History Of Termination Research Articles

Modern contraceptive utilization and its associated factors in East Africa: Findings from multi-country demographic and health surveys.

The use of modern contraceptives has been low in most Sub-Saharan African countries despite high population growth and a sluggish economy. This study aimed to identify the prevalence and determinants of modern contraceptive use among married reproductive-age women in East Africa. For this study, the Demographic and health survey (DHS) data from nine countries in East Africa were analyzed, yielding a weighted sample of 32,925 married women. A multilevel mixed-effect logistic regression model was used to identify characteristics associated with the utilization of modern contraceptives at a p-value less than 0.05. For model comparison, we used the Akaike and Bayesian Information Criteria (AIC and BIC). For assessing variation (random effects), we used community-level variance with standard deviation and intra-cluster correlation coefficient (ICC). The overall prevalence of modern contraceptive use was 45.68%, 95% CI (45.15, 46.21). Women's age, maternal education level, husband education level, media exposure, wealth status, occupation, religion, the total number of children ever born, distance to health facilities, history of termination of pregnancy, couple's desire for children, women's participation in decision making, living country and place of residence were significantly associated with modern contraceptive use in Eastern Africa. Conferring to this study, utilization of modern contraceptives is low in East Africa. Interventions to improve the use of modern contraceptives should encompass disseminating awareness through mass media, enrolment of males in family planning, giving maternal education, building health facilities in remote areas, and encouraging family planning programs in rural areas.

Spatial and Multilevel Analysis of Unscheduled Contraceptive Discontinuation in Ethiopia: Further analysis of 2005 and 2016 Ethiopia Demography and Health Surveys.

Unscheduled discontinuation of contraceptives is a public health problem among women of reproductive age. Particularly, it is associated with unwanted pregnancies that lead to maternal and child mortality, but little is known about the spatial distribution of the problem. Therefore, this study aims to assess the spatial distribution and associated factors of unscheduled contraceptive discontinuation in Ethiopia. This study used secondary data from the Ethiopia Demography and Health Survey (EDHS) data of 2005 and 2016. The study population was women who used contraceptives in the preceding 5 years before the survey. A total of 2,327 and 3,858 eligible women were included in the final analysis of the 2005 and 2016 EDHS, respectively. For the spatial analysis, both the 2005 and the 2016 EDHS data were analyzed using ArcGIS version 10.7, while for multilevel regression analysis, the 2016 EDHS data were used. The final model reported an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and a p-value of 0.05 was used to declare statistical significance. This study revealed that unscheduled discontinuation of contraceptives varied geographically, and hotspots were detected in the central, north, and eastern parts of Ethiopia. Moreover, diploma and higher education (AOR = 1.40; 95% CI: 1.01-1.95), urban residence (AOR = 1.37; 95% CI: 1.08-1.72), history of termination of pregnancy (AOR = 1.47; 95% CI: 1.14-1.94), married women (AOR = 10.79; 95% CI: 6.98-16.69), separated/divorced women (AOR = 1.54: 95% CI: 1.07-2.30), -two to four number of children (AOR = 1.46; 95% CI: 1.15-1.84), and involvement in the decision-making process of contraceptive use (AOR = 39.26; 95% CI: 28.84-53.45) were all factors associated with unscheduled discontinuation of contraceptives. This study revealed that unscheduled discontinuation of contraceptive distribution was significantly clustered in the central, north, and eastern parts of Ethiopia, as found in two surveys. The magnitude of this discontinuation increased from 2005 to 2016. The finding underscores that further interventions such as the availability of multiple mixed methods and improvement in women's decision-making ability in the choice of contraceptive methods and utilization are needed in hotspot areas of Ethiopia.

A first stage placental site trophoblastic tumor: a case report and review of literature.

Placental site trophoblastic tumor (PSTT) is a very rare form of gestational trophoblastic disease (GTD) that occurs mainly in women who have a history of termination of pregnancy. It has different characteristics from other gestational trophoblastic tumors: it grows slowly, secretes low levels of beta-human chorionic gonadotropin (β-hCG), with low metastatic potential. We report a case of PSTT of a 32-year-old patient. Seven months after delivery, the patient presented at our Center with persistence of menorrhagia for at least 1 month. A slightly high level of beta-human chorionic gonadotropin (β-hCG) was observed. TVUS and MRI, an operative hysteroscopy and a laparoscopy were performed. The histological and immunohistochemical findings demonstrated PSTT. Diagnosis of juvenile cystic adenomyoma (JCA) was also added. A total body CT scan was negative for metastases. A total hysterectomy with salpingectomy was performed. We performed a search of relevant studies about PSTT of the last years. A systematic search of Pubmed databases was conducted. Appropriate search terms were constructed by reviewing abstracts, titles and keywords relating to PSTT known to the authors. All articles known to the authors useful to the review were included, comparing with our clinical case. Stages and treatment are related to survival rates, with long term survival expected for stage I low-risk disease after hysterectomy. Our case is a stage I disease with good prognostic factors (patient's age and absence of metastases) and, as described in the literature, a total hysterectomy with salpingectomy was performed.

Acceptability of different mechanisms of action of contraception in women: a questionnaire survey

BackgroundThe mechanism of action of a contraceptive method is an importantg consideration in a woman’s choice of contraception. For the development of new methods of contraception it is important to...

Self-reported syndromes of sexually transmitted infections and its associated factors among reproductive (15–49 years) age women in Ethiopia

BackgroundSexually Transmitted Infections (STIs) are among the most important causes of maternal and neonatal morbidity and mortality. It remains a significant public health problem and disproportionately affects women posing a large public health burden in low and middle-income countries. However, there is little information on the magnitude of self-reported syndromes of STIs among reproductive-age women in Ethiopia. AimThis study aimed to determine the magnitude of self-reported syndromes of sexual transmitted infections and its associated factors among women of reproductive age in Ethiopia. MethodsThe study was based on the data from the Ethiopian Demographic Health Survey of 2016. The data on the status of self-reported STIs were extracted from the individual women dataset, and a total of 15,683 reproductive-age women were involved in the study. Since the data has a hierarchical and cluster nature sampling weight was applied for all analysis procedures to account for complex survey design. Rao-scot chi-square test that adjusts for complex sample design was used to examine the association of outcome and independent variables. In, multivariable analysis, the level of statistical significance was declared at P-value ≤ 0.05. Findings and conclusionsThe magnitude of self-reported STIs was 3.0 % (95% CI: 2.92–3.08). Among self-reported syndromes of STIs only, 33.3 % (158) seek care for sexually transmitted infections. Age (Adjusted Odds Ratio (AOR = 2.15; 95%CI:1.4, 3.4)), marital status (AOR = 1.72; 95%CI:1.02, 2.90), women attending higher education and above (AOR = 2.67; 95%CI:1.57,4.57), history of termination of pregnancy (AOR = 2.85; 95%CI:2.0,4.08), and risky sexual behavior (AOR = 1.72; 95%CI:1.02,2.90) were found to be associated with self-reported syndrome of sexually transmitted infections. The magnitude of self-reported syndromes of STI and health care seeking behaviors among reproductive-age women was found low. Therefore, the government should enhance the awareness of women for sexually transmitted syndromes, and increase accessibility of STI services. Moreover, qualitative studies should be done to identify the demand, supply, and barriers related to STI among women of reproductive age women in Ethiopia.

108 Infertility from retained fetal bone after termination: Case report and literature review

Primary Objective: To review the literature addressing symptoms of retained fetal content after termination. Secondary objective: To discuss a case of hysteroscopic management in a patient with retained fetal bone content after remote termination procedure. Case report and literature review in an Urban based healthcare system of a patient who underwent hysteroscopic removal of retained fetal bone after remote history of surgical termination. This report describes the case of a 37-year-old woman presenting for infertility who had a termination of pregnancy at 20 weeks 17 years prior. Upon ultrasound echogenic structures were seen in the cervix and further confirmed with MRI. Hysteroscopy revealed mature fetal bone which was then removed. Literature Review: In the literature, similar cases have an original presentation of secondary infertility. Studies of the underlying pathophysiology have shown that these patients have prostaglandin levels similar to those with intrauterine devices (IUD) (6). Thus, retained fetal bone in the uterus may cause an environment in the uterus similar to an IUD resulting in secondary infertility. Other instances of retained bone have been attributed to osseous metaplasia secondary to chronic inflammation of the uterus (7). This in addition to other causes of calcification must remain in the differential until ruled out. Retained products are not uncommon in patients with termination at an advanced gestational age. The presented case portrays an unusual finding in an infertility patient remote from her termination episode. Review of the images in this case may help providers consider retained bone as an alternative to causes of infertility in patients with a history of termination.

Multiple intrauterine transfusions for fetal Rh hemolytic disease: a case report

This study reported the outcome of a case of fetal hemolytic disease after multiple intrauterine transfusions due to Rh incompatibility between the mother and fetus. The pregnant women had a history of termination for fetal edema at 29 weeks of gestation due to undecided reason as no relevant tests were conducted. Fetal edema was found and hemolytic disease (severe anemia) was diagnosed at 24 gestational weeks in the index pregnancy. After five intrauterine transfusions, fetal edema and anemia were improved. The baby who was born by cesarean section at 33 gestational weeks, was diagnosed with hemolytic disease and transferred to the neonatology department. After one month of treatment, the baby was improved and discharged. Whereafter he was followed up to one year of age without any abnormality in physical or mental development. Key words: Erythroblastosis, fetal; Rh-Hr blood-group system; Blood group incompatibility; Blood transfusion, intrauterine

The epidemiology of rape and sexual violence in the platinum mining district of Rustenburg, South Africa: Prevalence, and factors associated with sexual violence.

BackgroundEstimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18–49 years) living in Rustenburg Municipality.Materials and methodsWe conducted a cluster-randomized household survey (November—December 2015). Women were asked about their experiences of SV, associated attitudes and behaviours, and access to services. Logistic regression was used to determine factors associated with partner and non-partner SV.ResultsOf eligible households, 83·1% (1700/2044) participated. Of 966 women invited, 836 participated (86·5%). Average age of participants was 31.6 years (95%CI: 30·9, 32·4) with 45% having completed at least secondary school, and 60% unemployed or looking for work.Lifetime prevalence of SV was 24.9% (95%CI: 21·7–28·5), reaching 9.0% (95% CI: 6·6–12·1) by age 15. Almost one third told no one of their SV experiences. Factors related to financial dependence were associated with SV by a partner. History of termination of pregnancy increased the likelihood of SV by a non-partner as an adult. Women who experienced SV in childhood or as an adult were more likely to experience SV from a different type of perpetrator than those who did not.ConclusionsWe found a high prevalence of SV, including during childhood, in this setting, with limited access to care. This and the high morbidity attributed to SV calls for increased service provision.

Subsequent pregnancy outcome after mid-trimester termination of pregnancy for preeclampsia.

In this study we determined the outcome of subsequent pregnancies after termination of pregnancy for preeclampsia, with the purpose of presenting data useful for counselling these women on future pregnancies. The cohort consisted of 131 women with a history of termination of pregnancy for preeclampsia. Data of 79 pregnancies were available for analysis, including 13 women with chronic hypertension and 16 women with thrombophilia. There were seven miscarriages (8.8%) and 72 ongoing pregnancies. Low-dose aspirin was prescribed for 64 women (89%). The mean gestational age at delivery was 356/7±4weeks with a mean birth weight of 2571±938g. Overall recurrence rate for preeclampsia was 29% at a mean gestational age of 32weeks. Thirty-eight women had an uncomplicated pregnancy (53%). The women with chronic hypertension had the highest recurrence rate of 38%. Neonatal mortality was4%. The course of subsequent pregnancies after mid-trimester termination for preeclampsia is uncomplicated in 53% with a recurrence rate for preeclampsia of 29%. The mean gestational age at delivery was 11weeks later and birth weight 2000g higher than in the index pregnancy.

