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Resumo O uso do misoprostol com finalidade abortiva é um fenômeno observado no Brasil desde o final da década de 1980. O medicamento começou a ser utilizado nessa época para autoindução do aborto, quando passou a ser comercializado para o tratamento de úlcera péptica. Seu acesso foi restringido a partir de 1998, porém o fármaco continua sendo comercializado na ilegalidade. O objetivo desse artigo é sintetizar o conhecimento produzido em pesquisas no Brasil sobre o aborto induzido e o uso do misoprostol. Foi realizada uma revisão integrativa de estudos originais feitos no Brasil e publicados em revistas indexadas nas bases SciELO, PubMed e Lilacs. Foram encontrados 68 títulos e incluídos 28 artigos na revisão. A maioria das mulheres que induz a interrupção da gestação é jovem e o faz antes das 15 semanas de gestação. A taxa de utilização do misoprostol variou entre 89% e 36%. Esse medicamento é eficaz para a interrupção da gestação no primeiro trimestre e apresenta baixa taxa de complicações. Contudo, quanto mais vulnerável socialmente a mulher, maiores os riscos para a saúde no processo do abortamento. Conclui-se que a compra do misoprostol como abortivo é facilitada, apesar de proibida, e suas complicações estão associadas ao contexto de vulnerabilidade da gestante.
Abstract The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.
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El objetivo de este trabajo fue conocer la frecuencia y la manera en que las plantas medicinales son empleadas por las gestantes del Centro de Salud Viña Alta del distrito de La Molina. En el estudio participaron veintiuna gestantes, quienes respondieron una encuesta, validada por expertos, sobre el uso de plantas medicinales. Se demostró que el 86,00 % de las gestantes utilizaron plantas medicinales, y que 67,00 % no consultó con un médico sobre su empleo. La manera más frecuente de consumo de las plantas medicinales fue la vía oral, en forma de infusiones. Las plantas medicinales más utilizadas fueron manzanilla, perejil, eucalipto, boldo, aloe, menta y ruda; y algunas de ellas mostraron efecto teratogénico, estimulante uterino, abortivo, entre otros. Es necesario conocer la cantidad real y la manera más frecuente en que las gestantes consumen las plantas medicinales, con la finalidad de clasificar estos productos de acuerdo al nivel de seguridad que ofrecen y promover el uso racional de la medicina tradicional para contribuir en la salud pública.
This research aimed to find out the frequency and ways of using medicinal plants by pregnant women treated at the Centro de Salud Viña Alta, located in La Molina district. Twenty-one (21) pregnant women voluntarily participated in the study, where they were administered an expert-validated survey regarding the use of medicinal plants. The results showed that 86 % of the pregnant women used medicinal plants and 67 % did not ask their doctor before using them. The most frequent way of using the medicinal plants was by oral intake as herbal teas. The most widely used medicinal plants were chamomile, parsley, eucalyptus, boldo, aloe, mint and rue, some of which produced a teratogenic effect, uterine stimulant action, abortifacient effect, among others. It is necessary to know the actual quantity and most frequent way of using medicinal plants by pregnant women to classify these products as for its safety level and promote the rational use of traditional medicine to contribute to public health.
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BACKGROUND: As part of the accelerated approval of mifepristone as an abortifacient in 2000, the Food and Drug Administration (FDA) required prescribers to report all serious adverse events (AEs) to the manufacturer who was required to report them to the FDA. This information is included in the FDA Adverse Event Reporting System (FAERS) and is available to the public online. The actual Adverse Event Reports (AERs) can be obtained through the Freedom of Information Act (FOIA). METHODS: We compared the number of specific AEs and total AERs for mifepristone abortions from January 1, 2009 to December 31, 2010 from 1. Planned Parenthood abortion data published by Cleland et al. 2. FAERS online dashboard, and 3. AERs provided through FOIA and analyzed by Aultman et al. RESULTS: Cleland identified 1530 Planned Parenthood mifepristone cases with specific AEs for 2009 and 2010. For this period, FAERS online dashboard includes a total (from all providers) of only 664, and the FDA released only 330 AERs through FOIA. Cleland identified 1158 ongoing pregnancies in 2009 and 2010. FAERs dashboard contains only 95, and only 39 were released via FOIA. CONCLUSIONS: There are significant discrepancies in the total number of AERs and specific AEs for 2009 and 2010 mifepristone abortions reported in 1. Cleland's documentation of Planned Parenthood AEs, 2. FAERS dashboard, and 3. AERs provided through FOIA. These discrepancies render the FAERS inadequate to evaluate the safety of mifepristone abortions.
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RESUMO: Objetivo: Analisar os fatores preditores do abortamento entre jovens com antecedentes gestacionais. Métodos: Estudo seccional realizado com 464 jovens de Teresina, Piauí, que finalizaram uma gravidez no primeiro quadrimestre de 2006 em seis maternidades do município, com faixa etária entre 15 e 19 anos. Os dados foram coletados de maio a dezembro de 2008, no domicílio das jovens após sua identificação nos registros das maternidades. Para a análise univariada dos dados, utilizou-se a estatística descritiva, e para a análise bivariada empregou-se o teste do χ2 de Pearson e o teste Z. A análise multivariada se deu por meio da Regressão Logística Múltipla (RLM), sendo empregado um nível de significância de 5%. Resultados: As jovens que tiveram mais de uma gestação foram quase nove vezes mais propensas a abortar quando comparadas àquelas que haviam vivenciado apenas uma gestação (p = 0,002). Além disso, as jovens que referiram ter sido pressionadas pelo parceiro a abortar eram quatro vezes e meia mais propensas a consumar o ato quando comparadas aos casos em que a pressão advinha de parentes e amigos do casal (p = 0,007). Conclusão: As jovens que vivenciaram duas ou mais gestações, e que sofreram pressão do companheiro para abortar, eram mais propensas a praticar o aborto. Assim, faz-se necessário que programas de Planejamento Familiar incluam, com maior profundidade, o público adolescente, com vistas a evitar gestações indesejadas nesta população e, consequentemente, o aborto induzido sob condições precárias.
