BVS, por meio de descritores estabelecidos previamente, resultando em 16 estudos elegíveis para análise. Foram encontrados resultados contrastantes quanto às repercussões da perda gestacional na parentalidade, sugerindo a necessidade de investigação de fatores de proteção. A perda apresentou-se como risco à conjugalidade, porém a comunicação conjugal emergiu como fator de proteção que merece maior investigação. Estudos futuros devem adotar métodos qualitativos ou mistos, incluir a perspectiva masculina sobre o tema e avaliar intervenções conjugais e familiares.

ABSTRACT This study aimed to analyze the scientific production from Jan 2006 to Mar 2021 regarding the repercussions of pregnancy loss on conjugality and parenthood. It is a systematic review carried out in Pubmed, PsycNET, and Portal BVS database through previously established descriptors, resulting in 16 eligible studies. We found contrasting results regarding repercussions in parenthood, suggesting the need to investigate protective factors also. Pregnancy loss shows as a risk for marital relationships, but marital communication emerged as a possible protection factor that deserves further investigation. Future research should adopt qualitative and mixed methods, include men’s perspectives, and evaluate marital and family interventions.

RESUMEN El objetivo de este estudio ha sido analizar la literatura científica en el período de enero de 2006 hasta marco de 2021 sobre las repercusiones de la pérdida gestacional en la conyugalidad y en la parentalidad. Esta es una revisión sistemática realizada en las bases Pubmed, PsycNET y Portal BVS, con los descriptores establecidos previamente, resultando en 16 estudios elegibles. Se encontraron resultados contrastantes en cuanto a las repercusiones en la crianza de los hijos, sugiriendo la necesidad de investigar también los factores protectores. La pérdida se presentó como un riesgo para la conyugalidad, sin embargo, la comunicación marital emergió como un posible factor protector que merece más estudios. Se indica que futuras investigaciones adopten métodos cualitativos, que incluyan la perspectiva masculina y evalúen intervenciones conyugales y familiares.

Alteraciones citogenéticas en pacientes con diagnóstico de infertilidad en Lima, Perú / Cytogenetic abnormalities in patients with infertility diagnosis in Lima, Peru

INTRODUCCIÓN: La infertilidad es una enfermedad multicausal y el componente genético representa uno de sus principales eventos. Si bien la distribución de la infertilidad puede variar entre poblaciones, las parejas de los países con bajos y medianos ingresos pueden verse más afectadas por la infertilidad, con una proporción de alteraciones citogenéticas aún no esclarecidas. OBJETIVO: Evaluar la frecuencia de alteraciones citogenéticas y su correlación con el número de abortos en pacientes peruanas con diagnóstico de infertilidad. MÉTODO: Se realizó un estudio de corte transversal en 400 pacientes de 18 a 60 años, de ambos sexos, con diagnóstico de infertilidad. Se registraron las características clínicas disponibles durante el examen genético y el análisis citogenético convencional fue con bandeo GTG en muestras de sangre periférica. El análisis de correlación se realizó con la prueba de Spearman. RESULTADOS: Del total, 389 pacientes cumplieron los criterios de inclusión, y de estos, 169 (43,44%) tuvieron reportes de abortos (promedio: 2,25, rango: 1-7). Hallamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas (p < 0,000). Reportamos 25/289 (6,43%) alteraciones cromosómicas, de las que 11/25 (44%) fueron heterocromatinas constitutivas y 6/25 (24%) fueron translocaciones reciprocas. Las alteraciones citogenéticas más frecuentes fueron 16qh+ y 9qh+ (ambas con un 16%), y afectaron a 17 (68%) varones. CONCLUSIONES: Existe una moderada frecuencia de alteraciones citogenéticas en pacientes peruanos con diagnóstico de infertilidad, y las alteraciones más frecuentes fueron heterocromatina constitutivas. Además, evidenciamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas.

