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As part of a pilot study for a larger project on provision of abortion counseling within general practice, a retrospective study was conducted of the demands made on a group general practice by patients who had been referred for an abortion between 1962-77 and who were currently registered with either of the 2 surgeries of the practice. A group practice of 4 doctors in northwest London, which provides medical care for about 10,000 patients who are registered either at surgery A or surgery B of the practice, were studied. Surgery A is located in an area of high value property with most patients living in expensive flats and maisonettes or in council houses. Only the younger segment of the population of the area is mobile including a fair proportion of au-pair girls and students. Surgery B is located in an area where extensive council estates have recently replaced multiple occupancy Victorian houses. A high proportion of the inhabitants are 1st or 2nd generation immigrants. Between 1962-77, 126 abortions were recorded in the medical records of women registered with surgery A and 240 with surgery B. Only the 100 women attending surgery A and the 164 women attending surgery B during this period for whom only 1 abortion had been recorded were considered. Concentration was on the 70 women from surgery A and 125 women from surgery B whose records concerning the abortion operation and the reasons for its recommendations were adequate. The following data were extracted from the medical records: background information; medical history before abortion; information about procedures associated with the abortion; information about contraception and complications after abortion; and detailed records of the dates, frequencies, attendances, and reasons for attendance at the surgery 1 year before and 2 years after the operation. Monthly rates of attendance at the surgery for the women in the samples was calculated starting both from date of abortion and from last menstrual period. Several autocorrelation analyses were performed. The incidence of severe emotional sequelae of the abortion was relatively low. 5 patients (7%) attending surgery A and 6 (4.8%) attending surgery B were referred for psychiatric help after expressing fellings of depression. No significant attendance peaks were found. Women attending surgery B had been registered on average much longer with the surgery at the time of their request for abortion and attended the surgery significantly more often than their controls in the year before their abortion; this relatively high rate of attendance was maintained for at least 2 years after the abortion. Women attending surgery A did so significantly less often than their controls in the year before abortion but significantly more often in the year after, moving toward the rate of attendance as those from surgery b.
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PMID:Demands made on general practice by women before and after an abortion. 674 31

There are currently numerous well-woman clinics in Britain which emphasize a specific aspect of health care, including cervical cancer screening (134 centers), family planning (142 centers), antenatal care (162 clinics), and venereal disease control (15 clinics). However, care provided in these clinics is fragmentary and excludes certain population groups from coverage. For example, cervical cancer smears are largely sought by upper class women under age 35, although this cancer has a higher incidence among older women from the lower social classes. Similarly, family planning clinics are not attracting women at highest risk of repeat abortion. Antenatal clinics, although effective in reducing perinatal and maternal mortality, exclude women beyond the childbearing years. At present, there are less than 10 comprehensive well-woman clinics in Britain. However, an estimated 17 million women could benefit from such a service, especially if cervical cytology screening was absorbed within it. A comprehensive clinic could focus on medical problems common to women, including menopause, frigidity, child abuse, obesity, thyroid disease, and depression. Omissions created by fragmented care, such as failure to test for conditions like anemia, could be avoided. The Manchester well-woman clinic, set up in 1981, provides an example of the role such clinics could play. The clinic is targeted at women who rarely see a general practitioner, e.g., poor, infertile, older women. Its emphasis is on the prevention and early detection of disease. Treatment is limited to self-help support groups and discussions with staff; however, new attendees are screened by a physician and nurse. 99% of attendees were found to have at least 1 medical problem. 2/3 of these problems, including breast problems, vaginal discharge, menopause problems, depression, and headache, were not already being treated. This experience suggests that there is an untapped need for such a facility, especially among women between menopause and old age.
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PMID:Evaluating well-woman clinics. 688 41

Women born in the 1st decade of the 10th century achieved the lowest average family size of any cohort of US women that has completed childbearing. A survey of white, ever married women whose childbearing years peaked during the 1920s and 30s whows that more than 70% practiced contraception, and that over 80% of contraceptors used the most modern methods then available. Although few admitted to use of sterilization for contraceptive purposes, nearly 30% were surgically sterilized before age 50, and the pattern suggests considerable use for contraceptive reasons. Those born in the latter 1/2 of the decade, who reached their peak reproductive years during the Depression, were more likely to have practiced contraception and to have used a modern method than those born earlier. Women who had 2 or more live births, those who were college educated, urban, white collar and non-Catholic were also more likely than others to have used contraception. There was considerable use of contraception to space children as well as to terminate childbearing. Only 3% reported having had an induced abortion, but the data suggest that many reported induced abortions (then mostly illegal) as miscarriages and stillbirths.
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PMID:Fertility control in the United States before the contraceptive revolution. 698 29

