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PubMed2004

Norplant insertions at the Zeynep Kamil Gynecologic and Pediatric Training Research Hospital in Istanbul.

OBJECTIVE: This study was conducted to determine sociodemographic characteristics and usage interval according to insertion period, observed side effects and reasons for discontinuation in 756 cases where Norplant was inserted and removed for any reasons at our hospital since 1994. METHODS: Seven-hundred and fifty-six cases in whom Norplant was inserted and removed since 1994 were included in our study. Sociodemographic characteristics, former contraception method, reasons for choosing this method and side effects seen during the usage period were determined. In all cases, reasons for discontinuation, sociodemographic characteristics and usage interval according to the insertion period were investigated. Statistical analysis of this study was performed with SPSS 9.0 (analysis of variance). RESULTS: Mean age of cases was 26.5 +/- 4.9 years, mean number of living children was 2.0 +/- 1.2, and 50.4% of cases had no health insurance. Most of the cases used coitus interruptus previously as a contraceptive method and chose Norplant use because of its effectiveness. Insertion periods were as follows: interval, n = 513 (67.9%); postpartum, n = 127 (16.8%) and postabortion, n = 116 (15.3%). Various side effects were detected in 79.8% of the cases. Bleeding problems were seen in 69.8%. Pregnancy occurred in only one case. Mean Norplant usage interval was 3.08 +/- 1.68 years. The longer usage interval was seen in cases with lower educational level. When we compared the usage intervals between interval, postpartum and postabortion periods, we found that the interval group had a shorter mean duration of Norplant use. Discontinuation because of bleeding problems occurred in 38.1%. Removal of all Norplant implants was performed at a single session in 731 cases (96.4%). After Norplant removal, most cases selected either condom or IUD as the contraceptive method. CONCLUSION: It is concluded that despite the frequent occurrence of side effects, Norplant is a modern, long-acting, highly effective, reversible, easy-to-use, satisfactory form of birth control, especially in selected cases.

Adult↗
PubMed2006

Contraception after medical abortion.

OBJECTIVES: This study's objectives were to examine current evidence on contraception after abortion and to formulate guidelines for the use of different contraceptives after medical abortion based on current evidence. METHODS: This study was based on review of published literature and guidelines on postabortion use of contraception. RESULTS: Contraception needs to be initiated early following a first-trimester abortion. Postabortion family planning is an integral part of comprehensive abortion care. Concurrent contraception with surgical abortion has been found to be practical and effective, with high contraception usage following abortion. Most methods can be safely used following medical abortion and can be initiated either on the day of misoprostol administration (oral pills, condoms and injectable contraceptives) or after the next menstrual cycle (intrauterine device and sterilization). CONCLUSION: With proper precautions, almost all contraceptive methods can be effectively used following medical abortion.

Abortion, Induced↗
PubMed1988

[Relationships following legal abortion--a longitudinal comparative study].

Although existence and functioning of a sexual relationship is of outstanding importance for the abortion decision as well as for the postabortive emotional adjustment, until now there are only some case studies focussing on the postabortive reaction of the sexual relationship. Results of a representative and controlled follow-up-study investigating the effects of legal abortion on the relationship with a partner are reported here. 117 women, a representative sample of all 263 women having a socially indicated legal abortion during the first 3 months of 1982 in Kiel, were interviewed some days before and 1 year after the abortion. The effects of abortion on the sexual relationship are described in comparison with a control group with similar preabortive characteristics of partnership using hormonal or intrauterine contraceptive devices. Rate and circumstances of separation, especially the role of abortion for the separation, as well as the quality of the remaining relationships have been analysed. We could find preabortive variables easily accessible for the counselor, predicting the development of the sexual relationship regarding quality and stability in the year after abortion.

Abortion, Legal↗
PubMed2004

Routine follow-up visits after first-trimester induced abortion.

