Elevated viral antibody titres in spontaneous abortion

To assess the possible role of virus infections in spontaneous abortion we undertook a prospective study of three groups of patients: women who had a spontaneous abortion; women seen in the antenatal booking clinic; and those undergoing therapeutic termination of pregnancy. Venous blood was taken for antibody detection, cervical swabs for virus isolation, and in the cases of spontaneous and therapeutic abortion products of conception were sent for virus culture. The infectious agents studied were influenza A and B, adenovirus, respiratory syncytial virus, measles, psittacosis, Varicella zoster, and mumps virus. Statistical analysis revealed that women in the spontaneous abortion group has a higher incidence of antibodies against respiratory syncytial virus (P less than 0.01), and mumps virus (P less than 0.01). Among women seropositive for each virus, higher titres were found only for respiratory syncytial virus (P less than 0.05) in cases rather than controls. These results could be explained if viruses such as respiratory syncytial virus caused abortion or if women having a spontaneous abortion mount exaggerated immune responses to fetal and viral infections, and the former altered immune response is associated with spontaneous abortion.     

Elevated viral antibody titres in spontaneous abortion

Abstract To assess the possible role of virus infections in spontaneous abortion we undertook a prospective study of three groups of patients: women who had a spontaneous abortion; women seen in the ante-natal booking clinic; and those undergoing therapeutic termination of pregnancy. Venous blood was taken for antibody detection, cervical swabs for virus isolation, and in the cases of spontaneous and therapeutic abortion products of conception were sent for virus culture. The infectious agents studied were influenza A and B, adenovirus, respiratory syncytial virus, measles, psittacosis, Varicella zoster , and mumps virus. Statistical analysis revealed that women in the spontaneous abortion group has a higher incidence of antibodies against respiratory syncytial virus ( P <0.01), and mumps virus ( P <0.01). Among women seropositive for each virus, higher titres were found only for respiratory syncytial virus ( P <0.05) in cases rather than controls. These results could be explained if viruses such as respiratory syncytial virus caused abortion or if women having a spontaneous abortion mount exaggerated immune responses to fetal adn viral infections, and the former altered immune response is associated with spontaneous abortion.     

CMA abortion survey.

Responses to the question as to whether abortions should be performed at the woman''s request during the first trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds, during the first trimester, from 61.5% of the respondents. Termination of pregnancy beyond the first trimester was supported by a majority of the respondents only in cases in which the woman''s life is in danger (73.9%) or in which there is evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman''s physical health is in danger (55.5%). Those who said they would not support abortion under any circumstances constitute, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in two questions and in both cases the respondents were evenly divided. The responses to these two questions were compared and found to be logically consistent. Only physicians should perform abortions, and they should be performed in hospitals with the woman either as an inpatient or, during the first trimester, as an outpatient. The performance of first-trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of the 885 respondents who wished to see some amendment to the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined.     

Induction of abortion by intra- and extra-amniotic prostaglandin F2 administration

PGF2 alpha was administered intrauterine in 115 patients during the 11th to 20th week of pregnancy for abortion induction. An intra-amniotic method was used in 61 cases, an extra-amniotic one in 54 cases. Average total dose administered was 35.1 (range 5 to 65 mg) in the amniotic group and 6358 mcg (range 1500 to 14000 mcg) in the extra-amniotic group. The intra-amniotic group had an abortion rate of 92% and a 74% rate of side effects, mainly gastrointestinal irritation. Corresponding figures for the extra-amniotic group were 72% and 54% respectively. In the extra-amniotic group, doses of 4750 mcg or more increased the abortion rate up to 80% and side effects up to 64%. There were no serious complications. The intra-amniotic approach of prostaglandin induction is suitable for second trimester therapeutic abortions. The extra-amniotic approach is useful in cases of fetus mortuus and hydatiform mole.     

Attitudes of Obstetric and Gynecologic Residents Toward Abortion

As a follow-up to Wolf''s study of attitudes of obstetrical housestaff toward therapeutic abortion,⁵ the attitudes of 48 obstetrical residents in the San Francisco Bay area were evaluated by questionnaire and structured interview. Specific issues studied were: (1) Willingness to perform therapeutic abortion, (2) impact of therapeutic abortion on Resident Training Program, (3) attitudes toward different operational procedures, and (4) preferred physician-patient relationship with therapeutic abortion patients. Findings suggest that although there is recognition and acceptance by most residents of the social need for therapeutic abortion, considerable ambivalence persists.     

The therapeutic exception: abortion, sterilization and medical necessity in Costa Rica

Based on the case of Rosa, a nine-year-old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity.     

