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A new look at an old technique: sterilization by infundibulectomy.

Removal of the fimbriated portion of the fallopian tube is, theoretically, quite an effective method of sterilization that has received scant attention in the recent medical literature. In this study 310 cases of infundibulectomy via laparotomy performed at the Castle Street Hospital for Women in Colombo, Sri Lanka, were analyzed. Most of the patients (88.4%) were sterilized within 10 days of the vaginal term delivery whereas the remainder were sterilized in the immediate postabortion period. General anesthetic was used in 93.9% of the procedures. Difficulties at surgery which prevented infundibulectomy were encountered in three cases (1.1%). Infection and other incision problems were the primary complications. Incision infection was noted prior to discharge in four postpartum cases (1.5%) and in no postabortion cases. At the time of the first follow-up visit, seven to 21 days after sterilization, this complication was noted in eight postpartum women (3.1%) and in one woman (2.8%) who had had an abortion. No pregnancies have been reported among the 169 patients who have already been seen at the six-month follow-up visit. The results of this study indicate that infundibulectomy is a safe and effective method of tubal occlusion for postpartum patients.

Adult↗

Mortality associated with sterilization: preliminary results of an international collaborative observational study.

Sterilization is the contraceptive method most widely used worldwide, yet the case-fatality rate of deaths attributable to sterilization is not known. We used data collected from 1971-1979 from 28 countries by Family Health International to estimate case-fatality rates. We adjusted these rates for individuals lost to follow-up. Of 41,834 sterilizations, 23 resulted in deaths temporally associated with the procedure used. The adjusted attributable case-fatality rates were 13.4 per 100,000 for interval procedures, 53.3 per 100,000 for postabortion procedures, and 43.4 per 100,000 sterilizations after vaginal delivery. Multiple factors contributed to the deaths, including pre-existing health problems, infection and anesthesia. Prevention of deaths resulting from sterilization depends on complete ascertainment of deaths associated with sterilization and careful investigation to determine preventable risk factors. We conclude that, overall, sterilization in these programs was conducted with very low attributable mortality.

Female↗

Contraceptive practice before and after therapeutic abortion. II. Use-effectiveness of oral contraceptives and intrauterine devices.

Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.

Abortion, Therapeutic↗

Perceived social support, self-efficacy, and adjustment to abortion.

Prior to their having a 1st trimester abortion, women's perceptions of social support from their partner, family, and friends and self-efficacy for coping were assessed. Depression, mood, physical complaints, and anticipation of negative consequences were measured after the 30-min recovery period. As predicted, perceived social support enhanced adjustment indirectly through its effects on self-efficacy. Women who perceived high support from their family, friends, and partners had higher self-efficacy for coping. Higher self-efficacy, in turn, predicted better adjustment on the psychological measures but not on the physical complaint measure. No direct path between social support and adjustment was observed. In addition, women who told close others of their abortion but perceived them as less than completely supportive had poorer postabortion psychological adjustment than either women who did not tell or women who told and perceived complete support.

Abortion, Induced↗

Mental models of attachment and coping with abortion.

This study explored the relationships between mental models of attachment and adjustment to abortion in 408 women undergoing a 1st-trimester abortion at a large free-standing abortion clinic. As expected, mental models of attachment were related to postabortion distress and positive well-being. These relationships were mediated by feelings of self-efficacy for coping with abortion, perceived support from a woman's male partner, and perceived conflict from this same source. Model of self and model of others interacted only in predicting perceived conflict and positive well-being. Model of self was more strongly related to the mediator and outcome variables than was model of others. The effects of model of self, however, were largely a reflection of the overlap between model of self and self-esteem.

Abortion, Induced↗

[Operative complications of laparoscopic tubal sterilization with Bleier clips (author's transl)].

