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PubMed1997

Chromosome analysis of aborted conceptuses of recurrent aborters positive for anticardiolipin antibody.

OBJECTIVE: To elucidate the relationship between anticardiolipin antibody and recurrent abortion. DESIGN: Prospective clinical study. SETTING: Institutional practice in which patients with recurrent abortion were registered at the outpatient clinic for infertility of Niigata University Hospital. PATIENT(S): Five hundred sixty-one patients with recurrent abortions and 148 patients who were not recurrent aborters and who had experienced sporadic abortion. INTERVENTION(S): Aborted conceptuses for chromosome analyses were collected from the patients. MAIN OUTCOME MEASURE(S): The positive rate of anticardiolipin antibody was assessed in patients with recurrent abortion. Chromosome analyses of aborted conceptuses were performed in 10 patients with positive anticardiolipin antibody who had experienced another pregnancy that resulted in repeated abortion. Similar analyses of aborted conceptuses from 148 sporadic early abortions (controls) were performed. RESULT(S): The incidence of chromosome abnormalities in anticardiolipin antibody-positive recurrent aborters was 20.0% (2 of 10 cases), which was significantly lower than that of patients with sporadic abortion (60.1%, 89 of 148 cases). CONCLUSION(S): The low incidence of chromosome abnormalities in aborted conceptuses of patients with positive anticardiolipin antibody suggests that this antibody is strongly implicated in the genesis of recurrent abortions.

Abortion, Habitual↗
PubMed2000

Risk of spontaneous abortion following induced abortion is only increased with short interpregnancy interval.

We set out to study the risk of spontaneous abortion following a first trimester induced abortion as a function of the interpregnancy interval between two pregnancies. The cohort study is based on the following databases: Danish national registries: the Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the induced Abortion Registry (IAR). All primigravid women in the time period from 1980 to 1982 were identified in the MBR, the HDR and the IAR. A total of 15 727 women who terminated the pregnancy with a first trimester induced abortion were selected as the induced abortion cohort, and 46 026 women who did not terminate the pregnancy with an induced abortion constituted the control cohort. By register linkage all subsequent pregnancies which were not terminated by induced abortion were identified from 1980 to 1994. Only women who had a non-terminated pregnancy following the index pregnancy were selected. Women whose first pregnancy was terminated following a first trimester induced abortion had a risk of spontaneous abortion of 11.0% vs. 9.4% in the control cohort. This relative difference of 1.17 was not statistically significant in logistic regression analyses. An increased risk was only found for women who had an interpregnancy interval of less than 3 months (OR=4.06, 95% C.I.=1.98-8.31). The abortion method, vacuum aspiration with dilatation or evacuation with dilatation did not modify this elevated risk. Overall the study did not show an increased risk of spontaneous abortion following one or more induced abortions, except for women with a short interpregnancy interval between an induced abortion and a subsequent pregnancy. We recommend women who have a first trimester induced abortion be advised to wait at least 3-6 months before trying to become pregnant again.

Journal Article↗
PubMed2002

Is "abortion culture" fading in the former Soviet Union? Views about abortion and contraception in Kazakhstan.

The Soviet legacy of widespread reliance on induced abortion is of critical importance to reproductive trends and policies in post-Soviet nations, especially as they strive to substitute contraception for abortion. Using data from two Demographic and Health Surveys conducted in 1995 and 1999, this study analyzes and compares trends in abortion and contraception, women's attitudes toward abortion, and their perceptions of problems associated with abortion and contraception in Kazakhstan. Despite an overall decline in abortion and an increase in contraceptive use since Kazakhstan's independence in 1991, abortion has remained a prominent part of the country's reproductive culture and practices. This study shows how abortion-related views reflect the long-standing ethnocultural differences between the indigenous Kazakhs and Kazakhstan's residents of European roots, as the latter continue to have significantly higher levels of abortion. The study, however, also reveals the internal diversity among Kazakhs with respect to abortion experiences and views, stemming from decades of the Soviet sociocultural influence in Kazakhstan. In addition, the analysis points to some generational differences in views concerning abortion and contraception. Finally, the study demonstrates parallels in attitudes toward abortion and toward contraception, thereby questioning straightforward assumptions about the replacement of abortion with contraception.

Abortion, Induced↗
PubMed2001

Does the liberalisation of abortion laws increase the number of abortions? The case study of Spain.

BACKGROUND: Over the course of the 1980s a public debate on abortion took place in Spain culminating in a more permissive social climate and, in 1985, the partial decriminalisation of abortion. Before this, women were forced to abort illegally or abroad in countries which had decriminalised abortions. The aim of this study is to present jointly the evolution of abortions in Spanish women in England and Wales between 1974 and 1995, The Netherlands between 1980 and 1995 and Spain since the start of the register in 1987 through to 1995 and to compare trends both before and after the law in Spain. METHODS: Incidence rates were calculated in each of the countries studied and the slopes of the curves for 1974-1984 and 1987-1995 were compared. Data were obtained from reports published by the offices of abortion surveillance in England and Wales, The Netherlands and Spain. RESULTS: The rates increased constantly throughout the study period. From 1974 to 1985, a total of 204,736 Spanish women aborted in England and Wales and The Netherlands. After the law was passed, 34,895 Spanish women had abortions in those countries over the period 1986-1995. During 1987-1995, 340,214 Spanish women terminated their pregnancies in Spain. The regression coefficients before and after the passing of the law were beta = 0.3538 (0.307-0.400) and beta = 0.319 (0.243-0.394) respectively; no difference was observed. CONCLUSIONS: During the study period a significant proportion of reproductive-aged Spanish women had abortions in England and Wales and The Netherlands. Decriminalisation has had no observed effect on the trends in abortion, but rather it has benefited Spanish women by making abortion available locally and, therefore, reducing the inequalities implied by lack of access to proper health care services. These data demonstrate the impact of the liberalisation of abortion on the trends of procedures performed in other countries.

Abortion Applicants↗
PubMed1986

Induced abortion and the chromosomal characteristics of subsequent miscarriages (spontaneous abortions).

Data from a case-control study of miscarriages (spontaneous abortions) were used to test whether single and multiple induced abortions are associated with miscarriage in subsequent euploid (chromosomally normal) pregnancies. Cases and controls were identified in three New York City hospitals between April 1974 and November 1982. It was hypothesized that, if induced abortion increased the risk of subsequent miscarriage, an association would be observed with euploid but not aneuploid (chromosomally abnormal) miscarriage. The frequencies of single and multiple induced abortions among euploid cases and aneuploid cases were compared with those among controls. Among both private and public patients, the proportion of women reporting a single induced abortion was similar in euploid cases and in aneuploid cases compared to controls. Among public patients only, the proportions reporting multiple induced abortions were also similar in euploid cases and in aneuploid cases compared to controls (odds ratios = 0.9 and 1.0, respectively). In contrast, among private patients, the proportion reporting multiple induced abortions was raised among euploid cases (odds ratio = 2.2, 95% confidence interval = 1.3-3.7), although not among aneuploid cases. This association was strongest when the first induced abortion was carried out before 1973, at a young age, or with a procedure other than suction curettage. In public patients, the associations with miscarriage did not vary with characteristics of the first induced abortion, but multiple induced abortion histories when the first two induced abortions occurred before 1973 were in excess among euploid cases compared to controls. These results suggest that, for both private and public patients, neither single nor multiple induced abortions as now performed are likely to increase the risk of miscarriage in subsequent pregnancies. They also suggest a mechanical origin for some miscarriages.

Abortion, Induced↗
PubMed1999

Legal abortion in Asturias (Spain) after the 1985 law: sociodemographic characteristics of women applying for abortion.

STUDY OBJECTIVE: To describe the use of induced abortion (IA) in Asturias after its legalisation as well as the socio-demographic characteristics of women applying for abortion. DESIGN AND SETTING: Descriptive study, population-based, using data collected by the regional abortion surveillance system for the period 1988 1994. MAIN RESULTS: The number of IA and the abortion rate (AR) (10 per 1000 women aged 15-49) have been stable in Asturias during the study period. The highest ARs were found for women in the age group 20-34, for divorced/separated, for women with a higher educational level and for women with only one child. The proportion of pregnancies which ended in abortion was one in four; for teenagers and women over 34 years it was one in two. This proportion was also higher for women not married, students and women with two or more children. Ninety-eight percent of all abortions took place in private clinics, the woman's physical/mental health being the medical indication for these abortions. Abortion was most often performed within eight weeks of gestation (65%). Late abortion ocurred more frequently among teenagers and women of low educational level. Eighteen percent of women had repeated abortions. A high proportion (61%) of women applying for abortion had not used the Family Planning (FP) services in the previous two years; adolescents and women of low educational level had the lowest frequencies of FP use. CONCLUSIONS: Compared with that of other European countries, the AR in Asturias was intermediate. The results regarding adolescents show the need for evaluation and promotion of sex education and contraceptive programmes. The lower and later use of abortion by women of low educational level shows inequalities that call for specific action.

Abortion, Legal↗
PubMed2001

Th1 and Th2 cytokine profiles in recurrent aborters with successful pregnancy and with subsequent abortions.

BACKGROUND: This study compared Th1-Th2 cytokine profiles in a subgroup of recurrent aborters who had an abortion with those in a subgroup of recurrent aborters who had a successful pregnancy. METHODS: Fifty-four women with a history of at least three normal pregnancies, 24 women with a history of recurrent spontaneous abortion (RSA) followed by abortion (RSA-->A) and 39 women with a history of RSA followed by normal pregnancy (RSA-->N) were studied. Blood samples and placentas were obtained at the time of delivery or abortion; peripheral blood mononuclear cells were stimulated separately with phytohaemagglutinin and with autologous placental cells, and the secreted cytokines estimated. RESULTS: Peripheral blood mononuclear cells from the RSA-->N subgroup secreted higher concentrations of Th1-type cytokines as compared with normal pregnant women, indicating a higher Th1 bias in these women. However, women in the RSA-->N subgroup had significantly higher concentrations of Th2 cytokines as compared with women in the RSA-->A subgroup. A comparison of Th1:Th2 cytokine ratios indicated a higher Th2 bias in RSA-->N women as compared with RSA-->A women. CONCLUSIONS: We conclude that abortion-prone women who proceed to have successful pregnancy are more Th2-biased than abortion-prone women who abort, and that recurrent aborters who undergo spontaneous abortion have a stronger Th1 bias than aborters who have normal pregnancy.

Abortion, Habitual↗
PubMed1983

Role of enzootic abortion and toxoplasmosis in an outbreak of abortion in a Scottish sheep flock.

During 1978-79 there was an outbreak of abortion in a large sheep flock during which approximately 10 per cent of the breeding ewes aborted. Both Toxoplasma gondii and Chlamydia ovis (the agent of enzootic abortion of ewes) were considered to be involved. In the year following this outbreak (1979-80), 156 ewes (11.4 per cent) aborted and the majority of cases were diagnosed as enzootic abortion: only one case showed gross pathology typical of toxoplasmosis. Serology carried out on sera collected from ewes at the time of abortion and at two post abortion samplings demonstrated that large numbers of animals had high titres against enzootic abortion of ewes while the prevalence of sheep with titres against toxoplasmosis was relatively low. Following the introduction of control measures to reduce the spread of enzootic abortion of ewes, the abortion rate in 1980-81 fell to 2.2 per cent. A small-scale trial was carried out to investigate the prophylactic effect of long acting oxytetracycline against enzootic abortion of ewes when given to pregnant sheep three weeks before lambing. Results indicated that treatment reduced the number of abortions in comparison with untreated controls.

Abortion, Veterinary↗
PubMed2001

Peri-abortion contraceptive care: can we reduce the incidence of repeat abortions?

INTRODUCTION: It is of great importance for repeat unwanted pregnancies to be prevented rather than aborted. We therefore sought to: determine the reasons for contraceptive failure in women seeking repeat abortions; audit the peri-abortion contraception services offered at our hospital, and make recommendations regarding peri-abortion contraception services based on the above findings. METHOD: A self-administered questionnaire was used to determine the contraceptive practices and details of peri-abortion contraceptive counselling received by 50 women undergoing a repeat, and 83 women undergoing a first-time, abortion. RESULTS: Ninety-eight percent of women undergoing a repeat abortion reported using contraception at the time of conception, as compared to 83% of women undergoing a first-time abortion. This difference was significant (p = 0.009). Condoms were the main method used by 57% of women undergoing a repeat and 70% of women undergoing a first-time abortion. The oral contraceptive pill (OCP), including both combined oral contraceptive and progestogen-only pill, was the main method used by 37% of women undergoing a repeat and 25% undergoing a first-time abortion. Both these methods were found to be ineffective because of user-dependent failures. All women received peri-abortion contraceptive counselling, but the perceived contents varied. Follow-up contraceptive appointments were made in less than half of women. Although most women chose an optimal contraceptive method as a result of the counselling, compliance with the chosen method in women undergoing repeat abortions was poor. CONCLUSIONS: Standards of audit were met with regards to receipt of contraceptive counselling and agreeing a contraceptive method before discharge. The content of this counselling needs to be improved. The ineffectiveness of the OCP and barrier methods of contraception needs to be highlighted during counselling. Adequate follow-up arrangements need to be provided to ensure compliance of the chosen method of contraception.

Abortion, Habitual↗
PubMed1997

Effect of congenitally acquired Neospora caninum infection on risk of abortion and subsequent abortions in dairy cattle.

OBJECTIVES: To estimate the extent to which abortion risk in dairy cattle during subsequent pregnancies was associated with congenitally-acquired Neospora caninum infection and previous abortions. ANIMALS: 468 Holstein cattle. PROCEDURE: Newborn heifer calves were tested for evidence of congenital infection attributable to N caninum and examined repeatedly until the completion of their second lactation for serologic status and evidence of abortion. RESULTS: Compared with noninfected cows, congenitally infected cows had a 7.4-fold higher risk of abortion during their initial pregnancy and a 1.7-fold higher risk of aborting the first pregnancy during their first lactation. During the first pregnancy of their second lactation, congenitally infected cows that had aborted previously had a 5.6-fold higher risk of abortion, compared with cows that had not previously aborted and that were seronegative. The fetal risk period for N caninum-associated death began sooner and extended later during the initial pregnancy compared with subsequent pregnancies. CONCLUSION: Congenitally acquired N caninum infection can cause a substantial number of abortions during the initial pregnancy of heifers, with abortion risk attributable to N caninum decreasing in subsequent pregnancies, possibly because of selective culling. Subsequent abortions can be expected in congenitally infected cows that have aborted previously.

Abortion, Veterinary↗
PubMed1977

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