Causes of Maternal Mortality in Rwanda, 2017-2019.

OBJECTIVE: To assess the causes of maternal mortality at a referral hospital in Rwanda. METHODS: A secondary data analysis of 217 women with recorded maternal mortality from 2017 to 2019 was conducted among 11,308 total maternal admissions. Demographics, diagnosis, management, referring hospital source, and outcomes were recorded. RESULTS: The mean (±SD) age of maternal death was 30.7±7.2 years (range 16-57 years). The overall maternal mortality rate was 1.99%, with yearly rates of 2.45%, 2.53%, and 1.84% in 2017, 2018, and 2019, respectively. A significant seasonal variation was noted. Sepsis was the most common cause of maternal death (50%), followed by hemorrhage (19%) and hypertensive disorders (15%). Causes of maternal deaths included preeclampsia (13%) and abortion (8%). Furthermore, 82% of all the deaths were referrals from smaller community hospitals. CONCLUSION: Maternal death due to sepsis remain a major cause of maternal deaths in Rwanda. Infection prevention and the early diagnosis and management of sepsis must be a priority in reducing maternal mortality.

State Abortion Policies and Maternal Death in the United States, 2015‒2018.

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.

Experiences of women seeking post-abortion care services in a Regional Hospital in Ghana.

INTRODUCTION: Abortions remain one of the highest contributors to maternal deaths in Ghana. In 2003, a policy on post-abortion care was introduced to help reduce abortion-related mortality and morbidity. However, depending on the method of pregnancy termination; women encounter varying experiences. This study examines the experiences of women seeking post-abortion care services in a Regional Hospital in Ghana. MATERIALS AND METHODS: In-depth interview technique was used to collect data from 20 purposively selected post-abortion care clients at the Volta Regional Hospital. Data were analysed manually using a qualitative content analysis technique. RESULTS: The study found that medical abortion was the main method of pregnancy termination used by women who participated in the study to induce abortion. Spontaneous abortion, however, was attributed mainly to engaging in activities that required the use of excessive energy and travelling on bad roads by pregnant women. The study also revealed that, women do not seek early post-abortion care services due to stigma and poverty. CONCLUSIONS: We found that severity of pain from complications, stigma and financial constraints were factors that influenced women's decision to seek post-abortion care services. Our findings also suggest that women who experienced spontaneous abortion mainly received financial and emotional support from partners and other family members. To encourage women to seek early post-abortion care services, the Ministry of Health and the Ghana Health Service should take pragmatic steps to educate women on the dangers associated with delay in seeking post-abortion care services and the factors that expose women to spontaneous abortions.

[Clandestine abortion complications and street drugs in Brazzaville]. / Avortements clandestins compliqués et médicaments de la rue à Brazzaville.

INTRODUCTION: clandestine abortions increase maternal morbi-mortality in sub-Saharan Africa and are closely linked to restrictive legislation and low contraceptive prevalence. In Brazzaville street drugs are commonly used to induce abortion. The purpose of this study is to determine street drug prevalence and socio-demographic characteristics of these patients. METHODS: we conducted a longitudinal study of 67 patients with induced abortion complications admitted to the Talangaï Hospital from July to December 2018. (i) Socio-demographic (ii) and obstetrical (iii) characteristics as well as abortion features (procedure, Manganguiste involvement, abortion rank and cost) were collected and analyzed using EPI info 7 software. We compared the means using student's test, proportions with CHI-2, p value was set to < 0.05. RESULTS: the average age of patients was 25 years ± 6.6; 59.7% of them were attending college, 53.8% had no income-generating activity, 38.8% lived alone and in 15% of cases biological father had denied paternity. Street drugs had been used in 74.5% of cases, mean abortion cost was 3500 CFA (US$7) and 29500CFA (US$59) when it had been performed by health-care professionals. High school respondents were more likely (73.69%) to know at least contraceptive methods (p<0.05). Greater numbers of singles (p=0.000) and of those who knew a contraceptive method (p=0.003) expressed the intention to use contraception. Conclusion: combatting the use of street drugs and securing the right to safe voluntary abortion are necessary to limit complications due to clandestine abortions.

Mortality Synopsis Among Women of Reproductive Age Group in Nigeria: A Hospital-Based Study.

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.

Overlapping borders: limit of viability and late terminations of pregnancy - a retrospective multicentre observational study.

AIMS OF THE STUDY: Based on an incidental observation made in the context of the Swiss National Science Foundation (SNSF) Project 67 “End-of-life decision-making in extremely low birth weight infants in Switzerland”, this retrospective multicentre observational study aimed to analyse circumstances of delivery room deaths after late termination of pregnancy (LTOP) in Switzerland over a 3-year period. METHODS: All delivery room deaths (including live and stillbirths) following LTOP among infants with a gestational age between 22 0/7 and 27 6/7 weeks at the nine Swiss level III perinatal centres between 1 July 2012 and 30 June 2015 were analysed. Indications for LTOP were classified as either (a) maternal emergencies or (b) fetal anomalies severe enough to cause significant maternal psychological distress. Whenever possible, specific diagnoses were recorded. Spontaneous intrapartum death and fetal death caused by injection of a cardioplegic drug were distinguished for stillborn infants. RESULTS: A total of 465 delivery room deaths among extremely low gestational age newborns (ELGANs) were identified over the 3-year study period of the SNSF project. Of these, 195 (42%) occurred in the context of LTOP. Central nervous system malformations, chromosomal anomalies, severe congenital heart disease, multiple malformations and maternal emergencies accounted for 70% of all LTOPs. LTOPs resulted in live births in 76 (39%) cases. No correlation between gestational age and rate of live births was observed. Fetal death caused by injection of a cardioplegic drug was documented in only three cases. All infants born alive after LTOP died in the delivery room without resuscitation attempts. The use of drugs for palliative care in these patients was either rare or, alternatively, incompletely documented. CONCLUSION: LTOPs contribute significantly to mortality rates among ELGANs and should therefore be included in perinatal registries. Uniform reporting of LTOPs should be established. Infants born alive after LTOP are entitled to comprehensive palliative care like any other infant born under different circumstances. Development of national guidelines for LTOPs (including the role of fetal death caused by injection of a cardioplegic drug and palliative birth as an alternative to induced abortion) would be highly desirable to guarantee acceptable standards of care.

Characterisation of induced abortion and consequences to women's health at Hospital Central do Huambo - Angola.

To characterise patients with abortion in Huambo, Angola, we have undertaken a descriptive, longitudinal, prospective survey. A structured questionnaire was applied to 715 patients. The study variables were grouped in socio-demographic and clinical-epidemiological variables. There were 29.8% women were aged 20-24, 45.6% had primary education, 41.1% were single and 26.9% worked as a non-formal salesperson. Menarche occurred at 16-18 years (55.5%), first sexual intercourse at 13-15 years (40.3%) and 74.8% did not use contraceptive methods. Abortion was of indeterminate type in 84.3% and 79.3% had had a previous abortion. Serious complications occurred in 8.0% with six maternal deaths (0.8%). Age of menarche and age at onset of sexual activity are interdependent variables (p ≤ .001), the earlier menarche appears, the earlier sexual activity begins. When there was a history of abortion, new abortions occurred earlier (p ≤ .001) and were of indeterminate type (89%). Indeterminate induced abortion is influenced by socioeconomic, educational and political conditions and continues to be a frequent cause of morbidity and mortality.Impact statementWhat is already known on this subject? Unsafe abortion contributes greatly to maternal morbidity and mortality, principally in countries with restrictive abortion laws. The relationship between socio-educational level and unwanted pregnancies is consensual.What the results of this study add? Early initiation of sexual activity combined with non-contraception contributes to unwanted pregnancy and consequent unsafe abortion. Most of the women had previously had an abortion.What the implications are of these findings for clinical practice and/or further research? It is necessary to develop access to adequate information and family planning to combat unwanted pregnancies. It is also important to evaluate long-term consequences of unsafe abortion.

Midwives and Post-abortion Care in Gabon: "Things have really changed".

Complications from spontaneous and induced abortion are a primary cause of death of women in sub-Saharan Africa. Le Réseau d'Afrique Centrale pour la Santé Reproductive des Femmes: Gabon, Cameroun, Guinée Équatoriale (the Middle African Network for Women's Reproductive Health, or GCG as it is commonly known) was founded in 2009 to identify and overcome obstacles to post-abortion care in Gabon. Research identified the main obstacle as lack of emergency skills and provisions among first-line health care providers. To fill the lacuna, GCG designed a program to train midwives in manual vacuum aspiration (MVA), misoprostol protocols, and the insertion of T-shaped copper IUDs. This article presents a nine-year retrospective (2009-2018) of the program. Qualitative and quantitative results confirm correlations between midwives' practice of MVA in health centers and spectacular decreases in treatment delays, with corresponding decreases in mortality from abortion complications. Our findings also demonstrate how these advances have been threatened by opposition to midwife practice in certain urban medical centers despite encouragement by the Gabon Ministry of Health to use the new protocols. Women's human right to the highest attainable standard of health, including access to safe abortion, is an assumption that GCG shares with the 40 African countries that have ratified the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa. The training program illustrates how a direct-action strategy can fully equip medical practitioners, especially those in peripheral sites with meager resources, to provide emergency post-abortion and abortion care even before governments legislate their human rights commitment.