Routine follow-up visits after abortion are intended to confirm that the abortion is complete and to diagnose and treat complications. Many clinicians also take advantage of the follow-up visit to provide general reproductive health care: discussing contraceptive plans and providing family planning services; diagnosing sexually transmitted infections; performing a Pap test or discussing abnormal Pap results. We reviewed the evidence related to the routine postabortion follow-up visit. Other than mifepristone medical abortion performed at 50 days of gestation or later and methotrexate medical abortion, we found little evidence that mandatory follow-up visits typically detect conditions that women themselves could not be taught to recognize. In addition, the natural history of the most severe complications after abortion-infection and unrecognized ectopic pregnancy-have time courses inconsistent with the usual timing of the follow-up visit. Costs associated with this visit can be great. These include travel expenses, lost wages, child-care expenses, privacy and emotional burdens for women, and scheduling disruptions and the related opportunity costs caused by "no-shows" for the provider. Follow-up appointments should be scheduled for those women likely to benefit from a physical examination. For the remainder of women, simple instructions and advice about detecting complications, possibly coupled with telephone follow-up, might suffice. Although arguably valuable in their own right, counseling, family planning services, or sexually transmitted infection diagnosis and treatment should not be so inflexibly bundled with postabortion care. Protocols that require in-person follow-up after abortion may not make the best use of a women's time or abilities, or of the medical system.

Abortion, Induced↗
PubMedDate not supplied

Anxiety in Japanese women after elective abortion.

OBJECTIVE: To examine women's anxiety levels after elective abortion. DESIGN AND SETTING: Women seeking elective abortion at six clinics in Japan were solicited to participate in a questionnaire survey. PARTICIPANTS: Sixty-six Japanese women requesting abortion participated in this survey. MAIN OUTCOME MEASURES: State anxiety was measured using Spielberger's State Trait Anxiety Inventory before and after abortion. RESULTS: Multiple regression analyses using predictor variables with a significant link to postabortion anxiety level showed that among potential predictors, a conservative attitude toward abortion was the most significant predictor of postabortion anxiety after controlling for the level of preabortion anxiety. CONCLUSION: These findings suggest that a woman's attitude toward abortion and reproductive rights is an important but neglected factor influencing postelective abortion anxiety. Medical and nursing professionals should, therefore, take note of a woman's attitude toward abortion as a part of her mental health care.

Abortion, Induced↗
PubMed1998

Molecular cloning and characterization of the genes coding for the highly immunogenic cluster of 90-kilodalton envelope proteins from the Chlamydia psittaci subtype that causes abortion in sheep.

Proteins present in the outer membrane of chlamydiae that are involved in mucosal epithelial cell infection must clearly be identified and characterized if we are to understand and modify the pathogenic mechanisms utilized by these organisms. We have identified and isolated a family of four genes encoding putative outer membrane proteins (POMPs), a group of proteins of approximately 90 kDa present in the outer membrane of the subtype of Chlamydia psittaci that causes ovine enzootic abortion (strain S26/3). These proteins, although minor components, are major immunogens, as shown by the immunoblotting of chlamydial outer membrane complexes with postabortion sheep sera, and are therefore potential diagnostic and/or protective antigen candidates. Immunoblotting of the expressed amino- and carboxy-terminal halves of one of the POMPs with postabortion sheep sera showed that the major humoral immune response appeared to be directed solely against the amino-terminal half. This result, in combination with the positive immunofluorescence staining of S26/3-infected cells using POMP-specific (specific to the amino-terminal half of the proteins) monoclonal antibodies, suggests the probable surface localization of the POMPs and, more specifically, the surface exposure of the amino-terminal half of these proteins. The four pomp genes are highly homologous, sharing 82 to 100% similarity with each other (two of the genes are identical). Genes with strong and weak homologies were also detected in C. psittaci avian and feline pneumonitis strains, respectively. No pomp homologs were found in strains of C. trachomatis and C. pneumoniae, but this does not preclude their existence. The absence of homology with various subtypes of C. pecorum, which complicate the diagnosis of the ovine abortion subtype, indicates the possible suitability of the these 90-kDa proteins as serodiagnostic antigens.

Amino Acid Sequence↗
PubMed2005

The incidence of induced abortion in the Philippines: current level and recent trends.

