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Background and Aim: Pregnancy termination before onset of labor is one of the midwifery problems. The aim of the present study was to compare extra-amniotic normal saline infusion plus hydrocortisone effect versus prostaglandin E2 suppository for cervical ripening and second- trimester pregnancy termination. Materials and Methods: This randomized clinical-trial study was performed on 50 pregnant women with gestation age of 14 to 28 weeks and Bishops Score ≤ 2 who required pregnancy termination for fetal indications. Half of the cases received extra-amniotic normal saline infusion plus 100 mg hydrocortisone (EASI+ H) and the other half received two doses of 3mg prostaglandin E2 suppository every 4 hours. Six hours later, induction of labor was started by means of a high dose of Oxytocin according to of Alabama University Protocol for Mid-trimester Abortion. The obtained data was analyzed by using statistical softwares Chi-square, Fisher and T-test. Results: There were no differences between the two groups regarding maternal age, parity, gestational age, Primary Bishops Score and indication of pregnancy termination. In the EASI+H group, the mean interval between initiation of labor induction and fetal expulsion was 23.04 ± 4.47 hours and in PGE2 group was 28.65 ± 2.87 hours (P=0.001). The success rate in the EASI+H group was 100% and in PGE2 group 80 % (P =0.04). Complications such as fever, nausea, vomiting, diarrhea, increase of blood pressure and need to curettage in PGE2 group were statistically and significantly more abundant. Conclusion: Extra-amniotic normal saline infusion plus hydrocortisone is an effective and safe method that is suggested for cervical ripening and second- trimester pregnancy termination.

Background: Medical induction abortion is an acceptable alternative to surgical abortion for pregnancy termination. Misoprostol is an inexpensive PGE1 analogue that can be used easily and safely as a single agent for first- and second-trimester pregnancy termination. The objective of this study was to evaluate the efficacy of two different doses of vaginal misoprostol for pregnancy termination with gestational age up to 16 weeks.Methods: This clinical trial included 100 pregnant women with gestational age up to 16 weeks requesting legal termination of pregnancy. The subjects were randomized in two equal groups, and received either 200 (group 1) or 400 µg (group 2) misoprostol vaginally every 6 hours with a maximum of four doses. Response to treatment was defined as complete or incomplete abortion within 48 hours after initial dose. Curettage was performed for patients with heavy bleeding or incomplete abortion. The abortion outcome and side-effects were assessed.Results: The groups were similar in maternal age, gestational age, parity and obstetrical history and indication for pregnancy termination. The side effects in group 2 were significantly higher than in group 1 (P

In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10–22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3–21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4–26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1–25 + 4], the difference was not found to be statistically significant. Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries. • Most of the cases in which pregnancy termination is performed are before the previable period. • The option of termination of pregnancy during the nonviable period is most often recommended due to genetic problems. • The decision-making processes of families who are offered the option of termination of pregnancy should be supported as much as possible • İt seems reasonable to perform fetocide procedure while the fetus is in the intrauterine period for viable pregnancies that are planned to be terminated. [ABSTRACT FROM AUTHOR]

Deafness is the most common sensory disability in humans, influencing all aspects of life, However, early diagnosis of hearing impairment and initiating the rehabilitation process are of great importance to enable the development of language and communication as soon as possible. We examined the differences in attitudes towards performing prenatal invasive tests and pregnancy terminations in Jewish and Muslim women in Israel due to deafness. Overall, 953 Israeli women, aged 18-46 years with a mean age of 32.0 (SD = 7.12), were enrolled. Of those, 68.7% were city dwellers and 31.3% were village dwellers, and 60.2% were Muslim women and 39.8% were Jewish women. All participants had a child with a hearing impairment or deafness. The group with no genetic hearing loss performed more prenatal invasive tests and pregnancy terminations than those with genetic hearing loss in both ethnic groups. Jewish women performed more invasive prenatal tests and, consequently, a pregnancy termination. Secular Jewish women more frequently underwent pregnancy terminations due to fetal deafness. Further genetic counseling and information concerning IVF and PGD procedures should be provided to the Muslim population.

Objective: Mid-trimester pregnancy terminations are becoming an increasingly common practice in obstetrics. Accurate prediction of delay from induction to abortion may help in planning the optimal time for the medical induction process and optimising the use of healthcare services. Therefore, we aimed to assess whether the transvaginal cervical length and cervical elastography can predict the time interval from medical induction to abortion in cases of medically indicated mid-trimester pregnancy termination., Materials and Methods: We performed a prospective observational pilot study between January 2022 and October 2022 in patients who have undergone medically indicated mid-trimester pregnancy termination with a non-dilated cervix for foetal morphological, chromosomal abnormalities or preterm premature rupture of membranes. Cervical length (CL) and cervical strain ratio (CSR) were measured by transvaginal sonography. The predictive value of CL and CSR on the induction to abortion interval was calculated after medical induction with misoprostol., Results: Fifty-three eligible pregnant women were evaluated. The mean gestational age at abortion was 17.61 ± 2.81 weeks. The mean time interval from induction to abortion was 31.72 ± 16.57 h. In multivariate linear regression analysis, CL and the history of previous vaginal delivery were the significant independent predictors of the induction to abortion interval (all p  < 0.01), with no additional significant contribution from CSR., Conclusion: Transvaginal CSR is unlikely to be useful in the prediction of induction to abortion interval in the mid-trimester medically indicated termination of pregnancy.SHORT CONDENSATIONTransvaginal cervical length is the significant independent predictor of the induction to abortion interval in the mid-trimester medically indicated termination of pregnancy with no additional significant contribution from cervical strain ratio.

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.Results: Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) infection is one of the most common congenital infections and the most frequent cause of mental retardation and non-genetically cause of deafness. The risk of fetal transmission is above 40%. The objectives of this study were to review and improve the CMV diagnosis in pregnancy. Method: 50 pregnant women took part in the study. They were taken in evidence at the virology counseling office. The reason for the need of viral diagnosis came from the fact that the result of previous routine serological testing came out positive for CMV IgM antibodies (Ab). Based on the test result, the gynecologist may normally indicate the termination of the pregnancy. Results: In the virology counseling office the results for CMV IgM Ab test turn out negative in 48 of the 50 (96%) referred pregnant women. In two women CMV IgM Ab test turn out positive. These women also tested positive for CMV IgG Ab test. The pregnant women were also tested for pp65 antigenemia. They presented a four times raise in CMV IgG Ab titer. All the rest were negative for pp65 antigemenia. Conclusion: From the 50 women only two needed to terminate their pregnancies. It is important to test for CMV infection in pregnancy along with other viral, bacterial or parasitic infections, but the indication of pregnancy termination must be taken only after a thorough examination and testing. It would be helpful if CMV tests, as well as all the TORCH tests were supported by the health insurance system. [ABSTRACT FROM AUTHOR]

Background: Sexual violence has been prevalent throughout the armed conflict in eastern Democratic Republic of Congo (DRC). Research on sexual violence-related pregnancies (SVRPs) and pregnancy termination in eastern DRC, a context with high prevalence of sexual violence, high maternal mortality, and restrictive abortion laws, is scant but crucial to improving the overall health of women in the DRC. Understanding women's perceptions and experiences related to an SVRP, and in particular to pregnancy termination in this context, is critical for developing effective, targeted programming. Methods: Respondent-driven sampling (RDS) was used to recruit two subgroups of women reporting SVRPs, 1) women raising a child from an SVRP (parenting group) and 2) women who had terminated an SVRP (termination group), in Bukavu, DRC in 2012. Semi-structured qualitative interviews on pregnancy history and outcomes were conducted with a systematically selected sub-group of women recruited through RDS methodology. Interview responses were translated, transcribed and uploaded to the qualitative data analysis software Dedoose. Thematic content analysis, complemented by the constant comparative technique from grounded theory, was subsequently used as the analytic approach for data analysis. Results: Fifty-five qualitative interviews (38 parenting group and 17 termination group) were completed. The majority of women in the termination group reported using traditional herbs to terminate the SVRP, which they often obtained on their own or through family, friends and traditional healers; whereas women in the parenting group reported ongoing pregnancies after attempting pregnancy termination with herbal medications. Three women in the termination group reported accessing services in a health center. Almost half of the women in the parenting group cited fear of death from termination as a reason for continuing the pregnancy. Other women in the parenting group contemplated pregnancy termination, but did not know where to access services. Potential legal ramifications and religious beliefs also influenced access to services. Conclusions: Women in this study had limited access to evidence-based safe abortion care and faced potential consequences from unsafe abortion, including increased morbidity and mortality. Increased access to reproductive health services, particularly safe, evidence-based abortion services, is paramount for women with SVRPs in eastern DRC and other conflict-affected regions. [ABSTRACT FROM AUTHOR]

