Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland.

BACKGROUND: Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic. AIM: To explore women's experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic. METHODS: Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper. RESULTS: Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals. CONCLUSIONS: Women's experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.

Spontaneous and Complicated Therapeutic Abortion in the Emergency Department.

Pregnancy-related emergency department visits are common in the United States. Although typically managed safely in the outpatient setting, patients with spontaneous abortion may also present with life-threatening hemorrhage or infection. Management strategies for spontaneous abortion are similarly wide-ranging from expectant management to emergent surgical intervention. Surgical management of complicated therapeutic abortion is similar to that of spontaneous abortion. The dramatic changes in the legal status of abortion in the United States may have significant influence on the incidence of complicated therapeutic abortion, and we encourage emergency physicians to familiarize themselves with the diagnosis and management of these conditions.

[Uterine rupture during medical termination of pregnancy or intrauterine death: A risk management study]. / Rupture utérine sur interruption médicale de grossesse ou mort fœtale in utero : une étude de gestion du risque.

OBJECTIVE: To describe and analyze a series of uterine ruptures (UR) that occurred in the context of medical termination of pregnancy (MTP) or intrauterine death (IUD) from a risk management perspective. METHODS: French retrospective descriptive observational study of all cases of UR occurring during induction for IUD or MTP, reported between 2011 and 2021 by Gynerisq. Cases were recorded on a basis of voluntary reports using targeted questionnaires. RESULTS: Between November 27, 2011, and August 22, 2021, 12 cases of UR occurring during an induction for IUD or MTP were recorded. 50 % of the patients had never given birth by cesarean section. The term of delivery varied from 17+3 days to 41+2 days. The clinical signs found were pain (n=6), ascending fetal presentation (n=5) and bleeding (n=4). All patients were managed by laparotomy, 5 were transfused. One vascular ligation and one hysterectomy were required. CONCLUSION: Knowledge of surgical history is involved in the prevention of UR. The signs of detection are pain, ascending presentation and bleeding. The speed of management and good teamwork allow a reduction of maternal complications. The findings of the morbidity and mortality reviews show that prevention and mitigation barriers can be established.

Conocimientos y actitudes sobre interrupción voluntaria del embarazo en estudiantes de una Universidad de Cartagena (Colombia) / Knowledge and attitudes regarding interruption of pregnancy in students of a University in Cartagena (Colombia)

Introducción: La interrupción voluntaria del embarazo es un asunto político que polariza las opiniones y genera controversias entre el sector salud, social, económico y cultural. Objetivo: Determinar el nivel de conocimiento y actitudes sobre la interrupción voluntaria del embarazo en estudiantes de dos programas de Ciencias de la Salud de Cartagena. Materiales y métodos: Estudio descriptivo transversal, se aplicó el cuestionario adaptado por Marceliano y Medrano a 231 estudiantes de Enfermería y Medicina, los datos se analizaron obteniendo frecuencias relativas y absolutas. Resultados: El nivel de conocimiento de los estudiantes fue alto con 92,20% (213). Sin embargo, el 37,2% (86) no sabía cuáles eran las tres causales para que el aborto no se considere un delito. El 56,7% asume actitudes negativas hacia firmar una petición para legalizar el aborto y el 18,8% considera que si una mujer se realiza un aborto debe ir a la cárcel. Conclusión: El nivel de conocimiento de los estudiantes de medicina y enfermería es alto, sin embargo, los patrones muestran desconocimiento sobre las causales de legalización del aborto de acuerdo con la norma vigente y una variabilidad de actitudes positivas y negativas ante la interrupción voluntaria del embarazo.

Introduction: Voluntary interruption of pregnancy is a political issue that polarizes opinions and generates controversy within the health, social, economic, and cultural sectors. Objective: To determine the level of knowledge and attitudes regarding voluntary interruption of pregnancy in university students from two Health Sciences programs of Cartagena. Materials and methods: A descriptive cross-sectional study; the questionnaire adapted by Marceliano and Medrano was given to 231 students within the Nursing and Medical programs; the data was analyzed through relative and absolute frequencies. Results: The level of knowledge of the students was high with a 92.20% (213). Yet, a 37.2% (86) did not know the three reasons why abortion is not considered a crime. 56.7% have negative attitudes regarding signing a petition to legalize abortion and an 18.8% believe that a woman who has an abortion should go to jail. Conclusion: The level of knowledge in medical and nursing students is high, yet the patterns show lack of knowledge of the reasons for legalization of abortion according to the current laws and a variety of positive and negative attitudes regarding the voluntary interruption of pregnancy.

Support Systems and Limitations in Therapeutic Abortion Care by the Gynecologist-Obstetrician of Public Hospitals in Peru.

OBJECTIVE: To identify the barriers to provide to women and adequately train physicians on therapeutic abortions in public hospitals in Peru. METHODS: Descriptive cross-sectional survey-based study. We invited 400 obstetrics and gynecology specialists from 7 academic public hospitals in Lima and 8 from other regions of Peru. Expert judges validated the survey. RESULTS: We collected survey results from 160 participants that met the inclusion criteria. Of those, 63.7% stated that the hospital where they work does not offer abortion training. Most of the participants consider that the position of the Peruvian government regarding therapeutic abortion is indifferent or deficient. The major limitations to provide therapeutic abortions included Peruvian law (53.8%), hospital policies (18.8%), and lack of experts (10.6%). CONCLUSION: Most surveyed physicians supported therapeutic abortions and showed interest in improving their skills. However, not all hospitals offer training and education. The limited knowledge of the physicians regarding the law and institutional policies, as well as fear of ethical, legal, and religious repercussions, were the main barriers for providing abortions.

OBJETIVO: Identificar as barreiras para oferecer às mulheres e capacitar adequadamente os médicos sobre abortos terapêuticos nos hospitais públicos do Peru. MéTODOS: Estudo descritivo transversal baseado em inquérito. Convidamos 400 especialistas em obstetrícia e ginecologia de 7 hospitais públicos acadêmicos de Lima e 8 de outras regiões do Peru. Juízes especialistas validaram a pesquisa. RESULTADOS: Coletamos os resultados da pesquisa de 160 participantes que atenderam aos critérios de inclusão. Destes, 63,7% afirmaram que o hospital onde trabalham não oferece treinamento sobre aborto. A maioria dos participantes considera que a posição do governo peruano em relação ao aborto terapêutico é indiferente ou deficiente. As principais limitações para fornecer abortos terapêuticos incluem a lei peruana (53,8%), políticas hospitalares (18,8%) e falta de especialistas (10,6%). CONCLUSãO: A maioria dos médicos pesquisados apoiava o aborto terapêutico e demonstrava interesse em aprimorar suas habilidades. No entanto, nem todos os hospitais oferecem treinamento e educação. O conhecimento limitado dos médicos sobre a lei e as políticas institucionais, além do medo de repercussões éticas, legais e religiosas, foram as principais barreiras para a realização do aborto.

[Thoracopagus conjoined twins: case study conducted in Libreville and literature review]. / Jumeaux conjoints thoracopages: à propos d'un cas à Libreville et revue de la littérature.

Conjoined twins are a rare form of monozygotic and monoamniotic twins. Fetal prognosis is very poor and, if the diagnosis is made early, it most often requires therapeutic abortion. We here report a case of three-hour old thoracopagus conjoined twins who were born vaginally, at term, at 40 weeks + 3 days. They were born to non-consanguineous parents, without any significant pathological history. Their mother was young and primiparous. She received 5 antenatal visits and 3 obstetric ultrasounds were performed by an inexperienced physician. The diagnosis of thoracopages twins was suspected based on clinical examination and computerized tomography (CT) results. This test showed cardiovascular abnormalities incompatible with life. The twins died after 23 hours of age due to acute respiratory distress. Conjoined twins are a rare congenital abnormality. Early diagnosis based on ultrasound would help to determine common anatomical structures, investigate associated congenital abnormalities, schedule delivery in a suitable structure and multidisciplinary neonatal management.

Seguridad de la Interrupción Voluntaria del Embarazo (IVE) en dos Instituciones Prestadoras de Salud en Medellín, Colombia, en 2019. Cohorte histórica / Safety of voluntary interruption of pregnancy (VIP) in two healthcare institutions in Medellín, Colombia, in 2019. Historical cohort

RESUMEN Objetivos: caracterizar una cohorte de mujeres con interrupción voluntaria del embarazo (IVE) y describir las complicaciones intraoperatorias según la técnica aplicada. Materiales y métodos: estudio descriptivo, de cohorte histórica en mujeres intervenidas a IVE en dos Instituciones Prestadoras de Salud-IPS en Medellín, Colombia, en el 2019. Se excluyeron aquellas mujeres con infección pélvica, e infecciones de transmisión sexual (ITS). Se realizó un muestreo consecutivo, se evaluaron variables sociodemográficas, de salud sexual y reproductiva, características clínicas del embarazo, causa legal de la IVE, características de la atención y las complicaciones hasta los 7 días posteriores al procedimiento de las técnicas de IVE. Finalmente, se hace análisis descriptivo. Resultados: durante el periodo de estudio hubo 1.520 mujeres elegibles de las cuales 46 fueron intervenidas en otras instituciones por lo que quedaron 1.474 candidatas a ingresar al estudio, de estas se excluyeron 30 por presentar infecciones pélvicas o de transmisión sexual, por lo que, finalmente, se analizaron 1.444 mujeres gestantes. Los riesgos para la salud de la mujer fueron la causa legal más frecuente con un 94,3%. El 99% de las mujeres tenían asesoría previa, y el 78,4% aceptó algún método anticonceptivo post-IVE. El 95,6% de las mujeres fueron intervenidas por la técnica de aspiración manual endouterina (AMEU) y al 4,4% se la practicó la técnica de dilatación y curetaje (D&C). En un 17,56% de las pacientes intervenidas con D&C se presentaron complicaciones hasta el séptimo día posoperatorio, no hubo complicaciones en el grupo sometido a AMEU, el 80% de las mujeres asistieron a control el séptimo día post-IVE. Conclusiones: la AMEU es un procedimiento seguro que no generó complicaciones intraoperatorias en el procedimiento, mientras la D&C se acompañó de complicaciones en una de cada seis pacientes. Se requieren estudios prospectivos que evalúen la seguridad y costos de las diferentes alternativas de IVE.

ABSTRACT Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and Sexually Transmitted Infections (STIs) were included. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to postprocedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother's health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with intraperatory comoplications. D&C was associated to complications in one of each six patients. Prospective studies to assess the safety and cost of the different VIP options are required.

Radiotherapy and pregnancy.

We present the updated recommendations of the French society for radiation oncology on radiotherapy and pregnancy. The occurrence of cancer during pregnancy is a rare event (approximately 1 in 1000 pregnancies). The risks for the embryo or the foetus depend on the gestational age at the time of irradiation. The main risks are malformations with microcephaly and mental retardation. There is also a risk of radiation-induced cancer in the unborn child. In the case of only supradiaphragmatic irradiation, radiotherapy can be performed most often in pregnant women without risk to the foetus. On the other hand, in the case of an indication for subdiaphragmatic irradiation, therapeutic termination of the pregnancy should be proposed. In all cases, when radiotherapy is chosen, a phantom estimation of the dose delivered to the foetus, confirmed by in vivo measurement, is recommended. Conformational radiotherapy is the preferred technique because of the lower dose delivered to the foetus (except in tumour locations where other techniques such as IMRT are recommended).

Goitre plongeant Particularités cliniques et thérapeutiques / Sub-sternal goitre: Clinical and therapeutic features

Etudier les caractéristiques cliniques, radiologiques et thérapeutiques des goitres plongeants et établir un arbre décisionnel de prise en charge Méthodes: Nous rapportons une étude rétrospective portant sur 67 cas de goitre plongeant colligés sur une période de 27 ans entre 1990 et 2016. Résultats: L'âge moyen des patients était de 53 ± 15,1 ans et le sex-ratio de 0,24. La tuméfaction basicervicale antérieure était le motif de consultation le plus fréquent, rapportée dans 82% des cas associée à des signes de compression dans 31% des cas. Une paralysie récurrentielle unilatérale a été objectivée dans quatre cas. Une radiographie de thorax a montré une opacité médiastinale dans 75% des cas et une déviation trachéale dans 85% des cas. Un scanner cervico-thoracique pratiquée dans 73% des cas a confirmé le diagnostic en objectivant cinq prolongements dépassant la crosse de l'aorte. Le traitement chirurgical était mené par voie cervicale dans 99% des patients et une sternotomie a été réalisée devant l'échec d'extraction par cervicotomie. Une paralysie récurrentielle postopératoire a été observée dans un cas et l'hypoparathyroïdie définitive a été rapportée chez six malades avec un recul moyen de trois ans. Conclusion: Les goitres plongeants sont devenus rares en Tunisie du fait de la prise en charge plus précoce des nodules thyroïdiens. Le scanner cervico-thoracique représente le gold standard pour l'étude et la confirmation du diagnostic du goitre plongeant ainsi que pour l'attitude thérapeutique. L'indication chirurgicale est toujours impérative devant le risque vital qu'il pose.

Tareas compartidas: una oportunidad para la atención del aborto en Argentina / Shared tasks: an opportunity for abortion care in Argentina

La aprobación de la Ley 27.610 de Acceso a la Interrupción Voluntaria del Embarazo (IVE) y a la Atención Posaborto marca una nueva etapa para la política de salud sexual y reproductiva argentina, que, como suele ocurrir, arrastra y se nutre de lo acumulado, y encuentra nuevos desafíos y respuestas. Bajo ese contexto, este documento introduce las "tareas compartidas", una estrategia de salud que impulsa la formación y habilitación de trabajadores de salud no médicos1 para labores específicas en la atención de IVE/ILE, de manera que puedan desempeñarse en ellas. Es una apuesta para ampliar el elenco del personal involucrado en la garantía y también para enfatizar el trabajo en equipos conformados por distintos profesionales (es decir, multiprofesional) y no jerárquico.

Utero-placental apoplexy during induction of therapeutic abortion in a 18-week pregnancy.

Utero-Placental Apoplexy, or Couvelaire Uterus, is a third-trimester major obstetrical complication, occurring especially during labor. It consists of placental abruption followed by an acute intradecidual hemorrhage produced by the rupture of the uterus-placental spiral arterioles leading to a retroplacental hematoma. This hemorrhage infiltrates the uterine wall up to intra- and retro-peritoneal areas. We provide a case report, on which no previous literature is available, of a utero-placental apoplexy during induction of therapeutic abortion.

Dilatation and curettage versus lesion resection in the treatment of cesarean-scar-pregnancy: A systematic review and meta-analysis.

This meta-analysis was performed to compare the efficacy and safety of dilatation and curettage (D&C) (simply D&C or combined with other treatments) and lesion resection for cesarean scar pregnancy (CSP). A search of English and Chinese databases from 2010 to 2019 was conducted. Thirty one studies were retrieved including sixteen random controlled and fifteen case controlled trials. Compared with abdominal resection surgery(ARS) and vaginal resection surgery(VRS), uterine artery embolization(UAE)+D&C has no obvious difference in curative effect and safety (UAE + D&C versus ARS: Cure rate(CR): P = 0.076, time for menstruation recovery/ß-HCG normalization: P = 0.545/0.949,Blood loss: P = 0.005, adverse event: P = 0.420; versus VRS: CR: P = 0.085, time for menstruation recovery/ß-HCG normalization: P < 0.001/P = 0.031,Blood loss: P = 0.902, adverse event: P = 0.249). UAE + D&C associated with lower blood loss and less postoperative complication than laparoscopic resection surgery(LRS), but LRS take more advantages in terms of the curative effect (CR: P = 0.047, time for menstruation recovery/ß-HCG normalization: P = 0.352/0.103). The efficacy and safety of VRS are better than D&C, methotrexate (MTX) + D&C (D&C versus VRS: CR: P < 0.001, time for ß-HCG normalization: P = 0.363,blood loss: P < 0.001, adverse event: P = 0.046; MTX + D&C versus VRS: CR: P < 0.001, time for menstruation recovery/ß-HCG normalization: P < 0.001/P = 0.005, blood loss: P < 0.001, adverse event: P < 0.001). Lesion resection had advantages in shorter time for menstrual recovery/ß-HCG normalization and less adverse events, lower failure rate over the administration of D&C treatments. In detail, the curative effect of UAE + D&C is similar to ARS and VRS, but inferior to LRS, while the safety of UAE + D&C is better than LRS. The efficacy and safety of simply D&C and MTX + D&C are not as good as VRS.

hCG values and gestational sac size as indicators of successful systemic methotrexate treatment in cesarean scar pregnancy.

OBJECTIVE: To retrospectively investigate cesarean scar pregnancy (CSP) patients who received systemic methotrexate (MTX) and to clarify the criteria for administering systemic MTX to CSP patients. MATERIALS AND METHODS: Fifteen CSP patients who were initially treated with systemic MTX (50 mg/m2/week) were included. Nine patients, who needed a uterine artery embolization (UAE) or a laparotomy, including a transabdominal hysterectomy (TAH), were defined as the unsuccessful MTX group. Six patients who did not require UAE or a laparotomy were defined as the successful MTX group. Furthermore, the hCG cut-off value and the GS cut-off size at the time of CSP diagnosis, which differentiated successful and unsuccessful patients, were defined. MTX success rates were investigated by combining the hCG and gestational sac (GS) size cut-off values. RESULTS: The hCG cut-off value was 17757.0 mIU/mL, and the GS cut-off size was 10.4 mm. In patients with hCG values less than 17757.0 mIU/mL, the MTX success rate was 75.0%. Fewer patients needed UAE or a laparotomy compared to patients with hCG values higher than 17757.0 mIU/mL (P = 0.007). In patients with a GS size less than 10.4 mm, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with a GS size greater than 10.4 mm (P = 0.089). In patients with hCG values and GS sizes lower than the cut-off values, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with hCG values and/or GS sizes higher than the cut-off values, respectively (P = 0.010). CONCLUSION: Patients with hCG values less than 17757.0 mIU/mL and GS sizes less than 10.4 mm may have a greater chance of successful systemic MTX treatment when it is used as the first line of treatment for CSP.

Is the presence of antiphospholipid antibodies a poor prognostic factor for patients with hemolysis, elevated liver enzymes, and low platelet count syndrome?

BACKGROUND: The characteristics of antiphospholipid syndrome-associated hemolysis, elevated liver enzymes, and low platelet count syndrome are poorly described, likely because of the low frequency of this combination of syndromes. OBJECTIVE: This study aimed to compare the characteristics and prognosis of hemolysis, elevated liver enzymes, and low platelet count syndrome in patients with and without antiphospholipid syndrome. STUDY DESIGN: In this multicenter, case-control study, adult women diagnosed with hemolysis, elevated liver enzymes, and low platelet count syndrome before 34 weeks' gestation and who were also tested for antiphospholipid antibodies according to international diagnostic recommendations were included. Cases labeled "HELLP-APS+" were defined as patients who fulfilled the international classification criteria for antiphospholipid syndrome; they were retrospectively recruited by screening the 672 patients with antiphospholipid syndrome in our antiphospholipid syndrome database. Control cases labeled "HELLP-APS-" were defined as patients who did not fulfill the criteria for antiphospholipid syndrome; they were retrospectively recruited from our hospital admission database. RESULTS: Overall, 71 patients were included (mean age, 30±5 years), with 23 patients in the hemolysis, elevated liver enzymes, and low platelet count syndrome with antiphospholipid syndrome group and 48 patients in the hemolysis, elevated liver enzymes, and low platelet count syndrome without antiphospholipid syndrome group. The live birth rate was significantly lower for patients with hemolysis, elevated liver enzymes, and low platelet count with antiphospholipid syndrome than for those with hemolysis, elevated liver enzymes, and low platelet count syndrome without antiphospholipid syndrome (43.5% vs 89.4%; P<.001). The patients with hemolysis, elevated liver enzymes, and low platelet count syndrome with antiphospholipid syndrome gave birth prematurely more often than the patients without antiphospholipid syndrome (24 weeks' gestation; 22.0-28.0 weeks vs 30 weeks' gestation; 27.0-33.0 weeks; P<.001). Among the patients with hemolysis, elevated liver enzymes, and low platelet count syndrome with antiphospholipid syndrome, 39% required an induced abortion owing to hemolysis, elevated liver enzymes, and low platelet count syndrome severity vs 8.5% of the patients with hemolysis, elevated liver enzymes, and low platelet count syndrome without antiphospholipid syndrome (P=.006). The intensive care unit admission rate was 61.9% in patients with hemolysis, elevated liver enzymes, and low platelet count syndrome with antiphospholipid syndrome, which was significantly higher than the rate of 27.7% in patients with hemolysis, elevated liver enzymes, and low platelet count syndrome without antiphospholipid syndrome (P=.007). None of the mothers died. CONCLUSION: Our results suggest that the presence of antiphospholipid syndrome is a poor prognostic factor for both the mother and fetus in patients with hemolysis, elevated liver enzymes, and low platelet count syndrome.

Postoperative reproductive outcomes in women with ovarian pregnancy: A retrospective analysis.

OBJECTIVE: The reproductive outcomes of ovarian pregnancy are currently unknown. Therefore, the objective of our study was to report the pregnancy outcomes of women with laparoscopically treated ovarian pregnancy. MATERIALS AND METHODS: In this retrospective case analysis, unpublished cases of ovarian pregnancy between 2009 and 2016 were reviewed. Women were followed up for 3 years to obtain subsequent pregnancy data. RESULTS: A total of 21 women who intended to become pregnant were included in this study. Predisposing risk factors for ovarian pregnancy including previous pelvic surgery (23.81%), presentation of pelvic endometriosis (23.81%), and prior intrauterine device insertion (9.52%) were identified. The major symptom at presentation was abdominal pain (85.71%), and no preoperative sonographic diagnosis of ovarian pregnancy was identified. Laparoscopic wedge resection was performed in most women (90.48%). During the 3-year follow-up period, spontaneous intrauterine pregnancy was observed in 13 women (61.90%), 2 women (9.52%) became pregnant through artificial insemination treatment, and 6 women are not able to get pregnant (28.57%). None of the women experienced recurrent ectopic pregnancy. CONCLUSION: The postoperative pregnancy outcomes of women with ovarian pregnancy were encouraging. In this study, the spontaneous intrauterine pregnancy rate was favorable, and no cases of recurrent ectopic pregnancy were reported.

Interrupción voluntaria del embarazo en Latinoamérica, superando barreras / Voluntary interruption of the pregnancy in Latin America, overcoming barriers

Resumen Introducción: El embarazo no planeado o no intencional y el aborto son situaciones que afectan la vida de mujeres a nivel mundial, sin distinción de etnia, edad, riqueza, o ubicación geográfica, sin embargo, tiene una mayor posibilidad de presentarse y generar consecuencias negativas en mujeres con ciertas determinantes sociales. Objetivo: Mostrar el estado actual de la interrupción voluntaria del embarazo en países de Latinoamérica y del Caribe con énfasis en el reciente avance de la legislación argentina sucedido durante diciembre del 2020. Metodología: Se realizó una búsqueda no estructurada de información sobre la legislación del aborto en países de Latinoamérica y del Caribe y se hizo una revisión de tema sobre aspectos actuales y relevantes de la interrupción voluntaria del embarazo. Conclusiones: Es necesario que prestadores de servicios de salud y sociedad latinoamericana repasen las lecciones aprendidas de diferentes países sobre las consecuencias negativas para la salud de las mujeres y sus familias debido a las restricciones para acceder al aborto seguro. El mejoramiento de la calidad y las capacidades de los sistemas de salud en los países de bajos y medianos recursos, con mayor inversión e investigación en temas de salud sexual y reproductiva, resultará en la eliminación de barreras e inequidades en la prestación de atención médica a las mujeres, respetando sus derechos y autonomía.

Abstract Introduction: Unplanned or unintended pregnancy and abortion are situations that affect the lives of women worldwide without distinction of ethnicity, age, economic level, or geographical location. However, they have a greater probability of occurring and negative consequences in women with certain social determinants. Objective: Our main objective is to show the current state of the Voluntary Interruption of Pregnancy in Latin American and Caribbean countries with special emphasis on the recent advance of the legislation of Argentina that occurred last December. Methodology: An unstructured search for information about Abortion Legislation in Latin American and Caribbean countries was carried out and a subject revision on current and relevant aspects of Voluntary Interruption of Pregnancy was made. Conclusions: It is necessary that as Health Service providers and as a Latin American Society, we review the lessons learned from different countries about the negative consequences on the health of women and their families due to the restrictions for accessing legal abortions. Improving the quality and capacity of the health system in low- and middle- income countries, in addition to greater investment and research in sexual and reproductive health issues, will derive a removal of barriers and inequity related to the provision of medical attention for women while respecting their rights and autonomy.

Revisiting the Role of Health Care Proxies in Reproductive Choice.

In an effort to protect patients' reproductive rights, many states prohibit health care proxies from serving as surrogate decision makers for pregnancy termination in patients who lack capacity. We explore the case of a 24-year-old developmentally delayed woman with intractable seizures and complex psychosocial needs who was found to be pregnant. Her older sister was her health care proxy and declared that an abortion would be in her best interest, medically and socially; the patient herself lacked capacity to make this decision. Legally, her sister's judgment alone was insufficient to move forward with the procedure. Here we describe our multidisciplinary medical, ethical, and legal review of this case and how, despite agreeing with the patient's sister, legal barriers hindered our ability to obtain an abortion for this patient. Her situation illustrates the unintended consequences of our current approach to surrogate decision making in pregnancy termination. It highlights the need to reconsider the role of health care proxies in reproductive-choice decisions and emphasizes the value of a holistic evaluation of patients' social circumstances.

Spontaneous rupture of enormous renal angiomyolipoma in a pregnant tuberous sclerosis patient: a rare case.

BACKGROUND: Renal angiomyolipoma (RAML) is a rare benign kidney tumour comprised of adipose tissue, smooth muscle, and blood vessels. It can cause fatal complications if it ruptures. Although there have been reports of RAMLs rupturing, it is unusual to see RAMLs rupture during pregnancy, especially in pregnant women with tuberous sclerosis (TSC). Moreover, we reported a rare complication after selective arterial embolization (SAE) for the first time, which called aseptic liquefaction necrosis. CASE PRESENTATION: The case is a 16-week-pregnant woman with TSC who presented with severe flank pain, which was secondary to the rupture of a large, previously unknown RAML. This was confirmed by emergency computed tomography and successfully treated with selective arterial embolization after the patient received counselling and provided prior informed written consent for medical termination of pregnancy (MTP). The patient underwent abortion 3 weeks after the SAE. The patient required drainage 2 months after the SAE because of aseptic liquefaction necrosis. During follow-up, the patient's lesion remained stable. CONCLUSION: RAML rupture is a rare but rather serious complication in pregnant tuberous sclerosis patients. Selective arterial embolization (SAE) should be performed immediately, and the status of the pregnancy needs to be assessed by a multidisciplinary team. We also report for the first time the rare complication of aseptic liquefaction necrosis after SAE of RAML, for which percutaneous drainage is effective.