A interrupção da gravidez na adolescência: aspectos epidemiológicos numa maternidade pública no nordeste do Brasil

The induced abortion is widely practiced by women in the context illegal in Brazil, considered a public health issue. To understand the complications and the clinical, behavioral and socio-demographic aspects and type of abortion in adolescents undergoing uterine curettage. A descriptive method based on interviews using a structured questionnaire related to the care of 201 adolescents with incomplete abortion and that underwent curettage in a hospital of the Health System, Maceió - Alagoas. Adolescents at risk of causing abortion are over sixteen, brown, with a stable partner, with either a wanted or an unwanted first pregnancy, gestational age less than 15 weeks; rare complications related to abortion, and the classification of World Health Organization, induced abortion in 98.01% of cases. Among the certainly caused miscarriages, 89.19% reported the use of misoprostol, which enhance greater public investment in assisting the use of contraceptives among adolescents by respecting their sexual and reproductive rights.O abortamento provocado é praticado amplamente pelas mulheres, em contexto clandestino, no Brasil, sendo considerado uma questão de saúde pública. Neste estudo, propõe-se a conhecer aspectos socio-demográficos, comportamentais, clínicos, complicações, e o tipo de abortamento praticado por adolescentes submetidas à curetagem uterina. Foi utilizada metodologia descritiva, através de entrevistas por meio de questionário estruturado no atendimento a 201 adolescentes com abortamento incompleto submetidas à curetagem uterina, em um hospital do Sistema Único de Saúde (SUS), em Maceió, Alagoas. Os principais determinantes para o abortamento foram: idade acima de dezesseis anos, com parceiro estável; pardas; não planejaram a gestação; desejavam a gestação, primigestas; idade gestacional menor que 15 semanas; raras complicações relacionadas ao abortamento, e utilizando a classificação da Organização Mundial da Saúde, observou-se abortamento provocado em 98,01% dos casos. Entre os casos de abortamentos certamente provocados, 89,19% reportaram o uso do misoprostol, o que reforça maior investimento público na assistência ao uso de métodos contraceptivos entre os adolescentes respeitando seus direitos sexuais e reprodutivos

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Epidemiological profile of hysterectomy cases in a Tertiary University Hospital

INTRODUCCIÓN: La histerectomía es el segundo procedimiento quirúrgico más común en mujeres en edad reproductiva, solo superado por la cesárea. Es un tratamiento quirúrgico de extirpación parcial o total del útero, indicado para diversas patologías del suelo pélvico femenino. Es una cirugía irreversible, con cambios en la integridad corporal e implicaciones para la identidad sexual femenina. OBJETIVO: describir el perfil clínico-epidemiológico de las pacientes sometidas a histerectomía, con el fin de evaluar la tendencia de las indicaciones quirúrgicas adoptadas. MATERIAL Y MÉTODOS: Esta investigación es un estudio descriptivo, comparativo y transversal, realizado en base a datos secundarios, recolectados a partir de informes histológicos y registros médicos de mujeres sometidas a histerectomía total en el Hospital Universitario Profesor Alberto Antunes (HUPAA), Maceió- AL, en la serie histórica de 2009 a 2018. RESULTADOS: El grupo de edad 41-50 correspondió al 43,8% de las pacientes sometidas a histerectomía. Los miomas uterinos, de acuerdo con lo mostrado en la literatura, representaron el 60,3% de las indicaciones. Los síntomas relacionados con los cambios menstruales fueron los principales mencionados. La ecografía pélvica, considerada el estándar de oro para el diagnóstico de los miomas uterinos, fue el examen complementario más utilizado. CONCLUSIÓN: Los datos recolectados, en general, están en línea con la literatura disponible. Sin embargo, todavía hay casos en los que se necesita una mejor investigación para la correcta indicación de la histerectomía.INTRODUÇÃO:A histerectomia é o segundo procedimento operatório mais frequente em mulheres na idade reprodutiva, sendo superada apenas pela cesariana. É um tratamento cirúrgico de remoção parcial ou total do útero, indicado para diversas patologias do assoalho pélvico feminino. Trata-se de uma cirurgia irreversível, com alteração da integridade corporal e com implicações na identidade sexual feminina. OBJETIVO: descrever o perfil clínico-epidemiológico das pacientes que passaram pela histerectomia, a fim de avaliar a tendência de indicações cirúrgicas adotadas. MATERIAL E MÉTODOS: A presente pesquisa se trata de um estudo descritivo, comparativo e transversal, realizado com base em dados secundários, coletados de laudos histológicos e prontuários médicos de mulheres submetidas à histerectomia total no Hospital Universitário Professor Alberto Antunes (HUPAA), Maceió-AL, na série histórica de 2009 a 2018. RESULTADOS: A faixa etária de 41-50 anos correspondeu a 43,8% das pacientes que passaram pela histerectomia. A miomatose uterina, em conformidade com o que demonstra a literatura, representou 60,3% das indicações. Os sintomas relacionados a alterações menstruais foram os principais citados. A Ultrassonografia pélvica, considerada padrão ouro para diagnóstico dos miomas uterinos, foi o exame complementar mais utilizado. CONCLUSÃO: Os dados coletados, de maneira geral, entram em consonância com a literatura disponível. Contudo, ainda existem casos em que é preciso uma melhor investigação para a indicação correta da histerectomia. &nbsp;INTRODUCTION: Hysterectomy is the second most common surgical procedure in women of reproductive age, being surpassed only by cesarean section. It is a surgical treatment of partial or total removal of the uterus, indicated for several pathologies of the female pelvic floor. It is an irreversible surgery, with changes in body integrity and implications for female sexual identity. OBJECTIVE: to describe the clinical-epidemiological profile of patients who underwent hysterectomy, in order to assess the trend of surgical indications adopted. MATERIAL AND METHODS: This research is a descriptive, comparative and cross-sectional study, carried out based on secondary data, collected from histological reports and medical records of women undergoing total hysterectomy at the Professor Alberto Antunes University Hospital (HUPAA), Maceió- AL, in the historical series from 2009 to 2018. RESULTS: The 41-50 year old age group corresponded to 43.8% of patients who underwent hysterectomy. Uterine fibroids, in accordance with what is shown in the literature, represented 60.3% of the indications. Symptoms related to menstrual changes were the main ones mentioned. Pelvic ultrasound, considered the gold standard for the diagnosis of uterine fibroids, was the most used complementary exam. CONCLUSION: The data collected, in general, are in line with the available literature. However, there are still cases in which a better investigation is needed for the correct indication of hysterectomy.

