Induced abortion frequency in Ankara,Turkey, before and after the legal regulation of induced abortion

Objective To determine the effects of the 1983 law that legalized induced abortion on the number and place of abortions, and on the use of family planning (FP) methods before and after abortion, and to determine the demographic characteristics and reproductive health features according to the order of abortion.

Method This study included 2455 married, widowed or divorced women presenting at Mother and Child Health-Family Planning Centres in Ankara. A questionnaire was used for data collection.

Result Nearly three out of 10 (28.7%) of the women had undergone at least one induced abortion. In the age groups 45–54 and 55–64, 49 and 37.3%, respectively, had had one or more terminations of pregnancy (TOPs). The induced abortion rate increased following the enacting of the law. In the 15–24 and in the 55–64 age group, 55.6 and 89%, respectively, of the women had been aborted by a private physician. Before the index pregnancy, 63.1% were not using contraception compared with 37.3% thereafter. The rate of use of FP increased after the law was passed.

Conclusion Although the most common reason for having an abortion was unwanted pregnancy in all age groups and nearly 60.0% of the women aged less than 55 reported that they were not using any FP method at the time of the TOP, the proportion of women having undergone at least one of these procedures increased after the law was passed, indicating that abortion is used as a FP method.     

One year of counseling before legal abortion

The required interview with a counselor before legal abortion in France can become depressing for the counselor because almost all clients are already committed, interpret it as one more bureaucratic barrier, and in mass appear as numerous cases of failure. Despite this the author tries to be open and nonjudgemental in order to permit free exchange and reconsideration, and to dispense information on contraception and social services. She encountered only 4 reconsiderations in hundreds of interviews.     

Trends in induced legal abortion morbidity and mortality

Abortion mortality in the USA experienced an eight-fold decline between 1972 and 1981, with the greatest decline occurring after 1975. The risk for all groups of women declined, but the decline was greater for some groups than for others. When both changing risk for a given characteristic and changing prevalence of that characteristic were examined, it appears that the declining mortality rates are largely due to a downward shift in the gestational ages at which abortions are obtained and the increased use of D&E for abortions at 12 gestational weeks or later. Although morbidity data analogous to the mortality data are not available, analysis of morbidity trends from three large multicentre prospective studies between 1970 and 1978 suggests that morbidity may not have declined quite as rapidly as mortality. The morbidity data, as well as giving information on cause-specific abortion mortality in the USA, showing dramatic declines for such causes as infection and pulmonary embolus, suggest that improved medical management of complications has contributed to declining abortion mortality in the USA.     

Contraception before and after induced abortion (author's transl)

This document presents data on contraception gathered on 1000 women who underwent voluntary induced abortion at the Minor Obstetric Surgery and Gynecologic Ward of the University of Rome, Italy. 33.4% of women were from outside of Rome; 61.3% were between 18-30, and only 6.2 were minors; 50.3% were unmarried and 49.7% were married; more than 50.8% had a high school education; 79.2% of requests for abortion were urgent, and most were done between the 7th and 9th week of gestation. Prior to the abortion only 40% of women had sometimes used an effective contraceptive method, i.e. 308 women had used the pill, 28 the IUD, and 25 the diaphragm. Of the remaining women 20%, or 210, had never used contraception, and 40%, or 421 women, relied on coitus interruptus, which remains the method of choice. 84 women used the Ogino-Knaus method, 60 used spermicidal agents, and 85 the condom. 841 women came back for a control visit; after appropriate counseling, medical and psychological, 203 women chose the IUD and 141 the pill as a contraceptive method. 116 women did not accept any contraception at all. These data show that knowledge about contraception is not widespread as it should be, and that efforts must be made by the medical and paramedical personnel.     

Contraceptive practices of women after abortion in Turkey.

OBJECTIVES: The aim ofthis study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the 1-year follow-up period were also assessed. METHODS: Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion family planning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-up for 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period. RESULTS: Following counselling, 79.64% of the patients signed for immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten out of 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs) (n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively. At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). In one case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up. CONCLUSION: The use of postabortion family planning significantly decreased the postabortion pregnancy rate. The use of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptable in our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate on the ideal conditions for conception or they do, in fact, practice some form of family planning.     

Curettage after mifepristone-induced abortion: frequency, timing, and indications.

