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Gestation, birth-weight, and spontaneous abortion in pregnancy after induced abortion. Report of Collaborative Study by W.H.O. Task Force on Sequelae of Abortion.

The outcome of pregnancy in 7228 women from eight European cities was studied. In two of the three city clusters, there was a significantly higher risk of adverse outcome in terms of either mid-trimester spontaneous abortion, preterm delivery, or low-birth-weight infant among women whose only previous pregnancy had been surgically terminated only previous pregnancy had been surgically terminated than among primigravidae or women whose only previous pregnancy had ended in live birth. In one city cluster in which surgical termination was accomplished both by conventional dilatation and currettage and by vacuum aspiration (V.A.), an increased risk of short gestation was noted for V.A., but the overall total risk of adverse outcome was not significantly increased. In the third city cluster, in which surgical termination was nearly entirely by V.A., induced abortion was not associated with any increased risk of adverse pregnancy outcome. The effects of spontaneous abortion on the subsequent pregnancy are similar to those of induced abortion.

Abortion, Induced

Estimating the probability of spontaneous abortion in the presence of induced abortion and vice versa.

An integrated approach to estimate the total number of pregnancies that begin in a population during one calendar year and the probability of spontaneous abortion is described. This includes an indirect estimate of the number of pregnancies that result in spontaneous abortions. The method simultaneously takes into account the proportion of induced abortions that are censored by spontaneous abortions and vice versa in order to estimate the true annual number of spontaneous and induced abortions for a population. It also estimates the proportion of pregnancies that women intended to allow to continue to a live birth. The proposed indirect approach derives adjustment factors to make indirect estimates by combining vital statistics information on gestational age at induced abortion (from the 12 States that report to the National Center for Health Statistics) with a life table of spontaneous abortion probabilities. The adjustment factors are applied to data on induced abortions from the Alan Guttmacher Institute Abortion Provider Survey and data on births from U.S. vital statistics. For the United States in 1980 the probability of a spontaneous abortion is 19 percent, given the presence of induced abortion. Once the effects of spontaneous abortion are discounted, women in 1980 intended to allow 73 percent of their pregnancies to proceed to a live birth. One medical benefit to a population practicing induced abortion is that induced abortions avert some spontaneous abortions, leading to a lower mean gestational duration at the time of spontaneous abortion.

Abortion, Induced

A study of abortion in countries where abortions are legally restricted.

In countries where induced abortion is permitted, national family planning programs are able to combine pre- and postconceptive fertility control methods to maximize success in achieving personally desired fertility levels and nationally desired growth levels. The proscription against induced abortion tends to produce criminal abortions and consequent morbidity and mortality which, in some countries, are often recognized as a national health problem. The International Fertility Research Program has undertaken this study of incomplete, inevitable, threatened and septic abortion cases, using a standard data collection instrument, to facilitate comparisons across institutions and countries. The data gather since 1971 in nine Asian, African and Middle Eastern hospitals includes 7,331 cases. Policies of the participating institutions with respect to what constitutes a therapeutic abortion affected the proportions of spontaneous abortions and of abortions induced outside the hospital and inside the hospital. Women treated for induced abortion tended to be of higher parity and more likely to have attained their desired family size than patients treated for spontaneous abortions. Morbidity rates were quite low for patients treated in centers where vacuum aspiration was mainly used, particularly in contrast to the morbidity rates for patients treated in centers where dilatation and curettage was used exclusively. High mortality rates in patients admitted with sepsis confirm the need not only for improvement of clinical procedures but also for reconsideration of the legal issues since many patients admitted with sepsis can be assumed to have had abortions induced.

Abortion, Illegal

Trends in rates of live births and abortions following state restrictions on public funding of abortion.

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.

Abortion, Legal

Death after legally induced abortion. A comprehensive approach for determination of abortion-related deaths based on record linkage.

