Regulation of abortion services -- for better or worse?
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The Center for Disease Control (CDC), Atlanta, Georgia implemented an eight-month prospective surveillance system in 24 hospitals distributed among states with and without public funding for abortion. Out of 3,157 visits for abortion-related complications, only 10 women gave a history of non-physician or self-induced abortion and none were Medicaid recipients. The small number of hospitals located in non-funded states and the smaller numbers of women served in these hospitals than in the funded states limited the power of out study. Women living along the Texas-Mexico border appeared more likely to have complications after illegal abortions than women from other areas of the country.
In almost every pregnancy feto-maternal transfusions occur. From the 6th week of pregnancy, blood containing Rhesus antigens may be infused into the maternal circulation and cause sensitization. In case of miscarriage, abortion, ectopic pregnancy and cystic mole the chance of fetomaternal transfusion followed by sensitization of the mother is significantly increased. Therefore immunoprophylaxis with anti-D-immunoglobins should be performed in all these cases.
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If risk of the one-time mechanical dilatation will be too high (with young first gravidae and progressed pregnancy) the methods of the two-time interruptio should be applied. As long as there will not be available sufficient quantities of Prostaglandin-analoga the present method of choice is the abort-induction by means of the extra-amnial application of Prostaglandin F2alpha. In 101 cases when extra-amnial Pg F2alpha with an average induction time of four hours, the contamination rate was checked and no danger of ascension appeared. If prostaglandines will not be available, metranoicter or laminarias should be applied in the first trimenon when there is a high risk of dilatation, in the second trimenon extra-amnial instillation methods should be used. In both the cases only can be spoken of interruptios low if risks of they are made up under guard of broad spectrum antibiotics--after negative proof of blastomyces (buddings). This recommendation results from microbiological researches made up with 423 patients under the aspect of possible hospital infections. With induction times longer than 18 hours, the cavum uteri proved accelerating contaminated microbially. There were found microbes in the cavum uteri respectively at laminarias and metranoicters of, enterobacteria (45,7%), staphylococci (24,7%), hemolyzing and anhemolytic streptococci (17,6%), enterococci (8,0%), Corynebacteria (3,0%) and blastomyces (buddings) (1,0%).
The midtrimester abortion program at a large community hospital was evaluated. During the 3-year study, 1839 patients aborted in the midtrimester by intraamniotic injection of hypertonic saline, prostaglandin F2alpha or a combination of saline and prostaglandin F2alpha. The method, using a combination of saline and prostaglandin F2alpha together with intracervical laminaria, showed significant reduction in the number of failures (4.3 to 1.0%), reduction in the injection-abortion interval from 33.9 to 14.6 hours, shortening of the hospital stay from 2 1/2 to 1 1/3 days, minimum incidence of live abortions (0.9%), infrequent need for oxytocin to effect delivery (7.7%); and low rates of hemorrhage (1.5%) and fever (2.8%). The main disadvantage was an increased rate of incomplete abortions (32.3%), which could be reduced to 27% by patient selection.
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We evaluated the cervical dilator device (CDD), an expanding balloon, as a substitute for laminaria tents before abortion at 13 to 16 1/2 weeks by extraction and vacuum curettage. The CDD was found to be an effective dilator, although it did not appear to have any advantage over laminaria tents when placed overnight and was associated with significant pain upon insertion and an apparent increased risk of endometritis. The present CDD or a subsequent modification may offer advantages over laminaria tents for short-term placement.
406 women--about one-fifth of those requesting an induced abortion and sterilisation over a thirty-three-month period--volunteered to be allocated randomly to either a concurrent induced-abortion/sterilisation group or a group which was sterilised six weeks after abortion. The abortion-attributable and sterilisation-attributable complication rates of 3.8% and 5.2%, respectively, for the concurrent group did not differ significantly from the 6.7% and 6.9% rates for the interval group. The estimated 2%-10% of women who would have changed their minds must be set against the 4% of women who became pregnant again before being sterilised. Efforts should be made to identify women likely to regret sterilisation.
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A study of 576 pregnant women, whose previous pregnancy had been terminated by legally induced abortion, has shown that the rate of pregnancy and delivery complications could not be correlated with the interval between the abortion and the subsequent pregnancy, nor with the gestational age at the time of abortion, nor the number of previous induced abortions. Neither was the abortion technique found to correlate with the frequency of complications in a subsequent pregnancy. It was found, however, that more infants with a birth weight below 2 501 grams were born to women whose cervical canal during abortion had been dilated more than 12 mm, and by women who had been submitted to récurettage. The latter group also demonstrated a higher frequency of retained placenta or placental tissue.
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Recent local, state and federal regulations intending to provide "informed consent" for women considering termination of pregnancy have misrepresented the current state of knowledge about certain long-term complications: the alleged risks are presented to the patient as if they were scientific facts rather than still-unproven hypotheses. While it is possible that some late sequelae are associated with previously induced abortions, there is no agreement in the scientific literature on the magnitude of the risks, if any. Moreover, few studies adequately define the particular method of induced abortion whose effects they are investigating. The current data do not support firm conclusions about induced abortion either causing or not causing any of the alleged long-term complications.
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