Bridging the Knowledge Gap: A Toolkit on Reproductive Rights for Pediatric Surgeons in the Post-Dobbs Era.

BACKGROUND: The ripple effect of the Supreme Court ruling in Dobbs v. Jackson Women's Health Organization has impacted physicians and patients across numerous medical specialties. In pediatric surgery, the patient population ranges from fetus to the pregnant patient. There is a gap in the knowledge of pediatric surgeons regarding abortion laws and access. This project aims to bridge the gap by creating access to reliable resources which may be used to optimize patient care and support physicians. METHODS: We collaborated with the Reproductive Health Coalition, co-founded by the American Medical Women's Association and Doctors for America, to curate a list of resources beneficial to pediatric surgeons. RESULTS: We created a web-based toolkit with the purpose of providing easily accessible and reliable information on reproductive rights in the United States. We identified up-to-date resources on state-by-state abortion laws, legal resources, patient-centered information on obtaining abortion care, and resources for physicians interested in getting involved in advocacy. CONCLUSION: Pediatric surgery rests at a critical juncture with respect to reproductive rights in the United States. Our toolkit enables users to understand the current climate and identify next steps to advocate for patients and physicians amidst a formidable legal environment. LEVEL OF EVIDENCE: Level V.

Navigating the Impact of the Dobbs Decision: Perspectives from Pediatric Surgeons on Reproductive Healthcare.

Nationwide abortion restrictions resulting from the Dobbs v Jackson Women's Health Organization (2022) decision have generated confusion and uncertainty among healthcare professionals, with concerns for liability impacting clinical decision-making and outcomes. The impact on pediatric surgery can be seen in prenatal counseling for fetal anomaly cases, counseling for fetal intervention, and recommendations for pregnant children and adolescents who seek termination. It is essential that all physicians and healthcare team members understand the legal implications on their clinical practices, engage with resources and organizations that can help navigate these circumstances, and consider advocating for patients and themselves. Pediatric surgeons must consider the impact of these changing laws on their ability to provide comprehensive and ethical care and counseling to all patients.

Medication abortion during the COVID-19 pandemic in France: A research based on the French national health insurance database.

OBJECTIVES: During the COVID-19 pandemic in France, abortion was recognized as an essential service that cannot be delayed, and such care was therefore presumed to be maintained. The aim is to analyze the changes in the practice of abortion in 2020 to identify the consequences of the two lockdowns and the effects of the extension of the legal time limit. METHODS: We analyzed the data collected by the French national health insurance system, which covers 99% of the population. All women who had an elective abortion, either surgical or with medication, in France in 2019 and 2020 were included in the study. Trend changes in abortions were analyzed by comparing the ratio of the weekly number of abortions in 2020 with the weekly number in 2019. RESULTS: Both 2020 lockdowns were followed by a drop in abortions, particularly after the first and stricter lockdown. This may be explained not by an abrupt shutdown of access to abortion services, but rather by a decrease in conceptions during the lockdown weeks. The decrease was more marked for surgical abortions than for medication abortions in a hospital setting, and less so for medication abortions in non-hospital settings. Moreover, the proportion of the latter type of abortions continued to increase, showing the reinforcement of a previous trend. CONCLUSIONS: Our findings indicate that expanding the legal time limit for abortion, diversifying the settings where abortions can be performed and the range of abortion providers help to facilitate access to this fundamental reproductive care.

Interrupciones voluntarias de embarazos en un Hospital Universitario de Uruguay: reporte de situación 2019-2020 / Voluntary interruption of pregnancies at the University Hospital of Uruguay: situation report 2019-2020 / Interrupções voluntárias de gravidez no Hospital Universitário de Uruguay: relatório de situação 2019-2020

