Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil
DOI:
https://doi.org/10.17566/ciads.v12i4.1026Keywords:
Abortion, Spontaneous, Abortion, Induced, Dilatation and Curettage, Decision Making, COVID-19Abstract
Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.
Received: 01/05/23|Review: 10/11/23|Accepted: 15/11/23
Downloads
References
World Health Organization. Coronavirus disease (COVID-19) Pandemic. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Brasil. Lei n° 13.979, de 6 de fevereiro de 2020. Dispõe sobre as medidas para enfrentamento da emergência de saúde pública de importância internacional decorrente do coronavírus responsável pelo surto de 2019. [citado em 02 nov. 2023]. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2020/lei/l13979.htm
Oliveira MTS et al. Factors associated with spontaneous abortion: a systematic review. Revista Brasileira de Saúde Materno Infantil [Internet]. 2020 [citado em 3 maio 2022]; 20(2): p. 361-372. Disponível em: https://doi.org/10.1590/1806-93042020000200003
World Health Organization. Medical Management of abortion. Geneva: Who, 2022 [citado em 15 maio 2022]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf
Brasil. Manual de Atenção Técnica para Prevenção, Avaliação e Conduta nos casos de abortamento. 2022 [citado em 01 ago. 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/atencao_avaliacao_conduta_abortamento_2ed.pdf
Pereira PP et al. Tratamento do abortamento incompleto por aspiração manual ou curetagem. Revista da Associação Médica Brasileira [Internet]. 2006 [citado em 23 ago. 2022]; 52(5): p. 304-307. Disponível em: https://doi.org/10.1590/S0104-42302006000500015
Fundação Oswaldo Cruz. Método de Aspiração Manual Intrauterina AMIU: quando e como fazer. Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente. 2018. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/48044/2/AMIU%20quando%20e%20como%20fazer.pdf
Pfitzer A, Lathrop E, Bodenheimer A, RamaRao S, Christofield M, MacDonald P, Arnold B, Bhatnagar N, Mielke E, Mikulich M. Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic. Glob Health Sci Pract. 2020 Sep 30 [citado em 06 nov. de 2023];8(3):335-343. PMID: 33008851; PMCID: PMC7541126. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541126/ doi https://doi.org/10.9745/GHSP-D-20-00263
Holanda AAR et al. Tratamento do Abortamento do primeiro trimestre da gestação: Curetagem versus Aspiração Manual a vácuo. Revista Brasileira de Ginecologia e Obstetrícia – RBGO. 2003 [citado em 5 maio 2022]; 25(4). Disponível em: https://www.scielo.br/j/rbgo/a/wXxB3NjdGxQ4Skj9RgHfR9q/?lang=pt&format=pdf
Dantas PBF, Trabach CB, Junqueira AA, Nunes CC, Veiga-Junior NN, Baccaro LF. The Impact of the Covid-19 pandemic on the care of women Experiencing Abortion in a University Hospital in Brazil. Ver Bras Gineco Obstet [Internet]. 2023 mar. [citado em 15 maio 2022]; 45(3):113-20. Disponível em: https://doi.org/10.1055/s-0042-1759749
World Health Organization. Medical Management of abortion. Geneva: Who; 2022 [citado em 15 maio 2022]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf
Pilecco FB, McCallum CA, Almeida MCC, Alves FJO, Rocha AS, Ortelan N, Gabrielli L, Menezes GMS. Abortion and the COVID-19 pandemic: insights for Latin America. Cadernos De Saúde Pública [Internet]. 2021[citado em 5 maio 2022]; 37(6):e00322320. https://doi.org/10.1590/0102-311X00322320
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Daiana Maria Santos de Sousa Silva (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors and coauthors retain copyright but license the right of first publication to the Iberoamerican Journal of Health Law.
The Journal has been using CC Attribution 4.0 International (CC BY 4.0) since January 2023. This license allows the user to share and adapt the work, but they must give the appropriate credit to authors and coauthors and mention the Iberoamerican Journal of Health Law. The license Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International was used until 2022.
