A selective bibliography on law and population.
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Abortion, Induced↗
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Abortion, Legal↗
Selected indicators of maternal child health in South Carolina.
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Abortion, Induced↗
Detection of human parvovirus B19 in early spontaneous abortuses using serology, histology, electron microscopy, in situ hybridization, and the polymerase chain reaction.
OBJECTIVE: To determine whether there is an association between parvovirus B19 infection and early spontaneous abortion at less than 20 weeks' gestation. METHODS: Eighty samples of early spontaneous abortions were analyzed. Each sample was examined histologically for the presence of viral inclusions, and selected cases were analyzed for parvovirus using electron microscopy and in situ hybridization. Polymerase chain reaction DNA amplification for the virus was done in each case. Maternal sera were analyzed for immunoglobulin (Ig) M and IgG parvovirus antibodies and compared with temporally matched controls. RESULTS: Five cases in the study group had evidence of seroconversion for parvovirus, compared with two controls. Products of conception from two of these five cases were positive for virus by polymerase chain reaction amplification, and only one of these two had a characteristic inclusion of parvovirus histologically. Conversely, five chorionic vesicles from mothers who had not seroconverted had histologic changes suggesting parvovirus infection, but all of these cases were negative for parvovirus using in situ hybridization, polymerase chain reaction, and electron microscopy. CONCLUSIONS: Parvovirus B19 DNA was found in two of 80 early spontaneous abortuses. Although viral DNA was detected in two cases, there was no clear evidence that the infections caused fetal death. Neither case showed erythroblastosis with large numbers of inclusions, as is seen in hydropic fetuses with parvovirus infection. In addition, in five cases in which parvovirus infection was not documented serologically or by the polymerase chain reaction, there was erythroid nuclear clearing suggestive of parvovirus B19 inclusions. This indicates that histologic evaluation for parvoviral inclusions is not always reliable in early spontaneous abortuses.
Abortion, Spontaneous↗
Immature monocyte-derived dendritic cells are productively infected with herpes simplex virus type 1.
Herpes simplex viruses (HSV) have developed several immunoevasive strategies. Here we demonstrate a novel mechanism by which HSV type 1 may interfere with the immune response through infection of immature dendritic cells (DC) and selective downmodulation of costimulatory molecules. In our study we show productive infection of immature monocyte-derived DC, which closely resemble sessile Langerhans cells, by sequential expression of immediate-early, early, and late viral proteins and of glycoprotein D mRNA, as well as production of infectious virus of moderate titers. Infection was cytopathic, with the progressive loss of 20 to 45% of cells from 24 to 48 h after infection, with no more than 80% of DC found to be infected. These results are in contrast to those of previous findings of nonpermissive or abortive infection of monocytes and mature monocyte-derived DC. Infection of immature DC also led to selective and asynchronous downregulation of CD1a, CD40, CD54 (ICAM-1) (12 h postinfection), CD80 (24 h postinfection), and CD86 (48 h postinfection) but not of CD11c or major histocompatibility complex class I and II molecules when compared to DC exposed to UV-inactivated virus. Thus, we propose that productive infection of epidermal Langerhans cells in vivo may lead to delayed activation of T cells, allowing more time for replication of HSV type 1 in epidermal cells.
Antigens, CD1↗
Ethics of fetal tissue transplantation.
Now that the Clinton Administration has overturned the ban on federal funding for fetal tissue transplantation, old ethical issues renew their relevance and new ethical issues arise. Is fetal tissue transplantation necessary and beneficial? Are fetal rights violated by the use of fetal tissue in research? Is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? Should pregnant women be allowed to designate specific fetal transplant recipients? What criteria should be used to select fetal tissue transplants? Whose consent should be required for the use of fetal tissue for transplantation? We review the current state of clinical research with fetal tissue transplantation, the legal history of fetal tissue research, the major arguments against the use of fetal tissue for transplantation, and the new postmoratorium ethical dilemmas. We include recommendations for guidelines to govern the medical treatment of fetal tissue in transplantation.