Objetivo: el objetivo de este estudio es conocer el estado de situación de los procesos de las usuarias que asistieron a la policlínica de interrupción voluntaria del embarazo en el Hospital de Clínicas en un período de agosto de 2019 a agosto de 2020. Metodología y materiales: estudio descriptivo y retrospectivo, a partir de la entrevista clínica de salud mental y una ficha de uso interno utilizada para relevar el proceso de toma de decisión. En muestra de 78 usuarias se analizan variables sociodemográficas, ginecoobstétricas y asociadas al proceso de interrupción, antecedentes psicológicos y/o psiquiátricos y motivos de interrupción. Resultados: el promedio de edad es de 25 años, la mayoría en pareja y ciclo básico educativo finalizado. El promedio de edad gestacional fue de 7,36 semanas. El 81% de las mujeres no había realizado un IVE. Un 65.4% de las mujeres no tienen antecedentes psicológicos y/o psiquiátricos. No existe relación significativa entre haber realizado un IVE previamente y tener antecedentes psicológicos y/o psiquiátricos.Utilizaban anticonceptivos 78.2%. Conclusiones: la interrupción del embarazo supone una situación vital estresante para quienes la transitan, se encuentran atravesadas por múltiples motivos que inciden en la toma de decisión de interrumpir. Se infiere que la realización de uno o más procedimientos de IVE no necesariamente está relacionada con tener un antecedente psicopatológico o cursar una psicopatología al realizar el proceso. Es pertinente promover la atención focalizada en las pacientes, integrando la perspectiva de género y derechos humanos, mejorar los procesos de atención, asesoramiento en salud mental, sexual y reproductiva de las usuarias y sus acompañantes.

Objective: The objective of this study is to know the status of the processes of the users who attended the polyclinic for voluntary termination of pregnancy at the Hospital de Clínicas in a period from August 2019 to August 2020. Methodology and materials: The study used descriptive and retrospective methods based on interviews with mental health professionals and a form that was used to ask about how people make decisions. In a sample of 78 users, sociodemographic, obstetric and gynecological variables associated with the discontinuation process, psychological and/or psychiatric history and reasons for discontinuation were analyzed. Results: The average age is 25 years, most people are married and have finished their elementary education. The average gestational age was 7.36 weeks. 81% of the women had not undergone an IVE. 65.4% of women have no psychological and/or psychiatric history. There is no significant relationship between having previously performed an IVE and having a psychological and/or psychiatric history. 78.2% used contraceptives. Conclusions: The interruption of pregnancy is a stressful life situation for those who go through it; they are faced with multiple reasons that influence the decision to terminate. It is inferred that carrying out one or more IVE procedures is not necessarily related to having a psychopathological history or experiencing psychopathology when carrying out the process. It is pertinent to promote patient-focused care, integrating the gender and human rights perspective, improve care processes, and provide advice on mental, sexual, and reproductive health of users and their companions.

Objetivo: O objetivo deste estudo é conhecer a situação dos processos das usuárias que compareceram à policlínica de interrupção voluntária da gravidez do Hospital de Clínicas no período de agosto de 2019 a agosto de 2020. Metodologia e materiais: estudo descritivo e retrospectivo, baseado na entrevista clínica de saúde mental e em formulário de uso interno utilizado para levantamento do processo de tomada de decisão. Numa amostra de 78 usuárias foram analisadas variáveis ​​sociodemográficas, obstétricas e ginecológicas associadas ao processo de descontinuação, histórico psicológico e/ou psiquiátrico e motivos de descontinuação. Resultados: a idade média é de 25 anos, a maioria vive em casal e completou o ciclo educativo básico. A idade gestacional média foi de 7,36 semanas. 81% das mulheres não realizaram IVE. 65,4% das mulheres não têm antecedentes psicológicos e/ou psiquiátricos. Não há relação significativa entre ter realizado EIV anteriormente e ter antecedentes psicológicos e/ou psiquiátricos, 78,2% faziam uso de anticoncepcional. Conclusões: a interrupção da gravidez é uma situação estressante de vida para quem passa por ela, pois se deparam com múltiplos motivos que influenciam na decisão de interrompê-la. Infere-se que a realização de um ou mais procedimentos de IVE não está necessariamente relacionada a ter histórico psicopatológico, ou vivenciar psicopatologia na realização do processo. É pertinente promover cuidados centrados no paciente, integrando a perspectiva de gênero e direitos humanos, melhorar os processos de cuidados e aconselhamento sobre saúde mental, sexual e reprodutiva dos utentes e dos seus acompanhantes.

