The "pregnancy zone" protein and fetal welfare.
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A single extra-amniotic injection of 2 or 4 mg of prostaglandin E2 in Tylose gel was administered to 30 primigravidae between the ages of 14 and 20 years to induce first-trimester abortion. Twenty-three patients (76.7%) aborted, though incompletely, within 9 hours, with a mean induction-abortion interval of 6.3 hours. In the remaining 7 (23.3%) the cervical os was found to be open and no mechanical dilatation was required at the time of vacuum aspiration. The only side effect was vomiting, which occurred in 2 patients. The method was shown to be safe and effective and may be employed in young primigravidae, thus eliminating the cervical complications attending vacuum aspiration.
Altogether 4719 women who had had a legally induced abortion in Uppsala County during 1970-75 were followed by means of computerized record linkage, and deliveries during 1970-78 after abortion were noted. Out of 1 364 deliveries traced, 670 were to primiparas who had had a previous vacuum-aspiration (VA) abortion. The outcome of the delivery for the 670 women was compared with that of matched controls, 622 primiparas and 626 secundiparas. Confounding variables were checked for by multiple regression analysis using the infant's birthweight and gestational duration as dependent variables. This analysis showed that the abortion did not have a statistically significant effect on the outcome. Low birth weight infants and preterm delivery did not occur more often after a previous VA abortion.
Complications subsequent to 5,851 consecutively induced first-trimester abortions during the period 1980-85 were analysed. Three hundred and fifty-six abortions (6.1%) led to complications requiring hospital admission. According to bivariable analysis, women below 25 years of age, women with parity 0, women with no spontaneous and with no induced abortions, and women in gestational week 8 had significantly higher postabortal complication rates than women 25 years of age and older (p less than 0.001), women with previous births (p less than 0.0001), women with spontaneous abortions (p less than 0.005), women with induced abortions (p less than 0.005), and women in other gestational age groups (p less than 0.0005). The mean stay in hospital per complicated abortion was 5.3 days. It was discussed whether the administration of prophylactic antibiotics to women with a history of pelvic inflammatory disease and young women completing their first pregnancy could reduce the complication rate.
All visitors who during one year visited a contraceptive clinic in the Solna district of Stockholm County and were below the age of 26 were asked to fill in a questionnaire and offered a test for C. trachomatis. Three hundred and six women (97%) participated. Ninety percent had at some time used oral contraceptives and 91% had experience of condom use. One-fifth of the whole group had undergone one or more legal abortions, and one fourth had experience of a sexually transmitted disease (STD). The most common STD experienced was chlamydia, followed by condyloma. The actual prevalence of chlamydia in the group was 6%. Sexual contacts were often made early in on-going steady relations. Forty-two percent admitted casual sex, but the number of life-time partners was five or less among the majority.
Serum concentrations of hCG were determined in blood samples taken 18-20 h and immediately before vacuum aspiration in 45 women in gestational weeks 7-9, admitted for legal abortion. In 35 of the women, a laminaria tent was inserted for cervical dilatation immediately after the first blood sampling. Serum hCG values decreased significantly in the women pretreated with laminaria tent, but were unchanged in the untreated women. This finding may indicate that pretreatment with a laminaria tent induces a partial placental detachment.
In a study at the University Hospital in Trondheim during 1983, the frequency of Chlamydia trachomatis among women terminating their pregnancies was 8.2%. Younger women were infected by C. trachomatis at a more frequent rate than older women (p less than 0.001). Treatment of chlamydia-positive women was initiated within the first two weeks after the abortion. However, among women readmitted to the hospital, chlamydia-positive women showed a higher frequency of salpingitis than chlamydia-negative women (p less than 0.08). Preabortion examination for C. trachomatis and treatment of chlamydia-positive women by practitioners before the abortion is carried out, may reduce the postabortal frequency of salpingitis.
Relationships between menarche and sexual, contraceptive, and reproductive life events were investigated by structured interviews of 585 Danish women, aged 15-54 years. Data were analyzed by multivariate test statistics. The trend toward an earlier menarche was confirmed. No association was found between menarche and social class. Women with early menarche had an earlier coital debut. After correction for coital debut, no association was observed between menarche and coital frequency, number of sexual partners, or use of oral contraceptives. Menarche was not associated with number of births, spontaneous or induced abortions, or frequency of ectopic pregnancies. The results suggest that the predictive value of the menarche for sexual and contraceptive life events is conditioned primarily by the association between menarche and coital debut.
After the Chernobyl accident serious concern spread throughout Italy about the possible effects of the consequent exposure to radioactivity on fetuses. A reduction of births in the first three months of 1987, and particularly in February (7.2% reduction in the birth rate), was observed throughout Italy. In April-June 1987 a 4.8% increase in the number of births was observed. The magnitude of both phenomena varied in different areas of the country. The total number of births in the first six months of 1987 was very similar to the expected (264,241 versus 263,659). Induced abortions increased in Lombardia (northern Italy) in June (+1.6%) and July of 1986 (+3.4%) and in Campania (southern Italy) in June (+12.7%) and August (+4.3%). No increase in legal abortions was detected in Lazio (central Italy). Italian data suggest a voluntary decrease in the number of planned pregnancies and the termination of some of them in the first weeks after the accident as a consequence of postdisaster stress.
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A computerized model that simulates reproductive events during the childbearing years of a cohort of women is used to analyze the impact of contraception and induced abortion on fertility. Four different reproductive regimens are investigated: (2) contraception only, (2) abortion only, (3) abortion as a backstop to contraception, and (4) combinations of abortion and contraception. It is concluded that in historical as well as in modern populations, levels of fertility near replacement are unlikely to be obtained without the use of induced abortion.
Pregnancies occurring with an intra-uterine device in situ were reviewed. Of 438 insertions since 1966, 31 patients became pregnant. 25 pregancies occurred with a Lippes Loop C or D of 277 insertions. Six pregnancies occurred with the Dalkon Shield among 161 patients. About 50% of the pregnancies occurred in the age group from 26 to 29 years and only 13% in the age group 20 to 25 years. Pregnancy did not occur in the age group below 20 years and in the age group above 40 years. The highest number of pregnancies occurred in Para 2's and Para 3's. 84% of all pregnancies occurred within the first 18 months after the insertion of the I.U.C.D. 13 of the pregnancies ended in therapeutic abortion and nine of these were combined with sterilization. Five pregnancies (about 20%) ended in a spontaneous abortion and one pregnancy ended in a premature delivery at 22 weeks. Five pregnancies went to term and three of these patients had tubal ligations post-partum. -- The three ectopic pregnancies are described in detail. There was one ovarian pregnancy, one tubal pregnancy and one pregnancy in the uterosacral ligament. -- The intra-uterine device is considered to be an acceptable method of contraception. The incidence of spontaneous abortion and ectopic pregnancy with an intra-uterine device in situ is increased. Because of the increased incidence of infertility following an ectopic pregnancy, the intra-uterine contraceptive device is only recommended with great reservation as a contraceptive method for nulligravidas.
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Data from the 1973 National Fertility and Family Planning Survey show that young unmarried women aged 18-27 desire small families and support family planning. These women express a lower son preference than did young currently married women surveved in 1973 and earlier. A majority of the respondents approve of the "stop at two" slogen of the family planning association, and they want to obtain more information about contraception before marrying. Unfortunately, survey results show that present sources of contraceptive information, including the schools, have not proved adequate.
During the first six months experience of a committee for the control of abortions, within the framework of Kupat Holim (Workers' Sick Fund of 'Histadrug' in Israel), 70 pregnant women sent by their physicians appeared before the committee for the interruption of their pregnancies. The reasons brought before the committee were of a medical, genetic, psychiatric or social nature. Discussed here are the socio-psychiatric cases, under the heading of the country of origin, age of the women, their cultural background and social situation of their families. Some conclusions are drawn in connection with the motivations which seem to have determined the positive or negative position of the committee and some possible implications are discussed concerning the legislation of the whole subject.
Whilst the medical indications for therapeutic abortion and the legal limitations set vary enormously from one country to another there is in general an undoubted trend towards giving the pregnant woman herself a greater say in the decision. During the first year of the operation of the Abortion Act, 1967, in England some 72 pregnant women were referred to the author and his colleagues for a recommendation on abortion. A psychiatric examination and follow-up over a period of one year was made both in those cases where abortion was performed as well as in those cases who were refused therapeutic abortion. In this communication a comparison is made between the reactions and outcome in the two groups. A provisional conclusion is reached that no significant psychiatric disturbance could be attributed to the performance of the operation or on the other hand to refusal of the woman's request.