Factors influencing morbidity in termination of pregnancy

This study analyzes the morbidity of therapeutic abortion and identifies predisposing factors. A retrospective case evaluation of 2,105 pregnancy terminations was performed. Major complications occurred in 5% of those undergoing curettage procedures, 41% of women undergoing prostaglandin amnioinfusion, and 17% of those who had hysterotomy as a method of abortion. Age, parity, and history of previous pregnancy termination, had little effect on morbidity. Surgical/technical factors and reliance on amnioinfusion and hysterotomy as procedures of choice for pregnancy termination contributed significantly to the high morbidity rates. This contribution, however, was overshadowed by the influence of patient delay, physician delay, and limited abortion facilities, resulting in 35.4% of pregnancy terminations being performed in the midtrimester. Improvements in abortion technique may lower the incidence of complications, but the need for more appropriate facilities is emphasized.

[The vaginal transverse low segment hysterotomy for second trimester therapeutic abortion (author's transl)]

A series of 100 therapeutic abortions by vaginal hysterotomy is reported. This method of vaginal hysterotomy with a transverse low segment incision just above the internal os of the cervix was first described by Fuchs in 1939. The important advantage of this method is complete avoidance of the uterine cervix. With this method a therapeutic abortion after the tenth week of gestation and in a few cases, up to the 20th week of gestation can be accomplished by a fast one stage technique with few side effects. The method is considered to be superior to the injection methods and the two stage procedures. With skill in vaginal operative techniques, this method can be used in any gynaecological department as a routine method. In this series, 28 cases had concomitant tubal ligations. There were two subsequent pregnancies. Complications were one uterine perforation during the curettage requiring laparotomy and suture. There was one laceration of the trigon of the bladder requiring suture. There were 2 cases of hemorrhage. There were 6 inflammatory reactions in the perimetria of which two required administration of antibiotics. There was superficial thrombophlebitis in one case. And there was a severe coagulation defect in one case of a missed abortion at 5 months gestation.

Trends in therapeutic abortion in San Francisco

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