A search of the literature on the psychiatric aspects of abortion revealed poor study design, a lack of clear criteria for decisions for or against abortion, poor definition of psychologic symptoms experienced by patients, absence of control groups in clinical studies, and indecisiveness and uncritical attitudes in writers from various disciplines. A review of the sequelae of therapeutic abortion revealed that although the data are vague, symptoms of depression were reported most frequently, whereas those of psychosis were rare. Positive emotional responses and a favourable attitude toward therapeutic abortion were often reported, although again the statistical bases for these reports were inadequate. There was a lack of evidence that the reported effects were due to having an abortion rather than to other variables.Other areas dealt with inadequately in most of the articles reviewed included analyses of symptoms and of the evidence on the duration of sequelae, descriptions of the criteria for approving abortions, investigation of the psychiatric histories of the patients, presentation of data on the effects of refusing abortion requests, systematic study of a number of epidemiologic factors, and analyses of the circumstances leading to pregnancy in patients having abortions. The evidence was found to be sparse on the effects of supportive relationships, different abortion techniques and the length of gestation on the psychologic status of patients. Little attention was paid to the consequences of psychiatric labelling of patients, or to the effect of having an abortion on factors that may influence future pregnancies.The potential roles of health care professionals appear to deserve more study, and little research seems to have been done to compare the psychologic factors associated with abortion and those associated with live birth. As well, there is little evidence that differences in abortion legislation account for significant differences in the psychologic reactions of patients to abortion.
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PMID:Psychiatric aspects of therapeutic abortion. 702 10

Cytotoxic drugs provoke teratogenic and mutagenic effects in animals and humans. Particularly at risk is the developing fetus, which in the first trimester of pregnancy undergoes rapid cell division and organogenesis. Systemic antineoplastic chemotherapy given to a pregnant women at this time may involve fetal risk of abortion, death, stunting, malformation, and systemic toxicity. Other adverse effects may include hematopoietic depression, infection secondary to leukopenia or immunosuppression, hemorrhagic phenomena, and hormonal alterations such as adrenal insufficiency. Although chemotherapy should be withheld during the first trimester unless the health and life of the mother are compromised, a review of the literature reveals that fetal malformation is not inevitable. Furthermore, the risk of fetal malformation following chemotherapy in the second and third trimester is minimal. However, investigators caution that fetal damage, including genetic impairment resulting from chemotherapy throughout pregnancy, may ot appear until much later in life. Most investigators agree that women who have recently recovered from or are being treated for a malignancy should not breast-feed their infants.
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PMID:Fetal and neonatal effects of cytotoxic agents. 703 41

Studies have shown that very few women experience significant depression in the weeks following abortion and most have strong feelings of relief and happiness; what mild feelings of guilt, regret, or remorse do exist immediately following abortion tend to diminish quickly. Traditionally attitudes were that abortion could even precipitate psychosis and cause infertility, depression, and sexual dysfunction. The findings of a 1963-65 study of 116 women who underwent abortions indicate that few women had regrets immediately. Studies done after the 1973 Supreme Court decision conclude that even psychiatrically disturbed women who undergo abortion remain stabilized or improved afterwards. Women who do have postabortion problems are usually those who were late aborters, who feel that the decision was not freely made, or that the pregnancy fulfilled certain needs. When working with these women clinicians use a variety of techniques, encouraging the women to express their feelings of loss and anger and supporting the choice that was made, while providing contraceptive and decision making education. The strategy in 3 cases described here involved the woman first saying goodbye to the fetus and her former relationship with it in a gestalt dialogue. The next part of the strategy is establishing positive remembrance of the significant meaning of the fetus to the woman. There are usually 5 sessions at the end of which the woman feels optimistic; the 6th session is a followup 6 months to 1 year later at which most women report no further symptoms.
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PMID:Abortion: a technique for working through grief. 711 93

It is stimulating to ascertain the comparative risk to the woman of hormonal contraceptives of the various kinds used today: combination preparations, which rely on blocking the secretion of gonadotropic hormones by the hypothesis; sequential preparations, which rearrange the physiological relationships of the menstrual cycle; gestagen preparations (minipills), which heighten the viscosity of the cervical mucus; longterm injectable preparations, which initially block ovulation and then act on the cervical mucus; postcoital preparations, which act by inducing abortion of the fertilized egg. Of these the most reliable are the fixed combinations, while sequential preparations are somewhat less so. The minipills are the least reliable. Interaction with other medications can reduce the reliability of these preparations; for instance, women on contraceptives have become pregnant after taking antiepileptic medications containing phenobarbitol and hydantoin. As far as risk is concerned, we must distinguish between those that merely harm the woman and those that pose a threat to life. Some of the former are: bleeding between cycles, failure of menses to appear after cessation of contraception, depression, breast-pains, hypertension, thrombophlebitis, and reduced libido. Hormonal contraceptives also have a series of beneficial effects, especially in women who ordinarily have menstrual difficulties. Among the more serious side effects are: risk of teratogenicity, carcinogenicity, liver problems, thromboses, and infarctions. To reduce the risks of these various side effects, the physician should observe carefully the contraindications: these are both absolute (cerebrovascular and retinal problems, thrombo-embolisms, hepatic disease, diabetes, porphyria, and sickle-cell anemia and relative (migraines, cardiac pains, hyperlipemia, epilepsy, and multiple sclerosis).
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PMID:[Safety and risks of hormonal contraceptives]. 712 52

