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PubMed2001

Mifepristone abortion in minors.

Approximately one-third of pregnant teenagers in the U.S. choose abortion. This prospective study evaluated whether medical abortion with mifepristone and misoprostol is physically and emotionally acceptable in adolescents. Adolescents 14- to 17-years-old, with pregnancies < or =56 days gestation, and seeking abortion services with parental consent from at least one parent were enrolled. Mifepristone (200 mg) was administered, followed 2 days later by 800 microg of misoprostol administered vaginally. Follow-up visit occurred on Day 4-8 to confirm abortion completion. Questionnaires regarding acceptability of the procedure as well as emotional coping were administered at the initial visit, at the follow-up visit, and by phone at 4 weeks postabortion. All 28 adolescents had complete medical abortions without complications or surgical intervention, and five minors did not require misoprostol. At the Day 4-8 follow-up visit, 75% of teens found the procedure acceptable, and that increased to 96% by the 4-week visit. Although 57% reported stress and 43% reported fear initially, by 4 weeks postabortion only 21% of the teens reported stress, and 8% were still experiencing fear. In addition, the minors' satisfaction with their abortion decision increased from 43% to 79% by 4 weeks postabortion. Medical abortion with mifepristone and misoprostol was highly effective and well tolerated, physically and emotionally, by adolescents in our sample. A larger clinical trial is needed to generalize these findings to other adolescent populations seeking medical abortion services.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

The effectiveness of preabortion contraception counseling.

OBJECTIVE: To demonstrate the impact of preabortion counseling followed by immediate postabortal provision of the chosen method on postabortion contraceptive use. METHODS: Three hundred and forty-two women undergoing voluntary termination of pregnancy at less than 10 weeks gestation were enrolled at the Woman and Child Health Training and Research Clinic, Medical School of Istanbul. Clinic visits and telephone surveys were performed to measure contraceptive use at 6 months following abortion. RESULT: Two hundred and thirty-six women either visited the clinic or responded to the telephone survey. Eighty percent of the respondents reported use of a modern contraceptive as compared to less than 40% prevalence found in the national survey. CONCLUSION: Preabortion counseling combined with immediate postabortal provision of contraceptives may significantly increase contraceptive use at 6 months postprocedure.

Abortion, Induced↗
PubMed1998

Emotional distress following induced abortion: a study of its incidence and determinants among abortees in Malmö, Sweden.

OBJECTIVE: To study incidence and determinants of emotional distress following induced abortion. SETTING: Department of Obstetrics and Gynecology, Lund University, University Hospital Malmö, Sweden. SUBJECTS: A series of 854 participants at 12-month postabortion follow-up, representing 66.5% of the 1285 women undergoing induced abortion at Malmö, 1989. METHODS: Analysis of data elicited at a semistructured interview 1 year after induced abortion, risk factors for emotional distress being determined in a "case" subgroup (n = 139) of women satisfying all the inclusion criteria (i.e., postabortion emotional distress, doubts about abortion decision, would not consider abortion again), as compared with a control group (n = 114) satisfying none of the inclusion criteria. The study design is a retrospective study. RESULTS: In the subgroup with emotional distress (duration ranging from 1 month to still present at 12-month follow-up), the following risk factors were identified: living alone, poor emotional support from family and friends, adverse postabortion change in relations with partner, underlying ambivalence or adverse attitude to abortion, and being actively religious. CONCLUSIONS: Thus, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases. The risk factors identified suggest that it may be possible to ameliorate or even prevent such distress.

Abortion, Induced↗
PubMed1989

Self-blame, self-efficacy, and adjustment to abortion.

The causal impact of attributions and coping self-efficacy on adjustment to abortion was examined. Two hundred and eighty-three women were randomly assigned prior to their abortion to 1 of 3 counseling interventions: 1 designed to alter attributions for unwanted pregnancy (ATT-INT), 1 designed to raise coping expectations (EXP-INT), or a control (standard counseling) group. Depression, mood, anticipated consequences, and physical complaints were assessed postabortion. Women in the ATT-INT or EXP-INT group were better adjusted immediately postabortion than women in the control group. The EXP-INT group was also less depressed than the ATT-INT group. Three individual difference factors were also related to better adjustment: high coping self-efficacy, low self-character blame, and low other-blame. Self-efficacy also predicted adjustment 3 weeks postabortion. Implications for theories of adjustment to major life events, therapeutic interventions to assist coping with such events, and public policy on abortion are discussed.

