Population Reports™ DESTAQUES O Tratamento Das Complicações Pós-Aborto Página Podemos Prevenir a Mortalidade Materna; E Evitar As Lesões

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Population Reports™ DESTAQUES O Tratamento Das Complicações Pós-Aborto Página Podemos Prevenir a Mortalidade Materna; E Evitar As Lesões Population Reports™ DESTAQUES O tratamento das complicações pós-aborto Página Podemos prevenir a mortalidade materna; e evitar as lesões............. 4 Uma intervenção para As declarações internacionais urgem por uma atenção salvar a vida da mulher humanizada.................................. 7 Planejamento para atenção médica Nos países em desenvolvimento, mais de meio de emergência.............................. 8 O Planejamento familiar é essencial....12 milhão de mulheres morrem anualmente por Lições aprendidas dos programas.....14 causas relacionadas à maternidade. Quase Guia REALCE ajuda na orientação em planejamento familiar todas estas mortes poderiam ser evitadas. Os pós-aborto....................................18 A mudança para anestesia local e esforços para evitar as mortes maternas con- aspiração manual intra-uterina seqüentes de uma causa principal—as compli- (AMIU) salva vidas e recursos para saúde....................................19 cações do aborto em condições de risco—são Planejamento familiar evita abortos....22 O que pode ser feito?......................26 cruciais, mas inadequados em grande parte do ÍNDICE mundo. A prestação de uma atenção médica Sumário dos redatores...................... 1 apropriada, imediatamente, poderia salvar a A Vida da Mulher Corre Risco.......... 3 vida de milhões de mulheres. O oferecimento Planejamento da Atenção Médica para Salvar a Vida da Mulher......... 7 de planejamento familiar poderia evitar muitas Atenção Integral à Saúde: Prestação de Serviços de gravidezes imprevistas e os conseqüentes abor- Planejamento Familiar...................12 tos em condições de risco no futuro. Atenção Apropriada: AMIU e Anestesia Local................19 O aborto que ocorre em condições de risco causa entre 50.000 e 100.000 Atenção Oportuna: mortes anualmente. Em alguns países, as complicações do aborto em con- Referência e Descentralização..... 23 dições de risco causam a maioria das mortes maternas e, em outros países, Bibliografia......................................28 são as causas principais de morte da mulher em idade reprodutiva. A Organização Mundial da Saúde calcula que cada ano, até 20 milhões de Incluído neste exemplar: abortos ocorrem em condições inadequadas e que entre 10% e 50% das H Cartaz: O planejamento familiar mulheres que abortam requerem atenção médica por complicações. Ainda, após o tratamento pós-aborto muitas mulheres também precisam de atenção depois de um aborto espon- tâneo (perda da gravidez). Em 86 hospitais de um país, por exemplo, cada Publicado pelo Population Information Program, Center for Communication mês cerca de 28.000 mulheres procuram tratamento para as complicações Programs, The Johns Hopkins Uni- de abortos em condições inadequadas ou de abortos espontâneos. versity Bloomberg School of Public As cinco causas principais da mortalidade materna são: a hemorragia, o Health, 111 Market Place, Suite parto obstaculizado, a infecção, a hipertensão induzida pela gravidez e 310, Baltimore, Maryland 21202, EUA as complicações do aborto em condições de risco. Muitos países estão Volume XXV, Número 1 iniciando programas para reduzir a taxa de mortalidade devida às outras Setembro de 1997 quatro causas, mas em poucos é oferecida atenção médica adequada de Série L, Número 10 Temas Mundiais de Saúde emergência, que reduziria o número total de mortes maternas atribuí- Este relatório foi preparado por Cynthia veis às complicações do aborto. O número de países onde são ofere- Salter, M.P.H., Heidi Bart Johnston e cidos serviços e orientação de planejamento familiar às mulheres Nicolene Hengen, M.S.P.H. Bryant tratadas por complicações do aborto é ainda menor. Robey, Redator, Stephen M. Goldstein, Chefe de Redação, Linda D. Sadler, Melhoramentos na Atenção Médica e Prestação Desenhista Gráfica. Produção a cargo de John R. Fiege, Mónica Jiménez, Peter de Serviços de Planejamento Familiar Hammerer e Merridy Gottlieb. Embora as complicações do aborto sejam uma emergência médica Agradecemos a colaboração oferecida comum nos países em desenvolvimento, a atenção médica freqüente- pelos seguintes revisores: Carla Abou-Zahr, mente é prestada em um contexto de crise. Por outro lado, através Janie Benson, Deborah L. Billings, M. do enfoque estratégico para a atenção pós-aborto, a necessidade de Virginia Chambers, Francine Coeytaux, Patricia Coffey, Michelle Folsom, Judith tratamento de emergência é prevista e o planejamento é antecipado Fortney, Sally Girvin, Lori Fritz, Ronald para cobrir esta necessidade, e prestam-se serviços de planejamento Gray, Forrest C. Greenslade, Robert familiar para evitar o ciclo repetitivo de