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Cureus May 2021Background Nitazoxanide shows adequate activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in...
Background Nitazoxanide shows adequate activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in pregnant women treated with nitazoxanide. Methodology This cross-sectional study included the files of COVID-19 positive pregnant women treated with nitazoxanide 500 mg every 6 hours, levofloxacin every 12 hours, and clarithromycin 500 mg every 12 hours. Results The data of 51 women (mean age: 27.4 ± 7.2 years) were analyzed. Eleven (21.56%) patients had to receive medical attention in the intensive care unit. There were 22 (43.13%) preterm deliveries, 21 by cesarean and one by vaginal delivery. The medical attention of this population was as follows: 31 cesareans, five vaginal deliveries, nine still pregnant, two requiring manual vacuum aspiration, two ectopic pregnancies, one requiring curettage, and one requiring hysterotomy. There were seven (13.72%) cases of preeclampsia, and there were two (3.92%) deaths. Conclusion Nitazoxanide prescription could be an option against COVID-19 in pregnancy due to its safety profile.
PubMed: 34131543
DOI: 10.7759/cureus.15002 -
Global Health, Science and Practice Aug 2019In 2015, the government of Tanzania began to strengthen the quality of postabortion care (PAC). Limited research has been conducted to understand clients' perceptions of...
BACKGROUND
In 2015, the government of Tanzania began to strengthen the quality of postabortion care (PAC). Limited research has been conducted to understand clients' perceptions of public sector provision of PAC. Accordingly, we carried out a mixed-method study between April and July 2016, using client surveys and in-depth interviews, both implemented immediately following PAC. Results were used to help guide the government's initiative.
METHODOLOGY
We assessed the quality of PAC in 25 public-sector facilities through a client survey of 412 women. Questions included satisfaction with client-staff interaction, counseling, provider competence, postabortion family planning, accessibility of care, and the facility environment. Based on responses, we developed and validated a scale representing women's overall satisfaction with the quality of care. We conducted bivariate analysis to identify the levels of care associated with clients' ranking of individual and composite measures of the quality of care. We used multivariate ordinal logistic models to assess the relative influence of multilevel factors on clients' overall satisfaction. We coupled our survey with qualitative analysis of in-depth interviews with 30 PAC clients.
RESULTS
Clients reported moderately high levels of satisfaction with the quality of PAC, with an overall mean score of 2.6 on a 4-point scale. Bivariate analysis identified several areas for improvement, including family planning counseling and provision, especially at regional hospitals; pain management; and reduced use of sharp curettage. The factors most strongly associated with satisfaction were advanced parity, receiving care at lower-level facilities, brief waiting periods, and manual vacuum aspiration for treatment of incomplete abortion. Qualitative analysis illuminated how client-provider interactions; pain; desire for counseling and information, especially on family planning; and congested facility environments shape clients' perceptions of the care they received.
CONCLUSIONS
Although clear areas for improvement in public-sector provision of PAC existed at all sites, women were less likely to report satisfaction with care at referral facilities owing primarily to inadequate counseling, delays in receiving PAC treatment after admission, and poor emphasis on postabortion fertility, family planning information, and contraceptive provision. PAC programs should ensure availability of a wide range of contraceptive methods and high-quality family planning counseling, especially at tertiary facilities.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Aftercare; Family Planning Services; Female; Hospitals, District; Humans; Middle Aged; Patient Satisfaction; Pregnancy; Public Sector; Quality of Health Care; Surveys and Questionnaires; Tanzania; Tertiary Care Centers; Young Adult
PubMed: 31455626
DOI: 10.9745/GHSP-D-19-00026 -
The Pan African Medical Journal 2022single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Objective: to compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria.
METHODS
the primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants' satisfaction with the treatment received.
RESULTS
two hundred and three participants who met the study criteria and completed the study were randomised into the intervention group (n=102) received single-dose sublingual misoprostol 400mcg and the control group (n= 101) received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001.
CONCLUSION
the treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: trial registration number - PACTR202009857889210, date of registration - September 23, 2020. Retrospectively registered.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Induced; Abortion, Spontaneous; Female; Humans; Misoprostol; Nigeria; Pregnancy; Vacuum Curettage
PubMed: 35432695
DOI: 10.11604/pamj.2022.41.90.29364 -
BMJ Global Health Jan 2021Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related...
INTRODUCTION
Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women's experience of abortion care in Africa.
