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Sample records for early medical abortion

  1. Abortion - medical

    Science.gov (United States)

    Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last ...

  2. Early medical abortion without prior ultrasound.

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    Raymond, Elizabeth G; Bracken, Hillary

    2015-09-01

    To explore the potential for using last menstrual period (LMP) rather than ultrasound to establish gestational age (GA) eligibility for medical abortion. We used the results of a recently published systematic review to identify studies with data on the number of abortion patients with GA more than 63 or 70 days by ultrasound but less than those or other specific limits by LMP. We analyzed data from these studies to estimate the proportion of women with GAs greater than 63 or 70 days by ultrasound in various subgroups of women defined by LMP. We found three studies with relevant data. One enrolled 4257 medical abortion patients of whom 4% had GAs of >70 days by ultrasound. Of the 2681 who were certain that their LMPs began no more than 56 days prior, only 16 (0.6%) were >70 days by ultrasound. In a second much smaller study of surgical abortion patients, of whom 19% were >70 days by ultrasound, 90 women were certain that their LMPs started more than 56 days prior, and of those, 7 (7.8%) had GAs of >70 days by ultrasound. In the third study, which included surgical abortion patients with a mean GA of 61 days, at least 12% of the 138 patients with LMPs 70 days by ultrasound. The possibility that access to medical abortion can be enhanced for selected women by omitting the requirement for a screening ultrasound is promising and should be further investigated. Gestational dating using LMP rather than ultrasound may be reasonable for selected patients before medical abortion. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Use of mifepristone and sublingual misoprostol for early medical abortion.

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    Lin, Mau; Li, Yiu-Tai; Chen, Fu-Min; Wu, Shu-Fang; Tsai, Ching-Wan; Chen, Tien-Hui; Kuo, Tsung-Cheng

    2006-12-01

    Existing drug-induced abortion techniques involve oral administration of 200 mg of mifepristone, followed by oral administration of 600 microg of misoprostol 48 hours later, but the effects are variable. As revealed by recent research, sublingual and oral administrations of misoprostol are equally efficacious in terms of rapid absorption, but the former lasts longer in serum. Hence, in the near future, sublingual administration of misoprostol may become the most effective way to induce abortion. Women with intrauterine pregnancy up to 49 gestational days received vaginal ultrasonography, followed by oral administration of mifepristone 200 mg and sublingual administration of misoprostol 600 microg 48 hours later. They returned for follow-up consultations 3 and 14 days after. The definition of a successfully induced complete medical abortion was that the abortion occurred without surgery or evacuating the uterus. A total of 356 women underwent medical abortion; the complete abortion rate was 98.3% (350 women). Medical abortion was unsuccessful in five (1.7%) women, who eventually had to undergo dilation and curettage. Patients found the side effects to be bearable; the reported satisfaction rate was 89.9% (325 women). Medical abortion for early termination of pregnancy should be achieved by oral administration of mifepristone, followed by sublingual administration of misoprostol.

  4. Medical Abortion.

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    Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew

    2016-04-01

    This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  5. Early versus Delayed Insertion of Intrauterine Contraception after Medical Abortion — A Randomized Controlled Trial

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    Sääv, Ingrid; Stephansson, Olof; Gemzell-Danielsson, Kristina

    2012-01-01

    Background Today, a large proportion of early abortions are medical terminations, in accordance to the woman's choice. Intrauterine contraceptives (IUC) provide highly effective, reversible, long-acting contraception. However, the effects of timing of IUC insertion after medical abortion are not known. Methods Women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUC were randomised to early insertion (day 5–9 after mifepristone) or delayed (routine) insertion (at 3–4 weeks after mifepristone). The primary outcome was the rate of IUC expulsion at six months after IUC insertion. Results A total of 129 women were randomized, and 116 women had a successful IUC insertion. There was no difference in expulsion rate between early (9.7%) vs. delayed (7.4%) IUC insertion (risk difference −9.2–13.4). Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI: 1.8–20.6%, p = 0.015), and a higher proportion of women (41%) had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16%) (p = 0.015). Adverse events were rare and did not differ between the groups. Conclusions Early insertion of IUC after medical abortion was safe and well tolerated with no increased incidence for expulsions or complications. Women were more likely to return for the IUC insertion if scheduled early after the abortion, and less likely to have had an unprotected intercourse prior to the IUC insertion. Early insertion should be offered as a routine for women undergoing first trimester medical abortion. Trial Registration ClinicalTrials.gov NCT01537562 PMID:23155432

  6. Early versus delayed insertion of intrauterine contraception after medical abortion - a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Ingrid Sääv

    Full Text Available BACKGROUND: Today, a large proportion of early abortions are medical terminations, in accordance to the woman's choice. Intrauterine contraceptives (IUC provide highly effective, reversible, long-acting contraception. However, the effects of timing of IUC insertion after medical abortion are not known. METHODS: Women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUC were randomised to early insertion (day 5-9 after mifepristone or delayed (routine insertion (at 3-4 weeks after mifepristone. The primary outcome was the rate of IUC expulsion at six months after IUC insertion. RESULTS: A total of 129 women were randomized, and 116 women had a successful IUC insertion. There was no difference in expulsion rate between early (9.7% vs. delayed (7.4% IUC insertion (risk difference -9.2-13.4. Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI: 1.8-20.6%, p = 0.015, and a higher proportion of women (41% had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16% (p = 0.015. Adverse events were rare and did not differ between the groups. CONCLUSIONS: Early insertion of IUC after medical abortion was safe and well tolerated with no increased incidence for expulsions or complications. Women were more likely to return for the IUC insertion if scheduled early after the abortion, and less likely to have had an unprotected intercourse prior to the IUC insertion. Early insertion should be offered as a routine for women undergoing first trimester medical abortion. TRIAL REGISTRATION: ClinicalTrials.gov NCT01537562.

  7. Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan.

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    Louie, Karmen S; Tsereteli, Tamar; Chong, Erica; Aliyeva, Faiza; Rzayeva, Gulnara; Winikoff, Beverly

    2014-12-01

    To examine the acceptability and feasibility of early medical abortion using mifepristone and misoprostol in Azerbaijan. A total of 863 women in Baku and two regions of Azerbaijan who sought termination of gestations up to 63 days were enrolled in the study. In the capital, women swallowed 200 mg mifepristone in the clinic and were given the option of taking 800 μg misoprostol buccally either at the clinic or at home 24-48 hours later. In the regions, women were given the option of taking both drugs at home. Follow-up visits were to take place two weeks after mifepristone administration to determine abortion status. Seventy-four percent of women in the regions chose home administration of mifepristone, and 92% of women from all locations selected misoprostol home administration. Ninety-seven percent of women had complete abortions, and 97% were satisfied or very satisfied with the method. The vast majority of participants preferred medical abortion for a future procedure (96%). Nearly all women (98%) would recommend medical abortion for pregnancy termination to a friend. Mifepristone-misoprostol medical abortion with the option of home administration of both drugs is an acceptable and feasible option for women in Azerbaijan.

  8. Early serum human chorionic gonadotropin (hCG) trends after medication abortion.

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    Pocius, Katherine D; Maurer, Rie; Fortin, Jennifer; Goldberg, Alisa B; Bartz, Deborah

    2015-06-01

    Despite increased reliance on human chorionic gonadotropin (hCG) for early pregnancy monitoring, there is limited information about hCG trends soon after medication abortion. The purpose of this study was to determine if there is a predictable decline in serum hCG values shortly after medication abortion. This is a retrospective study of women with early intrauterine pregnancies who underwent medication abortion with mifepristone and misoprostol and had a serum hCG level on Day 1 (day of mifepristone) and a repeat value on Day 2 to 6. The percent hCG decline was calculated from baseline to repeat measure, with repeat values from the same patient accounted for through repeated measure analysis of variance. Eighty-eight women with a mean gestational age of 5.5 weeks and median baseline hCG of 5220 IU met study criteria over a 3-year period. The mean decline (±SD) in hCG from the Day 1 baseline value was 56.9%±29.5% on Day 3, 73.5%±38.6% on Day 4, 86.1%±8.8% on Day 5, and 92.9%±3.4% on Day 6. Eighty-two women (93% of the cohort) had a complete abortion without further intervention. The least square means hCG decline among these women was 57.6% [95% confidence interval (CI): 50.3-64.9%] on Day 3, 78.9% (95% CI: 75.0-82.8%) on Day 4 and 86.2% (95% CI: 81.3-91.1%) on Day 5. There is a rapid decline in serum hCG within the first few days after early medication abortion. Further research is needed to delineate how soon after medication abortion this decline may be specific enough to confirm abortion completion. This study provides the largest cohort of patients followed with serial hCG values in the first few days after medication abortion. Our findings demonstrate the trend in hCG decline in this population, which may be predictable by Day 5. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    White Mary T

    2011-06-01

    Full Text Available Abstract Background Increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, which is achieved by increasing safe choices for pregnancy termination. Medical abortion for termination of early abortion is said to safe, effective, and acceptable to women in several countries. In Ethiopia, however, medical methods have, until recently, never been used. For this reason it is important to assess women's preferences and the acceptability of medical abortion and manual vacuum aspiration (MVA in the early first trimester pregnancy termination and factors affecting acceptability of medical and MVA abortion services. Methods A prospective study was conducted in two hospitals and two clinics from March 2009 to November 2009. The study population consisted of 414 subjects over the age of 18 with intrauterine pregnancies of up to 63 days' estimated gestation. Of these 251 subjects received mifepristone and misoprostol and 159 subjects received MVA. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit. Results The study groups were similar with respect to age, marital status, educational status, religion and ethnicity. Their mean age was about 23, majority in both group completed secondary education and about half were married. Place of residence and duration of pregnancy were associated with method choice. Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (91.2% vs 82.4%; P Conclusions Women receiving medical abortion were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. We conclude that medical abortion can be used widely as an alternative method for early pregnancy termination.

  10. Timing and indication for curettage after medical abortion in early pregnant women with prior uterine incision.

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    Wang, Guoyun; Li, Dong; Manconi, Frank; Dong, Baihua; Zhang, Yuncun; Sun, Bingcui

    2010-01-01

    Termination of pregnancy is an important and necessary back-up method for family planning services in many countries. The combination of mifepristone and misoprostol is a widely used alternative to surgical evacuation of the uterus in early pregnancy; however, there are few reports about medical abortion in women with a prior uterine incision and few studies have described curettage occurring as part of the procedure and an indication for the intervention. Curettage in a prior uterine incision can increase operative complications. The purpose of this study was to investigate whether vaginal bleeding intervals, routine ultrasound scan and serum beta-hCG test after medical abortion could accurately identify women with uterine scars who would require curettage. Six hundred sixty-eight women with a uterine scar and at up to 49 days of gestation underwent a medical abortion with mifepristone and misoprostol. Each woman took 50 mg and 25 mg of mifepristone orally in the morning and in the evening, respectively, for 2 days and 600 mcg of misoprostol orally on the third day. Of the 668 women, 6 (0.9%) were lost to follow-up. The overall complete abortion rate was 91.7%; 55 women underwent curettage, including 2 women with heavy bleeding, 3 women with ongoing pregnancy and 34 women with incomplete abortion. The incomplete abortion rate was significantly greater in women with persistent bleeding lasting 21 days than in women with persistent bleeding lasting 14 days (pabortion rate was also greater in women whose serum beta-hCG was >or=500 IU/L than in women whose serum beta-hCG was or=500 IU/L) were 97.1% and 62.5%, respectively. Moreover, the incomplete abortion rate was greater in women with an endometrial thickness >or=15 mm than in women with an endometrial thickness or=15 mm) were 94.1% and 75%, respectively. No complication occurred. The combination of mifepristone and misoprostol was found to be a safe and effective method to terminate early pregnancy in women with a

  11. Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone.

    Science.gov (United States)

    Ngoc, Nguyen Thi Nhu; Blum, Jennifer; Raghavan, Sheila; Nga, Nguyen Thi Bach; Dabash, Rasha; Diop, Ayisha; Winikoff, Beverly

    2011-05-01

    Nonsurgical abortion methods have the potential to improve access to high-quality abortion care. Until recently, availability and utilization of mifepristone medical abortion in low-resource countries were restricted due to the limited availability and perceived high cost of mifepristone, leading some providers and policymakers to support use of misoprostol-only regimens. Yet, this may not be desirable if misoprostol-only regimens are considerably less effective and ultimately more costly for health care systems. This study sought to document the differences in efficacy between two nonsurgical abortion regimens. This double-blind randomized placebo-controlled trial enrolled women with gestational ages up to 63 days seeking early medical abortion from August 2007 to March 2008 at a large tertiary hospital in Ho Chi Minh City, Vietnam. Eligible consenting women received either (1) two doses of 800 mcg buccal misoprostol 24 h apart or (2) 200 mg mifepristone and 800 mcg buccal misoprostol 24 h later. Participants self-administered all study drugs and returned to the hospital for follow-up 1 week later. The trial is registered at ClinicalTrials.gov as NCT00680394. Four hundred women were randomized to either misoprostol-only (198) or mifepristone+misoprostol (202). Complete abortion occurred for 76.2% (n=147) of women allocated to misoprostol-only vs. 96.5% (n=194) of those given mifepristone+misoprostol (RR 0.79, 95% CI 0.73-0.86). Ongoing pregnancy was documented for 16.6% (32) of misoprostol-only users and 1.5% (3) of mifepristone+misoprostol users (1.62, 0.68-3.90). Side effects were generally similar for both groups, although significantly more women allocated to misoprostol-only reported diarrhea. Mifepristone+misoprostol is significantly more effective than use of misoprostol-alone for early medical abortion. The number of ongoing pregnancies documented with misoprostol-only warranted an early end of the trial after unblinding of the study at interim analysis

  12. Early versus late misoprostol administration after mifepristone for medical abortion.

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    Tendler, Rene; Bornstein, Jacob; Kais, Mohamad; Masri, Irina; Odeh, Marwan

    2015-11-01

    To evaluate the successful medical termination of pregnancy comparing two regimens: misoprostol 2 or 48 h after mifepristone administration. Prospective randomized study. Department of Obstetrics and Gynecology. One hundred pregnant women admitted for medical termination of pregnancy were enrolled; no pregnancies were over 55 days gestational age. All subjects were randomly assigned for misoprostol administration either 2 or 48 h after mifepristone. All participants underwent transvaginal ultrasound examination for uterine contents 48 h and 3 weeks after mifepristone. Procedure failure, defined as the presence of fetal heart activity, presence of a gestational sac, or a need for uterine curettage after misoprostol administration. Each group consisted of 50 women. Fetal heart activity was significantly more frequent after 48 h in the 2-h interval group (10/50) than in the 48-h interval group (0/50) (p = 0.002). Three weeks after misoprostol administration, fetal heart activity was present in 4/50 (8 %) in the 2-h interval group (p = 0.118) and none of the 48-h interval group. At 48 h residual tissue was present in 13/50 (26 %) and 5/50 (10 %) in the 2 and 48-h interval groups, respectively (p = 0.031); this was reduced to 12/50 (24 %) compared to 5/50 (10 %) in the two groups, respectively (p = 0.054) after 3 weeks. Successful medical termination of pregnancy can be achieved using misoprostol administration 2 h after mifepristone in 76 % of cases. However, this regimen is not recommended as it is significantly inferior to the traditional 48-h interval regimen.

  13. Efficacy of early induced medical abortion with mifepristone when beginning progestin-only contraception on the same day.

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    Douthwaite, Megan; Candelas, Jose A; Reichwein, Barbara; Eckhardt, Carla; Ngo, Thoai D; Domínguez, Adriana

    2016-06-01

    To investigate whether starting progestin-only contraception immediately after mifepristone reduced the efficacy of early medical abortion with a mifepristone-misoprostol regimen. A review of patient records from October 1, 2012 to March 31, 2013 from four Marie Stopes Mexico clinics in Mexico City was conducted. Patients were eligible for inclusion if they had undergone a medical abortion with mifepristone-misoprostol at no later than 63days of pregnancy, had a recorded outcome, and had either started progestin-only contraception immediately after mifepristone administration or had not started contraception. The primary outcome-successful induced abortion-was defined as the complete evacuation of uterine contents without the need for further intervention. A secondary outcome was the number of induced abortions completed without the need for manual vacuum aspiration. Records from 2204 patients were included; 448 (20.3%) patients had started progestin-only contraception, and 1756 (79.7%) had not. Patients not taking progestin-only contraception were significantly more likely to be primigravidas and nulliparous. Medical abortion success did not vary between the two groups; 1890 (85.8%) were successful and 2085 (94.6%) were completed without the need for manual vacuum aspiration. Different methods of progestin-only contraception did not affect medical abortion outcomes. Beginning progestin-only contraception immediately following mifepristone for early medical abortion was not associated with reduced medical abortion effectiveness. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Comparison or oral versus vaginal misoprostol & continued use of misoprostol after mifepristone for early medical abortion.

    Science.gov (United States)

    Mittal, Suneeta; Agarwal, Sonika; Kumar, Sunesh; Batra, Ashima

    2005-08-01

    Medical abortion though legalized in India, is still not very popular. A disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion which may reduce acceptability. Due consideration needs to be given to the issues related to medical abortion for improving the reproductive health status of women suffering from consequences of unsafe and illegal surgical abortion. The present study compared the efficacy of oral and vaginal administration of misoprostol after a single dose of 200 mg of mifepristone and evaluated the influence of continuing misoprostol for one week on efficacy and side effects. A double-blind randomized controlled trial with 150 healthy pregnant women requesting medical abortion with misoprostol either orally or vaginally on day three. Women in the oral group and one of the two vaginal groups continued 0.4 mg of oral misoprostol twice daily for seven days. Complete abortion rate in each of the groups was 96-100 per cent. The addition of misoprostol 0.4 mg twice a day from day 4-10 did not help in increasing successful outcome or shortening of duration or amount of bleeding. Medical abortion for pregnancy up to 63 days using misoprostol 0.8 mg vaginal/oral after pretreatment with mifepristone 200 mg is a safe and successful procedure. No differences in efficacy or duration of bleeding were observed with addition of oral misoprostol for 1 wk after abortion.

  15. Primary Study on Medical Abortion in Early Pregnant Women with Myoma of Uterus

    Institute of Scientific and Technical Information of China (English)

    Chen CHEN; Xiao-ai LIU; Yu-cui JIN

    2002-01-01

    Objective To study the effectiveness and acceptability of the medical termination of early pregnancy accompanied with myoma Methods A total of 92 early pregnant women with myoma were admitted. Every woman was administrated mifepristone 150 mg in the first two days and Misoprostol 1 000 μg on d 3.Results The complete abortion rate was 89. 13%. The average bleeding duration was 11. 89± 6. 87 d. The expulsion time of gestational cyst was affected by the size of myoma. The bleeding duration and the expulsion time of gestational cyst were affected by the size of myoma and gestational cyst. The location and the number of myoma had no effect on the bleeding duration and the recovery of menses.Conclusion Mifepristone and Misoprostol could be safely and effectively used in the termination of early pregnancy with myoma.

  16. Efficacy and acceptability of early mifepristone-misoprostol medical abortion in Ukraine: results of two clinical trials.

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    Raghavan, Sheila; Maistruk, Galina; Shochet, Tara; Bannikov, Vladimir; Posohova, Svetlana; Zhuk, Svetlana; Lishchuk, Vladimir; Winikoff, Beverly

    2013-04-01

    Abortion services are legally available in Ukraine although there are issues in quality and access. Two studies were conducted in Ukraine to expand options for women, and to determine the efficacy and acceptability of medical abortion. Two open-label clinical trials were conducted at six clinics in Ukraine. Women were given 200 mg mifepristone followed after 48 hours by 400 μg oral misoprostol (Study One) and mifepristone followed after 24 hours by 400 μg sublingual misoprostol (Study Two). Follow-up visits were scheduled for two weeks after mifepristone administration to assess whether complete uterine evacuation had occurred. Success rates were 97% in the first study and 98% in the second one. The vast majority of participants were satisfied or very satisfied with their abortion method (Study One: 94%; Study Two: 98%). The two studies demonstrate high rates of success and acceptability of early medical abortion in Ukraine.

  17. Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial.

    Science.gov (United States)

    von Hertzen, H; Huong, N T M; Piaggio, G; Bayalag, M; Cabezas, E; Fang, A H; Gemzell-Danielsson, K; Hinh, N D; Mittal, S; Ng, E H Y; Chaturachinda, K; Pinter, B; Puscasiu, L; Savardekar, L; Shenoy, S; Khomassuridge, A; Tuyet, H T D; Velasco, A; Peregoudov, A

    2010-09-01

    To compare 400 and 800 microg sublingual or vaginal misoprostol 24 hours after 200 mg mifepristone for noninferiority regarding efficacy in achieving complete abortion for pregnancy termination up to 63 days of gestation. Placebo-controlled, randomised, noninferiority factorial trial, stratified by centre and length of gestation. Misoprostol 400 or 800 microg, administered either sublingually or vaginally, with follow up after 2 and 6 weeks. Fifteen obstetrics/gynaecology departments in ten countries. Pregnant women (n = 3005) up to 63 days of gestation requesting medical abortion. Two-sided 95% CI for differences in failure of complete abortion and continuing pregnancy, with a 3% noninferiority margin, were calculated. Proportions of women with adverse effects were recorded. Complete abortion without surgical intervention (main); continuing live pregnancies, induction-to-abortion interval, adverse effects, women's perceptions (secondary). Efficacy outcomes analysed for 2962 women (98.6%): 90.5% had complete abortion after 400 microg misoprostol, 94.2% after 800 microg. Noninferiority of 400 microg misoprostol was not demonstrated for failure of complete abortion (difference: 3.7%; 95% CI 1.8-5.6%). The 400-microg dose showed higher risk of incomplete abortion (P abortion (P = 0.47, difference in sublingual minus vaginal -0.7%, 95% CI -2.6-1.2%). A similar pattern was observed for continuing pregnancies (P = 0.21). Fewer women reported adverse effects with vaginal than sublingual administration and with the 400-microg dose than the 800-microg dose. Of the women, 94% were satisfied or highly satisfied with the regimens, 53% preferred the sublingual route and 47% preferred the vaginal route. A 400-microg dose of misoprostol should not replace the 800-microg dose when administered 24 hours after 200 mg mifepristone for inducing abortion in pregnancies up to 63 days. Sublingual and vaginal misoprostol have similar efficacy, but vaginal administration is associated with

  18. Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section.

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    Namazov, Ahmed; Grin, Leonti; Volodarsky, Michael; Anteby, Eyal; Gemer, Ofer

    2016-01-01

    To show the possibility of laparoscopic management of uterine rupture. Video with explanations. In the medical management with misoprostol for termination of pregnancy at any time the risk of uterine rupture may be possible. The risk is likely higher in women with a previous uterus surgery. In a systematic review of available studies, the risk of rupture was .28% among women with a prior cesarean delivery who were undergoing second-trimester misoprostol-induced abortion, meaning if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, 1 would experience uterine rupture. Uterine rupture has only been reported 3 times in first-trimester abortion and only once managed via laparoscopy: a missed abortion reported in 2005, a case of a ruptured unscarred uterus in a women undergoing medical abortion, and a case of a delayed miscarriage at 8 weeks' gestation after misoprostol managed by laparotomy and sharp curettage. Total laparoscopic management in a patient with uterine tear after misoprostol treatment. Early second-trimester medical abortions with misoprostol can cause uterine rupture. In hemodynamically stable cases, total laparoscopic management is possible approach. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  19. An overview of medical abortion for clinical practice.

    Science.gov (United States)

    Bryant, Amy G; Regan, Elizabeth; Stuart, Gretchen

    2014-01-01

    Medical abortion is a safe, convenient, and effective method for terminating an early unintended pregnancy. Medical abortion can be performed up to 63 days from the last menstrual period and may even be used up to 70 days for women who prefer medical abortion over surgical abortion. Counseling on the adverse effects and expectations for medical abortion is critical to success. Medical abortion can be performed in a clinic without special equipment, and it is perceived as more "natural" than a surgical abortion by many women. Follow-up for medical abortion can be simplified to include only serum human chorionic gonadotropin measurements when necessary, although obtaining an ultrasound remains the criterion standard. Pain associated with medical abortion is best treated with nonsteroidal anti-inflammatory medications, possibly in combination with opioid analgesics. Medical abortion can contribute to continuity of care for women who wish to remain with their primary care providers for management of their abortion.

  20. Alternatives to a routine follow-up visit for early medical abortion.

    Science.gov (United States)

    Clark, Wesley; Bracken, Hillary; Tanenhaus, Jini; Schweikert, Suzanne; Lichtenberg, E Steve; Winikoff, Beverly

    2010-02-01

    To evaluate the ability of women and their providers to assess abortion outcome without the routine use of ultrasonography. This multicenter trial enrolled 4,484 women seeking medical abortion at 10 clinics in the United States. Women received the standard medical abortion care with mifepristone-misoprostol in those clinics and blinded clinical assessments before follow-up ultrasonography. Data were collected prospectively on abortion outcomes, receipt of additional treatment, and clinical, laboratory, and ultrasound assessments associated with the procedure. We constructed five model algorithms for evaluating women's postabortion status, each using a different assortment of data. Four of the algorithms (algorithms 1-4) rely on data collected by the woman and on the results of the low-sensitivity pregnancy test. Algorithm 5 relies on the woman's assessment, the results of the pregnancy test, and follow-up physician assessment (sometimes including bimanual or speculum examination). A total of 3,054 women received medical abortion and had adequate data for evaluation. Twenty women (0.7%) had an ongoing pregnancy; 26 (0.9%) received curettage for retained tissue, empiric treatment for possible infection, or both; and 55 (1.8%) received additional uterotonics or other medical abortion-related care. Screening algorithms including patient-observed outcomes, a low-sensitivity pregnancy test, and nonsonographic clinical evaluation were as effective as sonography in identifying women who received interventions at or after the follow-up visit. Relying on women's observations, a low-sensitivity pregnancy test, and clinical examination, women and their providers can accurately assess whether follow-up care is required after medical abortion without routine ultrasonography. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00120224. II.

  1. WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion.

    Science.gov (United States)

    Honkanen, Helena; Piaggio, Gilda; Hertzen, Helena; Bártfai, Gyorgy; Erdenetungalag, Radnaabazar; Gemzell-Danielsson, Kristina; Gopalan, Sarala; Horga, Mihai; Jerve, Fridtjof; Mittal, Suneeta; Thi Nhu Ngoc, Nguyen; Peregoudov, Alexandre; Prasad, R N V; Pretnar-Darovec, Alenka; Shah, Rashmi S; Song, Si; Tang, Oi Shan; Wu, Shang Chun

    2004-07-01

    To compare the side effect profiles of regimens of oral and vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone and to investigate patients' perceptions of medical abortion. Double-blind, randomised controlled trial. Fifteen gynaecological clinics in 11 countries. A total of 2219 healthy pregnant women requesting medical abortion with misoprostol either orally or vaginally on day three. The oral group (O/O group) and one of the vaginal groups (V/O group) continued with 0.4 mg of oral misoprostol, and the vaginal-only group (V-only group) with oral placebo, twice daily for seven days. Side effects were recorded daily by women and reported at each visit. After misoprostol administration at the clinic, side effects were recorded at 1-hour interval up to 3 hours. Patients' perceptions were asked at the second follow up visit, six weeks after treatment. The outcome measures were the following: pregnancy-related symptoms (nausea, vomiting, breast tenderness, fatigue, dizziness, headache), drug-related side effects (diarrhoea, fever, rash and blood pressure change), side effects related to the abortion process (lower abdominal pain) and women's perceptions of the method. The pregnancy-related symptoms decreased in all groups after misoprostol, and breast tenderness decreased already after mifepristone. Oral administration of misoprostol was associated with a higher frequency of nausea and vomiting than vaginal administration at 1 hour after administration. With oral misoprostol, diarrhoea was more frequent at 1, 2 and at 3 hours after administration than with vaginal administration. Misoprostol induced fever during at least 3 hours after administration in up to 6% of the women, this peak being slightly higher and taking place later with the vaginal route. Lower abdominal pain peaked at 1 and 2 hours after oral misoprostol, while it did so at 2 and 3 hours after vaginal misoprostol. In the two groups that continued misoprostol, 27% of

  2. Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Iyengar, Kirti; Klingberg-Allvin, Marie; Iyengar, Sharad D; Paul, Mandira; Essén, Birgitta; Gemzell-Danielsson, Kristina

    2016-02-01

    Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting. This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days. Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience. Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. [Medical induced abortion].

    Science.gov (United States)

    Bettahar, K; Pinton, A; Boisramé, T; Cavillon, V; Wylomanski, S; Nisand, I; Hassoun, D

    2016-12-01

    Updated clinical recommendations for medical induced abortion procedure. A systematic review of French and English literature, reviewing the evidence relating to the provision of medical induced abortion was carried out on PubMed, Cochrane Library and international scientific societies recommendations. The effectiveness of medical abortion is higher than 95% when the protocols are adjusted to gestational age (EL1). Misoprostol alone is less effective than a combination of mifepristone and misoprostol (EL1). Gemeprost is less effective than misoprostol (EL2). The dose of 200mg of mifepristone should be preferred to 600mg (NP1, Rank A). Mifepristone can be taken at home (professional agreement). The optimum interval between mifepristone and misoprostol intake should be 24 to 48 hours (EL1, grade A). Before 7 weeks LMP, the dose of 400μg misoprostol should be given orally (EL1, grade A) eventually repeated after 3hours if no bleeding occurs. For optimal effectiveness between 7 and 14 LMP, the interval between mifepristone and misoprostol should not be shortened to less than 8hours (grade 1). An interval of 24 to 48hours will not affect the effectiveness of the method provided misoprostol dosage is 800μg (EL1). Vaginal, sublingual or buccal routes of administration are more effective and better tolerated than the oral route, which should be abandoned (EL1). An amount of 800μg sublingual or buccal misoprostol route has the same effectiveness than the vaginal route but more gastrointestinal side effects (EL1, grade A). Between 7 and 9 LMP, it does not seem necessary to repeat misoprostol dose whereas it should be repeated beyond 9 SA (grade B). Between 9 and 14 LMP, the dose of 400μg misoprostol given either vaginally, buccally or sublingually should be repeated every 3hours if needed (with a maximum of 5 doses) (EL2, grade B). There is no strong evidence supporting routine antibiotic prophylaxis for medical abortion (professional agreement). Rare contraindications

  4. Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa.

    Directory of Open Access Journals (Sweden)

    Heidi Bart Johnston

    Full Text Available To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit.Diagnostic accuracy study.Ethiopia, India and South Africa.Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam.Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa.The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.

  5. RU OK? The acceptability and feasibility of remote technologies for follow-up after early medical abortion.

    Science.gov (United States)

    Bracken, Hillary; Lohr, Patricia A; Taylor, Jeanette; Morroni, Chelsea; Winikoff, Beverly

    2014-07-01

    We tested the effectiveness and feasibility of remote communication technologies to increase follow-up after early medical abortion. Women (n=999) were randomized to 'remote' follow-up incorporating a low-sensitivity pregnancy test and standardized symptom questionnaire administered online, by text message or telephone by a non-clinical call center operator 2 weeks after treatment, or to 'clinic-based' follow-up with ultrasound at 1 week. Women in the clinic-based group who could not return performed a high-sensitivity pregnancy test at 3 weeks and had a telephone call with clinic staff. The primary outcome was completion of follow-up. Rates of complications, acceptability and preferences were compared. The overall follow-up rate did not differ by group {clinic-based, 73% vs. remote, 69%; risk ratio (RR) 1.0 [95% confidence interval (CI) 0.9-1.2]}. In the clinic-based group, 83% did not return for an ultrasound scan and were followed up by phone. In the remote group, follow-up by phone or text was more successful than online (text: 75.4%; phone: 73.7%; online: 46.5%, pafter medical abortion using remote communication is feasible and, for most women, preferable to a clinic visit. Medical abortion protocols typically use follow-up visits to ensure early identification of complications. This study demonstrates that follow-up can be achieved using remote communication technologies. This model may reduce the burden of multiple clinic visits on patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. "In patient" medical abortion versus surgical abortion: patient's satisfaction.

    Science.gov (United States)

    Di Carlo, Costantino; Savoia, Fabiana; Ferrara, Cinzia; Sglavo, Gabriella; Tommaselli, Giovanni Antonio; Giampaolino, Pierluigi; Cagnacci, Angelo; Nappi, Carmine

    2016-08-01

    To compare patients' satisfaction with medical and surgical abortion, implementing the Italian guidelines on medical abortion entailing an "in patient" procedure. A total of 1832 pregnant chose between surgical (vacuum aspiration) or medical abortion (mifepristone p.o. followed after 3 days by sublingual misoprostol) and expressed their expected satisfaction on a visual analog scale (VAS). A total of 885 women chose surgical and 947 medical abortion. The primary end-point was satisfaction VAS score 20 days after the procedure. Secondary end-points were: difference between pre- and post-abortion VAS score; difference in satisfaction VAS scores according to parity and previous abortion; incidence of side effects. VAS score was high in each group but significantly higher for the 1-day surgical than for the 3-day medical abortion procedure (7.9 ± 1.0 versus 7.2 ± 1.2; p after the treatment (6.9 ± 1.6 versus 7.9 ± 1.0, p abortion; women with a previous abortion preferred surgical abortion. Both procedures are considered satisfactory by the patients. Performing medical abortion as a 3-day "in patient" procedure, decreased women's satisfaction scores from their baseline expectations.

  7. Acceptability and feasibility of 400 μg buccal misoprostol after 200 mg mifepristone for early medical abortion in Georgia.

    Science.gov (United States)

    Tsereteli, Tamar; Chong, Erica; Louie, Karmen; Bokhua, Zaza; Winikoff, Beverly

    2016-10-01

    The aim of the study was to examine the acceptability and feasibility of early medical abortion using 200 mg mifepristone and 400 μg buccal misoprostol in Georgia, outside the capital city of Tbilisi. A total of 622 women in four regions of western and eastern Georgia who presented for termination of pregnancy at up to 63 d of gestation were enrolled in the study. In the western regions, women took one 200 mg pill of mifepristone in the clinic and were given the option of administering 400 μg misoprostol buccally, either at the clinic or at home, 24-48 h later. In the eastern region, women were given the option to take both drugs at home. Abortion status was determined 2 weeks after mifepristone administration. Ninety-five percent of participants had a successful abortion. Twenty-one percent of women in the eastern region elected to take mifepristone at home; nearly all participants in both regions (98%) chose to take misoprostol at home. Ninety-five percent of women were very satisfied or satisfied with the method, and 95% said they would prefer medical abortion for a future procedure. Medical abortion with mifepristone and 400 μg buccal misoprostol is an acceptable and feasible option for women in Georgia, outside the capital city of Tbilisi.

  8. Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation.

    Science.gov (United States)

    Cameron, Sharon T; Glasier, Anna; Dewart, Helen; Johnstone, Anne; Burnside, Audrey

    2012-07-01

    Telephone follow-up with a self-performed low-sensitivity urine pregnancy (LSUP) test was introduced at the Royal Infirmary of Edinburgh, Scotland, as an alternative to routine ultrasonography for confirming successful abortion at 2 weeks following early medical abortion (ultrasound. A service evaluation was conducted of the first 8 months of telephone follow-up consisting of a review of the numbers choosing this method of follow-up, the proportion successfully contacted and the efficacy for detecting ongoing pregnancies. In the last 3 months of the study, women were surveyed about their satisfaction with this method of follow-up. Opting for telephone follow-up were 476 out of 619 women (77%). Four women (1%) attended the clinic before telephone follow-up because of pain or bleeding. A total of 410 (87%) of the remaining 472 women were successfully contacted by telephone. Sixty women (15%) screened 'positive', three of whom had ongoing pregnancies, and one woman falsely screened 'negative'. The sensitivity of the telephone follow-up was 75% [95% confidence interval (CI) 30.1-95.4], and specificity was 86% (95% CI 82.2-89). The negative predictive value was 99.7% (95% CI 98.4-99.9), and positive predictive value was 5% (95% CI 1.7-13.7). All women surveyed (n=75) would recommend telephone follow-up to a friend. A telephone follow-up and an LSUP test at 2 weeks are effective for detecting ongoing pregnancy, have good follow-up rates and are popular choices for women. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. A qualitative study of women's decision to view or not view an ultrasound image before early medication abortion.

    Science.gov (United States)

    Cappiello, Joyce; Merrell, Joy; Rentschler, Dorothy

    2014-01-01

    Transvaginal ultrasounds are commonly performed for gestational dating of pregnancy before a medication abortion. This paper presents findings regarding women's perspectives on viewing the gestational dating ultrasound image, which arose from a study exploring women's medication abortion experience. By providing women the opportunity to talk about their medication abortion experience through open-ended interviews, women reported their experience of viewing or not viewing the ultrasound in detail, which to date has been underexplored. A constructivist, grounded theory approach was used. The purposive sample consisted of 18 women in the United States who experienced a medication abortion in the preceding 4 months. Not all women wanted to view the ultrasound; however, they all wanted a choice. Women wanted to view the image to confirm health and fertility, satisfy curiosity, and process their decision regarding the pregnancy. None of the women stated that they wanted to view the image as a prerequisite to making their decision to terminate the pregnancy; rather, viewing was a way to process their decision. Women wanted a choice of whether to view the ultrasound image because they felt it was their right to decide whether to access this aspect of their personal health information. They wanted providers to engage in a dialogue about viewing the image or not and to respect their decision. Providers need to be appropriately prepared to offer women the choice to view and to support women in their decision. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  10. STUDY OF WHO SAFE ABORTION REGIMEN IN MEDICAL ABORTIONS IN A TERTIARY CENTRE

    Directory of Open Access Journals (Sweden)

    Joylene Diana

    2015-07-01

    Full Text Available Medical abortion is the use of drugs to induce abortion of a fetus. Due to the advances in the field of research , numerous regimens have been formulated to ensure a fast and complete expulsion of the fetus. These regimens also aim to towards reduced post abortal side effects and to decrease the need for surgical evacuation post medical abortion. The objective of this cros s sectional analysis was to study the effectiveness of the WHO safe abortion regimen in a tertiary care hospital . METHODS: A total of 60 patients with pregnancies of 12 to 30 weeks of gestation and in whom a medical abortion was deemed necessary were chosen . After instituting the WHO SAFE ABORTION regimen they were analysed based on indication for pregnancy termination , onset of pain with WHO regimen and time of expulsion as well as post abortal side effects and the need for surgical evacuation due to failure of the WHO safe abortion regimen. Post abortion an ultrasound was done to confirm the success of the regimen . RESULTS: Majority of patients in our study was multiparous and Mean gestational age for pregnancy termination was 20.6 weeks . The most common indication for medical abortion was incidental diagnosis of fetal demise or fetal anomaly on ultrasonography ( 43.6% . The average duration for onset of pain was 3 hours and the average time needed for expulsion was 6 hours from the start of the Abortion regimen . The most common post abortal side effect was excessive bleeding . Only about 13.3 percent patients needed a surgical evacuation due to failure of the regimen. CONCLUSION: This study showed that the WHO safe abortion regimen is highly effective and a desirable method for medical termination of pregnancy , especially in early pregnancy and in patients in whom a surgical method of abortion could pose as a risk . The WHO SAFE ABORTION regimen has minimal post abortal side effects , need for surgical intervention and the time needed for expulsion is less. Hence it

  11. Elevated mRNA expression of PGF2alpha receptor splice variant 2(FP-V2) in human decidua is associated with incomplete mifepristone-misoprostol-induced early medical abortion by regulation of interleukin-8.

    NARCIS (Netherlands)

    Ma, C.; Feng, W.; Han, W.; Lu, Y.; Liu, W.; Sui, Y.; Zhao, N.; Lye, S.J.; Li, J.

    2016-01-01

    OBJECTIVE: The combination of mifepristone and misoprostol is an established method for the induction of early abortion, but 15% of women still experience the unpleasant side effect of incomplete medical abortion. The purpose of this study was to determine whether prostaglandin (PG) F2alpha receptor

  12. Fast-track vs. delayed insertion of the levonorgestrel-releasing intrauterine system after early medical abortion - a randomized trial.

    Science.gov (United States)

    Korjamo, Riina; Mentula, Maarit; Heikinheimo, Oskari

    2017-08-05

    To compare levonorgestrel (LNG) 52-mg intrauterine system (IUS) expulsion rates with fast-track (≤3 days) or delayed (2-4 weeks) insertion following mifepristone and misoprostol medical abortion. In this pilot trial, we randomized 108 women at ≤63 days' gestation to fast-track (n=55) or delayed (n=53) insertion. Follow-up visits occurred at 2-4 weeks, 3 months and 1 year. We assessed total and partial expulsion at 3 months and 1 year, adverse effects and bleeding profiles. We had follow-up data at 3 months and 1 year for 41 (74.5%) and 37 (69.8%) women in the fast-track group and 31 (56.4%) and 28 (52.8%) women in the delayed group. By 3 months, expulsion occurred in six (12.5%) women after fast-track and one (2.3%) woman after delayed insertion [risk ratio (RR) 5.50, 95% confidence interval (CI) 0.69-43.90]; most (n=5) of these were partial expulsions in the fast-track group. By 1 year, expulsion had occurred in seven (14.6%) and five (11.5%) women in the fast-track and delayed groups, respectively (RR 1.28, 95% CI 0.44-3.75). We found no differences in rates of vacuum aspiration, residual tissue, infection and bleeding or bleeding patterns within 3 months of insertion. Fast-track insertion of the LNG 52-mg IUS after medical abortion is feasible but may result in higher expulsion rates compared to delayed insertion. Due to lack of statistical power and high lost-to-follow-up rates, we were unable to fully address this question. Fast-tract initiation of LNG 52-mg IUS contraception after medical abortion is feasible. It results in higher expulsion rates than delayed insertion but may improve postabortal intrauterine contraception uptake. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The introduction of first trimester medical abortion in Armenia.

    Science.gov (United States)

    Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Vardanyan, Susanna; Winikoff, Beverly

    2015-02-01

    In Armenia, abortion is the main means of fertility regulation; however, before research activities were initiated only surgical methods were available and the quality of services was low in some areas. Our clinical study from 2008-2011 aimed to show that early medical abortion is an acceptable and feasible option. A total of 700 eligible women with pregnancies up to 63 days LMP presenting for abortion were recruited for the study in five locations. Participants took 200 mg mifepristone and 800 μg buccal misoprostol 24-48 hours later. They returned for a follow-up visit two weeks after mifepristone administration. 95% of the women had successful abortions and 95% were satisfied with the method. In 2012-2013, we conducted a follow-up assessment to examine the ongoing provision and quality of medical abortion services at the former research sites. Medical record reviews, interviews and observations were carried out three times approximately six months apart. The assessment found that all five sites had continued providing medical abortion, with about half of eligible women choosing the medical method. Four of the five sites were achieving high success rates. Staff turnover and the lack of trained providers likely contributed to the higher failure rate at the fifth site. These findings provide evidence that first trimester medical abortion is an acceptable and feasible option for Armenian women and providers, and that high quality services are being delivered. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  14. Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test.

    Science.gov (United States)

    Michie, Lucy; Cameron, Sharon T

    2014-05-01

    The objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service. A retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤9 weeks) and went home to expel the pregnancy was performed. Women who screened 'positive' at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected. A total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5-89.7) of those contacted screened 'negative'; no false negatives occurred. Eighty-three (13%, 95% CI 10.2-15.5) screened 'positive,' and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7-32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%-100%), and specificity was 88% (95% CI 84.9%-90.1%). The negative predictive value was 100% (95% CI 99.1%-100%), and positive predictive value was 3.6% (95% CI 0.9%-10.9%). A telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion. For most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self

  15. How do women seeking abortion choose between surgical and medical abortion? Perspectives from abortion service providers.

    Science.gov (United States)

    Newton, Danielle; Bayly, Chris; McNamee, Kathleen; Hardiman, Annarella; Bismark, Marie; Webster, Amy; Keogh, Louise

    2016-10-01

    Depending on availability, many Australian women seeking an abortion will be faced with the choice between surgical or medical abortion. Little is known about the factors that influence Australian women's choice of method. Through the perspectives of abortion service providers, this study aimed to explore the factors that contribute to Australian women's decision to have a surgical or medical abortion. In 2015, in-depth interviews were conducted with fifteen Victorian-based key informants (KIs) directly providing or working within a service offering medical abortion. Ten KIs were working at a service that also provided surgical abortion. Interviews were semi-structured, conducted face-to-face or over the telephone, transcribed verbatim and analysed thematically. KIs described varying levels of awareness of medical abortion, with poorer awareness in regional areas. When it comes to accessing information, women were informed by: their own research (often online); their own experiences and the experiences of others; and advice from health professionals. Women's reasons for choosing surgical or medical abortion range from the pragmatic (timing and location of the method, support at home) to the subjective (perceived risk, emotional impact, privacy, control, and physical ability). Women benefit from an alternative to surgical abortion and are well-placed to choose between the two methods, however, challenges remain to ensure that all women are enabled to make an informed choice. KIs identify the need to: promote the availability of medical abortion; address misconceptions about this method; and increase general practitioner involvement in the provision of medical abortion. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. [Medical and social implications of abortion].

    Science.gov (United States)

    Radu, A; Capra, G

    1988-01-01

    In the course of the evolution of human society the problem or idea of interrupting a pregnancy has been faced many times. Romania has adopted a mixed solution to the termination of pregnancy allowing abortions for medical, eugenic, and social reasons. The 1936 penal code allowed only medical abortion, but recent regulations have offered differing solutions. The old regulation not allowing termination of pregnancy or restricting it was in force with minor modifications until 1957. In 1966 a decree was issued that allowed women with 4 children an abortion for special reasons as determined by an abortion committee, but still therapeutic and strictly medical causes predominated. In 1985 a new regulation of medical law prohibited termination of normal pregnancy up to 28 weeks of gestation and infractions were punishable by law. Illegal induced abortion represents an antisocial manifestation that jeopardizes human relationships in society. Induced abortion occurs often in disintegrated family situations. The social implications of the phenomenon of birth are manyfold. Medical intervention is difficult because of the mutilating effect of abortion. The motives are a matter of reflection for physicians and jurists alike.

  17. Medical methods for first trimester abortion.

    Science.gov (United States)

    Kulier, Regina; Kapp, Nathalie; Gülmezoglu, A Metin; Hofmeyr, G Justus; Cheng, Linan; Campana, Aldo

    2011-11-09

    Surgical abortion by vacuum aspiration or dilatation and curettage has been the method of choice for early pregnancy termination since the 1960s. Medical abortion became an alternative method of first trimester pregnancy termination with the availability of prostaglandins in the early 1970s and anti-progesterones in the 1980s. The most widely researched drugs are prostaglandins (PGs) alone, mifepristone alone, methotrexate alone, mifepristone with prostaglandins and methotrexate with prostaglandins. To compare different medical methods for first trimester abortion. The Cochrane Controlled Trials Register, MEDLINE and Popline were systematically searched. Reference lists of retrieved papers were also searched. Experts in WHO/HRP were contacted. Types of studies Randomised controlled trials comparing different medical methods for abortion during first trimester (e.g. single drug, combination) were considered. Trials were assessed and included if they had adequate concealment of allocation, randomisation procedure and follow-up. Women, pregnant during the first trimester, undergoing medical abortion were the participants. The outcomes were mortality, failure to achieve complete abortion, surgical evacuation, ongoing pregnancy at follow-up, time until passing of conceptus, blood transfusion, side effects and women's dissatisfaction with the procedure. Two reviewers independently selected trials for inclusion from the results of the search strategy described previously.The selection of trials for inclusion in the review was performed independently by two reviewers after employing the search strategy described previously. Trials under consideration were evaluated for appropriateness for inclusion and methodological quality without consideration of their results. Data were processed using Revman software. Fifty-eight trials were included in the review. The effectiveness outcomes below refer to 'failure to achieve complete abortion' with the intended method unless

  18. Early pregnancy angiogenic markers and spontaneous abortion

    DEFF Research Database (Denmark)

    Andersen, Louise B; Dechend, Ralf; Karumanchi, S Ananth

    2016-01-01

    BACKGROUND: Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. OBJECTIVE: We investigated the association between...... maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. STUDY DESIGN: In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week ..., interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum

  19. The unmet need for safe abortion in Turkey: a role for medical abortion and training of medical students.

    Science.gov (United States)

    Mihciokur, Sare; Akin, Ayse; Dogan, Bahar Guciz; Ozvaris, Sevkat Bahar

    2015-02-01

    Abortion has been legal and safe in Turkey since 1983, but the unmet need for safe abortion services remains high. Many medical practitioners believe that the introduction of medical abortion would address this. However, since 2012 there has been political opposition to the provision of abortion services. The government has been threatening to restrict the law, and following an administrative change in booking of appointments, some hospital clinics that provided family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortion depends not only on permissive legislation but also political support and the ability of health professionals to provide it. We conducted a study among university medical school students in three provinces on their knowledge of abortion and abortion methods, to try to understand their future practice intentions. Pre-tested, structured, self-administered questionnaires were answered by 209 final-year medical students. The students' level of knowledge of abortion and abortion methods was very low. More than three-quarters had heard of surgical abortion, but only 56% mentioned medical abortion. Although nearly 90% supported making abortion services available in Turkey, their willingness to provide surgical abortion (16%) or medical abortion (15%) was low, due to lack of knowledge. Abortion care, including medical abortion, needs to be included in the medical school curriculum in order to safeguard this women's health service. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  20. 药物流产对妇女再次妊娠早孕期的影响探讨%IMPACT OF MEDICAL ABORTION ON EARLY PREGNANCY OF WOMEN WITH SUBSEQUENT PREGNANCY

    Institute of Scientific and Technical Information of China (English)

    金翠红

    2011-01-01

    [Objective]To explore the medical abortion on subsequent pregnancy.[Methods]A retrospective study was used to analyze the 368 pregnant women aged 23-33 years, among whom 126 cases with medical abortion history, 242 healthy pregnant women without medical abortion history.Compared the situations at early pregnancy (embryos whether to slop growing, whether with inevitable abortion or threatened abortion, the degree of response at early pregnancy, incidence rale of ectopie pregnancy).[Results]The situations al early pregnancy in medical abortion group and control group were not significantly different (P> 0.05).[Conclusion]Medical abortion has no significant adverse effects on early pregnancy of subsequent pregnancy, which is a safe, convenient and effective remedial measure after failed contraception.%[目的]探讨药物流产对再次妊娠的影响.[方法]采用回顾性研究,分析年龄在23~33岁有药物流产史后再次妊娠的健康妇女126例和无药物流产史的健康妊娠妇女242例,对早孕期(胚胎有无停育、难免流产有无、先兆流产有无、早孕反应程度、异位妊娠发生率)情况进行比较.[结果]药物流产组与无药物流产组妇女早孕期情况差异无统计学意义(P>0.05).[结论]药物流产对再次妊娠孕早期无明显不良影响,是一种安全、方便、有效的避孕失败后的补救措施.

  1. Prediction of late failure after medical abortion from serial beta-hCG measurements and ultrasonography

    DEFF Research Database (Denmark)

    Rørbye, C; Nørgaard, M; Nilas, Lisbeth

    2004-01-01

    BACKGROUND: Surgical treatment of failed medical abortion may be performed several weeks after initiation of the abortion. There are no recognized methods for early identification of these late failures. We assessed the prognostic values of beta-hCG and ultrasonography in predicting late failure...... after medical abortion. METHODS: A total of 694 consecutive women with gestational age (GA) abortion with mifepristone and gemeprost. Measurement of the endometrial...... thickness by ultrasonography was performed on day 15 after induction of medical abortion. Failures diagnosed after day 15 and within 15 weeks were identified and classified as late failures. All interventions in this group were due to bleeding problems. The predictive values of different absolute...

  2. Medical abortion. defining success and categorizing failures

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Vestermark, Vibeke;

    2003-01-01

    Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks. The differe......Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks...

  3. Expanding medical abortion: can medical abortion be effectively provided without the routine use of ultrasound?

    Science.gov (United States)

    Kaneshiro, Bliss; Edelman, Alison; Sneeringer, Robyn K; Ponce de Leon, Rodolfo Gomez

    2011-03-01

    Medical abortion studies have traditionally relied on ultrasound to confirm gestational age, intrauterine location and abortion completion. However, the routine dependence on ultrasound can limit access to safe services for women living in low resource settings that are often most in need of safe abortion care. This review discusses the literature surrounding the safe provision of medical abortion without the routine use of ultrasonography and concludes that clinicians can use the reported last menstrual period (LMP) and physical examination to reasonably estimate gestational age. Completed pregnancy expulsion can be confirmed primarily through history and physical examination with some studies indicating that urine pregnancy tests may also play a limited role. Central to the discussion of whether medical abortion can be provided in most low resource settings without the routine use of ultrasonography is the fact that the mifepristone-misoprostol regimen is a highly effective procedure for pregnancy termination through 63 days' gestation. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

    OpenAIRE

    Nai-peng Tey; Siew-yong Yew; Wah-yun Low; Lela Su'ut; Prachi Renjhen; Huang, M. S. L.; Wen-ting Tong; Siow-li Lai

    2012-01-01

    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 knowled...

  5. Medical abortion practices : a survey of National Abortion Federation members in the United States

    NARCIS (Netherlands)

    Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

    2008-01-01

    Background: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation

  6. Medical abortion practices : a survey of National Abortion Federation members in the United States

    NARCIS (Netherlands)

    Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

    2008-01-01

    Background: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (

  7. Clinical Effects of Lithospermum Ruderal on Medical Abortion by Mifepristone with Misoprostol

    Institute of Scientific and Technical Information of China (English)

    法韫玉; 刘建华; 孙桦; 曹爱华

    1996-01-01

    Early pregnancies (0. 05 ). In all, the medical abortion by mifepristone and Lithospermum Ruderal with misoprostol was even more successful, with less bleeding time. Therefore it is essential to make researches on the auxiliary effects of Lithospermum Ruderal on the medical abortion by mifepristone with misoprostol.

  8. Medical abortion. defining success and categorizing failures

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Vestermark, Vibeke

    2003-01-01

    Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks. The differe......Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks....... The difference in short- and long-term success rates increased with increasing gestational age. The majority of failures (76%) were diagnosed more than 2 weeks after initiation of the abortion. At a 2-week follow-up visit, the women who turned out to be failures had a larger endometrial width, higher beta......-hCG values and smaller reductions of beta-hCG than those treated successfully. To optimize comparison of success rates after different medical abortion regimens, we suggest that the criteria for success are stated clearly, that the success rates are stratified according to gestational age...

  9. Second trimester medical abortion – perceptions and experiences

    OpenAIRE

    Andersson, Inga-Maj

    2015-01-01

    Introduction Second-trimester abortions account for 10 - 15 % of all induced abortions worldwide with a wide variation of permits in different countries. In Sweden, second-trimester abortions account for less than 10 % of the total number of induced abortions. The indication can be fetal or socioeconomic. The medical abortion regimen with mifepristone and misoprostol, is the regimen used in Sweden. The treatment with misoprostol often causes painful contractions, and prophylactic as we...

  10. Medical students' attitudes toward abortion education: Malaysian perspective.

    Directory of Open Access Journals (Sweden)

    Nai-peng Tey

    Full Text Available 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.

  11. Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

    Science.gov (United States)

    Tey, Nai-peng; Yew, Siew-yong; Low, Wah-yun; Su’ut, Lela; Renjhen, Prachi; Huang, M. S. L.; Tong, Wen-ting; Lai, Siow-li

    2012-01-01

    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. PMID:23300600

  12. Medical students' attitudes toward abortion education: Malaysian perspective.

    Science.gov (United States)

    Tey, Nai-peng; Yew, Siew-yong; Low, Wah-yun; Su'ut, Lela; Renjhen, Prachi; Huang, M S L; Tong, Wen-ting; Lai, Siow-li

    2012-01-01

    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. 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. 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.

  13. [Repeat induced abortion: A multicenter study on medical abortions in France in 2014].

    Science.gov (United States)

    Opatowski, M; Bardy, F; David, P; Dunbavand, A; Saurel-Cubizolles, M-J

    2017-01-01

    To describe the social characteristics of women seeking a medical abortion, and the conditions of that abortion, according to whether they had one or more previous induced abortions. An observational study was carried out in 11 French units in 2013-2014, among women 18 years or older. A self-administered questionnaire on the abortion context and social situation was given to them, as well as a diary to record the pain level for each of five days following the mifepristone intake. The sample included 453 women. Among the respondents, 22% had had one previous abortion and 8% had had two or more. Women having had a previous voluntary abortion were more often isolated and in a poorer social situation than women having their first abortion. Better support for contraception after abortion could reduce the number of repeated abortions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. STUDY OF WHO SAFE ABORTION REGIMEN IN MEDICAL ABORTIONS IN A TERTIARY CENTRE

    OpenAIRE

    Joylene Diana; Sujaya V.

    2015-01-01

    Medical abortion is the use of drugs to induce abortion of a fetus. Due to the advances in the field of research , numerous regimens have been formulated to ensure a fast and complete expulsion of the fetus. These regimens also aim to towards reduced post abortal side effects and to decrease the need for surgical evacuation ...

  15. Mifepristone With Buccal Misoprostol for Medical Abortion

    OpenAIRE

    2015-01-01

    © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. Objective: To summarize clinical outcomes and adverse effects of medical abortion regimens consisting of mifepristone followed by buccal misoprostol in pregnancies through 70 days of gestation. Data Sources: We used PubMed, ClinicalTrials.gov, and reference lists from published reports to identify relevant studies published between November 2005 and January 2015 usi...

  16. Factors affecting attitudes towards medical abortion in Lithuania

    DEFF Research Database (Denmark)

    Lazarus, Jeff; Nielsen, Stine; Jakubcionyte, Rita

    2006-01-01

    Surgical abortion in Lithuania is governed by a 1994 ministerial decree that made it legal for any woman 16 or older. This article seeks to determine the key demographic factors in Lithuanian attitudes towards medical abortion, which is currently not legal.......Surgical abortion in Lithuania is governed by a 1994 ministerial decree that made it legal for any woman 16 or older. This article seeks to determine the key demographic factors in Lithuanian attitudes towards medical abortion, which is currently not legal....

  17. Medical abortion and the risk of subsequent adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Virk, Jasveer; Zhang, Jun; Olsen, Jørn

    2007-01-01

    BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...

  18. Update on medical abortion: simplifying the process for women.

    Science.gov (United States)

    Whaley, Natalie S; Burke, Anne E

    2015-12-01

    Medical abortion using mifepristone and misoprostol comprises a growing proportion of abortions performed in the United States. Simplifying the process of medical abortion can optimize use of resources and improve care for women. Medical abortion using evidence-based protocols is effective through 70 days' gestation. The requirement of a follow-up office visit with a transvaginal ultrasound to ensure completion of medical abortion is safely and effectively replaced with self-administered low-sensitivity or semiquantitative urine pregnancy tests and remote communication with women. Most contraceptive options can be initiated the same day as mifepristone administration to improve contraceptive use after medical abortion. State legislatures continue to pass laws that threaten evidence-based medical abortion practices. Such efforts ultimately limit access to well-tolerated and effective medical abortion services. Research supports simplification of the follow-up protocol for medical abortion, and provision of the contraceptive implant and progestin injectable for postabortion contraception the same day as mifepristone administration. With disregard to its documented safety and efficacy, legislative challenges persist as significant challenges to provision of evidence-based medical abortion.

  19. Legal, Social and Psycho-Medical Effects of Abortion

    OpenAIRE

    2012-01-01

    This work deals with the relationship between induced abortion and mental health with a special focus on the area of political controversy.  This article explores the historical background of the abortion and its legislative implications in Europe with special reference to Bosnia and Herzegovina. This work is based on etnographich, analitical and historical aproaches. It explains abortion in medical terms and analyzes the psychological effects of the abortion. This is a significant and challa...

  20. Knowledge of medication abortion among adolescent medicine providers.

    Science.gov (United States)

    Coles, Mandy S; Makino, Kevin K; Phelps, Rachael

    2012-04-01

    Adolescents are at high risk for unintended pregnancy and abortion. The purpose of this study was to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy. Using an online questionnaire, a survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine. We conducted χ(2) analyses to evaluate the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Furthermore, we examined the relationship between providers' self-assessed and actual knowledge using ANOVA. We surveyed 797 providers, with a 54% response rate. Almost 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was knowledge categories, except for expected outcomes. Medication abortion knowledge did not differ by adolescent medicine fellowship completion. Only 32% of respondents had very good knowledge, and self-assessed knowledge minimally predicted actual knowledge (r(2) = .08). Knowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians, and self-assessment poorly predicts actual knowledge. To ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  1. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia.

    Science.gov (United States)

    Dawson, Angela; Bateson, Deborah; Estoesta, Jane; Sullivan, Elizabeth

    2016-10-22

    Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. This review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical

  2. Medical students' attitudes toward abortion and other reproductive health services.

    Science.gov (United States)

    Rosenblatt, R A; Robinson, K B; Larson, E H; Dobie, S A

    1999-03-01

    This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.

  3. Sonographic patterns of the endometrium in assessment of medical abortion outcomes.

    Science.gov (United States)

    Tzeng, Chii-Ruey; Hwang, Jiann-Loung; Au, Heng-Kien; Chien, Li-Wei

    2013-07-01

    We aimed to define endometrial pattern and endometrial thickness in predicting the outcome of early medical abortion. While blinded to outcomes of abortion, we retrospectively reviewed the ultrasound scan performed 14-21 days after medical abortion. We assessed the endometrial pattern and endometrial thickness. A total of 943 women at or before 56 days of gestation who underwent medical abortions were included. Abortion was induced with mifepristone (600 mg) orally followed 48 h later with oral misoprostol (600 mcg). A successful medical abortion was defined as complete abortion without surgical intervention. Three sonographic patterns (homogenous, heterogeneous and multilayered) were devised to correlate with the outcome. Of the 940 women, 92 (9.8%) had failed medical abortions. Eighty-seven (94.6%) patients with failed treatment outcomes had a heterogeneous pattern, while no patients with failed treatments had a multilayered pattern. Based on multivariable logistic regression, women who had an endometrial thickness in the range of 10-15 or >15 mm were more likely to have failed outcomes than those with a thickness 10 mm in combination with a heterogeneous pattern had the highest balanced accuracy in the prediction of failed outcome (81.9%; 95% CI, 77.6-86.3). Women with a multilayered pattern could be reassured that they have successful medical abortion, while those with a heterogeneous pattern and/or endometrium >10 mm may need follow-up. Sonographic endometrial pattern and endometrial thickness may serve as objective criteria in the management of early medical abortions. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Abortion choices among women in Cambodia after introduction of a socially marketed medicated abortion product.

    Science.gov (United States)

    Sotheary, Khim; Long, Dianna; Mundy, Gary; Madan, Yasmin; Blumenthal, Paul D

    2017-02-01

    To assess whether a social marketing initiative focusing on medicated abortion via a mifepristone/misoprostol "combipack" has contributed to reducing unsafe abortion in Cambodia. In a questionnaire-based cross-sectional study, annual household surveys were conducted across 13 Cambodian provinces in 2010, 2011, and 2012. One married woman of reproductive age who was not pregnant and did not wish to be within the next 2 years in each randomly selected household was approached for inclusion. Participants were interviewed using a structured questionnaire. The questionnaire was completed by 1843 women in 2010, 2068 in 2011, and 2059 in 2012. Manual vacuum aspiration was reported by 61 (72.6%) of 84 women surveyed in 2010 who reported an abortion in the previous 12 months, compared with only 28 (52.8%) of 53 in 2012 (P=0.001). The numbers of women undergoing medicated abortion increased from 22 (26.2%) of 84 in 2010 to 27 (49.1%) of 53 in 2012 (P=0.003), whereas the numbers undergoing unsafe abortion decreased from 4 (4.8%) in 2010 to 0 in 2012 (P=0.051). Social marketing of medication abortion coupled with provider training in clinical and behavioral change could have contributed to a reduction in the prevalence of unsafe abortion and shifted the types of abortion performed in Cambodia, while not increasing the overall number of abortions. © 2016 International Federation of Gynecology and Obstetrics.

  5. Delivering medical abortion at scale: a study of the retail market for medical abortion in Madhya Pradesh, India.

    Directory of Open Access Journals (Sweden)

    Timothy Powell-Jackson

    Full Text Available Medical abortion (mifepristone and misoprostol has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972.We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion.Medical abortion was offered to undercover patients by 256 (71.3% pharmacists and 24 different brands were identified. Two thirds (68.5% of pharmacists stated that abortion was illegal in India. Only 106 (38.5% pharmacists asked clients the timing of the last menstrual period and 38 (13.8% requested to see a doctor's prescription - a legal requirement in India. Only 59 (21.5% pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3% provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4% gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent.The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women's health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion.

  6. Delivering medical abortion at scale: a study of the retail market for medical abortion in Madhya Pradesh, India.

    Science.gov (United States)

    Powell-Jackson, Timothy; Acharya, Rajib; Filippi, Veronique; Ronsmans, Carine

    2015-01-01

    Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972. We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion. Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor's prescription - a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent. The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women's health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion.

  7. Latin American women’s experiences with medical abortion in settings where abortion is legally restricted

    Directory of Open Access Journals (Sweden)

    Zamberlin Nina

    2012-12-01

    Full Text Available Abstract Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used. Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades. This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal. Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1 a medically supervised abortion in a clandestine clinic or 2 complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support. Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it

  8. Medication abortion in missed abortion up to 13 weeks amenorrhoea: a prospective study

    Directory of Open Access Journals (Sweden)

    Divya R. Prasad

    2016-11-01

    Conclusions: Medication abortion is a safe and effective method for the termination of missed abortion up to 13 weeks of pregnancy with fewer complications thus reducing the need for surgical methods. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3840-3842

  9. Practice of self-medication of mifepristone-misoprostol drug combination for medical abortion

    Directory of Open Access Journals (Sweden)

    Sushila Godara

    2014-06-01

    However, the use of mifepristone and ndash; misoprostol combination for medical abortion used as self-medication, is rising due to changing socio-cultural practices and increased awareness among women for the termination of early pregnancy up to 63 days. It is observed that many women indulge in the practice of self-medication for termination of pregnancy. They take medicines either from local pharmacists, nurses, on advice of relatives, friends, husband, neighbors, newspaper articles, radio, television, magazines or any other such unauthorized sources for termination of pregnancy which mostly leads to incomplete abortion or many complications. It is observed that only few number of women have complete abortion with self-medication from an unauthorized source and moreover they suffer from pain and heavy bleeding when compared to normal menstrual flow. It is noticed that now-a-days, these drugs are used irrationally and nonjudiciously. Women are thus advised to take proper regimen of mifepristone and misoprostol under the guidance of an authorized practitioner and if they still fail to abort, then they have to undergo surgical evacuation that is, vaccum aspiration for termination of pregnancy. [Int J Basic Clin Pharmacol 2014; 3(3.000: 572-573

  10. Women's experience of decision-making with medication abortion.

    Science.gov (United States)

    Cappiello, Joyce; Merrell, Joy; Rentschler, Dorothy

    2014-01-01

    Medication abortion received regulatory approval in 2001 in the United States with healthcare providers increasingly offering this method. However, most studies in the United States have only explored acceptability and decision-making with women who participated in clinical trials. Overall, the literature on women's experience with a method that it is now widely available is under research in the United States. To describe and analyze the women's experience as they choose the option of and experienced the process of medication abortion. A constructivist grounded theory study. Outpatient clinical offices in a three-state area in the northeast region of the United States. A purposive sample of 22 women aged 16 to 45 who experienced a medication abortion. Data were collected by in-depth, open-ended, face-to-face interviews. The constant comparative method was used for analysis. Five interwoven categories emerged regarding women's initial decision to have a medication abortion: choosing a natural process, avoiding "surgery," respecting the "baby," scheduling to meet needs, and appreciating the home setting. The enhanced sense of personal control associated with the medication abortion option was the overriding reason given for choosing this method. This study contributes to the paucity of literature on the reasons why women choose medication abortion. It is important for nurses to understand the complexity of medication abortion decision-making so that they can effectively support women through this process.

  11. 药物与人工流产终止早期妊娠的临床比较%Clinical comparison on termination of early pregnancy with medical abortion and induced abortion

    Institute of Scientific and Technical Information of China (English)

    柯梅英; 岑秋妹; 冯亦芳

    2014-01-01

    目的:比较药物流产和人工流产两种不同方式在终止早期妊娠上的被接受程度以及临床效果。方法选取2008~2012年在茂名市人口和计划生育综合服务中心终止早期妊娠的286例受术者,根据终止妊娠方式的不同,分为药物流产组(128例)和人工流产组(158例),比较两组受术者终止妊娠的临床效果以及再次意外妊娠后会选择的终止妊娠方式。结果两组在完全流产率、不完全流产率、人工流产综合征发生率、流产后阴道出血时间上比较差异无统计学意义(P >0.05)。两组再次意外妊娠后会选择的终止妊娠方式比较,差异有统计学意义(P 0. 05). Significant difference were fOund between twO grOuPs in chOOsing the terminatiOn methOd Of Pregnancy with anOther unexPected Pregnancy(P < 0. 05). Conclusion Drug abOrtiOn and induced abOrtiOn in the terminatiOn Of early Pregnancy have different advantages and disadvantages,aPPrOPriate terminatiOn Of early Pregnancy shOuld be chOsen accOrding tO the Patientˊs sPecific situatiOn and PreviOus abOrtiOn histOry tO imPrOve the clinical effect.

  12. Legal, Social and Psycho-Medical Effects of Abortion

    Directory of Open Access Journals (Sweden)

    Bisera Mavrić

    2012-10-01

    Full Text Available This work deals with the relationship between induced abortion and mental health with a special focus on the area of political controversy. This article explores the historical background of the abortion and its legislative implications in Europe with special reference to Bosnia and Herzegovina. This work is based on etnographich, analitical and historical aproaches. It explains abortion in medical terms and analyzes the psychological effects of the abortion. This is a significant and challanging topic for those who find themselves facing the moral dilemma of whether or not to terminate a pregnancy. Problems of controversy are numerous. Is abortion a murder or not? Is fetus a person or not? When it becomes the one if ever till the birth? If abortion is not morally wrong, that doesn't mean that it's right to have an abortion. If abortion is morally wrong, that doesn't mean that it is always impermissible to have an abortion. The comon dilema is whether having an abortion is less wrong than the alternatives. These are some of the questions this paper deals with.

  13. Can ultrasound predict IUD expulsion after medical abortion?

    Science.gov (United States)

    Shimoni, Noa'a; Davis, Anne; Westhoff, Carolyn

    2014-05-01

    Our randomized trial compared early and delayed intrauterine device (IUD) insertion following medical abortion. In this planned substudy, we explore if endometrial thickness and initial IUD position were associated with IUD expulsion. We also describe IUD movement within the uterus during the 6 months after insertion. We recruited women undergoing medical abortion and choosing the copper IUD for contraception (n=156). Participants were randomly assigned to early insertion 1 week after mifepristone or delayed insertion 4-6 weeks later. We measured endometrial thickness by transvaginal sonogram 1 week after abortion and IUD distance from the fundal aspect of the endometrial cavity three times: at insertion, 6-8 weeks later and at 6 months. We analyzed endometrial thickness in 113 women, baseline IUD position in 114 women and IUD movement in 65 women. Women who expelled IUDs (n=15) had slightly thicker endometria (p=.007) and slightly lower baseline IUD positions (p=.03) than those who retained IUDs, but no clear cutoffs emerged in the receiver operating characteristic curve analysis. Retained IUDs commonly moved up and down throughout the 6 months (from 14 mm towards the fundus to 32 mm towards the cervix). Overall, retained IUDs moved a median of 2mm towards the cervix between insertion and exit (pabortion, the risk of IUD expulsion increases with thicker endometria and lower baseline position. Since no clear cutoffs emerged in the analysis and expulsion remained uncommon even with thicker endometria, we do not recommend restricting IUD insertion based on ultrasound data. Copper T IUDs often move within the uterus without expelling. Expulsion is uncommon, and we do not recommend restricting IUD insertion based on ultrasound data. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Prediction of late failure after medical abortion from serial beta-hCG measurements and ultrasonography

    DEFF Research Database (Denmark)

    Rørbye, C; Nørgaard, M; Nilas, Lisbeth

    2004-01-01

    BACKGROUND: Surgical treatment of failed medical abortion may be performed several weeks after initiation of the abortion. There are no recognized methods for early identification of these late failures. We assessed the prognostic values of beta-hCG and ultrasonography in predicting late failure...... after medical abortion. METHODS: A total of 694 consecutive women with gestational age (GA) CG measurements initially on the day of treatment and on day 8 and day 15, after the medically induced abortion with mifepristone and gemeprost. Measurement of the endometrial...... and relative beta-hCG levels and different endometrial thickness were analysed. RESULTS: Of all failures in the study period, 65% (32) were diagnosed after the 2 week follow-up, and categorized as late failures. The absolute and the relative beta-hCG values on days 8 and 15 as well as the endometrial thickness...

  15. A comparison of transabdominal and transvaginal ultrasonography for determination of gestational age and clinical outcomes in women undergoing early medical abortion.

    Science.gov (United States)

    Lohr, Patricia A; Reeves, Matthew F; Creinin, Mitchell D

    2010-03-01

    We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion. We included all 120 women enrolled in a study of simultaneous oral mifepristone and buccal misoprostol for abortion through 63 days' gestation. Vaginal and abdominal ultrasound examinations were performed before and 24 h after medication administration. Visualization of a gestational sac and embryonic pole and presence or absence of cardiac activity were recorded. Sensitivity and specificity were calculated with the results from vaginal ultrasonography as the gold standard. The effect of body mass index (BMI) on ultrasound findings was also assessed. Before treatment, the sensitivities of abdominal ultrasonography were 100% (95% CI 97-100) and 68% (95% CI 58-77) for presence of a gestational sac and an embryonic pole, respectively. Overall, abdominal imaging underestimated mean gestational age by 1.6 days (95% CI 1.0-2.2). After treatment, abdominal ultrasonography missed three of 34 retained gestational sacs (sensitivity 91%, 95% CI 76-98%). Fourteen women had gestational cardiac activity by vaginal ultrasound at follow-up. Abdominal imaging identified the gestational sac in all cases, but cardiac motion was only visible in 10 (71%, 95% CI 42-92%). For every 10-point increase in BMI, the odds ratio for missing an embryonic pole at baseline was 2.8 (95% CI 1.5-5.0). Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  16. Awareness regarding abortions and medical termination of pregnancy act among medical students in Puducherry, India

    Directory of Open Access Journals (Sweden)

    Lal Bahadur Palo

    2015-10-01

    Conclusions: Legalization of abortions through the MTP Act in India resulted in a considerable decrease in maternal mortality through the decline in abortions but it has failed to ensure effective implementation and access to medically safe abortion services. Training in basic contraceptive counseling and abortion care should be incorporated in basic medical education in India. [Int J Res Med Sci 2015; 3(10.000: 2729-2733

  17. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...... extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA

  18. Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

    Science.gov (United States)

    Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

    2016-01-01

    Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

  19. First-trimester medical abortion practices in Canada

    Science.gov (United States)

    Guilbert, Edith R.; Hayden, Althea S.; Jones, Heidi E.; White, Katharine O’Connell; Steven Lichtenberg, E.; Paul, Maureen; Norman, Wendy V.

    2016-01-01

    Abstract Objective To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Design Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Setting Canada. Participants A total of 94 abortion facilities were identified. Main outcome measures Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ2 and t tests. Results A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. Conclusion In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. PMID:28192275

  20. First-trimester medical abortion practices in Canada: National survey.

    Science.gov (United States)

    Guilbert, Edith R; Hayden, Althea S; Jones, Heidi E; White, Katharine O'Connell; Steven Lichtenberg, E; Paul, Maureen; Norman, Wendy V

    2016-04-01

    To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Canada. A total of 94 abortion facilities were identified. Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ(2) and t tests. A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. Copyright© the College of Family Physicians of Canada.

  1. A randomized trial of hospital vs home self administration of vaginal misoprostol for medical abortion.

    Science.gov (United States)

    Shrestha, A; Sedhai, L B

    2014-01-01

    A combination of mifepristone followed after 24 hrs by misoprostol has proved a safe and effective abortifacient for termination of early pregnancy. Home use of misoprostol for medical abortion is still controversial in many countries including ours where women's literacy rate is low. Particularly in developing countries, this method markedly decreased the hospital visit which would be beneficial to patients and hospital staff. To see whether the home self administration of vaginal misoprostol was equally effective as administered by trained staff in terms of successful termination of early pregnancy. Secondary outcomes were bleeding and pain duration during medical abortion, side effects, reason for termination of pregnancy and women's acceptability of the procedure. One hundred and eighty eight women requesting medical abortion with pregnancy less than 63 days gestation were randomized into two groups either self administration of vaginal misoprostol (800 mcg) at home or hospital administration 24 hours after oral 200 mg mifepristone. Ultrasound was performed after 14 days to confirm complete abortion. The overall success rate was similar in two groups: 89.13% on home group Vs 86.9% in hospital group. Eleven out of 18 women (61.1%) having incomplete abortion had successful termination after 2nd dose misoprostol( 400 mcg). None of the women had continued pregnancy. Multigravida had slightly higher risk of failure (R.R: 1.04). Home self administration of vaginal misoprostol was safe and effective for early termination of medical abortion and was acceptable. Use of extra dose of misoprostol has advantage of higher completion rate of abortion.

  2. Abortion Services and Military Medical Facilities

    Science.gov (United States)

    2010-07-08

    general.83 However, the Senate agreed, subject to certain limitations, to consider legislation, S. 1104,84 “to provide for parental involvement in...Senators Frist and Brownback), would “provide for parental involvement in the performance of abortions for dependent children of members of the Armed

  3. Significant adverse events and outcomes after medical abortion.

    Science.gov (United States)

    Cleland, Kelly; Creinin, Mitchell D; Nucatola, Deborah; Nshom, Montsine; Trussell, James

    2013-01-01

    To analyze rates of significant adverse events and outcomes in women having a medical abortion at Planned Parenthood health centers in 2009 and 2010 and to identify changes in the rates of adverse events and outcomes between the 2 years. In this database review we analyzed data from Planned Parenthood affiliates that provided medical abortion in 2009 and 2010 almost exclusively using an evidence-based buccal misoprostol regimen. We evaluated the incidence of six clinically significant adverse events (hospital admission, blood transfusion, emergency department treatment, intravenous antibiotics administration, infection, and death) and two significant outcomes (ongoing pregnancy and ectopic pregnancy diagnosed after medical abortion treatment was initiated). We calculated an overall rate as well as rates for each event and identified changes between the 2 years. Among 233,805 medical abortions provided in 2009 and 2010, significant adverse events or outcomes were reported in 1,530 cases (0.65%). There was no statistically significant difference in overall rates between years. The most common significant outcome was ongoing intrauterine pregnancy (0.50%); significant adverse events occurred in 0.16% of cases. One patient death occurred as a result of an undiagnosed ectopic pregnancy. Only rates for emergency department treatment and blood transfusion differed by year and were slightly higher in 2010. Review of this large data set reinforces the safety of the evidence-based medical abortion regimen. III.

  4. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ...To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...

  5. Management of early pregnancy failure and induced abortion by family medicine educators.

    Science.gov (United States)

    Herbitter, Cara; Bennett, Ariana; Schubert, Finn D; Bennett, Ian M; Gold, Marji

    2013-01-01

    Reproductive health care, including treatment of early pregnancy failure (EPF) and induced abortion, is an integral part of patient-centered care provided by family physicians, but data suggest that comprehensive training is not widely available to family medicine residents. The purpose of this study was to assess EPF and induced abortion management practices and attitudes of family medicine physician educators throughout the United States and Canada. These data were collected as part of a cross-sectional survey conducted by the Council of Academic Family Medicine Educational Research Alliance that was distributed via E-mail to 3152 practicing physician members of Council of Academic Family Medicine organizations. The vast majority of respondents (88.2%) had treated EPF, whereas few respondents (15.3%) had provided induced medication or aspiration abortions. Of those who had treated EPF, most had offered medication management (72.7%), whereas a minority had provided aspiration management (16.4%). Almost all respondents (95%) agreed that EPF management is within the scope of family medicine, and nearly three-quarters (73.2%) agreed that early induced abortion is within the scope of family medicine. Our findings suggest that family physician educators are more experienced with EPF management than elective abortion. Given the overlap of skills needed for provision of these services, there is the potential to increase the number of family physician faculty members providing induced abortions.

  6. [Knowledge and attitudes of medical students on decriminalized induced abortion].

    Science.gov (United States)

    Quintero-Roa, Eliana M; Ochoa-Vera, Miguel E

    2015-12-01

    Objective To explore if the academic exposure to legal abortion affects the knowledge and attitudes of medical students. Method To asses this relationship, both qualitative and quantitative approaches were performed. We analyzed a medical student cohort enrolled in gynecology and obstetrics at two accredited universities in Bucaramanga, Colombia during the second half of 2011. Students were invited to participate in two anonymous surveys. One survey was conducted in the first three weeks of the semester, and the second was done in the last three weeks. A quantitative approach was taken by a group interview of two random groups of participants. One group was composed of medical students of gynecology and obstetrics (fourth year of medicine), and the other group was composed of medical students in their last year (internal medical students). Results The items pregnancy with risk to the mother´s life, or affected by a non-viable fetal malformation, or result of rape were recognized and accepted. 46% of the participants changed their attitude about legal abortion at the end of the semester. Three out of every four participants changed their attitude to accept the decriminalized conditions, while one out of every four people had the opposite change of opinion. Medical student´s don´t believe that general practitioners are trained to advice patients in these cases. Conclusions Educating and training general practitioners in issues related to legal abortion may decrease the risk of inadequate medical assessment in cases of legal abortion.

  7. Studies on Expression of IGF-II Gene in Deciduas Derived from Medical Abortion Patients

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To determine the effect of insulin-like growth factor-Ⅱ (IGF-Ⅱ ) upon the maintenance of decidua in early pregnancy and its relationship with progesterone, as well as its role in medical abortion. Materials & Methods Decidua tissue was obtained from 28 women who undergoing surgical abortion and 39 for medical abortion respectively at 5~7 weeks of gestation. The extracted total RNA was reversely transcripted and amplified by PCR with spe cific primers (IGF-Ⅱ and β-actin). The products were semi-quantitated by MIAS 300 system and qualitatively analyzed by southern blotting. Results The expression of IGF-Ⅱ gene in decidua from surgical abortion was signif icantly higher than that from medical abortion (P<0.05). The average IGF-Ⅱ gene transcription values were 1. 54±0.79 and 0.72±0.39 respectively. The results of southern blotting proved qualitatively that the RT-PCR products were IGF-Ⅱ cDNA. Conclusion IGF-Ⅱ plays a role in the maintenance of decidua in early pregnancy. It may act as a mediator of progestin. It's also involved in the molecular mechanism of mifepristone.

  8. Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse-Midwife Provision of Medical Abortion, 2011-2013.

    Science.gov (United States)

    Andersen, Kathryn L; Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

    2016-01-01

    The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11). By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. © 2016 The Authors. The Journal of Midwifery and Women's Health, published by Wiley Periodicals, Inc., on behalf of the American College of Nurse-Midwives.

  9. Medical abortion practices among private providers in Vietnam

    Directory of Open Access Journals (Sweden)

    Park MH

    2013-09-01

    Full Text Available Min Hae Park,1 Thang Huu Nguyen,2 Anh Thi Ngoc Dang,2 Thoai Dinh Ngo1 1Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK; 2Research and Metrics Team, Marie Stopes International Vietnam, Ha Noi, Vietnam Objective: To describe medical abortion (MA practices among private providers in Vietnam. Methods: The study subjects were women (n = 258 undergoing early MA through 12 private providers in Hanoi during February-June 2012. The women were interviewed on the day of their procedure and were followed up by telephone 14 days after mifepristone administration. Results: Of the 258 women in the study, 97% used a regimen of mifepristone plus misoprostol; 80% were instructed to administer misoprostol at home. MA resulted in a complete termination in 90.8% of cases. All women were provided with information on potential complications and were instructed to return for a follow-up visit. We successfully followed up 77.5% (n = 200 of participants by telephone, while nearly two-thirds of women returned to the clinic for a follow-up visit. At follow up, 39.5% of women reported having used a Help line service, while 7% had sought help from a health provider. A high unmet need for postabortion family planning was identified. Conclusion: Follow up of women, postabortion care, and the provision of family planning have been identified as important areas to address for strengthening MA services in the private sector in Vietnam. Keywords: misoprostol, mifepristone, abortion, mhealth, Vietnam

  10. Reduction in infection-related mortality since modifications in the regimen of medical abortion.

    Science.gov (United States)

    Trussell, James; Nucatola, Deborah; Fjerstad, Mary; Lichtenberg, E Steve

    2014-03-01

    From 2001 to March 2006 Planned Parenthood health centers throughout the United States provided medical abortion by a regimen of oral mifepristone followed 24-48 h later by vaginal misoprostol. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic coverage for all medical abortions. We performed a retrospective analysis of Planned Parenthood cases assessing the rates of mortality caused by infection following medical abortion during a time period when misoprostol was administered vaginally (2001 through March 2006), as compared with the rate from April 2006 to the end of 2012 after a change to buccal administration of misoprostol and after initiation of new infection-reduction strategies. The mortality rate dropped significantly in the 81-month period after the joint change to (1) buccal misoprostol replacing vaginal misoprostol and (2) either sexually transmitted infection (STI) screening or routine preventative antibiotic coverage (15 month period) or universal routine preventative antibiotic coverage as part of the medical abortion (66-month period), from 1.37/100,000 to 0.00/100,000, P=.013 (difference=1.37/100,000, 95% CI 0.47-4.03 per 100,000). The infection-caused mortality rate following medical abortion declined by 100% following a change from vaginal to buccal administration of misoprostol combined with screen-and-treat or, far more commonly, routine antibiotic coverage. Deaths from infection following medical abortion declined to zero after a change in the regimen. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Medical Abortion in Primary Care : Pitfalls and Benefits

    NARCIS (Netherlands)

    Boersma, A. A.; Meyboom-de Jong, B.

    2009-01-01

    We describe jive pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained

  12. Pain during medical abortion: a multicenter study in France.

    Science.gov (United States)

    Saurel-Cubizolles, Marie-Josèphe; Opatowski, Marion; David, Philippe; Bardy, Françoise; Dunbavand, Annabel

    2015-11-01

    To compare the level of pain reported by women by dose of mifepristone, 200 or 600mg, and describe the main factors related to the pain level in the 5 days after a medical abortion. Observational study in 11 medical centers in France between October 2013 and September 2014. The protocols were 200 or 600mg orally mifepristone on day 1 of the medical abortion and 400, 600 or 800μg orally misoprostol on day 3. Women returned a questionnaire that they completed during 5 days following the abortion; pain was recorded on a visual analog scale (0-10) daily. 453 women were included; the mean age was 29 years (range 18-49 years). Pain was greater with 200 than 600mg mifepristone: 33% of women reported a pain level of ≥8 on day 3 with 200mg as compared with 16% with 600mg. This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose. Percentages of symptoms as vomiting or diarrhea were also lower with 600mg mifépristone than 200mg. The mean pain severity experienced by women undergoing medical abortion is high; it is higher with a regimen of 200mg mifepristone. The findings emphasize the need to improve analgesic strategies and invite to opt for a protocol of 600mg instead of 200mg mifepristone. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Medical Abortion in Primary Care : Pitfalls and Benefits

    NARCIS (Netherlands)

    Boersma, A. A.; Meyboom-de Jong, B.

    2009-01-01

    We describe jive pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained produ

  14. Medical Abortion in Primary Care : Pitfalls and Benefits

    NARCIS (Netherlands)

    Boersma, A. A.; Meyboom-de Jong, B.

    2009-01-01

    We describe jive pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained produ

  15. Abortion

    OpenAIRE

    2005-01-01

    Abortion is not only a sin; it is also a crime as Canon Law describes it. The paper deals with the issue of abortion from the Canon Law's perspective. Not every sin of abortion is at the same time a crime in the legal sense. The paper discusses what the circumstances are to turn the sin of abortion into the crime of abortion. The censure of excommunication is imposed on the individuals who are guilty of the crime of abortion. If there is no crime, there is no excommunication which is attached...

  16. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  17. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  18. Abortion

    Science.gov (United States)

    An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most healthcare providers advise counseling.

  19. Misoprostol use as a method of medical abortion.

    Science.gov (United States)

    Salakos, N; Iavazzo, C; Bakalianou, K; Gregoriou, O; Paltoglou, G; Kalmantis, K; Botsis, D

    2008-01-01

    The aim of our study was to verify with the use of ultrasound (US) scanning the effectiveness of misoprostol in medical abortion. The study population included women with a medical miscarriage attending the 2nd Department of Obstetrics and Gynecology, University of Athens in Aretaieion Hospital, Athens, Greece. All women abortion was possible by the US measurements as endometrial thickness of 15 mm by transvaginal US was used as a cutoff level for successful abortion. The mean age of the study population was 27 years (ranging from 19 up to 37 years). Complete evacuation with misoprostol was performed in 149 women. The success rate was 85.2% (127/149). Twenty-two women experienced intrauterine echogenic structures with a diameter > 15 mm and all of them underwent surgical evacuation (14.8%). Vaginal bleeding was present in 17 patients after the procedure (11.4%). Less usual reported side-effects included nausea, vomiting, pain, or diarrhea. Misoprostol use is an effective, safe and acceptable method of medical abortion for women.

  20. First-trimester medical abortion service in Hong Kong.

    Science.gov (United States)

    Lo, Sue S T; Ho, P C

    2015-10-01

    Research on medical abortion has been conducted in Hong Kong since the 1990s. It was not until 2011 that the first-trimester medical abortion service was launched. Mifepristone was registered in Hong Kong in April 2014 and all institutions that are listed in the Gazette as a provider for legal abortion can purchase mifepristone from the local provider. This article aimed to share our 3-year experience of this service with the local medical community. Our current protocol is safe and effective, and advocates 200-mg mifepristone and 400-µg sublingual misoprostol 24 to 48 hours later, followed by a second dose of 400-µg sublingual misoprostol 4 hours later if the patient does not respond. The complete abortion rate is 97.0% and ongoing pregnancy rate is 0.4%. Some minor side-effects have been reported and include diarrhoea, fever, abdominal pain, and allergy. There have been no serious adverse events such as heavy bleeding requiring transfusion, anaphylactic reaction, septicaemia, or death.

  1. Efficacy and acceptability of outpatient, single-visit, medical abortion up to 59 days of gestation

    Directory of Open Access Journals (Sweden)

    Manisha Agarwal

    2010-11-01

    Full Text Available Manisha AgarwalDepartment of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry, IndiaAbstract: This study evaluated the efficacy and acceptability of medical abortion by a modified, single-visit treatment regimen for termination of early (up to 59 days pregnancy. The study population included 160 women. They were vaginally administered misoprostol 600 mg six hours after oral administration of mifepristone 200 µg. Patients’ symptoms were evaluated by telephone, and they were counseled accordingly. Follow-up sonography was performed two weeks later. The reasons patients chose this method were to avoid hospitalization, preference for a natural and noninvasive method, and confidentiality (55%. Side effects were mainly mild abdominal cramps (45% and prolonged bleeding (2.4%. The success rate of complete abortion was 98.12%, with 1.25% of these patients needing a second vaginal dose to complete the treatment. The single-visit medical abortion method is acceptable and efficacious for women in developing countries.Keywords: medical abortion, mifepristone, misoprostol, administration, intravaginal

  2. Pain during medical abortion, the impact of the regimen: a neglected issue? A review.

    Science.gov (United States)

    Fiala, Christian; Cameron, Sharon; Bombas, Teresa; Parachini, Mirella; Saya, Laurence; Gemzell-Danielsson, Kristina

    2014-12-01

    To evaluate pain and other early adverse events associated with different regimens of medical abortion up to nine weeks of amenorrhoea. The literature was searched for comparative studies of medical abortion using mifepristone followed by the prostaglandin analogue misoprostol. Publications, which included pain assessment were further analysed. Of the 1459 publications on medical abortion identified, only 23 comparative, prospective trials corresponded to the inclusion criteria. Patients in these studies received different dosages of mifepristone in combination with different dosages of misoprostol administered via diverse routes or at various intervals. Information on pain level was reported in 12/23 papers (52%), information regarding systematic administration of analgesics in 12/23 articles (52%) and information concerning analgesia used was available for only 10/23 studies (43%). Neither pain nor its treatment are systematically reported in clinical trials of medical abortion; this shortcoming reflects a neglect of the individual pain perception. When data are mentioned, they are too inconsistent to allow for any comparison between different treatment protocols. Standardised evaluation of pain is needed and the correlation between the dosage of misoprostol and the intensity of pain must be assessed in future studies.

  3. Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa.

    Science.gov (United States)

    Constant, Deborah; de Tolly, Katherine; Harries, Jane; Myer, Landon

    2015-02-01

    In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2-3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers' assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  4. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

    Directory of Open Access Journals (Sweden)

    Susanne Sjöström

    Full Text Available The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established.A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER were calculated. The study was conducted at a university hospital in Stockholm, Sweden.The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided.Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.

  5. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Sjöström, Susanne; Kopp Kallner, Helena; Simeonova, Emilia; Madestam, Andreas; Gemzell-Danielsson, Kristina

    2016-01-01

    The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.

  6. Improved accuracy of hysteroembryoscopic biopsies for karyotyping early missed abortions.

    Science.gov (United States)

    Ferro, Jaime; Martínez, Ma Carmen; Lara, Coral; Pellicer, Antonio; Remohí, José; Serra, Vicente

    2003-11-01

    To assess the potential of direct embryo and chorion biopsies obtained by hysteroembryoscopy for karyotyping early missed abortions. Clinical prospective descriptive study. Instituto Valenciano de Infertilidad, Valencia, Spain. Sixty-eight women (71 gestational sacs) with missed abortions. The gestational age on ultrasound was 6.3 weeks (range, 4-10 weeks). Transcervical hysteroembryoscopy before curettage. Comparison between the cytogenetic results from hysteroembryoscopic biospies and those of the curettage material. Hysteroembryoscopic biopsies could be taken in 97.2% of the gestational sacs. Direct embryo and chorion biopsies were suitable for chromosomal analysis. Selective samples identified misdiagnoses of the conventional curettage karyotype due to maternal contaminating tissues in 22.2% of the cases. Direct hysteroembryoscopic biopsies also enabled the diagnosis of a true placental mosaicism and the study of the individual karyotype of each gestational sac in bizygotic twin missed abortions. In early missed abortions, karyotypes from direct hysteroembryoscopic biopsies were more accurate than those from the curettage material. The finding of a 46,XX karyotype in the curettage material is not a reliable result.

  7. Practice bulletin no. 143: medical management of first-trimester abortion.

    Science.gov (United States)

    2014-03-01

    Over the past three decades, medical methods of abortion have been developed throughout the world and are now a standard method of providing abortion care in the United States. Medical abortion, which involves the use of medications rather than a surgical procedure to induce an abortion, is an option for women who wish to terminate a first-trimester pregnancy. Although the method is most commonly used up to 63 days of gestation (calculated from the first day of the last menstrual period), the treatment also is effective after 63 days of gestation. The Centers for Disease Control and Prevention estimates that 64% of abortions are performed before 63 days of gestation (1). Medical abortions currently comprise 16.5% of all abortions in the United States and 25.2% of all abortions at or before 9 weeks of gestation (1). Mifepristone, combined with misoprostol, is the most commonly used medical abortion regimen in the United States and Western Europe; however, in parts of the world, mifepristone remains unavailable. This document presents evidence of the effectiveness, benefits, and risks of first-trimester medical abortion and provides a framework for counseling women who are considering medical abortion.

  8. Attitudes and perspectives on medical abortion of health service providers; Manisa example

    Directory of Open Access Journals (Sweden)

    Saliha Ozpinar

    2015-04-01

    Full Text Available AIM: To better understand perceptions and perspectives of health service providers who provide medical abortion services and of senior students attending medical and nursing faculties in Manisa regarding medical abortion. METHODS: This study conducted in Manisa is a part of a Turkey-wide study on and #8220;health service providers and #8217; knowledge about, attitudes towards and perspectives on safe abortion and medical abortion and #8221;. It is a descriptive study. The questionnaire prepared by the researchers consists of two sections: one targeting health service providers and the other targeting students. The questionnaires were completed by individuals in the study group. RESULTS: According to the survey results, service providers know at least one abortion method. According to the study group, abortion performed by non-medical midwives ranks first in the definition of unsafe abortion. In the study, 100.0% of the gynecologists, 84.7% of the general practitioners, 74.6% of the nurses / midwives stated that they were knowledgeable about Medical abortion. According to the study group, of the advantages of medical abortion, the one ranks first is that no anesthesia is administered and of the disadvantages of medical abortion, the one ranks first is that the process takes a long time. Twenty-five percent of the obstetricians, 67.8% of the general practitioners, 57.3% of the nurses / midwives, 55.2% of the medical students and 63.2% of the nursing / midwifery students were unwilling to perform medical abortion and/or to assist it. CONCLUSION: The study indicates that although health service providers displayed a positive attitude towards medical abortion, not all of them had enough knowledge about it. Thus, it is important that medical abortion providers should attend pre-graduate training programs and that post-graduate training programs should be organized. [TAF Prev Med Bull 2015; 14(2.000: 87-92

  9. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Mandira Paul

    home-assessment in the future, as compared with 188 (70% of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001.Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.ClinicalTrials.gov NCT01827995.

  10. [Clinical study of induced abortion of early-early pregnancy: an analysis of 10, 404 cases].

    Science.gov (United States)

    Kang, Jian; Wang, Xue-fen; Zhang, Li; Liu, Jian-hua

    2012-01-03

    To evaluate the advantages and disadvantages of early-early pregnancy induced abortion (EPIA). A total of 10 404 cases of EPIA performed at our hospital from January 1993 to December 2003 were retrospectively analyzed and compared with 9434 cases of common induced abortion (CIA). The amount of hemorrhage and operative duration, degree of pain, rate of induced-abortion syndrome, rate of incomplete abortion, menstrual changes and post-operative onset of Asherman's syndrome were observed and compared between 2 groups. The average age, ratio of parous cases, ratio of the cases of first-pregnancy induced abortion were not different between 2 groups (P > 0.05). The amount of hemorrhage bleeding ((4.9 ± 3.2) ml), operative duration ((90.3 ± 12.4) s), degree of pain, rate of induced-abortion syndrome, menstrual changes and the rate of Asherman's syndrome in the EPIA group were all significantly less than those in the CIA group (P abortion (0.44%) in the EPIA group was significantly higher than that (0.21%) in the CIA group (P abortion stays high.

  11. Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia.

    Science.gov (United States)

    Fetters, Tamara; Samandari, Ghazaleh; Djemo, Patrick; Vwallika, Bellington; Mupeta, Stephen

    2017-02-16

    Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation. An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country's abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships. After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47

  12. Medical Students and Abortion: Reconciling Personal Beliefs and Professional Roles at One Medical School.

    Science.gov (United States)

    Dans, Peter E.

    1992-01-01

    Surveys of first- and fourth-year Johns Hopkins University (Maryland) medical students found little change in attitudes about abortion over four years. Attitudes correlated most strongly with personal beliefs about when a fetus is considered human life and somewhat with student gender. Results are used in a medical ethics course to illuminate…

  13. Medical abortion in the first trimester: the use of serum hCG and endometrial thickness as markers of completeness.

    Science.gov (United States)

    Parashar, Pooja; Iversen, Ole Erik; Midbøe, Grete; Myking, Ole; Bjørge, Line

    2007-12-01

    The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We assessed endometrial thickness, determined by ultrasound and serum-human chorionic gonadotropin (s-hCG) as markers of successful management. Prospective trial involving 255 women, with a gestation of 62 days or less, who were to undergo medical abortion. In addition to our established routines of performing clinical and ultrasound examinations, we also determined the s-hCG level prior to treatment and at follow-up. Of the 255 subjects treated during the study, 20 (7.8%) were lost to follow-up. The overall complete abortion rate was 94.0%. Fourteen subjects required vacuum aspiration, nine of them prior to the scheduled follow-up and five thereafter. None of the pregnancies were ongoing. A decrease of 99% in s-hCG levels was noted in 99% of the women, when levels determined prior to mifepristone intake and those measured 15-71 days post-abortion were compared. This study confirms that s-hCG levels drop sharply after medical abortion. To assess the completeness of medical abortion, we recommend that clinical examination to be combined with determination of s-hCG. Ultrasonography should be carried out only when indicated.

  14. Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal.

    Science.gov (United States)

    Suh, Siri

    2014-05-01

    Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating

  15. Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

    Science.gov (United States)

    Suh, Siri

    2014-01-01

    Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion

  16. Post abortion contraception.

    Science.gov (United States)

    Gemzell-Danielsson, Kristina; Kopp, Helena Kallner

    2015-11-01

    A safe induced abortion has no impact on future fertility. Ovulation may resume as early as 8 days after the abortion. There is no difference in return to fertility after medical or surgical abortion. Most women resume sexual activity soon after an abortion. Contraceptive counseling and provision should therefore be an integrated part of the abortion services to help women avoid another unintended pregnancy and risk, in many cases an unsafe, abortion. Long-acting reversible contraceptive methods that includes implants and intrauterine contraception have been shown to be the most effective contraceptive methods to help women prevent unintended pregnancy following an abortion. However, starting any method is better than starting no method at all. This Special Report will give a short guide to available methods and when they can be started after an induced abortion.

  17. Women's perspectives on medical abortion in Mexico, Colombia, Ecuador and Peru: a qualitative study.

    Science.gov (United States)

    Lafaurie, María Mercedes; Grossman, Daniel; Troncoso, Erika; Billings, Deborah L; Chávez, Susana

    2005-11-01

    In Latin America, where abortion is almost universally legally restricted, medical abortion, especially with misoprostol alone, is increasingly being used, often with the tablets obtained from a pharmacy. We carried out in-depth interviews with 49 women who had had a medical abortion under clinical supervision in rural and urban settings in Mexico, Colombia, Ecuador and Peru, who were recruited through clinicians providing abortions. The women often chose medical abortion to avoid a surgical abortion; they thought medical abortion was less painful, easier or simpler, safer or less risky. They commonly described it as a natural process of regulating their period. The fact that it was less expensive also influenced their decision. Some, who experienced a lot of pain, heavy bleeding or a failed procedure requiring surgical back-up, tended to be more negative about it. Regardless of legal restrictions, medical abortion was being provided safely in these settings and women found the method acceptable. Where feasible, it should be made available but cost should not have to be women's primary reason for choosing it. Psychosocial support during abortion is critical, especially for those who are more vulnerable because they see abortion as a sin, who are young or poor, who have limited knowledge about their bodies, whose partners are not supportive or who became pregnant through sexual violence.

  18. Studies on Expression of IGF-Ⅱ Gene in Deciduas De-rived from Medical Abortion Patients

    Institute of Scientific and Technical Information of China (English)

    刘峻; 汪玉宝; 毛叶萌; 毛全福; 杜晓岩

    2000-01-01

    Objective To determine the effect of insulin-like growth factor- Ⅱ (IGF- Ⅱ ) upon the maintenance of decidua in early pregnancy and its relationship with progesterone, as well as its role in medical abortion.Materials & Methods Decidua tissue was obtained from 28 women who undergoing surgical abortion and 39 for medical abortion respectively at 5~7 weeks of gestation.The extracted total RNA was reversely transeripted and amplified by PCR with spe-cific primers (IGF- Ⅱ and β-actin). The products were semi-quantitated by MIAS 300 system and qualitatively analyzed by southern blotting.Results The expression of IGF- Ⅱ gene in decidua from surgical abortion was signif-icantly higher than that from medical abortion (P<0. 05). The average IGF- Ⅱ gene transcription values were 1.54±0. 79 and 0. 72± 0. 39 respectively. The results of southern blotting proved qualitatively that the RT-PCR products were IGF- Ⅱ cDNA.Conclusion IGF- Ⅱ plays a role in the maintenance of decidua in early pregnancy. It may act as a mediator of progestin. It's also involved in the molecular mechanism of mifepristone.

  19. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia

    OpenAIRE

    2016-01-01

    Background Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to...

  20. Ovulation resumption after medical abortion with mifepristone and misoprostol.

    Science.gov (United States)

    Schreiber, Courtney A; Sober, Stephanie; Ratcliffe, Sarah; Creinin, Mitchell D

    2011-09-01

    As an antiprogestin, mifepristone may have an impact on the return to ovulation in a manner that is not only attributable to its abortifacient activity. Our aim was to measure the time-to-ovulation in women who received mifepristone 200 mg orally and misoprostol 800 mcg vaginally for abortion up to 63 days of gestation. This planned substudy was part of a multicenter randomized trial of mifepristone 200 mg followed immediately or 24 h later by misoprostol 800 mcg vaginally. Women who had successful expulsion of the gestational sac based on ultrasound examination 1 week after mifepristone treatment were enrolled. All subjects used nonhormonal contraception until study completion. Baseline serum progesterone (P) levels were drawn on day 8±1 after mifepristone administration and then twice weekly until the P level was >3 ng/mL, consistent with ovulation. The mean time-to-ovulation was calculated using interval censored regression to address the censoring due to participant discontinuation. Fourteen (52%) of 27 enrolled women completed the substudy. The longest period of time that a subject who did not complete the study was followed was 29 days. Ovulation occurred 20.6±5.1 (range 8-36) days after mifepristone administration. Time-to-ovulation was not affected by participant age, gestational age, study arm, body mass index or presence or absence of human chorionic gonadotropin. Return to ovulation following medical abortion with mifepristone and misoprostol occurs on average 3 weeks postabortion. Mifepristone 200 mg does not appear to have a lasting effect on ovarian function. Our results should be contextualized by the small sample size, although this is one of the larger studies on return to ovulation after abortion. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Administration of depot medroxyprogesterone acetate on the day of mifepristone for medical abortion: a pilot study.

    Science.gov (United States)

    Sonalkar, Sarita; McClusky, Jessica; Hou, Melody Y; Borgatta, Lynn

    2015-02-01

    We sought to evaluate satisfaction with timing of administration and continuation rates of depot medroxyprogesterone (DMPA) when given on the initial visit for first-trimester medical abortion. In this pilot study, we administered DMPA within 15 min of mifepristone administration. Participants were followed up in the clinic 7 days after enrollment and were contacted at 14 days, 28 days and 3, 6, 9 and 12 months by telephone. We assessed satisfaction with contraception timing, DMPA continuation, bleeding patterns and abortion completion. Twenty women were enrolled. At 7-day follow-up, 18 of 19 contacted participants (94.7%) were satisfied with timing of DMPA administration. Ten of 19 participants (52.6%) discontinued DMPA after the first injection. At 1 year, 3 participants out of 19 were continuing DMPA (15.7%). The median number of bleeding days after abortion was 19. Three participants had medical abortion failure. In the first year after abortion, there were four known repeat pregnancies. The timing of initiation of DMPA on the initial visit for medical abortion is satisfactory to women, but its influence on medical abortion efficacy requires further study. Continuation rates for DMPA were low in our sample. This pilot study provides groundwork for future larger studies to assess initiation of the injectable contraceptive DMPA on the day of mifepristone for medical abortion, but low continuation rates of DMPA in our sample emphasize the importance of access to intrauterine devices and implants after abortion. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Marmara University Medical Students' Perception on Sexual Violence against Women and Induced Abortion in Turkey.

    Science.gov (United States)

    Lüleci, Nimet Emel; Kaya, Eda; Aslan, Ece; Şenkal, Ece Söylem; Çiçek, Zehra Nadide

    2016-03-01

    Historically, sexual assault is a common issue in Turkey. As doctors are one of the steps to help sexually assaulted women, medical students should have basic knowledge of and sensitivity regarding this subject. Another common women's public health issue is induced abortion. In countries where access to abortion is restricted, there is a tendency towards unhealthy abortion. The aims of this study are: (1) to determine the attitudes and opinions of Marmara University Medical Faculty students about sexual assault against women and induced abortion and (2) to propose an educational program for medical students about sexual assault and abortion. Cross-sectional study. The questionnaires were self-administered and the data were analyzed using SPSS v.15.0. First, the descriptive statistics were analyzed, followed by Chi-square for contingency tests assessing differences in attitudes toward sexual assault and induced abortion by factors such as gender and educational term. Differences were considered statistically significant at p0.05). Although there was no significant difference regarding the extent of punishment by victim's status as a virgin, 21.3% (n=63) agreed that punishment should be more severe when the victim was a virgin. About 40.7% (n=120) agreed that the legal period of abortion in Turkey (10 weeks) should be longer. The majority (86.1%, n=255) agreed that legally prohibiting abortions causes an increase in unhealthy abortions. An educational program on these issues should be developed for medical students.

  3. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    Science.gov (United States)

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  4. High-dose misoprostol as an alternative therapy after failed medical abortion.

    Science.gov (United States)

    Li, Yiu-Tai; Hou, Guang-Qiong; Chen, Tien-Hui; Chu, Yi-Chih; Lin, Ta-Chin; Kuan, Long-Ching; Lin, Mau; Huang, Shu-Feng; Chen, Fu-Min; Kuo, Tsung-Cheng

    2008-12-01

    The aim of this study was to determine the complete abortion rate for the vaginal administration of high-dose misoprostol after a failed medical abortion. When their medical abortions failed after the conventional oral administration of mifepristone and misoprostol, participants then received 1,000 microg of misoprostol vaginally. The efficacy and side effects of this treatment were evaluated. Twenty-seven women who failed to abort after the conventional administration of mifepristone and misoprostol were enrolled in this trial. Fourteen days after the vaginal administration of 1,000 microg misoprostol, the overall complete expulsion rate had reached 88.8% (24/27). Most adverse effects were mild to moderate and did not require treatment. The vaginal administration of 1,000 microg misoprostol as a salvage therapy after a failed medical abortion appears to be a safe and highly effective alternative to surgical intervention.

  5. A prospective, non-randomized study of home use of mifepristone for medical abortion in the U.S.

    Science.gov (United States)

    Chong, Erica; Frye, Laura J; Castle, Jen; Dean, Gillian; Kuehl, Laurel; Winikoff, Beverly

    2015-09-01

    To determine the acceptability of taking mifepristone at home for early medical abortion in the United States. This prospective, non-randomized, open-label study at six Planned Parenthood centers gave women with pregnancies up to 63 days' gestation seeking medical abortion the choice of taking mifepristone in the center or at home. Participants were interviewed at a follow-up visit 1-2 weeks after mifepristone administration to assess their experience with the option they selected. Four-hundred women were enrolled between April 2013 and June 2014 of which 32% (n=128) chose to take mifepristone at home. Abortion success rates did not differ between home and center users (96% and 97%). Among home users, 82% reported taking the mifepristone at the time they planned with their provider and no participant took it after 63 days' gestation. The most common reason cited for selecting home use was scheduling flexibility and significantly more home users took misoprostol on the weekend (50% vs. 36%, p=.02). Home users were more likely than center users to report missing no days of work due to the abortion (47% vs. 28%, p=.08). Ninety-nine percent of home users reported that they would take mifepristone at home again and 96% would recommend home use to a friend. Offering this option did not increase the service delivery burden on study providers, who would recommend home use in the future for most participants. Home use of mifepristone is a highly acceptable practice for which there is current demand, and it should be offered as part of routine medical abortion services. Offering the option of home use of mifepristone to medical abortion patients can provide women and clinics with more flexibility while maintaining a safe, effective and acceptable service. These results provide support for telemedicine or pharmacy distribution. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2005-01-01

    BACKGROUND: The aim of the study was to compare satisfaction with medical and surgical abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA) < or = 63 days had either a medical (600 mg mifepristone followed by 1 mg gemeprost) or a sur......BACKGROUND: The aim of the study was to compare satisfaction with medical and surgical abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA)

  7. [No increase in medical consumption in general practice after induced abortion

    NARCIS (Netherlands)

    Kooistra, P.A.; Vastbinder, M.B.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To compare medical consumption in general practice between women who underwent an induced abortion and women who did not. DESIGN: Historical cohort study. METHOD: We selected 19o women who underwent an induced abortion in the period 1975-2004 and 145 control patients. Women were selected

  8. [No increase in medical consumption in general practice after induced abortion

    NARCIS (Netherlands)

    Kooistra, P.A.; Vastbinder, M.B.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To compare medical consumption in general practice between women who underwent an induced abortion and women who did not. DESIGN: Historical cohort study. METHOD: We selected 19o women who underwent an induced abortion in the period 1975-2004 and 145 control patients. Women were selected

  9. 影响早期流产方法选择的相关因素调查%Choice of methods of early abortion related factors

    Institute of Scientific and Technical Information of China (English)

    马海法

    2011-01-01

    Objective To study the method of choice of abortion in early pregnancy factors.Methods Totally 216 cases of early pregnancy conducted a questionnaire survey of women, according to women voluntarily choose different methods of abortion, medical abortion groups into the general surgical abortion group and the induced abortion group because of different methods of selection.Results The results have the same opportunity to choose abortion way, most young, unmarried choose medical abortion, when economic conditions are good choose induced abortion, while older, farmers, workers to choose surgery abortion.Conclusions The method of understanding abortion is not comprehensive,the choice of abortion method involves many problems, physicians should provide appropriate methods for women.%目的 探讨早期妊娠流产方法选择的影响因素.方法 对216例早孕妇女进行问卷调查,按照妇女自愿选择流产方法的不同,分为药物流产组,一般手术流产组和无痛人工流产组,分析选择不同方法的原因.结果 在有同等机会选择流产方法时,多数年轻、未婚者选择药物流产,其中经济条件好的选择无痛人工流产,而经济条件较差者选择常规一般手术流产.结论 妇女埘流产方法的认识并不全面,在选择流产方法时涉及许多问题,医生应尽可能为妇女提供适宜方法.

  10. Alienated from the womb: abortion in the early medieval West, c.500-900

    OpenAIRE

    Mistry, Z.

    2011-01-01

    This thesis is primarily a cultural history of abortion in the early medieval West. It is a historical study of perceptions, rather than the practice, of abortion. The span covered ranges from the sixth century, when certain localised ecclesiastical initiatives in the form of councils and sermons addressed abortion, through to the ninth century, when some of these initiatives were integrated into pastoral texts produced in altogether different locales. The thesis uses a range of predominantly...

  11. Feasibility of telephone follow-up after medical abortion.

    Science.gov (United States)

    Perriera, Lisa K; Reeves, Matthew F; Chen, Beatrice A; Hohmann, Heather L; Hayes, Jennifer; Creinin, Mitchell D

    2010-02-01

    This study was conducted to assess the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing as a primary method of follow-up after medical abortion. We enrolled 139 women up to 63 days of gestation to receive mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, per their choice. Participants were contacted by phone one week after mifepristone administration and interviewed using standardized questions. If the subject or clinician thought the pregnancy was not expelled, the subject returned for an ultrasound examination. Otherwise, subjects performed high-sensitivity home urine pregnancy testing 30 days after the mifepristone and were called within 3 days of the test. Those with positive pregnancy tests returned for an ultrasound examination. Those with negative tests required no further follow-up. Six of the 139 (4.3%, 95% CI 1.6-9.1%) subjects presented prior to Phone Call 1 for an in-person visit. All 133 (100%, 95% CI 97.8-100%) subjects eligible for their first telephone follow-up were contacted. Eight of the 133 (6.1%, 95% CI 2.6-11.5%) women were asked to return for evaluation and all did so (100%, 95% CI 63.1-100%). Eight of the 133 women eligible for the 30 day phone call presented for an interim visit prior to the call. After 30 days, 116 of the 117 (99.1%, 95% CI 97.5-100%) eligible subjects were contacted. One subject was not reached for the day 30 phone call. Twenty-seven of the 116 (23.3%, 95% CI 15.6-31.0%) subjects had a positive pregnancy test and required follow-up. Two of these subjects (7.4%, 95% CI 1.0-24.2%) did not return for in-person follow-up. Two of the 116 (1.7%, 95% CI 0.2-6.1%) subjects had inconclusive pregnancy tests and were asked to return for follow-up. One of these subjects (50%, 95% CI 1.2-98.7%) did not return. Complete follow-up was achieved in 135 of the 139 subjects (97.1%, 95% CI 94.3-99.9%). None of the 26 women evaluated for a positive or inconclusive pregnancy

  12. Veterinary and medical aspects of abortion in Danish sheep

    DEFF Research Database (Denmark)

    Agerholm, Jørgen S.; Aalbæk, Bent; Fog-Larsen, Anne Marie

    2006-01-01

    The Danish sheep population totals around 144,000 animals, but little is known of the causes and prevalance of diseases. This study focuses on the causes of abortion in Danish sheep. During one breeding season, aborted foetuses and stillbirths with signs of intrauterine death or malformation were...

  13. A comparative study on sublingual versus oral and vaginal administration of misoprostol for late first and early second trimester abortion.

    Science.gov (United States)

    Ganguly, Rajendra Prasad; Saha, Shyama Prasad; Mukhopadhyay, Sima; Bhattacharjee, Nabendu; Bhattacharyya, Subir Kumar; Patra, Kajal Kumar

    2010-05-01

    To compare the effectiveness, side-effects and outcome of sublingual with oral and vaginal administrations of misoprostol for induction of abortion in late first and early second trimester of gestation (9 to 16 weeks), a comparative observational study was carried out among 258 women with a period of gestation between 9 and 16 weeks, scheduled to have medical abortion, and randomly allocated into three groups and offered sublingual, oral and vaginal routes of misoprostol administration (400 mcg of misoprostol 6 hourly, maximum up to four dosages) respectively. Primary outcome measure was complete abortion rate and the secondary outcome measures were incidence of cases where surgical evacuation required, failure rate and induction-abortion interval. Development of side-effects and subjective assessment of patient's comfort with the different routes of administration were also recorded. Rate of complete abortion was higher in sublingual group in comparison to oral (p = 0.0338) and vaginal route (p = 0.5627). Surgical evacuation was required in less number of cases in sublingual group. Induction-abortion interval was also least with the sublingual route le, p route and least with the sublingual route. The patients were least comfortable with the vaginal route. Gastro-intestinal side-effects were least with the vaginal route, but significant vaginal bleeding (> 250 ml) was little bit higher with this route. Though misoprostol is effective in inducing medical abortion irrespective of the route of administration, sublingual route gives better results as compared to oral (statistically significant) and vaginal routes (in some respects, not of much statistical significance).

  14. Increase of tumor necrosis factor receptor 1 expression in women with unexplained early spontaneous abortion

    Institute of Scientific and Technical Information of China (English)

    YAN Chun-fang; YU Xue-wen; JIN Hui; LI Xu

    2004-01-01

    To investigate membrane tumor necrosis factor receptor 1 protein expression level in decidua andconcentration of soluble tumor necrosis factor receptor 1 in serum in women with unexplained early spontaneous abortion,threatened abortion, and compare the levels with healthy pregnant women. Methods: Thirty-seven women with unexplainedearly spontaneous abortion, 27 women with threatened abortion, and 34 healthy pregnant women undergoing artificial abortionof pregnancy at 6 - 10 weeks of gestation were selected. Decidual samples were collected when women were undergoing arti-ficial abortion, and blood samples were collected at the same time. The level of membrane tumor necrosis factor receptor 1 indecidua was detected by flow cytometer, and the concentration of soluble tumor necrosis factor receptor 1 in sera was mea-sured with an enzyme-linked immunosorbent assay. Results: The ercentages of membrane tumor necrosis factor receptor 1positive decidual cells were 16.42 ± 7.10 Mean ± SD for women with unexplained early spontaneous abortion and 13.14 ±6.30 for healthy pregnant women ( P < 0.05). Serum oncentration of soluble tumor necrosis factor receptor 1 was signifi-cantly higher in women with unexplained early spontaneous abortion than in healthy pregnant women and in women withthreatened abortion, and no difference was found between healthy pregnant women and women with threatened abortion.Conclusion: Women with unexplained early spontaneous abortion present significantly higher expression of tumor necrosisfactor receptor 1 than healthy pregnant women, suggesting that over-expression of tumor necrosis factor receptor 1 may cont-ribute to the development of early spontaneous abortion.

  15. The potential of medical abortion to reduce maternal mortality in Africa: what benefits for Tanzania and Ethiopia?

    Directory of Open Access Journals (Sweden)

    Rebecca F Baggaley

    Full Text Available BACKGROUND: Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. METHODS: By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. RESULTS: Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia. Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. CONCLUSIONS: This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.

  16. A randomized controlled trial of different buccal misoprostol doses in mifepristone medical abortion.

    Science.gov (United States)

    Chong, Erica; Tsereteli, Tamar; Nguyen, Nhu Ngoc Thi; Winikoff, Beverly

    2012-09-01

    An 800-mcg dose of buccal misoprostol following mifepristone has been shown to be highly effective in terminating pregnancies through 63 days since the last menstrual period (LMP) (B. Winikoff, I.G. Dzuba, M.D. Creinin, et al., Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol 2008; 112: 1303-1310). However, a two 200-mcg misoprostol pill option would simplify administration, and potentially reduce costs and increase women's satisfaction. This study compares a 400-mcg dose (Group I) to an 800-mcg dose (Group II) of buccal misoprostol. Eligible and consenting women requesting medical termination of early pregnancy (n=1122) were randomized and instructed to take misoprostol 36 to 48 h after taking 200 mg mifepristone. Follow-up visits occurred 12 to 15 days after mifepristone administration. Ninety-six percent of women in both groups had successful abortions. Women in Group I experienced significantly less vomiting and fever/chills than women in Group II. Ninety-six percent of women in both groups found the procedure very satisfactory or satisfactory. Four hundred micrograms of buccal misoprostol is as effective as the standard 800-mcg dose in terminating pregnancies up to 63 days LMP and reduces side effects. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Medication Abortion Through Telemedicine: Implications of a Ruling by the Iowa Supreme Court.

    Science.gov (United States)

    Yang, Y Tony; Kozhimannil, Katy B

    2016-02-01

    In summer 2015, the Iowa Supreme Court unanimously struck down a restriction that would have prevented physicians from administering a medication abortion remotely through video teleconferencing. In its ruling, the Iowa Supreme Court stated that the restriction would have placed an undue burden on a woman's right to access abortion services. It is crucially important for clinicians--especially primary care clinicians, obstetrician-gynecologists (ob-gyns), and all health care providers of telemedicine services--to understand the implications of this recent ruling, especially in rural settings. The Court's decision has potential ramifications across the country, for both women's access to abortion and the field of telemedicine. Today telemedicine abortion is available only in Iowa and Minnesota; 18 states have adopted bans on it. If telemedicine abortions are indeed being unconstitutionally restricted as the Iowa Supreme Court determined, court decisions reversing these bans could improve access to abortion services for the 21 million reproductive-age women living in these 18 states, which have a limited supply of ob-gyns, mostly concentrated in urban, metropolitan areas. Beyond the potential effects on abortion access, we argue that the Court's decision also has broader implications for telemedicine, by limiting the role of state boards of medicine regarding the restriction of politically controversial medical services when provided through telemedicine. The interplay between telemedicine policy, abortion politics, and the science of medicine is at the heart of the Court's decision and has meaning beyond Iowa's borders for reproductive-age women across the United States.

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

    Science.gov (United States)

    Carranza, María

    2007-08-01

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

  19. Efficacy and acceptability of a mifepristone-misoprostol combined regimen for early induced abortion among women in Mexico City.

    Science.gov (United States)

    Peña, Melanie; Dzuba, Ilana G; Smith, Patricio Sanhueza; Mendoza, Luis Jorge Arellano; Bousiéguez, Manuel; Martínez, María Laura García; Polanco, Ranulfo Ríos; Villalón, Antonio Eduardo Flores; Winikoff, Beverly

    2014-10-01

    To evaluate the experience of women receiving mifepristone-misoprostol for early induced abortion in public sector facilities in the Federal District of Mexico City. An open-label prospective study was conducted with 1000 pregnant women who sought induced abortion with a pregnancy of up to 63days of gestation, as measured from the date of their last menstrual period. The study was conducted in three public sector healthcare facilities: two secondary level hospitals and one primary care clinic. Women ingested 200mg mifepristone on day 1, followed by 800μg buccal misoprostol 24hours later, and they returned for follow-up on day 8. The primary outcome was complete abortion without recourse to surgical intervention. A total of 971 women received mifepristone-misoprostol and were included in the analysis for efficacy of treatment. The overall efficacy of the combined medical abortion regimen studied was 97.3% (n=945); the success rate did not vary significantly by gestational age (95.9%-100%; P=0.449). Most women (n=922, 95.0%) had a successful induced abortion with only one dose of misoprostol. The combined mifepristone and buccal misoprostol regimen was found to be highly effective and acceptable among Mexican women. www.ClinicalTrials.gov: NCT00386282. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Abortion Surveillance - United States, 2013.

    Science.gov (United States)

    Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

    2016-11-25

    .5 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. During 2004-2013, the decrease in abortion rates among adult women aged 20-39 years ranged from 8% to 27% across these age groups, whereas the abortion rate was stable for women aged ≥40 years. In 2013, adolescents aged abortions, respectively, and had abortion rates of 0.6 and 8.2 abortions per 1,000 adolescents aged abortions accounted for by adolescents aged 15-19 years decreased 31% and their abortion rate decreased 46%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2013 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2004 to 2013 for women in all age groups, except for adolescents aged abortions were performed by ≤8 weeks' gestation, and nearly all (91.6%) were performed by ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.1%) or at ≥21 weeks' gestation (1.3%). From 2004 to 2013, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.5%) and among those performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 16%. In 2013, among the 43 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 67.9% of abortions were performed by curettage at ≤13 weeks' gestation, 22.2% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.6% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.8% were completed by this method. From 2012 to 2013, the percentage of abortions reported as

  1. Abortion Surveillance - United States, 2012.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J

    2015-11-27

    12.4, 7.3, and 2.8 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20-24, 25-29, and 30-34 years by 24%, 18%, and 10%, respectively, whereas they increased among women aged ≥40 years by 8%. In 2012, adolescents aged abortions, respectively, and had abortion rates of 0.8 and 9.2 abortions per 1,000 adolescents aged abortions accounted for by adolescents aged 15-19 years decreased 27% and their abortion rate decreased 40%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2012 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30-39 years. Abortion ratios decreased from 2003 to 2012 for women in all age groups. In 2012, the majority (65.8%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.2%) were performed between 14-20 weeks' gestation or at ≥21 weeks' gestation (1.3%). From 2003 to 2012, the percentage of all abortions performed at ≤8 weeks' gestation increased 7%; the percentage performed at >13 weeks remained consistently low (≤9.0%). In 2012, among the 40 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 69.4% of abortions were performed by curettage at ≤13 weeks' gestation, 20.8% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.7% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible on the basis of gestational age for early medical abortion, 30.8% were completed by this method. The percentage of abortions reported as early medical abortions increased 10

  2. Trends in use of medical abortion in the United States: reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001-2008.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B

    2012-12-01

    With changing patterns and increasing use of medical abortion in the United States, it is important to have accurate statistics on the use of this method regularly available. This study assesses the accuracy of medical abortion data reported annually to the Centers for Disease Control and Prevention (CDC) and describes trends over time in the use of medical abortion relative to other methods. This analysis included data reported to CDC for 2001-2008. Year-specific analyses included all states that monitored medical abortion for a given year, while trend analyses were restricted to states that monitored medical abortion continuously from 2001 to 2008. Data quality and completeness were assessed by (a) examining abortions reported with an unspecified method type within the gestational age limit for medical abortion (med-eligible abortions) and (b) comparing the percentage of all abortions and med-eligible abortions reported to CDC as medical abortions with estimates based on published mifepristone sales data for the United States from 2001 to 2007. During 2001-2008, the percentage of med-eligible abortions reported to CDC with an unspecified method type remained low (1.0%-2.2%); CDC data and mifepristone sales estimates for 2001-2007 demonstrated strong agreement [all abortions: intraclass correlation coefficient (ICC)=0.983; med-eligible abortions: ICC=0.988]. During 2001-2008, the percentage of abortions reported to CDC as medical abortions increased (pabortions and for med-eligible abortions). Among states that reported medical abortions for 2008, 15% of all abortions and 23% of med-eligible abortions were reported as medical abortions. CDC's Abortion Surveillance System provides an important annual data source that accurately describes the use of medical abortion relative to other methods in the United States. Published by Elsevier Inc.

  3. Role of routine ultrasonography in monitoring the outcome of medical abortion in a clinical setting.

    Science.gov (United States)

    Acharya, Ganesh; Haugen, Michael; Bråthen, Anders; Nilsen, Ingard; Maltau, Jan Martin

    2004-04-01

    Clinical methods generally used to evaluate the completeness of medical abortion are not accurate. There are no published reports evaluating the role of routine ultrasonography in monitoring the outcome of medical abortion. The purpose of this study was to investigate whether routine transvaginal ultrasonography (TVS) at the follow-up visit after medical abortion can accurately identify women who will require surgical intervention. Retrospective review of medical records and charts of all women undergoing medical abortion in the first trimester of pregnancy between January 1999 and December 2001. Medical abortion was performed using oral mifepristone and a vaginal prostaglandin analog before 63 days gestation. All women had an initial TVS to confirm intrauterine pregnancy and gestational age, and another TVS at the follow-up visit 2-3 weeks later to assess the completeness of abortion. Surgical evacuation of the uterus was allowed as indicated on clinical grounds but not on the basis of ultrasound findings only. A total of 690 women consented to medical abortion during the study period. Eleven of these women were excluded from the study for various reasons. Of the remaining 679 cases, 95% (645/679) had a documented follow-up at the hospital. The pregnancy termination rate among these women was 99.2% (640/645) and TVS identified all five cases of continuing pregnancy at the follow-up. A total of 66 (10.2%) patients had complications. The uterine cavity was empty on TVS at the follow-up visit in 84.8% (547/645) of cases and only 3.1% (17/547) of them required surgical aspiration/curettage due to excessive or prolonged vaginal bleeding. In the remaining 15.2% (98/645) the uterine cavity was not empty, and 43.9% (43/98) of them had a curettage. The risk of requiring a surgical intervention was significantly higher [odds ratio (OR) 24.4; 95% confidence interval (95% CI) 14.9-39.7] when the uterine cavity was not demonstrated to be empty at the follow-up visit 2-3 weeks

  4. Efficacy of first-trimester ultrasound parameters for prediction of early spontaneous abortion.

    Science.gov (United States)

    Datta, Mamta Rath; Raut, Ankush

    2017-09-01

    To assess first-trimester ultrasound measurements for the prediction of early spontaneous abortion. In a prospective observational study in Jamshedpur, India, women with singleton pregnancies of 42-76 days were enrolled between November 2014 and April 2016. Inclusion criteria were spontaneous conception, embryonic cardiac activity, and regular menstrual cycle. Fetal crown-to-rump length (CRL), gestational sac diameter (GSD), yolk sac diameter (YSD), and fetal heart rate (FHR) were measured by transvaginal ultrasonography. Ultrasonography was repeated at 12 weeks and beyond to determine pregnancy continuation. Among 800 women, 140 (17.5%) experienced early spontaneous abortion. CRL, GSD, and FHR values below the 5th percentile (odds ratio [OR] 26.48, 26.94, and 100.63, respectively), and YSD above the 95th percentile (OR 1.04) were predictors of early abortion. Normal YSD did not reduce the risk of abortion if the other three parameters were below the 5th percentile (OR 34.27). For every 10-bpm decrease in FHR below 130, there was 26.7% increased risk of abortion. GSD-CRL difference of less than 5 mm was associated with a higher likelihood of abortion (OR 4.88). First-trimester ultrasound measurements are predictors of early abortion. Risk assessment tables based on combinations of abnormal measures might improve prediction rates. © 2017 International Federation of Gynecology and Obstetrics.

  5. Verifying the effectiveness of medical abortion; ultrasound versus hCG testing.

    Science.gov (United States)

    Fiala, Christian; Safar, Peter; Bygdeman, Marc; Gemzell-Danielsson, Kristina

    2003-08-15

    The combination of mifepristone and misoprostol is an established method for termination of pregnancy. However, there is no general agreement about how best to evaluate the treatment outcome. In 217 women with an unwanted pregnancy below 49 days of amenorrhoea, ultrasound examination and serum hCG test were performed before treatment and at follow-up. Treatment was successful in 98.2%. At follow-up their hCG dropped to a mean of 3% (S.D. 3) of initial levels and the endometrium measured a mean of 10 mm (S.D. 4). Interpretation of endometrium was difficult in some cases because of inhomogeneous structure. Using hCG was reliable in 98.5% of successful abortions. For ultrasound the corresponding figure was 89.8% for the cases with a confirmed intrauterine pregnancy before treatment but only 66% if all pregnancies were included. Measuring serum hCG before treatment and at follow-up is more effective than ultrasound to confirm a successful medically induced abortion in early pregnancy.

  6. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about......] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p

  7. [Abortion liberation: the opinion of medical and law students, São Paulo, Brazil].

    Science.gov (United States)

    Meira, A R; Ferraz, F R

    1989-12-01

    The results of a survey carried out with the participation of 155 medical and 141 law students are given. Of the total of 296 students, 142 agreed with the freeing of abortion from legal restrictions, 144 agreed with such restrictions and 6 gave no opinion. Of the 144, 12 rejected abortion under any circumstances. The differences were analysed by sex and school. The statistical analysis did not show significance at the level of 5%.

  8. Clinical diagnosis of completeness of medical abortion by nurses: a reliability study in Mozambique.

    Science.gov (United States)

    Gebreselassie, Hailemichael; Ustá, Momade; Andersen, Kathryn L; Mitchell, Ellen M H

    2012-07-01

    The provision of medical abortion continues to rely on routine use of ultrasound to confirm expulsion of pregnancy. However, the absence of ultrasound in most of the health facilities in developing countries and the additional training required to enable providers to use ultrasound is often prohibitive. The purpose of this study was to compare clinical history and physical examination with ultrasound in confirming completion of abortion. A total of 718 women consented for medical abortion with misoprostol and were assessed for pregnancy expulsion by nurses and gynecologists. Nurses used history and physical examination while gynecologists used ultrasound to establish their diagnoses. Nurses' clinical diagnoses for complete abortion, incomplete abortion and ongoing pregnancy were 83% (SE 0.01), 15% (SE 0.01) and 2% (SE 0.01), respectively. When gynecologists used ultrasound, the diagnoses for complete abortion, incomplete abortion, an ongoing pregnancy were 80% (SE 0.01), 17% (SE 0.01) and 3% (SE 0.01), respectively. Overall, nurses agreed with gynecologist diagnoses in 84% of cases, with a κ coefficient of 0.49 (SE 0.06) and chance-corrected first-order agreement (AC(1)) of 0.81 (SE 0.02). Agreement was very high for the diagnosis of complete abortion (AC(1) 0.89; SE 0.02), while it was moderate for ongoing pregnancy (AC(1) 0.58; SE 0.22) and incomplete abortion (AC(1) 0.45; SE 0.08). Clinical history and physical examination alone, without the use of ultrasonography, are effective for the determination of successful pregnancy expulsion. However, greater emphasis is required on the clinical identification of ongoing pregnancy during any training of providers. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2005-01-01

    .05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed surgical abortion were satisfied (17% vs 62......) or a surgical abortion (vacuum aspiration in general anaesthesia). The procedure was determined either by randomization (n = 111) or by choice (n = 922). Data on satisfaction, side effects and expectations were collected from questionnaires 2 and 8 weeks after termination. RESULTS: More women were very......BACKGROUND: The aim of the study was to compare satisfaction with medical and surgical abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA) medical (600 mg mifepristone followed by 1 mg gemeprost...

  10. Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management.

    Science.gov (United States)

    Gemzell-Danielsson, Kristina; Lalitkumar, Sujata

    2008-05-01

    Second trimester abortions constitute 10-15% of all induced abortions worldwide but are responsible for two-thirds of major abortion-related complications. During the last decade, medical methods for second trimester induced abortion have been considerably improved and become safe and more accessible. Today, in most cases, safe and efficient medical abortion services can be offered or improved by minor changes in existing health care facilities. Second trimester medical abortion can be provided by a nurse-midwife with the back-up of a gynaecologist. Because of the potential for heavy vaginal bleeding and serious complications, it is advisable that second trimester terminations take place in a health care facility where blood transfusion and emergency surgery (including laparotomy) are available. This article provides basic information on regimens recommended for second trimester medical abortion. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Efforts should be made to reduce unnecessary surgical evacuation of the uterus after expulsion of the fetus. Future studies should focus on improving pain management, the treatment of women with failed medical abortion after 24 hours, and the safety of medical abortion regimens in women with a previous caesarean section or uterine scar.

  11. Surgical and medical second trimester abortion in South Africa: A cross-sectional study

    Science.gov (United States)

    2011-01-01

    Background A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services. The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province. Methods We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery. Results Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p abortion (median 17 vs. 30 days, p abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols. PMID:21929811

  12. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2005-01-01

    .05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed surgical abortion were satisfied (17% vs 62...

  13. Serum human chorionic gonadotropin (hCG) trend within the first few days after medical abortion: a prospective study.

    Science.gov (United States)

    Pocius, Katherine D; Bartz, Deborah; Maurer, Rie; Stenquist, Asha; Fortin, Jennifer; Goldberg, Alisa B

    2017-03-01

    To prospectively describe the decline in serum human chorionic gonadotropin (hCG) in the first 5 days after complete medical abortion and evaluate the influence of initial hCG and gestational duration. We conducted a prospective, physiologic study of women ≤63 days gestation who underwent medical abortion with 200 mg mifepristone and 800 mcg buccal misoprostol. We stratified enrollment into two gestational cohorts, hCG values on Day 1 (day of mifepristone), Day 3, Day 5 and a routine follow up hCG on Days 7-14. We calculated the percent hCG decline from Day 1 to each repeat measure and evaluated trends based on initial serum hCG level and gestation. We enrolled 66 women; 59 were protocol-adherent and included in our analysis. Mean gestation on Day 1 was 49 days and mean baseline hCG was 72,332 IU. Fifty-seven subjects (97%) had a complete medical abortion without further intervention. The mean serum hCG decline among subjects with complete medical abortion was 70.0±10.6% [range 36.9-98.6%] on Day 3 and 91.4±4.4% [range 68.4-97.7%] on Day 5. The mean serum hCG decline from Day 1 to routine follow-up on Days 7-9 was 97.1±1.7% [range 92.4-99.2%], from Day 1 to Day 10-11 was 98.5±1.4% [range 94.7-99.6%] and from Day 1 to Day 12-14 was 98.7±2.8% [range 86.7-99.9%]. There was no difference in percent hCG decline stratified by initial hCG or gestation. There is a rapid and predictable decline in serum hCG as early as Day 5 after complete medical abortion through 63 days gestation. Rate of hCG decline is not affected by initial hCG or gestational duration. For women who require confirmation of complete abortion sooner than 1 week after mifepristone, due to patient preference, logistical constraints or in the setting of pregnancy of unconfirmed location, a single repeat hCG on Day 5 may be clinically useful. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals.

    Science.gov (United States)

    Nieminen, Petteri; Lappalainen, Saara; Ristimäki, Pauliina; Myllykangas, Markku; Mustonen, Anne-Mari

    2015-03-25

    Conscientious objection (CO) to participating in induced abortion is not present in the Finnish health care system or legislation unlike in many other European countries. We conducted a questionnaire survey with the 1(st)- and the last-year medical and nursing students and professionals (548 respondents; response rate 66-100%) including several aspects of the abortion process and their relation to CO in 2013. The male medical respondents chose later time points of pregnancy than the nursing respondents when considering when the embryo/fetus "becomes a person". Of all respondents, 3.5-14.1% expressed a personal wish to CO. The medical professionals supported the right to CO more often (34.2%) than the nursing professionals (21.4%), while ≥62.4% could work with someone expressing CO. Yet ≥57.9% of the respondents anticipated social problems at work communities caused by CO. Most respondents considered self-reported religious/ethical conviction to be adequate for CO but, at the same time, 30.1-50.7% considered that no conviction would be sufficient. The respondents most commonly included the medical doctor conducting surgical or medical abortion to be eligible to CO. The nursing respondents considered that vacuum suction would be a better justification for CO than medical abortion. The indications most commonly included to potential CO were second-trimester abortions and social reasons. Among the medical respondents, the men were more willing to grant CO also in case of a life-threatening emergency of the pregnant woman. While the respondents mostly seemed to consider the continuation of adequate services important if CO is introduced, the viewpoint was often focused on the staff and surgical abortion procedure instead of the patients. The issue proved to be complex, which should be taken into consideration for legislation.

  15. Acceptability and feasibility of medical abortion with mifepristone and misoprostol in Nigeria.

    Science.gov (United States)

    Okonofua, Friday; Shittu, Oladapo; Shochet, Tara; Diop, Ayisha; Winikoff, Beverly

    2014-04-01

    To examine the acceptability and feasibility of medical abortion in Nigeria. In total, 250 women who were eligible for legal pregnancy termination with a gestational age of up to 63 days since last menstrual period were enrolled in Benin City and Zaria between May 2005 and October 2006. Participants received 200 mg of oral mifepristone in the clinic and then took 400 μg of oral misoprostol 2 days later-choosing to either return to the clinic or take it at home. Women returned 2 weeks later for an assessment of abortion status. The vast majority (96.3%) of women had successful complete abortions. Ultrasound was used to determine outcome in less than one-third (28.9%) of participants. Most women (83.2%) took the misoprostol at home. Almost all (96.2%) participants were satisfied or very satisfied with the abortion method. The introduction of medical abortion with mifepristone and misoprostol could greatly expand current method options and improve the quality of reproductive health care in Nigeria and other settings in which access to legal abortion services is limited. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Self Medication of Abortion Pill: Women’s Health in Jeopardy

    Directory of Open Access Journals (Sweden)

    Rajal Thaker

    2014-01-01

    Full Text Available Background: Federation of Obstetrics and Gynaecological Societies of India (FOGSI recommends close monitoring of distribution of drugs that are used for medical abortion and that the medical profession and pharmaceutical industry should exercise due diligence in the promotion and usage of drugs that are used for medical abortion. Despite this, it has been perceived by the society that, medical abortions are extremely safe option even in hands of untrained personnel, leading to its over the counter dispensing and possibly increase in unsupervised terminations and life threatening complications. Objective: To study consequences of self medication of Abortion pill on women’s health Study Design: Retrospective Observational Study Duration of Study: One Year: August 2012 to July 2013 Material and Methods: After due permission from authority, data was collected from patients who had come for follow-up and treatment after self medication (purchased over the counter by self/family member without medical guidance/supervision for Medical method of Medical Termination of Pregnancy (MTP. Results: Data was collected in 37 patients, who had history of self medication of abortion pill. More than half, 20 (54% women were in age group of 20-29 years and married women were 35 (94.5%. Uneducated women were 12 (32.4%. Majority 33(89.1% of women had complaint of bleeding per vaginum. On Ultrasonography (USG, 26(70.2% women had incomplete abortion, 4 (10.8% women had intrauterine gestational sac with cardiac activity, 2(5.4% women had complete abortion and 1(2.7% woman had missed abortion. Surgical curettage was performed in 28(75.6% women. In 2(5.4% women, there was complete abortion after oxytocin and misoprostol. One woman (2.7% wanted to continue the pregnancy. Laparotomy was performed in 2 (5.4% women having ectopic pregnancy and in 1(2.7% woman who had perforation of uterus while undergoing surgical curettage at private hospital. Moderate and severe anaemia

  17. [Abortion and physicians in training: the opinion of medical students in Mexico City

    Science.gov (United States)

    González De León Aguirre D; Salinas Urbina AA

    1997-04-01

    This research project explores doctors' views regarding induced abortion. Abortion's penalization in Mexico greatly conditions its relevance as a social and public health problem. Physicians constitute a professional sector that can play an important role in reforming current laws on abortion. As a professional group, they have taken a conservative stance towards abortion. Their attitudes are to a great extent influenced by the medical training they receive. In this article we present results from a survey of 96 medical students from the Universidad Autónoma Metropolitana Xochimilco, in Mexico City. Data were processed with the SPSS program. Simple frequencies show that students have limited knowledge concerning the legal status of abortion and that they tolerate it with restrictions and in limited situations. Women students apparently take a more conservative stance, but statistical analysis with the c-square test did not show significant differences by gender. The article poses the need to modify doctors' training in the reproductive health field, allowing future doctors to acquire a broader view of health problems related to sexuality and reproduction. In the long run, this should also promote a kind of comprehensive health care practice in medical services, thus responding more satisfactorily to women's needs.

  18. Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis.

    Science.gov (United States)

    Wu, Hang-Lin; Marwah, Sheeba; Wang, Pei; Wang, Qiu-Meng; Chen, Xiao-Wen

    2017-05-10

    The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.

  19. Surgical and medical second trimester abortion in South Africa: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Lince Naomi

    2011-09-01

    Full Text Available Abstract Background A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services. The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province. Methods We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery. Results Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p Conclusions As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.

  20. 早孕药物流产中超声的监测效果分析%Analysis of Monitoring Effect of Ultrasound in Early Pregnancy Induced Abortion

    Institute of Scientific and Technical Information of China (English)

    余传莉

    2016-01-01

    Objective To evaluate the clinical value of ultrasonography in early medical abortion.Methods Early pregnancy women for medical abortion in our hospital were selected to monitore abortion effect by abdominal ultrasound,observe the effect of the drug in early pregnancy abortion women.Results Gestational sac diameter>10mm of comparison,the success rate of abortion gestational sac inside diameter of 10mm or less in significantly increased,the difference was statistically significant ( 10 mm的比较﹐孕囊内径在10 mm以下的流产成功率明显提高﹐差异有统计学意义(<0.05)﹔初次妊娠的药物流产成功率显著高于再次妊娠﹐差异有统计学意义(<0.05)。结论彩超在监测早孕妇女药物流产成功率方面安全可靠﹐药物流产选择时﹐尽量考虑低龄产妇或者初产妇。

  1. Voluntary termination of pregnancy (medical or surgical abortion: forensic medicine issues

    Directory of Open Access Journals (Sweden)

    Piras Mauro

    2016-01-01

    Full Text Available In Italy, Law 194 of 22 May 1978 provides for and regulates the voluntary termination of pregnancy (VTP. Medical abortion became popular nationwide after Mifepristone (RU-486 was authorized for the market by AIFA (Italian Drug Agency in July 2009. We searched articles in medical literature database with these terms: “medical abortion”, “RU486”, “surgical abortion”. We also searched laws and judgments concerning abortion in national legal databases. Ministerial guidelines were searched on official website of Italian Ministry of Health. We found many medical studies about medical and surgical abortion. We found also ministerial and regional guidelines, which were analyzed. From the point of view of legal medicine, the issues related to abortion with the pharmacological method consist in verifying compatibility and consistency with the safety principles and the parameters imposed by Law n. 194 of 1978, using off-label Misoprostol, what inpatient care should be used and informed consent. The doctor’s job is to provide the patient with comprehensive and clear information about how the procedure will be performed, any complications and the time period needed for both procedures.

  2. Legal and medical aspects of the ethics committee’s work relating to abortion

    Directory of Open Access Journals (Sweden)

    Ponjavić Zoran

    2011-01-01

    Full Text Available This paper analyses the legal and medical aspects of the work of ethics committees on abortion. According to the legislation of the Republic of Serbia, these committees are competent to determine justifiable terms for abortion after the twentieth week of the fetus. It is well known that abortion is not only a medical but a legal, ethic, social and demographic problem as well. A liberal solution in view of abortion in the first trimester has been accepted in most European countries, as by the legislature of the Republic of Serbia. Since prenatal diagnosis cannot always determine the fetus state with certainty but at times may do so at a later stage, abortion is then required when the child is already capable of extrauterine life. The necessity for performing abortion in the third trimester is thus a result of good knowledge of techno-medicine but also from the limited information it provides. In such situations, the physician needs confirmation and justification of his standpoint with respect to abortion through a legal formulation which should contain "minimum moral". Society has found a way to protect and help him through moral and ethic forms of prevention without anybody’s emotions being affected. Ethics committees should thus help the physician in view of determining the terms for performing late abortion, since the rules of doctor’s ethics are not sufficient in this case. The article especially analyses the work of the Ethics Committee of the Clinical Center in Kragujevac in the period 2000-2010. It is stated that the largest number of cases referred to determined diseases or fetus anomalies while only a negligible number (11.29% to the illness of the mother. There were no requests for abortions due to legal reasons (pregnancies from criminal offences. A significant number (40.28% of requests submitted to the Ethics Committee related to pregnancies under the 24th week of pregnancy. Since a pregnancy of 24 weeks represents a boundary

  3. Over the counter sale of drugs for medical abortion- Knowledge, Attitude, and Practices of pharmacists of Delhi, India

    Directory of Open Access Journals (Sweden)

    Archana Mishra

    2016-03-01

    Full Text Available Introduction: Despite the well defined law and highly liberal policy Government approved medical facilities are not the leading provider of abortion in Indian Scenario. Whether legally or not Pharmacists are already acting as provider of medical abortion for large number of women in India. Dispense of Medical abortion drugs via pharmacist has the advantages of convenience, relative anonymity, hasty transaction, easy accessibility and saving cost.Aims and Objectives: Objective of present study was to assess the over the counter sale of medical abortion in terms of knowledge, attitude and practices of pharmacists of Delhi, India.Material and Methods: It was a cross sectional interview based study conducted in 110 pharmacies of 6 districts of State of Delhi.Results: A total of 75 pharmacists and 35 pharmacy workers were interviewed. Knowledge and practices of all of them was inadequate in some aspects. 68% knew Medical abortion is legal and 57% thought that over the counter sale of drugs of medical abortion is also legal. Only 40.9% knew the correct regimen of mifepristone + misoprostol combination.Most of them is not aware of any serious side effects and failure rate. Their attitude is indifferent towards the clients but positive towards training in updating knowledge if given option.Conclusion: Their knowledge, attitude and practices while dispensing drugs for medical abortion were inappropriate to qualify them as an independent mid level provider in present scenario. Unregulated OTC sale of abortifacients is responsible for high number of self induced abortion related complications.

  4. Pharmacy workers in Nepal can provide the correct information about using mifepristone and misoprostol to women seeking medication to induce abortion.

    Science.gov (United States)

    Tamang, Anand; Puri, Mahesh; Lama, Kalyan; Shrestha, Prabhakar

    2015-02-01

    In Nepal, despite policy restrictions, both registered and unregistered brands of mifepristone and misoprostol can easily be obtained at pharmacies. Since many women visit pharmacies for abortion information, ensuring that they receive effective care from pharmacy workers remains an important challenge. We conducted an operations research study to examine whether trained pharmacy workers can correctly provide information on safe use of mifepristone and misoprostol for early first trimester medical abortion. Pharmacy workers in one district were given orientation and training using a harm-reduction approach, and compared with a non-equivalent comparison group in the second district. Overall, trained pharmacy workers' knowledge increased substantially, but no increase was found in the comparison group. Compared to the baseline (65%), 97% of trained pharmacy workers knew up to what stage of pregnancy and how women should use mifepristone and misoprostol. A higher percentage of pharmacy workers in the intervention group (77%) compared to the comparison group (49%) were knowledgeable at follow-up about determining whether an abortion was successful, implying a need for improving this aspect of training. As many mid-level health providers run their own pharmacies and offer medical abortion pills, it is important for the government to consider training these providers and registering their pharmacies as safe medical abortion service outlets. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  5. [Medical abortion provided by telemedicine to women in Latin America: complications and their treatment].

    Science.gov (United States)

    Larrea, Sara; Palència, Laia; Perez, Glòria

    2015-01-01

    To analyze reported complications and their treatment after a medical abortion with mifepristone and misoprostol provided by a telemedicine service to women living in Latin America. Observational study based on the registry of consultations in a telemedicine service. A total of 872 women who used the service in 2010 and 2011 participated in the study. The dependent variables were overall complications, hemorrhage, incomplete abortion, overall treatments, surgical evacuation, and antibiotics. Independent variables were age, area of residence, socioeconomic deprivation, previous children, pregnancies and abortions, and week of pregnancy. We fitted Poisson regression models with robust variance to estimate incidence ratios and 95% confidence intervals (95%CI). Complications were reported by 14.6% of the participants: 6.2% reported hemorrhage and 6.8% incomplete abortion. Nearly one-fifth (19.0%) received postabortion treatment: 10.9% had a surgical evacuation and 9.3% took antibiotics. Socioeconomic deprivation increased the risk of complications by 64% (95%CI: 15%-132%), and, among these, the risk of incomplete abortion by 82% (95%CI: 8%-206%) and the risk of surgical intervention by 62% (95%CI: 7%-144%). Previous pregnancies increased the risk of complications and, specifically, the risk of hemorrhage by 2.29 times (95%CI: 1.33-3.95%). Women with a pregnancy of 12 or more weeks had a 2.45 times higher risk of receiving medical treatment and a 2.94 times higher risk of taking antibiotics compared with women with pregnancies of 7 or less weeks. Medical abortion provided by telemedicine seems to be a safe and effective alternative in contexts where it is legally restricted. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  6. Abortion surveillance--United States, 2009.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B; Burley, Kim D; Jamieson, Denise J

    2012-11-23

    accounted for 14.7%, 8.8%, and 3.3% of all abortions, respectively, and had an abortion rate of 13.3 abortions per 1,000 women aged 30-34 years, 7.6 abortions per 1,000 women aged 35-39 years, and 2.7 abortions per 1,000 women aged ≥40 years. Throughout the period of analysis, abortion rates decreased among women aged 20-24 and 25-29 years, whereas they increased among women aged ≥40 years. In 2009, adolescents aged 15-19 years accounted for 15.5% of all abortions and had an abortion rate of 13.0 abortions per 1,000 adolescents aged 15-19 years. Throughout the period of analysis, the percentage of all abortions accounted for by adolescents and the adolescent abortion rate decreased. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2009 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2000 to 2009 for women in all age groups except for those aged abortions were performed at ≤8 weeks' gestation, and 91.7% were performed at ≤13 weeks' gestation. Few abortions (7.0%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. From 2000 to 2009, the percentage of all abortions performed at ≤8 weeks' gestation increased 12%, whereas the percentage performed at >13 weeks' decreased 12%. Moreover, among abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of these abortions performed at ≤6 weeks' gestation increasing 47%. In 2009, 74.2% of abortions were performed by curettage at ≤13 weeks' gestation, 16.5% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.1% were performed by curettage at >13 weeks' gestation. Among abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 25.2% were completed by this method

  7. Addressing gaps in abortion education: a sexual health elective created by medical students.

    Science.gov (United States)

    Caro-Bruce, Emily; Schoenfeld, Elizabeth; Nothnagle, Melissa; Taylor, Julie

    2006-05-01

    Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools.

  8. Induced Abortion

    Science.gov (United States)

    ... I need to follow up with my health care provider after having a medical abortion? You will need to see your health ... This is more likely to happen with a medical abortion. Infection—Your health care provider will prescribe antibiotics to prevent this. Antibiotics also ...

  9. Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy.

    Science.gov (United States)

    Liang, Hong; Gao, Er-sheng; Chen, Ai-min; Luo, Lin; Cheng, Yi-min; Yuan, Wei

    2011-12-01

    The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy. This observational cohort study was conducted during 1998-2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth. The rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤ 7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period. One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Experience of Sexual Abuse in Childhood and Abortion in Adolescence and Early Adulthood

    Science.gov (United States)

    Boden, Joseph M.; Fergusson, David M.; Horwood, L. John

    2009-01-01

    Objective: The present study examined the associations between the experience of sexual abuse in childhood (CSA) and the number of abortions in adolescence and early adulthood. Method: A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1,265 New Zealand children (630 females). Measures included…

  11. Randomized trial of oral versus sublingual misoprostol 24 h after mifepristone for medical abortion.

    Science.gov (United States)

    Dahiya, Krishna; Mann, Sonika; Nanda, Smiti

    2011-07-01

    To assess the efficacy, side effects, and acceptability of medical abortion using oral mifepristone (200 mg) followed 24 h later by oral or sublingual misoprostol (400 μg). A total of 93 women with pregnancies up to 56 days of gestational age were assigned to two groups according to the different misoprostol regimen (group I 400 μg orally and group II 400 μg sublingually). The principle outcome measure was complete abortion defined as a complete expulsion of intrauterine contents without a need for surgical intervention 7 days after the procedure. Successful abortion occurred in 87.5% of patients in group 1 and 95.5% patients in group 2 (p = 0.166, 95% CI -0.194, 0.033). The patient acceptability and satisfaction rates were similar in both the groups. It is concluded that 400 μg of sublingual misoprostol is as effective as oral misoprostol 24 h after mifepristone for medical abortion of ≤ 56 days.

  12. Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days.

    Science.gov (United States)

    Gatter, Mary; Cleland, Kelly; Nucatola, Deborah L

    2015-04-01

    The aim of this study was to report on the safety and efficacy of an evidence-based medical abortion regimen utilizing 200 mg of mifepristone orally followed by home use of 800 mcg misoprostol buccally 24-48 h later through 63 days estimated gestational age. We analyzed outcomes in women presenting for medical abortion between April 1, 2006, and May 31, 2011, using an evidence-based alternative to the United States Food and Drug Administration (FDA)-approved regimen. Cases were identified for this descriptive study from our electronic practice management (EPM) database, and our electronic database on adverse events was queried for information on efficacy and safety. The primary outcome was successful abortion. Logistic regression was used to identify predictors of successful abortion. Among the 13,373 women who completed follow-up, efficacy of the regimen was 97.7%. Efficacy was highest at 29 to 35 days (98.8%) and 36 to 42 days (98.8%) of gestation and lowest at 57 to 63 days (95.5%). The odds of needing aspiration for any reason were greatest at higher gestational ages. Rates of infection requiring hospitalization and rates of transfusion were 0.01 and 0.03%, respectively. An evidence-based regimen of 200 mg of mifepristone orally followed by home use of 800 mcg of buccal misoprostol 24-48 h later is safe and effective through 63 days estimated gestational age. Further, the need for aspiration for any reason was low, and hospitalization was rare. This study reinforces the safety and efficacy of the evidence-based regimen for medical abortion (200 mg mifepristone orally followed by home use of 800 mcg of misoprostol buccally 24-48 h later) through 63 days estimated gestational age, and contributes to the existing evidence against restrictions requiring use of the FDA-approved regimen. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Induced abortion.

    Science.gov (United States)

    2017-06-01

    Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  14. Safe, accessible medical abortion in a rural Tamil Nadu clinic, India, but what about sexual and reproductive rights?

    Science.gov (United States)

    Sri, Subha B; Ravindran, T K Sundari

    2015-02-01

    Women's control over their own bodies and reproduction is a fundamental prerequisite to the achievement of sexual and reproductive health and rights. A woman's ability to terminate an unwanted pregnancy has been seen as the exercise of her reproductive rights. This study reports on interviews with 15 women in rural South India who had a medical abortion. It examines the circumstances under which they chose to have an abortion and their perspectives on medical abortion. Women in this study decided to have an abortion when multiple factors like lack of spousal support for child care or contraception, hostile in-laws, economic hardship, poor health of the woman herself, spousal violence, lack of access to suitable contraceptive methods, and societal norms regarding reproduction and sexuality converged to oppress them. The availability of an easy and affordable method like medical abortion pills helped the women get out of a difficult situation, albeit temporarily. Medical abortion also fulfilled their special needs by ensuring confidentiality, causing least disruption of their domestic schedule, and dispensing with the need for rest or a caregiver. The study concludes that medical abortion can help women in oppressive situations. However, this will not deliver gender equality or women's empowerment; social conditions need to change for that. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  15. Comparison of two doses of oral misoprostol with one, after mifepristone in early abortion.

    Science.gov (United States)

    Jha, Tulika; Das, Anindya; Bhattacharya, Ajit Ranjan; Ganguly, Rajendra Prasad; Patra, Kajal Kumar; Das, Bibekananda

    2013-12-01

    A prospective randomised controlled study was conducted at RG Kar Medical College and hospital to compare the efficacy and side-effects of two doses of oral misoprostol, with one dose following mifepristone in early abortion. Two randomly allocated groups of seventy-five women each were formed, which were comparable in all respects and also conformed to the inclusion and exclusion criteria laid down in this study. Both groups received 200 mg of mifepristone on day one. After 48 hours, both groups received 400 microg of misoprostol and 3 hours later one group received 3 tablets of 200 microg misoprostol and the other group received 3 tablets of placebo. The women were then followed up to note the time of expulsion, completeness of the process, amount of bleeding encountered, side-effects if any or any other observation. The most important parameter ie, the completeness of the expulsion when compared showed no statistically significant difference between the two groups (p-value = 0.1025).

  16. [Post-abortion contraception].

    Science.gov (United States)

    Ohannessian, A; Jamin, C

    2016-12-01

    To establish guidelines of the French National College of Gynecologists and Obstetricians about post-abortion contraception. A systematic review of the literature about post-abortion contraception was performed on Medline and Cochrane Database between 1978 and March 2016. The guidelines of the French and foreign scientific societies were also consulted. After an abortion, if the woman wishes to use a contraception, it should be started as soon as possible because of the very early ovulation resumption. The contraception choice must be done in accordance with the woman's expectations and lifestyle. The contraindications of each contraception must be respected. The long-acting reversible contraception, intra-uterine device (IUD) and implant, could be preferred (grade C) as the efficacy is not dependent on compliance. Thus, they could better prevent repeat abortion (LE3). In case of surgical abortion, IUD should be proposed and inserted immediately after the procedure (grade A), as well as the implant (grade B). In case of medical abortion, the implant can be inserted from the day of mifépristone, the IUD after an ultrasound examination confirming the success of the abortion (no continuing pregnancy or retained sac) (grade C). Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Alternatives to ultrasound for follow-up after medication abortion: a systematic review.

    Science.gov (United States)

    Grossman, Daniel; Grindlay, Kate

    2011-06-01

    Requiring a follow-up visit with ultrasound evaluation to confirm completion after medication abortion can be a barrier to providing the service. The PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials and POPLINE databases were systematically searched in October and November 2009 for studies related to alternative follow-up modalities after first-trimester medication abortion to diagnose ongoing pregnancy or retained gestational sac. We calculated the sensitivity, specificity, positive predictive value and negative predictive value compared with ultrasound or clinician's exam. We also calculated the proportion of cases in each study with a positive screening test. Our search identified eight articles. The most promising modalities included serum human chorionic gonadotropin measurements, standardized assessment of women's symptoms combined with low-sensitivity urine pregnancy testing and telephone consultation. These follow-up modalities had sensitivities ≥90%, negative predictive values ≥99% and proportions of "screen-positives" ≤33%. Alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. Additional research is needed to demonstrate the accuracy, acceptability and feasibility of alternative follow-up modalities in practice, particularly of home-based urine testing combined with self-assessment and/or clinician-assisted assessment. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. [Induced abortion at home].

    Science.gov (United States)

    Jørgensen, Hilde; Qvigstad, Erik; Jerve, Fridtjof; Melseth, Eldbjørg; Eskild, Anne; Nielsen, Christopher S

    2007-09-20

    Medically induced abortion through week 9 is a well established procedure. The article concerns satisfaction among women who choose to do this at home, and possible associations between satisfaction, socio-demographic--and clinical factors. 110 women with pregnancy duration questionnaires filled in before and 1 and 3 weeks after the abortion. The degree of satisfaction was recorded on a scale from 1 to 10, where 1 was not content and 10 was very content. Follow-up data were available for 105 women. 90 of 105 women were very content (> 7 on the satisfaction scale) with the treatment. Discomfort and pain during the abortion and marital status seemed to influence the results. The degree of pain varied much. No serious complications were observed. The study showed a high degree of satisfaction with medically induced abortion at home early in the pregnancy. The study has a relatively small sample size and no control group, so the results on factors affecting satisfaction are uncertain. Medical abortion at home should be an opportunity for women applying for early pregnancy termination; as long as the women are well informed, are offered sufficient pain relief and a well functioning follow-up programme.

  19. Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia.

    Science.gov (United States)

    Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Abrahamyan, Ruzanna; Winikoff, Beverly

    2017-02-01

    The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia. Women seeking to terminate 13-22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24-48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4-17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2-6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13-22 weeks' gestation is an effective and acceptable option for women.

  20. Safety of Medical Abortion Provided Through Telemedicine Compared With In Person.

    Science.gov (United States)

    Grossman, Daniel; Grindlay, Kate

    2017-10-01

    To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service. We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year. During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11-0.29%] and 0.32% of in-person patients [95% CI 0.23-0.45%]). The difference in adverse event prevalence was 0.13% (95% CI -0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion. Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant

  1. Complications and the effect of varicocelectomy on semen analysis, fertility, early ejaculation and spontaneous abortion

    Directory of Open Access Journals (Sweden)

    Shamsa Ali

    2010-01-01

    Full Text Available Varicocele is still an enigma. Its effects on semen analysis, fertility and, more re-cently, early ejaculation and spontaneous abortion in spouses are not yet fully understood. In this retrospective study, we evaluated these four parameters (semen analysis, fertility, early ejacu-lation and spontaneous abortion among spouses in relation to varicocele and varicocelectomy during a 13-year period. A total of 1,711 patients with varicocele underwent varicocelectomy by high inguinal method (251 cases, subinguinal method (1,375 cases, scrotal method (34 cases, and subinguinal method with local anesthesia (38 cases. Our complication rate was acceptable. Sperm count, motility and morphology increased three months post operation in 55, 51, and 46%, respectively (P value 0.000, 0.000, and 0.015, respectively. Paternity was 56% after one year of post varicocelectomy follow-up. Only 7 out of 82 azoospermic men had sperm in their semen after varicocelectomy and only one of them with mild spermatogenic hypoplasia became a father. The spontaneous abortion rate in the spouses of respondents was 59%. Early ejaculation improved in 75% of the respondents. In conclusion, varicocelectomy does not improve sperm parameters in all men, but it improves pregnancy rate, early ejaculation, and scrotal pain.

  2. A comparison of the costs of manual vacuum aspiration (MVA) and evacuation and curettage (E and C) in the treatment of early incomplete abortions in Kenya.

    Science.gov (United States)

    Bradley, J; Rogo, K; Johnson, R; Okoko, L; Healy, J; Benson, J

    1993-01-01

    Limited access to safe abortion is a leading cause of maternal mortality and morbidity in the developing world. Hospitals are often overwhelmed by the large number of women presenting for treatment of the complications of previous unsafe abortions. In many settings, the number of incomplete or septic abortions comprises more than half of all gynecological admissions. In the absence of measures to reduce the incidence of unsafe abortions, hospitals treat these female patients with complications in the most efficient and effective manner allowed by limited available resources. In most developing countries, Evacuation and Curettage (E&C) is the standard approach to treating cases of incomplete abortion. Requiring a physician, operating theater, and often general anesthesia, E&C is usually performed in the hospital setting. Patients may have to wait several days for treatment, a period during which complications such as hemorrhage and sepsis may develop. In the developed world, however, Manual Vacuum Aspiration (MVA) is the standard treatment for uterine evacuation. MVA usually requires neither anesthesia, anesthetist, operating theater, nor an overnight stay, and it may be performed by a wide range of trained medical personnel including physician's assistants, nurse practitioners, and nurse midwives who may work in rural health clinics with no operating room facilities. This paper documents the magnitude of differences in cost between MVA and E&C in the treatment of early incomplete abortions in the following four hospitals in Kenya: Kenyatta National Hospital in Nairobi, Kisii District Hospital, Eldoret District Hospital, and Machakos District Hospital. Data were collected over the period March-June 1991 and consider costs comprehensively in terms of staff time, in-patient or hotel costs, and drugs and equipment. Analysis found MVA to be the most appropriate and cost-effective way of managing incomplete abortion. Effort should therefore be made to extend the

  3. Are two doses of misoprostol after mifepristone for early abortion better than one?

    Science.gov (United States)

    Coyaji, K; Krishna, U; Ambardekar, S; Bracken, H; Raote, V; Mandlekar, A; Winikoff, B

    2007-03-01

    The objective of this study was to determine if a repeat dose of misoprostol following mifepristone or a single dose of misoprostol increases the efficacy of medical termination of pregnancy. Randomised, placebo controlled trial. K.E.M. Hospital, Pune, India, and the Health Centre, Larsen and Toubro Limited, Mumbai, India. A total of 300 women seeking an abortion with amenorrhoea of 8 weeks or less. Methods Women were randomised to receive one or two doses of 400 microgram oral misoprostol at the clinic 48 hours after administration of 200 mg mifepristone. Main outcome measure Complete abortion without surgical intervention. Results The repeat administration of misoprostol 400 microgram improved the complete abortion rate from 86 to 92% and significantly reduced the rate of continuing pregnancy from 7 to 1%. Almost all the women who were administered the additional dose of misoprostol were either very satisfied (58%) or satisfied (37%) with the method. Conclusion While an additional oral dose of 400 microgram misoprostol did not significantly increase the rate of complete abortion without surgical intervention, the additional dose did significantly reduce the rate of continuing pregnancies without compromising the acceptability and ease of use of the method.

  4. The effectiveness of using misoprostol with and without letrozole for successful medical abortion: A randomized placebo-controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Elham Naghshineh

    2015-01-01

    Full Text Available Background: In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks. Materials and Methods: In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients′ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes. Results: Complete abortion was observed in 46 (76.7% letrozole group and 26 (42.6% controls (P < 0.0001. Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P < 0.0001. The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P < 0.0001. The incidence and severity of side-effects was comparable for the two groups (P = 0.9. Conclusion: Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.

  5. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial

    Science.gov (United States)

    Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D.; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie

    2015-01-01

    Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective To investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main Outcome Measures Women’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82

  6. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

    Science.gov (United States)

    Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie

    2015-01-01

    Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Secondary outcome of a randomised, controlled, non-inferiority trial. Outpatient primary health care clinics in rural and urban Rajasthan, India. Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as

  7. Expression of the Inducible Nitric Oxide Synthase Isoform in Chorionic Villi in the Early Spontaneous Abortion

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To investigate the relationship between inducible nitric oxide synthase (iNOS) and the early spontaneous abortion. , in situ hybridization and immunohistochemistry were used to detect the expression of iNOS in trophoblasts in the early pregnancy with and without spontaneous abortion (group Ⅰ and group Ⅱ ). By light microscopy and computer color magic image analysis system (CMIAS), light density (D) and the positive cell number per statistic square (N/S) in situ hybridization were used to analyze the positive cell index, while total positive cells (N) and the positive unit (Pu) were used in immunohistochemistry. By in situ hybridization, D and N/S in trophoblasts were 0. 35±0. 028, 0. 07±0. 011 respectively in group Ⅰ and 0. 18±0. 016,0. 015±0. 003 in group Ⅱ . In terms of immunohistochemical staining, N and Pu were 0. 058±±0. 007, 11. 94±2. 01 in group Ⅰ and 0. 013±0. 009, 1. 08±0. 35 in group Ⅱ in trophoblasts. Significant differences existed between two groups. It is concluded that the higher nitric oxide produced by the higher expression of iNOS in trophoblasts might play an important role in the early spontaneous abortion.

  8. Effect of Medical Abortion and Surgical Abortion on Subsequent Pregnancy%药物流产和手术流产对再次妊娠的影响

    Institute of Scientific and Technical Information of China (English)

    李虹娇; 岳阳

    2016-01-01

    Objective To analyze the impact of medical abortion and surgical abortion on subsequent pregnancy. Methods 70 cases of hospital medical abortion maternal(drug group),70 cases of surgical abortion pregnant women(surgery group)were retrospectively analyzed,compared two groups of pregnant women during pregnancy again during pregnancy and childbirth complications Happening. Results The surgical group threatened miscarriage during pregnancy were significantly higher than the medication group,data were significantly different(P <0.05),surgery group delivery of placenta accreta,placenta residue and other complications were higher than the medication group,data were significantly different(P < 0.05). Conclusion Compared with surgical abortion,medical abortion on subsequent pregnancy affect considerably smaller,and more secure.%目的:分析药物流产和手术流产对再次妊娠的影响。方法对我院70例药物流产孕产妇(药物组)、70例手术流产孕产妇(手术组)的临床资料进行回顾性分析,对比两组孕产妇再次妊娠时妊娠期及分娩期并发症发生情况。结果手术组妊娠期先兆流产发生率高于药物组,数据差异具有统计学意义(P<0.05);手术组分娩期胎盘粘连、胎盘残留等并发症发生率均高于药物组,数据差异具有统计学意义(P<0.05)。结论与手术流产相比,药物流产对再次妊娠的影响相当较小,安全性更高。

  9. Abortion, contraceptive use, and adolescent pregnancy among first-year medical students at a major public university in Mexico City.

    Science.gov (United States)

    Ortiz-Ortega, Adriana; De La Torre, Guadalupe García; Galván, Fernando; Cravioto, Patricia; Paz, Francisco; Díaz-Olavarrieta, Claudia; Ellertson, Charlotte; Cravioto, Alejandro

    2003-08-01

    If properly trained, medical students could become future opinion leaders in health policy and could help the public to understand the consequences of unwanted pregnancies and of abortions. The objective of this study was to analyze the frequency of unwanted pregnancies and induced abortions that had occurred among women who were first-year medical students at a major public university in Mexico City and to compare the experiences of those women with the experiences of the general population of Mexican females aged 15 to 24. In 1998 we administered a cross-sectional survey to all the first-year medical students at the National Autonomous University of Mexico, which is the largest university in Latin America. For this study we analyzed 549 surveys completed by female students. Out of the 549 women, 120 of them (22%) had been sexually active at some point. Among those 120 sexually active students, 100 of them (83%) had used a contraceptive method at some time, and 19 of the 120 (16%) had been pregnant. Of those 19 women who had been pregnant, 10 of them had had an illegal induced abortion (in Mexico, abortions are illegal except under a small number of extenuating circumstances). The reported abortion rate among the female medical students, 2%, was very low in comparison with the 11% rate for women of similar ages in the Mexican general population. The lower incidence of abortion among the female medical students indicates that when young Mexican women have access to medical information and are highly motivated to avoid unintended pregnancy and abortion, they can do so.

  10. The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review.

    Science.gov (United States)

    Schonberg, Dana; Wang, Lin-Fan; Bennett, Ariana H; Gold, Marji; Jackson, Emily

    2014-11-01

    We sought to evaluate the accuracy of assessing gestational age (GA) prior to first trimester medication abortion using last menstrual period (LMP) compared to ultrasound (U/S). We searched Medline, Embase and Cochrane databases through October 2013 for peer-reviewed articles comparing LMP to U/S for GA dating in abortion care. Two teams of investigators independently evaluated data using standard abstraction forms. The US Preventive Services Task Force and Quality Assessment of Diagnostic Accuracy Studies guidelines were used to assess quality. Of 318 articles identified, 5 met inclusion criteria. Three studies reported that 2.5-11.8% of women were eligible for medication abortion by LMP and ineligible by U/S. The number of women who underestimated GA using LMP compared to U/S ranged from 1.8 to 14.8%, with lower rates found when the sample was limited to a GA abortion at GA abortion by LMP but ineligible by U/S is needed to confirm the safety and effectiveness of providing medication abortion using LMP alone to determine GA. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac.

    Science.gov (United States)

    Reeves, Matthew F; Kudva, Anupa; Creinin, Mitchell D

    2008-10-01

    We sought to examine outcomes after a second dose of misoprostol was given at a 1-week follow-up visit after medical abortion for the presence of a persistent gestational sac (GS) on ultrasound examination. We examined outcomes in women who were enrolled in two randomized trials of medical abortion regimens. Pregnant women up to 63 days' gestation received mifepristone followed by misoprostol 800 mcg vaginally either 24 h later, 6-8 h later or within 15 min. Participants in both studies returned for an evaluation, including transvaginal ultrasonography, approximately 7 days after initiating treatment. We included women with a GS present at the follow-up visit. Subjects who had not expelled the GS received a second dose of misoprostol 800 mcg vaginally. Participants returned approximately 1 week later and were contacted by telephone 5 weeks after treatment. Of 1972 women who had a follow-up ultrasound examination within 11 days of treatment, a persistent GS was identified in 82 women (4.2%) of whom 68 opted to receive a second dose of misoprostol. All 68 women returned for follow-up evaluation and 42 (62%) expelled the GS. In the 26 women with an embryonic pole within the persistent sac, expulsion occurred in 5 (36%) of 14 with and 7 (54%) of 13 without gestational cardiac activity (GCA) (p = .45). Of the 14 pregnancies with GCA, only 5 (36%) had GCA at follow-up. More than half of women with a persistent GS after medical abortion will expel the pregnancy when treated with a second dose of misoprostol. One-third of women who have a GS with cardiac activity will expel the GS with a second dose of misoprostol, making a second dose a reasonable option.

  12. Induced abortion--a global health problem.

    Science.gov (United States)

    Odlind, V

    1997-01-01

    Every year around 500,000 women are estimated to die from pregnancy-related causes, the majority in the developing world and many as a consequence of unsafe abortion. Around 25 per cent of maternal deaths in Asia and 30-50 per cent of maternal deaths in Africa and Latin America occur as a result of induced abortion. Data on abortion related maternal morbidity is less reliable than mortality but suggests that for every maternal death 10-15 women suffer significant pregnancy-related morbidity, i.e. infertility, genito-urinary problems and/or chronic pain. Induced abortion occurs in practically every society in the world but only 40 per cent of the women in the world live in countries where abortion is legally free. A permissive legislation is an important prerequisite for medically safe and early abortion. Oppositely, with a restrictive law, abortion is difficult to obtain, costly and possibly unsafe, in particular to the least affluent women in the society. Induced abortion in a developed country with legal and easy access to services is a safe procedure with hardly any mortality and very low morbidity. The best strategy to reduce the number of unsafe abortions is prevention of unwanted pregnancy. The consequences of unsafe abortion on women's health need to be acknowledged by everybody in the society in order to improve abortion care. It is necessary to adjust legal and other barriers to medically safe abortion in order to follow the declaration at the UN conference on population in Cairo, 1994, which stated that abortion, wherever legal, should be safe. It is also necessary to introduce preventive measures where abortions are performed, i.e. good and easily accessible family planning services.

  13. Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial.

    Science.gov (United States)

    Raymond, Elizabeth G; Weaver, Mark A; Louie, Karmen S; Tan, Yi-Ling; Bousiéguez, Manuel; Aranguré-Peraza, Ana Gabriela; Lugo-Hernández, Elba M; Sanhueza, Patricio; Goldberg, Alisa B; Culwell, Kelly R; Kaplan, Clair; Memmel, Lisa; Sonalkar, Sarita; Jamshidi, Roxanne; Winikoff, Beverly

    2016-10-01

    To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy. ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.

  14. COMPLEX APPROACH TO TREATMENT OF SUBCHORIONIC HEMATOMA IN EARLY THREATENED ABORTION

    Directory of Open Access Journals (Sweden)

    S. N. Heryak

    2016-05-01

    Full Text Available Background. Currently, miscarriage is considered to be a multietiological disorder with trombofilic violations and hormone deficiency as the leading factors. Despite the achievements in treatment of miscarriage, the frequency of preterm termination of the wanted pregnancies is still high and the number of perinatal losses is significant. Therefore, pathogenetically based therapy, safe for the foetus, is very important in management of pregnancy interruption in the first trimester. A proper drugs administration provides optimal concentration of active ingredients and fast action. The aim is to improve effectiveness of the early threatened abortion treatment in cases of subchorionic hematoma (SCH by combination of sublingual natural micronized progesterone and tranexamic acid Objective. We examined 50 pregnant women with early threatened abortion with SCH. We studied system of haemostasis, basic hormonal markers and ultrasound criteria of threatened abortion. We compared efficacy of treatment between traditional (supportive therapy (sedation, spasmolytic, haemostatic drug and combination of supportive therapy in combination with tranexamic acid and natural micronized progesterone. Results. The result of lab tests showed minimal signs of hypercoagulation, hyperfibrinogenemia and platelet hyperactivity, a significant β-hCG level decrease and approximate decrease in progesterone and free estriol production. Sonographic examination showed presents of local myometrial hypertonus, deformation of fertilized egg, hypoplasia of chorion, low location of fertilized ovum, retarded growth of CRL.The research proved that combined administration of sublingual micronized progesterone and tranexamic acid for the treatment of threatened abortion with SCH has more significant positive effect for pregnancy maintenance due to clinical, biochemical, hormonal and ultrasound results if compared with the group which underwent supportive therapy. Conclusions. Complex

  15. Knowledge and provision practices regarding medical abortion among public providers in Hanoi, Khanh Hoa, and Ho Chi Minh City, Vietnam.

    Science.gov (United States)

    Ngo, Thoai D; Free, Caroline; Le, Hoan T; Edwards, Phil; Pham, Kiet H T; Nguyen, Yen B T; Nguyen, Thang H

    2014-03-01

    To assess public service providers' knowledge of medical abortion (MA) and practices, and perspectives on expanding the use of MA to primary and secondary health facilities in Vietnam. A cross-sectional study was conducted via an interviewer-administered questionnaire among abortion providers (n=905) from public health facilities between August 2011 and January 2012. Overall, 31.1% of providers performed both surgical and medical abortions; 68.9% offered only surgical abortion. Providers were knowledgeable about the regimen/dosage of mifepristone plus misoprostol regimen; however, knowledge scores were low for gestational age limits for MA, adverse effects of the combined drug regimen, and safety and effectiveness of MA compared with surgical abortion. Knowledge scores were significantly lower among providers in rural areas than among those in urban settings. A large proportion of providers (82.9%) thought that MA should be expanded to primary and secondary health facilities. Perceived barriers to MA expansion included lack of knowledge and training, qualified staff, adequate drug supplies, equipment, or facilities, guidelines and protocols on MA, and patient awareness. Provision of MA in Vietnam was found to be disproportionate to surgical abortion provision and to vary by region. Knowledge of MA was moderate, but poorer among providers in rural settings. Copyright © 2013 International Federation of Gynecology and Obstetrics. All rights reserved.

  16. Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

    Science.gov (United States)

    Tuladhar, H; Risal, A

    2010-06-01

    World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

  17. Medical Abortion and Surgical Abortion for Comparison and Analysis the Influence of Again Pregnancy%药物流产与手术流产对再次妊娠的影响对比分析

    Institute of Scientific and Technical Information of China (English)

    李素美

    2015-01-01

    目的:比较药物流产和手术流产对再次妊娠的影响,为医院选择合适的流产方式提供科学依据。方法选择药物流产史的108例健康妇女和手术流产史的108例健康妇女,分别设为药物流产组和手术流产组,观察两组妊娠期的先兆流产、早产、胎盘前置和产后出血等并发症,并进行比较分析。结果手术流产组再次妊娠的先兆流产、胎盘粘连、胎盘前置及产后出血率较药物流产组高,有显著差异(P<0.01),药物流产组较手术流产组产后出血率低(P<0.05)。结论药物流产对再次妊娠的不良影响较手术流产低得多,因此意外妊娠可首选药物流产。%Objective To compare the medical abortion and surgical abortion impact on subsequent pregnancy, the hospital provides a scientiifc basis for selecting the appropriate abortion method. Methods 108 cases of abortion history of drug 108 cases of healthy women and women's health history surgical abortion, medical abortion groups were set and surgical abortion groups were observed during pregnancy threatened abortion, premature birth, placenta previa and postpartum hemorrhage complications, and comparative analysis. Results The surgical abortion group again threatened abortion pregnancy, placenta accreta, placenta previa and postpartum hemorrhage rate higher medical abortion group, a signiifcant difference (P<0.01), medical abortion group compared with the low rate of postpartum hemorrhage surgical abortion group (P<0.05). Conclusion Adverse effects of abortion on subsequent pregnancy is much lower than the surgical abortion, unwanted pregnancy and therefore abortion can be the drug of choice.

  18. Predictive value of serum β-hCG for early pregnancy outcomes among women with recurrent spontaneous abortion.

    Science.gov (United States)

    Liu, Yinglin; Liu, Yukun; Li, Xuejiao; Jiao, Xuedan; Zhang, Rui; Zhang, Jianping

    2016-10-01

    To examine peak serum levels of the β-subunit of human chorionic gonadotropin (β-hCG) for prediction of early pregnancy outcomes among women with recurrent spontaneous abortion (RSA). In a retrospective study, the medical records of pregnant women with a history of RSA treated at Sun Yat-sen Memorial Hospital, China, between January 2011 and July 2013 were reviewed. Serum β-hCG had been measured twice weekly from 5 to 13weeks of pregnancy, and pregnancy was monitored by transvaginal ultrasonography to 13(+6)weeks. Optimal cutoff for peak β-hCG level was determined by receiver operator characteristic curve analysis and Youden index. Women were divided into four groups on the basis of optimal peak β-hCG cutoff and pregnancy outcome (pregnancy at 13weeks or spontaneous abortion). Peak β-hCG levels and length of pregnancy at this peak were examined. Overall, 1240 patients were included. The optimal cutoff value of peak β-hCG was 88 468IU/L, with a sensitivity, specificity, positive predictive value, and negative predictive value for successful pregnancy of 95.6%, 88.0%, 95.6%, and 89.0%, respectively. A faster rise in β-hCG, higher peak β-hCG, and longer pregnancy length at peak β-hCG were associated with successful early pregnancy. A cutoff value of serum β-hCG of 88 000IU/L could be used to predict early pregnancy outcomes for women with a history of RSA. Copyright © 2016. Published by Elsevier Ireland Ltd.

  19. Expression of Apoptosis and Inducible Nitric Oxide Synthase in Trophoblastic Cells in Early Spontaneous Abortion

    Institute of Scientific and Technical Information of China (English)

    夏革清; 孙永玉

    2001-01-01

    Objective To investigate the effect of apoptosis and inducible nitric oxide (Inos) on the early spontaneous abortion Methods TUNEL method was used to detect the apoptosis in trophoblast cells in early pregnancy with and without spontaneous abortion (the experiment group and the control group), while Inos was detected by both in situ hybridization and immunohis tochemistry. By computer color magic image analysis system (CMIAS), positive cell indexes were represented by D (density) and N/S (number/square) in both apoptosis and in situ hybridization, in immunohistochemistry were N/S and PU (positive unit).Results Positive cell indexes of apoptosis D and N/S were significntly higher in the experiment group (0. 48± 0. 004, 0. 045±0. 002) than that in the control group( 0. 35 +0. 06, 0. 031±0. 003. P<0. 001). D and N/S of inducible nitric oxide synthase in situ hybridization were 0. 33± 0. 028, 0. 074± 0. 001 respectively in the experiment group and 0. 13± 0. 015, 0. 019± 0. 004 respectively in the control group. N/S and PU were significantly higher in the experiment group( 0. 058± 0. 007, 11. 94± 2. 01)than that in the control group (0. 007± 0. 001, 1. 18± 0. 35, P<0. 01). There existed a positive correlation between Inos and apoptosis too.Conclution Apoptosis and Inos in trophoblasts might play an important role in early spontaneous abortion and there was a positive correlation between apoptosis and Inos.

  20. An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 microg for first-trimester legal medical abortion

    DEFF Research Database (Denmark)

    Ravn, Pernille; Rasmussen, Ase; Knudsen, Ulla Breth;

    2005-01-01

    the procedure over a 3-year period and 606 (92%) experienced successful medical abortion. The remaining 8% had vacuum aspiration performed mainly due to uterine retention (70%). Other reasons were vaginal bleeding (25%), vomiting (2%), or pelvic infection (4%). Most women reported no days with severe pain (67......%), 0--1 days with moderate pain (82%), and 0--1 days with light pain (62%). In terms of gastrointestinal side effects, 68% reported nausea, 33% vomiting, and 27% diarrhea. Most women (90%) felt that the information given at the hospital prior to the abortion was sufficient, 74% would prefer medical...

  1. Prospective study of home use of mifepristone and misoprostol for medical abortion up to 10weeks of pregnancy in Kazakhstan.

    Science.gov (United States)

    Platais, Ingrida; Tsereteli, Tamar; Grebennikova, Galina; Lotarevich, Tatyana; Winikoff, Beverly

    2016-09-01

    To evaluate the efficacy of at-home medical abortion in Kazakhstan. A comparative, non-randomized study was undertaken at three clinics in Kazakhstan between October 10, 2013, and November 27, 2014. Women who sought medical abortion and had an intrauterine pregnancy of up to 70days were enrolled. All participants took 200mg mifepristone followed by 600μg sublingual misoprostol 24-48hours later. Women were offered the choice to take mifepristone at the clinic or at home; all took misoprostol at home. Abortion completion was assessed at an in-clinic follow-up appointment scheduled for all participants 2weeks after mifepristone administration. Of 290 enrolled women, 185 (63.8%) chose to self-administer mifepristone at home. Three (1.0%) of 289 women included in outcome analyses required surgical intervention for incomplete abortion. Therefore, the overall success rate was 99.0% (95% confidence interval 97.0%-99.7%). No serious adverse events occurred. Outpatient medical abortion with mifepristone and misoprostol is safe and effective up to 70days of pregnancy. This service should be offered to women in Kazakhstan. ClinicalTrials.gov: NCT02018796. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion.

    Science.gov (United States)

    Chai, J; Tang, O S; Hong, Q Q; Chen, Q F; Cheng, L N; Ng, E; Ho, P C

    2009-02-01

    The conventional timing of misoprostol administration after mifepristone for second trimester medical abortion is 36-48 h, but simultaneous administration, which may make the regimen more convenient, has not been studied. The objective of this randomized comparison study is to compare two intervals of administration of misoprostol after pretreatment with mifepristone for second trimester medical abortion. Eligible women with gestational age between 12 and 20 weeks were randomized to receive mifepristone 200 mg orally followed by 600 microg misoprostol vaginally either immediately or 36-38 h later, followed by 400 microg vaginal misoprostol every 3 h for a maximum of four doses. The primary outcome measure was the success rate at 24 h after the start of misoprostol treatment and the secondary outcome measures were the induction-to-abortion interval and the frequency of side effects. There was a significant difference in the success rate at 24 h (36-38 h: 100%; immediate: 91.5%). The median induction-to-abortion interval was significantly shorter in the 36-38 h regimen (4.9 h) compared with the immediate regimen (10 h). Side effects in terms of febrile episodes and chills/rigors were significantly higher in the immediate administration group. Simultaneous use of mifepristone and misoprostol for second trimester medical abortion is not as effective as the regimen using a 36-38 h dosing interval.

  3. 探讨无痛人工流产用于终止早期妊娠的临床应用价值%The Clinical Value of the Induced Abortion in the Termination Early Pregnancy

    Institute of Scientific and Technical Information of China (English)

    胡蓉

    2013-01-01

    Objective:To observe the application value of the induced abortion used to the early pregnancy for clinical make guidance.Method:One hundred and four healthy pregnant women admitted to our hospital from March 2010 to March 2013 were selected,they were divided into the abortion group and the medical abortion group,52 cases in each group.The abortion group was given induced abortion,the medical abortion group was given Mifepristone Tablets and Misoprostol Tablets,The indexes(the amount of vaginal bleeding,vaginal bleeding time,menstrual recovery time,duration of abdominal pain),the rate of complete abortion and the incidence of adverse reactions were compared between the two groups after treatment.Result:The abortion group was significantly better than the medical abortion group after treatment,the difference was statistically significant(P<0.05);The abortion rate of the abortion group was 98.08%,it was significantly higher than the medical abortion group(80.77%),the difference was statistically significant (P<0.05);the adverse reaction rate of the abortion group was 11.54%,it was significantly lower than the medical abortion group(36.54%),the difference was statistically significant(P<0.05).Conclusion:Painless artificial abortion for termination of early pregnancy clinical effect significantly, has the characteristics of simple operation,less bleeding,complete abortion rate is high,less adverse reaction,and it is worthy of wide application.%目的:分析总结无痛人工流产用于终止早期妊娠的临床应用价值,为临床推广做出指导。方法:选取本站2010年3月-2013年3月收治的104例自愿终止妊娠的健康孕妇,按照随机数字表法将其分为人工流产组和药物流产组各52例,人工流产组给予无痛人工流产,药物流产组给予米非司酮联合米索前列醇口服,观察比较两组患者治疗后各项指标(阴道出血量、阴道出血时间、月经恢复时间、腹痛持续时间)、治

  4. Abortion incidence and service availability in the United States, 2011.

    Science.gov (United States)

    Jones, Rachel K; Jerman, Jenna

    2014-03-01

    Following a long-term decline, abortion incidence stabilized between 2005 and 2008. Given the proliferation of state-level abortion restrictions, it is critical to assess abortion incidence and access to services since that time. In 2012-2013, all facilities known or expected to have provided abortion services in 2010 and 2011 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. Incidence of abortions was assessed by provider type and caseload. Information on state abortion regulations implemented between 2008 and 2011 was collected, and possible relationships with abortion rates and provider numbers were considered. In 2011, an estimated 1.1 million abortions were performed in the United States; the abortion rate was 16.9 per 1,000 women aged 15-44, representing a drop of 13% since 2008. The number of abortion providers declined 4%; the number of clinics dropped 1%. In 2011, 89% of counties had no clinics, and 38% of women of reproductive age lived in those counties. Early medication abortions accounted for a greater proportion of nonhospital abortions in 2011 (23%) than in 2008 (17%). Of the 106 new abortion restrictions implemented during the study period, few or none appeared to be related to state-level patterns in abortion rates or number of providers. The national abortion rate has resumed its decline, and no evidence was found that the overall drop in abortion incidence was related to the decrease in providers or to restrictions implemented between 2008 and 2011. Copyright © 2014 by the Guttmacher Institute.

  5. Attributes and perspectives of public providers related to provision of medical abortion at public health facilities in Vietnam: a cross-sectional study in three provinces

    Directory of Open Access Journals (Sweden)

    Ngo TD

    2014-08-01

    Full Text Available Thoai D Ngo,1,2 Caroline Free,1 Hoan T Le,3 Phil Edwards,1 Kiet HT Pham,4 Yen BT Nguyen,4 Thang H Nguyen5 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 2Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK; 3Department of Environmental Health, 4Department of Health Economics, Hanoi Medical University, 5Research and Metrics Team, Marie Stopes International Vietnam, Hanoi, Vietnam Background: The purpose of this study was to investigate attributes of public service providers associated with the provision of medical abortion in Vietnam. Methods: We conducted a cross-sectional study via interviewer-administered questionnaire among abortion providers from public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City in Vietnam between August 2011 and January 2012. We recruited abortion providers at all levels of Vietnam's public health service delivery system. Participants were questioned about their medical abortion provision practices and perspectives regarding abortion methods. Results: A total of 905 providers from 62 health facilities were included, comprising 525 (58.0% from Hanoi, 122 (13.5% from Khanh Hoa, and 258 (28.5% from Ho Chi Minh City. The majority of providers were female (96.7%, aged ≥25 years (94%, married (84.4%, and had at least one child (89%; 68.9% of providers offered only manual vacuum aspiration and 31.1% performed both medical abortion and manual vacuum aspiration. Those performing both methods included physicians (74.5%, midwives (21.7%, and nurses (3.9%. Unadjusted analyses showed that female providers (odds ratio 0.1; 95% confidence interval 0.01–0.30 and providers in rural settings (odds ratio 0.3; 95% confidence interval 0.08–0.79 were less likely to provide medical abortion than their counterparts. Obstetricians and gynecologists were more likely to provide medical abortion than providers with

  6. Comparative Study on Effects of Arnebia Euchroma (Royle) Johnst Granular and Decoction Forms on Medical Abortion with Mifepristone and Misoprostol

    Institute of Scientific and Technical Information of China (English)

    Jian-hua LIU; Hua SUN; Yun-yu FA

    2004-01-01

    Objective To compare the effects of 2 dosage-forms (granular and decoction) of Arnebia euchroma (royle) Johnst (Arnebia EJ in short below) on medical abortion with that of mifepristone combined with misoprostol Methods Totally 648 women, who had pregnancy of 38-45 d and were willing to terminate pregnancy with mifepristone and misoprostol, were randomly divided into 3groups, each of which was respectively given granular of Arnebia E J, placebo granular,or decoction of Arnebia EJ besides mifepristone and misoprostol. The abortion results,bleeding duration, menstruation recovery and side-effects were observed.Results Neither complete abortion rates nor average bleeding durations of the granular group and the decoction group were significantly different (P>0. 05). The complete abortion rate and bleeding duration of the two groups were respectively higher and shorter than those of the placebo group (P<0. 05). However, the menstruation recovery was not significantly different among the three groups (P>0. 05). The decoctionof Arnebia EJ caused significantly more nausea and vomiting than the other groups (P<0. 05).Conclusion The granular form did not have the odor of Arnebia E J, and caused much less nausea and vomiting compared with the decoction form. The granular and decoction forms were equally effective in improving the results of medical abortion. Therefore it is necessary to conduct further studies on the granular form of Arnebia EJ.

  7. Acceptability and feasibility of the use of 400 μg of sublingual misoprostol after mifepristone for medical abortion up to 63 days since the last menstrual period: evidence from Uzbekistan.

    Science.gov (United States)

    Raghavan, Sheila; Tsereteli, Tamar; Kamilov, Asamidin; Kurbanbekova, Dilfuza; Yusupov, Dilmurod; Kasimova, Feruza; Jymagylova, Dilbar; Winikoff, Beverly

    2013-04-01

    To examine the efficacy, acceptability and feasibility of early medical abortion, with the option of home administration of misoprostol, in Uzbekistan. A total of 450 women were enrolled at national, municipal and private facilities in Tashkent, Uzbekistan. Women who presented for termination of pregnancy with gestations up to 63 days were recruited to participate in the study. All eligible pregnant women who consented to participate swallowed a 200 mg mifepristone pill in the clinic and were given the option of taking 400 μg misoprostol sublingually either at the clinic or at home 24-48 hours after mifepristone administration. Abortion status was determined two weeks later. Almost all women (99.5%) chose home administration of misoprostol. The sublingual route of misoprostol administration was acceptable or very acceptable to 89% of participants. Ninety-five percent of women had complete abortions after mifepristone and misoprostol. Almost all participants preferred a medical abortion to surgery for a future procedure (95%). Mifepristone medical abortion with home administration of misoprostol is an acceptable and feasible option for women in Uzbekistan. The method worked well at all three facility types.

  8. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States.

    Science.gov (United States)

    Sullins, Donald Paul

    2016-01-01

    To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30-1.62; p abortion. Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

  9. Two-dimensional ultrasonography in of medical abortion in the harem of residual experience%二维超声对药物流产后宫内残留的体会

    Institute of Scientific and Technical Information of China (English)

    原占国

    2015-01-01

    In recent years, medical abortion in wide clinical application, especially the menopause acuities were 49 days of pregnancy termination. But many patients use easy cause intrauterine residue after medical abortion. Now statistics from May 2009 to May 2011 among 420 patients with medical abortion of 50 cases of intrauterine residue analysis is as follows.

  10. Serum Angiopoietin-2 and β-hCG as Predictors of Prolonged Uterine Bleeding after Medical Abortion in the First Trimester

    Science.gov (United States)

    Wang, Maofeng; Chen, Junqing; Ying, Jun; Yu, Jiong; Huang, Bifei; Ren, Zhaoxiang; Wang, Xianyu; Guo, Qiaoqiao; Wang, Yunlai; Qiu, Liuyi; Yu, Hongsheng; Wan, Rugen

    2013-01-01

    Objective The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2(Ang-2) and β human chorionic gonadotropin (β-hCG) in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB). Methods Prospective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB) and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB). Serum determinations of Ang-2 levels by ELISA and β-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC) analyses were calculated and plotted for the diagnostic accuracy of serum β-hCG and Ang-2 concentration to discriminate PUB and NUB. Results Baseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum β-hCG levels with statistically significant correlation coefficients of 0.536. Serum β-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, β-hCG area under curve (AUC) was 0.65 (95% CI, 0.53–0.76) on day 7, rising to AUC = 0.83 (95% CI, 0.75–0.92) on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14). Conclusions Both parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation. PMID:23696855

  11. Serum angiopoietin-2 and β-hCG as predictors of prolonged uterine bleeding after medical abortion in the first trimester.

    Directory of Open Access Journals (Sweden)

    Maofeng Wang

    Full Text Available OBJECTIVE: The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2 (Ang-2 and β human chorionic gonadotropin (β-hCG in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB. METHODS: Prospective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB. Serum determinations of Ang-2 levels by ELISA and β-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC analyses were calculated and plotted for the diagnostic accuracy of serum β-hCG and Ang-2 concentration to discriminate PUB and NUB. RESULTS: Baseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum β-hCG levels with statistically significant correlation coefficients of 0.536. Serum β-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, β-hCG area under curve (AUC was 0.65 (95% CI, 0.53-0.76 on day 7, rising to AUC = 0.83 (95% CI, 0.75-0.92 on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14. CONCLUSIONS: Both parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation.

  12. Prediction of pregnancy outcomes with combined ultrasound scanning of yolk sacs and serum CA125 determinations in early threatened abortion.

    Science.gov (United States)

    Xie, Y J; Chen, M; Chen, S J

    2014-01-01

    To assess the predictive value of the combination of ultrasound scanning, yolk sacs and CA125 levels for pregnancy outcomes in early threatened abortion. A total 196 pregnant women at less than 12 weeks gestation were enrolled. They were assigned into: (A) normal pregnancy (n = 61); (B) early threatened abortion but with favorable outcomes after active treatment (n = 56); (C) pregnancy with spontaneous miscarriage and threatened abortions (n = 79). The yolk sacs were examined and serum CA125 levels were measured. The visualization rate in groups A and B were significantly higher than that in group C. For the mean yolk sac diameter, there was a statistically significant difference between groups A and C (p 0.05). The mean serum CA125 levels were significantly different (p ultrasound scanning of yolk sacs and measurement of serum CA125 levels is of great value for predicting pregnancy outcomes.

  13. Clinical features and hormonal profiles of cloprostenol-induced early abortions in heifers monitored by ultrasonography

    Directory of Open Access Journals (Sweden)

    Beckers Jean-François

    2006-11-01

    Full Text Available Abstract Background The present study describes the clinical features and plasma profiles of bovine pregnancy-associated glycoprotein 1 (bPAG1, the main metabolite of prostaglandin F2α (PG metabolite and progesterone (P4 in heifers in which early abortions were induced. Methods Early abortions were induced in four heifers with cloprostenol and monitored by ultrasonography. Blood samples were collected and the plasma were analyzed for bPAG 1, P4 and PG metabolite. Results The foetal heartbeat rates varied from 170–186 beats per minute for all foetuses up to the date of cloprostenol treatment. Foetal death was confirmed within two days after cloprostenol treatment. Prior to cloprostenol injection, blood plasma concentrations of bPAG1, PG metabolite and P4 varied from 8.4 – 40.0 ng/mL, 158 – 275 pmol/L and 20.7 – 46.9 nmol/L, respectively. After the foetus expelled, the plasma level of bPAG1 began to decrease but the decrease was small and gradual. The estimated half-life of bPAG1 was 1.8 – 6.6 days. The plasma level of the PG metabolite started to have short lasting peaks (above 300 pmol/L within three hours after cloprostenol treatment. The plasma concentrations of P4 dropped sharply to less than 4 nmol/L after 24 hours of cloprostenol injection. Conclusion The current findings indicated that after early closprostenol-induced foetal death, the plasma concentration of bPAG1 decreased gradually and showed a tendency of variation with the stages of pregnancy.

  14. Using a harm reduction lens to examine post-intervention results of medical abortion training among Zambian pharmacists.

    Science.gov (United States)

    Fetters, Tamara; Raisanen, Keris; Mupeta, Stephen; Malisikwanda, Isikanda; Vwalika, Bellington; Osur, Joachim; Dijkerman, Sally

    2015-02-01

    Despite broad grounds for legal abortion in Zambia, access to abortion services remains limited. Pharmacy workers, a primary source of health care for communities, present an opportunity to bridge the gap between policy and practice. As part of a larger operations study, 80 pharmacy workers, both registered pharmacists and their assistants, participated in a training on medical abortion in 2009 and 2010. Fifty-five of the 80 pharmacy workers completed an anonymous, structured training pre-test, treated as a baseline questionnaire; 53 of the 80 trainees were interviewed 12-24 months post-training in face-to-face interviews to measure the retention of information and training effectiveness. Survey questions were selected to illustrate the principles of a harm reduction approach to unsafe abortion. Bivariate analysis was used to examine pharmacy worker knowledge, attitudes and dispensing behaviours pre-training and at follow-up. A higher percentage of pharmacy workers reported referring women to a health care facility between surveys (47% to 68%, p = 0.03). The number of pharmacy workers who reported dispensing ineffective abortifacients decreased from baseline to end-line (30% to 25%) but the difference was non-significant. However, study results demonstrate that Zambian pharmacy workers have a role to play in safe abortion services and some are willing to play that role. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  15. Induced Abortion

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Induced Abortion Home For Patients Search FAQs Induced Abortion Page ... Induced Abortion FAQ043, May 2015 PDF Format Induced Abortion Special Procedures What is an induced abortion? What ...

  16. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

    NARCIS (Netherlands)

    Boersma, Adriana A.; Jong, Betty Meyboom-de; Kleiverda, Gunilla

    2011-01-01

    Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg

  17. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

    NARCIS (Netherlands)

    Boersma, Adriana A.; Jong, Betty Meyboom-de; Kleiverda, Gunilla

    2011-01-01

    Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg

  18. 萘普生栓配合润婷在初孕人工流产术中的临床观察%Clinical observation of Naproxen suppositories combined with "Run Ting" induced abortion in early pregnancy

    Institute of Scientific and Technical Information of China (English)

    蔡瑾

    2012-01-01

    Objective To find a secure, less painful, abortion methods with less side effects and complete abortion rate by comparing intravenous anesthesia by propofol abortion, compound naproxen suppository with the " Run-ting" abortion, and medical abortion. Methods 446 cases of early pregnancy ( 49 days menopause ) are divided into 3 groups: A, intravenous anesthesia by propofol abortion ( 55 cases ); B, compound naproxen suppository with the " Run-ting" ( 282 cases ); C, medical abortion (109 cases ). Blood loss, bleeding time, complete abortion rate,and postoperative infection rates were analyzed were analyzed. Results Propofol intravenous anesthesia was group the best in painless abortion rate. The least amount of bleeding abortion was in group of compound naproxen with " Run-ting" . As the least amount of bleeding induced abortion compound naproxen suppository with the " Run-ting" and intravenous anesthesia with propofol groups had a shorter bleeding time for 3 ~7 days,but in medical abortion group the bleeding time was relatively long for 7 ~ 14 days. The complete abortion rate of 77% was relatively low in medical abortion. Conclusion Compound naproxen suppository with the " Run-ting" abortion is safe and effective with small surgical trauma,less pain,and a higher clinical value in the near future.%目的 通过异丙酚复合静脉麻醉人工流产、复合萘普生栓配合"润婷"牌套装式一次性宫腔组织吸引管人工流产、药流术对停经49 d内终止妊娠比较,寻找一种痛苦少,副作用少,安全性能高,完全流产率高的流产方法.方法 选择门诊ASIS级无痛人流手术早孕患者446例(停经49 d),根据流产的妇女要求分为三组:A组采用异丙酚复合静脉麻醉(55例),B组采用复合萘普生栓配合"润婷"牌套装式一次性宫腔组织吸引管人工流产(282例);C组采用药物流产(109例).观察各组镇痛效果、出血量、出血时间、完全流产率、术后感染率.结果 异丙酚复合

  19. Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial.

    Science.gov (United States)

    Paul, Mandira; Iyengar, Sharad D; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Kirti; Bring, Johan; Klingberg-Allvin, Marie

    2016-10-17

    residence did not influence contraceptive use. Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. Clinicaltrials.gov NCT01827995.

  20. A review of evidence for safe abortion care.

    Science.gov (United States)

    Kapp, Nathalie; Whyte, Patti; Tang, Jennifer; Jackson, Emily; Brahmi, Dalia

    2013-09-01

    The provision of safe abortion services to women who need them has the potential to drastically reduce or eliminate maternal deaths due to unsafe abortion. The World Health Organization recently updated its evidence-based guidance for safe and effective clinical practices using data from systematic reviews of the literature. Systematic reviews pertaining to the evidence for safe abortion services, from pre-abortion care, medical and surgical methods of abortion and post-abortion care were evaluated for relevant outcomes, primarily those relating to safety, effectiveness and women's preference. Sixteen systematic reviews were identified and evaluated. The available evidence does not support the use of pre-abortion ultrasound to increase safety. Routine use of cervical preparation with osmotic dilators, mifepristone or misoprostol after 14 weeks gestation reduces complications; at early gestational ages, surgical abortions have very few complications. Prophylactic antibiotics result in lower rates of post-surgical abortion infection. Pain medication such as non-steroidal anti-inflammatories should be offered to women undergoing abortion procedures; acetaminophen, however, is not effective in reducing pain. Women who are eligible should be offered a choice between surgical (vacuum aspiration or dilation and evacuation) and medical methods (mifepristone and misoprostol) of abortion when possible. Modern methods of contraception can be safely initiated immediately following abortion procedures. Evidence-based guidelines assist health care providers and policymakers to utilize the best data available to provide safe abortion care and prevent the millions of deaths and disabilities that result from unsafe abortion. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Comparison of medical abortion follow-up with serum human chorionic gonadotropin testing and in-office assessment.

    Science.gov (United States)

    Horning, Erin L; Chen, Beatrice A; Meyn, Leslie A; Creinin, Mitchell D

    2012-04-01

    The study was conducted to compare lost to follow-up (LTFU) rates in women having a medical abortion who chose follow-up by in-office ultrasound assessment or serum beta human chorionic gonadotropin (β-hCG) testing. This retrospective chart review included 865 women who underwent medical abortion in a free-standing outpatient clinic from September 1, 2007, through September 30, 2010. Patients had a 1-week follow-up evaluation after receiving the medications consisting of in-office ultrasound assessment or serial serum β-hCG testing. Ultrasound assessment was offered throughout the study period, and serum β-hCG testing was offered as of September 1, 2008. Demographic and medical data were reviewed to evaluate LTFU rates based on patient's chosen method of follow-up. Multivariable logistic regression analysis was performed to evaluate factors that were independently associated with lack of follow-up. LTFU rates increased from 18% to 27% in the first and third years of the study period, respectively (p=.009). LTFU rates with ultrasound and β-hCG testing were 22.9% and 33.7%, respectively (p=.024). In multivariable analysis, follow-up method was not associated with increased LTFU. Increased parity, any previous induced abortion, increased distance from home to clinic site and unemployment were independently associated with increased LTFU. Although LTFU rates are higher with serum β-hCG testing than in-office ultrasound follow-up in our patient population, the women who choose this method are inherently more likely not to follow-up because of other characteristics that predict a high likelihood of being LTFU. Offering serum β-hCG testing does not decrease the LTFU rate in women having a medical abortion. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. 肿瘤坏死因子-α在药流中的作用%The effect of TNF-α in medical abortion

    Institute of Scientific and Technical Information of China (English)

    高玲; 刘延; 喇端端

    2010-01-01

    目的 观察米非司酮配伍米索前列醇终止早孕后,不同结局的绒毛和蜕膜中肿瘤坏死因子-α(TNF-α)的表达情况,探讨TNF-α在药流中的作用.方法 将本院45例孕龄0.05).TNF-α在3组蜕膜、绒毛细胞中均有阳性表达,对照组绒毛、蜕膜细胞中TNF-α表达最弱,阳性率为(4.75±10.22)%与(2.66±2.57)%;药物完全流产组绒毛、蜕膜细胞TNF-α阳性表达最强,阳性率达(26.67±7.46)%与(18.44±11.14)%,其表达强弱差异有统计学意义(P<0.05).结论 适量的TNF-α存在于正常妊娠中,而米非司酮可使早孕绒毛、蜕膜中的TNF-α分泌表达加强,干扰孕妇体内的免疫平衡,使免疫刺激和抑制失调,导致流产.%Objective To investigate the expression of tumor necrosis factor-alpha (TFN-α) in human villus and deciduas from different abortion. Methods From May 2008 to May 2009, 45 women with early pregnancy( <49days)were divided into three groups, medical abortion completed group ( n = 15),medical abortion uncompleted group( n = 15 )and control group( n = 15, patients with dilatation and curettage ). The villus and deciduas were collected at the third day of medical abortion or at the day of curettage.Immunohistochemical technique was carried out to examine the distribution of TNF-α in villus and deciduas of the three groups. Results The age, gestational age, diameter of gestional sac and levels of serum E2, P and B-HCG before abortion were similar in all three groups. The expression of TNF-o in villus and deciduas of the control group was lowest among three groups[(4. 75 ± 10. 22)% vs (2. 66 ±2. 57)%]. The expression of TNF-α in villus and deciduas of medical abortion completed group was highest among three groups [(26. 67 ± 7.46) % vs ( 18. 44 ± 11. 14) %, P < 0. 05]. Conclusion Appropriate amount of TNF-α exists in the normal pregnancy, mifepristone can increase the expression of TNF-α in human villus and deciduas. and disturb reproductive immunity and effect

  3. Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study.

    Science.gov (United States)

    Upadhyay, Ushma D; Johns, Nicole E; Combellick, Sarah L; Kohn, Julia E; Keder, Lisa M; Roberts, Sarah C M

    2016-08-01

    In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA)-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization. We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law's implementation (January 2010-January 2011) to 3 y post implementation (February 2011-October 2014) at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion), frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures). Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%-6.2%) in the prelaw and 14.3% (95% CI: 12.6%-16.0%) in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27-4.27). In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%-18.4%) absolute increase in the rate of requiring an additional

  4. [Misoprostol: off-label use in the first trimester of pregnancy (spontaneous abortion, and voluntary medical termination of pregnancy)].

    Science.gov (United States)

    Beucher, G; Dolley, P; Carles, G; Salaun, F; Asselin, I; Dreyfus, M

    2014-02-01

    State of knowledge about misoprostol's use out of its marketing authorization during the first trimester of pregnancy, in early miscarriage or to induce abortion or medical termination of pregnancy. French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. Cervical ripening prior to surgical uterine evacuation during the first trimester of pregnancy facilitates cervical dilatation and reduces operative time and uterine retention risk. Misoprostol, mifepristone and osmotic cervical dilators are equally efficient. Concerning first trimester miscarriage, surgical uterine evacuation remains the most effective and the quickest method of treatment (EL 1). Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious (EL 1). However, these alternatives generally require longer outpatient follow-up, which leads to more consultations, prolonged bleeding and not planned surgical procedures (EL 1). Concerning missed miscarriage, a vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio (EL 2). Concerning early abortion, medical method is a safe and efficient alternative to surgery (EL 2). Success rates are inversely proportional to gestational age (EL 2). According to the modalities of its marketing authorization, 400 μg of misoprostol can only be given by oral route, for less than 7 weeks of amenorrhea (WA) pregnancies and after 36 to 48 hours following 600 mg of mifepristone (EL 1). However, 200mg of mifepristone is as efficient as 600 mg (EL 1). Beyond 7WA, misoprostol buccal dissolution (sublingual or prejugal) or vaginal administration are more efficient and better tolerated than oral ingestion (EL 1). Between 7 and 9WA, the best protocol in terms of efficiency and

  5. Late Abortion: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Sheng Chiang

    2005-12-01

    Full Text Available Late termination of pregnancy (LTOP is defined as an abortion carried out beyond 24 gestational weeks, when the fetus has arguably attained viability. In Taiwan, the current abortion law, bearing a eugenic title, allows LTOP on certain medical grounds. However, the fetal and maternal conditions that constitute medical grounds are not clarified and remain legally untested. Professional debate on the abortion issue is also lacking in academia in Taiwan, despite societal concerns. With the advent of technology to detect fetal abnormalities, obstetricians are now confronted more frequently with acute dilemmas regarding LTOP. Quite often, they sail in an uncharted sea with no clinical guidelines from their professional societies or affiliated hospitals. Recently, LTOP at 35 gestational weeks for a fetus with Down syndrome, complicated with polyhydramnios and tetralogy of Fallot, triggered media scrutiny and aroused much public attention. Although the clinical decision making for pregnancies with fetal abnormalities entails increasingly balanced information and consideration in terms of the medical, ethical, legal, psychologic, and societal aspects, society at large is unaware of the complexity and intertwined nature of various abortion issues, especially LTOP. Obstetricians are now in a vulnerable position in Taiwanese society, where litigations relevant to the practice of early abortions are not rare. Therefore, a global and in-depth look into abortion issues from legal and ethical dimensions is indispensable for modern obstetric practice. This review considers the core issues in LTOP, including what conditions constitute a “serious” fetal abnormality to justify LTOP, the incidence of LTOP, legislation regarding LTOP in Western countries, and recent research on ambivalent fetal pain. It will also present procedures, some under the auspices of the ethical committee of a Presbyterian hospital in Taiwan, for clinical decision making, particularly

  6. [Septic abortion in the Hospital de Ginecología y Obstetricia no. 3 del Instituto Mexicana de Seguridad Social. Late and early morbidity].