ABSTRACT: Objective: To analyze the predictive factors of abortion among teenagers with gestational history. Methods: Cross-sectional study carried out with 464 teenagers aged between 15 and 19 years, from Teresina, Piauí, who completed a pregnancy in the first quarter of 2006 in six city maternity hospitals. Data were collected from May to December 2008, at the teenagers' home, after their identification in the hospital records. For the univariate analysis of data, descriptive statistics was used, and for bivariate analysis, Pearson's χ2-test and Z-test were applied. Multivariate analysis was performed by means of the Multiple logistic regression (MLR), with significance level of 5%. Results: Teenagers who had more than one pregnancy were almost nine times more likely to have an abortion when compared to those who had only one pregnancy (p = 0.002). Furthermore, the teenagers who reported being pressured by the partner to have an abortion were four times and a half more likely to do it, when compared to those pressured by relatives and friends (p = 0.007). Conclusion: The teenagers who had two or more pregnancies and were pressured by the partner to have an abortion were more prone to do it. Thus, it is necessary that programs of Family Planning include the teenagers more effectively, aiming at avoiding unwanted pregnancies among this population and, consequently, abortion induced in poor conditions.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Paridade , Estudos RetrospectivosRESUMO
Este artigo analisa como a mídia impressa brasileira noticia o comércio clandestino do misoprostol, o principal medicamento para aborto. Foram recuperadas 1.429 notícias, de 220 veículos de informação impressos e eletrônicos, entre 2004 e 2009. A análise foi realizada em 524 notícias de 62 veículos impressos regionais e nacionais. O misoprostol é pauta permanente, mas o enquadramento das notícias é policial, diverso do aborto como uma questão religiosa, política e de saúde pública que domina a mídia brasileira. O misoprostol está inserido no mercado ilegal de medicamentos de gênero, tais como os para emagrecimento, disfunção erétil ou anabolizantes. Sessenta e quatro (12 por cento) notícias impressas apresentam histórias de vida de mulheres que abortaram com o misoprostol. As mulheres têm de 13 a 46 anos e sua inserção de classe demarca diferentes experiências de aborto. Três personagens foram identificados nos itinerários de aborto: amigas, intermediários e médicos. As histórias de aborto tardio são confundidas com a tipificação penal do infanticídio e são casos-limite para a narrativa midiática.
This article analyzes how the Brazilian news media covers the illegal market for misoprostol, the main drug used to induce abortion. A total of 1,429 news stories were retrieved from 220 print and electronic media channels from 2004 to 2009. The analysis included 524 stories from 62 regional and national newspapers. Misoprostol appeared repeatedly in the news, but was usually approached from a criminal perspective, unlike abortion as a whole, which the Brazilian media routinely covers as a religious, political, and public health issue. Misoprostol is part of the illegal gender-related drug market, along with drugs for weight loss and erectile dysfunction and anabolic steroids. Sixty-four (12 percent) of the news stories told life histories of women who had aborted with misoprostol. The women's ages ranged from 13 to 46 years, and socioeconomic status was associated with different experiences with abortion. Three characters appeared in the women's abortion itineraries: girlfriends (confidantes), go-betweens, and physicians. Stories of late-stage abortion are confused with the criminal characterization of infanticide and provide the extreme cases in the media's narrative on abortion.
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Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Abortivos/efeitos adversos , Aborto Induzido/métodos , Comunicação em Saúde , Meios de Comunicação de Massa , Misoprostol/efeitos adversos , Comercialização de Medicamentos , BrasilRESUMO
O uso milenar de plantas medicinais mostrou ao longo dos anos, que determinadas plantas apresentam substâncias potencialmente perigosas. Do ponto de vista científico, algumas pesquisas mostraram que muitas dessas plantas possuem substâncias agressivas e por essa razão devem ser utilizadas com cuidado, respeitando seus riscos toxicológicos. Os efeitos mais preocupantes do uso indiscriminado de plantas medicinais são embriotóxico, teratogênico e abortivo, uma vez, que os constituintes da planta podem atravessar a placenta, chegar ao feto e gerar um desses efeitos. Este estudo objetiva fornecer uma listagem das principais plantas medicinais que tenham efeitos embriotóxicos, teratogênicos e abortivos comprovados, conhecendo as partes da planta utilizadas e seus respectivos nomes científicos, com a finalidade de alertar gestantes quanto aos riscos de seu uso. Realizou-se buscas nas bases eletrônicas de dados SciELO, PubMed, MEDLINE, LILACS, CAPES e Google acadêmico. Nos resultados encontrados, plantas como Arnica (Arnica montana), Artemísia (Artemisia vulgaris), Arruda (Ruta chalepensis/ Ruta graveolens), Barbatimão (Stryphnodendron polyphyllum), Boldo (Vernonia condensata) dentre outras, podem vir a gerar um desses efeitos. A partir deste estudo comprova-se que para a maioria das plantas medicinais não há dados a respeito da segurança de seu uso durante a gravidez.
The ancient use of medicinal plants has shown over the years that certain plants have potentially dangerous substances. From a scientific point of view, some studies have shown that many of these plants contain aggressive substances and therefore should be used with caution, respecting their toxicological risks. The most important effects of the indiscriminate use of medicinal plants are embryotoxic, teratogenic and abortifacient since the plant constituents can cross the placenta, reaching the fetus and leading to one of these effects. This study aimed to provide a list of the major medicinal plants that have proven embryotoxic, teratogenic and abortifacient effects, including the used plant parts and their respective scientific names, in order to warn pregnant women about the risks of its use. Searches were carried out in the electronic databases SciELO, PubMed, MEDLINE, LILACS, CAPES and Google Scholar. Results indicated that plants such as mountain arnica (Arnica montana), mugwort (Artemisia vulgaris), fringed rue (Ruta chalepensis / Ruta graveolens), "Barbatimão" (Stryphnodendron polyphyllum) and "Boldo" (Vernonia condensata) are likely to generate such an effect. This study shows that for most medicinal plants there are not data regarding the safety of their use during pregnancy.
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Abortivos , Plantas Medicinais , Teratogênicos , Substâncias Tóxicas , Estruturas Embrionárias , Feto/anormalidades , Feto , GravidezRESUMO
OBJETIVOS: a tentativa de aborto mal sucedida com o uso do misoprostol (Cytotec®) sem indicação médica tem sido associada a malformações congênitas. Este estudo teve por objetivo identificar, em recém-nascidos malformados e controles normais, a frequência de exposição ao misoprostol e o espectro de malformações associadas. MÉTODOS: estudo de caso-controle desenvolvido em 2005 nas quatro principais maternidades públicas de Fortaleza (CE). Através de busca ativa diária, foram identificados recém-nascidos com diagnóstico de malformação fetal (caso) e controles saudáveis de mesmo sexo nascidos em seguida na mesma maternidade (pareamento 1:1). A amostra foi de 252 parturientes entrevistadas por equipe treinada utilizando questionário estruturado com base no Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC). Além de abordar questões sociodemográficas e histórico familiar de malformação, o questionário objetivou identificar exposições diversas durante a gestação, incluindo o misoprostol. A análise bivariada com teste do χ2 comparou os grupos quanto às características e fatores associados à malformação e foi calculada a Odds Ratio para verificar a razão de chances de o Grupo Caso apresentar malformação em relação ao Grupo Controle com relação à exposição ao misoprostol. RESULTADOS: não houve diferenças significativas entre os grupos caso e controle quanto à maioria dos fatores de riscos investigados para malformações. O relato de tentativa de aborto foi de 6,8 por cento, havendo uma maior exposição ao misoprostol durante a gestação em neonatos malformados comparados a saudáveis, Odds Ratio (OR)=3,65 (IC95 por cento=0,74-17,91). O espectro de malformações encontradas entre os recém-nascidos expostos ao misoprostol foi compatível com a literatura, como os decorrentes de defeitos do tubo neural e disrupção vascular. CONCLUSÕES: os achados deste estudo, apesar de não apresentarem significância estatística, sugerem que ...
PURPOSE: failed attempted abortions with the use of misoprostol (Cytotec®) without medical indication have been associated with the occurrence of congenital malformations. The objective of the present study was to identify, in newborns with malformations and in normal controls, the frequency of exposure to misoprostol and the spectrum of associated malformations. METHODS: this was a case-control study involving a daily survey at four public maternities in Fortaleza (CE) for the identification of newborns with malformations and paired controls (1:1) during the period from July to November 2005. The sample comprised 252 parturients interviewed by a trained team by means of a structured questionnaire based on the Latin American Collaborative Study of Congenital Malformations (Estudo Colaborativo Latino-Americano de Malformações Congênitas, ECLAMC). The questionnaire was used to obtain sociodemographic data and a family history of malformations, as well as to identify diverse forms of exposure during pregnancy, including misoprostol. Bivariate analysis and the chi-square test were used to compare cases and controls regarding their characteristics and factors associated with malformation, and the Odds Ratio was calculated to determine the chance of the Case Group to present malformations as compared to the Control Group after exposure to misoprostol. RESULTS: there were no significant differences between groups regarding most of the risk factors for malformations investigated. Attempted abortion was reported by 6.8 percent of the mothers, with a higher exposure to misoprostol during pregnancy resulting in a greater proportion of malformed newborns, Odds Ratio (OR)=3.65 (95 percentCI=0.74-17.91). The spectrum of congenital defects encountered with exposure to misoprostol included defects of the central nervous, musculoskeletal, urogenital and cardiovascular systems, in agreement with literature data. CONCLUSION: the findings of this study suggest ...
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Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Anormalidades Induzidas por Medicamentos/etiologia , Abortivos não Esteroides/efeitos adversos , Misoprostol/efeitos adversos , Anormalidades Induzidas por Medicamentos/epidemiologia , Estudos de Casos e Controles , Medição de RiscoRESUMO
BACKGROUND: Misoprostol is commonly used to induce abortion in Brazil, and in other countries in South and Central America where abortions are illegal. However, misoprostol is not very effective in inducing abortions, and exposure to the drug in utero can cause abnormalities in the fetus. We aimed to define the common phenotypical effects of exposure to the drug. METHODS: We studied 42 infants from São Paulo, Brazil, who were exposed to misoprostol during the first 3 months of gestation, and then born with congenital abnormalities. We interviewed each of the infants' mothers to find out about misoprostol exposure and dosage. Each infant was physically examined by a geneticist or a neuropaediatrician. FINDINGS: 17 of the infants had equinovarus with cranial-nerve defects. Ten children had equinovarus as part of more extensive arthrogryposis. The most distinctive phenotypes were arthrogryposis confined to the legs (five cases) and terminal transverse-limb defects (nine cases) with or without Mobius sequence. The most common dose of misoprostol taken was 800 microg (range 200-16000 microg). INTERPRETATION: Deformities attributed to vascular disruption were found in these children. We suggest that the uterine contractions induced by misoprostol cause vascular disruption in the fetus, including brain-stem ischaemia. Information on the effects of taking misoprostol during pregnancy should be made more widely available, to dissuade women from misusing the drug.
