Raffaela Schiavon Ermani - Academia.edu (original) (raw)

Papers by Raffaela Schiavon Ermani

La reforma que en 2007 despenalizó el aborto en la Ciudad de México (CDMX) se tradujo en la imple... more La reforma que en 2007 despenalizó el aborto en la Ciudad de México (CDMX) se tradujo en la implementación inmediata del Programa de Interrupción Legal del Embarazo (ILE) en instalaciones de la Secretaría de Salud (Sedesa) del Gobierno del Distrito Federal. Adicionalmente, la reforma propició el aumento de la oferta de servicios privados de aborto. En este trabajo se comentan aspectos de los avances y retos de los servicios públicos y privados de ILE en la CDMX.

In the 6th chapter of this book, the readers wiil find an updated analysis (México 1990-2013) of... more In the 6th chapter of this book, the readers wiil find an updated analysis (México 1990-2013) of rates of maternal mortality, major causes and distributions, with a focus on abortion-related deaths, indirect obstetric deaths and adolescents' contribution to maternal deaths.

Results of a survey applied to 1, 085 Mexican Ob/Gyn on their Knowledge, Attitudes and Practices ... more Results of a survey applied to 1, 085 Mexican Ob/Gyn on their Knowledge, Attitudes and Practices (KAP) related to treatment of induced and/or spontaneous abortion. It analyzes stigma around abortion in the medical community

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (impact factor: 1.41). 09/2012; 118 Suppl 2:S78-86.

ABSTRACT To document the relative contribution of abortion-related deaths to overall maternal dea... more ABSTRACT To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100,000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100,000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico.

Reproductive health matters11/2010; 18(36):127-35

"ABSTRACT: In 2007, first trimester abortion was legalized in Mexico City, and the public sector ... more "ABSTRACT: In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157-505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved.

Singh S, Remez L and Tartaglione A. Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity and Mortality: A Review, New York: Guttmacher Institute; and Paris: IUSSP, Dec 2010

Gaceta medica de Mexico (impact factor: 0.22). 138(4):347-56

ABSTRACT In this document, we review the relevant aspects of the different medical methods of abo... more ABSTRACT 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.

Book chapter in "Emergency Contraception: the story of a reproductive health technology." Editors Angel M. Foster and L.L. Wynn. Palgrave MacMillan Publishers 2012.

Abstract Worldwide, more than one-fourth of all pregnancies are unintended. Emergency contrace... more Abstract

Worldwide, more than one-fourth of all pregnancies are unintended. Emergency contraceptives are used after sexual intercourse to reduce the risk of pregnancy and have the potential to significantly decrease the incidence of unplanned, unwanted, and mistimed pregnancy. But despite its safety and efficacy, emergency contraception (EC) continues to spark political controversy worldwide. In this edited volume, the authors explore how EC has been received, interpreted, and politicized. Through the in-depth examination of the journey of EC in 16 individual countries, chapters in this book reveal the ways that a global reproductive health technology is inflected with local cultural meaning and simultaneously influenced by transcendent challenges that condition the introduction of a new technology. The countries include USA, Canada, Jamaica, Mexico, Chile, UK, France, Tunisia, Lebanon, Morocco, Kenya, South Africa, Uganda, Australia, Bangladesh, and Thailand-Myanmar border.

Salud publica de Mexico (impact factor: 0.94). 51(3):255-61.

ABSTRACT There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for... more ABSTRACT There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation.

Contraception (impact factor: 2.72). 05/2004; 69(4):339-42.

ABSTRACT Previous research has established that emergency contraceptive pills are safe and have t... more ABSTRACT Previous research has established that emergency contraceptive pills are safe and have the potential to reduce unintended pregnancy; however, policy makers, providers and even women themselves have expressed concern about repeat use of the method. Evidence regarding the safety, efficacy and frequency of repeat use show that the method is safe and effective, even when used multiple times. Reported rates of repeat use are actually lower than would be expected, and needed, based on the frequency of unprotected intercourse and contraceptive failure reported in most countries. Healthcare providers should encourage use of emergency contraceptive pills as a backup after recognizable failure of barrier methods or other hormonal contraceptive methods, and should expect that women may need emergency contraceptive pills multiple times during their reproductive years.

paideia.synaptium.net

RESUMEN En el presente artículo, se revisa la información mas actualizada sobre los métodos utili... more RESUMEN En el presente artículo, se revisa la información mas actualizada sobre los métodos utilizados en anticoncepción de emergencia (AE), definidos estos como aquellos que previenen el embarazo en un periodo no mayor de tres días después del coito no ...

Cancer Epidemiology Biomarkers &amp Prevention (impact factor: 4.12). 11/2008; 17(10):2808-17. DOI:10.1158/1055-9965.EPI-07-2659

ABSTRACT The reduction in cervical cancer mortality in developed countries has been attributed to... more ABSTRACT The reduction in cervical cancer mortality in developed countries has been attributed to well-organized, population-based prevention and control programs that incorporate screening with the Papanicolaou (Pap) smear. In Mexico, there has been a decrease in cervical cancer mortality, but it is unclear what factors have prompted this reduction.
Using data from national indicators, we determined the correlation between cervical cancer mortality rates and Pap coverage, birthrate, and gross national product, using a linear regression model. We determined relative risk of dying of cervical cancer according to place of residence (rural/urban, region) using a Poisson model. We also estimated Pap smear coverage using national survey data and evaluated the validity and reproducibility of Pap smear diagnosis.
An increase in Pap coverage (beta= -0.069) and a decrease in birthrate (beta=0.054) correlate with decreasing cervical cancer mortality in Mexico. Self-reported Pap smear rates in the last 12 months vary from 27.4% to 48.1%. Women who live in the central (relative risk, 1.04) and especially the southern (relative risk, 1.47) parts of Mexico have a greater relative risk of dying of cervical cancer than those who live in the north. There is a high incidence of false negatives in cervical cytology laboratories in Mexico; the percentage of false negatives varies from 3.33% to 53.13%.
The decrease in cervical cancer mortality observed in Mexico is proportional to increasing Pap coverage and decreasing birthrate. Accreditation of cervical cytology laboratories is needed to improve diagnostic precision.

II Consenso Mexicano de Patología del …, Jan 1, 2006

Page 10. * Dirección General de Salud Reproductiva, SSA. Panorama actual del Programa de Detecció... more Page 10. * Dirección General de Salud Reproductiva, SSA. Panorama actual del Programa de Detección y Tratamiento del Cáncer Cérvico Uterino en México, 2005 Actual Panorama of Detection and Treatment of Cervical Uterine ...

… de Endocrinología y …, Jan 1, 2001

Acta Pediátrica de México, Jan 1, 2001

Acta pediátr. Méx, Jan 1, 1996

Resumo: La ginecología pediátrica es una disciplina relativamente joven que está adquiriendo cada... more Resumo: La ginecología pediátrica es una disciplina relativamente joven que está adquiriendo cada vez mayor importancia, debido al gran porcentaje de población pediátrica y adolescente en nuestro país así como a la atención creciente que se ha dado a los ...