[Incomplete uterine perforation diagnosed by laparoscopic examination].
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Abortion, Legal↗
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Role of routine ultrasonography in monitoring the outcome of medical abortion in a clinical setting.
BACKGROUND: Clinical methods generally used to evaluate the completeness of medical abortion are not accurate. There are no published reports evaluating the role of routine ultrasonography in monitoring the outcome of medical abortion. The purpose of this study was to investigate whether routine transvaginal ultrasonography (TVS) at the follow-up visit after medical abortion can accurately identify women who will require surgical intervention. DESIGN: Retrospective review of medical records and charts of all women undergoing medical abortion in the first trimester of pregnancy between January 1999 and December 2001. METHODS: Medical abortion was performed using oral mifepristone and a vaginal prostaglandin analog before 63 days gestation. All women had an initial TVS to confirm intrauterine pregnancy and gestational age, and another TVS at the follow-up visit 2-3 weeks later to assess the completeness of abortion. Surgical evacuation of the uterus was allowed as indicated on clinical grounds but not on the basis of ultrasound findings only. RESULTS: A total of 690 women consented to medical abortion during the study period. Eleven of these women were excluded from the study for various reasons. Of the remaining 679 cases, 95% (645/679) had a documented follow-up at the hospital. The pregnancy termination rate among these women was 99.2% (640/645) and TVS identified all five cases of continuing pregnancy at the follow-up. A total of 66 (10.2%) patients had complications. The uterine cavity was empty on TVS at the follow-up visit in 84.8% (547/645) of cases and only 3.1% (17/547) of them required surgical aspiration/curettage due to excessive or prolonged vaginal bleeding. In the remaining 15.2% (98/645) the uterine cavity was not empty, and 43.9% (43/98) of them had a curettage. The risk of requiring a surgical intervention was significantly higher [odds ratio (OR) 24.4; 95% confidence interval (95% CI) 14.9-39.7] when the uterine cavity was not demonstrated to be empty at the follow-up visit 2-3 weeks after medical abortion. However, 59.1% (55/93) of women did not require surgical intervention despite ultrasound evidence of thick endometrial echo-complex. CONCLUSION: Routine TVS 2-3 weeks after medical abortion appears to be an efficient means of accurately identifying the cases of ongoing pregnancy and diagnosing a complete abortion. Although TVS could be used as an adjunct to clinical examination to diagnose an incomplete expulsion, it does not accurately differentiate those women who require surgical intervention from those who do not.
Abortifacient Agents, Steroidal↗
A commercial vaccine for ovine toxoplasmosis.
This paper describes the development of the first commercial vaccine for toxoplasmosis. The vaccine comprises live tachyzoites of the S48 'incomplete' strain of Toxoplasma gondii and is deployed to control toxoplasma abortion in sheep. A discussion of protective immune mechanisms and recent studies on host responses to the vaccine is also included.
Animals↗
Understanding miscarriage or insensitive abortion: time for more defined terminology?
A search of the two major journals of obstetrics and gynecology published in the United States has shown that the word abortion rather than miscarriage to describe early pregnancy loss is 6 times more likely to be used compared with most other English language journals over the last 5 years. The use of miscarriage, with descriptive adjectives such as threatened, incomplete, and complete, is recommended and the term delayed miscarriage is suggested in place of missed abortion.
Abortion, Spontaneous↗
Manual vacuum aspiration, a safe and effective alternative in early pregnancy termination.
BACKGROUND AND OBJECTIVE: Vacuum aspiration has become standard surgical procedure for safe early pregnancy termination. Most of these operations are performed in the operating theater using suction curettage and an electric vacuum pump. MVA (manual vacuum aspiration) is an alternative that is well suited for use as a clinical procedure, which could have advantages both for the patient and the health care system. In order to compare conventional VA and MVA in a Swedish setting, a randomized study was undertaken. METHODS: Two hundred women requesting abortion in early pregnancy, gestational age less than 56 days, and choosing surgical termination, were randomized to VA or MVA. Main study outcome was frequency of complete abortion but also other variables were recorded. RESULTS: There were no significant differences between the two groups regarding background characteristics. Altogether 91 MVA and 88 VA operations were performed. There was no significant difference in frequency of complete abortion; two patients in each group subsequently needed re-curettage because of incomplete evacuation. No case of ongoing pregnancy occurred. Two patients in each group received treatment for endometritis. No other complications were recorded. CONCLUSION: This study indicates that MVA is effective in emptying the uterine cavity, on par with the standard vacuum aspiration. The rate of complications with MVA was on the same low level as with conventional VA.
