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Peer Reviewed

Title: The management of failed second-trimester termination of pregnancy.
Author: Basu JK; Basu D
Source: Contraception. 2009 Aug;80(2):170-3.
Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 342391 Notification

Peer Reviewed

Title: Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study.
Author: Nelson AL; Chen S; Eden R
Source: Contraception. 2009 Jul;80(1):81-3.
Abstract: BACKGROUND: The purpose of this pilot project was to test the feasibility of a technique designed to place a copper intrauterine device (IUD) through the hysterotomy incision of an elective cesarean delivery to minimize possible contamination and to guarantee that tailstrings were visible in the vagina for easy removal should complications occur. STUDY DESIGN: Women were monitored in the hospital for signs of infection or excessive blood loss. At the time of hospital discharge and at 2 and 6 weeks postpartum, they were examined to determine the status of the tailstrings. The position of the IUD was assessed by ultrasound at week 6. RESULTS: All seven of the subjects had successful placement. The sutures tied to the IUD strings were visible on vaginal examination in each case. The original tailstrings were visible in the vagina at 6 weeks and each IUD was fundally positioned. CONCLUSION: Successful intraoperative placement of Copper T-380A IUDs through incision at the time of cesarean birth is possible.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PILOT PROJECTS | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | HYSTEROTOMY | CESAREAN SECTION | ULTRASONICS | CONTRACEPTIVE REMOVAL | IUD EXPULSION | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Obstetrical Surgery
Document Number: 342788

Peer Reviewed

Title: Second-trimester surgical abortion.
Author: Prager SW; Oyer DJ
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):179-87.
Abstract: Surgical abortion in the second trimester became popularized in the 1970s, and now accounts for the majority of abortion procedures performed in this country. Dilation and evacuation is the most commonly used method in the second trimester, but dilation and curettage can be used with earlier gestations, and intact dilation and extraction accounts for a minority of later procedures. These various procedures will be addressed in detail. Other considerations such as preoperative and intraoperative use of ultrasound, use of uterotonics, pain management, appropriate location for second-trimester abortion provision, and routine postoperative care will also be reviewed.
Language: English
Keywords:
UNITED STATES OF AMERICA | WASHINGTON | RESEARCH REPORT | ABORTION | PREGNANCY, SECOND TRIMESTER | HYSTEROTOMY | GYNECOLOGIC SURGERY | POSTABORTION CARE | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342246 Notification

Peer Reviewed

Title: An historical overview of second trimester abortion methods.
Author: Bygdeman M; Gemzell-Danielsson K
Source: Reproductive Health Matters. 2008 May;16(31 Suppl):196-204.
Abstract: The methods used for abortion in the second trimester have changed considerably in recent years. The surgical procedure dilatation and evacuation (D&E) has replaced hysterotomy. Instead of injecting different compounds, such as hypertonic saline, prostaglandin analogues are administered by non-invasive routes. The most effective medical method is combining a prostaglandin analogue with mifepristone. The consequence of these developments is that abortion in the second trimester can be be performed significantly more effectively and that the currently recommended methods being used are associated with fewer side effects and complications.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | HYSTEROTOMY | ABORTION | PREGNANCY, SECOND TRIMESTER | PROSTAGLANDINS | CHANGES | Europe, Northern | Europe | Developed Countries | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Endocrine System | Physiology | Biology | Social Change | Sociocultural Factors
Document Number: 330090 Notification

5.
Peer Reviewed

Title: Risk factors for abdominal scar endometriosis after obstetric hysterotomies: a case-control study.
Author: de Oliveira MA; Ponce de Leon AC; Freire EC; de Oliveira HC
Source: Acta Obstetrica et Gynecologica Scandinavica. 2007 Jan;86(1):73-80.
Abstract: The objective was to identify risk factors that are associated with the development of scar endometriosis after obstetric hysterotomies. The hypothesis is that early hysterotomy in pregnancy (before 22nd week) is the main risk factor for the development of scar endometriosis. The authors conducted a case-control study between April 2000 and June 2003. A total of 117 women were selected, including 39 cases and 78 controls. Exposure and confounding variables were measured by a standardized questionnaire, which included sociodemographic characteristics, reproductive/physiologic history, past pathological history, history of obstetric surgeries, family history, and social history. The odds ratio (OR) and its 95% confidence interval (CI) were calculated using bivariate analysis for each possible risk factor. These estimates were obtained by multivariate analysis using unconditional logistic regression. Tests were made to assess the fit of the final model. In the multivariate analysis, positive associations were observed between scar endometriosis and hysterotomy type (early versus late: OR = 42.99; CI 8.77-210.81), amount of the menstrual blood flow (heavy versus light/normal: OR = 11.97; CI 2.35-60.82), and alcoholic consumption (yes versus no: OR = 5.31; CI 1.22-23.11). Negative association was observed between scar endometriosis and parity (OR = 0.61; CI 0.31-1.23), however it was not statistically significant (p > 0.05). Early hysterotomy in pregnancy is the main risk factor for scar endometriosis. Increased menstrual flow and alcohol consumption are also risk factors, while high parity may be a protecting factor. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CASE CONTROL STUDIES | QUESTIONNAIRES | WOMEN | PREGNANCY | HYSTEROTOMY | RISK FACTORS | MENSTRUATION DISORDERS | ENDOMETRIOSIS | ALCOHOL USE AND ABUSE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Diseases | Behavior
Document Number: 309965

Title: Uterocutaneous fistula in term abdominal pregnancy [letter]
Author: Promsonthi P; Herabutya Y
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2007 Jun;132(2):239-241.
Abstract: Advanced abdominal pregnancy is a rare but serious obstetric complication with an incidence of 10.9 per 100,000 live births. Several full-term abdominal pregnancies have been reported. However, the management of the placenta after foetal delivery remains challenging. We describe a rare complication, a uterocutaneous fistula, after the placenta was left in term abdominal pregnancy. A 41-year-old, gravida 2, para 2 woman was referred to our hospital because of massive haemorrhage after operative delivery of a baby from an undiagnosed abdominal pregnancy. Her first pregnancy had been uneventful. She had never had previous uterine surgery. In this pregnancy the antenatal course was normal. At 40 weeks' gestation, transabdominal sonography was performed due to a persistent breech presentation and an elective caesarean delivery was scheduled. During the laparotomy, a previously unrecognised abdominal pregnancy was discovered. The amniotic sac was pressed against the anterior abdominal wall with the placenta attached to the posterior peritoneal surface and the uterine fundus. The amniotic fluid volume was normal. A healthy female foetus was delivered weighing 3540 g. The umbilical cord was ligated with No. 1 silk close to its placental insertion. Part of the placental tissue was separated during the operation and massive haemorrhage ensued. The blood loss was 3000 ml and eight units of blood were transfused. The bleeding site was densely packed with sterile surgical swabs until the bleeding was under control. The abdomen was closed and she was referred to our hospital. (excerpt)
Language: English
Keywords:
THAILAND | SUMMARY REPORT | CASE HISTORIES | CLIENTS | PREGNANCY, ABDOMINAL | FISTULA | FETAL MEMBRANES | ULTRASONICS | LAPAROTOMY | BLEEDING | HYSTEROTOMY | UTERUS | Asia, Southeastern | Asia | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy, Ectopic | Pregnancy Complications | Diseases | Fetus | Pregnancy | Reproduction | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Signs and Symptoms | Gynecologic Surgery | Urogenital Surgery | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 317143