Análise do desejo de manter ou interromper gravidezes decorrentes de violência sexual / Analysis of the desire to maintain or interrupt pregnancies resulting from sexual assault

Objetivo: Avaliar o desejo de gestantes, vítimas de violência sexual, em manter ou interromper a gravidez. Métodos: Estudo transversal retrospectivo que avaliou o desejo da gestante vítima de violência sexual pela manutenção ou interrupção da gravidez, no Programa de Atendimento às Vítimas de Violência Sexual, no período de janeiro de 2019 a setembro de 2022. Resultados: Foram acolhidas 67 gestantes vítimas de violência sexual que procuraram atendimento com vistas a orientação, manutenção ou interrupção da gestação. Entre elas, 56 (83,6%) pacientes solici- taram a interrupção da gestação e para 32 (57,2%) a solicitação foi aceita; 9 (16%) não tiveram a solicitação de interrupção autorizada por equipe multidisciplinar e mantiveram a gestação; 11 (16,4%) não solicitaram a interrupção e também optaram pela manutenção da gestação. A média das idades foi de 26 anos. Em sua maio- ria, eram solteiras, brancas e procedentes de munícipios do entorno de Caxias do Sul. O agressor era quase sempre desconhecido, e a agressão teria ocorrido pre- dominantemente na residência da vítima ou do agressor. Conclusão: No período estudado, foram avaliadas 67 gestações decorrentes de violência sexual. Dessas, 56 pacientes solicitaram a interrupção da gestação e 32 tiveram a solicitação aceita; nove não tiveram a solicitação de interrupção autorizada e mantiveram a gestação; 11 não solicitaram a interrupção e também optaram pela manutenção da gestação. Não cabe ao médico julgar a decisão da vítima, mas, sim, acolher e ofertar o seu direito de escolha.

Objective: To evaluate the desire of pregnant women, victims of sexual violence, to maintain or terminate pregnancy. Methods: Retrospective cross-sectional study that evaluated the desire of pregnant women victims of sexual violence for the mainte- nance or interruption of pregnancy in Program to Assist Victims of Sexual Assault, from January 2019 to September 2022. Results: Sixty-seven pregnant women who were victim of sexual assault and who sought care for maintenance or interruption of pregnancy were received. Among these, 56 (83.6%) patients requested the interruption of pregnancy and in 32 (57.2%) cases the request was accepted; 9 (16%) didn't have the interruption request authorized by the multidisciplinary team and have kept the pregnancy; 11 (16.4%) didn't request the interruption and have chosen to keep the pregnancy. The average age was 26 years. They were single, white, and mostly from cities around Caxias do Sul. The aggressor was almost always unknown, and the assault occurred mostly at the victim's or aggressor's home. Conclusion: Sixty-seven pregnancies resulting from sexual assault were evaluated during the period of the study. Fifty-sixth patients of those have requested pregnancy termination and 32 had their request accepted; nine didn't have their request for termination authorized and have kept their pregnancy; eleven didn't request termination and have chosen to keep their pregnancy. It isn't up to the physician to judge the victim's decision, but to welcome and offer her the right to choose.

Interrupciones voluntarias del embarazo recurrentes. Estudio de prevalencia y exploración de factores asociados. Antioquia, Colombia, 2015 - 2021 / Recurrent voluntary termination of pregnancy. Prevalence study and exploration of associated factors. Antioquia, Colombia, 2015 ­ 2021

Objetivos: Describir la prevalencia de las interrupciones voluntarias del embarazo (IVE) recurrentes y efectuar una exploración de los factores asociados a esta. Materiales y métodos: Estudio de corte trasversal descriptivo, en el que se incluyeron mujeres atendidas entre 2015 y 2021 en cinco sedes, en el Departamento de Antioquia, de una Institución que promueve la atención en salud sexual y reproductiva (SSR) en Colombia. Se midieron variables sociodemográficas, de SSR, así como la realización de IVE recurrente, tipo de procedimiento utilizado en la primera IVE, y método de anticoncepción elegido posterior a esta. Se presenta la prevalencia de período de aborto recurrente global y por año. Se hace exploración de los factores asociados por medio de análisis multivariado. Se obtuvo aval del comité de investigación de la institución. Resultados: Se incluyó un total de 20.423 mujeres. La prevalencia de IVE recurrente fue del 4,07 % (n = 831) en todo el período, y varió del 2,3 al 6 % en los 6 años. El método más utilizado para la IVE recurrente fue inducción farmacológica (48,50 %). Después de la primera IVE, el 69,81 % de las mujeres utilizó métodos anticonceptivos clasificados como "muy efectivos", según la Organización Mundial de la Salud. Se identificaron como factores de riesgo de la IVE recurrente pertenecer al régimen de aseguramiento subsidiado por el Estado (Odds ratio ajustado (ORa) = 1,35; IC 95 %: 1,05-1,72) y haber tenido dos o más gestaciones (ORa = 1,23; IC 95 %: 1,06 - 1,44). Como factores protectores se identificaron: contratación del servicio de IVE bajo modalidad de pago de bolsillo (ORa = 0,71; IC 95 %: 0,61-0,82), el antecedente de IVE tardía (ORa = 0,30; IC 95 %: 0,11-0,81), y la elección del implante subdérmico posterior al primer aborto primer aborto como (ORa =0,64; IC 95 %: 0,49 - 0,83). Conclusiones: La prevalencia de IVE recurrente posiblemente está incrementando. Se requieren estudios prospectivos que evalúen si existe una tendencia al incremento y que verifiquen posibles hipótesis de asociación que surgen de este trabajo.

