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1.
Med Arch ; 78(2): 139-145, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38566864

RESUMEN

Background: Adolescent pregnancy is a global issue. The majority of these adolescents experience unintended pregnancy ending in abortion. Knowledge gaps and misconceptions about reproductive health are the main reasons for unintended pregnancy among adolescents. Objective: This study aims to identify knowledge, attitudes, practices, and related factors of reproductive health among adolescent post-abortion or those seeking abortion at Hanoi Obstetrics and Gynecology Hospital (HOGH), a tertiary hospital in Vietnam. Methods: Ours was a descriptive cross-sectional study of 103 adolescents who sought induced abortions between January 1, 2022 and June 30, 2023. Participants were interviewed directly via questionnaires to collect information. Results: The mean age of participants was 16.3 years. 64.1% of the population did not have general knowledge regarding reproductive health, 42.7% of subjects displayed incorrect attitudes regarding reproductive health. As a result, lack of knowledge and incorrect attitudes led to unsafe sex. The percentage of adolescents practicing unsafe sex is incredibly high (90.3%) thus causing unintended pregnancies. Education levels and family economic status were the main factors linked to knowledge, attitudes, and practices (KAP) regarding reproductive health. Conclusion: Most adolescents seeking abortion had poor KAP regarding reproductive health. Their KAP of reproductive health were linked to levels of education and family economic status. The findings emphasize the need to provide reproductive health care information and services for adolescents, and the need for appropriate attention from both family and society to the target group. We believe this will result in the improvement of their health and the avoidance of unfortunate consequences.


Asunto(s)
Aborto Inducido , Salud Reproductiva , Embarazo , Femenino , Humanos , Adolescente , Vietnam , Conocimientos, Actitudes y Práctica en Salud , Estudios Transversales
3.
BMC Pregnancy Childbirth ; 24(1): 247, 2024 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-38582864

RESUMEN

INTRODUCTION: Person-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers. METHODS: Counselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey. RESULTS: The 18 workshop participants most intensively discussed the dimensions "access to care", "person-centered characteristics of healthcare providers" and "personally tailored information". Four additional categories on a macro level ("stigmatization of women with unintended pregnancy", "stigmatization of healthcare providers", "political and legal aspects" and "corona pandemic") were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low. CONCLUSIONS: In Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare.


Asunto(s)
Aborto Inducido , Embarazo no Planeado , Embarazo , Humanos , Femenino , Accesibilidad a los Servicios de Salud , Estigma Social , Apoyo Social
4.
JAMA Netw Open ; 7(4): e246018, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38598235

RESUMEN

Importance: Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. Objective: To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. Design, Setting, and Participants: A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Main Outcomes and Measures: Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Results: Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). Conclusions and Relevance: The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.


Asunto(s)
Aborto Inducido , Farmacia , Embarazo , Femenino , Humanos , Adulto , Farmacéuticos , Estudios Transversales , California
5.
6.
Afr J Reprod Health ; 28(3): 114-121, 2024 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-38583074

RESUMEN

Misoprostol is a prostaglandin analogue that contracts the uterus, prompting the expulsion of the embryo. No systematic evaluation of the mechanisms of misoprostol has previously been performed. In this study, known targets of misoprostol were obtained from the DrugBank database; potential targets of misoprostol were predicted using data from the SwissTargetPrediction and PharmMapper databases; and the main targets of pregnancy termination were obtained from the GeneCards database. The protein-protein interaction (PPI) network of the shared genes between misoprostol and pregnancy termination was constructed using data from the STRING database, and the "misoprostol-pregnancy termination-pathway" network was constructed and potential targets was verified through molecular docking. We analyzed 37 shared target genes and obtained a network diagram of 134 potential targets, which the core therapeutic targets were HSP90AA1, EGFR, and MAPK1. GO functional and KEGG pathway enrichment analyses showed that misoprostol can modulate the VEGF signaling pathway, calcium signaling pathway, and NF-κB signaling pathway in pregnancy termination and mainly interferes with protein phosphorylation, cell localization, and protein hydrolysis regulation processes. This research illustrates the mechanism underlying the pharmacological effect of misoprostol, namely pregnancy termination. However, further experimental verification is warranted for optimal use of misoprostol during clinical practice.


