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PubMed2001

Surgical methods for first trimester termination of pregnancy.

BACKGROUND: Different surgical methods for termination of pregnancy have evolved over the years: Dilatation and curettage, power operated vacuum aspiration, manual vacuum aspiration (MVA) or hysterotomy. Local or general anaesthesia is used for all methods. Preabortion medical or mechanical cervical preparation may reduce the incidence of cervical or uterine injuries. OBJECTIVES: To compare the safety and efficacy of different surgical methods for first trimester abortion. SEARCH STRATEGY: The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using the Internet search service Pub Med. SELECTION CRITERIA: Randomised controlled trials comparing different surgical methods for first trimester abortion were eligible. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Three trials were included, resulting in 2 comparisons: vacuum aspiration versus dilatation and curettage and flexible versus rigid vacuum aspiration cannula. Results are reported as odds ratio for dichotomous data and weighted mean differences for continuous data. MAIN RESULTS: There were no reports of maternal deaths and cases of uterine perforation in the trials identified. Vacuum aspiration versus dilatation and curettage: There were no statistically significant differences for excessive blood loss, blood transfusion, febrile morbidity, incomplete or repeat uterine evacuation procedure, re-hospitalisation, post operative abdominal pain or therapeutic antibiotic use. Duration of operation was statistically significantly shorter with vacuum aspiration compared to D&C in both gestational age subgroups : < 9 weeks: weighted mean difference (WMD) -1.84 minutes, 95% confidence interval (CI) [-2.542,-1.138]; =/> 9 weeks: WMD -0.600 minutes, 95% CI [-1.166,-0.034]). Flexible versus rigid vacuum aspiration cannula: There were no statistically significant differences with regard to cervical injuries, febrile morbidity, blood transfusion, therapeutic antibiotic use, or incomplete or repeat uterine evacuation procedure. REVIEWER'S CONCLUSIONS: The included studies do not indicate a preference of providers for one or the other method. The trials included are small and lack power to to present meaningful differences for rare outcomes between the groups. outcomes such as women's satisfaction, the need for pain relief or surgeons preference for the instrument have been inadequately addressed. No data outcomes, such as fertility after surgical abortion, are available.

Abortion, Induced↗

PubMed1999

Prenatal development of the alveolar bone of human deciduous incisors and canines.

The formation of the human alveolar process around the incisors and canines is a hitherto unreported aspect of fetal oral development. The question is how, where, and when the alveolar process is formed. The purpose of this study was to elucidate the questions where and when and hence to analyze the pattern of formation of the alveolar bone around developing human deciduous canine and incisor teeth. The study was conducted with material selected from a sample of 61 normal human fetuses, legally or spontaneously aborted. Fertilization ages ranged from 9 to 22 weeks, crown-rump Length from 25 to 205 mm, and foot length from 4 to 34 mm. From this material, 7 maxillae and 10 mandibles were selected for the study according to developmental stages of the canines and incisors and according to the orientation of the histological sections. The skeletal investigation consisted of macroscopic and microscopic analysis of the mandibles and maxillae. The investigations revealed the absence of bone between the central and lateral incisors in the mandibles and maxillae of fetuses below the ages of 21 and 22 weeks, respectively. In three specimens, alveolar bone between the central and lateral incisors was recorded (21, 21, and 22 weeks of fertilization). Absence of bone labial to the canine was recorded in all fetuses investigated. In all other regions, alveolar bone occurred as a regular finding. The present study has shown that alveolar bone formation is strictly coordinated with tooth formation. Alveolar bone occurs later in the area labial to the canine and in the region between the central and lateral incisors than it does in other areas associated with the incisor/canine regions. Knowledge of this pattern in the formation of the alveolar process seems to be of importance for a future elucidation of how the alveolar process is initially formed.

Alveolar Process↗

PubMed2006

Understanding the opposition.

Current debates about sex selection start from a paradox: on the one hand, the 'liberal' argument in favour of sex selection is often thought to be sound; but on the other hand there is widespread public opposition to sex selection. So it is worth spending some time examining the arguments against sex selection. Four different types of argument are identified: (i) religious arguments; (ii) consequentialist arguments, mainly concerning disturbance to the sex ratio; (iii) arguments to the effect that sex selection involves a failure to respect the autonomy of a child; (iv) arguments to the effect that the motivation for sex selection brings with it an instrumental attitude to children not compatible with a child's need for unconditional acceptance and love. In the end the conclusion is reached that none of these arguments provide decisive arguments against the liberal thesis that sex selection ought to be permitted, especially where 'family balancing' is envisaged. In the light of this conclusion the issue of fetal sexing followed by selective feticide as a method of sex selection is discussed. It is argued that sex selection is not in general a good reason for abortion, but that this practice may become unstoppable.