Objectives: To describe the prevalence of recurrent voluntary termination of pregnancy (VTP) and to explore associated factors. Material and methods: Descriptive, cross-sectional cohort study which included women seen between 2015 and 2021 in five sites of an institution located in the Department of Antioquia which promotes sexual and reproductive health (SRH) care in Colombia. Measured variables included sociodemographics, SRH, recurrent performance of VTP, type of procedure used in the first VTP and contraception method selected afterwards. The prevalence of global and yearly recurrent abortion period is presented. Associated factors were explored using a multivariate analysis. The research committee of the institution approved the study. Results: In total, 20,423 women were included. The prevalence of recurrent VTP was 4.07 % (n = 831) during the entire period, ranging between 2.3 and 6 % over the 7 years. The most commonly used method for recurrent VTP was pharmacological induction (48.50 %). After the first VTP, 69.81 % of women used contraceptive methods classified as "very effective" according to the World Health Organization. The risk factors identified as being associated with recurrent VTP included being part of the state-subsidized health insurance system (adjusted odds ratio [aOR] = 1.35; 95 % CI:1.05-1.72) and having had two or more pregnancies (aOR = 1.23; 95% CI: 1.06 - 1.44). Protective factors were identified and included out-of-pocket payment for VTP service (aOR = 0.71; 95% CI: 0.61-0.82), a history of late VTP (aOR = 0.30; 95% CI: 0.11-0.81), and the selection of a subdermal implant for contraception following the first abortion (sOR = 0.64; 95% CI: 0.49 - 0.83). Conclusions: It is possible that the prevalence of recurrent VTP is increasing. Prospective studies are required in order to determine whether there is a growing trend and to verify potential association hypotheses derived from this work.

Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review.

Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.

Permanent Sterilization in Nulliparous Patients: Is Legislative Anxiety an Indication for Surgery?

AbstractThe Supreme Court's Dobbs v. Jackson Women's Health Organization decision, first leaked to the public on 2 May 2022 and officially released on 24 June 2022, overturned Roe v. Wade and thereby determined that abortion is no longer a federally protected right under the Constitution. Instead, the decision gives individual states the right to regulate abortion. Since the Dobbs decision first leaked, our institution has received numerous requests for permanent contraception from individuals stating that their motivation to pursue permanent contraception was influenced by the Dobbs decision and concerns about their reproductive autonomy. Discussions with patients seeking permanent contraception since the Supreme Court's leaked decision have led us to ask ourselves, is legislative anxiety an indication for surgery? This article presents a case series consisting of a convenience sample of 17 young, nulliparous individuals who sought out permanent contraception in the six months following the leak of the Dobbs decision. Healthcare professionals often feel discomfort in offering permanent contraception to young and nulliparous individuals. Accordingly, we discuss pertinent legal issues, review relevant ethical considerations, and offer a framework for these discussions intended to empower the consulting healthcare professional to center the bodily autonomy of every patient regardless of age, parity, or indication for permanent contraception.

COVID-19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia.