METHODS
A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women's characteristics, clinical information and women's experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications.
RESULTS
There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).
CONCLUSION
There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women's experiences of abortion care.
Topics: Abortion, Induced; Africa South of the Sahara; Cross-Sectional Studies; Female; Health Facilities; Humans; Pregnancy; World Health Organization
PubMed: 33514590
DOI: 10.1136/bmjgh-2020-003702 -
BMC Women's Health Sep 2018Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are...
BACKGROUND
Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections.
METHODS
All women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure.
RESULTS
A total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions < 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion > 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions < 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04-2.15). An incomplete abortion was the most common complication related to medical abortions < 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications.
CONCLUSIONS
The share of complications related to medical abortions < 12 weeks increased significantly during 2008-2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.
Topics: Abortifacient Agents; Abortion, Incomplete; Abortion, Induced; Adult; Bacterial Infections; Chlamydia Infections; Female; Follow-Up Studies; Gonorrhea; Humans; Incidence; Longitudinal Studies; Mass Screening; Mycoplasma Infections; Postoperative Complications; Pregnancy; Preoperative Period; Prevalence; Prospective Studies; Retrospective Studies; Sweden; Vaginosis, Bacterial
PubMed: 30253769
DOI: 10.1186/s12905-018-0645-6 -
Fertility and Sterility Aug 2009To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness.
DESIGN
Prospective, randomized clinical trial.
SETTING
University hospital.
PATIENT(S)
One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy.
INTERVENTION(S)
Manual vacuum aspiration (control and study groups) plus 400 microg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure.
MAIN OUTCOME MEASURE(S)
Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure.
RESULT(S)
Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group.
CONCLUSION(S)
In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Sublingual; Adult; Combined Modality Therapy; Female; Humans; Misoprostol; Postoperative Hemorrhage; Treatment Outcome; Vacuum Curettage
PubMed: 18774567
DOI: 10.1016/j.fertnstert.2008.07.1706 -
American Journal of Physiology.... Jun 2011This study tested the hypothesis that transdermal fluid (TDF) provides a more sensitive and accurate measure of exercise-induced increases in insulin-like growth...
This study tested the hypothesis that transdermal fluid (TDF) provides a more sensitive and accurate measure of exercise-induced increases in insulin-like growth factor-I (IGF-I) than serum, and that these increases are detectable proximal, but not distal, to the exercising muscle. A novel, noninvasive methodology was used to collect TDF, followed by sampling of total IGF-I (tIGF-I) and free IGF-I (fIGF-I) in TDF and serum following an acute bout of exercise. Experiment 1: eight men (23 ± 3 yrs, 79 ± 7 kg) underwent two conditions (resting and 60 min of cycling exercise at 60% Vo(2)(peak)) in which serum and forearm TDF were collected for comparison. There were no significant changes in tIGF-I or fIGF-I in TDF obtained from the forearm or from serum following exercise (P > 0.05); however, the proportion of fIGF-I to tIGF-I in TDF was approximately fourfold greater than that of serum (P ≤ 0.05). These data suggest that changes in TDF IGF-I are not evident when TDF is sampled distal from the working tissue. To determine whether exercise-induced increases in local IGF-I could be detected when TDF was sampled directly over the active muscle group, we performed a second experiment. Experiment 2: fourteen subjects (22 ± 4 yr, 68 ± 11 kg) underwent an acute plyometric exercise condition consisting of 10 sets of 10 plyometric jumps with 2-min rest between sets. We observed a significant increase in TDF tIGF-I following exercise (P ≤ 0.05) but no change in serum tIGF-I (P > 0.05). Overall, these data suggest that TDF may provide a noninvasive means of monitoring acute exercise-induced changes in local IGF-I when sampled in proximity to exercising muscles. Moreover, our finding that the proportion of free to tIGF-I was greater in TDF than in serum suggests that changes in local IGF-I may be captured more readily using this system.
Topics: Adolescent; Adult; Bicycling; Exercise; Female; Forearm; Humans; Insulin-Like Growth Factor I; Lasers; Male; Rest; Skin; Specimen Handling; Vacuum Curettage; Young Adult
PubMed: 21389329
DOI: 10.1152/ajpregu.00313.2010 -
PloS One 2017The objective of this study was to document sexual and reproductive health (SRH) practices among female sex workers (FSWs) including abortion, pregnancy, use of maternal...
