Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls.

Autor:	Stifani BM; Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, United States.; Department of Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States., Mei Hwang S; Hospital Maternidade Vila Nova Cachoeirinha, São Paulo, Brazil., Rodrigues Catani R; Department of Obstetrics & Gynecology, Universidade Federal de Uberlândia, Uberlândia, Brazil., Borges Martins da Silva Paro H; Department of Obstetrics & Gynecology, Universidade Federal de Uberlândia, Uberlândia, Brazil., Benfield N; Department of Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in global women's health [Front Glob Womens Health] 2022 Feb 22; Vol. 3, pp. 811412. Date of Electronic Publication: 2022 Feb 22 (Print Publication: 2022).
DOI:	10.3389/fgwh.2022.811412
Abstrakt:	Dilation and evacuation (D&E) is the recommended surgical procedure for uterine evacuation in the second trimester. Despite its established safety record, it is not routinely available in most countries around the world. In this paper, we describe the multi-phase capacity-building project we undertook to introduce D&E in Brazil. First, we invited a highly motivated obstetrician-gynecologist and abortion provider to complete an observership at an established D&E site in the United States. We then organized a month-long clinical training for two experienced gynecologists in Brazil, followed by ongoing remote mentorship. Almost all patients we approached during the training opted for D&E, and all expressed satisfaction with their experience. Despite the restrictive legal setting and prevailing abortion stigma in Brazil, our training was well-received, and we did not experience any overt resistance from hospital staff. We learned that obtaining institutional support is essential; and that presenting scientific evidence during dedicated didactic times was an important strategy to obtain buy-in from other local healthcare providers. An important challenge we encountered was low case volume given the restrictive legal setting. We addressed this by partnering with nearby hospitals and non-profit organizations for patient referrals. We also rescheduled, adapted and optimized this project for implementation in the midst of the COVID-19 pandemic. Despite the challenges we faced, this project led to the successful introduction of D&E up to 16-18 weeks at two sites in Brazil. In the future, we plan additional training to increase capacity for D&E at more advanced gestational ages. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Stifani, Mei Hwang, Rodrigues Catani, Borges Martins da Silva Paro and Benfield.)
Databáze:	MEDLINE
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