Title: Vaginal hysterectomy: Results and complications of 886 patients.
Author: Akyol D; Esinler I; Guven S; Salman MC; Ayhan A
Source: Journal of Obstetrics and Gynaecology. 2006 Nov;26(8):777-781.
Abstract: The aim of this study was to determine the feasibility, results and complications of vaginal hysterectomy. A total of 886 consecutive patients who had undergone vaginal hysterectomy for benign gynecological diseases were retrospectively analysed. Vaginal hysterectomy was successfully performed in 96.1% of the nulliparous and 99.9% of the parous patients. The mean duration (min) of the operation was 89.1 plus or minus 29.1. The operation time (min) of the nulliparous women was significantly higher than that of the primiparous and multiparous women (109.3 plus or minus 40.2 vs 81.1 plus or minus 33.2 and 85.1 plus or minus 28.3, respectively). The overall complication rate was 14.6%. The intraoperative and postoperative complication rates were 4.1% and 10.5%, respectively. The most common intraoperative complication was bladder injury (2.5%). Vaginal hysterectomy for benign gynaecological diseases has high feasibility with acceptable complication rates. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | CLIENTS | WOMEN | HYSTERECTOMY | HYSTEROTOMY | COMPLICATIONS | RISK FACTORS | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Biology
Document Number: 324021

8.
Peer Reviewed

Title: Hysterectomy: evolution and trends.
Author: Baskett TF
Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2005;19(3):295-305.
Abstract: Hysterectomy was mentioned in Greek manuscripts 2000 years ago, but there is no proof that it was performed. Early--usually fatal--attempts at vaginal hysterectomy are recorded from the 16th century. The origins of vaginal and abdominal hysterectomy are traced from the 19th century after the pioneering work of Langenbeck and Clay. Advances in anaesthesia, blood transfusion, antibiotics and surgical technique led to hysterectomy becoming the second most common operation in women. In the first part of the 20th century subtotal abdominal hysterectomy was standard, but by the 1950s this was replaced by total abdominal hysterectomy. There has been a recent, albeit minor, resurgence of interest in subtotal hysterectomy. The development of laparoscopic assisted hysterectomy in the 1990s has, ironically, led to the reemergence of standard vaginal hysterectomy as the method of choice for most cases of benign gynaecological disease requiring hysterectomy. At the start of the 21st century there are signs that alternatives to hysterectomy--such as hysteroscopic surgery, uterine fibroid embolization, and the levonorgestrel intrauterine device--are leading to a reduction in hysterectomy rates. (author's)
Language: English
Keywords:
CANADA | HISTORICAL REVIEW | EVALUATION | WOMEN | HYSTEROTOMY | RESEARCH ACTIVITIES | Developed Countries | North America, Northern | Americas | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Research Methodology
Document Number: 296933

10.
Peer Reviewed

Title: Chemical ablation of endometrium with trichloroacetic acid.
Author: Kucukozkan T; Kadioglu BG; Uygur D; Moroy P; Mollamahmutoglu L
Source: International Journal of Gynecology and Obstetrics. 2004 Jan;84(1):41-46.
Abstract: Objectives: The aim of this study was to assess the efficacy of topically applied trichloroacetic acid (TCA) for endometrial ablation in patients with dysfunctional uterine bleeding (DUB). This trial has also compared the advantages of prethinning the endometrium with danazol and goserelin acetate before ablation with TCA. Methods: This prospective trial was conducted on 90 volunteer cases. Patients were allocated into three treatment groups comprised of 30 patients. In group I cases underwent dilatation and curettage before endometrial ablation. In group II cases were administered danazol before ablation. Cases in group III received goserelin acetate on the same day and 28 days after ablation. Endometrium was evaluated by biopsy, transvaginal ultrasonography and hysteroscopy. Endometrial ablation was performed with 95% TCA. All of the patients were evaluated 3 and 6 months after TCA application. Results: After 6 months of treatment, the success rate was recorded as 83% in the first group, 92.3% in the second group and 96.6% in the third group. The mean length of uterine cavity was reduced in all groups, being only significant in Goserelin group (P-0.5). Endometrial thickness was decreased significantly in all treatment groups (P-0.001). Conclusions: This study concluded that endometrial ablation by TCA may readily be performed as an alternative treatment method in the management of DUB. Moreover, suppression of endometrium with danazol or especially with goserelin acetate before ablation, resulted in significant success rate. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CASE CONTROL STUDIES | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | HYSTEROSCOPY | ENDOMETRIAL EFFECTS | METRORRHAGIA | UTERINE EFFECTS | DRUGS | CURETTAGE | HYSTEROTOMY | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Economic Development | Economic Factors | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Bleeding | Signs and Symptoms | Diseases | Treatment | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 189661

11.
Peer Reviewed

Title: A case of hysterotomy for removal of an intrauterine contraceptive device and subsequent pregnancy.
Author: New FC; Candelier CK
Source: Journal of Family Planning and Reproductive Health Care. 2004 Jul;30(3):177-178.
Abstract: The Chinese policy of limiting family size is well known worldwide. We report the case of a patient who required hysterotomy for removal of an intrauterine contraceptive device inserted in China following termination of pregnancy. A 35-year-old Chinese woman was referred to the gynaecology outpatient clinic for removal of an intrauterine contraceptive device (IUD) that had been inserted following a termination of pregnancy in China in 1990. Prior to this pregnancy the woman had had an ectopic pregnancy. As a result of this she had undergone a left salpingectomy and evacuation of retained products of conception. She had a regular menstrual cycle with no intermenstrual or postcoital bleeding. At her outpatient appointment in August 2001 no coil threads were visible, but an ultrasound scan confirmed the presence of a normal sized uterus with an IUD within the uterine cavity. (excerpt)
Language: English
Keywords:
CHINA | RESEARCH REPORT | CASE STUDIES | WOMEN IN DEVELOPMENT | ABORTION | HYSTEROTOMY | IUD, COPPER RELEASING | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Economic Development | Economic Factors | Fertility Control, Postconception | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | IUD | Contraceptive Methods | Contraception
Document Number: 194758 Notification

