Obstetric antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is the most frequent acquired thrombophilia of autoimmune basis. Pregnancy complications of APS may include recurrent miscarriage, and placental dysfunction presenting as fetal death, prematurity, intrauterine growth restriction and preeclampsia. For the management of obstetric APS, a coordinated medical-obstetric management is essential, and this should start for a preconceptional visit in order to estimate the individual risk for complications, adjust therapies and establish the indications for preconceptional and first-trimester therapy. The basis of APS therapy during pregnancy is low-dose aspirin, combined in certain clinical scenarios with low-molecular weight heparin. Induction of delivery should not be routinely indicated in the absence of maternal and/or fetal complications. Postpartum management should be warranted.

Depression after pregnancy loss: the role of the presence of living children, the type of loss, multiple losses, the relationship quality, and coping strategies.

Background: Pregnancy loss (PL) is a common, yet rarely examined public health issue associated with an increased risk of impaired mental health, particularly depression.Objective: Previous research shows childlessness to be a correlate of depression after PL. First studies also indicate associations of the type of loss, multiple losses, relationship quality, and coping strategies with depression after the loss of a pregnancy. However, results are inconsistent and the few existing studies show methodological deficits. Therefore, we expect higher depression scores for women without living children, and we exploratively examine the associations between the type of loss, the number of losses, relationship quality, and coping strategies with depression scores for women who suffered a PL.Method: In an online setting, N = 172 women with miscarriage (n = 137) or stillbirth (n = 35) throughout the last 12 months completed the Patient Health Questionnaire (PHQ-D), Brief-COPE, and Partnerschaftsfragebogen (PFB), a German questionnaire measuring relationship quality.Results: In a multiple hierarchical regression analysis, stillbirth, ß = 0.15, p = .035, presence of living children, ß = -0.17, p = .022, and self-blame/emotional avoidance, ß = 0.34, p < .001, are predictors of depression scores. However, there was no association between depression symptoms and other coping strategies, relationship quality, and multiple losses.Conclusions: Especially with regard to women who have no living children, have suffered a stillbirth, or are affected by self-blame/emotional avoidance, health care providers should monitor the presence of depressive symptoms. Our results indicate the need for specific instruments measuring coping style and relationship quality after PL, since the standard items of the PFB and the Brief-COPE seem inappropriate for this setting.

Stillbirth is associated with higher maternal depression scores than miscarriage.Women with living children show lower depression scores after pregnancy loss than childless women.Self-blame and emotional avoidance are associated with higher maternal depression scores after pregnancy loss.

Hughes syndrome: The discovery of the antiphospholipid syndrome.

In the 40 years since the original detailed description of antiphospholipid syndrome (APS), the condition has come to be regarded as one of the most common autoimmune diseases. The impact of the description has been enormous - for example, the recognition that some individuals with connective tissue diseases require anticoagulation rather than corticosteroids or anti-inflammatory treatment has bought about fundamental change in medical practice. In obstetrics, APS is now regarded as the most important prothrombotic cause of recurrent pregnancy loss - with pregnancy success improving from below 20% to current live birth rate over 80%. In neurology, APS may be associated with up to 20% of strokes in people under 40 - a striking figure not least in terms of medical economics, let alone in potentially preventable suffering. In vascular medicine, APS links immunology with thrombosis and vascular disease and may well provide insights into immunological factors in the pathogenesis of atherosclerosis.

Differential rates of induced abortion in Spain: educational attainment and age among native and immigrant women.

OBJECTIVE: Analyzing the variations in induced abortion (IA) rates across different subpopulations in Spain based on country of origin, while considering educational and age composition. METHOD: Using 2021 Voluntary Termination of Pregnancy register and 2021 Spanish Census microdata, we calculated crude IA rates and age-specific abortion rates. We used age-standardized IA rates (ASIAR) to account for the confounding effect of age composition. We compared seven subpopulations residing in Spain, taking into account simple ages and educational levels aggregated into four categories. RESULTS: Immigrant women, especially those from Sub-Saharan and Latin American countries, consistently had higher IA rates compared to native Spanish women. According to age-specific IA rates, university-educated women had considerably fewer abortions than women with other education levels at any age. Age-standardized rates stratified by migratory origin revealed that native Spanish women with primary education or less had higher IA rates than their immigrant counterparts. There was a clear non-linear, association between educational level and IA rates among immigrants. The highest propensity for IA was found among secondary school graduates, while university graduates had the lowest IA rate. CONCLUSIONS: The study demonstrated that variability in sociodemographic characteristics had an impact on IA rates. Young women with middle educational attainment and immigrant background had a higher likelihood of undergoing IA in Spain. The relationship between educational level and IA rates was complex, with variations observed among different groups and changes over time.

Conflictos éticos en un contexto de gestión pública: objeción de conciencia y aborto en la red sanitaria pública española

En este artículo se sostiene, en primer lugar, que (1) la persistencia a nivel internacional de debates éticos en torno al estatus moral del nasciturus y (2) el tradicional compromiso deontológico de los profesionales sanitarios con la salud, tanto de la embarazada como del hijo que espera, dotan de pleno sentido y vigencia al derecho a la objeción de conciencia de dichos profesionales. Sin embargo, donde el aborto legal se configura como prestación sanitaria, surge entonces la dificultad de gestionar esa prestación y, al tiempo, el conflicto moral que expresa la objeción de conciencia. Si en una institución sanitaria pública la objeción es generalizada, se plantea una disyuntiva con implicaciones éticas entre derivar a las gestantes a otras instituciones o aplicar estrategias de integración de personal a nivel de servicio de salud. En el caso de España, se ha aprobado este año una reforma de la Ley Orgánica de salud sexual y reproductiva y de la interrupción voluntaria del embarazo (LOSSRIVE), que manifiesta una voluntad más taxativa de que la objeción de conciencia no impida el acceso al aborto en las instituciones sanitarias públicas, estableciéndose previsiones específicas al efecto. A partir de los trabajos parlamentarios identificamos los principales puntos de discrepancia política que remiten a dispares posiciones de fondo sobre el aborto y afectan al propio planteamiento de la reforma, así como a otros elementos no siempre novedosos -algunos de ellos ya estaban en la LOSSRIVE o se venían aplicando a nivel autonómico con el plácet del Constitucional.

