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Abstract: In Sri Lanka, induced abortion is a criminal offence except to save the life of the mother. This study determined the awareness and views of the law on abortion among women seeking an abortion. Three hundred and thirteen women were interviewed. The characteristics of the study group are discussed. 65.8% of the respondents stated they knew the current law, 25.6% stated they did not and 8.3% were unsure. On detailed analysis of each respondent’s knowledge regarding the situations where abortion is legalized including those who stated that they did not know the law, only 11.2% had an accurate knowledge. More than 75% stated that abortion should be legalized when the mother’s life was in danger, where there was pregnancy after rape or incest, when there was psychiatric illness in the mother and when there were fetal anomalies. Reasons for resorting to an abortion are discussed. Although 11.2% were aware of the law, there was no difference in the reasons for resorting to an abortion when compared with those who were unaware of the law. This study highlights the fact that availability of abortion services to women depend not only on the law and its awareness, but on how it is interpreted and enforced. [Copyright &y& Elsevier]

The Bruce effect is a phenomenon in which pregnant females terminate their pregnancies when exposed to strange males, and is hypothesised to be a female counter-strategy to infanticide risk. Since uncertain paternity decreases the incidence of infanticide, we tested the prediction that the Bruce effect would occur in mating systems where paternity is more certain (polygyny) rather than in mating systems where paternity is less certain (promiscuity). Using populations of the vlei rat Otomys irroratus that were either polygynous or promiscuous in nature, we studied the Bruce effect in captivity. Pregnancy termination almost always occurred in polygynous females but never in promiscuous females (N = 10 per population). We expected that the signal–receptor (male–female) system of pregnancy termination is present in polygynous but not promiscuous populations and predicted an absence of the Bruce effect in encounters between individuals of different mating systems. This occurred in promiscuous females. However, 50% of polygynous females terminated their pregnancies, indicating that males of both mating strategies might carry signals to disrupt pregnancy but only polygynous females respond to these signals. The Bruce effect may be an adaptive response to infanticide risk in polygynous populations, although studies of free-living populations would be important to confirm our findings. [ABSTRACT FROM AUTHOR]

Abstract: In the present study, resorption/abortion was induced between days 25 and 45 of gestation with aglepristone (group IRA, n =10). The aim was to observe the change in the distribution of progesterone (PR) and estrogen receptors (ER), in comparison to a group of spontaneous resorptions/abortions (group SRA, n =5), and a further group of normal healthy pregnant animals, ovariohysterectomized between days 25 and 45 of gestation (controls, n =7). The receptors were assessed by means of immunohistochemistry (IHC) and RT-PCR, at the placental and interplacental sites of the uterine horn as well as in the corpus uteri. Significant differences were observed between the controls on one side and the groups of resorption/abortion on the other side. The total scores of the progesterone receptors (TPR) in the placental and interplacental part of the uterine horn, was significantly lower in the endometrial stromal cells (ESC) of the control group than in those of the SRA- and IRA-group, respectively (placenta: 5.8 vs. 6.5 and 6.7, p <0.01; interplacental sites: 5.6 vs. 6.6 and 6.6, p <0.05). In contrary, the total scores of the estrogen receptors (TER) at interplacental sites and the corpus uteri, respectively, was significantly higher in the myometrial smooth muscle cells (MSMC) and the ESC (p <0.05) of the controls. We therefore conclude, that the here observed differences between groups point to an up-regulation of TPR- and a down-regulation of TER-scores in endometrial stromal cells at different uterine sites during resorption/abortion, which indicates a special role of these cells. [Copyright &y& Elsevier]

The article discusses how the creation of the electric vacuum aspirator changed methods for performing abortions in the U.S. Previous to the creation of the aspirator, abortions were performed through dilation and curettage (D&C) methodology. The author notes that use of the aspirator reduced the risk of infection and uterine perforation and increased due to the decriminalization of abortion. He comments on resistance to the technology and how following its adoption, some physicians modified and improved the device. The use of aspirators in gynecology by physicians such as T. Gaillard Thomas, Emil Novak and Franc Novak is noted.

Objectives: The primary aim was to evaluate which investigation performed after sonographic detection of central nervous system (CNS) or skeletal anomalies that had highest diagnostic yield. The secondary aim was to estimate recurrence risk. Design. Retrospective review of patients' records. Setting: Tertiary fetal medicine referral center. Sample: Pregnancy terminations (n=97) because of CNS or skeletal anomalies during a 17-year period, within 12-24 weeks gestation. Methods: Two medical geneticists and one genetic counselor reviewed charts independently. Main Outcome Measures: Primary ultrasound diagnosis, change in diagnosis following supplementary examinations in addition to prenatal ultrasound (medical history, autopsy, post-mortem X-ray, karyotyping, targeted DNA analysis and investigations for infection), the most useful method to determine diagnosis, and recurrence risk estimate including inter-rater agreement. Results: Mean gestational age was 19.8 weeks. All three investigators agreed in each case on which investigation constituted the best basis to determine the most precise diagnosis. The examinations performed in addition to prenatal ultrasound provided important diagnostic information in 54 cases (56%) and altered recurrence risk in 22 (23%) cases; in eight of these cases the risk estimate was increased. In nine cases (9%) the investigators disagreed in their estimates of recurrence risk. Kappa for inter-rater agreement was >0.90. Conclusions: A panel of diagnostic investigations, depending on the organ system involved, allows for a more precise diagnosis and a more reliable estimate of recurrence risk than prenatal ultrasound alone. In some instances, recurrence risk estimation is not straightforward as evidenced by lack of consensus. [ABSTRACT FROM AUTHOR]

Abstract: The efficacy of aglepristone treatment to induce abortion in does 15 and 16 days after mating was investigated. The pregnant does were randomly allocated into two groups: For group I, aglepristone was injected twice (10mg/kg, subcutaneously) on days 15 and 16 after mating (n =10); for group II the does got no treatment but the same volume of 0.9% sodium chloride solution was subcutaneously injected at the same days of pregnancy (n =5). Results: group I, termination of pregnancy was successful in all does. The mean interval between the first administration of aglepristone and the beginning of vaginal discharge was 32.4±5.6h (range 19–72h). Complete expulsion of all fetuses was observed in four does with first occurrences of vaginal discharge on the same day. The duration between the first occurrence of vaginal discharge to expulsion of all fetuses ranged between 21 and 130h (mean 70.2±12.2h). As important side effects, decrease in food consumption during abortion time and irregular mating behaviour (52.3±2.0 days/range 46–63) were recorded. But after this time all does were mated again, 8/10 became pregnant and they whelped normal and live kittens. Group II, all does gave birth to live kittens after a mean pregnancy length of 31.2±0.37 days (range 30–32 days). The mean serum progesterone (P4) concentrations were significantly different between control and treated does after day 20 of pregnancy (P <0.05). The results indicate that aglepristone treatment is effective to induce abortion in does and causes no serious negative effects on further fertility except a short non-receptive period after abortion and short time decrease in food consumption. [Copyright &y& Elsevier]

Aim: To compare the effectiveness of vaginal misoprostol between dry tablet insertion and gel form for second trimester pregnancy termination. Methods: A non-blinded block randomized controlled trial was conducted on 148 pregnant women with live fetuses in the second trimester undergoing pregnancy termination. They were randomly allocated to receive vaginal misoprostol (400 μg) either dry tablet insertion ( n = 72) or gel form ( n = 76). The same dose was then repeated every 3 h if adequate uterine contraction was not achieved until 48 h after the initiation of misoprostol. If abortion did not occur within this period, the treatment was considered a failure and other technique of termination was then given based on the decision of the attending physicians and the cervical status. Results: The mean induction–abortion interval in group 1 (20.9 ± 12.3 h) was not significantly different from that in group 2 (17.7 ± 10.2 h). The mean total dose of misoprostol was also not significantly different between the two groups (group 1, 1556.9 μg; group 2, 1350.9 μg), but the adverse effects of misoprostol (chill and diarrhoea) were more common in the gel group. Conclusion: Tablet insertion or gel form of vaginal misoprostol have similar effectiveness but the gel form was associated with more common adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: To compare the general characteristics and clinical outcome of women who underwent medical termination of pregnancy preceded or not by feticide. Methods: A total of 146 women of diverse gestational ages, who had received a sonographic or genetic diagnosis of fetal abnormality incompatible with postnatal life and chose to legally terminate their pregnancy, had labor induced following feticide (n = 82) or without having feticide performed (n = 64). Results: The number of obstetrical procedures was higher (p = 0.001) in the feticide group. Time of labor induction and complications were similar in both groups. Conclusion: Feticide does not alter the clinical obstetrical course of women undergoing medical termination of pregnancy, and poses no risk to maternal health regardless of gestational age. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study examined the psychosocial problems of a sample of adolescent women who presented for a pregnancy termination appointment at a family planning clinic located in the southeastern region of the United States. The sample consisted of 120 adolescent women, age 14-21 who were administered the Multidimensional Adolescent Assessment Scale (MAAS) while waiting for their pregnancy termination procedure. The MAAS is a self-administered instrument with multiple subscales that measure a variety of psychosocial problems. Results indicated that most subjects did not score in the clinical range on the various subscales, thus indicating respondents as overall being stable and healthy. This paper reviews the specific findings from the study and discusses implications for practice and future research directions on this understudied population. [ABSTRACT FROM AUTHOR]

