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PubMed1982

Septic shock and the obstetrician/gynecologist.

Septic shock continues to be a serious problem with a mortality ranging from 11% to 82%, depending upon the cause, the time of diagnosis, and the type of treatment. The condition is seen in pregnant patients with postabortal or postpartal endometritis, chorioamnionitis, and pyelonephritis. In gynecology patients it is seen after severe pelvic infection and in immunosuppressed patients with gynecologic cancer. Prompt diagnosis, adequate monitoring and vigorous treatment are essential if deaths are to be reduced. Over the period July 1, 1959, to June 30, 1981, 91 patients were treated for septic shock with a mortality of 18%. Although medical treatment is important, the most important aspect of treatment for most patients is removal of the septic focus.

Abortion, Septic↗

PubMed2004

Sexual behavior during the first eight weeks after legal termination of pregnancy.

BACKGROUND: The aim of the study was to describe sexual symptoms and resumption of sexual activity during the first 8 weeks after unrestricted first-trimester termination of pregnancy (TOP). METHODS: Questionnaires 2 and 8 weeks after legal first-trimester abortion in 1327 women. RESULTS: The 8-week questionnaire was returned by 941 (71%). Overall, 51.0% of the women recommenced coitus within 2 weeks after TOP. This figure was significantly higher among women aged 18-24 years (60.6%) than among women in higher age groups (41.7-47.8%). At 8 weeks follow-up coitus was reported by 86.9%, ranging from 65.8% of women not in a steady relationship to 93.7% of women in a relationship (p < 0.001), and age-related differences were insignificant. Long duration of vaginal bleeding, medical abortion and need for reevacuation of the uterus diminished the resumption frequency at 2 weeks follow-up, but 8 weeks after termination postabortion complications did not affect resumption. At 8 weeks follow-up 15.3% reported diminished sexual desire and 6.0% reported diminished orgasm ability comparing to prepregnancy level. Of the sexually active women 6.2% did not use sufficient contraception 8 weeks after termination. CONCLUSION: Coitus is recommenced shortly after termination of pregnancy but not always with sufficient contraception. Legal abortion is associated with few adverse effects on sexual function.

Abortion, Induced↗

PubMed2005

Is preoperative vaginal cleansing necessary for control of infection after first trimester vacuum curettage?

BACKGROUND: Traditionally, the vagina is cleansed, before a curettage is performed. A previous study, comparing cleansing with chlorhexidine solution and cleansing with saline solution before vacuum aspiration in the first trimester, did not show any difference in the frequency of postoperative pelvic inflammatory disease. We wanted to investigate whether this was true also for vaginal cleansing with chlorhexidine, compared to no vaginal cleansing at all. METHODS: Consecutive women having surgical first trimester legal abortions were randomized to vulvar and vaginal cleansing with chlorhexidine or vulvar cleansing only. The frequency of postabortion pelvic inflammatory disease was evaluated with patient questionnaires and study of medical records. RESULTS: Of the 486 patients included in the study, vaginal cleansing was performed on 246 and no vaginal cleansing on 240. The frequency of probable pelvic inflammatory disease was 2.4% with cleansing and 2.1% without cleansing (no significant difference). CONCLUSIONS: Under certain conditions, preoperative vaginal cleansing can be safely omitted.

Abortion, Induced↗

PubMed2006

Women and abortion: the past reaches into the present.

AIM: This paper reports a study of women's responses to abortion over an extended time. BACKGROUND: Most studies of postabortion responses do not portray what women experience over an extended time period, since many only use a 24 month follow-up period. Results from previous studies indicate that women have thoughts about their abortion that they suppress or find intrusive. METHOD: Sixteen women who had chosen to terminate a pregnancy for non-medical reasons at least 15 years previously were interviewed during the years 1999-2001. This phenomenological study revealed their responses to and thoughts about their abortion(s). FINDINGS: Each of the women spoke about thinking of their abortion(s) at varied times. The abortion(s) was/were not a time-limited event; instead thoughts, emotions, and insights about the meaning of these experiences were on-going, as life events unfolded. The past reached into the present in varied ways and at unplanned times. Difficulties with subsequent pregnancies, life milestones, and mundane occurrences involving friends' children were common triggers for recurring thoughts about past abortions. These recurrent thoughts had characteristics of avoidance or suppression and intrusion. CONCLUSION: When taking an obstetric history, nurses and midwives should be sensitive when inquiring about discrepancies between the number of times a woman has been pregnant and the number of living children. Opportunity should be given for a woman to discuss in a safe, non-judgmental environment any emotions or thoughts she may express. Providers of women's healthcare services must reflect about ways to reassure women of the common nature of recurrent thoughts and the spectrum of emotional responses that, even years later, is normal.