Attitude↗

PubMed1995

The Thom Award address. Industrial mycology and the new genetics.

The genetic investigation of fungi has been extended substantially by DNA-mediated transformation, providing a supplement to more conventional genetic approaches based upon sexual and parasexual processes. Initial transformation studies with the yeast Saccharomyces cerevisiae provided the model for transformation systems in other fungi with regard to methodology, vector construction and selection strategies. There are, however, certain differences between S. cerevisiae and filamentous fungi with regard to type of genomic insertion and the availability of shuttle vectors. Single-site linked insertions are common in yeast due to the high level of homology required for recombination between vectored and genomic sequences, whereas mycelial fungi often show a high frequency of heterologous and unlinked insertions, often in the form of random and multiple-site integrations. While extrachromosomally-maintained or replicative vectors are readily available for use with yeasts, such vectors have been difficult to construct for use with filamentous fungi. The development of vectors for replicative transformation with these fungi awaits further study. It is proposed that replicative vectors may be inherently less efficient for use with mycelial fungi relative to yeasts, since the mycelium, as an extended and semicontinuous network of cells, may delimit an adequate diffusion of the vector carrying the selectable gene, thus leading to a high frequency of abortive or unstable transformants.

Fungi↗

PubMed2005

Comparison of Coccidioides immitis serological antibody titres between forms of clinical coccidioidomycosis in horses.

A retrospective study was performed to determine if there is an association between serological Coccidioides immitis antibody titres (IgG) and form/severity of coccidioidal disease in horses, and to identify trends in survival and treatment success based on the form of the disease. Data were obtained on horses with positive serological titres tested at the Coccidioidomycosis Serology Laboratory, School of Medicine, University of California, Davis from 1981 to 2004. Thirty-nine cases in which a diagnosis of coccidioidomycosis had been made were selected for inclusion. Six distinct categories were identified including abortion (n=6), miliary/interstitial pneumonia (n=6), pneumonia with thoracic effusion (pleural or pericardial) (n=11), disseminated (n=10), osteomyelitis (n=3) and external abscessation (n=3) both without pulmonary disease. Statistical differences in titre distribution were found between the abortion category and the pulmonary category (P=0.003), the abortion category and pneumonia with thoracic effusion (P=0.001), the abortion category and disseminated disease (P=0.001), and the pulmonary form and pneumonia with effusion (P=0.001). The other categories had overlapping titre results. Higher serological antibody titres seemed to be associated with a poorer prognosis for survival. Categories with the highest titres, disseminated (geometric mean titre=104) and pneumonia with thoracic effusion (geometric mean titre=226), were overwhelmingly fatal (19/21 known deaths) due to severe clinical disease. The categories with lower titres, abortion (geometric mean titre=4), bone involvement only (geometric mean titre=13) and cutaneous (geometric mean titre=5), had a better survival rate (10/12 known survivors) and less severe clinical disease. Measurement of serological titre may be a useful diagnostic aid in establishing form and severity of disease and thus inform prognosis.

Animals↗

PubMed1993

Office management of benign headache. The science and the art.

Headache management requires a comprehensive strategy that includes accurate diagnosis, reassurance and education of the patient, nonpharmacologic methods of preventing attacks, and appropriate use of prophylactic and abortive medications. Personal input from the physician and judicious selection of headache medications are crucial. Implementation of such a strategy gives patients greater ability to control and cope with their headaches.

Analgesics↗

PubMed1989

Selective reduction in multiple gestation.

As new advances in the treatment and management of infertility become available, it is hoped that selective reduction procedures will no longer be necessary. In the interim, however, it is imperative that nurses be knowledgeable about the options available to parents experiencing multifetal pregnancy, including the choice of selective reduction procedures.

Abortion, Induced↗

PubMed1977

Studies on herediatary spherocytosis in Iceland.