Le misoprostol est un analogue des prostaglandines qui contracte l'utérus, provoquant l'expulsion de l'embryon. Aucune évaluation systématique des mécanismes du misoprostol n'a été réalisée auparavant. Dans cette étude, les cibles connues du misoprostol ont été obtenues à partir de la base de données DrugBank ; Les cibles potentielles du misoprostol ont été prédites à l'aide des données des bases de données SwissTargetPrediction et PharmMapper ; et les principales cibles de l'interruption de grossesse ont été obtenues à partir de la base de données GeneCards. Le réseau d'interaction protéine-protéine (IPP) des gènes partagés entre le misoprostol et l'interruption de grossesse a été construit à l'aide des données de la base de données STRING, et le réseau « voie d'interruption de grossesse-misoprostol ¼ a été construit et les cibles potentielles ont été vérifiées par amarrage moléculaire. Nous avons analysé 37 gènes cibles partagés et obtenu un diagramme de réseau de 134 cibles potentielles, dont les principales cibles thérapeutiques étaient HSP90AA1, EGFR et MAPK1. Les analyses d'enrichissement des voies fonctionnelles GO et KEGG ont montré que le misoprostol peut moduler la voie de signalisation VEGF, la voie de signalisation du calcium et la voie de signalisation NF-κB lors de l'interruption de grossesse et interfère principalement avec les processus de phosphorylation des protéines, de localisation cellulaire et de régulation de l'hydrolyse des protéines. Cette recherche illustre le mécanisme sous-jacent à l'effet pharmacologique du misoprostol, à savoir l'interruption de grossesse. Cependant, une vérification expérimentale plus approfondie est justifiée pour une utilisation optimale du misoprostol au cours de la pratique clinique.


Asunto(s)
Aborto Inducido , Misoprostol , Femenino , Embarazo , Humanos , Misoprostol/farmacología , Simulación del Acoplamiento Molecular , Farmacología en Red
7.
BMC Vet Res ; 20(1): 132, 2024 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-38566206

RESUMEN

BACKGROUND: Small ruminants are the principal component of livestock production in Tigray region, Ethiopia. But their productivity is affected by various factors. According to farmers and expert observation, goat abortion is among the leading causes of production losses in Tanqua-Abergelle district. However, study findings that examine the extent of distribution and economic impact of abortion cases in goats in the district are scarce. This retrospective study investigated the occurrence of abortion and its associated risk factors in three goat breed types at Abergelle Agricultural Research Center goat breeding site over a seven year period. The study included a total of does above one year old, and data were collected from a casebook that was specifically prepared for abortion cases. A thorough follow up was conducted to identify abortion cases. Additionally, a community survey was conducted in selected villages where the research center is located. RESULTS: The overall abortion proportion was 29.8% in the goat farm. Begait goat breeds had the highest abortion proportion (50.9%, CI 0.36-0.64) in 2015/16. Multivariate logistic regression analysis identified year, season, age and breed as major risk factors of abortion occurrence at flock level. Accordingly, the likelihood of goats experiencing abortion during the dry season (proportion = 34) was 1.87 times higher compared to those in the wet season (proportion = 22.8). Begait breeds had a higher incidence of abortion (proportion 37.5%, OR 4.87, CI 2.49-10.35) compared to other breeds. Age was negatively associated with abortion, suggesting that older goats (OR = 0.67) had a higher relative risk than younger goats (OR = 0.57). Moreover, the study noted a high incidence of abortion during the years 2014/15 to 2016/17 (proportion = 35.7-39.7). Within-breed analysis revealed that age and season were significant risk factors for Abergelle and Begait breeds, respectively by using a multivariate logistic regression analysis. A community survey indicated that 89.7% households responded their goats experienced abortion. CONCLUSIONS: This study highlighted the high prevalence of goat abortion at Abergelle and identifies important risk factors associated with its occurrence. The findings can inform targeted interventions to reduce abortion rates and improve goat productivity in the district.