Abortion, Induced↗
Risk of breast cancer among young women: relationship to induced abortion.
BACKGROUND: Certain events of reproductive life, especially completed pregnancies, have been found to influence a woman's risk of breast cancer. Prior studies of the relationship between breast cancer and a history of incomplete pregnancies have provided inconsistent results. Most of these studies included women beyond the early part of their reproductive years at the time induced abortion became legal in the United States. PURPOSE: We conducted a case-control study of breast cancer in young women born recently enough so that some or most of their reproductive years were after the legalization of induced abortion to determine if certain aspects of a woman's experience with abortion might be associated with risk of breast cancer. METHODS: Female residents of three counties in western Washington State, who were diagnosed with breast cancer (n = 845) from January 1983 through April 1990, and who were born after 1944, were interviewed in detail about their reproductive histories, including the occurrence of induced abortion. Case patients were obtained through our population-based tumor registry (part of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute). Similar information was obtained from 961 control women identified through random digit dialing within these same counties. Logistic regression analysis was used to estimate odds ratios and confidence intervals (CIs). RESULTS: Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50% higher than among other women (95% CI = 1.2-1.9). While this increased risk did not vary by the number of induced abortions or by the history of a completed pregnancy, it did vary according to the age at which the abortion occurred and the duration of that pregnancy. Highest risks were observed when the abortion was done at ages younger than 18 years--particularly if it took place after 8 weeks' gestation--or at 30 years of age or older. No increased risk of breast cancer was associated with a spontaneous abortion (RR = 0.9; 95% CI = 0.7-1.2). CONCLUSION: Our data support the hypothesis that an induced abortion can adversely influence a woman's subsequent risk of breast cancer. However, the results across all epidemiologic studies of this premise are inconsistent--both overall and within specific subgroups. The risk of breast cancer should be reexamined in future studies of women who have had legal abortion available to them throughout the majority of their reproductive years, with particular attention to the potential influence of induced abortion early in life.
Abortion, Induced↗
Maternal activity in relation to birth size in rural India. The Pune Maternal Nutrition Study.
OBJECTIVE: To describe the relationship of the mother's physical activity to the birth size of her baby in a rural Indian population. DESIGN: : Prospective observational study. SETTING: Six villages near Pune, Maharashtra, India. SUBJECTS: : A total of 797 women were studied after excluding abortions and termination of pregnancies (112), foetal anomalies (8), multiple pregnancies (3), incomplete pre-pregnancy anthropometry (14) and pregnancies detected later than 21 weeks of gestation (168). METHOD: An activity questionnaire was developed after focus group discussions and incorporated community-specific activities. It was validated against an observer-maintained diary. Activity scores were derived using published data on energy costs to weight the contributions of various activities. It was then administered to assess physical activity at 18 (+/-2) and 28 (+/-2) weeks of gestation. OUTCOME MEASURES: Birth outcome, maternal weight gain and neonatal anthropometry. RESULTS: The activity questionnaire was used to classify women into light, moderate and heavy activity categories. Maternal activity did not influence the incidence of prematurity or stillbirth, or the duration of gestation. It was inversely related to maternal weight gain up to 28 weeks of gestation (P=0.002). Higher maternal activity in early, as well as mid gestation, was associated with lower mean birth weight (P=0.05 and 0.02, respectively ), and smaller neonatal head circumference (P=0.005 and 0.009) and mid-arm circumference (P=0.03 and 0.01) after adjusting for the effect of major confounding factors. CONCLUSIONS: The Findings suggest that excessive maternal activity during pregnancy is associated with smaller foetal size in rural India, The approach described for developing an activity questionnaire has potential for adoption in other settings.