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Objective: To review the frequency of autopsy following pregnancy termination for fetal anomaly and its contribution to subsequent counselling. Methods: All medical pregnancy terminations for fetal anomaly performed after 14 weeks gestation from January 1997 to December 2006 were identified and the frequency of autopsy ascertained. The prenatal diagnosis prompting the termination was then compared with the autopsy data, and a diagnostic valuation was determined. The potential autopsy value ranged from no additional information provided, minor added value, significant added value, major added value to non-confirmation of the prenatal findings. Results: During the ten-year study period, there were 1012 consecutive terminations for fetal abnormality. The principal indications for termination were: karyotypic (38.4%); neural tube defects (16.1%); cardiac (10.3%) and cerebral anomalies (7.5%). Autopsy was performed in 809 cases (79.9%). The autopsy rate progressively declined from 95.1% in 1997 to 67.5% in 2006 ( P < 0.001). Women declining autopsy were older (31 years (26,35) vs 32 years (27,37), P = 0.005) and more likely to have a fetal chromosomal abnormality (30.6% vs 69.9%, P < 0.001) (autopsy vs no-autopsy). In euploid cases, autopsy confirmed the prenatal diagnosis with no additional information in 63.5% (357 of 562). In 1.1% (six cases), autopsy added major diagnostic information, and in 15.1% (85 cases), significant information was provided. Conclusions: Although contemporary prenatal testing has improved the recognition of fetal abnormalities, autopsy remains a valued tool by providing diagnosis or clarification of some prenatal findings in 16% of cases. Fetal autopsy rates are declining and this trend may lead to a loss of diagnostic and recurrence risk-counselling information. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: : To assess the indications of termination of pregnancy (TOP) for fetal anomaly beyond 22 weeks of gestation. Methods: : All pregnant women who underwent TOP for fetal anomaly between January 2002 and December 2006 were divided into 2 groups: group 1 (≤22 weeks of gestation); and group 2 (>22 weeks of gestation). A comparative analysis of the prenatal diagnosis, established by ultrasound, and the results of postmortem findings was performed. Results: : There were 249 (53.8%) and 214 (42.6%) cases in group 1 and group 2, respectively. TOP was performed at a mean gestational age of 22.1±5.37 weeks. The majority of group 2 TOPs (78%) were performed because of central nervous system defects, multiple malformations, and chromosomal diseases. Conclusion: : A substantial proportion of TOPs for fetal anomaly beyond 22 weeks of gestation could have been performed earlier with timely diagnosis. [Copyright &y& Elsevier]

Objective: To evaluate the association of ultrasound findings and other factors with the decision to terminate trisomy-21-affected pregnancies. Methods: We performed a retrospective analysis of trisomy-21-affected pregnancies diagnosed prior to 24 weeks’ gestation. Data were collected on maternal age, indications for prenatal diagnosis, gestational age at diagnosis, marital status, race, parity and ultrasound findings. Logistic regression, χ2, t test and Fishers exact test were used for statistical analysis. Results: Fifty-nine pregnancies were identified with a termination rate of 72.9%. Termination rates were significantly lower in patients with major (50%) or minor (64%) ultrasound abnormalities than in patients with normal ultrasound exams (92%), p = 0.026 and 0.022, respectively. Patients who chose terminations were older (36.1 vs. 32.3), but this did not reach statistical significance (p = 0.059). Conclusion: Patients with abnormal ultrasound results were more likely to continue a trisomy 21 pregnancy. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: We wished to investigate the prognosis of children infected with Toxoplasma gondii during the first trimester of pregnancy and whose ultrasound findings were entirely normal, in order to find out whether congenital toxoplasmosis did or did not justify termination of pregnancy if there was no fetal abnormality on ultrasound. Study Design: A prospective and retrospective study was carried out by 12 French centers who enrolled 36 children infected with T. gondii during the first trimester of pregnancy and whose ultrasound examinations showed no anomaly. The outcome of these children after the age of 12 months (mean 50 months, range 12-144 months) was analyzed. Results: Of the 36 infected children, 28 (78%) presented subclinical toxoplasmosis. Only specific IgG antibodies persisted after 1 year. The principal manifestation in 7 children (19%) was chorioretinitis without major vision loss. Their intellectual development was entirely normal. One child (3%) developed severe congenital toxoplasmosis. Conclusion: Since 97% of children infected with toxoplasmosis during the first trimester of pregnancy are asymptomatic or only slightly affected, we believe that in such circumstances termination of pregnancy is not indicated. However, appropriate treatment is essential and prenatal ultrasound examinations should be free of any anomaly. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present study was to investigate the effects of two medications on two subsequent abortions and plasma hormone concentrations of dogs. For this purpose, two groups of bitches (n =5 each), received the antiprogesterone aglepristone (Alizine®) at 10mg/kg body weight on two subsequent days around day 30 after mating. In group II, the antiprolactin cabergoline (Galastop®) was additionally administered po at 5μg/kg body weight until the start of abortion. The plasma concentrations of relaxin, progesterone (P4) and estradiol-17β (E2) were measured before, during and after each abortion. During the next cycle after the abortion, the same bitches were mated again and in pregnant animals, induction of abortion was performed as before. During the third cycle, pregnant bitches were allowed to whelp. Termination of first pregnancy occurred significantly earlier after the combined treatment (6.8 versus 10.6 days, p <0.05). In both groups and during both abortions, relaxin varied between individuals; however, there was a continuous decrease after the abortions and no significant differences between groups (p >0.05). In one bitch with high relaxin concentrations before treatment (11.6ng/ml), a cystic endometrial hyperplasia was diagnosed. In the aglepristone only group, P4 concentrations increased significantly after the first application (p <0.05), then decreased continuously until day 45 after the beginning of abortion. In the combined group, there was a continuous decrease until day 45 (p >0.05). At this time, P4 concentrations between 0.47 and 84.9nmol/l were measured in both groups. The level of E2 over time was not influenced by any medication. We therefore note that the two medications mainly influenced plasma concentrations of P4 in different ways, probably due to specific treatment-hormone interactions. However, all measurements fell within the range considered normal. [Copyright &y& Elsevier]