A case of inversion of the uterus following abortion is reported. The 35-year old patient, admitted October 10, 1978 to the Medical College and Hospitals in Calcutta, India was referred by a private practitioner with a history of amenorrhea for 16 weeks, bleeding for 3 days, expulsion of the fetus 3 days earlier, and something coming down per vaginum for 2 days. The patient was para 4+0 (all full term normal deliveries) and home delivery for the last child 1 1/2 years earlier. She had a history of regular menstrual periods. Her general condition was poor. The examination revealed a gangrenous mass coming out of the vulva with a very offensive smell. There was a raw surface on which placenta like tissue was attached. No active bleeding was seen. Fundus and cervix of the uterus could not be felt. On rectal examination the uterus could not be felt, a cup-like depression was felt at the site of the uterus. The provision diagnosis was inversion of uterus following abortion. Treatment was started with sedatives and antibiotics, and arrangements were made for a blood transfusion. The vaginal mass was covered with glycerine and acriflavine gauze, and a hysterectomy was decided upon after improvement of her general condition and control of the infection. On October 14th, the patient was placed in knee chest position and posterior vaginal wall was retracted with Sims' speculum when the inverted lump was spontaneously reduced within the vagina. The inverted uterus was felt in the region of the vaginal vault. Glycerine acriflavine pack was given which was taken out and repack was given daily until the operation. The hysterectomy was performed on October 23rd. The abdomen was opened up by a transverse incision and the pelvis was explored. In the region of the uterus a cup-shaped depression was noted. Tubes and ovaries of both sides were seen hanging laterally from the cupped area. The left tube was found congested and thickened. Reduction of uterus was done by making a vertical incision over the posterior rim of cervix and with pressure from below by a sponge holding forceps by an assistant. The uterus was found to be just bulky. A total hysterectomy was performed. The postoperative period was uneventful. The histopathological report showed chorionic villi with degeneration and necrosis. In the case reported, etiology of inversion of the uterus following an abortion may be because of a lack of muscle tone along with traction of placental tissue by a traditional midwife.
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PMID:Inversion of the uterus following abortion. 716 38

A literature review is presented about the risks of induced abortion, as indicated in research from Switzerland and other countries of the world. The attitude of the various countries toward abortion appears to be becoming more liberal. The incidence of legal induced abortions has decreased slightly over the past years, despite more liberal abortion laws. Switzerland lies about in the middle of the scale, with 139 abortions/1000 women and 227/1000 births in 1974. The mortality associated with induced abortion is 1-4 deaths to 100,000 pregnancies, which is about the same risk as 10 years' use of the IUD or oral contraceptives. Most of the deaths occur when abortion is induced after the 16th week of pregnancy. About 10% of all complications of abortion are serious. The complication rate of abortion is highest in patients who undergo hysterotomy or hysterectomy and lowest for those undergoing the Karmen method or vacuum aspiration. No studies have shown a significant increase in the incidence of spontaneous abortions, of cervical insufficiency, of premature births, and of small-for-date babies as a consequence of having undergone induced abortion. There is a tendency, for these complications to occur, especially when dilatation beyond 10 mm is necessary or when the pregnancy is in an advanced stage. It is important to remember, however, that similar tendencies are observed among multiparae, and that the risks of abortion are less than those of childbirth. Cases of depression are recorded in conjunction with induced abortion, but undergoing abortion also relieves many cases of depression due to unwanted pregnancy. There is an increased incidence of sterility after abortion when prophylactic measures are taken against pelvic infection. Outpatient abortions should be performed by dilatation and curettage, before the 12th week of pregnancy. Local paracervical anesthesia is the method of choice for ambulant operations.
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PMID:[Risks in legal, induced abortion. Review of the literature]. 719 47

The major developmental task of adolescence is to establish an identity. Psychological difficulties related to teenage pregnancy and motherhood may reflect the developmental stage of the early or midadolescent girl. Identity formation is vital for a close, meaningful relationship with one's sexual partner if it precedes the point of intimacy. Even young teenagers usually engage in intercourse with partners who represent relatively stable relationships; continuous promiscuous sexual activity reflects psychological problems. Since they are more likely to have experienced social and/or academic failure, teenages who become mothers tend to view family, school, and peers as sources of self-devaluing experiences. Becoming a mother provides an identity and a purpose. Elective abortion may be associated with feelings of guilt and anger that abortion was necessary. Varying degrees of depression are common. Teenage mothers will generally reach a lower educational level and be less successful vocationally than other teenagers. The older the adolescent is at the time of conception the more apt she is to complete high school or be gainfully employed. A key factor is the availability of family members for financial, psychological, and child care assistance. Psychosocial problems are caused by the inability to complete identity formation and lack of economic and social support.
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PMID:Psychosocial risk to mother and child as a consequence of adolescent pregnancy. 720 61


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