Case report | Volume 35, Article 17, 23 Jan 2020 | 10.11604/pamj.2020.35.17.15777

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique

Soufiane Badsi, Abderrahim El kaouini, Soufiane Diyas, Brahim Housni

Corresponding author: Soufiane Badsi, Service de Réanimation, CHU Mohamed VI, Faculté de Médecine et de Pharmacie d´Oujda, Université Mohammed 1er Oujda, Oujda, Maroc

Received: 12 Apr 2018 - Accepted: 14 Nov 2019 - Published: 23 Jan 2020

Domain: Intensive care medicine

Keywords: Accident voie publique, rupture post traumatique, aorte descendante, traitement chirurgical

©Soufiane Badsi et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Soufiane Badsi et al. Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique. Pan African Medical Journal. 2020;35:17. [doi: 10.11604/pamj.2020.35.17.15777]

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Case report

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique

Mandatory pre-abortion counseling is a barrier to accessing safe abortion services

Luchuo Engelbert Bain1,2,&


1Centre for Population Studies and Health Promotion, CPSHP, Yaounde, Cameroon, 2Athena Institute for Research on Innovation and Communication in the Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands



&Corresponding author
Luchuo Engelbert Bain, Centre for Population Studies and Health Promotion, CPSHP, Yaounde, Cameroon




Empirical research showcases that pre-abortion counseling scarcely reverses the woman’s decision either to terminate a pregnancy or not. Growing evidence regarding the high levels of decisional certainty among women seeking abortions renders a careful rethink of the place of mandatory pre abortion counseling packages. Mandatory counseling packages, when inscribed in the laws, at times contain false information that can deter women from going in for safe abortions. Mandatory waiting times indirectly label opting for an abortion as being not the right thing to do. In areas where abortion stigma from health care providers and communities remains highly prevalent, women are forced to incur extra expenses by travelling to other countries I argue that pre abortion counseling on opting-in grounds is ethically sound (enhances the woman’s reproductive autonomy), since most clients in need of abortions are certain on their decisions before the abortion care provider and do not regret these decisions after the process. Regrets are prone to be more prevalent in areas with high unsafe abortion practices, generally due to complications from excessive bleeding, pain, and post abortion infections. Allowing systematic mandatory pre abortion counseling practice as the rule in a competent adult is unjustified ethically and empirically, is time consuming and presents the legality of abortions in most settings an oxymoron.



Essay    Down



There is a global decreasing trend in abortion related mortality and morbidity worldwide [1]. This however is untrue for Sub-Saharan Africa, where maternal mortality rates ascribed to unsafe abortion remain stable at 13% [1]. Legislation is generally becoming liberal towards abortions, with many western countries allowing abortions on request up to 12 weeks of gestation [1-4]. Countries with restrictive laws on abortions suffer the most from unsafe abortion associated morbidity and mortality [1, 4, 5]. The abortion debate however remains hypocritical on legal grounds. For instance, in developing countries where abortion laws are more restrictive, they register the greatest number of maternal deaths related to unsafe abortions [1]. Also, in countries where abortions are legal, there is often no guarantee of getting access to an abortion, even when clients meet the legal requirements. Reports from Nepal indicate unacceptably many women presenting to health services for post unsafe abortion related complications, despite the legalization of abortions more than a decade ago [6]. Ignorance of existing legislation, conscientious objection by qualified health care providers, cost of having abortions, mandatory pre-abortion counseling and sometimes, distance from authorized health care facilities and stigma reduce access to safe abortion services [6-9]. Reports from the USA indicate many states are instituting even stricter abortion laws, but nothing has been done to increase or improve access to abortion services [10]. It is not rare to see reported cases of unsafe abortion or clients received later in pregnancy (second and third trimesters of pregnancy) though abortion remains legal [6]. For instance, this increased number of women seen later in the pregnancy course might have caused the French government to increase the legitimate gestational age for abortions from 12 to 14 weeks [2].


