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Postabortal sepsis.

A review of postabortal sepsis following a 2-year study undertaken at the Department of Obstetrics and Gynaecology, SSG Hospital, Baroda is presented here with a view to know the incidence of postabortal sepsis and septic induced abortions and to re-evaluate the effectiveness of the MTP services in reducing its impact on maternal morbidity and mortality, since the implementation of the MTP Act in 1972. It has been observed that postabortal sepsis is a major cause of maternal mortality even now and MCH service is to be improved to reduce the same.

Abortion, Illegal↗

Postabortal insertion of IUD.

During 1983, 823 first trimester therapeutic abortions were performed at the University Hospital of Trondheim, Norway. Of these patients, 229 had an IUD inserted at the end of the operative procedure. The remaining 594 patients served as controls. Microbiological samples were taken from the cervix and the urethra. No prophylactic antibiotic treatment was given. Compared to the group of patients not selecting an IUD as contraception, there was no increase in readmission frequency due to immediate postabortal IUD insertion. There were no positive cultures for N. gonorrhoeae, and the relative number of positive chlamydia cultures was the same in both groups. In the IUD group we did not find any increase in complications such as bleeding, pain, perforations or infections. During the first year of observation, 3 pregnancies occurred in the IUD group, giving a Pearl index of 1.3 pregnancies per year. Continuation rate after one year was 72.8%. We recommend immediate postabortal insertion of an IUD after first trimester abortion as a practical and safe procedure.

Abortion, Therapeutic↗

Efficacy of suppository analgesia in postabortion pain reduction.

PURPOSE: Termination of pregnancy is a painful procedure. Currently, there are no sufficient data regarding the best mode to reduce this pain. The aim of the study was to evaluate postabortion pain levels and to examine the analgesic effect of three different generic types of suppositories provided at the end of the surgical procedure prior to awakening from general anesthesia. METHOD: Two hundred seventeen women were randomly assigned to four groups: indomethacin (100 mg), paracetamol (1000 mg), tramadol (100 mg), and control group with no suppository treatment. Pain levels were evaluated by VAS five times--15, 30, 60, 90 and 120 min after abortion. The number of doses of rescue analgesia with dipyrone (1 g po) was recorded. RESULTS: There was a significant difference in pain levels between the four groups during the 2-h study (p<.05). Indomethacin always had the lowest VAS rank. Rescue analgesia was requested by 22/55 women in the control group, 10/55 in the tramadol group, 7/54 in the paracetamol group and 5/53 in the indomethacin group (chi(2)=19.0, p<.0001). CONCLUSION: The application of a single suppository of an analgesic drug, especially indomethacin, is a simple, inexpensive and safe mode to reduce postabortion pain.

Acetaminophen↗

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods.

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2-6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.

Abortion, Induced↗

Differences in hormonal patterns during the first postabortion menstrual cycle after two techniques of termination of pregnancy.

Fifteen patients underwent first-trimester abortion by one of two techniques. In group P, seven patients received prostaglandin vaginal suppositories during the 12 hours prior to vacuum aspiration, whereas eight patients in group V were aborted by aspiration alone. During the first postabortion menstrual cycle, daily peripheral blood levels of several hormones, including follicle-stimulating hormone (FSH), luteinizing hormone, human chorionic gonadotropin, estradiol, and progesterone, were determined. Patients in group P demonstrated a more rapid fall in progesterone levels following pregnancy termination (P less than 0.01). They also experienced a more physiologic first postabortion cycle as evidenced by a larger preovulatory estradiol peak (P less than 0.05) and a more normal luteal phase as judged by both the duration and elevation of progesterone levels. Certain endocrine changes common to both groups but different from those of normally menstruating women were also observed. These consisted of short-term spurts of progesterone secretion in many patients (10 of 15) prior to ovulation and exaggerated levels of FSH during the early follicular phase.

20-alpha-Dihydroprogesterone↗

Birth control use by teenagers. One and two years postabortion.

A prospective study was undertaken of the contraceptive behavior of adolescent women following a first-trimester abortion. Each women had an individual counseling session, including birth-control counseling. Effective birth control was used by 77% of the 182 respondents one year postabortion. Two years after abortion, 79% of those who remained in the study group continued to use reliable birth control methods. The repeat abortion rate for all respondents was 7% in the first year and 11% in the second year. These results suggest that teenagers who obtain abortions do not rely on the procedure as a method of contraception. Instead, they are more likely to be using reliable methods of birth control postabortion than they were before the unplanned pregnancy.