The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System.

OBJECTIVE: To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries. METHODS: All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death. FINDINGS: A total of 106 maternal deaths among 1 455 545 live births have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes. CONCLUSIONS: A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for preventing avoidable maternal deaths.

Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada.

Importance: Over the past 2 decades, there has been a trend toward increasing maternal age in many high-income countries. Maternal age may lead to greater attendant morbidity and mortality for Canadian mothers. Objective: To investigate the association of maternal age, adjusting for patient-level and hospital-level factors, with severe maternal morbidity (SMM) and maternal death in Canada. Design, Setting, and Participants: A nationwide population-based cohort study of all antepartum, peripartum, and postpartum women and adolescents seen at Canadian acute care hospitals from April 1, 2004, to March 31, 2015. All analyses were completed on September 13, 2018. Exposures: Maternal age at the index delivery. Main Outcomes and Measures: Severe maternal morbidity and maternal death during pregnancy and within 6 weeks after termination of pregnancy. Results: During the study period, there were 3 162 303 new pregnancies (mean [SD] maternal age, 29.5 [5.6] years) and 3 533 259 related hospital admissions. There were 54 219 episodes of SMM (17.7 cases per 1000 deliveries) in the entire study period, with a 9.8% relative increase from 2004-2005 to 2014-2015, in addition to an increasing proportion of pregnancies to older mothers. Independent patient-level factors associated with SMM included increasing Maternal Comorbidity Index; maternal age 19 years or younger and 30 years or older, with the greatest risk experienced by women 45 years or older (odds ratio [OR], 2.69; 95% CI, 2.34-3.06 compared with maternal age 20-24 years); and lowest income quintile (OR, 1.19; 95% CI, 1.14-1.22 compared with highest income quintile). Hospital-level factors associated with SMM included specific provinces. Independent patient-level factors associated with maternal mortality included increasing Maternal Comorbidity Index, age 40 to 44 years (OR, 3.39; 95% CI, 1.68-6.82 compared with age 20-24 years), age 45 years or older (OR, 4.39; 95% CI, 1.01-19.10 compared with age 20-24 years), and lowest income quintile (OR, 4.14; 95% CI, 2.03-8.50 compared with highest income quintile). Hospital-level factors associated with maternal mortality included lowest hospital pregnancy volume. Conclusions and Relevance: In Canada, maternal age and SMM have increased over the past decade. Results of this study suggest that province of residence, maternal comorbidity, residence income quintile, and extremes of maternal age, especially those 45 years or older, were associated with SMM and mortality. These findings are relevant to prospective parents, their health care team, and public health planning.

Men's support for abortion in Upper East and Upper West Ghana.

The second leading cause of maternal mortality in Ghana is unsafe abortion. Research in Ghana shows that men's support influences women's use of safe abortion services. The aim of this study was to understand what men know about abortion, why they support their partners to seek an abortion, and to identify effective ways to reach men with abortion information. We conducted eleven focus groups and ten in-depth interviews with men of reproductive age in rural Ghana. Inclusion criteria were written consent, age and marital status. Focus groups and interviews were conducted in local languages using a semi-structured guide. Focus groups and interviews were audiotaped, transcribed, translated, computerised and coded for analysis. Most men knew the difference between unsafe and safe abortion and would support their partner to have an abortion. Messages that reinforce safe abortion as acceptable and that address fears of death or barrenness should be developed to educate men about safe abortion. Multiple channels to communicate these messages should be used and include pictures, video or audio for those men who cannot read. Through an intensive intervention inclusive of men, women's access to safe abortion services can be improved in Ghana.

