Objetivos: O objetivo do nosso estudo foi verificar se a umidificação dos comprimidos com formulação brasileira de misoprostol vaginal aumenta a dilatação cervical antes da aspiração manual por vácuo (AMIU), em comparação com o uso de misoprostol seco nos abortos espontâneos no primeiro trimestre. O objetivo secundário foi verificar se houve correlação entre o pH vaginal e o grau de dilatação cervical usando um comprimido de misoprostol umedecido ou seco. Métodos: Estudo unicêntrico, duplo cego e randomizado, com 46 pacientes com aborto espontâneo de primeiro trimestre foram alocados aleatoriamente para o tratamento com 400 μg de misoprostol seco ou umedecido (com 200 μl de água destilada). Resultados: A dilatação cervical mediana (intervalo) nos grupos úmido e seco foi de 8 mm (6-12 mm) e 7 mm (5-10 mm), respectivamente ( p = 0,06). O tempo médio entre a inserção de misoprostol e a realização do procedimento não diferiu entre os grupos seco (406 min, intervalo 180-550 min) e molhado (448 min, intervalo 180-526 min) ( p = 0,1). Não foi encontrada correlação entre o pH vaginal e a dilatação cervical usando dados continuos ( p = 0.57; r = 0.08; intervalo de confiança de 95% -0.02, 0.3) ou dados dicotômicos (pH ≤5 /> 5, dilatação cervical ≥8 mm ou <8 mm; p = 0,8). Conclusão: Não foi observada diferença na dilatação cervical entre o uso de misoprostol umedecido e não umedecido antes do AMIU. / Objectives: The aim of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet. Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 μl distilled water) 400μg of misoprostol. Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p=0.06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p=0.1). No correlation was found between vaginal pH and cervical dilation using continuous data (p=0.57; r=0.08; 95% confidence interval -0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p=0.8). Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

Objetivos: O objetivo do nosso estudo foi verificar se a umidificação dos comprimidos com formulação brasileira de misoprostol vaginal aumenta a dilatação cervical antes da aspiração manual por vácuo (AMIU), em comparação com o uso de misoprostol seco nos abortos espontâneos no primeiro trimestre. O objetivo secundário foi verificar se houve correlação entre o pH vaginal e o grau de dilatação cervical usando um comprimido de misoprostol umedecido ou seco. Métodos: Estudo unicêntrico, duplo cego e randomizado, com 46 pacientes com aborto espontâneo de primeiro trimestre foram alocados aleatoriamente para o tratamento com 400 μg de misoprostol seco ou umedecido (com 200 μl de água destilada). Resultados: A dilatação cervical mediana (intervalo) nos grupos úmido e seco foi de 8 mm (6-12 mm) e 7 mm (5-10 mm), respectivamente ( p = 0,06). O tempo médio entre a inserção de misoprostol e a realização do procedimento não diferiu entre os grupos seco (406 min, intervalo 180-550 min) e molhado (448 min, intervalo 180-526 min) ( p = 0,1). Não foi encontrada correlação entre o pH vaginal e a dilatação cervical usando dados continuos ( p = 0.57; r = 0.08; intervalo de confiança de 95% -0.02, 0.3) ou dados dicotômicos (pH ≤5 /> 5, dilatação cervical ≥8 mm ou <8 mm; p = 0,8). Conclusão: Não foi observada diferença na dilatação cervical entre o uso de misoprostol umedecido e não umedecido antes do AMIU. / Objectives: The aim of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet. Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 μl distilled water) 400μg of misoprostol. Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p=0.06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p=0.1). No correlation was found between vaginal pH and cervical dilation using continuous data (p=0.57; r=0.08; 95% confidence interval -0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p=0.8). Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

Objetivos: O objetivo do nosso estudo foi verificar se a umidificação dos comprimidos com formulação brasileira de misoprostol vaginal aumenta a dilatação cervical antes da aspiração manual por vácuo (AMIU), em comparação com o uso de misoprostol seco nos abortos espontâneos no primeiro trimestre. O objetivo secundário foi verificar se houve correlação entre o pH vaginal e o grau de dilatação cervical usando um comprimido de misoprostol umedecido ou seco. Métodos: Estudo unicêntrico, duplo cego e randomizado, com 46 pacientes com aborto espontâneo de primeiro trimestre foram alocados aleatoriamente para o tratamento com 400 μg de misoprostol seco ou umedecido (com 200 μl de água destilada). Resultados: A dilatação cervical mediana (intervalo) nos grupos úmido e seco foi de 8 mm (6-12 mm) e 7 mm (5-10 mm), respectivamente ( p = 0,06). O tempo médio entre a inserção de misoprostol e a realização do procedimento não diferiu entre os grupos seco (406 min, intervalo 180-550 min) e molhado (448 min, intervalo 180-526 min) ( p = 0,1). Não foi encontrada correlação entre o pH vaginal e a dilatação cervical usando dados continuos ( p = 0.57; r = 0.08; intervalo de confiança de 95% -0.02, 0.3) ou dados dicotômicos (pH ≤5 /> 5, dilatação cervical ≥8 mm ou <8 mm; p = 0,8). Conclusão: Não foi observada diferença na dilatação cervical entre o uso de misoprostol umedecido e não umedecido antes do AMIU. / Objectives: The aim of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet. Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 μl distilled water) 400μg of misoprostol. Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p=0.06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p=0.1). No correlation was found between vaginal pH and cervical dilation using continuous data (p=0.57; r=0.08; 95% confidence interval -0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p=0.8). Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