Efforts by governments to dissipate information with regards to the legal status of abortions are grossly insufficient. Practicing physicians, mid wives and other health care providers in the management chain are not aware of existing legislation [11-13]. Legal status of abortion is no direct translation of increased access to obtain an abortion [10, 14, 15]. For instance, even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies [7]. Levels of awareness about the legality of abortion and its provision remain low, especially among adolescents [6, 16]. Similar low levels of awareness reported from Nepal where abortions were legalized in 2002 [16], with only 40% of young girls aware of abortion laws and the legal status under which they can obtain abortion. Responsibility of states towards protecting the wellbeing of citizens is primordial. One could argue that since getting an abortion is increasingly being considered a human right, the state should fund abortion services as it does for other medical conditions. Not only are routine first trimester abortions relatively safe, it is paradoxical that governments would rather prefer to fund expensive post abortion care services [4, 17-20]. Failure to fund abortion care labels abortion already as not the right thing to do. This could go a long way to aggravate abortion related stigma, thus scaring women from getting the services they might really need.




Pre-abortion counseling, autonomy and informed consent


Three interrelated elements underlie the long-standing tradition of informed consent: patients must possess the capacity to make decisions about their care; their participation in these decisions must be voluntary; and they must be provided adequate and appropriate information [10]. Daniels et al. in a recent review of state mandated consent forms report one third of the information as being medically inaccurate [21]. Association of abortions to breast cancer or mental disease generally purported in most pre-counseling packages have been characterized as false from recent scientific research [22]. Current evidence is almost conclusive on the fact that abortions do not increase the risk of mental illness later in life [23-25]. On the other hand, it is rarely mentioned that abortions, especially first trimester abortions, when carried out appropriately are relatively very safe, compared to the risks of carrying a pregnancy to term [23]. Some reported barriers to access to safe abortion services where abortions are legal include mandatory waiting times and pre-abortion counseling, false information on pre abortion counseling packages, labeling of safe abortions as not being the right thing to do by labeling the fetus an unborn child, as well as obligatory ultrasound visualization of the fetus in some circumstances [26-34]. Biased mandatory pre-abortion counseling information has also been reported from countries like Georgia, Latvia, Lithuania, Macedonia, Romania, Russia and Slovakia [35]. Indeed, Hoctor and Lamackováhave argued that mandatory pre abortion counseling simply labels an abortion as not the right thing to do, thus reinforcing abortion stigma [35].


Pre abortion counseling and decisional certainty


The value of mandatory pre abortion counseling has abundantly been put to question in the literature.Abortion counseling has 3 purposes: 1) to support the woman in making a decision for her unintended pregnancy, 2) to help her implement the decision, 3) to assist her in controlling her future fertility. Findings from empirical research indicate that most women do not need a counseling session to obtain an abortion [33, 34, 36]. In a recent systematic review on the efficacy of pre-abortion counseling in reducing subsequent unwanted pregnancies, Stewart et al. did not find any significant effect [37]. Indeed, since most women do not seem to want or need pre-termination counselling, therefore policies aimed at promoting mandatory counselling, would be contrary to women's wishes [33, 34]. The high levels of decisional certainty challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as: laws mandating compulsory waiting periods, counseling and ultrasound viewing. Without undermining the enormous gains accrued to pro-abortion counseling, opting-in in this process not only further renders more meaningful the envisaged autonomous decision of the client, but reinforces trust, respect and informed decision making. Elsewhere, mandatory waiting time, despite being a rule in many western countries offering legal abortions on request, has been described by women as not helpful [38]. Pregnancy, especially when unintended could be accompanied by some degree of stress. Some clients would therefore justly require some degree of support. Quality counseling on opting in grounds renders a trusting space, for a reasonable exchange to occur between the pregnant woman and the health care professionals, a pre-condition to make certain informed decisions. Making abortion counseling mandatory with a standard counseling package could be considered as unethical, as the women's free choice is not respected, and the very uniqueness and peculiar needs of each pregnant women might be difficult to be properly addressed.


