Cervicovaginal fistula: an apparent increased incidence with prostaglandin F2alpha.
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Abortion, Induced↗
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Extraovular prostaglandin F2alpha for early midtrimester abortion.
Twenty patients who were 13 to 15 weeks pregnant received extraovular prostaglandin F2-alpha (PGF2a) in dosages of 3 mg. every 1 to 3 hours. Ninety-five per cent of the patients successfully aborted and 30 per cent of the patients had retained placental tissue. The mean abortion time was 17 3/4 hours and the average total dose used was 29.2 mg. The abortion time appeared to decrease with parity and had no relationship to weeks of gestation. Only one patient failed to abort after 31 hours of therapy. She required a curettage and was the only patient to develop a postabortion infection. The technique appears to compare favorably with the results of intra-amniotic PGF2a. Extraovular prostaglandin may therefore be of particular value in inducing abortion in patients who are in the early midtrimester of pregnancy, i.e., when intra-amniotic instillation is technically infeasible.
Abortion, Induced↗
Gestational trophoblastic disease within an elective abortion population.
Gestational trophoblastic disease, most commonly hydatidiform mole, is an unusual condition within the United States. The incidence of hydatidiform mole has been reported to vary from 1 in 1,200 to 1 in 2,000 pregnancies. This report described eight cases of hydatidiform mole among 4,829 patients presenting for elective first-trimester abortion. Factors which might account for the frequency of hydatidiform mole of 1 in 600 are discussed. Although the clinical course of patients with hydatidiform mole appears benign- gross examination of tissue obtained at suction curettage and the liberal use of histologic evaluation in questionable cases is required to make the diagnosis.
Abortion, Induced↗
The risk of serious complications from induced abortion: do personal characteristics make a difference?
We examined the age, gestational age, parity, race, and number of previous spontaneous and induced abortions of 82,030 women who obtained abortions at less than or equal to 24 weeks' gestation. Among these women, 342 (0.4%) had serious complications, including 130 (0.2%) with fever greater than or equal to 38 degrees C for 3 or more days, 172 (0.2%) who required transfusions, 67 (0.1%) who required unintended surgery, and three who died. Factors significantly (p less than 0.05) associated with serious complications varied by period of gestation, including previous induced abortions (adjusted relative risk = 1.57, 95% confidence interval = 1.03 to 2.40) for procedures done at less than or equal to 12 weeks' gestation, advancing age (relative risk for a 5-year increment = 1.12, 95% confidence interval = 1.01 to 1.24), and advancing gestational age (relative risk for a 2-week increment = 1.50, 95% confidence interval = 1.43 to 1.57) for procedures done at greater than 12 weeks, and greater than or equal to 1 previous delivery (relative risk = 1.34, 95% confidence interval = 1.03 to 1.75) for all gestational ages. Although Hispanic women had higher rates of complications compared with white women, data were not available to control for socioeconomic status in comparing race groups. There was no significant association between previous spontaneous abortions and serious complications. Risk patterns were similar, but not identical, when fever, operation, and transfusion were considered separately.
Abortion, Induced↗
Midtrimester abortion with intramuscular injection of 15-methyl-prostaglandin F2alpha.
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Abortion, Induced↗
Effect of prior pregnancy and combined oral contraceptives on baseline menstrual blood loss and bleeding response to intrauterine devices.
No effect of pregnancy was found on baseline menstrual blood loss (MBL) in women within one year of parturition or abortion. The increased bleeding response of women to intrauterine devices (IUDs) was found to be independent of pregnancy status during the year preceding IUD sertion. Women pregnant within a year of insertion had no different MBL than those pregnant more than a year prior to insertion. MBL quantified in subjects within three months of discontinuing combined oral contraceptives (OCs) was significantly lower than in prior non-OC users. Furthermore, MBL was significantly reduced in the former group during the first three menses following IUD insertion. At the sixth and twelfth menses post-insertion, MBL was still lower in prior OC users, but the difference between users and non-users was less and no longer statistically significant.
Contraceptive Devices, Female↗
Conditions for choosing between drug-induced and surgical abortions.
In France, pregnant women with amenorrhoea of no more than 49 days intending to terminate pregnancy can choose between a surgical abortion via vacuum aspiration under local or general anesthesia and a drug method combining Mifepristone orally administered (RU 486 degrees), with a prostaglandin analogue. This prospective survey was conducted to study the conditions under which women choose their abortion method, and to evaluate the acceptability of each method after the abortion. The data gathered from 488 women were analyzed according to their initial decision, and then according to the method actually used. The majority (62%) chose RU 486. The women's choice was found to be linked to sociodemographic characteristics such as age, education, occupation, geographic origin, and certain attitudes towards pregnancy, as well as to the individual criteria of each method. The women who chose the drug protocol had most often already made their decision before going to the family planning center (68%), having been advised by their doctor (20%). They were slightly less satisfied with the abortion experience than they had expected: 12.4% were unsatisfied in the RU group and 3.6% in the aspiration group. They needed more rest and quiet afterwards (50%) than the other women. They were distinguished by their desire to verify the expulsion (63%). The length of pregnancy is therefore not the only criterion to be considered when recommending one or other of these methods: the women concerned have different requirements and should have several possibilities to choose from.
Abortion, Induced↗
Socioeconomic and demographic characteristics of induced abortion cases.
The age, parity, marital and socioeconomic status, education, religion, profession and the period of gestation of 200 patients who applied for legal abortions are analyzed. In this study 74% of the women were more than 20 years of age, 75% had attended secondary school, 63% were students or clerks, 53% came from lower- or middle-class families, 40% were Roman Catholics, 45% were unmarried, 40% were nulliparous and 57% had little or no knowledge of contraception.
Abortion Applicants↗
Cervical dilatation by sulprostone prior to vacuum aspiration for termination of early pregnancy.
In the period May 1983-October 1986 we treated 335 primigravidae requesting an abortion in the first trimester. They were given 500 micrograms sulprostone (16-phenoxy-omega-tetranor-PGE2-methylsulfonylamide) i.m. 12 to 14 hours before suction termination in order to obtain adequate and atraumatic cervical dilatation and thus reduce the possible risk of cervical incompetence and its consequences. The effects of this technique on the uterine cervix were compared with those obtained in 100 primigravidae after the insertion of laminaria to induce atraumatic cervical dilatation. We also evaluated the normal degree of cervical dilatation before any intervention in a control group of 100 primigravidae. The results obtained with sulprostone encourage the use of this drug to minimize cervical injury. The incidence of side-effects was not particularly high.
Abortifacient Agents↗
Multifetal pregnancy reduction: comparison of obstetrical results with spontaneous twin gestations.
Thirty-two multifetal pregnancies were reduced to twin gestations. Our control group was composed of 32 spontaneous twin gestations. The comparison of these two groups did not show that the procedure altered obstetrical results as far as duration of gestation, birth weight and rate of dismaturity are concerned.
Abortion, Induced↗
Laminaria augmentation of intra-amniotic prostaglandin F2 alpha for the induction of mid-trimester abortion.
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Abortion, Induced↗
Forces required for dilatation of human cervix in first trimester of pregnancy.
Cervical resistance to dilatation was measured in 76 patients undergoing first trimester legal abortion; a specially designed force-sensing instrument was used. No correlation between cervical resistance and patient age or gestational age was found. Increasing parity and earlier legal abortions were significantly correlated with a lowering of the cervical resistance. In patients dilated to 11 mm a lowering of resistance was noted suggesting a tear in cervical tissue.
Abortion, Legal↗
Intramuscular administration of 16 phenoxy omega 17,18,19,20 tetranor PGE2 methyl sulfonylamide for pre-operative cervical dilatation in first trimester nulliparae.
A single intramuscular dose of 500 microgram 16 phenoxy omega 17,18,19,20 tetranor PGE2 methyl sulfonylamide was used for cervical dilatation prior to vacuum aspiration in 80 first trimester nulliparae. Three hours after prostaglandin administration the cervix had dilated to 8 mm or more in 60 patients (75%). The uterus was evacuated in these patients without mechanical dilatation of the cervix. In the remaining 20 patients the cervix had dilated 4 to 7 mm. Further mechanical dilatation to 8 mm was carried out easily in most of these patients. Side effects included pain requiring analgesic (3 patients), vomiting (4 patients) and transient pyrexia (greater than 1 degrees C, 2 patients). There were no complications or damage to the uterus or the cervix during evacuation of the uterus.
