tailieunhanh - CLINICAL GYNECOLOGIC SERIES: AN EXPERT’S VIEW

The health effects of violence against women are serious, far-reaching, and intertwined. Health care providers have the opportunity and the obligation to identify cases of abuse. For many women in developing countries, a visit to a health clinic for reproductive or child health services may be their only contact with the health care system. The health care sector can capitalize on this opportunity by ensuring a supportive and safe environment for clients, helping providers ask about abuse, and helping women receive the care they need. The steps involved in integrating gender-based violence into health programs have been outlined in a guide developed by UNFPA. Ask about abuse. Training practitioners to ask women about. | CLINICAL GYNECOLOGIC SERIES AN EXPERT S VIEW We have invited select authorities to present background information on challenging clinical problems and practical information on diagnosis and treatment for use by practitioners. Methods for Induced Abortion Phillip G. Stubblefield MD Sacheen Carr-Ellis MD and Lynn Borgatta MD MPH We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators hygroscopic dilators or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone misoprostol combinations is replacing some surgical abortions. Two mifepristone misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester the majority of these by dilation and evacuation D E after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D E. Dilation and evacuation procedures have evolved to include intact D E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepris-tone misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol .