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PubMed1991

Human chorionic gonadotrophin and alpha-fetoprotein levels in matched samples of amniotic fluid, extraembryonic coelomic fluid, and maternal serum in the first trimester of pregnancy.

Separately identified samples of amniotic fluid and extraembryonic coelomic fluid obtained by high resolution transvaginal ultrasound-guided amniocentesis from 32 women between 7 and 12 weeks of pregnancy were analysed for human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP). There was a highly significant difference between the hCG levels in amniotic fluid (median level 6.3 U/ml; range 1.6-310.0 U/ml) and those in extraembryonic coelomic fluid (median level 400.0 U/ml; range 135.0-2250.0 U/ml) (p less than 0.001; Mann-Whitney U-test). The levels of AFP were very similar in amniotic fluid (median 26.0 kU/ml; range 10.0-116.5 kU/ml) and extraembryonic coelomic fluid (median level 24.1 kU/ml; range 12.4-94.4 kU/ml).

Abortion, Therapeutic↗
PubMed1992

The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality.

A retrospective study to investigate the psychosocial sequelae of a second-trimester termination of pregnancy (TOP) for fetal abnormality (FA) is described. After appropriate consent was obtained, 84 women and 68 spouses were visited 2 years after the event and asked to complete an extensive questionnaire. Most couples reported a state of emotional turmoil after the TOP. There were differences in the way couples coped with this confusion of feelings. After 2 years about 20 per cent of the women still complained of regular bouts of crying, sadness, and irritability. Husbands reported increased listlessness, loss of concentration, and irritability for up to 12 months after the TOP. In the same period, there was increased marital disharmony in which 12 per cent of the couples separated for a while and one couple obtained a divorce. These problems could be attributed to a lack of synchrony in the grieving process. Confusing and conflicting feelings led to social isolation and lack of communication. Difficulties in coming to terms with the fetal loss were not found to be linked to the type of fetal abnormality or religious beliefs but were related to parental immaturity, inability to communicate needs, a deep-rooted lack of self-esteem before the pregnancy, lack of supporting relationships, and secondary infertility. Suggestions for improved management are given.

Abortion, Therapeutic↗
PubMed1993

Low-dose sulprostone for pregnancy termination in cases of fetal abnormality.

Thirty-two pregnancies (11 primi- and 21 multi-gravid) with an abnormal fetus were terminated between 16 and 35 weeks (mean 22 weeks; median 20 weeks) and a continuous intravenous infusion of 1 microgram of the prostaglandin analogue sulprostone. All pregnancies were terminated vaginally, 31 of them with this regimen in a median induction-expulsion interval of 23 h (range 8-52 h). Complete expulsion of the placenta occurred in 72 per cent of cases. Median blood loss was 100 ml (range 20-2000 ml). There were only a few side-effects. We conclude that this induction regimen is both appropriate and safe for pregnancy termination in cases of fetal anomaly.

Abortifacient Agents, Nonsteroidal↗
PubMed1993

Attitudes of women of childbearing age towards prenatal diagnosis in southeastern France.

The objective of this study was to explore women's attitudes towards prenatal diagnosis of trisomy 21 and to examine some of the factors possibly responsible for these attitudes before implementing in real practice serological screening of pregnant women at risk for trisomy 21. We carried out a telephone survey on a representative sample of women who had recently had a normal livebirth delivery in the Marseille district in 1990. The participation rate was 80 per cent and the average age of the mothers was 28.9 years. Among the 514 women interviewed, 78 per cent stated that they would ask for an amniocentesis for a 1 per cent risk of trisomy 21 at their next pregnancy. When adjusting for confounding factors, the decision to have or not to have an amniocentesis was found to depend not only on the women's attitude towards induced abortion, but also on their understanding of the risk involved and on the social context (knowing a handicapped child, discussion with the father). It also depended on the women's age and on what they knew about amniocentesis from the medical point of view. The risk of miscarriage can influence a woman's choice but this objection was not found to affect the women's decisions significantly in our survey. The data showed the existence of a high potential demand for fetal karyotyping.

Abortion, Therapeutic↗
PubMed1993

Is selective abortion for a genetic disease an issue for the medical profession? A comparative study of Quebec and France.

This article discusses the results of a study of the stand and attitudes of physicians from the Picardie, Nord-Pas-de-Calais region in France and the province of Quebec (Canada) regarding abortion following the diagnosis of a fetal anomaly by ultrasound, amniocentesis, or chorionic villus sampling. The study examined the degree of acceptability of abortion for several specific conditions as well as the physicians' perceptions of their role in the women's decision to abort. The study shows a consensus (over 75 per cent of the physicians surveyed) for aborting a fetus with trisomy 21. There is a similar consensus, except among Francophones in Quebec, for muscular dystrophy, cystic fibrosis, and Huntington disease. Conversely, there is no consensus (below 60 per cent) for several anomalies. In these cases, Quebec Anglophone physicians find abortion more acceptable than Quebec Francophone or French physicians. Concerning the role of the practitioners in the decision to abort, physicians in France tend to be much more directive than their overseas colleagues. Several hypotheses are suggested to explain the difference between the three groups surveyed.

Abortion, Therapeutic↗
PubMed1993

Attitudes toward abortion for fetal anomaly in the second vs. the third trimester: a survey of Parisian obstetricians.

Cross-cultural differences exist in prenatal diagnosis and abortion for fetal anomaly, stemming from variations in laws, reimbursement policies, litigation, physicians' decision-making authority, and attitudes toward the prevention of handicaps. The first part of this paper discusses such differences in France and the U.S. The second part describes a survey of practising obstetricians in Paris, designed to assess (1) their attitudes toward pregnancy termination for various conditions, (2) their concern about fetal viability, (3) their desire for diagnostic certainty before justifying a late abortion, and (4) their perceived role in such decision-making. Among the 64.8 per cent (N = 217) who responded, the majority supported third-trimester termination (TTT) for diseases such as spina bifida, trisomy 21, microcephaly, and Duchenne muscular dystrophy; 30-59 per cent supported TTT for cystic fibrosis and sickle cell disease; and 22-29 per cent supported TTT for haemophilia, tetralogy of Fallot, limb amputation, and Turner and Klinefelter syndromes. Obstetricians who approved of abortion across trimesters were less concerned with the certainty of diagnosis than its severity, more likely to think that abortion ought to be the parents' choice, but more likely to report making a recommendation to the parents about whether to abort a fetus. Such permissive abortion attitudes might imply more permissive prenatal diagnosis and abortion practice among Parisian obstetricians, which might lead to increased migration of patients from other E.C. countries. Cross-cultural variation in obstetric practice suggests that an international registry of pregnancies terminated for medical reasons, enabling further study of this issue, would be valuable.

Abortion, Therapeutic↗
PubMed1975

Teratologic evaluation of imipramine hydrochloride in bonnet (Macaca radiata) and rhesus monkeys (Macaca mulatta).

Imipramine hydrochloride was administered orally twice daily to 18 bonnet and 3 rhesus monkeys between days 23 and 45 of pregnancy for 1-3 or 18-22 days at 1, 2, and 10 times the recommended human dose. No teratologic changes were observed, although signs of maternal toxicity occurred at the high dose level, and the abortion rate was higher than in controls.

Abortifacient Agents↗
PubMed1979

Threatened abortion, hormone therapy and malformed embryos.

Causal relations between maternal genital bleeding, supportive hormone therapy and external malformations of the embryos were investigated with special reference to the critical period of organogenesis. This was done using morphological and obstetrical data obtained by Nishimura and his associates from 667 undamaged embryos derived from induced abortions whose mothers had genital bleeding in early pregnancy. In addition, data from 90 embryos with polydactyly and 38 with limb reductions in the Nishimura collection were used for case history studies. Evidence was presented to demonstrate that, for major malformations such as CNS anomalies, cleft lip, polydactyly and limb reductions, maternal genital bleeding was not a cause but a consequence of the conception of an abnormal embryo. No indication was revealed that exogenous female hormones currently used in Japan for preventing miscarraiges could produce major malformations recognizable at the embryonic stage, including limb reductions, nor salvage the severely malformed embryos. This does not however mean to exclude the possible relationship of progestogens/estrogens intake during early pregnancy with an increased incidence at birth of certain internal and/or external malformations. It was suggested that most, if not all, of the minor anomalies observed at certain embryonic stages are kinds of normal variants without any functional impairment of embryonic development.

Abnormalities, Drug-Induced↗
PubMed1990

Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester.

As part of a new approach to counselling pregnant women concerned about antenatal exposure to drugs, chemicals, or radiation, we measured their tendency to terminate their pregnancy by using a visual analogue scale (VAS). Analysis of 78 cases where women had less than 50% tendency to continue pregnancy before they were advised by us reveals that 61 decided to continue their pregnancy after the consultation (57 normal, healthy infants, four miscarriages) and 17 terminated. Women who continued their pregnancy significantly changed their tendency after we discussed relevant information with them (from 34.3 +/- 2.5% to 84.5 +/- 3.3%, P less than 0.00001), whereas most of those who eventually terminated pregnancy did not change their tendency to continue pregnancy beyond the 50% mark (from 24.8 +/- 5.4% to 45.1 +/- 9.8%) (P greater than 0.1). Only two of the women who terminated their pregnancy were exposed to teratogenic drugs; however, in most other cases, other obvious reasons, unrelated to the exposure in question, were identified by the women as leading reasons for termination. An appropriate intervention in early pregnancy can prevent unnecessary pregnancy terminations by correcting misinformation and thereby decreasing the unrealistically high perception of risk by women exposed to nonteratogens.

Abortion, Induced↗
PubMed1983

Coping with fertility in Israel: a case study of culture clash.

The concepts of culture-bound belief systems and explanatory models focused on reproduction and contraception are applied to a case of a married Jewish woman seeking to interrupt an unwanted pregnancy. Discrepancies between the lay belief system held by the woman, and the clinical belief system of the medical mediators of contraception and abortion, have created a situation where none of the alternatives at the woman's disposal seems correct: the options available for preventing pregnancy are unacceptable or inefficient; having a child is also not acceptable; and termination of unwanted pregnancy by abortion is ethically and morally wrong. The "no-win" situation results from medical ethnocentrism and failure to interpret the context of meanings and norms within which health decisions are constructed.

Abortion, Induced↗
PubMed1992

Anencephaly and the interruption of pregnancy: policy proposals for HECs.

This article is directed to hospital communities where absolute proscriptions exist against abortion. The assumption is that many will be Catholic institutions and therefore Catholic moral teachings are examined carefully. By addressing anti-abortion arguments in the context of anencephaly, I hope to show that within even the most conservative moral traditions, humane exceptions to absolute proscriptions against abortion can be justified. More specifically, the article is directed to HECs which either have unstated or ambiguous policies on abortion. It will attempt to show what a reasonable policy could look like and how it could be defended. For committee members not involved in policy questions about abortion, it may stimulate some ethical discussion.

Abortion, Induced↗
PubMed1990

General anaesthesia, a risk factor for complication following induced abortion?

Of the 10,000 abortions performed at the Regional hospital at Modena in Italy between 1982 and 1986, 199 (2%) led to early complications. Investigation of the relationship between the risk of haemorrhage, injury, other complications and all complications and eight explanatory variables revealed that the adjusted odds ratio associated with the use of general anaesthetic compared with local anaesthetic was 4.6 (95% CI, 2.2-9.5) for haemorrhage, 1.3 (95% CI, 0.78-2.2) for injury, 1.6 (95% CI, 1.0-2.6) for other complications and 1.8 (95% CI, 1.4-2.5) for all complications. It is speculated that if the relationship between use of general anaesthetic and risk of complication is causal there could be about 40% fewer cases of complications and 75% fewer cases of haemorrhage following induced abortion if local anaesthesia were used rather than general anaesthesia.

Abortion, Induced↗
PubMed1975

Chromosome studies in 500 induced abortions.

A survey of the chromosome constitution in 500 induced abortions (5-12 menstrual weeks) was undertaken over a period of 1 1/2 years. There were 34 cases (6.8%) of gross chromosome anomalies: 2 cases of trisomy A; 5 of trisomy C (including XXX and XXY); 1 of mosaic trisomy C; 4 of trisomy D; 2 of trisomy E; 2 of trisomy G; 1 of double trisomy E and G; 1 of XYY; 4 of monosmy C (including XO); 2 of mosaic monosomy C; 1 of mosaicism of ring D chromosome; 1 of extra small metacentric chromosome; 3 of triploidy (including triploidy with double trisomy C and G); and 5 of tetraploidy and its mosaicism. An increased risk for the occurrence of trisomic anomalies was found with advancing age of the mothers. In contrast, the production of monosomies was not age-related. Trisomies were the most common type of anomalies and were found almost at random, regardless of the characteristics of chromosomes. Neither satellited nor small chromosomes were predominantly involved in the formation of chromosome anomalies.

Abortion, Induced↗
PubMed1982

Causes of chromosome anomalies suggested by cytogenetic epidemiology of induced abortions.

Women who visited hospitals requesting induced abortions were asked about their obstetric and medical histories by attending physicians prior to the operation. The information was solely based on their reports at the interview. The period of coverage was nine weeks, comprising six weeks before and three weeks after the onset of the last menstruation. Both the occurrence of acute respiratory infectious diseases, which included the common cold, upper respiratory tract infection (U.R.T.I.), influenza, and pneumonia, and the use of analgesics and antipyretics were most frequently reported. Regardless of whether they had an acute respiratory illness, the women who took analgesics and antipyretics (including antihistamine, cough remedy, and nasal decongestant) had 13.8% (8/58) gross chromosome anomalies. The women without the treatment had 6.3% (71/1136) anomalies. The difference was statistically significant (P less than 0.05). Triploid formation was particularly related to drug consumption, thus there were 5.2% (3/58) in the treated group and 0.5% (6/1136) in the untreated group (P=0.0074). In contrast, trisomy was not considered to be related to drug consumption on account of 8.6% (5/58) and 4.1% (47/1136) in the corresponding groups (0.10 less than P less than 0.20). When the occurrence of trisomy was examined in connection with two variables, i.e., the presence of drug consumption and the age of mothers, association was not evident (X2 assoc. = 0.883, d.f. = 1 by Cochran's method). Besides these results, neither maternal X-irradiation nor irregularity of the menstrual period was found to be related to the frequency of chromosome anomalies in the progeny.

Abortion, Induced↗
PubMed1976

[Antifertility effect of an active immunization of monkeys with human pregnancy-specific beta 1-glycoprotein (SP1) (author's transl)].

Fertile female cynomolgus monkeys (Macaca fascicularis) were actively immunized against human pregnancy-specific beta 1-glycoprotein (SP1). Native SP1 as well as chemically modified derivatives of SP1 served as antigens. The effect of the immunization on reproduction in these animals was investigated. The immunized monkeys showed a significant reduction in fertility: the conception rate in these animals was only slightly reduced when compared with the controls; but in the immunized monkeys pregnancy often resulted in abortion. The possibility of using immunization against SP1 as a contraceptive method in man is discussed.

Abortion, Spontaneous↗
PubMed1976

[Legal abortion and hemostasis. Histological examinations and comparison to post partum hemostasis (author's transl)].

30 women were examined to determine the hemostasis during the legally induced abortion. The blood coagulated in the intervillous spaces while the fetus is removed. Immediately after the termination of the curettment the nidation area is covered by filaments of fibrin and incorporated erythrocytes. More frequent as post partum platelet thrombi occur especially in the area of decidua parietalis. The intravascular findings are similar to post partum changes after the removal of the placenta. Obstruction clots of the spiral arterioles contain fibrin deposits, pletelet thrombi and erythrocytes (mixed form of thrombi). Residual decidua and trophoblast cells are seldom involved in the obturation of the vessels. The traumatic damages of the uterine wall are described (extravascular fibrin deposits, interstitial bleeding, succulent tissue a.s.o.).

Abortion, Legal↗