Abortion, Induced↗

Use of pH/whiff test or QuickVue Advanced pH and Amines test for the diagnosis of bacterial vaginosis and prevention of postabortion pelvic inflammatory disease.

BACKGROUND: Untreated bacterial vaginosis (BV) is a risk factor for postabortion pelvic inflammatory disease (PID). METHODS: Eight hundred and eight women who requested therapeutic abortion were consecutively examined for the presence of BV, using either pH/whiff test or QuickVue Advanced pH and Amines test. All patients who tested positive to BV were treated with clindamycin or metronidazole prior to abortion. RESULTS: Based on the wet smear examination, the incidence of BV was 21.6%. Positive pH and whiff test had a sensitivity of 53%, specificity of 98% and Kappa index 0.59 (n=239). Values for QuickVue Advanced pH and Amines test were 53%, 97%, and 0.58 respectively (n=508). The incidence of PID among all patients was 2.4% after pharmacological abortion and 4.9% after surgical abortion. Among the patients with microscopic presence of BV diagnosed positive by the pH/whiff test or QuickVue Advanced pH and Amines test and treated with antibiotics, no PID occurred. Patients with negative pH/whiff test or QuickVue pH and amines test who consequently did not receive preoperative antibiotics, but who later demonstrated microscopic presence of BV, had an incidence of 14.3% (5/35) postoperative PID compared to women with normal lactobacilli flora 4.3% (10/234) (OR 3.73; 95% CI 1.21-9.21). CONCLUSIONS: Although the pH/whiff test and QuickVue pH and Amines test failed to ascertain BV in almost half of the participants later found to have BV, we found that preabortal screening and subsequent treatment of those who test clinically positive does lower the incidence of postabortion PID.

Abortion, Induced↗

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992.

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.

Female↗

Dimensions of women's long-term postabortion experience.

PURPOSE: To explore and describe the long-term postabortion experience as lived by women, at least 5 years after a first-trimester-induced abortion. METHODS: This phenomenological study used semistructured interviews and constant-comparison analysis. Stories of 17 women were recorded on audio tape, transcribed verbatim, coded, and analyzed. RESULTS: Women who had induced abortions represented several ethnic groups, religions, and occupations, and were single, married, or divorced. The average number of years from abortion to interview was 18.9 (range 6-31 years). The age range at first abortion was 14 to 43, and at interview was 23 to 60 years of age. Five themes emerged within the women's stories: Making the Decision, Coping With the Memories, Gaining Perspective, Seeking Help, and Recognizing Its Worth. Most women who participated in this study were able to integrate the abortion experience into their lives, and had found meaning in the abortion experience. CLINICAL IMPLICATIONS: This study provides yet more reasons why nursing should encourage women to prevent unplanned pregnancies through fertility control. Women in this study described many life-changing experiences, both positive and negative, because of an abortion. Therefore, preabortion counseling should be sensitive and include information about possible long-term effects. Postabortion support should acknowledge spiritual issues, and include steps women can take to help heal themselves, such as grief counseling and mourning rituals when appropriate.

Abortion, Induced↗

Postabortion dysphoria and religion.

This study explores psychosocial factors, especially religion, in women identified as dysphoric 1 to 15 years after abortion. The Millon Clinical Multiaxial Inventory (MCMI) and a demographic questionnaire were mailed to patient-led support groups for women who had poorly assimilated a previous abortion experience. Of the 150 surveys mailed, 71 (47%) were returned. Thirty-three women (46%) stated they had changed to a Fundamentalist or Evangelical church. On the MCMI, members of these conservative denominations scored significantly lower on the subscales for passive-aggressive behavior, ethanol abuse, and avoidance. Religion was strongly perceived by the women as playing a healing role. These findings suggest that conservative personal values may be more critical in understanding attitudes toward abortion than other demographic characteristics. Previous follow-up studies that reported no change in postabortion religiosity may have been too short to detect changes in religion. Implications for treatment of postabortion dysphoria include sensitivity to patients' religious beliefs, with support for the healing aspects of their religion.

Abortion, Induced↗

Accurate diagnosis of postabortal placental remnant by sonohysterography and color Doppler sonographic studies.

The decision whether to perform uterine curettage for postabortal bleeding depends on the ability to demonstrate placental remnants in the uterine cavity. However, diagnosis of postabortal trophoblastic residua by conventional ultrasonography may be inconclusive. We report our experience with the use of combined sonohysterography and color Doppler to demonstrate a placental polyp after early pregnancy termination.

Abortion, Induced↗

Postabortion research: methodological and ethical issues.

The author conducted research on long-term postabortion experience guided by the principles of phenomenology, and she describes the ethical and methodological issues encountered during the study, in which she interviewed 17 women who were more than 5 years postabortion, in this article. Discussed here, in the context of abortion as a sensitive topic for researcher and participant, are personal bias; recruitment, protection, and interviewing of participants; data analysis; and communication of findings. During the research process, the author gave particular attention to the formulation of the consent form, contact with the participants, the interview technique, the choice of a transcriptionist, and the use of a second reader. She also acknowledged her personal position on abortion, the reality of role conflict, and the importance of debriefing.

Abortion, Legal↗

Adolescent postabortion groups: risk reduction in a school-based health clinic.

A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in th postabortion counseling group indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.

Abortion, Induced↗

Postabortal and postpartum tetanus. A review of 19 cases.

The occurrence of postabortal and postpartum tetanus over a 7 1/2-year period at Groote Schuur Hospital, Cape Town, is reviewed. Of all the women between the ages of 15 years and 50 years who were admitted with tetanus, 34,7% were admitted after abortions. The mortality rate was 15,8%, which appears to be the lowest thus far reported. Possible methods of preventing postabortal tetanus are discussed.

Abortion, Incomplete↗

[Inhibition of initial puerperal and postabortion lactation using oral prostaglandin E2 (Dinoprostone)].

Authors present their experience in oral administration of Prostaglandin E2 (Dinoproston, Upjohn) during postpartal and postabortal period (à 0.5 mg after legal pregnancy interruption) in suppression of lactation. Indications for postpartal lactation suppression were such as: stillbirth, postpartal neonatal death and maternal negative attitude towards breast feeding. The patients in whom the suppression of lactation was applied were of generative age (18-40 years) either primiparas or multiparas. All were delivered vaginally with no extra intrapartal or postpartal complications being the same in legal pregnancy interruptions which were performed by application of intravaginal, intracervical and intramuscular Prostaglandin preparations. The patients were administered 1 tbl od 0.5 mg Dinoproston preparation every 6-7 hours, 48 h after the delivery, i.e. 2 tbl in total (after meal). This method of lactation suppression was applied in 50 patients during 1990. Satisfactory results were achieved in all cases, while negative side effects and complications were not noted. Oral administration of PGE2 was found very efficient in postpartal and postabortal lactation suppression while compared with previously applied methods such as Estrogen-Testosterone preparation, i.e. small doses of Bromergon applied during 10-14 days. Oral administration of PG2 is more efficient and in a certain way more comfortable in relation to the previously applied methods.

Abortion, Induced↗

Postabortal laparoscopic tubal sterilization. Results in comparison to interval procedures.

This report documents our experiences in 3 groups of women undergoing laparoscopic tubal sterilization: those undergoing sterilization as an interval procedure, those performed in association with suction curettage, and those performed within 18 hours of second trimester pregnancy termination via intraaminiotic injection of prostaglandin F 2 alpha. As a postabortal sterilization procedure, laparoscopy is effective, logistically appealing, and convenient. There is, however, an increased risk of complications to the procedure when performed on the postabortal women. These include specifically, a 10-fold increased risk of infection and a 2.5-fold increased risk of bleeding complications as seen in our series. The results of these findings are discussed, and some suggestions for reducing these risks are offered.

Abortion, Induced↗

[Secondary immunodeficiency and its correction with thymus preparations in patients with postabortion endometritis].

The immune status has been assessed in 73 patients with postabortal endometritis and thymalin and T-activin have been evaluated as an intervention for secondary immunodeficiency associated with this condition. These drugs were found to have immunomodulating effects on quantitative and qualitative characteristics of T- and B-lymphocytes and their subpopulations and on phagocytic function of polynuclears. Comprehensive therapy using thymalin and T-activin improves the efficacy of management of postabortal endometritis.

Abortion, Spontaneous↗

[Postabortion complications and recovery of ovarian function in nulliparous women].

Induced abortions performed in 481 cases of nulliparous women were carefully investigated. The incidence of complications during operation was 2.1%, of which the majority was the induced abortion syndrome. The early postabortal complication rate was 6.4% and the majority was mild pelvic inflammatory disease. The late complication rate was 10.2% and manifested mainly by menstrual disturbance. Ovulation occurred in 67.4% of the first postabortal cycles. It is suggested that the induced abortion is not a safe procedure for nulliparous women.

Abortion, Induced↗