The sources for determination of abortion-related deaths in Georgia are the cause of death listed on the death certificate and reports from informal reporting channels. Although Georgia residents 10-44 years of age obtained 19,877 induced abortions in 1975, no deaths related to abortion were found through these two usual sources. To determine the sensitivity of this system, all abortion certificates for 1975 were compared with all death certificates of Georgia females aged 10-44 who died in 1975 and the first 2 months of 1976. Based on the age and racial distribution of the women who received abortions, approximately 13 deaths (from all causes) would be expected to have subsequently occurred during the period of time studied. The authors found only 10. From national death-to-case rates for legal abortion, the expected number actually atrributable to abortion was 0.78 death. Of the 10 deaths, 2 were potentially related to the previous abortion, but a causal relationship to the preceding abortion was not clearly evident for any of the 10 deaths. The data, therefore, tend to support the assertion that no large numbers of deaths related to abortion are undiscovered and that current measurements of abortion mortality are accurate.

Abortion, Legal

Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976).

Both non-abortion-related maternal and abortion-related mortality declined prior to the Supreme Court decisions of 1973. In order to determine the effect of legalized abortion on maternal mortality, we have analyzed the secular trends in national abortion mortality ratios for 1940 through 1976, compared the trends to those maternal mortality ratios, and hypothesized reasons for differences between these trends. Between 1940 and 1950 and after 1965, deaths from abortion declined more rapidly than deaths from other causes associated with childbirth. However, between 1951 and 1965, maternal mortality related to pregnancy of childbirth declined more rapidly than abortion-related mortality. Five possible explanations exist for the more rapid decline in abortion deaths since 1965--selected underreporting, changes in coding practices, improved safety of illegal abortion, introduction of more effective contraception, and increased availability of legal abortion. We consider the last two explanations as the most likely reasons for the accelerated decline in abortion-related deaths.

Abortion, Legal

The effect of legalized abortion on morbidity resulting from criminal abortion.

In order to examine the effect of legalized abortion on the complications of criminal abortion, a surveillance system was established at a large urban hospital in Atlanta, Georgia. Between 1969 and 1973, legally induced abortions at this hospital increased logarithmically from 8 to 498 per quarter year. The number of women admitting to attempts at illegal abortion decreased significantly, but the decline began only after three years of increasing numbers of legal abortions. A slight decrease in the number of septic "spontaneous" abortions also occurred. Making legal abortion services available can result in a decrease in morbidity associated with illegal abortions, but the availability of legal abortion must be sufficiently broad to obviate having to resort to criminal means.

Abortion, Illegal

[I. Induced abortions and spontaneous abortions. Psychopathological aspects apropos of a preliminary sample of 411 requests for pregnancy interruption].

Since 1975 (17th January), abortion is free and legal in France. The authors analyse 411 first cases of women requiring for an abortion (seen over a period of 11 weeks). Most of them are young women, single, many begin their sexual life. Unwanted pregnancy indicates absence of contraception by ignorance, refusal or ambivalence (never used = 184 cases). 105 women used archaic and inefficient contraceptive means. Modern contraceptive means was used by 154 women but ill applied, ill tolerated and/or discarded (pill = 103 cases, I.U.D. = 14, diaphragme = 2, condoms = 35). Unwanted pregnancy and abortion signify failure of contraception. We compare psychologic and psychopathologic features of women requiring repeated induced abortion with those of women suffering of repeated spontaneous abortion and infertility. These women have frequently (same) problems of feminine identity, bad maternal imago, absence of father, unhappy, and conflictive childhood, immature sexuality and personnality. Contradiction between conscious and unconscious wishes create the two opposite situations and intrapsychic conflicts (spontaneous abortion = conscious willing of pregnancy + unconscious rejection of unbearable pregnancy; induced abortion = strong but unconscious wish of pregancy + conscious and volontary rejection of maternity). Psychotherapy should improve sexual and affective life and in both cases. The authors compare infanticide and abortion behaviors, contraceptive means, and psychological problems of doctors who are asked abortion.

Abortion Applicants

[Incidence of abortive ova among spontaneous abortions].

