Reproductive rights of women with intellectual disability in India.

The reproductive rights of women with intellectual disability (WID) are a matter of concern for all stakeholders, including the woman herself, caregivers, guardians and her treating physicians. The judicial system often calls upon psychiatrists to opine regarding the “capacity to consent” of a WID to procedures such as medical termination of pregnancy and permanent sterilisation. Apart from physical and obstetric examinations, assessment of mental status and intelligence quotient (IQ) are also carried out to facilitate an understanding of the above issue. The Rights of Persons with Disabilities Act, 2016, (RPwD) and the Mental Healthcare Act, 2017, elucidate what constitutes free and informed consent as well as how to assess capacity. The assessment process of “capacity to consent” to reproductive system procedures among WID is important and can guide clinicians. Before assessing capacity, the treating physicians should educate a WID with appropriate information on the proposed procedure, its risks and benefits through various means of communication and then evaluate the “capacity to consent” to the procedure. This article summarises the provisions of the existing legislations on the reproductive rights of WID and puts forward guidance for clinicians on how to approach the issue.

Anemia en puérperas andinas peruanas según el tipo de parto: estudio comparativo / Anemia in Peruvian Andean puerperal women according to type of delivery: a comparative study

Resumen OBJETIVO: Describir y comparar las características obstétricas de pacientes puérperas, con anemia, con finalización del embarazo por parto o cesárea. MATERIALES Y METODOS: Estudio retrospectivo, observacional, descriptivo y comparativo de pacientes con anemia en el puerperio de parto y de cesárea atendidas en el Hospital de Lircay de Huancavelica en el año 2020. Se aplicó la técnica del análisis documental y el instrumento fue una ficha de recolección de datos. RESULTADOS: Se analizaron 162 partos y 46 cesáreas. En las características patológicas se encontró una diferencia significativa: anemia en el embarazo (112 de 162; 69.1% posparto y 23 de 46 [50% de poscesárea]), trastornos hipertensivos (4 de 162; 2.5% postparto y 8 de 46 [7.4% de poscesárea]), hemorragias de la segunda mitad del embarazo (2 de 162 [1.2% de postparto] y 4 de 46 [8.7% poscesárea]). En cuanto al grado de anemia se encontró diferencia significativa en ambos grupos en relación con el grado moderado (89 de 162 [54.9%] postparto y 33 de 46 [71.7%] en poscesárea). CONCLUSIONES: En la frecuencia de anemia puerperal se encontró una diferencia conforme al tipo de finalización del embarazo. La edad, grado de escolaridad, anemia gestacional, trastorno hipertensivo, hemorragia de la segunda mitad de embarazo y la placenta previa se identificaron como factores con diferencias significativas en la anemia, según el tipo de finalización del embarazo.

Abstract OBJECTIVE: To describe and compare the obstetric characteristics of postpartum patients with anemia, with termination of pregnancy by delivery or cesarean section. MATERIALS AND METHODS: Retrospective, observational, descriptive and comparative study of patients with anemia in the postpartum period after childbirth and cesarean section attended at the Lircay Hospital in Huancavelica in 2020. The documentary analysis technique was applied and the instrument was a data collection form. RESULTS: A total of 162 deliveries and 46 cesarean sections were analyzed. In the pathological characteristics a significant difference was found: anemia in pregnancy (112 of 162; 69.1% postpartum and 23 of 46 [50% post cesarean]), hypertensive disorders (4 of 162; 2.5% postpartum and 8 of 46 [7.4% post cesarean]), hemorrhages in the second half of pregnancy (2 of 162 [1.2% postpartum] and 4 of 46 [8.7% post cesarean]). Regarding the degree of anemia, a significant difference was found in both groups in relation to moderate degree (89 of 162 [54.9%] postpartum and 33 of 46 [71.7%] postcesarean section). CONCLUSIONS: In the frequency of puerperal anemia, a difference was found according to the type of termination of pregnancy. Age, level of education, gestational anemia, hypertensive disorder, hemorrhage in the second half of pregnancy and placenta previa were identified as factors with significant differences in anemia, according to the type of termination of pregnancy.

