Prolonged grieving after abortion: a descriptive study.
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Follow-up study of 60 cases (group B) of post medical termination of pregnancy Cu-T insertion and 100 cases (group A) of interval Cu-T insertion revealed that menstrual complaints like dysmenorrhoea and menorrhagia were more prevalent in the 1st 3 months. These were more frequently found in group B cases. After one year the incidence reduced to almost nil in both the groups. Pain in lower abdomen and backache, a more frequent complaint in group B in 1st 3 months were also reduced remarkably after one year. Two expulsions in group B and one expulsion in group A had occurred during the 1st 3 postinsertion cycles along with menstrual flow. Failure has occurred in only one case in group B. For some reason or other Cu-T was removed in 11 cases in group A and 5 cases in group B. Desire for another pregnancy was the prime cause of removal of Cu-T in group A and along with this cause menstrual trouble was equally responsible for its removal in group B cases. There was no case of perforation, displacement or ectopic pregnancy reported in the present study, though for a short period.
One hundred and thirty consecutive women were interviewed about the development of psychological symptoms related to induced abortion two days before and four months after the abortion. Sixty-one (47%) participated in the second interview. Of the 61 women, 52% were psychologically influenced before the abortion to an extent which indicated severe crisis or actual psychiatric illness. Four months after the abortion 13 of these women were still psychologically affected. Furthermore, five women who were not affected before the abortion had developed psychological problems. Among ten of these women (16%) the physiological problems could only be related to the circumstance in connection with the abortion. For a number of women (30%) the abortion had a negative influence on their relationships and their sex lives, whereas other claimed that their relationship had become closer because of their reactions towards the abortions. In spite of these conditions all women indicated that their decision about the abortion had been the correct one under the given circumstances.
Pelvic infection complicates up to 12% of induced abortions and has an adverse effect on future reproductive outcome. The presence in the lower genital tract of Neisseria gonorrhoeae, Chlamydia trachomatis or the anaerobic organisms characterizing bacterial vaginosis is associated with an increased risk of post-abortion infective morbidity. Meta-analysis of randomized trials has shown that prophylaxis with antibiotics effective against either C. trachomatis or bacterial vaginosis reduces the risk of post-abortion infective morbidity by around a half. Other strategies which have been advocated for minimizing the risk of infective morbidity are screening for lower genital tract infections, with treatment of positive cases only, and a combined strategy where women are screened for sexually transmitted infections as well as receiving prophylaxis. These strategies provide the opportunity for appropriate follow-up and partner notification of those women found to have sexually transmitted infections. A multicentre study designed to determine the prevalence of genital tract infections among Scottish women seeking induced abortion, and to compare strategies of 'universal prophylaxis' and 'screen and treat' for minimizing infective morbidity in such women has been undertaken. A total of 1672 women were recruited. Prevalence rates of lower genital tract gonorrhoea, chlamydia and bacterial vaginosis were found to be similar to those reported in other UK studies. Women managed by the 'screen and treat' strategy (particularly those whose genital tract swabs were reported negative) had slightly higher rates of infective morbidity in the 8 weeks after abortion than those managed by 'prophylaxis'. Using currently available screening tests and genitourinary medicine services, 'prophylaxis' appears to be the more cost effective of the two strategies studied.
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Report about the experiences in termination of 25 early pregnancies by vaginal hysterectomy in cases final infertilisation was necessary. Advantages of the method are seen in avoiding dilatation of the cervix and in the calculable blood loss as compared to suction or curettage for abortion and simultaneous sterilization. In contrast to many apprehensions the risks do not seem to rise when performing vaginal hysterectomy of the pregnant uterus up to the 12th week. Advantages and criteria of the method are discussed.