12.
Peer Reviewed

Title: Types of hysterectomy. Comparison of characteristics, hospital costs, utilization and outcomes.
Author: Campbell ES; Xiao H; Smith MK
Source: Journal of Reproductive Medicine. 2003 Dec;48(12):943-949.
Abstract: To compare hospital costs, patient characteristics and outcomes of 3 hysterectomy techniques-abdominal, vaginal and laparoscopically assisted vaginal A cross-sectional analysis was performed using patients discharged from Florida hospitals in 2000 with hysterectomy as the primary procedure. To avoid differences due to unrelated complications, records indicating cancer or other major non-hysterectomy-related procedure were excluded from the analysis. A total of 23,191 records were used to compare the 3 techniques on hospital costs and length of stay, con- trolling for patient differences in complicating diagnoses and related procedures. Consistent with previous studies, patients undergoing LAVH had higher hospital costs, shorter lengths of stay and no difference in surgical complications from either vaginal or total abdominal hysterectomy, even after controlling for patient co-morbidities. Other factors affecting hospital costs and length of stay were patient race, type of insurance, hospital ownership and location. LAVH is still more expensive than vaginal and total abdominal hysterectomy but offers a speedier recovery, with no measurable difference in the rate of complications. Further research is warranted to ascertain differences in readmission rates across the techniques and to investigate the process used to select which hysterectomy technique is used for a given patient. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | FLORIDA | RESEARCH REPORT | COMPARATIVE STUDIES | CROSS SECTIONAL ANALYSIS | WOMEN | HYSTERECTOMY | HYSTEROTOMY | COST BENEFIT ANALYSIS | UTILIZATION OF HEALTH CARE | HEALTH INSURANCE | ETHNIC GROUPS | HOSPITALS | OWNERSHIP | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Quantitative Evaluation | Evaluation | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors | Cultural Background | Population Characteristics | Health Facilities | Socioeconomic Factors
Document Number: 186396

13.
Title: Longevity after early surgical menopause -- the long-term effect of a permanent cessation of reproductive function and female sex hormone loss.
Author: Nilsson PM; Nilsson E; Svanberg L; Samsioe G
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2003 Sep 10;110(1):63-65.
Abstract: Objective: To investigate longevity in women after bilateral salpingo-oophorectomy (BSOE), not given hormonal replacement therapy (HRT) post-operatively, as compared to the national mean. Study design: Long-term follow-up study of a historical cohort of young women undergoing BSOE in the early 20th century at the General Hospital, Malm�, Sweden. Comparison was made with mean life expectancy in corresponding birth cohorts. Results: No difference in life expectancy was recorded in 152 women with an early menopause caused by BSOE and not substituted with HRT, as compared to national statistics of contemporary women. Half of the operated women died of cardiovascular disease and a minority of cancer, none of which was a breast cancer. Conclusion: Permanent loss of female sex hormones and reproductive function in early life does not seem to influence longevity but may change patterns of morbidity and mortality. (author's)
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | COHORT ANALYSIS | ADULTS | WOMEN | LENGTH OF LIFE | GYNECOLOGIC SURGERY | HORMONE REPLACEMENT THERAPY | MENOPAUSE | HYSTEROTOMY | CARDIOVASCULAR EFFECTS | CANCER | EPIDEMIOLOGY | ESTROGENS | Developed Countries | Europe, Northern | Europe | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Urogenital Surgery | Surgery | Treatment | Reproduction | Physiology | Biology | Neoplasms | Diseases | Public Health | Health | Hormones | Endocrine System
Document Number: 187547

14.
Peer Reviewed

Title: Interdelivery interval and risk of symptomatic uterine rupture.
Author: Shipp TD; Zelop CM; Repke JT; Cohen A; Lieberman E
Source: Obstetrics and Gynecology. 2001 Feb;97(2):175-177.
Abstract: The objective was to relate interdelivery interval to risk of uterine rupture during a trial of labor after prior cesarean delivery. We reviewed the medical records of all women who had a trial of labor after cesarean delivery over 12 years (July 1984 to June 1996). Analysis was limited to women with only one prior cesarean delivery and no prior vaginal deliveries who delivered term singletons and whose medical records included the month and year of the prior delivery. The time in months between the prior cesarean delivery and the index trial of labor was calculated, and the women were divided accordingly to permit comparison with respect to symptomatic uterine rupture. Two thousand four hundred nine women had trials of labor after one prior cesarean delivery and had complete data from the medical records. There were 29 uterine ruptures (1.2%) in the population. For interdelivery intervals up to 18 months, the uterine rupture rate was 2.25% (seven of 311) compared with 1.05% (22 of 2098) with intervals of 19 months or longer (P = .07). Multiple logistic regression was used to assess the risk of uterine rupture according to interdelivery interval while controlling for maternal age, public assistance, length of labor, gestational age at least 41 weeks, and oxytocin use. Women with interdelivery intervals of up to 18 months were three times as likely (95% confidence interval, 1.2, 7.2) to have symptomatic uterine rupture. Interdelivery intervals of up to 18 months were associated with increased risk of symptomatic uterine rupture during a trial of labor after cesarean delivery compared with that for longer interdelivery intervals. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | PREGNANT WOMEN | PREGNANCY COMPLICATIONS | UTERINE EFFECTS | RISK FACTORS | CESAREAN SECTION | BIRTH INTERVALS | MATERNAL AGE | HYSTEROTOMY | North America | Americas | Developed Countries | Data Analysis | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Measurements | Fertility | Population Dynamics | Parental Age | Age Factors | Gynecologic Surgery | Urogenital Surgery
Document Number: 180919

15.
Title: Death comes for the violinist: on two objections to Thomson's "Defense of Abortion".
Author: Boonin-Vail D
Source: Social Theory and Practice. 1997 Fall;23(3):329-364.
Abstract: I have argued elsewhere that both versions of this sort of objection to Thomson's argument should be rejected, and that if her argument succeeds in rape cases, then it succeeds in nonrape cases as well. I want to assume here that this analysis is correct, and to examine what I take to be two of the most powerful further objections to her argument. These objections turn on the claim that there is a morally relevant difference between the way in which the relationship between you and the violinist ends when you unplug yourself in Thomson's example and the way in which the relationship between the pregnant woman and the fetus ends when the woman has an abortion. The first objection maintains that there is a morally relevant difference between killing a person and letting a person die, and that abortion kills the fetus while unplugging yourself merely allows the violinist to die. The second objection has to do with a difference between the agent's attitude toward the deaths that result in the two cases. It maintains that there is a morally relevant difference between intending death and merely foreseeing it, and that abortion involves an intentional death while unplugging yourself from the violinist involves only a foreseeable death. On either version, the permissibility of abortion does not follow from the permissibility of unplugging yourself from the violinist. This is the objection, or pair of objections, that I wish to consider in this paper. I will argue that in both cases, even if one accepts the moral significance of the distinctions being drawn, Thomson's argument can be sustained. (excerpt)
Language: English
Keywords:
CRITIQUE | FETUS | ABORTION | ETHICS | HYSTEROTOMY | PREGNANCY, UNWANTED | DEATH | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Mortality
Document Number: 180174 Notification