Thirty members with typical hereditary spherocytosis (HS) and over 90 apparently unaffected members belonging to 12 families have been studied. Splenectomy has been performed on 22 HS patients. Of nine HS individuals, who had not undergone surgical treatment in 1957, four suffered from temporary severe anaemia, presumably due to aplastic crisis associated with influenza. One of them died, a male 18 years of age. Pedigree studies on one of the families indicate that the HS gene or genes have been transmitted through six generations over the past 200 years. Marked deficiency in the number of affected compared with the apparently unaffected members in the HS families is present. The most striking example of uneven genetic ratio is a sibship of 15 members investigated haematologically, with one suffering from typical HS. Much reduced penetration of the HS gene or the presence of the socalled "mild form" is upheld as the main explanation for the unevenness in the genetic ratio. However, families are also present in which abortions and death at an early age indicated that selection against the affected could also disturb the genetic ratio in HS families.

Adolescent↗

PubMed1995

Ventricular pacing induced ventricular tachycardia in patients with implantable cardioverter defibrillators.

Appropriately timed noncompetitive ventricular pacing potentially may initiate ventricular tachycardia in patients prone to these arrhythmias. The combination of bradycardia pacing and stored electrograms in a currently available cardioverter defibrillator provides an opportunity to evaluate the occurrence of such pacing induced ventricular tachycardia. During a surveillance period of 18.7 +/- 11.4 months, stored electrograms documented 302 episodes of ventricular tachycardia in 77 patients. Five patients (6.5%) demonstrated 25 episodes (1-16 per patient) of ventricular tachycardia that were immediately preceded by an appropriately paced ventricular beat (8.3% of all episodes of ventricular tachycardia). All five patients had prior myocardial infarctions and a history of monomorphic ventricular tachycardia occurring both spontaneously and in response to programmed electrical stimulation. Antitachycardia pacing terminated pacing induced ventricular tachycardia in 22 episodes; in one episode antitachycardia pacing accelerated ventricular tachycardia. In two cases shock therapy was aborted for nonsustained ventricular tachycardia. We conclude that, in selected nonsustained ventricular tachycardia. We conclude that, in selected postinfarction patients with recurrent sustained monomorphic ventricular tachycardia treated with implantable cardioverter defibrillators, appropriately timed ventricular pacing may induce ventricular tachycardia.

Aged↗

PubMed1989

Islamic medical ethics in the 20th century.

While the practice of Western medicine is known today to doctors of all ethnic and religious groups, its standards are subject to the availability of resources. The medical ethics guiding each doctor is influenced by his/her religious or cultural background or affiliation, and that is where diversity exists. Much has been written about Jewish and Christian medical ethics. Islamic medical ethics has never been discussed as an independent field of ethics, although several selected topics, especially those concerning sexuality, birth control and abortions, have been more discussed than others. Islamic medical ethics in the 20th century will be characterised on the basis of Egyptian fatawa (legal opinions) issued by famous Muslim scholars and several doctors. Some of the issues discussed by Islamic medical ethics are universal: abortions, organ transplants, artificial insemination, cosmetic surgery, doctor-patient relations, etc. Other issues are typically Islamic, such as impediments to fasting in Ramadan, diseases and physical conditions that cause infringement of the state of purity, medicines containing alcohol, etc. Muslims' attitudes to both types of ethical issues often prove that pragmatism prevails and the aim is to seek a compromise between Islamic heritage and the achievements of modern medicine, as long as basic Islamic dogma is not violated.

Bioethical Issues↗

PubMed1992

Treatment and results of chronic toxoplasmosis. Analysis of 33 cases.

