Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis.

OBJECTIVE: To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. DATA SOURCES: The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. SELECTION OF STUDIES: Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. DATA COLLECTION: Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. DATA SYNTHESIS: When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. CONCLUSION: Misoprostol has been determined as a safe option with good acceptance by patients.

OBJETIVO: Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. FONTES DE DADOS: Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. SELEçãO DOS ESTUDOS: Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. COLETA DE DADOS: Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. SíNTESE DOS DADOS: Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07­0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96­4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52­0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. CONCLUSãO: O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.

How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico.

Globally, obstetric emergencies majorly account for maternal morbidity and mortality. Guerrero, Oaxaca and Chiapas accounted for more than 13% of maternal deaths in the country in 2021. Obstetric haemorrhage was the leading cause of maternal death after COVID-19 infection and hypertensive disorders. This case highlights the clinical course and social determinants of health that limited access to health services in a young woman with an obstetric emergency in rural southern Mexico. The case describes common challenges during an obstetric emergency in resource-poor settings, such as timely referral to a second level of care. Our analysis identifies the social determinants of health behind the slow and inadequate emergency response. Additionally, we present several interventions that can be implemented in low-resource settings for strengthening the response to obstetric emergencies at the primary and secondary levels of care.

Manejo conservador de retención de productos de la concepción con anticonceptivos orales combinados / Conservative Management of Retained Products of Conception with Combined Oral Contraceptives. Case Report

Objetivo: presentar el caso de una paciente con retención de productos de la concepción (RPC) después de aborto médico, tratada con anticonceptivos orales combinados (ACOC), y efectuar revisión de la literatura. Caso Clínico: paciente de 37 años, con sangrado genital escaso y leve dolor pélvico, quien tuvo aborto provocado con misoprostol cuatro días antes, acude sin signos de infección, con endometrio mixto de 18,5 mm. Durante seis semanas de seguimiento persiste sangrado y endometrio mixto engrosado, con disminución lenta de la gonadotrofina corionica humana (GCH); se sospecha RPC, se suministra ciclo de ACOC y al terminarlos expulsa completamente el tejido retenido. Metodología: búsqueda bibliográfica en bases de datos Google Scholar, Science Direct, RIMA, PubMed. Revisión de literatura: la RPC se presenta después de parto o aborto (más frecuente). Criterios diagnósticos: sangrado persistente, hallazgos ecográficos y medición de GCH. Diagnóstico diferencial: enfermedad trofoblastica gestacional y malformaciones arteriovenosas uterinas. Es factible el manejo conservador, con bajas tasas de infección o procedimientos quirúrgicos. Ante la evolución prolongada, presencia de signos de infección o hemorragia importante, se impone la evacuación quirúrgica, tradicionalmente con dilatación y legrado, y más recientemente resección histeroscópica. La bibliografía reciente sugiere el uso de ACOC como manejo médico. En nuestro caso, la paciente tomó un ciclo de ACOC y al terminarlos presentó expulsión de los restos retenidos. Conclusiones: el manejo conservador de la RPC con ACOC surge como una opción en casos seleccionados; son necesarios estudios controlados para definir su utilidad..Au

Objective: to report the case of a patient with retained products of conception (RPC) after a medical abortion, successfully treated with combined oral contraceptives (COCs), and to review the literature. Clinical case: a 37-year-old patient, with little genital bleeding and slight pelvic pain, who had had a misoprostol-induced abortion four days before consulting, she attended without signs of infection, with a thikened 18.5 mm mixed endometrium. After six weeks follow-up genital bleeding and thickened mixed endometrium persist, with a slow decrease in human chorionic gonadotropin (HCG), RPC is suspected, and a COC cycle is administered, when finished, she completely expelled the retained tissue. Methodology: Google Scholar, Science Direct, RIMA and PubMed databases were searched. Literature review: RPC occurs after delivery or abortion (more frequent), diagnostic criteria: persistent bleeding, ultrasound findings and HCG measurement; the differential diagnosis includes gestational trophoblastic disease and uterine arteriovenous malformations. Conservative management is feasible, with low rates of infection or surgical procedures, however, in case of prolonged evolution, evident signs of infection or significant bleeding, surgical evacuation is required, traditionally with dilation and curettage, and more recently hysteroscopic resection. Novel bibliography suggests the use of ACOC as medical management. In our case, the patient took a cycle of COC and at the end she expelled the retained remains. Conclusions: conservative management of RPC with COC arises as an option in selected cases, controlled trails are needed to define its usefulness..Au