We set out to evaluate the safety and efficacy of the proposed misoprostol regimen in women with previous multiple caesarean sections. This was a retrospective cohort study of 21 women with more than one caesarean section who underwent termination of pregnancy (TOP) with 400 μg of vaginal misoprostol followed by 200 μg/6 h (max 800 μg). The complete abortion rate was 12/21 (57.14%) and six (28.57%) women had an incomplete abortion. Three TOPs (14.29%) failed. In the first trimester group, only 3/9 (33.34%) aborted completely, while (9/12) 75% second trimester patients aborted completely. There were no major complications. The proposed regimen is considered safe and reasonably effective in second trimester TOPs in women with previous multiple caesarean sections. In first trimester patients, the possibility of manual vacuum aspiration (MVA) should be discussed during counselling, or a higher dose should be used as the effectiveness is low. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the efficacy and side-effects of two regimens of vaginal misoprostol for pregnancy termination of up to 16 weeks. Methods: A randomised clinical trial of medical pregnancy termination of up to 16 weeks was conducted. A hundred pregnant women requesting legal termination of pregnancy were randomised into two groups to receive either 200 µg (50 women) or 400 µg (50 women) – vaginal misoprostol every six hours up to four doses. Outcome of abortion and side-effects were assessed. Results: The groups were similar in maternal age, gestational age, parity and indication for pregnancy termination. There were no statistically significant differences between the two groups in abortion ( P = 0.084) and mean induction to abortion time ( P = 0.35). However, the side-effects in the 400 µg group were significantly higher than in the 200 µg group ( P = 0.000). Conclusion: In pregnancy termination of up to 16 weeks, 200 µg vaginal misoprostol every six hours up to four doses was as effective as 400 µg, but side-effects were more common in 400 µg regimen. [ABSTRACT FROM AUTHOR]

Progesterone receptor antagonists (PAs) and selective progesterone receptor modulators (SPRMs) are members of the progesterone receptor ligand family. The PA mifepristone is usually used as a single dose for short-term indications, such as pregnancy termination, cervical dilation, fetal death and emergency contraception. In view of their antiproliferative effect on the endometrium and their ability to produce amenorrhea, both PAs and SPRMs may be used long term in the treatment of uterine myoma and endometriosis. They may also have applications in dysfunctional uterine bleeding, breast and ovarian carcinoma, contraception and, possibly, in postmenopausal women as a form of estrogen-free replacement therapy. Despite the endometrial antiproliferative effect, during long-term administration of these drugs some women have developed endometrial thickening on ultrasound. This may be interpreted as endometrial hyperplasia, although experienced pathologists have doubted whether this is true hyperplasia. [ABSTRACT FROM AUTHOR]

The Angels asked God: Is there a solution for the abortion debate? God: Yes, of course my Angels. It will be resolved. The Angels: When? God: Not in my lifetime. (Oktay Kedayifçi) The abortion debate is an emotional, sensitive and complicated issue that interests society and religion. Our intention is not to convince you to accept either side of the debate, but to help with an understanding of both sides. As a health care provider, our mission is to reduce unwanted pregnancies and provide a loving borne fox all children. Whatever our efforts as a medical health care provider, they have not been successful in meeting the needs. One of the available methods is pregnancy termination, but the main issue is whether pregnancy termination is a method or not. Pro-life and pro-choice proponents have their strong and reasonable views. In this paper, we try to clarify the claims of both sides without any intervention. [ABSTRACT FROM AUTHOR]

Objective: To compare antenatal diagnoses with autopsy findings in pregnancies terminated after ultrasound detection of fetal anomalies. A second aim was to study the quality of antenatal fetal diagnosis over time. Design: Retrospective, multicenter study over two consecutive six-year periods in Uppsala and Stockholm. Setting: Cases were identified through fetal autopsy reports. Subjects: Three hundred and twenty-eight fetuses from pregnancies terminated between 1992 and 2003 because of ultrasonographically diagnosed anomalies. Main Outcome Measures: The findings at the last ultrasound examination were compared with the autopsy reports. Results: In 299 cases (91.2%) ultrasound findings either exactly matched or were essentially similar to the autopsy findings. In 23 cases (7%) ultrasound findings were not confirmed at autopsy, but the postnatal findings were at least as severe as the antenatal ones. In six cases (1.8%) termination was performed for an anomaly which proved to be less severe than was predicted by ultrasound. The number of such cases was the same in both six-year periods, while the total number of cases increased from 113 in the first to 215 in the second period. Fetal examination provided further diagnostic information in 47% of the cases. In 10% a syndrome was disclosed. Conclusion: Termination of pregnancy was not always based on a correct antenatal diagnosis. All fetuses but one from terminated pregnancies had evident anomalies. In six cases (1.8%) the decision to terminate was based on suboptimal prognostic and diagnostic information. Fetal autopsy by an experienced perinatal pathologist is essential to provide a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: In order to evaluate the efficacy, the safety and the variation in plasma concentrations of estrogens, progesterone, PGFM, oxytocin, cortisol and prolactin after mid-pregnancy termination induced by aglepristone, 61 pregnant queens (33.3+4.2 days), were injected subcutaneously with 0.15mg/kg aglepristone, repeated once 24h later. Five queens served as control and received a placebo. The efficacy of aglepristone was 88.5% and termination of pregnancy was achieved in 50% of the queens within 3 days. Brief periods of depression and anorexia were noted in 9.3% of the queens before fetal expulsion (these symptoms were attributed to the phenomenon of fetal expulsions). Not one of the queens that aborted developed uterine disease. There were no changes in plasma concentrations of estrogen, prostaglandin, prolactin or oxytocin following aglepristone administration. However, there were significant increases in plasma concentrations of progesterone and cortisol 60 and 30h, respectively, after aglepristone administration. Termination of pregnancy occurred with high plasma progesterone concentrations. Fetal expulsion was characterised by an increase in estrogen, PGFM and oxytocin concentrations, whereas prolactin and cortisol levels remained at a basal level. [Copyright &y& Elsevier]

Abstract: There is an increasing demand for management of feral and wild carnivores; since many of them have become “pest species” by adapting successfully to changing environments, having substantial impacts on their prey species, and serving as reservoirs for infectious diseases. Also in captivity, a low adult mortality and an increase in longevity, especially in large carnivores, cause an urgent need for population management. This paper presents an overview on contraceptive strategies to control reproduction in carnivores. Factors that have to be considered before applying a certain method for fertility suppression are discussed. For birth control, several methods of hormonal chemosterilization, immunocontraception and pregnancy termination have been developed in domestic and captive exotic carnivores, but none of them are yet suitable for free-ranging animals. GnRH agonists, which suppress pituitary function very efficiently, are recommended in captive and domestic animals for reversible contraception. Immunological contraception, causing prolonged infertility after single application, is a promising approach for feral animals. However, a specific gamete or hormone-derived “self” antigen must be identified for each particular species. [Copyright &y& Elsevier]

Objective: This study aimed to describe reported contraceptive and abortion utilization and their relationship to human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Tashkent, Uzbekistan. Methods: For this cross-sectional study, women were recruited through outreach workers affiliated with Istiqbolli Avlod. Participants completed a self-administered questionnaire and underwent HIV testing. Results: Of 448 participants, the majority (86.2%, n=386) used contraception; 39.6% reported inconsistent use. Methods most frequently utilized were condoms (50.9%) and intrauterine devices (16.1%). One fourth (24.3%, n=109) reported multiple (>or=3) prior abortions. Inconsistent contraceptive users were more likely to be infected with HIV (AOR=2.72, 95% CI=1.19-6.22), but such infection was not related to a specific contraceptive method, including condoms, or utilization of abortion. Conclusions: Inconsistent contraceptive use is common and may be a predictor of HIV infection among Tashkent FSW. Factors preventing consistent contraceptive use may be related to HIV risk and require further study in this population. [ABSTRACT FROM AUTHOR]

Fetal echocardiography allows for early detection of congenital heart disease, and pregnancy termination may be an option in cases of complex defects, in the current study, the most important factors contributing to the diagnosis and termination of affected pregnancies are reviewed and their combined effect on the future prevalence of liveborn congenital heart disease is evaluated. The relative reduction of the prevalence of the most severe forms of congenital heart disease is estimated as the product of the probability that (1) a fetal cardiac screening is performed (Pevaluation), (2) an affected pregnancy is detected (Pdetection), (3) pregnancy termination is decided following antenatal diagnosis (Pdecision). In areas where termination of pregnancy is a realistic and supported option, a universal sonographic screening of all pregnancies (Pevaluation = 1), with an average reported sensitivity of 35% and a termi- nation rate of 43% following antenatal diagnosis, would result in a 15% overall reduction of the prevalence of the most severe forms of congenital heart disease, However, wide variability exists regarding the defect-specific esti- mates (2-50% prevalence relative reduction) due to con- siderable differences in the reported diagnostic sensitivity and termination rates associated with each heart defect, If an earlier diagnosis could be achieved, which is reported to be associated with an average 1 .4-fold increased proba- bility of termination, the overall reduction of the preva- lence of congenital heart disease could approach 21%. As the skills of obstetric and pediatric cardiology sonogra- phers improve, fetal echocardiography is expected to have a substantial impact on the future epidemiology of liveborn congenital heart disease. [ABSTRACT FROM AUTHOR]

Abstract: Medical abortion with the antiprogesterone mifepristone followed by a prostaglandin is highly effective and widely used. The mifepristone dose registered is a single dose of 600 mg followed by a suitable prostaglandin analogue 36–48 h later. The 600-mg dose was chosen arbitrarily, and later studies have proven one third of this dose to be equally effective when combined with a prostaglandin analogue. This report reviews published data on the efficacy of mifepristone in different doses and demonstrates that there are no differences neither clinically nor in pharmacokinetics if the dose is reduced to 200 mg. [Copyright &y& Elsevier]