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements -some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Este artigo argumenta, em primeiro lugar, que (1) a persistência, em nível internacional, de debates éticos sobre o status moral do nascituro e (2) o tradicional compromisso deontológico dos profissionais de saúde com a saúde da gestante e do filho que ela espera, dão pleno sentido e vigência ao direito à objeção de consciência desses profissionais. Entretanto, quando o aborto legal é configurado como um serviço de saúde, surge a dificuldade de gerir esse serviço e, ao mesmo tempo, gerir o conflito moral expresso pela objeção de consciência. Se, em uma instituição de saúde pública, a objeção for generalizada, haverá uma escolha com implicações éticas entre encaminhar as gestantes a outras instituições ou aplicar estratégias de integração de pessoal no nível do serviço de saúde. No caso da Espanha, foi aprovada este ano uma reforma da Lei Orgânica de Saúde Sexual e Reprodutiva e a Interrupção Voluntária da Gravidez (LOSSRIVE) que expressa uma vontade mais constrangedora de garantir que a objeção de consciência não impeça o acesso ao aborto em instituições públicas de saúde, estabelecendo disposições específicas para esse fim. Com base no trabalho parlamentar, identificamos os principais pontos de discrepância política, que remetem a diferentes posições de fundo sobre aborto e afetam a própria aproximação da reforma, assim como outros elementos que nem sempre são novos -alguns deles já estavam no LOSSRIVE ou já estavam sendo aplicados em nível regional com a aprovação do Tribunal Constitucional-.

Programa Atenas: serviço pioneiro de atenção extra hospitalar ao aborto no primeiro trimestre por telemedicina / Atenas Program: Pioneer Brazilian service of outpatient care by telemedicine for women with miscarriage or incomplete abortion

RESUMO A criminalização do aborto no Brasil e o acesso restrito ao misoprostol obrigam mulheres a buscarem métodos inseguros para sua indução. Atenção hospitalar ao aborto induzido ou espontâneo é padrão. Na contracorrente, no cenário internacional, a telessaúde no aborto medicamentoso é padrão ouro da atenção às perdas gestacionais, espontâneas ou induzidas. Este artigo apresenta o Programa Atenas iniciativa inédita de atenção ao aborto no primeiro trimestre gestacional - com foco no atendimento extra-hospitalar, através de monitoramento telefônico por enfermeiras, facultando às mulheres escolher o método de esvaziamento uterino (expectante, medicamentoso ou cirúrgico), com vistas à humanização da atenção. Foi realizada pesquisa etnográfica, em maternidade pública nordestina, entre 2014 e 2021. No contexto de dificuldades estruturais e conjunturais, 723 participantes foram atendidas; 73,6% prescindiram de hospitalização para resolução do aborto: 58,4% ocorreram de forma espontânea e 15,2% através do misoprostol hospitalar. Não houve registro de complicações. O monitoramento telefônico promoveu vínculo e cuidado individualizado a este público invisibilizado. Esta iniciativa orgânica do SUS, sem apoio financeiro de órgãos externos, representa um avanço na atenção humanizada às mulheres com aborto. Recomenda-se estender a toda rede pública de saúde, visando ampliação do acesso a um cuidado integral e humanizado no aborto.

ABSTRACT The criminalization of abortion and restricted access to misoprostol in Brazil force women to seek unsafe methods to terminate a pregnancy. Hospital care for miscarriage or abortion is standard. In contrast, telemedicine for the medical management of miscarriage and abortion is the gold standard of care internationally. This article presents the Atenas Program - an unprecedented initiative for first trimester abortion/miscarriage care, aiming at a humanized out-of-hospital service based on telephone monitoring by nurses, allowing women to choose the method of uterine evacuation (expectant, medical or surgical). For this purpose, ethnographic research was carried out in a northeastern public maternity hospital, between 2014 and 2021. In the context of structural and conjunctural difficulties, among the 723 Atenas participants, 73,6% dispensed with hospital admission for miscarriage and abortion resolution: 58,4% occurred spontaneously and 15,2% through hospital misoprostol. No complications were registered. Telephone monitoring by nurses provided the basis for continuity of individualized care for this invisibilized public. Atenas Program, initiative of a SUS institution run without external financial support, represents an advance in humanized care for women with miscarriage and abortion. It should be extended to the entire public health network, to expand access to rounded and humanized care for abortion and miscarriage.

Democracia representativa: uma leitura interseccional sobre a atuação legislativa da Frente Parlamentar de Combate ao Aborto ­ "Pró-vida", no Estado de Goiás / Representative democracy: An intersectional review of the legislative action of the Parliamentary Front to Combat Abortion ­ "Pro-life", in the State of Goiás / Democracia representativa: Una revisión interseccional de la acción legislativa del Frente Parlamentario de Lucha contra el Aborto ­ "Provida", en el Estado de Goiás

Objetivo: Analisar, a partir da perspectiva crítica e interseccional, a organização, composição e atuação legislativa de comissão voltada aos direitos sexuais e reprodutivos de mulheres, denominada Frente Parlamentar de Combate ao Aborto ­ Pró-Vida. Metodologia: Foi realizada leitura interseccional acerca da constituição de Frente Parlamentar de Combate ao Aborto - "Pró-Vida", da Assembleia Legislativa do Estado de Goiás (ALEGO), e o perfil sociodemográfico de seus integrantes foi traçado, discutido a luz dos marcadores sociais gênero, raça/etnia, classe social e religião, e problematizado acerca de um tema que implica diretamente na saúde e na vida das mulheres, o aborto. Resultados e Discussão: a análise dos resultados aponta a sub-representividade feminina, a prevalência de pessoas brancas e o predomínio de ideologia conservadora nos costumes e religião no perfil sociodemográfico dos membros integrantes da frente parlamentar estudada. Em contraponto, a literatura, ao discutir os marcadores sociais em investigação, traz o retrato daquelas que optam por realizar o aborto como sendo o de mulheres negras, de baixa renda e escolaridade, e que procuram em partidos de viés progressista advocacia para suas causas. Conclusão: A estrutura tradicional, presente na frente parlamentar investigada, enfrenta desafios na construção de um debate representativo e capaz de reproduzir nas políticas públicas as complexas identidades, necessidades e experiências das mulheres em risco de abortamento. Nessa argumentação, a construção de práticas políticas e tratos legislativos devem, prioritariamente, considerar as complexidades identitárias e as intersecções e opressões que levam as mulheres ao aborto para, enfim, construir-se uma democracia inclusiva, equitativa e representativa.

Objective: Analyze, from a critical and intersectional perspective, the organization, composition and legislative performance of a commission focused on women's sexual and reproductive rights, called the Parliamentary Front to Combat Abortion ­ Pró-Vida. Methodology: An intersectional reading was carried out regarding the constitution of the Parliamentary Front to Combat Abortion - "Pró-Vida", of the Legislative Assembly of the State of Goiás (ALEGO), and the sociodemographic profile of its members was outlined, discussed in light of social markers, gender, race/ethnicity, social class and religion and problematized about a topic that directly affects women's health and lives, abortion. Results and discussion: analysis of the results points to female underrepresentation, the prevalence of white people and the predominance of conservative ideology in customs and religion in the sociodemographic profile considered. In contrast, the literature, when discussing the social markers under investigation, portrays those who choose to have an abortion as black women, with low income and education, and who look to parties with a progressive bias to advocate for their causes. Conclusion: The traditional structure present in the Parliamentary Front investigated faces challenges in building a representative debate capable of reproducing in public policies the complex identities, needs and experiences of women at risk of miscarriage. In this argument, the construction of political practices and legislative approaches must primarily consider the complexities of identity and the intersections and oppressions that lead women to abortion in order to, ultimately, build an inclusive, equitable and representative democracy.

