Telemedicine for the provision of medication abortion to pregnant people at up to twelve weeks of pregnancy: a systematic literature review and meta-analysis.

BACKGROUND: Telemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy. METHODS: A literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations. RESULTS: 21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery. CONCLUSION: Telemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis.

BACKGROUND: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward. METHODS: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services. RESULTS: Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access. CONCLUSIONS: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

Effectiveness and safety of medication abortion via telemedicine versus in-person: A cohort of pregnant people in Colombia.

OBJECTIVE: To compare the effectiveness and safety of medication abortion (MAB) via telemedicine versus in-person in pregnant people with less than 12 gestational weeks in Colombia. STUDY DESIGN: A retrospective cohort study was conducted with 23,362 pregnant people who requested MAB service from Profamilia (a Colombian non-governmental organization) in 2021-2022. The outcomes were success and safety of MAB. We performed a descriptive and a multivariate statistical analysis using the binary regression model to obtain an adjusted Odds Ratio (aOR) to identify factors associated with abortion success. RESULTS: In comparison to in-person care (n = 20,289), individuals in telemedicine (n = 3073) were predominantly from urban areas, belonged to a lower socioeconomic stratum, single and did not identify with any ethnic group. In-person users tended to have higher levels of education and accessed the service through private insurance (p < 0,05). There were no differences in the odd of a successful abortion based on the modality of care (aOR 1.18; 95% CI=0.87-1.59). The results were also the same with sensitivity analysis stratified: pregnant people who were nine weeks gestation or less (aOR 0.86; 95% CI=0.63-1.17) or more (aOR 0.87; 95% CI=0.28-2.65). CONCLUSION: Telemedicine is an effective and safe option for MAB, as in-person care. Telemedicine has the potential to increase abortion access by extending the availability of providers and offering people a new option for obtaining care conveniently and privately, especially for women with disadvantaged socioeconomic and educational background. IMPLICATIONS: This study demonstrates that medication abortion (MAB) administered via telemedicine produces outcomes akin to those of in-person care, providing a compelling rationale for its adoption, particularly in underserved regions. This approach can be replicated in other countries in Latin America and the Caribbean.

Analysis of uterine evacuation methods in postabortion care after implementation of a surveillance network (CLAP MUSA-Network) at a university hospital.

BACKGROUND: Management of uterine evacuation is essential for increasing safe abortion care. Monitoring through surveillance systems tracks changes in clinical practice and provides information to improve equity in abortion care quality. OBJECTIVE: This study aimed to evaluate the frequency of manual vacuum aspiration (MVA) and medical abortion (MA), and identify the factors associated with each uterine evacuation method after surveillance network installation at a Brazilian hospital. METHODS: This cross-sectional study included women admitted for abortion or miscarriage to the University of Campinas Women's Hospital, Brazil, between July 2017 and November 2020. The dependent variables were the use of MVA and MA with misoprostol. The independent variables were the patients' clinical and sociodemographic data. The Cochran-Armitage, chi-square, and Mann-Whitney U tests, as well as multiple logistic regression analysis, were used to compare uterine evacuation methods. RESULTS: We enrolled 474 women in the study, 91.35% of whom underwent uterine evacuation via uterine curettage (78.75%), MVA (9.46%), or MA (11.54%). MVA use increased during the study period (Z = 9.85, p < 0.001). Admission in 2020 (odds ratio [OR] 64.22; 95% confidence interval [CI] 3.79-1086.69) and lower gestational age (OR 0.837; 95% CI 0.724-0.967) were independently associated with MVA, whereas the only factor independently associated with MA was a higher education level (OR 2.66; 95% CI 1.30-5.46). CONCLUSION: MVA use increased following the installation of a surveillance network for good clinical practice. Being part of a network that encourages the use of evidence-based methods provides an opportunity for healthcare facilities to increase access to safe abortions.

Implementing medical abortion through telemedicine in Colombia: a qualitative study.

The non-governmental organisation Profamilia developed and implemented medical abortion through telemedicine in response to the Covid-19 pandemic. This service is now integrated as an alternative to in-person care and available to abortion-seekers across Colombia. Previous research has emphasised bottlenecks in abortion provision, but less is known about implementation processes and experiences. We assessed the feasibility and acceptability of telemedicine for medical abortion from the perspectives of key informants involved in the implementation in Colombia. We conducted 15 in-depth interviews with healthcare professionals, coordinators and support staff implementing telemedicine for medical abortion in the early phase of implementation, between March and October 2021. We analysed the data using the framework method and applied the normalisation process theory in our analysis and interpretation of findings. Our findings show that strong leadership, organisational efforts on pre-implementation training, monitoring and evaluation, and collaboration between diversely skilled and experienced providers are essential for successful implementation. Participants were generally positive towards the use of telemedicine for medical abortion; concerns related to effectiveness, safety and safeguarding existed mainly among providers with less clinical experience. We identified contextual barriers, such as social opposition, regulatory barriers, providers' unavailability, and poor phone and internet connections in rural areas, which impacted the feasibility of the intervention negatively. In conclusion, to ensure stakeholders' buy-in and for the service to reach all abortion seekers in need, future implementation endeavours must address concerns about safety and effectiveness, and tackle identified contexual barriers.Plain Language SummaryIn telemedicine for medical abortion, all or some components of abortion care, such as initial consultations, home delivery of abortion medication, and post-abortion follow up are provided with the use of telecommunications. Telemedicine for medical abortion has been shown to be a safe and effective form of service delivery.In this study, we interviewed 15 healthcare providers and staff involved in the implementation of a telemedicine service for medical abortion in Colombia to determine whether they deemed the service to be acceptable and feasible. We found that collaboration between providers of different backgrounds and levels of experience, appropriate training and strong leadership were key factors for successfully implementing the service. However, some healthcare providers, especially those with less clinical experience, were concerned that telemedicine for medical abortion may not be safe and may risk the health and well-being of abortion-seekers. Further, social opposition to abortion, unclear regulation and limited access to technology were identified as barriers that need to be addressed to ensure the service reaches all abortion-seekers in need.In conclusion, despite contextual barriers and some provider's concerns about medical safety, telemedicine for medical abortion was viewed as a positive and feasible form of service delivery in Colombia.

Cuidados de enfermería a la mujer con aborto por automedicación / Nursing care for women with self-medication abortion

El aborto inducido es el resultado de maniobras practicadas con la intención de interrumpir el embarazo. Esta acción puede provocar complicaciones que ponen en riesgo la vida de la mujer, lo que muestra la importancia de los cuidados de enfermería para minimizar el riesgo de complicaciones en el posaborto. El propósito del estudio es describir los cuidados de enfermería a implementar en las mujeres con aborto por automedicación. Se realizó una revisión bibliográfica que incluyó la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica publicada relacionada con el problema de investigación. Se revisaron documentos publicados en los últimos 5 años en bases de datos regionales y de alto impacto como son Scielo, Redalyc, Latindex y PudMed. Se usaron descriptores de salud relacionados con el tema propuesto en idioma español, inglés y portugués. Se identificó un total de 83 documentos, de los cuales se usaron 46 en la investigación realizada. Los restantes 37 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su uso, o que su eje central no se ajustaba al tema de investigación planteado. Los cuidados de enfermería desempeñan un papel fundamental en la prevención o detección precoz de complicaciones en las mujeres con abortos por automedicación. La prevención de este tipo de actos debe fomentarse antes de la concepción de la gestación, basado en una adecuada educación sexual a las mujeres en edad fértil(AU)

Induced abortion is the result of maneuvers performed with the intention of interrupting pregnancy. This action can generate complications that put the woman's life at risk, which shows the importance of nursing care to minimize the risk of post-abortion complications. To describe the nursing care to be implemented in women with self-medication abortion. A bibliographic review was carried out that included the search, selection, review, interpretation and synthesis of the published scientific evidence related to the research problem. Documents published in the last 5 years in regional and high-impact databases such as Scielo, Redalyc, Latindex and PudMed were used. Health descriptors related to the proposed theme were used in Spanish, English and Portuguese. A total of 83 documents were identified, of which 46 were used in the research carried out. The remaining 37 manuscripts were excluded due to methodological deficiencies that limited their use; or that its central axis did not fit the proposed research topic. Nursing care plays a fundamental role in the prevention or early detection of complications in women with self-medication abortions. The prevention of this type of acts should be encouraged before the conception of pregnancy, based on adequate sexual education for women of childbearing age(AU)

Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study.

OBJECTIVE: We aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector. STUDY DESIGN: A prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one nonclinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7 to 14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests. RESULTS: We conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% of participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; 6 individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311). CONCLUSIONS: This study showed that guided self-managed telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, and those that rely on public sector services. IMPLICATIONS: The findings contribute evidence in support of telemedicine models for early medical abortion, demonstrating the feasibility of a self-management protocol implemented with supportive health care providers and the potential for a broad geographical reach in Mexico.

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

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

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

"It's not a seven-headed beast": abortion experience among women that received support from helplines for medication abortion in restrictive settings.

There are a growing number of abortion helplines where counselors provide person-centered medication abortion services in legally restrictive settings. Few researchers have explored the perceptions and experiences of the people who obtain support from these helplines. Between April and August 2017, we conducted 30 interviews with women who had a medication abortion with support from helpline counselors in Poland, Brazil, or Nigeria. Before seeking care with the helpline, women often heard negative stories about abortion and faced enacted stigma from the formal healthcare sector, or chose not to seek services from their doctors due to fear of stigmatizing treatment. Conversely, during their care with the helpline counselors, women received clear information in a timely manner, and were treated with kindness, compassion, respect, and without judgment. Many women gained knowledge and understanding of medication abortion, and some gained a sense of community among those who experienced abortion. Helpline models can provide high-quality, person-centered abortion care to people seeking abortions in legally restrictive contexts. Evidence from these service-delivery models could help improve service within the formal healthcare systems and expand access to high-quality, safe abortion by redefining what it means to provide care.

What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis.

INTRODUCTION: In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them. METHODS: A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews. RESULTS: Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications. CONCLUSIONS: As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.

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

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

Interrupción del embarazo en adolescentes de la provincia de Santiago de Cuba / Interruption of pregnancy in adolescents from Santiago de Cuba province

Introducción: La educación sexual debe promover actitudes positivas hacia una sexualidad responsable y contribuir a adoptar una postura activa para prevenir riesgos en las personas que inician su vida sexual. Objetivo: Caracterizar las adolescentes con interrupciones de embarazo según variables seleccionadas. Método: Se realizó un estudio observacional, descriptivo y transversal de 16 356 adolescentes, a quienes se les interrumpió el embarazo, pertenecientes a la provincia de Santiago de Cuba, durante el quinquenio 2012-2016. Se analizaron las siguientes variables: edad, total de adolescentes a quienes se les interrumpió el embarazo según métodos y procederes, así como tipo de interrupción. Resultados: Del total de interrupciones de embarazos, 25,3 % correspondió a adolescentes. Predominó el grupo etario de 15-19 años. Estas adolescentes decidieron no continuar el embarazo en edad gestacional avanzada (8-12 semanas). Entre los 2 métodos utilizados tuvo mayor frecuencia la práctica del aborto, lo cual continúa siendo un problema de salud en este segmento poblacional. Conclusiones: Las adolescentes mostraron un porcentaje significativo del total de interrupciones del embarazo entre las mujeres que se encontraban edad fértil, con un predominio del grupo de 15 -19 años de edad; el método más utilizado fue el aborto.

Introduction: Sexual education should promote positive attitudes toward a responsible sexuality and contribute to adopt an active posture to prevent risks in people that begin their sexual life. Objective: To characterize the adolescents with pregnancy interruptions according to selected variables. Method: An observational, descriptive and cross-sectional study of 16 356 adolescents from Santiago de Cuba, who interrupted their pregnancy was carried out, from 2012 to 2016. The following variables were analyzed: age, total of adolescents who interrupted their pregnancy according to methods and procedures, as well as type of interruption. Results: Of the total of pregnancies interruptions, 25.3 % corresponded to adolescents. The 15-19 age group prevailed. These adolescents decided not to continue the pregnancy in advanced gestational age (8-12 weeks). Among the 2 methods used the practice of abortion had a higher frequency, what is still a health problem in this sector of the population. Conclusions: The adolescents showed a significant percentage of the total of pregnancy interruptions among the women that were in fertility age, with a prevalence of the 15-19 age group; the most used method was abortion.

The "Abortion Pill" Misoprostol in Brazil: Women's Empowerment in a Conservative and Repressive Political Environment.

In the aftermath of the introduction of severe restrictions on abortion in several US states, some activists have argued that providing widespread access to an abortive drug, misoprostol, will transform an induced abortion into a fully private act and therefore will empower women. In Brazil, where abortion is criminalized, the majority of women who wish to terminate an unwanted pregnancy already use the illegal, but easily accessible, misoprostol. We examine the history of misoprostol as an abortifacient in Brazil from the late 1980s until today and the professional debates on the teratogenicity of this drug. The effects of a given pharmaceutical compound, we argue, are always articulated, elicited, and informed within dense networks of sociocultural, economic, legal, and political settings. In a conservative and repressive environment, the use of misoprostol for self-induced abortions, even when supported by formal or informal solidarity networks, is far from being a satisfactory solution to the curbing of women's reproductive rights.

Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons / Aborto entre mulheres vivendo e não vivendo com HIV/AIDS usuárias de serviços públicos de saúde no município de São Paulo: prevalência, contextos e motivos

Abstract Objectives: we investigated the lifetime prevalence of abortion and life contexts and reasons reported for first abortion among women living (WLHA) and not living with HIV/AIDS(WNLHA). Methods: representative samples of 975 users of public health care reference network for HIV/AIDS and of 1,003 users of the primary care public services in São Paulo municipality were selected by cluster-stratified sampling and answered an electronic socio-behavioral questionnaire. Results: the prevalence of abortion was 11.9% (CI95%9.8-13.9) among WLHA and 3.0% (CI95%2.4-5.7) for WNLHA.Most abortions (128) among WLHA occurred before diagnosis and 28 after diagnosis or during pregnancy when diagnosis was given. The majority of women did not use any contraception at the time of the first abortion. The use of misoprostol was the most reported method. Having HIV was very important in deciding to abort for half of the WLHA. Absence of marital life and the lack of desire to have children were the most reported reasons by both groups. Conclusions: the similarity in contexts and reasons to abort among WLHA and WNLHA suggests that they share experiences molded by gender and social inequalities that affect their ability to access sexual and reproductive health resources and services.

Resumo Objetivos: investigou-se a prevalência de aborto provocado alguma vez na vida e os contextos de vida e motivos referidos para realização do primeiro aborto entre mulheres vivendo (MVHA) e não vivendo com HIV/AIDS (MNVHA). Métodos: amostras representativas de 975 usuárias da rede especializada em HIV/AIDS e de 1.003 usuárias da rede de atenção básica no município de São Paulo foram selecionadas por amostragem estratificada por conglomerados e responderam um questionário eletrônico sócio-comportamental. Resultados: a prevalência de aborto provocado foi de 11,9% (IC95%9,8-13,9) entre MVHA e de 3,0% (IC95%2,4-5,7) para MNVHA. A maioria dos abortos (128) entre MVHA ocorreu antes do diagnóstico e 28 após o diagnóstico ou na gravidez que este foi dado. A maioria das mulheres não fazia contracepção à época do primeiro aborto. O uso de miso-prostol foi o método mais referido. Ter HIV foi muito importante na decisão de abortar para metade das MVHA. Ausência de vida conjugal e o não desejo de ter filhos foram os motivos mais referidos por ambos os grupos. Conclusões: a semelhança nos contextos e motivos para a realização de aborto entre MVHA e MNVHA sugere que elas compartilham experiências moldadas por desigualdades sociais e de gênero que afetam suas possibilidades de acesso a recursos e serviços de saúde sexual e reprodutiva.

Revisión de la utilidad del uso de progesterona en aborto recurrente de causa no precisada / Review of the usefulness of the use of progesterone in recurrent abortion of unknown cause

Resumen Introducción El AR de causa no precisada es un problema de salud reproductiva que impacta importantemente a las parejas. En casi el 50% de los casos de AR no se encuentra una etiología clara, por lo que es necesario lograr encontrar estrategias de tratamiento que puedan ayudar a mejorar las probabilidades de lograr un embarazo de término. Objetivo analizar la bibliografía existente en cuanto a la utilidad de la progesterona para reducir tasa de aborto en las parejas con AR de causa no precisada en ciclos naturales Métodos: Revisión sistemática cualitativa respecto al uso de progesterona en casos de aborto recurrente de causa no precisada. Resultados Se encontraron 3 artículos. Todos usaron progesterona vaginal, 2 desde el inicio de la fase lútea con disminución de los abortos, uno no demostró este efecto con inicio más tardío de la intervención. Conclusiones Los estudios encontrados orientan a que el uso de progesterona vaginal podría ser de utilidad para disminuir abortos en pacientes con AR iniciando la suplementación al comienzo de la fase lútea.

[SAFETY OF THE TREATMENT FOR VOLUNTARY PREGNANCY TERMINATION BY GESTATIONAL AGE. MEDELLÍN, COLOMBIA, 2013-2014].

OBJECTIVE: To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination. METHODS: Historical cohort of all pregnant women with up to 26 weeks of gestation who received treatment for voluntary pregnancy termination in a referral institution in Medellín, Colombia, between January 2013 and December 2014.Sampling was consecutive. Measured variables included sociodemographic and obstetric variables, undesired effects, and complications of the voluntary pregnancy termination treatment. A descriptive analysis was carried out. RESULTS: Overall, 87 women were included. The mean age at the time of termination was 24 years (inter-quartile range [IQR] = 12), 69.0% were single, and 73,4% were unemployed. The main reason for termination was the risk to the mother's health in 61,0% of cases, followed by a history of sexual violence in 26.4% and fetal malformations in 12.6%; a total of 70 women (80,4%) had less than 18 weeks of gestation and were treated with misoprostol plus manual vacuum aspiration; 17 (19,6%) had between 18 and 26 weeks of gestation and were treated with misoprostol followed by dilation and curettage. The first group (gestational age <18 weeks) experienced undesired effects such as pain and vomiting; in the second group (> or equal to 18 weeks), 41.0% of the women experienced hemorrhage. CONCLUSIONS: The risk to the mother's health was the main reason for the termination of pregnancy. Termination before 18 weeks was found to be safe, while termination between 18 and 26 weeks using misoprostol and curettage was associated with a high frequency of hemorrhage.

TITULO: SEGURIDAD DEL TRATAMIENTO DE LA INTERRUPCIÓN VOLUNTARIA DEL EMBARAZO SEGÚN EDAD GESTACIONAL EN MEDELLÍN, COLOMBIA, 2013-2014. OBJETIVO: describir la seguridad del tratamiento médico-quirúrgico empleado en mujeres que acuden a interrupción voluntaria del embarazo. METODOS: cohorte histórica. Se incluyeron todas las mujeres embarazadas, hasta con 26 semanas de edad gestacional, a quienes se les dio tratamiento para interrupción voluntaria del embarazo en una institución de referencia en Medellín, Colombia, entre enero de 2013 y diciembre de 2014. Muestreo consecutivo. Se midieron las variables sociodemográficas obstétricas, los efectos no deseados y las complicaciones en el tratamiento de la interrupción voluntaria del embarazo. Se hizo análisis descriptivo. RESULTADOS: se incluyeron 87 mujeres, la mediana de edad de las mujeres al momento de la interrupción fue de 24 años (rango intercuartílico [Rq] = 12), el 69,0 % estaban solteras y el 73,4% desempleadas. La principal causa de interrupción fue el riesgo para la salud de la madre en el 61,0 %, seguido por antecedente de violencia sexual en el 26,4 % y malformaciones fetales en el 12,6 %; un total de 70 mujeres (80,4 %) tenía menos de 18 semanas de gestación y fueron tratadas con misoprostol más aspiración manual endouterina; 17 (19,6%) tenían entre 18 y 26 semanas de gestación, las cuales recibieron misoprostol y legrado. El primer grupo (edad gestacional <18 semanas) no presentó complicaciones, solo efectos no deseados tales como dolor y vómito; el segundo grupo (> o igual a 18 semanas) presentó hemorragia en el 41 % de los casos. CONCLUSIONES: el riesgo para la salud materna constituyó el principal motivo para la interrupción del embarazo. La interrupción del embarazo antes de la semana 18 es segura, entre las semanas 18 a 26, con misoprostol y legrado uterino, se acompañó de una alta frecuencia de hemorragia.