13 anos depois: diálogos sobre a Interrupção Voluntária da Gestação em Portugal / 13 Years Later: Dialogues on Voluntary Termination of Pregnancy in Portugal

Resumo A Lei 16/2007 representou um marco na luta pelos direitos sexuais e reprodutivos das cidadãs portuguesas, instituindo a possibilidade da exclusão da ilicitude para as interrupções voluntárias da gestação, realizadas até a décima semana, por solicitação das mulheres. Através de uma pesquisa descritivo-analítica, objetivou-se conhecer a opinião das cidadãs e de investigadoras (atuantes na causa), frente a esse processo e às transformações que dele decorreram, com ênfase no contexto atual. Entre março e setembro de 2020 foram realizadas 12 entrevistas, divididas em duas etapas. Ao serem precedidas as técnicas da Análise de Discurso, chegou-se à existência de alguns pontos frágeis, como a incerteza sobre o acesso, a presença de julgamentos e as limitações interpostas pela objeção da consciência, que refletem as necessidades de ampliação das semanas gestacionais permitidas para a interrupção. Houve um reconhecimento quanto à segurança nos procedimentos, na liberdade das mulheres diante das suas escolhas, na maior abertura para o diálogo, fato este que contribuiu conjuntamente com o reforço no planejamento familiar. Para além dessas construções, novas demandas foram situadas.

Abstract Law 16/2007 represented a milestone in the quest for sexual and reproductive rights of Portuguese citizens, instituting the possibility of excluding all illegality for voluntary termination of pregnancy, performed until the 10th week, at the request of the women involved. Using a descriptive-analytical research, the objective was to establish the opinion of citizens and researchers (active in the cause), in the course of this process and the transformations that resulted from it, with emphasis on the current context. Between March and September, 12 interviews were conducted, divided into two stages. When the Discourse Analysis techniques were analyzed, there were some weak points, such as the uncertainty about access, the presence of judgments and the limitations interposed by the conscientious objectors, which reflect the need to expand the allowed gestational period for termination. There was recognition of security in procedures, women's freedom in their choices, greater openness to dialogue, a fact that contributed jointly with the strengthening of family planning. In addition to these constructions, new demands were configured.

Interrupción terapéutica del embarazo en casos de fetos anencefálicos y la objeción de conciencia: comparación entre bioética y jurisprudencia / Therapeutic Termination of Pregnancy in Cases of Anencephalic Fetuses and Conscientious Objection: Comparison Between Bioethics and Jurisprudence / Interrupção terapêutica da gravidez em fetos anencéfalos e objeção de consciência: comparação entre bioética e jurisprudência

Resumen: Si bien la interrupción terapéutica del embarazo en los casos de fetos anencefálicos ha sido ampliamente discutida, y se han llegado a conclusiones éticas que la justifican (si no existe contraindicación médica y se obtiene el consentimiento informado de la mujer), es importante reevaluar el tema. Por ello, se deben contrastar los principios bioéticos con sentencias judiciales de fenómenos jurídicos que están surgiendo en el mundo, y que pueden provocar cambios en los derechos sexuales y reproductivos. No obstante, esto no debe implicar un cambio en los argumentos bioéticos. Asimismo, debido al resurgimiento a nivel global de un conservadurismo moral, que propone un planteamiento en torno a la objeción de conciencia, se torna imperativo analizar desde la perspectiva bioética si la misma puede ser invocada en casos de interrupción terapéutica del embarazo. Para ello, se deberían ponderar los principios bioéticos y utilizar una bioética laica, pluralista y basada en ética de mínimos, la cual busque la dignidad de las personas que enfrentan una gestación de fetos anencefálicos. En ese sentido, la objeción de conciencia no debería utilizarse como instrumento para negar la atención a estas personas.

Abstract: Although the therapeutic interruption of pregnancy in cases of anencephalic fetuses has been widely discussed, and ethical conclusions have been reached that justify it (if there is no medical contraindication and the informed consent of the woman is obtained), it is important to reassess the issue. Hence, bioethical principles must be contrasted with judicial rulings on legal phenomena that are emerging in the world, and that can cause changes in sexual and reproductive rights. However, this should not imply a change in the bioethical arguments. Likewise, due to the global resurgence of moral conservatism, which proposes an approach regarding conscientious objection, it becomes imperative to analyze, from a bioethical perspective, if it can be invoked in cases of therapeutic interruption of pregnancy. To do this, bioethical principles should be weighed and a secular, pluralistic bioethics based on minimum ethics should be used, which seeks the dignity of persons facing an anencephalic fetus gestation. In this sense, conscientious objection should not be used as an instrument to deny care to these individuals.

Resumo: Embora a interrupção terapêutica da gravidez nos casos de fetos anencéfalos tenha sido amplamente discutida e tenham chegado a conclusões éticas que a justifiquem (se não houver contraindicação médica e for obtido o consentimento informado da mulher), é importante reavaliar a questão . Por isso, os princípios bioéticos devem ser contrastados com as decisões judiciais sobre fenômenos jurídicos que estão surgindo no mundo e que podem causar mudanças nos direitos sexuais e reprodutivos. No entanto, isso não deve implicar uma mudança nos argumentos bioéticos. Da mesma forma, devido ao ressurgimento global do conservadorismo moral, que propõe uma abordagem em torno da objeção de consciência, torna-se imperativo analisar na perspectiva bioética se ela pode ser invocada nos casos de interrupção terapêutica da gravidez. Para tanto, deve-se pesar os princípios bioéticos e utilizar uma bioética laica, pluralista, pautada na ética mínima, que busque a dignidade das pessoas diante da gestação de feto anencéfalo. Nesse sentido, a objeção de consciência não deve ser utilizada como instrumento para negar atenção a essas pessoas.

Study to compare the effectiveness of intravaginal misoprostol alone with combined use of intravaginal misoprostol and intracervical foley’s catheter for termination of mid trimester pregnancy

Background: The main concern of obstetrician is to provide the most effective and safest regimen for mid trimester termination of pregnancy which combines the shortest expulsion interval with least side effects. The combination of intravaginal misoprostol and intracervical Foley catheter for second trimester pregnancy termination has been described in previous studies with conflicting results. Hence gap exists in literature and not adequate evidence available so this study is undertaken.Methods: A prospective and interventional randomized comparative study was conducted in the department of obstetrics and gynecology, tertiary care centre, New Delhi. A total 60 pregnant female of 14 to 20 weeks of gestation who were admitted for termination of pregnancy due to any indication included in the study. Patients were divided into two groups (30 patients in each group). Group A (misoprostol and foleys combination group) and Group B (misoprostol group). Quantitative variables were compared with unpaired t-test/Mann-whitney test (when the data sets were not normally distributed) between the two groups and qualitative variables were compared by using chi-square test/Fisher’s exact test.Results: The mean induction to abortion interval was 18.31±1.95 hours in the female where misoprostol and foleys combination was used and 21.90±2.62 hours in the women where misoprostol alone used group. Authors found a significant reduction in induction to expulsion time in misoprostol and foleys combination group as compared to misoprostol alone group for mid-trimester termination of pregnancy. Total required dose of misoprostol use for termination of pregnancy was significantly less (p 0.008) in the women where both misoprostol and foleys was used than misoprostol alone.Conclusions: With the use of intracervical Foley’s catheter, the duration from induction to expulsion of abortus gets shortened and required dose of misoprostol is also reduced without any significant increase of side effects.

Prospective study of complications of first trimester medical termination of pregnancy at tertiary care center

Background: MTP (is common procedure done by obstetrician under certain circumstances as per MTP rules and guideline, but it has certain complication and data about complication are not fully available. The aims of this study are to analyse various complication and causes of this complication following MTP presenting at our hospital.Methods: This study was conducted in 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical college, Udaipur attending OPD (including emergency OPD) and IPD during August and September 2019 after MTP. This Study also included maternal mortality among all women participated in the study.Results: A total of 100 cases included in study attended OPD (including emergency OPD) and IPD during study period. All cases were eligible for inclusion in the study. Medical method of abortion (MMA) was the most common method of termination of pregnancy adopted by patient. Prolonged bleeding, anaemia and Incomplete abortion was the common complication related to MTP and manual vacuum aspiration was done in majority of cases to manage incomplete abortion in our hospital setting.Conclusions: The high rate of MTP related morbidity is due to induced abortion continue to be done at inappropriate places using inappropriate methods by person not eligible to do so.

Factors associated with induced second trimester abortion at a tertiary level hospital of Uttarakhand region: a 6-year retrospective study

Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security.

La legalidad oculta: Percepciones de estigma en los recorridos de mujeres que descubren y acceden a la interrupción legal del embarazo por causal salud / The hidden legality: perceptions of stigma in the tours of women who discovered and accessed the legal termination of pregnancy for health reasons / A legalidade oculta: percepções de estigma nas trajetórias de mulheres que descobrem e acessam a interrupção legal da gravidez por razões de saúde

Resumen Desde hace casi un siglo el código penal argentino incluye situaciones en las que el aborto no está penalizado: riesgo para la salud y embarazo producto de violación. Sin embargo, su implementación ha sido inexistente hasta recientemente. Este estudio cualitativo exploró las experiencias de mujeres que accedieron a un aborto legal con el fin de analizar los recorridos que transitan e identificar los modos en que el estigma se percibe, manifiesta y procesa. Las mujeres parten del supuesto de que el aborto es siempre ilegal y "descubren" la legalidad después de recorrer un laberinto plagado de estigma, riesgo, frustración y desesperación. Las situaciones de mayor angustia no se vinculan a la decisión de interrumpir el embarazo sino al recorrido tortuoso que deben transitar. La "legalidad oculta" es causa y consecuencia del estigma vinculado al aborto.

Abstract For nearly a century Argentina's penal code has included two exceptions in which abortion is permitted: health risk and rape. However, the implementation of legal abortion has been nearly nonexistent until recently. This qualitative study explored the experiences of women who accessed legal abortions in Argentina. It sought to analyze the paths they must walk through and to identify the ways in which stigma is perceived, manifested and processed. All women interviewed started searching for clandestine solutions to their unwanted pregnancy assuming abortion was always illegal. They "discovered" legality after walking through a path marked by stigma, risk, frustration and despair. Distress is not linked to the decision to end the pregnancy but is rather a result of the path they wander through. The "hidden legality" is a cause and consequence of abortion stigma.

Resumo Por quase um século, o código penal argentino inclui situações nas quais o aborto não penalizado: risco à saúde e gravidez resultante de estupro. No entanto, sua implementação não existia até recentemente. Este estudo qualitativo explorou as experiências de mulheres que acessaram um aborto legal, a fim de analisar as jornadas pelas quais passam e identificar as maneiras pelas quais o estigma é percebido, manifestado e processado. As mulheres assumem que o aborto é sempre ilegal e "descobrem" a legalidade depois de passar por um labirinto cheio de estigma, risco, frustração e desespero. As situações mais angustiantes não estão ligadas à decisão de interromper a gravidez, mas à jornada tortuosa pela qual devem passar. A "legalidade oculta" é causa e consequência do estigma associado ao aborto.

A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy

Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.

Consideraciones útiles para el asesoramiento genético de pacientes con anomalía de Ebstein / Useful considerations for the genetic advice of patients with Ebstein anomaly

La anomalía de Ebstein es una rara enfermedad que consiste en un espectro variable de anomalías, resultado de una implantación anormal de la válvula tricúspide en el ventrículo derecho; por tal razón, es considerada una afección grave e incurable que origina una tendencia a la terminación voluntaria del embarazo como opción reproductiva en el marco del asesoramiento genético prenatal. Los adelantos en el diagnóstico y control clinicoquirúrgico de esta enfermedad han garantizado el incremento de la supervivencia y una mejor calidad de vida en estos pacientes. Además, han permitido ajustar factores clínicos que implican su evolución y pronóstico. Se realizan algunas valoraciones, a fin de proveer los argumentos necesarios que permitan a la pareja elegir un curso de acción apropiado con vistas a los riesgos y objetivos familiares basados en los principios éticos del asesoramiento genético.

Ebstein anomaly is a strange disease that consists on a variable spectrum of anomalies, due to an abnormal installation of the tricuspid valve in the right ventricle; reason why, it is considered a serious and incurable disorder that originates a tendency to the voluntary termination of pregnancy as reproductive option in the mark of prenatal genetic advice. The advances in the diagnosis and clinical surgical control of this disease have guaranteed the increment of survival and a better life quality in these patients. Also, they have allowed to adjust clinical factors that involve its clinical course and prognosis. Some valuations are carried out, in order to provide the necessary arguments that allow the couple to choose an appropriate action course aimed at the risks and family objectives based on the ethical principles of the genetic advice.

Clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion / 中国基层医药

Objective@#To explore the clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion.@*Methods@#From May 2016 to June 2017, 90 cases of vaginal bleeding after drug abortion in the People's Hospital of Dongping County were divided into the observation group and the control group according to the digital table, with 45 cases in each group.The two groups were all treated with drug abortion to terminate pregnancy, and the control group was treated with metronidazole tablets + carbazochrome tablets after the termination of pregnancy.The observation group was treated with Huoxue Qing Gong decoction on the basis of the control group.The effect of abortion, bleeding time and bleeding volume after drug abortion, the time of menstrual recovery and menstrual duration after treatment in the two groups were observed and compared.@*Results@#The total abortion rate in the observation group was 95.6%, which was significantly higher than that in the control group(84.4%), the difference was statistically significant(χ2=5.620, P<0.05). The proportion of bleeding time≤7d after abortion in the observation group was 37.8%, which was significantly higher than that in the control group(11.1%), the difference was statistically significant(χ2=5.628, P<0.05). The proportion of bleeding time 8~14d of the observation group was 60%, which was significantly lower than that of the control group(73.3%), the difference was statistically significant(χ2=6.571, P<0.05). The proportion of bleeding time more than 15d after drug abortion of the observation group was 2.2%, which was significantly lower than that of the control group(15.6%), the difference was statistically significant(χ2=5.028, P<0.05). The proportion of vaginal bleeding volume<previous menstrual volume after drug abortion of the observation group was 60.0%, which was significantly higher than that of the control group(28.9%), the difference was statistically significant(χ2=6.021, P<0.05). The proportion of amount of vaginal bleeding=previous menstrual volume after drug abortion in the observation group was 22.2%, which was significantly lower than that in the control group(26.7%), the difference was statistically significant (χ2=5.114, P<0.05). The proportion of vaginal bleeding volume>previous menstrual volume after drug abortion of the observation group was 17.8%, which was significantly lower than that of the control group(44.4%), the difference was statistically significant(χ2=6.375, P<0.05). The period of menstrual recovery of the observation group was (29.5±4.2)d, which was significantly shorter than that of the control group[(37.9±4.3)d](t=5.028, P<0.05). The duration of menstruation in the observation group was (5.0±1.1)d, which was significantly shorter than that in the control group[(6.9±1.2)d], the difference was statistically significant(t=3.229, P<0.05).@*Conclusion@#Huoxue Qing Gong decoction in the treatment of vaginal bleeding after drug abortion can significantly shorten the time of vaginal bleeding, reduce the amount of vaginal bleeding, improve the rate of complete abortion, and has no obvious effect on the first menstrual cycle and menstrual period after the drug flow.

Clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion / 中国基层医药

Objective To explore the clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion.Methods From May 2016 to June 2017,90 cases of vaginal bleeding after drug abortion in the People's Hospital of Dongping County were divided into the observation group and the control group according to the digital table ,with 45 cases in each group .The two groups were all treated with drug abortion to terminate pregnancy ,and the control group was treated with metronidazole tablets +carbazochrome tablets after the termination of pregnancy .The observation group was treated with Huoxue Qing Gong decoction on the basis of the control group.The effect of abortion,bleeding time and bleeding volume after drug abortion ,the time of menstrual recovery and menstrual duration after treatment in thetwo groups were observed and compared .Results Thetotal abortion rate in the observation group was 95.6％,which was significantly higher than that in the control group (84.4％),the difference was statistically significant (χ2 =5.620,P<0.05).The proportion of bleeding time≤7d after abortion in the observation group was 37.8％,which was significantly higher than that in the control group (11.1％),the difference was statistically significant(χ2 =5.628,P<0.05).The proportion of bleeding time 8～14d of the observation group was 60％,which was significantly lower than that of the control group(73.3％),the difference was statistically significant(χ2 =6.571,P<0.05).The proportion of bleeding time more than 15d after drug abortion of the observation group was 2.2％,which was significantly lower than that of the control group (15.6％),the difference was statistically significant (χ2 =5.028,P<0.05).The proportion of vaginal bleeding volume <previous menstrual volume after drug abortion of the observation group was 60.0％,which was significantly higher than that of the control group(28.9％),the difference was statistically significant(χ2 =6.021,P <0.05).The proportion of amount of vaginal bleeding =previous menstrual volume after drug abortion in the observation group was 22.2％,which was significantly lower than that in the control group(26.7％),the difference was statistically significant (χ2 =5.114,P<0.05).The proportion of vaginal bleeding volume>previous menstrual volume after drug abortion of the observation group was 17.8％,which was significantly lower than that of the control group (44.4％),the difference was statistically significant (χ2 =6.375,P<0.05).The period of menstrual recovery of the observation group was (29.5 ±4.2) d,which was significantly shorter than that of the control group[(37.9 ±4.3)d](t=5.028,P<0.05).The duration of menstruation in the observation group was (5.0 ±1.1)d,which was significantly shorter than that in the control group[(6.9 ±1.2)d],the difference was statistically significant(t=3.229,P<0.05).Conclusion Huoxue Qing Gong decoction in the treatment of vaginal bleeding after drug abortion can significantly shorten the time of vaginal bleeding ,reduce the amount of vaginal bleeding ,improve the rate of complete abortion,and has no obvious effect on the first menstrual cycle and menstrual period after the drug flow .