Anxiety in high- and low-risk pregnancies and its influence on perinatal outcome

ObjectiveThis study investigates pregnancy- and birth-giving-related fears of women of different risk groups and examines their influence on pregnancy and delivery. Study designProspective study. SettingPregnant out-patients were recruited in medical practices in Berlin. Data on perinatal outcome were obtained from the charts of the obstetric units. Participants589 pregnant women between 16 and 22 weeks of gestation. MethodsPregnant women were interviewed by a semi-standardized questionnaire and related to information from the charts about perinatal outcome of the obstetric units. Results77 women were at risk of anxiety influencing pregnancy and perinatal outcome due to chronic diseases, 61 had a history of previous miscarriage, 38 had a history of termination of pregnancy. 288 had no risk factors. Women with previous miscarriage had the highest degree of pregnancy-related fears. Their pregnancies were significantly more often complicated by the threat of miscarriage. A relationship between high levels of pregnancy-related fears and pregnancy complications was only found in the group of “low- risk women”. ConclusionWomen with a history of miscarriage evidently make use of special care services and social support services. For these women no correlation between pregnancy-related fears and complications was found. Low-risk pregnant women seem to have fewer means of coping with their unreasonable fear.

Recurrent miscarriage in translocation carriers: no differences in clinical characteristics between couples who accept and couples who decline PGD.

Do clinical characteristics of recurrent miscarriage couples with a chromosomal abnormality and who opt for PGD differ from couples that decline PGD after extensive genetic counselling? No differences in clinical characteristics are identified between recurrent miscarriage couples carrying a structural chromosomal abnormality who opt for PGD compared with those that decline PGD after extensive genetic counselling. Couples who have experienced two or more miscarriages (recurrent miscarriage) are at increased recurrence risk if one of the partners carries a structural chromosomal abnormality. PGD can be offered to avoid (another) miscarriage or pregnancy termination when (invasive) prenatal diagnosis shows an abnormal result. To date, no reports are available that describe reproductive decision-making after genetic counselling on PGD in these specific couples. Retrospective cohort study of 294 couples carrying a structural chromosomal abnormality seeking genetic counselling on PGD between 1996 and 2012. Participants were recurrent miscarriage couples carrying a structural chromosomal abnormality. They had been referred for genetic counselling to the only national licensed PGD centre. Clinical characteristics analysed included couple associated characteristics, characteristics concerning reproductive history and external characteristics such as type of physician that referred the couple for genetic counselling and the clinical geneticist performing the counselling on PGD. Of 294 couples referred for counselling on PGD, 26 were not accepted because they did not meet the criteria for IVF-PGD. The remaining cohort of 268 couples consisted of two-thirds female and one-third male carriers. Main PGD indications were reciprocal translocations (83.9%) and Robertsonian translocations (16.7%). Following genetic counselling, 76.9% of included couples chose PGD as their reproductive option, the others declined PGD. Reproductive choice is not influenced by sex of the translocation carrier (P = 0.499), type of chromosomal abnormality (P = 0.346), number of previous miscarriages (P = 0.882), history of termination of pregnancy (TOP) because of an unbalanced fetal karyotype (P = 0.800), referring physician (P = 0.208) or geneticist who performed the counselling (P = 0.410). This study only included recurrent miscarriage couples carrying a structural chromosomal abnormality, who were actually referred to a PGD clinic for genetic counselling. We lack information on couples who were not referred for PGD. Some of these patients may not have been informed on PGD at all, while others were not referred for counselling because they did not opt for PGD to start with. This study shows that reproductive choices in couples with recurrent miscarriage on the basis of a structural chromosomal abnormality are not influenced by characteristics of the couple itself, nor by their obstetric history or external characteristics. These findings suggest that a couples' intrinsic attitude towards PGD treatment is a major factor influencing their reproductive choice. Future research will focus on these personal motives that seem to push reproductive decision-making following genetic counselling in a given direction.

Maternal and neonatal seroprevalence of hepatitis B surface antigen in a hospital based population in South-South, Nigeria

Despite the existence of a safe and effective vaccine, Nigeria has remained a hyper-endemic area for hepatitis B virus infection, with estimated 12% of the total population being chronic carriers. Vertical transmission is an important route of transmission for hepatitis B virus infection. Neonates who contact hepatitis B virus infection will have an almost 90% risk of developing chronic hepatitis B surface antigen (HBsAg) carrier state and chronic liver disease. The objectives of this study was to determine the sero-prevalence of hepatitis B Virus among pregnant women, rate of vertical transmission and identifying potential risk factors associated with the infection. This study was an observational cross-sectional study of 250 pregnant women who presented to the labour ward of the University of Port-Harcourt Teaching Hospital (UPTH). Blood samples from all consenting pregnant women and corresponding umbilical cord blood were collected at delivery. A structured proforma designed for this purpose was used to obtain socio-demographic information and the presence of risk factors. Data collated was analysed using Statistical Package for Social Sciences (SPSS) 17.0 for windows® statistical software with P<0.05 at 95% confidence interval.The mean age of the pregnant women studied was 33.5±0.8 years, while the mean parity was 1.58 ± 0.5. HBsAg was detected in 15 women, giving a seroprevalence rate of 6% and a neonatal seroprevalence rate of 3.2%. All HBsAg-positive babies were born to HBsAg-positive mothers with a vertical transmission rate of 53.3%. Hepatitis B virus infection amongst parturients was more in patients with history of termination of pregnancy and multiple sexual partners (P<0.05). An intermediate prevalence of hepatitis B virus infection was identified which justifies the need for routine screening in pregnancy in order to identify and treat the infection, thus reducing the risk of vertical transmission of the virus. Contraceptive options aimed at prevention of pregnancy and sexually transmitted infection (STI) should be encouraged. Key words: Hepatitis B surface antigen (HBsAg), seroprevalence, University of Port-Harcourt Teaching Hospital (UPTH), Nigeria.

Variables Influencing Pregnancy Termination Following Prenatal Diagnosis of Fetal Chromosome Abnormalities

The objective of this study was to identify variables that may influence the decision to terminate or continue a pregnancy affected by a chromosome abnormality. We performed a retrospective cohort analysis of 286 pregnancies diagnosed with a chromosome abnormality following genetic counseling and prenatal diagnosis. Data obtained included procedure type, chromosome results, ethnicity, maternal age, use of fertility treatments, and uptake of genetic counseling after results, among other factors. Wilcoxon rank sum test, Fisher's exact test, and univariate and multivariate logistic regression models were used for data analysis. The overall termination rate in this study was 82.9%. A lower likelihood to terminate was found in pregnancies with a diagnosis of a sex chromosome abnormality (OR 0.05, p < .0001), Filipina race (OR 0.10, p = .03), and uptake of second genetic counseling session (OR 0.05, p < .0001). Prior history of termination was associated with increased likelihood to terminate (OR 8.6, p = .02). Factors revealing no statistically significant association with termination included maternal age, gestational age, clinic site, fetal gender, ultrasound anomalies, reason for referral and who informed the patient. Our data affirm the complexity of the decision making process and reinforce that providers should refrain from making assumptions regarding a patient's likelihood to terminate based on factors such as maternal age, gestational age, type of procedure, or ultrasound.

Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women

ObjectiveHigh-risk behaviours are associated with an increased risk of adverse pregnancy outcomes. Exposure to drugs, infection or radiation is a cause of concern for pregnant women, who contact Teratology Information Services (TIS) to have a counseling but with an accurate medical history is possible to detect additional behavioural risk factors that can significantly interfere with pregnancy outcome.The aim of this study is to describe risk behaviours in a population of Italian women calling our TIS and to identify related maternal factors. Study designBetween December 2008 and January 2010 we collected data from 503 pregnant women calling our TIS (Telefono Rosso, Rome). We investigated about smoke, alcohol and abuse substances addiction and we also collected demographic data. ResultsOf the 503 women consenting to participate 34% were found to have an additional risk marker during the current pregnancy. Within this group were 22.7% (n=119) who reported smoking, the 17.7% (n=89) admitted to drink and 2 women (0.4%) used illicit drugs. In 13.7% of cases (n=69) reason for calling represented an exposure to teratogenic agents. Unmarried status and previous induced abortion represent a risk factor for all high-risk behaviours. Lower education (p<0.001) and use of neurological drugs (p<0.001) are related with cigarette consumption. A lower parity was a risk factor for alcohol assumption (p=0.04). Women with high-risk behaviours tend to be exposed to more than a risk factor. ConclusionsTeratogen Information Services are an important system to identify women with pregnancy risk markers. These services should have the ability to provide risk reduction information to women who smoke cigarettes or with alcohol or drug use. In addition to the phone based information these women may benefit from referral back to their physician for assessment and management of substance use/abuse during pregnancy. Substance abuse risks are often underestimated by pregnant women. Single mothers or women with an history of terminations of pregnancy represents an high-risk population. Physicians should inform their patients about possible risks related to high-risk behaviours during preconception counseling or during the first obstetric visit.

Profiles and motives for PGD: a prospective cohort study of couples referred for PGD in the Netherlands

PGD is nowadays a well-established alternative to prenatal diagnosis. However, information with respect to couples' motives and profiles for choosing PGD is scarce. A prospective cohort of 264 couples referred for PGD was interviewed semi-structurally after intake, and follow-up data were collated after 6-8 years. Outcome measures were: the primary choice shortly after intake (PGD intention), and their definitive use, until maximum 8 years later (PGD use). Logistic regression analysis was performed with clinical impact of the genetic disorder, couples' experiences, obstetric history and psychosocial factors as putative predictors. About 53.4% of the couples showed PGD intention. The experience of one or more miscarriages, the loss of an affected child and the absence of (acceptable) alternatives for the female partner positively contributed to PGD intention. For PGD use (45.8% of couples), infertility, a history of pregnancy termination(s) and the absence of alternatives according to the female partner were positive determinants. A living affected child reduced PGD use. Mode of inheritance and clinical impact of the disorder did not contribute. Fewer than 50% of the referred couples actually started PGD treatment. Personal experiences and reproductive history [the presence of a living affected child, infertility or a history of termination of pregnancy (TOP)] were more important determinants of eventual PGD use than the mode of inheritance or the expected clinical impact of the disorder.

Morbidity and mortality due to unsafe abortion in Pakistan

Objectives To determine the frequency of women who had undergone an unsafe abortion and attended a tertiary care hospital in Pakistan with complications. Methods Patients with a history of termination at a gestational age of less than or equal to 22 weeks were included in the study. Results Of 230 women who met the inclusion criteria, 50 (21.7%) patients had undergone an unsafe abortion and attended the hospital with associated complications. Unintended pregnancy was the reason for the abortion in 82% of women (n = 41). Eighteen (36%) underwent terminations performed by doctors, 18 (36%) by Lady Health Visitors (n = 18), 10 (20%) by an untrained birth attendant (Dai), and 4 (8.0%) by nurses. Dilatation and evacuation procedures were performed in 28 (56.0%) women, while a Laminaria tent prior to evacuation was used in 18 (36.0%). Major complications included uterine perforation and gastrointestinal injury, observed in 27 (54.0%) women. Hemorrhage was observed in 13 (26.0%) women with retained products of conception after incomplete abortion. Six (12.0%) women died. Conclusion Healthcare providers performed the majority of terminations. To prevent maternal mortality, improved skills through refresher courses and workshops on safer methods are needed.

Subserosal intramural ectopic pregnancy in an adenomyotic area following assisted reproduction treatment

A 38-year-old woman presented for early pregnancy ultrasound scanning 6 weeks and 4 days following an assisted reproduction treatment cycle. She had s human chorionic gonadotrophin (shCG) blood level of 10,853 IU/L 2 weeks before presentation. She gave previous history of termination of pregnancy, myomectomy and bilateral salpingectomy. The uterus was retroverted with multiple fibroids and non-homogenous myometrium in many areas. The endometrium was 21.1 mm thick with no intrauterine pregnancy. An initial diagnosis of cornual/interstitial ectopic pregnancy was made. However, 3D images rendering and the multiplanar technique showed a 27.5-mm gestation sac, medial and above the interstitial part of the right tube, with 7.6-mm-long foetal pole. shCG and progesterone blood levels on the same day were 19,551 IU/L and 43.2 nmol/l, respectively. The patient opted against methotrexate treatment. An ectopic pregnancy bulging out of the fundal area was excised laparoscopically. Histopathological assessment showed chorionic villi surrounded by myometrium, as well as foci of adenomyosis, reaching the outer serosa. To our knowledge, this is the second case of subserosal intramural ectopic pregnancy to be reported and the first in a subserosal area of adenomyosis.

Primary hyperaldosteronism- a resistant endocrine hypertension- A case report

 A thirty years old lady presented with uncontrolled hypertension and dizziness during working for last 5 years. She had history of termination of pregnancy due to treatment-resistant hypertension. Even in the post-partum period her blood pressure remains uncontrolled with more than three antihypertensive drugs. Her serum K+ level was low and USG of KUB &amp; adrenal glands showed slightly increased right renal cortical echotexture; CT scan of abdomen revealed right Adrenal adenoma. She underwent unilateral adrenalectomy. Now, she has no complaints and her blood pressure is normal without any antihypertensive drugs. There is no target organ damage. Key words: Primary hyperaldosteronism, unilateral adrenal adenoma, resistant endocrine hypertension  doi:10.3329/uhj.v4i2.2077 University Heart Journal Vol. 4 No. 2 July 2008 p.49-50

Is induced abortion a risk factor in subsequent pregnancy?

To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics. Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for. There was an overall trend towards an increased rate of preterm delivery at <or=36 weeks' gestation and early preterm delivery at <or=31 weeks' gestation in women who had previous pregnancy terminations. For the cohort of 28-30 years, the observed rates of prematurity in women with one and with >or=2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P<0.0001). The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy.

Acute abdomen after the termination of pregnancy

A 30-year-old woman presented with severe abdominal pain and mild fever. There was a history of termination of pregnancy at 16 weeks. There was no history of trauma. Physical examination showed tenderness and guarding rigidity of the abdomen. Laboratory results showed elevated liver enzyme levels and a low platelet count of 6000 cells/cumm. Emergency ultrasonography revealed a large lesion with a heterogeneous echotexture that could not be further characterized. Therefore a CT scan of the abdomen was performed. What is the diagnosis? A large irregularly shaped area of low attenuation with interspersed hyperdense areas of attenuation (80 HU) in the right hepatic lobe was suggestive of rupture of the right lobe with large hyperattenuating subcapsular haematoma. Ascites was also present. Aspiration from the liver lesion revealed blood. Despite aggressive management the patient died 7 days after admission. The diagnosis was HELLP syndrome. HELLP - a syndrome characterized by haemolysis elevated liver enzyme levels and a low platelet count-is a serious obstetric complication. HELLP syndrome was described by Weinstein in 1982. It generally presents in the third trimester of pregnancy but can also present in the post-partum period. With post-partum presentation the onset typically occurs within the first 48 h after delivery; however the signs and symptoms may not become apparent until as long as 7 days after delivery. The condition can progress rapidly with complications such as disseminated intravascular coagulation hepatic necrosis and haemorrhagic infarction. On histological analysis the portal areas of the liver are surrounded by a combination of deposited fibrin haemorrhage and hepatocellular necrosis. CT is the image modality of choice in HELLP syndrome because it can demonstrate subcapsular haematoma and hepatic rupture with intraperitoneal bleeding. Hepatic infarction can be seen on CT as low-attenuation wedge-shaped areas in the periphery of the liver without mass effect. In the majority of patients with HELLP syndrome the management is supportive. Delivery accomplished by whatever route is deemed safest and most expeditious is the cornerstone of therapy. Patients who experience hepatic rupture with intraperitoneal bleeding require immediate surgery or selective embolisation of the hepatic arteries. (excerpt)