CONTEXT: In the Philippines, abortion is legally restricted. Nevertheless, many women obtain abortions--often in unsafe conditions--to avoid unplanned births. In 1994, the estimated abortion rate was 25 per 1,000 women per year; no further research on abortion incidence has been conducted in the Philippines. METHODS: Data from 1,658 hospitals were used to estimate abortion incidence in 2000 and to assess trends between 1994 and 2000, nationally and by region. An indirect estimation methodology was used to calculate the total number of women hospitalized for complications of induced abortion in 2000 (averaged data for 1999-2001), the total number of women having abortions and the rate of induced abortion. RESULTS: In 2000, an estimated 78,900 women were hospitalized for postabortion care, 473,400 women had abortions and the abortion rate was 27 per 1,000 women aged 15-44 per year. The national abortion rate changed little between 1994 and 2000; however, large increases occurred in metropolitan Manila (from 41 to 52) and Visayas (from 11 to 17). The proportions of unplanned births and unintended pregnancies increased substantially in Manila, and the use of traditional contraceptive methods increased in Manila and Visayas. CONCLUSION: The increase in the level of induced abortion seen in some areas may reflect the difficulties women experience in obtaining modern contraceptives as a result of social and political constraints that affect health care provision. Policies and programs regarding both postabortion care and contraceptive services need improvement.

Abortion, Induced↗
PubMed1991

Antibiotic prophylaxis in hysterectomy and induced abortion. A review of the evidence.

By the early 1980s, perioperative prophylaxis in vaginal hysterectomy had been shown consistently to be of such value in reducing postoperative infection that some authors maintained that further placebo-controlled studies were no longer ethical. The benefit of prophylaxis in abdominal hysterectomy was less uniformly demonstrated, in studies which were prospective, placebo-controlled, double-blind and randomised. Prophylaxis may significantly reduce the incidence of febrile morbidity and/or wound/pelvic infection, the duration of hospital stay, or the total usage of antibiotics. It is therefore generally agreed that each centre should itself scientifically evaluate the efficacy of prophylaxis before a decision on its routine use in abdominal hysterectomy is made. In comparative studies, agents which were active against both anaerobic and aerobic organisms were more efficacious than those active against anaerobes only. Antibiotics with similar spectra of activity showed similar efficacy in both types of hysterectomy. Multiple- and single-dose regimens of the same antibiotics also showed equal efficacy. The new cephalosporins with a longer half-life were attractive theoretically as agents in single-dose regimens; ceftriaxone, however, has been shown to have an adverse effect on the normal gut flora. With the increased numbers of induced abortions carried out in the UK and other parts of the world in recent years, the need to reduce postabortal infection is generally appreciated. The results of early studies using tetracyclines as the prophylactic agents were difficult to evaluate because of the incomplete follow-up and different definitions of pelvic infections. No benefit was demonstrated in 2 studies using a single preoperative dose of tinidazole, whereas oral metronidazole in 3 doses and penicillin/pivampicillin for 4 days were shown to be efficacious in reducing postabortal infection. In a recent study with doxycycline, significant benefit was shown in patients with negative preoperative screening for gonococcal and chlamydial infection. These genital infections, together with a history of previous pelvic inflammatory disease (PID)/gonorrhoea, nulliparity with multiple partners, young age of the patient and gestational age have been described as significant risk factors. Some researchers hold the view that selective prophylaxis based on these risk factors should be practised instead of mass prophylaxis. All agree that an antibiotic regimen that is both efficacious and well tolerated has yet to be found.

Abortion, Induced↗
PubMed1997

Transvaginal sonohysterography for the early diagnosis of residual trophoblastic tissue.

We prospectively evaluated 29 patients with early postabortion or postpartum bleeding, suspected of having possible retained trophoblastic tissue by transvaginal sonography and transvaginal sonohysterography. All patients received methyl-ergometrine maleate (Sandoz) and amoxicillin and clavulinic acid (Pharmascope) orally for 5 days and were then reevaluated. Ten patients (34.5%) had a normal uterine cavity on both transvaginal sonography and sonohysterography. Nineteen patients (65.5%) were suspected of having residual trophoblastic tissue by transvaginal sonography. Of these, five (26%) showed normal uterine cavity by sonohysterography. One patient (8.3%) reported heavy bleeding with clots after the conservative treatment. Repeated examination revealed normal uterine cavity. The remaining patients underwent curettage, and histopathologic examination revealed trophoblastic tissue. Transvaginal sonohysterography is more accurate than transvaginal sonography for diagnosing residual trophoblastic tissue in patients with postpartum and postabortion bleeding. Its use may eliminate unnecessary curettage procedures.

Abortion, Induced↗
PubMed2000

Lymphocyte subpopulations after normal pregnancy and spontaneous abortion in primigravidas.

