Comparative histological investigations on the evacuated uterine mucous membrane in the vacuum-excochleation and classical methods of interruption of pregnancy

The author has investigated comparatively the degree of injury on the walls of the uterine cavity using the vacuum-excochleation method and classical methods of pregnancy interruption. The evacuated contents resulting from abortions in 823 patients were studied histologically. It was found that with the vacuum-excochleation method, the mucous membrane was separated in the spongiose in 66.2% of the cases, injury of basal layer occurred in 8%, muscular layer injury was found in 4.2%, and a deep injury of the muscular layer was found in .4%. With the classical method of pregnancy interruption, the incidence of injury of the basal layer was 24.3%, myometrial injury was found in 35.4%, and a deep injury of the muscular layer occured in 15.2% of the cases. The depth of injury of the mucous membrane with the vacuum-excochleation method depends on: 1) the strength of vacuum, 2) the model of the instrument; and 3) the size of the terminal aperture of the vacuum-curet.     

Post-abortion complications after interruption of pregnancy with misoprostol

The high incidence of abortion in Brazil and the increased use of misoprostol among women having clandestine/unsafe abortions has led to an interest in evaluating whether there is an association between the use of misoprostol and the incidence of septic complications post-abortion. To test this association, a retrospective cohort study was conducted with 1840 women treated post-abortion at the Instituto Materno-Infantil de Pernambuco (IMIP) between 1988 and 1992. Incidence of infection (4.2%) was lower in women stating they had used misoprostol than in those stating that the abortion was not induced (7.9%) and twelve times lower than in women stating that they had used other methods (49.4%). These results suggest that misoprostol is a safe, inexpensive method for inducing abortion, and leads to fewer complications and consequently shorter hospital stays. Misoprostol should be considered a viable option in situations where induction of abortion is legal or medically indicated.

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Resumen La alta incidencia de abortos en Brasil y el uso creciente de misoprostol entre mujeres que tienen abortos clandestinos/peligrosos suscitó interés por determinar si había alguna asociación entre el uso de misoprostol y la incidencia de complicaciones sépticas después del aborto. A fin de someter a prueba tal asociación, se realizó un estudio retrospectivo cohorte con 1840 mujeres tratadas después de un aborto en el Instituto Materno-Infantil de Pernambuco (IMIP) entre 1988 y 1992. La incidencia de infectión (4,2%) fue inferior en las mujeres que manifestaron haber utilizado misoprostol que en aquéllas que manifestaron que el aborto no había sido inducido (7,9%) y doce veces inferior que en las mujeres que manifestaron haber utilizado otros métodos (49,4%). Estos resultados sugieren que el misoprostol es un método seguro y económico para inducir el aborto, y que origina menos complicaciones y, por consiguiente, períodos más breves de hospitalización. El misoprostol debe considerarse como una opción viable en situaciones en las que la inducción del aborto es legal o está médicamente indicada.

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Resumé L'incidence élevée des interruptions de grossesse au Brésil et le recours de plus en plus fréquent au misoprostol par les femmes se soumettant à des avortements clandestins/dangereux ont conduit à rechercher une association éventuelle entre l'utilisation du misoprostol et l'incidence des complications septiques après l'avortement. Pour évaluer cette association, une étude cohorte rétrolective a été menée sur 1840 femmes traitées après l'avortement à l'Instituto Materno-Infantil de Pernambouc entre 1988 et 1992.L'incidence d'infection (4,2%) était moins élevée chez les femmes ayant signalé qu'elles avaient utilisé le misoprostol que chez celles ayant déclaré que l'avortement n'avait pas été provoqué (7.9%) et douze fois moins élevée que chez celles qui avaient eu recours à d'autres méthodes (49,4%). Ces résultats laissent à penser que le misoprostol est un moyen sans danger et peu coûteux pour déclencher l'avortement et qu'il entraïne moins de complications et, par conséquent, une hospitalisation de plus courte durée. On devrait considérer le misoprostol comme une option valable dans les situations où l'interruption de grossesse est légale ou indiquée pour des raisons médicales.

