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1.
JAMA Netw Open ; 3(12): e2029245, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337493

RESUMEN

Importance: Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking. Objective: To estimate the prevalence of SMA attempts among the general US population. Design, Setting, and Participants: This cross-sectional survey study was fielded August 2 to 17, 2017 among English- and Spanish- speaking, self-identified female panel members from the GfK web-based KnowledgePanel. Women ages 18 to 49 years were approached to complete a 1-time survey. Data were analyzed from September 22, 2017, to March 26, 2020. Main Outcomes and Measures: SMA was defined as "some women may do something on their own to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy." SMA was assessed using the question, "Have you ever taken or used something on your own, without medical assistance, to try to end an unwanted pregnancy?" Participants reporting SMA were asked about methods used, reasons, and outcomes. Factors associated with SMA experience, including age, race/ethnicity, socioeconomic status, nativity, reproductive health history, and geography, were assessed. Projected lifetime SMA prevalence was estimated using discrete-time event history models, adjusting for abortion underreporting. Results: Among 14 151 participants invited to participate, 7022 women (49.6%) (mean [SE] age, 33.9 [9.0] years) agreed to participate. Among these, 57.4% (95% CI, 55.8%-59.0%) were non-Hispanic White, 20.2% (95% CI, 18.9%-21.5%) were Hispanic, and 13.3% (95% CI, 12.1%-14.5%) were non-Hispanic Black; and 15.1% (95% CI, 14.1%-16.3%) reported living at less than 100% federal poverty level (FPL). A total of 1.4% (95% CI, 1.0%-1.8%) of participants reported a history of attempting SMA while in the US. Projected lifetime prevalence of SMA adjusting for underreporting of abortion was 7.0% (95% CI, 5.5%-8.4%). In bivariable analyses, non-Hispanic Black (prevalence ratio [PR], 3.16; 95% CI, 1.48-6.75) and Hispanic women surveyed in English (PR, 3.74; 95% CI, 1.78-7.87) were more likely than non-Hispanic White women to have attempted SMA. Women living below 100% of the FPL were also more likely to have attempted SMA compared with those at 200% FPL or greater (PR, 3.43; 95% CI, 1.83-6.42). At most recent SMA attempt, 20.0% (95% CI, 10.9%-33.8%) of respondents used misoprostol, 29.2% (95% CI, 17.5%-44.5%) used another medication or drug, 38.4% (95% CI, 25.3%-53.4%) used herbs, and 19.8% (95% CI, 10.0%-35.5%) used physical methods. The most common reasons for SMA included that it seemed faster or easier (47.2% [95% CI, 33.0%-61.8%]) and the clinic was too expensive (25.2% [95% CI, 15.7%-37.7%]). Of all attempts, 27.8% (95% CI, 16.6%-42.7%) of respondents reported they were successful; the remainder reported they had subsequent facility-based abortions (33.6% [95% CI, 21.0%-49.0%]), continued the pregnancy (13.4% [95% CI, 7.4%-23.1%]), had a miscarriage (11.4% [95% CI, 4.2%-27.5%]), or were unsure (13.3% [95% CI, 6.8%-24.7%]). A total of 11.0% (95% CI, 5.5%-21.0%) of respondents reported a complication. Conclusions and Relevance: This cross-sectional study found that approximately 7% of US women reported having attempted SMA in their lifetime, commonly with ineffective methods. These findings suggest that surveys of SMA experience among patients at abortion clinics may capture only one-third of SMA attempts. People's reasons for attempting SMA indicate that as abortion becomes more restricted, SMA may become more common.


Asunto(s)
Aborto Inducido , Embarazo no Deseado/psicología , Automanejo , Aborto Inducido/métodos , Aborto Inducido/estadística & datos numéricos , Adulto , Estudios Transversales , Toma de Decisiones , Grupos Étnicos , Femenino , Humanos , Embarazo , Prevalencia , Historia Reproductiva , Automanejo/métodos , Automanejo/psicología , Automanejo/estadística & datos numéricos , Factores Socioeconómicos , Estados Unidos/epidemiología
2.
PLoS One ; 15(10): e0239894, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33035246