Intrauterine bony fragments - An unexpected finding in the hysterectomy specimen

Intrauterine bony fragments (IUBF) are an unusual finding in hysterectomy specimen received in a histopathology laboratory. Females harboring IUBF may present non-specific symptoms like vaginal bleeding, leukorrhea, chronic pelvic pain, and secondary infertility. Herein we report the case of a 35-year-old female who presented vaginal discharge and bleeding for two years, since when she had an abortion. Later, hysterectomy specimen revealed bone pieces in the uterine cavity.

Aspiración manual endouterina (AMEU): Revisión de la literatura y estudio de serie de casos / Manual vacuum aspiration (MVA): a literature review and a case series study

Introducción y objetivo El aborto es la pérdida del producto de la concepción antes de la viabilidad fetal y se considera la principal complicación del embarazo. El objetivo de nuestro trabajo es evaluar los resultados iniciales y en mediano plazo del manejo con Aspiración Manual Endouterina (AMEU) del aborto en el primer trimestre. Métodos Análisis estadístico de serie de casos de 53 pacientes sometidas a AMEU en el Hospital Carlos Van Buren, Valparaíso desde noviembre 2017 a junio 2018 por aborto del primer trimestre. El diagnóstico fue clínico y mediante ultrasonografía. Se efectuó un cuestionario de satisfacción posterior al procedimiento. Resultados Se analizaron 53 pacientes, cuya edad promedio es de 29 años, 19 nulíparas, 34 multíparas, con edad gestacional promedio de 8 semanas. Se analizaron 53 biopsias de contenido intrauterino que resultaron en 53 abortos, de éstos 39 retenidos y 14 incompletos. Se registró un 3% de complicaciones (1 caso de perforación uterina que sólo requirió manejo médico y 1 caso de evacuación incompleta). El cuestionario reveló en una mayoría, el alivio de los síntomas y satisfacción en relación al procedimiento. Conclusión La AMEU es una buena alternativa en el manejo del aborto debido a menores costos, baja tasa de complicaciones y alta eficacia. Los centros que disponen de diversas alternativas para el manejo del aborto deben asegurarse de que la mujer participe activamente en la elección en cuanto a su resolución.

ABSTRACT Introduction and objective Miscarriage is the loss of the product of conception before fetal viability and it is considered the main complication of pregnancy. The main objective of our study is to evaluate initial and midterm reports using Manual Vacuum Aspiration (MVA) as management of first trimester miscarriage. Methods Statistic analysis of a case series of 53 patients submitted to MVA at Hospital Carlos Van Buren, Valparaíso since November 2017 until June 2018 with first trimester miscarriage. The diagnosis was clinical and ultrasonographic. A post procedure satisfaction questionnaire was carried out. Results Fifty-three patients were analyzed, with mean age of 29 years, 19 were nulliparous, 34 multiparous, mean gestational age of 8 weeks. Fifty-three intrauterine biopsies were analyzed, of which 53 were miscarriage, 39 retained sacs and 14 incomplete. We had 3% of complications (1 case of uterine perforation requiring only medical treatment and 1 case incomplete vacuum). The questionnaire revealed in a majority, the relief of symptoms and satisfaction with the procedure. Conclusion MVA is a good alternative in the management of miscarriage due to less costs, low rate of complications and high efficacy. The centres with various alternatives for miscarriage management must ensure that the women actively participates in the election of the resolution.

Evolución clínica de las pacientes con manejo quirúrgico vía aspiración manual endouterina del aborto incompleto menor de doce semanas cero días de edad gestacional / Clinical evolution of patients with surgical management via manual vacuum aspiration of incomplete abortion less than twelve weeks zero days of gestational age

El aborto espontáneo es la complicación más frecuente al inicio del embarazo, llegando a ocurrir hasta en un 20% de los mismos; siendo que la mayoría de los casos ocurren antes de las 12 semanas de edad gestacional. Se han establecido tres tipos de manejo del aborto espontáneo: el manejo quirúrgico (el más frecuentemente empleado), el manejo médico y el manejo expectante. El presente estudio es un estudio descriptivo retrospectivo que trata sobre el manejo quirúrgico del aborto incompleto espontáneo menor de 12 semanas mediante el uso de la aspiración manual endouterina, conocida también como AMEU, procedimiento con el que se pretende la evacuación de restos ovulares. Se realizó la revisión de 90 expedientes clínicos de pacientes a quienes se les realizó legrado por AMEU en caso de aborto incompleto espontáneo en el período comprendido entre junio y diciembre de 2017. La muestra se calculó a partir de un universo de 326 pacientes a quienes se les realizó legrado por AMEU durante el año 2017. A los expedientes revisados se le aplicó un instrumento de elaboración propia de los investigadores basado en los objetivos del estudio y en las variables a estudiar. La información obtenida se tabuló mediante el uso de Microsoft Excel y se graficó mediante el uso de dicho software. Los resultados obtenidos arrojaron una tasa de éxito del AMEU, entendiéndose ésta como la remoción completa de restos ovulares, de un 96.6%. Este dato se encuentra dentro del rango de éxito del AMEU a nivel internacional. Entre las complicaciones que se evidenciaron posterior al procedimiento se encontró retención de restos ovulares en un 3.3%, que requirieron reintervención. Se evidenció un caso de infección posterior al procedimiento; con una tasa de infección de 1.1%; dentro de los rangos descritos en la literatura médica internacional

Abordagem terapêutica no processo de esvaziamento uterino / Enfoque terapéutico en el proceso de vaciación uterino / Therapeutic approach in the uterine evacuation process

Objetivos identificar a terapêutica utilizada no processo de esvaziamento uterino e traçar o perfil obstétrico das mulheres assistidas nesse processo. Método pesquisa quantitativa, retrospectiva, de caráter exploratório-descritivo, constituída por 466 prontuários de mulheres internadas para esvaziamento uterino, no período de junho de 2015 a junho de 2016. Resultados a idade variou entre 14 e 43 anos, o principal diagnóstico foi o aborto incompleto, responsável por 44,85% das internações, a terapêutica inicial mais utilizada foi o misoprostol (57,71%) e o tempo de internação até o esvaziamento uterino variou entre 0,20 e 137 horas. Conclusão o perfil obstétrico da mulher que vivencia a perda gestacional não difere do encontrado nacionalmente; a curetagem foi a terapêutica final mais utilizada acrescida de alguns desfechos desfavoráveis, como maior tempo de internação e exposição excessiva a medicação.

Objetivos identificar la terapéutica utilizada en el proceso de vaciamiento uterino y trazar el perfil obstétrico de mujeres asistidas en ese proceso. Método investigación cuantitativa, retrospectiva, de carácter exploratorio-descriptivo, constituida por 466 prontuarios de mujeres internadas para vaciamiento uterino, de junio de 2015 a junio de 2016. Resultados edad entre 14 y 43 años, el principal diagnóstico fue el aborto incompleto, responsable por 44,85% de las internaciones, la terapéutica inicial más utilizada fue el misoprostol (57,71%) y el tiempo de internación hasta el vaciamiento uterino varió entre 0,20 y 137 horas. Conclusión el perfil obstétrico de la mujer que vive la pérdida gestacional no difiere de lo encontrado nacionalmente; el curetaje fue la terapia final más utilizada, sumada de algunos resultados desfavorables, como mayor tiempo de internación y exposición excesiva a la medicación.

Objectives identify the therapeutics used in the uterine evacuation process and outline the obstetric profile of the women attended in this process. Method quantitative, retrospective, exploratory and descriptive research, consisting of 466 records of women hospitalized for uterine evacuation between June 2015 and June 2016. Results ages ranged between 14 and 43 years. The main diagnosis was incomplete abortion, responsible for 44.85% of the hospitalizations. The most used initial therapy was misoprostol (57.71%) and the length of hospitalization before the uterine evacuation ranged between 0.20 and 137 hours. Conclusion the obstetric profile of women who experience gestational loss does not differ from the profile found in Brazil; curettage was the most used final therapy, in addition to some unfavorable outcomes, such as longer hospitalization and excessive exposure to medication.

