A risk reduction strategy to prevent maternal deaths associated with unsafe abortion.
BACKGROUND
Worldwide, 13% of maternal deaths are caused by complications of spontaneous or induced abortion, 29% in Uruguay and nearly half (48%) in the Pereira Rossell Hospital.


OBJECTIVE
This paper describes a risk reduction strategy for unsafe abortions in Montevideo, Uruguay, where over one-fourth of maternal deaths are caused by unsafe abortion.


METHODS
Although abortion is not legal in Uruguay, women desiring abortions can be counseled before and immediately after to reduce the risk of injury. Women contemplating abortion were invited to attend a "before-abortion" and an "after-abortion" visit at a reproductive health polyclinic. At the "before-abortion" visit, gestational age, condition of the fetus and pathologies were diagnosed and the risks associated with the use of different abortion methods (based on the best available scientific evidence) were described. The "after-abortion" visit allowed for checking for possible complications and offering contraception.


RESULTS
From March 2004 through June 2005, 675 women attended the "before-abortion" and 495 the "after-abortion" visit, the number increasing over time. Some women (3.5%) decided not to abort, others were either not pregnant, the fetus/embryo was dead or the woman had a condition that permitted legal termination of pregnancy in the hospital (7.5%). Most women, however, aborted. All women used vaginal misoprostol in the doses recommended in the medical literature. There were no serious complications (one mild infection and two hemorrhages not requiring transfusion).


CONCLUSIONS
The strategy is effective in reducing unsafe abortions and their health consequences.
Briozzo
L
L
Department of Obstetrics and Gynecology, School of Medicine, University of the Republic, Montevideo, Uruguay.
Vidiella
G
G
Rodríguez
F
F
Gorgoroso
M
M
Faúndes
A
A
Pons
J E
JE
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000024:Abortion, Illegal / Q000009:adverse effects*; D000028:Abortion, Induced / Q000379:methods* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D001938:Brazil; D003376:Counseling; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D016595:Misoprostol / Q000627:therapeutic use*; D016730:Program Development; D040242:Risk Reduction Behavior; D014583:Uruguay
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol