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Spontaneous abortion and induced abortion: an adjustment for the presence of induced abortion when estimating the rate of spontaneous abortion from cross-sectional studies.

The existence of high rates of induced abortion in the population may distort currently employed measures of the rate of spontaneous abortion. Since the frequency of induced abortion varies greatly between and within populations, an appropriate correction is needed to restore the comparability of spontaneous abortion rates. A simplified estimate of the "true" rate of spontaneous abortion is proposed. This statistic yields a sufficient approximation for most purposes.

Abortion, Induced↗

Risk of spontaneous abortion following induced abortion is only increased with short interpregnancy interval.

We set out to study the risk of spontaneous abortion following a first trimester induced abortion as a function of the interpregnancy interval between two pregnancies. The cohort study is based on the following databases: Danish national registries: the Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the induced Abortion Registry (IAR). All primigravid women in the time period from 1980 to 1982 were identified in the MBR, the HDR and the IAR. A total of 15 727 women who terminated the pregnancy with a first trimester induced abortion were selected as the induced abortion cohort, and 46 026 women who did not terminate the pregnancy with an induced abortion constituted the control cohort. By register linkage all subsequent pregnancies which were not terminated by induced abortion were identified from 1980 to 1994. Only women who had a non-terminated pregnancy following the index pregnancy were selected. Women whose first pregnancy was terminated following a first trimester induced abortion had a risk of spontaneous abortion of 11.0% vs. 9.4% in the control cohort. This relative difference of 1.17 was not statistically significant in logistic regression analyses. An increased risk was only found for women who had an interpregnancy interval of less than 3 months (OR=4.06, 95% C.I.=1.98-8.31). The abortion method, vacuum aspiration with dilatation or evacuation with dilatation did not modify this elevated risk. Overall the study did not show an increased risk of spontaneous abortion following one or more induced abortions, except for women with a short interpregnancy interval between an induced abortion and a subsequent pregnancy. We recommend women who have a first trimester induced abortion be advised to wait at least 3-6 months before trying to become pregnant again.

Journal Article↗

[Pathologico-anatomic findings in spontaneous abortion and induced abortion during the 2nd pregnancy trimester].

Reported in this paper are results obtained from morphological investigations of 200 fetal abortions which had occurred in the fourth to sixth months of pregnancy. They were spontaneous abortions and abortions induced primarily for fetal indications (31 cases). Causes are subdivided in this report by placental, fetal, and maternal factors. Fetal causes accounted for 18.5% of all cases (most of them fetal malformations, induced abortions included). Maternal causes accounted for 7.5%, among them edema-proteinuria-hypertension (EPH) gestosis and premature rupture of the amnion. No unambiguous clinical or morphological findings were established as causes in 36 cases, i.e. 18%. The majority of all causes, 55.5% was related to placental factors, among them impaired maturation of the placenta in 14.5%, disorders in maternal circulation in 17%, and inflammatory alterations in 23.5%. Early disorders in placentation accounted for a conspicuously high number of after-birth findings (complex early impairment of placental maturation in 28.6%), and so did maternal circulatory disorders, including retroplacental hemorrhage (55.2%), as well as decidual and membranous inflammations (43.4%).

Abortion, Induced↗

Outcome of first delivery after 2nd trimester two-stage induced abortion. A controlled historical cohort study.

In a historical cohort study the outcome of the first birth after a legal 2nd trimester two-stage abortion induced with saline or prostaglandin F2 alpha was evaluated for 142 nulliparous and 65 parous women. The birth-outcome was compared with that for 180 parity-matched control women and for all women in Sweden 1975. No statistically significant differences were disclosed with regard to means of infants' birthweight and length of gestation, or to occurrence of low birthweight (LBW) infants and preterm deliveries. The nulliparous women with a previously induced abortion tended, however, to have more LBW-infants than did the other nulliparae . More LBW-infants were born to the 29 nulliparae with a previous abortion induced with prostaglandin than to the 113 nulliparae having abortions induced with saline (p = 0.11); otherwise no noteworthy differences were found in the birth-outcome for the 39 women with a previous abortion induced by prostaglandin, compared with the 168 having abortions induced by saline.

Abortion, Induced↗

Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000.

OBJECTIVE: To test the hypothesis that pregnant and recently pregnant women enjoy a "healthy pregnant women effect," we compared the all natural cause mortality rates for women who were pregnant or within 1 year of pregnancy termination with all other women of reproductive age. STUDY DESIGN: This is a population-based, retrospective cohort study from Finland for a 14-year period, 1987 to 2000. Information on all deaths of women aged 15 to 49 years in Finland (n=15,823) was received from the Cause-of-Death Register and linked to the Medical Birth Register (n=865,988 live births and stillbirths), the Register on Induced Abortions (n=156,789 induced abortions), and the Hospital Discharge Register (n=118,490 spontaneous abortions) to identify pregnancy-associated deaths (n=419). RESULTS: The age-adjusted mortality rate for women during pregnancy and within 1 year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women, 57.0 per 100,000 person-years (relative risk [RR] 0.64, 95% CI 0.58-0.71). The mortality was lower after a birth (28.2/100,000) than after a spontaneous (51.9/100,000) or induced abortion (83.1/100,000). We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15 to 24 years (RR 4.08, 95% CI 1.58-10.55). CONCLUSION: Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.