INTRODUCTION: Infertility is a multicausal disease and the genetic component represents one of its main events. Although the distribution of infertility may vary between populations, couples in low-and-middle-income countries may be more affected by infertility with a proportion of cytogenetic alterations still unclear. OBJECTIVE: To evaluate the frequency of cytogenetic alterations and their correlation with the number of abortions in Peruvian patients with a diagnosis of infertility. METHOD: A cross-sectional study was carried out in 400 patients between 18 and 60 years-old, of both genders with a diagnosis of infertility. The clinical characteristics available during the genetic examination were recorded and the conventional cytogenetic analysis was with GTG banding in peripheral blood samples. The correlation analysis was performed with the Spearman test. RESULTS: Of the total 389 patients who met the inclusion criteria, of these 169 (43.44%) patients had reports of abortions (mean: 2.25, range: 1-7). We found a significant correlation between the number of abortions and cytogenetic alterations (p < 0.000). We report 25/289 (6.43%) chromosomal alterations, where 11/25 (44%) were constitutive heterochromatin, and 6/25 (24%) were reciprocal translocations. The most frequent cytogenetic alterations were 16qh + and 9qh + (both 16%), and affected 17 (68%) men. CONCLUSIONS: There is a moderate frequency of cytogenetic alterations in Peruvian patients diagnosed with infertility, where the most frequent alterations were constitutive heterochromatin. Furthermore, we evidenced a significant correlation between the number of abortions and cytogenetic alterations.

Grief and ruminative thought after perinatal loss among Turkish women: one-year cohort study

Abstract BACKGROUND: Among women who have suffered loss of pregnancy, the level of grief decreases gradually. Age, mental health status and childlessness are the factors known to mostly affect women's levels of grief. OBJECTIVES: To assess the levels of grief among women who experienced perinatal loss and the changes in their ruminative thought styles over the first year after their loss. DESIGN AND SETTING: One-year follow-up study carried out in a university hospital in Turkey. METHODS: The study population included 70 women who experienced loss of pregnancy in the hospital. The sample size was calculated using G*Power V3.1. Data were collected at 48 hours, at the third month, at the sixth month and at one year after pregnancy loss, between June 2018 and June 2019. A personal information form, the Perinatal Grief Scale and the Ruminative Thought Style Questionnaire were used for data collection. RESULTS: The women's highest levels of grief and ruminative thought style were in the first 48 hours. Their tendency towards grief and ruminative thought styles decreased over the repeated measurements during the follow-up. Women aged 20-29 years had the highest levels of grief at the third month after perinatal loss. CONCLUSIONS: Nursing assessments regarding grief and ruminative thought style over the first 48 hours after perinatal loss should be integrated into nursing care for these women. Grief follow-up programs for these women can be developed through nursing research.

Placental site trophoblastic tumor: A rare case with an unusual presentation / Philippine Journal of Obstetrics and Gynecology

@#We present a rare case of a 23‑year‑old female with intraperitoneal hemorrhage from uterine rupture as an uncommon presentation of placental site trophoblastic tumor (PSTT) after spontaneous abortion. A high index of suspicion with this clinical presentation and the use of appropriate diagnostic tools to arrive at a diagnosis can go a long way in decreasing the adverse outcome of this disease. The histopathological findings and immunohistochemical staining were helpful armamentaria for the confirmation of PSTT. The patient was successfully managed with primary hysterectomy and postoperative chemotherapy.

Retrospective analysis of 35 burn patients in different stages of pregnancy / 中华烧伤杂志

Objective: To summarize the clinical outcomes of burn patients in different stages of pregnancy and explore a rational therapeutic scheme for burns during pregnancy. Methods: A retrospective observational study was conducted. From June 2010 to June 2020, 21 patients who met the inclusion criteria were admitted to the Department of Burns of Wuhan Third Hospital and 14 patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University. Based on the pregnancy period when patients suffered burns, the 35 patients were divided into early pregnancy group with 18 patients (aged (26±4) years, with 8 (4, 11) weeks of gestation), middle pregnancy group with 10 patients (aged (26±3) years, with 21 (14, 27) weeks of gestation), and late pregnancy group with 7 patients (aged (30±5) years, with 32 (29, 35) weeks of gestation). All the patients received treatment including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements. The burn-related complications during the treatment, maternal outcomes, fetal outcomes, fetal delivery mode, gestational weeks at delivery, and newborn weight of patients in the 3 groups were recorded. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and Fisher's exact probability test. Results: During the treatment, there were 4, 4, and 2 patients who suffered wound infections and 1, 3, and 2 patients who developed shock symptoms, respectively, in early pregnancy group, middle pregnancy group, and late pregnancy group. There were no statistically significant differences in them among the 3 groups (P>0.05). One patient in late pregnancy group developed into multiple organ dysfunction syndrome after debridement. At last, all the pregnant women survived, and no statistically significant difference existed among the 3 groups (P>0.05). In early pregnancy group, middle pregnancy group, and late pregnancy group, the survived fetus cases were 9, 8, and 6, respectively, and the differences between them were not statistically significant (P>0.05). Variables including stillbirth and full-term birth were close in patients in the 3 groups (P>0.05), while the preterm birth and miscarriage in patients in the 3 groups were statistically different (P<0.05 or P<0.01), with the early pregnancy group having the most miscarriage cases and the fewest preterm birth cases. There were no statistically significant differences in fetal delivery mode, gestational weeks at delivery, and newborn weight among the patients with survived fetus in 3 groups (P>0.05). Conclusions: For patients suffering burns during early, middle, and late pregnancy, superior rates of maternal and fetal survival can be achieved after timely and adequate treatments including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Métodos anticonceptivos elegidos por mujeres después de aborto en un hospital público de Honduras / Contraceptive methods chosen by women after abortion in a public hospital in Honduras

Antecedentes: La tasa de embarazos no planeados en Latinoamérica está entre las más altas del mundo. Las adoles- centes están entre los grupos más vulnerables para embarazos no planeados con porcentajes de 32% a 45%. Objetivo: Describir los factores asociados a la elección de un anticonceptivo por las mujeres después de un aborto, en el Hospital Dr. Roberto Suazo Córdova, La Paz, Honduras, en el periodo de julio 2017 a junio 2019. Método: Estudio retrospectivo descriptivo. Los datos fueron obtenidos usando el Sistema Informático Perinatal Aborto (SIP Aborto) en la versión SIP 4.16. Resultados: El 50.0% (67/134) de las adolescentes y 50.1% (281/550) de las mayores de 19 años eligieron un anticonceptivo postaborto. El inicio del anticonceptivo se relacionó con antecedente de aborto (p=0.006). Uso previo de anticonceptivos (p=0.007). Los anticonceptivos más elegidos fueron: Acetato de medroxiprogesterona, anticonceptivos orales combinados y condón. La elección del anticonceptivo se relacionó con evacuación instrumental del aborto (p=0.022) en adolescentes y (p=0.000) en mayores de 19 años. Se eligieron menos los mé- todos reversibles de acción prolongada. Discusión: La elección anticonceptiva postaborto fue baja. El inicio de anticonceptivos se relacionó con antecedente de aborto, uso previo de anticoncepti- vos y evacuación instrumental. Los anticonceptivos más elegidos fueron los temporales de acción corta y los menos elegidos, los temporales de acción prolongada. Se debe fortalecer el acceso a información, mejorar la consejería, garantizar acceso y disponibili- dad de anticonceptivos sobre todo de acción prolongada para ase- gurar el apego al método anticonceptivo...(AU)

Aborto espontáneo en estudiantes universitarias en Pamplona Norte de Santander, Colombia en el periodo 2007-2016. Un estudio transversal / Miscarriage in University Students in Pamplona (Norte de Santander, Colombia) during 2007-2016. A Cross Sectional Study / Aborto espontâneo em estudantes universitárias em Pamplona (Norte de Santander, Colômbia) no período 2007-2016. Um estudo de corte transversal

Introducción: El aborto espontáneo se refiere al fenómeno por el cual un embrión o feto se descarga automática-mente del cuerpo de la madre por alguna razón involuntaria, generalmente a las 20 semanas del embarazo. Entre el 15 % y el 20 % de todos los embarazos tienen riesgo de aborto espontáneo y alrededor de un 10 % terminarán siendo abortos espontáneos. Metodología: Estudio descriptivo transversal con intención analítica. Se tomaron los datos de 207 historias clíni-cas del archivo del hospital público de Pamplona (Norte de Santander, Colombia) de mujeres gestantes universita-rias, correspondientes al periodo 2007-2016. Se consideró aborto espontáneo la variable reportada en la historia clínica. Se estimó la frecuencia de aborto espontáneo y se exploró la asociación con diferentes variables clínicas y sociodemográficas en estudiantes universitarias. Se construyeron modelos de regresión binomial simple y multiva-riable, para estimar la asociación entre las variables. Resultados: Se reportaron 15 abortos espontáneos (7,5 %). Aquellas quienes no se habían aplicado la vacuna anti-tetánica y quienes no se realizaron citología durante los 12 meses previos presentaron los mayores porcentajes de abortos espontáneos (16,7 % y 15,2 %, respectivamente). Las mujeres que acusaron haber estado hospitalizadas (RP: 4,01; IC95 %: 1,69-9,49) y haber tenido abortos previamente (RP: 7,53; IC95 %: 3,02-18,77) mostraron aso-ciación con el aborto espontáneo. Conclusión: Se pudo estimar que la proporción de abortos espontáneos es similar a lo reportado en otros estu-dios; no obstante, son necesarias investigaciones adicionales que evalúen la relación entre el aborto espontáneo y factores individuales y contextuales para generar estrategias que disminuyan estas cifras.