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP).Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups.Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05).Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition. [ABSTRACT FROM AUTHOR]

Objectives: Termination of pregnancy (TOP) is one of the most performed interventions in women worldwide: approximately one in three women will have at least one TOP in their reproductive life. Intrauterine adhesions (IUAs) have been reported as a possible complication after TOP, but their prevalence has not been established, as women are not routinely evaluated. IUAs are associated with menstrual disturbances, infertility and obstetric complications.Methods: We searched Ovid MEDLINE, Ovid EMBASE and CENTRAL from inception until November 2015 for studies evaluating women following TOP. We selected studies in which women were evaluated consecutively, independently of symptoms, by hysteroscopy or hysterosalpingography (HSG), for the presence of IUAs.Results: After an extensive review of the literature, no studies were found that evaluated women after medical TOP and no randomised trials following surgical TOP. Only two prospective cohort studies were identified. In the first, IUAs were detected in 21.2% of women evaluated by hysteroscopy following first trimester surgical TOP; adhesions were moderate to severe in 48%. In the second, IUAs were detected in 16.2% of women evaluated by HSG after second trimester TOP by intra-amniotic prostaglandin induction followed by D&C; a pathologically wide internal cervical os was observed in 12%.Conclusions: This systematic review suggests a link between TOP and adhesion formation, but, according to the scientific literature and despite new diagnostic facilities, the relationship between the methods of TOP and IUA formation remains unclear. Nevertheless, the reported frequency is in accordance with that found in women following D&C for miscarriage. Further research is required. [ABSTRACT FROM AUTHOR]

Unlabelled: With changing conditions affecting receipt of postabortion care, an updated estimate of the incidence of treatment for complications from unsafe pregnancy termination is needed to inform policies and programmes. National estimates of facility-based treatment for complications in 26 countries form the basis for estimating treatment rates in the developing world. An estimated seven million women were treated in the developing world for complications from unsafe pregnancy termination in 2012, a rate of 6.9 per 1000 women aged 15-44 years. Regionally, rates ranged from 5.3 in Latin America and the Caribbean to 8.2 in Asia. Results inform policies to improve women's health.Tweetable Abstract: An estimated 7 million women were treated in the developing world for complications of unsafe TOP in 2012. [ABSTRACT FROM AUTHOR]

Objectives: Among women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used.Study Design: We included all requests for pregnancy termination in Norway during the years 2007-2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level.Results: In total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20-24years old had used contraception, compared to 29.9% of women 40-44years old (odds ratio 0.55, 95% confidence interval 0.51-0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use.Conclusion: Among women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant.Implications: A large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review and metaanalysis was to determine the efficacy and safety of cervical ripening agents in the second trimester of pregnancy in patients with previous cesarean delivery.Study Design: Data sources were PubMed, EMBASE, CINAHL, LILACS, Google Scholar, and clinicaltrials.gov (1983 through 2015). Eligibility criteria were cohort or cross-sectional studies that reported on efficacy and safety of cervical ripening agents in patients with previous cesarean delivery. Efficacy was determined based on the proportion of patients achieving vaginal delivery and vaginal delivery within 24 hours following administration of a cervical ripening agent. Safety was assessed by the risk of uterine rupture and complications such as retained placental products, blood transfusion requirement, and endometritis, when available, as secondary outcomes. Of the 176 studies identified, 38 met the inclusion criteria. Of these, 17 studies were descriptive and 21 studies compared the efficacy and safety of cervical ripening agents between patients with previous cesarean and those with no previous cesarean. From included studies, we abstracted data on cervical ripening agents and estimated the pooled risk differences and risk ratios with 95% confidence intervals. To account for between-study heterogeneity, we estimated risk ratios based on underlying random effects analyses. Publication bias was assessed via funnel plots and across-study heterogeneity was assessed based on the I(2) measure.Results: The most commonly used agent was PGE1. In descriptive studies, PGE1 was associated with a vaginal delivery rate of 96.8%, of which 76.3% occurred within 24 hours, uterine rupture in 0.8%, retained placenta in 10.8%, and endometritis in 3.9% in patients with ≥1 cesarean. In comparative studies, the use of PGE1, PGE2, and mechanical methods (laminaria and dilation and curettage) were equally efficacious in achieving vaginal delivery between patients with and without prior cesarean (risk ratio, 0.99, and 95% confidence interval, 0.98-1.00; risk ratio, 1.00, and 95% confidence interval, 0.98-1.02; and risk ratio, 1.00, and 95% confidence interval, 0.98-1.01; respectively). In patients with history of ≥1 cesarean the use of PGE1 was associated with higher risk of uterine rupture (risk ratio, 6.57; 95% confidence interval, 2.21-19.52) and retained placenta (risk ratio, 1.21; 95% confidence interval, 1.03-1.43) compared to women without a prior cesarean. However, the risk of uterine rupture among women with history of only 1 cesarean (0.47%) was not statistically significant (risk ratio, 2.36; 95% confidence interval, 0.39-14.32), whereas among those with history of ≥2 cesareans (2.5%) was increased as compared to those with no previous cesarean (0.08%) (risk ratio, 17.55; 95% confidence interval, 3.00-102.8). Funnel plots did not demonstrate any clear evidence of publication bias. Across-study heterogeneity ranged from 0-81%.Conclusion: This systematic review and metaanalysis provides evidence that PGE1, PGE2, and mechanical methods are efficacious for achieving vaginal delivery in women with previous cesarean delivery. The use of prostaglandin PGE1 in the second trimester was not associated with significantly increased risk for uterine rupture among women with only 1 cesarean; however, this risk was substantially increased among women with ≥2 cesareans although the absolute risk appeared to be relatively small. [ABSTRACT FROM AUTHOR]

Study Question: Does the incidence of spontaneous abortion correlate positively over conception cohorts with the incidence of non-clinically indicated induced abortion as predicted by shared risk aversion?Summary Answer: We find that the number of spontaneous and non-clinically indicated induced abortions correlates in conception cohorts, suggesting that risk aversion affects both the conscious and non-conscious mechanisms that control parturition.What Is Known Already: Much literature speculates that natural selection conserved risk aversion because the trait enhanced Darwinian fitness. Risk aversion, moreover, supposedly influences all decisions including those that individuals can and cannot report making. We argue that these circumstances, if real, would manifest in conscious and non-conscious decisions to invest in prospective offspring, and therefore affect incidence of induced and spontaneous abortion over time.Study Design, Size, Duration: Using data from Denmark, we test the hypothesis that monthly conception cohorts yielding unexpectedly many non-clinically indicated induced abortions also yield unexpectedly many spontaneous abortions. The 180 month test period (January 1995 through December 2009), yielded 1 351 800 gestations including 156 780 spontaneous as well as 233 280 induced abortions 9100 of which were clinically indicated.Participants/materials, Setting, Methods: We use Box-Jenkins transfer functions to adjust the incidence of spontaneous and non-clinically indicated induced abortions for autocorrelation (including seasonality), cohort size, and fetal as well as gestational anomalies over the 180-month test period. We use cross-correlation to test our hypothesized association.Main Results and the Role Of Chance: We find a positive association between spontaneous and non-clinically indicated induced abortions. This suggests, consistent with our theory, that mothers of conception cohorts that yielded more spontaneous abortions than expected opted more frequently than expected for non-clinically indicated induced abortion.Limitations, Reasons For Caution: Limitations of our work include that even the world's best registration system will not capture all spontaneous abortions and that results may not generalize beyond Denmark.Wider Implications Of the Findings: Our findings imply that abortion, intentional or 'spontaneous,' follows from a woman's estimate, made consciously or otherwise, of the costs and benefits of extending gestation given characteristics of the prospective offspring, likely environmental circumstances at birth, and maternal resources.Study Funding/competing Interests: The Robert Wood Johnson Health and Society Scholars Program funded the research described in this manuscript. None of the authors has any conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Pregnant women routinely undergo prenatal screening in Australia and this has become a common experience of motherhood. When prenatal screening or prenatal testing results in diagnosis of a serious fetal abnormality, women are presented with a decision to continue or terminate their pregnancy. Few recent studies have explored women’s psychosocial experience of prenatal diagnosis and pregnancy termination for fetal abnormality, and within this small group of studies it is rare for research to consider the embodied aspect of women’s experiences. This paper reports on qualitative findings from in-depth interviews with 59 women in Melbourne, Australia who received a prenatal diagnosis of a significant abnormality and decided to terminate the pregnancy. Interview transcripts were coded inductively through thematic analysis. Two themes about embodiment were generated from the interviews: transitioning embodiment, and vulnerable bodies in un/comfortable spaces. Theory of pregnant embodiment was drawn on in interpreting women’s narratives. Recommendations arising from the analysis include health professionals recognising, acknowledging and accommodating the transitioning embodied state of women as they consider, prepare for, undergo and recover from pregnancy termination for fetal abnormality. Further recommendations address the connections and disconnections between this transitioning embodied state and the spaces of clinics, hospitals and home. [ABSTRACT FROM AUTHOR]

Objective: The study was aimed to determine the safety and efficacy of the vaginal administration of low dose misoprostol for late pregnancy termination in women with prior caesarean and unscarred uteri. Study design: A retrospective study was carried out from January 2008 to June 2012 on 209 pregnant women who underwent termination of pregnancy in the second and early third trimester. Among the women, 173 did not have a uterine scar (Group 1) while 36 had a history of prior caesarean (Group 2). The induction-to-abortion interval, the rate of complications and failureand the need for a different method during the process were assessed. Results: In group 1, 145 of patients (83.8%) delivered vaginally in 48 hours, the mean duration of the induction-toabortion interval was 21±10.3 hours. In this group, 11 patients (6.3%) needed one or more different methods and one case of uterine rupture (0.57%) was observed. In group 2, 26 of patients (72.2%) delivered vaginally in 48 hours (p=0.11), the mean induction-abortion interval was 22.7±10.8 hours (p=0.45). Six patients (16.7%) needed a different method (p=0.05) and there was also one case (2.7%) of ruptured uterus (p=0.28). Conclusion: Administration of low-dose vaginal misoprostol appears to be effective without excessive side effects or complications for late pregnancy termination. [ABSTRACT FROM AUTHOR]

Background: Termination of pregnancy requires a 48-hour 'window' between mifepristone and misoprostol. Shorter durations have been used in first-trimester termination, but there are few data available in later termination for fetal anomaly.Material and Methods: We reviewed all terminations for fetal anomaly at ≥13 weeks from May 2013 to May 2014. Cases were managed using a short (≤12 h) or standard (≥36 h) mifepristone-to-misoprostol interval.Results: Two hundred and twenty women underwent a termination of pregnancy for fetal anomaly during the study period, of which 119 were included for analysis. Sixty-six (55%) women were managed according to the short regimen and 53 (45%) women with the standard regimen. The short regimen resulted in a shorter mifepristone-to-delivery interval but was less likely to result in delivery within 12 h of misoprostol. Delivery rates at 24 h were equivocal. There was no difference in blood loss, vaginal delivery rates, complications or bed nights. The short regimen did require more doses of misoprostol. Feticide or previous uterine scar had no effect on outcomes.Discussion: There was no significant difference in clinical outcome for women managed with a short (≤12 h) or a standard (≥36 h) regimen for medical termination of pregnancy for fetal anomaly, suggesting that either regimen could be offered. [ABSTRACT FROM AUTHOR]

Aglepristone (RU 46534) is a competitive progesterone antagonist that is indicated for the treatment of various progesterone-dependent physiological or pathologic conditions. Aglepristone has proven to be an effective means of terminating pregnancy in most species. When used to induce parturition, aglepristone was effective in all cases in the bitch, cow, and goat, with no apparent adverse effects on neonatal health or milk production. When used to schedule an elective cesarean section, aglepristone treatment was deemed safe for dams and puppies, providing that the ovulation date had been accurately assessed at the time of breeding. Irrespective of the stage of pregnancy at injection, treatment with aglepristone has no apparent negative effects on subsequent fertility. Aglepristone is also a safe and relatively effective means of treating pyometra. However, given the high level of septic risk and the likelihood of rapid deterioration, such therapy is not recommended in emergency situations. Treatment of feline fibroadenomatosis using aglepristone has given promising results, but repeat treatment may be necessary in cats previously treated with long-acting progestagens. The use of aglepristone in other progesterone-dependent diseases has yet to be fully evaluated but may prove valuable, especially in the treatment of insulin-resistant diabetes mellitus, acromegaly, and the treatment of some vaginal tumors in the bitch. [ABSTRACT FROM AUTHOR]