Abortion, Induced↗

PubMed2000

Sonographic diagnosis of exencephaly: omphalocele at 11 weeks of gestation.

This report presents a sonographic diagnosis of exencephaly combined with omphalocele at 11 weeks of gestation. The transvaginal ultrasound showed frog-eye appearance face with no skull, abnormal shape of disorganized brain with covering membrane separated from brain mass by anechoic fluid in some area, and omphalocele of 8 mm diameter. Therapeutic abortion was successfully done with misoprostol. Postabortal macroscopic findings confirmed the prenatal diagnosis. The combination of exencephaly and omphalocele is rare, and this is one of the earliest diagnosis of not only exencephaly but also omphalocele. To our best knowledge, this represents the earliest diagnosis of the combination. In conclusion, transvaginal ultrasound proved highly informative for both exencephaly and omphalocele as early as in first trimester.

Abortion, Therapeutic↗

PubMed2005

Abortion discourse in Bolivian hospital contexts: doctors' repertoire conflicts and the Saving Women device.

The author proposes going Beyond attitudes (Potter and Wetherell 1987) to a more nuanced assessment of doctors' discursive variations. Through an application of Gilbert and Mulkay's (1984) interpretative repertoires, she defined three voices--technical, normative and pragmatic--in which Bolivian doctors spoke of abortion. In State and social security hospital contexts, doctors hastened to express compliance with government policy and institutional norms regulating abortion and postabortion care. Technical and pragmatic considerations, however, often entered into conflict with established rules. When contradictions became apparent in their own discourse, doctors regularly drew on the Saving Women device. This accounting strategy enabled them to save face as up-to-date professionals through justifying temporary deviance from norms in terms of benefit to women treated. The author describes her development of the repertoires, their validation with different medical audiences, and doctors' critical appropriation of the model to explain their own discursive variations.

Abortion, Incomplete↗

PubMed1980

Prolactin changes in maternal plasma following termination by vacuum curettage and the effect of bromocriptine treatment on these changes.

To study the prolactin secretion and its dependence on the sex steroid concentrations during pregnancy, we measured the circulating prolactin, oestradiol-17 beta, progesterone and testosterone levels following vacuum curettage for termination of early pregnancy in 10 normal women and in 10 other women whose prolactin levels had been lowered with bromocriptine treatment. In normal women, anaesthesia and vacuum curettage led to consistent and significant (p < 0.01) rises in prolactin levels between 0.5 to 5 hours after abortion. This increase was not seen in women treated with bromocriptine whose prolactin level of 8.6 +/- 1.4 ng/ml (mean +/- SE) before abortion was lower than that of 29.6 +/- 6.4 ng/ml found in normal women. The oestradiol and progesterone concentrations decreased rapidly but similarly in both groups of patients following the evacuation of the uterus, whereas the testosterone level did not change significantly. These results indicate: (i) vacuum curettage stimulates prolactin secretion, (ii) the prolactin-stimulating effect of stress appears to be stronger than the prolactin-suppressing effect of postabortal oestradiol and/or progesterone declines, and (iii) bromocriptine blocks the stress-induced prolactin rise.

Abortion, Legal↗

PubMed1992

A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion.

OBJECTIVE: To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion. DESIGN: Double-blind, randomized controlled trial. SETTING: Department of Surgery, County Hospital, Denmark. SUBJECTS: Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo. INTERVENTION: The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion. MAIN OUTCOME MEASURES: Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion. RESULTS: Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test). The prevalence of C. trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID). CONCLUSION: Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies.

Abortion, Induced↗

PubMed1984

Cervical occlusion due to adhesions following therapeutic abortion: an uncommon sequel to vacuum curettage.

Eleven women were referred with postabortal amenorrhoea and cyclical lower abdominal pain due to upper cervical occlusion by a thin band of fibrous adhesions. All had undergone first trimester termination of pregnancy by vacuum curettage. Associated intrauterine adhesions were found in 2 patients. Cervical adhesions were easily breached with a uterine sound and cervical dilators, and were then visualized with a hysteroscope. All women resumed normal menstrual cycles and suffered no sequelae. This unusual, but eminently treatable, complication of vacuum curettage should be more widely appreciated.

Abortion, Therapeutic↗

PubMed2002

Abortion risk and decisionmaking among young people in urban Cameroon.

