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Reproductive decision making of aunts and uncles of a child with cystic fibrosis: genetic risk perception and attitudes toward carrier identification and prenatal diagnosis.

This paper evaluates the perceived genetic risk, the perceived burden, the impact on reproductive decision making, and the attitudes of aunts and uncles of a child with cystic fibrosis toward carrier identification, prenatal diagnosis, and pregnancy termination. A mailed questionnaire was sent to the aunts and uncles of 32 CF children (1) who attended the Paediatric Department of the University Hospital and (2) whose parents agreed to give the names and addresses of their sibs. The results for the 109 respondents aged less than 40 years are discussed. About one-fourth of them was aware of the "approximate" level of the risk to be a carrier of the CF gene and/or of the risk of having a CF child themselves. Nevertheless the subjective evaluation of the genetic risk has played a part in the reproductive decision-making process of at least 39% of the respondents. About three-fourths would (probably) make use of heterozygote detection and would (probably) ask for prenatal diagnosis should they become pregnant. It is striking that less than half of the group would interrupt the pregnancy should the fetus be affected. The intention to use prenatal diagnosis was significantly correlated with age and educational level while the acceptance of pregnancy interruption was significantly correlated with perceived burden, respondents' age, and health situation of the proband.

Adult↗

A comparative cytogenetic study on cases of induced abortions in TCDD-exposed and nonexposed women.

In order to evaluate the cytogenetic findings previously obtained on induced abortions in women exposed to 2,3,7,8 tetrachlorodibenzo-p-Dioxim (TCDD) after the Seveso accident, chromosome analyses were carried out on a comparable control sample. The frequencies of aberrant cells, the relative proportions of individual types of chromosome aberration, the average number of lesions per damaged cell, and the frequencies of polyploids do not differ significantly in maternal blood and placenta in the two samples. A highly significant increase in the frequencies of aberrant cells and in the average number of aberrations per damaged cell was found in the fetal tissues in the group of exposed pregnancies. A noticeable feature of the data on the frequencies of cells with aberrations is the marked variability among individuals within tissues and within samples. On the basis of these results, the authors point to the need to continue cytogenetic investigations on interrupted pregnancies in TCDD-exposed and nonexposed women.

Abortion, Induced↗

Preoperative cervical dilatation with 15(S)15-methyl PGF2alpha methyl ester pessaries.

A clinical trial comparing two vaginal dose schedules of 15(S)15-methyl prostaglandin F2alpha (PGF2alpha) methyl ester (4 or 6 mg) for preoperative dilatation of the cervix is described. The trial included 28 patients at 8-12 weeks' gestation. Vaginal pessaries containing either 1.0 mg (15 patients) or 1.5 mg (13 patients) of the prostaglandin analogue were administered every 3 hours (maximum, 4 doses). The success rates for the two groups were 93% and 100%, respectively. Sixty percent of the patients aborted before the planned vacuum aspiration. Minor side effects, primarily vomiting and diarrhea, occurred in approximately 80% of the cases and were more prominent with the higher dose pessary. It is concluded that the vaginal administration of 15(S)15-methyl PGF2alpha methyl ester is highly effective for preoperative dilatation of the cervix before suction curettage abortion.

Abortion, Therapeutic↗

Abortion with sulprostone, a prostaglandin E2 derivative.

Sulprostone, a prostaglandin E2 derivative, was used in a multicenter trial to terminate 478 pregnancies of 8-21 weeks' gestation. The compound was clinically well accepted without premedication in extraovular, intravenous and intramuscular routes of administration. At 24 hours after treatment, 67%-88% of the patients had aborted, with a low average incidence of side effects. Sulprostone is preferred clinically to primary prostaglandins. Intravenous infusion was found to be the safest route, but intramuscular injection proved to be the most practical.

Abortifacient Agents, Steroidal↗

Attitudes toward the level of men's involvement in abortion decisions.

College students completed a questionnaire that assessed their attitudes toward the level of male responsibility in abortion decisions. Overall, both men and women thought that men should have some degree of involvement in the abortion decision. However, as expected by the first hypothesis, men indicated a desire for more responsibility in the abortion decision than women thought the men should have. A second hypothesis predicted women would feel more strongly than men that abortion was strictly a woman's issue. Contrary to the hypothesis, women tended to disagree that abortion was strictly a women's issue. Implications of the findings are discussed.

Abortion, Induced↗

First trimester selective reduction in multiple pregnancy guided by transvaginal sonography.

Transvaginal ultrasonography-guided fetal reduction was performed in 11 patients presenting with multiple pregnancies. Embryonic aspiration was carried out in 7 women at 7 to 8 weeks and in 4 patients fetal intrathoracic injection was performed at 9 to 11 weeks, menstrual age. Seven patients delivered healthy babies at greater than 35 weeks, 3 have delivered prematurely 15 to 17 weeks after the procedure with subsequent neonatal death of all sets of twins. We believe that our method overcomes the technical difficulties related to the transabdominal or transcervical approach and should be the method of choice for early selective abortion.

Abortion, Induced↗

Prostaglandins.

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Abortion, Therapeutic↗

Analysis of gossypol and gossypol-acetic acid by high-performance liquid chromatography.

Gossypol, a bis-sesquiterpenoid cotton pigment, is of current interest as a male fertility-regulating agent. For the purposes of analyzing material to be studied biologically, a method is described for the analysis of gossypol by high-performance liquid chromatography. This has been used for examining the purity of gossypol-acetic acid using a UV-absorbance ratio technique.

Chromatography, High Pressure Liquid↗

Fertility control.

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Chemical Phenomena↗

Trends in public attitudes toward legal abortion, 1972-1978.

Trends in public attitudes toward legal abortion were analyzed for 1972 and 1978. Data were drawn from seven independent probability samples (N = 10,652) of English-speaking persons 18 years of age or older living in noninstitutional arrangements within the continental United States. Attitudes were derived from responses to six items asking whether it should be possible for a pregnant woman to obtain a legal abortion under six different conditions. Guttman Scalogram Analysis revealed two predominant patterns; approval for all six reasons and approval only for the hard reasons (safeguarding the woman's health, preventing birth of a deformed child, or treating rape). Two major shifts were noted in the level of approval; a considerable increase in 1973 for each reason and a sharp decline in 1978 for all but woman's health and rape. These shifts paralleled the introduction of laws pertaining to abortion.

Abortion, Legal↗

Effects of mid-trimester induced abortion on the subsequent pregnancy.

The outcome of the pregnancy following (a) a mid-trimester termination of pregnancy (TOP) for fetal neural tube defect (NTD) (77 women = group 1); (b) mid-trimester TOP for fetal Down's syndrome (13 women = group 2); (c) delivery of a baby with NTD (119 women = group 3) was studied. The prenatal fetal loss was relatively high in all groups. In group 1 it was similar to that found in other studies after first trimester TOP, in group 2 it was associated with advanced maternal age and the unexpected finding in group 3 was not attributable to advanced maternal age. It is suggested that a previous NTD per se might increase the risk of fetal loss in the next pregnancy. A previous mid-trimester TOP for NTD was not associated with an increase in premature labour, small for dates babies or congenital abnormality in the next pregnancy, but there was a slight increase in the number of babies weighing less than 2500 g.

Abortion, Induced↗

Physicians' acceptability of termination of pregnancy after prenatal diagnosis in southern France.

The acceptability of prenatal diagnosis for Down's syndrome has been extensively studied over the last 15 years but that of other pathologies remains largely unexplored. The main goals of this study were to approach physicians' opinions on six reasons for termination of pregnancy showing different deficiencies, i.e., Down's, Turner and Klinefelter syndromes, cystic fibrosis, spina bifida, and haemophilia, and to identify the origins of reserves. The influence of sociodemographic and professional characteristics of physicians on their opinions and attitudes during the consultation were studied. The data presented are based on information gathered in 1985 by a mailed questionnaire answered by 853 general practitioners, gynaecologists, obstetricians, and pediatricians in the Marseilles Genetic Centre's region. Stepwise logistic regression was used for the multivariate analysis. The results showed that 78 per cent of those answering favour termination of pregnancy for Down's syndrome and that only moral reticences were mentioned by the physicians opposed. Conversely, for haemophilia, only 21 per cent of the physicians considered this indication justified; those opposed were for the most part concerned that severity of illness did not justify termination of pregnancy. Overall, 33 per cent of physicians would voice their personal opinion on termination of pregnancy if so requested by consultees. Results on the influence of age and specialty evidenced their role on physicians' opinions. Indeed, 30 per cent of physicians opposed to pregnancy termination for one of the six fetal anomalies retained herein would modify their positions if diagnosis were possible in the first trimester of pregnancy.

Abortion, Eugenic↗

Fetal exsanguination following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic co-twin.

Selective termination by intracardiac potassium chloride injection was performed in twins discordant for hydrocephaly at 20 weeks' gestation. Because of the potential for vascular anastomoses to exist between the twins, fetal angiography was performed prior to the selective termination procedure. Determination of vascular connections between the fetuses was hindered by fetal bradycardia following intracardiac administration of contrast material. Selective termination was performed without difficulty using intracardiac potassium chloride (KCl) to produce asystole in the twin with hydrocephaly. The unaffected fetus appeared active and had a normal heart rate during and immediately after the procedure. However, both twins were found to have died the following day. Pathologic examination documented several vascular anastomoses between the monochorionic, diamniotic fetuses. A likely cause of death was exsanguination of the normal twin into the abnormal one. This case illustrates the difficulties encountered in selective termination of monozygotic twins and, to our knowledge, represents the first reported use of intrauterine fetal angiography.

Adult↗

A 1 and 6 month follow-up of prenatal diagnosis patients who lost pregnancies.

This paper reports results of an exploratory study of prenatal diagnosis patients who experienced voluntary terminations of pregnancy following the detection of an abnormality or spontaneous miscarriages. The 121 participants were part of the national collaborative Chorionic Villus Sampling and Amniocentesis Study. They completed semi-structured telephone interviews and mailed questionnaires at 1 month and 6 months after the pregnancy losses. Scores on the Profile of Mood States showed that mood levels improved significantly over time. However, there were some declines in loss-related support from partners and others. The persisting distress and difficulties of a minority highlight the variability in women's responses to pregnancy losses. Women who lost pregnancies later in gestation, showed the greatest mood disturbances at initial assessments, used professional mental health assistance after the loss, or reported less satisfactory loss-related support from significant others showed the greatest levels of mood disturbance at the six-month assessment. Follow-up contacts with patients who lose pregnancies should be used to inform women about the variation in possible grief reactions, to assess the extent of support the women are receiving from their partners and significant others, and to provide additional follow-up or referral of those experiencing the greatest distress.

Abortion, Induced↗