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PubMed1979

Immediate postabortion intrauterine contraception in nulliparous adolescents.

Immediate postabortion insertion of an intrauterine device (IUD) was performed in 162 nulliparous adolescents. No insertion failures occurred. Twelve-month continuation rates were 86.6% for the Copper-7 IUD, 75.4% for the Copper-T device and 48.2% for the Lippes loop. Overall complications were greater for the Lippes loop than for the other two devices. The results suggest that immediate postabortion insertion should be considered for poorly motivated or uneducated adolescent girls who have already failed in contraception and require abortion.

Abortion, Induced↗
PubMed1984

Uterine embolization in a patient with postabortal hemorrhage.

A case of postabortal hemorrhage in a patient with von Willebrand's disease was controlled by arteriographic embolization of the uterine branch of the internal iliac artery. Selective internal iliac artery embolization has been effectively used to control postpartum hemorrhage and hemorrhage resulting from pelvic malignancy. A discussion is presented for expanding the use of selective embolization for controlling uterine hemorrhage to patients suffering from postabortal bleeding as a means of controlling hemorrhage without sacrificing fertility.

Abortion, Induced↗
PubMedDate not supplied

Cytologic findings in postpartum and postabortal smears.

A study was undertaken to evaluate the cytologic features of pregnancy-induced cell patterns (PIP) observed in postpartum and postabortal cervicovaginal smears. A total of 3,000 PIP were evaluated and studied by an indirect immunofluorescent technique using human chorionic gonadotropin (HCG). Three characteristic types of PIP were demonstrated. In type I PIP, the cells had a sheetlike arrangement with a fine chromatin pattern and were thought to be of decidual origin. Type II PIP were shed in clumps and had round nuclei, cytoplasmic vacuoles and coarse chromatin. They were thought to originate in the endometrium with the Arias-Stella reaction. Type III PIP were large and had large nuclei with marked atypism. They were thought to be cytotrophoblasts. Almost all of the type III PIP were positive with the anti-HCG stain. It is concluded that this classification and analysis is significant and could reduce the number of false-positive cytology reports on postpartum and postabortal smears.

Abortion, Spontaneous↗
PubMed1997

Forgiveness intervention with postabortion men.

An intervention designed to foster forgiveness was implemented with postabortion men. Participants were randomly assigned to either the treatment or the control (wait list) condition, which received treatment after a 12-week waiting period. Following treatment, the participants demonstrated a significant gain in forgiveness and significant reductions in anxiety, anger, and grief as compared with controls. Similar significant findings were evident among control participants after they participated in the treatment. Maintenance of psychological benefits among the 1st set of participants was demonstrated at a 3-month follow-up.

Abortion, Induced↗
PubMed1991

Vasopressin and operative hysteroscopy in the management of delayed postabortion and postpartum bleeding.

Two women, one with refractory postabortion hemorrhage and the other with refractory postpartum hemorrhage, were managed with vasopressin, operative hysteroscopy, and a dilute vasopressin pack. Both patients had been treated by standard methods (i.e., dilation and curettage) and both were being prepared for a surgical intervention procedure. It was decided in both cases to try to slow the bleeding by injection of vasopressin paracervically and then performance of operative hysteroscopy. In both cases, the injection of dilute vasopressin paracervically when coupled with operative hysteroscopy was quite effective in determining the cause of the bleeding and was instrumental in avoiding major operative procedures.

Abortion, Induced↗
PubMed1984

Immediate postabortion insertion of an IUD.

Conception may occur as early as 10 days postabortion. Therefore, immediate postabortum insertion (IPI) of an IUD reduces the danger of exposure to an unwanted pregnancy in the interval and offers better protection against repeat abortion than delayed insertion. Patient motivation to use contraception appears to be highest at the time of termination of an unwanted pregnancy. Complication and pregnancy rates of IPI are comparable with postmenstrual insertion. No serious complications are on record in the world literature; particularly, no cases of infection or perforation have been reported. These facts make IPI not only an acceptable but a highly advisable technique of family planning. In 1977, the American Food and Drug Administration rescinded its earlier prohibition and approved the IPI method. Nulliparous women should be inserted with a copper device, parous women with a Lippes loop.

