Milagros F. Atienza

Untreated endocervical gonorrhea and endometritis following elective abortion.

A matched-pair analysis of 228 cases of endometritis occurring over a two-year period in 4,823 elective abortion patients was carried out. Patients with postabortal endometritis were matched with control subjects for age, parity, race, pay status, time of abortion, and type of abortion procedure. The prevalence of endocervical gonorrhea was 2.7% in the entire group seeking abortion, with 14.7% of patients with gonorrhea subsequently developing endometritis. The matched-pair analysis detected a threefold increased risk for endometritis in patients with untreated gonoccocal endocervicitis when compared with control subjects (p less than 0.05). The significance of these findings to centers performing abortions is discussed.

Midtrimester abortion induced by hyperosmolar urea and prostaglandin F2α in patients with previous cesarean section: Clinical course and potential for uterine rupture

Abstract Reviewed was the clinical course of 76 patients with a history of previous cesarean section from among 1,626 patients undergoing midtrimester abortion induced with intra-amniotic hyperosmolar urea and prostaglandin F 2α . The cesarean section group had long injection-abortion intervals, more frequently received additional oxytocin for augmentation, and more frequently experienced incomplete abortion. Also, one patient experienced a uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical patient was older and multiparous, had an injection-abortion interval of more than 24 hours, and had received intravenous oxytocin continuously for more than 12 hours. Although there has been no previous report of a uterine rupture with midtrimester abortion in patients who have undergone a prior cesarean section, because of the present findings, such patients require careful monitoring and the judicious use of oxytocic agents.

Culture and treatment results in endometritis following elective abortion.

Endometrial culture and treatment results from 228 patients who developed endometritis following elective abortion were analyzed. The most common organisms isolated were group B beta hemolytic streptococci, Bacteroides, Neisseria gonorrhoeae, E. coli, and Staphylococcus aureus. In general, patients responded to treatment with penicillin or ampicillin, with the addition of an aminoglycoside for these requiring hospitalization. Curettage was an important adjunctive treatment for hospitalized patients and for some outpatients.

The synergistic activity of intra-amniotic prostaglandin F2α and urea in the midtrimester elective abortion

Abstract Most midtrimester abortions are still being performed with hypertonic saline and hysterotomy, but the morbidity and mortality rates are too high. The efficacy of a single intra-amniotic injection of prostaglandin F 2α and hyperosmolar urea without oxytocin augmentation was demonstrated and results were compared with those obtained by current methods.

Intra-amniotic urea as a midtrimester abortifacient: clinical results and serum and urinary changes.

Seventy-four patients, from 16 to 20 weeks pregnant, received intra-amniotic urea (80 Gm.) and intravenous oxytocin for the purpose of inducing abortion. Seventy-one of the 74 patients were successfully aborted by the primary method with a mean injection-to-abortion interval of 18.33 hours. There were no serious side effects, and the mean hospital stay was 32 hours. Following urea injection, the mean serum urea nitrogen rose to 33 mg. per cent at 4 hours. Maximum changes in serum electrolytes occurred at 8 to 12 hours after injection and included a decrease in the mean concentrations of sodium, chloride, and carbon dioxide and an increase in serum potassium. An increase in the urinary excretion of urea began within 4 hours, but significant diuresis did not occur in the presence of intravenous oxytocin administration. There was a significant increase in the leukocyte concentration while hematocrit values remained unchanged. Beginning approximately 8 hours following urea injection, the mean plasma fibinogen concentrations decreased by approximately 15 per cent and the mean platelet count showed a drop of approximately 18 per cent. Fibrinogen-fibrin degradation products were significantly increased in 36 per cent of the patients studied.

Intra-amniotic urea and prostaglandin F2α for midtrimester abortion: Clinical and laboratory evaluation

The clinical management of the elective midtrimester abortion continues to be unsatisfactory as judged by either national mortality or morbidity rates. This report documents the results of a randomized series of 19 midtrimester abortions induced by either intra-amniotic hyperosmolar urea and 5 mg. of prostaglandin F2alpha (PGF2alpha) or intra-amniotic hyperosmolar urea alone. Pertinent clinical characteristics and biochemical determinations were compared between these two groups. A series of 150 patients were then treated with urea and 5 mg. of PGF2alpha. The clinical results of this series of patients are presented and compared with a previous group who had urea and 10 mg. of PGF2alpha. These studies demonstrate that 5 mg. of PGF2alpha with 80 Gm. of urea achieves injection-abortion intervals that are less than 24 hours.

Intra-amniotic urea and prostaglandin F2α for midtrimester abortion: A modified regimen

Abstract A study comparing intra-amniotic urea plus intravenous oxytocin and intra-amniotic urea with 10 mg. prostaglandin F 2α was completed. In addition, the results obtained with a further 150 patients receiving urea and prostaglandin are reported. Mean injection-abortion intervals ranged from 15.75 hours for urea-prostaglandin to 18.93 hours for urea-oxytocin. The advantages of urea-prostaglandin and suggested improvements are discussed. Over all, the method appears efficacious though incomplete abortions and cervical laceration are persistent problems.

The incidence of abdominal surgical procedures in a population undergoing abortion

The incidence of abdominal surgical procedures was determined in 11,885 patients undergoing termination of pregnancy. Thirty-eight abdominal surgical procedures were completed, an incidence of 3.9 per 1,000 abortion cases. Seventy-two percent were completed for the diagnosis and management of coexistent genital pathologic conditions, with the remainder required for the management of abortion complications. These data provide patients an estimate of their chances of having to undergo abdominal surgical procedures, prior to their making a final decision to have a pregnancy terminated.

Gestational trophoblastic disease within an elective abortion population

Gestational trophoblastic disease, most commonly hydatidiform mole, is an unusual condition within the United States. The incidence of hydatidiform mole has been reported to vary from 1 in 1,200 to 1 in 2,000 pregnancies. This report described eight cases of hydatidiform mole among 4,829 patients presenting for elective first-trimester abortion. Factors which might account for the frequency of hydatidiform mole of 1 in 600 are discussed. Although the clinical course of patients with hydatidiform mole appears benign- gross examination of tissue obtained at suction curettage and the liberal use of histologic evaluation in questionable cases is required to make the diagnosis.

Coagulopathy with midtrimester induced abortion: Association with hyperosmolar urea administration

Coagulation changes, usually subclinical, have been reported in association with the induction of midtrimester abortion by the administration of intra-amniotic hypertonic sodium chloride, hyperosmolar urea, hyperosmolar urea plus prostaglandin F2alpha, and hyperosmolar ura or hypertonic glucose plus prostaglandin E2. In addition, clinically significant coagulopathy has been described in association with the administration of hypertonic sodium chloride. This study details a three-year experience involving 3,034 cases of midtrimester elective abortion and describes six cases of coagulopathy in association with the administration of hypertonic sodium chloride and two cases in association with the administration of hyperosmolar urea. The significance of these findings and etiologic considerations are discussed.