Termination of Pregnancy with Intra-amniotic Hypertonic Saline

Successful therapeutic abortion was performed consecutively by an intra-amniotic injection of hypertonic saline in 102 out of 110 patients in whom the size of the uterus corresponded with a pregnancy of 16 weeks or more.A spontaneous abortion of the fetus followed the injection alone in 92 of the cases, and the overall injection-delivery interval was 39·75 (range 11-98) hours. In 10 women intravenous oxytocin injection was used as an additional uterine stimulant because contractions were not established after 48 hours. Complete spontaneous expulsion of the placenta occurred in 71 cases, and evacuation of the placenta under general anaesthesia was required in the other 31.No major complication occurred among the 110 patients.     

Induction of abortion by intra- and extra-amniotic prostaglandin F2α administration

Legal abortion was induced by intrauterine administration of prostaglandin F_2α in 115 patients during the 11th – 20th week of pregnancy. An intra-amniotic method was used in 61 of the cases, an extra-amniotic one in 54 cases. The average total dose administered was 35.1 mg (range 5 – 65 mg) in the intra-amniotic group, and 6358 μg (range 1500 – 14000 μg) in the extra-amniotic group. Abortion rate was 92 % in the intra-amniotic material and 72 % in the extra-amniotic material, and side-effects, mainly gastrointestinal irritation, were noted in 74 % of the intra-amniotic cases and 54 % of the extra-amniotic ones. If total doses of 4750 μg or more were administered in the extra-amniotic cases, abortion rate went up to 80 %, but the frequency of side-effects simultaneously increased to 64 %. No serious complications occurred. Intrauterine prostaglandin induction is well suited therapeutic abortions in the second trimester, and the intra-amniotic technique is more practicable than the extra-amniotic one. The latter is applicable in cases where the puncture of the amniotic cavity is difficult to achieve, e.g. in cases of fetus mortuus and hydatiform mole.     

FORENSIC OBSTETRICS

Some of the more important and current aspects of forensic obstetrics are, broadly,1. Fulfillment of basic criteria in all cases of alleged traumatic abortion.2. Utilization of therapeutic abortion review boards, as well as sterilization committees, in all hospitals, with the active support of such committees by all those physicians interested in advancing the art and practice of obstetrics.3. Early and active joint study of professional liability problems by combined groups of physicians and lawyers in every community.     

Rupture of the uterus following treatment with 16-16-dimethyl E 2 prostaglandin vagitories.

Rupture of the uterine body was found after induction of therapeutic abortion with vaginal suppositories containing 16, 16-dimethyl prostaglandin E 2 in a 20-year-old primigravida. A short discussion is given on the cervical complications that can occur after prostaglandin induction of abortion, stating that rupture of the uterine body also can be seen. So far, no prostaglandin compound seems to avoid such complications.     

Rupture of the uterus following treatment with 16-16-dimethyl E 2 prostaglandin vagitories

Rupture of the uterine body was found after induction of therapeutic abortion with vaginal suppositories containing 16,16-dimethyl prostaglandin E 2 in a 20-year-old primigravida. A short discussion is given on the cervical complications that can occur after prostaglandin induction of abortion, stating that rupture of the uterine body also can be seen. So far, no prostaglandin compound seems to avoid such complications.     

Prenatal diagnosis of a translocation (X;Y) and genetic counseling

A cytogenetic prenatal diagnosis due to maternal age led us to find a male fetus with a (X;Y) translocation. This translocation is found in the mother, who presents no phenotypic abnormalities or mental retardation. The 22 cases described in the literature indicate that among male carriers of an (X;Y) translocation, half the cases present mental retardation and 2/3 phenotypic anomalies. These findings led us to give a genetic counselling of therapeutic abortion. Post mortem histological examination revealed no morphodysplasia.     

Before and after therapeutic abortion

Surveys conducted after therapeutic abortion were used to evaluate contraceptive use, to assess early physical and emotional effects and to provide feedback to the hospital nurses on their counselling role. The follow-up rate was only 53%. Of those who cooperated 82.9% were using effective contraception three months after abortion. Subjective morbidity was greater than anticipated. The main emotional response was relief coupled with some guilt and depression in a significant minority. The occurrence and significance of the after effects of abortion should be explained in advance. Training workshops for abortion counsellors would be useful. The surgical termination of pregnancy is only a small part of a comprehensive abortion service.     

Vaginally administered 16, 16-dimethyl-prostaglandin E2 as an agent for pre-operative cervical dilatation.