Abortion, Induced↗
PubMed1998

Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion.

We hypothesized that the effects of personality (self-esteem, control, and optimism) on postabortion adaptation (distress, well-being, and decision satisfaction) would be fully mediated by preabortion cognitive appraisals (stress appraisals and self-efficacy appraisals) and postabortion coping. We further proposed that the effects of preabortion appraisals on adaptation would be fully mediated by postabortion coping. Results of a longitudinal study of 527 women who had first-trimester abortions supported our hypotheses. Women with more resilient personalities appraised their abortion as less stressful and had higher self-efficacy for coping with the abortion. More positive appraisals predicted greater acceptance/reframing coping and lesser avoidance/denial, venting, support seeking, and religious coping. Acceptance-reframing predicted better adjustment on all measures, whereas avoidance-denial and venting related to poorer adjustment on all measures. Greater support seeking was associated with reduced distress, and greater religious coping was associated with less decision satisfaction.

Abortion, Induced↗
PubMed2001

Adolescents and adjustment to abortion: are minors at greater risk?

The authors tested the Supreme Court's assumption that minors are particularly susceptible to psychological distress following abortion. The responses of 38 minors (age < 18 years) were compared with those of 402 adults, 1 month and 2 years after an elective, 1st-trimester abortion. Minors were relatively less satisfied with their abortion decision and felt less benefit from the abortion than did adults 1 month postabortion, but they did not differ from adults in adjustment 2 years postabortion. Minors were not more depressed than adults at either time period, and their decision satisfaction and perceived benefit at both time periods did not suggest a population at risk. Age group differences in adjustment 1 month postabortion were explained by minors' reduced self-efficacy appraisals for coping, greater use of avoidant coping strategies, and greater perceived parental conflict. These findings challenge the Court's assumption that minors are particularly vulnerable to psychological harm following abortion.

Abortion, Induced↗
PubMed1976

Postpartum contraception: subsequent pregnancy, delivery, and abortion rates.

The first subsequent pregnancy rate in a group of women who accepted a variety of contraceptive methods after delivery and after therapeutic abortion is reviewed. Regardless of method chosen, 20 to 30% of postdelivery and 18 to 20% of postabortion patients were pregnant again after 1 year. In those patients who chose no method, 30 to 40% of postdelivery patients and 19 to 30% of postabortion patients were pregnant again 1 year later. When the postdelivery and postabortion patients were compared by outcome of this first subsequent pregnancy, there was no indication that subsequent therapeutic abortion was utilized to a greater extent by those who had had a prior therapeutic abortion than by those who had had a prior delivery.

Abortion, Therapeutic↗
PubMed2005

[Mortality case analyses of obstetric-gynecologic sepsis].

The aim of the study was the clinical and pathology description of patients who died due to post-delivery or postabortion sepsis. We performed the retrospective analysis based on the postmortem examination of patients who died after post-delivery or postabortion sepsis at the Anti-Sepsis Center during 1987-2000. For thirteen years at gynecological department of the Anti-Sepsis Center out of 524 patients hospitalized with the diagnosis of postpartum or postabortion sepsis 45 died (8.6%). During all those years lethality fluctuated between 2.2%-15.5%. The existence of extragenital diseases in pre-delivery period was afterwards the risk-factor for the development of polyorganic insufficiency with sepsis. These irreversible changes was the cause lethal outcome. The main factors were delayed hospitalization, severity of complications and septic shock.

Abortion, Induced↗
PubMed1985

Peroperative penicillins, bacteremia, and pelvic inflammatory disease in association with induced first-trimester abortion.

