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Failure to isolate Brucella abortus from embryos or ova from culture-positive superovulated cows.

Nine, Brucella abortus culture positive 2-yr-old cows were used to test the hypothesis that embryos and ova collected from such cows are not infected. Superovulation was induced at varying times postpartum or postabortion with intramuscular injections of follicle stimulating hormone (FSH). The cows were artificially inseminated with B. abortus-negative semen. Superovulations and nonsurgical embryo collections nonsurgical embryo collections were attempted twice for each cow. Jugular blood, udder secretions, cervical swabs, uterine collections, embryos and ova were cultured bacteriologically from the nine cows simultaneously at nonsurgical embryro collections, and B. abortus was isolated only from the udder secretions of seven cows. Brucella abortus was not isolated from 15 uterine collections, 21 embryos, or 18 ova from the culture-positive cows. It was concluded that B. abortus was not present at the detection limits of the culture method employed, which supports the finding or view that embryos and ova collected from donor cows at 100 days or greater post partum or post abortion are not likely to harbor Brucella.

Journal Article↗

Prenatal diagnosis of fetal diastematomyelia in a pregnancy exposed to acyclovir.

A rare form of spinal dysraphism, diastematomyelia, was diagnosed in a pregnancy exposed to acyclovir at the time of implantation. The prenatal diagnosis was based on the ultrasound examination of the fetus. Pathologic evaluation of the postabortion fetus confirmed the diagnosis. The use of acyclovir in pregnancy and associated anomalies are reviewed.

Acyclovir↗

Miscommunication between healthcare providers and patients may result in unplanned pregnancies.

Our objective was to examine the impact of prior healthcare provider counseling on previous use of contraception and knowledge of emergency contraception in women seeking surgical abortion. We performed a retrospective analysis of 342 patient charts from women seeking an office abortion in a private practice setting from January 1999 to June 2001. Data extracted included demographic information, primary method of contraception over the preceding few months, compliance with that method, contraceptive history, knowledge of emergency contraception and postabortion contraception. Patients were primarily white (69%) and unmarried (63%) and had private insurance that covered abortion services (72%). Only 19% of women were using a birth control method with no recognized potential failure. Twenty-two percent of women were using their birth control method correctly but experienced an event that put them at risk for pregnancy, 32% were using their birth control method incorrectly and 27% were using no birth control method at all. Miscommunication between patients and their healthcare provider(s) negatively affected use of a primary contraceptive method in 14% of patients. Of the 77% of women who did not know about emergency contraception, nearly two thirds had an identifiable event for which emergency contraception could have been used. Healthcare providers may contribute to the occurrence of unintended pregnancy if they provide poor medical advice or miscommunicate with patients.

Abortion, Legal↗

A randomized controlled study comparing 600 versus 1,200 microg oral misoprostol for medical management of incomplete abortion.

OBJECTIVES: Although a number of studies have shown misoprostol's promise as a nonsurgical treatment for incomplete abortion, few have systematically examined treatment protocols. This study documents the effectiveness of 600 versus 1,200 microg oral misoprostol for this indication. METHODS: From May 2002 to January 2003, 300 women with incomplete abortion were recruited at a large tertiary facility in Vietnam and randomized to either a single-dose (600 microg) or a repeated-dose (600 microg x 2) regimen of oral misoprostol for the treatment of their condition. RESULTS: Misoprostol effectively evacuated the uterus for nearly all women (94.6%; n=279), with most reporting bleeding for 4 days (+/-2.3) and pain/cramps lasting 1 day (+/-1.0). Women indicated that the side effects were tolerable (96%) and that their experience was satisfactory (95%). CONCLUSIONS: Oral misoprostol (600 or 1,200 microg) offers a safe, effective and acceptable treatment for incomplete abortion. Larger studies to assess the advantages and disadvantages of misoprostol as compared with standard surgical care are needed to assess its role in postabortion care programs worldwide.

Abortifacient Agents, Nonsteroidal↗

Abortion procedures in a tertiary care institution in India.