Birth Weight↗
Quantitative analysis of the role of receptor recycling in T cell polarization.
Activation of T cells of the immune system involves recognition of the antigen by the T cell receptor and subsequent internalization and recycling of this receptor. We present a numerical model for this process that accounts for the polarity of the intracellular traffic determined by the polarization of the microtubule-organizing center to the immunological synapse. Unexpectedly, the model explains the observed accumulation of receptors at the immunological synapse mainly as dynamic maintenance of the receptor density there, while the surface receptors everywhere else are depleted, even though the internalization occurs primarily at the synapse. In the case of an unsuccessful polarization of the microtubule-organizing center, which alters the polarity of the receptor trafficking, the model explains the absence of receptor accumulation as a dynamic downregulation at the synapse. The experiment shows that in this case the interaction of the T cell with its target is aborted. Disruption of recycling leads in the experiment to accumulation of the incompletely polarized cells. We propose that receptor recycling is a mechanism whereby the cell can sense its internal structure and detect polarity errors, analogous to checkpoint signaling mechanisms that ensure fidelity of cell division.
Algorithms↗
Customizing conception: a survey of preimplantation genetic diagnosis and the resulting social, ethical, and legal dilemmas.
One in six American couples experience difficulties conceiving a child. With fertility rates at an all time low, the business of treating infertility is booming. However, due to the United States prohibition on government funding for embryonic research, the $4 billion industry of assisted reproductive technologies (ART) has been incompletely monitored and largely removed from oversight. Additionally, due to the fervent abortion debate, in vitro fertilization (IVF) was introduced in the United States without a research phase and procedures have been forced to evolve in the private sector. Thus, the checks and balances on medical innovation that are generally imposed by the federal government for consumer protection are lacking. Decisions about when to go from the laboratory to the clinic are often left solely to the discretion of private physicians. Preimplantation genetic diagnosis (PGD) is just one of many such treatments offered by these clinics. This iBrief examines how, why, and to whom the reproductive procedure of PGD is offered. In addition, it evaluates the prospective effects to society that arise when PGD is used for sex selection and for nontherapeutic or enhancement purposes. Finally, it explores whether and how to regulate PGD in the United States by investigating approaches to policy making that have been adopted by the United Kingdom.
Advisory Committees↗
Calcium-channel blockers as adjuvant therapy postthrombolysis.
Following successful thrombolytic therapy for evolving acute myocardial infarction, the inevitable process of transmural necrosis is favorably altered in a majority of patients, resulting in an aborted, or interrupted, myocardial infarction. Presumably, such myocardial salvage results in an "incomplete" infarction, which is often associated with a patent (but residually stenotic) infarct-related coronary artery. In this regard, the acute myocardial infarction successfully reperfused with thrombolytic therapy resembles non-Q-wave infarction. The subsequent pharmacologic therapy of the "incomplete" infarction remains ill-defined. This article reviews the features which "naturally occurring" non-Q-wave infarction shares with the successfully reperfused myocardial infarction. In addition, the role of adjunctive pharmacologic therapy with calcium-channel-blocker therapy is addressed; in particular, the results of the Diltiazem Reinfarction Study and the non-Q-wave infraction subset analysis of the Multicenter Diltiazem Post-Infarction Trial are discussed to provide the conceptual basis for considering such treatment appropriate adjunctive pharmacologic therapy for the postthrombolysis patient.
Calcium Channel Blockers↗
Deaths from injuries and induced abortion among rural Bangladeshi women.
Information about injuries and violence as causes of death of women is scarce and often incomplete, and particularly so regarding women in the rural areas of South Asia. This report provides detailed specific information collected in Matlab, a sub-district of rural Bangladesh. Of 1139 women (aged 15-44 yr) who died there during the 11-yr period from 1976 to 1986, 207 (18%) were victims of unintentional injuries or violence. In this study, unintentional injuries include domestic and traffic accidents, drowning and snake-bites, while violent deaths are defined as due to intentional injury and include homicide, suicide and lethal complications of induced abortion. Injuries and violence accounted for 31% of all deaths among women aged 15-19 yr. This proportion dropped significantly with age to 10% among women aged 35-44 yr. Unmarried women suffered a higher proportion of such deaths (36%) than married women (15%). Violent deaths during pregnancy and complications of induced abortion among young unmarried women deserve special attention. In the male-dominated society under study, suicide and homicide are observed to be two frequent consequences of illegitimate pregnancy. Although this study suffers from the absence of data on non-fatal injuries and attempted violence, it may serve as a basis for recommending preventive measures.
Abortion, Induced↗
Mandatory parental involvement in minors' abortions: effects of the laws in Minnesota, Missouri, and Indiana.
OBJECTIVES: This study examined the effects of parental involvement laws on the birth rate, in-state abortion rate, odds of interstate travel, and odds of late abortion for minors. METHODS: Poisson and logistic regression models fitted to vital records compared the periods before and after the laws were enforced. RESULTS: In each state, the in-state abortion rate for minors fell (relative to the rate for older women) when parental involvement laws took effect. Data offered no empirical support for the proposition that the laws drive up birth rates for minors. Although data were incomplete, the laws appeared to increase the odds of a minor's traveling out of state for her abortion. If one judges from the available data, minors who traveled out of state may have accounted for the entire observed decline in the in-state abortion rate, at least in Missouri. The laws appeared to delay minors' abortions past the eighth week, but probably not into the second trimester. CONCLUSIONS: Several empirical arguments used against and in support of parental involvement laws do not appear to be substantiated.
Abortion Applicants↗
Myositis ossificans progressiva and pregnancy. A therapeutic dilemma.
Myositis ossificans progressiva is a rare but progressively debilitating autosomal dominant disease characterized by extraskeletal ossification involving muscle connective tissue. This report is the first on pregnancy and induced abortion in a patient with myositis ossificans progressiva. Intraoperative sector scanning ultrasound was of limited benefit in evacuation of the uterine cavity. Conservative management of an incomplete termination resulted in no adverse sequelae.
Abortion, Induced↗
Incomplete pregnancies and risk of ovarian cancer (Washington, United States).
Because of the reduced risk of ovarian cancer related to prior full-term pregnancies, we sought to determine whether there was any association with a history of one or more incomplete pregnancies. White female residents of three counties in Washington State (United States) diagnosed with ovarian cancer during 1986-88 (n = 322), and a random sample of control women selected from these same counties (n = 426), were interviewed regarding their pregnancy and childbearing histories. Among women who had given birth to at least one child, an additional incomplete pregnancy was not associated with the risk of ovarian cancer (relative risk [RR] = 1.1, 95 percent confidence interval [CI] = 0.8-1.6, adjusting for age, oral contraceptive use, and number of births). For those who had never given birth, a somewhat smaller proportion of cases had a history of incomplete pregnancy than controls (RR = 0.8, CI = 0.4-1.7). In an analysis restricted to ever-pregnant women, a prior induced or spontaneous abortion was not found to be associated with the incidence of ovarian tumors (RR = 1.0, CI = 0.6-1.7, and RR = 1.3, CI = 0.8-1.9, respectively). Other studies of the possible relation between incomplete pregnancies and ovarian cancer generally have observed either a weak negative association or no association at all. It is possible that if incomplete pregnancies do affect the risk of ovarian cancer, their impact might be too small to be identified reliably through epidemiologic studies.
Abortion, Induced↗
Does induced or spontaneous abortion affect the risk of breast cancer?
The influence of induced or spontaneous abortion on breast cancer risk has been the subject of numerous epidemiologic studies over the past decades and has recently received heightened attention. Here, we review the evidence to understand better the apparent inconsistencies among studies. We considered possible biases in data collection, presentation, and analysis that could create spurious associations or obscure real relations. A particularly important issue is the sensitive nature of abortion, which is a pervasive problem that could affect the validity of many studies. Also, an incomplete pregnancy deprives the woman of a potentially protective full-term pregnancy and therefore may appear harmful when compared with the experience of a woman who did carry to term. The dual effect of parity on breast cancer risk-short-term risk increase and long-term protection-adds another dimension of complexity to the interpretation of abortion studies. Long-term influences of abortion may have been insufficiently captured in some studies, as follow-up time was too short. Studies to date are inadequate to infer with confidence the relation between induced or spontaneous abortion and breast cancer risk, but it appears that any such relation is likely to be small or nonexistent.
Abortion, Induced↗
Anchorage in the developing placenta: an overlooked determinant of pregnancy outcome?
Anchoring villi are peripheral trophoblastic specializations that attach the placenta to the uterine wall. In addition, they supply the migratory trophoblast population that colonizes the maternal interstitium and arteries during the first 18 weeks of pregnancy. Establishment of anchoring villi and subsequent invasion of maternal uterine stroma and blood vessels play a critical role in pregnancy success; incomplete vascular invasion is associated with common pathological conditions of pregnancy, including spontaneous abortion, pre-eclampsia and growth retardation. Anchoring villi are already present as early as 18 days after ovulation, but new villi develop rapidly as the placenta grows. First trimester mesenchymal floating villi, when confronted with a permissive extracellular matrix (ECM) in explant culture, undergo de novo development of anchoring sites. The cellular and molecular characteristics of these specializations closely resemble those that are seen in vivo. It is postulated that development of new sites is important in the stabilization of placental attachment during growth and development in the first trimester. This may be compromised by function-blocking antibodies which inhibit cell--ECM interactions. This is supported by experiments in vitro as well as by the presence of auto-antibodies to adhesion molecules in women suffering from recurrent spontaneous miscarriage.
Journal Article↗
Disturbance in the allocation of carbohydrates to regenerative organs in transgenic Nicotiana tabacum L.
Transgenic tobacco (Nicotiana tabacum L, cv. SR-1) expressing mannitol 1-phosphate dehydrogenase, MTLD, in chloroplasts and myo-inositol O-methyltransferase, IMT1, in the cytosol after crossing of lines which expressed these foreign genes separately has been analysed. Plants expressing both enzymes accumulated mannitol and D-ononitol in amounts comparable to those following single gene transfer and showed phenotypically normal growth during the vegetative stage. Induction of flowering for transgenovar and wild-type occurred at the same time, but during flowering the phenotype of the transformed plants changed. Compared to wild-type, transgenic plants were characterized by curled, smaller upper leaves and elongated stems during flowering; incomplete development of flower buds with shorter sepals and pedicels resulted in increased abortion. Flowers completing development were normal. The vegetative biomass of the transformed plants was slightly higher than that of wild-type. Concentrations of soluble sugars and potassium were lower than in wild-type only in the apical parts of the transgenic plants. Both enzymes, under control of the CaMV 35S promoter, promoted accumulation of mannitol and D-ononitol in the youngest leaves close to the vegetative meristem and in flowers, suggesting that their presence could signal lower sink demand leading to a decrease in carbon import to flowers and developing seed capsules. The interpretation here is that increases of inert carbohydrates in developing sinks interfere with metabolism, such as respiration or glycolysis. This interference may be less significant in source tissues during vegetative growth than in sink tissues during seed development.
Carbohydrate Metabolism↗
Cloning animals by somatic cell nuclear transfer--biological factors.
Cloning by nuclear transfer using mammalian somatic cells has enormous potential application. However, somatic cloning has been inefficient in all species in which live clones have been produced. High abortion and fetal mortality rates are commonly observed. These developmental defects have been attributed to incomplete reprogramming of the somatic nuclei by the cloning process. Various strategies have been used to improve the efficiency of nuclear transfer, however, significant breakthroughs are yet to happen. In this review we will discuss studies conducted, in our laboratories and those of others, to gain a better understanding of nuclear reprogramming. Because cattle are a species widely used for nuclear transfer studies, and more laboratories have succeeded in cloning cattle than any other species, this review will be focused on somatic cell cloning of cattle.
Abortion, Veterinary↗