The socio-demographic profile of the acceptor of copper intrauterine device after medical termination of pregnancy in a tertiary care centre

Background: India is going to be highest populous country within less than a decade. To stabilize population growth as well as to reduce maternal mortality and morbidity resulting from unwanted pregnancy, greater utilization of the spacing methods is essential. In spite of several decades of effort the popularity of Cu-T among the Indian woman is not high. Aim of the study was to find out the profile of the Cu-T acceptor after medical termination of pregnancy (MTP).Methods: It was a retrospective study. Socio-demographic data of the woman accepting Cu-IUCD after MTP was collected from family planning operation theatre record book.Results: The majority of the participants were from rural area. The mean age of the acceptor was 27.28±4.78. The maximum number of woman was para two 74 (44.3%). The number of woman with LCB 2 years or less than 2 years was 96 (57.5%) and that of woman with LCB more than two years was 71 (42.5%).Conclusions: A significant number of woman use Cu-T after a long gap of two years after last child birth. Woman found to be inclined to use Cu-T after having at least one male child.

A hospital based exploratory study to assess the reasons and timings of seeking abortion services in a tertiary care hospital in Mumbai

Background: The adoption of the Medical Termination of Pregnancy (MTP) Act has allowed for abortion on the grounds of medical and social reasons since 1972.The aim of the present study is to establish the demographic of women seeking abortion care services and to determine the role of different factors in the timing of seeking an abortion.Methods: A retrospective hospital record-based study was carried out among pregnant women seeking an MTP in a tertiary care hospital in Mumbai. The records of women seeking MTP over a 5-year period from January 2012 to December 2016 were accessed and data pertaining to their demographic and obstetric history was recorded. Statistical tests of significance and analysis were done.Results: A total of 803 women underwent an MTP from January 2012 to December 2016. The number of deliveries during the same time period was 13735. The most common age group was 25-30 years. Stratification in terms of the educational backgrounds showed that 45.7% had received only secondary school education while 12.7% had no schooling. Majority of the women (74.8%) availed an MTP in the first trimester, out of which, most of them (36.9%) had 2 previous pregnancies. Most women coming in the second trimester (43.6%) hadn’t conceived before.Conclusions: Education didn’t seem to be a significant factor in determining the timing of seeking an MTP. School education did not necessarily include exposure to sexual education. Experience in terms of parity was more relevant in identifying signs of pregnancy and seeking appropriate services in a timely manner.

Self-administration of MTP Pills and its Complications: An Observational Study

Background: Medical termination of pregnancy (MTP) has been legalized in India since 1971. MTP pills are well effective inthe early weeks of gestation and safe only when used under medical supervision.Aims and Objectives: The aim of the study was to find out the clinical presentations and complications following selfadministration of MTP pills.Materials and Methods: This was a retrospective observational study conducted at SMGS Hospital, Government MedicalCollege Jammu from July 2018 to June 2019. Hundred patients were included in the study. Following factors were studied suchas chief complaints, complications, treatment given, and blood transfusion.Results: Majority (57%) of patients were aged between 30 and 39 years. About 66% were gravid three or more. Only 28% hadtaken the pill within prescribed gestational age limit for MTP, i.e., <7 weeks. Mid-trimester pill intake was encountered in 14%patients. About 41% presented with incomplete abortion. Anemia was present in majority of patients and blood transfusion wasdone in 38% patients. About 24% patients presented with life-threatening shock. Sepsis was present in 5% patients. Emergencylaparotomy was required in 4% cases. Hysterotomy was done in 2% cases. Continuation of pregnancy was noted in 6% patients.Unintended pregnancy and limiting family size were main reasons for abortion 62% and 32%, respectively.Conclusions: Unauthorized over-the-counter availability despite legal ban and ignorance of women have led to increasednumber of unsafe abortions. Increasing awareness among women regarding complications of unsupervised pill intake andeasily availability of safe contraceptive methods can help control this health hazard.

Knowledge and awareness of emergency contraception among women undergoing medical termination of pregnancy in a tertiary care hospital in Andaman and Nicobar Islands

Background: Emergency contraception (EC) is a safe and cost effective measure, which when used judiciously can avoid unintended pregnancies. This is especially relevant in our country where both population control and unsafe abortions are a serious concern. For any contraceptive to be effective, the general population must have a proper knowledge and a positive attitude towards it. Women who come for medical termination of unwanted pregnancy are the best representatives of this and our study aimed to assess the knowledge and awareness of EC in this group.Methods: It was a descriptive, cross-sectional study conducted using a predesigned questionnaire among 100 women who came for medical termination of pregnancy at G. B. Pant Hospital, Port Blair. Questions were asked to evaluate their awareness, knowledge and attitude towards EC.Results: Out of 100 women, only 26 % had heard about EC, mostly from mass media, and seven of these 26 women had correct knowledge of timing of using EC. Four women had used EC before, whereas among others, fear of menstrual irregularity was the major deterrent. A significant association was found between education level and occupation with knowledge of EC.Conclusions: Although EC is a potent tool to avoid unwanted pregnancies, ignorance and misconceptions regarding EC is unfortunately still prevalent among those who would benefit the most from it. Medical personnel and health workers should be more proactive to propagate benefits of EC and encourage its use, as they are usually the first point of contact to the target population.

Caracterización de la morbilidad materna extremadamente grave en el Hospital Ramón González Coro 2014 - 2017 / Characterizing of Extremely Severe Maternal Morbidity at Ramón González Coro Hospital, 2014 - 2017

Introducción: La morbilidad materna extremadamente grave constituye un indicador de calidad de los cuidados maternos y es uno de los temas que más atención ha tenido a nivel mundial debido a su estrecha relación con la mortalidad materna. Objetivo: Caracterizar epidemiológicamente gestantes con morbilidad materna extremadamente grave atendidas en el Hospital Ginecobstétrico Ramón González Coro en La Habana, Cuba. Métodos: Se realizó un estudio descriptivo, observacional y retrospectivo, cuya muestra fueron las 220 gestantes que evolucionaron hacia la gravedad en el cuatrienio 2014- 2017. Se procesó la información mediante estadística descriptiva y se determinaron intervalos de confianza para proporciones de características que se consideraron relevantes. Resultados: La edad materna promedio fue de 30 años y se detectó 16 por ciento de anemia a la captación. Se reportó una ganancia de peso anormal en 37 por ciento de las gestantes. El 75 por ciento tuvo indicación de cesárea para la terminación del embarazo por preeclampsia grave, hematoma retroplacentario o cesárea anterior. La edad gestacional promedio fue de 36,2 semanas. El 35 por ciento presentó complicaciones ante parto y 39 por ciento posparto. Las afecciones más frecuentes fueron la preeclampsia grave, la atonía uterina y el hematoma retroplacentario y las complicaciones fueron fallos hepáticos, renales y síndrome de poli transfusión y aunque no se reportó mortalidad materna, la secuela más importante fue la histerectomía y su consecuencia sobre la fertilidad. Conclusiones: Predominaron trastornos hemorrágicos e hipertensivos, seguidos de los placentarios, y las secuelas fueron histerectomía e infertilidad. No se reportó mortalidad materna(AU)

Introduction: Extremely severe maternal morbidity is an indicator of maternal care quality and it is one of the topics that has received the most attention worldwide due to the close relationship with maternal mortality. Objective: To epidemiologically characterize pregnant women with extremely severe maternal morbidity in patients treated at González Coro Gyneco-Obstetric Hospital in Havana, Cuba. Methods: A descriptive, observational and retrospective study was conducted in 220 pregnant women who evolved towards severity in the four-year period 2014-2017. Information was processed using descriptive statistics. Confidence intervals were determined for proportions of characteristics that were considered relevant. Results: The average maternal age was 30 years and 16 percent of anemia was detected at preganancy uptake. An abnormal weight gain was reported in 37 percent of pregnant women. 75 percent had an indication of caesarean section for termination of pregnancy due to severe preeclampsia, retroplacental hematoma or previous caesarean section. The average gestational age was 36.2 weeks. Complications before childbirth were seen in 35% and 39% in postpartum. The most frequent conditions were severe preeclampsia, uterine atony and retroplacental hematoma. Complications were hepatic, renal and polytransfusion syndrome and although maternal mortality was not reported, the most important sequel was hysterectomy and the consequence on fertility. Conclusions: Hemorrhagic and hypertensive disorders predominated, followed by placentals, and the sequelae were hysterectomy and infertility. No maternal mortality was reported(AU)

Los comités hospitalarios de bioética y la educación en salud: notas para la discusión

Este trabajo toma el caso mexicano de la exigencia legal de comités de bioética: comités hospitalarios de bioética ([CHB], comités de ética asistencial o comités de ética clínica) y los comités de ética en investigación (CEI); la Ley General de Salud hace obligatorios esos comités desde una modificación en 2011. La literatura refiere que los comités de bioética cuentan con tres funciones básicas: educativa, consultiva y normativa; por su parte el marco legal vigente retoma elementos teóricos importantes, uno de ellos corresponde a las funciones de los comités de bioética. Adicionalmente, profundiza en el análisis de la función educativa, toda vez que una buena parte de la literatura disponible se dirige a la función consultiva. Asimismo, se realizan algunas propuestas sobre contenidos en materia educativa. Así pues, es posible organizar grupos de problemas éticos en torno al inicio de la vida humana y problemas éticos alrededor del final de la vida humana. Efectivamente, hay muchos problemas éticos toda la vida, pero entrar o salir de la vida parece ser más conflictivo desde el punto de vista ético.

