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1.
Artigo em Inglês | MEDLINE | ID: mdl-32029379

RESUMO

Abortion care is a fundamental part of women's reproductive health care. Surgical and medical abortion methods are safe and effective throughout the gestational age range wherein abortions are performed. Although risks increase with the gestational age of the pregnancy being terminated, rates of complications remain low and comparable between surgical and medical techniques. A high-quality abortion service should offer women a choice between abortion methods and provide the one they prefer.


Assuntos
Aborto Induzido/métodos , Aborto Induzido/tendências , Feminino , Idade Gestacional , Humanos , Gravidez , Saúde da Mulher
2.
Artigo em Inglês | MEDLINE | ID: mdl-31937493

RESUMO

Globally, many women undergo unsafe abortion, although abortion is extremely safe when done in accordance with recommended guidelines. Hence, many women suffer from abortion-related complications, and unsafe abortion remains a major cause of maternal mortality. The high percentage of unsafe abortion is attributed to the inability of women to access safe abortion services. A critical barrier to access is the lack of trained providers. To address this problem, task sharing and the expansion of health worker roles in abortion care have become a public health strategy to mitigate health worker shortages and reduce unsafe abortion. This chapter provides an overview of the WHO guidance on task sharing in safe abortion care, discusses the special role of physicians, and highlights the complexity of implementing task sharing by analyzing the findings from six country case studies.


Assuntos
Aborto Induzido , Papel do Médico , Médicos , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Feminino , Acesso aos Serviços de Saúde , Humanos , Mortalidade Materna , Guias de Prática Clínica como Assunto , Gravidez , Saúde da Mulher , Organização Mundial da Saúde
3.
Artigo em Inglês | MEDLINE | ID: mdl-31859163

RESUMO

Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.


Assuntos
Aborto Induzido/métodos , Autogestão , Feminino , Humanos , Gravidez , Saúde da Mulher
5.
Medicine (Baltimore) ; 98(40): e17396, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577749

RESUMO

Oral mifepristone combined with rivanol lactate (rivanol) is commonly used in second-trimester pregnancy termination. However, rivanol is not suitable to premature rupture of membranes and oligohydramnios because amniocentesis is difficult. Mifepristone combined with misoprostol is suitable for the patients with oligohydramnios. In accordance with the misoprostol dosing recommendations by the International Federation of Gynecology and Obstetrics (FIGO), the incidences of uterine rupture and cervical laceration are relatively high in Chinese pregnant women. The aim of our study was to optimize misoprostol dosing regimen in terms of efficacy and safety in Chinese pregnant women.We modified the Bishop Score, and then gave patients low-dose misoprostol according to the modified Bishop score. Based on the amniotic fluid volume (AFV) indicated by type-B ultrasonic instrument, the cases with AFV ≤2 cm receiving low-dose misoprostol combined with mifepristone and the cases with amniocentesis failure followed by receiving low-dose misoprostol combined with mifepristone were enrolled into study group, and the cases with AFV >2 cm receiving rivanol combined with mifepristone were enrolled into control group. The start time of uterine contractions, time of fetal expulsion, birth process, hospital day, successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were observed and compared between the 2 groups.There were significant differences in the start time of uterine contractions, time of fetal expulsion, birth process, and hospital day between the control group and the study group (all P < .05). The successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were also significantly different between the 2 groups (all P < .05).In the induced labor of 16 to 28 weeks pathological pregnancy, low-dose misoprostol can markedly improve the successful induced labor rate and complete induced labor rate, shorten the birth process and hospital day, and decrease uterine curettage rate and uterine rupture risk. Low-dose misoprostol combined with mifepristone is suitable to the induced labor of 16 to 28 weeks pathological pregnancy in Chinese women.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Complicações na Gravidez/terapia , Segundo Trimestre da Gravidez , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Asiático , China , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Mifepristona/administração & dosagem , Mifepristona/efeitos adversos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Oligo-Hidrâmnio/terapia , Gravidez , Fatores de Tempo , Ruptura Uterina/prevenção & controle
6.
Sex Reprod Health Matters ; 27(1): 1571311, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533561

RESUMO

In the setting of increasing restrictions to legal abortion in the United States, reports have emerged of self-induced termination of pregnancies with misoprostol, obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion, and how they access information. In a cross-sectional study of women immediately following their abortion at three reproductive health clinics in the Midwestern United States, an anonymous survey queried gestational age, barriers, online investigation about self-induction and opinions concerning the availability of medical abortion. From June to September 2016, 276 women participated out of 437 presenting to the clinics during the study period. One hundred and ninety-one (74.6%) women had investigated abortion options online, and of those, 58 (30.9%) investigated misoprostol online, for home use. Women who investigated online options were less likely to have had a prior abortion than those who did not investigate online (29.3% vs. 63.1%, p < .01). They were also more likely to report prior home attempts to end this pregnancy (8.6% vs. 0%, p = .05). Overall, four (1.6%) of the respondents purchased misoprostol and three (1.2%) used it. A majority of women seeking an abortion sought online information prior to their clinic appointment, and almost a third of those had investigated misoprostol for home use. Women are accessing information regarding misoprostol for self-induction of abortion on the Internet. As barriers to legal abortion increase, women may be more likely to self-induce abortion.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Aborto Induzido/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Misoprostol/uso terapêutico , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos Transversais , Uso de Medicamentos , Feminino , Acesso aos Serviços de Saúde , Humanos , Comportamento de Busca de Informação , Serviços de Saúde Materna , Meio-Oeste dos Estados Unidos , Gravidez , Saúde Reprodutiva , Automedicação , Inquéritos e Questionários , Adulto Jovem
7.
Int J Gynaecol Obstet ; 147(3): 301-312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493314

RESUMO

BACKGROUND: Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. OBJECTIVES: To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. SEARCH STRATEGY: Research databases from January 2006 to October 2018. SELECTION CRITERIA: Randomized controlled trials with IUFD cases at 14-28 weeks of gestation. DATA COLLECTION AND ANALYSIS: We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. MAIN RESULTS: Sixteen trials from 1695 citations. When misoprostol is used alone, 400 µg is more effective than 200 µg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low. CONCLUSIONS: Misoprostol 400 µg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.


Assuntos
Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido/métodos , Morte Fetal , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Aborto Induzido/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Afr J Reprod Health ; 23(2): 148-151, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31433602

RESUMO

After years of the worsening burden of unsafe abortion and attendant morbidities and mortalities in Nigeria, a National Guideline on the Safe termination of pregnancy for legal indications was enunciated. This report presents and discusses an illustrative case of a hydranencephaly that benefited from it. A 43-year old multipara was informed during routine ultrasonography at booking for antenatal care, at 16 weeks of gestation, of a major defect in her baby and advised to meet her physician. Following a repeat high- resolution ultrasonography and discussions between the Obstetricians, Neurosurgeon, and Ultrasonologist, the woman was counseled on the diagnosis. At her insistence and provision of written consent, medical abortion with Mifepristone and Misoprostol was successfully instituted.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Hidranencefalia/diagnóstico por imagem , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides , Administração Oral , Adulto , Feminino , Humanos , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Gravidez , Segundo Trimestre da Gravidez , Resultado do Tratamento
9.
BMC Health Serv Res ; 19(1): 476, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296200

RESUMO

BACKGROUND: The use of medication abortion is increasing rapidly in India, the majority of which is purchased through pharmacies. More information is needed about the quality of services provided by pharmacist about medication abortion, especially barriers to providing high quality information. The goal of this study was to explore the quality of pharmacist medication abortion provision using mixed methods to inform the developed of an intervention for this population. METHODS: Data was collected via convenience sampling using three methods: a quantitative survey of pharmacists (N = 283), mystery clients (N = 111), and in-depth qualitative interviews with pharmacist (N = 11). Quality indictors from the quantitative data from surveys and mystery clients were compared. Qualitative interviews were used to elucidate reasons behind findings from the quantitative survey. RESULTS: Quality of information provided to client purchasing medication abortion was low, especially related to timing and dosing of misoprostol (18% of pharmacists knew correct timing) and side effects (31% not telling any information on side effects). Mystery clients reported lower quality (less correct information) than pharmacists reported about their own behaviors. Qualitative interviews suggested that many barriers exist for pharmacists, including perceptions about what information clients can understand and desire, and also lack of comfort giving certain information to certain types of clients (young women). CONCLUSIONS: It is essential to improve the quality of information given to client purchasing medication abortion from pharmacists. Our findings highlight specific gaps in knowledge and reasons for poor quality information. Differences in guidelines available at that time from the Indian Government, World Health Organization, and the medication abortion boxes may lead to confusion amongst pharmacists and potentially clients. Interventions need to improve both knowledge about medication abortion and also biases in the provision of care.


Assuntos
Aborto Induzido/métodos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Disseminação de Informação , Farmacêuticos/psicologia , Qualidade da Assistência à Saúde , Adulto , Feminino , Humanos , Índia , Masculino , Misoprostol/administração & dosagem , Farmacêuticos/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
10.
Eur J Contracept Reprod Health Care ; 24(4): 319-321, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204845

RESUMO

Purpose: The European Society of Contraception Expert Group on Abortion identified as one of its priorities the need to disseminate up-to-date evidence-based information on the use of urine pregnancy tests by women for the self assessment of the success of early medical abortion (EMA). Methods and materials: A concise communication was produced which summarises the latest research in an easy-to-read format suitable for busy clinicians. Information about individual urinary pregnancy tests is presented in boxes for ease of reference. Results: Urinary pregnancy tests (low sensitivity, high sensitivity and multilevel) can be used in combination with signs and symptoms of pregnancy to exclude an ongoing pregnancy after EMA. Conclusion: Women are able to determine the success of early medical abortion (EMA) themselves using a combination of signs, symptoms and a urine pregnancy test. This simplifies EMA, expands the range of professionals able to provide EMA and most importantly gives women greater control over their bodies and treatment.


Assuntos
Aborto Induzido , Testes de Gravidez/métodos , Gravidez/urina , Abortivos Esteroides/uso terapêutico , Aborto Induzido/métodos , Feminino , Humanos , Mifepristona/uso terapêutico , Autoavaliação
11.
Afr Health Sci ; 19(1): 1544-1553, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148982

RESUMO

Backround: A retrospective (case-controlled) study was conducted with the aim of identifying the effect of the use of misoprostol on termination time in patients who did and did not undergo feticide procedures in second trimester pregnancy terminations. Methods: The sampling of the study consisted of 144 pregnant women who were diagnosed as having major fetal anomalies incompatible with life, and were recommended for termination of pregnancy. The investigation showed that feticide procedures were performed for 99 women, and feticide procedures were not performed for 45 women. Misoprostol protocol was administered for 48 hours in the termination period; whether the feticide procedure directly affected the termination duration in patients who did and did not undergo feticide was evaluated. Results: Abortion/birth was achieved in 103 (71.5%) women during the first 48 hours. There was no significant difference between the termination duration of the misoprostol protocol among the women who did and did not undergo feticide. There was no significant difference between the termination durations and fetal biometric measurements (BPD, HC) except head diameters (p=0.020 and p=0.015). Conclusions: The misoprostol protocol is shown to be effective and safe for the termination of pregnancies during the second trimester. Feticide has no affect on the duration of termination.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/métodos , Misoprostol/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Administração Intravaginal , Administração Oral , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Misoprostol/efeitos adversos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
12.
PLoS One ; 14(5): e0217245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150440

RESUMO

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.


Assuntos
Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/genética , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Aborto Induzido/métodos , Adolescente , Adulto , Argentina , Chlamydia trachomatis/patogenicidade , Feminino , Genótipo , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Prevalência , Estudos Prospectivos , Fatores de Risco , Comportamento Sexual , Adulto Jovem
13.
Int J Gynaecol Obstet ; 146(3): 302-307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31152593

RESUMO

OBJECTIVES: To assess the severity of complications following misoprostol used to induce abortion compared with other methods among women admitted for postabortion complications. METHODS: A cross-sectional study of women who presented with complications of induced abortion at nine secondary and tertiary hospitals in South West Nigeria between April 1, 2013 and May 31, 2014. Face-to-face interviews were conducted and information on the current admission was extracted from patient records. Associations between abortion method used and severity of abortion complications were evaluated using χ2 and Fisher exact tests. RESULTS: Of 522 women included in the study, 177 reported an induced abortion: 41 women (23.2%) had used misoprostol at the first attempt to induce abortion, whereas 79 (44.6%) women had undergone surgical abortion. Occurrence of fever (P=0.06), bleeding (P=0.3), and lower abdominal pain (P=0.32) was not significantly different between the misoprostol and surgical abortion/other methods groups. Severe complications were rare with misoprostol, but more common among women in the surgical abortion/other methods group. Maternal mortality occurred only among women in the surgical abortion/other methods group. CONCLUSION: Use of misoprostol for induced abortion was associated with fewer complications and no maternal mortality compared with surgical abortion/other methods.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/métodos , Misoprostol/administração & dosagem , Aborto Induzido/efeitos adversos , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Mortalidade Materna , Nigéria , Gravidez , Estudos Prospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
14.
PLoS One ; 14(5): e0216738, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083665

RESUMO

INTRODUCTION: Abortion is legal in India and medication abortion (MA) using a combined regimen of mifepristone and misoprostol is the preferred method. Users increasingly purchase MA kits directly from pharmacies, in some cases experiencing perceived complications and approaching a facility for care. We present findings of a qualitative research tracing the decision-making pathway(s) of MA users in Uttar Pradesh, India, to help understand knowledge and behaviour gaps, and recommend ways to improve the overall quality of care at these service delivery points. METHODS: Forty in-depth interviews were conducted with recent MA users (20 each of clinic and pharmacy clients) across three districts. Providers were purposively selected in collaboration with an international organization selling MA kits, using their list of pharmacies and clinics. MA users were identified from the clients of the selected providers, and additionally through the snow ball method. Interviews were conducted in Hindi with verbal informed consent in a private place convenient to the respondent. Transcripts were translated to English and analysed thematically. RESULTS: Users first sought MA kits at pharmacies out of convenience, low cost and customer anonymity. Men often purchased kits for their partners and trusted the chemist for guidance on dosage, progression and side effects. For side effects or other concerns after using an MA kit, users first visited their neighbourhood doctor or traditional practitioner. These providers either attempted to treat the issue and failed, or directly advised her to consult a gynaecologist. The final point of care was gynaecologists, preferably female private practitioners with their own clinics. They diagnosed most abortion-related cases as incomplete abortions, emptying the uterus using the dilation and curettage method. Comparatively low cost and convenience made users inclined towards repeat use of MA. CONCLUSION: There are information gaps at various stages in the MA pathway that need to be addressed. Large scale public information programmes are required on safe abortion care- when is it legal, where to obtain MA, dosage, side effects and signs of possible complications. Pharmacists could be trained or incentivized to improve their quality of care to facilitate adequate exchange of information on MA. Since, for most couples, the male partner purchases MA, information approaches or tools are needed that pharmacists can give men to share directly with the MA user.


Assuntos
Aborto Induzido/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido/efeitos adversos , Aborto Induzido/psicologia , Adulto , Tomada de Decisões , Feminino , Ginecologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Masculino , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Farmácias , Gravidez , Pesquisa Qualitativa , Adulto Jovem
15.
Reprod Health ; 16(1): 68, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138253