Objetivo: Analizar, desde una perspectiva crítica e interseccional, la organización, composición y desempeño legislativo de una comisión enfocada en los derechos sexuales y reproductivos de las mujeres, denominada Frente Parlamentario de Lucha contra el Aborto ­ Pró-Vida. Metodología: Se realizó una lectura interseccional sobre la constitución del Frente Parlamentario de Lucha contra el Aborto - "Pró-Vida", de la Asamblea Legislativa del Estado de Goiás (ALEGO), y se delineó el perfil sociodemográfico de sus integrantes, discutido a la luz de marcadores sociales, género, raza/etnia, clase social y religión y problematizados sobre un tema que afecta directamente la salud y la vida de las mujeres, el aborto. Resultados y discusión: el análisis de los resultados apunta a la subrepresentación femenina, el predominio de personas blancas y el predominio de la ideología conservadora en las costumbres y la religión en el perfil sociodemográfico considerado. En contraste, la literatura, al discutir los marcadores sociales bajo investigación, retrata a quienes eligen abortar como mujeres negras, con bajos ingresos y educación, y que buscan partidos con un sesgo progresista para defender sus causas. Conclusión: La estructura tradicional presente en el Frente Parlamentario investigado enfrenta desafíos en la construcción de un debate representativo capaz de reproducir en políticas públicas las complejas identidades, necesidades y experiencias de las mujeres en riesgo de aborto espontáneo. En este argumento, la construcción de prácticas políticas y enfoques legislativos debe considerar principalmente las complejidades de la identidad y las intersecciones y opresiones que llevan a las mujeres al aborto para, en última instancia, construir una democracia inclusiva, equitativa y representativa.

Chromosome analysis of 303 pregnancy losses in Mexico.

BACKGROUND: Chromosomal abnormalities are present in 50 to 60% of miscarriages and in 6 to 19% of stillbirths. Although microarrays are preferred for studying chromosomal abnormalities, many hospitals cannot offer this methodology. OBJECTIVE: To present the results of the cytogenetic analysis of 303 products of conception (POC), which included 184 miscarriages, 49 stillbirths and 17 cases of undefined age. MATERIAL AND METHODS: Karyotyping, fluorescence in situ hybridization, short tandem repeats and microarrays were used, depending on the type of loss and available sample. RESULTS: In 29 POCs we found maternal tissue and were eliminated from the analyses. Informative results were obtained in 250 (91.2 %)/274 cases; the karyotyping success rate was 80.7%; that of single nucleotide polymorphism microarrays, 94.5%; and that of fluorescence in situ hybridization and short tandem repeat, 100%. Cytogenetic abnormalities were observed in 57.6% of miscarriages and in 24.5% of stillbirths; 94% of total anomalies were numerical and 6% were submicroscopic. CONCLUSIONS: Karyotyping with simultaneous short tandem repeat study to rule out contamination of maternal cells is effective for studying miscarriages; in stillbirths, microarrays are recommended.

ANTECEDENTES: Las alteraciones cromosómicas están presentes en 50 a 60 % de los abortos espontáneos y en 6 a 19 % de los mortinatos. Aunque se prefieren los microarreglos para estudiarlos, numerosos hospitales no pueden ofrecerlos. OBJETIVO: Presentar los resultados del estudio citogenético de 303 productos de la concepción (POC), 184 se obtuvieron de abortos espontáneos, 49 fueron mortinatos y en 17 no se identificó la de edad gestacional. MATERIAL Y MÉTODOS: Se empleó cariotipo, hibridación in situ con fluorescencia, secuencias cortas repetidas en tándem y microarreglos, según el tipo de pérdida y la muestra disponible. RESULTADOS: En 29 POC se encontró tejido materno, por lo que fueron eliminados de los análisis. En 250 (91.2 %)/274 casos se obtuvieron resultados informativos; la tasa de éxito del cariotipo fue de 80.7 %; la de los microarreglos de SNP, de 94.5 %; y la de la hibridación fluorescente in situ y la repetición corta en tándem, de 100 %. Se observaron anomalías citogenéticas en 57.6 % de los abortos espontáneos y en 24.5 % de los mortinatos; 94 % de las anomalías fueron numéricas y 6 %, submicroscópicas. CONCLUSIONES: El cariotipo en conjunto con el estudio de secuencias cortas repetidas en tándem para descartar contaminación de células maternas es efectivo para estudiar abortos espontáneos; los microarreglos se recomiendan en los mortinatos.

Tratamiento médico del aborto del primer trimestre: igual eficacia, más eficiencia / Medical treatment of abortion in the first trimester: Equal effectiveness, more efficiency

Antecedentes: La pérdida gestacional precoz acontece en el 10-20% de todas las gestaciones clínicas, siendo el 85% previos a la semana 12 de amenorrea. El aborto involuntario conlleva una carga muy significativa en los recursos destinados a sanidad, alcanzado un coste económico nacional en Reino Unido de 471 millones de libras esterlinas por año (533,06 millones de euros), cifra extrapolable a otros países industrializados. Según una revisión sistemática reciente no hay ensayos bien diseñados en gestaciones del primer trimestre que arrojen una evidencia consolidada sobre cuál es el mejor método de tratamiento de aborto del primer trimestre y existen diferentes estudios que han tratado de evidenciar reducción de costes con resultados contradictorios. Material y métodos: Se realiza un estudio de diseño observacional, retrospectivo y longitudinal. Se revisaron 892 pacientes diagnosticadas de aborto espontáneo durante el primer trimestre de gestación, en el periodo comprendido entre enero de 2013 y diciembre de 2016. En nuestro estudio hemos querido evaluar la efectividad del misoprostol vaginal como tratamiento médico para el aborto espontáneo en el primer trimestre, en comparación con el legrado obstétrico/evacuador y, cuantificar la diferencia en los costos de ambos procedimientos a través de un estudio de minimización de costes. Resultados: De las 892 pacientes reclutadas, se realizó tratamiento médico con misoprostol en 517 (57,95%) y tratamiento quirúrgico mediante legrado evacuador en 375 (42,05%). La efectividad del tratamiento médico fue del 82% (426/517). Con respecto al tratamiento quirúrgico la efectividad resultó del 100%. La tasa de éxito del tratamiento médico fue superior en el subgrupo de pacientes con aborto incompleto (92,9%), en comparación con los grupos de gestación anembrionada (85,7%) y aborto diferido (78,2%). Conclusiones: El tratamiento médico del aborto es un manejo seguro y aceptado por las pacientes...(AU)

