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PubMed2004

Prevention and control of thalassemia at Saraburi Regional Hospital.

OBJECTIVE: To evaluate the program in prevention and control of thalssemia among pregnant women and their spouses, prevention of new cases by screening tests, confirmatory test, genetic counselling, prenatal diagnosis, and selective abortion. SUBJECTS: The pregnant women, attending antenatal care unit, Saraburi center hospital, as well as their spouses. 1 January 2000-31 December 2001 METHOD: As part of the antenatal care assessment, pregnant women before 16 weeks gestation were screened, with pre- and post-test counselling, by osmotic fragility (OF) and dichorophenol indophenol precipitate (DCIP) tests, and confirmed by complete blood count (CBC), mean corpuscular volume (MCV), hemoglobin typing and polymerase chain reaction for alphathal1 (PCR alphathal1) if any of two screening tests was positive. The husbands of those who were carriers of severe thalassemia were encouraged to have thalassemia screening and confirmation. When both the pregnant women and their husbands were carriers of severe thalassemia, the pregnant women would voluntarily perform the prenatal diagnosis. Termination of pregnancy would be offered when the fetus had severe thalassemia. RESULTS: There were 3,739 from 4,214 women (88.7% of all antenatal women), who participated in the program. OF and/or DCIP were positive in 1,742 of 3,739 subjects (46.5%). Of those, 960 from 1,742 (55.1%), had husbands who were willing to have the testing, and OF and/or DCIP were positive in 443 of 960 cases (46.1%). The confirmatory tests revealed carrier and disease of thalassemia, and hemoglobinopathies in 931 of 1,742 women (53.9%), and 135 of 960 husbands (14.0%). The 20 couples who had the possibility of having severe thalassemic newborns, were strongly advised to have prenatal diagnosis. The 12 risk pregnancies had been performed cordocentesis. Finally 3 of 12 (25.0%) fetuses were documented to have severe thalassemia and all of them decided to have selective abortion. CONCLUSIONS: The screening model for thalassemia carriers by using the combination of OF and DCIP is the easy screening model. It can be done quickly, it is inexpensive, therefore it is suitable for large numbers of population screening. The systematic screening, confirmatory of thalassemia diagnosis and prenatal diagnosis are the measure of thalassemia prevention and control, and aims to decrease the number of newborns with severe thalassemia.

Abortion, Eugenic↗
PubMed1997

Gene-culture coevolution and sex ratios: II. Sex-chromosomal distorters and cultural preferences for offspring sex.

Cultural preferences for the sex of offspring may produce behavior, such as female infanticide, sex-selective abortion and sex-selective parental investment, which alter the sex ratio in a population. Empirical evidence suggests that some genetic sex-ratio distorters are located on the sex chromosomes. Interactions between cultural preferences and sex-linked sex-ratio distorters are examined. Criteria for the spread of cultural preferences and sex-chromosomal distorter alleles are derived analytically, and the coevolution of preferences and distorters is examined through numerical iteration. Evolutionary equilibria and trajectories of gene-culture interactions involving sex-chromosomal distorter alleles may produce severely male- or female-biased primary sex ratios and adult sex ratios in populations. Adult sex ratios, primary sex ratios, allele frequencies and the prevalence of cultural preferences in the population are sensitive to initial conditions and cultural transmission parameters. During the coevolutionary process phenoallelic association is observed in many cases and is associated with unusual dynamics.

Adult↗
PubMed1970

Chromosome studies in selected spontaneous abortions. 1. Conception after oral contraceptives.

Fifty-four abortuses from women who conceived within six months of discontinuing oral contraceptives were collected over a 2(1/2)-year period. Chromosome analysis of the abortuses showed an increase in triploidy which was highly significant statistically when compared with a control series. Triploidy is virtually always lethal early in embryonic life. Tetraploidy was also increased, but the numbers were too small for analysis. The chromosome disorders which are compatible with livebirth (trisomy and X-monosomy) were not increased in the post-oral-contraceptive abortuses. It is suggested that there is a temporary hormonal imbalance in some women after they discontinue oral contraceptives. This could affect the timing of fertilization. Triploidy could arise at the first or second meiotic division of the ovum or at fertilization. Abortuses are a valuable source of information relating to congenital defects.

