Late abortion practice in a teaching hospital in India

The medical records of 2055 patients undergoing late abortions were reviewed. These represented 15% of all abortions induced over 10 years. In 52%, abortion was performed between 13-16 weeks, and in 25% at or after 20 weeks. Abortion was requested for risk to health in 55% and for failed contraception in 40%. Surgical techniques were used in 39%. There was a trend to use vaginal surgical procedures increasingly, and intraamniotic saline decreasingly. Extraamniotic ethacridine lactate was used in 12%. Because of the cost, prostaglandin infusions were restricted to 2.5%. Planned evacuation of retained products following a medical procedure was performed in 71%; concomitant sterilization in 24%. The complication rate settled at 11% of which 4% were retained products of conception. Complications increased overall with advancing gestational age, and particularly from 15 weeks onward with vacuum aspiration (p0.05) and with dilatation and curettage (p0.05). Cervical injury increased with advancing gestation (p=0.01). In developing nations, there is a pressing need to educate illiterate women to request abortion earlier.

A comparison of the efficacy of gemeprost vaginal pessaries and extra-amniotic prostaglandin E2 gel in the induction of middle trimester abortion

In an open random allocation trial of 50 patients, 25 had abortion induced vaginally with gemeprost (16.16-dimethyl-trans-delta squared- prostaglandin E1 methyl ester; PGE) 1 mg pessaries inserted into the posterior fornix. The remainder received 7.5 mg PGE2 in a gel inserted into the extraamniotic space. Following the administration of 2 doses of PGE2 gel, abortion was achieved in 100% of the cases within 24 hours, whereas the group treated with a maximum of 3 gemeprost pessaries administered at 3-hour intervals only achieved abortion within 24 hours in 76% of the cases. 3 doses of gemeprost pessaries are the cost equivalent of 2 doses of PGE2 gel.

Nutritional status and unfavourable pregnancy outcome in Egyptian women

The nutritional status in 43 cases of repeated spontaneous (habitual and threatened) abortion with both favorable and unfavorable results was assessed by the 24-hour recall method, as compared to 19 normal terminating pregnancies, all of which were in women of low socioeconomic class and who were considered to be malnourished. All pregnant women were monitored at 2 points during gestation, namely 6-12 weeks and 12-16 weeks, by measuring human chorionic gonadotropin as the main hormonal marker in pregnancy and by total and fractional serum protein estimation as a biochemical probe to both the nutritional status and to the course and outcome of pregnancy. Chorionic gonadotropin was significantly decreased in cases of unfavorable outcome in both gestational periods. Apart from the usual physiological changes of pregnancy in total serum protein and its fractions, a significant increase of the beta globulin fraction in the earlier gestational period only was observed. This increase corresponded to and was inversely proportional to the decreased levels of hCG. The authors therefore suggest the introduction of serum protein electrophoresis as a simple routine procedure for screening high risk pregnancies and thus, the early prediction of unfavorable pregnancy outcome.

Some metabolic and hormonal changes in women using long acting injectable contraceptives

Some metabolic and hormonal changes in women using longacting injectables as a contraceptive method were examined. The 2 main injectables utilized were depomedroxyprogesterone acetate (DMPA), given every 90 +or- 5 days, and norethisterone enanthate (NET/EN) injected every 60 +or- 5 days. None of the studied cases became pregnant during injectable use, indicating the high contraceptive efficacy of the method. No statistically significant changes were observed in hemoglobin, hematocrit, all protein fractions including albumin, alpha1, alpha2 beta, gamma immunoglobulins IgG, IgA, and IgM after 6 and 12 months in both groups of injectable users as compared with the preinjection values. Statistically significant suppression of the estimated hormones, Follitropin, Luteotropin, and Estradiol-17beta were detected in both groups of NET/EN and DMPA users, after 6 and 12 months, as compared with the preinjection values.