Saroj Pachauri

A Comparison of D & C and Vacuum Aspiration for Performing First Trimester Abortion

Lean, T. H., Vengadasalam, D., Pachauri, Saroj and Miller, Eva R. (Kandang Kerbau Hospital, Singapore and International Fertility Research Program, Research Triangle Park, North Carolina, USA). A comparison of D & C and vacuum aspiration for performing first trimester abortion.

Experience with minilaparotomy in the Philippines.

This paper presents the socio‐demographic characteristics, medical histories, and clinical data on 651 women sterilized by interval minilaparotomy procedures in Manila, Philippines. About two thirds of the procedures were performed with local anesthesia; the Pomeroy technique was used for tubal ligation. In 2.8% of the patients, salpingectomy or fimbriectomy was performed on one side because of surgical difficulties and complications. Surgical difficulties were encountered in 19.8% of the procedures; adhesions (4.3%) and bowel interference (4.0%) were the most frequent causes of surgical difficulty. Complications occurred during surgery in 1.7% of the procedures. Early postoperative complications were noted in 9.1% of the cases. None of the patients required readmission to the hospital. While 612 women were followed up at 6 months, 299 were followed up at 12 months. One woman (0.2%) became pregnant after sterilization; at repeat minilaparotomy, ligation of the left round ligament rather than the tube was observed. Pelvic surgery, other than pregnancy‐related surgery, during the year following sterilization was reported for one patient who underwent exploratory laparotomy with appendectomy and oophorocystectomy. Menstrual pattern changes were minimal. The results of this study suggest that tubal ligation via minilaparotomy is practical, safe, and effective.

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectivness of the two surgical methods. One hundred and forty‐nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Follow-up study of oral contraceptive acceptors in Howrah District in India.

In the Howrah District in India, three clinics—one in each of the urban, slum, and rural areas of the city—were initiated by the Humanity Association of Howrah in November of 1968 to supply oral contraceptives (OCs) to women from 15 to 45 years of age. The project was discontinued in September, 1972. Of the 1700 patients still active when the project ended, 1 527 were contacted for the follow‐up survey. Findings indicate that most women in this district were satisfied with OCs and would continue to use them if they were available. In corroboration of this, it was found that 43% of the women had used OCs obtained from other sources after the project was discontinued. While 35.5% of the women who used no contraceptive method after the project ended reported becoming pregnant or suspected that they were pregnant at the time of the interview, only 4.2% of those who reported using some form of contraception reported pregnancy or suspected pregnancy. The demographic impact of the project will be evaluated on the basis of data to be obtained in a subsequent survey of the same communities.

Birth Weight, Gestational Age and Other Indices of Fetal Maturity

A number of indices for evaluating the maturity of the newborn were studied. Indices of anthropometric, anatomic, reflex and physiologic development were examined to evaluate their association with birth weight and gestational age; the validity of these diagnostic indices is discussed. Studies are recommended to establish a maturity score to identify high‐risk infants at birth.

The role of methylergonovine maleate in augmenting extraamniotic saline for midtrimester abortion.

This study was conducted in Bombay, India, to evaluate the role of oral methylergonovine maleate (Methergine®, Sandoz Pharmaceuticals, East Hanover, N. J., USA) in augmenting the effect of intermittent extraamniotic instillation of 20% saline for midtrimester abortion in 200 patients. Methylergonovine maleate (MEM) administration was randomly allocated to half the study subjects. All the study procedures were performed by a single operator, and to minimize evaluator bias, another physician evaluated all the study patients after abortion. This study showed that a statistically significant higher percentage of patients in the MEM treated group aborted within 24 hours. At 36 and 48 hours, the differences were not statistically significant, although the cumulative abortion rates were higher for subjects who received the drug than for those who did not. The incidence of incomplete abortions was lower for those treated with MEM than for those not treated with the drug, but the difference was not statistically significant. The rates of complications and side effects were similar for both study groups.

Laparoscopic Sterilization with Spring‐Loaded Clip and Tubal Ring in Postabortal Cases—One‐Year Follow‐up

This study was conducted in Bombay, India, to evaluate and compare the safety and effectiveness of laparoscopic application of the spring‐loaded clip and the tubal ring in 300 immediate postabortion patients. The two techniques were randomly assigned to the study subjects and, to minimize interoperation variability, performed by the same operator. Another physician, unaware of the procedure used, evaluated and cared for the patient after surgery. All but one of these women returned for follow‐up 7–21 days after sterilization, and 74.7% and 81.3%, respectively, of the clip and tubal ring groups reported for the six‐ and 12‐month follow‐up visits.

A comparison of socio-demographic and fertility characteristics of women sterilized in hospitals and camps.

Socio‐demographic characteristics of 5846 women undergoing sterilization in hospitals and 1752 women undergoing sterilization in camps in India are analyzed. The average age of women accepting sterilization was 29.8 years; the mean number of living children was 4.2. Women sterilized in hospitals were of significantly higher age and parity than those sterilized in camps. The mean parity for all women was 4.6. A steep increase in median parity was observed with increasing age in both hospitals and camps. The study indicates that, while the level of education may affect acceptance of sterilization, there is no minimum level of education necessary for its acceptance. Most of the women in the study were not gainfully employed. As expected, most of the women were Hindus. Muslims were underrepresented in the hospital series; in camps, however, Muslims showed a much higher rate of acceptance of sterilization. The rate of pregnancy wastage was significantly higher in the hospital and the child loss rate was significantly higher for the camp cases. While the rate of previous abortions was higher for low parity women, the child loss rate was higher for high parity women. The child loss parity ratio was significantly higher for the camps than for the hospital cases. The vast majority of women in both hospitals and camps reported no previous contraceptive practice. Sterilization appears to have been the method of choice for most of these women.

A Comparison of Metal and Plastic Cannulae for Vacuum Aspiration

A comparative study of the safety and effectiveness of metal (Purandare) versus plastic (Karman) cannulae for first trimester abortion was conducted on 400 women. Two hundred vacuum aspiration procedures were performed using each type of cannula. All aspirations were performed by a single physician, and patient follow‐up was performed by a second physician. The complication rates, amount of retained tissue, rates of cannula obstruction and procedure times of the two cannulae were compared. Our findings showed no significant difference in any of these evaluation criteria for the metal and plastic cannulae.