INTRODUCTION: During early stages of COVID-19 in the United States, government representatives in Kentucky, Ohio, and West Virginia restricted or threatened to restrict abortion care under elective surgery bans. We examined how abortion utilization changed in these states. METHODOLOGY: We examined COVID-19 abortion-related state policies implemented in March and April 2020 using publicly available sources. We analyzed data on abortions by method and gestation and experiences of facility staff, using a survey of 14 facilities. We assessed abortions that took place in February-June 2020 and February-June 2021. RESULTS: In February-June 2020 the monthly average abortion count was 1916; 863 (45%) were medication abortions and 229 (12%) were ≥14 weeks gestation. Of 1959 abortions performed across all three states in April 2020, 1319 (67%) were medication abortions and 231 (12%) were ≥14 weeks gestation. The shift toward medication abortion that took place in April 2020 was not observed in April 2021. Although the total abortion count in the three-state region remained steady, West Virginia had the greatest decline in total abortions, Ohio experienced a shift from instrumentation to medication abortions, and Kentucky saw little change. Staff reported increased stress from concerns over health and safety and increased scrutiny by the state and anti-abortion protesters. DISCUSSION: Although abortion provision continued in this region, policy changes restricting abortion in Ohio and West Virginia resulted in a decrease in first trimester instrumentation abortions, an overall shift toward medication abortion care, and an increase in stress among facility staff during the early phase of COVID-19.

Abortion Bans and Resource Utilization for Congenital Heart Disease: A Decision Analysis.

OBJECTIVE: To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects. METHODS: A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model. RESULTS: In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well. CONCLUSION: Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.

Descripción de las personas gestantes afiliadas a OSEP que solicitan una interrupción del embarazo / Description of pregnant people affiliated to osep who request a pregnancy interruption

En 2021 entró en vigencia en Argentina la Ley N.º 27.610. El objetivo es describir características de afiliadas a OSEP que solicitaron interrupción del embarazo (SIE).Trabajo observacional descriptivo. Se analizaron las variables del 0800 del Ministerio de Salud de la Nación de todas las personas que SIE con OSEP, entre el 24/01 y 31/12/2021. Los datos fueron analizados con SPSS Statistics. Se utilizaron moda, mediana, porcentaje, tasa y el chi2. Se recibieron 427 SIE, se concretaron 330 (77,3%). Solicitaron ive: media 28,59 años. Modo 19 y 33 años. Concretaron ive: modo 22 años. 84,5% se realizó ambulatorio con misoprostol. De las SIE, 50,4% eran solteras, 43,4% trabajaba, 59,1% tenía secundario completo. Se desconoce 32,8%. De las SIE, 52,7% refirió haber estado utilizando MAC (54,2% preservativo; 37,4% anticonceptivos orales; 2,8% métodos "naturales"; 2,2% DIU). La mayor cantidad fue de zonas urbanas del Gran Mendoza. Sin embargo, se observan tasas elevadas en zonas rurales respecto de algunas zonas urbanas y más pobladas. Se observó progresión de SIE a lo largo del año. Un 11% después de SIE decidió continuar con el embarazo. Aparentemente ninguna de las variables tuvo relación con esa decisión. El MAC utilizado fue mayormente preservativo y anticonceptivos orales. Esto podría indicar falta de educación y poco acceso a métodos de larga duración. La problemática de interrupción es transversal. En base a los resultados de este trabajo, las personas sin pareja conviviente, ante un embarazo no planificado serían las que SIE. Ninguna otra variable parece actuar como determinante. Tampoco del paso de la solicitud a la interrupción efectiva o a la continuación del embarazo. Hay que aumentar la accesibilidad a MAC en zonas rurales (AU)

In 2021, Law No. 27610 entered into force in Argentina. The objective is to describe characteristics of people with OSEP who requested termination of pregnancy (PWRTP). Descriptive observational work. The variables of the 0800 of the Ministry of Health of Argentina of all the PWRTP with OSEP, between 01/24 and 12/31/2021, were analyzed. Data were analyzed with SPSS Statistics. Mode, median, percentage, rate and chi2 were used. PWRTP: 427 requests were received, 330 (77.3%) were completed. PWRTP: mean 28.59 years. Mode 19 and 33 years. People who had an abortion: mode 22 years. 84.5% were performed on an outpatient basis with misoprostol. 50.4% of the PWRTP were single, 43.4% worked, 59.1% had completed high school, 32.8% unknown, 52.7% reported having been using contraceptive methods (CM): 54.2% condoms; 37.4% oral contraceptives; 2.8% "natural" methods; 2.2% IUDs. The largest amount was from urban areas of Mendoza. However, high rates are observed in rural areas. A progression of the amount of PWRTP was observed throughout the year. 11% after requesting an abortion decided to continue with the pregnancy. Apparently none of the variables was related to that decision. The CM used were mostly condoms and oral contraceptives. This may indicate a lack of education and poor access to long-acting CM. The problem of interruption is transversal. People without a cohabiting partner, faced with an unplanned pregnancy, are the ones who RTP. No other variable seems to act as a determinant. Nor from the transition from the request to the effective interruption or continuation of the pregnancy. We must increase the accessibility to CM in rural areas (AU)