Asunto(s)
Aborto Inducido , Enfermedades de las Cabras , Embarazo , Femenino , Animales , Cabras , Estudios Retrospectivos , Etiopía/epidemiología , Rumiantes , Crianza de Animales Domésticos , Aborto Inducido/veterinaria , Enfermedades de las Cabras/epidemiología
9.
Medicine (Baltimore) ; 103(10): e37071, 2024 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-38457586

RESUMEN

RATIONALE: Uterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture. PATIENT CONCERNS: on admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy. DIAGNOSES: The diagnosis of silent uterine rupture was based on clinical findings from cesarean delivery or laparoscopic exploration. INTERVENTIONS: Case 1 underwent emergent cesarean delivery, revealing a 0.25 cm × 0.25 cm narrow concave area above the Ring Ties with active and bright amniotic fluid flowing from the tear. Case 2 underwent vaginal delivery, and on the 12th postpartum day, ultrasound imaging and magnetic resonance imaging revealed a 5.8 cm × 3.3 cm × 2.3 cm lesion on the lower left posterior wall of the uterus, and 15th postpartum day, laparoscopic exploration confirmed the presence of an old rupture of uterus. Case 3 underwent elective cesarean delivery, revealing a 3.0 cm × 2.0 cm uterine rupture without active bleeding at the bottom of the uterus. OUTCOMES: The volumes of antenatal bleeding for the 3 patients were approximately 500 mL, 320 mL, and 400 mL, respectively. After silent uterine ruptures were detected, the uterine tear was routinely repaired. No maternal or neonatal complications were reported. LESSONS: Obstetricians should give particular consideration to the risk factors for silent uterine rupture, including a history of uterine surgery, such as laparoscopic transabdominal cerclage, laparoscopic myomectomy, and induced abortion.


Asunto(s)
Aborto Inducido , Laparoscopía , Rotura Uterina , Recién Nacido , Lactante , Embarazo , Femenino , Humanos , Rotura Uterina/diagnóstico , Rotura Uterina/etiología , Rotura Uterina/cirugía , Cesárea/efectos adversos , Útero , Aborto Inducido/efectos adversos , Laparoscopía/efectos adversos
10.
Womens Health (Lond) ; 20: 17455057241233124, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38426387

RESUMEN

BACKGROUND: There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. OBJECTIVE: The study aimed to identify what is known about health providers' reasons for participating in abortion provision. ELIGIBILITY CRITERIA: Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. SOURCES OF EVIDENCE: We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. METHODS: Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. RESULTS: From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). CONCLUSION: Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.


Asunto(s)
Aborto Inducido , Actitud del Personal de Salud , Embarazo , Femenino , Humanos , Conciencia , Instituciones de Salud
11.
JAMA Netw Open ; 7(3): e241833, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38483391

RESUMEN

Importance: Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences. Objective: To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy. Design, Setting, and Participants: This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022. Exposures: The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy. Main Outcomes and Measures: The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality. Results: Of 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury. Conclusions and Relevance: In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.


Asunto(s)
Aborto Inducido , Lesiones Accidentales , Embarazo en Adolescencia , Embarazo , Adolescente , Humanos , Femenino , Adulto , Adulto Joven , Mortalidad Prematura , Estudios de Cohortes , Ontario/epidemiología
12.
J Psychosom Obstet Gynaecol ; 45(1): 2321461, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38469857

RESUMEN

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.


Asunto(s)
Aborto Inducido , Embarazo no Planeado , Embarazo , Femenino , Humanos
13.
Psychol Addict Behav ; 38(2): 161-166, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38451697

RESUMEN

OBJECTIVE: In June 2022, the U.S. Supreme Court released a landmark decision in which they held that the right to abortion is not protected by the U.S. Constitution, ending almost 50 years of federally legal abortion in the United States. Because prior research demonstrates linkages between reproductive health and substance use at multiple socioecological levels, in this special section, we present studies that take a broad scope to understanding how addictive behaviors and reproduction-related behaviors, options, and access to care interrelate across a variety of contexts. METHOD: In this introduction, the guest editors detail the impetus for this special section, provide a brief overview of the present studies, discuss policy and intervention implications, and suggest future research directions. RESULTS: The five studies presented in this special section span a wide range of populations, methods, and substance use and reproduction-related issues, including reasons for past abortions among women with opioid use disorder, alcohol effects on men's condom use resistance, considerations regarding alcohol-involved rape on implementation of "rape exceptions" to abortion bans, the role of early exposure to substance use and sexual abuse on reproductive health outcomes, and the effects of exposure to abortion-related media coverage on alcohol use intentions following the Supreme Court decision. CONCLUSIONS: The studies in this special section highlight the ways in which substance use and reproductive health are inextricably intertwined. Recent and future changes in reproductive health legislation and policy underscore the critical need for continued empirical inquiry into these intersecting public health concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Asunto(s)
Aborto Inducido , Trastornos Relacionados con Sustancias , Femenino , Humanos , Embarazo , Aborto Legal , Decisiones de la Corte Suprema , Estados Unidos , Salud de la Mujer
14.
BMJ Open ; 14(3): e073799, 2024 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-38485172