OBJECTIVE: To determine the complications rate of termination of pregnancy (TOP) and the risk factors for complications following TOP. METHODS: Retrospective observational study of the records of 1287 women who underwent TOP in the Department of Obstetrics and Gynaecology of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between 1997 and 2001. First-trimester abortion was performed in 1088 women (85%) and second-trimester abortion in 199 women (15%). Most women (76%) were aged between 26 and 30 years; they were educated and requested TOP primarily to limit the number of their children or to space their births. A malformed fetus was the indication for TOP in 5.9% cases, and 16% of the women had medical disorders associated with the pregnancy. Suction evacuation was the method of choice for first-trimester abortion (88%); dinoprostone gel and extra-amniotic saline solution plus oxytocin infusion were the primary methods (71%) for second-trimester abortion. RESULTS: Uterine perforation occurred in 1 patient (0.09%) after a first-trimester abortion. The total rate of complications was 3.79% after first-trimester and 4.0% after second-trimester abortions. Excessive hemorrhage and retained placenta were chief complications associated with second-trimester abortion. Incomplete abortion (1.5%) and minor infection were seen in 2.3% patients. The rate of complications was higher among parous women. Postabortion insertion of a CuT intrauterine device increased the need for a second course of antibiotics. CONCLUSION: Termination of pregnancy is safe if adequate care is taken while performing the procedure.

Abortifacient Agents, Steroidal↗

Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services.

SUMMARY: Maternal mortality reduction has been a focus of major international initiatives for the past two decades. Widespread provision of emergency obstetric care (EmOC) has been shown to be an important strategy for addressing many of the complications that might otherwise lead to maternal death. However, unsafe abortion is one of the major causes of pregnancy-related deaths, and will be only partially addressed by EmOC. This manuscript presents a comprehensive approach to measuring whether abortion-related needs are met. PROPOSED METHODS: We propose a set of indicators for monitoring the implementation of safe abortion care (SAC) interventions. We build on the model developed for monitoring the availability and use of Emergency Obstetric (EmOC) services. We describe the critical elements ("signal functions") of SAC - including treatment of abortion complications, legal, induced abortion and postabortion contraception - and define the indicators necessary to assess the availability, utilization and quality of abortion-related services. SAMPLE EVIDENCE: Data from 5 countries suggest there are sufficient service delivery points to provide decentralized abortion care, but that the full range of necessary abortion care services may not be provided at all these sites. Studies from several countries also show that many women receiving services for the treatment of abortion complications accept contraceptive methods when offered prior to discharge. This is an important strategy for reducing unwanted pregnancy, repeat unsafe abortion and risk for abortion-related mortality. Both findings suggest there are considerable opportunities within the present facilities to improve the delivery of abortion care services. CONCLUSION: This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health.

Abortion, Induced↗

A case of Rh isoimmunization: should threatened first-trimester abortion be an indication for Rh immune globulin prophylaxis?

Despite the recommended 28 weeks' gestation antenatal, postnatal, and postabortion prophylaxis with Rh immune globulin, residual Rh immunization still occurs in Rh-negative women. We describe a patient whose history suggests development of an anti-D antibody after first-trimester bleeding. To our knowledge, this is the first such case reported in the English literature.

Abortion, Threatened↗

Coagulation factors in women using oral contraceptives or intrauterine contraceptive devices immediately after abortion.

The changes in coagulation parameters were studied in 24 women who started using microdose combined oral contraceptives immediately after first-trimester abortion. Another 24 women who had an intrauterine contraceptive device inserted at the end of the abortion procedure were studied as control subjects. In pill users, a slightly increaed tendency toward hypercoagulability was observed 1 week after abortion in terms of elevated fibrinogen and Factor VIII as well as decreased antithrombin levels. Other studies have shown that the new follicle development after first-trimester abortion starts beyond the first week. It would therefore seem that by postponing oral contraceptive use until 1 week after abortion, no decrease in the effectiveness of contraception occurs and the possible risks of hypercoagulabilty during the postabortal period can be avoided.

Abortion, Induced↗

Early readmission following elective laparoscopic sterilization: a brief analysis of a rare event.