Introduction: Miscarriage refers to the phenomenon among an embryo or fetus is automatically discharged from the mother's body for some involuntary reason, generally at 20 weeks of pregnancy. Between 15 and 20% of all pregnancies are at risk of miscarriage, about 10% will end in miscarriages. Methodology: A cross-sectional analytical study, data were obtained from 207 medical records of university pregnant women from the archive of the Public Hospital of Pamplona, Norte de Santan-der corresponding to the periods 2007-2016. Misscarriage was considered when it was reported in medical history. The frequency of spontaneous abortion was estimated and the association with diffe-rent clinical and sociodemographic variables in university students was explored. Results: 15 spontaneous abortions were reported (7.5%), those who did not apply tetanus and those who did not undergo cytology during the previous 12 months, presented the highest percentages of spontaneous abortions (16.7% and 15.2%), respectively. Women who reported having been hospi-talized (RP: 4.01; 95 % CI: 1.69-9.49) and having previously abortions (RP: 7.53; 95% CI: 3.02-18.77) had an association with miscarriage. A description of miscarriage was made for each of the variables. Simple and multivariate binomial regression models were estimated to explore association between the variables. Conclusion: The proportion of spontaneous abortions is like that reported in other studies, however, it is necessary to generate additional research that evaluates the relationship between this phenome-non and individual and contextual factors for generating strategies that reduce this quantity

ntrodução: O aborto espontâneo refere-se ao fenômeno pelo qual um embrião ou feto é automa-ticamente liberado do corpo da mãe por alguma razão involuntária, geralmente às 20 semanas da gravidez. Entre o 15 % - 20 % de todas as gravidezes estão em risco de aborto espontâneo e cerca de 10 % acabarão como abortos espontâneos. Metodologia: Estudo descritivo transversal com intenção analítica. Os dados foram retirados de 207 fichas médicas do arquivo do hospital público de Pamplona (Norte de Santander, Colômbia) de mul-heres universitárias gravidas, correspondentes ao período 2007-2016. O aborto espontâneo foi con-siderado a variável relatada na história clínica. Foi estimada a frequência de abortos espontâneos e foi explorada a associação com diferentes variáveis clinicas e sóciodemográficas em estudantes uni-versitárias. Modelos simples de regressão binomial e multivariavel, foram construídos para estimar a associação entre as variáveis. Resultado: Foram relatados 15 abortos espontâneos (7,5 %). Aquelas que não receberam a vacinação contra o tétano e aquelas que não fizeram a citologia nos 12 meses anteriores tiveram as maiores porcentagens de abortos espontâneos (16,7 % e 15,2 % respetivamente). As mulheres que relataram ter sido hospitalizadas (RP: 4,01; IC95 %: 1,69-9,49) e ter feito abortos anteriores (RP: 7,53; IC95 %: 3,02-18,77) foram associadas com abortos espontâneos. Conclusão: Foi estimado que a proporção de abortos espontâneos é semelhante à relatada em outros estudos; no entanto, são necessárias mais pesquisas para avaliar a relação entre abortos espontâneos e os fatores individuais e contextuais, a fim de gerar estratégias para reduzir esses números.

