Artigos Originais Archives - Page 8 of 81 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):596-600
DOI 10.1590/S0100-72032006001000005
PURPOSE: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. METHODS: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. RESULTS: During the follow-up of these patients, there was a good clinical response with significant reduction in the uterus and myoma volumes. Four of them got pregnant, two had an early abortion and two evolved normally till the end of gestation with a term delivery. One of these had twins. CONCLUSION: Embolization of the uterine arteries is an option for the treatment of uterine myoma, and presents good clinical and anatomical results, allowing patients to preserve their reproductive capacity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):596-600
DOI 10.1590/S0100-72032006001000005
PURPOSE: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. METHODS: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. RESULTS: During the follow-up of these patients, there was a good clinical response with significant reduction in the uterus and myoma volumes. Four of them got pregnant, two had an early abortion and two evolved normally till the end of gestation with a term delivery. One of these had twins. CONCLUSION: Embolization of the uterine arteries is an option for the treatment of uterine myoma, and presents good clinical and anatomical results, allowing patients to preserve their reproductive capacity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):601-606
DOI 10.1590/S0100-72032006001000006
PURPOSE: To verify the existence of association between sub-fertility or infertility and concurrent celiac disease in women attended at a reproductive disorders out-patient clinic of a general hospital. METHODS: This was a case-control study in which a group of 200 women with difficulty in conceiving was compared with a control group with 400 women who were treated at the same hospital for various reasons, but not for fertility problems. Both groups were submitted to the anti-endomysium antibody protocol using the indirect immunofluorescence method. Whenever positive, the diagnosis was further confirmed by endoscopic duodenal biopsy and histopathological exams. RESULTS: Anti-endomysium testing resulted positive in three patients (1.5%) within the group of women with difficulty in conceiving. Diagnosis of celiac disease was subsequently confirmed by histopathological exams of the duodenal mucosa. All the control patients presented negative results in the serological exams. CONCLUSION: Celiac disease was observed only in women with difficulty in conceiving, a relevant fact indicating that this disease may be more common in infertile women. However, new studies with a greater sample size are needed to confirm this possible association.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):601-606
DOI 10.1590/S0100-72032006001000006
PURPOSE: To verify the existence of association between sub-fertility or infertility and concurrent celiac disease in women attended at a reproductive disorders out-patient clinic of a general hospital. METHODS: This was a case-control study in which a group of 200 women with difficulty in conceiving was compared with a control group with 400 women who were treated at the same hospital for various reasons, but not for fertility problems. Both groups were submitted to the anti-endomysium antibody protocol using the indirect immunofluorescence method. Whenever positive, the diagnosis was further confirmed by endoscopic duodenal biopsy and histopathological exams. RESULTS: Anti-endomysium testing resulted positive in three patients (1.5%) within the group of women with difficulty in conceiving. Diagnosis of celiac disease was subsequently confirmed by histopathological exams of the duodenal mucosa. All the control patients presented negative results in the serological exams. CONCLUSION: Celiac disease was observed only in women with difficulty in conceiving, a relevant fact indicating that this disease may be more common in infertile women. However, new studies with a greater sample size are needed to confirm this possible association.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):513-522
DOI 10.1590/S0100-72032006000900003
PURPOSE: to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. METHODS: the EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. RESULTS: uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. CONCLUSIONS: the CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):513-522
DOI 10.1590/S0100-72032006000900003
PURPOSE: to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. METHODS: the EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. RESULTS: uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. CONCLUSIONS: the CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):523-529
DOI 10.1590/S0100-72032006000900004
