Safety of the treatment for voluntary pregnancy termination by gestational age. Medellín, Colombia, 2013-2014
DOI:
https://doi.org/10.18597/rcog.3267Keywords:
Therapeutic abortion, congenital abnormalities, sexual abuse, high risk pregnancy, mental healthAbstract
Objective: To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination.
Materials and methods: Historical cohort of pregnant women with up to 26 weeks of gestation who received treatment for voluntary pregnancy termination in a referral institution in Medellín, Colombia, between January 2013 and December 2014. Sampling was consecutive. Measured variables included sociodemographic and obstetric variables, undesired effects, and complications of the voluntary pregnancy termination treatment. A descriptive analysis was carried out.
Results: Overall, 87 women were included. The mean age at the time of termination was 24 years (inter-quartile range [IQR] = 12), 69.0% were single, and 73,4% were unemployed. The main reason for termination was the risk to the mother’s health in 61,0% of cases, followed by a history of sexual violence in 26.4% and fetal malformations in 12.6%; a total of 70 women (80,4%) had less than 17 weeks of gestation and were treated with misoprostol plus manual vacuum aspiration; 17 (19,6%) had between 18 and 26 weeks of gestation and were treated with misoprostol followed by dilation and curettage. The first group (gestational age < 18 weeks) experienced undesired effects such as pain and vomiting; in the second group (< 18 weeks), 41.0% of the women experienced hemorrhage.
Conclusions: The risk to the mother’s health was the main reason for the termination of pregnancy. Termination before 18 weeks was found to be safe, while termination between 18 and 26 weeks using misoprostol and curettage was associated with a high frequency of hemorrhage.
Author Biographies
Diana Patricia Restrepo-Bernal, Universidad CES
Alejandro Colonia-Toro, Universidad CES, Hospital General de Medellín
Marle Duque-Giraldo, Práctica privada
Psiquiatra de Enlace; MSc en Epidemiología. Medellín (Colombia).
Catalina Hoyos-Zuluaga, Clínica del CES, Medellín-Colombia
Vanesa Cruz-Osorio, Clínica Amiga, Medellín-Colombia
References
Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A. Induced abortion: Incidence and trends worldwide from 1995 to 2008. Lancet. 2012;379(9816):625-32. DOI: https://doi.org/10.1016/S0140-6736(11)61786-8
United Nations, Department of Economic and Social Affairs, Population Division. Abortion Policies and Reproductive Health around the World. 2014. Disponible en: http://www.un.org/en/development/desa/population/publications/pdf/policy/bortionPoliciesReproductiveHealth.pdf
Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: Global, regional, and sub-regional levels and trends. Lancet. 2016;388(10041): 258-679. DOI: https://doi.org/10.1016/S0140-6736(16)30380-4
Huq, ME, Raihan MJ, Shirin H, Chowdhury S, Jahan Y, Chowdhury AS, Rahman MM. Why abortion is illegal? Comparison of legal and illegal abortion: A critical review. Mymensingh Med J. 2017;26(4):944-52.
Ruibal A. Movement and counter-movement: A history of abortion law reform and the backlash in Colombia 2006-2014. Reprod Health Matters. 2014;22(44):42-51. DOI: https://doi.org/10.1016/S0968-8080(14)44803-1
DeJong J. The role and limitations of the Cairo International Conference on Population and Development. Soc Sci Med. 2000;51(6):941-53. DOI: https://doi.org/10.1016/0277-9536(00)00073-3
Ganatra B, Gerdts C, Rossier C, Johnson BR, Tuncalp O, Assifi A, et al. Global regional and sub-regional classifications of abortions by safety 2010-14: Estimates from a Bayesian hierarchical model. Lancet. 2017;390 (10110):2372-81. DOI: https://doi.org/10.1016/S0140-6736(17)31794-4
WHO. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 6 edition. Geneva: WHO; 2011.
Corte Constitucional. República de Colombia. Sentencia C-355 de 2006. Disponible en: http://www.corteconstitucional.gov.co/relatoria/2006/c-355-06.htm
Prada E, Biddlecom A, Singh S. Induced abortion in Colombia: New estimates and change between 1989 and 2008. Int Perspect Sex Reprod Health. 2011;37(3):114-24. DOI: https://doi.org/10.1363/3711411
Grimes DA. Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999. Am J Obstet Gynecol. 2006;194(1):92-4. DOI: https://doi.org/10.1016/j.ajog.2005.06.070
Bartlett LA, Berg CJ, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004;103(4):729-37. DOI: https://doi.org/10.1097/01.AOG.0000116260.81570.60
Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, Hamdan S. Abortion surveillance-United States, 2004. MMWR Surveill Summ. 2007;56(9):1-33.
Andersson, IM, Christensson K, Gemzell-Danielsson K. Experiences, feelings and thoughts of women undergoing second trimester medical termination of pregnancy. PloS One. 2014;9(12):e115957. DOI: https://doi.org/10.1371/journal.pone.0115957
Gemzell-Danielsson K, Lalitkumar S. Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: A review of methods and management. Reprod Health Matters. 2008;16(suppl 31):162-72. DOI: https://doi.org/10.1016/S0968-8080(08)31371-8
Organización Mundial de la Salud (OMS). Manual de práctica clínica para un aborto seguro. Montevideo: Organización Mundial de la Salud; 2014.
Darney BG, Simancas-Mendoza W, Edelman AB, Guerra-Palacio C, Tolosa JE, Rodriguez MI. Post-abortion and induced abortion services in two public hospitals in Colombia. Contraception. 2014;90(1):36-41. DOI: https://doi.org/10.1016/j.contraception.2014.03.004
González-Wilhelm L, Moreno L, Carnevali R. Medicolegal considerations about rape as a reason to decriminalize abortion. Rev Med Chil. 2016;144(6):772-80. DOI: https://doi.org/10.4067/S0034-98872016000600013
Fiala C, Agotini A, Bombas T, Cameron S, Lertxundi R, Lubusky M, et al. Management of pain associated with up-to-9-weeks medical termination of pregnancy (MToP) using mifepristone-misoprostol regimens: Expert consensus based on a systematic literature review. J Obstet gynaecol. 2019. DOI: https://doi.org/10.1080/01443615.2019.1634027
Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI. Medical abortion in the late first trimester: A systematic review. Contraception. 2019;99(2):77-86.
Costescu D, Guilbert E, Bernardin J, Black A, Dunn S, Fitzsimmons B, et al. Medical abortion. J Obstet Gynaecol Can. 2016;38(4):366-89. DOI: https://doi.org/10.1016/j.jogc.2016.01.002
Kelly T, Suddes J, Howel D, Hewison J, Robson S. Comparing medical versus surgical termination of pregnancy at 13-20 weeks of gestation: A randomised controlled trial. BJOG. 2010;117(12):1512-20. DOI: https://doi.org/10.1111/j.1471-0528.2010.02712.x
Meirik O, My Huong NT, Piaggio G, Bergel E, von Hertzen H. WHO Research Group on Postovulatory Methods of Fertility Regulation. Complications of first-trimester abortion by vacuum aspiration after cervical preparation with and without misoprostol: A multicenter randomized trial. Lancet. 2012;379 (9828);1817-24. DOI: https://doi.org/10.1016/S0140-6736(11)61937-5
Grossman D, Blanchard K, Blumenthal P. Complications after second trimester surgical and medical abortion. Reprod Health Matters. 2008;16(31 Suppl):173-82. DOI: https://doi.org/10.1016/S0968-8080(08)31379-2
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2019 Revista Colombiana de Obstetricia y Ginecología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |