Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged.

BACKGROUND: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. OBJECTIVE: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). METHODS: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). RESULTS: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. CONCLUSIONS: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Impact of mitigation measures against the COVID 19 pandemic on the perinatal results of the reference maternity hospital in Uruguay.

INTRODUCTION: Social consequences of pandemics, impacts on perinatal results, especially those who are the most vulnerable. OBJECTIVE: Determine effect of mitigation measures of the COVID 19 pandemic on perinatal results in the maternity hospital of the Pereira Rossell Hospital Center (CHPR). METHODS: A retrospective cross-sectional cohort study, with a comparative analysis of the semesters of March 15-30 September 2019 versus the same period in 2020 based on three variables low birth weight (LBW), preterm birth (PB), and small for gestational age (SGA). RESULTS: Incidence of PB (14.5%), LBW (12%) and SGA (6.9%) was higher in the 2020 semester during COVID 19 pandemic compared to the same period of 2019 (12.2%; 9.8%; 5.5%). PB showed a statistically significant increase of 21% in our hospital. CONCLUSION: Mitigation measures of the COVID 19 pandemic, aggravate the effects of the global syndemic on the reproductive process of the social sectors most violated in their rights.

The medical profession and the defense and promotion of sexual and reproductive rights.

The values of the medical profession and other healthcare providers allow assessment of the relationship between physicians, healthcare teams, patients, and healthcare networks regarding the defense and promotion of sexual and reproductive health and rights. This paper questions the traditional model of the relationship between healthcare professionals and patients, based on the classic paternalistic role of the physician. It describes the tools available to the medical profession and healthcare teams for the promotion of sexual and reproductive rights, and proposes specific actions that would lead to improvements for women and communities.

A risk reduction strategy to prevent maternal deaths associated with unsafe abortion.

INTRODUCTION: Worldwide, 13% of maternal deaths are caused by complications of spontaneous or induced abortion, 29% in Uruguay and nearly half (48%) in the Pereira Rossell Hospital. PURPOSE: This paper describes a risk reduction strategy for unsafe abortions in Montevideo, Uruguay, where over one-fourth of maternal deaths are caused by unsafe abortion. METHODS: Although abortion is not legal in Uruguay, women desiring abortions can be counseled before and immediately after to reduce the risk of injury. Women contemplating abortion were invited to attend a "before-abortion" and an "after-abortion" visit at a reproductive health polyclinic. At the "before-abortion" visit, gestational age, condition of the fetus and pathologies were diagnosed and the risks associated with the use of different abortion methods (based on the best available scientific evidence) were described. The "after-abortion" visit allowed for checking for possible complications and offering contraception. RESULTS: From March 2004 through June 2005, 675 women attended the "before-abortion" and 495 the "after-abortion" visit, the number increasing over time. Some women (3.5%) decided not to abort, others were either not pregnant, the fetus/embryo was dead or the woman had a condition that permitted legal termination of pregnancy in the hospital (7.5%). Most women, however, aborted. All women used vaginal misoprostol in the doses recommended in the medical literature. There were no serious complications (one mild infection and two hemorrhages not requiring transfusion). CONCLUSION: The strategy is effective in reducing unsafe abortions and their health consequences.

Aborto provocado: un problema humano. Perspectivas para su análisis, estrategias para su reducción / Provoked abortion: a human problem. Perspectives and strategy of prevention

Se aborda el problema del aborto provocado en condiciones de riesgo desde 5 perspectivas: la perspectiva biológica, la perspectiva sanitaria, la perspectiva de los derechos sexuales y reproductivos como derechos humanos, la perspectiva legal y, por último, la perspectiva bioética. Se sugiere un abordaje pragmático y con evidencias científicas para este complejo problema. Se critica las actitudes dogmáticas que tratan de imponer sus puntos de vista en una sociedad democrática como la uruguaya. Se plantea la necesidad de soluciones que van desde actividades sanitarias concretas expresadas en las Iniciativas sanitarias contra el aborto provocado en condiciones de riesgo hasta los cambios legislativos hoy en debate en nuestro país que buscan un doble objetivo: disminuir el número de muertes maternas y disminuir el número de abortos provocados. (AU)

Aborto provocado: un problema humano. Perspectivas para su análisis, estrategias para su reducción / Provoked abortion: a human problem. Perspectives and strategy of prevention

Se aborda el problema del aborto provocado en condiciones de riesgo desde 5 perspectivas: la perspectiva biológica, la perspectiva sanitaria, la perspectiva de los derchos sexuales y reproductivos como derechos humanos, la perspectiva legal y, por último, la perspectiva bioética. Se sugiere un abordaje pragmático y con evidencias científicass para este complejo problema. Se critica las actitudes dogmáticas que tratan de imponer sus puntos de vista en una sociedad democrática como la uruguaya. Se plantea la necesidad de soluciones que van desde actividades sanitarias concretas expresadas en las "Iniciativas sanitarias contra el aborto provocado en condiciones de riesgo" hasta los cambios legislativos hoy en debate en nuestro país que buscan un doble objetivo: disminuir el número de muertes maternas y disminuir el número de abortos provocados.