This paper takes the Mexican case of the legal requirement of bioethics committees: hospital bioethics committees (CHB; healthcare ethics committees or clinical ethics committees), and ethics committees in research (CEI). The General Health Law makes these committees compulsory since a modification in 2011. The literature says that bioethics committees have at least three basic functions: educational, advisory and normative. For its part, the current legal framework takes up important theoretical elements. One of which corresponds to the functions of bioethics committees. Also, it delves into the analysis of the educational function, since much of the available literature addresses the advisory role. Likewise, some proposals are made regarding contents in educational matters. Thus it is possible to organize groups of ethical problems around the beginning of human life and ethical problems around the end of human life. Indeed, there are many ethical problems along life, but getting in or out of life seems to be more controversial from the ethical point of view.

O presente trabalho pega o caso mexicano da exigência legal de comissões de bioética: comissões hospitalares de bioética (CHB; comissões de ética assistencial ou comissões de ética clinica) e os comissões de ética em investigação (CEI); a Lei Geral da Saúde torna obrigatórios estas comissões a partir de uma modificação em 2011. A literatura refere que as comissões de bioética têm três funções básicas: educativa, consultiva e de regulamentos; por sua vez, o quadro jurídico em vigor retoma elementos teóricos importantes, um deles corresponde às funções das comissões de bioética. Além disso, aprofunda na análise da função educativa, toda vez que uma grande parte da literatura disponível dirige-se à função consultiva. Além disso, realizam-se algumas propostas sobre os conteúdos referentes à educação. Assim então, é possível organizar grupos de questões éticas em torno a o início da vida humana e questões éticas em torno a o fim da vida humana. Na verdade, existem muitos problemas éticos a vida toda, mas entrar ou sair da vida parece ser mais controverso do ponto de vista ético.

Clinical effect of mifepristone combined with misoprostol for termination of pregnancy in high risk pregnant women / 中国基层医药

Objective To explore the clinical effect of mifepristone combined with misoprostol for termina-tion of pregnancy in high risk pregnant women and provide reference for clinical treatment.Methods 182 cases of high -risk maternal were divided into observation group and control group by the random number table method,each group 91 cases.The control group was treated with conventional abortion termination of pregnancy,the observation group was treated with the artificial abortion before oral administration of mifepristone tablets and misoprostol tablets. The operation time,the amount of blood loss,the degree of pain,the degree of cervical softening and the occurrence of complications of induced abortion were compared between the two groups.Results The operation time of the observa-tion group was (2.21 ±1.41)min,intraoperative bleeding was (15.29 ±4.06)mL,which were significantly less than those of the control group (t =7.122,8.256,all P <0.05);The pain degree grade I in the observation group was 58.24%,which was significantly higher than that in the control group,grade III accounted for 5.49%,which was sig-nificantly lower than the that in the control group (χ2 =44.887,44.121,all P <0.05),the observation group of cer-vical softening full was 59 cases,full softening rate was 64.84% and the control group in the cervical softening full was 41 cases,softening full rate was 45.05%.Fully softening rate in the observation group was significantly higher than that in the control group (χ2 =7.191,8.411,P <0.05),the control group,the incidence of uterine perforation in 2 cases,the occurrence of artificial abortion syndrome 7 cases,the incidence of complications for 9.89%,the obser-vation group had no uterine perforation occurred,1 case of artificial abortion syndrome and complications occurred rate was 1.10%.The incidence of complications in the observation group was significantly lower than that in the control group (χ2 =6.772,P <0.05).Conclusion Mifepristone combined with misoprostol for high -risk maternal termi-nation of pregnancy could significantly shorten the artificial abortion operation time,reduce intraoperative blood loss, reduce the patient pain,reduce the incidence of complications.

A Retrospective Review of 25 cases of Lethal Fetal Anomalies

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25 women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9 years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%) women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight (32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus. Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various maternal morbidities, in this case series , which could have been prevented if they were diagnosed and terminated at early trimester. A new direction is needed in our local practice.