Objective To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion. Design Randomised nonblinded trial. Setting Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area. Population Women of reproductive age. Methods Consenting women presenting for abortion services with gestations less than 56 days and who met inclusion criteria were given 200 mg mifepristone orally and then randomised into three misoprostol study groups: (group I) 400 micrograms of oral misoprostol, (group II) 600 micrograms of oral misoprostol, and (group III) 800 micrograms of vaginal misoprostol. Misoprostol was self-administered at home 24–48 hours following mifepristone, and participants were instructed to take a second similar misoprostol dose at 24 hours after the initial dose if bleeding was less than a normal menstrual period. Main outcome measures Successful abortion without surgery was 94.1%, with no significant differences across the three study groups (94.7% in group I, 93.4% in group II, and 94.3% in group III; P= 0.975). Results Efficacy and adverse effects did not differ significantly across the three study groups. Pain increased significantly across the study and the gestational age groups and was associated with lower acceptability. Conclusions There appears to be a range of safe and effective options for early medical abortion with mifepristone including a choice between oral and vaginal administration of misoprostol. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the safety and efficacy of termination of pregnancy using mifepristone and misosprostol at more than 15 weeks'' gestation in patients with uterine scar due to previous cesarean section. Materials and Methods: This retrospective study was conducted in a tertiary maternity ward between January 2000 and October 2004. A total of 252 women at more than 15 weeks'' gestation underwent termination of pregnancy including 50 women with uterine scar due to previous cesarean section (Group 1) and 202 control patients (Group 2) without known uterine scar. Abortion was induced with mifepristone and a prostaglandin analogue. Women between 15 and 34 weeks'' gestation received misoprostol intravaginally every 3 h at doses of 200 μg (Group 1) or 400 μg (Group 2). Women at more than 34 weeks'' gestation received Prostin E2 vaginal gel. Main end points were hemorrhage, fever, retained placenta, occurrence of complications including uterine rupture and dehiscence, and final outcome. Results: A total of 13 (26%) patients in Group 1 and 79 (39.1%) in Group 2 were at more than 24 weeks'' gestation. The abortion failure rate was 2% (1/50) in Group 1 and 0.5% (1/202) in Group 2 (p=.28). The median induction-to-delivery interval was 8.5 h (range, 3.0–114.2 h) for Group 1 and 9.0 h (range, 1.3–124.3 h) in Group 2 (p=.26). One case of uterine rupture and one case of dehiscence were observed, both in women in Group 1. The incidence of hemorrhage was not significantly different between Group 1 and Group 2 (2% vs. 0.9%, respectively, p=.56). The incidence of retained placenta was higher in the Group 1 (70% vs. 52.5%, respectively, p=.025). Conclusion: In this retrospective series of women who underwent abortion at 15–35 weeks'' gestation using mifepristone and a prostaglandin analogue for labor induction abortion, history of cesarean section was not associated with higher morbidity except risk of uterine rupture. However, dose and interval of misoprostol should be determined. A larger study is needed before drawing definitive conclusions about the safety of these regimens. [Copyright &y& Elsevier]

Summary: This review describes the epidemiology, pathology, clinical picture and therapeutic management of pregnant women with breast cancer. In addition, it covers other important issues like the safety of both diagnostic and treatment procedures, the indications for pregnancy termination, the mother and fetal outcome as well as the metastatic potential to the placenta and/or fetus. Several recommendations are also provided. [Copyright &y& Elsevier]

Objective: To determine whether misoprostol medical management of early pregnancy failures is more effective than expectant management. Study design: Patients diagnosed with early pregnancy failures, closed cervix, and minimal vaginal bleeding were randomized to 800 μg of misoprostol or placebo placed vaginally. Patients were evaluated by ultrasound imaging 24 hours and 48 hours after study drug administration, with repeat administration if 24-hour imaging showed a persistent gestational sac. Treatment success was defined as expulsion of uterine contents within 48 hours. Patient follow-up occurred 2 weeks after expulsion of uterine contents. Results: Treatment success occurred in 15 of 18 (83%) misoprostol patients and 2 of 16 (13%) placebo patients (P « .0001). Side effects were similar between groups except for vaginal bleeding, which was more common in the misoprostol group (P = .001). Patient satisfaction and pain perception were similar between groups. Conclusion: Misoprostol appears to be highly effective for treating early pregnancy failures, with few side effects and high patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective To test the feasibility, safety, and efficacy of home use of two doses of misoprostol for medical abortion (MA) in European settings. Methods One hundred thirty women (100 in Sweden, 30 in France) presenting for first-trimester MA were administered oral mifepristone in the clinic and sent home with two 400 μg doses of misoprostol, along with instructions to take the misoprostol at 24 h intervals. Women were also asked to complete a daily symptom diary. Outcomes of interest included effectiveness, side-effects, and adherence to and acceptability of the home-use regimen. Results Three women (all in France) were lost to follow-up. Of the remaining 127 women, 124 (98%) had a successful MA. All women adhered successfully to the home-use regimen, and satisfaction with home use was high (98%). Most women experienced noticeable, if transitory, side effects after both the first and second doses of misoprostol (97% and 94%, respectively). Conclusions Misoprostol may successfully and satisfactorily be used at home as part of a MA regimen in European settings as it has been for years in the US. Further research to determine if two doses of misoprostol are more effective than a single dose would be useful. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction. Study design: Women at 14 to 24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 µg × 1, then 400 µg every 4 hours × 5 (group 1) or escalating dose-concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 µg × 1, then 200 µg every 6 hours × 2, then 100 µg × 1 (group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval. Results: The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis because of a highly significant difference in 1 of the primary study outcomes. Twenty women were assigned to group 1 and 18 were assigned to group 2. Median induction-to-delivery interval was significantly shorter in group 1 (12 hours, range 4-44 hours) versus group 2 (18 hours, range 7-36 hours; P = .01). Induction success rate at 12 hours was significantly higher in group 1 (60%) compared with group 2 (22%, P = .02). No significant difference was noted in the live birth rate between groups 1 and 2 (13%, 0%, P = .16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups. Conclusion: Compared with concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens midtrimester labor inductions. [ABSTRACT FROM AUTHOR]

A phenomenological approach was used to examine the responses of women to elective abortion. Sixteen women who terminated a pregnancy for nonmedical reasons at least 15 years previously participated. These women were caught up in the moment, they made a decision, had an abortion, and life continued—for some as before, for others, forever altered. Women encountered a sense of disruption. The abortion and reflections about the experience existed as an unspoken story, confided to few. Thoughts of this past experience reached into present events and generated new awareness, producing insights. The terminated pregnancy for some became embodied. These women were compelled to make sense of their abortion experiences as they sought to integrate these experiences into their sense of self These women's relationships affected the abortion experience and were affected by the abortion experience. This research expands our understanding of the long-term responses of women after abortion. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A growing body of literature has shown that misoprostol alone could be effective for early medical abortion. We evaluated seven potential regimens in women up to 56 days of gestation in order to potentially identify an optimal regimen. Methods: In phase I of the study, women requesting early abortion were randomized to one of three misoprostol regimens (4×400 μg po every 3 h, 2×800 μg po every 6 h, 1×600 pv μg); in phase II, women were randomized to one of two regimens (2×800 μg po every 3 h, 1×800 pv μg). In phase III, we consecutively tested two regimens (800 μg pv wetted with saline repeated after 24 h if intact gestational sac, 2×800 μg pv wetted with saline) to validate previously published results. Results: Although most women experienced some side effects, all regimens were tolerable and acceptable. Five of the seven regimens resulted in complete abortion rates of 60% or less. Only repeated doses of 800 μg pv misoprostol resulted in efficacy exceeding 60%. Discussion: Misoprostol-alone abortion regimens using oral misoprostol are too ineffective for clinical use or further investigation. Regimens with repeated dosing of misoprostol 800 μg pv warrant further study to find the optimal treatment protocol. [Copyright &y& Elsevier]

Objective: The purpose of this study was compare outcomes of second-trimester pregnancy terminations with misoprostol between our previous low- (200 µg every 12 h) and present high-dose (400 µg every 6 h) regimens. Study design: This was an historic cohort study that was conducted from June 1996 to February 2004 on women undergoing medical termination of pregnancy at 13 to 27 weeks. Exclusion criteria were multiple gestation, placenta previa, and primary use of another medication. Results: The cohort consisted of 147 women. For the low- (n = 100) and high-dose (n = 47) groups, respectively, median times to delivery were 22.5 vs 13.25 hours (P = .001). More patients in the high-dose group were delivered vaginally within 24 (81% vs 54%; P = .002) and 48 hours (98% vs 84%; P = .014). Fewer patients in the high-dose group required a second abortifacient (6% vs 27%; P = .004). Clinical chorioamnionitis was more common in the high-dose group (P = .03). One patient experienced a uterine rupture and is included in the analysis. Side effects were uncommon and did not differ between groups. Conclusion: Our present high-dose regimen for misoprostol terminations of pregnancy effects delivery more rapidly without an appreciable increase in side effects or complications. [ABSTRACT FROM AUTHOR]

Abstract: Body temperature responses and the timing of abortions were evaluated in pregnant bitches with the anti-progestin aglepristone. Fifteen purebred and crossbred, 25–45 days pregnant, were included in this study and seven untreated bitches at the same stage of pregnancy served as controls. Treated bitches were administered two applications of aglepristone (10mg/kg SC) 24h apart for pregnancy termination. Pregnancy termination was confirmed by ultrasonographic assessment. Body temperature was rectally measured three times a day for 6 days beginning 24h before treatment or pregnancy diagnosis in the treated and control bitches, respectively. Additionally, serum progesterone concentrations were assessed at time points during the study in the treated bitches. Pregnancy was terminated in 14 treated bitches in a mean±S.E.M. of 4.3±0.7 days after treatment. Control bitches remained pregnant. In the treated bitches, but not in the controls, body temperature significantly decreased 24h after the beginning of the treatments (P &#60;0.01) and then gradually returned to pre-treatment values. Correlation between the day of mean minimum body temperature and the day of pregnancy termination was low (0.07; >0.05). Progesterone did not show significant change throughout the study. Body temperature does not seem to be a suitable variable to clinically monitor the aborting effect of aglepristone. Decrease of body temperature after aglepristone treatment could represent further evidence of its hypothalamic effects. [Copyright &y& Elsevier]

Objective: To identify information and service delivery needs for obstetric/gynecologic uses of misoprostol in developing countries.Methods: The study included a survey of reproductive health providers in 23 countries and a qualitative study of misoprostol use in four developing countries. Researchers used purposive sampling methods for the survey and qualitative study and conducted a descriptive statistical analysis of survey data and computer-assisted text-based content analysis of qualitative data.Results: In some developing countries, women frequently access misoprostol through pharmacies and self-medicate to induce early abortion. Some clinicians expressed concern about this use of misoprostol, but many stated that its availability had reduced serious complications resulting from unsafe abortions.Conclusion: Although misoprostol is routinely used for a range of off-label obstetric/gynecologic indications, evidence-based, up-to-date information about safety, effectiveness, and appropriate regimens is not widely available. This information is requested by providers, including pharmacists. Women need information and guidance about its use. [ABSTRACT FROM AUTHOR]

Objective: To report parental decisions regarding pregnancy termination following the prenatal diagnosis of a sex chromosome abnormality (SCA) in the fetus. Methods: Retrospective collection of data from records of 61 families receiving genetic counseling after prenatal diagnosis of a sex chromosome abnormality in the fetus in the Division of Medical Genetics, University Hospital of Geneva during the time period 1980–2001. Results: Among 61 couples with a prenatal diagnosis of a sex chromosome abnormality (SCA), 44 couples (72.1%) decided to terminate pregnancy. Pregnancy termination rates were 100, 73.9, 70, 50 and 42.9% for Turner syndrome, Klinefelter syndrome, 47,XXX females, 47,XYY males, and mosaic cases, respectively. In all 11 cases with a fetal abnormality seen on ultrasound, pregnancy was terminated. Termination rates were higher among couples with a higher mean number of previous children. Maternal age and year of test did not influence parental decisions. Conclusions: Parental decision to terminate a pregnancy for a fetus with a SCA varied by type of sex chromosome abnormality, by presence of fetal ultrasound anomalies, and by the mean number of previous children. [Copyright &y& Elsevier]

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Since the original description of the structure of the antiprogestin, mifepristone, was published, numerous related compounds have been synthesized which may function as progesterone antagonists (PAs) or progesterone receptor modulators (PRMs). The latter are mixed agonists–antagonists. Both PAs and PRMs have therapeutic applications in female health care. Mifepristone is predominantly a PA and displays only minimum agonist activity in certain systems. Together with a prostaglandin, mifepristone can terminate pregnancies of less than 9 weeks duration, and it may also be used at later gestational ages. Mifepristone causes expulsion of the uterine contents following intrauterine fetal death. A mifepristone–prostaglandin combination has been shown to be very effective treatment in women with menses delay of 11 days or less. Many PAs and PRMs display antiproliferative effects in the endometrium. Serum estradiol levels however remain in the early to mid-follicular phase range. For this reason, they have application in the treatment of endometriosis and myoma without being associated with bone loss and hypoestrogenism. PRMs may also find application in the treatment of dysfunctional bleeding as well as an adjunct to estrogens in hormone replacement therapy in postmenopausal women. Many PAs have contraceptive potential by suppressing follicular development and blocking the LH surge. Low doses may also be potential contraceptives by retarding endometrial maturation without affecting ovulation or inducing bleeding. Mifepristone is an excellent agent for use as an emergency “postcoital” contraceptive. PAs may also be useful in IVF programs to prevent a premature LH surge and to delay the emergence of the implantation window. In addition to their use in women’s health care, mifepristone and several other PAs are potent antiglucocorticoid agents and may be used to treat ACTH-independent Cushing’s syndrome. They may also be used in the treatment of tumors containing steroid receptors and in other situations which require suppression of the ACTH-cortisol axis. [Copyright &y& Elsevier]

Background: Few studies have evaluated the reasons why lethal chromosomal anomalies continue to occur despite the importance of this question for maximizing perinatal care. Aims: To determine why trisomy 13 or 18 births continue to occur in Alaska. Study design: Case series involving review of maternal and infant medical records. Subjects: All 28 known infants and fetuses that died with trisomy 13 or 18 during 1992–2001 and their mothers. Outcome measures: The proportion of mothers that declined or received a variety of routine prenatal tests, the results of prenatal testing, and the impact of testing on decisions related to pregnancy. Results: Seventeen women declined pregnancy termination or amniocentesis, 10 had no prenatal risk factors and were not offered these procedures, and one woman had an amniocentesis but was not offered pregnancy termination. Twenty-six women had ≥1 prenatal ultrasounds; for 17 women, these were interpreted as normal throughout pregnancy (n=11) or until after 30 weeks gestation (n=6) despite substantial fetal malformations. Fourteen of 15 women with an abnormal ultrasound had an amniocentesis compared to one of eight women whose only risk factor was advanced maternal age. Conclusions: Most trisomy 13 or 18 deliveries occurred to women who declined amniocentesis or pregnancy termination. Failure to identify abnormalities on prenatal ultrasound may have contributed to the decision not to have these procedures. [Copyright &y& Elsevier]

Objectives: To assess the effectiveness of a prostaglandin E1 analog, misoprostol, using different regimens compared with dinoprostone in termination of pregnancies in second and early third trimester complicated by either congenital fetal anomalies or intrauterine fetal demise. Methods: A retrospective review of 59 pregnancies between 15 and 30 weeks was performed which were terminated due to congenital fetal anomalies or intrauterine fetal demise. In group 1 (n=29) 400 μg oral and 600 μg vaginal misoprostol, in group 2 (n=12) 600 μg vaginal misoprostol and in group 3 (n=18) 0.5 mg dinoprostone gel were given for the termination of the pregnancies. All these groups were evaluated for demographic characteristics and delivery findings. Statistical analysis were performed by one-way ANOVA, Kruskal–Wallis and χ2-test. Results: No significant statistical difference was observed in terms of age, gravidity, parity, previous abortion, gestational week, frequency of prostaglandin usage, and birth weights among the three groups. The time intervals between the first administration and delivery were 20.3 h for oral vaginal misoprostol, 17.3 h for vaginal misoprostol and 22.5 h for the dinoprostone group (P=0.594). Evacuation rates after single doses were similar in all groups (83%, 73% and 72%, respectively). Uterine tachysystole was the only major side effect encountered in the oral-vaginal misoprostol group. Conclusions: All three regimens yielded similar results for termination of pregnancies in second and third trimester. The major advantage of misoprostol was the cost. [Copyright &y& Elsevier]