Aborto nos casos de infecção congênita pelo vírus Zika

Mota, Vivian Maria Ribeiro; Cavalcanti, Luciano Pamplona de Góes; Delfino, Alanna dos Santos; Lopes, Thayse Elaine Costa Figueiredo; Pessoa, André Luiz Santos; Ribeiro, Erlane Marques

doi:10.1055/s-0038-1648219

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 40 (07) • Jul 2018 • https://doi.org/10.1055/s-0038-1648219 copiar

Aborto nos casos de infecção congênita pelo vírus Zika

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A emergência provocada na saúde pública internacional por causa do vírus Zika trouxe à tona a discussão do aborto em casos de síndrome congênita de Zika. Portanto, propomos a realização de uma revisão bibliográfica sobre o aborto nesses casos. Foram pesquisados cinco bancos de dados utilizando os seguintes termos: aborto, aborto espontâneo, e zika, com interposição do operador booleano “E”. Na literatura selecionada, encontramos referências à falta de informações sobre os riscos e a gravidade da síndrome congénita de Zika, bemcomo ao grande sofrimento psicológico de mulheres grávidas e ao risco de aborto inseguro como justificativa para o aborto em casos de síndrome congênita de Zika. No entanto, é necessário ter testes disponíveis que possam diagnosticar, no primeiro trimestre da gravidez, que o feto foi afetada pelo vírus, e que ele pode ter limitações importantes, para subsidiar a discussão qualificada sobre o aborto nesses casos.

Palavras-chave:
infecção pelo zika vírus; aborto; bioética

Author	Year/ month	Journal	Title	Abstract/conclusions	Abortion-friendly?
Rego and Palácios²2 Rego S, PaláciosM. Ética, saúde global e a infecção pelo vírus Zika: uma visão a partir do Brasil. Rev Bioet 2016;24:430-434. Doi: 10.1590/1983-80422016243141 https://doi.org/10.1590/1983-80422016243...	2016/Dec	Revista Bioética	Ética, saúde global e a infecção pelo vírus Zika: uma visão a partir do Brasil	The authors show that Zika virus infection occurs mainly in pregnant women of the poorest classes, causing both economic and information inequality to suddenly reach these women. The authors provide these facts to justify the legalization of abortion in countries where abortion is still a crime for women with Zika virus infection.	Yes
Roa⁴4 Roa M. Zika virus outbreak: reproductive health and rights in Latin America. Lancet 2016;387(10021):843. Doi: 10.1016/S0140-6736(16)00331-7 https://doi.org/10.1016/S0140-6736(16)00...	2016/Feb	The Lancet	Zika virus outbreak: reproductive health and rights in Latin America	The author focuses on the lack of information regarding the severity of the consequences of the Zika virus infection, as well as the difficulty of access to the methods of contraception and reproductive health. The author exemplifies this fact by stating that the most disadvantaged women are likely to earn low wages. The article concludes by stating that the Zika epidemic may be an opportunity for governments to discuss safe abortion.	Yes
Camargo⁵5 CamargoTMCR. The debate on abortion and Zika: lessons fromthe AIDS epidemic. Cad Saude Publica 2016;32(05):e00071516. Doi: 10.1590/0102-311x00071516 https://doi.org/10.1590/0102-311x0007151...	2016/May	Cadernos de Saúde Pública	O debate sobre aborto e Zika: lições da epidemia de Aids	The author refers to the legality of abortion, bringing up proposals similar to those of the AIDS epidemic in 1990. The author also refers to the increase in the number of evangelical congressmen who seek to increasingly restrict the right to abortion. The article concludes with the notion that pregnant women with fetuses with microcephaly are forced to carry on with the pregnancy and give birth, and are often abandoned by their husbands, being left with the burden of having to care for a disabled infant alone.	Yes
Pitanguy⁶6 Pitanguy J. Os direitos reprodutivos dasmulheres e a epidemia do Zika Vírus. Cad Saude Publica 2016;32:e00066016. Doi: 10.1590/0102-311x00066016 https://doi.org/10.1590/0102-311x0006601...	2016/May	Cadernos de Saúde Pública	Os direitos reprodutivos das mulheres e a epidemia do Zika vírus	The article discusses that the fear of microcephaly constitutes emotional torture for the mother, which brings up the issue of women's reproductive rights, which would require a revision in Brazilian legislation. It talks about the high rates of morbidity and mortality in unsafe abortions. It concludes by reinforcing the importance that the State provide assistance to mothers who decide to have their children with CZS, as well as assistance to the children.	Yes
Mayor⁷7 Mayor S. Abortion requests increase in Latin America after Zika warning, figures show. BMJ 2016;353:i3492. Doi: 10.1136/bmj.i3492 https://doi.org/10.1136/bmj.i3492...	2016/Jun	British Medical Journal	Abortion requests increase in Latin America after Zika warning, figures show	The author relates to the Pan American Health Organization's alert about the Zika virus and the increase in the number of abortion drug requests sent to the non-governmental organization Women on Web. The article shows that requests from Brazil have doubled. It concludes that the reproductive choice must be safe, legal and accessible.	Yes
Galli⁸8 Galli B. Aonde está o direito ao aborto? Comentário sobre o documentário Zika, The Film. Cad Saude Publica 2016;32: eES010616. Doi: 10.1590/0102-311xes010616 https://doi.org/10.1590/0102-311xes01061...	2016/Jun	Cadernos de Saúde Pública	Aonde está o direito ao aborto? Comentário sobre o documentário Zika, The Film	This is a commentary on the documentary addressing the restriction to the right of women to end a gestation. It concludes that there are difficulties both in relation to the prenatal diagnosis and the information that is passed on to mothers about the complexity of congenital Zika virus syndrome.	Yes
Aiken et al⁹9 Aiken AR, Scott JG, Gomperts R, Trussell J, Worrell M, Aiken CE. Requests for abortion in Latin America related to concern about Zika virus exposure. N Engl J Med 2016;375(04):396-398. Doi: 10.1056/NEJMc1605389 https://doi.org/10.1056/NEJMc1605389...	2016/Jul	New England Journal of Medicine	Requests for abortion in Latin America related to concern about Zika virus exposure	The article refers to Women on Web, a non-governmental organization that provides abortive medicines. The authors survey the requests for these drugs, before and after the Zika infection outbreak, and compare countries that have legalized abortion and those that have not. They conclude that there was an increase in the number of requests for these drugs, mainly in Brazil, but it is not possible to ensure that this increase is related to the infection by the Zika virus.	Yes
Collucci¹⁰10 Collucci C. Brazilian attorneys demand abortion rights for women infected with Zika. BMJ 2016;354:i4657. Doi: 10.1136/bmj.i4657 https://doi.org/10.1136/bmj.i4657...	2016/Aug	British Medical Journal	Brazilian attorneys demand abortion rights for women infected with Zika	The article discusses the passivity of women in taking control of their lives, in view of the illegality of abortion, as well as the importance of offering social and health support to mothers who wish to continue the gestation of fetuses with microcephaly. It concludes that women who contracted the Zika virus during pregnancy and are in great mental suffering, which has been diagnosed after medical and psychological evaluations, should be entitled to an abortion.	Yes
Ventura and Camargo¹¹11 Ventura M, Camargo TMCR. Direito reprodutivo e aborto: as mulheres na epidemia de Zika. Rev Direito e Práx 2016;7:622-651	2016/Aug	Direito e Práxis	Direito reprodutivo e aborto: as mulheres na epidemia de Zika	The authors discuss the matter from a legal perspective. They note the lack of access to public health services and methods of contraception for the poorest women. They conclude that, based on the reproductive rights and private autonomy in the reproductive and sexual scope proposed in the Brazilian Federal Constitution, abortion in these cases should be allowed.	Yes