Abortion, Induced↗
Endocrine basis for the initiation, maintenance and termination of pregnancy in humans.
Channels of hormonal communication between the embryo and the mother are established early in the conceptual process. The preimplantation embryo exerts local uterine and systemic effects on the maternal organism to provide a suitable environment for embryonic development, to enable the development of a receptive endometrium for implantation, and to maintain corpus luteum function. In primates, implantation can be induced with progesterone alone if the proliferative effects of estrogens on the endometrium have already been achieved; estrogens may have a priming effect for progesterone on the endometrium, but it is not obligatory for implantation. Progesterone secretion from the corpus luteum is essential for the maintenance of early pregnancy until the placenta takes over the major role of steroidogenesis. This luteo-placental shift is completed at about the 50th day of human gestation. Withdrawal of progesterone effects by the administration of the competitive progesterone antagonist, RU 486, within 24 days after conception will terminate 85% of human pregnancies. Other nonsteroidal functions of the corpus luteum have been recently suggested. Relaxin and prorenin are peptides secreted by corpus luteum of pregnancy but their role remains putative at the present time.
Abortion, Spontaneous↗
Pregnancy outcome in Norway after Chernobyl.
Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.
Abortion, Legal↗
Incidence of legal abortions and congenital abnormalities in Hungary.
The annual and monthly distributions of congenital abnormalities and pregnancy outcomes as confounding factors were evaluated in Hungary in reflection of the accident at the Chernobyl reactor. The different congenital abnormality entities and the components of fetal radiation syndrome did not show a higher rate after the Chernobyl accident in the data-set of the Hungarian Congenital Abnormality Registry. Among confounding factors, the rate of induced abortions did not increase after the Chernobyl accident in Hungary. In the 9th month after the peak of public concern (May and June, 1986) the rate of livebirths decreased. Three indicator conditions: 15 sentinel anomalies as indicators of germinal dominant gene mutations, Down syndrome as an indicator of germinal numerical and structural chromosomal mutations, and unidentified multiple congenital abnormalities as indicators of germinal dominant gene and chromosomal mutations were selected from the material of the Hungarian Congenital Abnormality Registry. Diagnoses were checked, familial and sporadic cases were separated and only the sporadic cases were evaluated. The analysis of indicator conditions did not reveal any measurable germinal mutagenic effect of the Chernobyl accident in Hungary.
Abnormalities, Radiation-Induced↗
Breastfeeding: a natural method for child spacing.
Lactational amenorrhea plays an important role in child spacing. Recent research has led to a consensus regarding the status of lactational amenorrhea as a method of family planning. This is currently referred to as the lactational amenorrhea method. Research priorities were to field test the lactational amenorrhea method and define the factors that influence lactational amenorrhea and the interface between the lactational amenorrhea method and other family planning methods.
Amenorrhea↗
The influence of the post-Chernobyl fallout on birth defects and abortion rates in Austria.
OBJECTIVES: We analyzed the influence of the radioactive fallout after the Chernobyl disaster on the rate and regional distribution of birth defects and abortion rates in southern Austria. STUDY DESIGN: During 1985 to 1989 a total of 66,743 births was monitored. Twelve sources provided data on 1695 cases of birth defects, 1579 of which were suitable for analysis. All cases were analyzed in terms of their calculated conception date and divided into three main groups according to their vulnerable phase of embryogenesis, spermatogenesis, and oogenesis. To study possible regional changes, the findings were plotted in 17 political subdistricts. The overall abortion rate and the counseling frequency at termination clinics was determined. RESULTS: No significant changes in the incidence of birth defects, abortion rate, or counseling rate at pregnancy termination clinics were observed. CONCLUSIONS: Assessing the teratologic potential of low-dose radiation is difficult and requires adequate grouping of birth defects, sufficient baseline data, and highly reliable registries.
Abortion, Induced↗