PIP: In Brazil and other South and Central American countries where abortion is illegal, misoprostol is widely available and commonly used to induce abortion. However, misoprostol is not very effective as an abortifacient agent and can cause fetal abnormalities. The present study reviewed the cases of 42 infants from Sao Paulo, Brazil, who were exposed to misoprostol during the first trimester of pregnancy and then born with a congenital abnormality. 17 children had equinovarus with cranial nerve deficiencies and 10 had equinovarus as part of a more extensive arthrogryposis. The most distinctive phenotypes were arthrogryposis confined to the legs (5 cases) and terminal transverse limb defects (9 cases). Congenital hydrocephalus was present in 8 children. The most commonly taken dose of misoprostol was 800 mcg (range, 200-16,000 mcg). Greater awareness of the widespread use of misoprostol to induce abortion should lead to public health interventions to prevent teratogenic effects.
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Anormalidades Induzidas por Medicamentos/epidemiologia , Abortivos não Esteroides/efeitos adversos , Aborto Criminoso , Artrogripose/induzido quimicamente , Pé Torto Equinovaro/induzido quimicamente , Nervos Cranianos/anormalidades , Misoprostol/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Abortivos não Esteroides/administração & dosagem , Aborto Criminoso/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Misoprostol/administração & dosagem , Gravidez , AutoadministraçãoRESUMO
A prospective trial including 300 pregnant women seeking elective abortion was conducted to evaluate the safety and efficacy of methotrexate and misoprostol for abortion at < or = 63 days' gestation. Subjects received methotrexate 50 mg orally and were randomly allocated to receive 800 micrograms of misoprostol vaginally 3, 4, or 5 days after administration of the methotrexate. The misoprostol dose was repeated 48 and 96 h later if abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure) and side effects. Complete abortion occurred in 273 of 300 patients (91%, 95%, CI 87, 94%) patients. No significant statistical differences were found in the success rates when misoprostol was given days 3, 4, or 5 after the administration of methotrexate (p = 0.69). Vaginal bleeding lasted 7.1 +/- 3.8 days, spotting 4.1 +/- 2.5 days, and total bleeding 11.2 +/- 4.1 days. Side effects for methotrexate were minimal, whereas, for misoprostol they were mild and transient except for pain. The use of methotrexate and misoprostol together could be an alternative to the intramuscular use of methotrexate or the use of antiprogestins and prostaglandin for medical abortion.
PIP: The safety and effectiveness of oral methotrexate and vaginal misoprostol for early abortion were evaluated in a prospective study of 300 women who presented to the Cuidad de la Habana (Havana, Cuba) for termination of a pregnancy of a gestational age of 63 days or less. All women were given 50 mg of methotrexate at study entry and then were randomly allocated to receive 800 mcg of misoprostol either 3, 4, or 5 days later. If abortion did not occur, misoprostol was readministered 48 and 96 hours later. Complete abortion occurred in 273 women (91%); the success rate was 72% (216 cases) after just one dose of misoprostol. There were no significant differences in abortion rates based on the day on which misoprostol was administered. Vaginal bleeding lasted an average of 7.1 +or- 3.8 days, spotting continued for 4.1 +or- 2.5 days, and total bleeding persisted for 11.2 +or- 4.1 days. Side effects for methotrexate included nausea (9.7%), vomiting (6.7%), dizziness (10.3%), fatigue (6.3%), headache (5.3%), and chills (5.3%). For misoprostol, side effects included nausea (23.0%), vomiting (25.3%), diarrhea (51.7%), dizziness (18.3%), headache (18.0%), chills (60.0%), and pelvic pain (97.3%). All signs and symptoms were of low intensity and short duration, however. These results suggest that combined use of methotrexate and misoprostol represents a feasible alternative to the intramuscular use of methotrexate or of antiprogestins and prostaglandin for medical abortion. The efficacy and safety of this new regimen are very close to those of RU-486, but the cost is considerably less.
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Abortivos não Esteroides , Aborto Induzido , Metotrexato/administração & dosagem , Misoprostol/administração & dosagem , Administração Intravaginal , Administração Oral , Feminino , Idade Gestacional , Humanos , Metotrexato/efeitos adversos , Misoprostol/efeitos adversos , Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
Despite its prohibition, illegal abortion is widely practiced in Brazil, with important adverse health consequences. This report aims to document the prevalence and correlates of the unsuccessful use of drugs to "induce menstrual flow" in a cohort of pregnant Brazilian women. In a cross-sectional study, 6,102 pregnant women between gestation weeks 21 and 28 were interviewed in prenatal clinics of the Brazilian National Health Care System from April 1991 to November 1995. When asked "In order to know if you were pregnant, did you take any medication to induce menstrual flow", 874 (14.4%) responded "yes." The most frequently used drugs were herbal teas (41%), estrogens and/or progestogens (30%), and misoprostol (16%). As demonstrated through logistic regression analysis, independent correlates of such use were unplanned pregnancy (odds ratio [OR] 4.3), low educational attainment (OR 3.3), absence of a husband or partner (OR 1.8), number of children (one or more) (OR 1.5), a history of a previous induced abortion (OR 1.4), and use of oral contraceptives at the time (OR 1.4). Misoprostol use occurred in 2.2% of pregnancies, and showed a very strong association with an unplanned pregnancy (OR 16.0), absence of a husband or partner (OR 3.5), and a history of a previous induced abortion (OR 2.2). It was not associated with a history of menstrual irregularity. In contradistinction, the use of medroxyprogesterone was strongly associated with previous menstrual irregularity (OR = 5.0). The use of drugs and teas, many of which are unknown in terms of fetal risk, in early pregnancy to induce menstrual flow is quite common in women in the Brazilian National Health System. Although the objective of such drug use appears to be varied, analysis of the clinical correlates of use suggest attempted abortion to be the principal aim.
PIP: In countries such as Brazil, where abortion is prohibited, a range of drugs are used to induce menstruation. The present study investigated the prevalence and clinical correlates of unsuccessful use of drugs given to pregnant women to start menstrual flow. Enrolled were 6102 pregnant women at gestational weeks 21-28 presenting to the prenatal clinics of the Brazilian National Health Care System in 1991-95. 874 women (14.4%) responded affirmatively to the question, "In order to know if you were pregnant, did you take any medication to induce menstrual flow?" The frequency varied from 6-22% among the seven cities included in the study. The most commonly used drugs were herbal teas (41%), estrogens and/or progestogens (30%), and misoprostol (16%). Significant independent predictors of such medication use included unplanned pregnancy (odds ratio (OR), 4.3), low educational attainment (OR, 3.3), absence of husband or male partner (OR, 1.8), 1 or more living children (OR, 1.5), previous induced abortion (OR, 1.4), and current use of oral contraception (OR, 1.4). Herbal tea and misoprostol use were more strongly associated with unplanned pregnancy than medroxyprogesterone acetate; however, most drug use reported for menstrual induction appeared to be intended to avoid a possible pregnancy. Of concern is the effect of these medications and herbs on fetuses in cases where an abortion attempt is unsuccessful.
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Indutores da Menstruação , Abortivos não Esteroides , Aborto Criminoso , Aborto Induzido , Adulto , Bebidas , Brasil , Escolaridade , Estrogênios , Características da Família , Feminino , Humanos , Modelos Logísticos , Estado Civil , Misoprostol , Gravidez , Gravidez não Desejada , ProgestinasRESUMO
A randomized trial was conducted including 287 pregnant women seeking elective abortion to compare the efficacy of misoprostol given 3, 4, or 5 days after methotrexate for abortion at < or = 63 days' gestation. Subjects received 50 mg/m2 methotrexate intramuscularly and were randomly allocated to self-administer vaginally 800 micrograms of misoprostol 3, 4, or 5 days after the methotrexate. The misoprostol dose was repeated 48 and 96 h later if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), and side effects. Eighty-six cases (93%; 95% confidence interval [CI] 85%-97%) aborted in Group I; 90 cases (92%; 95% CI 84%-96%) aborted in Group II (relative risk [RR] = 1.09; RR 95% CI 0.38-3.14); and 89 (93%; 95% CI 86%-97%) cases aborted in Group III (RR = 0.97; RR 95% CI 0.33-2.87). No significant statistical differences were obtained for the success rates when misoprostol was given days 3, 4, or 5 after the administration of methotrexate (p = 0.97) nor with any of the characteristics of the subjects. Complete abortion occurred in 265/287 (92%; 95% CI 89%-95%) patients. Twenty-two cases (8%; 95% CI 5%-11%) resulted in failure. Side effects for methotrexate were minimal while for misoprostol they were moderate. This combination could be an alternative to surgical abortion or the use of antiprogestins and prostaglandins for medical abortion.
PIP: A randomized trial was conducted including 287 pregnant women seeking elective abortion to compare the efficacy of misoprostol given 3, 4, or 5 days after methotrexate for abortion at 63 days or less gestation. Subjects received 50 mg/sq. m methotrexate intramuscularly and were randomly allocated to self-administer vaginally 800 mcg of misoprostol 3, 4, or 5 days after methotrexate administration. The misoprostol dose was repeated 48 and 96 hours later if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure) and side effects. 86 cases [93%; 95% confidence interval (CI), 85-97%] aborted in Group I; 90 cases (92%; 95% CI, 84-96%) aborted in Group II [relative risk (RR) = 1.09; RR 95% CI, 0.38-3.14]; and 89 cases (93%; 95% CI, 86-97%) aborted in Group III (RR = 0.97; RR 95% CI, 0.33-2.87). No significant statistical differences were obtained for the success rates when misoprostol was given days 3, 4, or 5 after methotrexate administration (p = 0.97) nor with any of the characteristics of the subjects. Complete abortion occurred in 265/287 patients (92%; 95% CI, 89-95%). 22 cases (8%; 95% CI, 5-11%) resulted in failure. Side effects for methotrexate were minimal, while for misoprostol they were moderate. This combination could be an alternative to surgical abortion or the use of antiprogestins and prostaglandins for medical abortion.
Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/métodos , Metotrexato/administração & dosagem , Misoprostol/administração & dosagem , Adulto , Feminino , Humanos , Metotrexato/efeitos adversos , Misoprostol/efeitos adversos , Gravidez , Primeiro Trimestre da GravidezRESUMO
PIP: Citing information published in 2 Lancet articles (one by the research groups of Dr. Helena Coelho and Dr. Walter Fonseca and another by Sarah Costa and Martin Vessey), this article describes the misuse of the anti-ulcer prescription drug, misoprostol, which is actually obtainable over the counter, to induce abortion in Brazilian women. Its safety and efficacy are questionable. During a 2.5 year survey, Coelho found that 32% of the women admitted to the main obstetric hospital at Fortaleza had developed womb infections. Others hemorrhaged badly enough to require transfusions. Also, one-third of those who needed womb evacuations had used misoprostol or other illicit drugs to induce the miscarriage. Costa and Vessey discovered that 10% of the women studied who finished their pregnancies had initially attempted to use misoprostol as an abortifacient. Costa blames the lack of access to contraception for the rise in abortion attempts. Changes in prescription laws pertaining specifically to misoprostol have reduced its use in this manner.^ieng
Assuntos
Abortivos , Aborto Criminoso , Aborto Induzido , Inquéritos Epidemiológicos , Preparações Farmacêuticas , América , Brasil , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , América do Sul , TerapêuticaRESUMO
Cytotec, the commercial name for misoprostol, which is a synthetic analogue of prostaglandin E1, was approved for use in Brazil in 1986 to treat gastric and duodenal ulcers. The drug can and has also been used to induce abortion, which has created controversy in a country in which induced abortion is illegal. A study of the drug was undertaken in 1992 that included analyses of the drug's sales profile, of information published by the media, and of its use from women's and gynecologists' points of view, the latter examined using qualitative methodologies. The analysis of Cytotec's sales volume showed quick growth from its introduction until the first half of 1991, when its use was restricted by the Ministry of Health. For women, Cytotec's main advantages have been that it is relatively inexpensive, convenient to use, and can be used in private. Data obtained from gynecologists show that Cytotec's addition to the obstetric therapeutic arsenal was welcome and also confirmed the drug's influence in reducing the complications of illegal abortions shown in other studies.
PIP: A Brazilian study of 1986-92 sales of the prostaglandin analogue, misoprostol (Cytotec), often used as an abortifacient in Brazil, shows that an increasing trend began in January 1989 and was maintained until July 1991, when the Ministry of Health (MOH) imposed restrictions on Cytotec sales. Cytotec introduced in mid-1986 as a treatment for gastric and duodenal ulcers. Sales reached their lowest levels in 1992 (150,207 vs. 189,199-581,003 annual sales). Other factors contributing to the fall in sales wee reduced production due to an agreement between the manufacturer and MOH, a newspaper campaign by anti-Cytotec groups, and a law for a double-copy prescription. Hospital surveys in the early 1990s indicated that many women used Cytotec to induce an abortion. The media, pharmacies, physicians, women, and the manufacturer spread the news that Cytotec could be used to induce abortion. Women take 4-16 doses of Cytotec to induce abortion, generally during the first trimester. The use Cytotec because it is relatively inexpensive and less traumatic than other abortion methods and can be taken in privacy. Women also consider Cytotec to be safe. Nevertheless, most women complain of the pain they experience and the need to eventually go to a hospital. These negative views are a result of lack of information about the physical process of the drug. Gynecologists of the Sao Paulo public health system confirm the widespread use of Cytotec as an abortifacient. Cytotec allows gynecologists to perform abortions without the police being involved since women induce an abortion with Cytotec, and gynecologists perform a curettage. Hospital staff consider this type of induced abortion more acceptable than other methods. It also allows them to avoid the feelings of inadequacy they experience when women are admitted for an infection caused by a botched abortion or perforated uterus. These findings demonstrate that a favorable atmosphere exists in Brazil to promote the legalization of abortion.
Assuntos
Misoprostol , Aborto Criminoso/estatística & dados numéricos , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Brasil , Uso de Medicamentos/estatística & dados numéricos , Feminino , Grupos Focais , Ginecologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Misoprostol/provisão & distribuição , GravidezRESUMO
We report on the determinants and consequences of induced abortion among 803 women admitted to hospital with abortion complications in Rio de Janeiro, Brazil, in 1991. 458 (57%) women reported using misoprostol to induce abortion, 74% in the first 4 months of pregnancy. Doses of 200-16,800 micrograms were reported, with a median of 800 micrograms. 65% of the women took the drug orally, 29% used a combination of oral and vaginal routes, and 6% administered it intravaginally. Vaginal bleeding and uterine cramps were the commonest reasons for seeking hospital care. Only 8% of women reported gastrointestinal side-effects. Misoprostol induced vaginal bleeding within 12 h of administration in 52% of the women, but 16% waited 10 days or more for onset of bleeding. 4% were admitted to hospital with complete abortion. The likelihood of bleeding starting within 12 h increased with duration of gestation and it was greater when the drug was used both orally and intravaginally. A significantly smaller proportion of women taking misoprostol than of those who induced abortion by catheter insertion presented signs of infection or physical injuries or required blood transfusion (< 0.0005). Among 803 women interviewed at delivery as controls, 6% had taken misoprostol but abortion had not ensued. Misoprostol has an important role as an abortifacient among the women studied.