RESUMEN

INTRODUCTION: Worldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014 and 97%, occurred in low-and-middle income countries. Abortion among adolescent girls and young women (15-24 years) is a major public health issue, especially in low-and middle-income countries, including Ghana. Using data from the 2017 Maternal Health Survey, we sought to examine the association between mass media exposure and adolescent girls and young women's self-efficacy in abortion decision making. MATERIALS AND METHODS: A sample of 5,664 adolescent girls and young women in Ghana was considered in this study. Both descriptive and inferential analytical approaches were employed to analyse the data. The descriptive analytical approach involved the use of proportions to illustrate the proportion of adolescent girls and young women who had self-efficacy in abortion decision-making. Self-efficacy in abortion decision-making was derived from the question 'Could you decide on your own to get an abortion?' Respondents who answered "Yes" to this question were considered as having self-efficacy in abortion decision making. At the inferential level, a chi-square test and bivariate and multivariable logistic regression models were employed with statistical significance pegged at p-value <0.05. The results of the bivariate and multivariable logistic regression analyses were presented using crude and adjusted odds ratios respectively. RESULTS: Less than a quarter of adolescent girls and young women (24%) in Ghana had self-efficacy in abortion decision-making. We further found that adolescent girls and young women who were exposed to mass media had higher odds in self-efficacy in abortion decision-making compared to those who were not exposed to the mass media [AOR = 1.55, CI = 1.14-2.11]. It was also found that adolescent girls and young women aged 20-24 [AOR = 1.45, CI = 1.25-1.68], those who were cohabiting [AOR = 1.40, CI = 1.02-1.93], and those from the Ashanti region [AOR = 2.39, CI = 1.85-3.07] had higher odds on self-efficacy in abortion decision-making. On the other hand, adolescent girls and young women from the Eastern Region [AOR = 0.52, CI = 0.36-0.73] and those belonging to the Ga-Adangbe ethnic group [AOR = 0.70, CI = 0.50-0.99] had lower odds in self-efficacy in abortion decision-making. CONCLUSION: Less than a quarter of adolescent girls and young women in Ghana have self-efficacy in abortion decision-making which can affect adolescent girls and young women's future abortion seeking behaviours. Exposure to mass media was strongly associated with self-efficacy in abortion decision making. We recommend that policy makers should promote mass media campaigns scheduled on regular intervals in order to inform the target audience about safe abortions in Ghana. This could go a long way to ensure that cases of unsafe abortions are reduced to the starkest minimum.


Asunto(s)
Aborto Inducido/psicología , Toma de Decisiones , Medios de Comunicación de Masas/estadística & datos numéricos , Autoeficacia , Aborto Inducido/estadística & datos numéricos , Adolescente , Femenino , Ghana , Encuestas Epidemiológicas , Humanos , Salud de la Mujer/estadística & datos numéricos , Adulto Joven
3.
J Pregnancy ; 2020: 2856502, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029400

RESUMEN

Objectives: This study was aimed at assessing the magnitude of induced abortion and associated factors among students in Hawassa University, southern region, Ethiopia, 2019. Methods: An institutional-based cross-sectional study was conducted among a total of 422 students selected on the bases of a probability simple random sampling method. A pretested structured questionnaire was used to collect data. Analysis was made with SPSS 20. Descriptive summary and inferential statistics (binary logistic regression) were used with a 95% CI and P value of less than 5% as a level of significance. Findings were presented in tables, figure, and texts. Confidentiality of information was also secured. Results: The prevalence of induced abortion in the study setting was 68.7% (95% CI: 64.15%-73.2%). Participants who used emergency contraceptives had 12 times higher odds of undergoing abortion than those who did not use emergency contraceptives at AOR: 11.95, 95% CI: 5.615-25.326, P < 001. Conclusions: A higher prevalence of induced abortion was observed in the study setting. Contraceptive use was the predictor of induced abortion identified. Concerned bodies were recommended to work on the identified determinant of induced abortion in the study setting.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Estudiantes/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Urgencias Médicas , Etiopía/epidemiología , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
5.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S75-S89, set. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1138651

RESUMEN

INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.


INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adulto , Neumonía Viral/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Pacientes Ambulatorios , Signos y Síntomas , Resultado del Embarazo , Comorbilidad , Cesárea/estadística & datos numéricos , Chile/epidemiología , Tamizaje Masivo , Epidemiología Descriptiva , Factores de Riesgo , Estudios de Cohortes , Aborto Inducido/estadística & datos numéricos , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Cuidados Críticos , Diabetes Mellitus/epidemiología , Betacoronavirus , Hospitalización , Hipertensión/epidemiología , Obesidad/epidemiología
7.
Womens Health (Lond) ; 16: 1745506520953353, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32853055

RESUMEN

OBJECTIVES: Abortions are difficult to measure; yet, accurate estimates are critical in developing health programs. We implemented and tested the validity of a list experiment of lifetime abortion prevalence in Istanbul, Turkey. We complemented our findings by understanding community perspectives using in-depth interviews with key informants. METHODS: We conducted a household survey between March and June 2018. In a random sample of 4040 married women aged 16-44 years, we implemented a double list experiment. We averaged difference in mean values calculations between the average counts for each list to provide an estimated lifetime abortion prevalence. We conducted in-depth interviews with 16 key informants to provide insights into possible explanations for the quantitative results. RESULTS: The abortion prevalence estimate from the list experiment was close to that of the direct question (3.25% vs 2.97%). Key informant narratives suggest that differing definitions of abortion, inaccessibility, provider bias, lack of knowledge of abortion laws and safety, and religious norms could contribute to under-reporting. Results from the qualitative study suggest that abortion is largely inaccessible and highly stigmatized. CONCLUSION: Measuring experiences of abortion is critical to understanding women's needs and informing harm-reduction strategies; however, in highly stigmatized settings, researchers may face unique challenges in obtaining accurate reports.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Recolección de Datos/métodos , Aborto Inducido/psicología , Adolescente , Adulto , Femenino , Humanos , Embarazo , Prevalencia , Investigación Cualitativa , Estigma Social , Encuestas y Cuestionarios , Turquia/epidemiología , Adulto Joven
8.
Lancet Glob Health ; 8(9): e1152-e1161, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32710833

RESUMEN

BACKGROUND: Unintended pregnancy and abortion estimates document trends in sexual and reproductive health and autonomy. These estimates inform and motivate investment in global health programmes and policies. Variability in the availability and reliability of data poses challenges for measuring and monitoring trends in unintended pregnancy and abortion. We developed a new statistical model that jointly estimated unintended pregnancy and abortion that aimed to better inform efforts towards global equity in sexual and reproductive health and rights. METHODS: We developed a model that simultaneously estimated incidence of unintended pregnancy and abortion within a Bayesian framework. Data on pregnancy intentions and abortion were compiled from country-based surveys, official statistics, and published studies found through a literature search, and we obtained data on livebirths from the World Population Prospects. We analysed results by World Bank income groups, Sustainable Development Goal regional groupings, and the legal status of abortion. FINDINGS: In 2015-19, there were 121·0 million unintended pregnancies annually (80% uncertainty interval [UI] 112·8-131·5), corresponding to a global rate of 64 unintended pregnancies (UI 60-70) per 1000 women aged 15-49 years. 61% (58-63) of unintended pregnancies ended in abortion (totalling 73·3 million abortions annually [66·7-82·0]), corresponding to a global abortion rate of 39 abortions (36-44) per 1000 women aged 15-49 years. Using World Bank income groups, we found an inverse relationship between unintended pregnancy and income, whereas abortion rates varied non-monotonically across groups. In countries where abortion was restricted, the proportion of unintended pregnancies ending in abortion had increased compared with the proportion for 1990-94, and the unintended pregnancy rates were higher than in countries where abortion was broadly legal. INTERPRETATION: Between 1990-94 and 2015-19, the global unintended pregnancy rate has declined, whereas the proportion of unintended pregnancies ending in abortion has increased. As a result, the global average abortion rate in 2015-19 was roughly equal to the estimates for 1990-94. Our findings suggest that people in high-income countries have better access to sexual and reproductive health care than those in low-income countries. Our findings indicate that individuals seek abortion even in settings where it is restricted. These findings emphasise the importance of ensuring access to the full spectrum of sexual and reproductive health services, including contraception and abortion care, and for additional investment towards equity in health-care services. FUNDING: UK Aid from the UK Government, Dutch Ministry of Foreign Affairs, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and The Bill & Melinda Gates Foundation.


Asunto(s)
Aborto Inducido/legislación & jurisprudencia , Aborto Inducido/estadística & datos numéricos , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Embarazo no Planeado , Adolescente , Adulto , Teorema de Bayes , Femenino , Humanos , Persona de Mediana Edad , Modelos Estadísticos , Embarazo , Adulto Joven
9.
J Med Internet Res ; 22(8): e20961, 2020 08 06.
Artículo en Inglés | MEDLINE | ID: mdl-32716895

RESUMEN

BACKGROUND: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. OBJECTIVE: The purpose of this study was to assess the impact of COVID-19-related measures on partner relationships and sexual and reproductive health in China. METHODS: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). RESULTS: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22% of participants (n=212) reported a decrease in sexual desire; 41% (n=396) experienced a decrease in the sexual intercourse frequency; 30% (n=291) reported an increase in the frequency of masturbation; 20% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 % CI 0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI 1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI 1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. CONCLUSIONS: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Encuestas Epidemiológicas , Pandemias , Neumonía Viral/epidemiología , Salud Reproductiva/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Salud Sexual/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Adolescente , Adulto , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Oportunidad Relativa , Atención Perinatal/estadística & datos numéricos , Embarazo , Parejas Sexuales/psicología , Enfermedades de Transmisión Sexual/terapia , Aislamiento Social , Adulto Joven
10.
PLoS One ; 15(7): e0236670, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32722708

RESUMEN

Intimate partner violence (IPV) is a social problem in Bangladesh with adverse effects on maternal healthcare. This study analyzed the sociodemographic factors responsible for intimate partner violence and its overall association with reproductive healthcare-specifically miscarriages, stillbirths and induced abortions (MSA)-using Bangladesh Demographic Health Survey 2007, which contains the latest available intimate partner violence data till date, with the hypothesis that intimate partner violence is associated with miscarriages, stillbirths and induced abortions. The generalized linear regression model was fitted to 3,920 women adjusting survey weights and cluster/strata variations. The study concluded that 1 out of every 4 women who reported experiencing intimate partner violence also reported having one or more of miscarriages, stillbirths and induced abortions. The results revealed that intimate partner violence and miscarriages, stillbirths and induced abortions were significantly associated with the age of the women, residence, age of the women at their first birth, sex of household head and the household's financial condition. Furthermore, the odds of having one or more miscarriages, stillbirths and abortions was increased by 35% for women who were victims to intimate partner violence, establishing a significant association between miscarriages, stillbirths and abortions and intimate partner violence. There appeared to be a need to address the issue in both paradigms, particularly for the poor rural women in Bangladeshi patriarchal society. These findings demand a combined intervention effort in the vulnerable cohorts, especially if Bangladesh intends to attain the goals 3.1 and 5.2 of the Sustainable Development Goals (SDG) by 2030.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Aborto Espontáneo , Violencia de Pareja/estadística & datos numéricos , Mortinato , Aborto Inducido/psicología , Aborto Espontáneo/psicología , Adulto , Bangladesh , Femenino , Humanos , Modelos Lineales , Masculino
12.
PLoS One ; 15(7): e0235917, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32645088

RESUMEN

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Teorema de Bayes , Escolaridad , Femenino , Ghana/epidemiología , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro , Modelos Logísticos , Estado Civil , Persona de Mediana Edad , Paridad , Pobreza , Embarazo , Prevalencia , Adulto Joven
13.
J Perinat Med ; 48(9): 943-949, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-32628637

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was first identified in December 2019 in Wuhan, China and spread rapidly, affecting many other countries. The disease is now referred to as coronavirus disease 2019 (COVID-19).The Italian government declared a state of emergency on 31st January 2020 and on 11th March World Health Organization (WHO) officially declared the COVID-19 outbreak a global pandemic. Although the COVID-19 incidence remained considerably lower in Sardinia than in the North Italy regions, which were the most affected, the field of prenatal screening and diagnosis was modified because of the emerging pandemic. Data on COVID-19 during pregnancy are so far limited. Since the beginning of the emergency, our Ob/Gyn Department at Microcitemico Hospital, Cagliari offered to pregnant patients all procedures considered essential by the Italian Ministry of Health. To evaluate the influence of the COVID-19 pandemic on the activities of our center, we compared the number of procedures performed from 10th March to 18th May 2020 with those of 2019. Despite the continuous local birth rate decline, during the 10-week pandemic period, we registered a 20% increment of 1st trimester combined screening and a slight rise of the number of invasive prenatal procedures with a further increase in chorionic villi sampling compared to amniocentesis. Noninvasive prenatal testing remained unvariated. The request for multifetal pregnancy reduction as a part of the growing tendency of voluntary termination of pregnancy in Sardinia increased. The COVID-19 pandemic provides many scientific opportunities for clinical research and study of psychological and ethical issues in pregnant women.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Pandemias/estadística & datos numéricos , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Diagnóstico Prenatal/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Amniocentesis/estadística & datos numéricos , Muestra de la Vellosidad Coriónica , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Italia/epidemiología , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Reducción de Embarazo Multifetal/estadística & datos numéricos , Primer Trimestre del Embarazo , Diagnóstico Prenatal/métodos , Ultrasonografía Prenatal/estadística & datos numéricos
14.
Cent Eur J Public Health ; 28(2): 143-148, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32592560

RESUMEN

OBJECTIVE: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. METHODS: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. RESULTS: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. CONCLUSION: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Aborto Espontáneo/etnología , Embarazo de Alto Riesgo/etnología , Atención Prenatal/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Salud Reproductiva/etnología , Roma/etnología , Adolescente , Adulto , Femenino , Humanos , Paridad , Embarazo , Complicaciones del Embarazo/etnología , Estudios Retrospectivos , Factores de Riesgo , Eslovaquia/epidemiología , Determinantes Sociales de la Salud , Factores Socioeconómicos , Adulto Joven
15.
South Med J ; 113(6): 292-297, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483639

RESUMEN

OBJECTIVE: To assess patient- and hospital-level characteristics associated with opioid use in human immunodeficiency virus (HIV)-positive pregnant women and fetal health outcomes. METHODS: Using the 2002-2014 Nationwide Inpatient Sample database, we analyzed discharge records to describe the rates of opioid use among HIV-positive pregnant women. Logistic regression was used to quantify the magnitude of the association between exposure status and maternal-fetal outcomes. RESULTS: Opioid use was fourfold greater among HIV-positive pregnant women compared with their HIV-negative counterparts (odds ratio 4.0; 95% confidence interval 3.15-5.12). Relatively smaller but significant increases in the early onset of delivery, poor fetal growth, abortive pregnancy, and spontaneous abortion also were observed in association with HIV-positive status and opioid drug use during pregnancy. CONCLUSIONS: An increased risk of negative maternal-fetal complications persists among HIV-positive women who use opioids during pregnancy. Focusing on predisposing factors and monitoring opioid dispensing may mitigate overuse or abuse in this vulnerable population.


Asunto(s)
Aborto Espontáneo/epidemiología , Retardo del Crecimiento Fetal/epidemiología , Infecciones por VIH/epidemiología , Trastornos Relacionados con Opioides/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Aborto Inducido/estadística & datos numéricos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios de Casos y Controles , Depresión/epidemiología , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Trabajo de Parto Prematuro/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Sepsis/epidemiología , Uso de Tabaco/epidemiología , Estados Unidos/epidemiología , Adulto Joven
16.
BMC Womens Health ; 20(1): 120, 2020 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-32522197

RESUMEN

BACKGROUND: In China, the vast majority of induced abortions are performed in public hospitals. However, post-abortion care (PAC) services are provided through the national network of family planning clinics, which are independent of the health care system. The integration of PAC services into abortion clinics in public hospitals is a new concept. This study aimed to assess PAC utilization among abortion patients, and identify the possible factors associated with PAC uptake in Guangzhou, China. METHODS: A cross-sectional survey was conducted among 431 women aged 15-43 years in Tianhe district of Guangzhou, China from June to September 2018. We estimated multivariate logistic regression model to examine the factors associated with utilization of PAC services. RESULTS: Less than half (42%) of the participants used PAC services. Married women were 2.7 times significantly more likely to use PAC services than their unmarried counterparts. Immigrants were 52% significantly less likely to use PAC services than non-immigrants. Women who perceived that their fertility could return later and those who did not know were 45 and 61% significantly less likely to use PAC services compared to those who knew that their fertility could return soon after an abortion. Women with limited decision-making autonomy regarding contraceptive use were 54% significantly less likely to use PAC services than those who made such decisions themselves. CONCLUSIONS: The findings suggest the need for policies and programs to not only strengthen the provision of PAC services but also promote uptake among disadvantaged sub-groups of women in the study setting.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Cuidados Posteriores/estadística & datos numéricos , Anticoncepción , Servicios de Planificación Familiar/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Calidad de la Atención de Salud , Solicitantes de Aborto/psicología , Adolescente , Adulto , China , Anticonceptivos/uso terapéutico , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Embarazo , Adulto Joven
17.
PLoS One ; 15(6): e0233985, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32492055

RESUMEN

INTRODUCTION: In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn. AIMS: To identify the factors associated with adolescent motherhood in Tete (Mozambique). METHODS: This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn. RESULTS: The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040-0.110), pregnancy follow-up (OR 0.29; CI 0.173-0.488) and previous abortions (OR 4.419; 95% CI 1.931-10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn. CONCLUSION: Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.