O Brasil cumprirá o ODS 3. 1 da Agenda 2030? Uma análise sobre a mortalidade materna, de 1996 a 2018 / Will Brazil comply with the SDG 3. 1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018

Resumo O objetivo deste artigo é analisar as possibilidades de cumprimento da Meta 3.1 dos Objetivos de Desenvolvimento Sustentável pelo Brasil, a partir do diagnóstico sobre a situação da mortalidade materna nas Regiões de Saúde (CIR), em 2018, e as principais características desta mortalidade, entre 1996 e 2018, no país. Estudo com duas etapas articuladas: análise bibliográfica sobre a mortalidade materna no Brasil; e pesquisa no Sistema de Informação sobre Mortalidade (SIM). Em 2018, das 450 CIR, 159 apresentaram razão de mortalidade materna (RMM) superior a 70 por 100 mil nascidos vivos (NV). Entre 1996 e 2018, no Brasil, houve redução entre mulheres de 30 a 49 anos. Entretanto, a faixa de 10 a 29 anos permaneceu inalterada ao longo da série. A disseminação dos Comitês de Mortalidade Materna, o Programa de Humanização do Pré-Natal e Nascimento (PHPN), a Política Nacional de Atenção Integral à Saúde da Mulher (PNAISM) e a Rede Cegonha influenciaram melhorias na gravidez tardia, mas, não impactaram a prevenção dos óbitos entre mães jovens. O cumprimento do ODS 3.1 requer: a priorização das CIR com RMM superior a 70,0/100 mil NV; a qualificação dos serviços de pré-natal, com foco na atenção entre mulheres de 10 e 29 anos e nas complicações hipertensivas; a e legalização do aborto.

Abstract This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.

Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital / Fatores associados a complicações do aborto após a implementação de um sistema de vigilância (Rede MUSA) em um hospital universitário

Abstract Objective To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish). Methods A cross-sectional study withwomen who underwent abortion due to any cause and in any age group at UNICAMP Women's Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann-Whitney test, and multiple logistic regression were used for the statistical analysis. Results Overall, 305 women were enrolled (mean±standard deviation [SD] for age: 29.79±7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71). Conclusion Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.

Resumo Objetivo Avaliar os fatores associados às complicações em casos de aborto após a implementação da rede de vigilância de boas práticas Mujeres en Situación de Aborto (Mulheres em Situação de Aborto, MUSA, em espanhol). Métodos Um estudo transversal, com mulheres admitidas por aborto de qualquer causa e em qualquer faixa etária, no Hospital da Mulher da UNICAMP (parte da rede MUSA), Campinas, Brasil, entre julho de 2017 e agosto de 2019. A variável dependente foi a presença de qualquer complicação relacionada ao quadro de aborto durante a hospitalização. As variáveis independentes foram dados clínicos e sociodemográficos. O teste de qui-quadrado, o teste de Mann-Whitney, e a regressão logística múltipla foram usados na análise estatística. Resultados Foram incluídas 305 mulheres (média±desvio padrão [DP] da idade: 29,79±7,54 anos). A idade gestacional média foi de 11,17 (±3,63) semanas. A gravidez não foi planejada em 196 (64,5%) casos, 91 (29,8%) devido a falha de contraceptivo. Pelo menos 1 complicação foi observada em 23 (7,64%) mulheres, 8 (34,8%) das quais apresentaram mais de uma complicação. As complicações mais frequentes foram sangramento excessivo e infecção. Os fatores independentemente associados à maior prevalência de complicações foram idades gestacionais maiores (razão de chances [OR]: 1.22; intervalo de confiança de 95% [IC95%]: 1.09 a 1.37) e falha de contraceptivo (OR: 3.4; IC95%: 1.32 a 8.71). Conclusão Maior idade gestacional e falha de contraceptivo estiveram associados à maior prevalência de complicações. As informações obtidas pela rede de vigilância podem ser usadas para melhorar o cuidado, particularmente nas mulheres mais suscetíveis a desfechos desfavoráveis.

The effects of Coronavirus disease-2019 (COVID-19) pandemic on routine antenatal care visits and complications of pregnancy

SUMMARY OBJECTIVE: Routine follow-up of pregnancy is a comprehensive care process starting from planning of pregnancy that involves rational and careful use of medical, psychological, and social support. In this study, our objective was to compare the adherence rate to routine antenatal follow-up program during the COVID-19 pandemic with that of previous years among pregnant women, in an effort to shed light on health policies to be developed similar events in the future. METHODS: This retrospective cross-sectional study was carried out between March 11, 2019, when isolation measures were initiated in the context of precautionary steps taken in Turkey against the COVID-19 pandemic, and June 1, 2020, when the "normalization" was initiated. RESULTS: During the study period in 2020, the proportion of cesarean sections were higher, 61.1%, as compared to previous years (p=0.27). The stillbirths were numerically lower (1.2%, p=0.77), but the rate of spontaneous abortions was significantly higher (19.6%, p=0.009). The number of follow-up visits per pregnancy was lower than in previous years (3.8, p=0.02), although the proportion of patients visiting the outpatient units for regular controls to the overall patient group increased as compared to previous years (52.0%). CONCLUSION: During the flare-up of the COVID-19 pandemic (i.e. between March and June 2020), the rate of obstetric/neonatal morbidity and mortality except spontaneous abortion was not significantly higher as compared to the corresponding period in previous years. However, considering the potential increase in the risk of obstetric complications during a pandemic, specialized management programs targeting basic pregnancy follow-up services should be developed.

