Abordaje integral de la interrupción voluntaria del embarazo (primera entrega) / Comprehensive approach to the voluntary interruption of pregnancy (first issue)

En enero de 2021 entró en vigencia en Argentina la ley de Interrupción Voluntaria del Embarazo (IVE). Este cambio en la legislación implica una modificación sustancial de la práctica médica. En una serie de artículos, el equipo PROFAM comparte su punto de vista a través de una adaptación de su material educativo sobre la IVE. En esta primera entrega, las autoras abordan la aplicación de las cuestiones legales que determinan la práctica, la consejería general, y algunos lineamientos de cómo actuar ante la situación de un diagnóstico de embarazo inesperado. (AU)

In January 2021, the Voluntary Interruption of Pregnancy (VIP) law came into force in Argentina. This change in legislation implies a substantial modification regarding medical practice. In a series of articles, the PROFAM team shares its point of view through an adaptation of its educational material on the VIP. In this first issue, the authors address the application of the legal aspects that determine the practice, general counselling, and some guidelines on how to act when faced with a diagnosis of an unexpected pregnancy. (AU)

Abordaje integral de la Interrupción Voluntaria del Embarazo: (segunda entrega) / Comprehensive approach to the voluntary interruption of pregnancy: (second issue)

La legalización de la interrupción voluntaria del embarazo ha transformado la práctica médica con respecto a la atención de las pacientes que desean interrumpir la gestación hasta la semana 14 en Argentina. En la primera entrega, el equipo PROFAM compartió su punto de vista a través de una adaptación de su material educativo destinado, sobre todo, a aclarar los aspectos legales que hacen a la práctica cotidiana. En esta entrega se desarrolla en detalle el procedimiento para realizar un aborto farmacológico con misoprostol y mifepristona, así como las generalidades del aspirado manual endouterino. (AU)

The legalization of voluntary termination of pregnancy has transformed medical practice regarding the care of patients who wish to terminate a pregnancy up to 14 weeks in Argentina. In the first issue, the PROFAM team shared its point of view through an adaptation of its educational material aimed, above all, at clarifying the legal aspects of daily practice. In this issue, the procedure to perform a pharmacological abortion with misoprostol and mifepristone is developed in detail, as well as the generalities of manual uterine aspiration technique. (AU)

Resgate histórico do primeiro programa público de interrupção da gestação por estupro no Brasil / Historical rescue of the first public rape pregnancy program in Brazil

Os autores apresentam a evolução histórica dos caminhos percorridos até a criação do primeiro programa público de interrupção legal da gestação no Brasil. Mencionam o atendimento antes desse programa, que era realizado por poucos, de maneira dissimulada e sem publicidade nem publicações para a preservação das equipes. Mencionam como o Hospital Municipal Dr. Arthur Ribeiro de Saboya foi escolhido para esse desafio. Resgatam a luta das mulheres e dos movimentos feministas, e a criação da portaria que determinava a obrigatoriedade do atendimento para a realização do abortamento legal nos casos de antijuricidade, pela Prefeitura Municipal de São Paulo. Mencionam os difíceis caminhos até a constituição das equipes de atendimento e o desenrolar de uma sequência de fatos históricos, passando pelo início do atendimento imediato às vítimas no sentido de realizar as profilaxias pertinentes, a utilização de aspiração manual intrauterina (AMIU) como técnica principal para atendimento ao abortamento em todas as suas situações, os Fóruns Nacionais de Aborto Legal realizados pelo Cemicamp, Ministério da Saúde e Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), entre outros, que culminaram com tudo o que temos hoje em termos de atendimento integral à saúde da mulher, mormente no que tange aos direitos sexuais e reprodutivos, à violência sexual e à interrupção legal da gestação.(AU)

The authors present the historical evolution of the paths traveled until the creation of the First Public Program for Legal Interruption of Pregnancy in Brazil. They mention the care before this program that was carried out by a few, in a covert way and without advertisements or publications for the preservation of the team. Mention as the Municipal Hospital Dr. Arthur Ribeiro de Saboya was chosen for this challenge. They rescued the struggle of women and feminist movements, the creation of the ordinance that determined the mandatory care for the performance of legal abortion in cases of anti-juristy, by the city of São Paulo. They mention the difficult paths to the constitution of care teams and the development of a sequence of historical facts, through the beginning of immediate care to victims in order to perform the relevant prophylaxis, in the use of the AMIU as the main technique for abortion care in all its situations, the National Legal Abortion Forums held by Cemicamp, Ministry of Health and Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), among others, which culminated in all that we have today in terms of comprehensive care for women's health, especially with regard to sexual and reproductive rights, sexual violence and legal interruption of pregnancy.(AU)

Childbirth, puerperium and abortion care protocol during the Covid-19 pandemic / Protocolo de cuidados no parto, no puerpério e no abortamento durante a pandemia de Covid-19

Abstract The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARSCoV- 2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Resumo O novo coronavírus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV- 2) é umvírus que causa uma doença respiratória potencialmente grave que se espalhou por vários países, acometendo seres humanos de todas as faixas etárias, incluindo gestantes. O propósito deste protocolo é fornecer apoio técnico e científico aos obstetras brasileiros com relação aos cuidados no parto, pós-parto e aborto durante a pandemia.