Abortion, Induced↗

Assessing the Mental Health Impact of Induced Abortion.

Induced abortion is the subject of tremendous political conflict. Anti-abortion activists have frequently asserted that abortion results in major psychiatric sequelae. The evidence, however, clearly indicates that this is not necessarily the case. Studies performed to date confirm that it is possible to identify risk factors, help pregnant women make decisions compatible with their own values, and minimize psychiatric sequelae.

Journal Article↗

[Failed induced abortion. Pregnancy continuing after induced abortion].

Operations classified as induced abortion fail, i.e. the pregnancy continues, in approximately 0.05% of the cases. Termination procedures before 7-8 weeks of gestation and wrong assessment of the size of the uterus imply significantly increased risk of failed abortion. The article describes current methods for early termination of pregnancy, as well as preoperative procedures and postoperative advice aimed at avoiding or detecting failed induced abortions.

Abortion, Induced↗

Sudden increase of plasma fibrinopeptide A levels after induced abortion.

Plasma fibrinopeptide A levels were studied before and after abortion induced during the first trimester of pregnancy. Fibrinopeptide A levels were significantly increased 15 min after the induced abortion, and returned to preoperative values 2h later. This finding suggests that thrombotic activity is transiently increased immediately after the induced abortion. Activation of the clotting factors during the induced abortion appears to be important in controlling uterine hemorrhage.

Abortion, Induced↗

Abortion induced with methotrexate and misoprostol.

OBJECTIVE: To determine the outcome and side effects of a new drug protocol to induce abortion. DESIGN: Case series. SETTING: An urban primary care practice. PATIENTS: One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks' gestation. INTERVENTION: Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 micrograms, given vaginally). OUTCOME MEASURES: Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one. RESULTS: Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again. CONCLUSION: Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.

Abortifacient Agents, Nonsteroidal↗

[Medical indications for abortions induced in the 2d trimester of prenatal life. Epidemiological considerations and prospects of prevention].

A review of more then 20,000 induced abortions led to recognize a series of about 1,500 late abortions induced upon medical indication during the second trimester of pregnancy, in accordance with the 1978 italian Law. About 20% of these abortions were performed in teen-agers. Only 3.5% of these 1.500 abortions corresponded to the classic "therapeutical" motivation due to danger to the physical health of the mother. Eugenic abortions induced by ascertained fetal malformation, chromosomal abnormality or other suspected prenatal pathology, could be identified in 36.9% of cases, even if legal motivation went correlated to the mental health of the mother. In 59.6% of cases motivation was a peculiar psycho-emotional condition of mother suffering, inducing fear for her mental health. Data were analysed and correlated to a series of relevant variables. Considerations of general value regarding the prevalence of the phenomenon of rejected pregnancies, the rate of spontaneous abortions, and the lack of birth control, are based on the comparison of the results with those of the first trimester induced abortions, spontaneous abortions and natality rate recorded in the same Hospital, in the population of Milan and in the italian largest region, Lombardy. Consistently with the recognition, based on biological, medical and ethical ground, of the presence of a new human life during pregnancy, the Author stresses the need for a realistic approach to the problem also from the legal and medical point of view. In particular, the urgent need for comprehensive and efficient programs of prevention of abortion, which still remains all over the world a major challenge for society, human dignity and modern gynaecological science is emphasized.

Abortion, Induced↗

The disappearance of human chorionic gonadotropin from plasma and urine following induced abortion. Disappearance of HCG after induced abortion.

In 28 females, daily measurement of the HCG concentration in urine and in 15 of them daily measurement of the beta-HCG concentration in plasma was carried out during the first 2 weeks following first-trimester induced abortion by vacuum aspiration. Plasma beta-HCG concentration fell according to a multi-exponential curve with a half-life of 0.63 days in the first 2 days following induced abortion, and of 3.85 days in the subsequent 14 days. The disappearance of HCG from urine is exponential, with a half-life value of 1.3 days. A urine pregnancy test with a sensitivity of 1 IU/ml wil nearly always be negative in the course of 2 weeks after abortion. A positive test 4 weeks after abortion indicates an incomplete abortion or persistent trophoblast.

Abortion, Induced↗

Abortion-inducing effect of prostaglandin F2-alpha in the mid-trimester of pregnancy.

Prostaglandin (PG) F2-alpha was administered extraamnially to 70, and intraammially to 51 pregnant women to induce abortion in the 14th to 28th weeks of pregnancy. With intraamnial infusion of PGF2-alpha (25 mg/8-12 hours), the mean induction time was 27.1 hours and thus, oxytocin, too, was required in 19.6% of the cases. With extraamnial infusion of 5 mg PGF2-alpha at 4 to 6 hour intervals, mean induction time was 34.0 hours and addition of oxytocin was required in 46.1% of the cases. Moreover, if 15 to 30 mg of PGF2-alpha was infused at 18 to 29 hour intervals, or 1 mg at 2 hour intervals, the induction of abortion was considerably prolonged. In primigravidae, or in the 14th to 18th weeks pregnancy, the abortive effect of PGF2-alpha was weaker than in multigravidae or in the 19th to 28th weeks of pregnancy. In the case of intrauterine fetal deaths, the abortive effects was more marked than in intact pregnancies. After extraamnial infusion of PGF2-alpha, the uterine contractions were less coordinated than after intraamnial dosage. In about one-third of abortion induced by extraamnial PGF2-alpha, the fetal heart was found to work for 5 to 15 minutes after abortion.

Abortion, Induced↗

[Complications in pregnancy following abortion induced with PGF2 alpha ].

The influence of induced abortion on the subsequent pregnancy by intermittent intrauterine extraamniotic application of PG F2 alpha was studied in 159 secundigravidae. The results are compared with courses of pregnancy after conventional interruption and after induced abortion by extraamniotic application of glucose (Kovács). The investigations demonstrate the efficiency of cervical dilatation with PG F2 alpha for interruption in primigravidae.

Abortion, Induced↗

Bovine herpesvirus-1 infection of cattle: kinetics of antibody formation after intranasal exposure and abortion induced by the virus.

The kinetics of antibody formation in Holstein heifers after primary and secondary intranasal inoculation of bovine herpesvirus-1 (BHV-1) and after BHV-1-induced abortion was determined. Sera were fractionated by gel filtration and ion-exchange chromatography. The antibody activity within serum immunoglobulin (Ig) isotypes was assessed, using a plaque-reduction neutralization assay. The primary immune response to BHV-1 infection was characterized by the appearance of IgM and IgG antibodies in serum by postinoculation day (PID) 7. Maximal IgG antibody activity occurred at PID 35 in nonpregnant heifers and at PID 14 in pregnant heifers. Thereafter, IgG antibody activity declined slowly in both groups of heifers. Maximal IgM antibody activity occurred at PID 14 in both groups of heifers and declined rapidly thereafter. The IgG antibody activity during primary immune responses was restricted to the IgG1 subclass. Secondary responses were characterized by anamnestic IgG antibody responses. Antibody activity was present within the IgG1 and IgG2 subclasses during secondary immune responses, but the increase in antibody activity during this period was primarily in the IgG2 subclass. Secondary IgM antibody formation was elicited by abortion induced by the intra-amniotic inoculation of BHV-1, but not by reexposure by the intranasal route. Abortion occurred in 1 heifer 28 days after intranasal BHV-1 inoculation. Abortion in this heifer was not associated with a secondary antibody response. The nature of BHV-1 antigenic exposure in the bovine determined the relative distribution of anti-BHV-1 antibody activity in serum IgM, IgG1, and IgG2. The formation of IgM antibody, with the exception of secondary intranasal exposure, indicated recent BHV-1 antigenic exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Veterinary↗

Treatment of women who have undergone chemically induced abortions.

The pathophysiology of abortion induced by the transcervical introduction of compounds containing mixtures of soap, cresol and phenol is complex. A plan is necessary for the treatment of such critically ill women. The complex, multisystem damage produced by those compounds requires an extremely sophisticated treatment approach to avoid the many pitfalls that beset those cases.

Abortifacient Agents↗

Risk of spontaneous abortion following legally induced abortion.

Using the registration of all pregnant women living within a particular geographical district of Copenhagen the risk of spontaneous abortion has been calculated by means of a decremental method. A total of 3,042 pregnancies were registered and the total risk of spontaneous abortion was calculated at 10 per cent. In 431 women the previous pregnancy had been terminated by a legally induced abortion. Increased risk of spontaneous abortion could not be demonstrated in this group, where the cumulative risk of spontaneous abortion was 12 per cent. In particular, the risk of late abortion was not seen to increase.

Abortion, Induced↗

[Reporting of induced abortions in 1994. A comparison between the data in the Registry of Legally Induced Abortions and the National Patient Registry].

Up to 31st December 1994 all cases of legally induced abortions were notified by the physician responsible for the operation to the National Board of Health and recorded in the Register of Induced Abortions. Following this data, abortion statistics will rely on data concerning induced abortions in the Danish National Patient Register, which includes information based upon the unique personal number of all patients admitted to hospitals. The completeness of the Register of Induced Abortions and the National Patient Register as to induced abortions in 1994 was assessed to evaluate the impact of the change in method of monitoring on trends in the national and regional abortion rate. The complete number of induced abortions was estimated to be the sum of the number recorded in both registers, cases recorded only in the Register of Induced Abortions, cases recorded only in the National Patient Register, and the missing number of registration of induced abortions calculated by capture-recapture methods. Of these 18,429 abortions 96.4% were registered in the National Patient Register and 93.5% in the Register of Induced Abortions. There were some regional variations. In some counties more abortions were registered in the Register of Induced Abortions and in others in the National Patient Register. Considering the change from 1995 in sources of the statistics of induced abortions, analyses of trends in the abortion rate in the early 1990s in Denmark must be evaluated with prudence.

Abortion, Legal↗