Aborted Fetus↗
Legal abortion and placenta previa.
Legal abortion has been postulated to be a risk factor for placenta previa in subsequent pregnancies. To examine this hypothesis, we analyzed the deliveries of 28,665 women. We identified 68 women who had had placenta previa and compared their obstetric histories with those of 68 controls randomly selected from the same group of deliveries. The crude risk ratio for women with a history of one or more legal abortions was 1.4 (95% confidence interval, 0.5 to 3.6; p greater than 0.05). Standardizing the crude risk ratio for the effects of age and gravidity reduced the risk ratio to 1.1 (95% confidence interval, 0.4 to 2.8). In this predominantly black population legal abortion does not appear to have a significant association with placenta previa in subsequent pregnancies.
Abortion, Legal↗
Abortions and breast cancer: record-based case-control study.
It has been suggested that abortions leave the breast epithelium in a proliferative state with an increased susceptibility to carcinogenesis. Results from previous studies of induced or spontaneous abortions and risk of subsequent breast cancer are contradictory, probably due to methodological considerations. We investigated the relationship between abortions and subsequent breast cancer risk in a case-control study using prospectively recorded exposure information. The study population comprised women recorded in the population-based Swedish Medical Birth Register between 1973-91. Cases were defined by linkage of the birth register to the Swedish Cancer Register and controls were randomly selected from the birth register. From the subjects' antenatal care records we abstracted prospectively collected information on induced and spontaneous abortions, as well as a number of potential confounding factors. Relative risk of breast cancer was estimated by odds ratios (OR) with 95% confidence intervals (95% CI). A reduced risk of breast cancer was observed for women with a history of at least 1 compared to no abortions (adjusted OR = 0.84, 95% CI = 0.72-0.99). The adjusted OR decreases step-wise with number of abortions to 0.59 (95% CI = 0.34-1.03) for 3 or more compared to no abortions. The patterns are similar for induced and spontaneous abortions. In conclusion, neither a history of induced nor spontaneous abortions is associated with an increased risk of breast cancer. Our data suggest a protective effect of pregnancies regardless of outcome.
Abortion, Induced↗
The association between induced and spontaneous abortion and risk of breast cancer in Slovenian women aged 25-54.
The risk of breast cancer may be increased by induced or spontaneous abortion. The evidence for this association was evaluated in a population based case-control study in Slovenia, where 624 women aged 25-54 years with breast cancer diagnosed during 1988-1990 were matched for age and site of residence with controls randomly selected from the Slovenian Population Registry. Odds ratios (OR) and 95% confidence intervals (CI) were obtained by conditional logistic regression analyses. Spontaneous abortion was not associated with a significantly increased risk of breast cancer (nulliparous women: OR=1.41, 95% CI 0.22-9.01; uniparous women: OR=0.98, 95% CI 0.50-1.91; women with parity 2 or more: OR=1.40, 95% CI 0.91-2.15). Induced abortion was not associated with a statistically significant elevated risk. The risk of breast cancer was higher in nulliparous women (OR=2.49, 95% Cl 0.68-9.09), and was less among women who had more deliveries. In uniparous women, the risk of breast cancer appeared higher when the induced abortion took place before a first full-term pregnancy (OR=1.94, 95% CI 0.70-5.39) rather than after a first full-term pregnancy (OR=1.22, 95% CI 0.71-2.10) but neither of these odds ratios reached significance. We found no significant association between spontaneous abortion or induced abortion and breast cancer risk. This study found an elevated, but not statistically significant, risk associated with induced abortion among nulliparous women and among parous women when the induced abortion was before the first full-term pregnancy.
Journal Article↗
HL-A, fertility and natural selection.
The antibodies occasionally produced in gravid females usually cause no adverse effects and the mother may become hyporesponsive. Exceptions may occur in some cases of abortion where frequency of antibodies appears to be unduly high. Sperm antigens in the mouse include T locus alleles as well as H-2 and H-Y. The T locus is involved in differentiation. T locus alleles are expressed on early but not late embryos. A search for similar factors in man is in progress. The antigenic differences between sperm and mother and between foetus and mother may be important in natural selection. It is possible that the union of sperm with ovum is non-random and that the ovum can select "compatible" sperm through recognition of cell surface markers present on sperm. Immunologic differences between mother and foetus may cause local "graft-versus-host" reactions in the placenta. This leads to increased placental size and may be a factor in hybrid vigour as well as a protective device.
Antibody Formation↗
Mifepristone medical abortion in Albania: results from a pilot clinical research study.
OBJECTIVE: To explore the acceptability and feasibility of introducing mifepristone-misoprostol for early medical abortion in home and clinic settings in Albania. METHODS: This was a prospective study testing a simplified mifepristone-misoprostol regimen in two tertiary-level government health facilities in Tirana, Albania. Women (n = 409) with amenorrhea of 8 weeks or less received 200 mg mifepristone in the clinic and then chose whether to take 400 microg of oral misoprostol 2 days later either at home or in the clinic. RESULTS: Nearly 97% of women successfully terminated their pregnancies using the simplified regimen. Almost all women found the method either satisfactory (49.4%) or highly satisfactory (41.1%). Almost all women who were given the option selected the home use protocol. Women choosing home administration of misoprostol were able to manage the medical abortion process on their own. CONCLUSION: A reduced dose mifepristone medical abortion regimen with home administration of misoprostol is feasible for introduction into healthcare facilities in Albania.
Abortifacient Agents, Steroidal↗
Chromosomal abnormalities associated with infertility.
From a population of 515 subfertile couples and 119 women with amenorrhea, 38 patients were karyotyped because of specific signs and symptoms suggestive of chromosomal abnormality. The indications for karyotyping included primary amenorrhea, secondary amenorrhea with gonadal failure before 35 years of age, stature of less than 147.5 cm, azoospermia with eunuchoidism, and personal or family history of more than 2 spontaneous abortions or more than 2 severely abnormal children. In addition, 19 patients from the same subfertile population were selected randomly for karyotyping to serve as controls. Using banding techniques, chromosomal abnormalities were found in 18 of the 38 specifically selected individuals, whereas no abnormality was found among those randomly selected. Three of the 18 patients had chromosomal abnormalities not previously described; their karyotypes were 46,XY/48,XY,+8,+21; 46,X,inv dup(Xq)/q26 leads to q21); and 46,XY,t(9;20)(q22;q12).
Abortion, Spontaneous↗
Correlation of serum cytokine and adhesion molecule determinations with pregnancy outcome.
OBJECTIVE: To test the hypothesis that serum levels of T helper [Th]-1-type (interleukin [IL]-2, interferon [IFN]-gamma, tumor necrosis factor [TNF]-alpha) and Th2-type (IL-10) cytokines and the soluble intracellular adhesion molecule-1 (sICAM-1) are associated with pregnancy outcome in women with a history of recurrent spontaneous abortion. METHODS: Peripheral serum was obtained from 104 women between 29 and 42 years of age with a history of two or more (range two to 12, mode four) prior pregnancy losses. Levels of IL-2, IFN-gamma, TNF-alpha, IL-10, and sICAM-1 were measured by enzyme-linked immunosorbent assay in sera from 29 of the 104 individuals when not pregnant and 92 of these women when pregnant between 6 and 7 weeks of gestation. Seventeen women provided samples before and during pregnancy. RESULTS: Interleukin-2, IFN-gamma, and IL-10 were not detectable in any serum sample. Low levels of TNF-alpha were detected in 46 sera from pregnant women but did not correlate with pregnancy outcome. In contrast, sICAM-1 was demonstrable in all sera. However, no differences were observed between pregnant and nonpregnant women. Similarly, there was no difference in serum levels of sICAM-1 between women who subsequently aborted (n = 13) and those who successfully carried to term (n = 15). Neither patient age nor number of prior losses significantly correlated with serum cytokine and sICAM-1 levels. CONCLUSION: Peripheral serum levels of selected Th1-type and Th2-type cytokines and sICAM-1 were not associated with pregnancy outcome in women with a history of recurrent spontaneous abortion.