Evaluación de la experiencia de la implantación de la ley de interrupción voluntaria del embarazo en el Hospital de Clínicas / Law of voluntary interruption of pregnancy: experience in the Hospital de Clínicas / Lei de interrupção voluntária de gravidez: experiência no Hospital de Clínicas

Objetivos: Evaluar los datos clínicos obtenido en la policlínica de Salud Sexual y Reproductiva del Hospital Universitario a los 6 años de la implementación de la ley de interrupción voluntaria del embarazo (IVE). Métodos: revisión de historias clínicas de diciembre de 2012 a diciembre de 2018. Resultados: de 448 pacientes, 361 completaron el proceso IVE, 63 requirieron una segunda dosis de Misoprostol. Cuarenta pacientes decidieron continuar sus embarazos y siguieron con el control en el servicio y 32 no volvieron tras su primera entrevista. Conclusiones: basado en los resultados de la investigación, el procedimiento médico de IVE es efectivo en todos los casos, solo en 33 pacientes se requirió procedimientos quirúrgicos adicionales. La ley IVE representa un progreso considerable en la salud reproductiva de la mujer uruguaya. La IVE ha asegurado asistencia médica, salud y el respeto a los derechos reproductivos sexuales y humanos, incluyendo oportunidad, continuidad y humanización de la interrupción del embarazo. La existencia de la ley de por sí no garantiza que las mujeres opten por abortar.

Aims: To evaluate clinical data from the Sexual and Reproductive Health Clinic of the University Hospital six years after the implementation of the voluntary interruption of pregnancy law (VIP). Methods: revision of clinical records from December 2012 to December 2018. Results: Out of 448 patients, 361 interrupted their pregnancies. 63 patients required a second dose of Misoprostol, 30 patients required additional medical interventions, 49 patients decided to continue their pregnancies and were provided assistance, and 32 did not return following their first interview. Conclusions: Based on the research findings, the medical procedure of VIP is effective in all the cases, just 33 needs surgical additional process. The VIP law represents a considerable progress in the reproductive health of Uruguayan women. As a result, there is a higher rate of abortions in the country. VIP has ensured medical assistance, healthcare and respect for sexual and human reproductive rights, including opportunity, continuity, and humanization of pregnancy interruption. The existence of the law per se does not ensure that women will opt for abortion.

Objetivos: Avaliar os dados clínicos obtidos na Policlínica de Saúde Sexual e Reprodutiva do Hospital Universitário 6 anos após a implementação da lei da interrupção voluntária da gravidez (IVE). Métodos: revisão de historias de dezembro de 2012 a dezembro de 2018. Resultados: Dos 448 pacientes, 361 completaram o processo IVE, 63 necessitaram de uma segunda dose de Misoprostol. Quarenta y nove pacientes decidiram continuar suas gestações e continuei o controle no serviço e 32 não retornaram após a primeira entrevista. Conclusões: Com base nos resultados da investigação, o procedimento médico do IVE é eficaz em todos os casos, apenas em 33 pacientes foram necessários procedimentos cirúrgicos adicionais. A lei do IVE representa um progresso considerável na saúde reprodutiva das mulheres uruguaias. O IVE assegurou cuidados médicos, saúde e respeito pelos direitos sexuais e reprodutivos humanos, incluindo oportunidades, continuidade e humanização da interrupção de gravidez a existência da lei em si não garante que as mulheres a optar por abortar.

Reflexiones sobre la despenalización del aborto en México / Reflections on the decriminalization of abortion in Mexico

Hace aproximadamente cinco años, se aprobó por la Asamblea de Representantes del Distrito Federal la despenalización del aborto en el D. F. Esta situación hace reflexionar acerca de la condición moral y ética de los representantes que elegimos para que salvaguardaran nuestros intereses en la Cámara de Diputados. ¿A quién le preguntaron si estábamos de acuerdo con la modificación del Código Penal? ¿Cómo influirá en la práctica de enfermería esta nueva ley que obliga a las enfermeras a participar en actos contrarios a sus creencias y principios? ¿Dónde quedó el respeto al derecho de objeción de conciencia de los profesionales de salud? Son preguntas que quedarán por resolverse. Lo que sí es necesario hacer es un análisis de la situación desde el punto de vista ético-legal, y las implicaciones que acarrea para la práctica profesional. El presente ensayo hace una reflexión sobre los aspectos éticos y morales que se deben de cuestionar las enfermeras cuando les toque enfrentar alguna situación como la que se está tratando; así mismo, se realizará un resumen de las leyes, tanto nacionales como internacionales que protegen al no nacido y que fueron pasadas por alto para aprobar el decreto que despenaliza al aborto en el Distrito Federal.

About five years ago, was approved by the Representatives Assembly of the Federal District, the legalization of abortion in D. F. This situation does reflect on the moral and ethical representatives who chose to have safeguarded our interests in the House of Representatives, because who asked if we agreed with the amendment of the penal code? How to influence nursing practice this new law requiring nurses to participate in acts contrary to their beliefs and principles? What happened to respect the right of conscientious objection by health professionals? This are questions that remain to be resolved. What if you need to do is analyze the situation from the standpoint of legal ethics, and carries implications for professional practice. This paper will make a beginning of reflection on the ethical and moral question that must be nurses when they touch face a situation such as being treated, and it will be a summary of the laws, both national and international protect the unborn and that were overlooked in order to pass the decree decriminalizing abortion in Mexico City.

Medical abortion in late second trimester--a comparative study with misoprostol through vaginal versus oral followed by vaginal route.

A randomised controlled trial was conducted to compare the relative efficacies of two regimens: Misoprostol given only vaginally or orally followed by vaginal administration of the same drug, for second trimester abortion. Multiparous women with a pregnancy of 16 to 20 weeks with no contra-indications to the drug were selected. They were randomly allocated into two groups. Patients in the first group, the 'only vaginal misoprostol' group (n = 30), were given misoprostol 400 microg 6 hourly only through vaginal route up to a maximum of 4 such doses. Women in the other group, the 'oral plus vaginal misoprostol' group (n = 24), received 400 microg of the drug at intervals of 12 hours for 2 doses, followed by 400 microg 6 hourly per vaginum up to a maximum of 4 such. Ten units of oxytocin was started in all cases when os was 4 cm dilated. Complete expulsion was 83.33% with an average time of 13.28 hours in the only vaginal misoprostol group. Complete expulsion occurred in 87.5% of women receiving oral followed by vaginal misoprostol with an average time of 8.93 +/- 0.01 hours from the first vaginal dose (p<0.05). More importantly, 66.67% women in second group delivered within 10 hours of the vaginal dose. Complete expulsion was defined in those cases where no check curettage was needed. Side-effects were not significant. This implies that misoprostol given by the vaginal route following oral priming doses had a higher success rate and a potential for a reduced hospital stay and higher bed turn-over rate.

efficacy of vaginal misoprostol in treatment of missed abortions

Missed Abortion is a important obstetric and gynecology complication because of its serious outcomes such as DIG, infection, shock, hemorrhage and death. There are various medical and surgical methods for treatment of missed abortion. Medical treatment of missed abortion is safe, effective, acceptable and an inexpensive alternative. Misoprostal is a synthetic prostaglandin [El] and recommended by PDA for treatment of missed abortion. There are different views about its safety, dosage and effectiveness. This study was designed in order to determine the efficacy of vaginal misoprostol for termination of pregnancy in women with missed abortions admitted in Shahid Sadoughi, Madar and Mojibian hospitals of Yazd from 2003 to 2004. The method of study was semi-experimental. [Clinical trial without control group] 50 women with missed abortion and the required criteria [age 15-45 years, gestational age

Comparative study of midtrimester termination of pregnancy using hypertonic saline, ethacridine lactate, prostaglandin analogue and iodine-saline.

The study consisted of terminations of 200 cases of second trimester pregnancies ranging from 14 weeks to 20 weeks. Out of these 200 cases, in 50 cases intra-amniotic instillation of 20% hypertonic saline (200 ml) was done after withdrawing 35-200 ml of amniotic fluid. Ethacridine lactate was instilled in 50 cases extra-amniotically. Prostaglandin F2 alpha was injected intramuscularly at regular intervals in 50 cases. Fifty cases of pregnancies were terminated with extra-amniotic instillation of 5% povidone-iodine solution mixed with normal saline. Comparison was made among all the methods regarding instillation-abortion interval, completeness of abortion, failure of the procedure and postoperative complications. Solution of 5% povidone-iodine in normal saline was found to be comparable in all aspects to other methods and above all a much cheaper alternative for poor patients. Success rate was highest with iodine-saline solution (100%) followed by ethacridine lactate (98%), hypertonic saline (96%) and lowest with prostaglandin F2 alpha (90%).