Objective: Existing abortion stigma research has rarely isolated the reason for termination; thus, the consequences of termination for medical reasons (TFMR) are poorly understood. We aimed to understand the association of stigma and social support with decision satisfaction in TFMR., Methods: We performed a cross-sectional study on the experiences of 132 individuals who had a TFMR in the second or third trimester. We recruited participants via Facebook. Most participants were non-Hispanic White (85.6%), between 31 and 40 years old (72.7%), highly educated (84.1% with a 4-year degree), and married (89.4%). Participants completed an online demographic data questionnaire, including questions about stigma and social support, and an adapted satisfaction with decision survey. We used t -tests to explore the connection of stigma and social support with decision satisfaction., Results: Results did not reveal an association between stigma and decision satisfaction, but showed that higher social support is associated with higher decision satisfaction. Decision satisfaction was higher in participants who experienced more than one source of support [ t (130) = 2.527, p  = 0.01], compared with those reporting only one source of support, and in those who experienced support from a relative [ t (130) = 1.983, p  = 0.049] and physician [ t (130) = 2.357, p  = 0.020] than in those who did not., Discussion: Social support can alleviate the suffering related to TFMR. Exploring how different forms of social support, including therapy groups, can impact decision satisfaction might help develop interventions to improve postabortion outcomes., Practice Implications: Provider training must encourage providers to (1) support patients having a TFMR and (2) connect patients with other sources of support., Competing Interests: No competing financial interests exist., (© Tayler Hendrix et al., 2023; Published by Mary Ann Liebert, Inc.)

Aims: The study aimed to present a broad overview of the research conducted and to synthesize evidence of the utility of nonpharmacological interventions for pain management in medical and surgical abortions., Background: High-quality care for medical and surgical abortion requires pain to be managed effectively. However, women reported low satisfaction with pain management in abortion care., Design: A scoping review design was employed., Data Sources: No date limit was set. PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL, PsycINFO, ProQuest and Scopus were searched in April 2021., Review Methods: Arksey and O'Malley's framework was used. The Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews was followed., Results: Fifteen studies were included. The results revealed that support interventions, music therapy, acupoint stimulation and hypnotic analgesia were nonpharmacological interventions used to decrease abortion pain., Conclusions: Clinical nurses, nurse managers and policymakers should attach full importance to the pain management in abortion and may use the study findings to guide the pain management practice., (© 2022 John Wiley & Sons Australia, Ltd.)

Legal, institutional, and payer policies regulating reproductive health care lack a shared language with medicine, resulting in great confusion and consternation. This paper critically examines the implications and ramifications of unclear language related to abortion care. Using a case-based approach, we highlight the ways in which language and terminology may affect the quality and accessibility of care. We also address repercussions for providers and patients within their team, institutional, state, and payer landscapes. In particular, we explore the stigmatization of abortion as both a word and a process, the role of caregivers as gatekeepers, the implications of viability as a limit for access, and the hierarchy of deservedness and value. Recognizing the role of language in these discussions is critical to building systems that honor the complexities of patient-centered reproductive decision-making, ensure access to comprehensive reproductive health care including abortion, and center patient autonomy. Healthcare providers are uniquely positioned to facilitate institutional, state, and national landscapes in which pregnant patients are supported in their autonomy and provided with just and equitable reproductive health care., (Copyright © 2022. Published by Elsevier Inc.)

Background: Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy.Methods: Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship.Results: Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years.Conclusions: Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the causes of stillbirth and the termination of pregnancy. Methods: 23 fetal death cases from our hospital were selected. The general information, causes of stillbirth in pregnant women and termination of pregnancy were analysis. Results: Stillbirth in pregnant women, older than 36 years were the most, a total of 8 cases, accounting for 34.8%. The number of pregnant women at 28-36+6 weeks of gestation was the most, and there were 10 cases, accounting for 43.5%. At the beginning of 17 women, accounting for 73.9%. There were 9 cases of pregnant women with miscarriage, accounting for 39.1%. Among all the causes, the proportion of umbilical cord was the largest, and there were 11 cases, accounting for 47.8%. Placenta and maternal factors, 5 cases, each accounted for 21.7%, 2 cases of fetal cause and unknown reasons, each accounted for 8.7%. On the choice of termination of pregnancy, the implementation of the amniotic cavity puncture of the number of cases, a total of 13 cases, accounting for 56.5%. Cesarean section, a total of 5 cases, accounting for 21.7%, accounting for 13% of the 3 cases of abortion, childbirth, from 2 patients, accounting for 8.7%. Conclusion: umbilical cord factors is the main reason causing stillbirths occur. Secondly, placenta and maternal factors, pregnant women with were comprehensive examination during pregnancy and maternal health education, in order to reduce fetal death, and choose the suitable method of pregnancy termination in order to alleviate the pain of pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: We studied the proportion of all pregnancy terminations requested by women with a history of pregnancy termination. We also studied risk factors for repeat pregnancy termination.Material and Methods: We used data from the Norwegian Register of Pregnancy Termination during the period 2007-2011, a total of 80,346 requests for pregnancy termination before the end of the 12th gestational week. Odds ratios for repeat pregnancy termination were estimated according to age, parity, contraceptive use, marital status, education, employment status and region of residency by applying logistic regression analyses. Repeat pregnancy termination was defined as request for pregnancy termination for the second time or more.Results: Among the 80 346 requests for pregnancy termination, 36.7% were among women with a history of pregnancy termination. In total, 25.0% had one prior termination and 11.7% had two or more. Factors associated with repeat pregnancy termination were; age ≥25 years, having one or more children, and use of contraception at the time of conception. College/university education as compared with primary school only, was associated with reduced risk of repeat termination.Conclusion: Among all requests for pregnancy termination in Norway, 36.7% were from women with a history of pregnancy termination. Many women with repeat pregnancy termination have children and/or used contraception at the time of conception. Our findings therefore suggest that high fecundity is an underlying risk factor for repeat pregnancy termination. [ABSTRACT FROM AUTHOR]

Study Question: How does a national prenatal screening program for Down syndrome (DS) perform in detecting sex chromosome abnormalities (SCAs)-Turner syndrome (TS), Klinefelter syndrome, 47,XXX and 47,XYY syndromes.Summary Answer: The SCA detection rate resulting from DS screening was below 50% for all four groups of SCAs.What Is Known Already: The detection rates of SCAs are higher in countries with DS screening. TS is associated with greater nuchal translucency (NT) and lower pregnancy-associated plasma protein-A (PAPP-A). However, specific detection rates of SCAs using prenatal DS screening have not been determined. No clear trend in PAPP-A, free beta human chorionic gonadotropin (β-hCG) and NT has been found in the remaining SCAs. Several lines of inquiry suggest that it would be advantageous for individuals with SCA to be detected early in life, leading to prevention or treatment of accompanying conditions. There is limited information about pre- and perinatal status that distinguishes SCA embryogenesis from normal fetal development.Study Design, Size, Duration: A register-based case-control study from the Danish Central Cytogenetic Register (DCCR), cross-linked with the Danish Fetal Medicine Database (DFMD), was performed from 2008 to 2012. Groups of SCAs were compared with DS and then matched with non-SCA controls to assess differences between these groups in prenatal markers and birth outcomes.Participants/materials, Setting, Methods: We included cases with prenatal and post-natal SCA karyotypes (n = 213), DS (n = 802) and 168 056 controls. We screened 275 037 individuals examined prenatally. We retrieved information regarding maternal age, NT, β-hCG and PAPP-A, as well as details regarding maternal and newborn characteristics.Main Results and the Role Of Chance: The DS screening procedure detected 87 per 100 000 TS (42% of expected), 19 per 100 000 Klinefelter syndrome (13% of expected), 16 per 100 000 47,XXX (16% of cases) and 5 per 100 000 47,XYY (5% of expected) SCAs, with an overall detection rate of 27%. Compared with controls, all four SCA groups showed significantly higher NT and lower PAPP-A compared with controls (all P < 0.01) and similar to DS. The legal abortion rate was high for all four syndromes (47,XXX: 24%; 47,XYY: 29%; Klinefelter syndrome: 48%, TS: 84%). For SCA fetuses carried to term, only TS fetuses had consistently lower birthweights and placenta weights than non-SCA controls (both P = 0.0001). A few SCA cases localized in DCCR could not be found in DFMD (n = 16).Limitations, Reason For Caution: Controls were matched on sex of the fetus of cases, meaning that all electively aborted fetuses (before week 12) were excluded, possibly reducing the diversity in the control group. We were not able to localize all diagnosed cases of SCA and DS in DFMD. Although these cases were present in DCCR, we were not able to account for the discrepancy. In addition, we suspect that several SCA children have not been diagnosed yet and future post-natal diagnosis of these cases would reduce the diagnostic yield reported here even further.Wider Implications Of the Findings: The prenatal detection rate is below 50% for all SCAs. The approach used for detecting DS cannot be extended to also include SCAs. In addition, all SCAs have low PAPP-A and increased NT, thus probably reflecting an abnormal embryogenesis. Growth retardation of TS fetuses is if anything more pronounced than previously reported, both when evaluating fetus and placenta.Study Funding/competing Interests: This study received support from Aarhus University and the Novo Nordisk Foundation. The authors have no competing interests that may be relevant to the study. [ABSTRACT FROM AUTHOR]

