石油作业习惯性流产女性细胞遗传毒性研究

目的:研究石油作业环境对女性习惯性流产的遗传毒性。方法:随机选择习惯性流产的石油作业女性38人和正常的育龄女性20人,检测其外周血淋巴细胞姐妹染色单体互换,记数SCE发生率。结果:观察组的外周血淋巴细胞SCE发生率为8.81±0.35,明显高于对照组(P0.05)。结论:SCE的发生可作为石油作业习惯性流产女性染色体结构稳定性的检测指标。石油作业环境对女性生育具有遗传毒性。     

石油作业习惯性流产女性细胞遗传毒性研究

目的：研究石油作业环境对女性习惯性流产的遗传毒性。方法：随机选择习惯性流产的石油作业女性38人和正常的育龄女性20人,检测其外周血淋巴细胞姐妹染色单体互换,记数SCE发生率。结果：观察组的外周血淋巴细胞SCE发生率为8．81＋0．35,明显高于对照组（P〈0．05）。结论：SCE的发生可作为石油作业习惯性流产女性染色体结构稳定性的检测指标。石油作业环境对女性生育具有遗传毒性。     

脂肪乳剂在复发性流产中的作用机制

复发性流产是导致育龄女性不孕的一大原因,其病因多种多样,而免疫异常占比最大.脂肪乳剂是以大豆油为基础的静脉注射用药,临床主要用于为人体补充必需脂肪酸及提供能量.由于脂肪乳剂可作用于NK细胞核受体,减少促炎介质的形成,从而降低NK细胞毒性,同时也可减少NK细胞数量,近年来,有将脂肪乳剂应用在免疫异常的复发性流产患者中的报...     

孕激素及人绒毛促性腺激素与药物流产后异常子宫出血的关系

目的:分析孕激素和人绒毛膜促性腺激素(h CG)与药物流产后异常子宫出血的关系。方法:选择2017年1月至2017年12月我院妇产科收治的药物终止妊娠的妇女150例,患者口服米非司酮配伍米索前列醇药物终止早期妊娠。将药物流产后子宫出血时间≤14 d作为对照组(n=75),14d作为异常组(n=75)。比较两组患者在药物流产后10 d、14 d、18 d、22 d血清中孕激素和h CG含量,分析两组患者孕激素和h CG含量相关性。结果:两组患者在年龄、月经周期、孕次、受孕天数、体重等方面比较无统计学差异(P0.05)。异常组在药物流产后10 d、14 d、18 d、22 d血清孕激素和h CG含量均高于对照组(P0.05)。两组患者在药物流产后10 d、14 d、18 d、22 d孕激素含量呈先降低再升高的趋势(P0.05)。对照组患者在药物流产后10 d、14 d、18 d、22 d血清hCG含量逐渐降低(P0.05);异常组在药物流产后10 d、14 d血清h CG含量比较无统计学差异(P0.05),在药物流产后18 d、22 d血清hCG含量低于药物流产后10 d、14 d,且药物流产后22 d低于药物流产后18 d(P0.05)。对全部样本的全部时点数据合并进行Pearson相关检验分析,孕激素和h CG含量呈正相关关系(P0.05)。结论:药物流产后异常子宫出血妇女血清的孕激素、hCG含量较高,两者呈正相关关系。药物流产后10 d、14 d监测血清HCG值无明显下降提示有异常子宫出血的可能,联合监测孕激素、hCG含量有利于药物流产后异常子宫出血的预测和治疗。     

生育与男性的年龄也有较大关系

巴黎艾劳辅助生殖中心的研究人员发现．女性生育与男性的年龄也有较大关系,男性一旦过了不惑之年．会使女性怀孕成功率降低．流产风险增加。他们从1．2万多对夫妇约2．1万例子宫内授精手术中提取精子样本．检查精子质量,并对女方的怀孕、流产和生育率进行了跟踪,结果发现,女方超过35岁,怀孕变难,流产风险增加,这与预料的一样;可令人惊讶的是,男方超过40岁,也会对女方造成类似影响。研究人员说,男方的年龄会影响女方的怀孕成功率,但令他们没想到的是．男方的年龄甚至会影响到女方的流产概率。研究表明,男方超过40岁,女方流产的概率约为35％;男方不到30岁,女方流产的概率约为10％～15％。     

米非司酮配伍米索前列醇抗早孕356 例的观察护理体会

目的：探讨米非司酮配伍米索前列醇终止49天以内妊娠的护理方法。方法：我站在2006年1～9月共有356例孕妇采用米非司酮配伍米索前列醇终止49天以内妊娠。结果：310例患者顺利排出胎囊。结论：护理人员在用药期间观察和全面了解药物的疗效厦副作用,加强药物流产期间的用药指导、心理护理厦药物流产后加强指导可防止感染以厦大出血的发生,这些都是药物流产取得成功的重要环节。     

胎儿稽留流产与染色体异常的关系及其影响因素分析

目的：探讨B超联合FISH实验室诊断技术分析胎儿稽留流产与染色体非整倍体关系并对其他影响因素进行综合分析。方法：采用FISH技术对广西267例B超诊断为稽留流产孕妇的胎儿绒毛组织行13,16,18,21,22,X,Y染色体数目检测,荧光显微镜下观察结果;采用SPSS13．0对相关数据进行统计分析。结果：267例稽留流产胎儿绒毛组织中,染色体数目异常95例,异常率35．6％,数目异常以三体最常见,其次为四体,少见部分单体;异常病例样本中存在多种染色体混合嵌合体现象,如混合嵌合三体（2n＋1／2n）,混合嵌合四体（2n＋2／2n）,混合嵌合单倍体、三体、四体（2n-1／2n＋l／2n＋2／2n）等;稽留流产与患者年龄、流产史、孕周具有显著相关性。结论：染色体数目异常与染色体混合嵌合均是稽留流产的重要原因,同时稽留流产发生与患者高龄、多次流产史、早期妊娠密切关系。     

不明原因复发性流产的治疗进展

正复发性流产(recurrent spontaneous abortion,RSA)是指与同一性伴侣连续遭受2次或2次以上在妊娠20周前的胎儿(体重≤500g)丢失者[1]。RSA的病因十分复杂,包括遗传因素、解剖异常、内分泌异常、感染因素、免疫紊乱和血栓前状态等。但除此之外,仍有约50%的患者病因不明,临床上称之为不明原因复发性流产(unexplained recurrent spon-     

人工感染羊嗜流产衣原体豚鼠流产模型的建立

目的通过人工感染怀孕豚鼠建立嗜流产衣原体发病模型,观察流产病理学变化的差异,确定豚鼠是否可以作为嗜流产衣原体的动物模型。方法35只清洁级怀孕40d的豚鼠随机分为7组,每组5只。将羊嗜流产衣原体分离株B10011、CG1株分别以三个剂量组（10^-1,10^-2,10^-3）腹腔攻毒1次,每只0．5mL,以灭菌生理盐水为阴性对照。攻毒后观察豚鼠的临床体征、流产和死亡数量。攻毒后20d安乐死处理剩余的大小豚鼠,无菌摘取组织,分成2份。一份-20℃冷冻保存,PCR检测病原在组织中的分布;另外一份固定于10％中性甲醛溶液,组织切片和免疫组化观察。结果（1）羊嗜流产衣原体分离株B10011和CG1均可造成怀孕豚鼠流产、产弱胎、畸形胎或死胎。2种分离株感染不同剂量造成豚鼠平均流产时间、流产数量、豚鼠死亡数量均有显著差异,且CG1株敏感性高于B10011株。（2）2个分离株均可造成肾脏、肝脏肿大,肺脏呈局灶性出血,卵巢出血坏死,胎盘子宫阜水肿;病理组织学显示肾小管上皮细胞变性、坏死,单核细胞大量增生;肝细胞颗粒样病变。脾髓质弥漫性出血,皮质区淋巴小结生发中心萎缩。（3）免疫组化结果显示衣原体包涵体主要分布于肾脏近曲小管、远曲小管,以及脾脏的髓质区。（4）PCR检测显示分离株感染后,肾脏、脾脏、肺脏、肝脏中均呈阳性。在卵巢组织中,高剂量组呈阳性。结论以B10011和CGl分离株人工感染怀孕豚鼠均可导致豚鼠出现流产,且CG1分离株敏感性较高,呈剂量一效应关系;感染豚鼠病理学变化与临床羊流产相似。因此,人工感染豚鼠流产模型可以用于反刍动物嗜流产衣原体病的研究。     

血立停胶囊对早孕大鼠RU486药流后子宫收缩的实验研究

目的:研究血立停胶囊对早孕大鼠Ru486药物流产后对子宫平滑肌收缩频率、收缩幅度及活动力变化的影响,旨在探讨血立停胶囊治疗药物流产后出血的作用机制。方法:选择妊娠Wistar大鼠,随机分为6组,即对照组,米非司酮组,大剂量血立停组,小剂量血立停组,催产素组,止血敏组。于妊娠第7天,开始相应处理,妊娠第14天分别监测以下指标后处死:在体子宫平滑肌收缩力,收缩幅度、收缩频率。结果:大剂量血立停可明显增强大鼠在体子宫平滑肌活动力、提高子宫平滑肌收缩频率、收缩幅度,与对照组比较差异有显著性(p<0.05)。结论:血立停胶囊可增强大鼠子宫平滑肌兴奋性,从而起到对药物流产后阴道出血的治疗作用。     