Women who grew up in Turkey, where undercooked meat is part of the usual diet, have an increased risk of toxoplasmosis. This study covers treatment and prognosis of 33 cases with chronic toxoplasmosis. The study group was selected among the patients with a history of repeated abortions, recurrent preterm labor, stillbirths and babies with congenital anomaly after all other causative reasons were ruled out. IgG and IgM antibody titers were detected by Sabin-Feldman's dye test and indirect fluorescence antibody test. 33 patients, who had negative IgM and IgG antibody titers above 1/64, were accepted as having chronic toxoplasmosis and were included in our study group. These patients were treated with our pyrimethamine treatment protocol (Dinçer Formula) for 36 days before their pregnancies. IgG antibody titers were repeated in the 8th and the 20th week of pregnancy. With the exception of 7 cases, 24 patients (72.7%) still had IgG antibody titers of more than 1/64 and were given the same treatment protocol in the 8th week of pregnancy. Very early abortions occurred in 2 cases. Of 24 patients, 8 had antibody titers still above 1/64 and were treated with spiramycine. While 28 cases (84.8%) had healthy and living infants, pregnancies of 3 cases are still continuing. No teratogenic effects of pyrimethamine on the fetuses were seen. As a result, we can say that a patient who presents with complaints of repeated abortions, recurrent preterm labor or stillbirth should be investigated for toxoplasmosis during pregnancy; even if the IgG antibody test is normal before pregnancy, she should be treated with the protocol mentioned above before pregnancy and in the 8th week of pregnancy when chronic toxoplasmosis is diagnosed.

Abortion, Spontaneous↗

PubMed2003

The person-affecting restriction, comparativism, and the moral status of potential people.

Traditional ethical theories have paradoxical implications in regards to questions concerning procreation and our moral duties to future people. It has been suggested that the crux of the problem resides in an all too 'impersonal' axiology and that the problems of population axiology can be solved by adopting a 'Person Affecting Restriction' which in its slogan form states that an outcome can only be better than another if it is better for people. This move has been especially popular in the context of medical ethics where many of the problems of population axiology are actualized. Examples are embryo or egg selection, pre-implantation genetic testing, assisted reproduction programmes, abortion, just to mention a few. I discuss a number of different interpretations of the Restriction and in particular one interpretation which I call Comparativism. According to this view, we should draw a distinction between uniquely and non-uniquely realizable people. The former people only exist in one out of two possible outcomes, whereas the latter exist in both of the compared outcomes. The idea is that we should give more weight to the well-being of non-uniquely realizable people or take it into account in a different way as compared to the well-being of uniquely realizable people. I argue that the different versions of the Person Affecting Restriction and Comparativism either have counterintuitive implications of their own or are compatible with traditional theories such as Utilitarianism.

Bioethical Issues↗

PubMed2001

[Preimplantation genetic diagnosis. The first experiences in Denmark].

INTRODUCTION: Preimplantation genetic diagnosis (PGD) is a possible alternative to prenatal diagnosis, whereby families with serious inherited diseases can avoid having children with the disease. The genetic diagnosis is performed on embryos before implantation and therefore implies IVF. Hence, PGD offers the possibility of transferring embryos without disease, thereby avoiding termination of pregnancy owing to an affected fetus. MATERIAL AND METHODS: Activities at the Centre for Preimplantation Genetic Diagnosis at Aarhus University Hospital since its opening in February 1999 are described. The fluorescent in situ hybridisation (FISH) technique was used for sex selection (hemophilia A and Duchenne's muscular dystrophy) and translocations. The polymerase chain reaction (PCR) was used for cystic fibrosis. RESULTS: Of 20 PGD cycles started, 15 were successful in terms of transference of healthy or carrier embryos. A positive pregnancy test was found after six of 15 embryo transfers (40%) with two subsequent clinical pregnancies. CONCLUSIONS: The present pregnancy rates with PGD are comparable to those following IVF; the clinical pregnancy rate may seem low, but the cycle numbers are small. Preimplantation genetic diagnosis seems to be a realistic alternative for selected genetic diseases, in cases where the couple find abortion unacceptable.

Adult↗

PubMed1988

Prevention of HIV transmission.

With screening of the blood supply and effective heat and chemical treatment of blood product derivatives, the overwhelming majority of newly acquired adult HIV infections will result from consensual acts, through the exchange of blood or sexual secretions. Societal relaxation about discussion of sex, death, homosexuality, drugs, and abortion is essential to prevent further deaths. Careful partner selection, use of condoms in conjunction with nonoxynol-9 (a viricidal spermicide), and selected confidential HIV antibody testing could help decrease the number of infected persons. Efforts directed toward IV drug users to decrease initiation of drugs, make drug treatment more accessible, provide simple techniques for cleaning needles such as a quick rinsing with bleach and water, and emphasizing the risks of sharing needles could decrease the exponential rise of HIV infection in IV drug users. A substantial percentage of women infected with both HIV and hepatitis B are unaware of their infection. Information, counseling, and antibody testing of men and women prenatally with informed options could reduce infection in children. Health care providers must work through their own valid issues of fear and possible discomfort with various lifestyles to function effectively in the health professions.

