Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A).

Autor:	Romero M; Health, Economy and Society Department, CEDES, Buenos Aires, Argentina mromero@cedes.org.; CONICET, Buenos Aires, Argentina., Gomez Ponce de Leon R; Latin American Center for Perinatology/Women's Health and Reproductive Health, Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay., Baccaro LF; UNICAMP, Campinas, Brazil., Carroli B; CREP, Rosario, Santa Fe, Argentina., Mehrtash H; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Randolino J; CREP, Rosario, Santa Fe, Argentina., Menjivar E; Pan American Health Organization El Salvador, San Salvador, El Salvador., Estevez Saint-Hilaire E; Hospital Materno Infantil San Lorenzo de los Mina, Santo Domingo, Dominican Republic., Huatuco MDP; ESSALUD, Lima, Peru., Hernandez Muñoz R; Pan American Health Organization Bolivia, La Paz, Bolivia, Plurinational State of., Garcia Camacho G; CREP, Rosario, Santa Fe, Argentina., Thwin SS; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Campodonico L; CREP, Rosario, Santa Fe, Argentina., Abalos E; CREP, Rosario, Santa Fe, Argentina., Giordano D; CREP, Rosario, Santa Fe, Argentina., Gamerro H; CREP, Rosario, Santa Fe, Argentina., Kim CR; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Ganatra B; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Gülmezoglu M; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Tuncalp Ö; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland., Carroli G; CREP, Rosario, Santa Fe, Argentina.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Aug; Vol. 6 (8). Date of Electronic Publication: 2021 Aug 20.
DOI:	10.1136/bmjgh-2021-005618
Abstrakt:	Introduction: Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. Methods: This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. Results: We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. Conclusions: This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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