Bottom-up advocacy strategies to abortion access during the COVID-19 pandemic: Lessons learned towards reproductive justice in Brazil

In Brazil, abortion is only allowed in cases of rape, serious risk to a woman's life or fetal anecephaly. Legal abortion services cover less than 4% of the Brazilian territory and only 1,800 procedures are performed, in average, per year. During the COVID-19 pandemic, almost half of the already few Brazilian abortion clinics shut down and women had to travel even longer distances, reaching abortion services at later gestational ages. In this paper, we describe three bottom-up advocacy strategies that emerged from difficulties deepened during the COVID-19 pandemic at a single abortion service in Brazil, amidst anti-gender policies from the federal government. Telemedicine abortion, outpatient surgical abortion and the provision of abortion after 20 weeks' gestation are important strategies that may reduce inequalities that impact the most vulnerable populations, such as black and indigenous women, children, adolescents and women experiencing domestic violence.     

A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu

In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly‐funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end‐of‐life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access.     

POST‐ABORTION SYNDROME: CREATING AN AFFLICTION

The contention that abortion harms women constitutes a new strategy employed by the pro‐life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post‐abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of trauma are only selectively investigated. We argue that there is no such thing as post‐abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites.     

Brazilian public policies for reproductive health: family planning, abortion and prenatal care

This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom.     

Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

Background

Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools.

Methods and Results

A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity.

Conclusions

Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights.     

Population and abortion policies in China: Their impact on minority nationalities

The history of abortion in China is closely linked to the evolution of the country's population policy over the past four decades. Abortion in China has been legal since 1953 and is widely available through services offered by the country's national family planning program. In 1971, following the uncertain period of the Cultural Revolution (1965–1968), the government of China, confronting the reality of its population size — which in 1970 was estimated by the United Nations at 800 million people — decided to make a concerted effort to lower demographic growth by means of an effective birth planning campaign and services, backed up with legal and safe abortion. Within a decade, in 1979, China strengthened its policy and imposed on the population a reproductive norm allowing for only one child, known as the One-Child Family Policy. Ethnic minorities were at first exempt from demographic policies but more recently pressure has been increasingly applied to them to control their fertility. Abortion is now prevalent among nearly all Chinese ethnic minorities. Because of their remoteness and less favorable socio-economic circumstances, minorities lack access to quality services that would lower or make abortion unnecessary. The paper represents an effort to reverse the gap and confusion in the existing literature on ethnic group response to population and family planning policies in China.     

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.     

Illegal abortion and reproductive injustice in the Pacific Islands: A qualitative analysis of court data

The Oceania region is home to some of the world's most restrictive abortion laws, and there is evidence of Pacific Island women's reproductive oppression across several aspects of their reproductive lives, including in relation to contraceptive decision-making, birthing, and fertility. In this paper we analyse documents from court cases in the Pacific Islands regarding the illegal procurement of abortion. We undertook inductive thematic analysis of documents from eighteen illegal abortion court cases from Pacific Island countries. Using the lens of reproductive justice, we discuss the methods of abortion, the reported context of these abortions, and the ways in which these women and abortion were constructed in judges' summing up, judgements, or sentencing. Our analysis of these cases reveals layers of sexual and reproductive oppression experienced by these women that are related to colonialism, women's socioeconomic disadvantage, gendered violence, limited reproductive control, and the punitive consequences related to not performing gender appropriately.     

Primary care and abortion legislation in Chile: A failed point of entry

While Chile's partial decriminalization of abortion in 2017 was a long overdue recognition of women's sexual and reproductive rights, nearly four years later the caseload remains well below expectations. This pattern is the product of standing barriers in access to abortion-related health services, especially at the primary care point of entry. This study seeks to identify and describe these barriers. The findings presented here were obtained through a qualitative, exploratory study based on 19 semi-structured interviews with relevant actors identified through non-random sampling and snowballing techniques. Coding was inductive and complemented by semantic content analysis. The authors find that the key barriers in primary care to accessing legal abortion are unfamiliarity with the law, insufficient practitioner training, intersectoral discrimination, and the stigma surrounding abortion. They conclude that the government needs to exercise its constitutional mandate as guarantor of public health and act promptly to safeguard and guarantee the abortion rights of Chilean women.     

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.