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1.
Zhongguo Zhong Yao Za Zhi ; 46(15): 3990-3997, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34472276

RESUMO

To systematically evaluate the efficacy and safety of Gongxuening Capsules in the treatment of abnormal vaginal bleeding after medical abortion. CNKI, Wanfang, SinoMed, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to comprehensively collect the clinical randomized controlled trials(RCTs) of Gongxuening Capsules for treatment of abnormal vaginal bleeding after medical abortion from the establishment of the databases to October 10, 2020. Literature screening, data extraction and quality evaluation were conducted independently by two system reviewers according to the inclusion and exclusion criteria. Cochrane Handbook bias risk assessment tool was used for the literature methodology quality evaluation, RevMan 5.3 software was used for Meta-analysis, and the evidence quality of outcomes was evaluated by the evidence quality grading system(GRADE). A total of 16 RCTs were inclu-ded. The results of Meta-analysis showed that as compared with the western medicine treatment alone, the addition of Gongxuening Capsules to the western medicine treatment can reduce the amount of vaginal bleeding(RR=1.23, 95%CI[1.19, 1.27], P<0.000 01), shorten vaginal bleeding time(RR_(≤15 d number of people)=1.39, 95%CI[1.31, 1.48], P<0.000 01; MD_(number ofdays)=-1.20, 95%CI[-1.66,-0.74],P<0.000 01). However, there was no obvious advantage in abortion effect(RR=1.02, 95%CI[0.99, 1.06], P=0.14) and menstrual recovery(MD=-0.35, 95%CI[-0.96, 0.25], P=0.25). The results of GRADE showed that the grading level was low for vaginal bleeding volume and vaginal bleeding time, and extremely low for abortion effect and mens-trual recovery. In terms of safety, 16 studies reported adverse events. Only one study showed no adverse events and the rest showed transient nausea, vomiting, stomach burning, upper abdominal discomfort and other gastrointestinal symptoms. The results show that the addition of Gongxuening Capsules to the application of western medicine in treatment of drug abortion can reduce the amount of vaginal bleeding and shorten vaginal bleeding time, but the abortion effect and menstrual recovery have no obvious advantages. The use of Gongxuening Capsules helps to achieve less adverse reactions and higher safety. Due to the small sample size of the included studies and many methodological quality problems, no conclusions with clinical guidance value can be obtained. Large sample-zise, high-qua-lity randomized controlled trials are still needed for further verification.


Assuntos
Aborto Induzido , Medicamentos de Ervas Chinesas , Aborto Induzido/efeitos adversos , Cápsulas , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Gravidez , Hemorragia Uterina
2.
Wiad Lek ; 74(7): 1559-1565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459752

RESUMO

OBJECTIVE: The aim: To determine trend of legal induced surgical abortion and to assess the frequency of infection complications after termination of pregnancy in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a prospective multicentre cohort study was based on surveillance data of healthcare-associated infection (HAI) after legal induced surgical abortion in women's from January 2017 to 2019 in Ukraine. Definitions of HAI after induced abortion were used from the CDC/ NHSN. RESULTS: Results: The number of surgical abortions in Ukraine increased by 32.8%. A total of 25.9% HAIs were identified after surgical abortion. Of these HAIs, 25.9 were Endometritis, 21.8% Bacterial Vaginitis, 14.3% Parametritis, 13.1% Cervicitis, 9.9% Adnexa utery, 7.8% Salpingitis, 6.3% Chorioamnionitis, and 0.9% other reproductive tract infections. E.coli were most commonly reported, accounting for 25.9% of all organisms, followed by Enterococcus spp. (16.2%), Staphylococcus aureus (15.5%), P. aeruginosa (10.9%), and Enterobacter spp. (10.1%). Antimicrobial resistance in the isolates associated with HAIs showed, among the gram-positive bacteria, that 19.1% and 3.6% of coagulase-negative staphylococci isolates were b-lactam (oxacillin) - and glycopeptide-resistant, respectively. Meticillin resistance was reported in 23.2% of S aureus isolates. Vancomycin resistance was reported in 3.7% of isolated enterococci. Among the gram-negative bacteria, third-generation cephalosporins resistance was found in 33.1% of Klebsiella spp and in 24.1% of E.coli isolates. CONCLUSION: Conclusions: The results of this study revealed high rates of HAIs after surgical abortion and most causing pathogens were associated with resistant to antibiotic strains. This knowledge is essential to develop targeted strategies to surveillance and reduce the incidence of post-abortion infections.


Assuntos
Aborto Induzido , Infecção Hospitalar , Aborto Induzido/efeitos adversos , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana , Feminino , Humanos , Gravidez , Estudos Prospectivos , Ucrânia
3.
BMJ Glob Health ; 6(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34417270

RESUMO

INTRODUCTION: Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. METHODS: This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS: We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. CONCLUSIONS: This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.


Assuntos
Aborto Induzido , Aborto Induzido/efeitos adversos , Região do Caribe , Estudos Transversais , Feminino , Humanos , Lactente , América Latina/epidemiologia , Morbidade , Gravidez , Organização Mundial da Saúde
4.
Cochrane Database Syst Rev ; 6: CD013566, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114643

RESUMO

BACKGROUND: Medical abortion is usually offered in a clinic or hospital, but could potentially be offered in other settings such as pharmacies. In many countries, pharmacies are a common first point of access for women seeking reproductive health information and services. Offering medical abortion through pharmacies is a potential strategy to improve access to abortion. OBJECTIVES: To compare the effectiveness and safety of medical abortion offered in pharmacy settings with clinic-based medical abortion. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, four other databases, two trials registries and grey literature websites in November 2020. We also handsearched key references and contacted authors to locate unpublished studies or studies not identified in the database searches. SELECTION CRITERIA: We identified studies that compared women receiving the same regimen of medical abortion or post-abortion care in either a clinic or pharmacy setting. Studies published in any language employing the following designs were included: randomized trials and non-randomized studies including a comparative group. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed both retrieved abstracts and full-text publications. A third author was consulted in case of disagreement. We intended to use the Cochrane risk of bias tool, RoB 2, for randomized studies and used the ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions) to assess risk of bias in non-randomized studies. GRADE methodology was used to assess the certainty of the evidence. The primary outcomes were completion of abortion without additional intervention, need for blood transfusion, and presence of uterine or systemic infection within 30 days of medical abortion. MAIN RESULTS: Our search yielded 2030 records. We assessed a total of 89 full-text articles for eligibility. One prospective cohort study met our inclusion criteria. The included study collected data on outcomes from 605 women who obtained a medical abortion in Nepal from either a clinic or pharmacy setting. Both sites of care were staffed by the same auxiliary nurse midwives. Over all domains, the risk of bias was judged to be low for our primary outcome. During the pre-intervention period, the study's investigators identified a priori appropriate confounders, which were clearly measured and adjusted for in the final analysis. For women who received medical abortion in a pharmacy setting, compared to a clinic setting, there may be little or no difference in complete abortion rates (adjusted risk difference (RD)) 1.5, 95% confidence interval (CI) -0.8 to 3.8; 1 study, 600 participants; low certainty evidence). The study reported no cases of blood transfusion, and a composite outcome, comprised mainly of infection complications, showed there may be little or no difference between settings (adjusted RD 0.8, 95% CI -1.0 to 2.8; 1 study, 600 participants; very low certainty evidence). The study reported no events for hospital admission for an abortion-related event or need for surgical intervention, and there may be no difference in women reporting being highly satisfied with the facility where they were seen (38% pharmacy versus 34% clinic, P = 0.87; 1 study, 600 participants; low certainty evidence). AUTHORS' CONCLUSIONS: Conclusions about the effectiveness and safety of pharmacy provision of medical abortion are limited by the lack of comparative studies. One study, judged to provide low certainty evidence, suggests that the effectiveness of medical abortion may not be different between the pharmacy and clinic settings. However, evidence for safety is insufficient to draw any conclusions, and more research on factors contributing to potential differences in quality of care is needed. It is important to note that this study included a care model where a clinician provided services in a pharmacy, not direct provision of care by pharmacists or pharmacy staff. Three ongoing studies are potentially eligible for inclusion in review updates. More research is needed because pharmacy provision could expand timely access to medical abortion, especially in settings where clinic services may be more difficult to obtain. Evidence is particularly limited on the patient experience and how the care process and quality of services may differ across different types of settings.


Assuntos
Aborto Induzido/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Aborto Induzido/efeitos adversos , Aborto Induzido/normas , Viés , Feminino , Humanos , Nepal/epidemiologia , Satisfação do Paciente , Assistência Farmacêutica/normas , Complicações Pós-Operatórias/epidemiologia , Gravidez , Estudos Prospectivos , Infecção Puerperal/epidemiologia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Resultado do Tratamento
5.
Pan Afr Med J ; 38: 307, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178225

RESUMO

Uterine arteriovenous malformations are possible causes of persistent metrorrhagia, in particular in patients with a history of abortion and trophoblast diseases. We here report the diagnostic and therapeutic features of two patients with uterine arteriovenous malformations complicating post-abortion in the Maternity Ward of the University Hospital of Pointe-a-Pitre in Guadeloupe. Patients had metrorrhagias after abortion with curettage. Arteriovenous malformation was suspected based on ultrasound combined with Doppler. Arteriography confirmed the diagnosis and allowed, in the same time, for conservative treatment by arterial embolization. No complication was reported. The lack of knowledge about uterine arteriovenous malformations can lead to deleterious consequences ranging from haemostatic hysterectomy due to cataclysmic hemorrhage to death.


Assuntos
Malformações Arteriovenosas/diagnóstico , Embolização Terapêutica/métodos , Metrorragia/etiologia , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Aborto Induzido/efeitos adversos , Adulto , Angiografia , Malformações Arteriovenosas/terapia , Feminino , Humanos , Gravidez , Ultrassonografia Doppler , Anormalidades Urogenitais/terapia , Útero/diagnóstico por imagem , Adulto Jovem
6.
Issues Law Med ; 36(1): 3-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33939340

RESUMO

Objectives: Primary: Analyze the Adverse Events (AEs) reported to the Food and Drug Administration (FDA) after use of mifepristone as an abortifacient. Secondary: Analyze maternal intent after ongoing pregnancy and investigate hemorrhage after mifepristone alone. Methods: Adverse Event Reports (AERs) for mifepristone used as an abortifacient, submitted to the FDA from September 2000 to February 2019, were analyzed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAEv3). Results: The FDA provided 6158 pages of AERs. Duplicates, non-US, or AERs previously published (Gary, 2006) were excluded. Of the remaining, there were 3197 unique, US-only AERs of which there were 537 (16.80%) with insufficient information to determine clinical severity, leaving 2660 (83.20%) Codable US AERs. (Figure 1). Of these, 20 were Deaths, 529 were Life-threatening, 1957 were Severe, 151 were Moderate, and 3 were Mild.The deaths included: 9 (45.00%) sepsis, 4 (20.00%) drug toxicity/overdose, 1 (5.00%) ruptured ectopic pregnancy, 1 (5.00%) hemorrhage, 3 (15.00%) possible homicides, 1 (5.00%) suicide, 1 (5.00%) unknown. (Table 1).Retained products of conception and hemorrhage caused most morbidity. There were 75 ectopic pregnancies, including 26 ruptured ectopics (includes one death).There were 2243 surgeries including 2146 (95.68%) D&Cs of which only 853 (39.75%) were performed by abortion providers.Of 452 patients with ongoing pregnancies, 102 (22.57%) chose to keep their baby, 148 (32.74%) had terminations, 1 (0.22%) miscarried, and 201 (44.47%) had unknown outcomes.Hemorrhage occurred more often in those who took mifepristone and misoprostol (51.44%) than in those who took mifepristone alone (22.41%). Conclusions: Significant morbidity and mortality have occurred following the use of mifepristone as an abortifacient. A pre-abortion ultrasound should be required to rule out ectopic pregnancy and confirm gestational age. The FDA AER system is inadequate and significantly underestimates the adverse events from mifepristone.A mandatory registry of ongoing pregnancies is essential considering the number of ongoing pregnancies especially considering the known teratogenicity of misoprostol.The decision to prevent the FDA from enforcing REMS during the COVID-19 pandemic needs to be reversed and REMS must be strengthened.


Assuntos
Abortivos , Mifepristona/efeitos adversos , Abortivos/efeitos adversos , Abortivos Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , COVID-19 , Feminino , Humanos , Misoprostol , Pandemias , Gravidez , SARS-CoV-2
7.
Obstet Gynecol ; 137(6): 1055-1060, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33957651

RESUMO

OBJECTIVE: To compare the effect of cervical priming with mifepristone with that of misoprostol on pain perception during surgical induced abortion under paracervical block. METHODS: We conducted a randomized, single-blind, two-center study of women undergoing surgical induced abortion at less than 14 weeks of gestation under paracervical block. Participants were randomized to receive cervical priming with 200 mg of oral mifepristone 36 hours or 400 micrograms buccal misoprostol 3 hours before surgery. The primary outcome was pain during mechanical cervical dilation evaluated by a 100-mm visual analog scale (VAS). Secondary outcomes were pain during aspiration, preoperative and postoperative pain, participant satisfaction, duration of the procedure, occurrence of complications, and ease of performing the procedure (assessed by a 100-mm VAS). We estimated that 110 women would have to be included to have 90% power to detect a 13mm-difference of VAS for pain. RESULTS: Between June 2017 and May 2019, 314 women were eligible and 110 were randomized (55 in each group). Patient characteristics were similar in the two groups. The mean VAS score during mechanical cervical dilation was lower in the mifepristone group (35.6±21 vs 43.5±21, P=.04) as was the mean VAS during aspiration (34±24 vs 47.8±23, P=.003). The preoperative and postoperative mean VAS, satisfaction and duration of procedures were similar between groups. The procedure was significantly easier to perform in the mifepristone group (88±16 vs 80±23, P=.004). CONCLUSION: Cervical priming with mifepristone for surgical induced abortion under paracervical block up to 14 weeks of gestation is more effective than misoprostol in reducing pain perception. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03043014.


Assuntos
Abortivos não Esteroides/uso terapêutico , Abortivos Esteroides/uso terapêutico , Aborto Induzido/efeitos adversos , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Dor Processual/prevenção & controle , Aborto Induzido/métodos , Adulto , Anestesia Obstétrica , Feminino , Humanos , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Processual/etiologia , Satisfação do Paciente , Gravidez , Primeiro Trimestre da Gravidez , Método Simples-Cego , Adulto Jovem
8.
Aust N Z J Obstet Gynaecol ; 61(4): 607-611, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33872380

RESUMO

Abortion is an essential medical service; however, the lack of standardised protocols and follow-up can cause unintended harm. We present four cases of post-abortion complications presenting to a Sydney tertiary hospital which could have been avoided by appropriate ultrasound prior to abortion and peri-abortion care. While social progress has led to significant reforms in abortion law, clinical guidelines must also be updated and consistently applied to ensure safety of this practice.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Induzido/efeitos adversos , Feminino , Humanos , Gravidez , Ultrassonografia
9.
Reprod Health ; 18(1): 76, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827597

RESUMO

OBJECTIVES: To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization. METHODOLOGY: We estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis. RESULTS: The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception. CONCLUSION: Despite significant improvement in the management of PAC, the uptake in WHO approved technology-namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.


Assuntos
Aborto Induzido/efeitos adversos , Assistência ao Convalescente , Serviços de Planejamento Familiar/métodos , Adolescente , Adulto , República Democrática do Congo , Feminino , Hospitais , Humanos , Gravidez , Encaminhamento e Consulta , Adulto Jovem
10.
PLoS One ; 16(4): e0249529, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793655

RESUMO

BACKGROUND: Dilation and evacuation is a method of second trimester pregnancy termination introduced recently in Ethiopia. However, little is known about the safety and effectiveness of this method in an Ethiopian setting. Therefore, the study is intended to determine the safety and effectiveness of dilation and evacuation for surgical abortion as compared to medical abortion between 13-20 weeks' gestational age. METHODS: This is a quasi-experimental study of women receiving second trimester termination of pregnancy between 13-20 weeks. Patients were allocated to either medical or surgical abortion based on their preference. A structured questionnaire was used to collect demographic information and clinical data upon admission. Procedure related information was collected after the procedure was completed and before the patient was discharged. Additionally, women were contacted 2 weeks after the procedure to evaluate for post-procedural complications. The primary outcome of the study was a composite complication rate. Data were collected using Open Data Kit and then analyzed using Stata version 14.2. Univariate analyses were performed using means (standard deviation), or medians (interquartile range) when the distribution was not normal. Multiple logistic regression was also performed to control for confounders. RESULTS: Two hundred nineteen women chose medical abortion and 60 chose surgical abortion. The composite complication rate is not significantly different among medical and surgical abortion patients (15% versus 10%; p = 0.52). Nine patients (4.1%) in the medical arm required additional intervention to complete the abortion, while none of the surgical abortion patients required additional intervention. Median (IQR) hospital stay was significantly longer in the medical group at 24 (12-24) hours versus 6(4-6) hours in the surgical group p<0.001. CONCLUSION: From the current study findings, we concluded that there is no difference in safety between surgical and medical methods of abortion. This study demonstrates that surgical abortion can be used as a safe and effective alternative to medical abortion and should be offered equivalently with medical abortion, per the patient's preference.


Assuntos
Abortivos Esteroides/administração & dosagem , Aborto Induzido/métodos , Mifepristona/administração & dosagem , Cuidados Pré-Operatórios/estatística & dados numéricos , Aborto Induzido/efeitos adversos , Adulto , Etiópia , Extração Obstétrica/métodos , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Inquéritos e Questionários , Adulto Jovem
11.
Am J Nurs ; 121(5): 11, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33872240

RESUMO

Telehealth proves to be more than just a stopgap in providing support to patients.


Assuntos
Aborto Induzido/efeitos adversos , Dismenorreia/induzido quimicamente , Mifepristona/efeitos adversos , Telemedicina/métodos , Hemorragia Uterina/induzido quimicamente , Feminino , Humanos
12.
Contraception ; 104(1): 49-53, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33789080

RESUMO

OBJECTIVE: To demonstrate the effectiveness of medication abortion with the implementation of telemedicine and a no-test protocol in response to the COVID-19 pandemic. STUDY DESIGN: This is a retrospective cohort study of patients who had a medication abortion up to 77 days gestation at the University of Hawai'i between April and November 2020. Patients had the option of traditional in clinic care or telemedicine with either in clinic pickup or mailing of medications. During this time, a no-test protocol for medication abortion without prior labs or ultrasound was in place for eligible patients. The primary outcome was the rate of successful medication abortion without surgical intervention. Secondary outcomes included abortion-related complications. RESULTS: A total of 334 patients were dispensed mifepristone and misoprostol, 149 (44.6%) with telemedicine with in-person pickup of medications, 75 (22.5%) via telemedicine with medications mailed, and 110 (32.9%) via traditional in person visits. The overall rate of complete medication abortion without surgical intervention was 95.8%, with success rates of 96.8, 97.1, and 93.6% for the clinic pickup, mail, and clinic visit groups, respectively. Success for those without an ultrasound performed prior to the procedure was 96.6%, compared to 95.5% for those with ultrasound. We obtained follow-up data for 87.8% of participants. CONCLUSIONS: Medication abortion was safe and effective while offering multiple modes of care delivery including telemedicine visits without an ultrasound performed prior to dispensing medications. IMPLICATIONS: Incorporating telemedicine and a no-test protocol for medication abortion is safe and has the potential to expand access to abortion care. All care models had low rates of adverse events, which contradicts the idea that the Risk Evaluation and Mitigation Strategyincreases the safety of medication abortion.


Assuntos
Abortivos , Aborto Induzido/métodos , COVID-19/prevenção & controle , Mifepristona , Misoprostol , Telemedicina/métodos , Aborto Induzido/efeitos adversos , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/tendências , Feminino , Hawaii , Humanos , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal
13.
BMC Womens Health ; 21(1): 98, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663467

RESUMO

BACKGROUND: Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency. CASE PRESENTATION: We present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful. CONCLUSIONS: Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.


Assuntos
Aborto Induzido , Obstrução Intestinal , Perfuração Uterina , Aborto Induzido/efeitos adversos , Adolescente , Adulto , Camarões , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Gravidez , Perfuração Uterina/etiologia , Perfuração Uterina/cirurgia
14.
Artigo em Inglês | MEDLINE | ID: mdl-33689917

RESUMO

OBJECTIVE: To clarify the natural history of retained products of conception (RPOC) following abortion at less than 22 weeks of gestation, and those who show major bleeding during course observation. STUDY DESIGN: We retrospectively reviewed 640 patients who had spontaneous or artificial abortion at less than 22 weeks of gestation between January 2011 and August 2019 in our institute. Of those, patients with RPOC were included. The maternal background, RPOC characteristics, and subsequent complications including additional interventions were reviewed. RESULTS: Fifty-four patients with RPOC were included. The incidence of RPOC was 6.7 %. The median (interquartile range: IQR) RPOC length was 29 (20-38) mm. RPOC hypervascularity was observed in 26 (48 %) patients. The median (IQR) periods of RPOC flow disappearance and RPOC disappearance on ultrasound from abortive treatment were 50 (28-76) and 84 (50-111) days, respectively. Of the 54, 44 patients were selected for expectant management. Of the 44, 34 (77 %) patients were observed without intervention (recovery group); the other 10 (23 %) patients required additional interventions associated with subsequent bleeding (intervention group). Compared with the recovery group, heavy bleeding (> 500 mL) at abortion (6/10: 60 %) and RPOC hypervascularity (8/10: 80 %) were more frequently observed in the intervention group. CONCLUSION: Expectant management was successful in almost 80 % of patients with RPOC following abortion. The additional interventions were required in patients with heavy bleeding at abortion and RPOC hypervascularity.


Assuntos
Aborto Induzido , Aborto Espontâneo , Complicações na Gravidez , Aborto Induzido/efeitos adversos , Aborto Espontâneo/epidemiologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Conduta Expectante
15.
BMC Pregnancy Childbirth ; 21(1): 130, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579224

RESUMO

BACKGROUND: Ectopic pregnancy is an abnormal condition in which implantation of the blastocyst occurs outside the endometrium of the uterus. It is gynecological important, particularly in the developing world, because of associated with enormous rate of high morbidity, during the first trimester of pregnancy. A better understanding of its risk factors can help to prevent its prevalence. However, the determinants of ectopic pregnancy are not well understood and few researches conducted in our country were based on secondary data covering small scale area. This study aimed to identify determinants of ectopic pregnancy among pregnant women attending referral hospitals in Southwestern part of Oromia regional state, Southwest Ethiopia. METHODS: Hospital-based case control study was employed from June 1 to September 30, 2019. The study was conducted in five referral hospitals in Southwestern part of Oromia regional state. Final sample size includes 59 cases and 118 controls. Data were entered by using Epidata version 3.1 and analyzed using SPSS version 23. Descriptive statistics were used to explore the data. All explanatory variables with p-value of < 0.25 in bi-variable analysis, then entered into multivariable logistic regression. Associated factors were identified at 95% confidence interval (p < 0.05). RESULTS: Out of 177 (59 cases and 118 controls) participants, 174 (58 cases and 116 controls) were participating in the study. Prior two or more induced abortions [AOR = 3.95:95% CI: 1.22-13.05], previous history of caesarean section [AOR = 3.4:95% CI: 1.11-10.94], marital status (being single) [AOR = 4.04:95%CI: 1.23-13.21], reporting prior recurrent sexual transmitted infection [AOR = 2.25:95%CI: 1.00-5.51], prior history of tubal surgery [AOR = 3.32:95%CI: 1.09-10.13], were more likely to have an ectopic pregnancy with their respective AOR with 95%CI. CONCLUSION: It was found that having a history of more than two induced abortions during previous pregnancies, marital status (single), recurrent sexual transmitted infection, prior history of tubal surgery and experiencing prior caesarean section were found to be determinants of ectopic pregnancy. Hospitals should give emphasis on prevention and early detection of risks of ectopic pregnancy and create awareness in order to reduce the burden of ectopic pregnancy.


Assuntos
Aborto Induzido/efeitos adversos , Cesárea/efeitos adversos , Gravidez Ectópica/etiologia , Doenças Sexualmente Transmissíveis/complicações , Adulto , Estudos de Casos e Controles , Etiópia , Feminino , Hospitais Públicos , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal , Encaminhamento e Consulta , Fatores de Risco
16.
BMJ Glob Health ; 6(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33514590

RESUMO

INTRODUCTION: Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women's experience of abortion care in Africa. METHODS: A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women's characteristics, clinical information and women's experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS: There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%). CONCLUSION: There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women's experiences of abortion care.


Assuntos
Aborto Induzido , Aborto Induzido/efeitos adversos , África ao Sul do Saara/epidemiologia , Estudos Transversais , Feminino , Instalações de Saúde , Humanos , Gravidez , Organização Mundial da Saúde
18.
Obstet Gynecol ; 137(1): 100-107, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33278292

RESUMO

OBJECTIVE: To evaluate whether high-frequency transcutaneous electrical nerve stimulation (hfTENS) reduces pain during medication abortion. METHODS: We conducted a randomized, placebo-controlled trial. Participants who were undergoing medication abortion with mifepristone and misoprostol through 70 days of gestation either received active 80 Hz hfTENS or sham to use for a minimum of 60 minutes within 8 hours of misoprostol. Maximum pain on an 11-point numerical rating scale at 8 hours after misoprostol was the primary outcome. We estimated 20 per group for 80% power to detect a 2-point difference and up to 10% attrition. Secondary outcomes included a maximum pain score at 24 hours, additional analgesia use, the difference in score before and after treatment, the experience of side effects, abortion outcomes, and acceptability. We collected data at baseline, time of misoprostol (0-hour), 8-hour and 24 hours using real-time electronic surveys, and at follow-up. RESULTS: Between June 2019 and March 2020, we screened 251 patients and randomized 40-20 each to hfTENS or sham-with one postrandomization exclusion and two patients lost to follow-up. Baseline characteristics were similar. Median maximum pain scores at 8 hours were 7.0 (interquartile range 3.0) and 10.0 (interquartile range 3.0) for hfTENS and sham, respectively. The distribution of these scores was lower among hfTENS users compared with sham (mean rank 15.17 vs 22.63, P=.036). High-frequency TENS users also experienced a significant reduction in posttreatment pain score (-2.0 [interquartile range 2.5] vs 0 [interquartile range 1.5], P=.008). We found no statistically significant differences in use of additional analgesia, distribution of maximum pain scores at 24 hours, side effects, or measures of acceptability. CONCLUSION: High-frequency TENS reduced maximum pain scores within 8 hours of misoprostol and reduced pain scores immediately after treatment compared with placebo. High-frequency TENS offers an effective nonpharmacologic option for pain management during medication abortion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03925129.


Assuntos
Aborto Induzido/efeitos adversos , Dor Processual/prevenção & controle , Estimulação Elétrica Nervosa Transcutânea/estatística & dados numéricos , Abortivos não Esteroides , Abortivos Esteroides , Adolescente , Adulto , Feminino , Humanos , Mifepristona , Misoprostol , Dor Processual/etiologia , Autocuidado , Adulto Jovem
19.
Int J Gynaecol Obstet ; 153(1): 125-129, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33043458

RESUMO

OBJECTIVE: To determine the efficacy and safety of intra-cardiac lidocaine administration to induce fetal demise before second-trimester medication abortion in a teaching hospital in Addis Ababa, Ethiopia. METHODS: We performed a retrospective chart review to collect selected sociodemographic and clinical information. All patients who received fetal intra-cardiac lidocaine between January 1, 2019 and April 30, 2019 were included in the study. Fetal demise was considered successful if achieved within 24 hours after fetal intra-cardiac lidocaine administration. We analyzed the data using SPSS version 20. We used frequency tables to describe the data and performed a multivariable analysis to determine associations between variables. RESULTS: A total of 80 fetuses were given intra-cardiac lidocaine.The mean gestational age was 23+1  weeks (range 21+0 -27+5  weeks). Twenty-four hours after lidocaine administration 76 (95%) pregnancies showed negative fetal cardiac activity. Fetuses at gestational ages of 21-23+6  weeks were five times more likely to have negative cardiac activity compared with those with gestational ages between 24 and 28 weeks (P=0.001). Two women developed nausea, vomiting, and a metallic taste, but no serious adverse events were reported. CONCLUSIONS: Intra-cardiac lidocaine is effective at inducing fetal demise before late second-trimester medication abortion with no associated serious adverse events or complications.


Assuntos
Aborto Induzido/métodos , Morte Fetal/etiologia , Lidocaína/administração & dosagem , Aborto Induzido/efeitos adversos , Adolescente , Adulto , Etiópia , Feminino , Coração Fetal , Idade Gestacional , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Adulto Jovem
20.
Ann Emerg Med ; 77(2): 221-232, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33341294

RESUMO

Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges. This article reviews the epidemiology and background of abortion care, including the range of symptoms and adverse effects that are within the scope of an uncomplicated procedure. This review also offers a comprehensive overview of management of abortion complications, including algorithms for more common complications and descriptions of less common but more severe adverse events. The article concludes with a recognition of the social stigma and legal regulations unique to abortion care.


Assuntos
Aborto Induzido/efeitos adversos , Assistência ao Convalescente , Medicina de Emergência/métodos , Feminino , Humanos , Gravidez
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