Background: Early pregnancy loss occurs in 10-20% of all clinical pregnancies, 85% being prior to week 12 of amenorrhea. Miscarriage entails a very significant burden on healthcare resources, reaching a national economic cost in the United Kingdom of £471 million per year (€533.06 million), a figure that can be extrapolated to other industrialized countries. According to a recent systematic review, there are no well-designed trials in first-trimester pregnancies that provide consolidated evidence on what is the best first-trimester abortion treatment method, and there are different studies that have tried to demonstrate cost reduction with contradictory results. Material and methods: An observational, retrospective and longitudinal design study was carried out. 892 patients diagnosed with spontaneous abortion during the first trimester of pregnancy were reviewed, in the period between January 2013 and December 2016. In our study, we wanted to evaluate the efficacy of vaginal misoprostol as a medical treatment for spontaneous abortion in the first trimester, in comparison with obstetric curettage-evacuator, and to quantify the difference in the costs of both procedures through a cost minimization study. costs. Results: Of the 892 recruited patients, medical treatment with misoprostol was performed in 517 (57.95%) and surgical treatment by curettage in 375 (42.05%). The effectiveness of medical treatment was 82% (426/517). With respect to surgical treatment the effectiveness of 100%. The success rate of medical treatment was higher in the subgroup of patients with incomplete abortion (92.9%), compared to the anembryonic gestation (85.7%) and delayed abortion (78.2%) groups. Conclusions: The medical treatment of abortion is a safe management and accepted by the patients. The adequate selection of candidate patients leads to an increase in the success rate and a decrease in costs...(AU)

Experiência de retorno ao trabalho de mulheres que tiveram aborto espontâneo / Return to work experience of women who had gestational loss / Experiencia de regreso al trabajo de mujeres que tuvieron un aborto espontáneo

INTRODUÇÃO: O aborto espontâneo pode acarretar impactos psicossociais prolongados para a mulher. A presença de uma rede de apoio, inclusive no ambiente de trabalho, é essencial para o luto saudável, uma vez que o retorno às atividades laborais após o aborto é um evento significativo. OBJETIVO: Compreender a experiência de retorno ao trabalho de mulheres que tiveram aborto espontâneo. MÉTODO: Realizou-se uma pesquisa de natureza qualitativa, com três mulheres, maiores de 18 anos, residentes no Litoral Norte de estado da região Sul do Brasil, que se encontravam regularmente empregadas durante e após a gestação e que tiveram aborto espontâneo nos últimos 2 anos. Como instrumento para a coleta de dados, foi utilizada a entrevista semiestruturada e os dados coletados foram analisados pela análise de conteúdo. RESULTADOS: Os resultados demonstraram que o contexto laboral carece de preparo para receber a mulher enlutada, seja enquanto recursos organizacionais como pessoais. CONCLUSÃO: Destaca-se a importância da implementação, nas organizações, de ações que promovam o acolhimento da mulher após o aborto espontâneo.

| INTRODUCTION: Gestational loss can lead to prolonged psychosocial impacts for the woman. The presence of a support network, including in the workplace, is essential for healthy grieving, since returning to work after a miscarriage is a significant event. OBJECTIVE: This study aimed to understand the experience of returning to work of women who had a pregnancy loss. METHOD: A qualitative research was conducted with three women, over 18 years old, residents on the North Coast of a state in the Southern region of Brazil, who were regularly employed during and after pregnancy and who had a miscarriage in the last 2 years. As an instrument for data collection, a semi-structured interview was employed, and the data collected was analyzed by content analysis. RESULTS: The results showed that the labor context lacks preparation to receive the bereaved woman, both as organizational and personal resources. CONCLUSION: It is worth highlighting the importance of implementing, in organizations, actions that promote the support of women after gestational loss.

| INTRODUCCIÓN: El aborto espontáneo puede tener impactos psicosociales prolongados en las mujeres. La presencia de una red de apoyo, incluso en el lugar de trabajo, es fundamental para un duelo saludable, ya que el retorno a las actividades laborales después de un aborto es un evento significativo. OBJETIVO: Comprender la experiencia de retorno al trabajo de mujeres que han sufrido un aborto espontáneo. MÉTODO: Se realizó una investigación cualitativa con 3 mujeres, mayores de 18 años, residentes en la costa norte de un estado de la región sur de Brasil, que trabajaban regularmente durante y después del embarazo y que habían experimentado un aborto espontáneo en los últimos 2 años. Como instrumento para la recolección de datos se utilizó la entrevista semiestructurada y los datos recolectados fueron analizados mediante análisis de contenido. RESULTADOS: Los resultados demostraron que el contexto laboral carece de preparación para recibir a la mujer en duelo, ya sea como recursos organizacionales o personales. CONCLUSIÓN: Se destaca la importancia de implementar, en las organizaciones, acciones que promuevan la acogida de las mujeres después de un aborto espontáneo.

[Abortion in Melilla: barriers to ocean and frontier]. / Aborto en Melilla: barreras de océano y frontera.

OBJECTIVE: To provide insights into the challenges faced by women seeking abortion services in Melilla, Spain. It seeks to describe the journey these women undertake and to identify and analyze the barriers they encounter in accessing abortion care. METHOD: A qualitative research approach was employed, involving a series of eight semi-structured interviews during 2022. Three interviews were conducted with national experts in the field of abortion, while five interviews were conducted with healthcare professionals from the Melilla Health Area who are directly involved in providing abortion services and supporting women throughout the process. The study was guided by a theoretical framework that focuses on barriers to abortion access and sexual and reproductive rights. The collected data was analyzed using content analysis and categorized based on key dimensions of the study. RESULTS: The study identified several significant barriers to abortion care access in Melilla. These include conscientious objection among healthcare providers, the geographical remoteness of Melilla, the legal challenges faced by Moroccan women due to their irregular status, and the requirement of parental consent for minors aged 16 and 17. Consequently, women seeking abortion services are forced to travel to mainland Spain, continue with undesired pregnancies, or resort to unsafe clandestine abortions in Morocco, thereby endangering their lives in the worst cases. CONCLUSIONS: The barriers to abortion access identified in this study represent a violation of women's reproductive rights in Melilla. Urgent action is required to review the current process, ensuring that access is improved and the right to safe abortion is guaranteed for all women residing in Melilla.