This study examines the use of induced abortion among Cameroonian adolescents and young women, based on biographical data collected in 1997 among young women and men residing in Yaoundé. Results suggest a high prevalence of abortion during adolescence and early adulthood (35 percent of all pregnancies reported). Although most clandestine abortions were performed by a physician or a nurse, the prevalence of abortion performed by nonmedical personnel or using unsafe methods is still high, and postabortion health complications are reported for about one-fourth of all abortions. Logistic regression models are used to examine the effect of women's, partners', and relationships' characteristics at the time of pregnancy on the odds that a pregnancy will be terminated through abortion. The analysis shows a significant effect of school enrollment, parity, and stability and social acknowledgment of the sexual relationship on the risk of having an abortion. Young men's involvement in decisions and their motivations concerning abortion are also examined.

Abortion, Induced↗

PubMed2004

Reassessing the level of unintended pregnancy and its correlates in Vietnam.

Despite rapidly increasing contraceptive use and rapidly declining fertility, unintended pregnancy and induced abortion remain common in Vietnam. This study reassesses the level of unintended pregnancy in Vietnam and its correlates, drawing on retrospective calendar data gathered for the Vietnam Demographic and Health Survey II. Data from 13,540 "segments" of outcomes and contraceptive practice were analyzed. Based on the calendar data, 40 percent of pregnancies during the 1994-97 period are estimated to have been unintended, a proportion 48 percent higher than the prevailing estimate calculated from the reported intendedness of live births. When concealment of pregnancies ending in induced abortions is taken into account, the unintended pregnancy rate in Vietnam is likely to approach levels found only in developing countries. Unintended pregnancy was found to be associated with age, early marriage, spousal age difference, number of living sons, past unintended pregnancy, geographic region, contraceptive use prior to pregnancy, and the family planning supply environment. The findings suggest that broadening the method mix at the community level, targeting high-risk and underserved groups, and expanding postabortion counseling and services are likely to have a dramatic impact on the unintended pregnancy rate in Vietnam.

Abortion, Induced↗

PubMed1990

Type I and type III collagen interactions during fibrillogenesis.

There is some evidence that type I and type III collagens may be present in the same fibril. In order to demonstrate this, double labeling immunofluorescence microscopy and immunoelectron microscopy were performed with antibodies directed against the collagen molecule and the aminopropeptide domains of type I and type III procollagens using embryonic (postabortion) and adult human skin. Double indirect and protein A immunoelectron microscopy were carried out with 5- and 15-nm gold particles. Skin extracts were also studied by immunoblotting. Double immunofluorescence microscopy with antibodies against type I and type III collagen molecules revealed patterns of fluorescence that were identical in both fetal and adult skins. Immunofluorescence microscopy using an antibody directed against the aminopropeptide of type III procollagen labeled the entire dermis in both embryonic and adult skins. In contrast, although the aminopropeptide of type I procollagen was present throughout embryonic dermis, it was markedly reduced in adult dermis, except for the epidermo-dermal junction. Double immunoelectron microscopy of fetal skin revealed labeling of the aminopropeptide of type I and type III procollagens on the same thin (20-30 nm) fibrils. Large type I fibrils (90-100 nm) were coated with type III collagen molecules and their corresponding aminopropeptide but not with the aminopropeptide of type I procollagen. The aminopropeptide of type I procollagen was present on thin fibrils only at the epidermo-dermal junction in adult skin. Immunoblotting of skin extracts revealed the presence of both pN-type III procollagen (collagen plus the aminopropeptide) and pN-type I procollagen in fetal skin, but only pN-type III in adult skin. This study demonstrates that type I and type III collagens coexist within the same fibril and that the aminopropeptide of type III procollagen is present at the surface of type I collagen fibrils that apparently have reached full growth.

Adult↗

PubMed1980

Therapy of obstetrical infections with moxalactam.

We evaluated moxalactam in 62 patients with puerperal or postabortal genital infections. In all patients, the initial dose was 6 g/day. In 84% of patients, we found anaerobes in genital specimens. Of aerobic isolates, only enterococci were resistant. Among anaerobes tested, only two isolates (a Clostridium leptum and a Bacteroides disiens) had minimal inhibitory concentrations of greater than or equal to microgram/ml. Good clinical responses occurred in 56 of 62 (90%). Moxalactam was well tolerated with little local irritation and minimal hepatic, renal, or hematological abnormalities.

Abortion, Spontaneous↗

PubMed1998

Serodiagnosis of neosporosis in individual cows and dairy herds: A comparative study of three enzyme-linked immunosorbent assays.

The performance of three enzyme-linked immunosorbent assays (ELISA) for detection of antibodies to Neospora caninum in bovine sera was evaluated by using various categories of sera. Two commercial ELISA methods, one based on chemically fixed intact tachyzoites and one based on a sonicate lysate of whole tachyzoites, were compared with an in-house ELISA based on a detergent lysate of whole tachyzoites. A brief description of the development of the latter ELISA is also given. There was good agreement among all three tests with regard to postabortion sera. By using acute-phase abortion sera from cows with confirmed N. caninum-induced and non-N. caninum-induced abortions, satisfactory levels of sensitivity and specificity were calculated for all tests. In addition, similar test results were obtained with postpartum samples from dams and calves. However, considerable differences were found between test results of sequential samples and cross-sectional and total-herd samples. Apparently, these discrepancies were due to different sensitivities of the tests for detection of low antibody levels in chronically infected animals. It is suggested that these differences were primarily due to the use of different antigens and different test sample dilutions. It is concluded that all tests are applicable as an additional diagnostic tool in cases of abortion in cattle and for monitoring of congenitally infected calves. For herd screening, the lysate-based ELISAs appear to be more adequate because of their higher sensitivities.

Abortion, Veterinary↗

PubMed1973

Psychiatric aspects of female sterilization.

Follow-up of 151 women who had been sterilized for social or gynaecological reasons one to three years earlier showed that 146 were completely satisfied with the results of the operation on their health and on their sexual relationships with their husbands. The five who were dissatisfied either wished they could still conceive or found the operation had not produced the effect hoped for. On the basis of this study we believe that adverse psychiatric sequelae of sterilization can be kept to a minimum with careful selection of patients. Women should be over 30 or if younger should have had two or more children, and the operation should not be performed at childbirth, in the neonatal period, or during a postabortive depression.

Abortion, Induced↗

PubMed1972

Alpha-fetoprotein in abortion.

The clinical value of maternal serum alpha-fetoprotein (AFP) as a guide to the outcome of threatened abortion was assessed. After the thirteenth week of gestation, abortion occurred more frequently (10/12) in women with abnormal serum AFP levels than in those (2/12) whose AFP concentrations were within the normal range. Low levels were present in women with blighted ovum and high concentrations were associated with intrauterine fetal death. In legal first and second trimester abortions, the circulating maternal AFP levels in postabortion samples were often higher than before abortion, irrespective of whether abortion was performed instrumentally or induced with prostaglandins. Maternal serum AFP levels provide a new means for prediction of the outcome of threatened abortion.

Abortion, Legal↗

PubMed1990

Screening for cervical Chlamydia trachomatis infections in two Dutch populations.

Endocervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae were taken from 492 women attending an outpatient clinic for sexually transmitted diseases (group I) and 560 women seeking legal abortion (group II). Possible risk factors for C trachomatis infection were evaluated by multivariate analysis. The prevalence rates for C trachomatis and N gonorrhoeae were 7.3% and 2.5% in group I and 9.4% and 0.4% in group II. From multivariate analysis it was found that age (p less than 0.01), number of sexual partners (p less than 0.01), abnormal vaginal discharge (p less than 0.01), and endocervical mucopus (p = 0.02) were independently associated with chlamydial infection in group I. In the abortion clinic age (p = 0.03) and endocervical mucopus (p = 0.03) were the only significant independent predictors of C trachomatis. In all women vaginal discharge was collected for Gram staining. A significant higher number of polymorphonuclear cells was seen in the smears of C trachomatis positive women (group I: p = 0.04; group II: p = 0.03). In group II there was also a significant association between C trachomatis and Gardnerella type bacterial flora (p = 0.02) and the presence of comma-shaped rods (p = 0.04). Screening for C trachomatis infection may help to decrease the incidence of (post-abortal) pelvic inflammatory disease. Because screening in abortion clinics is not always possible, decreasing the incidence of postabortal pelvic inflammatory disease could be achieved by using prophylactic antibiotics. Selective use of prophylaxis in high risk patients can minimise costs and the incidence of side effects.

Adult↗

PubMed1987

Gestational trophoblastic neoplasia: diagnosis with Doppler US.

The sonographic appearance of gestational trophoblastic neoplasia is nonspecific and also seen in complete or partial hydatidiform mole, hydropic degeneration, degenerating fibroids, or ovarian dysgerminomas. Correlation with the serum human chorionic gonadotropin (hCG) level may be helpful since levels exceeding 100,000 IU/L are strongly suggestive of gestational trophoblastic neoplasia. However, low hCG levels may also be found in the presence of this disease. The authors studied six patients who were suspected of having gestational trophoblastic neoplasia. Three of the six proved to have incomplete abortions or molar degeneration. Doppler ultrasound (US) was used to record the signal in the uterine arteries of these patients. The signals were compared with those of three nongravid volunteers and three patients in the first trimester of pregnancy. Analysis of the signals in the uterine artery showed higher systolic and diastolic Doppler shifts in gestational trophoblastic neoplasia when compared with postabortal, gravid, and nongravid signals. These preliminary results indicate that Doppler US has the potential to be clinically useful in the diagnosis of gestational trophoblastic neoplasia.

Abortion, Incomplete↗