PURPOSE: to determine the values of perineal muscular force (PMF) in the lying and seated positions and to identify the values of PMF between first pregnancy, according to type and the characteristics of the vaginal delivery and cesarean section. METHODS: study of the transversal type, performed in a maternity of Brazilian Public the Health System (SUS) in the city of São Paulo. The sample consisted of 95 primiparae at term. Evaluation occurred between the 40th and 45 th, day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. RESULTS: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. CONCLUSION: there was association between the type and the characteristics of the delivery and PMF.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):523-529
DOI 10.1590/S0100-72032006000900004
PURPOSE: to determine the values of perineal muscular force (PMF) in the lying and seated positions and to identify the values of PMF between first pregnancy, according to type and the characteristics of the vaginal delivery and cesarean section. METHODS: study of the transversal type, performed in a maternity of Brazilian Public the Health System (SUS) in the city of São Paulo. The sample consisted of 95 primiparae at term. Evaluation occurred between the 40th and 45 th, day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. RESULTS: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. CONCLUSION: there was association between the type and the characteristics of the delivery and PMF.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):530-535
DOI 10.1590/S0100-72032006000900005
PURPOSE: to compare the incidence of preterm deliveries, and of low birth weight newborns, among primiparous adolescents, from two age groups. METHODS: this is a comparative, cross-sectional clinical study composed of 522 primiparous adolescents whose deliveries occurred at the gestational age of 25 to 42 weeks. The adolescents were divided into 2 groups according to their age; Gprec: from 10 to 15 complete years old (n=104); Gtard: from 16 to 19 complete years old (n=418). The research data were obtained by an individualized, confidential and ethical interview, soon after delivery; and by a written questionnaire with questions about the gestational age in complete weeks, and about the newborns birth weight. The gestational age was calculated at the delivery day, according to the date of the last trustworthy menstrual period, being also confirmed by the earliest pregnancy scanning or by Capurro's index, when there were any doubts about the previously described parameters. All newborns with gestational age under 37 weeks at birth were considered preterm babies. The newborn weight was taken by neonatologists immediately after delivery; all newborns with less than 2,500g were considered to be low weight babies. Thus, we compared prematurity rate and low birth weight among newborns from primiparous puerperal adolescents. The chi² test was used for the statistic analysis and the partition chi² test for the found differences. As the significancy level was 0.05 (alpha =5%), lower levels than that were considered significant. RESULTS: the prematurity rate was not significantly different between the two groups (5.8 and 2.6%). The incidence of low birth weight in Gprec (13.5%) was significantly higher than in Gtard (3.1%). CONCLUSIONS: the group with primiparous adolescents under 15 years old showed a significantly higher risk of low birth weight newborns. However, a statistically significant incidence of prematurity between the groups studied was not verified.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):530-535
DOI 10.1590/S0100-72032006000900005
PURPOSE: to compare the incidence of preterm deliveries, and of low birth weight newborns, among primiparous adolescents, from two age groups. METHODS: this is a comparative, cross-sectional clinical study composed of 522 primiparous adolescents whose deliveries occurred at the gestational age of 25 to 42 weeks. The adolescents were divided into 2 groups according to their age; Gprec: from 10 to 15 complete years old (n=104); Gtard: from 16 to 19 complete years old (n=418). The research data were obtained by an individualized, confidential and ethical interview, soon after delivery; and by a written questionnaire with questions about the gestational age in complete weeks, and about the newborns birth weight. The gestational age was calculated at the delivery day, according to the date of the last trustworthy menstrual period, being also confirmed by the earliest pregnancy scanning or by Capurro's index, when there were any doubts about the previously described parameters. All newborns with gestational age under 37 weeks at birth were considered preterm babies. The newborn weight was taken by neonatologists immediately after delivery; all newborns with less than 2,500g were considered to be low weight babies. Thus, we compared prematurity rate and low birth weight among newborns from primiparous puerperal adolescents. The chi² test was used for the statistic analysis and the partition chi² test for the found differences. As the significancy level was 0.05 (alpha =5%), lower levels than that were considered significant. RESULTS: the prematurity rate was not significantly different between the two groups (5.8 and 2.6%). The incidence of low birth weight in Gprec (13.5%) was significantly higher than in Gtard (3.1%). CONCLUSIONS: the group with primiparous adolescents under 15 years old showed a significantly higher risk of low birth weight newborns. However, a statistically significant incidence of prematurity between the groups studied was not verified.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):536-544