Assuntos
Aborto Criminoso , Misoprostol/administração & dosagem , Aborto Induzido , Administração Intravaginal , Administração Oral , Adolescente , Adulto , Brasil , Feminino , Idade Gestacional , Hospitalização , Humanos , Misoprostol/efeitos adversos , Cãibra Muscular/induzido quimicamente , Gravidez , Medição de Risco , Fatores Socioeconômicos , Hemorragia Uterina/induzido quimicamenteRESUMO
PIP: As a non-invasive means of early abortion, RU-486 has the potential to increase women's reproductive options; at the same time, the "abortion pill" has stimulated debate about the ethics and safety of new medical technologies. When combined with a prostaglandin (PG), the success rate for RU-486 is 96% for pregnancies of up to 9 weeks' gestation. In France, over 120,000 women have used RU-486/PG to terminate pregnancy, and this regimen is now used in about 25% of abortions. Clinical trials of RU-486 are underway in Cuba, China, India, Singapore, and Zambia. The Program for Appropriate Technology has identified four considerations for introducing RU-486 to developing countries: whether abortion or menstrual regulation is legal; whether women find the method acceptable and can comply with the multiple visit treatment regimen; whether the health infrastructure can support safe method use, including prevention of misuse and provision of appropriate medical backup personnel and facilities; and whether the cost of the regimen is affordable to individuals and/or programs --conditions unlikely to be met in most such countries. Ideal would be development of a medical abortifacient that is single dose and the lowest possible dose of each drug, provokes miscarriage within a more predictable time frame with less acute and prolonged bleeding, is safe and effective beyond two months, has minimal side effects, and maximizes short-term safety and minimizes long-term effects. Technological advances are being undermined, however, by political and religious attacks on the method. Even some feminists have expressed concerns about potential long-term effects of RU-486 use.^ieng
Assuntos
Abortivos , Países em Desenvolvimento , Ética , Estudos de Avaliação como Assunto , Feminismo , Mifepristona , Política , Aborto Induzido , Biologia , Países Desenvolvidos , Sistema Endócrino , Europa (Continente) , Serviços de Planejamento Familiar , França , Antagonistas de Hormônios , Hormônios , FisiologiaRESUMO
PIP: Brazilian women's reliance on Cytotec--a prostaglandin commercially marketed for the treatment of gastric ulcers but with abortifacient potential--demonstrates the depth of determination of poor women to control their fertility in countries where abortion is illegal. An estimated 1-4 million clandestine abortions are performed in Brazil each year. After Cytotec's introduction in 1986, sales rose rapidly to 50,000 units/month by 1991. In 1991, however, the Ministry of Health altered the regulations surrounding sales of Cytotec. Its sale was prohibited in 1 state, its use was restricted to hospitals in another, and the remaining states required 2 prescriptions. As a result, sales dropped to 5000 units/month in 1992. At the time these restrictions were enacted, Cytotec was the agent used to introduce half the abortions induced by Brazilian women. Women found this method acceptable because of its low cost, accessibility, and privacy. The major complication of its use, uterine bleeding, is far easier to treat than the uterine perforation and pelvic infections associated with other methods of self-induced abortion. In fact, the improved abortion-related mortality/morbidity statistics in Brazil in recent years are probably a direct result of Cytotec use. Restricted access to this agent is expected to reverse this trend.^ieng
Assuntos
Abortivos , Aborto Criminoso , Marketing de Serviços de Saúde , Mortalidade Materna , Prostaglandinas , Aborto Induzido , América , Biologia , Brasil , Demografia , Países em Desenvolvimento , Economia , Sistema Endócrino , Serviços de Planejamento Familiar , América Latina , Mortalidade , Fisiologia , População , Dinâmica Populacional , América do SulRESUMO
In 1987, 38 percent of married Paraguayan women aged 15-44 were practicing contraception, with oral contraceptives being the most prevalent method. Fertility rates for the population were at corresponding levels, with an overall fertility rate of 5.4 births per woman. Fertility has not changed substantially for the nation as a whole since 1979, and contraceptive use has increased by only 6 percentage points. Findings from the present study are consistent with the lack of a public sector family planning program in the country. Pharmacies are the principal source of contraceptives in the country. Twenty-two percent of all women and one-third of married women are at risk of having an unplanned pregnancy. The greatest impact on contraceptive use can be made if new and continued program efforts focus n the interior of the Oriental region of the country.
PIP: In 1987, staff from the International Planned Parenthood Federation affiliate in Paraguay (CEPEP) with technical assistance from the US Centers for Disease Control (CDC) selected 1500 households in metropolitan Asuncion and the interior of the Oriental region (the Interior) to study contraceptive behavior and fertility. Eligible respondents to the survey consisted of women 15 to 44 years old, regardless of marital status. Researchers interviewed only 1 woman per household and completed 2224 interviews. The 1987 overall fertility rate of 5.4 births per woman did not change much since 1979 (4.9), and contraceptive use only increased from 32.1% to 37.6%. Metropolitan Asuncion reported the highest prevalence (more than 50%). In terms of methods to control family size, oral contraceptive (OC) led the list of contraceptive use at 13.5%, followed by native herbs called yuyos at 7.2% and intrauterine devices (IUDS) at 5.1%. After the Paraguayan MOH stopped providing family planning services through MOH facilities in 1979, pharmacies became the primary source of contraceptives (51%). Prior to 1979, the MOH supplied 45% of all contraceptives. Findings in the survey indicated that 22% of all women and 33% of married women are at risk of having an unplanned pregnancy. Also the women exhibited a strong interest in spacing or limiting family size, but because the public sector does not provide contraceptives women cannot do so.