In a clinical, controlled trial including 474 women, 250 were randomised to prophylactic treatment with penicillin/pivampicillin and 224 to placebo treatment. Cervical, uterine, and blood cultures were obtained at abortion. In the treatment group, 13 percent developed bacteremia versus 14 percent in the placebo group. The distribution of species cultured from the cervix and uterus was not significantly different from that of the species recovered in the blood. A previous report found that women with a history of pelvic inflammatory disease (PID) carried a higher risk of contracting postabortal genital infection. However, the frequency of bacteremia in these women was not significantly different from the frequency in women without previous PID (p greater than 0.3). In women with and without postabortal infection, no significant differences were observed between the frequencies of bacteremia, either in the antibiotic group (p greater than 0.9) or in the placebo group (p greater than 0.7), suggesting that the release of bacteria into the blood stream from the instrumented tissues is without pathogenetic importance in postabortal infection.

Abortion, Induced↗
PubMedDate not supplied

[Advantages and disadvantages of IUD insertion immediately after abortion].

In 672 women the interval insertion of intrauterine contraception devices (IUD) was applied: Lippes loop D in 138 women. In 530 women the insertion was applied immediately after artificial abortion: Lippes loop C in 390 and Lippes loop D in 140 cases. Data on the effectiveness of intrauterine contraception were biostatistically treated. One- and two-year gross cumulative rates of pregnancy were 4.4 and 6.4, respectively 3.7 and 6.3 for the interval insertion of Lippes loop C and D, and 2.1 and 4.5, respectively 4.2 and 11.2 for the postabortion insertion of the same devices. Two-year cumulative rates of spontaneous expulsions of 18.5 and 8.1 for interval insertions were significantly higher than in the group of women in whom the insertion of the same devices was performed immediately after abortion and in whom these rates were 11.1 and 5.9. The removal of intrauterine contraception devices because of bleeding and pain, or because of both, with the rates of 6.4 and 3.2 in 100 women after a two-year use, was less frequent in the group of women in whom interval insertion was performed than in the group of postabortion insertions with the corresponding rates of 7.3 and 9.9, respectively. To prevent repeated abortions, a frequent use of postabortion IUD insertion is recommended. Only when an intensified bleeding is expected, it is advisable to postpone insertion at least until the first menstruation.

Abortion, Induced↗
PubMed1993

Factors influencing spontaneous abortion, dyspareunia, dysmenorrhea, and pelvic pain.

OBJECTIVE: To investigate the following: 1) the influence of pelvic inflammatory disease, postabortal complications, previous induced abortions, and age on the rate of subsequent spontaneous abortion; and 2) the influence of pelvic inflammatory disease, postabortal complications, previous induced abortions, previous spontaneous abortions, age, and parity on the rates of dyspareunia, dysmenorrhea, and chronic pelvic pain. METHODS: The study population consisted of a cohort of 1229 pregnant women, of whom 868 were referred for delivery and 361 for first-trimester abortion. Outcome measures examined were spontaneous abortion and the occurrence of dyspareunia, dysmenorrhea, and chronic pelvic pain. RESULTS: In 839 women without previous induced abortion, a history of pelvic inflammatory disease was associated with an increased risk of spontaneous abortion (odds ratio 1.55, 95% confidence interval [CI] 1.03-2.33); women above age 33 had a lower risk of spontaneous abortion (odds ratio 0.53, 95% CI 0.30-0.96). In 382 women with previous induced abortion, the influence of age on the rate of spontaneous abortion was continuous so that an increase of 1 year of age reduced the risk of spontaneous abortion by 0.91 (95% CI 0.85-0.96). Women with any previous pelvic inflammatory disease, when compared with those without, more often had dyspareunia (14 versus 3%; odds ratio 3.87, 95% CI 2.35-6.37) and chronic pelvic pain (6 versus 0.4%; odds ratio 13.07, 95% CI 10.09-16.04). Age was inversely associated with the incidence of dysmenorrhea (odds ratio 0.94, 95% CI 0.91-0.97). CONCLUSION: Pelvic inflammatory disease is associated with later spontaneous abortion, whereas age correlates inversely with the rate of spontaneous abortion. Spontaneous and postabortal pelvic inflammatory diseases carry significantly elevated risks of dyspareunia and chronic pelvic pain.

Abdominal Pain↗
PubMed1996

Transvaginal sonohysterography: a new aid in the diagnosis of residual trophoblastic tissue.

OBJECTIVE: The study was undertaken to evaluate the diagnostic accuracy of transvaginal sonohysterography in postabortion and postpartum patients suspected of having residual trophoblastic tissue. METHODS: Twenty two women with late postabortion and postpartum bleeding were evaluated by transvaginal sonography and transvaginal sonohysterography. The patients were prospectively divided into two groups according to the sonohysterographic findings. Women with an empty uterine cavity or with free-floating masses received conservative treatment. Those with suspected attached residual trophoblastic tissue underwent curettage. RESULTS: Sonohysterography confirmed the findings of two-dimensional sonography of an empty uterus in 8 patients; however, a free floating endometrial mass was found in 4 patients and that of an empty uterine cavity in another 2 of 14 patients suspected of having residual trophoblastic tissue by the two-dimensional ultrasound. All 14 patients who were treated conservatively ceased bleeding. The 4 patients with a free-floating mass reported ejection of a vaginal mass within 6 days of treatment. Eight patients underwent curettage. Residual trophoblastic tissue was found in all of them. CONCLUSION: Transvaginal sonohysterography is a simple and effective method for the evaluation of residual trophoblastic tissue in patients with postpartum and post-abortion bleeding. Its use may eliminate unnecessary curettage procedures.

Abortion, Incomplete↗
PubMed1977

Contraceptive practice after women have undergone "spontaneous" abortion in Indonesia and Sudan.

Studies of hospitalized "spontaneous" abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.

Abortion, Induced↗
PubMed1978

Second trimester abortion with 5% intraamniotic saline--a pilot study.

The risk of hypernatremia and related postabortion complications resulting from the intraamniotic administration of a 20-25% hypertonic saline solution, a widely used procedure all over the world, prompted this trial of 5% saline. Midtrimester abortion was induced in 150 women with a 5% saline solution administered intraamniotically at the National Medical College, Calcutta, India, from August 1974 to October 1975. The abortion was complete within 48 hours in 90% of the cases. All the fetuses were delivered dead. In one case, hysterotomy was performed because of severe bleeding. The immediate complication rate was 36% (12% serious). The follow-up complication rate was 2%. One patient died on the seventh postabortal day due to severe, uncontrolled septicemia. The authors conclude that because this procedure is simple and low cost and because it reduces the risk of hypernatremia it should be a welcome addition to service programs in developing countries.

Abortion, Induced↗
PubMed1994

The early prenatal sonographic diagnosis of renal agenesis: techniques and possible pitfalls.

Out of 13,252 cases in which fetal bilateral echogenic kidneys were detected by transvaginal sonography between 12 and 18 weeks' gestation, there were nine fetuses where oval hypoechogenic masses were detected in the renal bed. In five fetuses where hypoechogenic masses in the renal bed were sonographically visualized, postabortal examination was compatible with renal agenesis and the hypoechogenic masses proved to be enlarged adrenals. In three additional cases, unilateral renal agenesis was accompanied by unilateral enlarged adrenals, radiologically confirmed postnatally. In one case, a false-positive sonographic diagnosis of Potter syndrome was made because of bilateral hypoechogenic masses in the renal bed. Postabortal examination detected hypoplastic kidneys, but of normal histology, in a dyskaryotic fetus with trisomy 22. In four cases of renal agenesis, the amniotic fluid was of normal volume until the 17th week. In two of the five cases of Potter syndrome, a cystic structure, compatible with the urinary bladder, was detected in the pelvis at 14 weeks. The diagnostic criteria for renal agenesis in the early fetus differ from those used in the second half of gestation.

Adrenal Glands↗
PubMed2002

Bacterial Vaginosis Complicating Pregnancy and Gynecologic Surgery.

Bacterial vaginosis, the most commonly diagnosed vaginitis, has traditionally been regarded as a benign condition. However, recent evidence suggests association with preclinical miscarriage, early pregnancy loss, preterm labor, low birth weight infants, gynecologic surgical infections, and postabortal pelvic inflammatory diseases. Since studies show significant reduction in preterm labor and postabortal endometritis with treatment, it is recommended that bacterial vaginosis in high-risk women for preterm labor and women who undergo surgical abortion be treated regardless of symptoms. No treatment is recommended, however, for asymptomatic low-risk women.

Journal Article↗
PubMed1991

The effect of adding copper onto Lippes Loop IUDs: results from a ten-year study in Yugoslavia.

The present study is the first randomized ten-year comparison of the standard, non-medicated Lippes Loop D and the same device with the addition of 200 mm2 of copper in the form of copper sleeves. The devices were randomly inserted immediately after first trimester medical termination of pregnancy. Out of 400 postabortal IUD insertions, 371 were followed for up to ten years. Gross cumulative life-table accidental pregnancy rates after one year of use were 0.56 for the copper-bearing Lippes Loop and 4.63 for the standard Lippes Loop. After two, four and ten years, these rates were 1.24, 2.70 and 3.62 and 6.03, 7.58 and 14.94, respectively (in all comparisons, rates were significantly different at the 0.05 level or lower). At each time interval, expulsion/displacement rates were 4.49, 4.49, 5.23 and 6.32 for the copper-bearing Lippes Loop and 12.61, 13.29, 15.46 and 19.79 for the standard Lippes Loop (rates were significantly different at the 0.01 level or lower). Differences in removal rates for bleeding and/or pain were not significantly different at any of the follow-up intervals. The lower event rates for copper-bearing Lippes Loop D users indicates that the addition of copper to the Lippes Loop IUD may result in better long-term efficacy profiles for this device among postabortal women. The results also suggest that large, medicated IUDs may be more efficacious for women with larger uteri who often experience higher failure rates due to expulsion or displacement of smaller IUDs into the lower uterine segment.

Adolescent↗
PubMed1986

Observations on the use of prostaglandin F(2alpha) as an abortifacient and effect of gonadotrophin-releasing hormone on ovarian activity after induced abortion during the breeding season in goats.

Results of two experiments are described. In the first experiment, forty-one mixed-breed goats (does) with unknown gestation lengths were given 10 mg prostaglandin F(2alpha) (PGF(2alpha)) (2 doses of 5 mg each, 24 h apart) i.m. Blood samples were obtained before each treatment with PGF(2alpha) by jugular venipuncture, and plasma progesterone (P(4)) concentrations were determined by a nonextraction solid-phase radioimmunoassay. P(4) concentrations (ng/ml) were significantly decreased (15.47 vs 1.55, P<0.005) 24 h after the first injection of PGF(2alpha). A total of 63 fetuses was collected within 46.5 h following the first injection. Mean (+/- SE) crownrump lengths and body weights of 62 fetuses were 21.46 +/- 0.29 centimeters (cm) and 575.00 +/- 20.60 g, respectively. Based on these findings, the mean gestation length of these does was estimated to be 86.96 +/- 0.74 d. Thirty-one does retained their placenta for 12 to 72 h and were treated with a single injection of 5 mg PGF(2alpha) and 800 mg oxytetracycline i.m. Placental expulsion in all does occurred within 24 h posttreatment. The results of this study suggest that two doses of 5 mg PGF(2alpha) intramuscularly (i.m.) 24 h apart is an effective abortifacient at about 3 mo of pregnancy in does. In the second experiment, 38 does from the first experiment were divided in two groups of 19 each on Day 13 postabortion. Group A (treated) was given 50 ug GnRH i.m. while Group B (control) received 1 ml 0.9% saline i.m. Blood samples were obtained prior to treatment and on Day 23 postabortion and assayed for P(4) concentrations. There was no significant difference (P>0.10) in P(4) concentrations of samples obtained pre- and post-GnRH treatment. However, 14 of 19 and 12 of 19 in Groups A and B, respectively, exhibited estrus within 52 days following abortion. Twenty-six does were bred naturally and 17 became pregnant.

Journal Article↗