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A 1 and 6 month follow-up of prenatal diagnosis patients who lost pregnancies.

This paper reports results of an exploratory study of prenatal diagnosis patients who experienced voluntary terminations of pregnancy following the detection of an abnormality or spontaneous miscarriages. The 121 participants were part of the national collaborative Chorionic Villus Sampling and Amniocentesis Study. They completed semi-structured telephone interviews and mailed questionnaires at 1 month and 6 months after the pregnancy losses. Scores on the Profile of Mood States showed that mood levels improved significantly over time. However, there were some declines in loss-related support from partners and others. The persisting distress and difficulties of a minority highlight the variability in women's responses to pregnancy losses. Women who lost pregnancies later in gestation, showed the greatest mood disturbances at initial assessments, used professional mental health assistance after the loss, or reported less satisfactory loss-related support from significant others showed the greatest levels of mood disturbance at the six-month assessment. Follow-up contacts with patients who lose pregnancies should be used to inform women about the variation in possible grief reactions, to assess the extent of support the women are receiving from their partners and significant others, and to provide additional follow-up or referral of those experiencing the greatest distress.

Abortion, Induced

Clinical guides to preventing ethical conflicts between pregnant women and their physicians.

We provide a justification for preventive ethics in obstetric practice. Four clinical guides to resolving ethical conflicts between pregnant women and their physicians can be identified: (1) informed consent as an ongoing dialogue between the pregnant woman and her physician, (2) negotiation as a clinical strategy, (3) respectful persuasion as a clinical strategy, and (4) the proper use of ethics committees.

Beneficence

A chill wind blows: Webster, obstetrics, and the health of women.

The Supreme Court decision in Webster v Reproductive Health Services permits states to regulate abortion in fashions that may be medically unsound and may significantly restrict access. This decision challenges the contemporary practice of obstetrics and threatens to curtail access to needed services, particularly for poor women, who are at highest risk of pregnancy-associated medical complications and death. Governmental restrictions on abortion interfere with the obstetrician's basic goal of providing optimal care for the patient. Obstetricians dedicated to providing the best care to their patients should help to ensure that safe abortion be part of a spectrum of reproductive health care that is available to all American women.

Abortion, Legal

The role of confidential enquiries in the reduction of maternal mortality and alternatives to this approach.

The aim of confidential enquiries into maternal deaths is to identify weaknesses in the maternal health care system with a view to remedying them. The method of confidential enquiry is explained using the British system as an example. The reasons why this apparently useful practice is not more widely adopted can in some countries include fears of litigation or lack of trust in confidentiality. Alternative approaches to maternal death audit are discussed.

Cause of Death

A new era in contraceptive counseling for early adolescents.

In a new era of increased concern about sexually transmitted diseases, the ethical focus of contraceptive counseling for the early adolescent has changed. A discussion of the ethical aspects of contraceptive counseling is included to emphasize contemporary concerns about informed consent and safe contraceptive methods.

Acquired Immunodeficiency Syndrome