The operative complications of 1613 laparoscopic tubal sterilization with Bleier clips were evaluated in a prospective study at the Stadtkrankenhaus Offenbach/M from March 1978 to July 1981 (1239 interval and 374 postabortal procedures; two-puncture technique under general endotracheal anaesthesia). No major complications requiring laparotomy occurred. Minor intraoperative complications were observed in 8.4% of cases. Clip-related problems were encountered in 1.9% (slight tubal or mesosalpingeal bleeding). Other complications included haemorrhage at the puncture site (2.4%), preperitoneal emphysema (1.8%) and uterine perforation during curettage (1,6%). Technical difficulties were recorded in 8,4% of sterilizations; in 6.6% more than one clip per tube was placed to effect complete tubal occlusion. Adnexal pathology prohibited bilateral clip application in 4 women (0.3%). Postoperative complications were negligible. No pregnancies have yet been reported during a mean follow-up period of 17 months. A successful refertilization procedure was performed on one patient. It is concluded that this technique represents a commendable alternative to convention methods of tubal sterilization due to its low operative morbidity, acceptable contraceptive safety and potential reversibility.

Abortion, Legal↗

A comparison of the delta copper T and the copper T 200 in Bologna, Italy.

An analysis is presented of a comparative study of the Delta T and Copper T 200 IUDs. A total of 195 postabortion insertions was performed between March 1981 and August 1982. All insertions were performed with an inserter. Primary bleeding/pain complaints after insertion were largely related to intermenstrual problems, with spotting the most frequently reported. Nine women had their devices removed for PID. One pregnancy occurred at ten months in the Delta T group. Both groups had one expulsion/displacement. Eight devices in each group were removed for bleeding/pain. Two women in the TCu group had their devices removed for personal reasons. The 6-months continuation rates for the two groups were 85.5 for the Delta T group and 82.2 for the TCu group. The 6-months follow-up rate for the Delta T group was 39.4 and 38.8 for the TCu group.

Abortion, Induced↗

Rh hemolytic disease. Epidemiologic surveillance in the United States, 1968 to 1975.

Nationwide surveillance of Rh hemolytic disease of the newborn showed that associated infant mortality decreased from 941 deaths in 1968 to 269 deaths in 1975, or from 2.7 to 0.9 per 10,000 live births. The incidence of Rh hemolytic disease declined from 45 per 10,000 total births in 1970 to 21 per 10,000 in 1975. In 1970, an estimated 16,000 infants were affected, whereas in 1975, the number was 6,000. Several state-based Rh disease surveillance programs reported declining mortality and incidence and increasing use of Rh immune globulin. Rh immune globulin was administered to an estimated 80% of eligible Rh-negative women in 1974, eighty-one percent in 1975, and 82% in 1976. More concerted efforts are needed to determine the frequency of maternal sensitization and to identify and correct gaps in postpartum and postabortion use of Rh immune globulin.

Erythroblastosis, Fetal↗

Exencephaly-anencephaly sequence: proof by ultrasound imaging and amniotic fluid cytology.

We present and discuss major current theories about the developmental natural history of the anencephalic human fetus. We confirm previous observations made using transvaginal ultrasonography of exencephalic fetuses which were later imaged and/or delivered as anencephalic fetuses. We explore the possibility of proving the theory of the slowly rubbed-off exposed brain tissue by cytologic examination and special staining of aspirated cells in amniotic fluid. Three fetuses with a typical sonographic picture of exencephaly at 13-15 postmenstrual weeks underwent amniocentesis. The aspirated fluid contained pathognomonic neural cells. The same fetuses later showed the characteristic sonographic and postabortion picture of anencephaly. Our results support the theory that exencephaly is the forerunner of anencephaly.

Amniocentesis↗

Antibiotics for incomplete abortion.

OBJECTIVES: The value of routine antibiotics before surgical evacuation of the uterus in women incomplete abortion is controversial. In some health centres antibiotic prophylaxis is advised in others antibiotics are only prescribed when there is signs of infection. The objective of this review is to evaluate the effectiveness of routine antibiotic prophylaxis to women with incomplete abortion. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE and Popline. Date of last search: January 1999. SELECTION CRITERIA: Randomised trials comparing a policy of routine antibiotic prophylaxis with no routine prophylaxis were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two reviewers independently. Trial quality was assessed. MAIN RESULTS: One study involving 140 women was included. A second well-conducted trial was excluded because of high losses to follow-up. No differences were detected in postabortal infection rates with routine prophylaxis or control. However, compliance with antibiotic treatment was also low. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion.

Abortion, Incomplete↗

Arias-Stella reaction in a cervicovaginal smear of a woman undergoing infertility treatment: a case report.

Arias-Stella reaction commonly is seen in gestational endometrium, but rarely is described outside the endometrium, particularly in nonpregnant women. Although the cytological diagnoses of Arias-Stella reaction by cervical Papanicolaou (Pap) smears in pregnant, postpartum, and postabortal women are documented, to our knowledge, this is the first report of Arias-Stella reaction in a cervicovaginal smear of a nonpregnant woman undergoing infertility treatment with clomiphene and beta-human chorionic gonadotropin (beta-HCG). The cytological features observed in this case were characteristic of Arias-Stella reaction but mimic malignancy leading to initial misinterpretation. It is of paramount importance to recognize this phenomenon in cervical Pap smears, especially in women receiving ovulation-inducing agents and exogenous hormonal treatment to avoid this potential cytological pitfall.

Adenocarcinoma↗

Study of "spontaneous" abortion in Thailand.

This analysis includes data on 3 530 patients with septic or incomplete, inevitable or threatened abortions who were treated at the Siriraj Hospital in Bangkok between January 1972 and December 1973. Data on the patients' socio-demographic characteristics; their reproductive, abortion, and medical histories; their pre- and postabortion contraceptive acceptance; and a clinical profile of their abortion treatment, including procedure time, length of hospitalization, and immediate and delayed postoperative complications are analyzed.

Abortion, Incomplete↗

Reducing the morbidity of vacuum aspiration abortion.

This paper reports an analysis of the measures taken at Preterm, Inc, of Washington, DC, to reduce the incidence of complications of first trimester outpatient abortions. Data are presented on the 291 complications (40.0/1000) resulting from 7272 procedures performed during 1976. Forty-one women were hospitalized (5.6/1000). It has been our experience that routine use of ultrasonography when gestational age is unclear, careful examination of tissue especially when a small quantity is present and early use of reevacuation to diagnose and treat postabortal complications are essential in reducing the incidence and severity of abortion complications.

Abortion, Legal↗

Tubal occlusion via laparoscopy in Latin America: an evaluation of 8186 cases.

Ease of performance, safety and effectiveness of laparoscopic sterilization techniques are evaluated for 8186 procedures (6995 interval, 680 postabortion and 511 postpartum) performed in Latin America from June 1972 through February 1978. The tubes were occluded via electrocoagulation or application of the spring-loaded clip or the tubal ring. Less than 1% of the procedures were declared technical failures (ie, those which were not completed as planned). For all the tubal occlusion techniques, interval patients had the lowest rate of surgical complications. Pregnancy rates were low for the electrocoagulation and for the tubal ring techniques; patients sterilized by the spring-loaded clip, however, had a significantly higher pregnancy rate.

Actuarial Analysis↗

Susceptibility of abortion patients to infection: Correlation to cervical flora.

Cervical bacterial microflora was studied with a semiquantitative method in 29 women both before and after the termination of their pregnancy. The main findings were high prevalence of anaerobic bacteria (in 72%-79% of the specimens) consisting predominantly of Bacteroides species and anaerobic Gram-positive cocci, and low prevalence of aerobic bacteria (in 24%-38% of the specimens). Among the other microbes studied, the prevalence of Chlamydia excretors was high (24%), probably reflecting a promiscuous study population. Seventeen percent of the women developed febrile postabortion endometritis or salpingits. However, the cervical culture results predicted neither the patient prone to infection nor her response to antimicrobial treatment, suggesting the need for more data concerning the virulence properties of the bacteria, together with isolation of the organism from an infected site.

Abortion, Spontaneous↗

Prenatal diagnosis of inherited epidermolysis bullosa in a patient with no family history: a case report and literature review.

OBJECTIVE: The junctional form of epidermolysis bullosa (EB) is a recessively inherited mechanobullous disease in which minimal trauma results in blister formation at the dermal-epidermal junction. A rare form associated with pyloric atresia (JEB-PA) is a severe clinical subtype leading to rapid demise after birth, thus justifying prenatal diagnosis. The case characterized by abnormal ultrasound findings at 35 weeks of gestation (gastric dilatation associated with polyhydramnios) of a patient with no family history is reported. METHOD: Postabortion skin biopsies were analyzed by immunofluorescence that revealed marked reduction of integrin alpha6beta4 in accordance with the diagnosis of JEB-PA. RESULTS: Amniotic fluid contained excess total protein (4 MoM), abnormally high AFP (20.4 MoM) related to skin lesions and abnormally elevated digestive enzyme suggestive of fetal vomiting of bile. The electrophoretic pattern of cholinesterases was unusual (additional slow band). Maternal serum AFP was 3.14 MoM and free beta-hCG 13.1 MoM. Because of these concomitant findings, JEB-PA was suspected. CONCLUSION: The case under study was atypical because of late clinical manifestations of the disease: polyhydramnios, gastric enlargement. As maternal serum AFP at 15 weeks may be normal, it was suggested that discovery of polyhydramnios during the second or the third trimester should prompt biochemical analysis of amniotic fluid, such as AFP and GGTP assay in all cases.

Adult↗

Assessment of archived paraffin-embedded cervical condyloma tissues for mycoplasma-conserved DNA using sensitive PCR-ELISA.

Clinically, it is important to detect mycoplasmas because these organisms have been implicated in gastric and ovarian cancer, pneumonia, postabortal fever, pelvic inflammatory disease, pyelonephritis, endometritis, urethritis, perinatal mortality, arthritis, spontaneous abortion, infertility and interference with sperm development and they act as cofactors catalyzing the HIV disease state. Recently, the combined polymerase chain reaction and enzyme-linked immunosorbent assay method targeting the consensus DNA of over 15 species of mycoplasmas was shown to be superior for the detection of mycoplasmas. The objective was to determine if there was an association between mycoplasmas and cervical neoplasia. Cervical tissues, histopathologically categorized by cervical intraepithelial neoplasia (CIN) grade, flat or exophytic, and acanthosis or koilocytotic, were used. The results showed that mycoplasmas DNA were present in 21.4% of the condyloma tissues and in 33.3% of condyloma tissues with CIN. In contrast, mycoplasmas DNA were not detected when there were no CIN. The presence or absence of human papillomavirus (HPV) did not make a difference. Mycoplasmas DNA were present in 40.0 and 12.5% of the exophytic and flat condylomas, respectively. A higher percentage of cervical tissues graded with slight koilocytosis had (P = 0.05) mycoplasmas DNA compared with tissues graded with moderate koilocytosis. The detection of mycoplasmas DNA in archived cervical condyloma tissues with CIN corroborated previous reports of an association between mycoplasmas and CIN. However, the association between mycoplasmas and the presence of HPV could not be made in this study.

Condylomata Acuminata↗

Clinical experience with the MLCu250 IUD (eight-year results).

Between 1977 and 1981, 1561 MLCu250 standard model IUDs were inserted at the Family Planning Center, Department of Obstetrics and Gynecology, University Medical School of Debrecen, Hungary. The majority were in the first (61.3%) and second (32.2%) segment and only a few were in the third (5.4%), fourth (1.0%) or fifth (0.1%) segment. Insertions were performed in the postmenstrual, postabortal, postpartal and postpuerperal periods. This report evaluates the data for interval insertions only, representing a total of 1457 cases and 65762 woman-months of use during an 8-year follow-up period. Using Tietze's life table technique, cumulative and yearly specific termination rates have been calculated. Fifty per cent of the devices were in place after 5 years of use, and 27.8% of the patients wore the IUD even at the end of the eighth year after insertion. The pertinent termination rate (pregnancy, expulsion, removal for bleeding/pain and for other medical reasons together) was 56.8 in the 96th ordinal month. These findings prove the good over-all performance of the MLCu250 IUD and demonstrate a longer life span for the device than was previously expected.

Female↗