Background: Despite proven efficacy, Manual Vacuum Aspiration (MVA) use for incomplete abortions is low in the Swaziland setting, including Raleigh Fitkin Memorial (RFM) Hospital. Uncertainty in the costs implications of introducing MVA to replace Dilatation and Curettage (D&C) is the major hindrance to change. This study aimed to evaluate the cost-effectiveness of introducing MVA as an evacuation method for first trimester incomplete miscarriages as well as assess the implications of the introduction of MVA to the entire post-abortion care budget at RFM Hospital. Methods: The methods comprised cost-effectiveness and budget impact analyses from a healthcare perspective based on a theoretical cohort. Clinical outcomes data for procedures were obtained from relevant literature. Costs were collated from prospective suppliers and then compared for the two treatment modalities. Future numbers of annual evacuations were extrapolated from previous annual figures. First trimester miscarriages were in turn extrapolated from proportions found in previous studies. Total budgets were calculated under the current scenario, as well as if MVA had to be introduced. Results: With initial capital costs of ZAR11 093.00, introduction of MVA for first trimester incomplete abortions will cut post-abortion care costs by 34.7%. MVA would cost ZAR819.86 per procedure while D&C costs ZAR1 255.40 per procedure. An estimated 26 MVA procedures done instead of D&C will compensate for the initial capital investment. Introduction of MVA into the post-abortion care programme will save the hospital about ZAR516 115.30 annually, with at least similar clinical outcomes compared to D&C. Conclusions: MVA should be considered as the first option in first trimester post abortion care. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)

The aim of this study was to describe the nurses‘ perception of termination of pregnancy and her perception of her conduct towards clients that request termination of pregnancy guided by Kings‘ Systems Approach and Goal Attainment Theory. A non-experimental quantitative descriptive correlational design was used. A non-probability purposive sampling method was used consisting of institutions in the Western Cape, available to participate in this study, which deliver termination of pregnancy services, gov ernment health care institutions (21) and Marie Stopes clinics (3). Non-probability convenience sampling was used consisting of registered nurses who are working in termination of pregnancy units in these facilities (N=82). Data were collected through the administration of a self-designed questionnaire. The main findings of the study indicate that respondents (personal system) appear to feel positive about the work they are doing. Formal improvement and development are however not utilised optimally. Regarding the interpersonal system, respondents also show a positive orientation to both the woman opting for termination of pregnancy and the foetus. The potential towards transaction and ultimately goal attainment reside within this system. The respondents are also positive about legislation, employers and policies (social system) relating to termination of pregnancy. This orientation creates a milieu that is conducive to transactions, interactions and goal attainment.The main recommendation is that three systems as proposed by King be continuously integrated within the termination of pregnancy setup through, amongst other measures: values clarification, management support, in service education, the inclusion of termination of pregnancy in undergraduate programmes, focus groups and the like. / Die doel van hierdie studie was om die verpleegkundige se persepsie van terminasie van swangerskap en haar persepsie van haar houding en gedrag teenoor kliёnte wat terminasie van swangerskap versoek, aan die hand van King se Sisteembenadering en Doelwitbereikingsteorie te ondersoek en te beskryf. `n Nie-eksperimentele kwantitatiewe beskrywende korrelasie navorsingsontwerp was gebruik. `n Nie-waarskynlike doelbewuste-steekproefneming van die staatsgesondheidsorg-instansies wat terminasie van swangerskapdienste aanbied, is geneem en wat beskikbaar vir hierdie studie was (21) asook die Marie Stopesdienste (3), in die Wes-Kaap. `n Nie-waarskynlike gerieflikheidsteekproefneming is van verpleegkundiges geneem wat swangerskappe in hierdie afdelings termineer of moet termineer (N=82). Data is met behulp van `n selfontwerpte vraelys ingesamel. Die hoofbevindings van die studie dui daarop dat respondente (persoonlike sisteem) positief voel oor hul werk. Formele ontwikkelingshulpbronne word egter nie optimaal deur die sisteem benut nie. Wat die interpersoonlike sisteem betref, toon respondente ook ‗n positiewe oriëntasie tot beide die vrou wat terminasie van swangerskap aanvra en die fetus. Die potensiaal tot transaksie-sluiting en uiteindelike doelwitbereiking is binne hierdie sisteem geleë. Die respondente is ook positief oor wetgewing en die werkgewer en beleid (sosiale siteem) ten opsigte van terminasie van swangerskap. Hierdie oriëntering laat ‗n milieu wat bevorderlik is vir transaksie-sluiting, interaksie en doelwitbereiking. Die hoofaanbeveling is dat voortdurend gepoog moet word na die integrasie van King se drie sisteme binne die terminasie van swangerskapafdelings deur onder meer: waarde-uitklaringswerkswinkels, ondersteuning van bestuur, indiensopleiding, die insluiting van terminasie van swangerskap in voorgraadse kurrikula, fokusgroepe en so meer. / Health Studies / D. Litt. et Phil. (Gesondheidstudies)