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PubMed2003

Abortion trends 1990-1999 in a Swiss region and determinants of abortion recurrence.

OBJECTIVE: To assess age- and nationality-specific trends in abortion rates over the last decade, and to describe women's characteristics, identifying risk factors for repeated abortion. METHODS: From 1990-1999, the Health Department of Canton Vaud (Switzerland) received 13'857 abortion requests from residents aged 14-49. Population data were obtained to compute rates. RESULTS: Both the number of abortions (1400 annually) as well as their rate (8.9 per thousand women [95% confidence interval (CI) 7.3-10.5]) were stable over the decade in question. The rate of abortion for foreign women, especially from ex-Yugoslavia and Africa, was twice that for Swiss women. Half of the requests came from single women, 43% had a low education level, and half were childless. The main reason for requesting termination of pregnancy was psychosocial (93%). The mean gestational age was 7.7 weeks (SD +/- 2.3), but 96% of requests were submitted before 12 weeks. Sixty-three percent of women reported that they had used no contraception, 36% the condom and 17% the pill. Among requests, the adjusted risk of repeated abortion (22% of abortion candidates) was greater among divorced/separated/widowed women (odds ratio [OR] 1.9 [95% CI 1.5-2.4]), unemployed women (OR 1.8 [95% CI 1.5-2.1]), and those who had not attended university (OR 1.6 [95% CI 1.1-2.2]). CONCLUSIONS: Although Swiss law only permitted abortion under strict conditions, this procedure was widely available in Vaud, which nevertheless has one of the lowest rates worldwide. Efforts must be intensified to ensure universal access to family planning services, especially for foreign women and adolescents. Professionals should also target "repeaters" to provide personalised counselling.

Abortion, Induced↗
PubMedDate not supplied

Demographic and fertility variables as determinants of spontaneous abortions in women with previous abortions.

The objective of the study was to examine the demographic and fertility factors that may predispose to spontaneous abortion in women with prior abortion. The study was conducted in King Khalid University Hospital, Riyadh, Saudi Arabia. It included a series of women who aborted their pregnancies over a period of months (January 1; 1992-December 31, 1992). Chi-square and Fisher's exact test were used to analyze the statistical relationship between abortion and various demographic and fertility, related to abortion. There was a direct statistically significant relationship between maternal age, level of education, parity and a history of previous abortion. In a multivariate logistic regression analysis, parity and history of previous abortion were found to be significant as determinants of recurrent abortion. Even though many of these risk factors are not preventable, counseling of the women about the value of education, early reproduction in the child-bearing age, and control of fertility would go a long way in reducing the incidence of fetal wastage in these women.

Abortion, Habitual↗
PubMed1978

[Incidence of abortive ova among spontaneous abortions].

345 spontaneous abortions of the period 1975/76 are investigated histologically. 174 of them content chorionic villi (100 per cent). Among these we have found 91 abortive ovas (52.3 per cent), 7 hydatiform moles (4.0 per cent) and 35 histological regular abortions (20.1 per cent). Furthermore, 41 cases are suspicious of abortive ova (23.6 per cent) and, 22 cases show signs of early disturbances of placental maturation (12.7 per cent). In all groups there is inflammation of the maternal side and of the endometrium. Regressive changes of the villi are particularly severe in abortive ovas and in the suspicious cases. On the base of our own study of legal abortions as well as this material of spontaneous abortions we estimate the frequency of abortive ovas among all the pregnancies for about 15--25 per cent.

Abortion, Spontaneous↗
PubMed1997

The epidemiology of incomplete abortion in South Africa. National Incomplete Abortion Reference Group.

OBJECTIVE: To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa. DESIGN: Multicentre, prospective, descriptive study. SETTING: Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies). PATIENTS: All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period. MAIN OUTCOME MEASURES: Incidence of, morbidity associated with and mortality from incomplete abortion. MAIN RESULTS: An estimated 44686 (95% CI 35633-53709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% CI 78-735) women die in public hospitals from complications of abortion. Fifteen per cent (95% CI 13-18) of patients have severe morbidity while a further 19% (95% CI 16-22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity. CONCLUSIONS: Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion.

Abortion, Incomplete↗
PubMed1993

[Current concepts in the pathogenesis and treatment of abortion and septic shock I. The epidemiology, pathogenesis and management of septic abortion].

In view of the illegal status induced abortion, it is difficult to determine the degree to which it is practiced. In our country there are a great inconsistency in the statistics on the number of abortions and the number of maternal deaths due to this cause. The principal complication of the illegal induced abortion is the septic abortion, with an uncontrolled bacterial infection and systemic complications that dominate the clinical picture. The mortality of the septic abortion is elevated, in the majority of cases due to septic shock. The treatment consist on antimicrobial agents and early surgery. A reduction on the number of illegal abortions will decrease significantly the number of septic abortion's cases.

Abortion, Illegal↗
PubMed1977

[Incidence of abortive ova in abortion material].

The material of 250 legal abortions is investigated histologically. In 47 cases we have found no trophoblastic tissue. Among the other 203 cases we diagnose 50 (24,6 per cent) abortive ova. 40 cases (19,7 per cent) are suspicious of abortive ovum. Only 7 cases (3,4 per cent) show signs of inflammation. Furthermore in 10 cases (4,9 per cent) early disturbances of placentation (maturation) are supposed. According to the statistical results of are supposed our hospital, the frequency of abortive ova among all pregnancies (number of deliveries, spontaneous abortions and legal abortions) is calculated for 14,9%. The real value of spontaneous abortions may be between 15 and 25 per cent.

Abortion, Legal↗
PubMed1999

Side effects of mifepristone-misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India.

Although serious adverse events of early abortion have been studied, little attention has been paid to the more common side effects experienced by early medical or surgical abortion clients. Using data from a multicenter comparative trial of women < or = 56 days' gestation in China, Cuba, and India (n = 1373), side effects experienced by mifepristone-misoprostol medical abortion and surgical abortion clients were analyzed at the different stages of their abortions. Data on side effects came from women's reports at each clinic visit, providers' observations during the clinic visits, and symptom diaries maintained during the study period. Medical abortion clients at all sites experienced more side effects than their surgical counterparts. The disparity between the two groups was particularly pronounced for bleeding and pain. Despite more reports of side effects among medical abortion clients, however, assessments of well-being and reports of satisfaction at the exit interview were similar in both treatment groups.

Abortifacient Agents↗
PubMed1997

Spontaneous abortion and psychosomatics. A prospective study on the impact of psychological factors as a cause for recurrent spontaneous abortion.

A group of 36 patients who had had at least two consecutive spontaneous abortions and who desired to have children was subjected to a psychosomatic investigation before a biomedical diagnostic screening programme was started. A semi-structured interview regarding sociodemographic data, current relationship, social support, education, occupation and medical anamnesis was carried out. In addition, all women completed four standardized questionnaires on the topics of anxiety, somatization disorder, life satisfaction and depression. A control group of 36 women, matched for age and occupation, was subjected to the same psychosomatic investigation. The findings of the diagnostic screening programme showed that 16 women had abortions because of physical abnormality, and 15 women had no physically confirmed cause (in five women, the investigations were not completed). Following recurrent spontaneous abortion, 18 women had a successful pregnancy within 2 years, and 18 women were still childless. The comparison between patients and the control group revealed that patients with recurrent abortion were significantly more satisfied with their life quality regarding leisure time, financial situation and occupation. No significant differences were observed in any other variables. Patients who suffered spontaneous abortions due to a physical disorder showed partner relationship of longer duration, and more frequent miscarriages. Women with successful pregnancy within 2 years after recurrent miscarriage were significantly younger and had fewer physically related abortions compared with women who remained childless. In summary, psychological factors seem to be of subordinate importance as a cause for recurrent spontaneous abortion. Moreover, physical abnormalities in the reproductive system have a predominant impact on the prediction of a future successful pregnancy.

Abortion, Habitual↗
PubMed1989

[Pilot study on assessing medical, psychological and psychosocial factors in stillbirth and spontaneous abortion and recurrent abortion].

84 women (mean age: 29 years) with a history of spontaneous abortion (unexplained in 95% of cases) were compared with a control group (n = 72). Two subgroups, each of 31 women were selected, in which cases with recurrent spontaneous abortion were compared with uncomplicated pregnancies. Psychological disturbances, ineffective coping strategies and medical risk factors were significantly increased in the abortion group, but socioeconomic (occupational, financial) problems linked with higher social class level less importantly. In women with recurrent spontaneous abortions psychological problems and depressive coping modes were predominant, in uncomplicated pregnancies the risk factors were very low. The most frequent psychological disturbances in the abortion group were mourning reactions after pregnancy loss. It appears that psychological factors are less a cause than the consequence of the abortion event. Moreover, both the multifactorial hypothesis of early pregnancy wastage, and the importance of prenatal diagnosis in order to identify possible risk factors, especially in cases of habitual abortion, are stressed.

Abortion, Habitual↗
PubMed2004

Repeat induced abortions and contraceptive practices among unmarried young women seeking an abortion in China.

OBJECTIVE: To determine the rates of repeated abortion and contraceptive use among unmarried young women seeking an abortion in China. METHODS: We used an anonymous self-administered questionnaire at abortion clinics in Beijing, Changsha, and Dalian from January to September 2000. RESULTS: Of 4547 unmarried young women seeking an abortion, 33.0% reported having had one previous induced abortion. Of those who had had more than one abortion, only 29.7% used a contraceptive method at their first sexual intercourse after the procedure; and of the 446 women who chose contraception, 41.3% used the traditional methods of withdrawal or rhythm. Although 65.0% of the young women had used condoms at least once, only 9.6% did so consistently and correctly; 47.7% of the current pregnancies were associated with nonuse of any contraceptive, and 52.3% were related to contraceptive failure. CONCLUSION: The rate of unmarried young women seeking repeated abortions was high in China on 2000. The rate of consistent condom use was low, and the rate of contraceptive failure was higher.

Abortion, Induced↗
PubMed2000

Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost.

The antiprogesterone mifepristone in combination with a suitable prostaglandin provides an effective method for induction of abortion in early pregnancy up to 63 days of gestation. The combination of 600 mg mifepristone followed by 1 mg of gemeprost vaginal pessary 48 h later is one of the standard regimens in practice, which is registered in several countries in Europe. In 1995, we reduced the doses for both mifepristone and gemeprost to 200 mg and 0.5 mg respectively, as this was shown to decrease significantly the incidence of side effects whilst maintaining a high efficacy. In this article, we report our experience with this regimen in routine clinical practice by analysing 3161 consecutive medical abortions retrospectively. Twelve case notes (0.4%) were not available, and for 310 (9.8%) women, the outcome was not known with certainty as they did not return for their follow up visit. Of the remaining 2839 women, 2732 (96.2%) had a complete abortion following their treatment. One-hundred-two (3.6%) women required an evacuation of the uterus: for incomplete abortion in 63 (2.2%) and ongoing pregnancy in 39 (1.4%). Three women had to undergo surgery for ectopic pregnancies. The surgical intervention rate was significantly higher at gestation of >49 days compared to < or = 49 days (5.7% vs. 2.6%, p = 0.002) and at >56 days than among those at < or = 56 days (6.7% vs. 3.1%; p <0.001). However, for incomplete abortion a significant increase was only seen at gestation >49 days compared to < or = 49 days (3% vs. 1.6%, p = 0.017). The incidence of ongoing pregnancies increased significantly only after 56 days of gestation compared to < or = 56 days (3.8% vs. 0.9%; p <0.001). Parity was related to the outcome with parous women having significantly more incomplete/ongoing abortions compared to nulliparous women (5.4% vs. 2.0%; p <0.001), although parous women did present earlier in pregnancy for termination than nulliparous women (p = 0.01). The incidence of complications was low: 165 (5.8%) women were given antibiotics for presumed genital infection and severe haemorrhage occurred in 11 (0.4%) women, of whom only two required blood transfusion. In summary, the recommended regimen with the reduced doses of mifepristone and gemeprost is highly effective, meeting the anticipated efficacy with a complete abortion rate of >95%. We have concluded from the data that gestation and parity are strong predictors for clinicians to anticipate the probability of a successful medical termination of pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