O planejamento familiar e a mortalidade materna por aborto / Family planning and maternal mortality for abortion / La planificación familiar y la mortalidad materna por aborto

A mortalidade materna é considerada um excelente indicador de saúde, não apenas da mulher, mas da população como um todo. No Brasil, a morte materna configura-se como um problema de saúde pública. Segundo o Ministério da Saúde, as altas taxas de mortalidade materna compõem um quadro de violação dos direitos humanos de mulheres e de crianças, atingindo desigualmente aquelas das classes sociais com menor ingresso e acesso aos bens sociais nas várias regiões brasileiras. O planejamento familiar, quando oferecido de forma contínua e prolongada, pode contribuir para a redução do número de gestações indesejadas, de abortos ilegais e da mortalidade materna. Trata-se de estudo de revisão sistemática de literatura do tipo exploratória com abordagem qualitativa. Após a leitura seletiva das referências, teve início a fase analítica. Realizou-se o grupamento em duas categorias temáticas, a seguir discriminadas: (1) o homem no planejamento familiar; (2) contracepção pós-abortamento e redes de cuidado. No que tange ao aborto, a participação masculina é de extrema relevância, pois a não aceitação da gravidez ou o abandono do parceiro são alguns dos motivos que levam a mulher ao aborto provocado. O cuidado integral à saúde da mulher em situações de abortamento deve incluir, além do tratamento de emergência, o acesso universal ao planejamento reprodutivo, inclusive orientações para as mulheres que desejam uma nova gestação.

Maternal mortality is considered an excellent indicator of health, not only for women but also for the population as a whole. In Brazil, maternal death is a public health problem. According to the Ministry of Health, the high rates of maternal mortality constitute a framework of violation of human rights for women and children, unequally affecting those of the lower income classes and with less access to social assets in various Brazilian regions. Family planning, when provided on a continuous and protracted basis, can contribute to reducing the number of unwanted pregnancies and illegal abortions as well as maternal mortality rates. This is a systematic review of literature with a qualitative approach and exploratory nature. After selective reading of the references, the analytical phase began. The data were grouped into two thematic categories, as follows: (1) The man in family planning; (2) Post-abortion contraception and care networks. Regarding abortion, male participation is extremely relevant, and non-acceptance of pregnancy as well as partner abandonment were some of the reasons that lead women to abortion. Comprehensive care for women's health in abortion situations should include universal access to reproductive planning and guidelines for women seeking a new pregnancy, in addition to emergency treatment.

La mortalidad materna se considera un excelente indicador de salud no solo de la mujer, sino de la población como un todo. En Brasil, la muerte materna se configura como un problema de salud pública. Según el Ministerio de Salud, las altas tasas de mortalidad materna componen un cuadro de violación a los derechos humanos de mujeres y de niños, alcanzando desigualmente las clases sociales con menor ingresos y acceso a los bienes sociales, en las distintas regiones brasileñas. La planificación familiar, cuando se ofrece de forma continua y prolongada, puede contribuir a la reducción del número de embarazos no deseados y abortos ilegales, y de la mortalidad materna. Se trata de un estudio de revisión sistemática de literatura de tipo exploratorio, con abordaje cualitativo. Después de la lectura selectiva de las referencias, se inició la fase analítica. Se realizó el agrupamiento en dos categorías temáticas: (1) el hombre en la planificación familiar; (2) contracepción postaborto y redes de cuidado. En lo que se refiere al aborto, la participación masculina es de extrema relevancia, pues la no aceptación del embarazo o el abandono del compañero son algunos de los motivos que llevan a la mujer al aborto. El cuidado integral a la salud de la mujer en situaciones de aborto debe incluir, además del tratamiento de emergencia, el acceso universal a la planificación reproductiva, comprendiendo orientaciones para las mujeres que desean una nueva gestación.

Abortion care in Haiti: A secondary analysis of demographic and health data.

BACKGROUND: Abortion-related mortality accounts for 8% of all global maternal deaths and 97% of the estimated 25 million unsafe abortions performed each year occur in low- and middle-income countries. Haiti has the highest rate of maternal mortality in the western hemisphere and to further understand the circumstances of induced abortion in Haiti, the current work uses data from the 2012 Demographic and Health Survey (DHS) to describe the methods of induced abortion in Haiti between 2007-2012 and to identify potential factors associated with use of different abortion methods. METHODS: This is a secondary analysis of nationally representative cross-sectional data from the 2012 Haitian DHS, a two-stage cluster randomized household survey. Analysis included descriptive statistics on participant demographics, methods of abortion, and location of / assistant for the abortion. Multivariate regression was conducted to determine if demographic characteristics were associated with: 1) increased or decreased odds of having an abortion; or 2) increased or decreased odds of reporting an evidence based or non-evidence based method of abortion. RESULTS: Among the 14,287 women of childbearing age who completed the 2012 Haiti DHS survey, 289 women reported having an induced abortion in the previous five years. Recommended methods, manual vacuum aspiration (MVA) or misoprostol alone, were used in 26.6% of the abortions (n = 77). Additionally, 13.8% (n = 40) of abortions used these recommended methods in combination with a non-evidenced based method such as injections, plants or tablets. A total of 92 women had a dilation and curettage (D&C) abortion, either alone (n = 77) or in combination with another method (n = 15) and over a quarter (n = 80) of reported abortions were conducted by non-evidence based methods (n = 80). A majority of abortions using a recommended method were assisted by a relative/friend (n = 28) or were unassisted (n = 34). Most abortions occurred in private homes (n = 174) with hospitals/clinics being the second most common location (n = 84). Women in the middle (OR = 3.3, 95% CI = 2.0-5.6) and highest (OR = 7.4, 95% CI = 4.4-12.3) wealth brackets were more likely to have had an abortion in comparison to women in the lowest wealth bracket. Women who had ever been in a marital union were more likely to have had an abortion than those who had not. The only demographic factor predictive of aborting using a recommended method was living in an urban area, with urban-dwelling women being less likely to use a recommended abortion method (OR = 0.4, 95% CI = 0.2-0.9) in comparison with women living in rural settings. CONCLUSION: In a nationally representative survey in Haiti, 2% of women of childbearing age reported having an abortion in the five years prior to the survey. A large proportion of these abortions were carried out using non-evidence based methods and over half occurred outside of the formal health care system. Understanding women's attitudes, knowledge and barriers around abortion is paramount to improving knowledge and access to evidence-based abortion care in an effort to decrease maternal morbidity and mortality in Haiti.

Embryonic mortality and abortion in goats caused by ingestion of Poincianella pyramidalis / Mortalidade embrionária e aborto em caprinos causados pela ingestão de Poincianella pyramidalis

This study aimed to characterize the embryotoxic, teratogenic and abortifacient effect of Poincianella pyramidalis in goats. Twenty pregnant goats with 18 days of gestation were divided into five groups of four animals each. After collection, the leaves of P. pyramidalis were dried in the shade and crushed. The daily feed provided to the goats was equivalent to 3% of their body weight, being 1% concentrated feed and 2% roughage. In Group 1 (control), the provided roughage was Cynodon dactylon (Tifton) hay; in Groups 2, 3 and 4, 10%, 20% and 80% of the C. dactylon roughage was replaced by dry and ground P. pyramidalis, respectively. In Group 5, all the roughage was replaced by green P. pyramidalis ad libitum, collected daily. Ultrasonographic examination was performed twice a week throughout the pregnancy. Goats in Groups 1, 2 and 3, delivered normal kids. Two goats in Group 4 aborted at 127 and 90 days of gestation. In group 5, three goats showed embryonic death at 25, 30 and 31 days of gestation and the other goat aborted at 39 days of pregnancy. Malformations were not observed. It is suggested that P. pyramidalis, which is very common in the semiarid region of northeastern Brazil, should be considered as an important cause of reproductive losses in this area. Due to its high palatability, it is important to avoid the ingestion of P. pyramidalis by pregnant and mating goats.(AU)

O objetivo deste trabalho foi estudar o potencial embriotóxico, abortivo e teratogênico da Poincianella pyramidalis em caprinos. Para tanto foram utilizadas 20 cabras prenhes com 18 dias de gestação, divididas em cinco grupos de quatro animais. Depois da coleta, as folhas de P. pyramidalis era secas a sombra e trituradas. A alimentação diária fornecida aos caprinos foi proporcional a 3% do seu peso vivo, sendo 1% de alimento concentrado e 2% de volumoso. No Grupo 1 (controle), o volumoso fornecido foi apenas feno de Cynodon dactylon (Tifton). Já nos Grupos 2, 3 e 4, 10%, 20% e 80% do volumoso foi substituído por folhas secas e trituradas de P. pyramidalis, respectivamente. No Grupo 5, todo o volumoso foi constituído por P. pyramidalis verde ad libitum, coletadas diariamente. Para o acompanhamento das gestações, exames ultrassonográficos foram realizados duas vezes por semana, durante toda a gestação. As cabras dos Grupos 1, 2 e 3 pariram cabritos normais. Duas cabras no Grupo 4 abortaram, sendo uma com 127 dias de gestação e outra com 90 dias. No grupo 5, três cabras apresentaram morte embrionária no 25º, 30º e 31º dia de gestação e uma cabra abortou no 39º dia de gestação. No presente estudo não foi observada nenhuma malformação. Com esses resultados e considerando a ampla difusão de P. pyramidalis na região semiárida do nordeste Brasileiro sugere-se que esta planta é uma importante causa de perdas reprodutivas na região. Devido a sua alta palatabilidade, recomenda-se evitar a permanência de cabras prenhes em áreas onde ocorre P. pyramidalis.(AU)

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)