¿Existe una asociación entre polimorfismos de inserción/supresión - 2549 en la región promotora del gen que codifica la vegfa como factor de riesgo y el descargo espontáneo idiopático recurrente en una muestra de mujeres jordanas? / Is there an association between - 2549 Insertion/ Deletion Polymorphisms in the Promotor Region of the Gene Encoding for VEGFA as a Risk Factor and the Idiopathic Recurrent Spontaneous Miscarriage in a sample of Jordanian Women?

Antecedentes: al menos el 50% de los casos de aborto espontáneo recurrente son etiológicamente idiopáticos. Recientemente se han propuesto varios polimorfismos genéticos como factores de riesgo de susceptibilidad a la pérdida del embarazo. Objetivo: El objetivo del presente estudio de casos y controles es establecer la asociación entre los polimorfismos funcionales −2549 I / D en la región promotora del gen del factor de crecimiento endotelial vascular A (VEGFA) y el aborto espontáneo recurrente idiopático (IRSM) en una muestra de las mujeres jordanas. Sujetos y métodos: Se reclutaron 328 sujetos, 103 y 98 mujeres con IRSM primario y secundario, respectivamente, se seleccionaron 127 mujeres normales como grupo de control. Se aisló ADN genómico de una muestra de sangre extraída de cada participante, luego, se genotipificaron los polimorfismos I / D -2549 del gen VEGFA mediante la reacción en cadena de la polimerasa (PCR). Resultados: Los resultados obtenidos revelaron que el polimorfismo ID y el alelo D de VEGFA -2549 polimorfismos I / D tienen las frecuencias más altas en pacientes IRSM tanto primario como secundario, sin diferencia significativa entre los tres grupos en cuanto a polimorfismos y frecuencias alélicas, pacientes con DD + ID Los modelos genéticos tienen una asociación positiva con un alto riesgo de IRSM versus el modelo II, y los pacientes con alelo D son más propensos a tener IRSM que los que tienen el alelo I, no hay diferencia significativa en la asociación de polimorfismos VEGFA -2549 I / D con IRSM en los tres modelos genéticos de los pacientes con IRSM primario y secundario. Conclusión: los pacientes con modelo genético ID de polimorfismos I / D -2549 en la región promotora del gen VEGFA y el alelo D tienen mayor riesgo de IRSM

Background: At least 50% of the cases of recurrent spontaneous miscarriage are aetiologically idiopathic. Recently various genetic polymorphisms have been proposed as susceptibility risk factors for pregnancy loss. Objective: The aim of the present case control study is to establish the association between the functional −2549 I/D polymorphisms in the promoter region of the vascular endothelial growth factor A (VEGFA) gene and idiopathic recurrent spontaneous miscarriage (IRSM) in a sample of Jordanian women. Subjects and methods: 328 subjects were recruited, 103 and 98 women with primary and secondary IRSM, respectively, 127 normal women were selected as a control group. Genomic DNA was isolated from a blood sample withdrawn from each participant, then, -2549 I/D polymorphisms of VEGFA gene were genotyped by Polymerase Chain Reaction (PCR). Results: The obtained results revealed that ID polymorphism and D allele of VEGFA -2549 I/D polymorphisms have the highest frequencies in both primary and secondary IRSM patients, no significant difference between the three groups regarding polymorphisms and allele frequencies, patients with DD+ID genetic models have positive association with high risk of IRSM versus II model, and patients with D allele are more liable to have IRSM than those having I allele, no significant difference in the association of VEGFA -2549 I/D polymorphisms with IRSM in the three genetic models of the primary and secondary IRSM patients. Conclusion: patients with ID genetic model of -2549 I/D polymorphisms in the VEGFA gene's promotor region and D allele have higher risk for IRSM.