345 spontaneous abortions of the period 1975/76 are investigated histologically. 174 of them content chorionic villi (100 per cent). Among these we have found 91 abortive ovas (52.3 per cent), 7 hydatiform moles (4.0 per cent) and 35 histological regular abortions (20.1 per cent). Furthermore, 41 cases are suspicious of abortive ova (23.6 per cent) and, 22 cases show signs of early disturbances of placental maturation (12.7 per cent). In all groups there is inflammation of the maternal side and of the endometrium. Regressive changes of the villi are particularly severe in abortive ovas and in the suspicious cases. On the base of our own study of legal abortions as well as this material of spontaneous abortions we estimate the frequency of abortive ovas among all the pregnancies for about 15--25 per cent.

Abortion, Spontaneous

[Incidence of abortive ova in abortion material].

The material of 250 legal abortions is investigated histologically. In 47 cases we have found no trophoblastic tissue. Among the other 203 cases we diagnose 50 (24,6 per cent) abortive ova. 40 cases (19,7 per cent) are suspicious of abortive ovum. Only 7 cases (3,4 per cent) show signs of inflammation. Furthermore in 10 cases (4,9 per cent) early disturbances of placentation (maturation) are supposed. According to the statistical results of are supposed our hospital, the frequency of abortive ova among all pregnancies (number of deliveries, spontaneous abortions and legal abortions) is calculated for 14,9%. The real value of spontaneous abortions may be between 15 and 25 per cent.

Abortion, Legal

[Pilot study on assessing medical, psychological and psychosocial factors in stillbirth and spontaneous abortion and recurrent abortion].

84 women (mean age: 29 years) with a history of spontaneous abortion (unexplained in 95% of cases) were compared with a control group (n = 72). Two subgroups, each of 31 women were selected, in which cases with recurrent spontaneous abortion were compared with uncomplicated pregnancies. Psychological disturbances, ineffective coping strategies and medical risk factors were significantly increased in the abortion group, but socioeconomic (occupational, financial) problems linked with higher social class level less importantly. In women with recurrent spontaneous abortions psychological problems and depressive coping modes were predominant, in uncomplicated pregnancies the risk factors were very low. The most frequent psychological disturbances in the abortion group were mourning reactions after pregnancy loss. It appears that psychological factors are less a cause than the consequence of the abortion event. Moreover, both the multifactorial hypothesis of early pregnancy wastage, and the importance of prenatal diagnosis in order to identify possible risk factors, especially in cases of habitual abortion, are stressed.

Abortion, Habitual

Serum immunoglobulins in aborted and non-aborted bovine foetuses.

The concentration of immunoglobulin classes G, M and A (IgG, IgM and IgA) in the sera of 233 aborted and 201 non-aborted foetuses was measured. IgM was first detected in a foetus at day 90 of gestation while IgG and IgA were first detected on day 111 of gestation. Immunoglobulins were detected in 81.5% of aborted foetuses and 32.8% of non-aborted foetuses. Total immunoglobulin concentrations of 20 mg/100 ml or greater were found in 35.2% of aborted foetuses but only in 4.5% of non-aborted foetuses. It is suggested that factors resulting in antigenic stimulation of the foetus may play an important part in bovine abortion.

Abortion, Veterinary

[Frequency of abortion and seroprevalence of the principal diseases causing ovine infectious abortion in the area of Rabat (Morocco)].

A survey was carried out on 23 sheep flocks to estimate the frequency of abortion as well as the prevalence of antibodies against abortive infections. During the visit of each farm, a questionnaire was completed with the collaboration of the owner and blood samples were collected from all aborted ewes and some of those with normal lambing. A rate of 7% abortion was reached in both aborted and normally lambed ewes. Anti-Chlamydia psittaci antibodies were the most frequently detected (14 flocks). Anti-Coxiella burnetii and anti-Toxoplasma gondii antibodies were found in 9 flocks, whereas anti-Brucella and anti-Salmonella abortus ovis were present in only 1 flock each. None of the 5 infections was detected in 2 flocks. Mixed infections were prevalent: 13 flocks were simultaneously infected by at least 2 abortive pathogens. The procedure used does not allow the cause of abortion to be identified in all cases.

Abortion, Veterinary