Abortion care might not be different from other medical conditions. Gawronand Watson in a recent qualitative study conclude that women seeking abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures [39]. A non-judgmental counseling process could positively affect women, actually clarifying their concerns with regards to sensitive decisions like havingan abortion. This only becomes truly ethical (autonomy enhancing and non-paternalistic) on the premise that pre-abortion counseling is voluntary. In Belgium, pre-abortion counseling is mandatory [40]. Vandamme et al. in Belgium have reported high levels of satisfaction amongst women using pre-abortion services [41]. This is of course difficult to ascertain since the counseling sessions are mandatory and women really have no choice. Adult women have a right to take autonomous decisions regarding their health. Mandating pre-abortion counseling before taking their decisions into consideration could breach the right to self-determination and their reproductive autonomy. Pre-abortion counseling could even be more dangerous in settings where conscientious objection for health care providers is not regulated by law. In countries where abortion service providers are limited, this could be a key issue of concern. Falling into the hands of a conscientious objector increases the risk of a biased counseling session towards dissuasion and failure to obtain an abortion. Conscientious objection does not only limit the woman's right to having an abortion, but also results in negative consequences regarding women's access to sexual and reproductive health services [42, 43]. Holistic abortion care could be a unique opportunity for women to receive a complete reproductive health counselling package. For instance, optimal contraceptive practices have the potential of reducing the burden of abortions and unintended pregnancies by more than one third alone [44].


Socioeconomic implications of mandatory pre abortion counseling and restrictive legal atmospheres in the abortion debate


Mandatory pre abortion counseling poses a serious inequity and social justice concern, as the poor are bound to suffer from failure of obtaining abortions services, even when they are legally entitled to. For instance, in Italy where 70% of gynecologists would refuse doing abortions (legal) on ground of their conscience, the rich women move to countries like the UK to obtain abortions [45, 46]. This is injustice in forcing some women to put to birth either against their will, or at an inappropriate time. Also, it is purely an unacceptable social justice burden meted on women of the lower socioeconomic class. The more restrictive a law is, the greater the prevalence of unsafe abortion related deaths [2]. Over 8-18% of these deaths result from unsafe abortions with an estimated 47,000 women dying each year [47]. Rahman has reported reproductive autonomy to be a strong predictor of unintended pregnancy rates in Bangladesh [48]. Abada and Tenkorang have reported similar findings from the Philippines, and underscored the importance of rendering reproductive decision making more autonomous among women, as one solution to reduce unintended pregnancies among women [49]. The justification of forcing women to give birth either at the wrong time, or against their will could have serious socioeconomic implications. Within the framework of the Sustainable Development Goals (SDGs), enhancing sexual and reproductive health rights of women could play significant roles in reducing gender equality (Goal 5), allowing women to continue studies and thus have the right and opportunities to quality education (Goal 4) and consequently work and contribute to economic growth (Goal 8) [50]. There is hypocrisy in making access to abortion services as a key obstacle in guaranteeing women's reproductive health rights. This simply guarantees the fact that women will turn to clandestine abortion providers, and will be forced to bear children against their will. The psychological and emotional implications of having children against one's will, both from the child's and women's side still remain understudied.


It is difficult to understand the fact that governments would prefer to spend much on post abortion care services, which are far more expensive than providing safe abortion services [50-53]. Unintended pregnancies shall continue to occur even with optimal contraceptive uptake. Not all women will opt to carry pregnancies to term. The reality of opting for abortions remains. Refuting legalization of safe abortion care simply guarantees persistence of unsafe abortions, especially among the poor. With disturbing and unacceptable abortion related deaths still registered in some countries, provision of post abortion care instead of optimal access to safe abortion services remains unjustified. Advocates for safe abortion care and access must go a step further, for reduction of safe abortion fees, which still remain unacceptable to some women that required this service. Mandatory pre- abortion counseling simply implies the client has to make a minimum of two visits to the health care facility in most instances. In Utah in the United States, extending the waiting period to 72 hours was associated with a reduction in the number of women returning for abortions [54]. This is not only time consuming, but also carries an economic cost [35]. Elsewhere, this practice might be able to lead women to go past the gestational ages that qualify them for legal abortions [35]. Indeed, some women are forced to travel to other countries to obtain second and third trimester abortions. It is possible that women who are not economically viable could turn to unsafe abortion providers in such instances. Elsewhere, others might be forced to continue the pregnancy to term against their will. The social, economic, and health implications for the mother who unwillingly continuous a pregnancy to term, as well as the resulting baby could be an interesting area for future research.




Since unintended pregnancies cannot be completely eliminated, and as the demand for safe abortions is a constant reality, ethically sound counseling approaches are required. Making pre-abortion counseling mandatory, does not only go against the fundamental human rights of the woman, the right to self-determination and her reproductive autonomy, but could deter a great number of women from getting access to safe abortion services, and to turn to clandestine abortion care providers. Pre-abortion counseling undoubtedly could be helpful, but even more helpful if offered on purely selective and voluntary (opting-in) grounds. Autonomous agents evidently could make mistakes with regards to what may be good to them. Pre-abortion counseling could be helpful in this case to clarify or reinforce the agent's understanding regarding the risks involved in this process, or to address specific social, psychological and contraceptive needs. This is justified on grounds that the counseling process is purely non-directive. This is however unrealistic in the abortion world, where legal, personal, religious and diverse moral convictions are active players at different levels. Not only is mandatory pre-abortion counseling unjustified from evidence-based perspective, it is unethical and ignores the woman's fundamental human right to reproductive autonomy and self-determination. In the years to come, a new pandemic of unsafe abortion related deaths could be driven by an unjustified barrier of mandatory pre-abortion counseling. Allowing this practice as the rule in competent adults requesting abortions is unjustified, unacceptable and presents the legality of abortions an oxymoron on practical grounds. Mandatory pre-abortion counseling could constitute a key obstacle to obtaining safe abortions in the years to come. Women might either shy away from seeking abortion care, revert to "shadow"; abortion providers or present for abortions late in the pregnancy course.



Authors' contributions Up    Down

Luchuo Engelbert Bain conceived the study, carried out the literature searches and wrote the initial draft of the paper.



Acknowledgements Up    Down

I would like to acknowledge the very insightful comments of the expert reviewers.



References Up    Down

  1. Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016 Jul 16;388(10041):258-67. PubMed | Google Scholar

  2. Levels M, Sluiter R, Need A. A review of abortion laws in Western-European countries: a cross-national comparison of legal developments between 1960 and 2010. Health Policy. 2014 Oct;118(1):95-104. PubMed | Google Scholar

  3. Cook RJ. Developments in abortion laws: comparative and international perspectives. Annals of the New York Academy of Sciences. 2000 Sep 1;913(1):74-87. PubMed | Google Scholar

  4. Boland R, Katzive L. Developments in laws on induced abortion: 1998-2007. Int Fam Plan Perspect. 2008 Sep;34(3):110-20. PubMed | Google Scholar

  5. Faúndes A, Shah IH. Evidence supporting broader access to safe legal abortion. Int J Gynaecol Obstet. 2015 Oct;131 Suppl 1:S56-59. PubMed | Google Scholar

  6. Rocca C, Puri M, Dulal B, Bajracharya L, Harper C, Blum M et al. Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals. BJOG: Int J ObstetGy. 2013 Aug 1;120(9):1075-83. PubMed | Google Scholar

  7. Coast E, Murray SF. “These things are dangerous”: Understanding induced abortion trajectories in urban Zambia. Soc Sci Med. 2016 Mar;153:201-9. PubMed | Google Scholar

  8. Harris LH. Recognizing conscience in abortion provision. New England Journal of Medicine. 2012 Sep 13;367(11):981-3. PubMed | Google Scholar

  9. Lertxundi R, Ibarrondo O, Merki-Feld GS, Rey-Novoa M, Rowlands S, Mar J. Proposal to inform European institutions regarding the regulation of conscientious objection to abortion. Eur J Contracept Reprod Health Care. 2016 Jun;21(3):198-200. PubMed | Google Scholar

  10. Guttmacher Institute. 2012 saw second-highest number of abortion restrictions ever. 2013. Accessed 2016 Oct 21.

  11. Assifi AR, Berger B, Tunçalp Ö, Khosla R, Ganatra B. Women’s awareness and knowledge of abortion laws: a systematic review. PLoS ONE. 2016;11(3):e0152224. PubMed | Google Scholar

  12. Ramos S, Romero M, Ramón Michel A. Health care providers’ opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina. Reproductive Health. 2014 Sep 24;11(1):72. PubMed | Google Scholar

  13. Okonofua FE, Hammed A, Nzeribe E, Saidu B, Abass T, Adeboye G et al. Perceptions of policymakers in Nigeria toward unsafe abortion and maternal mortality. Int Perspect Sex Reprod Health. 2009 Dec;35(4):194-202. PubMed | Google Scholar