Psychosocial profiles of women who legally terminated a pregnancy in Mexico City / Perfiles psicosociales de mujeres que interrumpieron legalmente un embarazo en la Ciudad de México

Abstract Introduction Reproductive autonomy enables a person to freely decide their life plan, including sexual and reproductive health. However, its exercise can be constrained by health determinants and other structural conditions. Knowing the background of women who undergo a Legal Interruption of Pregnancy (LIP) helps identify patterns of inequality and their impact on the exercise of reproductive autonomy. Objective To analyze the profile of women who legally terminate a pregnancy in Mexico City. Method Latent class analysis, with the participation of 274 women who terminated a first trimester pregnancy at a public facility. Results Model of two latent classes: adult (68.34%) and young women (31.65%). Stigma was the predictor variable for class; the higher the score, the lower the probability of belonging to the adult group (p = .019). Adult women were characterized by having lower educational attainment, engaging in unpaid activities, having at least one child, and having had previous abortions, having experienced intimate partner violence in the past twelve months and reporting that their partners did not agree with the interruption of their pregnancy. Young women were students, partnered and reported that their partners had agreed with them to request an abortion. Discussion and conclusion Despite the legal changes effected, stigma is still present in the abortion demand and access, particularly for women with certain characteristics. It would be useful to include interventions to reduce stigma in counseling, using an approach based on previous experience.

Resumen Introducción El ejercicio de la autonomía reproductiva permite tomar decisiones libres sobre el plan de vida incluyendo la salud sexual y reproductiva. Las determinantes de la salud y otros condicionantes estructurales pueden obstaculizar su ejercicio. Conocer los antecedentes de las mujeres que realizan una Interrupción Legal del Embarazo contribuye a determinar patrones de desigualdad y su impacto sobre el ejercicio de la autonomía reproductiva. Objetivo Analizar el perfil de mujeres que interrumpen legalmente un embarazo en la Ciudad de México. Método Análisis de clases latentes, participaron 274 mujeres que interrumpieron un embarazo de primer trimestre en un servicio público. Resultados Modelo de dos clases latentes: adultas (68.34%) y jóvenes (31.65%). El estigma fue la variable predictora de la clase; a mayor puntaje menor probabilidad de pertenecer al grupo de adultas (p = .019). Para las adultas se caracterizaron por tener menor escolaridad, actividades no remuneradas, tener al menos un hijo y abortos previos, experimentaron violencia de pareja en los últimos doce meses y reportaron que su pareja no estuvo de acuerdo con la interrupción. Las jóvenes eran estudiantes, tenían pareja y reportaron que habían acordado con ella solicitar el aborto. Discusión y conclusión A pesar de los cambios legales, el estigma está presente en la demanda y el acceso a los servicios de aborto y resulta particularmente relevante en mujeres con ciertas características. Sería oportuno incluir en la consejería intervenciones para disminuirlo buscando un enfoque centrado en las experiencias previas.

Estudio cromosómico de 303 pérdidas gestacionales en México / Chromosome analysis of 303 pregnancy losses in Mexico

Resumen Antecedentes: Las alteraciones cromosómicas están presentes en 50 a 60 % de los abortos espontáneos y en 6 a 19 % de los mortinatos. Aunque se prefieren los microarreglos para estudiarlos, numerosos hospitales no pueden ofrecerlos. Objetivo: Presentar los resultados del estudio citogenético de 303 productos de la concepción (POC), 184 se obtuvieron de abortos espontáneos, 49 fueron mortinatos y en 17 no se identificó la de edad gestacional. Material y métodos: Se empleó cariotipo, hibridación in situ con fluorescencia, secuencias cortas repetidas en tándem y microarreglos, según el tipo de pérdida y la muestra disponible. Resultados: En 29 POC se encontró tejido materno, por lo que fueron eliminados de los análisis. En 250 (91.2 %)/274 casos se obtuvieron resultados informativos; la tasa de éxito del cariotipo fue de 80.7 %; la de los microarreglos de SNP, de 94.5 %; y la de la hibridación fluorescente in situ y la repetición corta en tándem, de 100 %. Se observaron anomalías citogenéticas en 57.6 % de los abortos espontáneos y en 24.5 % de los mortinatos; 94 % de las anomalías fueron numéricas y 6 %, submicroscópicas. Conclusiones: El cariotipo en conjunto con el estudio de secuencias cortas repetidas en tándem para descartar contaminación de células maternas es efectivo para estudiar abortos espontáneos; los microarreglos se recomiendan en los mortinatos.

Abstract Background: Chromosomal abnormalities are present in 50 to 60 % of miscarriages and in 6 to 19 % of stillbirths. Although microarrays are preferred for studying chromosomal abnormalities, many hospitals cannot offer this methodology. Objective: To present the results of the cytogenetic analysis of 303 products of conception (POC), which included 184 miscarriages, 49 stillbirths and 17 cases of undefined age. Material and methods: Karyotyping, fluorescence in situ hybridization, short tandem repeats and microarrays were used, depending on the type of loss and available sample. Results: In 29 POCs we found maternal tissue and were eliminated from the analyses. Informative results were obtained in 250 (91.2 %)/274 cases; the karyotyping success rate was 80.7 %; that of single nucleotide polymorphism microarrays, 94.5 %; and that of fluorescence in situ hybridization and short tandem repeat, 100 %. Cytogenetic abnormalities were observed in 57.6 % of miscarriages and in 24.5 % of stillbirths; 94 % of total anomalies were numerical and 6 % were submicroscopic. Conclusions: Karyotyping with simultaneous short tandem repeat study to rule out contamination of maternal cells is effective for studying miscarriages; in stillbirths, microarrays are recommended.

Aborto en Melilla: barreras de océano y frontera / Abortion in Melilla: barriers to ocean and frontier

Objetivo: Describir el recorrido que realizan las mujeres para abortar en Melilla, así como identificar y analizar las barreras para su acceso. Método: Investigación cualitativa con un total de ocho entrevistas semiestructuradas realizadas durante 2022 a tres personas referentes en el tema del aborto de ámbito nacional y a cinco profesionales del Área de Salud de Melilla implicadas tanto en la prestación como en el recorrido que hacen las mujeres para poder abortar. El marco teórico que se siguió fueron las barreras de acceso al aborto y los derechos sexuales y reproductivos. Se realizó un análisis temático del contenido y por categorías según las dimensiones del estudio. Resultados: Se han identificado varias barreras de acceso al aborto en Melilla, entre las que destacan la objeción de conciencia, la localización geográfica de Melilla, la situación irregular de las mujeres marroquíes y la necesidad de consentimiento en las menores de 16 y 17 años. Estos obstáculos obligan a las mujeres que quieran abortar a trasladarse a la Península para conseguir el procedimiento, a continuar con un embarazo no deseado o, en el peor de los casos, a someterse a un aborto clandestino en Marruecos poniendo en riesgo su vida. Conclusiones: Las barreras de acceso descritas suponen una vulneración y una violación del derecho al aborto en Melilla. Se debe revisar el recorrido que se ven obligadas a hacer las mujeres de forma que se facilite el acceso y se garantice el derecho a un aborto seguro a todas las mujeres residentes en Melilla.(AU)