abortos. Um plano eficaz de Gringle, Joanne Grossi, Joan Healy, Sahar atenção pós-aborto garante que a mulher receba atenção integral, Hegazi, Charlotte E. Hord, Douglas Huber, apropriada e oportuna (“IAO”). Dale Huntington, Brooke R. Johnson, Ann H. Leonard, James McCarthy, Harrison • Integral. Muitas das mulheres tratadas por complicações de aborto McKay, Phyllis Tilson Piotrow, Malcolm querem evitar a gravidez; no entanto, menos de um terço das Potts, Jill E. Sherman, Lynn Sibley, J. Joseph mulheres que recebem este tratamento usaram métodos anticon- Speidel, James Shelton, Karen Stein, Judith cepcionais eficazes alguma vez na vida. Muitas delas querem ser Winkler e Sung Hee Yun. informadas em relação ao planejamento familiar para poder evitar Population Information Program a gravidez. O lugar mais apropriado para oferecer serviços e orien- Center for Communication Programs tação em planejamento familiar é o mesmo lugar onde a mulher The Johns Hopkins University Bloomberg School of Public Health recebe atenção pós-aborto de emergência. Sendo que a atenção Phyllis Tilson Piotrow, Ph.D., Diretora, Center pós-aborto freqüentemente é uma crise médica e emocional, é for Communication Programs e Investigadora especialmente importante fornecer à mulher orientação com empa- principal, Population Information Program (PIP). tia que evite preconceitos, para que ela seja capaz de evitar uma Ward Rinehart, Diretoro de Projeto, (PIP). futura gravidez não desejada e, por conseguinte, o aborto em con- Linda D. Sadler, Editora-gerente das edições de dições de risco. Population Reports™ em outres idiomas. Anne W. Compton, Diretora Adjunta, PIP, Chefe • Apropriada. A maioria das mulheres que procuram tratamento de dos serviços de bibliografia computadorizada emergência sofre de aborto incompleto, o qual, se não for tratado, POPLINE. pode resultar em hemorragia, infecção e morte. A evacuação uteri- Hugh M. Rigby, Diretor Associado, PIP, e Chefe, Centro de Materiais de Comunicação. na pode ser realizada segura e eficientemente através da aspiração Jose G. Rimon II, Diretor Adjunto, Center for manual intra-uterina (AMIU) com anestesia local. A AMIU sob Communication Programs e Diretoro de anestesia local pode ser realizada segura e eficientemente. A AMIU Projeto, Population Communication Services, é mais segura e geralmente mais barata do que a curetagem uterina serviço para o desenvolvimento de estratégias de comunicação, projetos, treinamento e mate- com anestesia geral, o tratamento mais comum usado em muitos riais de planejamento familiar. países. Em um hospital no Quênia, por exemplo, o custo do tra- Population Reports™ (USPS 063-150) is publish- tamento pós-aborto foi reduzido em 66% depois que a AMIU ed four times a year (Spring, Summer, Fall, substituiu a curetagem uterina, principalmente devido à dramática Winter) at 111 Market Place, Suite 310, Balti- more, Maryland 21202, USA by the Johns redução na duração da permanência no hospital. Hopkins University Bloomberg School of Public • Oportuna. Freqüentemente, a mulher não recebe tratamento médi- Health. Periodicals postage paid at Baltimore, Maryland. Postmaster to send address changes co de maneira oportuna. Os atrasos colocam a sua vida em risco. to Population Reports™, Population Information A descentralização da atenção de emergência reduz os atrasos por- Program, The Johns Hopkins University Bloom- que oferece certo nível de atenção pós-aborto em cada nível do berg School of Public Health, 111 Market Place, sistema de saúde. Por sua vez, o estabelecimento de um sistema Suite 310, Baltimore, Maryland 21202, USA. formal de referência ajuda cada mulher a alcançar rapidamente o Este relatório é produzido através do nível de atenção que ela precisa. apoio de G/PHN/POP/CMT, de Global e da Agência dos Estados Unidos para Uma estratégia planejada para atenção pós-aborto conota uma aten- o Desenvolvimento Internacional, sob ção mais eficaz—e freqüentemente com poupanças—do que o con- os termos da concessão HRN-A-00- texto de crise, que atualmente caracteriza a maioria dos serviços de 97-00009-00. As opiniões aqui expres- atenção pós-aborto. Além disso, satisfaz as necessidades da mulher de sadas não necessariamente refletem as receber atenção com empatia e serviços contínuos de saúde reprodu- opiniões da Agência dos tiva. O tratamento médico eficaz de emergência das complicações do Estados Unidos para o De- aborto, em conjunto com uma orientação e serviços sensíveis de pla- senvolvimento Internacional, nem da Universidade Johns nejamento familiar podem salvar a vida da mulher. Hopkins. 2 POPULATION REPORTS n A Vida da Mulher A Caminho de uma Maternidade sem Riscos Corre Risco Embora ainda considerada “uma tragédia ignorada” em mui- tos países (230), durante a última década a mortalidade mater- Nos países em desenvolvimento, cada ano, é estimado que na se converteu em um foco de ação internacional. Em 1987, morrem
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