Uso de misoprostol em obstetrícia / Misoprostol use in obstetrics

PONTOS-CHAVE O misoprostol é um análogo da prostaglandina E1 (PGE1) que consta na Lista de Medicamentos Essenciais da Organização Mundial da Saúde (OMS) desde 2005 O Brasil possui uma das regulações mais restritivas do mundo relacionadas ao uso do misoprostol, estabelecendo que o misoprostol tem uso hospitalar exclusivo, com controle especial, e venda, compra e propaganda proibidas por lei Atualmente, o misoprostol é a droga de referência para tratamento medicamentoso nos casos de aborto induzido, tanto no primeiro trimestre gestacional quanto em idades gestacionais mais avançadas O misoprostol é uma medicação efetiva para o preparo cervical e indução do parto O misoprostol é um medicamento essencial para o manejo da hemorragia pós-parto

Otolaryngologists and Reproductive Rights.

Our nation faces contentious questions regarding reproductive rights and access to abortion which have long been viewed as beyond the scope of otolaryngology. The broad implications of the recent Supreme Court ruling in Dobbs v Jackson Women's Health Organization (Jackson) impact all people who are, or can become, pregnant and their health care providers. The consequences for otolaryngologists are thus far-reaching and poorly understood. Here we describe how the post-Dobbs landscape is relevant to the practice of otolaryngology and offer suggestions for how otolaryngologists can best respond, prepare, and support their patients in this tenuous political landscape.

Severely Restricting Abortion Threatens Equitable Health Outcomes for People With Human Immunodeficiency Virus.

Equitable access to abortion is a critical component of reproductive care. Women with human immunodeficiency virus (HIV) in the United States are disproportionately Black and will be disproportionately affected by abortion bans following the Supreme Court's decision to overturn Roe v Wade. We argue that this decision is directly in conflict with the National HIV/AIDS Strategies and Centers for Disease Control and Prevention's goals to eliminate perinatal HIV transmission.

The far-reaching impact of abortion bans: reproductive care and beyond.

On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.

Aborto, o direito maldito: uma análise sócio-histórica a partir da ADPF 442 / Abortion, the damn right: a socio-historical analysis from ADPF 442

Esta tese investiga os discursos hegemônicos em torno da "questão do aborto" no Brasil contemporâneo, a partir das 50 exposições realizadas na audiência pública sobre a Arguição de Descumprimento de Preceito Fundamental (ADPF) 442. Tal ação, ajuizada pelo Partido Socialismo e Liberdade em março de 2017, propõe a descriminalização do aborto induzido pela própria gestante ou com o seu consentimento, até a 12ª. semana de gravidez. A ADPF 442 deflagrou a convocação, pelo Supremo Tribunal Federal (STF), da referida audiência pública, realizada em agosto de 2018 e acompanhada presencialmente pela pesquisadora. O objetivo da pesquisa consiste em examinar a atual configuração das disputas travadas em torno da "questão do aborto" no Brasil, em uma perspectiva socio-histórica. Na primeira parte da tese, reconstituímos as dinâmicas de reprodução social e as políticas reprodutivas (inclusive, mas não apenas, aquelas relativas ao aborto) vigentes desde o período colonial até a democracia liberal contemporânea, através de um extenso levantamento historiográfico sobre o tema. Na segunda parte da tese, nos debruçamos sobre o conteúdo das exposições realizadas na audiência pública, utilizando o método da análise documental. O material empírico da pesquisa é composto pelo registro audiovisual e pela transcrição das exposições - ambos disponibilizados pelo STF. Dentre as 50 exposições, 33 foram favoráveis à ADPF, e 17, contrárias, havendo uma variação significativa na distribuição destas posições entre os quatro campos de enunciação e argumentação identificados, quais sejam: o da saúde, o do direito, o das religiões e o das organizações não governamentais, institutos e associações. Ao longo do processo analítico-interpretativo, buscamos apreender os sentidos e significados (patentes ou ocultos) dos discursos proferidos, nos quais a problemática do aborto aparece imbricada a questões atinentes às esferas da sexualidade, da contracepção, da maternidade, da família, da violência, dos valores morais, dos direitos, entre outras. Organizamos os resultados da análise documental em dois eixos. No primeiro, discutimos as diferentes maneiras como os atores políticos em cena enquadram a sua posição em relação à descriminalização do aborto em termos de uma batalha pela vida e contra a morte. Enquanto no campo favorável à ADPF esse embate entre morte e vida focaliza as condições concretas e desiguais sob as quais diferentes grupos de mulheres vivenciam a sexualidade e a reprodução, no campo contrário à ADPF a defesa da "inviolabilidade da vida desde a concepção" se dá de forma abstrata, como uma verdade autoevidente, incontestável e universal, completamente alheia aos percursos que levam a uma gravidez imprevista e aos dilemas enfrentados pelas mulheres que se deparam com tal situação. O segundo eixo analítico aborda as distintas noções - unitárias ou plurais - (re)produzidas na audiência a respeito da(s) mulher(es), família(s) e (não) maternidade(s). Nesta seara, os atores favoráveis à ADPF defendem a descriminalização do aborto como um dos elementos necessários à promoção da justiça social, indissociável de um conjunto de políticas públicas integrais, equânimes e universais, ao passo que os atores contrários à ação tendem a manifestar expectativas, preconceitos, prescrições e interdições centrais a uma agenda de restauração moral exacerbada no atual cenário político brasileiro.

