misoprostol and Sepsis

With changing conditions affecting receipt of postabortion care, an updated estimate of the incidence of treatment for complications from unsafe pregnancy termination is needed to inform policies and programmes. National estimates of facility-based treatment for complications in 26 countries form the basis for estimating treatment rates in the developing world. An estimated seven million women were treated in the developing world for complications from unsafe pregnancy termination in 2012, a rate of 6.9 per 1000 women aged 15-44 years. Regionally, rates ranged from 5.3 in Latin America and the Caribbean to 8.2 in Asia. Results inform policies to improve women's health.. An estimated 7 million women were treated in the developing world for complications of unsafe TOP in 2012.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Aftercare; Asia; Caribbean Region; Developing Countries; Female; Health Facilities; Health Policy; Health Services Accessibility; Humans; Incidence; Latin America; Misoprostol; Pregnancy; Sepsis; Uterine Hemorrhage; Uterine Perforation; Women's Health

Menstrual regulation (MR) has been part of the Bangladesh family planning program since 1979. However, clandestine abortion remains a serious health problem in Bangladesh, and anecdotal reports indicate that clandestine use of misoprostol has increased since the most recent estimates (for 2010). Because of this, it is important to assess changes in the use of MR services and the incidence of clandestine abortion since 2010.. A survey of a nationally representative sample of 829 health facilities that provide MR or postabortion care services and a survey of 322 professionals knowledgeable about these services were conducted in 2014. Direct and indirect methods were applied to calculate the incidence of MR and induced abortion.. In 2014, an estimated 1,194,000 induced abortions were performed in Bangladesh (29 per 1,000 women aged 15-49), and 257,000 women were treated for complications of such abortions (a rate of 6 per 1,000 women aged 15-49). Among women with complications, the proportion presenting with hemorrhage increased significantly, from 27% to 48%. An estimated 430,000 MR procedures (using MVA or medication) were performed in health facilities nationwide, a decline of about 40% in the MR rate-from 17 to 10 per 1,000 women aged 15-49-from 2010 to 2014.. Given declines in MR provision, more attention needs to be paid to building capacity, including hiring and training more providers of MR. Harm-reduction approaches should be pursued to increase the safety of clandestine use of misoprostol in Bangladesh.. La regulación menstrual (RM) ha sido parte del programa de planificación familiar de Bangladesh desde 1979. Sin embargo, el aborto clandestino sigue siendo un serio problema de salud en ese país, e informes anecdóticos indican que el uso clandestino de misoprostol ha aumentado según las estimaciones más recientes (de 2010). Por esta razón es importante analizar los cambios en el uso de los servicios de RM y la incidencia del aborto clandestino desde 2010. MÉTODOS: En 2014 se condujeron dos encuestas, una a partir de una muestra representativa a nivel nacional de 829 instituciones de salud que proveen servicios de RM o de atención postaborto, y otra realizada a 322 profesionales conocedores de esos servicios. Se aplicaron métodos directos e indirectos para calcular la incidencia de la RM y del aborto inducido.. Se estima que en 2014 se realizaron 1,194,000 abortos inducidos en Bangladesh (29 por 1,000 mujeres en edades de 15–49 años) y que 257,000 mujeres recibieron tratamiento por complicaciones de esos abortos (una tasa de 6 por 1,000 mujeres en edades de 15–49 años). Entre las mujeres con complicaciones, la proporción que presentó hemorragia aumentó significativamente de 27% a 48%. Se estima que en instituciones de salud a nivel nacional se realizaron 430,000 procedimientos de RM (usando AMEU o medicación), lo que representa una disminución de alrededor del 40% en la tasa de RM—de 17 a 10 por 1,000 mujeres en edades de 15–49 años—entre 2010 y 2014.. Dadas las disminuciones en la provisión de RM, es necesario prestar más atención al fortalecimiento de capacidades, incluidos el reclutamiento y la capacitación de más proveedores de RM. Debe proseguirse con enfoques de reducción de daños para aumentar la seguridad del uso clandestino de misoprostol en Bangladesh.. La régulation menstruelle (RM) fait partie du programme de planification familiale du Bangladesh depuis 1979. L'avortement clandestin continue cependant de poser un grave problème de santé dans le pays, où des rapports anecdotiques font état d'un usage clandestin du misoprostol en hausse depuis les dernières estimations en date (pour l'année 2010). Aussi est-il important d'évaluer les changements d'usage des services de RM et d'incidence de l'avortement clandestin depuis 2010. MÉTHODES: Deux enquêtes ont été menées en 2014, l'une auprès d'un échantillon nationalement représentatif de 829 structures de santé prestataires de services de RM ou de soins après avortement, et l'autre auprès de 322 professionnels informés au sujet de ces services. L'incidence de la RM et de l'avortement provoqué a été calculée par méthodes directes et indirectes. RÉSULTATS: En 2014, on estime à 1 194 000 le nombre d'avortements pratiqués au Bangladesh (29 pour 1 000 femmes âgées de 15 à 49 ans), tandis que 257 000 femmes étaient traitées pour cause de complications de ces avortements (soit un taux de 6 pour 1 000 femmes âgées de 15 à 49 ans). Parmi les femmes atteintes de complications, la proportion présentant une hémorragie est en hausse nette, de 27% à 48%. On estime à 430 000 le nombre de procédures de RM (par AMIU ou médicamenteuse) pratiquées dans les structures de santé à l'échelle du pays, soit une baisse d'environ 40% du taux de RM — de 17 à 10 pour 1 000 femmes âgées de 15 à 49 ans — de 2010 à 2014.. Étant donné la baisse de la prestation de la RM, il convient de prêter davantage attention au renforcement de capacité, y compris l'engagement et la formation d'un plus grand nombre de prestataires de la RM. Les approches axées sur l'amoindrissement des préjudices doivent être poursuivies pour accroître la sécurité de l'usage clandestin du misoprostol au Bangladesh.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Aftercare; Bangladesh; Drug Utilization; Family Planning Services; Female; Health Care Surveys; Health Personnel; Health Services Accessibility; Health Services Research; Hemorrhage; Hospitals; Humans; Incidence; Menstrual Cycle; Middle Aged; Misoprostol; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted; Sepsis; Young Adult

In rural Africa, deaths from childbirth are common and access to health care facilities with skilled providers is very limited. Leading causes of death for women are bleeding and infection. In this pilot study, we establish the feasibility of distributing oral medications to women in rural Tanzania to self-administer after delivery to reduce bleeding and infection. Of the 642 women provided with medications, 90% of the women took them appropriately, while the remaining 10% did not require them. We conclude that is it feasible to distribute oral medications to rural women to self-administer after delivery.

Topics: Administration, Oral; Adolescent; Adult; Feasibility Studies; Female; Humans; Maternal Health Services; Middle Aged; Misoprostol; Oxytocics; Patient Acceptance of Health Care; Pilot Projects; Postpartum Hemorrhage; Pregnancy; Qualitative Research; Risk Factors; Rural Health Services; Rural Population; Self Administration; Sepsis; Socioeconomic Factors; Tanzania; Treatment Outcome; Young Adult

Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.. This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher's exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.. Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks' gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).. Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Age Factors; Case-Control Studies; Cross-Sectional Studies; Educational Status; Employment; Female; Gestational Age; Ghana; Hospitals, Public; Humans; Kidney Diseases; Length of Stay; Liver Diseases; Misoprostol; Multivariate Analysis; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Self Care; Sepsis; Tertiary Care Centers; Uterine Hemorrhage; Young Adult

Topics: Africa South of the Sahara; Community Health Planning; Female; Humans; Maternal Health Services; Maternal Mortality; Misoprostol; Models, Statistical; Oxytocics; Postpartum Hemorrhage; Pregnancy; Sepsis

Maternal mortality in Africa has changed little since 1990. We developed a mathematical model with the aim to assess whether improved community-based access to life-saving drugs, to augment a core programme of health-facility strengthening, could reduce maternal mortality due to post-partum haemorrhage or sepsis.. We developed a mathematical model by considering the key events leading to maternal death from post-partum haemorrhage or sepsis after delivery. With parameter estimates from published work of occurrence of post-partum haemorrhage and sepsis, case fatality, and the effectiveness of drugs, we used this model to estimate the effect of three potential packages of interventions: 1) health-facility strengthening; 2) health-facility strengthening combined with improved drug provision via antenatal-care appointments and community health workers; and 3) all interventions in package two combined with improved community-based drug provision via female volunteers in villages. The model was applied to Malawi and sub-Saharan Africa.. In the implementation of the model, the lowest risk deliveries were those in health facilities. With the model we estimated that of 2860 maternal deaths from post-partum haemorrhage or sepsis per year in Malawi, intervention package one could prevent 210 (7%) deaths, package two 720 (25%) deaths, and package three 1020 (36%) deaths. In sub-Saharan Africa, we estimated that of 182 000 of such maternal deaths per year, these three packages could prevent 21 300 (12%), 43 800 (24%), and 59 000 (32%) deaths, respectively. The estimated effect of community-based drug provision was greatest for the poorest women.. Community provision of misoprostol and antibiotics to reduce maternal deaths from post-partum haemorrhage and sepsis could be a highly effective addition to health-facility strengthening in Africa. Investigation of such interventions is urgently needed to establish the risks, benefits, and challenges of widespread implementation.. Institute of Child Health and Faculty of Mathematical and Physical Sciences, University College London, and a donation from John and Ann-Margaret Walton.

Topics: Africa South of the Sahara; Anti-Bacterial Agents; Cause of Death; Community Health Services; Female; Humans; Malawi; Maternal Health Services; Maternal Mortality; Misoprostol; Models, Statistical; Oxytocics; Postnatal Care; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Infectious; Program Evaluation; Risk Factors; Sepsis; Total Quality Management

To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.. Observational study.. Aberdeen Maternity Hospital, Aberdeen.. A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200 mg mifepristone orally, following which a 24-48 hour interval was recommended before administration of misoprostol. For gestations of 24-34 weeks, 200 microg of intravaginal misoprostol was administered, followed by four oral doses of 200 microg at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100 microg misoprostol.. The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P = 0.04). Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.. The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Administration, Intravaginal; Adult; Drug Therapy, Combination; Female; Fetal Death; Gestational Age; Humans; Mifepristone; Misoprostol; Pregnancy; Scotland; Sepsis; Ultrasonography