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PubMed2001

A multicenter study of bacterial vaginosis in women with or at risk for human immunodeficiency virus infection.

BACKGROUND: Bacterial vaginosis is a common gynecologic infection that has been associated with a variety of gynecologic and obstetric complications, including pelvic inflammatory disease, postabortal infection and premature delivery. Recent studies suggest that bacterial vaginosis may increase a woman's risk for human immunodeficiency virus (HIV). We undertook this study to assess whether the prevalence and characteristics of bacterial vaginosis differed according to HIV status in high-risk US women. METHODS: Prevalence of bacterial vaginosis was assessed by Gram's stain and clinical criteria for 854 HIV-infected and 434 HIV-uninfected women enrolled in the HIV Epidemiology Research (HER) Study. Multiple logistic regression techniques were used to determine whether HIV infection independently predicted bacterial vaginosis. RESULTS: Almost half (46%) the women had bacterial vaginosis by Gram's stain. The prevalence of bacterial vaginosis was 47% in the HIV-positive women compared with 44% in the HIV-negative women; this difference was not statistically significant (p = 0.36). After adjustment for other covariates, HIV-positive women were more likely than HIV-negative women to have bacterial vaginosis (odds ratio (OR) 1.31; 95% confidence interval (CI) 1.01-1.70) by Gram's stain but not by clinical criteria (OR 1.16; CI 0.87-1.55). Among HIV-positive women, use of antiretroviral drugs was associated with a lower prevalence of bacterial vaginosis (adjusted OR 0.54; Cl 0.38-0.77). CONCLUSIONS: In this cross-sectional analysis of high-risk US women, HIV infection was positively correlated with bacterial vaginosis diagnosed by Gram's stain.

AIDS-Related Opportunistic Infections↗

PubMed2000

Transvaginal sonohysterography for the evaluation and treatment of retained products of conception.

Diagnosing retained products of conception in a woman presenting with postpartum or postabortion bleeding presents a clinical challenge. Although ultrasonographic examination may be potentially useful in detecting retained products of conception, its accuracy has not yet been established. Saline infusion sonohysterography is a simple ultrasonographic technique for enhanced transvaginal sonographic imaging of the endometrial cavity by the instillation of saline into the uterine cavity during ultrasonographic evaluation. This technique enhanced our ability to diagnose retained products of conception, and we describe our experience in evacuating them under sonographic guidance while performing saline infusion sonohysterography.

Dilatation and Curettage↗

PubMed1989

Anniversary reactions and due date responses following abortion.

Of 83 women who responded to surveys exploring postabortion coping, 30 women reported anniversary reactions associated with the abortion or due date. Women in the anniversary reaction group more often reported ambivalence about the decision to abort (p less than 0.007). This group also acknowledged fewer suicidal thoughts and attempts, but expressed more concern about verbally abusing their children (p less than 0.04). Strong trends toward dependency and somatoform disorders were present among anniversary group members (p less than 0.06). The authors recommend that physicians be alert to the possibility of hidden anniversary reactions of both physical and emotional nature during patient evaluation.

Abortion, Induced↗

PubMed2001

Isolated pulmonic valve endocarditis caused by group B streprococcus (Streptococcus agalactiae)--a case report and literature review.

The pulmonic valve is the least commonly involved valve in infective endocarditis. Pulmonic valve endocarditis is usually associated with tricuspid valve endocarditis, and isolated pulmonic valve endocarditis is exceedingly rare. The predisposing factors for developing pulmonic valve endocarditis include a congenitally anomalous pulmonic valve, intravenous drug abuse, and the presence of indwelling intravenous or flow-directed pulmonary artery catheters. More cases of group B streptococcus endocarditis are being reported. The risk factors for group B streptococcus endocarditis include diabetes mellitus, cancer, alcoholism, malnutrition, immunocompromised status, intravenous drug abuse, postpartum and postabortion states, and underlying valvular disease. The vegetations of this type of endocarditis are usually large and have a higher tendency to result in embolism. The presentation of group B streptococcus endocarditis is usually acute and may result in rapid valve destruction if not treated promptly. A case of isolated pulmonic valve endocarditis caused by group B streptococcus, Streptococcus agalactiae, is presented that was diagnosed with multiplane transesophageal echocardiography in a 40-year old, alcoholic, malnourished man, who was successfully treated with intravenous penicillin G. The literature on the isolated pulmonic valve endocarditis caused by group B streptococcus is reviewed.

Adult↗

PubMed2007

Women's stories of abortion in southern Gabon, Africa.

The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.

Abortion, Induced↗

PubMed1984

The social and gynaecological background of 218 sterilized women.

This is the first part of a longitudinal follow-up study of 218 consecutively sterilized women. The operations were performed at the Gynaecological Department of Akershus Central Hospital during the period May 22nd 1973 to February 1, 1974. The mean age of the women was 33.5 years, their mean parity 2.8. They could not be distinguished from the women of the same age in the county at large with regard to incomes, education or housing conditions. The usage of contraception was widespread, but not consistent. Fifty-eight per cent of the operations were performed postabortion, 69% of the women had at least one, 21% at least two induced abortions before the sterilization. Family planning was the predominant stated motive for sterilization, and the present study indicates that the sterilization legislation of 1934 was outdated some years before it was succeeded by a new law. Sterilization was suggested by the doctor in 40%, at abortion application in 30%.

Abortion, Induced↗

PubMed1981

A separate mechanism of gonadotropin recovery after pregnancy termination.

To further elucidate the mechanism of return of pituitary secretory function after gestation, eight women were studied for up to 55 days after pregnancy termination. As long as serum estradiol (E2) and progesterone (P) levels were elevated, serum FSH remained low. Four to 6 days after abortion, serum E2 and P decreased to levels seen in the early follicular phase, and thereafter the initial increase in FSH occurred while serum beta-LH remained undetectable. After the initiation of FSH secretion, the levels fluctuated within the normal follicular phase range, resulting in a steady increase of E2 to a mean preovulatory peak of 257 +/- 37 pg/ml at a mean time of 21 +/- 1.3 days after pregnancy termination. This E2 peak was followed by FSH and LH peaks and subsequent ovulation. In contrast to FSH, serum beta-LH levels increased only after PRL-concentrations diminished to 30 ng/ml or less. This initiation of beta-LH secretion followed the advent of FSH secretion in six of eight patients. Therefore, a temporally separate mechanism of FSH and LH secretion after pregnancy termination is theorized. The theory of FSH occurs soon after the E2 and P levels decline while PRL levels are still elevated. However, the secretion of beta-LH increases only after levels have risen from the postabortion decline.

Abortion, Induced↗

PubMed1988

Immunochemical and biological characteristics of a human autoantibody to human chorionic gonadotropin and luteinizing hormone.

Anti-hCG/LH autoantibodies were found in the serum of an infertile woman a few days after an abortion which occurred after 46 days of amenorrhea. The antibody titer increased for approximately 4 more weeks, and then declined to low levels during a 14-month anovulatory period, after which regular menses resumed. Immunoglobulins isolated from a pool of serum obtained during the postabortion period neutralized the activity of both hCG and LH in an in vivo bioassay, and the binding affinity of the antibodies toward both hormones was high. When menses were resumed, there was a considerable reduction of the affinity toward LH. The variations in antibody titers and/or affinities can explain the sequence of fertilization, abortion, anovulatory period, and normalization of menses.

Abortion, Spontaneous↗

PubMed2005

Ectopic pregnancy: an 11-year review in a tertiary centre in the Niger Delta.

Ectopic pregnancy still remains a leading cause of maternal mortality and morbidity in the first trimester of pregnancy and also a significant cause of reproductive failure in Nigeria. A descriptive review of 211 consecutive cases of ectopic gestation over an 11-year period was undertaken. Ectopic pregnancy constituted 9.5% of gynaecological admissions. In all, 86% were nulliparous and 62.6% were married. Abdominal pain and tenderness were the most consistent modes of presentation. Also, 95.3% presented as ruptured ectopic pregnancy. Induced abortion (72%) was the most common factor associated with ectopic pregnancy. Anaemia was the most common post-operative complication. In all, 21% had prior dilatation and curettage as a result of misdiagnoses. The case fatality rate was 2.5%. Ectopic pregnancy presents a major public health challenge among women of reproductive age in this region. Community-based comprehensive health education programme focusing on contraception, sex education, prevention and treatment of postabortal sepsis, pelvic inflammatory disease and puerperal sepsis are urgently needed.

