Postabortion Group Research Articles

Factors associated with infection-related severe maternal outcomes in pregnant and recently pregnant women: Asecondary analysis of the WHO global maternal sepsis study.

The aim of the present study was to identify the risk factors for severe maternal outcomes (SMO) of women with suspected or confirmed infections using the data from the WHO global maternal sepsis study (GLOSS). We conducted a secondary analysis of the GLOSS cohort study, which involved pregnant or recently pregnant women with suspected or confirmed infection around 713 health facilities in 52 low- and middle-income countries, and high-income countries. A nested case-control study was conducted within the GLOSS cohort. Cases included infection-related maternal deaths or near misses, while controls represented non-SMO. Logistic mixed models, adjusting for country variations, were employed. Using univariate analysis, we calculated crude odds ratios (crude OR) and their 95% confidence interval (95% CI). Variables were identified with less than 16% missing data, and P values less than 0.20 were used to perform the multivariate logistic model multilevel. A total of 2558 women were included in the analysis. As for the cases, 134 patients were found in the pregnant in labor or not in labor group and 246 patients in the postpartum or postabortion group. Pregnant women with prior childbirths faced a 64% increased risk of SMO. Ante- or intrapartum hemorrhage increased risk by 4.45 times, while trauma during pregnancy increased it by 4.81 times. Pre-existing medical conditions elevated risk five-fold, while hospital-acquired infections increased it by 53%. Secondary infections raised risk six-fold. Postpartum/postabortion women with prior childbirths had a 45% elevated risk, and pre-existing medical conditions raised it by 2.84 times. Hospital-acquired infections increased risk by 93%. Postpartum hemorrhage increased risk approximately five-fold, while abortion-related bleeding doubled it. Previous cesarean, abortion, and stillbirth also elevated risk. Key risk factors for SMO include prior childbirths, hemorrhage, trauma, pre-existing conditions, and hospital-acquired or secondary infections. Implementing effective alert systems and targeted interventions is essential to mitigate these risks and improve maternal health outcomes, especially in resource-limited settings.

Pregnancies Following Hysteroscopic Removal of Retained Products of Conception after Delivery Versus Abortion

Aim: To compare clinical variables, sonographic findings and pregnancy outcomes following the hysteroscopic removal of retained products of conception (RPOC) after delivery and abortion. Methods: This is a retrospective cohort of operative hysteroscopies performed between 2011 and 2015 for suspected RPOC, during which trophoblastic tissue was obtained. Patient demographics, clinical presentation, sonographic evaluation, subsequent infertility and pregnancy outcomes were compared between post-delivery (n = 85) and post-abortion (n = 93) cases. Results: The main presenting symptom in both study groups was vaginal bleeding. On sonographic evaluation, maximal endometrial thickness was significantly higher in the post-delivery group, while irregularity and increased flow were more common in the post-abortion group. There was a similar rate of deliveries following hysteroscopy in both groups with 40% in the post-delivery group and 39.7% in the post-abortion group. Deliveries in the post-delivery group were characterized by a higher rate of abnormal placentation – 30.5% – including low lying placenta and placenta accreta. A significant rate of vaginal deliveries in both groups entailed manual removal of the placenta or exploration of the uterine cavity (23.5 and 10.5%, p = 0.20). Conclusion: Pregnancies following RPOC after delivery entail a higher rate of abnormal placentation.

Contraceptive behavior among women after abortion in Nepal

ObjectiveTo investigate the timing of contraceptive use and estimate the discontinuation rates of temporary methods among women after abortion, or a live birth or stillbirth. MethodsA sample of married women with detailed pregnancy and contraceptive histories was analyzed in a population-based cross-sectional study based on calendar data extracted from the 2011 Nepal Demographic and Health Survey. Kaplan–Meier cumulative and discrete-time hazard models were used to estimate the timing of contraceptive use and discontinuation rates among users of temporary methods. ResultsThe final analysis sample included 3190 women. Of 684 women who had had an abortion, 298 (43.6%) had not initiated any contraceptive use in the 12months afterwards. Women initiated contraceptive use significantly earlier after abortion (hazard ratio [HR] 2.25; 95% CI, 1.96–2.59; P<0.001). The rate of discontinuation among contraceptive users was significantly higher in the postabortion group (HR 1.32; 95% CI, 1.05–1.65; P<0.05). Women who were educated, wealthier, had used contraceptives before the index pregnancy, had two sons and had autonomy initiated contraceptive use significantly earlier in the post-abortion period than their counterparts. ConclusionPostabortion contraceptive use is low in Nepal. Postabortion family-planning counseling and related services should be strengthened with systematic monitoring and follow-up interventions.

