Voluntary Abortion Research Articles

Facteurs associés à l’échec du traitement médical de la grossesse extra-utérine: cas de l’Hôpital Gyneco-Obstétrique et Pédiatrique de Yaoundé

Introductionl´objectif de notre travail était d´identifier les facteurs associés à l´échec du traitement médical de la grossesse extra-utérine (GEU) chez les femmes à l´Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé.Méthodesil s´agissait d´une étude cas-témoins avec collecte rétrospective des données, sur une période de 10 ans, du 1er janvier 2008 au 31 décembre 2017. Les cas étaient toutes les patientes prises en charge pour GEU avec échec du traitement médical et les témoins celles chez qui le traitement médical de la GEU avait réussi. Les variables étudiées étaient: les caractéristiques sociodémographiques, cliniques, paracliniques et thérapeutiques. L´échantillonnage était consécutif et exhaustif. Nous avons réalisé une analyse multivariée.Résultatsnous avons recruté 92 patientes dont 23 cas et 69 témoins. Les variables associées à l´échec du traitement médical de la GEU après analyse univariée étaient: un taux de β-HCG initial > 10000UI/L (OR=3,05;P=0,031), un taux de β-HCG à J4 > 10000UI/L (OR=7,15;P=0,000), un taux de β-HCG à J7 > à 10000UI/L (OR=20;P=0,000), un score de Fernandez ≥ 13 (OR=3,09;P=0,020), la présence d´activité cardiaque de l´embryon (OR=2,8;P=0,036), l´antécédent d´interruption volontaire de grossesse (OR=2,67;P=0,043) et le niveau de scolarisation primaire (P=0,013). Après analyse multivariée, les facteurs prédictifs étaient: un taux de β-HCG initial >10000 UI/L (OR=8,97; P=0,004), un taux de β-HCG à J4 >10000 UI/L (OR=8,44;P= 0,007), un score de Fernandez ≥ 13 (OR=1,12;P=0,005) et la présence de l´activité cardiaque de l´embryon (OR=6,09;P=0,026).Conclusionles facteurs prédictifs de l´échec du traitement médical de la GEU à HGOPY sont liés au taux de β-HCG initial et la viabilité embryonnaire.

Assessment of the potential impacts of the Chernobyl nuclear disaster on maternal and fetal health in Hungary

Objective: Radiation exposure is known to be mutagenic and teratogenic. The aim of this study was to analyze the effects of the increased ionizing radiation emitted by the Chernobyl nuclear disaster on maternal and fetal outcomes in Hungary. Methods: A retrospective analysis of abortion, stillbirth, and congenital anomaly data for pregnancies in Hungary between 1 January 1981 and 31 December 1991 was conducted. Results: Trend analysis revealed increasing trends in spontaneous and voluntary abortion rates in Hungary during the study time period, while late pregnancy losses showed a decreasing trend. Overall, there were generally decreasing incidence rates for birth defects throughout the 1980s. Increased voluntary abortions over the study period might reflect, at least in part, maternal anxiety in the post-Chernobyl years. Decreased late pregnancy loss over the same period may be attributable to improvements in prenatal diagnostics. A notable weakness of this study is that missing data could not be complemented due to the decades that have passed since the incident. Conclusions: In conclusion, the present data suggest that the nuclear catastrophe in 1986 did not cause a significant increase in pregnancy loss or congenital malformations in Hungary.

Very early prenatal diagnosis of Cockayne’s syndrome by coelocentesis

Cockayne’s syndrome (CS) is a rare autosomal recessive multisystem disease characterised by early severe progression of symptoms. This study reports the feasibility of earlier prenatal diagnosis of CS by coelocentesis at 8 weeks of gestation respect to amniocentesis or villocentesis. Three couples at risk for CS asked to perform prenatal diagnosis by coelocentesis. Coelomic fluid was aspired from coelomic cavity in four singleton pregnancy at 8 weeks of gestation and 40 foetal cells were recovered by micromanipulator. Maternal DNA contamination was evaluated by quantitative fluorescent PCR (QF-PCR) and target regions of foetal DNA containing parental mutations of ERCC6 gene were amplified and sequenced. In all these cases, molecular analysis was possible. One foetus resulted affected of CS and the diagnosis was confirmed on placental tissue after voluntary abortion. In three cases, foetuses resulted carrier of a parental mutation and the results were confirmed after the birth. This study suggests that reliable prenatal diagnosis of CS could be performed using foetal cells present in coelomatic fluid in earlier pregnancy. Coelocentesis could be applied in prenatal diagnosis of CSs as well as for other monogenic diseases, at very early stage of pregnancy, if parental mutations are already known. Impact Statement What is already know on this subject? Previous studies utilising coelocentesis for prenatal determination of foetal sex reported variable success ranging from 58% to 95%, because of low total DNA content and presence of maternal cell contamination. This procedure has never been reported for early prenatal diagnosis at 8 weeks of gestation for rare genetically transmitted diseases such as Cockayne’s syndrome. What do the results of this study add? This study demonstrates that coelomic fluid sampling combined with well-standardised laboratory procedures can be applied for prenatal diagnosis at eight weeks of gestation for any rare monogenic disease if molecular defects are known. What are the implications of these findings for clinical practice and/or further research? The findings of this study in at risk couples for monogenic diseases investigated by coelocentesis demonstrate that embryo-foetal cell selection from CF allows reliable and early prenatal diagnosis of diseases. This technique is attractive to parents because it provides prenatal diagnosis of genetic disease at least 4 weeks earlier than what can be achieved by the traditional procedures reducing anxiety of parents and provides the option for medical termination of affected cases at 8–10 weeks’ gestation, which is less traumatic and safer than second-trimester surgical termination. Further research concerns the possibility to obtain foetal karyotype at eight weeks of gestation and the possibility of intrauterine corrective therapy.

Psychosocial factors involved in the termination of pregnancy – our experience

Introduction. The lifestyle of each partner, the parent-child relationships and the entourage endanger the normal course of pregnancy through economic, educational and eth­nic interests, and in these situations, voluntary abortion oc­curs. The purpose of our study was to evaluate the fac­tors that determine the decision for the termination of preg­nan­cy. Materials and method. We realized a prospective stu­dy that included patients who presented for abortion on request at the “Bucur” Maternity Hospital, “Sf. Ioan” Emer­gen­cy Clinical Hospital in Bucharest, between April 2018 and June 2018. Those patients were interviewed using a self-questionnaire. Results. The study included 68 patients who presented for abortion on request. The pa­tients from the studied group were between 15 and 45 years old (mean 25.7 years old, standard deviation 7.33). Our analysis iden­tified that 52.9% of the women from our stu­dy were married. The majority of women were Orthodox Chris­tian (79.41%). Regarding the ethnicity declared by the pa­tients, the majority were Romanian (60.3%), followed by Roma wo­men (36.8%) and 2.94% undeclared. We made an as­ses­sment of termination of pregnancy reasons, and we found out that the main reason were the disagreements with the partner (39.71%), seconded by the lack of employment (in 19.12% of cases). Conclusions. The familial and economic factors were decisive for the voluntary termination of the pregnancy. Many of the women interviewed reported that they would use the method again in the future. Overall, low-income young women are most likely to request abortion.

"The system is still precarious". Barriers in access to medical abortion: the experience of accompanying persons in three regions of Mexico

The study aimed to identify the most frequent barriers in access to abortions in both clandestine and legal clinical contexts, from the perspective of accompanying persons, namely feminist activists who accompanied women that opted for voluntary abortions with medication. We performed 14 semi-structured interviews with accompanying persons in three regions of Mexico: Baja California and Chiapas, both of which are restrictive contexts, and Mexico City, where elective abortion is legal up to 12 weeks' gestational age. We identified four categories in which the social vulnerabilities of women who elect to undergo abortion intersect, namely lack of information, persistence of stigma, influence of the legal framework, and flaws in abortion care, including in clinics for legal termination of pregnancy (in Mexico City), and poor quality of the services provided, with verbal abuse, conscientious objection, and healthcare provider complaints, and finally the antichoice groups and their strategies. In the three regions, access to abortion clinics is still a privilege reserved for women with the necessary economic, logistic, and socials resources for the procedure in these settings. The existence of a program for legal termination of pregnancy (Interrupción Legal de Embarazo) in only one entity reveals the existence of a legal and health inequality. The study's findings on accompanying persons for women undergoing abortions provide backing for the Mexican government to improve access to safe abortions for all women, especially now that the country's Supreme Court has decreed the procedure's decriminalization and its imminent nationwide legalization.

The abortion jurisprudence in Brazil: An analysis of ADPF 54 from feminist equality-based perspectives

Abstract Building on the feminist legal theory-driven analysis of equality-based approaches to voluntary abortion, this article offers a critical reading of the Brazilian Supreme Court decision on ADPF 54, the constitutional lawsuit that challenged the constitutionality of the application of the legislation that prohibits abortion in cases of fetal anencephaly. The article first presents the arguments and then offers feminist equality-based counterpoints that bring some vulnerabilities of the decision to the forefront. The article argues that, from the perspectives adopted, the arguments presented by the justices in ADPF 54 do not disrupt the logic that underlies the abortion prohibition norm and end up legitimizing it. Second, the principles used can be viewed skeptically. By missing inequality issues that permeate reproduction, the principles obscure power relations and as such, become potential tools for furthering inequalities. We conclude the article by delineating how, despite being cited only timidly as a precedent, ADPF 54 still resonates in other minor cases put before the Brazilian Supreme Court, imbuing them with the same set of problems. Having in mind the vulnerabilities of the arguments, the article makes a tentative normative assessment on how the use of a substantive equality principle as an analytical tool and guide for interpretation could mitigate the problems and offer responses with emancipatory potential.

Factors associated with postpartum resumption of sexual intercourse among women in China: A retrospective multicenter study.

To examine the prevalence and factors associated with early resumption of sexual intercourse among postnatal women in China. We conducted a retrospective multicenter study of 15 834 postpartum women from 60 hospitals in 15 different locations across China. Data were obtained from questionnaires administered to the participants. All dates were analyzed using a one-way ANOVA and two-level Cox multiple linear regression models. More than half of the participating women (55.9%) resumed sexual intercourse by 3months postpartum. The independent variables associated with the postpartum resumption of sexual intercourse included sociodemographic characteristics (age, geographic location, educational attainment) and medical histories, including the previous abortion (incorporate with spontaneous and voluntary abortion) frequency, menstrual recovery, exclusive breastfeeding, and number of living children (p < 0.05). More than half of the women in this study resumed sexual intercourse within 3months postpartum. Women with a lower educational attainment and from the western regions of China were more likely to resume sexual intercourse earlier. Increasing age, delayed recovery of menses, and exclusive breastfeeding were associated with a delayed resumption of sexual intercourse. Women who had greater experience with abortion or the number of living children resumed sexual intercourse earlier than their counterparts.

Аn overview of the ethical issues of optional abortion

Аbortion has been a controversial issue throughout human history and has been determined according to the socio-economic conditions, moral and religious norms of different societies. It has been practiced at all times and by all peoples. The purpose of this examination is to investigate and analyse the literature related to the ethical and legal options for the woman. For the world at large, at the moment the attitude is extremely contradictory - from a total ban to full acceptance. The moderate opinion allows abortion in certain symptoms according to the period of pregnancy, rejecting full liberalisation as unethical. In twenty European states optional abortion is lawful. In the rest seven members (U.K., Finland and Cyprus) is allowed a broad interpretation of the grounds for refusal, (Ireland, Poland and Luxembourg) restrictive interpretation of the grounds for refusal and complete unwillingness or fear of performing abortions, lead to extremely rare (reported) legal abortions if any. In Bulgarian, the attitude towards abortion goes through a ban and upward liberalization. In the 1950s, abortion was banned, except on strict medical grounds. At a later stage, this problem was again discussed, and in the 1990 s the conditions for voluntary abortion were completel liberalised. Conclusion The bottom line is that a dual strategy is needed. In the event of an accident, adequate, accessible, safe and legal abortion services must be provided. On the other hand, every woman should be given the opportunity to prevent unwanted pregnancies by provided information, training, counseling, affordable contraceptive services and the provision of a wide variety of reliable, safe, acceptable methods of contraception.

