Case Report
A 38-year-old woman with a legal and voluntary interruption of pregnancy due to mental health risk. An unexpected outcome
Mujer de 38 años con interrupción legal y voluntaria del embarazo por riesgo para la salud mental. Un desenlace inesperado
Diana Restrepo
, Marle Duque, Laura Montoya, Catalina Hoyos
Corresponding author
dianarestrepobernal@gmail.com
Corresponding author at: Calle 10 A # 22- 04 Universidad CES Medellín, Colombia.
Corresponding author at: Calle 10 A # 22- 04 Universidad CES Medellín, Colombia.
Medicine, Psychiatry, CES University, Medellín, Colombia
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Un desenlace inesperado" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Human reproduction has been termed a complex phenomenon from the psychological point of view.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Pregnancy is always a novel event that implies stress and adaptation, and both the desire to be a mother, to experience pregnancy and childbirth, and the desire to resort to abortion are processes that put women's mental health to the test.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The feelings a woman experiences on finding out that she is pregnant can be different and contrasting: happiness, disbelief, worry, fear, frustration, anger or an ambivalent mixture. The subjective response of the individual is dependent on multiple factors, including age, physical condition, the relationship with the child's father, financial and employment circumstances, family and social support, and the cultural context.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Colombia, in accordance with sentence <span class="elsevierStyleSmallCaps">C</span>-355 of 2006, abortion is legal in the following three circumstances: a) when the mother's physical, mental and/or emotional health is in danger as a direct result of the pregnancy; b) when the pregnancy is a result of rape or a fertility treatment that was not consented to by the mother; and c) when the foetus presents serious deformities that render life outside the womb impossible.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this case report is to present the complex clinical case of a mother who requested a legal and voluntary interruption of pregnancy (LVIP) due to mental health risk. The informed consent of the woman described herein was obtained, which states that her information would be used for academic and scientific publication purposes. To protect the identity of the mother and child and the right to confidentiality of the information provided by the patient, no specific information that could identify her or the child was included.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 38-year-old woman was admitted as an outpatient of a public hospital in the city of Medellín to undergo a LVIP procedure. A few days previously, she was seen as an outpatient at the healthcare facility for a medical assessment as she thought she might be pregnant. The pregnancy was confirmed and the woman was informed of her right to a LVIP, as she felt “sad and unenthusiastic” which, for the healthcare professionals treating her, constituted a “risk to maternal mental health”. The woman was referred to a tertiary-level hospital with a judge's order to undergo the LVIP procedure.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Hospital admission</span><p id="par0030" class="elsevierStylePara elsevierViewall">The woman, whose gestational age was unknown and who had been living in a consensual union for 3 months, had been educated up to the fourth year of primary school and who was a housewife, was admitted into the gynaecology and obstetrics department where she stated that this was her fourth pregnancy. The physical examination describes a woman seemingly in good general health: hydrated, conscious, alert, with a blood pressure reading of 120/80<span class="elsevierStyleHsp" style=""></span>mmHg, a heart rate of 80<span class="elsevierStyleHsp" style=""></span>bpm, 16 breaths per minute and afebrile; with no cardiac or pulmonary auscultation findings; pregnant abdomen, fundal height of 22<span class="elsevierStyleHsp" style=""></span>cm. On the patient's medical history, “no foetal heart rate taken” is specified. Normal external genitals; during the vaginal examination, the neck of the anterior cervix measured 3<span class="elsevierStyleHsp" style=""></span>cm in length, with an external orifice admitting one finger; a little foul-smelling vaginal discharge was also observed. Normal extremities with no oedemas. No neurological deficits were observed. On the analysis and admission report, the following was noted “38-year-old patient, approximately 20–22 weeks pregnant according to fundal height, unplanned and unwanted pregnancy, admitted for a LVIP due to mental health. Procedure and risks explained to the patient, who accepts”.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The LVIP procedure was initiated with 400<span class="elsevierStyleHsp" style=""></span>μg sublingual misoprostol every 3<span class="elsevierStyleHsp" style=""></span>h, in 5 doses. “Emotional lability” is reported in the gynaecology/obstetrics observations, so a psychological assessment was requested. Psychology assessed the patient and wrote in her medical history: “She wishes to terminate this pregnancy due to relationship problems and her mental health. On an emotional level, she feels distressed by what she is going through”. Following this evaluation, Psychology discharged her with no follow-up plan.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">The birth</span><p id="par0040" class="elsevierStylePara elsevierViewall">36<span class="elsevierStyleHsp" style=""></span>hours after admission, the following was recorded in the patient's medical history: “Patient delivers live foetus, in a poor physical condition; weight, 1050<span class="elsevierStyleHsp" style=""></span>g; transferred to perinatology”. The mother was discharged the following day, in good health.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Referral to liaison psychiatry</span><p id="par0045" class="elsevierStylePara elsevierViewall">Five months after the aforementioned birth, liaison psychiatry received a clinical referral request to assess a 5-month-old baby whose mother, as described by the paediatricians in the medical history, “objected to any necessary medical procedures and processes”. They also noted the following in the paediatrics record: “Aggressive, intolerant mother who does not accept the explanations offered by the medical personnel and does not comply with the strict isolation measures”.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Liaison psychiatry reviewed the infant's medical history and summoned the mother for assessment, with no information on the circumstances of the birth or the reason behind the infant's prematurity. The mother attended the psychiatric consultation at the specified time. Her socio-demographic information was confirmed; the woman was living in a town in Antioquia, had received a primary education and was unemployed. She had three older daughters and had separated from the child's father 3 months prior due to physical and verbal abuse following a 9-month relationship.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mother said she had no pre-existing medical conditions. She did not use psychoactive substances. She had not attempted suicide. She had no personal or family history of mental illness. She had not been seen by psychology or psychiatry beforehand. She described her family as “very close”, where they all look out for one another; she claimed she had the support of her sisters, mother and daughters. She had no contact with her ex-partner, who is unaware about what happened with his son.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">What the patient said at the psychiatric consultation</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">“I got with him because I had no money...” (explaining why she began the relationship with her ex-partner).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">“I was scared my daughters would completely reject me for having his child... the guy was the worst” (explaining why she initially rejected the pregnancy).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">“I was in hospital for two days; when I got out, my family were really worried because they didn’t know where I was; I told my sister what happened, she was very confused, but told me to reconsider and that she urged me to keep going with my son... to not give him up” (explaining how her family found out that she was pregnant and that she had been to hospital for a LVIP).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">“When I saw him, I felt awful, I really regretted what I had done, it was all my fault” (explaining the first time she went to visit her son, who was hospitalised in the intensive care unit).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">“Now I’m in the hospital looking after him” (explaining how she started going to the paediatrics department where her son was and how she gradually took on caring for him).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">“...the idea is to go back to the village to my parents’ house... They gave my sister custody of the child, but I intend to sort everything out with Family Welfare so he can stay with me” (explaining what she is thinking of doing when they discharge her son).</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">“All I want is to fight for my baby and to move forward to make up for lost time and give him all my love and affection, because he's not to blame for what happened” (expanding on the previous idea).</p></span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Mental status examination based on the psychiatric assessment</span><p id="par0065" class="elsevierStylePara elsevierViewall">The woman's personal appearance was appropriate and she was pleasant and cooperative during the consultation. Oriented to person, place and time. Normal attention. Seemingly calm. Makes visual contact. No motor disorders. Modulated, resonant, euthymic affect. Normal speech. Coherent, logical thought, with ideas of guilt regarding her son's condition. No suicidal or delusional thoughts expressed. Preserved memory. Appropriate judgement and reasoning. Intelligence seems normal. Positive prospection, adequate introspection.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Liaison psychiatry intervention</span><p id="par0070" class="elsevierStylePara elsevierViewall">An unstructured psychiatric interview was performed in which no anxious, depressive or psychotic symptoms were observed that constitute any major psychiatric disorder according to the DSM-5 criteria.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Suicidal risk was ruled out. It was established that the woman had adequate family support, including three older daughters. It was determined that the woman had separated from her son's father and felt at ease with this decision. The mother was encouraged to cooperate with the instructions of the nursing and medical staff for the favourable development of the child. The woman was responsive and promised to cooperate.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">This complex clinical case can be analysed from multiple perspectives, including: a) the rights of the premature baby; b) the reproductive rights of the woman; c) LVIP in Colombia and the legal vacuum regarding the maximum age at which the procedure can be performed; d) the physicians performing the LVIP on a woman of advanced gestational age; e) what constitutes a “risk to mental health” in the context of an unwanted pregnancy; f) the rights of the child's father; and g) society, which may not understand the outcome of a LVIP procedure.