Abortamento provocado na adolescência sob a perspectiva bioética Abortion among adolescents: a bioethical approach

OBJETIVOS: descrever características sócio-demográficos, comportamentais, clínicos, analise anatomopatológica, e o tipo de abortamento em adolescentes, de modo a discuti-los bioeticamente. MÉTODOS: aplicou-se questionário estruturado no atendimento a 201 adolescentes com abortamento incompleto submetidas à curetagem uterina, em uma maternidade pública no nordeste do Brasil. RESULTADOS: idade média de 16,1 anos; parceiro estável; mulatas; não usavam preservativos nas relações sexuais; média de idade de início de atividade sexual de 15 anos; não planejaram a gestação; desejavam a gravidez; idade gestacional média de 13,2 semanas. O desfecho da gravidez, quanto ao tipo de abortamento 1,99% abortamento espontâneo e 81,59% certamente provocados, dados obtido através da classificação da Organização Mundial da Saúde. Tecidos embrionários e maternos no anatomopatológico 88,56% e 11,44%, respectivamente. Entre os abortamentos certamente provocados, um caso de mola hidatiforme. CONCLUSÕES: recomenda-se urgência nos programas estratégicos de planejamento familiar; realização do anatomopatológico no material proveniente de aborto; a bioética refletindo pró-ativamente se apresenta como instrumento para diretrizes mínimas de proteção e assistência a adolescente, e auxilio ao profissional de saúde.<br>OBJECTIVES: to describe the socio-demographic, behavioral, clinical and anatomical-pathological characteristics and the type of abortion in adolescents as a way of discussing the subject from a bio-ethical perspective. METHODS: a structured questionnaire was applied to 201 adolescent girls receiving treatment for incomplete abortion and being subjected to uterine curretage, at a public maternity unit in the Northeast region of Brazil. RESULTS: the mean age was 16.1 years; most girls had a stable partner, were of mixed race, and were not accustomed to using condoms during sexual intercourse. The mean age for initiation of sexual activity was 15 years. Most had not planned the pregnancy but wanted to get pregnant. The mean gestational age of the fetus was 13.2 weeks. With regard to the type of abortion, 1.99% were spontaneous and 81.59% were certainly provoked, according to data obtained using the World Health Organization classification. Fetal and maternal tissue were 88.56% and 11.44%, respectively. Of the abortions that were certainly provoked, there was one case of the use of a hydatidiform mole. CONCLUSIONS: it is recommended that strategic family planning programs be urgently introduced and that anatomical-pathological tests be carried out on the material resulting from an abortion. Proactive bioethical reflection seems to be the tool for providing minimal guidelines for the protection and care of adolescents and for assisting health professionals