Abortion, Therapeutic↗
PubMedDate not supplied

Postabortal infectious morbidity after antibiotic treatment of chlamydia-positive patients.

The postabortal infection rate in chlamydia-positive women after antibiotic treatment (doxycycline or erythromycin) was compared with infectious morbidity among untreated culture-positive women in a comparable previous study. Of 69 chlamydia-positive patients, 5 (7.2%) developed endometritis and one (1.4%) salpingitis during the first postoperative month. The corresponding figures during the previous regimen were 16 (23.2%) and 10 (14.5%), respectively, i.e. a highly significant decrease (P less than 0.001). The infection rate among the chlamydia-negative women was unchanged. It is suggested that preoperative screening for C. trachomatis should precede legal abortion. Initiation of treatment of culture-positive cases before or at least in conjunction with the abortion seems to reduce the risk of infectious complications to the same level as in chlamydia-negative women.

Abortion, Induced↗
PubMed1975

Postpartum and postabortal insertion of intrauterine contraceptive devices.

One hundred forty-four patients are studied over an 18 month period. Postpartum and postabortal insertions of intrauterine contraceptive devices using the Lippes Loop and the Dalkon Shield are compared. The age, parity, previous methods of contraception, and marital status of the study group indicated a poorly motivated patient population. Although accidental pregnancy rates and expulsion rates are higher, the technique is considered worth-while in the population studied. Future research should be directed toward improved devices in order to decrease side effects and to increase appeal of the technique to those who will benefit most.

Abortion, Induced↗
PubMed2000

Immediate post-abortal insertion of intrauterine devices.

OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used Medline, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate post-abortal insertion. The Peto OR for discontinuation for pregnancy was 0.4 (95% CI 0.2-0.7) compared with the Lippes Loop D and 0.5 (95% CI 0.3-0.8) compared with the Copper 7. Expulsions were also significantly less common with the TCu 220C than with the other two IUDs. In single-center trials, the Nova T IUD had a signicantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. Addition of copper sleeves to a Lippes Loop D improved its performance, but addition of a topical hydrogel to a Spring Coil did not offer benefit. Overall, rates of perforation and pelvic inflammatory disease were low. REVIEWER'S CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. This was true for both induced and reported "spontaneous" abortions, many of which may have been induced under clandestine circumstances. IUD expulsion rates were higher after second-trimester abortions than after earlier abortions, so delaying insertion may be advisable after later abortions. Although Copper 7 devices inserted unrelated to pregnancy may perform better than those inserted after abortion, many women who express interest in intrauterine contraception do not return for the scheduled insertion. These women may remain unprotected against unintended pregnancy. However, evidence is inadequate to compare the safety and efficacy of IUD insertion immediately after abortion vs. insertion some weeks later.

Abortion, Induced↗
PubMed2004

Immediate postabortal insertion of intrauterine devices.

BACKGROUND: Insertion of an intrauterine device (IUD) immediately after an abortion has several potential advantages. The woman is known not to be pregnant, a major concern for clinicians. For example, many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries potential risks as well. For example, the risk of spontaneous expulsion may be increased due to recent cervical dilation. OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used MEDLINE, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate postabortal insertion. In single-center trials, the Nova T IUD had a significantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). The levonorgestrel-releasing device was more effective in preventing pregnancy than was the Nova T. Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. REVIEWERS' CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions.

Abortion, Induced↗
PubMedDate not supplied

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectiveness of the two surgical methods. One hundred and forty-nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Abortion, Induced↗
PubMed1985

Postabortion insertion of the Nova T and MLCu250: preliminary results of a comparative study.

This 4-year prospective randomized study is designed to compare the effectiveness and complication rates of the Nova T and MLCu250 inserted immediately postabortion. At the cut-off date (30 November 1983), all patients in the first cohort of 400 women had completed at least 12 months of use. At this stage of the trial, no significant differences had emerged between the two devices in any of the standard termination categories.

Abortion, Induced↗
PubMed1989

Serovars of Chlamydia trachomatis causing postabortion salpingitis.

In a previously reported investigation, 69 women with genital chlamydial infection following legal abortion were studied prospectively. Ten cases of postabortion salpingitis and 16 cases of endometritis were identified. To ascertain whether some serovars of Chlamydia trachomatis are particularly likely to initiate an infection in the fallopian tubes and cause salpingitis, the chlamydial isolates from the patients with salpingitis and those isolates from cases free of infectious complications were serotyped using a panel of monoclonal antibodies. Six of the seven different serovars demonstrated in the symptom-free group were identified in salpingitis cases. The strains associated with salpingitis seemed to reflect the overall distribution of chlamydial serovars in the entire study group. The predominant serovars were E, F and H. A protective effect associated with chlamydial serum antibodies had previously been observed in salpingitis cases. Therefore, the antibody titres subdivided according to serovar were compared. No difference in the antibody response induced by the different serovars could be verified statistically, but the B-complex strains were associated with a higher antibody titre than the C-complex strains or the intermediate strains F and G.

Abortion, Legal↗
PubMed1976

The susceptibility of the postpartum and postabortal cervix and uterine cavity to infection with attenuated rubella virus.

To determine the susceptibility of the postpartum and postabortal genital tract to infection with attenuated rubella virus, 30 patients with negative hemagglutination inhibition (HI) titers were studied. Following inoculation with Cendehill or RA 27/3 vaccine, viral cultures of the cervix and uterine cavity were obtained with blood specimens to evaluate serologic conversion. Attenuated rubella virus was not isolated in any patient; seropositive conversion was achieved in 24 women. The significance of these findings related to wild rubella virus infection is discussed.

Abortion, Legal↗
PubMed1984

Postabortal pelvic infection associated with Chlamydia trachomatis and the influence of humoral immunity.

Among 1101 women undergoing legal abortion by vacuum aspiration within 14 weeks of gestation, 69 (6.3%) harboured Chlamydia trachomatis in the cervix and/or urethra. Of the chlamydia-positive women, 16 (23.2%) developed endometritis and 10 (14.5%) developed salpingitis during the first postoperative month. The corresponding figures among the chlamydia-negative women were 59 (5.7%) and 5 (0.6%). These differences are highly significant (p less than 0.001). To study the significance of systemic and local humoral immunity to C. trachomatis in these complications, chlamydial antibodies were determined in serum and cervical secretions. No difference in frequency of local IgA antibodies in chlamydia-positive women was observed between those with and those without complications. On the other hand, there was a strong indication that chlamydia-positive women who developed salpingitis had a lower mean titer (17) of serum IgG chlamydial antibodies than carriers without symptoms (82, p less than 0.02). The group of endometritis patients did not differ in this respect from chlamydia-positive women who were free of infectious complications. These results suggest that C. trachomatis may be an etiologic agent in postabortal salpingitis and probably also in endometritis. Serum antibodies seemed to offer some protection against salpingitis in chlamydia-positive cases, whereas local antibodies did not.

Abortion, Induced↗
PubMed1985

Sonographic monitoring to guide the performance of postabortal uterine curettage.

This communication describes a technique of sonographically monitored uterine curettage. This method is of particular value in the management of postabortal endomyometritis associated with retained products of conception or in any situation in which anatomic variation (for instance, retroversion) makes curette insertion difficult.

Dilatation and Curettage↗
PubMed2004

Effectiveness of preabortion counseling on postabortion contraceptive use.

In a randomized trial, the effect of preabortion counseling was evaluated and contraceptive use postabortion described. The 420 women, who were assigned into either an intervention group (n = 210) or a control group (n = 210), were followed-up 4-6 months later, a total of 148 and 128 women in each respective group. No significant difference was found between the two groups regarding contraceptive use after abortion (86%, 85%), which indicates no immediate intervention effect. The women, in both groups, who had previously undergone abortion were less likely to use contraception. The main contraceptive methods used by intervention and control groups were oral contraceptives (61% and 58%, respectively) and injectables (12% and 11%). Choice of method was mainly based on women's prior perception of effectiveness and convenience of use. A majority of the women in both groups could not specify their contraceptive plans. A postrandomization inequality regarding age, education and parity in the two groups had, however, to be taken into account. Intensive contraceptive counseling before abortion may not be effective, but those who are at higher risk of unplanned pregnancy need special attention.

Adolescent↗