</p><p id="par0080" class="elsevierStylePara elsevierViewall">For practical reasons, the following two perspectives are analysed: the legal vacuum regarding maximum age at which the LVIP procedure can be performed, which led to the survival of a foetus subjected to a medical procedure designed to end the gestation, and what constitutes a risk to the mental health of the mother in the context of an unwanted pregnancy.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The Sentence issued by the Colombian Court, which made therapeutic abortion constitutional, did not establish the maximum gestational age at which abortion could be performed.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> This legal vacuum enabled the case presented herein to go from being a therapeutic abortion to a preterm birth with a critically ill premature baby. Terminations of pregnancy in the second trimester represent between 10% and 15% of all induced abortions worldwide and cause two-thirds of all abortion-related complications.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> In Colombia, according to the Technical Standard for interrupting pregnancy,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> after 12 full weeks following the last menstrual period, a regimen of mifepristone and misoprostol must be administered, with 97% efficacy.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> The difficulty lies in the fact that it did not consider that, after a certain gestational age, the procedure could give rise to a premature birth instead of a therapeutic abortion, and the Technical Standard bans physicians from requesting meetings or asking for a second opinion because these are considered to be strategies that exclusively aim to deny or delay the LVIP procedure.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In terms of the second perspective, although the concept of health is broad, there is no doubt that “health” is more than the absence of disease. The World Health Organisation defines mental health as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Millions of unwanted pregnancies occur every year. A lack of correspondence between the expectations of women and their partners regarding the number of children they want and the many situations women face in which they have to control their fertility make unwanted pregnancies likely.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Therapeutic abortion for the purpose of preserving the woman's mental health is explicitly recognised in the laws of 23 countries around the world, including Colombia.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> However, no study has found therapeutic abortions due to mental health risk to be associated with improved mental health outcomes,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> nor is it evident despite the debate that therapeutic abortion exacerbates mental health. The outcomes concerning this controversial topic are dotted with social and political disputes, which is difficult to avoid and can lead us to overlook the importance of supporting arguments based on valid, statistically sound study results that control confounding factors and consider pre-pregnancy mental illness,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> without it being necessary to assimilate a woman's wish to abort as pathological or a synonym of “risk to mental health” when she faces an unwanted pregnancy.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In recent decades, there has been increasing interest in establishing whether abortion constitutes a risk factor for mental illness; the outcomes studied are, among others, depression,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13,14</span></a> anxiety,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15,16</span></a> substance use<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17,18</span></a> and suicidal behaviour.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19,20</span></a> Moreover, although recent studies have tried to control these confounding factors, further evidence is needed to appropriately resolve the existing disputes.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0105" class="elsevierStylePara elsevierViewall">This case reveals the need to revise the maximum age at which the conduct of a LVIP procedure is allowed in Colombia and the measures that must be taken to ensure the woman undergoes therapeutic abortion and not a preterm birth.</p><p id="par0110" class="elsevierStylePara elsevierViewall">It is also a priority to establish the meaning of the “risk to maternal mental health” concept in Colombia, so that a woman facing an unwanted pregnancy does not need to undergo a psychiatric assessment.check</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres851696" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec846315" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres851695" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec846314" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case report" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Hospital admission" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "The birth" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Referral to liaison psychiatry" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "What the patient said at the psychiatric consultation" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Mental status examination based on the psychiatric assessment" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Liaison psychiatry intervention" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-13" "fechaAceptado" => "2016-05-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec846315" "palabras" => array:4 [ 0 => "Therapeutic abortion" 1 => "Risk factor" 2 => "Mental health" 3 => "Legal abortion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec846314" "palabras" => array:4 [ 0 => "Aborto terapéutico" 1 => "Factor de riesgo" 2 => "Salud mental" 3 => "Aborto legal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe a case of legal and voluntary interruption of pregnancy due to a mental health risk in the mother. However, the foetus survived and the mother decided to care for the child.