OBJECTIVES
The objective of this study was to document sexual and reproductive health (SRH) practices among female sex workers (FSWs) including abortion, pregnancy, use of maternal healthcare services and sexually transmitted infections (STIs) with the aim of developing recommendations for action.
METHODS
A total of 731 FSWs aged between 15 and 49 years were surveyed using a stratified sampling in Dhaka, Bangladesh. A workshop with 23 participants consisted of policy makers, researchers, program implementers was conducted to formulate recommendations.
RESULTS
About 61.3% of 731 FSWs reported SRH-related experiences in the past one year, including abortion (15.5%), ongoing pregnancy (9.0%), childbirth (8.3%) or any symptoms of STIs (41.6%). Among FSWs who had an abortion (n = 113), the most common methods included menstrual regulation through manual vacuum aspiration (47.8%), followed by Dilation and Curettage procedure (31%) and oral medicine from pharmacies (35.4%). About 57.5% of 113 cases reported post abortion complications. Among FSWs with delivery in the past year (n = 61), 27.7% attended the recommended four or more antenatal care visits and more than half did not have any postnatal visit. Adopting sustainable and effective strategies to provide accessible and adequate SRH services for FSWs was prioritized by workshop participants.
CONCLUSION
There was substantial unmet need for SRH care among FSWs in urban areas in Dhaka, Bangladesh. Therefore, it is important to integrate SRH services for FSWs in the formal healthcare system or integration of abortion and maternal healthcare services within existing HIV prevention services.
Topics: Abortion, Induced; Adolescent; Adult; Bangladesh; Birth Rate; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Menstruation; Middle Aged; Pregnancy; Prenatal Care; Reproductive Health; Reproductive Health Services; Sex Workers; Sexual Behavior; Sexually Transmitted Diseases; Surveys and Questionnaires; Young Adult
PubMed: 28369093
DOI: 10.1371/journal.pone.0174540 -
Acta Obstetricia Et Gynecologica... Mar 2005The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning...
CONTEXT
The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria.
METHODS
Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities.
RESULTS
Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors.
CONCLUSIONS
These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.
Topics: Abortion, Induced; Adult; Aftercare; Aged; Attitude of Health Personnel; Counseling; Family Planning Services; Female; Health Services Needs and Demand; Humans; Male; Maternal Health Services; Middle Aged; Nigeria; Practice Patterns, Physicians'; Pregnancy; Pregnancy, Unwanted; Private Practice; Reproductive Medicine; Surveys and Questionnaires; Vacuum Curettage; Women's Health Services
PubMed: 15715536
DOI: 10.1111/j.0001-6349.2005.00405.x -
Family Medicine Oct 2018The goal of this study was to explore family medicine residents' experiences with abortion training and identify positive and negative influences, and facilitators and...
BACKGROUND AND OBJECTIVES
The goal of this study was to explore family medicine residents' experiences with abortion training and identify positive and negative influences, and facilitators and barriers to providing abortion care.
METHODS
We conducted a qualitative study of recent graduates of an urban family medicine residency in the Northeast United States with an opt-out abortion curriculum. Individual recorded interviews were conducted with two classes of graduated residents until data saturation was reached. Data were coded and interpreted by both authors using the template analysis method.
RESULTS
Twenty residents completed interviews. Most trainees had limited or no abortion exposure prior to residency but were open to learning abortion care. By graduation, residents reported confidence in providing options counseling for unintended pregnancy. Overall, residents felt more comfortable providing medication abortion than aspiration abortion. Many reported feeling less emotional reaction to medication abortion and noted more technical and logistical barriers to learning aspiration abortion. Logistical barriers impede integration of medication abortion into practice for many, but were perceived to be less difficult to overcome than barriers to aspiration abortion integration. All participants agreed abortion care fits into the scope of primary care. Due to a variety of barriers, few of those who had not previously planned to become abortion providers after graduation incorporated it in their practice.
CONCLUSIONS
Abortion training prepared residents to counsel women with unintended pregnancy, but numerous barriers inhibit integration of abortion care into practice. Given limited abortion training resources and fewer perceived barriers to medication abortion provision, family medicine residencies may consider focusing training on medication abortion.
Topics: Abortifacient Agents; Abortion, Induced; Attitude of Health Personnel; Continuity of Patient Care; Curriculum; Family Practice; Humans; Practice Patterns, Physicians'; Qualitative Research; Vacuum Curettage
PubMed: 30307587
DOI: 10.22454/FamMed.2018.529396