Postabortion Complications Research Articles

Pregnancy in women with von Willebrand's disease or factor XI deficiency.

To assess the obstetric outcome in women with von Willebrand's disease or factor XI deficiency. Haemophilia Centre and Haemostasis Unit, The Royal Free Hospital. Women with von Willebrand's disease (n = 31) and with factor XI deficiency (n = 11) registered at the Royal Free Hospital Haemophilia Centre who had had a pregnancy within the previous 17 years (1980-1996), including 84 in women with von Willebrand's disease and 28 in women with factor XI deficiency. Women were interviewed and details of the obstetric history were obtained. The records of the Haemophilia Centre and the women's maternity records were also reviewed. Threatened miscarriage occurred in 33% and 14% of pregnancies with von Willebrand's disease and factor XI deficiency, respectively. Excluding recurrent miscarriages, 14/68 (21%) of pregnancies with von Willebrand's disease and one pregnancy with factor XI deficiency miscarried spontaneously. There was an increased incidence of primary and secondary post-abortal bleeding complications. Factor VIII and von Willebrand factor antigen and activity levels increased significantly in pregnancy in all women apart from those with severe von Willebrand's disease. Factor XI, however, did not show any significant change. No neonatal haemorrhagic complications in association with the birth process were reported, although ventouse and difficult forceps deliveries were avoided. Extensive perineal bruising and haematoma was reported in three women with von Willebrand's disease; two of these were associated with forceps delivery. The incidence of primary postpartum haemorrhage was 18.5% in von Willebrand's disease and 16% in factor XI deficiency. Blood transfusion was required in six cases of von Willebrand's disease and two cases of factor XI deficiency. Ten of fourteen instances of primary postpartum haemorrhage occurred when maternal factor levels were < 50 IU/dL with no prophylactic treatment for labour. The incidence of secondary postpartum haemorrhage was 20% in von Willebrand's disease and 24% in factor XI deficiency. None of the women who had prophylactic treatment during labour or the puerperium suffered any significant bleeding complications. There were three neonatal bleeding complications. Pregnancy, labour and the puerperium are associated with significant bleeding problems in women with von Willebrand's disease or factor XI deficiency, but these are largely preventable. Specialist obstetric care in close liaison with the haemophilia centre is essential to minimise maternal and neonatal complications.

"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.

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.

Improving the Medical Care and Counseling of Postabortion Patients in Egypt

This report analyzes the results of an operations research project carried out at two sites in Egypt to improve the medical care and counseling of postabortion patients. Preintervention and postintervention surveys and observations were conducted. After the introduction of vacuum aspiration under local anesthesia, the number of cases treated with dilatation and curettage under general anesthesia dropped from an average of 169 per month to 16. The majority of the remaining cases (an average of 119 per month) were treated with vacuum aspiration. Both providers' and women's knowledge about postabortion complications improved. Family planning information provided to postabortion patients increased as a result of the project's training program. The proportion of patients intending to use a contraceptive method increased by 30 percentage points due to the improved counseling. Future programs linking family planning and postabortion medical services should be prepared to improve the medical care of existing emergency health services and to add counseling services.

Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy

Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0 75%) trichomonas infection, and 1 (0·25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections.

Aborto induzido em mulheres de baixa renda: dimensão de um problema

This paper examines the practice of abortion, especially induced abortion among low income women. The discussion is based on survey data collected between 1984 and 1985 in seven slum communities (favelas) situated in the metropolitan area of Rio de Janeiro, Brazil. Despite restrictive law, induced abortion is extremely frequent. Among married women 21.4 per cent reported experience of induced abortion. Most abortions were performed by physicians, however the quality of care of these procedures can be questioned since almost all induced abortions are illegal there is no possible supervision by health authorities. The incidence of post-abortion complication is very high, especially for those performed by traditional midwifes or by the woman herself. More than 60 per cent of the women were not using contraception at the time of pregnancy. About, 21 per cent reported that they were using the pill. Such a high pill failure rate is inacceptable, and probably was related to incorrect use. This points to the need for a better access to family planning care within the health services. The consequences of the restrictive abortion laws in Brazil are also discussed. Restrictions that in practice prove to have little impact on the practice of induced abortion, appear to be very effective in brooding even more the social-economic inequalities.

Induced abortion: Chlamydia trachomatis and postabortal complications. A cost benefit analysis.

The overall prevalence of Chlamydia trachomatis among 873 abortion-seeking women was 9.3% during 1985. Significantly higher age-specific prevalences of C. trachomatis occurred among younger women (p less than 0.001). None of 17 women treated for C. trachomatis before the abortion was carried out, was readmitted to the hospital. Of 64 Chlamydia-positive women, who commenced treatment within the first 2 weeks after the abortion was carried out, 14.1% were readmitted to the hospital, compared with 5.7% of Chlamydia-negative women (p less than 0.02). Postabortal salpingitis was verified at readmission among 10.9% of Chlamydia-positive women and 3.2% of Chlamydia-negative women (p less than 0.01). An analysis of screening of all abortion-seeking women is estimated to be worthwhile when the prevalence of C. trachomatis exceeds 4.3%. We recommend screening for Chlamydia trachomatis of all abortion-seeking women, 30 years or younger, at the pre-abortion visit, provided that treatment can be completed before the abortion is carried out.

Epidemiology of legal abortion in Italy.

The paper reports on the trends of induced abortion in Italy since its legalization in 1978. Data collected through the national surveillance system show that the abortion rates and ratios in Italy, after an initial increase, have been stable in the last four years, and are comparable to those of other European countries. Italian women seeking abortion, however, are generally older and more frequently married and parous than in most other western countries. The data on abortion services and procedures show a slow improvement with increasing use of local rather than general anaesthesia, suction rather than surgical curettage, and outpatient rather than inpatient admissions. Post-abortion complications are infrequent and there have been no cases of death from legal abortion. The paper attempts to analyse the effect of legal abortion on fertility and on other maternal and child health indices, reaching tentative conclusions on the contribution of the legalization of abortion to the improvement of reproductive health. Uneven availability of abortion services, however, is currently a major problem; in many of the less developed areas of the country, it is estimated that as many as 50% of abortions are still performed outside the legal abortion service network.

Second trimester abortion with 5% intraamniotic saline--a pilot study.

The risk of hypernatremia and related postabortion complications resulting from the intraamniotic administration of a 20-25% hypertonic saline solution, a widely used procedure all over the world, prompted this trial of 5% saline. Midtrimester abortion was induced in 150 women with a 5% saline solution administered intraamniotically at the National Medical College, Calcutta, India, from August 1974 to October 1975. The abortion was complete within 48 hours in 90% of the cases. All the fetuses were delivered dead. In one case, hysterotomy was performed because of severe bleeding. The immediate complication rate was 36% (12% serious). The follow-up complication rate was 2%. One patient died on the seventh postabortal day due to severe, uncontrolled septicemia. The authors conclude that because this procedure is simple and low cost and because it reduces the risk of hypernatremia it should be a welcome addition to service programs in developing countries.

Reducing the morbidity of vacuum aspiration abortion.

This paper reports an analysis of the measures taken at Preterm, Inc, of Washington, DC, to reduce the incidence of complications of first trimester outpatient abortions. Data are presented on the 291 complications (40.0/1000) resulting from 7272 procedures performed during 1976. Forty-one women were hospitalized (5.6/1000). It has been our experience that routine use of ultrasonography when gestational age is unclear, careful examination of tissue especially when a small quantity is present and early use of reevacuation to diagnose and treat postabortal complications are essential in reducing the incidence and severity of abortion complications.

Medical Abortion Complications

It is estimated that 1,000,000 abortions were performed in the United States in 1975. An unfortunate aspect of this relatively simple procedure is the vast number of complications. This study is designed to investigate some of the confounding factors etiologically associated with postabortal complications, specifically, septic incomplete abortion. The data included in this study were obtained by personal interview and retrospective chart review of 420 cases of first trimester pregnancy termination performed in a central Missouri family planning clinic. The period of observation was from May 1974 to July 1975. A number of variables including age, race, marital status, gestational age, gravidity, and parity were studied and associations were drawn where possible. Also noted were pertinent preexisting conditions such as diabetes, epilepsy, diseases of the circulatory system, and recurrent urinary tract infections to determine any possible correlations. A preliminary review of these cases shows a statistically significant association between gestational age at termination and the incidence of septic incomplete abortion, with maximum risk being associated with procedures performed at less than 7 weeks and greater than 10 weeks of gestation. Possible reasons for this association are thought to be contingent on three factors: uterine motility, the degree of fixation of the developing fetus, and the size of the fetus at varying stages of gestation.

Mortality and morbidity associated with legal abortions in Hungary, 1960-1973.

In Hungary, with 10 million inhabitants, the number of induced abortions in the 1960's first approached and then reached 200,000 cases annually. These data mean that the number of induced abortions has increased substantially compared with earlier decades. A qualitative change has also occurred, from criminal abortions to, in most cases, legally induced abortions performed in hospitals. On the basis of 32 deaths directly resulting from legal induced abortion in the first trimester during 1960-1972, maternal mortality is about 1.5 per 100,000 abortions in Hungary, the lowest rat observed until the present anywhere in the world. According to a special survey conducted in Budapest in 1966, the overall morbidity rate was 41.6 per 1,000 abortions of which 0.9 was due to perforations, 22.7 to post-abortal hemorrhages, and 18.0 to inflammatory complications, i.e., early post-abortal complications had to be reckoned with in every 25th case. Data in the present study suggest a correlation between induced abortions and the incidence of placenta previa, premature separation of the placenta, and premature births.

Consequences of unintended pregnancy among young married women in Nepal

Aim: To explore the consequence of unintended pregnancy, and compare these with real experiences amongst young married women in Nepal. Method: Sample survey of 997 married women and 19 in-depth case histories were studied. Results: The findings suggest that conflicts with spouses and family members, depression, worries or mental tension, loss of education and employment opportunities were the major anticipated socio-psychological consequences of unintended pregnancies. Reduced prenatal and postnatal care, unsafe abortions, postabortion complications, and maternal deaths were the major expected health outcomes of an unintended pregnancy. In general, the perceived opinions on socio-psychological consequences corroborated with real experiences. However, there are some differences between the perceived opinions and real experiences. Conclusions: Programmes that focus to identify couples at risk of unintended pregnancies, to address worries and mental tension, and enable them to make timely decisions and responsible choices are required. Keywords: abortions, health consequences, maternal deaths, socio-psychological consequences, unintended pregnancy doi:10.3126/njog.v1i2.2396 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 37-46 Nov-Dec 2006

Factors associated with complications following provoked abortion

Post-operative complications, so frequently associated with provoked abortion, have aroused public attention and concern in Chile. This paper is the second based on an investigation started in 1961 to provide better knowledge of the factors associated with provoked abortion (Armijo and Monreal, 1966). The study is based on data obtained from a random sample of 1,890 women of reproductive age in Greater Santiago, interviewed in 1962. A total of 496 women were found to have had a history of provoked abortion; they had experienced 1,394 abortions, or 2.8 abortions per woman. Excluding 72 abortions for which data on hospitalization were not available, a total of 1,322 provoked abortions remained for analysis, of which 31.5 per cent had required hospitalization. The question then arises: what were the factors associated with the need for hospital care which might be considered indicators for complications? In an attempt to answer this question, this paper relates the risk of complications, as expressed in terms of hospital admission, to such factors as the age of the woman at the time of abortion, the order of the interrupted pregnancy, the number of previous abortions, the month of gestation, the type of person inducing the abortion, and the method used. The age distribution of all women having induced abortions and the number and per cent of those hopsitalized, by age group, are shown under A of Table 1. The rate of hospital admissions of women younger than 30 years at time of abortion is approximately equal to that of older women. In fact, the proportion hospitalized differs by only a few percentage points between the 5-year age groups from under 19 years to 35 years and older. It can therefore be concluded that age at time of abortion does not seem tO be a factor as far as postabortion complications are concerned. A relationship between pregnancy order and the risk of complica# The authors wish to thank Miss Sarah Lewit for her editorial assistance.