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Description of the case and a non-systematic review of the relevant literature.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A multiparous woman of 38 years with unknown gestational age who requests legal and voluntary interruption of pregnancy. After abortion a male child born of 1050<span class="elsevierStyleHsp" style=""></span>g was born, intubated and admitted to intensive care. Subsequently, the mother, without the mental problems that led to abortion, gradually assumed the care of the child.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">To address this complex case, several aspects are analysed: first, the change of mind of a woman in her desire to be a mother. Second, the disappearance of mental symptoms in the immediate postpartum. Third, the need to review the clinical, ethical and legal foundations of the legal ruling that allows therapeutic abortion in Colombia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir un caso clínico de interrupción legal y voluntaria del embarazo por riesgo para la salud mental de la madre con sobrevida del feto y posterior deseo de la madre de cuidar del niño.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Descripción del caso clínico y revisión no sistemática de la literatura relevante.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mujer de 38 años multigestante, con edad gestacional desconocida, solicitó interrupción legal y voluntaria del embarazo por riesgo para la salud mental por embarazo no deseado. Luego de la interrupción del embarazo, nació un varón de 1.050<span class="elsevierStyleHsp" style=""></span>g de peso, al que se intubó y trasladó a cuidados intensivos. Tras el parto, los síntomas mentales que llevaron a esta mujer al aborto terapéutico desaparecieron, y decidió asumir el cuidado del niño.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Frente a este complejo caso, se analizan varios aspectos: primero, el cambio de opinión de una mujer sobre su deseo de ser madre; segundo, la desaparición de los síntomas mentales en el posparto inmediato, y tercero, la necesidad de revisar los fundamentos clínicos, éticos y legales de la norma legal que permite el aborto terapéutico en Colombia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Restrepo D, Duque M, Montoya L, Hoyos C. Mujer de 38 años con interrupción legal y voluntaria del embarazo por riesgo para la salud mental. Un desenlace inesperado. Rev Colomb Psiquiat. 2017;46:116–120.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Motherhood and mental health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.F. Brockington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1996" "editorial" => "Oxford University Press" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Salud mental y aborto terapéutico. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 5 | 21 |
| 2024 October | 75 | 4 | 79 |
| 2024 September | 109 | 17 | 126 |
| 2024 August | 74 | 11 | 85 |
| 2024 July | 61 | 3 | 64 |
| 2024 June | 36 | 7 | 43 |
| 2024 May | 58 | 3 | 61 |
| 2024 April | 86 | 8 | 94 |
| 2024 March | 100 | 6 | 106 |
| 2024 February | 86 | 4 | 90 |
| 2024 January | 83 | 3 | 86 |
| 2023 December | 69 | 6 | 75 |
| 2023 November | 72 | 5 | 77 |
| 2023 October | 80 | 6 | 86 |
| 2023 September | 53 | 2 | 55 |
| 2023 August | 47 | 0 | 47 |
| 2023 July | 44 | 6 | 50 |
| 2023 June | 35 | 2 | 37 |
| 2023 May | 35 | 3 | 38 |
| 2023 April | 33 | 2 | 35 |
| 2023 March | 51 | 3 | 54 |
| 2023 February | 42 | 13 | 55 |
| 2023 January | 48 | 1 | 49 |
| 2022 December | 48 | 3 | 51 |
| 2022 November | 37 | 7 | 44 |
| 2022 October | 26 | 7 | 33 |
| 2022 September | 40 | 8 | 48 |
| 2022 August | 21 | 14 | 35 |
| 2022 July | 32 | 8 | 40 |
| 2022 June | 22 | 8 | 30 |
| 2022 May | 20 | 6 | 26 |
| 2022 April | 10 | 8 | 18 |
| 2022 March | 19 | 9 | 28 |
| 2022 February | 13 | 8 | 21 |
| 2022 January | 25 | 3 | 28 |
| 2021 December | 15 | 11 | 26 |
| 2021 November | 21 | 8 | 29 |
| 2021 October | 24 | 8 | 32 |
| 2021 September | 26 | 10 | 36 |
| 2021 August | 11 | 10 | 21 |
| 2021 July | 22 | 7 | 29 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 26 | 13 | 39 |
| 2021 April | 34 | 44 | 78 |
| 2021 March | 26 | 11 | 37 |
| 2021 February | 11 | 12 | 23 |
| 2021 January | 17 | 19 | 36 |
| 2020 December | 20 | 6 | 26 |
| 2020 November | 26 | 8 | 34 |
| 2020 October | 28 | 4 | 32 |
| 2020 September | 28 | 11 | 39 |
| 2020 August | 20 | 13 | 33 |
| 2020 July | 10 | 4 | 14 |
| 2020 June | 14 | 15 | 29 |
| 2020 May | 16 | 16 | 32 |
| 2020 April | 17 | 6 | 23 |
| 2020 March | 22 | 9 | 31 |
| 2020 February | 14 | 4 | 18 |
| 2020 January | 20 | 5 | 25 |
| 2019 December | 20 | 10 | 30 |
| 2019 November | 10 | 7 | 17 |
| 2019 October | 19 | 7 | 26 |
| 2019 September | 13 | 2 | 15 |
| 2019 August | 11 | 6 | 17 |
| 2019 July | 14 | 10 | 24 |
| 2019 June | 30 | 16 | 46 |
| 2019 May | 79 | 51 | 130 |
| 2019 April | 22 | 3 | 25 |
| 2019 March | 11 | 2 | 13 |
| 2019 February | 4 | 1 | 5 |
| 2019 January | 4 | 2 | 6 |
| 2018 December | 1 | 2 | 3 |
| 2018 November | 7 | 3 | 10 |
| 2018 October | 9 | 6 | 15 |
| 2018 September | 8 | 5 | 13 |
| 2018 August | 2 | 2 | 4 |
| 2018 July | 4 | 3 | 7 |
| 2018 June | 2 | 2 | 4 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 8 | 2 | 10 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 6 | 0 | 6 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 11 | 1 | 12 |
| 2017 November | 7 | 1 | 8 |
| 2017 October | 4 | 1 | 5 |
| 2017 September | 1 | 0 | 1 |
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