Asunto(s)
Salud del Adolescente/estadística & datos numéricos , Salud del Lactante/estadística & datos numéricos , Salud Materna/estadística & datos numéricos , Embarazo en Adolescencia/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Adolescente , Servicios de Salud del Adolescente/organización & administración , Estudios Transversales , Femenino , Número de Embarazos , Planificación en Salud/organización & administración , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Mozambique/epidemiología , Embarazo , Embarazo en Adolescencia/prevención & control , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
18.
Womens Health (Lond) ; 16: 1745506520929546, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32578513

RESUMEN

BACKGROUND: Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion. OBJECTIVE: The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors. RESULT: Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41-17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16-32.76) were associated with induced second trimester abortion. CONCLUSION: This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Segundo Trimestre del Embarazo , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Modelos Logísticos , Embarazo , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
19.
BMC Womens Health ; 20(1): 129, 2020 06 19.
Artículo en Inglés | MEDLINE | ID: mdl-32560651

RESUMEN

BACKGROUND: Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities. METHODS: A cross-sectional household survey among women aged 15-49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied. RESULTS: A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women's health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law. CONCLUSION: Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women's health. There is a need for widespread sensitization about the new law and its benefits.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Aborto Legal , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Legislación como Asunto , Adolescente , Adulto , Ciudades , Conducta Anticonceptiva/etnología , Estudios Transversales , Femenino , Derechos Humanos , Humanos , Persona de Mediana Edad , Mozambique/epidemiología , Embarazo , Adulto Joven
20.
J Pregnancy ; 2020: 2793960, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32566298

RESUMEN

Maternal mortality rate (MMR) is one of the main worldwide public health challenges. Presently, the high levels of MMR are a common problem in the world public health and especially, in developing countries. Half of these maternal deaths occur in Sub-Saharan Africa where little or nothing progress has been made. South Sudan is one of the developing countries which has the highest MMR. Thus, this paper deploys statistical analysis to identify the significant physiological causes of MMR in South Sudan. Prediction models based on Poisson Regression are then developed to predict MMR in terms of the significant physiological causes. Coefficients of determination and variance inflation factor are deployed to assess the influence of the individual causes on MMR. Efficacy of the models is assessed by analyzing their prediction errors. The paper for the first time has used optimization procedures to develop yearly lower and upper profile limits for MMR. Hemorrhaging and unsafe abortion are used to achieve UN 2030 lower and upper MMR targets. The statistical analysis indicates that reducing haemorrhaging by 1.91% per year would reduce MMR by 1.91% (95% CI (42.85-52.53)), reducing unsafe abortion by 0.49% per year would reduce MMR by 0.49% (95% CI (11.06-13.56)). The results indicate that the most influential predictors of MMR are; hemorrhaging (38%), sepsis (11.5%), obstructed labour (11.5%), unsafe abortion (10%), and indirect causes such as anaemia, malaria, and HIV/AIDs virus (29%). The results also show that to obtain the UN recommended MMR levels of minimum 21 and maximum 42 by 2030, the Government and other stakeholders should simultaneously, reduce haemorrhaging from the current value of 62 to 33.38 and 16.69, reduce unsafe abortion from the current value of 16 to 8.62 and 4.31. Thirty years of data is used to develop the optimal reduced Poisson Model based on hemorrhaging and unsafe abortion. The model with R 2 of 92.68% can predict MMR with mean error of -0.42329 and SE-mean of 0.02268. The yearly optimal level of hemorrhage, unsafe abortion, and MMR can aid the government and other stakeholders on resources allocation to reduce the risk of maternal death.


Asunto(s)
Aborto Inducido/efectos adversos , Aborto Inducido/estadística & datos numéricos , Hemorragia , Mortalidad Materna , Femenino , Hemorragia/epidemiología , Humanos , Embarazo , Sudán/epidemiología
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