  14. Gerdts C, DePiñeres T, Hajri S, Harries J, Hossain A, Puri M et al. Denial of abortion in legal settings. J Fam Plann Reprod Health Care. 2015 Jul;41(3):161-3. PubMed | Google Scholar

  15. Pinter B, Aubeny E, Bartfai G, Loeber O, Ozalp S, Webb A. Accessibility and availability of abortion in six European countries. Eur J Contracept Reprod Health Care. 2005 Mar;10(1):51-8. PubMed | Google Scholar

  16. Adhikari R. Knowledge on legislation of abortion and experience of abortion among female youth in Nepal: A cross sectional study. Reproductive Health. 2016;13:48. PubMed | Google Scholar

  17. Ilboudo PGC, Greco G, Sundby J, Torsvik G. Costs and consequences of abortions to women and their households: a cross-sectional study in Ouagadougou, Burkina Faso. Health Policy Plan. 2015 May;30(4):500-7. PubMed | Google Scholar

  18. Gerdts C, Fuentes L, Grossman D, White K, Keefe-Oates B, Baum SE et al. Impact of clinic closures on women obtaining abortion services after implementation of a restrictive law in Texas. Am J Public Health. 2016 May;106(5):857-64. PubMed | Google Scholar

  19. Barnard S, Kim C, Park MH, Ngo TD. Doctors or mid-level providers for abortion. Cochrane Database Syst Rev. 2015 Jul 27;(7):CD011242. PubMed | Google Scholar

  20. Leone T, Coast E, Parmar D, Vwalika B. The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion. Health Policy Plan. 2016 Sep;31(7):825-33. PubMed | Google Scholar

  21. Daniels CR, Ferguson J, Howard G, Roberti A. Informed or misinformed consent? Abortion policy in the United States. J Health Polit Policy Law. 2016 Apr;41(2):181-209. PubMed | Google Scholar

  22. American Cancer Virus. Abortion and cancer risk. 2016. Accessed 2020 Mar 13.

  23. Virk J, Zhang J, Olsen J. Medical abortion and the risk of subsequent adverse pregnancy outcomes. New England Journal of Medicine. 2007 Aug 16;357(7):648-53. PubMed | Google Scholar

  24. Biggs MA, Rowland B, McCulloch CE, Foster DG. Does abortion increase women’s risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open. 2016 Feb 1;6(2):e009698. PubMed | Google Scholar

  25. Leppälahti S, Heikinheimo O, Kalliala I, Santalahti P, Gissler M. Is underage abortion associated with adverse outcomes in early adulthood? A longitudinal birth cohort study up to 25 years of age. Hum Reprod. 2016 Sep;31(9):2142-9. PubMed | Google Scholar

  26. Baron C, Cameron S, Johnstone A. Do women seeking termination of pregnancy need pre-abortion counselling? J FamPlannReprod Health Care. 2015 Jul;41(3):181-5. Google Scholar

  27. Greasley K. Abortion and regret. J Med Ethics. 2012 Dec 1;38(12):705-11. PubMed | Google Scholar

  28. Purcell C, Cameron S, Lawton J, Glasier A, Harden J. Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context. Contraception. 2016 Feb;93(2):170-7. PubMed | Google Scholar

  29. Törnbom M, Ingelhammar E, Lilja H, Svanberg B, Möller A. Decision-making about unwanted pregnancy. Acta Obstet Gynecol Scand. 1999 Aug;78(7):636-41. PubMed | Google Scholar

  30. Goenee MS, Donker GA, Picavet C, Wijsen C. Decision-making concerning unwanted pregnancy in general practice. Fam Pract. 2014 Oct;31(5):564-70. PubMed | Google Scholar

  31. Tatum C, Rueda M, Bain J, Clyde J, Carino G. Decision making regarding unwanted pregnancy among adolescents in Mexico City: a qualitative study. Stud Fam Plann. 2012 Mar;43(1):43-56. PubMed | Google Scholar

  32. Centre for reproductive rights. Mandatory Waiting Periods and Biased Counseling Requirements in Central and Eastern Europe. [cited 2020 Mar 25]

  33. Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SCM. Measuring decisional certainty among women seeking abortion. Contraception. 2017 Mar;95(3):269-78. PubMed | Google Scholar