OBJECTIVE:To characterize women who underwent curettage after medical abortion with mifepristone and vaginal misoprostol, to describe when curettage occurred and the reasons for the intervention, and to categorize the indications for curettage according to a simple classification schema. METHODS: These analyses used data from two multisite, randomized controlled trials sponsored by Abortion Rights Mobilization. In the first study, women pregnant less than 63 days received 200 mg of mifepristone and 800 microg of vaginal misoprostol to use 48 hours after taking mifepristone. In the second study, women pregnant less than 56 days were randomly assigned to insert vaginal misoprostol at 1, 2, or 3 days after mifepristone administration. Case report forms and clinical case notes of all women who underwent curettage were examined. RESULTS: Of the 4393 women enrolled in both studies, 116 (2.6%, 95% confidence interval 2.1%, 3.1%) curettages were identified. The gestational age and a history of prior elective abortion were associated with the rate of curettage. The distribution of indications for curettage included bleeding, 61 (53%); continuing pregnancy, 17 (15%); patient request, 36 (31%); and indeterminate, 2 (1.7%). The timing of curettage differed by the indication and scheduled interval between study visits. The distribution of the timing was bimodal. One subset of women, 44 (38%), underwent curettage in the first study week and another subset, 43 (37%), during weeks 3-5. CONCLUSION: Curettage after medical abortion with mifepristone and vaginal misoprostol is rare. At least one half of the curettages were performed for persistent bleeding several weeks after treatment. Both acute heavy bleeding and continuing pregnancy are extremely rare.     

Observations on patients two years after legal abortion,

The patients who underwent legal abortions in 1971 were invited to a follow-up examination 2 years later. 25% of the 562 patients invited came to be examined. Anamnestic data were obtained on 60%. Early complications had occurred in 10% of the cases. During the 2-year period which had elapsed, the 338 patients had had 73 new pregnancies (22%), of which 60% had terminated in delivery. No spontaneous abortions in the second trimester had occurred in the new pregnancies. 15% of the patients had resorted to repeated legal abortion. 44% of the patients were using oral contraceptives or IUCD 2 years after the abortion. A gynecological examination gave rise to a suspicion of cervical insufficiency in 10% of the cases examined. Hysterosalpingography suggested tubal pathology in 18%. In laparoscopy no occurrences of bilateral tubal occlusion were found. The need of new follow-up examination later is obvious.     

Contraceptive practices of women after abortion in Turkey

Objectives The aim of this study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the 1-year follow-up period were also assessed. Methods Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion family planning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-up for 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period. Results Following counselling, 79.64% of the patients signed for immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten out of 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs) (n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively. At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). In one case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up. Conclusion The use of postabortion family planning significantly decreased the postabortion pregnancy rate. The use of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptable in our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate on the ideal conditions for conception or they do, in fact, practice some form of family planning.     

A study of delta intrauterine devices in Ankara, Turkey

Delta devices, modifications of standard Lippes Loop D and TCu 220C IUDs, were designed for postpartum insertion. A study of the Delta T and the Delta Loop was conducted at Hacettepe University School of Medicine in Ankara, Turkey. The IUDs were randomly allocated to 246 immediately postpartum women (less than 10 min postplacenta). Twelve-month expulsion rates were low for both devices; 3.7 for Delta Loop users and 7.6 for Delta T users.     

Rh immunoglobulin utlization after spontaneous and induced abortion.

To monitor the utilization of Rh immunoglobulin (RhIG), we reviewed the charts of 389 spontaneous and 1350 induced abortion patients treated in 1975 at a metropolitan hospital. The rate of ascertainment of Rh type was significantly higher for induced (99.6%) than for spontaneous abortion patients (95.1%) (P less than 0.001). Utilization of Rh immunoglobulin (RhIG) also was significantly higher for induced (98.9%) than for spontaneous abortion patients (80.6%) (P less than 0.001). Women at risk who did not receive RhIG after spontaneous abortion were mostly young, of low gravidity, and at gestational ages (mean 14.4 weeks) associated with substantial risks of Rh sensitization. Eradication of Rh hemolytic disease requires improvement in the system of identifying and treating patients who need prophylaxis.     

Ultrasonographic view and women's behaviour before first-trimester induced abortion

Women's behaviour before induced abortion during an ultrasonographic exam was described. A psychosomatic analysis was carried out in the discussion to try to explain the different women's attitudes. Most women do not want to see ultrasonographic scan or keep photographs. One must of course respect women's choices as to their desire to see or not the ultrasound image of their foetus when pre-induced abortion ultrasound examination is performed. One should nonetheless be able to listen to their request, be it implicit.     

HIV antibody screening in a gynecology and obstetrics clinic Ankara, Turkey

In 416 pregnant women, admitted to our outpatient obstetric clinic for antenatal care between December 1987 and August 1988, HIV antibody assesments were performed by ELISA technique. No seropositive case was reported.     

Incidence of spontaneous abortion in Bahrain before and after the Gulf War of 1991.

OBJECTIVES: To determine the incidence of spontaneous abortions in the 5 years before and 5 years after the Gulf War of 1991 and to explore the possible causes that may have affected these changes. To analyze the clinical types, associated medical problems, morbidity, length of hospital stay and mortality rate of abortions. DESIGN: Retrospective study for the period starting on 1 January 1987-31 December 1996. SUBJECTS: The study involved 14,850 cases of abortions admitted into Salmaniya Medical complex during this period. SETTING: The Salmaniya Medical Complex (SMC) is the main referral hospital in Bahrain. METHODS: Analysis of medical records of patients admitted with diagnosis of abortion during this period. RESULTS: By comparing the incidence of abortions in the 5 years before (1 January 1987-31 December 1991) and the 5 years after (1 January 1992-31 December 1996) the Gulf War a significant rise was observed--starting from 1992, reaching a peak in 1994, which then began to decline in 1996. CONCLUSION: Several published reports from Iraq, Kuwait and now from Bahrain are suggestive of an increase in the incidence of abortion and adverse outcome of pregnancy after the Gulf War of 1991. The mechanism is not clear, i.e. whether this is affected by toxicity acquired through the food chain, the oil spillage, smoke pollution resulting from the burning of the Kuwaiti oil fields or stress and anxiety caused by the war.     

Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy

Human chorionic gonadotropin (hCG) in maternal serum was analyzed by a hCG-beta-subunit, radioimmunoassay (hCG-beta-RIA) in 36 cases after induced first-trimester abortion, 35 cases of spontaneous abortion in the first trimester, and in 35 cases of ectopic pregnancy to determine the time between the apparent removal of all trophoblastic tissue by surgical intervention and the disappearance of hCG from the blood. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy and removal of the affected tube. There was a significant correlation between the initial hCG levels and the disappearance time in each series. The demonstrated disappearance times are longer than previously recognized, which should be appreciated when hCG is analyzed after termination of early pregnancy.     

Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000

OBJECTIVE: To test the hypothesis that pregnant and recently pregnant women enjoy a "healthy pregnant women effect," we compared the all natural cause mortality rates for women who were pregnant or within 1 year of pregnancy termination with all other women of reproductive age. STUDY DESIGN: This is a population-based, retrospective cohort study from Finland for a 14-year period, 1987 to 2000. Information on all deaths of women aged 15 to 49 years in Finland (n=15,823) was received from the Cause-of-Death Register and linked to the Medical Birth Register (n=865,988 live births and stillbirths), the Register on Induced Abortions (n=156,789 induced abortions), and the Hospital Discharge Register (n=118,490 spontaneous abortions) to identify pregnancy-associated deaths (n=419). RESULTS: The age-adjusted mortality rate for women during pregnancy and within 1 year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women, 57.0 per 100,000 person-years (relative risk [RR] 0.64, 95% CI 0.58-0.71). The mortality was lower after a birth (28.2/100,000) than after a spontaneous (51.9/100,000) or induced abortion (83.1/100,000). We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15 to 24 years (RR 4.08, 95% CI 1.58-10.55). CONCLUSION: Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.     

The disappearance of human chorionic gonadotropin from plasma and urine following induced abortion. Disappearance of HCG after induced abortion

In 28 females, daily measurement of the HCG concentration in urine and in 15 of them daily measurement of the beta-HCG concentration in plasma was carried out during the first 2 weeks following first-trimester induced abortion by vacuum aspiration. Plasma beta-HCG concentration fell according to a multi-exponential curve with a half-life of 0.63 days in the first 2 days following induced abortion, and of 3.85 days in the subsequent 14 days. The disappearance of HCG from urine is exponential, with a half-life value of 1.3 days. A urine pregnancy test with a sensitivity of 1 IU/ml wil nearly always be negative in the course of 2 weeks after abortion. A positive test 4 weeks after abortion indicates an incomplete abortion or persistent trophoblast.