    Science.gov (United States)

    López Ortiz, E; Sandoval Sevilla, S; Arteaga, V M; Rosas Arceo, J; Ortíz Arroyo, R

    1974-02-01

    268 cases of septic abortion which occurred between 1964-72 in a large metropolitan hospital in Mexico were analyzed retrospecively. There cases represented 0.88% of all cases of abortion during the same time. Most patients were between 21-30, and 48% with parity 2-5; 63% were at their first abortion; only 16 patients declared to have attempted abortion, and most cases were first trimester abortion. Pre- and postoperative procedures and vital signs were carefully taken, and time elapsed from medical treatment to surgery was 4-12 hours. There were 237 curettages, and 28 hysterectomies. Complication from surgery were 4.1%; there were 19 deaths, i.e. 7.5% of patients, of which 10 only 24 hours after hospitalization. Protocol of treatment of septic abortion is discussed, and surgical treatment highly recommended.

  7. Conceptualising abortion stigma.

    Science.gov (United States)

    Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M H

    2009-08-01

    Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.

  8. Comparing Intravenous Oxytocin Vs. Rectal Misoprostol for Third-Stage Management after Second-Trimester Medically Induced Abortion

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    A Amirabi

    2012-09-01

    Full Text Available Background: Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin, ergots, and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination. Methods: In this randomized clinical trial, 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 µg of rectal misoprostol to manage the third stage of labor.Results: In this study, the frequency of placenta retention was significantly (P=0.034 lower in the misoprostol group (n=3, 7.5% compared with oxytocin group (n=10, 25%. The average duration of placenta delivery was significantly lower in the misoprostol group (7.95 min Vs. 19.22 min, respectively; P=0.015. Decreases in hemoglobin concentration was not significantly different between the two groups. Conclusion: Generally, management of the third stage of labor in second-trimester abortions could reach a better outcome, regarding lower risks of placenta retention and duration of delivery, if rectal misoprostol is administered instead of intravenous oxytocin.

  9. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States

    Science.gov (United States)

    Sullins, Donald Paul

    2016-01-01

    Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3) of the prevalence of mental disorders examined over the period were attributable to abortion. Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

  10. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States

    Directory of Open Access Journals (Sweden)

    Donald Paul Sullins

    2016-09-01

    Full Text Available Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss. Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p < 0.0001. Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p < 0.0001 overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3 of the prevalence of mental disorders examined over the period were attributable to abortion. Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

  11. Medical abortion follow-up with serum human chorionic gonadotropin compared with ultrasonography: a randomized controlled trial.

    Science.gov (United States)

    Dayananda, Ila; Maurer, Rie; Fortin, Jennifer; Goldberg, Alisa B

    2013-03-01

    To estimate whether follow-up with serum human chorionic gonadotropin (hCG) results in fewer unplanned visits and interventions than follow-up with ultrasonography. Women were randomized to either in-clinic serum hCG or ultrasound follow-up after medical abortion. The primary outcome, unplanned interventions and visits, was measured as a composite binary outcome including: additional clinic or emergency room visits, repeat dosing of misoprostol, and surgical evacuation of the uterus. Surveys were administered at initial follow-up and again 1 month after abortion to inquire about unscheduled visits, interventions, and patient satisfaction. Medical records were reviewed for evidence of additional interventions and visits. A total of 376 patients was randomized. Most participants were white (56%), single (83%), nulliparous (63%), and had completed high school (96%). Average participant age was 26±6 years and average gestational age was 46±6 days. Within 2 weeks of abortion, there was no significant difference in the rate of unplanned interventions and visits between arms, 8.2% (13/159) in the serum hCG arm compared with 6.6% (10/151) in the ultrasound arm (relative risk 1.23, 95% confidence interval [CI] 0.56-2.73, P=.60). By 4 weeks postabortion, 4.4% (6/135) in the ultrasound arm and 1.4% (2/142) in the hCG arm had undergone surgical evacuation (relative risk 0.32, 95% CI 0.07-1.54, P=.16). The majority in both the serum hCG (88%) and ultrasound (95%) arms was satisfied with their assigned follow-up method. Medical abortion follow-up with serum hCG does not reduce the rate of unplanned interventions and visits compared with ultrasonography. Overall, the number of unplanned interventions is low and both methods of follow-up are acceptable to women.

  12. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  13. Study on the Influence of Medical Abortion and Surgical Abortion on Subsequent Pregnancy%药物流产和手术流产对再次妊娠的影响对比

    Institute of Scientific and Technical Information of China (English)

    姚利红

    2014-01-01

    目的:观察并讨论药物流产和手术流产两种方法对孕妇再次妊娠的影响。方法将曾有过药物流产经历,且无清宫史的健康孕期妇女分为药流组,曾有过手术流产经历的健康孕期妇女分为术流组,比较她们两组在妊娠期间并发症出现率高低,如先兆流产例数,前置胎盘、胎膜早破、胎盘粘连等例数,还有在分娩期并发症的出现率。结果药流组在先兆流产和前置胎盘发生率方面明显比术流组低,在分娩期并发症方面,药流组中产后出血、胎盘粘连、胎盘早破等的发生率低于术流组,差异具有统计学意义(P<0.05)。结论妇女在选择流产时,可能选择药物流产能够降低再次妊娠时妊娠并发症和分娩并发症的发生率,适当保障孕妇再次妊娠时的安全性,降低各种并发症的发生几率。%Objective to observe and discuss the influences of medical abortion and surgical abortion on subsequent pregnancy.Methods the healthy pregnant women were divided into medical abortion group and surgical abortion group, the medical abortion group women had a medical abortion experience and no history of clearing the uterus, while surgical abortion group women had a surgical experience. their complications rates during pregnancy were compared such as precursor abortions, placenta praevia, premature rupture of fetal membranes, adherent placenta and so on. and also the complications rates during delivery were compared.Results the rate of precursor abortions and placenta praevia in medical abortion group was signiifcantly lower than that in the surgical abortion group. In terms of complications during delivery, the rate of postpartum hemorrhage, adherent placenta and premature rupture of membranes is significantly lower than that in the surgical abortion group. the difference was statistically significant.Conclusion the medical abortion can reduce incidence of subsequent pregnancy

  14. Medical grand rounds at Yale-New Haven Hospital. Septic abortion.

    Science.gov (United States)

    Sachs, F L; Landsberg, L

    1970-09-01

    a 17-year-old gravida 1, para 0, single white girl who had undergone criminal abortion, presented at the hospital with high fever and red urine. Her vital signs were monitored and laboratory tests were performed. A total abdominal hysterectomy and salpingo-oophorectomy were performed because of gangrenous uterus and ovaries. The patient developed postoperative complications and blood transfusion was performed. The criminal abortion was induced using some type of liquid (eg., Lysol) that was injected into the uterus transvaginally. The use of Lysol, soap and detergents in criminal abortion produces an area of tissue necrosis. The compounds are also absorbed into the bloodstream. The necrotic tissue is susceptible to infection, while the part which is absorbed into the bloodstream is nephrotoxic, hepatotoxic and produces hemolysis. Common complications of septic abortion are pelvic abscesses; metastatic abscesses; tetanus; renal insufficiency; cortical necrosis; and acute tubular necrosis. Coagulation abnormalities, as well as the psychological, economic and legal aspects of septic abortion are also discussed. It is hoped that all physicians would actively support legislation which would liberalize abortion laws.

  15. Infectious abortions in swine

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    Vakanjac Slobodanka

    2003-01-01

    Full Text Available Abortions in pigs can be caused by infectious or non-infectious factors About 38% of all diagnosed abortions in pigs were caused by infectious agents. Consequences of infection can be early embryonal deaths or abortions which occur after the 40th day following conception. Causes of abortions include different species of viruses (parvoviruses, enteroviruses pseudorabies viruses, PRRS or bacteria (Brucella, Leptospira, and others. A precise diagnosis is imperative for therapy and prevention of abortions in pigs, and it is necessary to apply measures to prevent reproductive disorders in pigs.

  16. Historical perspective on induced abortion through the ages and its links with maternal mortality.

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    Drife, James Owen

    2010-08-01

    Abortion is mentioned in ancient medical texts but the effectiveness of the methods described is doubtful. Attitudes varied from apparent disapproval by Hippocrates to open approval in Ancient Rome. In mediaeval times abortion was practised by women in secret and this continued during the 19th and early 20th centuries. Despite being illegal in England induced abortion became more common in Victorian times as the population grew. At the same time the link between criminal abortion and maternal mortality became increasingly clear, and if a woman died after a procedure the abortionist (sometimes a midwife) could be sentenced to death. The law was more tolerant of abortions performed by registered doctors. In the 20th century pressure grew for its legalisation. At the time of the 1967 Abortion Act, abortion was the leading cause of maternal death in the UK but within fifteen years death from illegal abortion had been abolished.

  17. Abnormal expression of MMP-9 and imbalance of MMP-9/TIMP-1 is associated with prolonged uterine bleeding after a medical abortion with mifepristone and misoprostol.

    Science.gov (United States)

    Li, Li; Zhou, Zanhua; Huang, Lili

    2009-01-01

    To investigate the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitory of metalloproteinase-1 (TIMP-1) in women who had undergone a medical abortion and explore their possible role in the mechanism of prolonged uterine bleeding after a mifepristone-misoprostol abortion. Cross-sectional study. Tertiary referral university hospital. Forty women were recruited following a medical abortion with mifepristone and misoprostol, 20 with duration of bleeding >14 days and 20 with duration of bleeding 14 days after a medical abortion (bleeding group), whereas each sample of women with duration of bleeding after a medical abortion (control group) showed normal endometrial changes. Immunohistochemistry and semi-quantitative scoring showed a significantly decreased expression level of MMP-9 in the bleeding group, compared with the control group. There was no significant difference of TIMP-1 expression between the bleeding group and the control group. The MMP-9/TIMP-1 ratio value was significantly lower in the bleeding group than in the control group. This study documents that prolonged bleeding after a medical abortion with mifepristone and misoprostol is associated with retained products of conception with inflammatory cell infiltration, abnormal expression of MMP-9 and imbalance of MMP-9/TIMP-1.

  18. Risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology: a meta-analysis.

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    Jun-Zhen Qin

    Full Text Available BACKGROUND: Studies on the risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology (ART are relatively controversial and insufficient. Thus, to obtain a more precise evaluation of the risk of embryonic chromosomal abnormalities in first-trimester miscarriage after ART, we performed a meta-analysis of all available case-control studies relating to the cytogenetic analysis of chromosomal abnormalities in first-trimester miscarriage after ART. METHODS: Literature search in the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL based on the established strategy. Meta-regression, subgroup analysis, and Galbraith plots were conducted to explore the sources of heterogeneity. RESULTS: A total of 15 studies with 1,896 cases and 1,186 controls relevant to the risk of chromosomal abnormalities in first- trimester miscarriage after ART, and 8 studies with 601 cases and 602 controls evaluating frequency of chromosome anomaly for maternal age≥35 versus <35 were eligible for the meta-analysis. No statistical difference was found in risk of chromosomally abnormal miscarriage compared to natural conception and the different types of ART utilized, whereas the risk of fetal aneuploidy significantly increased with maternal age≥35 (OR 2.88, 95% CI: 1.74-4.77. CONCLUSIONS: ART treatment does not present an increased risk for chromosomal abnormalities occurring in a first trimester miscarriage, but incidence of fetal aneuploidy could increase significantly with advancing maternal age.

  19. Risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology: a meta-analysis.

    Science.gov (United States)

    Qin, Jun-Zhen; Pang, Li-Hong; Li, Min-Qing; Xu, Jing; Zhou, Xing

    2013-01-01

    Studies on the risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology (ART) are relatively controversial and insufficient. Thus, to obtain a more precise evaluation of the risk of embryonic chromosomal abnormalities in first-trimester miscarriage after ART, we performed a meta-analysis of all available case-control studies relating to the cytogenetic analysis of chromosomal abnormalities in first-trimester miscarriage after ART. Literature search in the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) based on the established strategy. Meta-regression, subgroup analysis, and Galbraith plots were conducted to explore the sources of heterogeneity. A total of 15 studies with 1,896 cases and 1,186 controls relevant to the risk of chromosomal abnormalities in first- trimester miscarriage after ART, and 8 studies with 601 cases and 602 controls evaluating frequency of chromosome anomaly for maternal age≥35 versus chromosomally abnormal miscarriage compared to natural conception and the different types of ART utilized, whereas the risk of fetal aneuploidy significantly increased with maternal age≥35 (OR 2.88, 95% CI: 1.74-4.77). ART treatment does not present an increased risk for chromosomal abnormalities occurring in a first trimester miscarriage, but incidence of fetal aneuploidy could increase significantly with advancing maternal age.

  20. [Pregnancy termination in Bulgaria – past, present and future perspectives. Drugs induced abortion – guidelines by WHO].

    Science.gov (United States)

    Marinov, B; Andreeva, A

    2013-01-01

    There are still too many unsafe abortions performed worldwide. Together with the efforts to reduce the abortion by choice, we note a rise in the need for mid trimester pregnancy termination for medical reasons. The article looks at the past present and future perspective of the abortion as a procedure in Bulgaria. States the fact that medical abortion is officially not widely performed. We reckon that with the existing guidelines by WHO and with Mifepriston and Misoprostol recently registered in Bulgaria, it is time for the medical abortion to become part of the clinical practice in Bulgaria. We believe that early medical abortion as well as mid trimester induced abortion is and adequate if not better alternative to the existing in Bulgaria procedures.

  1. Abortion ethics.

    Science.gov (United States)

    Fromer, M J

    1982-04-01

    Nurses have opinions about abortion, but because they are health professionals and their opinions are sought as such, they are obligated to understand why they hold certain views. Nurses need to be clear about why they believe as they do, and they must arrive at a point of view in a rational and logical manner. To assist nurses in this task, the ethical issues surrounding abortion are enumerated and clarified. To do this, some of the philosophic and historic approaches to abortion and how a position can be logically argued are examined. At the outset some emotion-laden terms are defined. Abortion is defined as the expulsion of a fetus from the uterus before 28 weeks' gestation, the arbitrarily established time of viability. This discussion is concerned only with induced abortion. Since the beginning of recorded history women have chosen to have abortions. Early Jews and Christians forbade abortion on practical and religious grounds. A human life was viewed as valuable, and there was also the practical consideration of the addition of another person to the population, i.e., more brute strength to do the necessary physical work, defend against enemies, and ensure the continuation of the people. These kinds of pragmatic reasons favoring or opposing abortion have little to do with the Western concept of abortion in genaeral and what is going on in the U.S. today in particular. Discussion of the ethics of abortion must rest on 1 or more of several foundations: whether or not the fetus is a human being; the rights of the pregnant woman as opposed to those of the fetus, and circumstances of horror and hardship that might surround a pregnancy. Viability is relative. Because viability is not a specific descriptive entity, value judgments become part of the determination, both of viability and the actions that might be taken based on that determination. The fetus does not become a full human being at viability. That occurs only at conception or birth, depending on one's view

  2. Can early ultrasound reduce the gestational age at abortion for fetal anomalies?

    Science.gov (United States)

    Chasen, Stephen T; Kalish, Robin B

    2013-01-01

    A significant proportion of second-trimester abortions are done for fetal anomalies. Our objective was to evaluate the impact of ultrasound at abortion for structural fetal abnormalities. Retrospective review identified all patients undergoing abortion following sonographic diagnosis of structural fetal anomalies at a single institution from 2004-2011. First-trimester ultrasound findings were reviewed, and abnormalities were categorized as "diagnostic" or "nondiagnostic." Chi-square analysis and Mann-Whitney U test were used for statistical comparison. One hundred thirty-two patients who underwent abortion due to structural fetal abnormalities were included, 109 of whom underwent ultrasound at 11-13 weeks. In those scanned at ultrasound in 16 cases (14.7%). In those scanned at abortion was earlier compared to those who underwent initial anatomic evaluation in the second trimester, 19 weeks (13.5-21) versus 21 weeks (19-22), p=.001. Ultrasound at abortion in pregnancies with structural fetal abnormalities. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Two-pill regimens of misoprostol after mifepristone medical abortion through 63 days' gestational age: a randomized controlled trial of sublingual and oral misoprostol.

    Science.gov (United States)

    Raghavan, Sheila; Comendant, Rodica; Digol, Irena; Ungureanu, Sergiu; Friptu, Valentin; Bracken, Hillary; Winikoff, Beverly

    2009-02-01

    A 400 mcg dose of sublingual misoprostol has high efficacy and few side effects when used with 200 mg mifepristone for medical abortion through 63 days' gestation. Eligible and consenting women (n=480) were randomized to 400 mcg of misoprostol sublingually or orally, 24 h after 200 mg of mifepristone. Abortion status was assessed two weeks later. Complete abortion occurred in 98.7% of the sublingual group and 94.0% of the oral group (p value=.006, RR: 1.05, 95% CI=1.01--1.09). Over 90% of women in both arms expressed high satisfaction with the method. Side effects were similar in both groups, with only fever or chills reported by significantly more women in the sublingual arm. The sublingual route appears superior to the regimen of 400 mcg misoprostol used orally and may be a good option for mifepristone medical abortion.

  4. Treating 120 cases of complications following medical abortion with Qinggong decoction%清宫汤治疗药物流产后合并症120例

    Institute of Scientific and Technical Information of China (English)

    公翠兰; 周燕

    2014-01-01

    120 patients were treated with Qinggong decoction following medical abortion, the efficiency of complete abortion was 91.67%. Qinggong decoction improved complete abortion rate of medical abortion;it is a safe, effective as assistant medicine and worthy of widely promotion.%120例终止妊娠的患者,药物流产后给予清宫汤治疗,完全流产110例,占91.67%。清宫汤提高了药物流产的完全流产率,是安全有效的药物流产辅助药物,值得临床推广使用。

  5. Gestational trophoblastic tumor with liver metastasis after misoprostol abortion.

    Science.gov (United States)

    Mousavi, S A; Behnamfar, F

    2009-04-01

    Early elective medical abortion is performed frequently in different countries of the world. Serious complications like gestational trophoblastic neoplasia (GTN) are uncommon and mostly nonmetastatic. High risk metastatic GTN following medical abortion is a rare event which may occur coincidentally. A 26 year-old-woman, gravida 2 para 1, 6 weeks after misoprostol abortion presented with sever nausea, vomiting, and right upper abdominal pain. Human chorionic gonadotropin (hCG) level was 2,500,000 mIU/ml and metastatic work up revealed multiple liver metastases. She totally received nine cycles of EMA-CO (ethoposide- methotrexate- actinomycin- cyclophosphamide, vincristine) regimen for treatment and consolidation. Six months after treatment she is in complete remission. Follow up of patients after medical abortion by means of single serum hCG measurement is highly recommended for early diagnosis of complications including gestational trophoblastic tumor. EMA-CO regimen seems to be an effective and safe treatment for liver metastatic gestational trophoblastic neoplasia.

  6. [The significance of social factors in choice of legal abortion. A social-medical study of 531 women applying for abortion and 285 pregnant control patients].

    Science.gov (United States)

    Wohlert, M; Larsen, F M

    1978-07-24

    Sociomedical factors were compared for a group for 531 women seeking abortion and 285 pregnant women, in order to give a differentiated picture of the social conditions which may motivate a woman to seek abortion and the stress which bearing a child can cause. Married women tended to want to carry the pregnancy to term in all age groups. Among the abortion seekers there was a significant overrepresentation of unskilled workers and students. The abortion frequency increased with the number of children. Each woman was classified according to whether her situation was characterized by a chronic social stress, an imminent social stress, or no social stress. The group designated by imminent social stress was significantly predominated by single women, the other two by married women. This group also had a significantly higher representation of students and unskilled workers. (p .0005) The chronic social stress group more often lived in apartments and had more children living at home. Among the abortion seekers, those with chronic situations most often gave as a reason for applying for abortion that they had enough children, that they were alone or had marital problems. Among the imminent stress group the reasons most often given were that the woman was too young or still pursuing her education. Among the group with no social stress, the most frequent reasons for seeking abortion were that the woman was too old or had enough children. It was concluded that bearing a child would cause actual social stress among ca. 50% of the women studied.

  7. Safety, efficacy and acceptability of outpatient mifepristone-misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City.

    Science.gov (United States)

    Sanhueza Smith, Patricio; Peña, Melanie; Dzuba, Ilana G; García Martinez, María Laura; Aranguré Peraza, Ana Gabriela; Bousiéguez, Manuel; Shochet, Tara; Winikoff, Beverly

    2015-02-01

    Extensive evidence exists regarding the efficacy and acceptability of medical abortion through 63 days since last menstrual period (LMP). In Mexico City's Secretariat of Health (SSDF) outpatient facilities, mifepristone-misoprostol medical abortion is the first-line approach for abortion care in this pregnancy range. Recent research demonstrates continued high rates of complete abortion through 70 days LMP. To expand access to legal abortion services in Mexico City (where abortion is legal through 12 weeks LMP), this study sought to assess the efficacy and acceptability of the standard outpatient approach through 70 days in two SSDF points of service. One thousand and one women seeking pregnancy termination were enrolled and given 200 mg mifepristone followed by 800 μg misoprostol 24-48 hours later. Women were asked to return to the clinic one week later for evaluation. The great majority of women (93.3%; 95% CI: 91.6-94.8) had complete abortions. Women with pregnancies ≤ 8 weeks LMP had significantly higher success rates than women in the 9th or 10th weeks (94.9% vs. 90.5%; p = 0.01). The difference in success rates between the 9th and 10th weeks was not significant (90.0% vs. 91.2%; p = 0.71). The majority of women found the side effects (82.9%) and the use of misoprostol (84.4%) to be very acceptable or acceptable. This study provides additional evidence supporting an extended outpatient medical abortion regimen through 10 weeks LMP. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  8. The abortion paradox.

    Science.gov (United States)

    Bergin, J D

    1983-10-12

    Abortion surfaced as a community problem when, following the passage of the 1967 Abortion Act in England and the subsequent rapid rise in medically induced abortion, a few doctors and a group of lay people in Auckland founded the Society for the Protection of the Unborn Child. Soon after this the opposition formed the Abortion Law Reform Association whose aims came to be vocalized by women's liberation groups like Women's Electoral Lobby and WONAAC. As in other countries, the media gave the proabortion movement a good boost and the medical profession did little to discourage it. A bold and significant move was made by the abortion promoters when they established a clinic in Remuera to carry out abortion in Auckland. There was a reaction and eventually (September 1974) a police raid and a court case based on a dozen cases that looked like infringements of the law. Dr. Woolnough, principal operator, was tried but the jury failed to agree. On a retrail he was acquitted. In August 1974 Dr. Gerard Wall introduced a private member's bill aimed at restricting therapeutic abortion to public hospitals. The bill was amended so that duly licensed institutions other than public hospitals were also acceptable for abortion procedures. The Remuera clinic which had ceased working when the provision of the Wall bill became operative transferred its operations to the Aotea Clinic in Epsom which had applied for and obtained a license. The following year the late Air Commodore Frank Gill introduced another bill (August 1976) aimed at changing the situation back toward Wall's position, i.e., restricting induced abortion to public hospitals. In December 1977 a law called the Contraception, Sterilization and Abortion Act was passed, which in essence allowed abortion where it seemed that the mother's life or mental or physical health would be seriously endangered, where the mother was very young or somewhat old, where the child was conceived of incest. Abortion figures raise the question

  9. Effects of Abortion Legalization in Nepal, 2001–2010

    Science.gov (United States)

    Henderson, Jillian T.; Puri, Mahesh; Blum, Maya; Harper, Cynthia C.; Rana, Ashma; Gurung, Geeta; Pradhan, Neelam; Regmi, Kiran; Malla, Kasturi; Sharma, Sudha; Grossman, Daniel; Bajracharya, Lata; Satyal, Indira; Acharya, Shridhar; Lamichhane, Prabhat; Darney, Philip D.

    2013-01-01

    Background Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion. Methods We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010). Results 23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75). Conclusion Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance

  10. Effects of abortion legalization in Nepal, 2001-2010.

    Directory of Open Access Journals (Sweden)

    Jillian T Henderson

    Full Text Available BACKGROUND: Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion. METHODS: We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001-2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001-2003, early implementation (2004-2006, and later implementation (2007-2010. RESULTS: 23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85. Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75. CONCLUSION: Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women's health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the

  11. Abortion: the continuing controversy.

    Science.gov (United States)

    Behrens, C E

    1972-08-01

    While most countries of the world practice abortion, government policy, medical opinion, private opinion and actual practice vary widely. Although mortality from legal abortions is quite low, complications rise sharply after 12 gestational weeks. No conclusive proof shows adverse postabortion psychological effects. Romania, Japan and the Soviet Union experienced declining birth rates when abortion was made available and New York City saw a decline in illegitimacy of approximately 12% from 1970 to 1971. Throughout the world abortion laws vary from restrictive to moderate to permissive. Where laws are restrictive, as in France and Latin America, illegal abortions are estimated in the millions. The controversy over abortion centers around the arguments of what constitutes a human life, and the rights of the fetus versus the right of a woman to control her reproductive life. A review of state abortion laws as of August 1972 shows pressure on state legislatures to change existing laws. The future of abortion depends upon technological advances in fertility control, development of substitutes like menstral extraction, prostaglandins and reversible sterilization. Development of these techniques will take time. At present only through education and improved delivery of contraceptives can dependence on abortion as a method of fertility control be eased. Citizen education in the United States, both sex education and education for responsbile parenthood, is in a poor state according to the Commission on Population Growth and the American Future. If recourse to abortion is to be moderated, it is the next generation of parents who will have to be educated.

  12. Metformin exposure in early pregnancy and spontaneous abortions in women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Lauszus, Finn; Viftrup-Lund, Mette; Gade, Melina

    2014-01-01

    Objective: We sought to determine whether metformin affects the rate of first trimester spontaneous abortions and congenital malformations in women with PCOS. Design. Consecutive series of metformin treated women with a questionnaire followup. Setting. Department of Gynecology and Obstetrics at H...

  13. Are two doses of misoprostol after mifepristone for early abortion better than one?

    National Research Council Canada - National Science Library

    Coyaji; Krishna; Ambardekar; Bracken; Raote; Mandlekar; Winikoff

    2007-01-01

    .... Sample A total of 300 women seeking an abortion with amenorrhoea of 8 weeks or less. Methods Women were randomised to receive one or two doses of 400 microgram oral misoprostol at the clinic 48 hours after administration of 200 mg mifepristone...

  14. Plasma β-Endorphin Levels in Women with Early Threatened Abortion before and after the Treatment of Integrated Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    孙斐; 俞瑾

    1999-01-01

    To observe plasma β-endorphin(β-EP)and gonadotrophin releasing hormone(GnRM),human chorionic gonadotrophin(hCG),progesterone (P4) levels in women with early threatened abortion and with a history of recurrent spontaneous abortions(RSA).Twenty patients with threatened abortion at 7-8 weeks of gestation were re-cruited,all of them had a history of 3 or more recurrent unexplained abortions.They were treated with psychological consultation accompanied by traditional Chinese herbs.Blood samples were taken to measure β-EP,GnRM,hCG and P4 levels by radioim-munoassay(RIA).The treatments were continued till 10-12 weeks,blood was taken during this period to compare changes in these peptides/hormones.Twenty normal pregnant women at 7-8 and 10-12weeks and 20patients with incomplete abortion at 10- 12weeks were recruited for comparative studies.Results:(1)In normal pregnant women,plasma β-EP,GnRH,hCG and P4 levels at 10-12 weeks were significantly higher than that at 7-8 weeks(P0.05).(3)Plasma β-EP levels in patients with incomplete abortions at 10-12 weeks were dramatically higher and GnRH,hCG and P4levels were lower than in normal pregnant women(P<0.01).β-EP might play a role in the pathophysiology of spontaneous abortion.

  15. Logistic regression analysis on inlfuencing factors of medical abortion outcome%药物流产结局影响因素的logistic回归分析

    Institute of Scientific and Technical Information of China (English)

    刘梅云; 张红杰; 朱继红; 高敬

    2014-01-01

    目的:探讨药物流产结局的影响因素,为制定相应的干预措施提供依据。方法以药物流产后因不全流产或失败行手术干预者为病例组,以药物流产后完全流产者为对照组,采用病例对照研究,分析影响药物流产结局的因素。采用SPSS16.0进行数据分析。结果共调查病例组32例,对照组170例。单因素分析结果表明,手术流产史(χ2=4.691, P=0.030)、药物流产的地点(χ2=13.487,P=0.000)、药物流产的孕周(χ2=6.747,P=0.009)、药物流产前是否诊断为阴道炎(χ2=22.153,P=0.000)对药物流产是否完全流产的影响有统计学意义;多因素logistic回归分析结果表明,药物流产的地点(OR=3.693,P=0.009)和药物流产前是否诊断为阴道炎(OR=4.520,P=0.000)是药物流产结局的独立影响因素。结论在私立诊所行药物流产妇女比选择公立医院或计划生育诊所,更可能发生流产不全或失败;患有阴道炎的妇女发生药物流产不全或失败的可能性更大。%Objective To explore the influencing factors of medical abortion outcome, and provide evidences for making intervention measures. Methods A case-control study was adopted with cases who had incomplete or failure abortion after medical abortion, and the controls were those who had complete abortion. The data was analyzed by SPSS16.0. Results The univariate analysis showed that factors such as the surgical abortion history (χ2=4.691, P=0.030), the site of the medical abortion (χ2=13.487, P=0.000), pregnant weeks (χ2=6.747, P=0.009), whether vaginitis before medical abortion (χ2=22.153, P=0.000) were influencing the medical abortion outcome. The multivariate analysis showed that risk factors were the site of the medical abortion (OR=3.693, P=0.009)and whether vaginitis before medical abortion (OR=4.520, P=0.000). Conclusion In private clinics, the ratio of incomplete abortion or failure of medical

  16. Single and repeated elective abortions in Japan: a psychosocial study.

    Science.gov (United States)

    Kitamura, T; Toda, M A; Shima, S; Sugawara, M

    1998-09-01

    Despite its social, legal and medical importance, termination of pregnancy (TOP) (induced abortion) has rarely been the focus of psychosocial research. Of a total of 1329 women who consecutively attended the antenatal clinic of a general hospital in Japan, 635 were expecting their first baby. Of these 635 women, 103 (16.2%) had experienced TOP once previously (first aborters), while 47 (7.4%) had experienced TOP two or more times (repeated aborters). Discriminant function analysis was performed using psychosocial variables found to be significantly associated with either first abortion or repeated abortion in bivariate analyses. This revealed that both first and repeated aborters could be predicted by smoking habits and an unwanted current pregnancy while the repeated aborters appear to differ from first aborters in having a longer pre-marital dating period, non-arranged marriages, smoking habits, early maternal loss experience or a low level of maternal care during childhood. These findings suggest that both the frequency of abortion and its repetition have psychosocial origins.

  17. Abortion — facts and consequences

    OpenAIRE

    Perinčić, Robert

    1990-01-01

    The author sets forth some of the most recent demographic data, important directions of legal documents as regards abortion, tackling medical and ethical problems of abortion. Some essentials particulars are also given as to the embryonic and foetal development. The whole paper concerns the problems of legal abortion during the first three months of pregnancy. The second part of the paper relates to the consequences of abortion affecting the physical and mental health of a woman as show...

  18. Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ushma D Upadhyay

    2016-08-01

    Full Text Available In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization.We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law's implementation (January 2010-January 2011 to 3 y post implementation (February 2011-October 2014 at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion, frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures. Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%-6.2% in the prelaw and 14.3% (95% CI: 12.6%-16.0% in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27-4.27. In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%-18.4% absolute increase in the rate of requiring an additional

  19. T-HELPER 1 CYTOKINES INCREASE DURING EARLY PREGNANCY IN WOMEN WITH A HISTORY OF RECURRENT SPONTANEOUS ABORTION

    Directory of Open Access Journals (Sweden)

    A. Rezaei A. Dabbagh

    2000-08-01

    Full Text Available The measurment of various cytokines may provide a different tool for evaluation of the immune system. Recent investigations have shown that the number and function of peripheral natural killer cells (NK- cells increase during early pregnancy in women with a history of unexplained recurrent spontaneous abortions (RSA. NK-cells activity may be responsible for some cases of RSA. The objective of this study was to assess the role of the Thl cytokines (IL-2, IFN-y, TNF-a ; TNF-/0 in this phenomenon, and detection of Thl cytokines in women with RSA. The control group consisted of 40 women with no history of pregnancy loss and complication. The abortion group comprised of 92 women having at least 3 pregnancy losses. Blood from the control group and women with RSA was taken at the end of first trimester of gestational age and at the time of abortion, respectively. Sera were separated and peripheral blood lymphocytes were challenged with PHA using RPMI medium. All samples were tested for concentration of Thl cytokines using ELISA methods. It was considered that sera from women with RSA produced higher concentration of TNF-«, TNF-/? , and IL-2 in comparison with sera from normal pregnant women (NPW (P<0.001. We were not able to detect IL-2 in (NPW whereas in 31% sera from RSA group, IL-2 was detectable (P<0.001. However, there was no significant difference between IFN-y, concentration in sera from patients and control group (P<0.182. Tissue culture supernatant from women with RSA also produced higher concentration of TNF-a. IFN-y, TNF-/* and IL2, than control group. These data may explain the increase NK-cells cytotoxicity during early pregnancy in women with a history of RSA. It may also provide a diagnostic tool to predict the outcome of pregnancy.

  20. Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial.

    Science.gov (United States)

    Chawdhary, Rashmi; Rana, Ashma; Pradhan, Neelam

    2009-02-01

    To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days.

  1. 'The trial the world is watching': the 1972 prosecution of Derk Crichton and James Watts, abortion, and the regulation of the medical profession in apartheid South Africa.

    Science.gov (United States)

    Klausen, Susanne M

    2014-04-01

    After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman's life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country's newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary's stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their 'duty' to procreate within marriage. Ultimately, the event encapsulated a great deal about elites' attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa's extremely restrictive Abortion and Sterilisation Act (1975).

  2. Early- and late-onset pelvic inflammatory disease among women with cervical Chlamydia trachomatis infection at the time of induced abortion--a follow-up study

    DEFF Research Database (Denmark)

    Sørensen, Jette Led; Thranov, I; Hoff, G

    1994-01-01

    in order to detect an early- and late-onset pelvic inflammatory disease (PID). For statistical analysis survival analysis by Kaplan-Meir estimates and Mantel-Cox test were carried out. Untreated women with C. trachomatis infection at the time of abortion had a cumulative risk of 72% of developing early and...

  3. Antipsychotic medication for early episode schizophrenia

    Science.gov (United States)

    Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

    2014-01-01

    Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications

  4. Comparison of condition specific indicators among illegal induced abortion: septic and non-septic abortion in Songkla Center Hospital.

    Science.gov (United States)

    Phaumvichit, Tatpong; Chandeying, Verapol

    2012-05-01

    Determine the clinical indications of illegal induced abortion, comparison between septic and non-septic abortion. The present retrospective descriptive study was conducted among pregnant women who were admitted in the hospital with the illegal induced abortion. The demographic data, gestational age, the method used, and personnel performing were gathered, as well as symptomatology, basic laboratory, condition progression, and medical and surgical intervention. There were 92 patients with illegal induced abortion between March 2009 and December 2010. The three main induced methods for termination of pregnancy was vaginal suppository, likely to be misoprostol-a synthetic prostaglandin E, analog (43.5%), oral Thai herbal medicine (19.6%) and combined medication (16.3%), respectively. Of septic/non-septic abortion, the first visit body temperature of 38.0 degrees Celsius or more (74.1/12.3%), heart rate of 100 per minutes or more (74.1/12.3%), fever index 3 degree-hours or more in the first 24 hours (81.5/12.3%) and fever index 5 degree-hours or more in the first 24 hours (59.3/1.5%), were statistically significant (all p-values of abortion was incomplete abortion 68 in 92 cases (73.9%). The first visit body temperature of 38.0 degrees C or more, heart rate of 100 per minutes or more and fever index of 3 and 5 degree-hours, are clinically helpful in the early diagnosis and treatment of septic abortion.

  5. Cost of abortions in Zambia: A comparison of safe abortion and post abortion care.

    Science.gov (United States)

    Parmar, Divya; Leone, Tiziana; Coast, Ernestina; Murray, Susan Fairley; Hukin, Eleanor; Vwalika, Bellington

    2017-02-01

    Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

  6. Oral contraception following abortion

    Science.gov (United States)

    Che, Yan; Liu, Xiaoting; Zhang, Bin; Cheng, Linan

    2016-01-01

    Abstract Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies. A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707). In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P abortion (P abortion, and reduce the risk of complications and unintended pregnancies. PMID:27399060

  7. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao.

    Science.gov (United States)

    Boersma, Adriana A; Meyboom-de Jong, Betty; Kleiverda, Gunilla

    2011-04-01

    To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curaçao, where induced abortion is severely restricted by law. In a prospective study 330 women received 200 mg mifepristone and were instructed to take four tablets (800 μg) of misoprostol via the buccal route 24-36 h later, at home. One week later, follow-up took place. The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64-70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea. Home administration of buccal misoprostol 24-36 h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curaçao, where induced abortion is legally restricted.

  8. How to assess success of treatment when using multiple doses: the case of misoprostol for medical abortion.

    Science.gov (United States)

    Seuc, Armando H; Shah, Iqbal H; Ali, Moazzam; Diaz-Olavarrieta, Claudia; Temmerman, Marleen

    2015-11-07

    The assessment of treatment success in clinical trials when multiple (repeated) doses (courses) are involved is quite common, for example, in the case of infertility treatment with assisted reproductive technology (ART), and medical abortion using misoprostol alone or in combination with mifepristone. Under these or similar circumstances, most researchers assess success using binomial proportions after a certain number of consecutive doses, and some have used survival analysis. In this paper we discuss the main problems in using binomial proportions to summarize (the overall) efficacy after two or more consecutive doses of the relevant treatment, particularly for the case of misoprostol in medical abortion studies. We later discuss why the survival analysis is best suited under these circumstances, and illustrate this by using simulated data. The formulas required for the binomial proportion and survival analysis (without and with competing risks) approaches are summarized and analytically compared. Additionally, numerical results are computed and compared between the two approaches, for several theoretical scenarios. The main conceptual limitations of the binomial proportion approach are identified and discussed, caused mainly by the presence of censoring and competing risks, and it is demonstrated how survival analysis can solve these problems. In general, the binomial proportion approach tends to underestimate the "real" success rate, and tends to overestimate the corresponding standard error. Depending on the rates of censored observations or competing events between repeated doses of the treatment, the bias of the binomial proportion approach as compared to the survival analysis approaches varies; however, the use of the binomial approach is unjustified as the survival analysis options are well known and available in multiple statistical packages. Our conclusions also apply to other situations where success is estimated after multiple (repeated) doses (courses

  9. Clinical experience and perception of abortion: A cross-sectional survey of gynecologists in Japan.

    Science.gov (United States)

    Mizuno, Maki

    2015-12-01

    This study describes aspects of early induced abortion from the experience and perspectives of a sample of gynecologists in Japan. The survey questionnaire data were collected from 343 gynecologists from September to October 2010. Approximately 83% of participants preferred using only dilation and curettage (D&C), and 10.4% used electric vacuum aspiration (EVA). The cost of surgical abortion was not covered by insurance. Most gynecologists used intravenous pain management during abortion. Approximately 50% of the gynecologists were opposed to introducing medical abortion in Japan. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. 阴道超声在药物流产中应用的价值探讨%Vaginal ultrasound in the value of application in medical abortion

    Institute of Scientific and Technical Information of China (English)

    张海林; 赵竹茹; 张士琴

    2015-01-01

    目的:探讨阴道超声监测孕囊大小及子宫位置与药物流产临床结局的相关性及临床应用价值。方法回顾性分析950例要求药物流产的孕妇,用药前阴道超声检查,服药后8天未排出孕囊为药流失败,服药孕囊自行排出后10天阴道超声复查仍有异常回声组织或阴道出血过多淋漓不净最终清宫者为药流失败。结果子宫位置中,后倾后屈位者药流失败率明显高于其他位置;孕囊﹤8mm组及>25mm组药物流产失败率高有显著差异(P﹤0.05)。结论阴道超声监测具有方便准确的优点,可监测药物流产效果,并指导临床处理。%Objective To investigate the relationship between gestational sacs(GS) size,Uterine position and medical abortion efficacy by transvaginal ultrasonography and its clinical application value. Methods Analyzing 950 pregnant women requirirlg medical abortion Vaginal ultrasound before using this drug.For oral administration 8 days didn't see pregnant bursa belongs to medical abortion failure;Gestational sac discharge after 10 days,transvaginal ultrasonography showed abnormalities echo in the Uterine cavity, and all subjects who still had irregular vaginal bleeding were performed curettage, These patients are classified as medicine abortion failure.Results The rate of medical abortion failure in the case with retroflexion uterus and retroverted uterus were higher than that of others. The failing rates of medical abortion for the groups with GS size﹤8 mm and GS size>25 mm simwed sigilificant difference compared with other three groups(P﹤0.05).Conclusion Transvaginal ultrasonography was convenient to monitor the efficacy of medical abortion and guide clinical treatment.

  11. Risky, early, controversial. Puberty in medical discourses.

    Science.gov (United States)

    Cozzi, Donatella; Vinel, Virginie

    2015-10-01

    This article comes within the compass of a research program (entitled CorAge. Bodily Experiences and AgePassages among 9-13 year-olds (ANR-09-ENFT-017) conducted between 2009 and 2013 about the emergence of a "new" age in life--"preadolescence"--as instanced in France (Alsace, Lorraine) and Italy (Venetia). The impressive amount of references to "early puberty" and "precocious puberty", in a context of feeling of a premature end of childhood, led us to make an in-depth study of this issue: first, through an analysis of international and French and Italian medical journals; second, through interviews with health professionals. Following the thesis of Foucault, we assume that the discourses on puberty timing participate of classifications of the child body drenched with moral representations of childhood, especially on gender and age issue. Our results: the question of whether a secular trend in puberty timing even exists continues to be debated between American and European scientists. Second, the terms "puberty", "precocious puberty", "early puberty" have been used to indicate a variety of puberty markers, increasing confusion. A controversy has focused on early breast development in girls, because this attribute is questioning the order of ages and gender. Moreover, psychosocial factors presented as accelerating early puberty, do not demonstrate the relation between earliness and risk behavior. The literature, as it is moved by the female precocity, creates a medical category to objectify the complex and flexible process of puberty and invent female child precocity. These differences between American and European scholars and the interviews with French and Italian health professional show a gap between the international literature and practitioners, clinicians and nurses who regularly work with children: they neither find pubertal advancement, nor increase of "true precocious puberty", although they share concerns about premature feminization of girls (France) or

  12. Increasing women's choices in medical abortion: a study of misoprostol 400 microg swallowed immediately or held sublingually following 200 mg mifepristone.

    Science.gov (United States)

    Akin, Ayşe; Dabash, Rasha; Dilbaz, Berna; Aktün, Hale; Dursun, Polat; Kiran, Sibel; Aksan, Güldeniz; Doğan, Bahar; Winikoff, Beverly

    2009-06-01

    To assess the efficacy and acceptability of two misoprostol regimens (400 microg oral or sublingual) following mifepristone for medical abortion. Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 microg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85-1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women.

  13. Abortion in Poland.

    Science.gov (United States)

    Szawarski, Z

    1991-12-01

    As of July 1991 abortion is still legal in Poland. Currently the Polish Parliament has taken a break from the debate because the issue is so important that any decision must not be made in past. There is strong pressure from the Catholic Church to eliminate access to abortion. In the fall the Polish people will vote for and elect their first truly democratic Parliament. Abortion does not seem to be playing as important a role as other political issues. In 1956 a law was passed that allowed a woman to have an abortion for medical or social reasons. This law resulted in allowing women in Poland to use abortion as their primary form of contraception. The vast majority of the abortions were performed under the social justification. Then, when democracy same to Poland with the help of the Catholic Church, an unprecedented debate in the mass media, churches, and educational institutions was stirred up. The government attempted to stay out of the debate at first. But as people from different side of the debate saw that they had an opportunity to influence things in their favor, they began to politicize the issue. Currently there are 4 different drafts of the new Polish abortion law. 3 of them radically condemn abortion while the 4th condemns it as a method of family planning, but allows to terminate pregnancies in order to save the life of the mother.

  14. [Epidemiology of induced abortion in France].

    Science.gov (United States)

    Vigoureux, S

    2016-12-01

    Conduct a synthesis of existing knowledge about the frequency of induced abortion or termination of pregnancy and unplanned pregnancies, the exposure factors of unplanned pregnancies and abortion and the associated morbidity and mortality. Consultation of The Medline database, and national and international reports on abortions in France and in developed countries. Voluntary termination of pregnancy is an induced abortion, opted for non-medical reasons, which in France can be performed before 14 weeks of gestation. Abortion is a common procedure, with rare complications, amounting to about 220,000 procedures per year in France with a stable rate over decades. Similarly to births, women aged 20 to 24 are most affected. The possibility of an abortion exists for all women; this potential event, however, is not equal for each and varies by age of women, socio-professional situations, geographical origins, marital status and past or present domestic and sexual violence. The French historical analysis shows that for 50 years the increase in contraceptive prevalence rate is associated with a decrease in the frequency of unplanned pregnancies. It is therefore possible that the prevention of unplanned pregnancy through early uptake of contraception and contraception options by women is related to a woman's lifestyle. Nonetheless, the number of abortion remains stable since its decriminalization despite the large increase in medicalized contraceptive prevalence rate. Good knowledge of the epidemiology of voluntary termination of pregnancy and unplanned pregnancies is a prerequisite to better adopt prevention and case management strategies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Early radiology and the National Medical Association.

    Science.gov (United States)

    Oestreich, Alan E

    2011-01-01

    Both the discovery of the x-ray and the founding of the National Medical Association (NMA) occurred in 1895. Radiologists have participated importantly in the NMA since the lecture of Dr Marcus F. Wheatland at the 1909 Annual Meeting in Boston, Massachusetts, which led to his election as president of the NMA for the following year. More recently, Dr Tracy M. Walton was president of the NMA in its centennial year. This article details early and continued participation in the NMA by radiologists, including the founding of the Section on Radiology in 1949, with its first chairman, Dr William E. Allen, Jr, longtime leader in radiology, the section, and the NMA.

  16. Clinical Outcomes and Women's Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa.

    Science.gov (United States)

    Constant, Deborah; Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, Daniel

    2016-01-01

    To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (pmisoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, pmisoprostol-only cohorts. The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion

  17. [Induced abortion in Mexico: what do Mexican Ob/Gyn know, think and do].

    Science.gov (United States)

    Montoya-Romero, José de Jesús; Schiavon, Raffaela; Troncoso, Erika; Díaz-Olavarrieta, Claudia; Karver, Tahilin

    2015-01-01

    The causals for legal abortion in Mexico vary as established by the Constitution of each State; from 2007 it is legal in Mexico City. To identify knowledge, attitudes and practice of abortion between gynecologists and obstetricians. Survey study conducted between some of the gynaeco-obstetricians attended the 64th Mexican Congress of Gynecology and Obstetrics held in Mexico City, October 2013. From the 1,085 respondents, 77% correctly identified that abortion is legal accord to Constitutional Signs of each State; 17.5% said it is never legal and 5.7% thought that is always legal. The 67% comment that public institutions should have infrastructure and trained medical personnal to legal abortion practice. The 72% response they would attend or denounce the woman who underwent an abortion outlawed. The remaining 28% showed negative attitudes, from informing the couple or parents (18%), scold women (2%) or reporting it to the authorities (8%). In 39%, they felt that the medical profession who practice discriminates abortions; 28% admit stigmatize partener and 27% feel stigmatized if performing abortions. Percentage high hospitalized patients in case of early abortions, for surgical or medical treatment. It is necessary to increase and improve knowledge technical and legal about abortion, especially among gynaeco-obstetricians, they are who responsibility to comply about prescribed by law, in accordance with international recommendations and the exercise of reproductive rights of women.

  18. Occupational risk factors of spontaneous abortion in medical personnel%医务人员自然流产职业危险因素

    Institute of Scientific and Technical Information of China (English)

    杨蕾

    2016-01-01

    近几年,在医务人员中,发生自然流产的事件越来越多,医务人员由于其工作的特殊性,在工作过程中存在着较多的危险因素,本文分析医务人员自然流产职业危险因素,为临床提供探讨。%In recent years,in medical personnel,spontaneous abortions are more and more,due to the particularity of the work in medical staff,there are many risk factors in the course of the work.In this paper,the author analysed the occupational risk factors of spontaneous abortion in medical personnel,to provide discuss for clinic.

  19. 无痛人流与药物流产的临床对比研究%Clinical comparative study between painless and medical abortion

    Institute of Scientific and Technical Information of China (English)

    黄立春

    2012-01-01

      目的探索并对比无痛人流与药物流产终止妊娠的临床效果.方法选取自2010年1月至2012年1月在我院分别自愿采取无痛人流的84名患者,药物流产的86名患者进行回顾性分析.对比观察两组的流产成功率、镇痛效果、出血量及术后出血持续时间、手术并发症及不良反应等.结果无痛人流组流产成功率明显优于药物流产组(P﹤0.01),镇痛效果、出血量及术后出血持续时间少于药物流产组,差异显著(P﹤0.05).结论无痛人流镇痛终止妊娠的临床效果优于药物流产,值得临床广泛推广.%  Objective To explore and compare the painless medical abortion to terminate the pregnancy, the clinical effect. Methods 84 patients from January 2010 to January 2012 in the hospital voluntarily take painless, medical abortion, 86 patients were analyzed retrospectively. The contrast observed abortion success rate of the two groups, the analgesic effect, amount of bleeding and postoperative bleeding duration, complications and adverse reactions. Results the painless group of abortion success rate significantly better than the medical abortion group (P﹤0.01), analgesia, blood loss and postoperative bleeding duration less than the medical abortion group, the difference was significant (P ﹤0.05). Conclusion painless analgesic clinical effect of termination of pregnancy better than abortion, and worthy of wide dissemination.

  20. Comparison of 400 mcg buccal and 400 mcg sublingual misoprostol after mifepristone medical abortion through 63 days' LMP: a randomized controlled trial.

    Science.gov (United States)

    Raghavan, Sheila; Comendant, Rodica; Digol, Irena; Ungureanu, Sergiu; Dondiuc, Iurie; Turcanu, Steliana; Winikoff, Beverly

    2010-12-01

    Buccal misoprostol 800 mcg and sublingual misoprostol 400 mcg demonstrate high efficacy and few adverse effects when used with 200 mg mifepristone for medical abortion through 63 days since the last menstrual period (LMP). Little is known about a 400-mcg buccal dose. This study compares two in-the-mouth routes of misoprostol using the same dose. Eligible and consenting women (n=550) were randomized to 400 mcg of misoprostol buccally or sublingually 24 h after ingestion of 200 mg of mifepristone. Abortion status was assessed 2 weeks later. Complete abortion occurred in 97.1% of the buccal group and 97.4% of the sublingual group (p=.97, RR: 1.00, 95% CI=0.97-1.03). Adverse effects were similar in both groups. Over 90% of women in both arms expressed high satisfaction with the method. Both 400 mcg buccal misoprostol and 400 mcg sublingual misoprostol after mifepristone appear to be good options for medical abortion through 63 days' LMP. Copyright © 2010 Elsevier Inc. All rights reserved.

  1. Abortion and Catholic thought. The little-known history.

    Science.gov (United States)

    1996-01-01

    This article traces the history of the abortion policy of the Roman Catholic Church. The introductory section notes that the Church has consistently opposed abortion as evidence of sexual sin but has not always regarded it as homicide because Church teaching has never been definitive about the nature of the fetus. In addition, the prohibition of abortion has never been declared an infallible teaching. The chronology starts with a sketch of events in the first six Christian centuries when Christians sought ways to distinguish themselves from pagans who accepted contraception and abortion. During this period, Christians also decided that sexual pleasure was evil. Early Church leaders began the debate about when a fetus acquired a rational soul, and St. Augustine declared that abortion is not homicide but was a sin if it was intended to conceal fornication or adultery. During the period of 600-1500, illicit intercourse was deemed by the Irish Canons to be a greater sin than abortion, Church leaders considered a woman's situation when judging abortion, and abortion was listed in Church canons as homicide only when the fetus was formed. St. Thomas Aquinas declared that a fetus first has a vegetative soul, then an animal soul, and finally a rational soul when the body was developed. The next period, 1500-1750, found anyone who resorted to contraception or abortion subject to excommunication (1588), saw these rules relaxed in 1591, and banned abortion even for those who would be murdered because of a pregnancy (1679). From 1750 to the present, excommunication was the punishment for all abortions (1869). This punishment was extended to medical personnel in 1917, but the penalty had exceptions if the woman was young, ignorant, or operating under duress or fear. In 1930, therapeutic abortions were condemned, and, in 1965, abortion was condemned as the taking of life rather than as a sexual sin. By 1974, the right to life argument had taken hold and became part of a theory of

  2. Abortion and Selection

    OpenAIRE

    2006-01-01

    The introduction of legalized abortion in the early 1970s led to dramatic changes in fertility behavior. Some research has suggested as well that there were important impacts on cohort outcomes, but this literature has been limited and controversial. In this paper, we provide a framework for understanding the mechanisms through which abortion access affects cohort outcomes, and use that framework to both address inconsistent past methodological approaches, and provide evidence on the long-run...

  3. Medical confidentiality in the late nineteenth and early twentieth centuries: an Anglo-German comparison1

    Science.gov (United States)

    2012-01-01

    Summary Professional secrecy of doctors became an issue of considerable medico-legal and political debate in the late nineteenth and early twentieth centuries in both Germany and England, although the legal preconditions for this debate were quite different in the two countries. While in Germany medical confidentiality was a legal obligation and granted in court, no such statutory recognition of doctors’ professional secrecy existed in England. This paper is a comparative analysis of medical secrecy in three key areas - divorce trials, venereal disease and abortion - in both countries. Based on sources from the period between c.1870 and 1939, our paper shows how doctors tried to define the scope of professional secrecy as an integral part of their professional honour in relation to important matters of public health. PMID:21077462

  4. PREGNANCY OUTCOME FOLLOWING ABORTION

    Directory of Open Access Journals (Sweden)

    Annapurna

    2015-10-01

    Full Text Available The previous two or three induced - were spontaneous abortion will carry a risk of preterm, ectopic pregnancy. This is to study is to evaluate the outcome of pregnancy with history of previous abortion. MATERIAL AND METHODS : This study was conducted for on e and half year period in Regional Institute of Medical Sciences, Imphal, Manipur. RESULTS: We observed that majority of the women in the study fell in 25 to 35 years of age. 116 (71.9% women with history of induced abortion were aged between 25 to 30 yea rs of age. 52(73.3% women with history of spontaneous abortions were less than 30 years of age. There were only 7(9.7% women in the spontaneous abortion group who were above 35 years of age. CONCLUSION: We concluded that women with previous history of tw o or three induced abortions were at risk of preterm birth, very preterm birth and low birth weight babies in the subsequent pregnancies. The risk of caesarean was found to be increased in women with previous two or three spontaneous abortions exposing the women to the morbidity associated with the C-section

  5. Accuracy of gestational age estimated by menstrual dating in women seeking abortion beyond nine weeks.

    Science.gov (United States)

    Norman, Wendy V; Bergunder, Jeannette; Eccles, Lisa

    2011-03-01

    We sought to quantify the accuracy of estimating gestational age by reported last menstrual period among women seeking surgical abortion. We observed that women seeking surgical abortion underestimated their gestational age when making the appointment, leading to poor allocation of resources. This tendency to underestimate has not previously been reported and differs from the accurate dating reported among women choosing either medical abortion or continuation of the pregnancy. We performed a retrospective review of randomly selected medical records for women with abortions scheduled at 9 to 20 weeks' gestation (n = 415) at two clinics in Vancouver between 2002 and 2008. The mean gestational age calculated by menstrual dates (14.3, SD 3.9) was 1.2 (95% CI 0.9 to 1.4) weeks less than that calculated by ultrasound (15.5, SD 3.4) (P abortions, illicit drug use, and contraceptive method at conception) were not significant predictors of inaccurate menstrual dating. Women seeking surgical abortion for pregnancies of 9 to 20 weeks underreport gestational age by an average of 1.2 weeks using menstrual dating. We found that women who intended to continue with their pregnancy overestimated their gestational age, those seeking very early abortion estimated most accurately, and those seeking surgical abortion at more than nine weeks had a clinically significant underestimation of their gestational age. Clinicians referring and counselling women who are considering surgical abortion must facilitate timely access to clinical or ultrasound dating of their pregnancy.

  6. Teenage pregnancies and abortion.

    Science.gov (United States)

    Morgenthau, J E

    1984-01-01

    The issue of abortion, except when it is rendered moot because the fetus endangers the life of the mother, is not really a medical issue. The physician's role is to help patients achieve and maintain their maximum potential for physical, mental, and social well-being. To accomplish this, the physician must acquire a constantly evolving database of scientific knowledge, must evaluate this information in a critical and ethical manner, and must be prepared to apply what is learned. In the realm of applied ethics, no particular religion, profession, culture, class, or sex should be thought of as having all the answers in the realm of applied ethics. This physician's actions are predicated on the belief that, to a large extent, ethical precepts reflect the broader social and economic issues of the period in which they are articulated. If this is the case, then in today's world the population explosion, the postindustrial society, the women's rights movement, inequality of access, and the ability to perform prenatal diagnosis are all factors which have molded the approach to the issue of abortion. Only the last 3 of these can in any way be considered as medical. When considering the role of a physician in dealing with the issue of abortion in the adolescent, this individual relies on the concept articulated by the World Health Association (WHA): promoting the physical, emotional, and social well-being of one's patients. Each year in the US over 1 million 15-19 year olds become pregnant, resulting in over 600,000 births. Most of these pregnancies are unintentional, yet approximately 90% of the infants are kept in the home by mothers who are ill prepared to be parents. What is most disturbing is that the pregnancy rate for the younger mother, 16 years or under, is accounting for an ever increasing percentage of the total. Studies at the Adolescent Health Center of the Mount Sinai Hospital in New York City as well as national studies suggest that the younger teens are more

  7. [Historical background of the acceptance of induced abortion].

    Science.gov (United States)

    Obayashi, M

    1982-12-01

    Japanese attitude toward induced abortion with its historical background is examined. There is a record of induced abortion as early as the beginning of the 12th century. Abortion was practiced frequently as a means of family planning during Edo Period (1603-1867), especially among the poor. Shogunate and feudal lords were aware of the problem but generally acquiesced. Some Buddhist priest preached on the vice of abortion from a humanitarian point of view and suggested that each community should cooperate and regulate the practice. In 1842 Shogunate at last banned induced abortion in the capital, Edo, but left the rest of the country alone. Ironically this practice of voluntary abortion among the poor and the killing of newborns among peasants controlled the size of population of the nation throughout Edo Period, which saw 35 famines and undue taxation on peasants. In 1868 the new government of Meiji announced to have a tight control over midwives who performed abortion in most cases. In modernizing the nation the government advocated enlarged population under the slogan: rich nation with strong soldiers. This trend persisted till the end of World War II. Overpopulation and shortage of food after World War II with soldiers and people from lost colonies returning home prompted Japan to control her population and adopt a eugenic law. It was not until 1970's in the midst of women's liberation movement that Japanese women became aware of their own right to the reproductive aspect of their life. In comparison, in the United States Supreme Court decision in 1973 virtually legalized abortion and each state has responded to it differently. Prior to 1900 induced abortion was accepted as a means of birth control in the United States, and midwives had monopolized that area of medicine. Crusaders of anti-abortion from the turn of the century were not necessarily well publicized Catholics but "licensed" doctors who joined forces in their attempt to shut out midwives from

  8. Abortion and compelled physician speech.

    Science.gov (United States)

    Orentlicher, David

    2015-01-01

    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.

  9. 早期自然流产与环境因素的相关性分析%Association between early spontaneous abortion and environmental factors

    Institute of Scientific and Technical Information of China (English)

    石波; 施雯慧

    2011-01-01

    目的 探讨与早期自然流产相关的环境危险因素,为降低自然流产率、减少不良妊娠结局的发生提供参考.方法 采用问卷调查的方式,分析比较了97例在厦门市妇幼保健院诊断为早期自然流产的妇女和76例同期正常分娩的妇女的个人史资料和早孕期环境接触情况.结果 单因素分析显示,自然流产组妇女的妊娠次数、既往自然流产次数、早孕期被动吸烟、每日手机通话次数以及使用染发剂的比例显著高于对照组(P均<0.05).多因素分析显示,以上提到的三个环境接触因素均可增加早期自然流产的危险.结论 早孕期被动吸烟、每日手机通话次数以及使用染发剂均与自然流产有一定关联,因此孕妇在怀孕期间应尽量避免被动吸烟、长时间使用电磁辐射大的设备以及接触染发剂等化学物质.%Objective: Explore the environmental risk factors of early spontaneous abortion, so as to reduce the percent of miscarriage and Occurrence of adverse pregnancy outcome. Methods: Use standard questionnaires to investigate 97 women who were diagnosed as early spontaneous abortion in Hospital of Women and Children of Xiamen and 76 women who give birth normally in the same hospital during the same period, compare their medical records and information of exposure to environment during early pregnancy. Results: One-factor analysis shows that there existed differences between the case group and the control group on pregnant times, times of miscarriage, times of cell phone use per day, passive smoking, and usage of hair-dyes (P <0. 05). Multi-factors analysis shows that all the three environmental factors are risk factors of spontaneous abortion. Conclusion: Passive smoking, times of cell phone use per day, and usage of hair-dyes are related with miscarriage, pregnant women should avoid passive smoking, hair coloring and using electric equipments such as cell phone, microwave ovens for long time.

  10. The dysfunction of CD4(+CD25(+ regulatory T cells contributes to the abortion of mice caused by Toxoplasma gondii excreted-secreted antigens in early pregnancy.

    Directory of Open Access Journals (Sweden)

    Jin-ling Chen

    Full Text Available Toxoplasma gondii is an opportunistic intracellular parasite that is highly prevalent in human and warm-blooded animals throughout the world, leading to potentially severe congenital infections. Although the abortion caused by T. gondii is believed to be dependent on the timing of maternal infection during pregnancy, the mechanism remains unclear. This study was focused on the effects of T. gondii excreted-secreted antigens on pregnant outcomes and CD4(+CD25(+ Foxp3(+ regulatory T cells at different stages of pregnancy. The results showed that in mice the frequency and suppressive function of CD4(+CD25(+ regulatory cells were diminished after injection of T. gondii excreted-secreted antigens at early and intermediate stages of pregnancy. The abortion caused by T. gondii excreted-secreted antigens at early pregnancy could be partly prevented by adoptively transferring of CD4(+CD25(+ cells from the mice injected with T. gondii excreted-secreted antigens at late pregnancy, but not from the mice with the same treatment at early pregnancy. Furthermore, T. gondii excreted-secreted antigens induced apoptosis of CD4(+CD25(+ regulatory cells of mice in early and intermediate stages of pregnancy by down-regulating their Bcl-2 expressions and Bcl-2/Bax ratio. This study provides new insights into the mechanism that T. gondii infection is the high risk factor for abortion in early pregnancy.

  11. Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland.

    Science.gov (United States)

    Aiken, Abigail R A; Digol, Irena; Trussell, James; Gomperts, Rebecca

    2017-05-16

    Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine.Design Population based study.Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances.Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012.Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised.Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice

  12. Foaling rates and risk factors for abortion in pregnant mares presented for medical or surgical treatment of colic: 153 cases (1993–2005)

    Science.gov (United States)

    Chenier, Tracey S.; Whitehead, Ashley E.

    2009-01-01

    The purpose of this study was to determine foaling rates in mares presented for medical or surgical treatment of colic, and to examine risk factors associated with abortion following colic. A retrospective analysis of 153 medical records found that mares treated surgically for colic (P = 0.0007) were 3.5 times more likely to have a negative pregnancy outcome than were mares treated medically for colic. Anesthetic time (P = 0.01) and intra-operative hypotension (P = 0.03) were significantly associated with negative pregnancy outcome. Mares with an anesthetic time ≥ 3 h were 6 times more likely to abort. Signs of endotoxemia (P = 0.30), hypoxia (P = 0.89), flunixin meglumine administration (P = 0.13), mucous membrane color at the time of presentation (P = 0.82) and capillary refill time (P = 0.76) were not associated with pregnancy outcome. There was no difference in the foaling rate for mares that had received progestin supplementation versus those that had not (P = 0.42). In this study, the significant risk factors for abortion were surgically treated colic, long anesthetic time, and intraoperative hypotension. PMID:19436632

  13. Septic shock due to Klebsiella pneumoniae after medical abortion with misoprostol-only regimen.

    Science.gov (United States)

    Kaponis, Apostolos; Papatheodorou, Stefania; Makrydimas, George

    2010-09-01

    To report a case of a healthy woman who was admitted to the hospital with septic shock caused by a common uropathogen after self-administration of misoprostol for pregnancy termination. Case report. Tertiary hospital. A 38-year-old woman, gravida 5, para 3, who developed septic shock after medical termination of pregnancy. Suction curettage, antibiotic treatment, plasma and platelet transfusions. Klebsiella pneumoniae was isolated from blood samples. Ten days after her admission she was discharged home in good condition on oral antibiotics. Severe infections leading to septic shock from common pathogen bacteria can occur after medical termination of pregnancy, independently of the regimen used. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. ACOG Committee opinion no. 612: Abortion training and education.

    Science.gov (United States)

    2014-11-01

    Access to safe abortion hinges upon the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports education for students in health care fields as well as clinical training for residents and advanced practice clinicians in abortion care in order to increase the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports the expansion of abortion education and an increase in the number and types of trained abortion providers in order to ensure women's access to safe abortions. Integrated medical education and universal opt-out training policies help to lessen the stigma of abortion provision and improve access by increasing the number of abortion providers. This Committee Opinion reviews the current status of abortion education, describes initiatives to ensure the availability of appropriate and up-to-date abortion training, and recommends efforts for integrating and improving abortion education in medical schools, residency programs, and advanced practice clinician training programs.

  15. Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion.

    Science.gov (United States)

    Ramesh, Shanthi; Roston, Alicia; Zimmerman, Lindsay; Patel, Ashlesha; Lichtenberg, E Steve; Chor, Julie

    2015-09-01

    We sought to compare the effectiveness of at least 1 h of 400 mcg of buccal misoprostol to overnight osmotic dilators for early second-trimester surgical abortion cervical preparation. We conducted a retrospective cohort study, reviewing 145 consecutive charts to compare procedure duration for women who received 400 mcg of buccal misoprostol at least 1 h preprocedure vs. overnight osmotic dilators before dilation and evacuation between 14 weeks, 0 days and 15 weeks, 6 days' gestation. Primary outcome was procedure duration and secondary outcomes included maximum mechanical dilator size, estimated blood loss and side effects. Sixty-four women (44.1%) received buccal misoprostol (mean 1.6 h), and 81 women (55.9%) received overnight osmotic dilators. Groups did not differ regarding mean gestational age or gynecologic history. All procedures in both groups were completed. Procedure duration was not significantly different between the misoprostol and osmotic dilator groups (median 11.0 min vs. 10.0 min, p=.22), even after multivariable linear regression (p=.17). The mean total cervical preparation duration was 1.6 h for women in the misoprostol group compared to 20.3 h in the osmotic dilator group (pmisoprostol decreased the duration of cervical preparation for early second-trimester procedures performed by an experienced surgeon. In this small, retrospective review, at least 1 h of preprocedure buccal misoprostol decreased the duration from cervical preparation initiation to procedure completion in early second-trimester procedures performed by an experienced surgeon. These results should be considered as a pilot evaluation, and further prospective study is needed to further clarify whether this short interval could be applied in general practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Abortion: taking the debate seriously.

    Science.gov (United States)

    Kottow Lang, Miguel Hugo

    2015-05-19

    Voluntarily induced abortion has been under permanent dispute and legal regulations, because societies invariably condemn extramarital pregnancies. In recent decades, a measure of societal tolerance has led to decriminalize and legalize abortion in accordance with one of two models: a more restricted and conservative model known as therapeutic abortion, and the model that accepts voluntary abortion within the first trimester of pregnancy. Liberalization of abortion aims at ending clandestine abortions and decriminalizes the practice in order to increase reproductive education and accessibility of contraceptive methods, dissuade women from interrupting their pregnancy and, ultimately, make abortion a medically safe procedure within the boundaries of the law, inspired by efforts to reduce the incidence of this practice. The current legal initiative to decriminalize abortion in Chile proposes a notably rigid set of indications which would not resolve the three main objectives that need to be considered: 1) Establish the legal framework of abortion; 2) Contribute to reduce social unrest; 3) Solve the public health issue of clandestine, illegal abortions. Debate must urgently be opened to include alternatives in line with the general tendency to respect women's decision within the first trimester of pregnancy.

  17. The consequences of abortion legislation.

    Science.gov (United States)

    Braude, M

    1983-01-01

    This article examines the consequences of the 1973 US Supreme Court decision legalizing abortion as well as potential implications of proposed legilation aimed at nullifying this decision. In addition to giving women the right to determine their own reproduction, legal abortion had had beneficial health effects for both mothers and infants. The partial reversal of abortion gains due to restrictions on public funding and limitations on how and where abortions can be performed has produced a slight increase in abortion mortality, but the impact has not been dramatic. Moreover, each year since 1973, women have been obtaining abortions earlier in pregnancy. Abortion may be experienced as a loss by the mother, but there is no evidence of serious psychological sequelae. In contrast, a large body of evidence supports the physical, psychological, and social benefits of legal abortion to women, children, and families. However, proponents of the proposed Human Life Amendment place protection of the rights of the fetus over all other considerations. Their antiabortion actions have challenged the medical tradition of privacy and the confidentiality of the doctor-patient relationship. Most supporters of legal abortion would prefer that there be fewer abortions; such a decrease is more likely as a result of better education and contraceptive methods rather than coercion.

  18. Abortion law reform in Nepal.

    Science.gov (United States)

    Upreti, Melissa

    2014-08-01

    Across four decades of political and social action, Nepal changed from a country strongly enforcing oppressive abortion restrictions, causing many poor women's long imprisonment and high rates of abortion-related maternal mortality, into a modern democracy with a liberal abortion law. The medical and public health communities supported women's rights activists in invoking legal principles of equality and non-discrimination as a basis for change. Legislative reform of the criminal ban in 2002 and the adoption of an Interim Constitution recognizing women's reproductive rights as fundamental rights in 2007 inspired the Supreme Court in 2009 to rule that denial of women's access to abortion services because of poverty violated their constitutional rights. The government must now provide services under criteria for access without charge, and services must be decentralized to promote equitable access. A strong legal foundation now exists for progress in social justice to broaden abortion access and reduce abortion stigma.

  19. Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

    Science.gov (United States)

    Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, Daniel

    2016-01-01

    Objective To document clinical outcomes and women’s experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. Methods Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2–4 weeks after discharge for the 2014 cohort. Results The 2014 cohort received 200 mg mifepristone, which was self-administered 24–48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3–4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (pmisoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, pmisoprostol-only cohorts. Conclusion The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has

  20. Study on providers' perceptive about medical abortion: A qualitative research%流产服务提供者对药物流产认知的定性研究

    Institute of Scientific and Technical Information of China (English)

    任姗姗; 茅群霞; 姜晓梅; 庞成; 程怡民

    2012-01-01

    Objective; To explore abortion service providers'perception about medical abortion and its influencing factors. Methods: We conducted in - depth interviews among 32 abortion service providers in Shenzhen City and Henan province in May 2009. Results; Most providers regarded high incidence of incomplete abortion, long duration of bleeding, multiple counseling , severe complications and side - effects, and challenge in communication with clients were major demerits of medical a-bortion, while higher acceptability and less impairment were its merits. Given that both medical abortion and surgical abortion were suitable, only minority of providers would like to recommend or choose the medical abortion. Considering about " safety" , "efficiency" , and sometimes the effect of "implementation of policy" , most respondents would select a surgical method. Majority of providers indicated that there was no relationship between the abortion method and providers' personal benefits. However, the money - oriented behavior during abortion method recommendation and selection in medical facilities couldn't be excluded completely. Abortion clients were not influenced by the payment in choosing a medical or a surgical abortion. Conclusion : Concerning about safety, efficacy, workload, and policy implementation, providers tend to opine that a surgical abortion is more suitable than a medical abortion in China. So we suggest that comprehensive and integrated training on medical a-bortion should be developed among providers. Specialization and cooperation as well as referral should be promoted to remove the restriction of existing medical resources on the availability of medical abortion services .%目的:调查流产服务提供者对药物流产的认知及其影响因素.方法:2009年5月对河南省、深圳市32名流产服务提供者进行个人深入访谈.结果:多数服务提供者认为药物流产缺点为不完全流产率高、出血时间长、需要多次复诊、并发

  1. Provokeret abort

    DEFF Research Database (Denmark)

    Christiansen, Connie; Schmidt, Garbi; Christoffersen, Mogens

    Gennem en række interview om kvinders oplevelse og erfaringer med provokert abort, samt ved at bruge data fra en stor forløbsundersøgelse af kvinder født i 1966, giver forfatterne bag denne rapport et præcist signalement af de kvinder, der vælger at få foretaget en provokeret abort og de eventuelle...... for sundhedspersonale og andre socialarbejdere. Den statistiske undersøgelse viser, at hver fjerde danske kvinde vil komme i den situation at skulle have en abort. Især kvinder med vanskelige opvækstvilkår er i risikogruppen. Tilgengæld er der næsten ingen langvarige fysiske og psykiske virkninger abort af abort, med...

  2. Provokeret abort

    DEFF Research Database (Denmark)

    Christiansen, Connie; Schmidt, Garbi; Christoffersen, Mogens

    Gennem en række interview om kvinders oplevelse og erfaringer med provokert abort, samt ved at bruge data fra en stor forløbsundersøgelse af kvinder født i 1966, giver forfatterne bag denne rapport et præcist signalement af de kvinder, der vælger at få foretaget en provokeret abort og de eventuelle...... for sundhedspersonale og andre socialarbejdere. Den statistiske undersøgelse viser, at hver fjerde danske kvinde vil komme i den situation at skulle have en abort. Især kvinder med vanskelige opvækstvilkår er i risikogruppen. Tilgengæld er der næsten ingen langvarige fysiske og psykiske virkninger abort af abort, med...

  3. Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study

    Directory of Open Access Journals (Sweden)

    Kim Sung

    2012-12-01

    Full Text Available Abstract Background Risk stratification of the early repolarization pattern (ERP is needed to identify malignant early repolarization. J-point elevation with a horizontal ST segment was recently suggested as a malignant feature of the ERP. In this study, the prevalence of the ERP with a horizontal ST segment was examined among survivors of sudden cardiac arrest (SCA without structural heart disease to evaluate the value of ST-segment morphology in risk stratification of the ERP. Methods We reviewed the data of 83 survivors of SCA who were admitted from August 2005 to August 2010. Among them, 25 subjects without structural heart disease were included. The control group comprised 60 healthy subjects who visited our health promotion center; all control subjects were matched for age, sex, and underlying disease (diabetes mellitus, hypertension. Early repolarization was defined as an elevation of the J point of at least 0.1 mV above the baseline in at least two continuous inferior or lateral leads that manifested as QRS slurring or notching. An ST-segment pattern of Results The SCA group included 17 men (64% with a mean age of 49.7 ± 14.5 years. The corrected QTc was not significantly different between the SCA and control groups (432.7 ± 37.96 vs. 420.4 ± 26.3, respectively; p = 0.089. The prevalence of ERP was not statistically different between the SCA and control groups (5/25, 20% vs. 4/60, 6.7%, respectively; p = 0.116. The prevalence of early repolarization with a horizontal ST segment was more frequent in the SCA than in the control group (20% vs. 3.3%, respectively; p = 0.021. Four SCA subjects (16% and one control subject (1.7% had a J-point elevation of >2 mm (p = 0.025. Four SCA subjects (16% and one (1.7% control subject had an ERP in the inferior lead (p = 0.025. Conclusion The prevalence of ERP with a horizontal ST segment was higher in patients with aborted SCA than in matched controls. This result suggests that ST morphology has

  4. Medical students' professional identity development in an early nursing attachment.

    NARCIS (Netherlands)

    Helmich, E.; Derksen, E.; Prevoo, M.; Laan, R.F.J.M.; Bolhuis, S.; Koopmans, R.T.C.M.

    2010-01-01

    OBJECTIVES: The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an ass

  5. Australia: Abortion and Human Rights.

    Science.gov (United States)

    Sifris, Ronli; Belton, Suzanne

    2017-06-01

    This article adopts a human rights lens to consider Australian law and practice regarding elective abortion. As such, it considers Australian laws within the context of the right to equality, right to privacy, right to health, and right to life. After setting out the human rights framework and noting the connected nature of many of the rights (and their corresponding violations), the article shifts its focus to analyzing Australian law and practice within the framework of these rights. It considers the importance of decriminalizing abortion and regulating it as a standard medical procedure. It discusses the need to remove legal and practical restrictions on access to abortion, including financial obstacles and anti-abortion protestors. Further, it comments on the importance of facilitating access; for example, by keeping accurate health data, securing continuity of health care, increasing the availability of medical abortion, and ensuring appropriate care is provided to the most marginalized and vulnerable women.

  6. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States

    OpenAIRE

    Donald Paul Sullins

    2016-01-01

    Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adu...

  7. El aborto y la educación médica en México Abortion and medical education in Mexico

    Directory of Open Access Journals (Sweden)

    Deyanira González de León-Aguirre

    2008-06-01

    Full Text Available La educación médica en México tiene deficiencias importantes en el terreno de la salud sexual y reproductiva, y ofrece a los estudiantes pocos elementos para el reconocimiento del aborto como un problema relevante de la práctica profesional de la medicina. La educación médica carece de opciones para la capacitación clínica de los futuros médicos en modelos para la atención integral del aborto, que incluyen el uso de tecnologías seguras y eficaces, y una gama de servicios para responder a las necesidades de las mujeres. Estas limitaciones tienen especial relevancia en países como México, donde el aborto inseguro sigue siendo un importante problema de salud pública. Además, el marco legal del aborto ha empezado a cambiar en la década presente, por lo que la búsqueda de alternativas para incorporar un enfoque amplio sobre el aborto en los programas de las escuelas de medicina es una tarea que no se puede postergar.Medical education in Mexico has significant deficiencies in the area of sexual and reproductive health and does not offer students the information needed for dealing with abortion as a relevant problem in the professional practice of medicine. Medical education does not offer options for the clinical training of future physicians in integrated models for abortion care, which include the use of safe and effective technologies as well as a range of services to respond to women's needs. These limitations are especially relevant in countries such as Mexico where unsafe abortion continues to be a significant public health problem. In addition, the legal context for abortion has begun to change during the current decade; therefore, the search for alternatives to incorporate a broad approach to abortion in medical school programs is a task that cannot be postponed.

  8. The Effects of Abortion Training on Family Medicine Residents' Clinical Experience.

    Science.gov (United States)

    Summit, Aleza K; Gold, Marji

    2017-01-01

    RHEDI, Reproductive Health Education in Family Medicine, offers technical assistance and funding to family medicine residency programs to support integrated opt-out abortion and reproductive health training for residents. This study assessed the impact of this enhanced training on residents' reproductive health experience. Investigator-developed pre- and post-surveys were administered online to 214 residents at 12 family medicine residency programs before and after their RHEDI training experience. Surveys addressed experience in contraception and abortion, attitudes around abortion provision, and post-residency intentions. Descriptive statistics were generated, and statistical tests were performed to assess changes after training. Surveys had a 90% response rate. After the RHEDI enhanced reproductive health rotation, residents reported increased experience in contraception provision, early pregnancy ultrasound, aspiration and medication abortion, and miscarriage management. After training, residents with experience in IUD insertion increased from 85% to 99%, and contraceptive implant insertion experience rose from 60% to 85%. Residents who had performed any abortions increased from 15% to 79%, and self-rated competency in abortion increased. Finally, almost all residents agreed that early abortion was within the scope of family medicine, and training confirmed residents' intentions to provide reproductive health services after residency. Integrated training in reproductive health, with an emphasis on abortion, increases residents' experience and underscores their understanding of the role of these services in family medicine. Increasing the number of family medicine residency programs that offer this training could help prepare family physicians to meet their patients' needs for reproductive health services.

  9. Survey on medical abortion services of China%药物流产服务现状调查

    Institute of Scientific and Technical Information of China (English)

    吉宁; 庞成; 何电; 张颖; 周猷; 程怡民

    2012-01-01

    Objective: To explore the situation of medical abortion ( MA) services in China. Methods: Shenzhen city and Henan Province were selected intentionally. A multiple stratified sampling method was used to choose totally 658 abortion service providers from family planning service centers (FPSC) and hospitals between Nov. , 2009 and May, 2010. Results;Firstly, 97.80% , 99.20% , 68.00% , 74.30% and 95.90% service providers reported they performed general physical checkup, ultrasound examination, analgesic therapy, alleviation of vomiting and antibiotic prophylaxis to each woman or some women when providing MA services. Secondly, as to the quality of MA services, toilet facilities for discharge of gestational sac and the gestational sac washing equipment were relatively poor, scoring 3. 02 and 3. 15 respectively. Thirdly, Service providers scored 56. 91 on service experience in using mifepristone combined with oral prostaglandin (or misoprostol / gemeprost) and scored 70. 29 in using cervical dilation and vacuum aspiration. Multivariate analysis showed that the educational level and years of service had an impact on service expedience in MA. Conclusion; The MA - related services are in a good situation. The toilet facilities for discharge of gestational sac and the gestational sac washing equipment need to improve. Most service providers have service experience in MA.%目的:了解药物流产相关服务现状及医护人员药物流产服务经验影响因素.方法:2009年11月~2010年5月,采用多阶段分层随机抽样方法抽取广东省深圳市和河南省计划生育中心及医院658名流产医护人员进行问卷调查.结果:药物流产相关的全身检查、超声检查、止痛、止吐、预防性使用抗生素项目每次或有时开展的比例分别为97.80%、99.20%、68.00%、74.30%和95.90%;流产服务中排除孕囊的设备(3.02分)和冲洗孕囊的设备(3.15分)是得分较低的环节;医护人员的服务经验得分

  10. [History of the medical indication of induced abortion. A historical contribution to the discussion of a current problem].

    Science.gov (United States)

    Gottlieb, J

    1974-10-01

    Of all the religious injunctions against abortion, the most effective one over time has been the belief that God is the giver of life and that therefore abortion constitutes an attack on Divine Will. The question of when the soul enters the embryo is, under that view, of secondary importance. 2 schools of thought, each with a large body of supporting literature, have developed on the subject, however; 1 is that life is created complete and by Divine impulse, and the other that the soul enters the body after its creation as a continuing act of Divine creation. Writers supporting the latter view tend to agree that only God knows or can know the moment of the soul's entrance, and furthermore that it probably occurs quite soon after conception. In any case, a doctor can respect his own religious principles with regard to abortion but does not have the right to condemn those of his colleagues who hold different views.

  11. Patient experience of sexual hallucinations after propofol-induced painless abortion may lead to violence against medical personnel.

    Science.gov (United States)

    Yang, Zhiyong; Yi, Bin

    2016-06-01

    Painless abortion is an outpatient surgical procedure performed under general anesthesia, which requires an appropriate anesthetic reagent that must be safe, comfortable for the patient, and highly controllable. At present, fentanyl and propofol are first-choice anesthetic reagents in clinical applications. However, both have various side effects, including the inhibition of respiration and circulation and the occurrence of postoperative sexual fantasies and amorous behavior. In this report, we will demonstrate three cases of allegations of assault and violence caused by sexual hallucinations in patients who were anesthetized with propofol and fentanyl during painless abortion surgery.

  12. Study of methyl transferase (G9aMT) and methylated histone (H3-K9) expressions in unexplained recurrent spontaneous abortion (URSA) and normal early pregnancy.

    Science.gov (United States)

    Fatima, Nishat; Ahmed, S H; Salhan, Sudha; Rehman, S M F; Kaur, Jatinder; Owais, M; Chauhan, Shyam S

    2011-11-01

    We investigated the expression of methyl transferase G9a and methylated histone H3-K9 in fresh human decidual/endometrial tissue of 12 normal early pregnancies and 15 unexplained recurrent spontaneous abortions (URSA). The samples were obtained through dilatation and curettage and collected as per strict inclusion-exclusion criteria. The tissue was subjected to immunohistochemical analysis (IHC), western blotting (WB) and RT-PCR analysis. The results demonstrated methyl transferase G9a to have a lower expression in abortions when compared with that in normal pregnancy (P K9 was significantly lower (P < 0.0001) in URSA tissues than in controls. This study suggests that methylation may cause URSA and indicates the need for further work to explore the role of methylation in URSA and its possible prevention through locally acting methylating/demethylating agents.

  13. Abortion trends from 1996 to 2011 in Estonia: special emphasis on repeat abortion

    Science.gov (United States)

    2014-01-01

    Background The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia. Methods Data were retrieved from the Estonian Medical Birth and Abortion Registry and Statistics Estonia. Total induced abortion numbers, rates, ratios and age-specific rates are presented for 1996–2011. The percentage change in the number of repeat abortions within selected socio-demographic subgroups, contraception use and distribution of induced abortions among Estonians and non-Estonians for the first, second, third, fourth and subsequent abortions were calculated for the periods 1996–2003 and 2004–2011. Results Observed trends over the 16-year study period indicated a considerable decline in induced abortions with a reduction in abortion rate of 57.1%, which was mainly attributed to younger cohorts. The percentage of women undergoing repeat abortions fell steadily from 63.8% during 1996–2003 to 58.0% during 2004–2011. The percentage of women undergoing repeat abortions significantly decreased over the 16 years within all selected socio-demographic subgroups except among women with low educational attainment and students. Within each time period, a greater percentage of non-Estonians than Estonians underwent repeat abortions and obtained third and subsequent abortions. Most women did not use any contraceptive method prior to their first or subsequent abortion. Conclusion A high percentage of women obtaining repeat abortions reflects a high historical abortion rate. If current trends continue, a rapid decline in repeat abortions may be predicted. To decrease the burden of sexual ill health, routine contraceptive counselling, as standard care in the abortion process, should be seriously addressed with an emphasis on those groups - non-Estonians, women with lower educational attainment, students and women with children

  14. Studies on Relationship between Serum Nitric Oxide and Plasma Cyclic Guanosine Monophosphate and Prolonged Bleeding after Medical Abortion as well as Prophylaxis and Treatment of Bleeding with Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    廖玎玲; 谭布珍; 辛华; 贺晓菊

    1999-01-01

    Objectives To study the relationship between serum nitric oxide(NO and plasma cyclic guanosine monophosphate(cGMP)and prolonged bleeding after medical abortion.Methods A total of 120women having received medical abortions at random were recruited and divided into two groups:the one(Group A,n=60) taking “Gong-Fu Mixture(Uterus-Recovering Mixture)”and the other(Group B,n=60)not taking it after abortion.On d 10,20 and 30 after medical abortion,serum NO and plasma cGMP were tested before and after mifepristone administration and 10 d later by Gresis reac-tion method and radioimmunoassay respectively.Results NO concentration in serum and cGMP concentration in plasma decreased signifi-cantly after taking mifeprlstone given(P<0. 05).Ten days later,the number of thos ewith bleeding discontinuation in the group A was significantly greater than that in the group B(P<0.05).Serum NO level and plasma cGMP level in the group A de-creased more significantly than those in the group B(P<0. 05).Conclusion The slow decrease of serum NO and plasma cGMP is closely related to prolonged bleeding after medical abortion.“Gong-Fu Mixture(uterus-recovering mixture)”is effective in prevention and treatment of prolonged bleeding.

  15. Medical versus surgical termination of early pregnancy: satisfaction with care, emotional impact and acceptability of the procedure

    Directory of Open Access Journals (Sweden)

    Prasanna L. Akkenapally

    2016-09-01

    Conclusions: Satisfaction with both the methods of medical and surgical abortion is high. Acceptability of the procedure next time was more with surgical abortion. MTOP had higher emotional impact. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3158-3166

  16. Abortion Decision and Ambivalence: Insights via an Abortion Decision Balance Sheet

    Science.gov (United States)

    Allanson, Susie

    2007-01-01

    Decision ambivalence is a key concept in abortion literature, but has been poorly operationalised. This study explored the concept of decision ambivalence via an Abortion Decision Balance Sheet (ADBS) articulating reasons both for and against terminating an unintended pregnancy. Ninety-six women undergoing an early abortion for psychosocial…

  17. Abortion-Related Mortality in the United States: 1998-2010.

    Science.gov (United States)

    Zane, Suzanne; Creanga, Andreea A; Berg, Cynthia J; Pazol, Karen; Suchdev, Danielle B; Jamieson, Denise J; Callaghan, William M

    2015-08-01

    To examine characteristics and causes of legal induced abortion-related deaths in the United States between 1998 and 2010. Abortion-related deaths were identified through the national Pregnancy Mortality Surveillance System with enhanced case-finding. We calculated the abortion mortality rate by race, maternal age, and gestational age and the distribution of causes of death by gestational age and procedure. During the period from 1998-2010, of approximately 16.1 million abortion procedures, 108 women died, for a mortality rate of 0.7 deaths per 100,000 procedures overall, 0.4 deaths for non-Hispanic white women, 0.5 deaths for Hispanic women, and 1.1 deaths for black women. The mortality rate increased with gestational age, from 0.3 to 6.7 deaths for procedures performed at 8 weeks or less and at 18 weeks or greater, respectively. A majority of abortion-related deaths at 13 weeks of gestation or less were associated with anesthesia complications and infection, whereas a majority of abortion-related deaths at more than 13 weeks of gestation were associated with infection and hemorrhage. In 20 of the 108 cases, the abortion was performed as a result of a severe medical condition where continuation of the pregnancy threatened the woman's life. Deaths associated with legal induced abortion continue to be rare events-less than 1 per 100,000 procedures. Primary prevention of unintended pregnancy, including those in women with serious pre-existing medical conditions, and increased access to abortion services at early gestational ages may help to further decrease abortion-related mortality in the United States. III.

  18. Abortion care services delivered from a community sexual and reproductive health setting: views of health care professionals.

    Science.gov (United States)

    Michie, Lucy; Cameron, Sharon T; Glasier, Anna

    2013-10-01

    Abortion services should provide high-quality contraceptive care. The community sexual and reproductive health (SRH) services may be well placed to deliver more abortion care in the UK. We wished to determine the views of health professionals working in SRH regarding their attitudes towards providing more abortion services and also the views of staff within one community SRH centre in Scotland where a service providing early medical abortion (EMA) was due to commence. An anonymous questionnaire distributed to attendees at a UK SRH scientific meeting collected data on demographics, current practice of and attitude to abortion, and views on delivery of abortion services. An internet questionnaire distributed by e-mail to staff at a community SRH clinic in Scotland sought demographics, views regarding the planned introduction of an EMA service and willingness to participate in it. 165 questionnaires were completed out of 200 distributed at the scientific meeting (an 82% response rate). 128 (78%) respondents felt that abortion services were suited to community clinics and 115 (70%) stated that they would be willing to participate in them. 62/90 (69%) staff from the SRH clinic responded to the internet questionnaire. 44 (71%) felt the plan to introduce abortion services was a natural extension to services already offered and the same number would be willing to be involved in such a service. There is clear support amongst health professionals in community SRH in the UK towards greater participation in the provision of abortion care services.

  19. 78 FR 60291 - Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies...

    Science.gov (United States)

    2013-10-01

    ... ``Investigational Device Exemptions (IDEs) for Early Feasibility Medical Device Clinical Studies, Including Certain... facilitate early feasibility studies of medical devices, using appropriate risk mitigation strategies, under the IDE regulations. Early feasibility studies allow for limited early clinical evaluations of...

  20. ‘The Trial the World is Watching’: The 1972 Prosecution of Derk Crichton and James Watts, Abortion, and the Regulation of the Medical Profession in Apartheid South Africa

    Science.gov (United States)

    Klausen, Susanne M.

    2014-01-01

    After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman’s life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country’s newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary’s stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their ‘duty’ to procreate within marriage. Ultimately, the event encapsulated a great deal about elites’ attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa’s extremely restrictive Abortion and Sterilisation Act (1975). PMID:24775430

  1. Legal duties to respect abortion choices.

    Science.gov (United States)

    Dickens, Bernard M

    2003-01-01

    This paper addresses legal protection of individual choices to obtain abortion services, to decline to perform abortions on grounds of religious objection, and to participate in these procedures. It considers legal duties to respect women as decision-makers in their own lives, including when they decide to continue pregnancy. The choice to decline participation in abortions is an aspect of religious freedom available to physicians, nurses, and, for instance, pharmacists, but not artificial legal persons such as hospital and clinic corporations. Refusal does not extend to ancillary functions such as serving meals, routine pre-operative and post-operative care of abortion patients or typing abortion referral letters. Physicians practising in proximate care must be trained in appropriate medical management of incomplete and threatened abortion even when they would refuse to apply such techniques to induce abortion.

  2. Mental health and abortion: review and analysis.

    Science.gov (United States)

    Ney, P G; Wickett, A R

    1989-11-01

    This survey of studies which relate to the emotional sequelae of induced abortion, draws attention to the need for more long-term, in-depth prospective studies. The literature to this point finds no psychiatric indications for abortion, and no satisfactory evidence that abortion improves the psychological state of those not mentally ill; abortion is contra-indicated when psychiatric disease is present, as mental ill-health has been shown to be worsened by abortion. Recent studies are turning up an alarming rate of post-abortion complications such as P.I.D., and subsequent infertility. The emotional impact of these complications needs to be studied. Other considerations looked at are the long-term demographic implications of abortion on demand and the effect on the medical professions.

  3. Abortion--the breath of life.

    Science.gov (United States)

    Joling, R J

    1974-01-01

    A scholarly review of medical-legal and biblical authority on the su bject of abortion supports abortion as a woman's right when it is performed before the fetus has had its "breath of life." Based on biblical evidence, a person becomes a living being when the soul, the "breath of life" is breathed into it. Without the "breath of life" no person exists. A fetus less than 28 weeks old is incapable of breathing alone; thus an aborted fetus that age is not truly a living human being capable of surviving independently of its mother's womb. Legal aspects include supreme, local and state court decisions defining abortion. It is ultimately expected that each person will determine what approach to take towards the abortion question. Abortion is still a personal problem regardless of supreme court decisions or ecclesiastical determinants. Religion and moral concepts should be the guiding conscience involved in the question of abortion.

  4. Unsafe abortion: a cruel way of birth control

    African Journals Online (AJOL)

    2014-06-02

    Jun 2, 2014 ... Development Goal 5A – unsafe abortion contribution to maternal ... Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Kancheepuram. ... of unsafe abortion in Colombia, 1989-2008.

  5. Low dose Mifepristone (100 mg for medical termination of pregnancy

    Directory of Open Access Journals (Sweden)

    Shikha Seth

    2011-02-01

    Full Text Available Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg of Mifepristone (PO instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90% women had completely aborted within 5 hours of taking Misoprostol. Three (3.75% women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.

  6. [Abortion and conscientious objection].

    Science.gov (United States)

    Czarkowski, Marek

    2015-03-01

    Polish laws specify the parties responsible for lawful medical care in the availability of abortion differently than the Resolution of the Council of Europe. According to Polish regulations they include all Polish doctors while according to the Resolution, the state. Polish rules should not discriminate against anyone in connection with his religion or belief, even more so because the issue of abortion is an example of an unresolved ethical dispute. The number of lawful abortion in Poland does not exceed 1000 per year and can be carried out by only a few specialists contracted by the National Health Fund. Sufficient information and assistance should be provided to all pregnant women by the National Health Fund. The participation of all physicians in the informing process is not necessary, as evidenced by the lack of complaints to provide information on where in vitro fertilization treatment can be found - until recently only available when paid for by the individual and performed in much larger numbers than abortion. Entities performing this paid procedure made sure to provide information on their own. The rejection of the right to the conscientious objection clause by negating the right to refuse information may lead some to give up the profession or cause the termination of certain professionals on the basis of the professed worldview. Meanwhile, doctors are not allowed to be discriminated against on the basis of their conscience or religion.

  7. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

    Directory of Open Access Journals (Sweden)

    Samandari Ghazaleh

    2012-04-01

    Full Text Available Abstract Unsafe abortion's significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal's restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal's Ministry of Health and Population, enabled the country subsequently to introduce and scale up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination. Important elements of this successful model of scaling up safe legal abortion include: the pre-existence of postabortion care services, through which health-care providers were already familiar with the main clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public- and private-sector actors; reliance on public-health evidence in formulating policies governing abortion provision, which led to the embrace of medical abortion and authorization of midlevel providers as key strategies for decentralizing care; and integration of abortion care into existing Safe Motherhood and the broader health system. While challenges remain in ensuring that all Nepali women can readily exercise their legal right to early pregnancy termination, the national safe abortion program has already yielded strong positive results. Nepal's experience making high-quality abortion care widely accessible in a short period of time offers important lessons for other countries seeking to reduce maternal mortality and morbidity from unsafe abortion and to achieve Millennium Development Goals.

  8. Road map to scaling-up: translating operations research study’s results into actions for expanding medical abortion services in rural health facilities in Nepal

    OpenAIRE

    Puri, Mahesh; Regmi, Shophika; Tamang, Anand; Shrestha, Prabhakar

    2014-01-01

    Background Identifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. However, enhancing women’s awareness on and access to safe and legal abortion services, particularly in rural areas, remains a challenge in Nepal despite a decade of the initiation of safe abortion services. Methods Between January 2011 and December 2012, an operations research...

  9. Access, equity and costs of induced abortion services in Australia: a cross-sectional study.

    Science.gov (United States)

    Shankar, Mridula; Black, Kirsten I; Goldstone, Philip; Hussainy, Safeera; Mazza, Danielle; Petersen, Kerry; Lucke, Jayne; Taft, Angela

    2017-06-01

    To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation. Cross-sectional survey of 2,326 women aged 16+ years attending for an abortion at 14 Dr Marie clinics. Associations with later presentation assessed using multivariate logistic regression. Over a third of eligible women opted for a medical abortion. More than one in 10 (11.2%) stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560, compared to $470 for a surgical abortion at ≤9 weeks. Beyond 12 weeks, costs rose considerably. More than two-thirds (68.1%) received financial assistance from one or more sources. Women who travelled ≥4 hours (AdjOR: 3.0, 95%CI 1.2-7.3), had no prior knowledge of the medical option (AdjOR: 2.1, 95%CI 1.4-3.1), had difficulty paying (AdjOR: 1.5, 95%CI 1.2-1.9) and identified as Aboriginal and/or Torres Strait Islander (AdjOR: 2.1, 95%CI 1.2-3.4) were more likely to present ≥9 weeks. Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health: Policy reform should focus on reducing costs and enhancing early access. © 2017 The Authors.

  10. Early detection of influenza like illness through medication sales.

    Science.gov (United States)

    Socan, Maja; Erculj, Vanja; Lajovic, Jaro

    2012-06-01

    Monitoring sales of medications is a potential candidate for an early signal of a seasonal influenza epidemic. To test this theory, the data from a traditional, consultation-oriented influenza surveillance system were compared to medication sales and a predictive model was developed. Weekly influenza-like incidence rates from the National Influenza Sentinel Surveillance System were compared to sales of seven groups of medications (nasal decongestants, medicines for sore throat (MST), antitussives, mucolytics, analgo-antipyretics, non-steroidal anti-inflamatory drugs (NSAIDs), betalactam antibiotics, and macrolide antibiotics) to determine the correlation of medication sales with the sentinel surveillance system - and therefore their predictive power. Poisson regression and regression tree approaches were used in the statistical analyses. The fact that NSAIDs do not exhibit any seasonality and that prescription of antibiotics requires a visit to the doctor's office makes the two medication groups inappropriate for predictive purposes. The influenza-like illness (ILI) curve is the best matched by the mucolytics and antitussives sales curves. Distinct seasonality is also observed with MST and decongestants. The model including these four medication groups performed best in prediction of ILI incidence rate using the Poisson regression model. Sales of antitussives proved to be the best single predictive variable for regression tree model. Sales of medication groups included in the model were demonstrated to have a predictive potential for early detection of influenza season. The quantitative information on medication sales proves to be a useful supplementary system, complementing the traditional consultation-oriented surveillance system.

  11. Choosing early pregnancy termination methods in Urban Mozambique

    NARCIS (Netherlands)

    E.M.H. Mitchell; A. Kwizera; M. Usta; H. Gebreselassie

    2010-01-01

    Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration fo

  12. Contraception and induced abortion in the West Indies: a review.

    Science.gov (United States)

    Boersma, A A; de Bruijn, J G M

    2011-10-01

    Most islands in the West Indies do not have liberal laws on abortion, nor laws on pregnancy prevention programmes (contraception). We present results of a literature review about the attitude of healthcare providers and women toward (emergency) contraception and induced abortion, prevalence, methods and juridical aspects of induced abortion and prevention policies. Articles were obtained from PubMed, EMBASE, MEDLINE, PsychlNFO and Soclndex (1999 to 2010) using as keywords contraception, induced abortion, termination of pregnancy, medical abortion and West Indies. Thirty-seven articles met the inclusion criteria: 18 on contraception, 17 on induced abortion and two on both subjects. Main results indicated that healthcare providers' knowledge of emergency contraception was low. Studies showed a poor knowledge of contraception, but counselling increased its effective use. Exact numbers about prevalence of abortion were not found. The total annual number of abortions in the West Indies is estimated at 300 000; one in four pregnancies ends in an abortion. The use of misoprostol diminished the complications of unsafe abortions. Legislation of abortion varies widely in the different islands in the West Indies: Cuba, Puerto Rico, Martinique, Guadeloupe and St Martin have legal abortions. Barbados was the first English-speaking island with liberal legislation on abortion. All other islands have restrictive laws. Despite high estimated numbers of abortion, research on prevalence of abortion is missing. Studies showed a poor knowledge of contraception and low use among adolescents. Most West Indian islands have restrictive laws on abortion.

  13. Abortion services at hospitals in Istanbul.

    Science.gov (United States)

    O'Neil, Mary Lou

    2017-04-01

    Despite the existence of a liberal law on abortion in Turkey, there is growing evidence that actually securing an abortion in Istanbul may prove difficult. This study aimed to determine whether or not state hospitals and private hospitals that accept state health insurance in Istanbul are providing abortion services and for what indications. Between October and December 2015, a mystery patient telephone survey of 154 hospitals, 43 public and 111 private, in Istanbul was conducted. 14% of the state hospitals in Istanbul perform abortions without restriction as to reason provided in the current law while 60% provide the service if there is a medical necessity. A quarter of state hospitals in Istanbul do not provide abortion services at all. 48.6% of private hospitals that accept the state health insurance also provide for abortion without restriction while 10% do not provide abortion services under any circumstances. State and private hospitals in Istanbul are not providing abortion services to the full extent allowed under the law. The low numbers of state hospitals offering abortions without restriction indicates a de facto privatization of the service. This same trend is also visible in many private hospitals partnering with the state that do not provide abortion care. While many women may choose a private provider, the lack of provision of abortion care at state hospitals and those private hospitals working with the state leaves women little option but to purchase these services from private providers at some times subtantial costs.

  14. Surgical abortion prior to 7 weeks of gestation.

    Science.gov (United States)

    Lichtenberg, E Steve; Paul, Maureen

    2013-07-01

    The following guidelines reflect a collation of the evaluable medical literature about surgical abortion prior to 7 weeks of gestation. Early surgical abortion carries lower risks of morbidity and mortality than procedures performed later in gestation. Surgical abortion is safe, practicable and successful as early as 3 weeks from the start of last menses (no gestational sac visible on vaginal ultrasound) provided that (a) routine sensitive pregnancy testing verifies pregnancy, (b) the tissue aspirate is immediately examined for the presence of a gestational sac plus villi and (c) a protocol to identify ectopic pregnancy expeditiously--including calculation of readily obtained serial serum quantitative human chorionic gonadotropin titers when clinically appropriate--is in place and strictly adhered to. Manual and electric vacuum aspiration methods for early abortion demonstrate comparable efficacy, safety and acceptability. Current data are inadequate to determine if any of the following techniques substantially improve procedure success or safety: use of rigid versus flexible cannulae, light metallic curettage following uterine aspiration, uterine sounding or routine use of intraoperative ultrasound. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Overview on application of clinical abortion on high-risk early uterine pregnancy%高危早期宫内妊娠临床流产方法应用综述

    Institute of Scientific and Technical Information of China (English)

    袁照

    2011-01-01

    介绍了高危早期妊娠流产的概念、因素及目前几种终止高危早期宫内妊娠的临床流产方法,对各种方法的优缺点进行分析对比.并提出加强对高危流产手术的管理和重视、针对不同因素的高危早期妊娠选择合适的流产方法,是减少并发症发生、确保受术者安全的关键.%To study the concept and effect factors of high-risk early uterine pregnancy and introduce several clinical abortion methods at present of stopping high-risk early uterine pregnancy.The merits and demerits among these ways were compared and analyzed.Enhancing the management to highrisk abortion operation,paying enough attention to high-risk abortion operation,and choosing proper abortion ways according to the different factors of high-risk early uterine pregnancy are the key points to reduce the occurrence of complication and guarantee the safety of the patients who receive the abortion operation.

  16. Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain.

