Coêlho H L, Teixeira A C, Santos A P, Forte E B, Morais S M, La Vecchia C, Tognoni G, Herxheimer A
Department of Pharmacy, Federal University of Ceará, Fortaleza, Brazil.
Lancet. 1993 May 15;341(8855):1261-3. doi: 10.1016/0140-6736(93)91157-h.
Misoprostol, a prostaglandin E1 analogue indicated for ulcer treatment, has been widely used as an abortifacient by women in Brazil, where abortion is legal only in cases of rape or incest, or to save the woman's life. Because misoprostol is an inefficient abortifacient, many women who use it have incomplete abortions and need uterine evacuation. We reviewed the records of women admitted to the main obstetric hospital of Fortaleza, capital of Ceará state, Brazil, between January, 1990, and July, 1992, for uterine evacuation after induced abortion. The number of incomplete abortions induced by misoprostol increased substantially during the first half of 1990, and declined thereafter. Of the 593 cases in 1991, 75% were related to misoprostol, 10% to the use of other specified drugs, and 6% to unspecified drugs. For the remaining 9% the procedure used was not recorded; these included 3% in whom abortion had been induced by a clandestine abortionist. The number of uterine evacuations per month fell from 89 in August, 1990, to 62 in July, 1991, when sales of misoprostol in Ceará state were suspended. The fall continued after the sale of misoprostol ceased, to about 20 cases in December, 1991; numbers remained around this level until June, 1992, sustained by clandestine sales. The lack of access to contraception is the main reason for the large numbers of unplanned pregnancies and is a major public health issue for Brazilian women. The prohibition of abortion creates a void in which misuse of medicines is one extra complication, mainly because of the poor control of drug marketing.
米索前列醇是一种用于溃疡治疗的前列腺素E1类似物，在巴西被妇女广泛用作堕胎药，而在巴西只有在强奸、乱伦或挽救妇女生命的情况下堕胎才合法。由于米索前列醇作为堕胎药效果不佳，许多使用它的妇女会出现流产不完全的情况，需要进行清宫手术。我们查阅了1990年1月至1992年7月期间入住巴西塞阿拉州首府福塔莱萨主要产科医院进行人工流产后清宫手术的妇女记录。1990年上半年，米索前列醇导致的不完全流产数量大幅增加，此后有所下降。在1991年的593例病例中，75%与米索前列醇有关，10%与使用其他特定药物有关，6%与未指明的药物有关。其余9%的手术方式未记录；其中包括3%由非法堕胎者实施堕胎的病例。每月清宫手术数量从1990年8月的89例降至1991年7月的62例，当时塞阿拉州米索前列醇的销售被暂停。米索前列醇停止销售后，数量继续下降，到1991年12月约为20例；在1992年6月之前，数量一直维持在这一水平，靠非法销售维持。缺乏避孕措施是意外怀孕数量众多的主要原因，也是巴西妇女面临的一个重大公共卫生问题。堕胎禁令造成了一个空白，药物滥用成为了一个额外的并发症，主要是因为对药品销售缺乏有效管控。
