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Objective To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua. Methods An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011–2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy. Results Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P = 0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P Conclusion The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable.

En este trabajo subrayamos la necesidad de contar las muertes maternas que ocurren como resultado de episodios de violencia domestica, y tambien exponemos algunas de las principales dificultades que se enfrentan al tratar de hacerlo. Examinamos algunos elementos basicos que deben tenerse presentes al contar las muertes maternas de este tipo y explicamos como una definicion de mortalidad materna que de cabida a la violencia domestica como causa de muerte mejorara la vigilancia epidemiologica y las intervenciones de salud. Lograr un acuerdo general acerca de la definicion de "muerte materna por violencia domestica" y un marco estrategico para responder a ese tipo de muerte constituiria un logro de gran importancia para los sectores de la comunidad internacional que velan por la salud de la mujer y la equidad de genero.

Objective. To examine the relationship between family structure and the prevalence of exclusive breastfeeding (EBF) in Nicaragua. Material and Methods. A subset of the Nicaraguan Demographic and Health Survey conducted in 1998 was obtained by selecting all last-born infants less than 4 months old at the time of the survey. Weighted chi-squared and multivariate logistic regression analyses were used to examine the association. Results. Interviewee women heads of household and interviewee women whose husbands were the heads of the household had a significantly lower prevalence of EBF. Exposure to the health care system was not related to EBF. Conclusions. New approaches are needed to promote that men support women’s decisions to breastfeed. Health institutions should effectively communicate the benefits of breastfeeding on both the mother and the child.The English version of this paper is available too at: http://www.insp.mx/salud/index.html

To document the under-registration of violent deaths related to pregnancy and the importance of considering these violent deaths within the definition of maternal mortality.The study was carried out in the state of Morelos, based on the review of all death certificates (394) of reproductive aged women (12-49 years) who died during 2001. Based on a list of diagnostic criteria we eliminated 167 certificates that were neither violent deaths nor maternal deaths. The remaining 227 certificates were further evaluated through verbal autopsy and/or review of medical charts.Fifty-one violent deaths were found. Eighteen maternal deaths were officially reported in 2001, however, our study identified 23 direct maternal deaths and four violent deaths during pregnancy and the post-partum period. We found that this reproductive event was the direct trigger for the homicide or suicide of these four women, and only one of these cases was documented officially.Violent deaths related to pregnancy should be included in official maternal mortality statistics as indirect causes of maternal deaths. This would allow for a greater and more accurate understanding of violent maternal deaths and guide appropriate prevention and care policies, programs and services. Verbal autopsy is a useful technique for identifying cases of violent maternal deaths.

This study measured the contribution of abortion-related deaths to overall maternal mortality and calculated the underestimation of maternal mortality using verbal autopsy and clinical record review where available. We reviewed 807 death certificates of women aged 12–50 who died in 2001 in two sites of about 1.5 million inhabitants each in the state of Morelos (primarily rural) and the municipality of Nezahualcoyotl (primarily urban) in the state of Mexico. Deaths were classified as definite, possible or non-maternal deaths. Finally, we identified abortion-related deaths and calculated the underestimation of maternal mortality. Among 326 possible maternal deaths, we encountered five misclassified cases: one spontaneous abortion and four non-abortion maternal deaths. Among 32 registered maternal deaths, we found four misclassified cases that were actually second trimester, abortion-related deaths. There were no officially registered abortion-related deaths in either Morelos or Nezahualcoyotl, making the overall underestimation of abortion mortality 100%. Abortion contributed 13.5% of all maternal deaths. The overall underestimation of maternal mortality was 13.5%, higher in Morelos (21.7%). There were no unregistered maternal deaths in Nezahualcoyotl. Unsafe abortion continues to be an important cause of maternal mortality, though first trimester deaths appear to be decreasing. We identified domestic violence as an important cause of death among pregnant and post-partum women, and two abortion-related suicides, and believe these should be reconsidered as indirect maternal deaths. The misclassification of second trimester abortion deaths as maternal deaths from other causes is an obstacle to preventing them.

To determine the contribution of induced abortion to tubal infertility in Mexico.Population- and hospital-based case-control study.Tertiary hospitals in Mexico City.Women between 20 and 40 years with infertility and controls of the same age: 251 cases, 502 hospital controls, 502 neighbourhood controls.A case-control study was conducted in four tertiary hospitals in Mexico City with 251 cases and 1004 controls (two hospital and two neighbourhood controls per case, matched by age [+/-2 years]). Cases were infertile women, aged 20-40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, who had carried a pregnancy to term within the last two years. Participants completed a previously validated questionnaire asking about reproductive history and induced abortion.Our study did not show an association between induced abortion and tubal infertility among women that did not relate both events (cases vs hospital controls: OR = 1.57, 95% CI: 0.29-8.65; cases vs neighbourhood controls: OR = 0.82, 95% CI: 0.07-8.99) using conditional logistic models adjusting by marital status, number of pregnancies, age at first sexual intercourse and history of pelvic inflammatory disease. In contrast, early age at sexual debut and history of pelvic inflammatory disease significantly increased the risk of tubal infertility.In Mexico, the lack of association between induced abortion and tubal damage causing infertility observed in this population might be explained by a shift toward "safer" abortion practices.

In this document, we review the relevant aspects of the different medical methods of abortion. We describe the principal medical regimens currently used in North America, Europe, and a growing number of developing countries. We also describe specific treatment regimens (which usually involve a combination of two drugs), physiological methods of action, potential side effects and complications, method requirements, including follow-up visits, any existing contraindication, and acceptability of these methods among patients. Finally, we comment on the potential role of medical abortion in Mexico and throughout Latin America.

Several factors limited HIV transmission during the 1980s, includ-ing a ten-year civil war accompanied by an economic blockade by the United States of America (USA), which isolated the country for several years; a relatively controlled commercial sex industry; low infection rates for injecting drug users; and a ban on the commercial sale of blood. In the late 1990s, however, the spread of HIV rapidly increased.