Análisis de conocimiento, actitudes y prácticas sobre aborto incompleto en una muestra de proveedores de salud en obstetricia de Ecuador / Analysis of knowledge, attitudes and practices about incomplete abortion in a sample of obstetrics health providers in Ecuador

Objetivos: analizar el nivel de conocimientos, actitudes y prácticas que tiene una muestra voluntaria de proveedores de salud en obstetricia asistentes al XXI Congreso Nacional de Ginecología y Obstetricia del Ecuador sobre muerte materna, leyes nacionales y tratamientos relacionados al aborto incompleto. Material y Métodos: Se realizó una intervención investigativa transversal...

Objectives: To examine the level of knowledge, attitudes and practices which has voluntary sample of health care providers at obstetrician tending the 21st National Congress of Gynecology and Obstetrics of Ecuador on maternal death, national laws and treatment related to incomplete abortion. Material and Methods: a descriptive and analytical cross - sectional investigative intervention through suvery...

Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiracion manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013 / Remifentanil as complementary analgesia in paracervical blocking for endouterine manual aspiration. Hospital Vicente Corral Moscoso. Cuenca, 2013

OBJETIVO:Disminuir el dolor producido por la Aspira-ción Manual Endouterina (AMEU) en pa-cientes que se intervienen bajo bloqueo paracervical. MATERIALES Y MÉTODOS:Con un diseño clínico controlado aleato-rizado ciego, se incluyó, 80 pacientes (en dos grupos de 40) seleccionadas para tra-tamiento de aborto incompleto mediante Aspiración Manual Endouterina, en el De-partamento de Gineco-Obstetricia del Hospital Vicente Corral Moscoso. El grupo "A" (n = 40), recibió adicional al bloqueo para-cervical 1 mcg/kg de peso de remifentanil endovenoso como dosis inicial seguida de bolos de 0,5 mcg/kg de peso cada 4 minu-tos y al grupo "B" (n = 40), se realizó el proce-dimiento bajo bloqueo paracervical única-mente; Se determinó la intensidad del dolor mediante la escala visual análoga de 10 puntos, cambios hemodinámicos y efectos secundarios.RESULTADOS:No hay diferencia significativa en los grupos de estudio tanto en edad (p = 0,118), peso (p = 0,522), talla (p = 0,114), IMC (p = 0,668), nivel de instrucción (p = 0,699). La adición de remifentanil, disminuyó el dolor según la EVA de 7,58 grupo "B" con respecto a 2,98 del grupo "A", (p = 0,000); no se tuvo cambios significativos en cuanto a tensión arte-rial media y frecuencia cardiaca (p > 0,05); el efecto secundario que se presentó con diferencia estadísticamente significativa (p = 0,001) es la náusea que es mayor en el gru-po "B".DISCUSIÓN:La adición de remifentanil al bloqueo para-cervical, disminuyó el dolor mediante EVA en un 46%, sin mayor cambio en la hemo-dinamia y con menos efectos secundarios que los que presenta el grupo control (náu-sea 92,3% con p de 0,001).

OBJECTIVE:To reduce the pain of manual vacuum aspi-ration (MVA) in patients involved under pa-racervical block. MATERIALS AND METHODS:In a clinical randomized controlled blind design, 80 patients were included (in two groups of 40) selected for an incomplete treatment of abortion with manual vacuum aspiration, in the Gynecology and Obstetrics Department of the Vicente Corral Moscoso Hospital. The group "A" (n = 40) received ad-ditional to the paracervical block 1 mcg / kg intravenous remifentanil as an initial dose fo-llowed by 0.5 mcg / kg every 4 minutes and the group "B" (n = 40), the procedure was performed only under paracervical. Pain in-tensity was determined by visual analog sca-le of 10 points, hemodynamic changes and side effects. RESULTS:There is no a significant difference in the study groups in both age (p = 0.118), weight (p = 0.522), height (p = 0.114), BMI (p = 0.668), educational level (p = 0.699). The addition of remifentanil, reduced pain according to the EVA of 7.58 group "B" with respect to 2.98 group "A", (p = 0.000); it had no significant changes in arterial pressure and heart rate (p> 0.05); the side effect was presented with statistically significant difference (p = 0.001) it is nausea which is higher in group "B". DISCUSSION:The addition of remifentanil to paracervical block, decreased the pain through EVA by 46%, without much change in hemodyna-mics and with fewer side effects than has the control group (92.3% nausea with p 0.001).