Assuntos
Anticoncepção , Fertilidade , Adolescente , Adulto , Fatores Etários , Aleitamento Materno , Escolaridade , Características da Família , Serviços de Planejamento Familiar , Feminino , Inquéritos Epidemiológicos , Humanos , Magnoliopsida , Paraguai , Gravidez , Projetos de Pesquisa , População Rural , População UrbanaRESUMO
PIP: A sesquiterpene lactone given the trivial name leucanthanolide, from the Mexican zoapatle plant (Montanoa leucantha), long used as an herbal remedy, was isolated and was found to have cytotoxicity but no uterine activity. The compound was isolated from the fraction containing zoapatanol, a substance being investigated for its ability to induce menses, abortion and labor. The compound has a molecular formula of C19H2606, a 5-membered lactone ring, an ester group, and a germacradienolide skeleton. It was evaluated for abortifacient activity in pregnant guinea pigs by intraperitoneal injection on day 22 of gestation. 3 of 5 animals had abnormal fetuses, but there was no evidence of early uterine activity. Cytotoxic testing in vitro was done on KB and P-388 test systems in cell culture. The ED50 of leucanthanolide was 0.57 mcg/ml (KB) and 0.93 (P-388). In comparison, the ethyl acetate fraction had an ED50 of 1.35 mcg/ml and 5.2 mcg/ml respectively.^ieng
Assuntos
Antineoplásicos Fitogênicos , Plantas Medicinais/análise , Sesquiterpenos/farmacologia , Abortivos , Animais , Feminino , Cobaias , Humanos , Células KB , Leucemia P388/patologia , Masculino , Espectrometria de Massas , México , GravidezRESUMO
PIP: Despite the existence of 2 government health centers in Mexico's San Francisco township, the use of herbal remedies for the treatment of reproductive health problems and the management of reproduction is almost universal. An ethnographic study conducted in 1980-1981 of 180 women and 126 women investigated use of specific herbal remedies in this highland area. The largest number of reproduction-related medicinal plants used San Francisco are for postpartum recovery. In fact, 80% of the women interviewed reported using only herbal remedies after their last delivery. These remedies are relied on to restore lost blood, heal the birth scar, and stop bleeding. Of the 40% of respondents who reported postpartum hemorrhaging, 70% used herbal remedies. Several of the plants used to treat menorrhagia and hemorrhaging are also used for infertility. The infertility remedies are believed to cleanse the blood and uterus, heal or strengthen the back so the fetus can adhere, help the womb retain the fetus, and cool the blood. Both infertility and miscarriage are attributed to incomplete postpartum recovery. Another large group of medicinal remedies is employed to speed labor or ease labor pains. These remedies are thought to stimulate blood flow or uterine contractions. An additional 15 plants are used to prevent or terminate pregnancy. The mechanism of action in these case is believed to be to both warm the blood to facilitate its flow and irritate the uterus so it will evacuate its contents. Reliance on these remedies derives from Chinantec ethnomedical understandings. Given the persistence of use of herbal remedies in many communities in the Third World, research is needed on their safety and efficacy.^ieng
Assuntos
Abortivos , Coleta de Dados , Serviços de Planejamento Familiar , Infertilidade , Medicina Tradicional , Menorragia , Plantas Medicinais , Período Pós-Parto , Gravidez , Autocuidado , Aborto Induzido , América , Atenção à Saúde , Países em Desenvolvimento , Doença , Saúde , Serviços de Saúde , América Latina , Medicina , Distúrbios Menstruais , México , América do Norte , Reprodução , Pesquisa , Estudos de Amostragem , TerapêuticaRESUMO
PIP: The possible teratogenic effects of prostaglandins (PGs) in humans have not been investigated in detail, yet these drugs appear to be deleterious in laboratory animals. A case report is presented of congenital anomalies in a newborn infant whose mother received intravaginal PG 7 weeks after conception but failed to abort. The infant was delivered after 34 weeks' gestation with a birth weight of 2.34 kg. The mother had been placed in an experimental protocol using intravaginal PG 15-methyl F2alpha. She received 1 mg, then another 3 mg after 1 hour and was sent home with instructions to call in 24 hours if no tissue was passed. She experienced nausea, vomiting, and intense abdominal cramping but no vaginal blood or tissue loss occurred. She then decided to continue the pregnancy and did not mention these events when she went to a different clinic for prenatal care. Routine ultrasound examination at 24 weeks disclosed dilated lateral cerebral ventricles, which progressively enlarged over the next 3 weeks. No other anomalies were seen. Amniotic fluid alpha-fetoprotein concentration was normal, and karotype was 46,XY. Referral was made to Yale-New Haven Hospital, where at 27 weeks a silastic catheter was placed by Dr. Richard Berkowitz through the fetal skull into the left lateral ventricle under ultrasound guidance, creating a ventriculoamniotic shunt. There was an initial decrease in the size of the left lateral ventricle and improvement in thickness of the corticle mantle. The right ventricle remained enlarged, and the left dilated again after 4-6 weeks, indicating probable blockage of the shunt. The infant was delivered at 34 weeks by cesarean section after pulmonary maturity was demonstrated by amniotic fluid L/S ratio. At birth the Apgar score was 9 at 5 minutes and maturity ratings were consistent with 34-35 weeks. The head was large, the circumference being 34 1/2 cm. The face was not dysmorphic but the ears appeared slightly small. The most striking abnormality concerned the digits of all 4 limbs; all were tapered and shortened with hypoplastic or absent nails. There was a left simian crease. The infant had a shrill cry and was hypertonic but a good suck was present. Radiographs of the hands revealed missing or hypoplastic distal phalanges of all fingers; the middle phalanges of the 3rd and 4th digits of the right hand also were absent. More proximal osseous structures were normal. A search of the literature failed to reveal a report of the association of hydrocephalus and these digital anomalies.^ieng