DOI 10.1590/S0100-72032006000900006
PURPOSE: to evaluate risk factors associated with cervical intraepithelial lesion recurrence after LEEP conization. METHODS: nested case-control study in a cohort of 201 patients with cervical intraepithelial lesion, that were submitted to LEEP conization. Average follow-up of these patients was 2 years. Ninety-four HIV-infected women and 107 non-infected were enrolled. Cervical conization was achieved by the Loop Electrosurgical Excision Procedure (LEEP). Evaluated surgical biopsy histopathological characteristics were lesion grade, lesion borders and glandular involvement. After surgery all patients were submitted to a colposcopy and cytological evaluation every six months. Recurrent lesions were defined it confirmed by biopsy after surgery. Cases were patients with and controls patients without recurrence. chi2 test and multivariable analysis by logistic regression were used for group comparisons. Kaplan Meier's method was performed for the survival analyses (log-rank test). RESULTS: 40 patients had lesion recurrence. Initially, significant variables were: partner number, HIV-infection, lesion borders and glandular involvement. The most frequent recurrence occurred when there were simultaneous association between positive margins and glandular involvement as indicator for recurrence risk. After logistic regression analysis the main factors associated with lesion recurrence were: glandular involvement (OR-9.1; 95% CI:13.0- 27.5); HIV-infection (OR-4.6; 95% IC:1.1-6.3); compromised margins (OR-2.6; 95% IC:1.9-11.2). CONCLUSIONS: risk factors associated with cervical intraepitelial lesion recurrence were HIV-infection, glandular involvement and compromised margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):536-544
DOI 10.1590/S0100-72032006000900006
PURPOSE: to evaluate risk factors associated with cervical intraepithelial lesion recurrence after LEEP conization. METHODS: nested case-control study in a cohort of 201 patients with cervical intraepithelial lesion, that were submitted to LEEP conization. Average follow-up of these patients was 2 years. Ninety-four HIV-infected women and 107 non-infected were enrolled. Cervical conization was achieved by the Loop Electrosurgical Excision Procedure (LEEP). Evaluated surgical biopsy histopathological characteristics were lesion grade, lesion borders and glandular involvement. After surgery all patients were submitted to a colposcopy and cytological evaluation every six months. Recurrent lesions were defined it confirmed by biopsy after surgery. Cases were patients with and controls patients without recurrence. chi2 test and multivariable analysis by logistic regression were used for group comparisons. Kaplan Meier's method was performed for the survival analyses (log-rank test). RESULTS: 40 patients had lesion recurrence. Initially, significant variables were: partner number, HIV-infection, lesion borders and glandular involvement. The most frequent recurrence occurred when there were simultaneous association between positive margins and glandular involvement as indicator for recurrence risk. After logistic regression analysis the main factors associated with lesion recurrence were: glandular involvement (OR-9.1; 95% CI:13.0- 27.5); HIV-infection (OR-4.6; 95% IC:1.1-6.3); compromised margins (OR-2.6; 95% IC:1.9-11.2). CONCLUSIONS: risk factors associated with cervical intraepitelial lesion recurrence were HIV-infection, glandular involvement and compromised margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):545-550
DOI 10.1590/S0100-72032006000900007
PURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):545-550
DOI 10.1590/S0100-72032006000900007
PURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(7):380-387
DOI 10.1590/S0100-72032006000700002