Características de las adolescentes que presentan aborto incompleto y que son sometidas al procedimiento de aspiración manual endouterina en el Servicio de Gineco-Obstetricia del Hospital Nacional Daniel Alcides Carrión. Callao-2013 / Characteristics of adolescents with incomplete abortion and that are submitted to the manual vacuum aspiration procedure in the Service of Gynecology and Obstetrics at the National Hospital Daniel Alcides Carrion. Callao-2013

Objetivo: Determinar las características de las adolescentes que presentan aborto incompleto y son sometidas al procedimiento de aspiración manual endouterina en el Servicio de Gineco-Obstetricia del Hospital Nacional Daniel Alcides Carrión. Callao-2013. Materiales y Métodos: Este trabajo fue es un diseño cualitativo, descriptivo y transversal, el cual permitirá determinar las características de las adolescentes que presentan aborto incompleto y son sometidas al procedimiento de aspiración manual endouterina. Resultados: Los antecedentes ginecoobstétricos de la adolescente, como son en que el 62 por ciento (31) solo han tenido una sola gestación. En cuanto al número de partos, el 74 por ciento (37) no presento ningún parto. En cuanto a las cesáreas el 88 por ciento (44) no realizó ninguna. En cuanto a la ocurrencia de abortos en las adolescentes, se tiene que el 38 por ciento (19) han tenido un aborto como mínimo. Los resultados obtenidos acerca de las características del AMEU en la adolescente, se tiene que en cuanto al tipo de anestesia el 80 por ciento (40) tuvo seudoanalgesia. El tipo de dolor que se presentó, el 64 por ciento (32) presento dolor leve, y el 36 por ciento (18) presento dolor moderado. En cuanto a los restos obtenidos, el 60 por ciento (30) tuvo restos regulares, y el 34 por ciento (17) tuvo restos escasos. Conclusiones: EI único factor sociodemográfico que constituye un riesgo para el aborto espontáneo en las mujeres del servicio de Gineco-obstetricia del Hospital Nacional Daniel Alcides Carrión es edad mayor o igual de 18 años. En cuanto a los síntomas que antecedieron a los abortos, el dolor abdominal fue el presentado mayoritariamente en las adolescentes, y en segundo lugar el sangrado transvaginal. El tipo de dolor que se presento fue el dolor leve. En cuanto a los restos obtenidos en la mayoría de adolescente se obtuvo restos regulares.

Objective: To determine the characteristics of adolescents with incomplete abortion and are subject to manual vacuum aspiration procedure in the Service of Gynecology and Obstetrics in National Hospital Daniel Alcides Carrion. Callao-2013. Materials and Methods: This study was a qualitative, descriptive and cross-sectional design, which will determine the characteristics of adolescents with incomplete abortion and are subject to manual vacuum aspiration procedure. Results: Teen reproductive background, as they are in that 62 per cent (31) have had only one pregnancy. As for the number of births, 74 per cent (37) did not present any delivery. As for C-sections 88 per cent (44) did not perform any. Regarding the occurrence of abortions among adolescents, there is that 38 per cent (19) have had an abortion. The results obtained about the characteristics of MVA in the adolescent, must be about the type of anesthesia, 80 per cent (40) had seudoanalgesia. The type of pain that is present, 64 per cent (32) presented mild pain, and 36 per cent (18) presented moderate pain. As for the rest obtained, 60 per cent (30) had regular remains, and 34 per cent (17) had little rest. Conclusions: The only sociodemographic factor that constitutes a risk for spontaneous abortion in women of Gynecology and Obstetrics Service of the National Hospital Daniel Alcides Carrion is greater or equal age of 18-24 years. As for the symptoms that preceded the abortions, abdominal pain was presented mainly in adolescents, and vaginal bleeding as the term. The kind of pain that was present mild pain. As residues obtained in most regular traces obtained teenager.

The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina.

OBJECTIVE: To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina. DESIGN: Multicentre collaborative cross-sectional study. SETTING: Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area. POPULATION: Women giving birth in participating hospitals during a 1-year period. METHODS: All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively. MAIN OUTCOME MEASURES: Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate. RESULTS: A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7). CONCLUSIONS: This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.

Efectividad del tratamiento médico con misoprostol en pacientes con aborto incompleto que acudieron al Hospital Nacional Dos de Mayo: enero-diciembre 2012 / Effectiveness of medical treatment with misoprostol in patients with incomplete abortion attended at the National Hospital Dos de Mayo: january-december 2012

El presente trabajo de investigación surge a raíz de la resistencia, temor y la falta de compromiso del personal médico del HNDM (Hospital Nacional Dos de Mayo) para incorporar el Misoprostol como primera alternativa en el tratamiento del aborto incompleto precoz, esto quizás por el miedo a las complicaciones y por ende a los problemas médico legales a pesar de que existen varias revisiones sistemáticas quienes demuestran fehacientemente la efectividad del Misoprostol en el tratamiento del aborto incompleto precoz. Este trabajo de investigación es mediante un estudio Descriptivo, Transversal y retrospectivo el cual nos permitirá demostrar una vez más la efectividad y beneficios del Misoprostol en pacientes que acudieron al HNDM y que fueron diagnosticados de aborto incompleto y recibieron tratamiento médico con Misoprostol en relación al Tx quirúrgico, esto permitirá motivar al personal de salud del HNDM a incorporar al Misoprostol como tratamiento de primera línea en el aborto incompleto precoz. El número total de abortos en general en el Hospital Nacional Dos de Mayo en el periodo de Enero a Diciembre del 2012 fue 496 de los cuales 322 (65 por ciento) fueron aborto incompleto que cumplían los criterios para el TX médico, y solo 111 (34 por ciento) recibieron tratamiento médico con misoprostol 600 mcg vía oral en dosis única y 153 (48 por ciento) termino en AMEU y 58 (18 por ciento) en EBA más LU. El servicio de Gineco Obstetricia del HNDM cuenta con 28 Gíneco Obstetras de los cuales solo 12 (43 por ciento) realiza tratamiento médico con misoprostol y 16 (57 por ciento) tratamiento quirúrgico (AMEU-LU) a pacientes con aborto incompleto que cumplen los criterios para TX médico, siendo las principales causas: resistencia al cambio 56 por ciento, temor a las complicaciones 31 por ciento y falta de capacitación 13 por ciento. De un total de 111 HCL con abortos incompletos que reciben tratamiento médico con misoprostol el 78 por ciento son menores de 30 años y el...

The present research stems from the resistance, fear and lack of commitment HNDM medical staff to incorporate Misoprostol as first aIternate in the earIy treatment of incompIete abortion, that perhaps the fear of compIications and hence medico-legal probIems even though there are several systematic reviews who clearly demonstrate the effectiveness of MisoprostoI in the treatment of earIy incomplete abortion. This research is a descriptive, transversal and retrospective which will allow us to further demonstrate the effectiveness of Misoprostol in patients attending the HNDM and who were diagnosed with incomplete abortion with Misoprostol received medical treatment, this will allow us to motivate the HNDM health staff to incorporate the Misoprostol as first line treatment of incomplete abortion in earIy. The total number of abortions in general in the National Hospital Dos de Mayo in the period from January to December 2012 was 496 of which 322 (65 per cent) were incomplete abortion that met the criteria for the TX doctor, and only 111 (34 per cent) received medical treatment with Misoprostol 600 mcg orally in a single dose and 153 (48 per cent) ended in MV A and 58 (18 per cent) in aduIt education more LV The Department of Obstetrics and Gynecology of the HNDM account with 28 Ob/gyns of which only 12 (43 per cent) performs medical treatment with Misoprostol and 16 (57 per cent) TX in surgical patients with incomplete abortion that meet the criteria for TX doctor, being the main causes: resistance to change 56 per cent, fear of complications 31 per cent and lack of training 13 per cent. A total of 111 HCL with incomplete abortions that receive medical treatment with Misoprostol 78 per cent are under 30 years of age and 39 per cent and 33 per cent come from the District of Lima and Victory respectively, 52 per cent have full high school education and 31 per cent complete primary school, on the other hand, the 41 per cent are housewife and 53 per cent merchant...

Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina / Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage

OBJETIVO: Analisar a eficácia e a ocorrência de complicações, além do tempo de permanência hospitalar e as perdas sanguíneas. MÉTODOS: Trinta pacientes foram selecionadas, alternada e consecutivamente, em um dos grupos (15 no Grupo Curetagem e 15 no Grupo de Aspiração manual intrauterina). As variáveis analisadas foram: eficácia do método, ocorrência de complicações, tempo pré-procedimento, tempo de execução do procedimento, tempo pós-procedimento e tempo total de permanência hospitalar, além de hematócrito e hemoglobina, medidas antes e após o procedimento. As pacientes foram avaliadas clinicamente 10 a 14 dias após o procedimento. Para a análise estatística, foram aplicados testes paramétricos e não-paramétricos e o nível de significância admitido foi de p>0,05. RESULTADOS: Ambos os métodos foram eficazes e não foi registrada nenhuma complicação. As perdas sanguíneas foram semelhantes e o tempo de permanência hospitalar foi significativamente menor no Grupo de Aspiração Manual Intrauterina (p=0,03). CONCLUSÃO: a aspiração manual intrauterina é tão eficaz e segura quanto à curetagem uterina, com a vantagem de necessitar menor tempo de permanência hospitalar, o que aumenta a resolutividade do método, melhorando a qualidade da assistência a essas pacientes.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

Oral misoprostol for the management of incomplete abortion in Ecuador.

OBJECTIVE: To assess the feasibility of introducing misoprostol for the treatment of incomplete abortion in Quito, Ecuador. METHODS: In a randomized prospective study conducted at a large tertiary-level maternity hospital and a private secondary-level clinic between November 2006 and November 2007, women with incomplete abortion were treated with either 600 µg of oral misoprostol (n=122) or manual vacuum aspiration (MVA) (n=120). All participants were requested to return for follow-up care on day 7 to determine the success of the treatment and to document their satisfaction with the method and the adverse effects experienced. RESULTS: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcomes are unknown. Among those who did return, 94% (100/106) of women showed successful completion of abortion after treatment with misoprostol, as compared with 100% (97/97) of women treated with MVA. Most women described their adverse effects after treatment as tolerable (misoprostol, 95%; MVA, 91%). Nearly all women reported being satisfied with their treatment (196/203); there were no differences among the women's reports of satisfaction according to treatment received. CONCLUSION: An oral dose of 600 µg of misoprostol was found to be an acceptable and effective non-surgical option for treating incomplete abortion. Clinical trials.gov NCT00674232.

O abortamento incompleto (provocado e espontâneo) em pacientes atendidas em maternidade do Sistema Único de Saúde / Incomplete abortion (spontaneous and induced) in patient's admitted to a Sistema Único de Saúde maternity

JUSTIFICATIVA E OBJETIVOS: A interrupção da gestação, no Brasil, é praticada amplamente pelas mulheres, em contexto clandestino. O Ministério da Saúde (MS) defende que é uma questão de saúde pública. O objetivo deste estudo foi conhecer aspectos do abortamento incompleto em 1000 mulheres submetidas à curetagem uterina, atendidas em hospital do Sistema Únicode Saúde (SUS).MÉTODO: Aplicou-se um método descritivo por meio de questionário estruturado.RESULTADOS: Obtiveram-se 36,4% de abortamentos espontâneos e 63,6% provocados; dados obtidos através da classificação da Organização Mundial da Saúde (OMS). Destes, 18,2% são certamente provocados, 2%, provavelmente provocados; 43,4% são possivelmente provocados. Entre os abortamentos certamente provocados, 89% reportaram ao uso do misoprostol.CONCLUSÃO: O perfil das mulheres com risco de provocarem o abortamento é jovem com parceiro estável; são mulatas; não usuárias de anticoncepcional ou preservativo nas relações sexuais;tiveram início precoce da atividade sexual; não planejaram a gestação; secundigestas; primíparas; idade gestacional menor que 10 semanas; raras complicações relacionadas ao abortamento.(AU)

