Search PubMed⌕ Search
Home/Archive/PubMed

PubMed · 15229018

Methods for induced abortion.

Phillip G Stubblefield·Sacheen Carr-Ellis·Lynn Borgatta
View original source ↗Export metadata ↓

Abstract

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.

Explore related subjects

Abortion, InducedDilatationFemaleHumansLabor, InducedPregnancyPregnancy Trimester, FirstPregnancy Trimester, SecondVacuum CurettageJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Phillip G Stubblefield, Sacheen Carr-Ellis, Lynn Borgatta. 2004. Methods for induced abortion.. https://doi.org/10.1097/01.aog.0000130842.21897.53

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Late human cytomegalovirus (HCMV) proteins inhibit differentiation of human neural precursor cells into astrocytes.

Human cytomegalovirus (HCMV) is the most common cause of congenital infections in developed countries, with an incidence varying between 0.5-2.2%. Such infection may be the consequence of either a primary infection or reactivation of a latent infection in the mother and the outcome may vary from asymptomatic to severe brain disorders. Moreover, infants that are asymptomatic at the time of birth may still develop neurologic sequelae at a later age. Our hypothesis is that infection of stem cells of the central nervous system by HCMV alters the proliferation, differentiation or migration of these cells, and thereby gives rise to the brain abnormalities observed. We show that infection of human neural precursor cells (NPCs) with the laboratory strain Towne or the clinical isolate TB40 of HCMV suppresses the differentiation of these cells into astrocytes even at an multiplicity of infection (MOI) as low as 0.1 (by 33% and 67%, respectively). This inhibition required active viral replication and the expression of late HCMV proteins. Infection as late as 24 hr after the onset of differentiation, but not after 72 hr, also prevented the maturation of infected cultures. Furthermore, in cultures infected with TB40 (at an MOI of 1), approximately 54% of the cells were apoptotic and cell proliferation was significantly attenuated. Clearly, HCMV can reduce the capacity of NPCs to differentiate into astrocytes and this effect may provide part of the explanation for the abnormalities in brain development associated with congenital HCMV infection.

Abortion, Induced↗
PubMed2007

New Hampshire House Bill 1719-FN. "An act defining human life as beginning at the moment of fertilization for the purposes of prenatal, pregnancy, and maternity services and programs".

Recently, the author was asked by the New Hampshire State Medical Society to testify before the State of New Hampshire's House Judiciary Committee, to address a bill that would establish the definition of when human life begins. Other states, such as South Dakota, recently passed a ban on abortion. Such legislation will severely limit a woman's ability to exercise her right to terminate her pregnancy. With the present composition of the US Supreme Court, it seems possible that in the not-too-distant future there will be a successful challenge to Roe v Wade. It is important that as health care providers we take the time to educate our public officials and general citizenry about the complexity of such issues. The subsequent editorial will paraphrase the statement that was delivered. Fortunately, the bill was defeated.

Abortion, Induced↗
PubMed2007

Arias-Stella reaction in upper genital tract in pregnant and non-pregnant women: a study of 120 randomly selected cases.

AIMS: 1. To study the diagnostic importance of the Arias-Stella reaction. 2. To study tubal epithelial changes in ectopic pregnancy. 3. To study the occurrence of Arias-Stella reaction in non-pregnant women receiving hormonal treatment. METHODS: A prospective study was conducted on 120 patients who underwent endometrial curettage and/or salpingectomy. The patients were divided into four groups, each comprising of 30 patients. Groups 1 and 4 included non-pregnant patients who were being evaluated for infertility and dysfunctional uterine bleeding respectively, while pregnant patients were included in Group 2 (intra-uterine abortions) and Group 3 (ectopic tubal gestation). The endometrial curettings and fallopian tube lining epithelial cells were examined for the changes described by Arias-Stella. Cases which showed the presence of the Arias-Stella reaction were further classified. RESULTS: The changes of the Arias-Stella reaction in endometrial glands were observed in 80% cases of intra-uterine abortions. Secretory/hypersecretory pattern was the most commonly observed type (36.67%). The reaction was seen in 3.33% each of patients evaluated for infertility and patients on hormonal therapy with oral progestational agents for the management of dysfunctional uterine bleeding. Although uncommon, the Arias-Stella reaction was noted in the epithelium of fallopian tubes (16.67%) from patients with ectopic tubal gestation. CONCLUSION: The findings of the present study emphasize the diagnostic importance of the Arias-Stella reaction. The changes of the reaction are a histological clue to the presumptive diagnosis of the presence of chorial tissue in cases in which the chorionic material is not found in the endometrial biopsy. The morphological features can be mistaken for malignancy if the pathologist is not aware of the patient's pregnancy or history of hormonal intake.

Abortion, Induced↗