Prostaglandin-induced Abortion: Assessment of Operative Complications and Early Morbidity

A total of 626 patients undergoing a prostaglandin-induced abortion, the majority in the second trimester, have been analysed for complications occurring during inpatient treatment. Of the last 155 consecutive patients 143 were critically assessed six to eight weeks after abortion for morbidity occurring during their early recovery period.Blood loss of 250 ml or more occurred in 68 patients, pyrexia in 34, pelvic infection in three, and readmission in 14 of the 626 patients studied, and a transfusion was required in eight.Bleeding after abortion stopped within six weeks in all 143 of the 155 consecutive patients assessed but three required readmission for uterine curettage. Menstruation was re-established within six weeks of abortion in 106 patients.The incidence of operative morbidity was similar to that reported for first trimester abortion and better than that in most reported series of second trimester abortions.     

不同人群人工流产术围手术期预防用多西环素临床分析

目的:分析不同人群人工流产术围手术期预防用多西环素的临床疗效。方法:采用回顾性调查方法,抽取本院2012年要求行人工流产术的日间手术住院患者4073例,分为正常人群和高危人群。正常人群中预防用多西环素者(预防组)2007例,未预防用抗菌药物组(未预防组)688例,高危人群中预防组865例,未预防组513例。对比分析不同人群预防组和未预防组术后1个月的手术部位感染率和远期(1年)并发症发生率。结果:正常人群预防组的手术部位感染率及远期并发症发生率分别为2.14%、7.77%,均分别显著低于未预防组的6.54%、11.05%(P0.05),而高危人群预防组分别为4.62%、10.06%,与未预防组的4.68%、12.09%比较,差异均无统计学意义(P0.05)。结论:围手术期预防用多西环素可降低人工流产术中正常人群的手术部位感染率和远期并发症发生率,而对于高危人群的作用不明显,因此术前应对患者的高危感染因素进行积极治愈或纠正后,预防用药价值可能较大。     

凝结芽孢杆菌活菌片预防先兆流产保胎妇女胃肠功能紊乱的临床观察

目的观察凝结芽孢杆菌活菌片（商品名：爽舒宝）预防先兆流产保胎妇女胃肠功能紊乱的临床疗效。方法将60例先兆流产保胎妇女随机分为爽舒宝预防组和对照组,预防组30例,对照组30例,两组均给予常规服用保胎药物,出现顽固性便秘后用开塞露通便,其中预防组在此基础上同时口服凝结芽孢杆菌活菌片首次2. 1 g,以后1.05 g/次,3次/d,温水送服,疗程2-4周。观察保胎期间孕妇胃肠功能紊乱情况和使用开塞露的通便次数。结果预防组患者胃肠功能紊乱的发生率显著低于对照组,差异有统计学意义（P〈0.05 ）。结论凝结芽孢杆菌活菌片预防先兆流产保胎妇女胃肠功能紊乱疗效显著,值得临床推广。     

Habitual abortion

Habitual abortion should be defined as the spontaneous sequential loss of three or more pre-viable pregnancies. The incidence and etiology of spontaneous single and repeated, sequential abortion are discussed. The theoretical role of the various hormones in the treatment of abortion is examined. The modes of therapy now in effect are reviewed and their probable value estimated. Preconceptual therapy of the wife and husband for the successful salvage of a viable infant following previous sequential abortion is recommended. Logical postconceptual and emergency therapy is outlined for the patient who is an habitual aborter.A critical view of previous and present methods of study and treatment of habitual abortion is expressed.     

HABITUAL ABORTION

Habitual abortion should be defined as the spontaneous sequential loss of three or more pre-viable pregnancies.The incidence and etiology of spontaneous single and repeated, sequential abortion are discussed.The theoretical role of the various hormones in the treatment of abortion is examined.The modes of therapy now in effect are reviewed and their probable value estimated.Preconceptual therapy of the wife and husband for the successful salvage of a viable infant following previous sequential abortion is recommended.Logical postconceptual and emergency therapy is outlined for the patient who is an habitual aborter.A critical view of previous and present methods of study and treatment of habitual abortion is expressed.     

Structural determinants of the abortion rate: a cross-societal analysis

Data for a sample of 89 countries are used to examine societal-level predictors of the legal status of abortion and its incidence as indicated by abortion rates. Measures of socioeconomic development, women's labor force participation, and dominant religion are considered as predictors of abortion. Logistic regression analysis reveals that socioeconomic development has a positive effect on the probability of abortion being legal. Both a greater dominance of Catholicism and Islam in a society reduce the probability that abortion is legal. Results of tobit analyses show that development has curvilinear effects on abortion rates, with lower rates of abortion at both the lower and higher ends of development. Findings also indicate a positive effect of female labor force participation on the abortion rate that initially grows stronger with increases in socioeconomic development, but weakens with further increases. Finally, a greater proportion of Catholics in a population lowers the abortion rate.     

Incidence of Induced Abortion and Post-Abortion Care in Tanzania

Background

Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence.

Objectives

To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar).

Methods

A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology.

Results

In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15–49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone.

Conclusions

The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies.     

Prostaglandin-induced abortion and outcome of subsequent pregnancies: a prospective controlled study

We analysed a prospective series of 204 pregnancies occurring in 168 women after a prostaglandin-induced abortion. The mean (±standard error of mean) interval between abortion and first subsequent conception was 10·4 ± 0·6 months; no patient reported secondary subfertility.Fifty-five of the subsequent pregnancies were terminated, 23 during the second trimester, again using prostaglandins. Of the 149 pregnancies not terminated, 127 were delivered at term, and 19 spontaneously aborted, seven during the second trimester; there was one missed abortion and two ectopic pregnancies. Morbidity in the 127 term pregnancies was infrequent; spontaneous preterm labour occurred in three patients, and four singleton infants weighed less than 2500 g at birth. There was no apparent association between morbidity in the subsequent pregnancies and the period of gestation at the time of the previous abortion, route of prostaglandin administration, or need for post-abortion curettage.The results obtained overall were very similar to a control group of 612 women consecutively admitted for delivery or abortion to the Oxford obstetrical and gynaecological units. There was, however, an increased incidence of spontaneous abortion and placenta praevia after prostaglandin-induced abortion, and the multigravidae in that group had a longer average duration of labour than the control group. Sixty-five per cent of the post-abortion pregnancies were unplanned compared with 36% of the control group.     

Influence of past reproductive performance on risk of spontaneous abortion.

OBJECTIVE--To investigate the incidence of spontaneous abortion in a population of women in order to establish their risk of spontaneous abortion and the obstetric factors predisposing to it. DESIGN--Prospective study of women recruited by radio and poster appeal and from hospital outpatient clinics. SETTING--English provincial community. PATIENTS--630 Women from the general population intending to become pregnant. INTERVENTIONS--The viability of the pregnancy was assessed by abdominal ultrasonography before completion of the eighth week, and the assessment was repeated if vaginal bleeding occurred. MAIN OUTCOME MEASURE--Spontaneous abortion or live births in women with or without a previous history of spontaneous abortion. RESULTS--The overall incidence of clinically recognisable spontaneous abortion before 20 weeks of gestation was 12% (50/407 pregnancies). The risk of spontaneous abortion in each category of patient was classified with respect to the patient''s past reproductive performance and found to be influenced greatly by her previous obstetric history. In primigravidas and women with a history of consistently successful pregnancies the incidences of abortion were low (5% (4/87) and 4% (3/73) respectively), whereas women with only unsuccessful histories had a much greater risk of aborting the study pregnancy (24% (24/98)), even when their sole pregnancy had ended in abortion (20% (12/59)). The outcome of the last pregnancy also influenced the outcome of the study pregnancy; only 5% of women (5/95) whose previous pregnancy had been successful aborted, whereas the incidence of loss of pregnancy among women whose last pregnancy had aborted was 19% (40/214). CONCLUSIONS--A knowledge of the patient''s reproductive history is essential for the clinical assessment of her risk of spontaneous abortion. As the most important predictive factor for spontaneous abortion is a previous abortion, the outcome of a woman''s first pregnancy has profound consequences for all subsequent pregnancies.     

两个育性相关基因在BNS和YS小麦温敏雄性不育系中的表达差异分析

为研究雄性不育相关基因TA1和TA2在BNS和YS小麦温敏雄性不育系732A花粉发育时期的表达特点,探讨这2个育性相关基因与温敏雄性不育小麦育性转换的联系,本研究利用荧光实时定量PCR方法,在BNS和YS型不育系732A花药发育四分体期、单核期、二核期和三核期定量检测基因TA1和TA2的mRNA表达水平。结果表明:(1)在732A和BNS花粉发育四分体时期至二核期,基因TA1相对表达量上调,在三核期相对表达量下降;(2)基因TA2相对表达量在BNS花粉发育的四分体时期至二核期逐渐下降,三核期上升;在732A花粉发育4个时期中的相对表达量变化刚好相反;(3)在BNS和732A花粉发育二核期,基因TA1和TA2均表现极值,推测二核期可能为BNS和YS型小麦温敏雄性不育系花粉发育最敏感时期;(4)在不育系BNS和732A花粉发育过程中,基因TA1的相对表达量变化幅度比TA2的高。推测TA1对不育系BNS和732A花粉败育影响程度强于TA2;(5)基因TA1和TA2相对表达量在BNS的花粉发育时期表达趋势相反,推测其对BNS花粉败育影响表现为拮抗作用,且2个基因不连锁;在732A花粉发育时期表达趋势相同,推测其对不育系732A花粉败育影响表现为协同作用。     

Legalized Abortion in Japan

The enactment of the Eugenic Protection Act in Japan was followed by many changes. The population explosion was stemmed, the birth rate was halved, and while the marriage rate remained steady the divorce rate declined. The annual total of abortions increased until 1955 and then slowly declined. The highest incidence of abortions in families is in the 30 to 34 age group when there are four children in the family. As elsewhere abortion in advanced stages of pregnancy is associated with high morbidity and mortality.There is little consensus as to the number of criminal abortions. Reasons for criminal abortions can be found in the legal restrictions concerning abortion: Licensing of the abortionist, certification of hospitals, taxation of operations and the requirement that abortion be reported. Other factors are price competition and the patient''s desire for secrecy.Contraception is relatively ineffective as a birth control method in Japan. Oral contraceptives are not yet government approved. In 1958 alone 1.1 per cent of married women were sterilized and the incidence of sterilization was increasing.     

Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003

BackgroundIn Uganda, abortion is permitted only when the life of a woman is in danger. This restriction compels the perpetuation of the practice in secrecy and often under unsafe conditions. In 2003, 294,000 induced abortions were estimated to occur each year in Uganda. Since then, no other research on abortion incidence has been conducted in the country.MethodsData from 418 health facilities were used to estimate the number and rate of induced abortion in 2013. An indirect estimation methodology was used to calculate the annual incidence of induced abortions ─ nationally and by major regions. The use of a comparable methodology in an earlier study permits assessment of trends between 2003 and 2013.ResultsIn 2013, an estimated 128,682 women were treated for abortion complications and an estimated 314,304 induced abortions occurred, both slightly up from 110,000 and 294,000 in 2003, respectively. The national abortion rate was 39 abortions per 1,000 women aged 15–49, down from 51 in 2003. Regional variation in abortion rates is very large, from as high as an estimated 77 per 1,000 women 15–49 in Kampala region, to as low as 18 per 1,000 women in Western region. The overall pregnancy rate also declined from 326 to 288; however the proportion of pregnancies that were unintended increased slightly, from 49% to 52%.ConclusionUnsafe abortion remains a major problem confronting Ugandan women. Although the overall pregnancy rate and the abortion rate declined in the past decade, the majority of pregnancies to Ugandan women are still unintended. These findings reflect the increase in the use of modern contraception but also suggest that a large proportion of women are still having difficulty practicing contraception effectively. Improved access to contraceptive services and abortion-related care are still needed.     

Psychological Sequelae of Elective Abortion

A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy.     

Abortion-seeking behaviour among Nigerian women

This study used data from a community-based survey to examine women's experiences of abortion in Nigeria. Fourteen percent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two percent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women's socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman's life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.     

The relationship between abortion rates and economic fluctuations

We analyze the relationship between abortions and economic fluctuation at the U.S. state level for the 1995–2016 period. We do not find a statistically significant association between the overall abortion rate and the unemployment rate across the full sample period. However, we observe a procyclical association from approximately 2004 to 2010, during which a one percentage point increase in the unemployment rate is associated with a roughly 5% decrease in the abortion rate. This procyclical association is confirmed when we subsample our data to the 2005–2016 period. Our subgroup analysis indicates a procyclical association for the abortion rates for younger women, while we do not observe statistically significant associations when the analysis is stratified by race or ethnicity. The associations we observe for the younger age groups are especially pronounced in states with restrictions on Medicaid funding of abortions. Our analysis suggests that economic conditions may be an important factor in the reproductive choices by women.     

Suicide,Psychiatrists and Therapeutic Abortion

Pressures for interruption of pregnancy by therapeutic abortion constantly increase, both for liberalization of laws and for interpreting existing law more broadly.There are wide variations and inconsistencies in psychiatric attitudes and practices about therapeutic abortion. Follow-up patient data are scant, but necessary. Results of questionnaires indicate that such data can be obtained, and convey the impression that patients seem to manage after pregnancy, regardless of outcome, much as they had before pregnancy.This study indicates that the incidence of suicide in pregnant women is approximately one-sixth that of the rate for non-pregnant women in comparable age groups, implying that perhaps pregnancy has a psychically protective role.     

Fertility and legal abortion in England and Wales: performance indicators for family planning services.

The relation between fertility rates and legal abortion rates was investigated in a sample of health authorities in England and Wales to see how these varied. Total period fertility rates and total period legal abortion rates were derived from the average number of live births or legal abortions that would be experienced per woman if women experienced the age specific rates of the year in question throughout their childbearing years. The sample of 30 health authorities was selected by taking the districts with the highest and lowest fertility rates in each English region and in Wales in 1986. Total period fertility rates varied from 1.37 in Riverside to 2.42 in Tower Hamlets, while abortion rates varied from 0.25 in East Yorkshire to 0.99 in Riverside. When the two rates were added to provide a potential fertility rate it became clear that some districts with similar potential fertility rates had very different underlying component rates. Such comparisons can be used for service monitoring, indicating the need for better abortion and family planning services in districts with high fertility rates and for better family planning services in those with high abortion rates.     

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.     

孕早期亚临床甲状腺功能减退与流产发生的相关性

目的:探讨孕早期亚临床甲状腺功能减退与流产发生的相关性.方法:2017年2月至2019年选择在本院进行建档的孕早期孕妇120例,检测血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid stimulating ...