Twenty-one women in the 10th-12th week of pregnancy were treated prior to vacuum aspiration with vaginal suppositories containing 16, 16-dimethyl-PGE2 (free acid). An average total dose of 3.4 mg led to abortion or adequate cervical dilatation in all patients. Based upon previous experience with the compound, no prophylactic anti-emetic or anti-diarrhetic medication was given. Gastrointestinal side effects were minimal. Excessive bleeding was not observed. In two cases, slight temperature elevation was noted prior to abortion. The low incidence of side effects in combination with the effectiveness of the compound help to make this method an attractive therapeutic adjunct to vacuum aspiration beyond the 10th week of gestation. Under the experimental conditions of this study, the results suggest that vaginally administered 16, 16-dimethyl-PGE2 can be a safe and effective method for cervical dilatation before vacuum aspiration.     

Therapeutic Abortion in a Canadian City

In a city of 200,000, 119 therapeutic abortions were performed during the period 1962 to 1968. Multiple grounds were commonly given for abortion; these often included depression. Very frequently the absence of support from other people was a factor in deciding to perform abortion. Only five psychiatrists were involved in 82 cases seen in psychiatric consultation. Abortions carried out for more conventional medical reasons, including rubella, decreased in 1967 and 1968 but there was an overall increase beginning in 1967. In the later years of the study (1967-68) a higher proportion of patients were single, younger, had had no previous pregnancy and were aborted later in pregnancy; more were sterilized.A marked increase in abortion rate related particularly to the activity of one of the psychiatrists.One hundred and sixty-six abortions were performed in 1969; a comparable figure (179) was obtained from one other Canadian centre; another centre had performed more (291); two others, 109 and 63; the combined total for 27 other centres from whom replies were obtained was 186.     

Therapeutic Abortion—Attitudes and Practices of California Physicians

A questionnaire about attitudes and practices regarding therapeutic abortion was sent to 943 diplomates of the American Board of Obstetrics and Gynecology listed in California. In the 748 replies received, certain disparities between the views and practices of the specialists on the one hand and current California statutes on the other were noted. The responses to the questions strongly suggested that current California laws governing the performance of therapeutic abortion are in need of modernization and liberalization if they are to accord with the views and practices of California obstetrician-gynecologists.     

Impact on Hospital Practice of Liberalizing Abortions and Female Sterilizations

The number of therapeutic abortions performed at the Vancouver General Hospital in 1969 was double the average number for the previous four years and in 1970 the total reached 1465. The more liberal attitude towards abortion has resulted in a decided reduction in the number of children available for adoption in the community. This policy has required a streamlining of the duties of the Therapeutic Abortion Committee and an alteration in the pattern of bed and operating-room utilization. By far the greatest number of abortions were performed on psychiatric-social grounds. The complication rate of 17% was influenced chiefly by the advanced duration of the gestation in a high proportion of cases. Gynecologists and hospitals must be prepared to assume their altered role in providing abortion and sterilization in today''s society.     

CRIMINAL ABORTION—A Consideration of Ways to Reduce Incidence

The problem of criminal abortion in the United States is of enormous magnitude, both in terms of incidence and of resultant morbidity and mortality. Several studies suggest that one of every five pregnancies terminates in criminal abortion, or a total of more than one million abortions for 1960, with a possibility of more than 5,000 deaths resulting therefrom.The inadequate laws regarding therapeutic abortion in most jurisdictions contribute much to the problem. Tracing the origins of these laws provides additional clues concerning the development of this enigma.Suggested answers to the problem include: (1) Broadening and clarifying therapeutic abortion laws to reflect current medical practice, yet provide stringent controls; (2) prevention of unwanted pregnancy through consultation centers for women, encouragement of contraceptive research and education of the public.     

Mass-Produced,Assembly-Line Abortion—A Prime Example of Unethical,Unscientific Medicine

The incidence of psychologic sequelae associated with abortion cannot be established scientifically, and so continues to be disputed. Since there are no truly scientific criteria on which to make a prediction as to the psychologic outcome, it seems only proper that elective abortion be labeled “experimental,” rather than “therapeutic.”This uncertainty as to therapeutic benefit is compounded by the fact that adequate studies and information about physical sequelae are also lacking. Furthermore, preliminary statistics from the Population Council indicate that the morbidity rate of abortion performed even under proper medical auspices is unacceptably high.Viewed in this light and in relation to our own ethical code, the current practice of performing innumerable, mechanized, elective abortions can only be considered unethical. If it is argued that abortion can be ethically validated merely by surrounding it with the same controls used in other experimental procedures, then the medical profession should insist on such controls forthwith.