Early termination of pregnancy: differences in gestational age estimation using last menstrual period and ultrasound in Mexico.

BACKGROUND: Gestational age estimation is key to the provision of abortion, to ensure safety and successful termination of pregnancy. We compared gestational age based on reported last menstrual period and ultrasonography among a large sample of women in Mexico City's public first trimester abortion program, Interrupcion Legal de Embarazo (ILE). METHODS: We conducted a retrospective study of 43,219 clinical records of women seeking abortion services in the public abortion program from 2007 to 2015. We extracted gestational age estimates in days based on last menstrual period and ultrasonography. We calculated the proportion of under- and over-estimation of gestational age based on last menstrual period versus ultrasonography. We compared overall differences in estimates and focused on discrepancies at two relevant cut-offs points (70 days for medication abortion eligibility and 90 days for ILE program eligibility). RESULTS: On average, ultrasonography estimation was nearly 1 (- 0.97) days less than the last menstrual period estimation (SD = 13.9), indicating women tended to overestimate the duration of their pregnancy based on recall of date of last menstrual period. Overall, 51.4% of women overestimated and 38.5% underestimated their gestations based on last menstrual period. Using a 70-day limit, 93.8% of women who were eligible for medication abortion based on ultrasonography would have been correctly classified using last menstrual period estimation alone. Using the 90-day limit for ILE program eligibility, 96.0% would have been eligible for first trimester abortion based on last menstrual period estimation alone. CONCLUSIONS: The majority of women can estimate gestational age using last menstrual period date. Where available, ultrasonography can be used, but it should not be a barrier to providing care.

Proliferaciones Oncocíticas de Glándulas Salivales: Estudio Estructural e Inmunohistoquímico de 7 Casos / Oncocytic Proliferations of Salivary Glands: Structural and Immunohistochemical Study of 7 Cases

RESUMEN: Los oncocitos son células originadas probablemente por transformación metaplásica del epitelio ductal o acinar de parótida y submandibular. Su proliferación puede originar condiciones patológicas que incluyen hiperplasias oncocíticas adenomatosas multinodulares (HOAM), oncocitomas y carcinomas oncocíticos. Los tumores oncocíticos constituyen el 1 % de todos los tumores salivales y entre el 82 y 90 % se desarrollan en la parótida; el resto se divide entre la glándula submandibular y las glándulas salivales menores. Las hiperplasias oncocíticas multinodulares son extremadamente raras. En el presente trabajo se analizaron 5 casos de oncocitomas de parótida y dos casos de HOAM, uno de parótida y otro de submandibular y se describieron las características estructurales e inmunohistoquímicas de los oncocitos. Cortes seriados de las biopsias incluidas en parafina se colorearon con Hematoxilina - Eosina, Hematoxilina/ácido fosfotúngstico (PTA/H), PAS y se marcaron con AC antimitocondrial, CK 5/6, CK 20 y EMA. Los tumores mostraron un crecimiento nodular encapsulado por tejido conectivo denso. En los cortes histológicos se identificaron oncocitos eosinófilos (oscuros) y granulaciones violáceas con PTA/H. En dos casos de parótida y el caso de HOAM de submandibular presentaron además oncocitos claros PAS positivos. La inmunomarcación fue positiva en todas las células siendo la marcación para mitocondrias periférica en los oncocitos claros. Las células eosinofílicas PTA/H positivas y con fuerte marcación con AC antimitocondrial, CKs y EMA confirman el diagnóstico de patología oncocítica. En tres casos coexisten oncocitos claros y oscuros. Las células claras son oncocitos que acumulan glucógeno en su citoplasma desplazando a las mitocondrias hacia la periferia. En el diagnóstico diferencial de este tumor debemos considerar los tumores salivales con células claras, el carcinoma renal metastásico, el tumor de Whartin, la variante de células claras del carcinoma epitelial/mioepitelial y el carcinoma mucoepidermoide con metaplasia oncocítica.

ABSTRACT: Oncocytes are cells probably originated by metaplastic transformation of the ductal or acinar epithelium of parotid and submandibular. Its proliferation can cause pathological conditions that include multinodular adenomatous oncocytic hiperplasia (HOAM), oncocytomas and oncocytic carcinomas. Oncocytic tumors make up 1 % of all salivary tumors and between 82 and 90 % develop in the parotid; the rest of the tumors are divided between the submandibular gland and the minor salivary glands. Multinodular oncocytic hyperplasias are extremely rare. In the present work we analyzed five cases of parotid oncocytomas and two cases of HOAM, one of parotid and the other of submandibular; structural and immunohistochemical characteristics of the oncocytes were described. Biopsies were included in paraffin, serial cuts were stained with H&E, Hematoxylin / phosphotungstic acid (PTA / H), PAS and were marked with antimitochondrial AC, CK 5/6, CKs 20 and EMA. The tumors showed a nodular growth encapsulated by dense connective tissue. The histological cuts showed dark eosinophilic oncocytes and violaceous granulations with PTA / H. In two cases of parotid and the case of submandibular HOAM, PAS positive clear oncocytes were also present. The immunostaining was positive in all the cells, being the labeling for peripheral mitochondria in the clear oncocytes. Eosinophilic cells PTA / H positive with strongly marked with antimitochondrial AC, CKs and EMA confirm the diagnosis of oncocytic pathology. In three cases, light and dark oncocytes coexist. Clear cells are oncocytes that accumulate glycogen in their cytoplasm, displacing the mitochondria to the periphery. In the differential diagnosis we should consider salivary tumors with clear cells, metastatic renal carcinoma, Whartin's tumor, the clear cell variant of epithelial / myoepithelial carcinoma and mucoepidermoid carcinoma with oncocytic metaplasia.

Quantifying disparities in access to public-sector abortion based on legislative differences within the Mexico City Metropolitan Area.

OBJECTIVES: In the Mexico City Metropolitan Area, only women in the city center have local access to legal first-trimester abortion. We quantify how this legislative discrepancy affects access to legal, public-sector abortion across the metropolitan area. STUDY DESIGN: In this observational study, we used a dataset representing 67.2% of all abortions occurring between 2010 and 2012 in Mexico City's public abortion program and census population data. We calculate utilization rates for 75 municipalities in the metropolitan area for 2010-2012. We compare utilization between municipalities with and without local legal access, adjusting for differences in sociodemographic drivers of abortion demand. We explore the effects of local abortion legality, travel time and socioeconomic status (SES). RESULTS: Women who had to travel into the city center for legal abortions used services at only 18.6% (95% CI 13.3%-33.0%) of the expected rate if they had local access, adjusting for sociodemographic factors. After controlling for travel time and SES, women who lived where abortion is illegal had a 58.6% (95% CI 21.5%-78.1%) reduction in access, and each additional 15 min of travel further reduced access by 33.7% (95% CI 18.2%-46.3%). Women who travel to seek legal abortions are more likely to have completed secondary education compared to other reproductive age women in their municipality (p = <.00001). CONCLUSIONS: We find that, in the Mexico City Metropolitan Area, both living where abortion is illegal and having to travel further to access services substantially reduce access to legal, public-sector abortion. These burdens disproportionately affect women of lower SES. IMPLICATIONS: Both local legality and proximate access are key to ensuring equity in access to public-sector abortion. Legalization of abortion services across the greater Mexico City Metropolitan Area has the potential to increase equity in utilization and meet unmet demand for legal abortion.

Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?

OBJECTIVE: To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City's public sector first trimester abortion program. METHODS: We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007-2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women's characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics. RESULTS: Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12-17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p< 0.05). In multivariable analyses, all age groups of adult women had significantly lower odds than adolescents of presenting past the limit (aOR = 0.77, aOR = 0.63, aOR = 0.58 and aOR = 0.37 for 19-24, 25-29, 30-39, and > = 40 years' old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02-4.26% across adult age groups). CONCLUSIONS: Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services.