First trimester surgical abortion practices: a survey of National Abortion Federation members.

The objective of this study was to survey first trimester surgical abortion practices of North American providers. A survey was mailed to the 310 active member clinics of the National Abortion Federation, the professional organization of abortion providers in North America. The 236 respondents (76%) comprising the study group provided approximately 30% and 33% of all first trimester abortions in the US and Canada, respectively. Of the 529 practitioners who perform most abortions at the clinics, 68% are obstetrician-gynecologists, and 18% are family physicians; 51% are at least 50 years old. The majority of respondents (156 of 236, 66%) confirm gestational age with ultrasonography. Of the 202 clinics that favor one method of anesthesia, 58% use local cervical block with or without oral pre-medication, 32% combine local anesthesia with intravenous sedation, and 10% use general anesthesia. Most clinics open the cervix with tapered dilators (207 of 233, 89%), evacuate the uterus by using curved rigid plastic cannulas (157 of 229, 69%) and an electric vacuum source (191 of 233, 82%), and explore the uterus with a metal curette following aspiration (133 of 232, 57%). A large majority of respondents examine the uterine aspirate on-site (91%), prescribe antibiotics (91%), and offer oral contraceptives (95%) when requested. Although variations exist, surgical techniques and postoperative practices are quite uniform among clinics. Local anesthesia is presently the most frequent method of pain control. Ultrasonographic dating before abortion is common practice. The "graying" of skilled practitioners raises concerns about the future availability of abortion.

Abortion, Legal↗
PubMed2002

Complications of unsafe abortion: a case study and the need for abortion law reform in Nigeria.

Complications of unsafe abortion account for 30-40% of maternal deaths in Nigeria. This paper reports a case of unsafe abortion by dilatation and curettage, carried out by a medical practitioner in a private clinic on a 20-year-old single girl in Lagos, Nigeria. The girl was 16 weeks pregnant. She suffered complications consisting of perforation of the vaginal wall through the utero-vesical space into the abdominal cavity with gangrenous loops of small intestine herniating through it. Information was obtained from her case notes and the operating theatre register. She had a resection and anastomosis of the small intestine and had to remain in hospital, where she made a full recovery, for two weeks. Unsafe abortion is fraught with many complications, including pelvic sepsis, septicaemia, haemorrhage, renal failure, uterine perforation and other genital tract injuries, and gastro-intestinal tract injuries. Where expert, emergency treatment for these is not available, women die. Unsafe abortion procedures, untrained abortion service providers, restrictive laws and high morbidity and mortality from abortion tend to occur together. We advocate for a review of the existing restrictive laws in Nigeria in order to reduce the high morbidity and mortality from unsafe abortion.

Abortion, Legal↗
PubMed1998

Preventing abortion and repeat abortion with the Gynefix intrauterine implant system--preliminary results.

The provision of immediate post-abortal contraception is important to reduce the number of unplanned pregnancies and the number of repeat abortions. Immediate post-abortal insertion of an IUD has many advantages and is an acceptable and safe method. However, side-effects and expulsion of conventional IUDs remain a problem. In an attempt to minimize these problems, the frameless intrauterine implant (IUI) was developed. Clinical studies conducted over the past 12 years have shown the validity of the anchoring concept. The design characteristics of the IUI (fixed, frameless and flexible) are responsible for the low expulsion, high effectiveness and high tolerance rates. This communication is the first report of clinical experience with the post-abortal version of Gynefix (Gynefix PT) in a limited number of women with pregnancies of less than 10 weeks' duration. This experience suggests that immediate post-abortal insertion of Gynefix PT is easy, safe and the implant appears to be as reliable and effective as interval insertion of the interval version. We conclude that the immediate post-abortal insertion of Gynefix PT is an important novel approach to reducing the incidence of repeat abortions.