PURPOSE: to evaluate all maternal deaths that occurred between 1927 and 2001, among 164,161 patients admitted to the Maternidade Therezinha de Jesus, the obstetrical service of the "Universidade Federal de Juiz de Fora", Brazil. METHODS: a retrospective study of 144 maternal deaths that occurred in the maternity hospital in 75 years, with 131,048 live births in the same period of time, analyzing all patients's records regarding their clinical history and data from death certificates. Autopsies were not performed. Data obtained were age, parity, gestation length, complications, moment, and causes of death. The index of maternal mortality (IMM) period 100 thousand live births was utilized. For statistical analysis the chi2 test and the exponential smoothing technique were used (alpha=0.05). RESULTS: IMM decreased from 1544 in the period 1927-1941 to 314 (p<0.001) between 1942 and 1956 and from 1957 to 1971 it was reduced to 76.4 per 100 thousand live births (p<0.001). Nevertheless, since 1972 there was no further significant improvement (IMM=46 in the last 15 years, p=0.139). Maternal mortality was more frequent in the 15 to 39 years age group, in nulliparous patients with term pregnancies and mostly in the immediate postpartum period (53%). Direct obstetric causes occurred in 79.3% and indirect causes in 20.7% of the cases. Analyzing the evolution of the causes of death, it was found that in the first period of time the most frequent direct obstetric causes in descending order were puerperal infection, eclampsia and uterine rupture, while in the second period they were prepartum hemorrhage and eclampsia, and from 1977 to 2001 hemorrhage, abortion and preeclampsia. Analysis of the past 15 years showed the absence of maternal deaths by either preeclampsia or puerperal infection and the main causes were peripartum hemorrhage, abortion and indirect obstetrical causes. Relating maternal mortality to the type of delivery by the relative risk between cesarean section and vaginal delivery, it was found that when the indication of cesarean section is inevitable its risk is lower (relative risk = 0.6) than through vaginal delivery. CONCLUSIONS: despite the reduction along the 75 years of study, maternal mortality of 46 per 100,000 live births is still very high, and there was no significant decrease since 1972. Many deaths are avoidable. Hemorrhage is at present the most frequent cause of maternal death, the decision to intervene should be fast, and a proper indication for a cesarean section is a safe option. Maternal mortality caused by abortion is increasing alarmingly and family planning is essential.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(7):380-387
DOI 10.1590/S0100-72032006000700002
PURPOSE: to evaluate all maternal deaths that occurred between 1927 and 2001, among 164,161 patients admitted to the Maternidade Therezinha de Jesus, the obstetrical service of the "Universidade Federal de Juiz de Fora", Brazil. METHODS: a retrospective study of 144 maternal deaths that occurred in the maternity hospital in 75 years, with 131,048 live births in the same period of time, analyzing all patients's records regarding their clinical history and data from death certificates. Autopsies were not performed. Data obtained were age, parity, gestation length, complications, moment, and causes of death. The index of maternal mortality (IMM) period 100 thousand live births was utilized. For statistical analysis the chi2 test and the exponential smoothing technique were used (alpha=0.05). RESULTS: IMM decreased from 1544 in the period 1927-1941 to 314 (p<0.001) between 1942 and 1956 and from 1957 to 1971 it was reduced to 76.4 per 100 thousand live births (p<0.001). Nevertheless, since 1972 there was no further significant improvement (IMM=46 in the last 15 years, p=0.139). Maternal mortality was more frequent in the 15 to 39 years age group, in nulliparous patients with term pregnancies and mostly in the immediate postpartum period (53%). Direct obstetric causes occurred in 79.3% and indirect causes in 20.7% of the cases. Analyzing the evolution of the causes of death, it was found that in the first period of time the most frequent direct obstetric causes in descending order were puerperal infection, eclampsia and uterine rupture, while in the second period they were prepartum hemorrhage and eclampsia, and from 1977 to 2001 hemorrhage, abortion and preeclampsia. Analysis of the past 15 years showed the absence of maternal deaths by either preeclampsia or puerperal infection and the main causes were peripartum hemorrhage, abortion and indirect obstetrical causes. Relating maternal mortality to the type of delivery by the relative risk between cesarean section and vaginal delivery, it was found that when the indication of cesarean section is inevitable its risk is lower (relative risk = 0.6) than through vaginal delivery. CONCLUSIONS: despite the reduction along the 75 years of study, maternal mortality of 46 per 100,000 live births is still very high, and there was no significant decrease since 1972. Many deaths are avoidable. Hemorrhage is at present the most frequent cause of maternal death, the decision to intervene should be fast, and a proper indication for a cesarean section is a safe option. Maternal mortality caused by abortion is increasing alarmingly and family planning is essential.