Robert E. Hall

Therapeutic abortion, sterilization, and contraception

On Sept. 1, 1955, a Therapeutic Abortion Board was formed at Sloane Hospital. Prior to this date the mechanism for obtaining permission to perform an abortion, although it entailed approval of the Chief of Service, was considerably less formal. Since this date abortion applications have been reviewed by a three-member board composed of a senior obstetrician, internist, and psychiatrist. Because of this abrupt change in policy, the abortion cases for this study were selected from the time period between Sept. 1, 1950, and August 31, 1960. Incidence. During these study years, the ratio of therapeutic abortions to deliveries was as follows:

A reappraisal of intrauterine contraceptive devices

Abstract Nineteen IUD perforations are reported from the Sloane Hospital for Women. The perforation rate for first insertions of the Birnberg bow varied with the skill of the individual physician from 1:13 to 1:338. The perforation rate for first insertions by two experienced physicians varied from 1:111 for the bow to 1:738 for the other IUDs. Of the 100 IUD perforations reported thus far in the English literature, only 13 have been attributed to the Lippes loop. Of the 7 cases of intestinal damage associated with IUD perforations, none has been caused by a loop.

Continuation and pregnancy rates with four contraceptive methods

At the Sloane Hospital for Women, 1498 patients, comprising a representative sample of 8,642 postpartum patients between 1966 and 1969, were offered a choice of the pill, IUD, diaphragm, and rhythm methods of contraception and were studied in follow-up for a minimum of 15 months. The selected sample was evaluated by life-table technique in order to determine cumulative termination and pregnancy rates by reason for termination and change of method, by ethnic group, by first contraceptive method, by age of patient, and by number of children. Cross tabulation of results with pairs of these factors was also done. Results are presented in extensive tables and are compared with findings in other studies. No significant difference was discovered in the ultimate rates of termination (22.3%-25.8% after 1 year) and pregnancy (12.6-13.6% after 1 year) whether the first method chosen was IUD, pill or diaphragm. Only a small proportion (4.3%) of women chose the diaphragm as the first method, compared to 17.5% choosing the IUD and 50.9% choosing oral contraceptives. Age, ethnic origin and parity ranked in this increasing order in determining termination rates (highest among younger age, Spanish, and low parity groups). Pregnancy rates (highest among younger age and low parity groups) were influenced significantly and almost equally by age and parity but imperceptibly by ethnic origin. It is concluded from this minimally supervised program that in addition to the age, parity and ethnic origin of the patient and her initial choice of a contraceptive method, the intensity of follow-up care determines to a significant extent the overall success of a contraceptive program.

Fetal death before the onset of labor: An analysis of 407 cases

Abstract 1. 1. Four hundred and seven cases of antepartal fetal deaths are reviewed. 2. 2. Fetal deaths attributable to (a) unknown cause, (b) toxemia, and (c) abruptio placentae were found to account for two thirds of the series. 3. 3. The interval between fetal death and the onset of labor was found, in a definite but inconstant trend, to be inversely related to the gestational age of the fetus at the time of its death. 4. 4. The incidence of puerperal morbidity was increased. 5. 5. The incidence of postpartum hemorrhage was increased. 6. 6. Management was essentially conservative. 7. 7. Oxytocics, amniotomy, and cesarean section, when indicated, were employed. 8. 8. The syndrome of postmaturity and hypofibrinogenemia are briefly discussed and their importance questioned.

Induced abortion in New York City. A report of six separate studies.

Abstract A report is given of 6 recent abortion studies conducted in New York City. These studies consisted of: (1) the 1968 experience of 115 hospitals with therapeutic abortion and possibilities of expanding the service, (2) an analysis of records of 200 consecutive applicants for abortion from the authors private practice, (3) a review of 2,206 abortions at Sloane Hospital for Women between January 1 1932, and June 30 1970, (4) an analysis of first 53 abortions performed by the author with suction curettage, (5) a study of the desire for abortion among 751 antepartum clinic patients, and (6) a report on the 1965 experience with septic abortion at 13 New York City municipal hospitals.

The Supreme Court decision on abortion

THE UNITED STATES Supreme Court’s decision on abortion, handed down on January 22, 1973, will significantly affect the practice of obstetrics in this country. It therefore behooves every American obstetrician to be familiar with this decision and its meaning. Since the Court’s ruling is so extensive and detailed, it is unlikely that many obstetricians will read the original document. With consultative help from several prominent constitutional lawyers, I propose to cite the most important passages of the decision, to interpret it in medicolegal terms, and to add a few comments about its implementation.

The Treatment of Hyperemesis Gravidarum with Chlorpromazine

Summary 1. The results of the treatment of 42 eases of hyperemesis gravidarum with ehlorpromazine are presented. 2. The severity of these cases is documented by the incidence of aceto-nuria, weight loss, history of hyperemesis with prior pregnancies, arid failure to respond to other drugs during the current pregnancy. 3. The dosage regimen is outlined, emphasizing the importance of beginning therapy in the hospital and individualizing the dose according to the patient’s response. 4. Thirty of our 42 patients were cured, 5 were improved, and 7 were initially unrelieved. Two of the latter 7 responded to a second course of therapy. 5. The toxicity of the drug is discussed in detail. All but 7 of the 42 patients exhibited some degree of toxic reaction, usually somnolence and weakness. Four of our own patients became jaundiced, an incidence of 10 per cent. Two other cases of jaundice were sent to us, and one other patient had a transient elevation of serum bilirubin.