Abortion, Induced↗
PubMed1978

Serum immunoglobulins in aborted and non-aborted bovine foetuses.

The concentration of immunoglobulin classes G, M and A (IgG, IgM and IgA) in the sera of 233 aborted and 201 non-aborted foetuses was measured. IgM was first detected in a foetus at day 90 of gestation while IgG and IgA were first detected on day 111 of gestation. Immunoglobulins were detected in 81.5% of aborted foetuses and 32.8% of non-aborted foetuses. Total immunoglobulin concentrations of 20 mg/100 ml or greater were found in 35.2% of aborted foetuses but only in 4.5% of non-aborted foetuses. It is suggested that factors resulting in antigenic stimulation of the foetus may play an important part in bovine abortion.

Abortion, Veterinary↗
PubMed1990

[Frequency of abortion and seroprevalence of the principal diseases causing ovine infectious abortion in the area of Rabat (Morocco)].

A survey was carried out on 23 sheep flocks to estimate the frequency of abortion as well as the prevalence of antibodies against abortive infections. During the visit of each farm, a questionnaire was completed with the collaboration of the owner and blood samples were collected from all aborted ewes and some of those with normal lambing. A rate of 7% abortion was reached in both aborted and normally lambed ewes. Anti-Chlamydia psittaci antibodies were the most frequently detected (14 flocks). Anti-Coxiella burnetii and anti-Toxoplasma gondii antibodies were found in 9 flocks, whereas anti-Brucella and anti-Salmonella abortus ovis were present in only 1 flock each. None of the 5 infections was detected in 2 flocks. Mixed infections were prevalent: 13 flocks were simultaneously infected by at least 2 abortive pathogens. The procedure used does not allow the cause of abortion to be identified in all cases.

Abortion, Veterinary↗
PubMed1996

[Use of contraception and reasons for choosing abortion among abortion applicants].

The object of this study was to describe a group of women applying for legal abortion in relation to their use of contraception and reasons for choosing an abortion. During a period of 13 months (1991-92) a questionnaire was distributed to women applying for legal abortion at Hillerød Hospital in Denmark. Three hundred and thirty-nine women participated. Fifty-nine percent of the women had become pregnant although they had used contraception. As seen in other studies, women still state demographic factors as their most important reasons for choosing an abortion. Women with two or more children do not want to have more children. Single women do not want children without being in a stable relationship. Furthermore occupation and education were frequently stated as important reasons for having an abortion. Economy and housing were not main reasons but contributory factors. Thirty percent of the women expressed ambivalence about the choice of abortion at the time when the abort was due.

Abortion Applicants↗
PubMed1998

Abortion in guinea pigs by Chlamydia psittaci isolates from natural sheep abortion.

Experimental model for chlamydial abortion was planned using pregnant guinea pigs to study whether the isolate of Chlamydia psittaci from natural cases of sheep abortion is able to cause experimental abortion in pregnant guinea pigs or not. Follow up and clinical observations like thermal reaction and haematological changes exhibited biphaic febrile response and marked leucopenia in both intraperitoneal group as well as intravaginal group. The laboratory examinations revealed presence of chlamydial intracytoplasmic inclusions in the impression smears of aborted foetal tissues. C. psittaci was reisolated successfully from all the aborted foetal tissues. It was observed that rate and severity of abortion were more in the intraperitoneal group as compared to intravaginal group. On correlating the results of clinical and laboratory examinations it was observed that guinea pig can be used as a suitable model for chlamydial abortion in future studies like cell mediate immune response and to see protective role of chlamydial vaccine, if any.

Abortion, Veterinary↗