HIV infection among women undergoing abortion in Montreal.

OBJECTIVE: To determine the seroprevalence and correlates of HIV infection in a subpopulation of women of childbearing age in Montreal. DESIGN: Anonymous unlinked seroprevalence study. SETTING: Pregnancy termination unit in a teaching hospital in Montreal. PARTICIPANTS: Women presenting for abortion from July 1989 to June 1993 who resided in Quebec and were not known to have HIV infection; 12,017 (99.6%) of 12,068 eligible women were included in the study. INTERVENTION: HIV antibody testing of serum left over from samples obtained for routine Rh typing; the same algorithm as for serodiagnostic testing, namely enzyme immunoassay (EIA) followed by confirmatory testing of repeatedly EIA-reactive samples, was used. OUTCOME MEASURES: HIV serostatus by age, marital status, region of residence (metropolitan Montreal versus other), country of birth and number of living children. RESULTS: Most (84.7%) of the subjects resided in metropolitan Montreal. The median age was 27.0 (range 13 to 50) years. The serum samples of 22 women were confirmed to be HIV positive, for an overall seroprevalence rate of 1.8 per 1000 (95% confidence interval 1.1 to 2.8). The seroprevalence rate did not vary significantly by age, marital status, region of residence or study year. However, it was strongly correlated with country of birth: Canada 0.16, Haiti 23.5, HIV-endemic countries other than Haiti 5.3 and non-HIV-endemic countries other than Canada 0.0 per 1000. The seroprevalence rate among women born in Haiti was 147 times higher than that among women born in Canada (p < 0.0001). Of the women born in Haiti the rate was 3.0 times greater among those who immigrated to Canada in 1985 or later than among those who immigrated earlier (p = 0.047). CONCLUSIONS: The results of this study indicate that the HIV seroprevalence rate among women in Montreal is strongly associated with country of birth, women born in HIV-endemic countries, especially Haiti, having the highest rate. These results will help in the development of policies regarding HIV antibody testing and prevention of HIV transmission in Quebec.     

Thyroid function before and after induced abortion in normal pregnant women.

We assessed thyroid function before and after induced abortion in 25 normal pregnant women. Serum TSH was significantly increased (P less than 0.02), and serum hCG-beta was significantly reduced (P less than 0.001) 1 week after induced abortion, compared with the levels before induced abortion. There was a significant negative correlation between hCG-beta and TSH, and a positive one between hCG-beta and FT4 before induced abortion (P less than 0.02). No difference was observed in thyroid hormones before and 1 week after induced abortion. The results suggest that hCG stimulates the thyroid gland, gaining an advantage over TSH, in normal pregnant women.     

Complications of induced abortion

The abortion problem has been a major topic of debate for many years. Polish legislation permitting abortion has both supporters and opponents. It appears that both groups fail to fully recognize the risks of the various medical complications of induced abortion. A literature review of the complications of abortion shows that these complications are often underestimated by the public and the medical community. The review clearly demonstrates that abortion adversely affects women's health. Inflammation of the genital system is the most frequent complication. The ocurrence of complications increases as the term of the pregnancy advances. It is concluded that the public is not fully aware of the immediate danger and aftereffects of induced abortion. Wider popularization of the extensive body of scientific information regarding the risks of induced abortion might change current perceptions about the "safety" of abortion.     

Induced abortion potential among Indian women

Information on abortion is limited and inaccurate, especially in the developing world, which has led to speculation on the prevalence of abortion in these regions. A rise in prevalence of abortion is mostly counted in terms of increase in the prevalence of induced abortions which reflects on the reproductive health of women. With the growing concern for the reproductive health of women, the study of abortion has drawn the attention of researchers world-wide. This paper is an attempt to assess the induced abortion potential among Indian women by utilizing information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India. This exercise may facilitate a better understanding of the exact prevalence of induced abortion, which necessarily should be less than the estimated potential depending on the levels of unwanted and ill-timed fertility.     

Clandestine induced abortion: prevalence,incidence and risk factors among women in a Latin American country

Background

Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country.

Methods

We conducted a large population-based survey of women aged 18–29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure.

Results

Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%– 12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%– 14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%– 3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07– 1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84– 0.91), geographic region (highlands: OR 1.56, 95% CI 1.23– 1.97; jungle: OR 1.81, 95% CI 1.41– 2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68– 0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23– 2.09; ≥ 3 partners: OR 2.79, 95% CI 2.12– 3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01– 1.72; ≥ 2 partners: OR 1.54, 95% CI 1.14– 2.02). Overall, 49.0% (95% CI 47.6%– 50.3%) of the women who reported being currently sexually active were not using contraception.

