Interruption of Pregnancy by Indigenous Method

Abstract

The stem from a creeper vine of the species Asclepeadaeae (further identification of the plant has not yet been made) has been used in some areas of Bangladesh as a means of inducing abortion. Although it has not been performed by physicians, many women believe this method of abortion to be safe and effective. In a study conducted to determine the safety and effectiveness of this method, 108 women, between 12 and 24 menstrual weeks' gestation and 15 to 42 years of age, were studied. One of three sizes of stems from the plant (thin, 2–3 mm; medium, 3–4 mm.; thick, 4-4.5 mm.) was inserted through the cervical canal either manually or with a Lippes loop inserter. Subjects were observed a minimum of 72 hours after insertion of the stem. Fifty-four (54.596) of the patients aborted within 72 hours. Insertion-to-abortion time was affected by the size of the stem and by gestational age, but not by parity. Patients aborted with the thick stem and those greater than 16 weeks' gestation aborted more rapidly (mean: 47.2 and 41.4 hours, respectively). Complications consisted of excessive bleeding (13.1%), persistent fever (9.1%), and persistent pain (14.1%). Thirteen (13.1%) of the patients were diagnosed as having pelvic infections. No other potentially serious complications were observed. In this initial series, the method compares favorably with other experimental methods (urea, alcohol, laminaria tents, or Karman coil methods); however, it is not as safe or effective as intra-amniotically administered Prostaglandin F2g Abortion rates and induction-to-abortion times were similar to those for intra-amniotic saline inductions, but the rate of complications for the stem was significantly higher. Further study is needed to determine the mechanism of action for this indigenous method. It would appear that the stem contains an oxytocic agent; however, the oxytocic and/or abortifacient agent has not been identified. Hopefully, when the aborti-facient agent(s) are identified and administered in maximally effective doses under sterile conditions, a practicable method of artificial aobrtion can be defined.