Abortion, Spontaneous↗
PubMed1997

Gene-Culture Coevolution and Sex Ratios: II. Sex-Chromosomal Distorters and Cultural Preferences for Offspring Sex

Cultural preferences for the sex of offspring may produce behavior, such as female infanticide, sex-selective abortion and sex-selective parental investment, which alter the sex ratio in a population. Empirical evidence suggests that some genetic sex-ratio distorters are located on the sex chromosomes. Interactions between cultural preferences and sex-linked sex-ratio distorters are examined. Criteria for the spread of cultural preferences and sex-chromosomal distorter alleles are derived analytically, and the coevolution of preferences and distorters is examined through numerical iteration. Evolutionary equilibria and trajectories of gene-culture interactions involving sex-chromosomal distorter alleles may produce severely male- or female-biased primary sex ratios and adult sex ratios in populations. Adult sex ratios, primary sex ratios, allele frequencies and the prevalence of cultural preferences in the population are sensitive to initial conditions and cultural transmission parameters. During the coevolutionary process phenoallelic association is observed in many cases and is associated with unusual dynamics. Copyright 1997 Academic Press

Journal Article↗
PubMed2006

Determinants of high sex ratio among newborns: a cohort study from rural Anhui province, China.

This study analysed the relative contributions of three possible determinants to the high sex ratio among newborns in rural China - under-reporting of female births, abortions of female fetuses and excess early female neonatal mortality. A cohort of 3,697 pregnancies collected at village level in 20 rural townships from a county in Anhui province in 1999 was followed from pregnancy registration to seven days after birth. The cohort was later completed with 267 retroactively registered pregnancies. In the original cohort, the sex ratio at birth was 152 males to 100 females and in the supplemented cohort 159 males to 100 females, being similar to the sex ratios in the census data of the same townships. The risk of death for girls was almost three times that for boys during the first 24 hours of life. A comparison of the estimated number of missing girls by parity and pregnancy approval status to the recorded abortions and stillbirths suggests that selective abortions of female fetuses contributed most to the extremely high sex ratio among newborns. The under-reporting of female live births and neglect or poorer care of female newborn infants seemed to play a secondary role. New technology has helped the one-child policy to become, in practice, an "at-least-one-son" practice.

Abortion, Induced↗
PubMed2005

Knowledge and attitudes about abortion legislation and abortion methods among abortion clients in Latvia.

OBJECTIVE: To assess knowledge of abortion legislation and knowledge and attitudes about medical and surgical abortion among women seeking a legal abortion in Latvia. METHODS: Data are drawn from a survey of 371 abortion clients from 16 purposively selected abortion clinics in Latvia. A semi-structured questionnaire was used to collect socio-demographic data and information on women's knowledge of and attitudes toward abortion law and abortion methods. RESULTS: Most women knew that abortion is legal either under any (53%) or certain (37%) circumstances. Almost one third (31%) of women interviewed were aware of medical abortion. After hearing a description of medical abortion, respondents felt the method as described would be advantageous because it could avoid a surgical intervention (33%) or found it simple, easy, convenient, or natural (12%). Women were concerned that the method might not be completely effective (38%) or be associated with side-effects (22%). CONCLUSIONS: Respondents were interested in medical abortion as a less invasive option to surgical abortion. Efforts should be undertaken to inform women about the safety and efficacy of the method.

Abortion, Induced↗
PubMed1994

First trimester prenatal diagnosis: earlier is not necessarily better.

In the past few years considerable attention has been given to a relatively new method of prenatal diagnosis known as chorionic villus sampling (CVS). Because CVS can be performed in the first trimester it is hailed by many as a significant advance over amniocentesis. What has not been as publicized, however, are the disadvantages of CVS and earlier prenatal diagnosis. The emotional costs of CVS in terms of the greater number of both spontaneous and selective abortions following CVS, the use of CVS for sex selection and, because of the greater social acceptability of first trimester abortion, the possibility of increased pressure on women to undergo prenatal diagnosis by health insurance companies, medical professionals and government agencies, all need to be weighed against the advantages of early prenatal diagnosis.

Abortion, Induced↗
PubMed1982

Bovine leptospirosis: microbiological and serological findings in aborted fetuses.

Leptospiral infection was diagnosed in 41.6 per cent of 245 randomly selected aborted bovine fetuses and 68.9 per cent of 103 aborted fetuses from farms with abortion problems. Diagnosis was based on combined leptospiral isolates from fetal kidney and eye, and fetal serology and immunofluorescence. Fifty-six of the 58 strains of leptospira isolated belonged to the Hebdomadis serogroup and were similar to serovar hardjo while one of the remaining two strains belonged to the Icterohaemorrhagiae serogroup and the other to the Canicola serogroup. These findings indicate that serovar hardjo infection is a major factor in the aetiology of bovine abortion and that it is possible to isolate this organism from fetal kidney by the careful application of dilution culture technique.

Abortion, Veterinary↗
PubMed1986

[Psychological sequelae of abortion based on fetal indications].

Prenatal diagnosis is based on the concept of selective abortion. The termination of a pregnancy for genetic reasons means a great emotional loss followed by grief and mourning. The case reports of two women are presented, who chose to abort after the prenatal diagnosis of trisomy X. One of them showed psychological and psychosomatic symptoms as a sign of a pathological grief reaction. The depth of her grief is also shown by the published empirical investigations. Four analogous situations are discussed: abortion for psychosocial reasons, miscarriage, stillbirth and the death of premature or newborn babies. In comparison, the specific aspects of abortion for genetic reasons are: the intensive relationship to the child at the time of termination; the strains and anxiety engendered during pregnancy by medical investigations; the conflict situation without a simple solution; the personal decision and responsibility for the abortion; the compounded task of grieving and dealing with feelings of guilt. A routine follow-up for the affected women would be desirable.

Abortion, Eugenic↗
PubMed2003

[Access to health care for an induced abortion: qualitative and quantitative approaches].

BACKGROUND: Despite recent studies showing evidence that the organisation of the French health care system raises some problems concerning access to abortion, far little is known on the reality of access conditions and the views of women on the difficulties they experience when they attend an abortion clinic. In this article, we discuss the complementarity of materials from two surveys one qualitative, the other quantitative in the study of patterns of care for an abortion. METHODS: The qualitative survey included 51 women who reported a history of induced abortion, selected from a qualitative study on unintended pregnancy in France. The quantitative survey included 480 women, who had an abortion in the past 10 years. These women were selected from a representative sample of 2863 women aged 18 to 44, who participated in a study on contraception and abortion. RESULTS: The variety of patterns of care for an abortion, the rareness of dysfunctions in the health care system and the importance of the first professional women contacted, demonstrated in the qualitative survey, were confirmed in the quantitative survey. The quantitative survey enabled quantifying the distribution of the different patterns of care. It also permitted to identify factors associated with the choice of first professional contacted and with the type of subsequent patterns of care. The qualitative survey permitted to explore these patterns of care and to highlight the interaction between the women's request and the representation of the legitimacy of their request. Difficulties of access seemed to be linked to the lack of support women experienced in the process of finding an abortion clinic. Results suggest that general practitioners are less well informed of the procedures required for an abortion than other professionals. However, the qualitative survey also shows that problems of access cannot be reduced to the lack of information of professionals, as their practice was also linked to their own representation of abortion, and their perception of the legitimacy of the women's request. CONCLUSION: Our results underline the need for the definition of a clear health policy that should include two priorities: the improvement of the visibility of health care supply for an abortion and the promotion of information delivered to health care professionals.

Abortion, Induced↗
PubMed2002

Sex selection: the systematic elimination of girls.

In strongly patriarchal societies, where the cultural and economic value of sons is at a premium, son preference manifests itself in many ways, ranging from differential allocation of household resources, medical care and neglect of girl children to female infanticide. With the increasing availability of ultrasound in the mid-1980s sex determination followed by sex-selective abortion began to become widespread as well. The following paper introduces this Roundtable and discusses the following questions: Is sex selection a part of women's right to free choice and control over their reproduction? What is the role of the medical profession? Are all manifestations of sex selection equally unethical? Are there solutions? Do the solutions themselves pose new ethical dilemmas? Following this paper, four respondents put different points of view on sex selection as a gender-based preference for a pregnancy; progress in getting the Supreme Court of India to implement a 1994 law regulating the use of antenatal diagnostic technology; why sex selection should be available as a form of reproductive choice; and why sex selection may be empowering for women and justify their actions in the short run, given the demands on them. All agree that only improved status for women and girls will reduce the demand for sex selection.

Abortion, Induced↗
PubMed2004

Methods for induced abortion.

We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.

Abortion, Induced↗