    Science.gov (United States)

    Aiken, Abigail R A; Guthrie, Katherine A; Schellekens, Marlies; Trussell, James; Gomperts, Rebecca

    2017-09-20

    To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help. Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control. Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks. The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in

  17. 药物流产与手术流产对女性生活质量以及再次妊娠的影响%The Effect of Medical Abortion and Surgical Abortion on the Quality of Life and the Second Pregnancy

    Institute of Scientific and Technical Information of China (English)

    朱敏

    2016-01-01

    目的:比较药物流产与手术流产对女性生活质量以及再次妊娠的影响。方法按照既往人工流产方式将120例孕妇分为药物组及手术组,各60例,比较分析两组生活质量以及再次妊娠的影响。结果药物组人工流产后生活质量指标等方面得分优于手术组,再次妊娠后先兆流产、前置胎盘、胎盘粘连及异位妊娠发生率均低于手术组,差异有统计学意义(P<0.05)。结论药物流产后女性生活质量较高,对再次妊娠的不良影响小。%Objective To compare the effect of medical abortion and surgical abortion on the quality of life and the second pregnancy.Methods According to the previous method of artificial abortion,120 cases were divided into drug group and operation group,60 cases in each group,quality of life and the impact of the second pregnancy between two groups were comparative analysed.Results The scores of quality of life in the drug group after induced abortion were significantly better than that in the operation group,the incidence of threatened abortion,placenta placenta,placenta adhesion and ectopic pregnancy were significantly lower than that in the operation group,the difference was statistically significant(P<0.05).Conclusion After medical abortion,the quality of life of women is higher,and has less adverse effects on the second pregnancy.

  18. [Abortion using health insurance].

    Science.gov (United States)

    Gritschneder, O

    1984-09-01

    The author reports on current German court rulings on whether non-medically indicated abortions (although not prohibited by law and therefore not actionable) should be financed via the compulsory health insurance scheme or by the Federal Government. 1. The social welfare court at Dortmund ruled that current legislation governing the financing of welfare expenditure violates the Federal German constitution, and has, therefore, referred this matter to the Federal Constitutional Court. However, the Federal Constitutional Court turned down the referral and dismissed the case, since an application for declaring a Federal law null and void can be filed by the Federal Government or by a Federal Land Government or by at least one-third of the total number of members of the Federal German Parliament (Bundestag) only. This means that the current proceedings at the Dortmund social welfare court must continue. The plaintiff pleads to prohibit the compulsory health insurance scheme authorities from defraying the expenses for performing foeticide via legally permitted abortion without medical indication. 2. The Federal Land Government of Baden-Württemberg is the only Land Government of the Federal Republic of Germany that does not grant any financial aid towards performing non-medically indicated (albeit not legally actionable) abortions. Hence, the Baden-Württemberg Administrative Courts turned down the plea filed by a woman government servant towards paying such aid. The court decision was based on the judge's opinion that even the principle of equality before the law guaranteed by the Constitution would not compel the Land Government to emulate the example of the other Land Governments who are agreeable to bearing abortion costs.

  19. Abortion-Related Mortality in the United States 1998–2010

    Science.gov (United States)

    Zane, Suzanne; Creanga, Andreea A.; Berg, Cynthia J.; Pazol, Karen; Suchdev, Danielle B.; Jamieson, Denise J.; Callaghan, William M.

    2015-01-01

    OBJECTIVE To examine characteristics and causes of legal induced abortion–related deaths in the United States between 1998 and 2010. METHODS Abortion-related deaths were identified through the national Pregnancy Mortality Surveillance System with enhanced case-finding. We calculated the abortion mortality rate by race, maternal age, and gestational age and the distribution of causes of death by gestational age and procedure. RESULTS During the period from 1998–2010, of approximately 16.1 million abortion procedures, 108 women died, for a mortality rate of 0.7 deaths per 100,000 procedures overall, 0.4 deaths for non-Hispanic white women, 0.5 deaths for Hispanic women, and 1.1 deaths for black women. The mortality rate increased with gestational age, from 0.3 to 6.7 deaths for procedures performed at 8 weeks or less and at 18 weeks or greater, respectively. A majority of abortion-related deaths at 13 weeks of gestation or less were associated with anesthesia complications and infection, whereas a majority of abortion-related deaths at more than 13 weeks of gestation were associated with infection and hemorrhage. In 20 of the 108 cases, the abortion was performed as a result of a severe medical condition where continuation of the pregnancy threatened the woman’s life. CONCLUSION Deaths associated with legal induced abortion continue to be rare events—less than 1 per 100,000 procedures. Primary prevention of unintended pregnancy, including those in women with serious pre-existing medical conditions, and increased access to abortion services at early gestational ages may help to further decrease abortion-related mortality in the United States. PMID:26241413

  20. 米非司酮配伍米索前列醇抗早孕药物流产的临床影响因素分析及对策%Clinical impact factor analysis and countermeasures of mifepristone combined with misoprostol anti-early pregnant drug abortion

    Institute of Scientific and Technical Information of China (English)

    穆改莲

    2015-01-01

    Objective:To summarize and explore clinical affecting factors of mifepristone combined with misoprostol in early pregnant drug abortion.Methods:490 cases of early pregnant were selected from March 2011 to December 2012.They were all given mifepristone combined with misoprostol for drug abortion.The clinical data were retrospectively analyzed.The influences of drug dosage,maternal age,gestational age,pregnant bursa size,uterine position,the history of cesarean section and other factors for drug abortion were summarized.Results:401 cases were drug complete abortion in 490 cases of early pregnant,and the age more than or equal to 35 years old,the gestational age more than or equal to 6 weeks,the pregnancy sac diameter more than or equal to 20 mm,uterine position non horizontal position,a history of cesarean section;the medical abortion success rate was relatively low. These factors were the independent factors affecting the results of drug abortion.Conclusion:In mifepristone combined with misoprostol anti-early pregnant drug abortion,the maternal age, gestational age,pregnant bursa size,uterine position,the history of cesarean section and other factors have influence on the drug abortion.Clinical should be considered the above factors to choose appropriate drug dose and mode of administration and improve the success rate of abortion.%目的:总结探讨米非司酮与米索前列醇配伍在早孕药物流产中的临床影响因素。方法:2011年3月-2012年12月收治早孕患者490例,均给予米非司酮与米索前列醇配伍进行药物流产,回顾分析其临床资料,总结药物剂量、孕妇年龄、孕龄、孕囊大小、子宫位置、剖宫产史等因素对药物流产的影响。结果:490例早孕者中药物完全流产401例,且年龄≥35岁、孕龄≥6周、孕囊直径≥20 mm、子宫位置非水平位、有剖宫产史等早孕者药物流产成功率相对较低,这些因素都是药物流产效果的独立影响因素

  1. To abort or not to abort: that is the question.

    Science.gov (United States)

    Thomison, J B

    1991-02-01

    Abortion is not a medical issue, as the law would like to make it when requesting definitions of when life begins. To medicine, life begins at conception. conception is the 1st step in the miracle of life. It is up to the law and society to determine when life begins legally. Doctors have responsibilities as citizens to do what they can to support laws they believe in. The American Medical Association has remained neutral on the issue. Abortion can be ethical if the mother's life is threatened. But it is unethical and unconstitutional when it is done out of convenience to correct indiscretions.

  2. Early-life medical care and human capital accumulation

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2015-01-01

    that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic...

  3. Evaluation of serum concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-10, and nitric oxide (NO) during the estrous cycle, early pregnancy and abortion in goats.

    Science.gov (United States)

    Chen, Youwang; Lv, Wenting; Jia, Jingliang; Wang, Jiantao; Yang, Jianhui

    2016-11-01

    The aim of this study was to establish the serum concentrations, ranges, and trends of Th1 type cytokine (tumor necrosis factor (TNF)-α and interleukin (IL)-2), Th2 type cytokine (IL-10), and nitric oxide (NO) during the estrous cycle, early pregnancy and abortion in goats. Boer goats (n=25) having symptoms of normal estrous cycles were selected, 20 were mated and 15 conceived a pregnancy, and the remaining five were not mated and served as estrous controls. On the Day 60 of pregnancy, all 15 pregnant goats were induced to abort the pregnancy by intramuscular injection of prostaglandin (PG). Serum samples were collected on Days 1, 7, 14, and 19 of the estrous cycle, at Days 0, 10, 20, 30, 40, 50, and 60 of pregnancy, and at Days 1, 3, 8, 10 over the period when abortion were occurring. Results of the present study indicated that during the estrous cycle the balance between Th1 and Th2 cytokines slightly shifted toward Th1 cytokine production (TNF-α and IL-2). The NO may have a direct positive role in inducing a Th1 response. During early pregnancy, TNF-α and IL-2 serum concentrations markedly increased from Days 0 to 10, and gradually decreased from Days 10 to 60, while IL-10 and NO serum concentrations remained elevated from Days 0 to 60. The increased concentrations of IL-10 and decreased concentrations of TNF-α and IL-2 are characteristic of a Th2-enhanced response, which may be related to increased concentrations of NO. These changes may be essential to maintain a normal pregnancy. In addition, the serum concentrations of TNF-α, IL-2 and NO at Days 1, 3, 8 and 10 of the period of induced abortion were markedly greater than that on Day 60 of pregnancy. Conversely, IL-10 concentrations at these four time points of abortion were markedly less than that on Day 60 of pregnancy. After abortion, the Th2 response shifted to a Th1-enhanced response. Thus, NO concentrations increase and the Th1-enhanced response may function synergistically to be involved in

  4. Review of early assessment models of innovative medical technologies

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Krahn, Murray D; Kidholm, Kristian

    2017-01-01

    INTRODUCTION: Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models...... for early assessment in different health organisations and discusses which models hold most promise for hospital decision makers. METHODS: A scoping review of published studies between 1996 and 2015 was performed using nine databases. The following information was collected: decision context, decision...... problem, and a description of the early assessment model. RESULTS: 2362 articles were identified and 12 studies fulfilled the inclusion criteria. An additional 12 studies were identified and included in the review by searching reference lists. The majority of the 24 early assessment studies were variants...

  5. Pattern Distribution Laws of Early Threatened Abortion and Analysis on Its Related Factors%早期先兆流产证型分布规律及其相关因素的分析

    Institute of Scientific and Technical Information of China (English)

    邸文淑

    2014-01-01

    Objective:To reveal pattern distribution laws of early threatened abortion and the factors influenc-ing pattern distribution by studying the conditions of TCM pattern distribution of early threatened abortion. Methods:Pattern distribution law of early threatened abortion was explored by statistical analysis of pattern distributions of 100 cases of early threatened abortion. Results:Patterns of early threatened abortion were distributed in the orders:kidney deficiency pattern, dual deficiency of spleen and kidney pattern, blood heat pattern, kidney deficiency and blood stasis pattern, Qi and blood insufficiency pattern. Pattern distribution was related to the age, abortion times and the history of menstruation to a certain degree. Conclusion:Common patterns of early threatened abortion are:kid-ney deficiency pattern, kidney deficiency pattern, blood heat pattern, kidney deficiency and blood stasis pattern, Qi and blood insufficiency pattern, kidney deficiency pattern the most one. Pattern distribution is connected to age, abortion times, the history of menstruation and the occupation to a certain extent.%目的:研究早期先兆流产(胎漏、胎动不安)的中医证型分布情况,揭示其证型分布规律及影响证型分布的因素。方法:通过对100例早期先兆流产患者证型分布情况的统计分析,探讨本病证型分布规律。结果:早期先兆流产证型分布由大到小依次为:肾虚证、脾肾两虚证、血热证、肾虚血瘀证、气血虚弱证。证型分布与年龄、流产次数、月经史有一定相关性。结论:早期先兆流产常见证型有肾虚证、脾肾两虚证、血热证、肾虚血瘀证、气血虚弱证5种,以肾虚证为多。证型分布与年龄、流产次数、月经史、职业有一定内在联系。

  6. Freedom of conscience, professional responsibility, and access to abortion.

    Science.gov (United States)

    Dresser, R S

    1994-01-01

    The current shortage of US physicians willing to perform induced abortions has created a conflict between women's legal right to access to pregnancy termination and physicians' right to refuse participation in a procedure they regard as morally objectionable. According to a 1993 survey, 84% of US counties (housing 30% of women of reproductive age) had no abortion provider. This situation has been exacerbated by a trend to isolate abortion from other medical procedures; in 1992, only 12% of residency programs in obstetrics and gynecology routinely offered training on first-trimester abortion. Also contributing to physician reluctance to become abortion providers have been the violence, death threats, property damage, and harassment of abortion seekers perpetrated by anti-abortion groups. To ameliorate the abortion access crisis, without intruding on the religious convictions of individual physicians, there must be greater collaboration between professional and community groups. Local community officials and pro-choice supporters are urged to use their influence to protect abortion providers from harassment. Professional organizations should provide both symbolic and practical support, e.g. increased status and remuneration, to physicians who commit to the hardship of abortion provision. Older physicians, most aware of the threat to women's health posed by any erosion of abortion rights, should educate their younger colleagues about the importance of safe abortion. Finally, training on abortion techniques should be integrated into the medical school curriculum and rotations should be established at local abortion clinics.

  7. Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework.

    Science.gov (United States)

    Taylor, Diana; Upadhyay, Ushma D; Fjerstad, Mary; Battistelli, Molly F; Weitz, Tracy A; Paul, Maureen E

    2017-07-01

    To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first

  8. Elevated expression levels of matrix metalloproteinase-9 in placental villi and tissue inhibitor of metalloproteinase-2 in decidua are associated with prolonged bleeding after mifepristone-misoprostol medical abortion.

    Science.gov (United States)

    Zhuang, Yaling; Qian, Zhida; Huang, Lili

    2014-01-01

    To determine whether the expression levels of matrix metalloproteinases 2 and 9 (MMP-2 and -9) and tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1 and -2) in the villi and the decidua are associated with prolonged bleeding after medical abortion. Case-controlled study. University hospital. Mifepristone-misoprostol medical abortion patients were divided into two groups (20 women each) based on the length of time (>14 or ≤14 days) of bleeding after the abortion. Discharged villi and deciduas were collected. The expression levels of MMP-2 and -9 and TIMP-1 and -2 in the villi and deciduas were assessed with semiquantitative immunohistochemistry. The median semiquantitative immunohistochemistry staining index (SI) scores for MMP-9 expression in the villi were elevated in the bleeding group compared with the control group (median SI scores 0.31 and 0.03, respectively). TIMP-2 expression was elevated in the decidua in the bleeding group compared with the control group (median SI scores 1.00 and 0.20, respectively). No significant differences were observed between the two groups in the expression levels of MMP-2 in the villi or of MMP-2, MMP-9, or TIMP-1 or of the ratios of MMP-9/TIMP-1 or MMP-2/TIMP-2 in the decidua. Elevated expression levels of MMP-9 in the villi and of TIMP-2 in the decidua were associated with prolonged bleeding after medical abortion. Copyright © 2014. Published by Elsevier Inc.

  9. 口服米非司酮预防早孕人流不全的临床分析%Clinical Analysis on Preventing Early Pregnancy of Incomplete Abortion with Mifepristone

    Institute of Scientific and Technical Information of China (English)

    黄志利

    2014-01-01

    ObjectiveAnalysis of therapeutic effect of mifepristone suction palace is not complete for induced abortion.Methods From 2012 November to 2014 March in our hospital to terminate early pregnancy patients selected 110 cases, were randomly divided into the use of mifepristone orally to prevent incomplete abortion in observation group (55 cases) and the control group by oral administration of progesterone tablet in the prevention of incomplete abortion (55 cases), was observed in the two groups of results, evaluation of mifepristone for preventive effect of incomplete abortion.Results The use of mifepristone prevention of incomplete abortion group were 55 cases of early pregnancy abortion pregnant women were successful, the success rate was 100%, with oral administration of progesterone tablet in the prevention of incomplete abortion 55 cases in the control group were 45 cases of early pregnant women with success, the success rate was 81.8%, the prevention effect of the two groups were incomplete abortion were significantly (P<0.05).Conclusion Mifepristone prevention effect was incomplete abortion, safe and effective, worthy of promotion.%目的:分析口服米非司酮对于早孕人流吸宫不全的治疗效果。方法从2012年11月至2014年3月在我院要求终止妊娠的早孕患者中选取110例,随机分成采用米非司酮口服预防人流不全的观察组(55例)及采用口服黄体酮片预防人流不全的对照组(55例),观察两组人流结果,评价米非司酮对于人流不全的预防效果。结果采用米非司酮预防人流不全的观察组55例早孕孕妇均流产成功,成功率100.0%,采用口服黄体酮片预防人流不全的55例对照组早孕孕妇共45例引产成功,成功率81.8%,两组人流不全的预防效果差异显著(P<0.05)。结论口服米非司酮预防人流不全的效果显著,安全可行,值得推广。

  10. Is Induced Abortion Really Declining in Armenia?

    Science.gov (United States)

    Jilozian, Ann; Agadjanian, Victor

    2016-06-01

    As in other post-Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in-depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex-selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self-administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices.

  11. Contesting the cruel treatment of abortion-seeking women.

    Science.gov (United States)

    Fletcher, Ruth

    2014-11-01

    This article draws on legal arguments made by civil society organisations to challenge the legal reasoning that apparently produced the decision in the Ms Y case in Ireland in August 2014. I show how legal standards of reasonableness and practicality ought to be interpreted in ways that are respectful of the patient's wishes and rights. The case concerned a decision by the Health Service Executive, the Irish public health authority, to refuse an abortion to a pregnant asylum seeker and rape survivor on the grounds that a caesarean section and early live delivery were practicable and reasonable alternatives justified by the need to protect fetal life. I argue that the abortion refusal may not have been a reasonable decision, as required by the terms of relevant legislation, for four different reasons. First, the alternative of a caesarean section and early live delivery was not likely to avert the risk of suicide, and in fact did not do so. Second, the consent to the caesarean section alternative may not have been a real consent in the legal sense if it was not voluntary. Third, an abortion refusal and forcible treatment fall below the norms of good medical practice as interpreted through a patient-centred perspective. Fourth, an abortion refusal that entails forms of cruel, inhumane and degrading treatment ought not to be a reasonable action under the legislation. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  12. An unusual complication of unsafe abortion

    Directory of Open Access Journals (Sweden)

    Sunita Gupta

    2011-01-01

    Full Text Available Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity. Case Report: A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.

  13. Abortion in Iranian legal system: a review.

    Directory of Open Access Journals (Sweden)

    Mahmoud Abbasi

    2014-02-01

    Full Text Available Abortion traditionally means, "to miscarry" and is still known as a problem which societies has been trying to reduce its rate by using legal means. Despite the pregnant women and fetuses have being historically supported; abortion was firstly criminalized in 1926 in Iran, 20 years after establishment of modern legal system. During next 53 years this situation changed dramatically, so in 1979, the time of Islamic Revolution, aborting fetuses before 12 weeks and therapeutic abortion (TA during all the pregnancy length was legitimate, based on regulations that used medical justification. After 1979 the situation changed into a totally conservative and restrictive approach and new Islamic concepts as "Blood Money" and "Ensoulment" entered the legal debates around abortion. During the next 33 years, again a trend of decriminalization for the act of abortion has been continuing. Reduction of punishments and omitting retaliation for criminal abortions, recognizing fetal and maternal medical indications including some immunologic problems as legitimate reasons for aborting fetuses before 4 months and omitting the fathers' consent as a necessary condition for TA are among these changes. The start point for this decriminalization process was public and professional need, which was responded by religious government, firstly by issuing juristic rulings (Fatwas as a non-official way, followed by ratification of "Therapeutic Abortion Act" (TAA and other regulations as an official pathway. Here, we have reviewed this trend of decriminalization, the role of public and professional request in initiating such process and the rule-based language of TAA.

  14. Misoprostol Abortion: Ultrasonography versus Beta-hCG Testing for Verification of Effectiveness.

    Science.gov (United States)

    Behnamfar, Fariba; Mahdian, Mehrdad; Rahimi, Fereshteh; Samimi, Mansoureh

    2013-11-01

    Miscarriage is a common complication of early pregnancy with medical and psychological consequences. Dilation and Curettage are considered as two standard caring ways for early pregnancy failure. Alternatively misoprostol has been used as a single agent for termination of early pregnancy. Aim of the present study was to compare the usefulness of serum β-hCG measurement and ultrasound examination to predict complete abortion after medical induction. There were one hundred and thirty three patients experiencing missed abortion or blighted ovum. Ultrasound examination and serum β-hCG test were performed before treatment and during follow-up in all these patients. Treatment was successful without any need for surgical intervention in 92.4% of the cases. Both methods could verify the complete abortion among all the patients at the end of the study (4(th) week). Kappa agreement coefficient for the two methods of diagnosis was 0.327 (P ultrasound in confirming a successful medically induced abortion in early pregnancy, but it should be used as supplements to clinical assessments.

  15. Induced abortion and placenta complications in the subsequent pregnancy

    DEFF Research Database (Denmark)

    Zhou, Wei Jin; Nielsen, Gunnar Lauge; Larsen, Helle

    2001-01-01

    Background. To study the risk of placenta complications following an induced abortion as a function of the interpregnancy interval. Methods. This study is based on three Danish national registries; the Medical Birth Registry, the Hospital Discharge Registry, and the Induced Abortion Registry. All...... primigravida women from 1980 to 1982 were identified in these three registries. A total of 15,727 women who terminated the pregnancy with a first trimester induced abortion were selected to the abortion cohort, and 46,026 women who did not terminate the pregnancy with an induced abortion constituted...... or the Medical Birth Registry records. Results. A slightly higher risk of placenta complications following an abortion was found. Retained placenta occurred more frequently in women with one, two or more previous abortions, compared with women without any previous abortion of similar gravidity. Adjusting...

  16. Fetal Pain, Abortion, Viability and the Constitution

    OpenAIRE

    Cohen, I. Glenn; Sayeed, Sadath Ali

    2011-01-01

    In early 2010, the Nebraska state legislature passed a new abortion restricting law asserting a new, compelling state interest in preventing fetal pain. In this article, we review existing constitutional abortion doctrine and note difficulties presented by persistent legal attention to a socially derived viability construct. We then offer a substantive biological, ethical, and legal critique of the new fetal pain rationale.

  17. Fetal pain, abortion, viability, and the Constitution.

    Science.gov (United States)

    Cohen, I Glenn; Sayeed, Sadath

    2011-01-01

    In early 2010, the Nebraska state legislature passed a new abortion restricting law asserting a new, compelling state interest in preventing fetal pain. In this article, we review existing constitutional abortion doctrine and note difficulties presented by persistent legal attention to a socially derived viability construct. We then offer a substantive biological, ethical, and legal critique of the new fetal pain rationale.

  18. Reproductive rights: Current issues of late abortion

    Directory of Open Access Journals (Sweden)

    Mujović-Zornić Hajrija

    2009-01-01

    Full Text Available This article considers the legal issues surrounding induced late abortion in cases when severe medical, therapeutic or ethical reasons have not been in dispute. Generally discussing the essential question about abortion today, it means not anymore legality of abortion but, in the first place, safety of abortion. From the aspect of woman health the most important aim is to detect and avoid possible risks of medical intervention, such as late abortion present. This is the matter of medical law context and also the matter of the woman's reproductive rights, here observed through legislation and court practice. The gynecologist has an obligation to obtain the informed consent of each patient. Information's should be presented in reasonably understandable terms and include alternative modes of treatment, objectives, risks, benefits, possible complications, and anticipated results of such treatment. Pregnant woman should receive supportive counseling before and particularly after the procedure. The method chosen for all terminations should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Reform in abortion law, making it legally accessible to woman, is not necessarily the product of a belief in woman's rights, but can be a means of bringing the practice of abortion back under better control. Counseling and good medical practice in performing late abortion are the instruments to drive this point even further home. It does not undermine the woman who wants to make a positive decision about her life and its purpose is not to produce feelings of insecurity and guilt. It concludes that existing law should not be changed but that clear rules should be devised and board created to review late term abortion. In Serbia, this leads to creation and set up guidelines for reconciling medical justification for late abortion with existing law, especially with solutions which brings comparative law. .

  19. Evaluation of outcome of pregnancy in threatened abortion by serum progesterone levels

    Directory of Open Access Journals (Sweden)

    Rizwana Habib Kant

    2015-10-01

    Full Text Available Background: Early pregnancy maintenance depends on the progesterone production by the developing trophoblasts of the placenta and the corpus luteum of ovary. Threatened abortion has a psychological impact on patients so we need to have a tool that could predict the outcome of threatened abortion in advance. Serum progesterone level has shown to be a reliable marker of pregnancy outcome. The aim of the study was to assess the correlation between maternal serum progesterone level and pregnancy outcome in threatened abortion and to assess the role of maternal serum progesterone levels in the immediate diagnosis of pregnancy failure. Methods: This observational study was conducted in the Department of Gynaecology and Obstetrics, Lalla Ded Hospital, Government Medical College, Srinagar over a period of 1 year in 100 women presenting with threatened abortion of less than 12 weeks of gestation, having spotting but without cervical dilatation. Results: Mean maternal serum progesterone level in patients of threatened abortion who aborted was 21.5 +/- 10.4 nanograms per millilitre and patients of threatened abortion who progressed normally to the period of viability had mean maternal serum progesterone level of 41.6 +/- 10.8 nanograms per millilitre. Considering 24 nanograms per millilitre as cut off limit, 19% of patients of threatened abortion were having serum progesterone level of lesser than or equal to 24 nanograms per millilitre and 81% of patients of threatened abortion were having serum progesterone level of greater than 24 nanograms per millilitre. Conclusions: Serum progesterone level is easy and reliable assay for determination of pregnancy outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1313-1318

  20. Medical Connections and Exchanges in the Early Modern World

    Directory of Open Access Journals (Sweden)

    Michael Naylor Pearson

    2011-12-01

    Full Text Available For most of human history there have been extensive exchanges of medical information all over Eurasia. Some diseases were considered to be geographically determined, and hence had to be cured using local knowledge. Other ailments were found in many places, but cures could differ according to location. Most healers, whether book based or experiential, took a non-judgemental approach to different healing methods, as seen especially in India in the early colonial period.

  1. Global consequences of unsafe abortion.

    Science.gov (United States)

    Singh, Susheela

    2010-11-01

    Unsafe abortion is a significant cause of death and ill health in women in the developing world. A substantial body of research on these consequences exists, although studies are of variable quality. However, unsafe abortion has a number of other significant consequences that are much less widely recognized. These include the economic consequences, the immediate costs of providing medical care for abortion-related complications, the costs of medical care for longer-term health consequences, lost productivity to the country, the impact on families and the community, and the social consequences that affect women and families. This article will review the scientific evidence on the consequences of unsafe abortion, highlight gaps in the evidence base, suggest areas where future research efforts are needed, and speculate on the future situation regarding consequences and evidence over the next 5-10 years. The information provided is useful and timely given the current heightened interest in the issue of unsafe abortion, growing from the recent focus of national and international agencies on reducing maternal mortality by 75% by 2015 (as one of the Millennium Development Goals established in 2000).

  2. Characteristics of private abortion services in Mexico City after legalization.

    Science.gov (United States)

    Schiavon, Raffaela; Collado, Maria Elena; Troncoso, Erika; Soto Sánchez, José Ezequiel; Zorrilla, Gabriela Otero; Palermo, Tia

    2010-11-01

    In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157-505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  3. Abortion practice in Mexico: a survey of health care providers.

    Science.gov (United States)

    Dayananda, Ila; Walker, Dilys; Atienzo, Erika E; Haider, Sadia

    2012-03-01

    Little is known about abortion practice in Mexico postlegalization of abortion in Mexico City in 2007. In 2009, we anonymously surveyed 418 Mexican health care providers at the Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting using audio computer-assisted self-interview technology. The majority of respondents were obstetrician gynecologists (376, 90%), Catholic (341, 82%), 35-60 years old (332, 79%) and male (222, 53%) and worked with trainees (307, 74%). Prior to 2007, 11% (46) and 17% (71) provided medical and surgical abortions; now, 15% (62) and 21% (86) provide these services, respectively. Practitioners from Mexico City were more likely to provide services than those from other areas. Most medical abortion providers (50, 81%) used ineffective protocols. Surgical abortion providers mainly used either manual vacuum aspiration (39, 45%) or sharp curettage (27, 32%). Most abortion providers were trained in residency and wanted more training in medical (54, 87%) and surgical (59, 69%) abortion. Among nonproviders, 49% (175) and 27% (89) expressed interest in learning to perform medical and surgical abortion, respectively. Given the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Medical students' preparedness for professional activities in early clerkships.

    Science.gov (United States)

    Bosch, Josefin; Maaz, Asja; Hitzblech, Tanja; Holzhausen, Ylva; Peters, Harm

    2017-08-22

    Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level. Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression. Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress. The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.

  5. Early experiences with big data at an academic medical center.

    Science.gov (United States)

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  6. A case of toxic shock due to clandestine abortion by misoprostol self-administration.

    Science.gov (United States)

    Cittadini, Francesca; Loyola, Giovanni; Caradonna, Letizia; Minelli, Natalia; Rossi, Riccardo

    2014-11-01

    Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol-only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected. © 2014 American Academy of Forensic Sciences.

  7. Abortion: Strong's counterexamples fail

    DEFF Research Database (Denmark)

    Di Nucci, Ezio

    2009-01-01

    This paper shows that the counterexamples proposed by Strong in 2008 in the Journal of Medical Ethics to Marquis's argument against abortion fail. Strong's basic idea is that there are cases--for example, terminally ill patients--where killing an adult human being is prima facie seriously morally......'s scenarios have some valuable future or admitted that killing them is not seriously morally wrong. Finally, if "valuable future" is interpreted as referring to objective standards, one ends up with implausible and unpalatable moral claims....

  8. Conceptualising abortion stigma

    NARCIS (Netherlands)

    A. Kumar; L. Hessini; E.M.H. Mitchell

    2009-01-01

    Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies

  9. Early detection of Toxoplasma gondii by real-time polymerase chain reaction methods in patients with recurrent spontaneous abortions

    Directory of Open Access Journals (Sweden)

    Parviz Saleh

    2014-11-01

    Full Text Available Introduction: One of the causes of recurrent spontaneous abortions (RSA is an infection by the toxoplasmosis Protozoa. In comparison, we present detailed results using real-time polymerase chain reaction (PCR methods of detection. In this study, it was tried to detect Toxoplasma gondii (T. gondii by real-time PCR methods in patients with RSA. Methods: Amniotic fluid sampling was performed in the 16-20th weeks of gestation in 50 pregnant women with a history of RSA. The extracted deoxyribonucleic acid (DNA samples were analyzed using quantitative real-time PCR. Results: In all the cases, the detection of T. gondii was negative in the peripheral blood, and amniotic fluid samples by using the molecular methods (real-time PCR. Using the serological detection methods, 6% of patients were diagnosed as positive for the immunoglobulin M (IgM antibody. In addition, the IgG antibody was positive in 46% of the patients. Conclusion: It can be concluded that the serological methods lack specificity.

  10. THE EARLY BIRD CATCHES THE WORM : EARLY COST-EFFECTIVENESS ANALYSIS OF NEW MEDICAL TESTS

    NARCIS (Netherlands)

    Buisman, Leander R; Rutten-van Mölken, Maureen P M H; Postmus, Douwe; Luime, Jolanda J; Uyl-de Groot, Carin A; Redekop, William K

    2016-01-01

    OBJECTIVES: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases. METHODS: Step 1 is to narrow down the scope of analysis by defining the test's application, target populat

  11. Research on the prediction of the outcome of medical abortion by transrectal ultrasonography%经直肠超声检查预测药物流产结局的研究

    Institute of Scientific and Technical Information of China (English)

    郭玮; 郭敏

    2012-01-01

    目的 探讨经直肠超声在预测药物流产结局方面的临床应用价值.方法 选择120例无任何合并症和并发症的药物流产妇女,于药物流产后第3天经直肠超声观察宫腔情况.根据宫腔内容物血流信号特征,分为Ⅰ、Ⅱ、Ⅲ型;根据宫腔内容物最大前后径,分为A(<10.0 mm)、B(11.0~30.0 mm)和C(>30.0 mm)三组;并随访各组药物流产结局.结果 Ⅰ、Ⅱ、Ⅲ型患者药流成功率依次为95.83%、31.03%、0;清宫率依次为0、17.24%及100%;A、B、C三组患者药流成功率依次为94.67%、3.03%、0;清宫率依次为0、24.24%、100%,且各组间比较差异有统计学意义(P<0.05).此外,随着血流信号丰富程度的增加,宫腔内容物大小呈逐渐上升趋势,差异有统计学意义(P<0.01).结论 应用直肠超声观测宫腔情况对预测药物流产结局有一定的指导意义.对于宫腔内容物血流信号丰富且体积较大的药物流产患者,应加强监测,可积极行清宫术.%Objective To explore the value of transrectal ultrasonography in predicting the outcome of medical abortion. Methods One hundred and twenty women who received medical abortion without any complications were enrolled in the study. Transrectal ultrasonography was performed to observe the situation of uterine cavity three days after medical abortion. Subjects were divided into group I , II and IE according to the features of blood flow signal in uterine cavity contents. Subjects were divided into group A(30.0 mm) according to the maximum diameter of uterine cavity contents. The outcome of medical abortion in all groups was followed. Results The success rate of medical abortion of group I , II and IH was 95.83% , 31.03% and 0, while the ratio of additional curettage was 0, 17.24% and 100% , respectively. By contrast, the success rate of medical abortion of group A, B and C was 94.67% , 3.03% , and 0, and the ratio of additional curettage was 0, 24.24% and

  12. [Illegal abortion with misoprostol in Guadeloupe].

    Science.gov (United States)

    Manouana, M; Kadhel, P; Koffi, A; Janky, E

    2013-04-01

    The aim of this study was to describe the typical profile, and to assess the motivations of women who underwent illegal abortion with misoprostol in Guadeloupe (French West Indies). We conducted a 1-year prospective study on women who consulted after failure or complication of an illegal abortion with misoprostol. Fifty-two cases of illegal abortion with misoprostol were recorded. The most common profile was an unemployed woman, who was unmarried, foreign-born, had no medical insurance, and a low level of education; the median age was 28 (range 17 to 40). The justifications given were that the legal procedure was considered to be too slow, the young age of the woman, the ease of the self-medication procedure, a history of illegal abortion by misoprostol in the woman's country of origin, ignorance of the legal process, and financial and/or administrative problems. The problem of illegal abortion is probably underestimated in Guadeloupe and possibly France. This description of the profile of the population concerned and the justifications for choosing illegal abortion by misoprostol provides elements allowing better focus of education concerning abortion, contraception and family planning. Access to legal abortion centers should also be improved. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  13. Distance traveled for Medicaid-covered abortion care in California.

    Science.gov (United States)

    Johns, Nicole E; Foster, Diana Greene; Upadhyay, Ushma D

    2017-04-19

    Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

  14. Barriers to rural induced abortion services in Canada: findings of the British Columbia Abortion Providers Survey (BCAPS.

    Directory of Open Access Journals (Sweden)

    Wendy V Norman

    Full Text Available BACKGROUND: Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC. METHODS: We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. RESULTS: Surveys were returned by 39/46 (85% of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67 of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52 abortions annually, including 35 (SD 30 medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. CONCLUSIONS: Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4% for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians.

  15. Barriers to rural induced abortion services in Canada: findings of the British Columbia Abortion Providers Survey (BCAPS).

    Science.gov (United States)

    Norman, Wendy V; Soon, Judith A; Maughn, Nanamma; Dressler, Jennifer

    2013-01-01

    Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC). We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians.

  16. Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

    Science.gov (United States)

    Norman, Wendy V.; Soon, Judith A.; Maughn, Nanamma; Dressler, Jennifer

    2013-01-01

    Background Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC). Methods We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. Results Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. Conclusions Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians. PMID:23840578

  17. Place, remove the intrauterine device, and medical abortion correlation analysis%放置、取出宫内节育器和药物流产相关性分析

    Institute of Scientific and Technical Information of China (English)

    杨慧(通讯作者); 朱晓琴; 季金陵; 姜璐璐

    2013-01-01

    Objective: To investigate place the intrauterine device,take out the intrauterine device and medical abortion number changes among contraception operation from 2008 to 2011 in Huaian. Methods: al the region engaged in family planning technical service work by the trained professionals to fil in the monthly number of contraception technical services, report step by step, statistics place the intrauterine device,take out the intrauterine device and medical abortion number changes among contraception operation. Results: The number of place the intrauterine device and take out the intrauterine device in 2008~2011 in Huaian were reduced year by year. The number of medical abortion number increased too. Conclusion: The number of medical abortion with highly linear negative correlation with The difference between the place and remove the intrauterine device number.%目的研究淮安市2008~2011年计划生育手术中放置与取出宫内节育器和药物流产人次数变化情况。方法本地区所有从事计划生育技术服务的工作单位由受过培训的专业人员每月填写计划生育技术服务数量情况,逐级上报,统计分析淮安市计划生育手术中放置与取出宫内节育器和药物流产人次数变化情况。结果淮安市2008~2011年放置与取出宫内节育器例数逐年减少,药物流产人次数逐年上升。结论药物流产人次数与放置、取出宫内节育器例数之差有高度线性负相关。

  18. [Readers' position against induced abortion].

    Science.gov (United States)

    1981-08-25

    Replies to the request by the Journal of Nursing on readers' positions against induced abortion indicate there is a definite personal position against induced abortion and the assistance in this procedure. Some writers expressed an emotional "no" against induced abortion. Many quoted arguments from the literature, such as a medical dictionary definition as "a premeditated criminally induced abortion." The largest group of writers quoted from the Bible, the tenor always being: "God made man, he made us with his hands; we have no right to make the decision." People with other philosophies also objected. Theosophical viewpoint considers reincarnation and the law of cause and effect (karma). This philosophy holds that induced abortion impedes the appearance of a reincarnated being. The fundamental question in the abortion problem is, "can the fetus be considered a human life?" The German anatomist Professor E. Bleckschmidt points out that from conception there is human life, hence the fertilized cell can only develop into a human being and is not merely a piece of tissue. Professional nursing interpretation is that nursing action directed towards killing of a human being (unborn child) is against the nature and the essence of the nursing profession. A different opinion states that a nurse cares for patients who have decided for the operation. The nurse doesn't judge but respects the individual's decision. Some proabortion viewpoints considered the endangering of the mother's life by the unborn child, and the case of rape. With the arguments against abortion the question arises how to help the woman with unwanted pregnancy. Psychological counseling is emphasized as well as responsible and careful assistance. Referral to the Society for Protection of the Unborn Child (VBOK) is considered as well as other agencies. Further reader comments on this subject are solicited.

  19. Alcohol consumption in early adolescence and medical care.

    Science.gov (United States)

    Borrás Santiesteban, Tania

    2016-10-01

    Alcohol consumptionin adolescents is a risky behavior that can be prevented. Objective. To determine health care and alcohol consumption pattern in early adolescence and its relation to determinants of health (biological, environmental, social and health system factors). A qualitative-quantitative, crosssectional study was carried out in the four schools belonging to Popular Council 8 of Mario Gutiérrez Ardaya health sector in May, 2013. The study universe was made up of adolescents aged 10-14. The sample was determined through a simple randomized sampling. Surveys were administered to adolescents, parents, educators and senior health staff members to determine alcohol consumption, medical care quality and level of knowledge on the problem. A nominal group with health professionals was created. Two hundred and eighty eight adolescents were included. 54.5% were alcohol users, of which 30.2% were 10-11 years old. Those classified as low risk were prevailing (55.6%). 100% of the senior health staff expressed the need for a methodology of care. 90.4% of education staff considered adolescence as a vulnerable stage. Relatives reported that there should be adolescent-specific medical appointments (61.8%). The nominal group's most important opinions were based on the main features that a consultation for adolescents should have and on the problems hindering proper care. Alcohol consumption was considered high and early start prevailed. Insufficient care to early adolescents who use alcohol was made evident. Sociedad Argentina de Pediatría.

  20. Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion misoprostol: study protocol for a randomized, controlled trial.

    Science.gov (United States)

    Dragoman, Monica V; Grossman, Daniel; Kapp, Nathalie; Huong, Nguyen My; Habib, Ndema; Dung, Duong Lan; Tamang, Anand

    2016-10-12

    Pain is often cited as one of the worst features of medical abortion. Further, inadequate pain management may motivate some women to seek unnecessary clinical care. There is a need to identify effective methods for pain control in this setting. We propose a randomized, placebo-controlled trial. 576 participants (288 nulliparous; 288 parous) from study sites in Nepal, South Africa and Vietnam will be randomly allocated to one of three treatments: (1) ibuprofen 400 mg PO and metoclopramide 10 mg PO; (2) tramadol 50 mg PO and a placebo; or (3) two placebo pills, to be taken immediately before misoprostol and repeated once four hours later. All women will be provided with supplementary analgesia for use as needed during the medical abortion. We hypothesize that women receiving prophylactic analgesia will report lower maximal pain scores in the first 8 h following misoprostol administration compared to women receiving placebos for medical abortion through 63 days' gestation. Our primary objective is to determine whether prophylactic administration of ibuprofen and metoclopramide or tramadol provides superior pain relief compared to analgesia administration after pain begins, measured during the first eight hours after misoprostol administration. Secondary objectives include identifying covariates associated with higher reported pain scores; determining any impact of the study medicines on medical abortion success; and, qualitatively exploring women's physical experiences of medical abortion, especially related to pain, and how can they be improved. Data sources include medical records, participant symptom diaries and interview data obtained on the day of enrollment, during the medical abortion, and at follow-up. Participants will be contacted via telephone on day 3 and return for follow-up will occur approximately 14 days after mifepristone, concluding study participation. A subset of 42 women will also be invited to undergo in-depth qualitative interviews following

  1. Physician opinions concerning legal abortion in Bogotá, Colombia.

    Science.gov (United States)

    Stanhope, Kaitlyn; Rochat, Roger; Fink, Lauren; Richardson, Kalie; Brack, Chelsey; Comeau, Dawn

    2017-01-19

    Since the decriminalisation of abortion in 2006, women in Colombia have continued to seek clandestine abortions, endangering their health and contributing to maternal mortality and morbidity. The goal of this study was to explore physicians' opinions towards and knowledge about legal abortion in Bogotá, Colombia, and key barriers to the legal abortion access. We conducted 13 key informant interviews followed by a survey with a probability sample of 49 doctors working in public hospitals in Bogotá. Interview and survey data showed lack of technical experience in the provision of abortion and nuanced opinions towards its practice. Key informants described ignorance and lack of abortion training in medical schools as key barriers to provision. In the survey, 16/49 respondents had performed an abortion, 24/49 had referred a woman for an abortion and only 33/49 showed correct knowledge of the law.

  2. [Induced abortion: Guidelines for clinical practice - Text of the Guidelines (short text)].

    Science.gov (United States)

    Vayssière, C; Gaudineau, A; Attali, L; Bettahar, K; Eyraud, S; Faucher, P; Fournet, P; Hassoun, D; Hatchuel, M; Jamin, C; Letombe, B; Linet, T; Msika Razon, M; Ohanessian, A; Segain, H; Vigoureux, S; Winer, N; Wylomanski, S; Agostini, A

    2016-12-01

    Develop recommendations for the practice of induced abortion. The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted. The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being±5 days, IA could be done if measurements are respectively less than 90mm for CRL and less than 30mm for BIP (Professional consensus). A medical IA performed with a dose of 200mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional

  3. Health benefits of legal abortion: an analysis.

    Science.gov (United States)

    Tyrer, L B

    1985-01-01

    The abolition of legal abortion in the US would seriously threaten the health, and even the lives, of women and children. Statistics on the relationship between abortion and health attained before and after abortion was legalized were used to project some of the probable consequences of reversing the US Supreme Court's 1973 Roe v. Wade decision. Abortion has been widely practiced throughout US history, but the actual number of procedures performed before some states legalized abortion is unknown. Few legal procedures were performed for medical reasons, yet many illegal abortions took place. In 1955, a panel of experts could only provide a "best estimate" of between 200,000 and 1,200,000 illegally induced abortions occurring annually in the US. The actual number was most likely closer to the higher figure. The complication rates for illegal abortions, most of which were performed by unskilled practitioners in unsafe settings, were much higher than the rates for legal abortion now. Complications were related to ineffective or unsafe methods, Sepsis, particularly with the bacterium "Clostridium prefringens," which causes gas gangrene, was a major problem that has virtually disappeared. Each year prior to the 1970s, more than 100 women in the US died of abortion complications. Due to the fact that vital statistics reflect an incomplete ascertainment of deaths, the actual number of deaths is probably larger, possibly by as much as 50%. In 1983 more than 1.3 million procedures were performed -- a figure close to the estimated number of illegal abortions performed before 1970. In comparison, 672,000 hysterectomies and 424,000 tonsillectomy operations were performed the same year. The number of abortion-related deaths in the US decreased between 1972 and 1980, from 90 to 16. Most of this decrease resulted from the availability and safety of legal abortion. Legal abortion carries an especially low risk of death, particularly when performed in the 1st trimester. For the 1972

  4. Spillover Effects of Early-Life Medical Interventions

    DEFF Research Database (Denmark)

    Breining, Sanni Nørgaard; Daysal, N. Meltem; Simonsen, Marianne;

    2015-01-01

    substantial positive spillovers on all our measures of academic achievement. Our estimates suggest that siblings of focal children who were slightly below the VLBW cutoff have higher 9th grade language and math test scores, as well as higher probability of enrolling in a high school by age 19. Our results......We investigate the spillover effects of early-life medical treatments on the siblings of treated children. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we first confirm...... the findings in the previous literature that children who are slightly below the VLBW cutoff have better short- and long-term health, and higher math test scores in 9th grade. We next investigate spillover effects on siblings and find no evidence of an impact on their health outcomes. However, we find...

  5. 益肾祛瘀汤对药物流产后生殖激素水平、阴道出血及月经的影响%Effect of adding Chinese herb after routine medical abortion on the levels of reproductive hormones

    Institute of Scientific and Technical Information of China (English)

    吕同尊; 范勤颖; 李银宽; 张艳梅; 刘进满

    2011-01-01

    目的 探讨益肾祛瘀汤对药物流(以下简称药流)后生殖激素水平、阴道出血及月经失调的影响及其作用机制.方法 将168例停经49 d内妊娠者随机分为3组.药流组56例,服米非司酮及米索前列醇药物流产;人工流产(以下简称人流)组56例,采用负压吸引术术终止妊娠;药流加中药组56例,药流方法同药流组,待孕囊排出后加服益肾祛瘀汤.3组均于孕囊排出后第8、14、22 d抽肘静脉血,测定雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成激素(LH)、人绒毛膜促性腺激素(HCG),并观察阴道出血及月经情况.结果 药流加中药组第14、22 d E2 均较药流组升高(P<0.05),HCG较药流组降低(P<0.05);人流组第14、22 d HCG均较药流组降低(P<0.05);药流加中药组P较药流组降低(P<0.05);人流组、药流加中药组LH均较药流组降低(P<0.05);药流加中药组第8 d FSH较药流组升高(P<0.05).人流组、药流加中药组阴道出血时间≤7 d者较药流组多(P<0.01);药流加中药组阴道出血时间>15 d者较人流组少(P<0.05).人流组、药流加中药组阴道出血量均较药流组减少(P<0.01);药流加中药组阴道出血量大于月经量者较人流组少(P<0.05).人流组、药流加中药组月经情况均优于药流组(P<0.01);药流加中药组月经情况均优于人流组(P<0.05).结论 益肾祛瘀汤具有调节药流后E2、P水平,使子宫内膜同步,促进卵巢功能恢复,减少药流后阴道流血量,缩短出血时间和防治月经失调的作用.%Objective To explore the mechanism of decoction for tonifying kidney and removing blood stasis on the prevention and treatment of bleeding and menstrual disorder after medical abortion. Methods 168 patients with pregnancy of menopause for 49 days were randomly divided into three groups. Patients in medical abortion group ( n = 56) were treated by medical abortion of Mifepristone and Misoprostol. Termination

  6. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    Science.gov (United States)

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  7. Two steps back: Poland's new abortion law.

    Science.gov (United States)

    Nowicka, W

    1993-06-01

    After the fall of Communism in Poland, the Catholic church exerted pressure to increase its influence in public life. One way in which this pressure has manifested itself has been in the passing of a restrictive abortion bill which was signed into law on February 15, 1993. Abortion had been legalized in Poland in 1956 and was used as a means of birth control because of a lack of availability and use of contraceptives. The number of abortions performed was variously reported as 60,000 - 300,000/year. In 1990, the Ministry of Health imposed restrictions on abortions at publicly funded hospitals, and 3 deaths were reported from self-induced abortions. In 1 year (1989-90), the number of induced abortions at 1 hospital dropped from 71 to 19, while the number of self-induced abortions increased from 48 to 85. Further restrictions were introduced in May 1992 as part of the "Ethical Code for Physicians," which allows abortions only in cases where the mother's life or health is in danger or in cases or rape. This code brought abortions to a halt at publicly funded hospitals and doubled or even tripled the cost of private abortions. Women have been refused abortions in tragic and life=threatening situations since the code was adopted. When an outright anti family planning bill was drafted in November 1992, the Polish citizenry collected 1,300,000 signatures to force a referendum. The referendum was not held, but the bill was defeated. The amended bill which passed allows abortions in publicly funded hospitals only when the mother's life or health is in danger and in cases of rape, incest, or incurable deformity of the fetus. The implications of this law remain unclear, since its language is strange and vague. The reproductive rights of Polish women face a further threat because the Catholic church is working to limit the availability of contraceptive methods which they deem to be "early abortives." On the other side of the issue, the Federation for Women and Planned

  8. EARLY MEDICAL REHABILITATION OF THE PATIENTS WITH SPINAL CORD INJURY

    Directory of Open Access Journals (Sweden)

    Aleš Demšar

    2003-12-01

    Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

  9. Analysis of the clinical application of mifepristone and misoprostol on medical abortion%米非司酮配伍米索前列醇药物流产的临床应用分析

    Institute of Scientific and Technical Information of China (English)

    李成梅

    2015-01-01

    Objective:To study the clinical effect of mifepristone combined with misoprostol in the treatment of medical abortion. Methods:200 pregnant women that treated with mifepristone and misoprostol in medical abortion were selected.All of the patients were treated with oral mifepristone,taken 50 mg in the morning of first day,then taken 25 mg after 12 hours.At the second day they were taken the same dosage as the first day,while at the third day morning,patients were added 0.6 mg of misoprostol on fasting state.Results:After the treatment,the hemorrhage days was 14~19 days,the complete abortion rate was 96% ,the incomplete abortion rate was 4% ,no abortion failure cases.3 cases had gastrointestinal reaction,and the symptoms disappeared after withdrawal.Conclusion:Mifepristone combineded with misoprostol has good clinical effect on medical abortion,and less adverse reaction.%目的:探讨米非司酮配伍米索前列醇在药物流产中的临床应用效果。方法:采用米非司酮配伍米索前列醇进行药物流产孕妇200例,所有患者均用冷开水送服米非司酮,第1天早晨口服50 mg,12 h后再服25 mg,第2天和第1天同样服法,第3天早上空腹加服米索前列醇0.6 mg。结果:经过治疗,出血天数14~19 d,完全流产率96.0%,不完全流产率4.0%,无流产失败病例发生。出现胃肠道反应3例,停药后症状消失。结论:米非司酮配伍米索前列醇药物流产临床效果好,不良反应少。

  10. Compound Mifepristone and Mifepristone Curative Effect is Observed in A Medical Abortion%米非司酮与复方米非司酮在药物流产中疗效比较分析

    Institute of Scientific and Technical Information of China (English)

    李君; 何慧

    2016-01-01

    Objective Comparison and analysis the curative effect of compound mifepristone and mifepristone used for med-ical abortion.Methods Random choice during January 2013 ― February 2013 in our hospital 100 cases of pregnant women in line of medical abortion as the research object, were randomly divided into control group and observation group, 50 cases each. Drug abortion: the control group using mifepristone unilaterally, observation group used compound mifepristone, com-pare the results, two groups of abortion pregnant sac discharge time, bleeding time after abortion, blood loss and adverse re-actions after abortion. Results Observation group complete abortion rate (94.0%) is significantly higher than control group (80.0%), observation group of pregnant women pregnant bursa discharge time, bleeding time after abortion (bleeding amount) are significantly less than the control group, the difference between groups (P< 0.05). Observation group adverse reaction rate was 16.0%, significantly lower than the control group (30.0%), the difference between group P<0.05. Conclusion Ap-plication of compound mifepristone abortion in drug abortion effect is more ideal, amount of bleeding after miscarriage and duration is relatively small, the clinical curative effect is better than that of unilateral mifepristone.%目的对比分析米非司酮与复方米非司酮用于药物流产的疗效。方法随机选择2013年1月―2015年2月期间在该院行药物流产的100例孕妇作为研究对象,随机分为对照组和观察组,各50例。药物流产:对照组采用单方米非司酮,观察组采用复方米非司酮,比较两组流产结果、孕囊排出时间、流产后出血时间,统计流产后出血量及不良反应情况。结果观察组完全流产率(94.0%﹚显著高于对照组(80.0%﹚,观察组孕妇孕囊排出时间、流产后出血时间(流血量﹚均显著少于对照组,组间差异有统计学意义(P<0.05﹚。

  11. A project to improve the quality of abortion services in Moldova.

    Science.gov (United States)

    Comendant, Rodica

    2005-11-01

    Abortion has been available legally in Moldova since 1955, and since then the abortion rate has gradually declined. The quality of abortion care remains low, however, and there is a high level of maternal mortality related to unsafe abortion. The goals of the 2005-2015 National Reproductive Health Strategy are to reduce unwanted pregnancy, reduce abortion-related morbidity and mortality, improve access to and quality of abortion care, including the methods of vacuum aspiration and medical abortion. This paper presents information on the current abortion law, policy and services in Moldova. It describes a project whose aim is to improve the quality of abortion services, including the introduction of medical abortion through training of service providers and community education. Manual vacuum aspiration has also recently been introduced. The drugs for medical abortion are officially approved, a clinical study evaluating the efficacy and acceptability of medical abortion in a low-resource setting has been completed, and training of providers has been carried out. However, institutionalisation of medical abortion faces many problems in relation to organisation of service delivery, the higher cost of medical than aspiration abortion, and doctors' reluctance to use new methods.

  12. 人工流产与继发不孕%Abortion and secondary infertility

    Institute of Scientific and Technical Information of China (English)

    刘建华

    2012-01-01

    人工流产是一种有创性节育方法,有电吸人工流产和药物流产两种方法.人工流产后的继发不孕主要与多次人工流产、流产后生殖道感染等引起的子宫内膜损伤和流产后发生的盆腔炎性疾病有关.电吸人工流产时宫腔内的子宫内膜组织碎片和血液可经输卵管逆流入腹腔,引起盆腔子宫内膜异位症,也是引起不孕症的重要原因之一.加强避孕宣教、重视流产时子宫内膜的保护,以及控制生殖道感染是预防人工流产后继发不孕的重要措施.%Induced abortion is a traumatic method of terminating early pregnancy, including vacuum aspiration induced abortion and medical abortion. The infertility to induced abortion has been increasing, which may be correlated to multiple induced abortion, the pelvic inflammatory disease (PID) and the damage of endometrium caused by the induced abortion. The decidual scraps and blood during the vacuum aspiration procedure may get into peritoneal cavity from the uterine cavity through the tubes, which may cause pelvic endometriosis. Endometriosis is also considered as one of the important causes of female infertility. The preventive measures of infertility secondary to induced abortion should include the publicity and education of contraception, emphasis on protection of endometrium during induced abortion, and the PID prevention.

  13. The diagnosis of early pregnancy and missed abortion in European and Svalbard reindeer (Rangifer tarandus tarandus and Rangifer tarandus platyrhyncus

    Directory of Open Access Journals (Sweden)

    Tata Ringberg

    1982-05-01

    Full Text Available Progesterone levels in peripheral plasma from a total of 38 pregnant an non-pregnant Norwegian and Svalbard reindeer (R. tarandus tarandus and R. t. platyrhyncbus, respectively, were measured 5 to 6 times between November and May, and the size of 18 corresponding fetuses determined. The serum levels of progesterone were similar in the two subspecies, and increased from 1.5 nmol/1 (non-pregnant level to 10—30 nmol/1 in November in pregnant animals. A maximum of 40—80 nmol/1 was reached in April whereafter the levels declined as time of delivery (beginning of June approached. Animals with «missed» abortions had progesterone levels in serum of 5—6 nmol/1 in November. The size of the fetuses in November (average 3.7 and 30.7 mm makes delayed implantation in reindeer unlikely.Tidlig diagnostisering av drektighet og skjult abort i europeisk rein og Svalbardrein (Rangifer tarandus tarandus og Rangifer tarandus platyrhuncus.Abstract in Norwegian / Sammendrag: Progesteron er det viktigste drektighetshormon hos pattedyr, og allerede tidlig i drektighetsperioden kan man hos en rekke arter påvise en økning i konsentrasjonen av dette hormon i blodet. Det har vært diskutert om det samme var tilfelle hos rein. Hvis det var så, ville det være mulig ved hjelp av en enkelt blodprøve på høsten å bestemme om dyret var drektig eller ei, og således ha et bedre grunnlag for å velge ut simler for slakt. Formålet med de forsøkene som er beskrevet i denne artikkel var derfor å måle progesteron-verdiene i blodet hos drektige og ikke-drektige simler for å se om de førstnevnte hadde høyere nivå, og dernest å se om det var en sammenheng mellom fosterets størrelse og progesteron-nivået. Til forsøkene ble det brukt tretti V2—2V2 år gamle simler fra reineier John Nordfjells flokk på Røros, samt åtte Svalbard-rein simler. Fra de norske rein ble blodprøver og fostre samlet under slaktning d. 26. november 1979, og fra Svalbard-reinen ble det

  14. Medical Abortion and Abortion Women's Mental Status of the Investigation%药物流产和人工流产妇女心理状态的调查分析

    Institute of Scientific and Technical Information of China (English)

    王燕燕

    2015-01-01

    Objective Understood that medicine miscar iage and induced abortion woman psychology whether to have the dif erence and the related influencing factor. Methods Uses the SDS meter car ies on the psychological test to the selected medicine miscar iage and induced abortion woman each 30 examples, and uses the questionnaire which to it independently designs to carry on the questionnaire survey. Results 30 example medicine miscar iage woman SDS grading result ( x±s) is 35.43±7.96,30 the example induced abortion woman SDS grading result ( x±s) is 50.97±10.93, the medicine class group and the stream of people group SDS grading compares, ﹤0.05;The medicine miscar iage and induced abortion woman family degree of support comparison result u=2.44, the medicine class group and the stream of people group compare, ﹤0.05;Miscar iage woman years of schooling comparison,* ﹤0.01,∆ ﹤0.01;Stream of people group marital status comparison,**﹤0.05. Conclusion Medicine miscar iage group's psychology obvious good in induced abortion group.%目的了解药物流产和人工流产妇女心理状态是否有差异及其相关影响因素。方法采用SDS量表对入选的药物流产和人工流产妇女各30例进行心理测试,并对其采用自行设计的问卷进行问卷调查。结果30例药物流产妇女SDS评分结果(x±s)为35.43±7.96,30例人工流产妇女SDS评分结果(x±s)为50.97±10.93,药流组与人流组SDS评分比较,﹤0.05;药物流产和人工流产妇女家庭支持程度比较结果u=2.44,药流组与人流组比较,﹤0.05;流产妇女文化程度比较,*﹤0.01,∆﹤0.01;人流组婚姻状况比较,**﹤0.05。结论药物流产组的心理状态明显好于人工流产组。

  15. [A note on induced abortion in Italy].

    Science.gov (United States)

    Cagiano De Azevedo, R

    1980-01-01

    The adoption of a recent law on abortion (1978) makes available in Italy new statistics at both the national and regional levels. Following the official source of ISTAT, the abortion rate/100 livebirths in 1979 was about 28%, about 40% in the northern part of Italy, and only 16% in Mezzogiorno. This abortion rate, as an average data at the national level, corresponds to a normal position among similar rates in western countries; closer to EEC member states. But the regional variability seems a very interesting new aspect of the Italian tryptic (north, center, south) largely presented in many demographic indicators. 3 factors are presented as a possible explication of this variability: a real different attitude of women and couples towards abortion from cultural, religious, and political points of view; the coexistence of legal and illegal abortion despite the adoption of a new liberal law; and the very important disequilibrium in the distribution of structures and medical services available to assure abortions in different parts of the country. Some other demographic points related to abortion are also presented here, particularly in connection with age structure of women and their marital status. Future trends in abortion with subsequent effects on fertility are also discussed at the end of this article. The arguments follow 2 alternatives presented in Italy by the National Committee on Population and the Committee of Demographic Studies. (author's modified)

  16. Violence against abortion increases in US clinics.

    Science.gov (United States)

    Roberts, J

    1994-08-13

    In the US, violence against abortion clinics is escalating. In July 1994, a doctor who performed abortions and one of his escorts was gunned down outside of an abortion clinic. In March of 1993, another doctor was killed outside of a clinic. That killing prompted passage of a federal law designed to protect abortion providers and clinics from violence. In addition to the individuals murdered, the number of violent incidents against abortion clinics increased four-fold to 250 in 1993. Some elderly physicians feel compelled to continue to perform the procedure instead of retiring because there are no young practitioners to replace them. These physicians note that the young practitioners have no experience with the deaths and illness which resulted from illegal abortions and have not been properly trained by their medical schools. The US Attorney General has dispatched federal marshalls to guard abortion clinics, and local police are increasing their protection of clinics. Abortion protestors say that the new federal law will cause some formerly peaceful protestors to resort to violence.

  17. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  18. Women's perspectives on ultrasound viewing in the abortion care context.

    Science.gov (United States)

    Kimport, Katrina; Preskill, Felisa; Cockrill, Kate; Weitz, Tracy A

    2012-01-01

    In recent years, states have passed a range of regulations regarding ultrasound procedures in abortion care. Abortion rights opponents have promoted ultrasound viewing, believing that women who view their own ultrasound images are likely to be dissuaded from abortion. Abortion rights advocates, in contrast, routinely oppose these regulations, citing concerns that ultrasound viewing in the abortion context will be emotionally difficult for women. However, no empirical research has examined the effects of ultrasound viewing in unwanted pregnancies. We conducted in-depth interviews with 20 respondents who received an ultrasound as part of their abortion care in one of two states in the American heartland. Interview transcripts were analyzed using grounded theory and a matrix technique for discussion of ultrasound viewing and regulations about ultrasound viewing. Respondents' accounts offer support for anti-abortion claims that ultrasound viewing can dissuade women from abortion, as well as support for abortion rights claims that viewing an ultrasound can cause emotional difficulty for a woman planning to abort. Interviews point to unexpected outcomes of ultrasound viewing, including reports that viewing better enabled respondents to cope with their abortion. Ultrasound viewing does not have a singular effect. These data suggest that current assumptions about viewing effects are inaccurate, or at the least incomplete. We do not find support for legislating mandatory ultrasound viewing in abortion care. Questions about clinical care practices are best address in the medical context, not the legislative arena. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. 同型半胱氨酸水平与早期妊娠流产相关性分析%Analysis on the Correlation Between Homocysteine Level and Early Pregnancy Abortion

    Institute of Scientific and Technical Information of China (English)

    杨梦婕; 骆斯莹; 熊晶; 朱付凡

    2014-01-01

    Objective] To explore the correlation of homocysteine(HCY) level with polycystic ovary syn‐drome(PCOS) and early pregnancy abortion(EPL) .[Methods]Totally 123 patients with PCOS including 65 patients with one or more than one abortion within 12 weeks(PCOS abortion group) and 58 patients with nor‐mal pregnant history(PCOS non‐abortion group) were collected .Other 147 patients with one or more than one abortion within 12 weeks but without PCOS (non‐PCOS abortion group) were selected in the same period . HCY level was detected by enzymatic cycling method and compared among 3 groups .[Results] The level of HCY in PCOS abortion group was obviously higher than that in PCOS non‐abortion group and non‐PCOS abor‐tion group ,and that in non‐PCOS abortion group was markedly higher than that in PCOS non‐abortion group , and there was significant difference( P<0 .05) .[Conclusion]High HCY level is a risk factor for EPL and can be used as the indicator of early pregnancy outcome .%目的 探讨同型半胱氨酸(Hcy)水平与多囊卵巢综合症(PCOS)、早期妊娠流产(EPL)的相关性。方法 收集PCOS患者123例,其中既往有一次或一次以上12周内流产的患者65例(PCOS流产组),有正常妊娠史的患者58例(PCOS非流产组),另外选取同期既往有一次或一次以上12周内流产并排除PCOS的患者147例(非PCOS流产组)。采用循环酶法检测三组 Hcy 水平并比较。结果 PCOS 流产组 Hcy 水平(14.69±3.91)明显高于PCOS非流产组(11.67±2.93)和非PCOS组流产组(13.14 ± 3.37),且非PCOS流产组显著高于PCOS非流产组,其差异均有统计学意义( P <0.05)。结论 高Hcy水平是导致EPL发生的危险因素,可作为预测早期妊娠结局的指标。

  20. Abortion among Adolescents.

    Science.gov (United States)

    Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne

    2003-01-01

    Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…

  1. Abortion among Adolescents.

    Science.gov (United States)

    Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne

    2003-01-01

    Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…

  2. Sex ratios at birth after induced abortion.

    Science.gov (United States)

    Urquia, Marcelo L; Moineddin, Rahim; Jha, Prabhat; O'Campo, Patricia J; McKenzie, Kwame; Glazier, Richard H; Henry, David A; Ray, Joel G

    2016-06-14

    Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking. We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions. Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births. High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy. © 2016 Canadian Medical Association or its licensors.

  3. Abortion 1982: the Supreme Court once again.

    Science.gov (United States)

    Healey, J M

    1982-11-01

    Clearly, abortion in the US continues to be a major medico-legal issue which will not go away. 5 major abortion cases are scheduled for review by the US Supreme Court during its 1982-83 term. Taken together, these 5 cases challenge several of the key conclusions of the Court's review of the abortion question. The primary focus of the cases is the state's power to regulate the abortion decision during the 1st and 2nd trimester of the pregnancy. 2 cases involve ordinances passed by the City of Akron regulating access to abortion in areas such as consent and notification requirements and the location of abortions after the 1st trimester. 2 of the cases involve a Missouri statute also dealing with the requirement that abortions after the 1st trimester be performed in a hospital. The final case involves a Virginia criminal prosecution of a physician accused of violating the state's requirement of in-hospital performance of a 2nd trimester abortion. In the case of Roe v. Wade, the Court had established the "trimester trilogy" governing state regulation of the abortion procedure. For the stage of the pregnancy prior to the end of the 1st trimester, the Court held that the abortion decision and its effectuation must be left to the medical judgment of the pregnant women's attending physician. For the stage of the pregnancy subsequent to the end of the 1st trimester, the Court ruled that the state may promote its interest in the health of the mother by regulating the abortion procedure in ways reasonably related to maternal health. For the stage of pregnancy subsequent to viability, the state may promote its interest in the potentiality of human life by regulation, even prohibiting abortion, except where it is necessary to preserve the mother's life or health. These 5 cases challenge the role of the Court in determining the scope of appropriate state regulation at various stages of the pregnancy. Suffering a loss of prestige in the 10 years since the Roe v. Wade and Doe v

  4. Unsafe Abortion- A Tragic Saga of Maternal Suffering

    Directory of Open Access Journals (Sweden)

    M C Regmi

    2010-03-01

    Full Text Available INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8% were of high grade. Most of them recovered but there were total 8maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country. Keywords: abortion, legalization, maternal death, unsafe.

  5. Major trends in recent abortion research.

    Science.gov (United States)

    Van Der Tak, J

    1975-05-01

    Abortion research continues actively. 1 finding has been that abortion has distinct regional features. In Western Europe the rights of the woman in relation to the rights of the fetus are under study while Eastern European researchers examine the effect of long standing available abortion on birthrates, women's health, subsequent pregnancies, and contraceptive use. The increase in illegal abortion shows that improved health and contraceptive services, better data, and changes in restrictive laws are necessary. Changes in the laws, either from less to more liberal or the opposite, have brought about national studies of subsequent trends in abortion, maternal and infant mortality, service facilities, contraceptive practice and fertility. The technique of menstrual regulation, performed within 14 days of a missed menstrual period and before pregnancy can be determined, has created new research problems. It raises the questions of whether menstrual regulation can legally be considered an abortion and whether effectiveness rates can be reliably determined if a large proportion of the women are not even pregnant. The relative risks of menstrual regulation in very early pregnancy and vacuum aspiration and dilation and curretage at a later stage are now being researched. The World Health Organization is planning research of the psychosocial aspects of the relationship between the users and providers of abortion services. Also receiving research attention is the incidence of repeat abortions and the effects of an abortion refused. The fact that overall birthrates have not been substantially changed by the liberalization of abortion laws in the last 20 years appears to be associated with the improvement of contraceptive methods.

  6. Expression of AIF-1 and RANTES in Unexplained Spontaneous Abortion and Possible Association with Alloimmune Abortion

    Institute of Scientific and Technical Information of China (English)

    Yong-hong LI; Hai-lin WANG; Ya-juan ZHANG

    2007-01-01

    Objective To investigate the effects of allograft inflammatory factor-1(AIF-1)and (RANTES) in sera and deciduas on unexplained early spontaneous abortion.Methods AIF-1 and RANTES were examined in sera and deciduas/endometria of 43 unexplained early spontaneous abortion women (group A),40 healthy women with early pregnancy(group B)and 20 healthy women with no pregnancy (group C). Immunohistochemistry and enzyme linked immunosorbent assay (ELISA) were used in this study. Results AIF-1 protein was expressed both in deciduas of group A and in endometria of group C.In group A, H scores in the recurrent abortion deciduas specimens were significantly greater than those in the first abortion;in endometrium,expression of AIF-1 was greater in the secretory than in proliferative phase of group C.In group B,concentrations of RANTES in sera were higher in 7th-8th week of pregnancy than in 6th-7th and >8th week of pregnancy;expression of AIF-1 protein showed a negative correlation with RASNTES concentration;a significant increase of the RANTES levels in sera and tissue was observed in group B. Conclusion These results demonstrate, for the first time,that AIF-1 are expressed in deciduas of unexplained spontaneous abortion suggesting that AIF-1 involve in alloimmune abortion; RANTES might act as a novel blocking antibody;AIF-1 and RANTES might act as reliable markers for diagnosis of early alloimmune abortion.

  7. 玉米叶片早衰及籽粒败育的机理与影响因素%The Mechanism and Effect of the Early Ageing and Kernel Abortion of Corn Leaves

    Institute of Scientific and Technical Information of China (English)

    范杰英; 王昱; 姜晓莉; 张世忠

    2011-01-01

    Genes and environmental factors and cultural practices related to early ageing of corn leaves were reviewed in the paper. The relationship between early ageing and condition of roots was discussed. Kernel abortion was because of nutrition, the position of kernel, transportation and assimilation limits, potential and activity of sink. Factors affecting kernel abortion were genetic factor, water condition, temperature,light condition and kernel density. Measures for reducing kernel abortion were put foreword, such. as choosing fine seeds, suitable density,plucking out ears, fertilizing reasonably, improving nutrition condition, suitable irrigation and timely emission of water.%综述了导致玉米叶片早衰的遗传基因、外界环境条件和栽培措施等因素,及玉米籽粒败育的机理(营养供应限制、粒位与籽粒败育、输导及合成限制、库容及库活性)和影响籽粒败育的因素(遗传因素、水分条件、温度及光照条件和密度等);提出了减少籽粒败育的几点措施(选用优良品种,适宜密度、拔除雄穗,科学合理施肥、改善植株营养条件,适宜灌溉、及时排涝).

  8. Spontaneous Abortion and a Diet Drug Containing Caffeine and Ephedrine: A Study within the Danish National Birth Cohort

    OpenAIRE

    Howards, Penelope P.; Irva Hertz-Picciotto; Bech, Bodil H.; Nohr, Ellen A; Anne-Marie Nybo Andersen; Charles Poole; Jørn Olsen

    2012-01-01

    BACKGROUND: Medications may be consumed periconceptionally before a woman knows she is pregnant. In this study, the authors evaluate the association of a prescription diet drug (Letigen) containing ephedrine (20 mg) and caffeine (200 mg) with spontaneous abortion (SAB) in the Danish National Birth Cohort. METHODS: Women were recruited during their first prenatal visit from 1996-2002. Pre-conception and early pregnancy medication use was reported on the enrollment form, and pregnancy outcome w...

  9. [Abortion in Brazil: a household survey using the ballot box technique].

    Science.gov (United States)

    Diniz, Debora; Medeiros, Marcelo

    2010-06-01

    This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.

  10. An increase in vascular endothelial growth factor (VEGF and VEGF soluble receptor-1 (sFlt-1 are associated with early recurrent spontaneous abortion.

    Directory of Open Access Journals (Sweden)

    Lihong Pang

    Full Text Available Recurrent spontaneous abortion (RSA is a health problem that affects approximately 1% to 5% reproductive age woman. Yet, in around half of these patients, the mechanism for RSA is unexplained. Recent studies have indicated that placental ischemia/hypoxia and endothelial dysfunction are important factors in miscarriage. Other studies have indicated that the level and expression of soluble FMS-like tyrosine kinase-1 (sFlt1 is increased under a hypoxic environment. However, decreased sFlt-1 in the maternal circulation during the first trimester has recently been proposed as a potential marker for identifying risk of pregnancy loss. In this prospective study clinical samples were obtained within a short time after the fetal death, protein expression and maternal serum levels of sFlt1 were assessed and compared to samples taken from those with normal pregnancies. Our results indicate that levels of VEGF and sFlt-1 are both increased in women during early pregnancy compared women that are not pregnant (p<0.05 indicating that VEGF and sFlt-1 are both associated with pregnancy. More importantly, we detected a significant (p<0.05 increase in sFlt1 and VEGF levels and expression in the RSA patients who suffered subsequent miscarriages compare to controls. These results demonstrate that there is likely a relationship between VEGF, sFlt-1 and RSA suggesting that the high levels and over expression of sFlt-1 and VEGF might be associated with the pathogenesis of RSA.

  11. Abortion care for adolescent and young women.

    Science.gov (United States)

    Renner, Regina-Maria; de Guzman, Anna; Brahmi, Dalia

    2014-07-01

    Unintended pregnancy among adolescents (10-19years) and young women (20-24years) is a global public health problem. Adolescents face challenges in accessing safe abortion care. To determine, via a systematic data review, whether abortion care for adolescent and young women differs clinically from that for older women. In a comprehensive data review, the Cochrane Central Register of Controlled Trials, MEDLINE, and POPLINE databases were searched from the earliest data entered until November 2012. Randomized controlled trials and observational studies comparing effectiveness, safety, acceptability, and long-term sequelae of abortion care between adolescent/young women and older women were identified. Two reviewers independently extracted data, and the Cochrane guidelines and Newcastle-Ottawa Scale were used for quality assessment. In total, there were 25 studies including 346 000 women undergoing first- and second-trimester medical abortion, vacuum aspiration, or dilation and evacuation. Effectiveness and overall complications were similar among age groups. However, younger women had an increased risk for cervical laceration and a decreased risk of uterine perforation and mortality. Satisfaction and long-term depression were similar between age groups. Except for less uptake of intrauterine devices among adolescents, age did not affect post-abortion contraception. Evidence from various healthcare systems indicates that abortion is safe and efficacious among adolescent and young women. Clinical services should promote access to safe abortion for adolescents. © 2013.

  12. Duration of Vaginal Bleeding after Medical Abortion on Subsequent Pregnancy Effect%药物流产后阴道出血时间对再次妊娠分娩的影响

    Institute of Scientific and Technical Information of China (English)

    李以国

    2012-01-01

      Objective:To explore the duration of vaginal bleeding after drug abortion on subsequent pregnancy complications influence. Method:The hospital drug abortion,pregnancy to foot menstrual vaginal delivery of 98 cases of maternal medical records were reviewed and analyzed,observe the childbirth complications,and 100 cases of no drug abortion history of full-term pregnancy vaginal delivery of maternal medical complications were statistically analyzed by.Result:The duration of vaginal bleeding after drug abortion with the third stage of labor,postpartum hemorrhage,placental adhesion related.Both the statistical analysis:vaginal bleeding time by more than 10 days there was a significant difference at(P<0.05);vaginal bleeding time more than 15 days the difference was significant at(P<0.01).Conclusion:The duration of vaginal bleeding after drug abortion on subsequent pregnancy to term childbirth complications have an impact.%  目的:探讨药物流产后阴道出血时间对再次妊娠分娩时并发症的影响.方法:对笔者所在医院住院有药物流产史、再次妊娠至足月经阴分娩的98例产妇病历进行回顾和分析,观察其分娩时出现的并发症,并将其与同期100例无药物流产史的足月妊娠经阴分娩的产妇所出现的并发症进行对比.结果:药物流产后阴道出血时间长短与第三产程、产后出血、胎盘粘连相关.两组阴道出血时间超过10、15 d比较差异有统计学意义(P<0.05,P<0.01).结论:药物流产后阴道出血时间长短对再次妊娠至足月分娩时并发症有一定影响.

  13. Algorithm for Determination of Orion Ascent Abort Mode Achievability

    Science.gov (United States)

    Tedesco, Mark B.

    2011-01-01

    For human spaceflight missions, a launch vehicle failure poses the challenge of returning the crew safely to earth through environments that are often much more stressful than the nominal mission. Manned spaceflight vehicles require continuous abort capability throughout the ascent trajectory to protect the crew in the event of a failure of the launch vehicle. To provide continuous abort coverage during the ascent trajectory, different types of Orion abort modes have been developed. If a launch vehicle failure occurs, the crew must be able to quickly and accurately determine the appropriate abort mode to execute. Early in the ascent, while the Launch Abort System (LAS) is attached, abort mode selection is trivial, and any failures will result in a LAS abort. For failures after LAS jettison, the Service Module (SM) effectors are employed to perform abort maneuvers. Several different SM abort mode options are available depending on the current vehicle location and energy state. During this region of flight the selection of the abort mode that maximizes the survivability of the crew becomes non-trivial. To provide the most accurate and timely information to the crew and the onboard abort decision logic, on-board algorithms have been developed to propagate the abort trajectories based on the current launch vehicle performance and to predict the current abort capability of the Orion vehicle. This paper will provide an overview of the algorithm architecture for determining abort achievability as well as the scalar integration scheme that makes the onboard computation possible. Extension of the algorithm to assessing abort coverage impacts from Orion design modifications and launch vehicle trajectory modifications is also presented.

  14. Misoprostol and the politics of abortion in Sri Lanka.

    Science.gov (United States)

    Kumar, Ramya

    2012-12-01

    Misoprostol, a WHO essential medicine indicated for labour induction, management of miscarriage and post-partum haemorrhage, as well as for induced abortion and treatment of post-abortion complications, came up for registration in Sri Lanka in December 2010. The decision on registration was postponed, indefinitely. This has wide-ranging implications, as misoprostol is widely available and used, including by health professionals in Sri Lanka, without guidance or training in its use. This paper attempts to situate the failure to register misoprostol within the broader context of unsafe abortion, drawing on data from interviews with physicians and health policymakers in Sri Lanka. It demonstrates how personal opposition to abortion infiltrates policy decisions and prevents the issue of unsafe abortion being resolved. Any move to reform abortion law and policy in Sri Lanka will require a concerted effort, spearheaded by civil society. Women and communities affected by the consequences of unsafe abortion need to be involved in these efforts. Regardless of the law, women will access abortion services if they need them, and providers will provide them. Decriminalizing abortion and registering abortion medications will make provision of abortion services safer, less expensive and more equitable. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  15. Exploring the pathways of unsafe abortion in Madhya Pradesh, India.

    Science.gov (United States)

    Banerjee, Sushanta K; Andersen, Kathryn

    2012-01-01

    Nearly 40 years after enactment of the Medical Termination of Pregnancy Act of 1971, unsafe abortion continues to be a neglected women's health issue in India. This prospective study of women presenting for post-abortion care in 10 selected hospitals in Madhya Pradesh, India, aimed to understand the incidence, types and severity of post-abortion complications, probable causes of complications and consequences to women in terms of hospitalisation and incurred costs. Among 1565 women presenting for induced abortion-related services between July and November 2007, 381 women with post-abortion complications consented to participate. Data reveal a high prevalence of post-abortion complications (29%). Approximately half of women originally attempted to induce abortion at home using medication, home-made concoctions or traditional methods. Ninety percent sought care from either qualified (37%) or unqualified providers. More than half of the women were hospitalised as a result of post-abortion complications. This study suggests that supporting access to safely induced abortion services and improving community awareness on legal aspects, safe methods and approved providers are all necessary to reduce morbidity associated with unsafe abortion.

  16. Nurses in abortion care: identifying and managing stress.

    Science.gov (United States)

    Lipp, Allyson; Fothergill, Anne

    2009-02-01

    The psychological impact of abortion on the women undergoing the procedure is well researched, but little is known about the potential psychological impact on nurses working in abortion care. The proportion of medical abortions in the UK is rising compared to surgical abortions. A recent research study found that being more directly involved in the procedure places more emotional demands on the nurses. This emotional labour required by nurses working in abortion care may increase their stress levels. This paper examines the potential increase in stress in nurses caused by medical abortions. A model of stress comprising stressors, moderators and stress outcomes was used as a framework for this examination. Research on abortion and mental health nursing was applied to managing stress in abortion care; this included coping mechanisms, prevention and intervention strategies. This showed that stress, burnout and coping are important issues in abortion care. On this basis, recommendations for practice have been formulated to inform practice for nurses and managers in abortion care.

  17. 药物流产对继后妊娠分娩期并发症的影响%Effect of medical abortion on the complications of subsequent pregnancy and parturition

    Institute of Scientific and Technical Information of China (English)

    徐永君

    2013-01-01

    Objective To investigate the effect of medical abortion on the complications of subsequent pregnancy and parturition. Methods Four hundred and fifty-five primiparas with once medical abortion history were enrolled as the study group. Five hundred and sixty primiparas without medical abortion history were enrolled as the control group. Placenta abruption, placenta accretion or implantation, prolonged third stage of labor and postpartum hemorrhage of labor were compared between the two groups. Results The incidences of prolonged third stage of labor and postpartum hemorrhage in the study group were significantly higher than those in the control group (5.49% vs 2.14% and 3.29% vs 0.71%). The incidence of placenta abruption, placenta accretion or implantation showed no statistically significant difference between the two groups (P<0.05). Conclusion Medical abortion may enhance the occurrence of prolonged third stage of labor and postpartum hemorrhage, but has no effect on placenta abruption, placenta accretion or implantation of subsequent pregnancy.%目的 探讨药物流产对继后妊娠分娩期并发症的影响.方法 选择455例有一次药物流产史的首次分娩孕妇为实验组,560例无药物流产史的首次分娩孕妇为对照组;观察各实验对象分娩期的胎盘早剥、胎盘粘连或植入、第三产程延长、产后出血等并发症情况.结果 实验组的第三产程和产后出血发生率高于对照组(5.49% vs 2.14%,3.29% vs 0.71%),胎盘早剥和胎盘粘连或植入与对照组比较差异无统计学意义(P<0.05).结论 药物流产可以增加继后妊娠分娩期的第三产程延长和产后出血的发生率,对胎盘早剥和胎盘粘连或植入无影响.

  18. Serious infection associated with induced abortion in the United States.

    Science.gov (United States)

    Dempsey, Angela

    2012-12-01

    Though serious infection after induced abortion is rare, infections account for one third of abortion-related deaths in the United States. Most fatal cases of infection after induced medical abortion have involved clostridial species. These reported cases share important clinical features that may guide clinicians to earlier recognition and institution of therapy. This article reviews our current knowledge regarding serious clostridial infections postabortion including the typical clinical presentation, pathophysiology, modes of diagnosis, and available treatment.

  19. Theorizing Time in Abortion Law and Human Rights.

    Science.gov (United States)

    Erdman, Joanna N

    2017-06-01

    The legal regulation of abortion by gestational age, or length of pregnancy, is a relatively undertheorized dimension of abortion and human rights. Yet struggles over time in abortion law, and its competing representations and meanings, are ultimately struggles over ethical and political values, authority and power, the very stakes that human rights on abortion engage. This article focuses on three struggles over time in abortion and human rights law: those related to morality, health, and justice. With respect to morality, the article concludes that collective faith and trust should be placed in the moral judgment of those most affected by the passage of time in pregnancy and by later abortion-pregnant women. With respect to health, abortion law as health regulation should be evidence-based to counter the stigma of later abortion, which leads to overregulation and access barriers. With respect to justice, in recognizing that there will always be a need for abortion services later in pregnancy, such services should be safe, legal, and accessible without hardship or risk. At the same time, justice must address the structural conditions of women's capacity to make timely decisions about abortion, and to access abortion services early in pregnancy.

  20. Adolescent Girls and Abortion.

    Science.gov (United States)

    Wellisch, Lawren; Chor, Julie

    2015-09-01

    Abortion is an extremely common procedure in the United States, with approximately 2% of women having an abortion before age 19 years. Although most pediatricians do not provide abortions, many will care for a young woman who is either considering an abortion or has already had one; therefore, the pediatrician should be able to provide accurate and appropriate counseling about this option. To provide the best care for adolescent patients considering abortion, pediatricians must be knowledgeable of aspects of abortion that are universal to all women and have an understanding of considerations specific to the adolescent patient. The purpose of this article is to (1) review recent statistics about teenagers and abortion, (2) explain the different types of abortion available to teenagers who desire to terminate an unwanted pregnancy, (3) discuss aspects of abortion unique to the adolescent population, such as insurance coverage and parental involvement laws, and (4) address common misconceptions about abortion. [Pediatr Ann. 2015;44(9):384-385,388,390,392.]. Copyright 2015, SLACK Incorporated.

  1. Medical specialty considerations by medical students early in their clinical experience

    Directory of Open Access Journals (Sweden)

    Weissman Charles

    2012-03-01

    Full Text Available Abstract Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83% questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in

  2. [Some signs of women applying for abortion].

    Science.gov (United States)

    Simonová, D; Fait, T; Weiss, P

    2010-05-01

    To discover the motivation of women for abortion. Prospective questionary study. Department of Obstetrics and Gynecology, 1st Faculty of Medicine Charles University and General Faculty Hospital Prague. Special questionnaire centered on the social situation, sexual behavior, knowledge about contraception and the use of contraception, and a motivation for abortion was given to one hundred women attending our clinic for abortion for non-medical reasons. Results were discussed in comparison with population survey data. Although education and acces to modern contraceptive methods have induced the great progress in the area of family planning, abortion is still an important psychosocial problem. In our sample an earlier start of sexual intercourse, higher number of sexual partners, and substantialy lower number of hormonal contraception users were found.

  3. Misoprostol and attempted self-induction of abortion.

    Science.gov (United States)

    Jones, M M; Fraser, K

    1998-04-01

    Sporadic reports have documented the use, in countries such as Brazil and Mozambique, of misoprostol to self-induce pregnancy termination (PT). This paper presents the case of a young woman from Mozambique who presented to a UK surgery requesting PT . She stated she was concerned about medication she had taken for epigastric pain in early pregnancy. She reluctantly acknowledged the medication was misoprostol obtained from a friend from Portugal. The patient had taken a total dose of 1000 mcg of misoprostol on the same day. After counseling on the potential adverse effects of misoprostol during pregnancy, specifically miscarriage and fetal abnormalities, the woman accepted but later declined a referral for induced abortion. She gave birth to a healthy infant. There is concern that the access to medical information from unregulated sources through the Internet will increase the potentially dangerous use of misoprostol as an abortifacient.

  4. Physician provision of abortion before Roe v. Wade.

    Science.gov (United States)

    Joffe, C

    1991-01-01

    With the possibility of the Supreme Court overturning the landmark Roe v. Wade (1973) case legalizing abortion, a review of abortion practices pre-Roe is instructive. Abortion became criminalized in the US around 1870, yet many abortions were performed. While estimates for the yearly number of pre-Roe illegal abortions roughly resemble today's number of legal abortions, the difference between legal and illegal abortion rests in the difference between the large number of women who died or were injured then, and the very few women who now die from illegal abortions. Along with the self-induced abortion, different categories of providers performed illegal abortions: physicians, nonphysicians, nurses, midwives, and lay people; all with varying skill, experience, and motives. While there were "butchers" and sexual exploiters, there were also competent, beloved physicians. There were the financially motivated physicians providing abortions full time, and the occasional providers acting with a sense of conscience, risking successful practices and jail. Within this "conscience" group of 44 interviewees gathered through personal networks, ads, etc., abortions were: performed outside of hospitals, reducing the risk of discovery, but creating greater medical risks; begun outside of a hospital with the intrusion into the uterus of an object, provoking a "spontaneous abortion" (miscarriage) needing completion by D and C (dilation and curettage) within a hospital, but only a limited number of such patients could be referred before arousing suspicion; and in a hospital under disguised circumstances, a very tricky undertaking with severe limitations, available only a few times before risking detection. Avoidance and lack of training by today's physicians and the well organized antiabortion groups will undoubtedly make illegal abortions even more difficult to engage in than the pre-Roe days.

  5. Abortion Legalization and Life-Cycle Fertility

    Science.gov (United States)

    Ananat, Elizabeth Oltmans; Gruber, Jonathan; Levine, Phillip

    2007-01-01

    The early-1970s abortion legalization led to a significant drop in fertility. We investigate whether this decline represented a delay in births or a permanent reduction in fertility. We combine Census and Vital Statistics data to compare the lifetime fertility of women born in early-legalizing states, whose peak childbearing years occurred in the…

  6. [Psychological aspects of induced abortion].

    Science.gov (United States)

    Sz Makó, Hajnalka; Veszprémi, Béla

    2011-01-01

    The present paper, based on the results of international studies, is focused on the reconsideration of the psychological aspects of induced abortion. By presenting a narrow cross-section of the Hungarian demographic data, we would like to emphasise the necessity and the significance of a deeper understanding of the subject. Factors behind the decision-making, short- and long term outcomes of the intervention influencing primarily the mental health of women and partner-relationship aspects are discussed in details. While acknowledging the complexity of the subject deriving from the legal, ethical, moral, religious, medical, social and sociological concerns, our aim is to call attention to the psychological aspects of induced abortion and the importance of psychological care of women undergoing surgical operation.

  7. Induced abortion in villages of Ballabgarh HDSS: rates, trends, causes and determinants.

    Science.gov (United States)

    Kant, Shashi; Srivastava, Rahul; Rai, Sanjay Kumar; Misra, Puneet; Charlette, Lena; Pandav, Chandrakant S

    2015-05-29

    Induced abortion has been legal in India on a broad range of medical and social grounds since 1980s. Often, induced abortion is resorted to as a means for contraception, and has a potential to be misused for sex selective feticide. We assessed the rates, trends, causes and determinants of induced abortions from 2008-12 in a rural community of northern India. Present study is a secondary data analysis of pregnancy outcomes at Ballabgarh Health and Demographic Surveillance System from 2008-12. The data was retrieved from the Health and Management Information System maintained at Ballabgarh. Cause of abortion was self-reported by the women who underwent abortion. Of the 11,102 pregnancies, 1,226 (11%) culminated as abortions of which 425 (3.8%) were induced abortions. Spontaneous abortion rate (7.2%) was twice that of induced abortion rate (3.8%). Both abortion rates had an increasing trend during the course of the study period. Self-reported reasons for opting for induced abortions were bleeding per vaginum (23%), unwanted pregnancy (16%), and unviable fetus diagnosed by ultrasonography (11%). Eight percent of the induced abortions were due to the female sex of the fetus. About 11% of the abortions were performed beyond 20 weeks of gestation which was the upper legal permissible gestational age for performing induced abortions in India. About 10% of the abortions were performed by unqualified practitioners. Caste, wealth index, birth order and size of the village population were the factors that were significantly associated with induced abortion. Though the abortion rate was low, the proportionate contribution of induced abortion was more than what could be expected. Unsafe and sex selective abortion, though illegal, was prevalent. Upper caste and higher socio-economic status families were more likely to opt for induced abortion.

  8. Abortion in the Republic of Sakha (Yakutia: Incidence and Trends

    Directory of Open Access Journals (Sweden)

    Natalia I. Duglas

    2016-09-01

    Full Text Available Background: The abortion incidence is influenced by many medical and socioeconomic factors. In some way, it indicates the wellbeing of the population, and the abortion statistics can show the ways to improve medical services and to raise the living standards of people. The objective of the study was to estimate the abortion incidence and to describe its current trends in the Republic of Sakha (Yakutia (the RS(Y. Materials and Methods: The study was designed as a population-based descriptive study, based on the results of a longitudinal analysis of national and regional reports of the Yakut healthcare services and an analysis of medical records describing 34,220 abortions among women living in all regions of Yakutia, which occurred between 2010 and 2014 and in the first 9 months of 2015. Results: The absolute number of abortions performed each year, the rate of abortions per 1,000 women of fertile age, and the rate of abortions per 100 deliveries declined (p<0.01 by about 37%, 32% and 37%, respectively, between 2006 and 2014. The rate of abortions per 1000 women of fertile age in the first 9 months of 2015 decreased by 1.3%, compared to the same period of 2014 (p=0.05. Though the number of abortions in primigravida women decreases every year, the percentage of them is still rather high, especially at the age of 20 to 24 and 15 to 19, accounting for approximately 2.4% of all abortions. The relative number of miscarriages before 12 weeks of pregnancy increased. Changes in the relative number of abortions performed between 12 to 21 weeks of pregnancy characterized by a decrease in the percentage of miscarriages from 2012 to 2015 and a dramatic increase in the percentage of therapeutic abortions. Conclusion: The revealed trends of the absolute number of abortions and the rates of occurrence in the RS(Y can be considered in total as favorable, but compared to the data obtained in Russia in total, the dynamics of these trends cannot be regarded as

  9. Basal body temperature recordings in spontaneous abortion.

    Science.gov (United States)

    Cohen, J; Iffy, L; Keyser, H H

    1976-01-01

    Basal body temperature (BBT) charts taken during the cycle of conception in cases that resulted in spontaneous abortion appear to provide the best available information concerning events associated with time of fertilization in doomed gestations. This study is based on a series of 227 patients who had early spontaneous abortion occurring between January 1967 and December 1974. A diagnosis of pregnancy initiated regular assays of urinary estrogen and pregnanediol excretion. Patients were instructed to report any bleeding episode which might occur, and to preserve all tissues that might be expelled. A total of 11 basal body temperature charts were obtained from patients who had subsequent early spontaneous abortion. Chromosome studies and histologic investigations were conducted. Another group of 11 consecutive BBT records were obtained from patients who had normal deliveries. The study shows that women with normal cycles experience a midcycle temperature rise requiring 1 to 3 days. In subsequent patients, this time limit was exceeded in 7 out of 11 cases of early abortion, and in 4 of 11 fertilization that resulted in an apparently normal gestation and infant. As temperature rise resulted from vigorous progesterone secretion by the corpus luteum, subnormal levels indicate inadequate steroidogenesis in the early luteal phase, and falling estrogen and progesterone levels predicted fetal demise in all cases. These findings are useful in the management of early pregnancy that follows repeated spontaneous first trimester abortions or a prolonged period of infertility. They also confirm experimental and clinical evidence regarding the role of ovulation defects in the occurrence of various types of reproductive wastage, including early abortion, anatomic and chromosome defects of the embryo and others. Prospective studies of cycles of conception through BBT recordings/hormone assays may shed light in the understanding of defects of human reproduction.

  10. 崩漏停对药物流产大鼠子宫出血模型的影响%Effect of Benglouting on Uterine Bleeding of Medical Abortion Rats

    Institute of Scientific and Technical Information of China (English)

    吴敏; 叶凤; 干红女; 王梦; 嵇晶; 许云; 程建明

    2016-01-01

    Objective:Uterine bleeding model rats were carried out to study Benglouting on uterine bleeding.Methods:Mifepristone and misoprostol were given to early-pregnancy rats orally to cause vaginal hemorrhage model in rats.The effects of Benglouting were observed by the change of uterine bleeding quantity,plasma coagulation index,serum estradiol and progesterone levels.The weight and histological change of uterus and ovary were observed as well.Results:Benglouting could promote coagulation and reduce uterine bleeding quantity in uterine bleeding model rats.High dose can improve the levels of serum estradiol and progesterone.Pathology examination of uterine and ovarian tissue showed that high dose group gained the best function recovery of ovarian and the highest value of endometrial repair score,but no significant difference between groups.Conclusion:Benglouting can reduce uterine blood loss of medical abortion and is contribute to ovarian and endometrial repair.%目的:采用流产大鼠子宫出血模型研究崩漏停治疗在体子宫出血症状.方法:采用早孕大鼠灌服米非司酮和米索前列醇造成阴道出血模型,观察崩漏停对该模型子宫出血量的影响,同时观察大鼠的血浆凝血指标、血清雌二醇和孕酮水平变化,子宫和卵巢重量及组织学形态变化.结果:崩漏停对药物流产大鼠有促进凝血和减少子宫出血的作用,高剂量可提高血清雌二醇和孕酮水平.子宫和卵巢组织病理学检查,高剂量组的卵巢功能恢复最好,药物流产子宫内膜修复评分值高剂量组最高,但各组间没有明显差异.结论:崩漏停可减少早孕大鼠药物流产模型的子宫出血量,并有助于卵巢和子宫内膜修复.

  11. Benjamin Moore, Science, and Medical Planning in Early Twentieth-Century Britain

    Science.gov (United States)

    Lawson, Gordon S.

    2008-01-01

    Benjamin Moore (1867-1922), physiologist and biochemist, was an eminent member of the British scientific and medical community in the early twentieth century. As a founder and president of the State Medical Services Association (SMSA) from its establishment in 1912 until his untimely death in 1922, Moore was a prominent medical services activist…

  12. Clandestine abortion in Port Harcourt: user\\'s profile and motivation ...

    African Journals Online (AJOL)

    However a lot of abortions, especially those carried out by medical doctors do ... Data on all the women that sought abortion in the clinics between January and ... that they did not want any more children (3.66%) as a reason for the abortion.

  13. Effect of Marvelon on Medical Abortion: a Randomized, Double-blind and Multi-center Control Study%妈富隆提高药物流产效果的随机双盲对照研究

    Institute of Scientific and Technical Information of China (English)

    陈勤芳; 黄紫蓉; 范晓芳; 方爱华; 黄咏梅; 庄留琪

    2011-01-01

    Objective: To evaluate the clinical effect of Marvelon on the abortion induced by mifepristone and misoprostol. Methods: This was a randomized, double-blind, multi-center control study. Pregnant women meeting the criteria of medical abortion were enrolled in different outpatient centers (3 hospital) of Shanghai,China. After the gestational sac was discharged, all subjects were randomly assigned into two groups: group A based on that the subjects were administered medicine A and group B based on that the subjects was administered medicine B for the next continual 21 d. The complete abortion rate and the time of vaginal bleeding and menstruation recovery were followed up. Results: Total 414 subjects were recruited: group A——Marvelon (desogestrel ethinyl estradiol tablets) group, included 209 cases, and group B——the placebo (only starch) group, included 205 cases. Group A had significant high rate of complete abortion, short time of vaginal bleeding and menstruation recovery compared with group B (P<0.05). Conclusion: Oral administration of Marvelon for continual 21 d just after medical abortion significantly enhances the rate of complete abortion and shortens the time of vaginal bleeding and menstruation recovery.%目的:观察药物流产后及时服用妈富隆的临床效果.方法:在上海市区3个临床中心共招纳600例因非意愿妊娠要求药物流产的早孕(<49 d)健康妇女,采用随机双盲对照的多中心临床研究.各中心门诊按药物流产常规接纳对象,口服米非司酮配伍米索前列醇,孕囊排出后随机分为A组和B组,于当日起每晚加服A或B药(外包装相似)1片,连服21d,定期随访完全流产率、阴道出血时间、月经恢复情况等.结果:完全按医嘱执行并纳入资料分析的共414例,统计后揭秘A药为妈富隆(去氧孕烯炔雌醇片),209例,B药为安慰剂(不含任何药物的淀粉剂),205例,妈富隆组完全流产率高、月经恢复时间和经期出血时间短,

  14. Abortion in Adolescence.

    Science.gov (United States)

    Campbell, Nancy B.; And Others

    1988-01-01

    Explored differences between 35 women who had abortions as teenagers and 36 women who had abortions as adults. Respondents reported on their premorbid psychiatric histories, the decision-making process itself, and postabortion distress symptoms. Antisocial and paranoid personality disorders, drug abuse, and psychotic delusions were significantly…

  15. Abortion in adolescence.

    Science.gov (United States)

    Greydanus, D E; Railsback, L D

    1985-09-01

    This article reviews the difficult but complex subject of abortion in adolescents. Methods of abortion are outlined and additional aspects are presented: psychological effects, counseling issues, and legal parameters. It is our conclusion that intense efforts should be aimed at education of youth about sexuality and prevention of pregnancy, utilizing appropriate contraceptive services. When confronted with a youth having an unwanted pregnancy, all legal options need to be carefully explored: delivery, adoption, or abortion. The decision belongs to the youth and important individuals in her environment. Understanding developmental aspects of adolescence will help the clinician deal with the pregnant teenagers. If abortion is selected, a first trimester procedure is best. Finally, physicians are urged to be aware of the specific, ever changing legal dynamics concerning this subject which are present in their states. Abortion is a phenomenon which has become an emotional but undeniably important aspect of adolescent sexuality and adolescent health care, in this country and around the world.

  16. Constructing abortion as a social problem: “Sex selection” and the British abortion debate

    Science.gov (United States)

    2017-01-01

    Between February 2012 and March 2015, the claim that sex selection abortion was taking place in Britain and that action needed to be taken to stop it dominated debate in Britain about abortion. Situating an analysis in sociological and social psychological approaches to the construction of social problems, particularly those considering “feminised” re-framings of anti-abortion arguments, this paper presents an account of this debate. Based on analysis of media coverage, Parliamentary debate and official documents, we focus on claims about grounds (evidence) made to sustain the case that sex selection abortion is a British social problem and highlight how abortion was problematised in new ways. Perhaps most notable, we argue, was the level of largely unchallenged vilification of abortion doctors and providers, on the grounds that they are both law violators and participants in acts of discrimination and violence against women, especially those of Asian heritage. We draw attention to the role of claims made by feminists in the media and in Parliament about “gendercide” as part of this process and argue that those supportive of access to abortion need to critically assess both this aspect of the events and also consider arguments about the problems of “medical power” in the light of what took place. PMID:28367000

  17. SUPPRESSOR OF APICAL DOMINANCE1 of Sporisorium reilianum changes inflorescence branching at early stages in di- and monocot plants and induces fruit abortion in Arabidopsis thaliana.

    Science.gov (United States)

    Drechsler, Frank; Schwinges, Patrick; Schirawski, Jan

    2016-05-03

    sporisorium reilianum f. sp. zeae is a biotrophic smut fungus that infects maize (Zea mays). Among others, the fungus-plant interaction is governed by secreted fungal effector proteins. The effector SUPPRESSOR OF APICAL DOMINANCE1 (SAD1) changes the development of female inflorescences and induces outgrowth of subapical ears in S. reilianum-infected maize. When stably expressed in Arabidopsis thaliana as a GFP-SAD1 fusion protein, SAD1 induces earlier inflorescence branching and abortion of siliques. Absence of typical hormone-dependent phenotypes in other parts of the transgenic A. thaliana plants expressing GFP-SAD1 hint to a hormone-independent induction of bud outgrowth by SAD1. Silique abortion and bud outgrowth are also known to be controlled by carbon source concentration and by stress-induced molecules, making these factors interesting potential SAD1 targets.

  18. Perceptions of misoprostol among providers and women seeking post-abortion care in Zimbabwe.

    Science.gov (United States)

    Maternowska, M Catherine; Mashu, Alexio; Moyo, Precious; Withers, Mellissa; Chipato, Tsungai

    2015-02-01

    In Zimbabwe, abortions are legally restricted and complications from unsafe abortions are a major public health concern. This study in 2012 explored women's and providers' perspectives in Zimbabwe on the acceptability of the use of misoprostol as a form of treatment for complications of abortion in post-abortion care. In-depth interviews were conducted with 115 participants at seven post-abortion care facilities. Participants included 73 women of reproductive age who received services for incomplete abortion and 42 providers, including physicians, nurses, midwives, general practitioners and casualty staff. Only 29 providers had previously used misoprostol with their own patients, and only 21 had received any formal training in its use. Nearly all women and providers preferred misoprostol to surgical abortion methods because it was perceived as less invasive, safer and more affordable. Women also generally preferred the non-surgical method, when given the option, as fears around surgery and risk were high. Most providers favoured removing legal restrictions on abortion, particularly medical abortion. Approving use of misoprostol for post-abortion care in Zimbabwe is important in order to reduce unsafe abortion and its related sequelae. Legal, policy and practice reforms must be accompanied by effective reproductive health curricula updates in medical, nursing and midwifery schools, as well as through updated training for current and potential providers of post-abortion care services nationwide. Our findings support the use of misoprostol in national post-abortion care programmes, as it is an acceptable and potentially life-saving treatment option.

  19. Abortion, 1973: some recent world events in relation to pregnancy termination.

    Science.gov (United States)

    1974-06-01

    This selective report notes recent events relating to pregnancy termination in the U.S., France, England, Italy, East and West Germany, Norway, Sweden, and the Netherlands. Due to the Supreme Court decision in January 1973, abortion is now legal in the U.S. Although abortions is illegal in France, an estimated 400,000-1,000,000 clandestine abortions occur each year. Although abortions are legal in Britain, the ease with which they can be obtained varies regionally. As of March 1973, contraceptives are part of Britain's National Health Service. In Italy, a bill to legalize abortion has been introduced in Parliament, though there is little likelihood of its passing. In East Germany, abortion can be granted for medical or social reasons, while in West Germany, the governmental policies are more conservative, resulting in an abundance of illegal abortions performed by physicians. There is a trend toward easier abortion laws in Norway and Sweden. Little is happening in the Netherlands as far as liberalizing the abortion laws. Rather liberal grounds for pregnancy termination exist in China (though emphasis is on contraception), India, Russia, and Eastern Europe (with the exception of Romania). Abortion is frowned upon in Africa, Latin America, and the Middle East resulting in a large number of illegal abortions. It is concluded that there is liberalized abortion in communist bloc countries, there is trend toward liberalizing abortion in a large group of western countries, and tradition and religion are responsible for conservative abortion laws in a third group of countries.

  20. Effects of Yishenyangxuehuoxue decoction on colporrhagia and menstruation after drug induced abortion%益肾养血活血汤对药物流产后阴道出血及月经的影响

    Institute of Scientific and Technical Information of China (English)

    李海霞

    2015-01-01

    Objective To investigate the effects of Yishenyangxuehuoxue decoction( YSYXHX decoction) on colporrhagia and menstruation after drug induced abortion.Methods One hundred and forty-eight women with early pregnancy were selected, and divided into simple medical abortion group(n=47), medical abortion+traditional Chi-nese medicine group(n=50), operation abortion group(n=51).The simple medical abortion group was given oral mifepristone tablets.The medical abortion+traditional Chinese medicine group was given YSYXHX decoction based on the same treatment as the simple medical abortion group.The operation abortion group used vacuum aspiration a-bortion.The changes of reproductive hormone, vaginal bleeding duration, vaginal bleeding amount and occurrence of menstrual disorder were compared among the three groups during the follow-up period.Results HCG, LH, P at the seventh days after discharge of gestational sac in the operation abortion group and in the medical abortion+traditional Chinese medicine group were significantly lower than those in the simple medical abortion group(P<0.05), and than those in the operation abortion group(P<0.05).The FSH, E2 at the seventh days after discharge of gestational sac in the operation abortion group and in the medical abortion+traditional Chinese medicine group were significantly higher than those in the simple medical abortion group.And than those in the operation abortion group(P<0.05). The rates of vaginal bleeding duration at 8~15 days and more than 15 days in the operation abortion group and the medical abortion+traditional Chinese medicine group were lower than those in the simple medical abortion group( P<0.05 ) .The rates of abnormal vaginal bleeding in the operation abortion group and in the medical abortion+tradition-al Chinese medicine group were lower than that in the simple abortion group(P<0.05).The incidences of menstrual disorders in the operation abortion group and in the medical abortion+traditional Chinese medicine