RESUMEN

OBJECTIVE: This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis. DATA EXTRACTION AND SYNTHESIS: The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16. RESULTS: The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination. CONCLUSIONS: One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.


Asunto(s)
Aborto Inducido , Embarazo , Femenino , Humanos , Etiopía/epidemiología , Prevalencia , Estudios Transversales , Conducta Sexual
15.
Taiwan J Obstet Gynecol ; 63(2): 214-219, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38485317

RESUMEN

OBJECTIVES: While the decision of abortion is undeniably complex, there are situations where it becomes a necessary choice. In such circumstances, a secure abortion procedure is essential to safeguard the physical and mental well-being of women. A uterine direct visualization system was designed to fulfill the requirements and this study undertook an assessment of the system's safety and effectiveness within a medical facility setting. MATERIALS AND METHODS: Induced abortion requested women in 17 institutions across the country between December 2016 and February 2017 were enrolled. Subjects were separated to the study and control group randomly. Induced abortion was conducted by a uterine direct visualization system and an ultrasound-guided system in the study and control group, respectively. The clinical indexes collected during intra- and post-procedures were analyzed and compared between groups. RESULTS: Overall, 392 and 339 subjects were included in the study and control group, respectively. The baseline demographic and clinical characteristics were similar between two groups. Subjects in the study group had significant smaller number of uterine cavity entry (p < 0.001), less 2-h and 14-days postoperative bleeding (all p < 0.001), and less 14-days postoperative abdominal pain (p < 0.001). Significantly higher ratio of normal menstruation, in terms of incidence and duration after 60-days of operation, was observed in the study group (all p < 0.001). CONCLUSIONS: Induced abortion with uterine direct visualization system generate better outcome and less complication than the conventional ultrasound-guided abortion procedures.


Asunto(s)
Aborto Inducido , Aborto Espontáneo , Embarazo , Femenino , Humanos , Aborto Inducido/efectos adversos , Aborto Inducido/métodos , Útero/diagnóstico por imagen , Útero/cirugía , Dolor Abdominal
16.
Rev Med Liege ; 79(3): 143-145, 2024 Mar.
Artículo en Francés | MEDLINE | ID: mdl-38487907

RESUMEN

An intrauterine infection during the first trimester of pregnancy can rapidly lead to bacteremia, with severe consequences for the patient. While these infections are mainly found after a miscarriage or an abortion, the diagnosis is sometimes made while the pregnancy is still in progress. The clinical history and symptoms reported by the patient lead to the suspicion of such a complication. Treatment must be rapid and based on a broad-spectrum antibiotic regimen covering Gram-negative, Gram-positive, aerobic and anaerobic bacteria. As soon as the treatment has been initiated, uterine curettage should be performed to remove the infected material, whether or not foetal cardiac activity is present at the time of diagnosis.


Une infection intra-utérine durant le premier trimestre de la grossesse peut rapidement mener à une bactériémie et avoir des conséquences sévères pour la patiente. Alors que ces infections sont principalement retrouvées après une fausse couche ou une interruption volontaire de grossesse, le diagnostic est parfois posé alors que la grossesse est évolutive. L'histoire clinique et les symptômes rapportés par la patiente permettent de suspecter une telle complication. La prise en charge doit être rapide et repose sur un traitement antibiotique à large spectre couvrant les bactéries Gram négatif, Gram positif, les aérobies et les anaérobies. Dès le traitement instauré, un curetage utérin devra être réalisé afin d'éliminer le matériel infecté, que l'activité cardiaque fœtale soit présente ou non au moment du diagnostic.