Interpretation

The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.In most developing countries, induced abortion is legal only if the pregnancy threatens the health or life of the mother. Many women, therefore, seek clandestine abortions, which are too often unsafe and place the woman at risk of complications and death.¹Forty percent of women live in countries where abortion is legally restricted.² In 2003, an estimated 55% of induced abortions in developing countries were unsafe, and 97% of all unsafe abortions were in developing countries.³ Induced abortion is highly restricted in most countries in Latin America and the Caribbean.¹ According to the World Health Organization (WHO), the region of Latin America and the Caribbean has the same estimated incidence of clandestine induced abortions as Africa (3% per year among women aged 15–44 years).⁴ It also has the highest proportion of maternal death from unsafe abortion (12%).⁵ Women who have complications from clandestine abortions may not seek medical help for fear of being reported to legal authorities by health care workers.^6,7Elimination of unsafe abortions is a key component of sexual and reproductive health care.⁸ There is a public health need to determine more accurately the burden of, and risk factors for, clandestine induced abortion in different countries. Because of data limitations, the WHO reports only regional estimates.⁴ The lack of official records and underreporting by those involved make this task difficult, requiring that estimates calculated by different methods be compared.Rates of clandestine induced abortion are estimated with the use of either direct methods, such as population-based surveys and surveys of providers of illegal abortions, or indirect methods, such as the application of multipliers to recorded rates of hospital admission or death attributed to induced abortions.^4,9We performed a large, representative, population-based survey to determine the prevalence and incidence of, and risk factors for, induced abortion in an urban population of a Latin American country where access to abortion services is legally restricted.     

Monthly variation in conceptions leading to induced abortion

Abstract

Abortions performed in upper New York State and in New York City over a six‐year period were examined for monthly variation in conception. Significant differences in the month of conception were observed which correlated strongly with monthly conception indices from previous studies of conception leading to illegitimate and legitimate births. Since, for the most part, aborted pregnancies were unwanted, the current findings support the notion that cyclical changes in fecundity may be responsible for seasonality of conception rather than seasonal preferences for marriage followed by an increased risk of conception in the early months after marriage.     

Risks and costs of illegally induced abortion in Bangladesh

This article reports on women admitted to Dhaka Medical College Hospital for incomplete, illegally induced abortion. Women with low complication rates more often had abortions induced by medical practitioners. These women were younger, of lower parity and better educated than women having abortions initiated by other practitioners. Poorly educated women from slum areas almost always had an abortion induced by a nonmedical practitioner through the insertion of a solid object. These women experienced high complication rates and often required hysterectomies. This group also had high mortality rates. The drain on hospital resources needed to treat these abortion patients was great.     

Aspirin and indomethacin: Effect on instillation/abortion time of mid-trimester hypertonic saline induced abortion

Two acidic non steroid anti-inflammatory drugs, aspirin (acetylsalicyclic acid) and indomethacin were administered to patients undergoing mid-trimester saline induced abortion, to test their analgesic properties and to observe their effect on the instillation/abortion time interval. Both drugs when administered to patients undergoing mid-trimester saline abortion prolong significantly the instillation/abortion interval. These observations on human mid-trimester saline induced abortion treated with aspirin and indomethacin correspond with experimental data recently published relative to the antiprostaglandin activity of acidic non steroid drugs. The analgesic properties of both aspirin and indomethacin are difficult to assess accurately because of the highly emotional state of the patients studied; indomethacin, however, appears to be more effective for the prodromal abortion type of pain experienced by the patient but is still inadequate for sedation for the pain resulting from strong uterine contractions.     

Characteristics of embryos from repeat breeder and virgin heifers

The characteristics of 7-day-old embryos non-surgically collected from 35 repeat breeder heifers (RBH) and 24 virgin heifers (VH) were compared by repeated observations within each animal. A higher incidence of the embryos collected from the VH was classified as normal and had reached a more advanced developmental stage than embryos from the RBH. Nearly all VH yielded normal (N) embryos, but morphologically deviated (MD) or degenerated embryos (D) appeared occasionally in many VH. The RBH group contained three subgroups of animals. One group of RBH yielded a high percent of N embryos. A second group yielded mostly MD or D embryos with an occasional N embryo, and the third group only D embryos or no embryos. Heifers from which no embryos were recovered on day 7 yielded uncleaved ova, apparently retarded embryos or no embryos when slaughtered three days after insemination. It is concluded that retarded embryonic development may be a common factor for most RBH. The embryo morphology and the degree of retardation differ among animals and between oestrous periods in the same animal.     

The effect of analgesic drugs on the instillation/abortion time of hypertonic saline induced mid-trimester abortion

Three drugs, a non-steroid anti-inflammatory drug sodium salicylate, an analgesic propoxyphene hydrochloride and an antipyretic-analgesic acetaminophen were administered orally to patients undergoing mid-trimester hypertonic saline induced abortion to determine analgesic potency and the effect on the instillation/abortion time interval (I/ATI). Sodium salicylate (structurally related to acetylsalicylic acid, aspirin) and propoxyphene hydrochloride did not prolong the I/ATI. Acetaminophen, reportedly free of anti-inflammatory activity, prolonged the I/ATI. Clinically, acetaminophen and propoxyphene appeared to provide better analgesia than sodium salicylate. The hypothesized relationship of the three drugs to suppression of prostaglandin biosynthesis is presented.