This thesis investigates the hegemonic discourses around the "abortion issue" in contemporary Brazil, based on the 50 exhibitions held at the public hearing on the Fundamental Precept Noncompliance Claim (ADPF) 442. This action, filed by the Socialism and Freedom Party in March 2017, proposes the decriminalization of abortion induced by the pregnant woman herself or with her consent, until the 12th. week of pregnancy. ADPF 442 triggered the convening, by the Supreme Court (STF), of the aforementioned public hearing, held in August 2018 and accompanied in person by the researcher. The objective of the research is to examine the current configuration of disputes around the "issue of abortion" in Brazil, from a socio-historical perspective. In the first part of the thesis, we reconstruct the dynamics of social reproduction and the reproductive policies (including, but not limited to, those related to abortion) in force from the colonial period to contemporary liberal democracy, through an extensive historiographical survey on the subject. In the second part of the thesis, we focus on the content of the exhibitions held at the public hearing, using the method of document analysis. The empirical material of the research consists of the audiovisual record and the transcript of the exhibitions - both made available by the STF. Among the 50 expositions, 33 were in favor of ADPF, and 17 were against it, with a significant variation in the distribution of these positions among the four identified fields of enunciation and argumentation, namely: health, law, religions and non-governmental organizations, institutes and associations. Throughout the analytical-interpretative process, we seeked to apprehend the senses and meanings (patent or hidden) of the speeches, in which the issue of abortion appears intertwined with issues related to the spheres of sexuality, contraception, motherhood, family, violence , moral values, rights, among others. We organized the results of the document analysis into two axes. In the first one, we discuss the different ways in which political actors on the scene frame their position on the decriminalization of abortion in terms of a battle for life and against death. While in the field favorable to ADPF this clash between death and life focuses on the concrete and unequal conditions under which different groups of women experience sexuality and reproduction, in the field contrary to ADPF the defense of the "inviolability of life from conception" takes place abstractly, as a self-evident, indisputable and universal truth, completely alien to the paths that lead to an unforeseen pregnancy and to the dilemmas faced by women who are faced with such a situation. The second analytical axis addresses the different notions - unitary or plural - (re)produced in the audience regarding women, family(ies) and (non)maternity(ies). In this field, the actors in favor of ADPF defend the decriminalization of abortion as one of the necessary elements to promote social justice, inseparable from a set of integral, equitable and universal public policies, while the actors opposed to the action tend to express expectations, prejudices, prescriptions and interdictions central to an agenda of moral restoration exacerbated in the current Brazilian political scenario.

Characterizing two models for abortion care in Argentina pre-Law 27.610: 2016-2019 / Utilización de dos modelos en la atención al aborto en Argentina pre-Ley 27.610: 2016-2019

ABSTRACT OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

RESUMEN OBJETIVO Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016-2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba chi-cuadrado. RESULTADOS En el 2016, 37 personas por cada 100,000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100,000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100,000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0.2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas.