Aborto provocado: redução da frequência e gravidade das complicações. Consequência do uso de misoprostol?

The use of misoprostol in the termination of pregnancy: a review of studies carried

The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.

The use of misoprostol in the termination of pregnancy: a review of studies carried

Abstract The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.

Advantages and Disadvantages of Medical Abortion, According to Brazilian Residents in Obstetrics and Gynaecology

OBJECTIVE

 To find out which was the opinion of residents in obstetrics and gynecology about the advantages and disadvantages of medical abortion as compared with surgical procedures.

METHOD

 Cross-sectional multicenter study among residents in obstetrics and gynecology from 21 maternity hospitals located in 4 different geographical regions of Brazil, using a self-responded questionnaire with 31 questions related to their opinion and experience on providing abortion services.

RESULTS

 Most residents agreed that "being less invasive" (94.7%), "does not require anesthesia" (89.7%), "can be accompanied during the process" (89.1%), "prevents physical trauma" (84.4%) were the main advantages of medical abortion.

CONCLUSION

 Residents perceived both clinical and personal issues as advantages of medical abortion.

Abortion and health in Brazil: challenges to research within a context of illegality

Abortion research faces great challenges, even more so in contexts in which it is illegal. Women tend to omit the voluntary termination of pregnancy or to declare having miscarried, which results in an underestimation of abortions. Research on this subject is indispensable because it enables us to estimate the incidence of abortion and its complications, and to identify unmet demands and more vulnerable groups so as to subsidize health actions and policies. In this article, we seek to describe the main challenges faced by researchers through a review of original studies on abortion and our reflections based on empirical studies we have conducted. We discuss the difficulties in obtaining information, strategies and techniques used to increase accuracy and reliability and their limits and advantages, and strategies for estimating the occurrence of abortion and its complications, using direct (interviews and data from medical charts) and indirect (secondary data on mortality and morbidity) methods. When investigating abortion complications, we address studies on mortality and morbidity, emphasizing the specificities of abortion among obstetric causes. We discuss the main indicators used by researchers and methodological aspects of their construction. We make recommendations for overcoming methodological problems and conducting new studies. In the conclusion, we reiterate the relevance of research on abortion and the need for approaches that contemplate its complexity.

Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018

O objetivo deste estudo é atualizar o conhecimento sobre o aborto inseguro no país. Foi realizada uma revisão sistemática com busca e seleção de estudos via MEDLINE e LILACS, sem restrição de idiomas, no período 2008 a 2018, com avaliação da qualidade dos artigos por meio dos instrumentos elaborados pelo Instituto Joanna Briggs. Foram avaliados 50 artigos. A prevalência de aborto induzido no Brasil foi estimada por método direto em 15% no ano de 2010 e 13% no ano de 2016. Prevalências mais elevadas foram observadas em populações socialmente mais vulneráveis. A razão de aborto induzido por 1.000 mulheres em idade fértil reduziu no período 1995-2013, sendo de 16 por 1.000 em 2013. Metade das mulheres referiu a utilização de medicamentos para a interrupção da gestação e o número de internações por complicações do aborto, principalmente complicações graves, reduziu no período 1992-2009. A morbimortalidade materna por aborto apresentou frequência reduzida, mas alcançou valores elevados em contextos específicos. Há um provável sub-registro de óbitos maternos por aborto. Transtornos mentais comuns na gestação e depressão pós-parto foram mais frequentes em mulheres que tentaram induzir um aborto sem sucesso. Os resultados encontrados indicam que o aborto é usado com frequência no Brasil, principalmente nas regiões menos desenvolvidas e por mulheres socialmente mais vulneráveis. O acesso a métodos mais seguros provavelmente contribuiu para a redução de internações por complicações e para a redução da morbimortalidade por aborto. Entretanto, metade das mulheres ainda recorre a outros métodos e o número de internações por complicações do aborto é ainda elevado.

Unsafe abortion: social determinants and health inequities in a vulnerable population in São Paulo, Brazil

This cross-sectional population-based study in a peripheral low-income community in São Paulo, Brazil, aimed to estimate the prevalence of unsafe abortion and identify the socio-demographic characteristics associated with it and its morbidity. The article discusses the study's results, based on univariate and multiple multinomial logistic regression analyses. The final regression models included: age at first intercourse < 16 years (OR = 4.80); > 2 sex partners in the previous year (OR = 3.63); more live born children than the woman's self-reported ideal number (OR = 3.09); acceptance of the abortion due to insufficient economic conditions (OR = 4.07); black ethnicity/color (OR = 2.67); and low schooling (OR = 2.46), all with p < 0.05. The discussion used an approach to social determinants of health based on the concept and model adopted by the WHO and the health inequities caused by such determinants in the occurrence of unsafe abortion. According to the findings, unsafe abortion and socio-demographic characteristics are influenced by the social determinants of health described in the study, generating various levels of health inequities in this low-income population.