Malentendidos sobre el efecto de la legalización del aborto

Abortion laws are generally liberal in most of the developed countries and restrictive in developing countries, particularly in Latin America, with two exceptions. International health and human rights organizations promote broader access to safe abortion based on its effectiveness in immediate reduction of maternal morbidity and mortality. Laws remain restrictive in Latin America because of the erroneous concept that liberalization of the law would increase the number of induced abortions, something most people would not like. This is a crucial misunderstanding because evidence shows abortions are not less in countries with restrictive laws and number of abortions does not increase following liberalization of the law. It is also believed that most people are against liberalization of the law, but further inquiry reveals that most people are against punishing women who have abortions. The main misunderstanding is the belief that there are people “in favor of abortion”, while even women who abort do not like abortion. The real difference is that there are people who believe that keeping restrictive laws can prevent abortion and others accept evidence which shows that increasing access to safe abortion not only reduces suffering and deaths but contributes to reduce induced abortions.Las leyes sobre aborto son liberales en la mayor parte de los países desarrollados y muy restrictivas en países en desarrollo, particularmente América Latina, con dos excepciones. Organismos internacionales de Salud y Derechos Humanos promueven un mayor acceso al aborto seguro por su efecto inmediato de reducción de morbilidad y mortalidad materna. A pesar de eso las leyes permanecen muy restrictivas en la mayor parte de los países de América Latina, donde prevalece el concepto errado de que liberalizar la ley va a llevar a un aumento en el número de abortos, lo que casi todos prefieren evitar. Ese es un importante malentendido, porque las evidencias son que no hay menos aborto donde las leyes son restrictivas y no aumentan los abortos cuando las leyes se hacen más liberales. Así mismo, se cree que la mayor parte de la población está contra liberalizar la ley, pero preguntando mejor se descubre que la mayor parte está contra castigar a la mujer que aborta. Pero, el principal malentendido es creer que hay personas ‘a favor del aborto’, en circunstancia que ni siquiera a la mujer que se provoca el aborto le gusta abortar. La diferencia está en pensar que prohibiendo se soluciona el problema, o aceptar las evidencias que muestran que aumentando el acceso al aborto seguro no solo reduce el sufrimiento y la muerte, sino contribuye a reducir los abortos

Avaliaçao da idade gestacional através da identificaçao ultra-sonográfica dos núcleos de ossificaçao epifiseais de ossos longos fetais no terceiro trimestre de gestaçao