Acquired Immunodeficiency Syndrome↗

PubMed2001

DNA analysis of abortion material assisted by histology screening.

In cases of rape leading to fertilization, paternity testing can retrospectively identify the assailant. Abortion material commonly represents a mixture of maternal and fetal tissue and blood, which cannot be differentiated with the naked eye. Consequently, DNA typing of abortion material may be complicated, including band overlap if maternal tissue predominates. Therefore, histology screening of the abortion content for typical fetal tissue components, such as chorionic villi, followed by selected DNA typing of this sample is suggested. This combined approach is illustrated by a selected case demonstrating the reliability and concurrence of the histology and genetic results.

Abortion, Induced↗

PubMed1975

Characteristics of pregnant women who report previous induced abortions.

Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women.Women who reported abortions were less likely to be strict as regards religious observance and less likely to have had a previous stillbirth or child death, other variables being equal. They were more likely to be smokers or former smokers and to be delivered of their babies in certain obstetric units. They more often reported vomiting, bleeding, and medication in early pregnancy. On the other hand, there was no significant association with diabetes, anaemia, blood groups, or season of birth.The findings show that women reporting previous induced abortions differ significantly from other pregnant women in a wide range of demographic and health characteristics. Such women may also be biased for complications of pregnancy and outcome, particularly if selected from a clinic population. Observations that indicate a deleterious effect of induced abortions on subsequent pregnancy outcomes must therefore be interpreted with considerable caution.

Abortion, Induced↗

PubMed1998

Quality of care in abortion services in Finland.

BACKGROUND: The aim of this study was to describe the quality of abortion services and women's experiences with the care they had received during their abortion. METHODS: A population-based postal survey of 3000 randomly selected 18-44-year old Finnish women in 1994. The response rate was 74% (n=2189). The following were used as indicators of quality of services: referral problems, loss of follow up, adequacy of counseling, and satisfaction with treatment. RESULTS: Fifteen percent (n=320) of the respondents had experienced at least one abortion. After adjusting for age, women who had an abortion were more likely to come from the lower social class, to be divorced, widowed, or in a nonmarital relationship, and to have had previous pregnancies. Fifty-two percent reported not using any contraceptive method when getting pregnant. Altogether 6% reported referral problems and 8% did not have post-abortion follow-up. Twenty-five percent would have preferred more discussion with a physician or a nurse before the abortion and 30% after it. Psychological effects of abortion was the most often mentioned subject upon which they needed discussion. The need for discussion was not influenced by the length of time lapsed since the abortion. The satisfaction with treatment increased from 69% (abortion >10 years ago) to 82% (abortion <5 years ago). Dissatisfaction was related to need for more discussion and the abortion having been performed in a central hospital. CONCLUSION: The overall quality of abortion care was good but there is still a need for improvement, especially in the communication and human part of the care.

Abortion, Legal↗

PubMedDate not supplied

Experimental ovine salmonellosis (Salmonella abortusovis): pathogenesis and vaccination.

Salmonella enterica subsp. enterica ser. Abortusovis, a sheep-adapted serotype, causes a contagious disease. Abortion is the major symptom and the main source of contamination. Research on this ovine disease may aid farmers, but may also contribute to comparative biological knowledge. Innate resistance partly controlled by the Ity locus, increased resistance to reinfection and humoral and T-cell-mediated immunity were observations gained with a murine model. In ewes, abortion regularly occurs following subcutaneous challenge carried out from the third month of gestation onwards. This ovine model was used to evaluate prevention methods for Salmonella Abortusovis infection. One subcutaneous injection of a live attenuated lyophilized vaccine containing a selected streptomycin-independent reverse mutant was shown to protect ewes against abortion and excretion of Salmonella Abortusovis. This vaccine could be administered simultaneously with other commercial live vaccines such as Brucella melitensis Rev. 1 vaccine. In sheep, application of the vaccine to the conjunctiva (an easy, individual and hygienic route of mucosal vaccination) was followed by lymph node bacterial colonization and a serological response without local or general clinical reactions. The early events of natural infection remain to be explored, as do the mechanisms underlying the host specificity of Salmonella Abortusovis.

Abortion, Veterinary↗