RESUMO

BACKGROUND: Despite the legalization of abortion services in 2002, unsafe abortion (abortion services conducted by persons lacking necessary skill or in substandard settings or both) continues to be a public health concern in Nepal. There is a lack of national research exploring the characteristics of women who choose to have an abortion. This study assessed abortion in Nepal and its correlates using data from a nationally representative population-based cross-sectional survey. METHODS: We employed data from the Nepal Demographic and Health Survey 2016. Sample selection was based on stratified two-stage cluster sampling in rural areas and three-stage sampling in urban areas. The primary outcome is report of induced abortion in the 5 years preceding the survey, as recorded in the pregnancy history. All values were weighted by sample weights to provide population-level estimates. Bivariate and multivariate logistic regressions were performed using STATA 14 considering cluster sampling design. RESULTS: A total of 12,862 women of reproductive age (15-49 years) were interviewed. Overall, 4% (95% CI: 3.41-4.29) reported an abortion within the last 5 years (and less than 1% had had more than one abortion during that time). A higher proportion of women aged 20-34 years (5.7%), women with primary education (5.1%), women aware of abortion legalization (5.5%), and women in the richest wealth quintile (5.4%) had an abortion in the past 5 years. Compared to women aged < 20 years, women aged 20-34 years had higher odds (AOR: 5.54; 95% CI: 2.87-10.72) of having had an abortion in the past 5 years. Women with three or more living children had greater odds (AOR: 2.24; 95% CI: 1.51-3.31) of having had an abortion than women with no living children. The odds of having an abortion in the past 5 years increased with each wealth quintile, with the richest wealth quintile having almost three-fold greater odds of having had an abortion. No significant association was observed between having an abortion and the ecological zone and place of residence. CONCLUSION: This nationally representative study shows that abortion is associated with women's age, knowledge of abortion legality, wealth status, number of living children, and caste/ethnicity. Targeted interventions to young women, those in the poorest wealth quintile, women from Terai caste groups, and those who reside in Province 2 would be instrumental to address disproportional access to abortion services. Overall, strengthening contraceptive provision and abortion education programs would be cornerstone to improving the health of women and girls in Nepal.


Assuntos
Aborto Induzido/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Aborto Induzido/métodos , Aborto Induzido/psicologia , Adulto , Estudos Transversais , Escolaridade , Características da Família , Feminino , Humanos , Pessoa de Meia-Idade , Nepal , Gravidez , População Rural , Adulto Jovem
16.
Fertil Steril ; 111(4): 609-610, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30929717

RESUMO

Endometrial receptivity is an essential component of the complex process of embryo implantation. Its existence is inferred from the observation that not all embryo transfers result in pregnancy. The endometrium is a unique tissue which undergoes dramatic and rapid changes throughout the menstrual cycle. There appears to be a window of implantation, a time of optimal endometrial receptivity, when embryos are most likely to implant. The assessment of the timing and duration of this window of implantation has been a topic of interest and debate since the 1950s. The existence of the window of implantation led to the development of cycles in which endometrial receptivity is induced with exogenous E2 and P. These cycles are essential to third party parenting and frozen embryo transfers and have therefore become a common part of the practice of assisted reproduction.


Assuntos
Aborto Induzido/métodos , Técnicas de Diagnóstico Obstétrico e Ginecológico , Implantação do Embrião/fisiologia , Endométrio/fisiologia , Cuidado Pré-Concepcional/métodos , Implantação Tardia do Embrião/fisiologia , Transferência Embrionária/métodos , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Humanos , Gravidez
17.
J Obstet Gynaecol ; 39(6): 799-804, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30999795