OBJECTIVE: To evaluate lymphocyte subpopulations after a first pregnancy in women who had normal pregnancies and in those whose pregnancies terminated in spontaneous abortion. STUDY DESIGN: Sixty healthy, nonpregnant women in three groups were studied: 20 with a prior abortion, 20 with a prior normal pregnancy and 20 nulligravid. Peripheral blood lymphocytes were studied using monoclonal antibodies and flow cytometry. Women were followed for one year, and if they became pregnant again, pregnancy complications were recorded. RESULTS: The percentage of B lymphocytes was significantly decreased in the postpartum group (6% +/- 2.22) in comparison to nulligravid women (8.7% +/- 3.37) (P = .005). The percentage of CD4 lymphocytes was significantly higher in the postabortion group (44.7% +/- 7.81) in relation to the control group (39.85% +/- 6.01) (P = .03). A significantly higher CD4/CD8 ratio was found in the postabortion group in relation to the control group (1.65 vs. 1.24) (P = .01). Women with pregnancy complications in their next pregnancy had a lower absolute value for total lymphocytes (P = .02), T lymphocytes (P = .04), absolute CD8 lymphocytes (P = .01) and percentage of CD8 lymphocytes (P = .02) and a higher percentage of CD4 lymphocytes (P = .03) and higher CD4/CD8 ratio (P = .02) than women who had not experienced any pregnancy complications. CONCLUSION: The percentage of B lymphocytes was lower in normal primipara in comparison to women who had never been pregnant. Women with previous spontaneous abortions had an immunologic profile expected in a rejection phenomenon; that result was more marked if they went on to experience complications in their next pregnancies.

Abortion, Spontaneous↗
PubMed2003

Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases.

BACKGROUND: Pregnancy developing within a previous cesarean section scar is one of the rarest kinds of ectopic pregnancy. It can result in term pregnancy and therefore must be distinguished from cervical pregnancy. Irregular vaginal bleeding is common, but massive bleeding may lead to life-threatening situations. The treatment for postabortal or postpartal hemorrhage is total or subtotal hysterectomy. CASES: Three cases of pregnancy within scars from previous cesarean sections are reported. Two patients were transferred to our hospital due to postabortal hemorrhage for unwanted pregnancy. The third patient went to the emergency department for low abdominal pain with vaginal spotting and was mis-diagnosed as having a tubal pregnancy from the initial ultrasound examination. Exploratory laparotomy was done for evacuation of the abnormally implanted conception tissue. Transarterial embolization of bilateral uterine arteries (UAs) was performed to stop postoperative bleeding in one case and to prevent intraoperative hemorrhage in the other two. Subsequently, the postoperative bleeding case underwent cesarean delivery of a full-term infant following an uneventful pregnancy. CONCLUSION: Conservative surgical treatment following transarterial embolization of bilateral uterine arteries is an alternative method of managing the patients with early pregnancy in the scar from a cesarean section. This technique preserves the uterus and greatly reduces morbidity.

Adult↗
PubMed1992

[Preventive antibiotics in induced first-trimester abortion].

The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.

Abortion, Induced↗
PubMed1985

Metronidazole prophylaxis in elective first trimester abortion.

In a double-blind controlled trial, the efficacy of prophylactic metronidazole in elective first trimester abortions was assessed. Of 119 randomized women, 100 followed the protocol. Fifty-one women received 400 mg metronidazole one hour before and again four and eight hours after abortion; 49 women received a placebo. In the placebo group 20.4% contracted postabortal genital infection compared with 3.9% in the metronidazole group (P less than .025). Of 25 women with a positive history of pelvic inflammatory disease, six contracted postabortal infection, which was a significantly increased frequency compared with women without previous episodes of pelvic inflammatory disease (P less than .05). The administration of prophylaxis, however, did not significantly influence the frequency. The number of hospital days was not significantly lower in the prophylaxis group (P greater than .05). The total amount of metronidazole prescribed in the study group was significantly larger than in the placebo group (P less than .05), whereas the amount of ampicillin/pivampicillin prescribed in the placebo group was significantly larger (P less than .05). The difference between the penicillin doses given in the treatment and placebo groups was not significant (P greater than .1).

Abortion, Induced↗
PubMed1982

Cephalothin prophylaxis for midtrimester abortion.

A randomized prospective double-blind study was conducted to determine the efficacy of prophylactic antibiotics as compared with placebo in 198 women undergoing second-trimester intraamniotic injection abortions. Patients received either sodium cephalothin or placebo intravenously before the procedure and for up to 8 additional doses. In 11 patients postabortion endometritis developed; 2 had received the antibiotic and 9 had received a placebo (P less than .05). Prophylactic cephalothin decreased the incidence of endometritis in patients undergoing midtrimester injection abortion. An injection-abortion interval greater than 24 hours appears to identify patients at risk for the development of postabortion endometritis.

Abortion, Induced↗
PubMed1978

The psychiatric abortion consultation.

The role of the psychiatric consultant has changed with the recent liberal "on demand" abortion legislation. This paper emphasizes factors relevant to the psychiatric consultant in the evaluation of the adolescent patient, the retarded patient and the patient with psychiatric illness. In addition, a survey of the literature is made to identify the patient who is at high risk of developing postabortion psychiatric complications. The authors conclude that postabortion complications are infrequent and that there are no absolute psychiatric contraindications to elective abortion.

Abortion, Induced↗
PubMedDate not supplied

[Optimal terms for sterilization].

Sterilization can be performed in the immediate postpartum, post abortion, or as an interval procedure. Traditionally, postpartum sterilization should be performed within the first two days after delivery, thereafter the risk for infection is believed to increase. Sterilization and artificial abortion are performed as concomitant procedures, while interval sterilization is carried out at least six weeks after the termination of pregnancy. Though many authors consider the sterilization in the immediate postpartum and postabortion period safe enough, the comparative studies show that interval sterilization has less complications. Postpartum (postabortion) sterilization has much more disadvantages than advantages in comparison to interval sterilization. The main advantage of postpartum sterilization is only one hospitalization while disadvantages are the increased risk of hemorrhage, uterine perforation, thromboembolic disease, infection, technical difficulties, and psychological problems. For these reasons interval sterilization is recommended.

Abortion, Induced↗
PubMed1994

[Factors influencing incidence of spontaneous abortion, dyspareunia, dysmenorrhea and chronic pelvic pain].

The aim of this study was to investigate the association between on the one hand pelvic inflammatory disease (PID), induced abortion, postabortal complications and age and on the other the rate of spontaneous abortion. The influences of PID, induced and spontaneous abortion, postabortal complications, age and parity on the rates of dyspareunia, dysmenorrhea and chronic pelvic pain were also investigated. Questionnaires were given to all women referred for delivery and induced first-trimester abortion to the Department of Obstetrics and Gynaecology at Gentofte hospital during the period January-May 1988. Altogether 1229 women answered the questionnaire, 868 were referred for delivery and 361 for induced abortion. In 839 women without previous induced abortion, a history of PID was associated with an increased risk of spontaneous abortion (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.03-2.33); women above the age of 33 had a lower risk of spontaneous abortion (OR 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 one year of age reduced the risk of spontaneous abortion by 0.91 (95% CI 0.85-0.96). Women with any previous PID when compared to those without, more often had dyspareunia (14 versus 3%, OR 3.87, 95% CI 2.35-6.37) and chronic pelvic pain (six versus 0.4%, OR 13.07, 95% CI 10.09-16.04). Age was inversely associated with the incidence of dysmenorrhea (OR 0.94, 95% CI 0.91-0.97). We conclude that PID is associated with spontaneous abortion, whereas age correlates inversely with the rate of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1993

Sudden death due to rupture of ectopic pregnancy concurrent with therapeutic abortion.

We report three cases of sudden death resulting from internal hemorrhage associated with the rupture of an ectopic pregnancy. In each case, the woman had undergone therapeutic abortion before death. The ectopic pregnancies, however, were not suspected or identified before the women left the treatment facility. Subsequently, all three women suffered fatal rupture of a tubal pregnancy and associated massive intraperitoneal hemorrhage during the postabortive period (range, 14 to 32 days). Our investigation of these cases has identified the lack of standardized procedures for the adequate monitoring of tissue recovered during therapeutic abortion. Such monitoring could have resulted in identification of the ectopic pregnancy and possibly led to successful intervention. We discuss the causes and risks of failure to diagnose ectopic pregnancy during the postabortive period.

Abortion, Therapeutic↗