16.
Title: Pregnancy termination.
Author: Chaudhuri SK
Source: In: Practice of fertility control: a comprehensive textbook. 3rd ed., [edited by] S.K. Chaudhuri. New Delhi, India, B.I. Churchill Livingstone, 1992. :197-228.
Abstract: Intentional termination of pregnancy before about 22 weeks gestation is called induced abortion. China and the USSR have the highest number of abortions (14.4 million and 11 million, respectively) and abortion ratios (43.1 and 68, respectively) in the world. Abortion data tend to be underestimated in some countries. In India which allows abortions with some restrictions, the legal abortion rate is 3.3, but is actually 36-55 due to so many illegal abortions. In fact, 40% of all abortions worldwide are illegal. 4-7% of all maternal deaths in hospitals in developing countries area result of complications of illegal abortions (e.g., peritonitis, septicemia, tetanus, and shock). The standard techniques for induced abortion during the first trimester of pregnancy include the surgical methods, vacuum aspiration and dilation and curettage. 0.5 mg eregometrine dilates the cervix for surgical methods. The complication rate for these methods is less than 1%. Complications are uterine hemorrhage, pregnancy continuation, cervical injury, uterine perforation, retained conceptus, and mortality. The mortality risk is 11 times lower than that of pregnancy and childbirth. Medical methods are administration of prostaglandins or the antiprogesterone RU-486. They are as effective as the surgical methods within 7-8 weeks. Second trimester abortion methods include intrauterine instillation of drugs (hypertonic saline, urea, ethacridine lactate, and prostaglandins). Laminaria tents soften and dilate the cervix and stimulate contractions in the second trimester uterus. Japanese health workers often use catheters to introduce various solutions extraovularly to induce second trimester abortions. Surgical methods during the second trimester are dilation and evacuation, abdominal hysterotomy (a mini cesarean section), and hysterectomy (rarely used). Some health workers use a combination of procedures. They all should advise patients to use contraception immediately after abortion.
Language: English
Keywords:
DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | INDIA | USSR | CHINA | ABORTION | ABORTION RATE | PREGNANCY, FIRST TRIMESTER | PREGNANCY, SECOND TRIMESTER | RU-486 | PROSTAGLANDINS | CURETTAGE | PREOPERATIVE PROCEDURES | POSTOPERATIVE PROCEDURES | EQUIPMENT AND SUPPLIES | PREGNANCY COMPLICATIONS | BLEEDING | UTERINE PERFORATION | INFECTIONS | ORGANIC CHEMICALS | LAMINARIA TENTS | CATHETER | OXYTOCIN | HYSTEROTOMY | HYSTERECTOMY | CONTRACEPTION | Asia, Southern | Asia | Asia, Eastern | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Diseases | Signs and Symptoms | Perforations | Ingredients and Chemicals | Cervical Dilatation | Pituitary Hormones | Gynecologic Surgery | Urogenital Surgery
Document Number: 079639 Notification

17.
Title: Comparison of the Foley catheter and dinoprostone pessary for cervical preparation before second trimester abortion.
Author: Hackett GA; Reginald P; Paintin DB
Source: BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1989 Dec;96(12):1432-4.
Abstract: A Foley catheter with the balloon inflated above the internal cervical os, and a 3 mg dinoprostone pessary (Prostin E2) were compared for cervical dilatation before early second trimester dilatation and evacuation. Experimental subjects were 21 women given PGE2 and 23 having catheters, comprising all women between 12-16 weeks' gestation presenting consecutively for termination, allocated at random. Cervical preparation was done after an antiseptic swab, 24 hours before surgery. The size 14-Foley catheter was inserted 3-4 cm into the cervix and inflated with 25 ml water; the pessary was inserted into the posterior fornix. Under general anesthesia, dilatation, measured using largest dilators 1st, averaged 10.4 mm compared to 3.2 mm before treatment in the catheter group, but 8.7 in the PG group compared to 3.7. The increase in dilatation was 7.2 mm in the catheter group, and 5.0 in the PG group (p<0.003). Cervical compliance, estimated on a scale of 1-5 by the surgeon, averaged 4.4 in the catheter group, and 2.8 in the PG group (p,0.001). 4 women complained of pain after catheters, 1 after PG. There was 1 case of cervical tear and rigid cervix, requiring hysterotomy. In this protocol, the Foley catheter seems to be the most efficient means of dilating the cervix.
Language: English
Keywords:
CLINICAL RESEARCH | HUMAN VOLUNTEERS | ABORTION | PREGNANCY, SECOND TRIMESTER | PROSTAGLANDINS | VAGINAL SUPPOSITORY | CATHETER | HYSTEROTOMY | PREOPERATIVE PROCEDURES | CERVICAL DILATATION | Research Methodology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Endocrine System | Physiology | Biology | Vaginal Spermicides | Contraceptive Methods | Contraception | Equipment and Supplies | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment
Document Number: 060071 Notification

18.
Title: Pregnancy termination.
Author: Chaudhuri SK
Source: In: Practice of fertility control: a comprehensive textbook. 2nd ed., [by] S.K. Chaudhuri. New Delhi, India, B.I. Publications, 1988. :205-40.
Abstract: This chapter on pregnancy termination evaluates the significance of induced and illegal abortion, and describes the currently accepted medical abortion techniques in detail. Although it is generally agreed that no country can reduce its population growth without legal abortion, abortion is illegal in most Muslim, Latin American and 3 European countries. Abortion should be distinguished from contraception and interceptive postcoital methods. Estimates of numbers of induced abortions range from 40-60 million per year worldwide, of which 33 million are legal. These figures, expressed in terms of abortion rate or ratio, approximate the incidence reported in Eastern European countries. The mortality from illegal abortion is 10-250 times that of any kind of contraception, and accounts for 4-70% of maternal mortality. The medical methods described in detail are: the 1st trimester application of prostaglandins, vacuum aspiration, dilation and evacuation; and the 2nd trimester methods of hypertonic saline, urea and rivanol, prostaglandins, combined methods, dilatation and evacuation, aspirotomy, hysterotomy and hysterectomy. Abortion should be considered a part of the family planning program, as a back-up method, as a method to recruit new acceptors, and as an alternative to the deadly and injurious consequences of illegal abortion.
Language: English
Keywords:
FAMILY PLANNING | FERTILITY CONTROL, POSTCONCEPTION | ABORTION | MORTALITY | MATERNAL MORTALITY | PROSTAGLANDINS | PROSTAGLANDINS, SYNTHETIC | ACRIDINES | ORGANIC CHEMICALS | PREGNANCY | PREGNANCY, FIRST TRIMESTER | PREGNANCY, SECOND TRIMESTER | SURGERY | OBSTETRICAL SURGERY | UROGENITAL SURGERY | GYNECOLOGIC SURGERY | HYSTERECTOMY | HYSTEROTOMY | ANALGESIA | EQUIPMENT AND SUPPLIES | SURGICAL EQUIPMENT | LITERATURE REVIEW | PREVENTION AND CONTROL | Population Dynamics | Demographic Factors | Population | Endocrine System | Physiology | Biology | Ingredients and Chemicals | Reproduction | Treatment | Diseases
Document Number: 047680 Notification

19.
Title: [Case study of a patient with hysterotomy]
Author: Cho CH
Source: TAEHAN KANHO. KOREAN NURSE. 1988 Feb 29;27(1-2):47-50.
Abstract: In 1987, a primigravida with 17 weeks of pregnancy who was hospitalized with a high fever of undetermined origin and abdominal pain received ampicillin for 1 week. After 4 days at home, she was readmitted because of pain. She had had a miscarriage in 1982 and an abortion with dilatation and curettage biopsy in 1983. In 1984, she was operated on because of an unbalanced pelvis and became pregnant again, delivering a child weighing 3.3 kg. In 1985, a new pregnancy ended in dilatation and evacuation abortion. Her 5 pregnancies resulted in 1 birth, 1 miscarriage, 2 induced abortions and 1 PDA. Before admission, her last menstrual period was on April 27, 1987. She got divorced because of frequent hospitalizations. Her last pregnancy ended in midtrimester induced abortion because of high fever. Following the abortion, she underwent hysterotomy at her own request. Hysterotomy is usually performed at 13-24 weeks of pregnancy up to the 26th week. Postoperatively, 100 mg of im Tridol was given for respiratory difficulty; doperzine, velosef (1 g iv every 8 hours), and selexid (400 mg im every 12 hours) for breast engorgement and flatulence. She also got cough syrup, 60 mg of codeine phosphate 3 times po, and 1 T of dalmadone to help sleeping. 8 days later she was released.
Language: Korean
Keywords:
KOREA | CASE STUDIES | HYSTEROTOMY | ABORTION | PREGNANCY HISTORY | Studies | Research Methodology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Fertility Control, Postconception | Family Planning | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population
Document Number: 052511 Notification

20.
Title: Selective termination of multiple gestations.
Author: Golbus MS; Cunningham N; Goldberg JD; Anderson R; Filly R; Callen P
Source: AMERICAN JOURNAL OF MEDICAL GENETICS. 1988 Oct;31(2):339-48.
Abstract: Physicians selectively terminated 22 fetuses of multiple gestations between November 1983-August 1987. In the case of same sex twins, after initially identifying 1 fetus by amniocentesis as chromosomally abnormal, fetal blood samples were drawn for karyotyping 48-72 hours before selective termination to identify the affected fetus. These samples were repeated at time of termination to confirm termination of that fetus. Practitioners used ultrasound to perform all procedures, except hysterotomy, and to confirm asystole in the affected fetus and normal heart activity in the remaining fetus (es). 18 patients delivered normal infants, 6 of whom delivered at a gestational age of < 37 weeks. Only 1 infant of the 5 monochorionic pregnancies lived. In this case, termination of the sibling fetus occurred via hysterotomy and the physician prescribed oral tocolytics for the mother. Procedures used and their results for dichorionic pregnancies follow. Potassium chloride injections into the heart or into the pericardial region of the chest resulted in a reduced premature labor rate (20%) than did cardiac puncture with air embolization (33.3%). This may be due to decreased intrauterine manipulation and decreased procedure time required to administer the potassium chloride injections. 1 exsanguination was to be performed, but the affected fetus died in the interim between fetal blood sampling and the scheduled day of confirmation. As this study confirmed, poor outcome of remaining normal fetuses is based on premature labor and monochorionic placentation. New techniques add to the many social and ethical considerations of selective termination, especially in those cases where the aborted fetuses are normal.
Language: English
Keywords:
ABORTION | INFANT, PREMATURE | CHROMOSOME ABNORMALITIES | CONGENITAL ABNORMALITIES | FETAL DEATH | RISK FACTORS | PREGNANCY, MULTIPLE | PREGNANCY OUTCOMES | AMNIOCENTESIS | ULTRASONICS | HYSTEROTOMY | Fertility Control, Postconception | Family Planning | Infant | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Neonatal Diseases and Abnormalities | Diseases | Mortality | Population Dynamics | Biology | Pregnancy | Reproduction | Genetic Techniques | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment
Document Number: 057094 Notification

21.
Title: Morphology, yield and functional integrity of islet-like cell clusters in tissue culture of human fetal pancreata obtained after different means of abortion.
Author: Otonkoski T; Knip M; Panula P; Andersson S; Wong I; Goldman H; Simell O
Source: ACTA ENDOCRINOLOGICA. 1988 May;118(1):68-76.
Abstract: The morphology, yield, and functional integrity of islet-like cell clusters (ICC) from 140 human fetal pancreata obtained after abortions performed at 11-23 weeks of gestation were examined. The culture method developed for this study was based on the formation of numerous ICC from collagenase-digested fetal pancreata after culture in medium supplemented with human serum. 12 of the abortions were performed by hysterotomy, 75 by mechanical dilatation and extraction, and 53 were induced by prostaglandin. Up to 2000 free-floating ICC were formed from a single pancreas. More than 100 ICC per pancreas were isolated from 100% of the fetuses from hysterotomies and 87% of the fetuses from mechanical abortions, but from only 53% of the tissues from prostaglandin-induced abortions. Insulin and glucagon levels in the culture medium decreased rapidly during the 1st 7 days of culture, but then remained stable for at least 31 days despite the decrease in the number of ICC. Stimulation of the ICC with glucose and theophylline promptly released insulin. Insulin release was stimulated 12.2-fold in hysterotomy-derived ICC, 6.5-fold in ICC from mechanical abortions, and 5.4-fold in ICC from prostaglandin-induced abortions. Despite the low proportion of B cells, insulin biosynthesis accounted for 10% of the total protein biosynthesis in low glucose. This finding suggests that the nonendocrine cells of the ICC were less active and viable than the endocrine ones. Overall, this study demonstrates a clear correlation between the morphologic and functional characteristics of cultured fetal tissue, with the number of ICC reflecting the degree of tissue viability.
Language: English
Keywords:
CLINICAL RESEARCH | FETAL MEMBRANES | FETUS | EMBRYO | PHYSIOLOGY | ABORTION | FERTILITY CONTROL, POSTCONCEPTION | FAMILY PLANNING | PROSTAGLANDINS | CARBOXYLIC ACIDS | HYSTEROTOMY | GYNECOLOGIC SURGERY | SURGERY | Research Methodology | Pregnancy | Reproduction | Biology | Endocrine System | Organic Chemicals | Ingredients and Chemicals | Urogenital Surgery | Treatment
Document Number: 054329 Notification

22.
Title: Twin-twin transfusion syndrome: the surgical removal of one twin as a treatment option.
Author: Urig MA; Simpson GF; Elliott JP; Clewell WH
Source: FETAL THERAPY. 1988;3(4):185-8.
Abstract: The twin-twin transfusion syndrome, associated with acute polyhydramnios in weeks 18-28 of gestations has a high perinatal mortality rate. Patients managed without intervention have essentially a 100% mortality rate for the involved twins. Different methods of intervention have been described, including therapeutic amniocentesis, selective feticide, and placental vessel puncture. In this case report, the authors describe the selective removal of 1 twin at 21 weeks of gestation by hysterotomy in a patient with twin-twin transfusion syndrome. (author's modified)
Language: English
Keywords:
UNITED STATES OF AMERICA | ARIZONA | CASE STUDIES | PREGNANCY, MULTIPLE | PREGNANCY, SECOND TRIMESTER | HYSTEROTOMY | ULTRASONICS | RISK FACTORS | ETHICS | COMPLICATIONS | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Biology | Diseases
Document Number: 062883

23.
Title: Ectopic pregnancy after tubectomy (a case report).
Author: Saxena N
Source: PATNA JOURNAL OF MEDICINE. 1987 Apr;61(4):73-4.
Abstract: 2 cases of ectopic pregnancy after tubal sterilization were diagnosed at the Patna Medical College Hospital in 1986. One woman was 28 years old, para 4, and had pain for 15 days and vaginal bleeding for 1 month. She has undergone a hysterotomy and ligation 2 years before. Sonography revealed a cystic mass to the left of the uterus. The mass enlarged with time. Laparotomy revealed hemoperitoneum and a ruptured left tube distal to the ligation. Another woman, aged 25, para 4, was admitted with severe pain of 12 days duration. A mass was felt in the left posterior fornix. She was initially treated with antibiotics and antiinflammatory agents. Sonography showed a gestation sac, and laparotomy revealed a ruptured left tube and hemoperitoneum. The increasing numbers of reports of ectopic pregnancy in previously sterilized women should be noted, and related to the growing numbers of sterilized women in the world today.
Language: English
Keywords:
INDIA | TUBAL OCCLUSION | PREGNANCY, TUBAL | ULTRASONICS | HYSTEROTOMY | CASE STUDIES | CONTRACEPTION FAILURE | COMPLICATIONS | Asia, Southern | Asia | Developing Countries | Female Sterilization | Sterilization, Sexual | Family Planning | Pregnancy, Ectopic | Pregnancy Complications | Diseases | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Studies | Research Methodology | Contraceptive Usage | Contraception
Document Number: 057776

24.
Title: [Second trimester abortion: indications and problems] Les indications et les problemes poses par les interruptions therapeutiques du deuxieme trimestre de la grossesse.
Author: Etienne F; Sarrot G; Chartier M
Source: SEMAINE DES HOPITAUX. 1986 Jan 30;62(5):286-90.
Abstract: The 1975 abortion law in France permits abortion at any stage of pregnancy if a high probability exists that the infant will have a serious and incurable defect or if the pregnancy poses a grave threat to the health of the mother. Over the past several years, with the advent of improved prenatal diagnostic tools, fetal indications for 2nd trimester abortion have become increasingly prominent. A study of 470 records of therapeutic abortions at a French hospital between 1970-83 indicated that 207 abortions were performed for maternal indications and 252 for fetal indications. In 11 cases the indications were not specified. The proportion of abortions for fetal indications increased from 23% in 1970-73 to 75% in 1981-83. Between 1970-83, 26.9% of fetal indications referred to chromosomal anomalies, 25.7% to metabolic disorders, 19.8% to malformative syndromes, 14.6% to toxoplasmosis, 7.1% to rubeola, and 5.5% to various factors including use of teratogenic medications during pregnancy. The number of abortions for fetal indications increased from 18 in 1970-73 to 93 in 1981-83 because of improved diagnosis of fetal anomalies, but about 1/3 of such abortions were performed because of the probability rather than the certainty of serious defects. New techniques currently under study may eliminate such abortions except in cases of proven fetal anomalies. Between 1970-83, 99 therapeutic abortions for maternal indications were performed for medical reasons, including cancer, diabetes, hypertension,other serious medical or surgical problems, or failure of tubal sterilization. 68 were performed for psychiatric disorders, and 40 were performed for psychosocial reasons including rape and incest. the number of abortions between 1970-73 and 1981-83 for maternal indications declined from 25 to for medical reasons and from 26 to 8 for psychiatric problems. The number for social reasons increased from 9 to 10 in the same years. 2nd trimester abortion techniques have become simpler, quicker, and safer for patients despite the psychological distress they always cause. The surgical method of inducing 2nd trimester abortion by hysterotomy was the most widely utilized for many years and some clinicians still use it despite its higher mortality rate. Intraamniotic injections of hypertonic solutions, curettage, and mechanical means should be abandoned because of their high morbidity rate. Prostaglandins are currently the best means of inducing such abortions. Their use is easy nontraumatising, and without risk for future fertility.
Language: French
Keywords:
FRANCE | EUROPE, WESTERN | EUROPE | ABORTION | FERTILITY CONTROL, POSTCONCEPTION | PREGNANCY, SECOND TRIMESTER | PREGNANCY | REPRODUCTION | CONGENITAL ABNORMALITIES | NEONATAL DISEASES AND ABNORMALITIES | DISEASES | ABORTION LAW | LEGISLATION | POLITICAL FACTORS | EXAMINATIONS AND DIAGNOSES | HYSTEROTOMY | CURETTAGE | PROSTAGLANDINS, SYNTHETIC | Developed Countries | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Obstetrical Surgery | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 040238 Notification

26.
Title: The comparative safety of second-trimester abortion methods.
Author: Grimes DA; Schulz KF
Source: In: Abortion: medical progress and social implications, edited by Ruth Porter and Maeve O'Connor. London, England, Pitman, 1985. :83-101. (Ciba Foundation Symposium 115) Paper from a symposium on Abortion: Medical Progress and Social Implications, held at the Ciba Foundation, London, 27-29 November 1984.
Abstract: 2nd trimester abortions account for a disproportionate amount of the morbidity and mortality related to abortion, and these procedures consume large amounts of health care resources. Hence the relative safety of these abortion methods is medically and economically important to women. This paper reviews data on the comparative safety of methods used for 2nd trimester abortion, with emphasis on the experience in the US where dilatation and evacuation (D and E) was the predominant method of 2nd trimester abortion (67%) in 1981, followed by instillation abortion methods (33%). Existing data indicate that D and E is the safest method of 2nd trimester abortion; it is safer than instillation abortion, which, in turn is safer than hysterotomy or hysterectomy. The 3rd phase of the Joint Program for the Study of Abortion (JPSA III) a multicenter prospective study of the early complications of legal abortion in the US, has provided additional information about the comparative safety of methods of 2nd trimester abortion. A restricted set of (serious) complications was the focus of the analysis. These included: 1) temperature 38 degrees c for 3 or more days; 2) hemorrhage necessitatiing blood transfusion; and 3) any complication requiring unintended surgery with the exception of repeat curettage. The term seious complication rate refers to the number of women sustaining 1 or more of these 3 complications/100 abortions. Results indicate D and E was significatnly safer than urea-prostaglandin when abortion was performed in the 13-24 weeks' gestation period. The serious complication rate for D and E was 0.49, whereas that for urea-prostaglandin was 1.09 (relative risk 2.1). The urea-prostaglandin procedure had significantly greater relative risks of several complications, including fever, retained products of conception, endometritis, hemorrhage and cervical injury requireing repair. On the other hand, uterine perforatio was significantly more frequent with D and E. When the analysis focused on the 17-20 week interval, D and E and urea-prostaglandin was comparable in safety. In comparing the safety of urea-prostaglandin and hypertonic saline abortion methods, the former was found to be significantly safer than the latter. The serious complication rates for the 2 methods were 1.03 and 2.18 per 100 abortions, respectively. Hemorrhage that required transfusion was the most frequent serious complication associated with saline, and it accounted for most of the difference in serious complication rates between the 2 methods. Coagulopathy is one of the most feared complications of abortions. Although the association between this complication and saline instillation abortion is well documented, its occurrence is infrequently reported for either D and E or suction curettage abortion. Current morbidity data are on immediate and delayed complications; potential late sequelae remain largely unknown. The spectrum of complications leading to death differs for each method. Infection ( usually of retained products of conception) and hemorrhage (usually from uterine perforation) accounted for over 70% from D and E; amniotic fluid embolism was the most frequent cause from instillation abortion.
Language: English
Keywords:
COMPARATIVE STUDIES | NORTH AMERICA | UNITED STATES OF AMERICA | PREGNANCY OUTCOMES | ABORTION | PREGNANCY, SECOND TRIMESTER | FERTILITY CONTROL, POSTCONCEPTION | GESTATIONAL AGE | MORBIDITY | CURETTAGE | MORTALITY | MATERNAL MORTALITY | CAUSES OF DEATH | DATA ANALYSIS | PROSPECTIVE STUDIES | RETROSPECTIVE STUDIES | RESEARCH REPORT | CONFERENCES AND CONGRESSES | COMPLICATIONS | HYSTERECTOMY | HYSTEROTOMY | BLEEDING | UTERINE EFFECTS | UTERINE PERFORATION | EMBRYO | Studies | Research Methodology | Americas | Developed Countries | Pregnancy | Reproduction | Family Planning | Fetus | Diseases | Obstetrical Surgery | Surgery | Treatment | Population Dynamics | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Signs and Symptoms | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Perforations
Document Number: 034473 Notification

27.
Title: Mid-trimester abortion using extraovular normal saline.
Author: Abramovici H; Rofe A; Atad J; Faktor JH
Source: In: Hafez ES, ed. Voluntary termination of pregnancy. Lancaster, England, MTP Press, 1984. :27-30. (Advances in Reproductive Health Care)
Abstract: The methods available to terminate a midtrimester pregnancy or a midtrimester missed abortion utilize various approaches -- vaginal, intraamniotic, parenteral, or the abdominal operative routes. Intravaginal administration of prostaglandins PGE2 or PG2alpha suppositories can induce evacuation of a large uterus. The method is simple and relatively safe but there can be drug-related side effects. Dilatation and curretage or vacuum aspiration may be indicated for a large uterus between 12-15 weeks only, but this procedure has an increased risk of uterine perforation, incomplete evacuation, infections, and cervical damage. The extraovular route for administration of rivanol, hypertonic saline, prostaglandins, or other drugs was described by Scandinavian and Japanese gynecologists. This route is simple and safe, but drug side effects are frequently encountered. The intraamniotic route is the most widely used. It consists of amniocentesis and intraamniotic instillation of pharmacological agents such as hypertonic glucose, urea, hypertonic saline, and prostaglandins. All these drugs injected into the amniotic sac are effective in producing abrotion by different mechanisms, yet they tend to induce drug-related side effects. In addition, there are difficulties related to the amniocentesis itself, especially in cases of obese women, anterior location of placenta, or in midtrimester missed abortion cases. Oral, intravenous, or intramuscular prostaglandins, or intravenous oxytocin are used to induce midtrimester abortions as primary methods but are more frequently used in order to shorten the instillation-abortion time when other methods are used. Drug-related side effects are not infrequent. Hysterotomy or hysterectomy are rarely performed to evacuate a large uterus. These are surgical procedures associated with the relevant operative morbidity and mortality rates. Most of the complications in midtrimester abortions have 2 main features: drug-related side effects and complications and needle penetration into the amniotic sac when the intraamniotic route is used. To avoid these sources of complications, normal saline (hving no side effects) is instilled through the normal physiologic opening of the cervix into the extraovular space. An ultrasonic examination should be performed prior to the procedure to locate the placenta and to rule out placenta previa. After expulsion of the fetus and placenta, a gentle control curretage is performed to assure that the uterine cavity is empty. The only contraindication to the procedure is in cases with central placenta previa, because of the danger of severe bleeding.
Language: English
Keywords:
ABORTION | FERTILITY CONTROL, POSTCONCEPTION | PROSTAGLANDINS | CARBOXYLIC ACIDS | ORGANIC CHEMICALS | PREGNANCY, SECOND TRIMESTER | PREGNANCY | REPRODUCTIVE BEHAVIOR | HYSTEROTOMY | HYSTERECTOMY | GYNECOLOGIC SURGERY | UROGENITAL SURGERY | SURGERY | COMPLICATIONS | ADMINISTRATION AND DOSAGE | Family Planning | Endocrine System | Physiology | Biology | Ingredients and Chemicals | Reproduction | Fertility | Population Dynamics | Demographic Factors | Population | Treatment | Diseases | Drugs
Document Number: 027117 Notification

28.
Title: The social and gynecological long-term consequences of tubal sterilization. A personal six-year follow-up investigation.
Author: Bordahl PE
Source: Acta Obstetrica et Gynecologica Scandinavica. 1984;63(6):487-95.
Abstract: 216 of the 218 women who underwent sterilization between May 22, 1973 and february 1, 1974, at the Akershus Central Hospital in Nordbyhagen, Norway, agreed to participate in a longitudinal study of the complications and consequences of tubal sterilization. The women were interviewed prior to surgery and at discharge and then followed up to 3 months, 12 months, and 6 years. The present report presents finding on the longterm consequences at 6-year follow-up only. Follow-up information was obtained from 208 patients; 186 were interviewed personally and 16 returned mailed questionnaires. Among the 145 patients who had Pomeroy sterilizations there was 1 failure 4 months following sterilization, giveing a Pearl failure rate of 0.1 for the 70 laparoscopy sterilizations, 4 patients conceived 15-52 months later, giving a Pearl failure rate of 1.0. All of the failed sterilizations were performed by junior staff members. 8 women were bothered by itching and discomfort from laparoscopy scars for 2 or more years following surgery, and 3 of these women required surgery to remove suture granulomata of the fascia. At 6 year follow-up, 72% of the patients reported an improvement in sexual relations, 5% reported a deterioration, 23% reported no change, and 1% were undecided. 57% reported a general improvement in their marriage, 2% reported deterioration, 36% reported no change, and 4% were undecided. 195 women were satisfied with their sterilization after 6 years; however, 26 of these 195 had experienced some regret or ambivalence about their decision at some point during the intervening years, and 3 of the 26 experienced a prolonged period of serious regret. The remaining 13 patients seriously regretted their decision at 6 year follow-up. 11 of the 16 serious regretters experienced a change in marital status during the intervening years. Many of the serious regretters were advised to have a sterilization by their physicians or by an abortion committee when they sought an abortion. They felt pressured to accept sterilization. 7 of the regretters sought reversals, and 4 had reversal surgery. No pregnancies occurred in these 4 cases. 84% of the women openly discussed their sterilizations with others, and 71% recommended sterilization to others. 103 of the couples discussed the possibility of vasectomy prior to the wife's sterilization, 90 did not discuss vastectomy, and 15 could not remember. 60 of the 103 couples did not pursue vasectomy because the husband did not want a vasectomy. 142 of the women felt they received adequate preoperaive information, 57 felt the information was insufficient, and 1 was undecided. When questioned about the sterilization procedures, 104 women, including many who felt sufficiently informed, were unable to adequately describe what was done to them. 96 women would have preferred earlier sterilizations, 13 said they would have preferred later sterilizations, and 99 were satisfied with the timing. A controlled comparison of 146 random laparoscopy and Pomeroy patients revealed no differences in postoperative bleeding patterns or in poststerilization gynecological surgery. The incidence of poststerilization hysterectomy was relatively low among the 146 patients.
Language: English
Keywords:
NORWAY | EUROPE, NORTHERN | EUROPE | FOLLOW-UP STUDIES | LONGITUDINAL STUDIES | COMPARATIVE STUDIES | TUBAL OCCLUSION | FEMALE STERILIZATION | STERILIZATION, SEXUAL | LONGTERM EFFECTS | ATTITUDES | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USAGE | FAMILY PLANNING ACCEPTORS | SIDE EFFECTS | POMEROY METHOD | SEX BEHAVIOR | HUSBAND-WIFE COMMUNICATION | COMMUNICATION | IEC | PEARL'S FORMULA | MEASUREMENT | CONTRACEPTION FAILURE | REVERSIBILITY | HYSTEROTOMY | MENSTRUATION DISORDERS | GENITAL EFFECTS, FEMALE | UROGENITAL EFFECTS | Developed Countries | Studies | Research Methodology | Family Planning | Time Factors | Population Dynamics | Demographic Factors | Population | Psychological Factors | Behavior | Contraception | Family Planning Programs | Treatment | Tubal Ligation | Partner Communication | Interpersonal Relations | Program Activities | Programs | Organization and Administration | Contraceptive Use-Effectiveness | Contraceptive Effectiveness | Gynecologic Surgery | Urogenital Surgery | Surgery | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 028847

29.
Title: [Disseminated intravascular coagulation and rupture of the splenic vein following hysterotomy] Dissemineret intravaskulaer koagulation og miltveneruptur efter sectio parva.
Author: Borlum KG
Source: Ugeskrift for Laeger. 1983 Mar 28;145(13):996-7.
Abstract: Disseminated intravascular coagulation may lead to formation of macrothrombi in the circulating blood. A case is described where rupture of a splenic vein probably occurred in this manner. This case occurred as a complication of pregnancy termination by abdominal hysterotomy. (author's modified) (summary in ENG)
Language: Danish
Keywords:
HYSTEROTOMY | BLOOD COAGULATION EFFECTS | ABORTION | FERTILITY CONTROL, POSTCONCEPTION | FAMILY PLANNING | COMPLICATIONS | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Hematological Effects | Hemic System | Physiology | Biology | Diseases
Document Number: 018435 Notification

30.
Title: Pregnancy termination.
Author: Chaudhuri SK
Source: In: Chaudhuri SK. Practice of fertility control: a comprehensive textbook. Calcutta, India, Current Book Publishers, 1983. :189-222.
Abstract: Worldwide, an estimated 55 million pregnancies are terminated. This chapter presents an overview of the medical and surgical techniques, including their application and complications, used to induce abortion. During the 1st trimester, surgical procedures are the standard techniques for pregnancy termination, however, a medical method using prostaglandins is under investigation and shows some success. Both natural and synthetic prostaglandins have high effectiveness rates but the side effects are unacceptable. Vacuum aspiration and dilatation and evacuation are the 2 surgical procedures used in 1st trimester termination. Preoperative procedures, including examination and counseling, and the necessary equipment and facilities are described. Step-by-step details of dilatation, aspiration and evacuation are presented, followed by a brief description of postoperative care and follow up. Compared to other surgical procedures, 1st trimester pregnancy termination is quite safe; the rate of major complications is less than 1/100 procedures. Possible complications include: uterine hemorrhage, pelvic infection, cervical injury, uterine perforation, retained products and pregnancy continuation. Morbidity is lowest when termination occurs at 8 weeks gestation or earlier. Longterm complications indicate an increased chance of future abortions, prematurity, and low birth weight infants. 2nd trimester pregnancy termination is induced by uterine stimulation or surgical procedures. The most effective drugs to induce abortion are intrauterine instillation of hypertonic saline, urea, or rivanol and administration of prostaglandins by various routes. The techniques of intraamniotic and extraamniotic instillation are detailed. The induction-abortion interval of hypertonic saline varies between 22 and 39 hours, the success rate is 88-97% within 72 hours, and the most common complications are hemorrhage and infection. With urea induction, the interval is longer, ranging from 43.7-51 hours, but can be augmented by oxytocin drip. Ethacridine lactate (rivanol) is used extraamniotically, and even with oxytocin augmentation, the interval is usually 30 hours. Intraamniotic instillation of prostaglandins is quite effective and has an acceptable level of side effects. Complications tend to be minor and n responsive to treatment. Prostaglandins tend to act faster tha saline, but side effects have reduced their advantage. The potential serious complications of saline, including hypernatremia and coagulopathy, however are difficult to treat and may cause maternal death. Laminaria tents are the only commonly used devices and are inserted into the cervical os before induction by dilatation and evacuation, prostaglandins, or other agents, to soften and open the cervix and stimulate uterine contractions. Some combination procedures, in which drugs or other agents are used simultaneously, have shown good results. Surgical methods for 2nd trimester abortion include dilatation and evacuation, hysterotomy, and hysterectomy. The techniques and complications are described. Hysterectomy is not supported as a routine method of pregnancy termination because of higher associated morbidity and mortality. Illegal abortions are performed in various ways and are much more hazardous, especially in developing countries. The appropriate role of abortion in fertility control is as a recruiting method for contraception and as a backup method in the case of contraceptive failure.
Language: English
Keywords:
FERTILITY CONTROL, POSTCONCEPTION | ABORTION | CURETTAGE | HYSTEROTOMY | HYSTERECTOMY | ORGANIC CHEMICALS | PROSTAGLANDINS | SALINE SOLUTION, HYPERTONIC | ACRIDINES | SIDE EFFECTS | Family Planning | Obstetrical Surgery | Surgery | Treatment | Gynecologic Surgery | Urogenital Surgery | Ingredients and Chemicals | Endocrine System | Physiology | Biology
Document Number: 014292 Notification


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