  34. Roberts SCM, Turok DK, Belusa E, Combellick S, Upadhyay UD. Utah’s 72-Hour Waiting Period for Abortion: Experiences Among a Clinic-Based Sample of Women. Perspect Sex Reprod Health. 2016 Dec;48(4):179-87. PubMed | Google Scholar

  35. Hoctor L, Lamacková A. Mandatory waiting periods and biased abortion counseling in Central and Eastern Europe. Int J Gynaecol Obstet. 2017 Nov;139(2):253-8. PubMed | Google Scholar

  36. Guttmacher Institute. Mandatory counseling for abortion. 2016. Accessed 2018 Dec 10.

  37. Stewart H, McCall SJ, McPherson C, Towers LC, Lloyd B, Fletcher J et al. Effectiveness of peri-abortion counselling in preventing subsequent unplanned pregnancy: a systematic review of randomised controlled trials. J Fam Plann Reprod Health Care. 2016 Jan;42(1):59-67. PubMed | Google Scholar

  38. Lupfer M, Silber BG. How patients view mandatory waiting periods for abortion. Fam Plann Perspect. 1981 Apr;13(2):75-9.. PubMed | Google Scholar

  39. Gawron LM, Watson K. Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications. Contraception. Contraception. Feb 2017;95(2):175-180. PubMed | Google Scholar

  40. Popinchalk A, Sedgh G. Trends in the method and gestational age of abortion in high-income countries. BMJ Sex Reprod Health. 2019 Apr;45(2):95-103.. PubMed | Google Scholar

  41. Vandamme J, Wyverkens E, Buysse A, Vrancken C, Brondeel R. Pre-abortion counselling from women's point of view.Eur J Contracept Reprod Health Care. 2013 Aug;18(4):309-18. doi: 10.3109/13625187.2013.796586. Epub 2013 Jun 10. PubMed | Google Scholar

  42. Keogh LA, Gillam L, Bismark M, McNamee K, Webster A, Bayly C, et al. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Medical Ethics. 2019 Jan 31;20(1):11.. PubMed | Google Scholar

  43. Morrell KM, Chavkin W. Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents. Curr Opin Obstet Gynecol. 2015 Oct;27(5):333-8. PubMed | Google Scholar

  44. Guttmacher Institute. Adolescents’ need for and use of abortion services in developing countries. 2016. Accessed 2016 Nov 11.

  45. Minerva F. Conscientious objection in Italy. J Med Ethics. 2015 Feb;41(2):170-3. PubMed | Google Scholar

  46. Gerdts C, DeZordo S, Mishtal J, Barr-Walker J, Lohr PA. Experiences of women who travel to England for abortions: an exploratory pilot study. Eur J Contracept Reprod Health Care. 2016 Oct;21(5):401-7. PubMed | Google Scholar

  47. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol. 2009;2(2):122-6. PubMed | Google Scholar

  48. Rahman M. Women’s autonomy and unintended pregnancy among currently pregnant women in Bangladesh. Matern Child Health J. 2012 Aug;16(6):1206-14. PubMed | Google Scholar

  49. Abada T, Tenkorang EY. Women’s autonomy and unintended pregnancies in the Philippines. J Biosoc Sci. 2012 Nov;44(6):703-18. PubMed | Google Scholar

  50. Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG: An International Journal of Obstetrics & Gynaecology. 2016 Aug;123(9):1489-98.. PubMed | Google Scholar

  51. Lince-Deroche N, Fetters T, Sinanovic E, Devjee J, Moodley J, Blanchard K. The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa. PLOS ONE. 2017 Apr 3;12(4):e0174615. PubMed | Google Scholar

  52. Benson J, Gebreselassie H, Mañibo MA, Raisanen K, Johnston HB, Mhango C, et al. Costs of postabortion care in public sector health facilities in Malawi: a cross-sectional survey. BMC Health Services Research. 2015 Dec 17;15(1):562.. PubMed | Google Scholar

  53. Guttmacher Institute. Estimates of health care system costs of unsafe abortion in Africa and Latin America. 2016. [cited 2016 Nov 11]

  54. Sanders JN, Conway H, Jacobson J, Torres L, Turok DK. The longest wait: examining the impact of Utah’s 72-hour waiting period for abortion. Womens Health Issues. 2016 Oct;26(5):483-7. PubMed | Google Scholar






























Case report

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique

Case report

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique

Case report

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique