Indications For Termination Of Pregnancy Research Articles

Cervical ripening and induction of labor with intravaginal misoprostol and Foley catheter cervical traction

A randomized controlled trial was performed to study 300 pregnant women with an indication for termination of pregnancy. Inclusion criteria were gestational age of 28 weeks or greater Bishop score of 5 or less singleton pregnancy cephalic presentation and intact membranes. Exclusion criteria were previous cesarean delivery or any surgical operation on the uterus vaginal bleeding known allergy to prostaglandins and intrauterine growth restriction or fetal distress. The 300 women were randomly assigned to 3 groups. (excerpt)

The pregnant mother with breast cancer: Diagnostic and therapeutic management

This review describes the epidemiology, pathology, clinical picture and therapeutic management of pregnant women with breast cancer. In addition, it covers other important issues like the safety of both diagnostic and treatment procedures, the indications for pregnancy termination, the mother and fetal outcome as well as the metastatic potential to the placenta and/or fetus. Several recommendations are also provided.

Intravaginal misoprostol for pregnancy termination

Misoprostol is one of the most popular products used for pregnancy termination because of its high efficacy, low cost and stability at room temperature. It was found that a dosage of 400 mcg of intravaginal misoprostol is optimal for secondtrimester termination [1–3]; however, the optimal time interval between doses has not been established. We conducted this study to compare the efficacy of intravaginal misoprostol, 400 mcg, administered every 3 and 6 h. Pregnant women with live fetus and unfavorable cervix at accurate gestational age of 14–28 weeks with indications for pregnancy termination were allocated into either group of 3-h interval or 6-h interval by block randomization. A Bishop score was obtained for cervical assessment just before initiating misoprostol. Exclusion criteria

Treatment of severe preeclampsia and HELLP syndrome

Severe preeclampsia and HELLP syndrome are still one of the leading causes of maternal and perinatal morbidity and mortality. The current definitions of the diseases should be considered before treatment. The timely allocation to a perinatal center and an intensive monitoring of mother and child after admission are mandatory for successful management of these patients. The aim of therapy is immediate stabilization of the mother's condition by means of anticonvulsive prophylaxis with intravenous magnesium sulphate, well-controlled reduction of blood pressure by the administration of urapidil or nifedipine, controlled volume expansion and an adequate treatment of coagulation disorders by giving fresh frozen plasma (not heparin). Immediate delivery is the method of choice in cases of severe preeclampsia/HELLP syndrome > or = 34 weeks' gestations; we prefer cesarean section in patients with an unripe cervix and the full-blown picture of HELLP syndrome. In patients < 34 weeks' gestation expectant management is generally possible under intensive monitoring of the mother and the fetus. Maternal and fetal indications for immediate termination of pregnancy should be considered carefully. The systemic application of corticosteroids is a promising approach to prolong pregnancy. During the past decade the increasing awareness of obstetricians and other disciplines have led to a significant reduction of maternal mortality (< 1 %) and perinatal mortality (9.4-16.2 %) in cases of HELLP syndrome, in particular in the West European countries.

A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination

Objective: Our purpose was to compare the efficacy of oral misoprostol with that of vaginal misoprostol for midtrimester termination of pregnancy. Study Design: Women seen for midtrimester pregnancy termination were randomly assigned to receive either misoprostol orally in a dose of 200 μg every hour for 3 hours followed by 400 μg every 4 hours or vaginally in a dose of 400 μg every 4 hours. The protocol was followed for 24 hours, after which time further management was at the discretion of the attending physician. The primary outcome measure was the induction-to-delivery interval. Sample size was calculated a priori. Statistical analysis was performed with the t test for continuous variables and the χ2 test for categorical variables. P <.05 was considered significant. Results: One hundred fourteen women were randomized, with 49 receiving vaginal misoprostol and 65 receiving oral misoprostol. The two groups were comparable with respect to maternal age, parity, indication for pregnancy termination, gestational age, and maternal weight. The mean induction-to-delivery interval was significantly shorter for the vaginal group (19.6 ± 17.5 hours vs 34.5 ± 28.2 hours, P <.01). Length of stay was also shorter in the vaginal group (32.3 ± 17.3 hours vs 50.9 ± 27.9 hours, P <.01). Significantly more patients in the vaginal group were delivered within 24 hours (85.1% vs 39.5%, P <.01), and more patients in the oral group required changes in the method of induction when they were undelivered after 24 hours (38.2% vs 7%, P <.01). The only complication was an increase in febrile morbidity in the vaginal group (25% vs 6.7%, P =.046). This did not result in an increased use of antibiotics, and all the fevers resolved post partum without further complications. Conclusions: Vaginal administration of misoprostol resulted in a shorter induction-to-delivery interval. The shorter length of stay should result in improved patient care. (Am J Obstet Gynecol 2002;187:853-7.)

Paracetamol overdose in pregnancy analysis of the outcomes of 300 cases referred to the teratology information service

A prospective study was carried out to investigate the outcome of pregnancy in 300 women who had self-administered an overdose of paracetamol, either alone, or as part of a combined preparation. Exposure occurred in all trimesters. The most striking feature of this study is that the majority of the pregnancies had normal outcomes. Over half of the mothers (160 = 53%) required treatment for the overdose, and 49 of these had specific antidotes (33 mothers had acetylcysteine and 16 mothers had methionine). The rest of the mothers were given nonspecific treatments including ipecacuanha (52), gastric lavage (42), and charcoal (16). None of the mothers died. There were 219 liveborn infants with no malformations, 61 of whom had been exposed in the first trimester. Eleven liveborn infants had malformations; none was exposed in the first trimester. One other infant exposed at 18 weeks had a diaphragmatic hernia; this pregnancy was terminated at 22 weeks. In none of these 12 infants can the malformations be directly associated with paracetamol exposure. There were no apparent differences either in the sex ratio or the body weights of term infants. There were seven full-term infants with neonatal problems that seem unrelated to paracetamol exposure. Six premature infants also had neonatal problems, which were more likely to be related to their degree of prematurity rather than paracetamol exposure. There was no obvious relationship between the time of exposure and the time of delivery. The overall conclusion is that paracetamol overdose per se is not an indication for termination of pregnancy.

Idiopathic Granulomatous Angiitis of the Central Nervous System in Pregnancy

Idiopathic granulomatous angiitis of the central nervous system (IGANS) is a rare vasculitis primarily affecting the spinal cord and brain not related to any underlying systemic disease. Clinical manifestations range from simple headache to cerebral vascular accidents secondary to vascular occlusion. The management of a pregnancy complicated by multiple risk factors including underlying IGANS is reported. An expectant, empiric approach was adopted and resulted in excellent maternal and neonatal outcomes. The first report of the management of a pregnancy complicated by IGANS is presented. Underlying maternal IGANS may not necessarily represent an indication for pregnancy termination.

Paracetamol Poisoning in Pregnancy: An Analysis of the Outcomes of Cases Referred to the Teratology Information Service of the National Poisons Information Service

A study was carried out to investigate the outcome of pregnancy in 115 women who had been exposed to paracetamol overdose. Follow up was obtained in 48 cases. Exposure occurred in all trimesters, and the most striking feature of this series is that the majority of the pregnancy outcomes were normal. None of the mothers died. There were 39 live born infants with no malformation, 14 of whom had been exposed in the first trimester. Four babies, exposed in the third trimester had neonatal problems, but these seem unrelated to paracetamol. There were two live born infants with gross malformations (spina bifida occulta; and cleft lip and palate). However, as the overdoses occurred at weeks 26 and 28 respectively, long after the structural development of these organs, the malformations could not have been caused by the paracetamol. There were two spontaneous abortions, both in the first trimester, which occurred two weeks after the overdose which may be related to the paracetamol. The overall conclusion is that paracetamol overdose per se is not necessarily an indication for termination of pregnancy.

Genetic counseling and termination of pregnancy in Hungary.

The practice of prenatal diagnosis has brought with it the utilization of pregnancy termination as a preventive approach. In this paper the genetic/teratologic, fetal and maternal indications for termination of pregnancy used in Hungary are described, as well as the legal requirements and the proposed mode of termination at the different stages of gestation. The author is the director of the largest prenatal genetic counseling service in Hungary.

Vaginally administered 16,16-dimethyl-PGE1-methyl ester (Gemeprost) to induce termination of pregnancy after the first trimester.

The results of the first 40 patients, whose pregnancies were terminated using Gemeprost vaginal suppositories are presented. The indication for termination of pregnancy was either fetal abnormality, or fetal death in utero. The mean gestational age was 20.9 +/- 4.4 weeks. 82.5% of patients were delivered within 24 hours, following a mean number of 3.9 +/- 1.3 pessaries. Side-effects were uncommon, and the procedure was well tolerated, with 30% of patients requiring no analgesia, and 60% receiving narcotic analgesia only. The results obtained compare favourably with the overseas experience with this method. Augmentation with oxytocic agents is of questionable value, and routine evacuation of the uterine cavity, under general anaesthesia seems unnecessary. Administration is simple and well tolerated by patients, and this method of pregnancy interruption appears safe, efficient and superior to extra-amniotic infusion of PGF2 alpha.

Continuous extraovular prostaglandin F 2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery

Late pregnancy termination by continuous extraovular instillation of prostaglandin F 2α (PGF 2α ) was successfully performed in 13 patients with previous cesarian section (CS) delivery. The indications for pregnancy termination were intrauterine fetal demise in nine patients, social indications in two patients, Down's Syndrome in one patient and quadruplets pregnancy in one patient. One patient had a previous classical vertical cesarian section, two had two previous and one three previous low segment transverse (LST) cesarian sections. The other nine patients had one previous low segment transverse cesarian section. The instillation of prostaglandin solution was obtained by using a new double balloon catheter designed for extraovular pregnancy terminations. All patients aborted following the procedure with no complications. The instillation abortion time ranged from 5 1 2 to 20 h (mean 13.3 h).

Incidence and significance of chromosomal translocations in prenatal diagnosis

In the study reported here the incidence and significance of translocations in antenatal diagnosis are described with reference to data of the cytogenic laboratory of Cologne University Gynecological Clinic. During the last 10 years 19 translocations were found in 4532 amnion cell cultures (0.44%), without exception in single pregnancies. In 18 cases the chromosome aberrations were balanced, i.e., the location of the genetic material was changed without loss or addition of parts of chromosomes. In one case the diagnosis of an unbalanced translocation in the form of a translocation mongolism led to termination of pregnancy. All of the other pregnancies were continued to term. Phenotypically and clinically the children were normal. The translocations were inherited in 78.9% (n = 15; 11 from the mother, 4 from the father), and de novo in 21.1% (n = 4). The results are in agreement with those of the DFG study, which identified 0.66% translocations in over 10,000 antenatal diagnoses. Of the balanced chromosome aberrations all of the newborns but one were clinically and phenotypically healthy. In cases of inherited translocations in particular, no increase in risk to the child could be determined. In cases of de novo chromosome aberrations there is a slight increase in the residual risk due to loss of minute portions of the gene. With careful technique this risk may be assumed to be very slight, so that in such cases also there is no indication for termination of pregnancy.

Fetal indication for termination of pregnancy -- from the legal view

Evaluation of conditions determining foetal indication for termination of pregnancy must be based on the severity of the damage to the child and the degree of probability of such damage, as well as on the individual physical and mental capacity of the mother to bear the involved stress. If a viable child is born as a result of the termination of pregnancy, it is automatically placed from the moment of its birth under the protection of current legislation applying to culpable homicide and culpable homicide not amounting to murder.

Termination of pregnancy on the grounds of foetal indication--seen from a gynaecologist's viewpoint

As far as the Federal Republic of Germany is concerned, the legal basis of "foetal" indication is, under the aspects of legal philosophy, exclusively directed at the question whether continuation or termination of pregnancy can be expected of, or tolerated by, the pregnant mother. This creates both for the parents and for the physician who is expected to become active or to remain inactive, a particularly tragic conflict arising from the confrontation with the child, which is either certain to be, or suspected of being, seriously diseased, handicapped or deformed or teratoid; this is, so to say, a second dimension of the indication for induced abortion. The conflict situation between the doctor, the patient and the child is analysed in this article on the basis of consultation talks; in such discussions, the doctor is unable to pass any verdict on the value of diseased human life, using medical categories of thinking. The article points out the necessity of acquiring a firm mental hold on the possibilities of prenatal diagnosis and the foetal indication for termination of pregnancy; in this connection, the article explains which of the relevant diseases can be diagnosed by the intrauterine route, with particular emphasis on the rapid development of improved methods of diagnosis which are likely to evolve in the foreseeable future.

Fetal indication for the termination of pregnancy from an ethical viewpoint

The author goes into five ethical problems involved in foetal indication for termination of pregnancy: 1. The method of prenatal diagnosis is considered to be ethically neutral. 2. Arguments and indication for termination of pregnancy in case of foetal indication are critically reviewed. Four degrees of severity are distinguished in the field of prenatal damage. 3. After expounding the arguments for a continuation of pregnancy, the only case in which termination is declared as ethically justifiable is the occurrence of "total malformation" of the foetus (anencephaly). 4. In everyday practice, great importance must be attached to a differentiation between judgement of what can be considered as correct from the viewpoint of morals as tolerated by society on the one hand, and the moral value attached to a concrete action on the other. 5. Termination of pregnancy in case of foetal indication, which has largely become a matter of course, is examined and reflected with regard to its importance for the development of (medical and social) moral awareness.

Contraception and Pregnancy in the Young Female Hypertensive Patient

Aspects of primary or secondary hypertension in relation to oral contraceptive use and pregnancy are discussed. Possible mechanisms of oral contraceptive-induced secondary hypertension and contraindications to the pill are listed. Hypertension as a contraindication to pregnancy is weighed in relation to sterilization and cases of term pregnancies in hypertensive patients are cited. Misdiagnosis of secondary hypertension as toxemia in most pregnant patients with elevated blood pressure is characterized in a review of a clinical study involving 4273 patients (Table 1). A method for differential diagnosis of hypertension in pregnancy which includes ophthalmoscopic examination and urinalysis is outlined (Figure 1). Suggested treatment for the pregnant patient with hypertension is a low sodium diet for the first 20 weeks of pregnancy followed by the stepped care program (Figure 2). The most desirable therapy for pregnant women with toxemia are diuretics during the early pathological phase (sodium retention and edema) with edema in the periorbital areas and hands as diagnostic indicators for this phase. The efficacy of diuretics (alone or combined with hypotensive agents) in hypertensive patients is evaluated with regard to maternal and fetal risks. Indications for termination of pregnancy or induction of labor in hypertensive or toxemic women are summarized.

The impact of recent changes in therapeutic abortion laws.

This report summarizes the current status of abortion legislation as of January 1, 1971. Data are presented from several sources to characterize the population receiving abortion services in terms of age, race, marital status, and indications for pregnancy termination. A special section details the abortion scene in New York City, especially insofar as it pertains to the availability of abortion services to out-of state women. Certain conclusions are drawn. The practice of legal abortion is increasing dramatically. From January to June 1970, there were 34,143 abortions in 9 selected states. It was estimated that no more than 8000 legal abortions per year were done as recently as 1965. It is apparent that the status of a given law regulating the performance of abortions does not necessarily dictate the actual number performed. While it is true that the complexity or liberalism of the worded law may be instrumental in guiding physicians to the greater performance of legal abortions, it is just as clear that the intention of the practicing physician or hospital to comply with the spirit of the law may, in fact, be more critical. A disproportionate number of abortions reported as a given statewide experience are still being done by a limited number of institutions in that state. States like California and Oregon are defined as "liberal performance states". They do more abortions for mental health indications and more abortions on women who are young and unmarried. Based on the abortion data in this report, it is obvious that race-specific abortion ratios do not correspond to race-specific live birth rates. In Jefferson County, Alabama, and in the State of California, black women have obtained hospital abortions at a rate nearly equal to that of white women, but in Georgia and South Carolina, there is a lower abortion ratio among black women than among white women. It has yet to be determined if this variability is the result of a negative patient attitude or a policy of willful or accidental physical and hospital discrimination. New York City is now providing abortion services for the entire country. The highly significant rise in the citywide abortion ratio between prelaw 1968 and the first postlaw reporting period of 1970 was almost 4 times greater for private than for ward patients. A large influx of out-of-state women was documented and may help to account for this disparity in current abortion ratios. It is concluded that there is an unmet need for more accessible abortion services in these women's home states.

Indications for termination of pregnancy.

Indications for termination of pregnancy.

Indications for Termination of Pregnancy

Indications for Termination of Pregnancy

Indications for Termination of Pregnancy

Indications for Termination of Pregnancy