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Case Reports
. 2022 Feb 22:3:811412.
doi: 10.3389/fgwh.2022.811412. eCollection 2022.

Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls

Bianca M Stifani  1   2 , Susane Mei Hwang  3 , Renata Rodrigues Catani  4 , Helena Borges Martins da Silva Paro  4 , Nerys Benfield  2
Affiliations
Case Reports

Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls

Bianca M Stifani et al. Front Glob Womens Health. .

Abstract

Dilation and evacuation (D&E) is the recommended surgical procedure for uterine evacuation in the second trimester. Despite its established safety record, it is not routinely available in most countries around the world. In this paper, we describe the multi-phase capacity-building project we undertook to introduce D&E in Brazil. First, we invited a highly motivated obstetrician-gynecologist and abortion provider to complete an observership at an established D&E site in the United States. We then organized a month-long clinical training for two experienced gynecologists in Brazil, followed by ongoing remote mentorship. Almost all patients we approached during the training opted for D&E, and all expressed satisfaction with their experience. Despite the restrictive legal setting and prevailing abortion stigma in Brazil, our training was well-received, and we did not experience any overt resistance from hospital staff. We learned that obtaining institutional support is essential; and that presenting scientific evidence during dedicated didactic times was an important strategy to obtain buy-in from other local healthcare providers. An important challenge we encountered was low case volume given the restrictive legal setting. We addressed this by partnering with nearby hospitals and non-profit organizations for patient referrals. We also rescheduled, adapted and optimized this project for implementation in the midst of the COVID-19 pandemic. Despite the challenges we faced, this project led to the successful introduction of D&E up to 16-18 weeks at two sites in Brazil. In the future, we plan additional training to increase capacity for D&E at more advanced gestational ages.

Keywords: Brazil; abortion (induced); capacity building; clinical simulation and skills; dilation and evacuation; surgical training.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
D&E simulation model made with 32 oz plastic container as uterus; mylar balls and flexible darts as “fetal parts”.
Figure 2
Figure 2
D&E model covered with felt to practice extraction of “fetal parts” by feel.
Figure 3
Figure 3
D&E model in action with Bierer forceps used to extract “fetal parts”.
See this image and copyright information in PMC

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