Continuation of the Etonogestrel Implant in Women Undergoing Immediate Postabortion Placement

Long-acting reversible contraceptive (LARC) methods can prevent repeat abortion. Two effective reversible LARC methods, the intrauterine device (IUD) and subdermal implant, have the potential to significantly reduce the rate of both unintended pregnancy and abortion. Some clinicians are concerned that women receiving an immediate postabortion etonogestrel implant may have higher rates of discontinuation compared with women who have the implant not in association with a recent pregnancy (interval insertion). Previous studies have not adequately investigated continuation rates for this implant following immediate postabortion insertion. The aim of this study was to compare 12-month continuation rates among women who received an immediate postabortion etonogestrel subdermal implant with those of women who had an interval insertion. The authors performed a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study designed to evaluate continuation and satisfaction for reversible LARC methods. Kaplan-Meier estimator of survival function and Cox proportional hazard models were used to compare continuation rates. Among 1178 women who received the implant during the study period, 141 received the implant immediately postabortion, and 935 had an interval insertion. Rates of 12-month continuation were similar in both groups: 81.5% for women who underwent immediate postabortion placement and 82.8% who had an interval placement (P = 0.54). Survival analysis showed that the likelihood of discontinuation among women who received an immediate postabortion implant was the same as those who had an interval placement; the adjusted hazard ratio was 1.04, with a 95% confidence interval of 0.68 to 1.60. In both groups, frequent or irregular bleeding was the most common reason given for discontinuation of the implant: 65.4% in the immediate postabortion group and 56.7% in the interval group (P = 0.29). These findings show that women who undergo immediate postabortion placement of the subdermal implant are no more likely to discontinue using it than women who have an interval placement. All women undergoing induced abortion should be offered immediate postabortion LARC to reduce the risk of unintended pregnancy and repeat abortion.

Évaluation de la tolérance de l’implant contraceptif selon le contexte de prescription (post-IVG ou non) : étude prospective chez 127 patientes

While contraceptive methods increased in number, the number of abortions has remained stable. The aim of this study was to estimate the satisfaction of women toward a contraceptive implant (Implanon(®)) available in France in order to clarify prescription. The survey concerned 127women who visited Angers and Nantes family planning centres between January2009and January2010in two implant prescription contexts (postabortion or not). They agreed to answer a first questionnaire describing the reasons for their choice. A second questionnaire was sent six months after to assess its tolerance. In our study, 82% of patients were using a contraceptive method prior to implant (68% in postabortion and 88% in the other group). The first reason for choosing the implant was the fear of forgetting-it was more important in the postabortion group (88% vs. 61%). The main side effects were amenorrhea (50%), weight gain (30%) and mood disorders (19%). More than one in two women (54%) was very satisfied by the implant. It should be noted that in one quarter of cases, women seek early withdrawal of the contraceptive implant (23% in postabortion and 21% in the other group), a rate that is 39% in patients under 25years and 47% in patients who reported a mood disorder. There is a tendency to better tolerance of the implant out of a context of abortion. Furthermore, mood disorders appear to be poorly tolerated. These elements encourage greater caution in prescribing the contraceptive implant in postabortion, situation in which patients have already psychological disorders, and even more among younger patients.

Neospora caninum, potential cause of abortions in dairy cows: The current serological follow-up in Slovakia

Neosporosis is considered to be a contributing risk factor for abortions in dairy cows and other farm animals and has negative economic impact on their breeding. In respect of the rapid spread of neosporosis in herds throughout the world, our aim was to detect the prevalence of anti- Neospora antibodies in cows post-abortion (PA) (PA Group n = 716) and in cows without any reproduction problems (Control Group n = 247) on large breeding farms from Eastern Slovakia. The overall mean seropositivity in PA Group (20.1%) was significantly higher ( p < 0.0001) in comparison with the Control Group (2.3%), and this demonstrates the causal dependency of abortions on neosporosis. On farms from south-east region, 15.6% of cows were seropositive on average ranging from 7.8% to 25.8% in different districts. In the northern region, significantly ( p = 0.0002) higher 26.2% mean seropositivity was detected. The seroprevalence in different districts ranged from 2.9% to 39.4%. In the PA Group a high seropositivity to infectious bovine rhinotracheitis (41.5%) and sporadic occurrence of Q-fever, leptospirosis and chlamydiosis was also detected. From 11 Toxoplasma-seropositive cows, only one animal was simultaneously positive to Neospora. The relatively high prevalence rate in cows warrants the attention and a need of surveillance in Slovak herds. A better knowledge of epidemiology of this etiological agent and the mechanisms of its transmission may help in the introduction of more effective preventive and control measures.