ApendicesOrientador: Aníbal FaúndesCo-orientador: Edson Gomes TristaoDissertaçao(mestrado)- Universidade Federal do Paraná. Setor de Ciencias da Saúde. Curso de Pós-Graduaçao em TocoginecologiaInclui bibliografiaÁrea de concentração : TocoginecologiaResumo: A presença dos núcleos de ossificação nas epífises dos ossos longos, detectados pelos Rx, já foi usada como sinal indicativo de idade gestacional. A aplicação da ultra-sonografia com o mesmo propósito foi motivo de várias publicações, porém, ainda não existe um padrão universalmente aceito. Este estudo objetivou verificar a idade gestacional em que aparecem os Núcleos de ossificação distai do fémur (NODF), proximal da tíbia (NOPT) e proximal do úmero (NOPU), os diâmetros destes núcleos e sua somatória, em cada idade gestacional, a utilidade destas medidas para prognosticar maturidade fetal e sua utilização para criar uma curva "normal" de desenvolvimento ósseo fetal. Foram estudadas 376 grávidas diferentes, com amenorréia conhecida de 30 a 40 semanas, feto único, sem patologias ou intercorrências clínicas nesse período, nas quais se identificou e mediu o maior diâmetro dos NODF, NOPT e NOPU. O número de observações para cada semana de gestação variou entre 30 e 39. Cada mulher foi observada apenas uma vez. Encontrou-se que às 32 semanas, 71% dos fetos apresentavam NODF, às 37 semanas 83% tinham NOPT visível e que o NOPU apareceu apenas às 38 semanas, com presença em 54% dos fetos de 40 semanas. Houve boa correlação entre os diâmetros dos NODF e NODT e idade gestacional, mas a melhor correlação foi com a somatória dos diâmetros dos 3 núcleos. Um valor de 7mm da somatória dos núcleos associou-se a 82% de probabilidade de o feto ter 37 semanas, 11 mm a 94% e 13mm a 100% de certeza de que o feto atingiu 37 semanas. Construiu-se uma curva normal de crescimento da somatória dos diâmetros dos núcleos que se propõe para a avaliação da normalidade do crescimento ósseo fetal.Abstract: The presence of the epiphyses ossification centers of long bones detected by X-Rays was used as indicator of gestational age since long ago. The use of ultrasonography with the same purpose has resulted in a number of publications, but they're still no universally accepted standard relating ossifications centers with gestational age. The purpose of this study was to verify the gestational age at which the distal femoral (DFOC) proximal tibial (PTOC) and proximal humeral (PHOC) epiphyseal ossification centers appear, the diameter of each of these center and the sum of the three diameters, by gestational age. To evaluate the usefulness of these indicators to estimate fetal maturity and its application to create a normal curve of fetal bone development were also objectives of the study. Three hundred and seventy six pregnant women, with known last menstrual period, between 30 and 40 weeks of normal pregnancy and singleton fetuses were studied. The DFOC, PTOC and PHOC were identified and their diameter measured. The number of subjects for each gestational age varied from 30 through 39. Each woman was observed only once. The DFOC was observed in 71% of the women at 32 weeks, the PTOC was visible in 83% at 37 weeks and the PHOC was present in only 54% of the fetus at 40 weeks of pregnancy. There was good correlation between the diameters of the DFOC and PTOC and gestational age, but the best correlation was observed with the sum of the diameters of the three ossification centers. A value of 7mm of the sum of the three centers was associated with 82% of chance of the fetus having 37 weeks of gestational age, 11mm with 94% and 13mm with 100%. A normal curve with the values of the sum of the three diameters for each gestational age, from 30 through 40 weeks was built and is proposed as a parameter to evaluate the normalcy of fetal bone development

Effects of a novel estrogen-free, progesterone receptor modulator contraceptive vaginal ring on inhibition of ovulation, bleeding patterns and endometrium in normal women

BACKGROUND: Progesterone receptor modulators (PRMs) delivered by contraceptive vaginal rings provide an opportunity for development of an estrogen-free contraceptive that does not require daily oral intake of steroids. The objective of this proof-of-concept study was to determine whether continuous delivery of 600–800 mcg of ulipristal acetate (UPA) from a contraceptive vaginal ring could achieve 80% to 90% inhibition of ovulation. STUDY DESIGN: This was a prospective, controlled, open-labeled, multicenter international trial to examine the effectiveness and safety of this prototype vaginal ring. Thirty-nine healthy women, 21–40 years old and not at risk of pregnancy, were enrolled at three clinic sites. Volunteers participated in a control cycle, a 12-week treatment period and a post-treatment cycle. Pharmacodynamic effects on follicular function and inhibition of ovulation, effects on endometrium, bleeding patterns and serum UPA levels were evaluated. RESULTS: Mean UPA levels during treatment were nearly constant, approximately 5.1 ng/mL throughout the study. Ovulation was documented in 32% of 111 “4-week treatment cycles.” A correlation was observed between serum UPA and degree of inhibition of ovarian activity. There was no evidence of hyperplasia of endometrium, but PRM-associated endometrial changes were frequently observed (41%). CONCLUSION: In this study, the minimum effective contraceptive dose was not established. Further studies are required testing higher doses of UPA to attain ovulation suppression in a higher percentage of subjects

What Can We Do As Gynecologists/obstetricians To Reduce Unsafe Abortion And Its Consequences? The Uruguayan Response

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Malentendidos sobre el efecto de la legalización del aborto

Abortion laws are generally liberal in most of the developed countries and restrictive in developing countries, particularly in Latin America, with two exceptions. International health and human rights organizations promote broader access to safe abortion based on its effectiveness in immediate reduction of maternal morbidity and mortality. Laws remain restrictive in Latin America because of the erroneous concept that liberalization of the law would increase the number of induced abortions, something most people would not like. This is a crucial misunderstanding because evidence shows abortions are not less in countries with restrictive laws and number of abortions does not increase following liberalization of the law. It is also believed that most people are against liberalization of the law, but further inquiry reveals that most people are against punishing women who have abortions. The main misunderstanding is the belief that there are people “in favor of abortion”, while even women who abort do not like abortion. The real difference is that there are people who believe that keeping restrictive laws can prevent abortion and others accept evidence which shows that increasing access to safe abortion not only reduces suffering and deaths but contributes to reduce induced abortions.Las leyes sobre aborto son liberales en la mayor parte de los países desarrollados y muy restrictivas en países en desarrollo, particularmente América Latina, con dos excepciones. Organismos internacionales de Salud y Derechos Humanos promueven un mayor acceso al aborto seguro por su efecto inmediato de reducción de morbilidad y mortalidad materna. A pesar de eso las leyes permanecen muy restrictivas en la mayor parte de los países de América Latina, donde prevalece el concepto errado de que liberalizar la ley va a llevar a un aumento en el número de abortos, lo que casi todos prefieren evitar. Ese es un importante malentendido, porque las evidencias son que no hay menos aborto donde las leyes son restrictivas y no aumentan los abortos cuando las leyes se hacen más liberales. Así mismo, se cree que la mayor parte de la población está contra liberalizar la ley, pero preguntando mejor se descubre que la mayor parte está contra castigar a la mujer que aborta. Pero, el principal malentendido es creer que hay personas ‘a favor del aborto’, en circunstancia que ni siquiera a la mujer que se provoca el aborto le gusta abortar. La diferencia está en pensar que prohibiendo se soluciona el problema, o aceptar las evidencias que muestran que aumentando el acceso al aborto seguro no solo reduce el sufrimiento y la muerte, sino contribuye a reducir los abortos

Evidence Supporting Broader Access To Safe Legal Abortion

Unsafe abortion continues to be a major cause of maternal death; it accounts for 14.5% of all maternal deaths globally and almost all of these deaths occur in countries with restrictive abortion laws. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. Despite this evidence, abortion is denied even when the legal condition for abortion is met. The present article aims to contribute to a better understanding that one can be in favor of greater access to safe abortion services, while at the same time not be "in favor of abortion," by reviewing the evidence that indicates that criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates. (C) 2015 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.1311S56S5

Clinical evaluation of an oral progestin contraceptive, R-2323, 5mg, administered at weekly intervals

A new contraceptive compound, R-2323, was tried as a "weekly pill". The pregnancy rate at 12 months was 3.7 considering only method failures. The most important ill effect was alterations in bleeding patterns, with a predominance of cycle irregularity. Oligomenorrhea was present in 58% of the cycles after 6 months of use, and this symptom was responsible for a discontinuation rate of 10 percent at the end of a year. Polymenorrhea and intermenstrual bleeding were less frequent and caused a discontinuation rate of 6 percent in a year of use. Chloasma, acne and hirsutism increased in frequency with time of use, and even though these problems affected relatively few patients, almost all of those with these problems discontinued. These three symptoms together caused almost as many discontinuations as excessive bleeding. Endometrial biopsies taken during treatment showed both proliferative and secretory endometria in the group receiving 2.5 mg a week and were predominantly proliferative in

Restricted abortion law in El Salvador

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Association of marital status and years of schooling with perinatal outcome: The influence of pre-natal care as an intermediate variable

Peer Reviewe