     

Medicinal interruption of pregnancy using epostane

Vacuum curettage is the most efficient way of terminating unwanted pregnancies for amenorrhea periods not exceeding 12 weeks. Although fairly safe, the method can cause complications such as infections, bleeding, perforations and incomplete evacuations, and the long term effects are uncertain. The use of medicinal drugs has several advantages, e.g., damage to the cervix can be eliminated. Epostane, a steroid still in clinical trial phase, inhibits progesterone genesis and synthesis in the corpus luteum and placenta, which may lead to abortion. 50 informed and consenting women, above 18 and pregnant less than 8 weeks, determined echographically, were tested with the drug in order to check for efficiency and possible side effects. A dose of 200 mg was given orally during 7 days. Progesterone levels in serum were determined by radioimmunoassay, on day 0, 7 and 14. the results was evaluated on the 14th day. Of the 50, a group of 8 were still pregnant. The progesterone levels in the luteal phase, and the rate of decrease of progesterone concentrations, although on an average higher in the non-respondent group, showed some individual inconsistencies pointing to other hormonal agents responsible for protecting pregnancy. The results also indicated clear but insignificant responsive differences between primi- and multiparous women (90% vs. 76%), which were only minimally reflected in progesterone concentrations. When progesterone production, after 5-6 weeks of amenorrhea, is shifted from the corpus luteum to the placenta, in the corpo-luteal phase, chances of blocking progesterone synthesis are considered theoretically to be the highest. The number of responses during that time period confirmed this. Of importance for dispensation on an out-patient basis is to establish how much blood loss occurs. The tests showed clinically accepted norms.     

Our experience with the IUD (contraceptive loop) inserted immediately after interruption of pregnancy

In Hungary, abortion seemed to be the preferred method of family planning. A study was undertaken of 426 women aged between 20 and 30 who volunteered for IUD insertion after abortion. The Hungarian nylon IUD and the 3-dimensional Organom device were employed. For a 9 month period, 5 pergnancies were reported, in 4 of which the IUD was missing from the uterus. There were 9 expulsions, and 4 removals for bleeding and pain. 93.5% of women found the IUD satisfactory.     

A suggested set of working definitions and criteria applicable to interruption of pregnancy

A list of prerequisites, essential items of information and definitions applying to studies on interruption of pregnancy is presented. It is suggested that such would permit proper analysis and comparison of results obtained by different investigators.     

Intra-amniotic Rivanol injection for the mid-term interruption of pregnancy

Authors report their experiences about the use of intraamniotic Rivanol injection in the interruption of midtrimester pregnancies. Instillation was made between 15-24 gestation weeks with the use of 0.1% Rivanol solution in 108 cases. The abortion occurred averagely 36.9 hours after induction without remarkable complications in all cases. According to their experiences the intraamniotic Rivanol injection is an effective and safe method for the interruption of second-trimester pregnancies.     

Contraceptive method continuation according to type of provider

A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.     

Meanings of risk in pregnancy according to obstetrics: bibliographic study

This study analyzes the meaning of high-risk pregnancy in articles published by a representative Brazilian journal in the field of Obstetrics in the 1990s. The methodological approach includes the quantitative and qualitative analysis of 40 articles, which reveals a diversity of meanings attributed to high-risk pregnancy and a reduced discussion on the theme. The conclusion shows the need to include an interdisciplinary approach to the theme by taking into account the complexity of the aspects involving women's participation in pregnancy care.     

Variation in newborn size according to pregnancy weight change by trimester

BACKGROUND: The timing of maternal weight change in pregnancy may be an important determinant of the newborn's size. OBJECTIVE: The purpose was to identify effects of maternal weight change by trimester on newborn size, under the hypothesis that low weight gain early in pregnancy predicts proportionately smaller newborns. DESIGN: Women planning to become pregnant were followed by clinic visits and questionnaires through delivery. This study includes 389 women and their singleton infants born at a gestational age of > or = 241 d. RESULTS: In multiple regression analyses including a variety of potential confounders, maternal weight gain in the first and second trimesters predicted newborn weight (1-kg weight gain in the first trimester predicted a 31-g increase in newborn weight, P < 0.0007, and 1-kg weight gain in the second trimester predicted a 26-g increase in newborn weight, P < 0.007), but weight gain in the third trimester did not. Newborn ponderal index (in kg/m(3)) was predicted by weight gain in the first (1-kg weight gain predicted an added 0.21 units, P < 0.0003) and third (1-kg weight gain predicted an added 0.12 units, P < 0.03) trimesters but not in the second trimester. Newborn weight was 211 g lower (P < 0.006) and ponderal index 1.2 units lower (P < 0.02) in infants born to women who lost weight in the first trimester. CONCLUSIONS: The use of measured prepregnancy weight in tests of the effect on newborn size of weight gain by time in pregnancy produces different results than does the use of recalled prepregnancy weight. Maternal weight change in the first trimester of pregnancy more strongly influences newborn size than does weight change in the second or third trimester.