Adult↗

PubMed2003

Abortion beliefs and practices among midwives (parteras) in a rural Mexican township.

Reproduction and motherhood are among the most important components of women's identity throughout Mexico and, for many women, are the only vehicles for gaining recognition and status in the family and community. At the same time, however, abortion is a central experience in the lives of many women and carries with it the complexities and contradictions of women's reproductive and sexual health. This paper presents results from an ethnographic study conducted with midwives in one rural township of Morelos, Mexico to understand their conceptualizations of and practices related to abortion and postabortion care. Overall, midwives viewed miscarriage as a woman's failure to fulfill her primary role as mother and induced abortion as a grave sin or crime. Nevertheless, under certain circumstances induced abortion was justified for many midwives. Helping women to "let down the period" in situations when a woman's menstrual period was delayed was acceptable to midwives as it was not viewed as abortion and enabled women to regain health and well-being.

Abortion, Induced↗

PubMed2005

The incidence of induced abortion in Uganda.

CONTEXT: Although Uganda's law permits induced abortion only to save a woman's life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. METHODS: A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. RESULTS: Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country's most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. CONCLUSIONS: Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women's health, increased access to contraceptive services is needed for all women.

Abortion, Induced↗

PubMed2006

Induced abortion and unintended pregnancy in Guatemala.

CONTEXT: Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. METHODS: Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. RESULTS: Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. CONCLUSIONS: Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.

Abortion, Induced↗

PubMed1979

Malignant group B streptococcal endocarditis associated with saline-induced abortion.

A 20-year-old woman developed acute group B streptococcal endocarditis following saline-induced abortion. In the pre-antibiotic era, most cases of group B streptococcal endocarditis occurred in parturient or postabortal women. Currently, this disease is rarely described in obstetrical patients, and no previous cases following saline-induced abortion have been reported. Purulent pericarditis and a perivalvular abscess were present in our patient and represent only the second instance in which these findings have been documented in this disease.

Abortion, Induced↗

PubMed1998

Attitudes of the physician membership of the society for adolescent medicine toward medical abortions for adolescents.

OBJECTIVE: To document the practices and attitudes of the US physician members of the Society for Adolescent Medicine (SAM) regarding adolescent abortion and contraception, as well as physician willingness to prescribe medical abortion if approved by the Food and Drug Administration (FDA). DESIGN: Cross-sectional questionnaire survey. Participants. The entire physician membership of SAM (N = 1001) was surveyed. A total of 713 physicians responded, with 668 usable surveys yielding an adjusted response rate of 70%. RESULTS: Of the respondents, 81% were trained as pediatricians; 58% had additional adolescent medicine training. Ninety-six percent prescribed contraception for their patients. Sixty-one percent of respondents identified abortion as an option for pregnant adolescents in all circumstances, whereas 4% believed abortion should never be an option. Eighty-nine percent referred their patients for abortions; 90% were aware of medications to induce abortions medically. If these medications (methotrexate and misoprostol, RU-486) were FDA-approved, 42% would prescribe them for their patients; 34% were unsure. Fifty-four percent believed if medical abortions were routinely available, they should be available from primary care physicians. Physicians were significantly more likely to consider prescribing medical abortions if the physician were female, offered postcoital contraception, performed Norplant insertions, referred adolescents for abortions, or performed postabortion medical checkups. Physicians were no more likely to consider prescribing medical abortions according to physician age, specialty training, or date of residency training. Religious affiliation per se was not associated with likelihood of prescribing medical abortions, but Catholic physicians were significantly less likely to consider prescribing medical abortions. CONCLUSIONS: Virtually all SAM physician respondents (96%) reported that abortion for pregnant adolescents should be available under some circumstances. Forty-two percent would prescribe medical abortion if the medications were FDA-approved, suggesting that medical abortion would potentially be available to adolescents from a larger group of physicians than is currently available.