Objective: To provide insights into the challenges faced by women seeking abortion services in Melilla, Spain. It seeks to describe the journey these women undertake and to identify and analyze the barriers they encounter in accessing abortion care. Method: A qualitative research approach was employed, involving a series of eight semi-structured interviews during 2022. Three interviews were conducted with national experts in the field of abortion, while five interviews were conducted with healthcare professionals from the Melilla Health Area who are directly involved in providing abortion services and supporting women throughout the process. The study was guided by a theoretical framework that focuses on barriers to abortion access and sexual and reproductive rights. The collected data was analyzed using content analysis and categorized based on key dimensions of the study. Results: The study identified several significant barriers to abortion care access in Melilla. These include conscientious objection among healthcare providers, the geographical remoteness of Melilla, the legal challenges faced by Moroccan women due to their irregular status, and the requirement of parental consent for minors aged 16 and 17. Consequently, women seeking abortion services are forced to travel to mainland Spain, continue with undesired pregnancies, or resort to unsafe clandestine abortions in Morocco, thereby endangering their lives in the worst cases. Conclusions: The barriers to abortion access identified in this study represent a violation of women's reproductive rights in Melilla. Urgent action is required to review the current process, ensuring that access is improved and the right to safe abortion is guaranteed for all women residing in Melilla.(AU)

Percepción bioética de ginecólogos residentes de mastología sobre la interrupción del embarazo en cáncer de seno / Bioethical perception of gynecology specialist mastology residents regarding pregnancy interruption in cases with breast cancer

Objetivo: describir la percepción bioética en un grupo de residentes de mastología frente a la interrupción voluntaria en el primer trimestre del embarazo (IVE,) en casos con cáncer de mama temprano, y las implicaciones de sus conductas médicas en un hospital universitario. Metodología: estudio cualitativo de tipo fenomenológico descriptivo. La técnica de recolección de datos fue la entrevista a profundidad, Para la inclusión de los participantes se utilizó un muestreo intencional. La información se analizó siguiendo el método de Colaizzi que considera la codificación abierta, axial y selectiva. Se elaboraron matrices (microsoft office Excel) para el análisis y comparación de los datos, y para las categorías mediante la consolidación de los descriptores. Para mantener el rigor de la investigación y la validez de sus resultados se tuvieron en cuenta los criterios de credibilidad, auditabilidad y transferibilidad propuestos por Lincoln y Guba, analizando los datos dos investigadores para triangulación de la información. Estudio de riesgo mínimo dado que no se modifican variables en los participantes, se tuvieron en cuenta consideraciones de la Resolución 8430 de 1993 y se obtuvo aprobación del comité de ética de investigación en seres humanos. Resultados: participaron médicos, especialistas en ginecología y obstetricia, residentes de la especialidad de mastología. A partir de la categorización de los significados formulados de las entrevistas, se organizaron en cinco categorías que dan cuenta del dilema de sugerir o no la interrupción de un embarazo en mujeres con cáncer de mama temprano, dudas de los profesionales encargados en la toma de decisiones y sensación de carga de responsabilidad aumentada. Conclusión: la autonomía del médico se ve afectada en casos complejos, en especial cuando considera que no es adecuada la interrupción. Se debería incluir en los programas académicos una formación en bioética no principialista sino centrada en la persona.

Objective: to describe the bioethical perception of a group of mastology residents regarding first trimester voluntary pregnancy interruption (VPI) in cases with early-stage breast cancer, and the implications of their medical behaviors in a university hospital. Methodology: a qualitative descriptive phenomenological study was conducted. Data was obtained through in-depth interviews. Purposive sampling was adopted for recruiting participants. Colaizzi ́s method was used for data analysis including open, axial, and selective coding. Analysis and comparison matrices, and for categories by descriptors consolidation, were created in Microsoft Office Excel. The credibility, auditability, and transferability criteria proposed by Lincoln and Guba, were used to ensure research rigor and validity of its results. Data triangulation was performed involving two researchers. This is a minimal risk study given no variables are modified in participants, in accordance with Resolution 8430 of 1993. Approval was obtained from the ethics committee for research on human beings. Results: participants included physicians, gynecology, and obstetrics specialists, and mastology residents. They were categorized into five groups based on the categorization of the meanings proposed in the interviews, that account for the dilemma of whether suggesting pregnancy interruption in women with early-stage breast cancer, concerns of physicians who play the decision-making role and a feeling of increased responsibility burden placed on them. Conclusion: physician ́s autonomy is affected in complex cases, especially when he/she considers that pregnancy interruption is not appropriate. Training in bioethics should be provided in academic programs, not based on principles but as a person-centered approach.

Caracterización de la interrupción voluntaria del embarazo en pacientes mayores de 19 años

Introducción: Se conoce como interrupción voluntaria del embarazo a la muerte biológica del embrión o feto para su posterior eliminación, con o sin asistencia médica y en cualquier circunstancia social o legal. Objetivo: Caracterizar la interrupción voluntaria del embarazo en pacientes mayores de 19 años en los municipios de la región del Guacanayabo perteneciente a la provincia Granma en el año 2022. Métodos: Se realizó un estudio descriptivo, retrospectivo y de corte transversal sobre la interrupción voluntaria del embarazo en pacientes mayores de 19 años pertenecientes a los siete municipios a la región del Guacanayabo, provincia Granma en el periodo de enero a diciembre del 2022. El universo estuvo constituido por 579 gestantes, para lo cual se seleccionó una muestra de 572 mediante muestreo no probabilístico intencional. Resultados: El municipio de Manzanillo fue el que mayor casos aportó (53,1 %). Prevalecieron las edades de 20 a 24 años (34,3 %). Predominaron las mujeres con un nivel de escolaridad de preuniversitario/técnico medio (56,9 %), 71,9 % estaban casadas, el 53,2 % trabajaban, el 54,9 % eran de procedencia urbana y 76,4 % de las mujeres tenían antecedentes obstétricos. El método de interrupción más utilizado fue el de dilatación y curetaje (98,6 %). Conclusiones: El municipio Manzanillo aportó el mayor número de casos de interrupciones de embarazos al año. Las mujeres de procedencia urbana se someten con mayor frecuencia a interrupciones de embarazos, siendo el procedimiento de dilatación y curetaje el método de interrupción más empleado.

Introduction: It is known as voluntary interruption of pregnancy to the biological death of the embryo or fetus for its subsequent elimination, with or without medical assistance, and in any social or legal circumstance. Objective: To characterize the voluntary interruption of pregnancy in patients over 19 years of age in the municipalities of the Guacanayabo region belonging to Granma province in 2022. Methods: A descriptive, retrospective and cross-sectional study was conducted on voluntary termination of pregnancy in patients over 19 years of age from the seven municipalities of the Guacanayabo region, Granma province, from January to December 2022. The universe consisted of 579 pregnant women, for which a sample of 572 was selected by intentional non-probabilistic sampling. Results: The municipality of Manzanillo was the one with the highest number of cases (53, 1 %). The prevalence was between 20 and 24 years of age. Women with a pre-university/intermediate technical education predominated. (56, 9 per cent), 71, 9 per cent were married, 53, 2 per cent worked, 54.9 per cent were of urban origin and 76.4 per cent of women had an obstetric history. The most commonly used method of interruption was dilatation and curettage (98,6 %). Conclusions: The municipality of Manzanillo contributes the highest number of cases of terminations of pregnancies per year. Urban women are more likely to undergo abortions, with dilatation and curettage being the most widely used method of termination.

Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II / Itinerarios para el cuidado de la salud de mujeres en situación de abortamiento: aspectos metodológicos del estudio cualitativo de la encuesta Nacer en Brasil II / Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

O aborto legal em casos de gravidez decorrente de violência sexual: percepções e vivências de médicas e médicos obstetras / Legal abortion in cases of sexual violence pregnancy: perceptions and experiences of obstetricians / El aborto legal en casos de embarazo resultante de violencia sexual: percepciones y experiencias de médicas y médicos obstetras

Resumo: Este estudo objetivou analisar as percepções de obstetras e residentes de ginecologia-obstetrícia, atuantes numa maternidade escola federal, sobre o aborto legal em casos de gravidez decorrente de violência sexual, desvelando suas motivações, resistências e sentimentos, e identificando suas experiências com o tema. A primeira etapa correspondeu ao preenchimento de um questionário autoaplicável. Os critérios de seleção foram: obstetras vinculados ao centro obstétrico; diretor da divisão médica; e residentes do programa de ginecologia-obstetrícia da instituição. Obtiveram-se 36 questionários respondidos. A segunda etapa correspondeu à realização de uma entrevista, tendo sido utilizado o critério de amostragem por saturação e foram entrevistados seis médicos. As entrevistas foram analisadas pelo método de análise de conteúdo, na modalidade temática. Os questionários retrataram que todos os participantes já haviam prestado assistência a mulheres em situação de violência sexual e que a maioria já havia participado da realização de um aborto legal. As entrevistas evidenciaram os dilemas enfrentados pelos profissionais na assistência a esses casos e a escassez da formação profissional em relação à temática. A palavra da mulher foi tida ora como objeto de suspeição em relação à veracidade do estupro, ora como capaz de suscitar afetação das profissionais em suas escutas, o que possibilitou que essas se aproximassem das vítimas e ofertassem uma assistência mais humanizada. Os resultados apontaram para a importância da temática ser abordada nos campos da saúde e da formação para além do enfoque técnico-científico, visando produzir novas estratégias de cuidado.

Abstract: This study aimed to analyze the perceptions of obstetricians and gynecology-obstetrics residents at a federal school maternity hospital regarding legal abortion in cases of sexual violence pregnancy, understand their motivations, strengths, and feelings, and identify their experience with this topic. The first stage consisted of answering a self-administered questionnaire. The selection criteria were: obstetricians linked to the obstetric center, director of the medical division, and residents of the institution's obstetrics-gynecology program. In total, 36 questionnaires were answered and returned. The second stage corresponded to an interview using a saturation sampling criterion. Six physicians were interviewed. The interviews were evaluated using a thematic content analysis. The questionnaires showed that all participants had already provided care to women in situations of sexual violence and that most of them had already participated in a legal abortion procedure in these cases. The interviews highlighted the dilemmas faced by professionals in providing care to these women and the lack of professional training to handle these cases. The speeches of women were sometimes seen as an object of suspicion regarding the veracity of sexual violence, and sometimes as an object that caused professionals to feel emotionally affected while listening to them, allowing professionals to approach the victims and offer more humanized care. The results pointed to the importance of addressing this topic in the areas of health and providing training beyond the technical-scientific focus in order to support the development of new care strategies.

Resumen: El estudio tuvo como objetivo analizar las percepciones de obstetras y residentes de gineco-obstetricia de una maternidad escolar federal sobre el aborto legal en casos de embarazo resultante de violencia sexual, revelar sus motivaciones, resistencias y sentimientos, e identificar sus experiencias con el tema. La primera etapa consistió en completar un cuestionario autoadministrado. Los criterios de selección fueron los siguientes: obstetras vinculados al centro obstétrico; director de la división médica; y residentes del programa de gineco-obstetricia de la institución. Se obtuvieron 36 cuestionarios cumplimentados. La segunda etapa consistió en una entrevista, utilizando un criterio de muestreo por saturación. Se entrevistó a 6 médicos. Las entrevistas se analizaron mediante el método de análisis de contenido, en la modalidad temática. Los cuestionarios mostraron que todos los participantes ya habían brindado asistencia a mujeres en situación de violencia sexual y que la mayoría ya había participado en la realización de un aborto legal en estos casos. Las entrevistas pusieron de manifiesto los dilemas que enfrentan los profesionales en la asistencia a estos casos y la escasa formación profesional con relación al tema. La palabra de la mujer fue vista a veces como objeto de sospecha con respecto a la veracidad de la violación, y a veces como un objeto capaz de suscitar la afectación de las profesionales en sus escuchas, lo que les permitió acercarse a las víctimas y ofrecer una asistencia más humanizada. Los resultados señalaron la importancia de que la temática sea abordada en los campos de la salud y de la formación más allá del enfoque técnico-científico, con el objetivo de producir nuevas estrategias de cuidado.

O aborto na perspectiva de graduandos em enfermagem

Objetivos: Explorar as representações sociais de estudantes de enfermagem sobre o abortamento provocado e discutir as representações sociais sobre o cuidado de enfermagem à mulheres em processo de abortamento ou pós-aborto com complicações. Método: Trata-se de um estudo qualitativo, fundamentado na Teoria das Representações Sociais, realizado com 16 estudantes de enfermagem do curso de Enfermagem da região do nordeste do Brasil, realizado no período de novembro de 2022. Foi utilizado como critério de inclusão ser estudante de enfermagem devidamente matriculado(a) no semestre 2022.2 da UNEB e de exclusão ser menor de 18 anos. Os dados foram coletados através da entrevista semiestruturada e analisados por meio do software Iramuteq que gerou a Classificação Hierárquica Descendente. Resultados: Após o processamento dos dados e o agrupamento das palavras feito pelo sistema, obteve-se a classificação dos segmentos de texto e a definição dos nomes das classes: Classe 1: Cuidado de enfermagem à mulher em situação de aborto; Classe 2: Representação do abortamento provocado na perspectiva dos direitos sexuais e reprodutivos e sua legalização como forma de reduzir o risco de complicações e morte; Classe 3: Representação do abortamento provocado na perspectiva dos direitos sexuais e reprodutivos e sua legalização como forma de reduzir o risco de complicações e morte. Conclusão: Torna-se necessário que na graduação o tema seja discutido com mais frequência para que se possa ampliar o conhecimento frente aos desafios e complexidades que futuros profissionais irão lidam na prestação de cuidados à mulheres em processo de abortamento ou pós-aborto com complicações.