BACKGROUND AND OBJECTIVES: Illegal abortion is a common practice among Brazilian women. Ministry of Health considers it as a matter of public health. The aim of this research is to know the aspects involved in incomplete abortion among 1000 women submitted to uterine curettage attending a public hospital of Sistema Único de Saúde (SUS).METHOD: A descriptive method carried out through interviews by means of a questionnaire was applied and it was duly structured for the data gathering.RESULTS: Through the use of structured questionnaire, 36,4% were spontaneous abortions and 63.3% were induced abortions. Accordingto the classification of World Health Organization (WHO),among the induced abortions, 18.2% were certainly induced, 2% probably induced and 43.4% were possibly induced. Among certainly induced abortions 89% reported the use of misoprostol.CONCLUSION: The profile of women in risk of practicing abortion:young, stable partner, multiethnic, not using a contraceptive method or condom for intercourses, early search, non desired pregnancy, second pregnancy, primipara, gestational age under ten weeks, rare complications related to the abortion.(AU)

Perda gestacional retida: tratamento baseado em evidência / Missed miscarriage: treatment based on evidence

A perda gestacional é a complicação mais comum da gestação, a qual acarreta sérias repercussões sociais, psicológicas e clínicas para as pacientes. Perda gestacional retida é definida como a visualização do saco gestacional vazio até a décima segunda semana de gestação, gestação intrauterina no primeiro trimestre com perda da atividade cardíaca ou a estabilização da medida comprimento crânio-nádega (CCN) em avaliações ecográficas sucessivas. Historicamente, a conduta cirúrgica tem sido o tratamento de escolha para esse quadro clínico. No entanto, há novas tendências baseadas em estudos recentes que sugerem alternativas terapêuticas válidas como a conduta expectante ou a conduta farmacológica. Esta revisão apresentou a evidência científica atual das diferentes possibilidades de tratamento da perda gestacional, sua eficácia e a relação com possíveis complicações.

Miscarriage is the most common complication of pregnancy which causes serious social, psychological and clinical consequences for patients. Missed miscarriage is defined as the visualization of a gestational sac empty until 12th week of pregnancy, 1st trimester intrauterine pregnancy with loss of heart activity or stabilization of the cranial-rump length measurement (CRL) in successive sonographic evaluations. Historically the surgical approach has been the treatment of choice for this clinical event. However, the new trends based on recent studies suggest that alternative therapies are valid as expectant treatment or pharmacological treatment. This review presented the current scientific evidence of the different possibilities for the treatment of pregnancy loss, its efectiveness and relation to possible complications.

[Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage]. / Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

Nuliparidad como factor asociado al dolor operatorio severo, durante el tratamiento del aborto incompleto mediante aspiración manual endouterina: Hospital Nacional Dos de Mayo 2008 / Parity as factor associated to the severe pain postoperative, during the treatment of the incomplete abortion by manual aspiration endouterine: National Hospital Two of May 2008

Objetivo: Determinar si la nuliparidad está asociada al dolor pélvico intraoperatorio severo, durante la aspiración manual endouterina por aborto incompleto. Metodología: Estudio observacional de corte transversal y prospectivo, incluyendo pacientes con aborto incompleto operadas mediante la aspiración manual endouterina (AMEU). El dolor pélvico fue cuantificado utilizando la Escala Visual Numérica. Para el análisis de los datos, se usó la prueba Chi cuadrado, OR y análisis multivariado. Resultados: De 272 pacientes con aborto incompleto operadas mediante la AMEU, entre julio 2008 y marzo 2009, 191 (70.2 por ciento) fueron incluidas y 81 (29.8 por ciento) excluidas. El 67.5 por ciento de las pacientes incluidas tuvieron entre 20 y 34 años, 40.8 por ciento procedían de los distritos La Victoria y El Cercado, 72.2 por ciento eran casadas o convivientes, y el 82.7 por ciento pertenecían al nivel socioeconómico C, D y E. Las nulíparas representaron el 50.8 por ciento y las no nulíparas el 49.2 por ciento. El 66.0 por ciento de las nulíparas y el 56.4 por ciento de las no nulíparas tuvieron dolor pélvico intraoperatorio severo, siendo la diferencia no significativa (p=0.168; OR=1.656, lC: 0.809-3.389). El promedio del dolor pélvico intraoperatorio (6.82±2.20 puntos) fue significativamente mayor que el dolor preoperatorio (2.81±1.87), (p=0.00). Conclusión: La nuliparidad no estuvo asociada significativamente al dolor pélvico intraoperatorio severo, durante la AMEU por aborto incompleto.