Prevalence, risk factors and molecular characterization of Chlamydia trachomatis in pregnant women from Córdoba, Argentina: A prospective study.

BACKGROUND: Chlamydia trachomatis causes the most prevalent bacterial Sexual Transmitted Infection. In pregnant women, untreated chlamydial infections are associated with abortions, premature rupture of membranes, postpartum endometritis, low birth weight and transmission to the newborn. In Córdoba, Argentina, there is little knowledge about the prevalence of Chlamydia trachomatis in women in their third trimester of pregnancy, so, the aim of this study was to evaluate Chlamydia trachomatis prevalence and genotypes present in Cordovan pregnant women with different age and socioeconomic status. METHODS AND FINDINGS: Design: prospective study. Settings: Women population from Cordoba city, Argentina. Population: Pregnant women having 35 to 37 weeks of gestation. Methods: Five hundred and nine cervical swabs were collected. Each sample was subjected to DNA extraction and PCR for Chlamydia trachomatis using primers NRO/NLO and CTP1/CTP2. Positives samples were sequenced to determine genotype. Main outcome measures: Demographic data of the patients were collected to detect a population at risk for this infection. RESULTS: A prevalence of 6.9% (35/509) for Chlamydia trachomatis infection was detected, with 32/295 and 3/214 from pregnant women with low or better economic resources respectively (p = 0,0001). Results showed a significantly increased rate of 11.6% (30/258) in women under 25 years compared with 2% (5/251) in patients over that age (p = 0,00003). Genotype E was the most prevalent. CONCLUSIONS: With these results, we can say that pregnant women under 25 years old and low economic resources are one of the populations in which the screening programs of Chlamydia trachomatis should focus.

Use of an at-home multilevel pregnancy test and an automated call-in system to follow-up the outcome of medical abortion.

OBJECTIVE: To assess the feasibility of using an at-home multilevel pregnancy test (MLPT) and interactive voice response (IVR) call-in system for remote follow-up of medical abortion. METHODS: A prospective pilot study was conducted among women who had a medical abortion at up to 70 days at a clinic in Mexico City, Mexico, between June 1, 2015, and January 30, 2016. Participants took an MLPT at the initial clinic visit and another MLPT at home 2 weeks later. They were requested to report their MLPT results via the IVR system and attend the clinic for follow-up evaluation. RESULTS: Of 200 women considered for inclusion, 163 (81.5%) were included in the analysis. Only 10 (6.6%) of the 152 women who had a medical abortion on or before 63 days from last menstrual period reported MLPT results to the IVR system that required clinical evaluation to assess medical abortion outcome. The remaining 142 (93.4%) women in this group reported MLPT results that ruled out ongoing pregnancy (confirmed at clinical evaluation). Reported MLPT results ruled out ongoing pregnancy among the 11 women who had a medical abortion after 63 days; however, 1 (9%) had an ongoing pregnancy at clinical evaluation. CONCLUSION: Use of MLPTs and the IVR system provided a streamlined approach to follow-up after medical abortion.