Objetivos: Explorar las representaciones sociales de estudiantes de enfermería sobre el aborto inducido y discutir las representaciones sociales de los cuidados de enfermería a mujeres sometidas a un aborto o postaborto con complicaciones. Método: Se trata de un estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 16 estudiantes de enfermería del curso de Enfermería de la región noreste de Brasil realizado en noviembre de 2022. El criterio de inclusión fue ser estudiante de enfermería debidamente matriculado en la 2022.2 semestre en la UNEB y exclusión debe ser menor de 18 años. Los datos fueron recolectados mediante entrevistas semiestructuradas y analizados mediante el software Iramuteq, que generó la Clasificación Jerárquica Descendente. Resultados: Después del procesamiento de los datos y la agrupación de las palabras realizadas por el sistema, se clasificaron los segmentos de texto y se definieron los nombres de las clases: Clase 1: Atención de enfermería a la mujer sometida a aborto; Clase 2: Representación del aborto inducido desde la perspectiva de los derechos sexuales y reproductivos y su legalización como forma de reducir el riesgo de complicaciones y muerte; Clase 3: Representación del aborto inducido desde la perspectiva de los derechos sexuales y reproductivos y su legalización como forma de reducir el riesgo de complicaciones y muerte. Conclusión: Es necesario que durante la graduación se discuta con mayor frecuencia el tema para que se puedan ampliar conocimientos ante los desafíos y complejidades que enfrentarán los futuros profesionales al brindar atención a mujeres en proceso de aborto o postaborto con complicaciones.

Objectives: Exploring the social representations of nursing students about induced abortion and discuss the social representations of nursing care for women undergoing an abortion or post-abortion with complications. Method: This is a qualitative study based on the Theory of Social Representations, carried out with 16 nursing students from the Nursing course in the Northeast region of Brazil held in November 2022. The inclusion criterion was being a student of nursing duly enrolled in the 2022.2 semester at UNEB and exclusion must be under 18 years of age. Data were collected through semi-structured interviews and analyzed using the Iramuteq software, which generated the Descending Hierarchical Classification. Results: After processing the data and grouping the words carried out by the system, the text segments were classified and the names of the classes were defined: Class 1: Nursing care for women undergoing an abortion; Class 2: Representation of induced abortion from the perspective of sexual and reproductive rights and its legalization as a way of reducing the risk of complications and death; Class 3: Representation of induced abortion from the perspective of sexual and reproductive rights and its legalization as a way of reducing the risk of complications and death. Conclusion: It is necessary that during graduation the topic is discussed more frequently so that knowledge can be expanded in the face of the challenges and complexities that future professionals will deal with when providing care to women in the process of miscarriage or post-abortion with complications.

Pregnancy loss in women with systemic lupus erythematosus: Grounded Theory / Pérdida del embarazo en mujeres con lupus eritematoso sistémico: una Teoría Fundamentada en Datos / Perda gestacional por mulheres com Lúpus Eritematoso Sistêmico: uma Teoria Fundamentada nos Dados

ABSTRACT Objective: to learn the meanings attributed to pregnancy loss by women with Lupus. Method: qualitative research, based on Symbolic Interactionism and Grounded Theory. Data collection took place between January and August 2022 through in-depth interviews. Data analysis went through the stages of initial and focused coding. Results: seventeen women participated. The central phenomenon "The climb to motherhood: falls and overcoming" was constructed, consisting of three categories: "Falling to the ground during the climb: the experience of pregnancy loss"; "Getting up and following the path: new attempts to conceive"; and "Remembering the journey: meanings attributed to pregnancy losses". Final considerations: experiencing pregnancy is, analogously, like climbing a mountain, where obstacles need to be overcome to reach the summit. The experience of pregnancy loss is seen as complex, especially when there is fragility in healthcare and a lack of awareness regarding feelings of loss and grief.

RESUMEN Objetivo: comprender los significados atribuidos a la pérdida del embarazo por mujeres con Lupus. Método: investigación cualitativa, basada en el Interaccionismo Simbólico y la Teoría Fundamentada en Datos. La recolección de datos se realizó entre enero y agosto de 2022, mediante entrevistas en profundidad. El análisis de datos pasó por las etapas de codificación inicial y focalizada. Resultados: participaron 17 mujeres. Se construyó el fenómeno central "La subida a la maternidad: caídas y superación", conformado por tres categorías: "Caer al suelo durante la subida: la experiencia de la pérdida del embarazo"; "Levantarse y seguir el camino: nuevos intentos de concebir"; y "Recordando el viaje: significados atribuidos a las pérdidas de embarazos". Consideraciones finales: vivir el embarazo es, análogamente, como escalar una montaña, donde es necesario superar obstáculos para llegar a la cima. La experiencia de la pérdida del embarazo se considera compleja, especialmente cuando hay fragilidad en la atención de salud y falta de conciencia sobre los sentimientos de pérdida y duelo.

RESUMO Objetivo: apreender os significados atribuídos à perda gestacional por mulheres com lúpus. Método: pesquisa qualitativa, pautada no Interacionismo Simbólico e na Teoria Fundamentada nos Dados. A coleta de dados ocorreu entre janeiro e agosto de 2022, mediante entrevistas em profundidade. A análise de dados percorreu as etapas de codificação inicial e focalizada. Resultados: participaram 17 mulheres. Construiu-se o fenômeno central "A escalada da maternidade: quedas e superações", constituído por três categorias: "Caindo ao chão durante a subida: a vivência da perda gestacional"; "Levantando e seguindo o caminho: novas tentativas de gestar"; e "Rememorando o percurso: significados atribuídos às perdas gestacionais". Considerações finais: vivenciar a gestação é, analogicamente, como escalar uma montanha, onde obstáculos precisam ser vencidos até o alcance do cume. A vivência de perdas gestacionais é significada como complexa, em especial quando há fragilidade na assistência à saúde e falta de sensibilização diante dos sentimentos de perda e luto.