What can we do as gynecologists/obstetricians to reduce unsafe abortion and its consequences? The uruguayan response

Sem informação1341S1S

El falso dilema de estar a favor o en contra del aborto

Conferencia dictada en Montevideo en julio de 2003 en el marco de la campaña a favor del proyecto de ley de Defensa de la Salud Reproductiva.http://www.mysu.org.uy/IMG/pdf/libro3.pd

[comprehensive Healthcare For Female Victims Of Sexual Violence: The Experience Of The Women's Comprehensive Healthcare Center, State University In Campinas, Brazil].

The Women's Comprehensive Healthcare Center (CAISM) has provided care for women who have suffered sexual violence since 1986. Since 1998, a special multidisciplinary team has been in charge of emergency and long-term care for victims of sexual violence. From August 1998 to May 2006, 1,174 women were treated, with an average of 150 per year in the last five years. During the same period, 71/109 women who became pregnant after rape had their pregnancies terminated, 23/109 continued the pregnancy to term, and 15/109 did not undergo abortion due to gestational age greater than 20 weeks. In Brazil, there are not enough public services to treat female victims of sexual violence who require legal abortion. Nationwide implementation of new services should be encouraged, in addition to all measures known to reduce the problem such as sex education in schools and widespread information and easy access to effective contraception.23465-

Overall and abortion‐related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights

To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter‐Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five‐year period, the variation in the percentage of abortion‐related deaths, and the correlation with HDI indicators were evaluated. Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10 years also coincides with a reduction in poverty and an improvement in the HDI. A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.1341S20S2

Perspectiva de médicos brasileiros sobre a estratégia da segunda opinião antes de realizar uma cesárea

OBJECTIVE: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. METHODS: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. RESULTS: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. CONCLUSION: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.OBJETIVO: Descrever a opinião dos médicos que participaram no Brasil do Estudo Latino-Americano de Cesárea sobre a estratégia da segunda opinião antes de decidir fazer uma cesárea. MÉTODOS: Setenta e dois médicos dos hospitais do grupo de intervenção, onde se implantou a estratégia da segunda opinião, e 70 do grupo controle auto-responderam um questionário estruturado e pré-testado. Prepararam-se tabelas descritivas para apresentar a freqüência das variáveis mais relevantes sobre a opinião dos médicos a respeito: da efetividade da implementação da estratégia da segunda opinião; se recomendariam ou não a sua implementação e as razões para não a recomendarem em instituições privadas; a factibilidade da sua implementação e as razões para não a considerarem factível em instituições privadas. RESULTADOS: Metade dos médicos dos hospitais de intervenção (50%) e cerca de dois terços do grupo controle (65%) consideraram que a estratégia da segunda opinião havia sido ou poderia ser eficaz para reduzir o número de cesáreas na instituição em que eles trabalhavam. A grande maioria dos médicos que responderam o questionário nos hospitais de intervenção e controle considerou que a estratégia seria factível em instituições públicas (87% e 95% respectivamente), mas não nas privadas (64% e 70% respectivamente), principalmente porque nessas últimas os médicos não aceitariam a interferência de um colega sobre a sua decisão de fazer uma cesárea. CONCLUSÃO: Embora a estratégia da segunda opinião tenha sido percebida como capaz de reduzir as taxas de cesariana, os médicos não a consideraram factível fora do sistema público de saúde no Brasil.23323

Brazilian doctors' perspective on the second opinion strategy before a C-section

OBJECTIVE: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. METHODS: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. RESULTS: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. CONCLUSION: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.OBJETIVO: Descrever a opinião dos médicos que participaram no Brasil do Estudo Latino-Americano de Cesárea sobre a estratégia da segunda opinião antes de decidir fazer uma cesárea. MÉTODOS: Setenta e dois médicos dos hospitais do grupo de intervenção, onde se implantou a estratégia da segunda opinião, e 70 do grupo controle auto-responderam um questionário estruturado e pré-testado. Prepararam-se tabelas descritivas para apresentar a freqüência das variáveis mais relevantes sobre a opinião dos médicos a respeito: da efetividade da implementação da estratégia da segunda opinião; se recomendariam ou não a sua implementação e as razões para não a recomendarem em instituições privadas; a factibilidade da sua implementação e as razões para não a considerarem factível em instituições privadas. RESULTADOS: Metade dos médicos dos hospitais de intervenção (50%) e cerca de dois terços do grupo controle (65%) consideraram que a estratégia da segunda opinião havia sido ou poderia ser eficaz para reduzir o número de cesáreas na instituição em que eles trabalhavam. A grande maioria dos médicos que responderam o questionário nos hospitais de intervenção e controle considerou que a estratégia seria factível em instituições públicas (87% e 95% respectivamente), mas não nas privadas (64% e 70% respectivamente), principalmente porque nessas últimas os médicos não aceitariam a interferência de um colega sobre a sua decisão de fazer uma cesárea. CONCLUSÃO: Embora a estratégia da segunda opinião tenha sido percebida como capaz de reduzir as taxas de cesariana, os médicos não a consideraram factível fora do sistema público de saúde no Brasil

Brazilian Doctors' Perspective On The Second Opinion Strategy Before A C-section.

To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.40233-

Mortality among childbearing-age women in Campinas, São Paulo (1985-1994)

To provide a profile of the main health problems in childbearing-age women, we studied all 3,086 death certificates from the SEADE Foundation for women from 10 to 49 years of age and residing in the municipality of Campinas, from January 1, 1985, to December 31, 1994. The primary cause of death was identified and classified according to the 10th review of the ICD. Population data were obtained from the Laboratory for Epidemiological Analyses and Research, UNICAMP. One-fourth of the deaths were cardiovascular in origin, one-fifth were from external causes, and almost 20% were due to neoplasms. Maternal mortality was the ninth cause of death. External causes predominated in the 10-to-34-year age group, as compared to cardiovascular diseases and neoplasms in the 35-to-49-year group. Most alarming were the predominance of traffic accidents among causes of death in women up to age 34 (greater than AIDS during the study period) and the high mortality rate from homicides.Com o fim de obter um perfil das principais doenças que afetam as mulheres em idade fértil, estudaram-se todas as 3.086 declarações de óbito de mulheres de 10 a 49 anos, residentes no Município de Campinas, Estado de São Paulo. Óbitos ocorridos entre primeiro de janeiro de 1985 e 31 de dezembro de 1994, fornecidos pela Fundação SEADE. A causa básica desencadeante do óbito foi identificada e classificada segundo a CID 10ª revisão. Os dados populacionais para o períodos foram obtidos do Laboratório de Análises e Pesquisas Epidemiológicas da UNICAMP. Um quarto dos óbitos foram por doenças cardiovasculares e um quinto por causas externas. A terceira causa, próxima a 20% do total, foi neoplasia. A mortalidade materna constituiu a nona causa de morte. As causas externas foram as principais causas de morte entre 10 e 34 anos. A partir dos 35 anos, predominaram as causas cardiovasculares e neoplasias. Chama a atenção o predomínio dos acidentes de trânsito como primeira causa de morte ate os 34 anos de idade, superando a AIDS durante o período estudado, assim como a alta mortalidade por homicídio.67167

Duration of Intraepithelial Neoplasia and Invasive Carcinoma of the Cervix in Relation to Age at Diagnosis

Purpose: to estimate the duration of cervical neoplasia from human pappilomavirus (HPV) infection to advanced invasive carcinoma, using as paremeter the mean age of the women at diagnosis. Methods: this cross-sectional study included 1,177 women with HPV infection, 1,561 with cervical intraepithelial neoplasia (CIN) and 773 with invasive carcinoma. Results: the mean ages of CIN 1 and CIN 2 on diagnosis were not statistically different. The mean duration of CIN 2 was 2.2 years. The mean duration of CIN 3 was 10.3 years, with 4.1 years as severe dysplasia and 6.2 years as carcinoma in situ (CIS). The mean duration of high grade squamous intraepithelial lesions was 12.5 years. The duration means of invasive carcinoma stages Ia, Ib and II were 3.0, 2.7 and 3.7 years, respectively. Conclusions: according to the results, CIN 1 and CIN 2 may arise directly from HPV infection and most of these lesions are transient. CIS presented the longest duration and the mean asymptomatic period of cervical neoplasia is 18.2 years. These results were discussed considering the present knowledge of the natural history of cervical carcinoma and other studies on duration of this neoplasia.Objetivo: estimar a duração e o tempo de evolução da neoplasia do colo uterino, a partir da infecção por papilomavírus humano (HPV) até as formas invasoras avançadas, tomando como parâmetro a idade média ao diagnóstico. Método: estudo observacional-transversal que incluiu 1.177 mulheres com infecção por HPV, 1.561 com neoplasia intra-epitelial cervical (NIV) e 773 com carcinoma invasor. Resultados: não houve diferença estatisticamente significante entre as médias de idade ao diagnóstico da NIC 1 e NIC 2. A duração da NIC 2 foi 2,2 anos e da NIC 3 foi 10,3 anos, sendo 4,1 anos como displasia grave e 6,2 anos como carcinoma in situ (CIS). A duração da lesão intra-epitelial escamosa de alto grau foi 12,5 anos e do carcinoma invasor estádio Ia, Ib e II foram, respectivamente, 3,0, 2,7 e 3,7 anos. Conclusões: de acordo com os resultados deste estudo, as NIC 1 e NIC 2 originam-se diretamente da infecção por HPV e a maioria das NIC 2 seria uma lesão transiente. A lesão de maior duração é o CIS e o tempo médio do período subclínico da neoplasia do colo uterino é de 18,2 anos. Estes resultados são discutidos em função do conhecimento mais atual da história natural do carcinoma do colo uterino e de outros estudos que estimaram a duração desta neoplasia.56556

Factors associated to knowledge and opinion of gynecologists and obstetricians about the Brazilian legislation on abortion

INTRODUCTION: Unsafe abortion accounts for about 12% of maternal deaths in Brazil, although many of these women could meet the requirements for legal abortion in this country. Physicians' inappropriate knowledge of the law may be playing a role in this situation. OBJECTIVE: To evaluate which factors are associated with the level of information and the opinion of the Brazilian gynecologists-obstetricians concerning abortion laws. METHODS: Questionnaires (14.320) were sent to all physicians affiliated to the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO), and 30.2% were returned completed. RESULTS: Most of respondents showed a good knowledge of the situations in which abortion is allowed but not about the documents required to carry out a legal abortion. However, most of them knew about the need for a judicial order in case of abortion of malformed fetus. Knowledge was associated with age, number of children and years of practice. DISCUSSION AND CONCLUSIONS: Poor knowledge on the requirements to carry out an abortion within the law may be a main factor responsible for the lack of access to legal abortion in Brazil.INTRODUÇÃO: Estima-se que 12% dos casos de mortalidade materna no Brasil sejam conseqüência de aborto clandestino. Muitas dessas mulheres cumpririam as condições para interrupção legal da gestação; entretanto, a prática do aborto previsto em lei em hospitais públicos é exceção, provavelmente por desconhecimento dos médicos a respeito da legislação brasileira referente ao aborto. OBJETIVO: Avaliar o conhecimento e a opinião dos ginecologistas e obstetras filiados à Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) sobre a legislação brasileira referente ao aborto, e sua correlação com algumas características sociodemográficas dos entrevistados. MÉTODOS: Foram enviados 14.320 questionários para serem respondidos por todos os membros da FEBRASGO, com taxa de resposta de 30,2% (4.323 questionários). RESULTADOS: A maioria apresentou uma boa compreensão das situações previstas na legislação e baixo conhecimento a respeito dos documentos necessários para a realização do aborto, exceto nos casos de malformação congênita grave, apresentando associação com a idade, tempo de prática e número de filhos. DISCUSSÃO E CONCLUSÕES: A pouca informação sobre os requerimentos legais para realizar um aborto permitido pela lei pode ser um dos principais fatores responsáveis pela falta de acesso ao aborto legal no Brasil.618Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP