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PubMed1984

Urban black adolescents who obtain contraceptive services before or after their first pregnancy. Psychosocial factors and contraceptive use.

This paper compares three groups of urban black teenagers at their enrollment in a contraceptive program and at a one-year follow-up. The groups comprise 263 never-pregnant, postabortion, and postpartum teens ages less than or equal to 17 years at their initial family planning visit. Self-report questionnaires examined attitudes and information about pregnancy and contraceptive use, sources of contraceptive information, sexual and contraceptive experience, family and partner support for contraceptive use, and demographic background factors. Emotional, personality, and psychosocial factors were assessed with standard measures. Age, partner relationships, and items relating to the mother's communication about contraception and pregnancy were significant variables in the outcome of never-pregnant and delivery of pregnancy. Self-esteem was highest in the never-pregnant group. Personality factors, emotional distress, and social adjustment scores were in the normal ranges and did not differ between the groups. Contraceptive use at follow-up was most consistent in the never-pregnant group. These data suggest the need for earlier family involvement in educating and guiding teens together with access to contraceptive services in preventing unwanted adolescent pregnancies.

Abortion, Induced↗
PubMed2003

Global infertility and the globalization of new reproductive technologies: illustrations from Egypt.

Infertility is a problem of global proportions, affecting on average 8-12 percent of couples worldwide. In some societies, however-particularly those in the "infertility belt" of sub-Saharan Africa-as many as one-third of all couples are unable to conceive. Factors causing high rates of tubal infertility in parts of the developing world include sexually transmitted, postpartum, and postabortion infections; however, male infertility, which is rarely acknowledged, contributes to more than half of all cases. Unfortunately, the new reproductive technologies (NRTs) such as in vitro fertilization (IVF), which are prohibitively expensive and difficult to implement in many parts of the developing world, represent the only solution to most cases of tubal and male infertility. Not surprisingly, these technologies are rapidly globalizing to pronatalist developing societies, where children are highly desired, parenthood is culturally mandatory, and childlessness socially unacceptable. Using Egypt as an illustrative case study, this paper examines five of the major forces fueling the global demand for NRTs; these include demographic and epidemiological factors, the fertility-infertility dialectic, problems in health care seeking, gendered suffering, and adoption restrictions. Following this overview, a detailed examination of the implications of the rapid global spread of NRTs to the developing world will be offered. By focusing on Egypt, where nearly 40 IVF centers are in operation, this article will demonstrate the considerable constraints on the practice and utilization of NRTs in a developing country on the "receiving end" of global reproductive technology transfer. The article concludes by stressing the need for primary prevention of infections leading to infertility, thereby reducing global reliance on NRTs.

Anthropology, Cultural↗
PubMed1997

Multiple induced abortions: Danish experience.

Experience with 50 first time aborters, 50 second time aborters, and 50 third time aborters residing in an urban area of Copenhagen suggests that women having a repeat abortion are more similar than dissimilar to women having a first induced abortion. There were no differences in socioeconomic status, educational level, or stated reasons for choosing abortion (usually socioeconomic and family considerations). Though similar to first and second time aborters in their life situations and greater contraceptive risk-taking, third timers seemed to become pregnant more readily. They were also less willing to be interviewed. Related studies and suggestions for postabortion counseling are discussed.

Abortion, Induced↗
PubMed1993

Infection due to Chlamydia trachomatis in pregnancy and the newborn.

Bacteria in the genus Chlamydia comprise three species, C. trachomatis, C. psittaci and C. pneumoniae. C. trachomatis infection is common, varying in prevalence in women from 0% to 37%. In the United States, the prevalence rate is estimated currently to be about 5%. Pregnancy may predispose to an increased chance of infection with C. trachomatis, through physiological immunosuppression and/or cervical ectopy. Maternal antibodies to C. trachomatis provide limited, if any, protection for the newborn. C. trachomatis causes pelvic inflammatory disease--which can result in tubal infertility or ectopic pregnancy and postabortal or late postpartum endometritis. It may also cause chorioamnionitis and premature delivery of the fetus. The incidence of vertical transmission of chlamydiae from mother to baby varies; if the mother is untreated, 20-50% of the newborns will develop conjunctivitis and 10-20% will develop pneumonia. C. psittaci infection in pregnancy is rare, but can cause spontaneous abortion. Whether C. pneumoniae infection in pregnancy has any influence on the outcome has not been ascertained. C. trachomatis can be detected by one or more of several methods; enzyme immunoassays are the least sensitive, but the most widely used. Screening for C. trachomatis in pregnancy may be of benefit in areas of high prevalence, and is generally regarded as being cost-effective if the prevalence rate is more than 5%. Pregnant women are best treated with erythromycin, 250 mg four times daily for 7 days. This will prevent infection of the newborn in more than 90% of cases. The infected neonate should be treated with erythromycin, given systemically and also with topical tetracycline if conjunctivitis is present.

Chlamydia Infections↗
PubMed2004

Cystic teratoma-provoked peritonitis after pregnancy termination.

BACKGROUND: Cystic teratoma is an unusual cause of postabortal pelvic peritonitis. CASE: A healthy 22-year-old woman underwent outpatient first-trimester vacuum pregnancy termination, followed by a 3-day course of oral doxycycline. On the thirteenth day after pregnancy termination, she presented with fever, an acute abdomen, and pelvic pain. The woman underwent re-aspiration of her uterus, which yielded scanty tissue. She then underwent pelvic ultrasound and computerized tomogram, both of which revealed a posterior pelvic mass, presumed to be an abscess. After 5 days of broad-spectrum antibiotics had failed to alleviate her fever and pain, culdocentesis was performed yielding 30 cm3 of pus, hair, and fat. The woman underwent laparotomy, which revealed a 10 x 8 x 5 cm multiloculated, infected benign cystic teratoma with extensive capsular adhesions. CONCLUSION: If postoperative infection is to develop after pregnancy termination, signs will usually appear within the first week. Onset of pelvic peritonitis more than 1 week after uneventful conclusion of a pregnancy event should raise suspicion of either non-gynaecologic causes or, as in this case, a pelvic neoplasm.

Abortion, Induced↗
PubMed1993

Personality and self-efficacy as predictors of coping with abortion.

The present study explored the relationships among dispositional optimism, self-esteem, chronic perceptions of control, depression, and self-efficacy in predicting psychological adjustment among women undergoing an abortion. Self-efficacy was found to be a strong, proximal predictor of adjustment, both immediately after the abortion and 3 weeks later. Optimism, perceptions of personal control, and high self-esteem were all related to better postabortion adjustment (mainly through the mediator of increased self-efficacy for coping). In addition, the effects of these three personality variables were found to overlap considerably. Finally, preabortion depression had both direct and indirect (through self-efficacy) effects on adjustment. These effects did not overlap completely with the effects attributable to personality.

Abortion, Legal↗
PubMed1997

Mixed messages: implications of social conflict and social support within close relationships for adjustment to a stressful life event.

The authors examined the impact of women's perceptions of negative (conflict) and positive (support) exchanges with their mothers, partners, and friends before having an abortion on negative (distress) and positive (well-being) indexes of adjustment after the abortion. Preabortion conflict and support from the partner predicted postabortion adjustment in the same affective domain: Conflict uniquely predicted distress, whereas support uniquely predicted well-being. Within-source interactions were observed between support and conflict from mothers and friends. Women who perceived high support from their mothers or friends were more distressed if they also perceived them as sources of high conflict than if they perceived them as sources of low conflict. Among women who perceived their mothers or friends as nonsupportive, no relationship was observed between conflict and distress. Cross-source buffering was not observed.

Abortion, Induced↗
PubMed2003

The 'frameless' intrauterine system for long-term, reversible contraception: a review of 15 years of clinical experience.

AIM: The development of the 'frameless' intrauterine system (IUS) is a response to the growing need to develop high-performing, long-acting, reversible, and acceptable contraceptives with a high continuation of use. METHODS: This is a review of 15 years of clinical experience in randomized controlled and non-randomized clinical trials. RESULTS: The IUS has a similar failure rate as the TCu380A Intrauterine device (IUD), considered the 'golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional 'framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15,000 woman-years experience. CONCLUSIONS: Young nulliparous/nulligravid and parous women may significantly benefit from the advantages the 'frameless' IUS, which could be strategically important to help in reducing the increasing number of unintended pregnancies and induced abortions worldwide. Furthermore, the 'frameless' IUS has been shown to be highly effective for emergency contraception and for immediate postabortal insertion. The long lifespan of the IUS could constitute a cost-effective reversible alternative to irreversible female sterilization.

Female↗
PubMed1998

Transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler to detect residual trophoblastic tissue.

The value of transvaginal B-mode ultrasonography combined with color velocity imaging and pulsed Doppler to detect retained trophoblastic tissue was evaluated prospectively in a series of 40 patients with postpartum (n = 15) or postabortion (n = 25) bleeding. Color velocity imaging was used to identify color-coded blood flow signals within myometrium and/or endometrium. Flow was subjectively quantified as absent, scanty or abundant. Pulsed Doppler was used to assess blood flow impedance by calculating the resistance index. The presence of abundant flow with a lowest resistance index of less than 0.45 was considered as suspicious of residual trophoblastic tissue. Twenty-two (55%) out of the 40 patients underwent dilatation and curettage and chorionic villi were demonstrated in 15 of these. Eighteen (45%) patients were managed conservatively. None of these patients suffered complications or needed readmission for curettage, and all of them were considered as not having retained tissue. On color pulsed Doppler ultrasound examination, 15 patients had suspected retained tissue; all of these underwent curettage and residual trophoblast was found in 14 (93.3%). Out of 25 patients considered as having no residual tissue on color pulsed Doppler ultrasound examination, seven underwent curettage and chorionic villi were found in one patient (false-negative rate 6.7%) All patients managed conservatively had an unsuspicious scan. We concluded that transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler could be useful to detect retained trophoblastic tissue and to select patients suitable for conservative management.

Abortion, Induced↗
PubMed2000

Management of side effects and complications in medical abortion.

Side effects are an expected part of medical abortion; some, such as pain and bleeding, result from the abortion process itself and are generally managed with orally administered analgesics and counseling. True medication side effects most commonly include nausea, vomiting, diarrhea, and warmth or chills. Complications of medical abortion usually represent an extreme or severe side effect. Large series have reported transfusion rates of <1%. Because of the infrequency of uterine instrumentation, postabortal endometritis appears to be rare with medical abortion. As with early surgical abortion, the clinician must remain aware of the possibility for ectopic pregnancy. Overall approximately 2% to 10% of patients will require surgical intervention for control of bleeding, resolution of incomplete expulsion, or termination of a continuing pregnancy. Understanding the types of side effects and complications that can occur will enable the clinician to counsel patients properly as well as to understand when medical intervention is necessary during the medical abortion process.

Abortifacient Agents↗
PubMed1995

Laparoscopic silastic band sterilization failures.

Silastic band laparoscopic sterilization was introduced in the early 1970s as an alternative to unipolar cautery laparoscopy. Banding eliminates burn injury and reduces tubal destruction. However, in comparison with other methods, the success of Silastic banding may depend more on tubal morphology. This case-control study of 70 banding failures and 140 controls matched for age, gravidity, and date of procedure reveals that morphologic abnormalities of pelvic organs (adhesions or tubal thickening) or a history of a disease known to cause such abnormalities (pelvic inflammatory disease) increases the risk of sterilization failure. The risk of failure is further increased if the procedure is performed immediately postpartum or postabortion rather than as an interval procedure.

Age Factors↗
PubMedDate not supplied

Risk factors for complications of induced abortions in Nigeria.

BACKGROUND: The prevalence and risk factors for unsafe abortions and their complications are not well defined. METHODS: A cross-sectional study of patient-reported reproductive history was conducted in three hospitals in southwest Nigeria from 1998 to 1999. Data on pregnancy outcomes and sociodemographic characteristics were collected for 1836 women ages 15-49 seeking family planning and antenatal services. Independent predictors for complications from induced abortion of first pregnancies were analyzed using logistic regression models. RESULTS: Four hundred twenty-four women (29.7%) terminated their first pregnancy. As many as 43.1% of women unmarried at first pregnancy had an abortion, and being unmarried at pregnancy was the strongest predictor of abortion in the adjusted model. Almost 30% experienced complications at the time of abortion (heavy bleeding, high fever, and other), and 22.9% reported complications subsequent to and within 6 weeks of abortion. Heavy bleeding and 6-week complications were significantly associated with age at pregnancy, circumcision, and religion, and 87.6% of women with 6-week complications reported complications for 1 day. Type of provider was the sole significant predictor of fever, and doctor provider reduced the risk of fever. Induced abortion and related complications were common despite the widespread provision by doctors. CONCLUSIONS: Policies and programs should address improving abortion practices and postabortion care, increasing contraceptive use, and reducing the practice of female circumcision.

Abortion, Induced↗
PubMedDate not supplied

Tricuspid valve group B streptococcal endocarditis following elective abortion.

Streptococcus agalactiae, a group B streptococcus, has been a well-known cause of postpartum and postabortion endocarditis since the preantibiotic era. Streptococcus agalactiae is capable of infecting normal valves and usually produces left-sided disease. We describe a 30-year-old woman who developed tricuspid valve endocarditis due to S. agalactiae. Excision of the valve and a 4-week course of therapy with vancomycin resulted in cure.

Abortion, Induced↗
PubMed1993

Bacterial vaginosis and anaerobes in obstetric-gynecologic infection.

Anaerobic infections of the upper genital tract are common. Antibiotic regimens designed to inhibit anaerobes markedly reduce morbidity. A vaginal infection associated with an increased concentration of anaerobic bacteria (bacterial vaginosis) has been recently linked to a wide variety of upper genital tract infections. Bacterial vaginosis has an important role in the development of clinical chorioamnionitis, postpartum endometritis, posthysterectomy vaginal-cuff cellulitis, postabortion pelvic inflammatory disease, and upper genital tract infections such as amniotic fluid infection and chorioamnion infection associated with premature delivery.

Abortion, Spontaneous↗
PubMed1993

Vaginal flora in health and disease.

This chapter has portrayed the normal vaginal flora as a range of microbial species that associates in a stable way with human vaginal epithelium. The human vagina provides these microorganisms with the physical and chemical environment that allows them to use this tissue as a normal habitat. Because the relationship of the normal flora to the underlying tissue is that of an ecosystem, the components of this system are in dynamic equilibrium. Consequently, a change in the environmental conditions provided by the vaginal epithelium will result in changes in the population density or the species composition of the normal flora. Although the microbial flora appears to provide a benefit to the host by reducing the probability of colonization by exogenous microorganisms, it may participate in various undesirable symptoms, including various types of vaginitis or postoperative, postabortion, and post-Caesarean section infections, and upper tract invasion after lower tract infection. All future attempts to understand vaginitis in all its manifestations necessarily must include recognition of the importance of the normal flora because all types of vaginitis are superimposed on an existing endogenous microbial flora.

Animals↗
PubMed1993

Trichomonas vaginalis: a reemerging pathogen.

Infestation with T. vaginalis is a common and potentially morbid infection. In addition to reproductive tract discharge and irritation, infection with this protozoa is increasingly recognized to be associated with reproductive tract complications, including postabortal infection, postcesarean infection, preterm birth, and PROM. Clinical diagnosis is often difficult and newer approaches using specific antigen and nucleic acid technologies will probably replace "wet prep" microscopic techniques. Effective treatments continue to depend on oral metronidazole treatment. Cure of resistant strains, which remain rare, depends on administration of higher, more prolonged doses of metronidazole. Improved understanding of the natural history, pathobiology, diagnosis, and treatment of this common protozoa is urgently needed. Practitioners should consider routinely screening and treating women for trichomoniasis before any reproductive tract surgery (chorionic villi sampling, hysterectomy, cesarean section, dilatation and curettage, therapeutic abortion, and so on), after changing sexual partners, and during pregnancy. Both symptomatic and asymptomatic patients and their sexual contacts should be treated.

Diagnosis, Differential↗
PubMed2001

Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda.

BACKGROUND: The cause of bacterial vaginosis remains poorly understood. Recent evidence strengthens the association between bacterial vaginosis and serious medical complications. GOAL: To review the evidence linking bacterial vaginosis with adverse pregnancy outcomes, complications after gynecologic procedures, and HIV infection, and to identify prevention strategies. METHODS: In March 1999, the Centers for Disease Control and Prevention organized a conference to accomplish this goal. RESULTS: Better understanding is needed concerning the etiology, epidemiology, and natural history of bacterial vaginosis. More efficacious treatment of bacterial vaginosis and strategies to reduce maternal complications associated with bacterial vaginosis, such as premature rupture of the fetal membranes, chorioamnionitis, premature labor and delivery, postdelivery endometritis, and postpartum infant complications should be developed. Recent evidence shows that screening and treatment of bacterial vaginosis before abortion reduces postabortion pelvic inflammatory disease, and that anaerobic coverage during hysterectomy reduces postoperative complications. Better understanding concerning the relation of bacterial vaginosis to acquisition of sexually transmitted diseases and HIV infection are needed as well as possible prevention strategies. CONCLUSIONS: A national prevention effort should be guided by the results of research that addresses current knowledge gaps.

Abortion, Induced↗
PubMed1980

Recognizing the teen-ager who needs to be pregnant: a clinical perspective.

Based on the last three years' clinical experience with 600 inpatient adolescents at the Adolescent Center of Houston International Hospital, this paper reviews the pregnancy issue in terms of primary, secondary, and tertiary prevention. The majority of the patients were white middle-class girls ranging in age from 12 to 17. The clinical symptoms which especially identified at-risk patients were (1) failure experiences, (2) stymied aggression, (3) rights of passage proclamation, (4) parental complicity, (5) the guaranteed spouse, (6) perceived love deprivation, (7) contrived need for parental acceptance, and (8) pseudoknowledge. Secondary prevention is described in terms of (1) parents' group for the parents of the young parents, (2) use of peer group psychotherapy, and (3) parents' groups as a means for dealing with "pregnancy substitutes." Tertiary prevention is depicted in terms of (1) peer group psychotherapy in the postabortion phase, (2) use of peer groups and parents' groups to avoid further pregnancies, and (3) peer/parents' group psychotherapy as a source of contraceptive information. Illustrative vignettes are included for each category. Follow-up at six months after hospitalization has supported the effectiveness of the methods of intervention described.

Adolescent↗