Campos¹²12 de Campos TC. Zika, public health, and the distraction of abortion. Med Health Care Philos 2017;20(03):443-446. Doi: 10.1007/s11019-016-9739-9 https://doi.org/10.1007/s11019-016-9739-...	2016/Nov	Medicine, Health Care and Philosophy	Zika, public health, and the distraction of abortion	The author raises the idea that the discussion of abortion in the cases of congenital Zika syndrome can be a distraction when more important issues, such as preventative actions, are not being given due attention. In addition, the article refers to Zika as a neglected disease because it is related to poverty; thus, few resources are available to subsidize research for a treatment and for vaccines. It concludes that it is imperative that there be a discussion about prevention methods before discussing abortion.	No
Perry and Beca¹³13 Perry CN, Beca IJB. Virus ZIKA y aborto por correspondencia, una realidad cercana a Chile. Rev Chil Obstet Ginecol 2017;82:89-92. Doi: 10.4067/S0717-75262017000100015 https://doi.org/10.4067/S0717-7526201700...	2017/Feb	Revista Chilena de Obstetricia y Ginecología	Virus Zika y aborto por correspondencia: una realidad cercana a Chile	The article shows various information about what is occurring in countries where abortion is restricted and Zika virus infection is spreading. Based on the facts, the authors try to expose women's risks of using clandestine abortions or non-governmental organizations such as Women on Web, which provides abortion drugs. The article attempts to show that in addition to the risk to the lives of women who undergo these procedures, they become criminals, making that not only a social problem, but also a legal problem.	Yes
Blanchard and Starrs³3 Blanchard K, Starrs AM. Contraception, safe abortion, and the Zika response. Lancet 2017;389(10079):1603. Doi: 10.1016/S0140- 6736(17)31010-3 https://doi.org/10.1016/S0140-...	2017/Apr	The Lancet	Contraception, safe abortion, and the Zika response	The article shows that it is important for the government to invest in preventing unwanted pregnancies during times of congenital infection by the Zika virus. The authors state that it is necessary to raise women's awareness so that they do not have unwanted pregnancies, and for the government to offer the appropriate preventive methods so that they can choose the best method for them. In addition, the authors state that, if women wish to terminate a pregnancy, they should have this right and should be directed to do so as safely as possible.	Yes
Ali et al¹⁴14 Ali M, Miller K, Folz R, Johnson BR Jr, Kiarie J. Study protocol on establishment of sentinel sites network for contraceptive and abortion trends, needs and utilization of services in Zika virus affected countries. Reprod Health 2017;14(01):19. Doi: 10.1186/s12978-017-0282-9 https://doi.org/10.1186/s12978-017-0282-...	2017/Feb	Reproductive Health	Study protocol on establishment of sentinel sites network for contraceptive and abortion trends, needs and utilization of services in Zika virus-affected countries	The article describes the implementation of a counseling program for women who are pregnant or plan to become pregnant, and who are infected or at risk of infection by the Zika virus. The authors show the need for family planning, contraception and safe abortion. The goal of the program is to deploy a sentinel network of sites to transmit safe information to women in countries at the highest risk of congenital infection by the Zika virus, and it would be a pilot program in sex education for the future needs generated by other emerging infections.	Yes
Galli and Deslandes¹⁵15 Galli B, Deslandes S. Threats of retrocession in sexual and reproductive health policies in Brazil during the Zika epidemic. Cad Saude Publica 2016;32(04):e00031116. Doi: 10.1590/0102-311x00031116 https://doi.org/10.1590/0102-311x0003111...	2016/Apr	Cadernos de Saúde Pública	Ameaças de retrocesso nas políticas de saúde sexual e reprodutiva no Brasil em tempos de epidemia de Zika	The article mentions that Brazil is one of the most restrictive countries in the world regarding abortion laws. The authors cite Brazilian laws, which, on the one hand, consider the reproductive and sexual rights of women and, on the other hand, are harsh and restrictive regarding abortion. In addition, the article associates restrictive laws with the Christian churches' influence on Brazilian laws. It ends by suggesting that health policies should be reviewed to provide abortion and safe information for pregnant women with congenital infection by the Zika virus.	Yes
Vélez and Diniz¹⁶16 Vélez AC, Diniz SG. Inequality, Zika epidemics, and the lack of reproductive rights in Latin America. Reprod Health Matters 2016;24(48):57-61. Doi: 10.1016/j.rhm.2016.11.008 https://doi.org/10.1016/j.rhm.2016.11.00...	2016/Nov	Reproductive Health Matters	Inequality, Zika epidemics, and the lack of reproductive rights in Latin America	The article shows that social inequality leads to a greater number of cases of Zika in pregnant women from poor neighborhoods, which present more favorable conditions for the appearance of the mosquito that transmits the disease, such as lack of sanitation and health education. In view of this, these women suffer more with congenital Zika virus syndrome because they must spend more time caring for their children, often leaving them to go to work. Thus, the authors argue that having a child with neurological diseases only increases the burden they already carry due to poverty and vulnerability.	Yes
Burke and Moreau¹⁷17 Burke A, Moreau C. Family planning and Zika virus: the power of prevention. SeminReprodMed 2016;34(05):305-312.Doi: 10.1055/s-0036-1592068 https://doi.org/10.1055/s-0036-1592068...	2016/Sep	Seminars In Reproductive Medicine	Family Planning and Zika Virus: The Power of Prevention	The article seeks to show that family planning programs can be a powerful tool to reduce the impact of congenital Zika virus syndrome, especially in Latin American countries. The authors focus on restrictive abortion laws in some Latin American countries, which are among the main foci of Zika virus infection, and show an increase in the number of abortion drug requests in those countries. Thus, the authors argue that, in addition to prevention and planning, there must be safe abortion facilities for cases of congenital Zika virus syndrome.	Yes

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[1] Address for correspondence Vivian Maria Ribeiro Mota, Medical Student, Universidade de Fortaleza, Rua Vasco de Ataíde 895, Fortaleza, CE, 60841-395, Brazil (e-mail: vivianmariaribeiromota@gmail.com).