Abortifacient Agents↗

PubMed2006

Patient privacy and conflicting legal and ethical obligations in El Salvador: reporting of unlawful abortions.

Postabortion care providers who breach patient confidentiality endanger women's health and violate ethics. A 1998 abortion ban in El Salvador likely spurred an increase in the number of women investigated, because many women were reported to legal authorities by health care providers. Having analyzed safeguards of confidentiality in laws and ethical guidelines, we obtained information from legal records on women prosecuted from 1998 to 2003 and identified factors that may lead to reporting through a survey of obstetrician-gynecologists (n=110). Although ethical and human rights standards oblige providers to respect patients' privacy, 80% of obstetrician-gynecologists mistakenly believed reporting was required. Most respondents (86%) knew that women delay seeking care because of fear of prosecution, yet a majority (56%) participated in notification of legal authorities.

Abortion, Illegal↗

PubMed1992

Luteal maintenance in cattle after conceptus death during the first trimester of gestation.

The objectives of this experiment were to evaluate effect of age of the conceptus at death on subsequent interval to estrus and to determine whether prostaglandin F2 alpha (PGF) treatment after induced conceptus death would reduce interval to estrus. Sixty-four beef cows were diagnosed pregnant by ultrasonography between 24 and 50 d of gestation. Nine pregnancy groups were identified; each encompassed a 3-d interval from d 24 through 50 of gestation. Cows were allocated at random within pregnancy group to be treated with colchicine to induce conceptus death. Forty-eight hours after colchicine treatment, conceptus death was verified by ultrasonography and each animal received either saline or PGF. There was no evidence of an effect of age of conceptus at death on the subsequent interval to estrus after either saline or PGF. Interval to estrus after saline was 13.5 +/- .8 d, which was greater (P less than .01) than the 6.2 +/- .8 d after PGF. After saline, the estimate for the linear effect of time on serum progesterone (P4) was -1.32 +/- .36 ng/d and was less (P less than .05) than -2.83 +/- .36 ng/d for cows given PGF. Cows were exposed to fertile bulls at the first postabortion estrus. Pregnancy rates were 37.5% for cows given saline vs 31.3% for those given PGF. These results indicate that interval to estrus after conceptus death between 24 and 50 d of gestation is not affected by the age of the conceptus and can be reduced by PGF treatment.

Animals↗

PubMed1983

Vaginal cleansing at vacuum aspiration abortion does not reduce the risk of postoperative infection.

Does a thorough vaginal cleansing with bactericidal solutions prior to induced first-trimester vacuum aspiration abortion reduce the frequency of postabortal pelvic inflammatory disease (PID)? To answer this question we compared the frequency of PID in 372 women where a thorough preoperative vaginal cleansing with a bactericidal solution was undertaken at abortion with that in 350 women where the upper part of the vagina was swabbed with a pad moistened with a 0.9% saline solution. A postoperative PID was recorded in 25 (6.7%) of the former women and in 23 (6.6%) of the latter women.

Abortion, Induced↗

PubMed1987

Early complications after induced first-trimester abortion.

Complications subsequent to 5,851 consecutively induced first-trimester abortions during the period 1980-85 were analysed. Three hundred and fifty-six abortions (6.1%) led to complications requiring hospital admission. According to bivariable analysis, women below 25 years of age, women with parity 0, women with no spontaneous and with no induced abortions, and women in gestational week 8 had significantly higher postabortal complication rates than women 25 years of age and older (p less than 0.001), women with previous births (p less than 0.0001), women with spontaneous abortions (p less than 0.005), women with induced abortions (p less than 0.005), and women in other gestational age groups (p less than 0.0005). The mean stay in hospital per complicated abortion was 5.3 days. It was discussed whether the administration of prophylactic antibiotics to women with a history of pelvic inflammatory disease and young women completing their first pregnancy could reduce the complication rate.

Abortion, Induced↗