Adolescent Postabortion Groups: Risk Reduction in a School-Based Health Clinic

&lt;p&gt;A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in the postabortion counseling groups indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.&lt;/p&gt;

Role of sonography in the diagnosis of retained products of conception.

To present our experience with clinical and sonographic diagnosis of retained products of conception and to evaluate its correlation with histopathologic findings. This was a retrospective study on 156 patients admitted for retained products of conception. Women were referred because of 1 or more of the following: abdominal pain, bleeding, and fever. The status of the cervix was evaluated by bimanual examination. The diagnosis of retained products of conception was made when a sonographic finding of hyperechoic or hypoechoic material was seen in any part of the uterine cavity or the presence of a thickened endometrial stripe greater than 8 mm and an irregular interface between the endometrium and myometrium was found. One hundred twenty-one women (77.6%) were admitted after dilation and curettage for abortion, and 35 (22.4%) were admitted after spontaneous labor. Histopathologic reports confirmed the diagnosis of retained products of conception in 86 (71%) of 121 women in the postabortion group and in 17 (48.5%) of 35 women in the postpartum group. The overall false-positive rate for sonographic diagnosis was 34%. For women after abortion and after delivery, the false-positive rates were 28.9% and 51.5%, respectively. Reliance on common signs and symptoms to diagnose retained products of conception as well as the use of sonography is associated with an unacceptably high false-positive rate, mainly after delivery. A more conservative approach to the treatment of retained products of conception is suggested.

The quality of the caregiving environment and child developmental outcomes associated with maternal history of abortion using the NLSY data.

Studies suggest that experiencing a perinatal loss may leave women vulnerable to mental health problems and may compromise parenting. Unfortunately, compared to miscarriages and stillbirths, very little research has examined the potential for grief and feelings of loss associated with elective abortion. Therefore, the aim of this study was to compare the quality of the childcare environment and children's development among children of mothers with a history of abortion prior to childbirth (n = 672) and children of non post-abortive women (n= 4,172). Data were derived from the National Longitudinal Survey of Youth (NLSY), with comparisons based on two assessments of the caregiving environment and scores on four child outcome variables. The sample was divided into three child age categories: 1-4 years (n = 1,502), 5-9 years (n = 2,121), and 10-13 years (n = 1,524). After controlling for numerous potentially confounding socio-demographic variables, lower scores were observed for the post-abortion group relative to the level of emotional support in the home among first-born children in the youngest age category. Further, among 5-9-year-olds, more behavior problems were revealed for the children of women with a history of abortion. Finally, no main effects were detected between the abortion history groups relative to the level of cognitive stimulation in the home. Although it is widely recognized that at least 10% of post-abortive women experience negative psychological consequences, the potential effects of negative subjective experiences on parenting need more systematic attention.

Post-abortion group therapy.

Two hundred fifty women who had had a therapeutic abortion attended a group therapy program after discharge from the hospital. Each group was led by a psychiatrist-gynecologist team and consisted of three to five women. The authors concluded that the program was beneficial, helping patients to cope with guilt feelings and to clear areas of misinformation about sexual function and contraception. This program also provided an opportunity to combine educational, therapeutic, and preventive aspects of gynecological and psychiatric practice.

International Postpartum Family Planning Program: Report on the First Year

Since conception occurs at a high rate after the first postpartum menstrual period and since women who have recently been pregnant are highly motivated to contraceptive use the Population Council began the International Postpartum Family Planning Program in 1966 in 25 hospitals in 14 countries. The total target population was 2720434 of which about 10% received family planning education and information. In the first 12 months of the program 101725 patients accepted family planning. 51% accepted IUDs 26% oral contraceptives 10% sterilization and 13% other methods. The expulsion rate for the first 3 months of use was 23.4 per 100 insertions for the obstetrical group and 13.1 for the postabortion group but there was a high rate of reinsertion of 60% to 95%. The median age of direct acceptors was 24.9 years and 27.1 for indirect acceptors. The median number of living children was 2.1 and 2.7 respectively. There was a substantial increase in postpartum return rates due to the family planning program. A sample survey of 1930 women showed that after 6 months only 7% were not using any form of contraception. The total cost per prevented virth is estimated at $24.00 assuming 40399 births were prevented by the program.