Verónica Fiol

Improving care of women at risk of unsafe abortion: Implementing a risk-reduction model at the Uruguayan-Brazilian border

To describe the initial stages of the implementation of a risk‐reduction model designed by Iniciativas Sanitarias to shield women from unsafe abortion in a traditional community on the Uruguay‐Brazil border.

Tocolysis and delayed delivery versus emergency delivery in cases of non‐reassuring fetal status during labor

Aim:  To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non‐reassuring fetal heart‐rate (FHR) pattern using conventional heart rate monitoring.

The role of medical abortion in the implementation of the law on voluntary termination of pregnancy in Uruguay

To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population.OBJECTIVE To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population. METHODS The legal and regulatory provisions are described and the national data-provided by the Ministry of Public Healths National Information System (SINADI)-on the number of voluntary terminations of pregnancy, the abortion method (medical or surgical), and whether it was performed as an outpatient or inpatient are analyzed. To determine complications, the number of maternal deaths and admissions to intensive care units for pregnant women was used. The study period ran from December 1, 2012, to December 31, 2014. RESULTS A total of 15 996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of the latter, only 3.4% required hospitalization. Less than half of the pregnancies were terminated up to 9 weeks of gestation and 54% were at 10 to 12 weeks in a sample from the Pereira Rossell Hospital. CONCLUSION The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to a large degree thanks to the availability and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm reduction strategy.

Conscientious objection as a barrier for implementing voluntary termination of pregnancy in Uruguay: Gynecologists’ attitudes and behavior

To analyze the attitudes and behavior of gynecologists in Uruguay with respect to the right to conscientious objection that is included in the law concerning voluntary termination of pregnancy.

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

Cervical cancer prevention and treatment in Latin America

Cervical cancer is a preventable disease with a known etiology (human papillomavirus), effective preventive vaccines, excellent screening methods, and a treatable pre‐invasive phase. Surgery is the primary treatment for pre‐invasive and early‐stage disease and can safely be performed in many low‐resource settings. However, cervical cancer rates remain high in many areas of Latin America. This article presents a number of evidence‐based strategies being implemented to improve cervical cancer outcomes in Latin America.

Legal termination of pregnancy as an opportunity for expanding postabortion contraception: Experience at the Pereira Rossell Hospital, Montevideo, Uruguay

To determine to what extent women adopted highly effective contraceptive methods after a legal abortion.OBJECTIVE To determine to what extent women adopted highly effective contraceptive methods after a legal abortion. METHODS The data available during a period before and another period after liberalization of the abortion law were reviewed. The data gathering was incomplete and reliable only during certain periods, which were used in the study. RESULTS There was an increase in the proportion of women who returned for contraception and in the proportion who used any method and long-acting methods; however, no contraception was administered immediately after abortion and only 16% of all women treated started to use a long-acting method during the period after the law was liberalized. CONCLUSION The proposed objective was not being achieved, the recommended guidelines were not being followed, and data gathering was incomplete. Good intentions are not enough and it is always necessary to evaluate the performance of a program. The results indicate that immediate reforms are necessary in postabortion contraception services.

P299 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion (health initiatives against unsafe abortion) in first level health centers of Uruguay

P299 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion (health initiatives against unsafe abortion) in first level health centers of Uruguay V. Fiol, M. Nozar, M. Gorgoroso, A. Labandera, C. Stapff, L. Briozzo. Pereira Rossell Hospital, School of Medicine, Health Initiatives, Pereira Rossell Hospital, Health Initiatives, Pereira Rossell Hospital, School of Medicine, Health Initiatives

O313 Implementation of a risk reduction strategy to prevent maternal death associated with unsafe abortion in the major third level health center of Uruguay

Objective: To evaluate the implementation of the risk reduction strategy Health Initiatives Against Unsafe Abortion in the major third level women health center of Uruguay, Pereira Rossell Hospital. Methodology: Comparative analysis between 2 periods: 2004– 2005, first experience of implementation of the strategy (“Advisory Service”); and 2007–2008, implementation of the strategy under a comprehensive Sexual Health Service. Population: 675 users in the first period and 640 users in the second. Data was collected using a pre-designed form for the “before-abortion” and “after-abortion” visit, filled by the professionals and identified with a number. Results: In the first period most of users (68%) attended before and after abortion visits, while in the second period most of them (70.5%) attended only the before-abortion visit. Concerning gestational age, in the second period more users attended the before-abortion visit with ages less than 12 weeks (77% vs. 82.5%). Concerning the final decision, in both periods most women decided to abort. In some cases (4% and 6%) women were either not pregnant or the embryo was dead, which kept them away from any risks. Concerning post-abortion contraception, it increases in the second period (56% vs.67%) with a substantial increase in the use of the intrauterine device (5.5% vs. 33%). Conclusions: The implementation of the Health Initiatives Against Unsafe Abortion in the Pereira Rossell Hospital offers a necessary service to women undergoing an unwanted pregnancy who desire an abortion. The strategy is effective in reducing unsafe abortions and their health consequences. Its implementation under a comprehensive Sexual Health Service improves access to contraception.

Corioamnionitis histológica en el recién nacido menor de 1.000 gramos. Incidencia y resultados perinatales

Histological chorioamnionitis in the newborn with birth weight less than 1 000 g perinatal incidence and results Objective: Determine the incidence of clinical and histological chorioamnionitis on extremely low birth weight infants and its correlation with perinatal outcome. Method: Descriptive and prospective study carried out between May 2004 and April 2005. All newborns weighting between 500 - 1 000 g and with placental histopathological study were included. Results: A total of 52 infants fulfilled the inclusion criteria. Histological study of the placenta was performed in 44 patients (84.6%). The average birth weight was 822.3 g (SD 127 g) and the mean gestational age was 26 weeks (SD 2 weeks). Preterm labour was recorded in 28 mothers (63.6%), where 18 (40.9%) had premature membrane rupture. Histological diagnosis of chorioamnionitis was done in 27 cases (61.4%), where 12 (27.2%) had a clinical diagnosis of chorioamnionitis previously. In 13 of 27 cases with histological chorioamnionitis, no premature membrane rupture was recorded. 75% (9) of patients with clinical diagnosis presented chorioamnionitis with fetal response in the placenta at the histological study. In 5 cases, histological chorioamnionitis with fetal response was found in absence of clinical diagnosis. Early neonatal mortality was observed in 15 (34%)