Raffaela Schiavon

Decreasing Cervical Cancer Mortality in Mexico: Effect of Papanicolaou Coverage, Birthrate, and the Importance of Diagnostic Validity of Cytology

Background: The reduction in cervical cancer mortality in developed countries has been attributed to well-organized, population-based prevention and control programs that incorporate screening with the Papanicolaou (Pap) smear. In Mexico, there has been a decrease in cervical cancer mortality, but it is unclear what factors have prompted this reduction. Methods: Using data from national indicators, we determined the correlation between cervical cancer mortality rates and Pap coverage, birthrate, and gross national product, using a linear regression model. We determined relative risk of dying of cervical cancer according to place of residence (rural/urban, region) using a Poisson model. We also estimated Pap smear coverage using national survey data and evaluated the validity and reproducibility of Pap smear diagnosis. Results: An increase in Pap coverage (β = −0.069) and a decrease in birthrate (β = 0.054) correlate with decreasing cervical cancer mortality in Mexico. Self-reported Pap smear rates in the last 12 months vary from 27.4% to 48.1%. Women who live in the central (relative risk, 1.04) and especially the southern (relative risk, 1.47) parts of Mexico have a greater relative risk of dying of cervical cancer than those who live in the north. There is a high incidence of false negatives in cervical cytology laboratories in Mexico; the percentage of false negatives varies from 3.33% to 53.13%. Conclusions: The decrease in cervical cancer mortality observed in Mexico is proportional to increasing Pap coverage and decreasing birthrate. Accreditation of cervical cytology laboratories is needed to improve diagnostic precision. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2808–17)

Treatment of incomplete abortion and miscarriage with misoprostol

A literature review was conducted to determine whether misoprostol is an effective treatment for incomplete abortion and, if so, to recommend an appropriate regimen. All English language articles published before October 2007 using misoprostol in at least one of the study arms were reviewed to determine the efficacy of misoprostol when used to treat incomplete abortion in the first trimester. All available unpublished data previously presented at international scientific meetings were also reviewed. Sufficient evidence was found in support of misoprostol as a safe and effective means of non‐surgical uterine evacuation. A single dose of misoprostol 600 μg oral is recommended for treatment of incomplete abortion in women presenting with a uterine size equivalent to 12 weeks gestation.

Analysis of maternal and abortion-related mortality in Mexico over the last two decades, 1990-2008

To document the relative contribution of abortion‐related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990–2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion‐related deaths per 100 000 abortion‐related hospitalizations, expressed as a modified abortion case‐fatality rate. During 2000–2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100 000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico.

Mecanismos de acción de la anticoncepción hormonal de emergencia: efectos del levonorgestrel anteriores y posteriores a la fecundación

There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.

Mechanisms of action of emergency contraception: pre and post-fertilization effects of levonorgestrel.

There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.

Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City

Objective To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City’s public sector first trimester abortion program. Methods We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007–2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women’s characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics. Results Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12–17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p< 0.05). In multivariable analyses, all age groups of adult women had significantly lower odds than adolescents of presenting past the limit (aOR = 0.77, aOR = 0.63, aOR = 0.58 and aOR = 0.37 for 19–24, 25–29, 30–39, and > = 40 years’ old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02–4.26% across adult age groups). Conclusions Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services.

Mechanisms of action of emergency contraception

There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.