Asunto(s)
Aborto Inducido , Aborto Espontáneo , Embarazo , Femenino , Humanos , Primer Trimestre del Embarazo , Aborto Espontáneo/cirugía , Aborto Espontáneo/etiología , Aborto Inducido/efectos adversos , Útero , Legrado/efectos adversos
17.
PLoS One ; 19(3): e0299245, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38489318

RESUMEN

BACKGROUND: Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades. METHODS: Trends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents. RESULTS: The trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion. CONCLUSION: The trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.


Asunto(s)
Aborto Inducido , Embarazo no Planeado , Embarazo , Femenino , Adolescente , Humanos , Etiopía/epidemiología , Atención Prenatal , Demografía , Análisis Multinivel
18.
Front Public Health ; 12: 1309068, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38525331

RESUMEN

Background: Roe was overturned in 2022. No peer-reviewed evidence exists for the indirect spillover effects of overturning Roe on non-abortion reproductive care access for diverse patient populations. Methods: National data were from 2013-2023 HHS Title X Directory, 2013-2020 CDC Artificial Reproductive Technologies (ART) Surveillance and 2021-2023 manual collection, and Guttmacher Institute. Outcome measures included numbers of ART clinics and Title X entities. Title X entities are those that receive federal funds to establish and operate voluntary family planning projects, especially for low-income patients. We reported pre-and post-Roe changes, associations between changes in measures and abortions, and characteristics of changed measures by region and political geography. Results: Post-Roe America witnessed national declines of 1.03% in ART clinics and 18.34% in Title X entities, and average state decreases of 0.08 ART clinics (p < 0.05) and 18 Title X entities (p < 0.001). State-level ART clinic closures and abortion reductions had little association except for Texas, Oklahoma, Arizona, New York, and California. Plummets in Title X entities and abortions were positively associated: Reducing 100 abortions was associated with defunding two Title X entities (p < 0.05). The South experienced the largest losses of both, while 83.39% of lost Title X entities were in states that voted Republican in the 2020 presidential election, disproportionate to the 49.02% of states that voted Republican and the 42.52% of US population residing in these states. Conclusion: We provide one of the first few evidence of spillover impacts of overturning Roe on non-abortion care access for diverse populations: low-income men and women, single parents by choice, and biologically and socially infertile patients. Early evidence warns of worsening challenges of inequities and calls for immediate policy actions.


Asunto(s)
Aborto Inducido , Embarazo , Masculino , Femenino , Humanos , Servicios de Planificación Familiar , Américas , Texas , Política
20.
PLoS One ; 19(3): e0288947, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38551970

RESUMEN

INTRODUCTION: On June 24, 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson reversed the precedent set forth by Roe v. Wade, empowering individual states to regulate abortion care. This aftermath of this ruling has given rise to widespread bans, limiting the accessibility of abortion services for patients and impeding providers' ability to deliver a comprehensive spectrum of reproductive health services. Of particular concern is the disproportionate impact on medically underserved groups, further heightening existing social and structural disparities in reproductive health. METHODS: We conducted a scoping review to broadly evaluate the clinical and public health impact of Dobbs on patients' access to abortion care and related reproductive health services, in addition to the training and clinical practice of healthcare providers. We searched eight bibliographic databases (PubMed, Scopus, Embase, PsycINFO, Google Scholar, Science Direct, JSTOR, and Web of Science) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) using various combinations of keywords related to 'abortion', 'Dobbs', and 'Roe' on March 22, 2023. Four reviewers independently screened the studies based on pre-specified eligibility criteria and one reviewer performed data extraction for pre-identified themes. The search was conducted based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. RESULTS: Eighteen studies, comprising 12 peer-reviewed articles and 6 study abstracts, met the inclusion criteria. The studies demonstrated that Dobbs increased demand for contraception, magnified existing travel- and cost-related barriers to access, further polarized views on abortion and complex family planning on social media (e.g., Twitter), and evoked substantial concerns among medical trainees regarding their scope of practice and potential legal repercussions for providing abortion care. CONCLUSION: In the wake of Dobbs v. Jackson, further public health and clinical interventions are urgently needed to bridge disparities in abortion care and reproductive health, mitigating the deleterious consequences of this emerging public health crisis.


Asunto(s)
Aborto Inducido , Salud Pública , Femenino , Embarazo , Humanos , Estados Unidos , Personal de Salud , Pacientes , Anticoncepción , Aborto Legal
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