This study examines some potential factors that are associated with occasional readmission soon after discharge for laparoscopic sterilization--a generally innocuous outpatient procedure. Thirty-six early readmissions among 22,000 cases of laparoscopic sterilization (an incidence rate of 1.6 per 1,000 procedures) in an international data set were investigated. Early follow-up (7 to 21 days after sterilization discharge) was 95%. The complications that led to readmission were of a more serious nature (e.g., intestinal burn/injury) among women sterilized by electrocoagulation (all unipolar) than among women sterilized with clips. Among electrocoagulation cases, women who were sterilized less than 42 days postabortion or postpartum were significantly more likely to be readmitted than were women who had not recently been pregnant. All readmitted women were discharged in satisfactory condition. The mean overall hospital stay during readmission was 7.3 days--10.6 days for electrocoagulation, 5.6 days for tubal ring, and 2.1 days for clip cases. A case-control analysis did not reveal a significantly higher relative risk for readmission among women with previous abdominal operations than among those without.

Abscess↗

Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration.

When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.

Abortion, Incomplete↗

Vaginal misoprostol for late first trimester abortion.

A group of 120 women with gestations from 64 to 84 days received 800 micrograms of vaginal misoprostol every 24 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side effects, and mean time of expulsion and vaginal bleeding. Complete abortion occurred in 104 of 120 (87%, 95% CI 79, 92) subjects. The decrease of hemoglobin was statistically significant (p = 0.0001) but clinically unimportant: 12.2 mg/dL (SD 1.1) before treatment and 11.6 mg/dL (SD 1.0) after treatment. Statistically significant differences were found only between the success rates for white women in comparison with nonwhite women, in which case the success rates were higher for white than for nonwhite women. Vaginal bleeding lasted 8 +/- 5 days, spotting 4 +/- 3, and total bleeding 12 +/- 4 days. The acceptable expulsion time, the fact that postabortion systematic curettage was not needed, the clinically insignificant hemoglobin loss, and the success rate obtained show that misoprostol administered vaginally may be a valid method for interrupting gestations of 10-12 weeks.

Abortifacient Agents, Nonsteroidal↗

Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete.

The purpose of this study was to evaluate the diagnostic accuracy of transvaginal sonography for first trimester spontaneous abortions, thought to be incomplete or complete, in patients with postabortion bleeding or uterine cramping within 5 days of abortion. In a prospective study, 78 patients underwent transvaginal sonography to evaluate the maximum anteroposterior diameter of the uterine cavity on the long axis view and echo pattern of the retained products of conception. Patients were divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with solid components (n = 38, group B), and those with a uterine cavity containing solid components (n = 27, group C). Group A was considered not to have retained products of conception, and the latter two groups were considered to have retained products of conception. Patients in group A were assigned to receive conservative treatment. In groups B and C, patients with significant vaginal bleeding during 48 h of follow-up underwent elective curettage and those with minimal-mild bleeding received conservative management. A total of 73 patients (12 in group A, 35 in group B and 26 in group C) completed the study. There were no differences in any of selected reproductive data of the groups (p > 0.05). In group B, all patients with uterine cavity diameter of 10 mm or greater underwent elective curettage. In group C, all patients with a diameter of the uterine cavity 8 mm or greater underwent elective curettage. The overall complication and patient satisfaction rates were approximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with first trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%.

Abortion, Incomplete↗

Hysteroscopic findings after missed abortion.

OBJECTIVE: To identify the relation of missed abortions and intrauterine pathology. DESIGN: A postabortal hysteroscopy was performed 8 to 12 weeks after a dilatation and curettage (D&C) for missed abortion. SETTING: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. PATIENTS: Sixty patients after a D&C for a missed abortion. MAIN OUTCOME MEASURES: The hysteroscopic appearance of the uterine cavity. RESULTS: Intrauterine adhesions occurred in only 10 patients (16.7%) with most of them of the mild type. A previous missed abortion was recorded in 60% of these cases. Uterine anomaly was found in one quarter of the cases, mainly an incomplete uterine septum. CONCLUSION: We believe that missed abortion does not predispose for intrauterine adhesions to the extent that was previously believed. A partial uterine septum is a major factor predisposing for the occurrence of missed abortion. Hysteroscopy after a missed abortion is an easy and efficient means for both identifying such uterine anomaly and excluding intrauterine adhesions.

Abortion, Missed↗

A randomized clinical trial of prophylaxis for vacuum abortion: 3 versus 7 days of doxycycline.

OBJECTIVE: To estimate prospectively whether reducing oral doxycycline prophylaxis from 7 to 3 days increases the incidence of endometritis after elective first-trimester vacuum abortion. METHODS: We randomized 800 women requesting first-trimester abortion to two study groups: 1) 100 mg of doxycycline administered orally twice a day for 7 days or 2) 100 mg of doxycycline orally twice a day for 3 days followed by an oral placebo twice daily for the last 4 days. Doxycycline was prescribed immediately after surgery. RESULTS: There were no statistically significant differences in age, race, gravidity, parity, number of previous abortions, current gestational age, and history of previous pelvic infection, chlamydia, or intrauterine device use. Women in the doxycycline plus placebo group were more likely to have had a history of gonorrhea (3.3% versus 0.8%, P =.42) or chlamydia (7.0% versus 4.3%, P =.18). The 66.3% of enrollees returning for 2-week examinations were distributed similarly between study groups and were similarly compliant in self-reported pill taking (mean 97.5%). The study groups did not differ in the incidence of postoperative symptoms or examination findings suggesting infection. One patient in the doxycycline-only group developed endometritis and was treated as an outpatient. CONCLUSION: Shortening oral doxycycline prophylaxis from 7 to 3 days had no adverse effect on the incidence of postabortion infection.

Abortion, Induced↗

Gestational trophoblastic tumor after medical abortion.

BACKGROUND: Nonmetastatic gestational trophoblastic tumor occurring after early elective medical abortion using mifepristone and misoprostol is unusual. CASE: A young woman at 6 to 7 weeks' gestation presented with brown spotting requesting medical abortion. Pretreatment ultrasound was consistent with an abnormal pregnancy. Passage of tissue ensued after mifepristone-misoprostol administration. Recovery was normal, with a postabortion ultrasound on day 16 showing a reduction in intracavitary contents. The patient declined surveillance with serial beta-human chorionic gonadotropin (beta-hCG) levels and was lost to follow-up. Sixty days after initial treatment, she presented to a hospital with a history of intermittent bleeding and underwent curettage, revealing a complete hydatidiform mole. Chemotherapy was instituted when levels of hCG plateaued. Complete hCG regression occurred after three weekly injections of methotrexate, and postmolar surveillance is uneventful to date. CONCLUSION: Gestational trophoblastic tumor may occur after early medical abortion.

Abortifacient Agents, Steroidal↗

Pregnancy in the adolescent patient. Screening, diagnosis, and initial management.

Despite declines in adolescent pregnancy rates in the past decade, unplanned pregnancies among adolescents remain a significant problem in the United States. Clinicians caring for adolescents can be certain to encounter pregnancy in their patients. This article addresses surveillance and diagnosis for pregnancy in the adolescent, management, and referral of the newly-diagnosed pregnant adolescent, early pregnancy complications, common medical conditions affecting pregnancy in adolescents, and management of the postpartum and postabortal adolescent.

Abortion, Induced↗

Delayed presentation of uterine perforation.

A 30-year-old woman presented to the emergency department with nonspecific abdominal pain 17 days after voluntary vacuum aspiration interruption of a first-trimester pregnancy. Physical examination and laboratory evaluation demonstrated mild diffuse abdominal tenderness without peritoneal signs and a mildly increased WBC count, respectively. When the patient's condition failed to improve she was admitted, and exploratory laparotomy was performed 5 days later. It revealed two uterine perforations, one of which contained incarcerated omentum with associated ischemic small bowel and complete small-bowel obstruction. Although uterine perforation with intraabdominal injury is a well-described complication of vacuum aspiration termination of pregnancy, most postabortion perforations go undetected. Delayed presentation of an acute complication is rarely observed.

Abortion, Induced↗

Fatal myocardial infarction resulting from coronary artery septic embolism after abortion: unusual cause and complication of endocarditis.

Significant medical complications after elective abortion are rare. However, complications do occur, and the emergency physician should always bear this in mind when evaluating a patient with significant illness who has recently undergone an elective abortion. Reported here is a case of postabortion endocarditis, manifesting as a septic coronary artery embolism, that led to a fatal acute myocardial infarction.

Abortion, Induced↗