Impact of the COVID-19 pandemic on voluntary terminations of pregnancy in an Italian metropolitan area

Purpose The COVID-19 pandemic and national lockdown from 9 March to 4 May 2020 changed social, familial, and sexual relationships, as well as how citizens interact with the health services. How these profound changes have affected sexuality, contraception and voluntary terminations of pregnancy is still largely undescribed. The main objective of this study was therefore to find out whether the COVID-19 pandemic and ensuing lockdown affected the demand for legal abortion. Material and methods The study period was divided into three phases: the pre-pandemic (January and February 2020); lockdown (March and April); and post-lockdown (May and June). The number and characteristics of women requesting pregnancy termination each month during that time were compared with the stats for the same months in the preceding three years (2017–2019). Results Immediately after national lockdown, the number of voluntary abortions markedly declined (-40.45%). The effect was more evident in women below 20 years of age (-66.67%), employed versus unemployed women (-42.71% vs. −21.05), and non-Italian versus Italian citizens (-53.01 vs. −32.85). No difference was found in the mean time from request to execution of the procedure, or in the type of the procedure used. Conclusion(s) National lockdown reduced the number of unwanted pregnancies, especially in younger women. The Italian health service’s response to the demand appears to have been unaffected by the pandemic. However, as the demand for abortion is still high, probably due to unplanned pregnancies among cohabitants within a stable relationship, contraception guidance should be improved among women traditionally deemed low-risk in terms of sexual behaviour.

Exaggerated Placental Site as a Cause of Hysterectomy for Massive Bleeding After First Trimester Voluntary Abortion.

Placental implantation anomalies in first-trimester abortions may determine severe bleeding leading to hysterectomy. There are very few cases of urgent hysterectomy post-abortion reported in the literature, related to placenta accreta spectrum, but in any of them is considered association with benign trophoblastic lesions. We report the case of a woman, who underwent surgical voluntary abortion by vacuum aspiration during first trimester, without any apparent surgical complications. Immediately, after this procedure, the patient had massive vaginal bleeding; an emergency hysterectomy was performed. Histological examination showed an exaggerated placental site (EPS). Morphological findings describe a trophoblastic tumor-like lesion, which differs from placenta accreta and often considered an asymptomatic occasional feature. Proliferative index, evaluated by double immunostain for CK8-18 and Ki-67, was unremarkable (<1%). Only a single report in the literature describes a case of symptomatic EPS 65 after first-trimester abortion. Major attention should be paid to trophoblastic pathology in order to understand a possible relationship with uterine bleeding and to find a clinical, ultrasound or chemical indicator.

Fertility characteristics and related factors impacting on Syrian refugee women living in Istanbul.

Women's fertility characteristics are affected by many different factors. To gain an awareness of fertility characteristics of Syrian refugee women and the influential factors. This study was planned as a cross-sectional study to determine the efficiency and related factors of Syrian refugees living in Istanbul. The survey of 300 refugee women applying Arabs who migrated to Turkey, Kurds, Turkmen and Yezidi origin they receive. Average age of the women studied was 34.26 ± 10.15, 34.6% of the participants had not received any education, 37% had less than two-year inter-pregnancy interval, 58.6% have not received "Safe Motherhood" service, 43.6% have conceived their last child unwillingly. Women in the study group had in average 3±2,4 children and the number of children they wanted was 3±1,59. These values were substantially affected negatively by the women's education level and positively by the income level. Yezidis had significantly more children than other ethnic groups and did not have a "religious ban" on voluntary abortion. It has been noted that fertility characteristics of refugee women who migrated to Turkey changed according to their ethnic backgrounds and were sustained in the country they migrated to. Along with harsh living conditions and insufficient access to health services the situation has been observed to pose serious risks on reproductive health.

P1470PREGNANCY IN HEMODIALYSIS: EXPERIENCE OF HEMODIALYSIS CENTERS IN SOUTHERN TUNISIA DURING 34 YEARS

Abstract Background and Aims Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis. The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia. Method It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy Results The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth. Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described. Conclusion Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.

A unique neuroendocrine cell model derived from the human foetal neural crest.

Nowadays, no human neuroendocrine cell models derived from the neural crest are available. In this study, we present non-transformed long-term primary Neural Crest Cells (NCCs) isolated from the trunk region of the neural crest at VIII-XII gestational weeks of human foetuses obtained from voluntary legal abortion. In NCC, quantitative real-time RT PCR demonstrated the expression of neural crest specifier genes, such as Snail1, Snail2/SLUG, Sox10, FoxD3, c-Myc, and p75NTR. Moreover, these cell populations expressed stemness markers (such as Nanog and nestin), as well as markers of motility and invasion (TAGLN, MMP9, CXCR4, and CXCR7), and of neuronal/glial differentiation (MAP2, GFAP, SYP, and TAU). Functional analysis demonstrated that these cells not only possessed high migration properties, but most importantly, they expressed markers of sympatho-adrenal lineage, such as ASCL1 and tyrosine hydroxylase (TH). Moreover, the expression of TH increased after the induction with two different protocols of differentiation towards neuronal and sympatho-adrenal phenotypes. Finally, exposure to conditioned culture media from NCC induced a mature phenotype in a neuronal cell model (namely SH-SY5Y), suggesting that NCC may also act like Schwann precursors. This unique human cell model provides a solid tool for future studies addressing the bases of human neural crest-derived neuroendocrine tumours.

Clandestine abortion complications and street drugs in Brazzaville

Introductionles avortements clandestins augmentent la morbi-mortalité maternelle en Afrique sub-Saharienne et sont favorisés par les législations restrictives et la faiblesse prévalence contraceptive. A Brazzaville l´automédication par les « médicaments de la rue » semble être un procédé abortif fréquent. L´étude visait à déterminer la proportion des « médicaments de la rue » et le profil sociodémographique des patientes impliquées.Méthodesnous avons réalisé une étude longitudinale de juillet à décembre 2018, 67 patientes admises pour complications d´avortement provoqués ont été recrutées à l´hôpital de Talangaï. Leurs (i) caractéristiques socio démographiques, (ii) obstétricales et (iii) les caractéristiques de l´avortement (procédé, implication du manganguiste, rang et coût de l´avortement) ont été collecltées et analysées avec le logiciel Epi info 7. Nous avons comparé les moyennes avec le test de student, les proportions avec le CHI-2, p était fixé à <0,05.Résultatsl´âge moyen était de 25 ans ±6,6 ; 59,7% étaient au collège, 53,8% sans activité génératrice de revenu dans et 38,8% des cas vivaient seules dans; 15% avaient une paternité refusée. Les « médicaments de la rue » étaient retrouvés dans 74,5%, où le coût moyen de l´avortement était 3500 CFA (7$US) et 29500CFA (59$US) chez les professionnels de santé. Les enquêtées du lycée étaient plus nombreuses (73,69%) à connaitre au moins méthode contraceptive (p<0,05). Les célibataires (p=0,000) et celles qui connaissaient une méthode contraceptive (p=0,003) exprimaient plus l´intention d´adopter une contraception. Conclusion: lutter contre les « médicaments de la rue » ainsi que sécuriser l´avortement volontaire sont nécessaires pour limiter les avortements clandestins compliqués.

Reproductive injustice, trans rights, and eugenics

This article explores how the recognition of the gender identity of trans people can have negative consequences on their reproductive health and rights. First, it argues that, while both the right to gender identity and the right to sexual and reproductive health are part of the indivisible core of human rights, in practice trans people are forced to choose between them. Understanding this scenario requires focusing on the eugenic dimensions of trans policies, even in states where the recognition of a gender identity other than that assigned at birth is not tied to surgical or hormonal compromises. The concept of “passive eugenics”, coined over twenty years ago by James Bowman, offers a valuable key in this respect. Second, the paper highlights some factors that hinder a successful approach to the reproductive health and rights of trans people. These factors include: the normative imageries about the reproductive capacities and desires of trans people, representations about pregnancy and “womanhood”, and the form taken by identity politics in contemporary feminist movements. The attention given as a priority (if not exclusively) to initiatives for the legalisation of voluntary abortion, understood as a right pertaining to (cis) women, offers a significant example of these difficulties. Finally, the paper advocates the adoption of a reproductive justice approach to work on sexual and reproductive health and rights, arguing that it has, among other virtues, that of challenging the binary matrix that characterises Western thought.

Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients

BackgroundThe abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women’s experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay.MethodsWe interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women’s experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women’s age and number of abortions.ResultsMost of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18–21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged.ConclusionsThese findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent “repeat” abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.

Outcomes of Pregnancies in Patients with Sickle-Cell Disease : Update from European Non-Interventional, Multicentric, Prospective Escort-HU Study

Hydroxyurea (HU) is approved in EU and USA for the prevention of vaso-occlusive crises (VOC) including acute chest syndromes (ACS) in patients over 2 years with sickle-cell disease (SCD). Patients on HU wishing to conceive should stop treatment 3 to 6 months before pregnancy if possible. Pregnancy in SCD female patients are considered at risk for the mother and the fetus. This condition is associated with increased pain, infections, thromboembolic events,[1] and vaso-occlusion in placenta can lead to adverse fetal outcomes.[2] A few cases of HU exposure during pregnancy in SCD patients previously published[3],[4] suggested that the risk of deleterious teratogenic effect of HU shown in animal species[5] may have been overestimated in humans.[6] Therefore, a much larger dataset of pregnancies with HU exposure was needed. ESCORT-HU study (European Sickle Cell Disease COhoRT - HydroxyUrea) is a multicentric, prospective, non-interventional European study initiated to collect information about long-term safety of HU when used in current practice. This is the first study in which all pregnancy courses were collected irrespectively of action taken with HU before or during pregnancy. Overall 1906 patients were enrolled from 63 centers in France, Germany, Greece and Italy, 854 men (45%) and 1052 women (55%) among them around 2/3 aged from 15 to 49 years during the follow-up. During the study, 125 pregnancies in 101 women and 12 pregnancies in 10 partners of male patients were collected in the study, regardless HU exposure. In pregnancies with HU paternal exposure, 10 live births and 2 miscarriages were reported. Durations of HU exposure and outcomes of pregnancies in females treated with HU are provided in Table 1. The mean age at the pregnancy was 30 years. The mean HU duration before pregnancy was nearly 5 years. In only 16 pregnancies with maternal exposure (15%) HU was stopped at least 15 days before conception. In 43 pregnancies (34%), transfusions were reported. Live births were reported in 73% of pregnancies with maternal HU exposure excluding voluntary abortions. There was no statistical difference (Chi-squared test) in the proportions of live birth in exposed and non-exposed females (p=0.577). VOC or ACS have been reported in 3 women after the stop of HU. Although women are advised to stop HU before pregnancy, in current practice continuation of HU may be required and HU remains the only alternative to protect the mother and the fetus from deleterious effects of VOC. In conclusion, the data on pregnancy outcome following HU exposure are reassuring when compared to those in general SCD population. Overall in ESCORT-HU, 61% of pregnancies resulted in live birth, which is more than the 42% of pregnancies in the MSH study participants.4 It is notable, without considering voluntary abortions, that the percentage of live birth in ESCORT-HU reached 71%. The rate of preterm delivery (13%) was similar to the one (16%) in HbSS patients from a French cohort.[7] The fertility in women treated with HU seems to be even better and no particular problem in newborns has been reported to date. Disclosures Galactéros: Addmedica: Membership on an entity's Board of Directors or advisory committees. Cannas:Addmedica: Membership on an entity's Board of Directors or advisory committees. Bartolucci:AddMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; HEMANEXT: Membership on an entity's Board of Directors or advisory committees. Voskaridou:Addmedica: Membership on an entity's Board of Directors or advisory committees; Acceleron: Consultancy, Research Funding; Genesis: Consultancy, Research Funding; Protagonist: Research Funding; Celgene Corporation: Consultancy, Research Funding.

POLÍTICAS PÚBLICAS SOBRE ABORTO NO URUGUAI E NO BRASIL

O objetivo deste trabalho é analisar as políticas públicas do Uruguai sobre a questão do aborto, mais especificamente a Lei n.º 18.987/2012 e o Decreto n.º 375/2012 e suas consequências. Além disso, faz-se uma análise das políticas públicas brasileiras sobre o tema e a atual discussão sobre a descriminalização do aborto na ADPF 442, bem como na criminalização de todas as hipóteses com a PEC 19/2015 do Senado e a PEC 181/15 da Câmara dos Deputados. Por questões metodológicas, esclarecemos que não se trata de um estudo comparativo, uma vez que não existe no Brasil nenhuma norma que regulamenta o aborto voluntário como no caso uruguaio e, portanto, não é possível realizar a comparação. Esta pesquisa é de revisão da literatura, com a exposição da política do Uruguai sobre o tema do aborto e a questão no Brasil atualmente para, ao final, tecer conclusões para aprimoramento das políticas públicas brasileiras com base na experiência bem-sucedida uruguaia.

Pregnancies and obstetrical prognosis after oocyte donation in Turner Syndrome: A multicentric study

IntroductionTurner syndrome is one of the most frequent chromosomal abnormalities in women, with a prevalence estimated to be 1 of 2500 live birth. Pregnancy in women with Turner syndrome is known to be at high risk, whether it is spontaneous or after oocyte donation, because of miscarriages and potential cardio-vascular complications which can be life-threatening. All of these patients should therefore be screened with a comprehensive cardio-vascular assessment before pregnancy, and have a close follow-up during and after pregnancy. Patients and methodsIt is a retrospective study, conducted in 10 of the 27 French oocyte donation centers between 2012 and 2016, on all the patients presenting with Turner syndrome included in an oocyte donation program. Results151 embryo transfers were realized in 73 patients, resulting in 39 pregnancies. Among these pregnancies, 24 children were born healthy, 11 spontaneous miscarriages, 3 voluntary abortions, 1 extra-uterine pregnancy and 1 maternal death from non-cardio-vascular origin occurred. Pregnancies were complicated by gravid arterial hypertension in 28.2% of cases, preeclampsia in 10.3% of cases, and gestational diabetes in 7.7% of cases. ConclusionThis study bring out obstetrical complications of the same magnitude than the ones described in the literature. Lead over a period of 4 years, in 10 French oocyte donation centers, it doesn’t reveal any cardio-vascular complications, conversely to other studies published before French and American recommendations. This study reinforces the usefulness of specific recommendations for the care of these particular patients.

El aborto voluntario en debate. Análisis de la construcción de conciencias públicas en un programa de TV abierta

La lucha por la despenalización y legalización del aborto voluntario en Argentina aborto voluntario está atravesando un momento histórico significativo. Protagonizando la escena televisiva durante los meses de enero y febrero de 2018, Intrusos en el espectáculo convocó a diferentes mujeres que se pronunciaron a favor del aborto voluntario. Entonces, resulta significativo estudiar la mediatización del tema en la TV argentina, indagando cómo se construyen conciencias públicas. En este artículo analizaremos el discurso del conductor y examinaremos en profundad el de una de las primeras invitadas al programa.&#x0D;