Abortion, Habitual↗
Unfinished feticide.
A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple pregnancy is reduced to a singleton or a twin pregnancy to improve the likelihood that the remaining fetuses will reach viability. In each case, through cause or coincidence, an abnormal baby may be born. The well-intentioned physician, responding to a patient's medical or psychological needs, risks a legal action in negligence or assault brought by a deformed surviving child. This hazard means that medical termination of pregnancy and selective pregnancy reduction put the practising physician at substantial risk in a way not usually associated with induced abortion.
Abortion, Eugenic↗
Screening for Chlamydia trachomatis infection in pregnant women in Martinique.
GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.
Abortion, Induced↗
Neospora abortions in dairy cattle: diagnosis, mode of transmission and control.
AIM: To determine the contribution of Neospora caninum to abortions on a dairy farm in NSW (Australia), determine the mode of transmission and develop and trial a control option for infection. METHODS: Two whole herd bleeds were conducted 12 months apart and the association between serological status and abortion events were calculated for a number of bovine abortifacients. Family trees were constructed for N. caninum seropositive cattle in the herd. Some N. caninum seropositive cows were culled from the herd and no female offspring was retained from seropositive cows. RESULTS: At the first whole-herd bleed in December 2002 a seroprevalence of 10.2% for N. caninum infection was detected. Cows with N. caninum infection were 13 times more likely to abort than uninfected ones. Seventy-five percent of seropositive animals in the herd were related, suggesting a high degree of congenital infection/transmission. Only 15% of infections were likely to be postnatally acquired. Selective culling of seropositive cows and not breeding from them reduced the number of seropositive animals. Only one newly sero-converted cow was detected at the second whole-herd bleed 12 months later. CONCLUSIONS: Seroepidemiological approaches were able to establish a high degree of association between N. caninum infection and low-level abortion in the dairy herd. Vertical transmission of infection was the predominant mode of infection and hence control efforts aimed at selectively culling seropositive animals from the herd were highly successful in reducing the level of infection.
Abortion, Veterinary↗
Comparison of ploidy analysis by flow cytometry and image analysis in hydatidiform mole and non-molar abortion.
Determination of DNA ploidy is useful in the diagnosis and classification of hydatidiform mole. Most reports of ploidy analysis in molar tissue have used DNA flow cytometry. Although image analysis cytometry offers theoretical advantages over flow cytometry, there have been few reports of ploidy analysis by image analysis in hydatidiform mole. We selected 47 cases and measured DNA ploidy by flow cytometry and image analysis cytometry in complete hydatidiform mole, partial hydatidiform mole and non-molar abortion. The two cytometry modalities were compared using kappa statistics. There was reasonable overall agreement between the two modalities (kappa = 0.69) and when ploidy was stratified into diploid/polyploid and triploid categories there was near perfect agreement (kappa = 0.93). Aneuploid cell populations, which were not evident on flow cytometry, were identified by image analysis in a significant proportion of complete and partial hydatidiform moles and in a small number of non-molar abortions. Flow cytometry and image analysis cytometry yield comparable ploidy information, useful in the diagnosis and classification of hydatidiform mole. Image analysis cytometry offers greater sensitivity in the detection of small non-diploid cell populations but the significance of this latter finding is uncertain.
Abortion, Spontaneous↗
Chromosome breakage in individuals with single-cell structural aberrations and habitual abortions.
The rate of spontaneous and methotrexate (MTX)-induced chromosome breakage was studied in individuals with a history of habitual abortions in whom a structural chromosomal aberration was found in a single cell during routine cytogenetic analysis. Twelve such individuals were selected because they were not under the influence of any known mutagenic factor such as smoking, alcohol, medication and apparent irradiation; they were compared to 12 age- and sex-matched control parents. A detailed statistical analysis revealed that the spontaneous and MTX-induced chromosome breakage was significantly increased in the abortion group. The MTX-induced breakage rate was especially elevated in the women of the abortion group.
Abortion, Habitual↗