Objective The objective was to evaluate whether the use of sevoflurane during general anesthesia for dilation and evacuation (D&E) procedures increases the frequency of interventions to treat excess bleeding. Study design A randomized, double-blinded, placebo-controlled trial of a standardized general anesthesia protocol with or without inhaled sevoflurane for D&Es between 18 and 24 weeks’ gestation was performed. The primary outcome was need for any intervention to treat blood loss. Secondary outcomes included measured blood loss, procedure time, complications, side effects, patient satisfaction and provider ease of procedure. Results One hundred sixty subjects were randomized. Those in the sevoflurane group were slightly more likely to have interventions for bleeding as compared to those subjects who did not receive sevoflurane (25% versus 16.3%, p=.17) or a measured blood loss above 300 mL (15% versus 7.5%, p=.13); however, these differences could have arisen by chance. Most cases of excess bleeding required only minor interventions, including uterine massage and/or uterotonic agents. Procedure time, complications, side effects, satisfaction and ease of procedure were similar between groups. Conclusion Addition of sevoflurane to general anesthesia during a D&E between 18 and 24 weeks’ gestation did not increase the risk of intervention for bleeding; however, this study was underpowered to detect clinically important differences. Implications In this randomized, double-blinded, placebo-controlled trial, sevoflurane did not significantly increase the risk of intervention for bleeding during D&Es. However, this agent should be used with caution as an anesthetic for surgical abortions. [ABSTRACT FROM AUTHOR]

The present paper examines the level and correlates of unintended pregnancies among young women in the Islamic Republic of Iran using a sub-sample of 4,402 ever-married women aged between 15 and 24 from the 2010 Iran Multi-Indicator Demographic and Health Survey (IrMIDHS). Multivariate analysis is then applied to the 2005 Iran Low Fertility Survey (ILFS) to explore the experience of pregnancy termination in young ages. The comparison of the outcomes of wanted and unintended pregnancies shows that the proportion of both induced and spontaneous abortions are significantly higher for unintended than for wanted pregnancies. The higher rates of abortion among the more recent pregnancy cohorts (1995-2005) indicate an increasing trend of pregnancy termination in the Islamic Republic of Iran. The paper concludes with a recommendation stressing the importance of continued provision of family planning services to young couples, in order to reduce the risk of unintended pregnancy and to avoid unsafe and clandestine abortions that may cause numerous irreversible adverse effects on women's health. [ABSTRACT FROM AUTHOR]

Objectives We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time. Study design We conducted a longitudinal qualitative study of decision satisfaction, grief and coping among women undergoing termination (dilation and evacuation or induction termination) for fetal anomalies and other complications. We conducted three post-procedure interviews at 1–3 weeks, 3 months and 1 year. We used a generative thematic approach to analyze themes related to grief using NVivo software program. Results Of the 19 women in the overall study, 13 women’s interviews were eligible for analysis of the grief experience. Eleven women completed all three interviews, and two completed only the first interview. Themes that contributed to grief include self-blame for the diagnosis, guilt around the termination decision, social isolation related to discomfort with abortion and grief triggered by reminders of pregnancy. Social support and time are mechanisms that serve to alleviate grief. Conclusions Pregnancy termination in this context is experienced as a significant loss similar to other types of pregnancy loss and is also associated with real and perceived stigma. Women choosing termination for fetal anomalies may benefit from tailored counseling that includes dispelling misconceptions about cause of the anomaly. In addition, efforts to decrease abortion stigma and increase social support may improve women’s experiences and lessen their grief response. Implications The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients’ suffering and offer tools to direct their grief toward positive coping. [ABSTRACT FROM AUTHOR]