RESUMO

Most hospitals in Great Britain only offer a medical termination of pregnancy for a fetal anomaly (TOPFA) in the second trimester. We describe the safety and acceptability of a surgical TOPFA service delivered by an independent-sector abortion provider. Non-identifiable data for women undergoing TOPFA at British Pregnancy Advisory Service from 1 January 2015 to 31 March 2016 was extracted from existing databases. Anonymous feedback was obtained using a questionnaire. Women (n = 389) were treated along a specialised care pathway within routine abortion lists. The anomalies were chromosomal (64.0%), structural (30.8%), suspected chromosomal and/or structural or unknown (5.1%). The termination method was vacuum aspiration (41.9%) or dilation and evacuation (58.1%). No complications were reported. Feedback (173 women, 122 partners) indicated care was sensitive (99.6%), supportive (100.0%), knowledgeable (99.2%), and helpful (100.0%). Most (92.1%) reported the right amount of partner involvement. All of the respondents were likely/very likely to recommend the service. A cross-sector approach safely and satisfactorily increases the choice of TOPFA methods. Impact Statement What is already known on this subject? A surgical abortion in the first and second trimesters has been demonstrated to be safe and acceptable, if not preferable, to a medical induction for most women, including those seeking a termination of pregnancy for a foetal anomaly (TOPFA). However, most hospitals in Britain only offer a medical TOPFA in the second trimester, often due to a lack of skills to provide a surgical alternative. The lack of choice of method has a negative impact on women's experiences of TOPFA care. Independent sector abortion clinics provide the majority of surgical abortions in the second trimester in Britain, and are therefore a potential site of surgical TOPFA care. What do the results of this study add? Women and NHS service providers can be reassured that when a dedicated care pathway for TOPFA is employed in the context of routine abortion provision in the independent sector, the choice of termination method can be safely and satisfactorily increased. What are the implications of these findings for clinical practice and/or further research? The main implication is the raising of awareness among NHS providers of the availability and acceptability of this model of TOFPA service delivery, so it can become an option for more women who do not want to have a medical induction. We hope that the demonstration of some women's preferences for surgical TOPFA and the safety of this option will lead to development of this service within routine abortion lists within hospital settings. Further research could include determining the reasons why women and their partners may ultimately not choose to pursue a surgical TOPFA within the independent sector abortion service and an in-depth exploration of women's experiences of being treated within this setting.


Assuntos
Aborto Induzido/métodos , Aberrações Cromossômicas/embriologia , Anormalidades Congênitas/embriologia , Serviços de Saúde Reprodutiva , Adolescente , Adulto , Feminino , Humanos , Obstetrícia , Satisfação do Paciente , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Inquéritos e Questionários , Reino Unido , Adulto Jovem
19.
BJOG ; 126(9): 1094-1102, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30869829

RESUMO

BACKGROUND: Telemedicine is increasingly being used to access abortion services. OBJECTIVE: To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine. SEARCH STRATEGY: We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017. STUDY CRITERIA: We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service). DATA COLLECTION AND ANALYSIS: Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis. MAIN RESULTS: Rates relevant to success rate, safety, and acceptability outcomes for women ≤10+0 weeks' gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10+0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers. CONCLUSION: Based on a synthesis of mainly self-reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in-person abortion care, and surgical evacuation rates are higher. TWEETABLE ABSTRACT: A systematic review of medical abortion through telemedicine shows outcome rates similar to in-person care.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Aborto Induzido/métodos , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Pesquisa Qualitativa , Autorrelato , Telemedicina/métodos
20.
J Med Case Rep ; 13(1): 53, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30841899

RESUMO

BACKGROUND: Cesarean scar pregnancy is rare but may be related to early uterine rupture and may result in massive hemorrhage. Nowadays, most cesarean scar pregnancies are diagnosed early and can be managed properly. However, diagnoses of cesarean scar pregnancies that develop in the obstetrical area are sometimes delayed. CASE PRESENTATION: A 28-year-old Asian woman visited our institution because of suspected cesarean scar pregnancy. Ultrasonography and computed tomography confirmed a cesarean scar pregnancy with a live fetus with a crown-rump length of 4.83 cm, corresponding to 11 weeks 6 days of gestation. Initially, we injected 50 mg of methotrexate in the amniotic sac under transabdominal ultrasonographic guidance. However, fetal cardiac activity was still observed 2 days later. We decided to perform open laparotomy because of the possibility of massive bleeding. The gestational sac was removed, as well as most of the trophoblastic tissues that were adherent and invading the wall of the lower uterine segment. She was discharged in good condition 5 days after the operation. CONCLUSIONS: Despite the popular use of ultrasonography in prenatal care, diagnosis of cesarean scar pregnancy is still delayed. Surgical treatment with local methotrexate injection could be an option for the management of advanced cesarean scar pregnancy.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/métodos , Cesárea/efeitos adversos , Cicatriz/patologia , Metotrexato/administração & dosagem , Gravidez Ectópica/patologia , Adulto , Diagnóstico Tardio , Feminino , Humanos , Laparotomia , Gravidez , Gravidez Ectópica/terapia , Resultado do Tratamento
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