A study of admissions to Ward 1, Port of Spain General Hospital for early pregnancy loss: May-June 1999 - Poster abstract

OBJECTIVE: To compare early pregnancy loss in spontaneous versus induced abortions and determine the most common methods of pregnancy termination. DESIGN AND METHODS: In this prospective study, 205 patients admitted to Ward 1, Port of Spain General Hospital from May 1 to June 31, 1999 were interviewed with respect to age and circumstances surrounding thier pregnancy loss. Patient records were subsequently examined to obtain results of investigations and medical or surgical interventions undertaken. RESULTS: Patient were placed into 3 groups: spontaneous abortions (SA), induced abortions (1A) (all types) and mosprostol-induced abortions (MA). Patients' ages ranged from 14 to 43 years (mean 25 years). Length of hospital stay ranged from 1 to 24 days (mean 2.1 days). There was no difference in patient age or length of hospital stay among the three groups. Patients in the MA group exhibited increased rates of sepsis (53.7 percent vs 34.5 percent in the SA group), more episodes of blood transfusion (18.5 percent, MA vs 8.8 percent, SA) and had a higher rate of incomplete abortions (79.8 percent, MA vs. 59.0 percent SA). This led to an increased need for surgical intervention (72.2 percent, MA vs 49.1 percent, IA). Patients in the SA group display intermediate values in all parameters. CONCLUSIONS: Self-medication with Misoprostol is by far the most popular method of termination of unwanted pregnancy in this population. It was associated with increased rates of sepsis, anaemia and necessity for surgical evacuation of the uterus when compared with IA in the same population.(AU)

Medical education, women's status, and medical issues' effect on women's health in the Caribbean

At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influence treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction of health policy if aid or educational programs are to be effective.(AU)

RU 486/Misoprostol (3/2+1) (Myfegine/Citotec) in Guadeloupe - abstract

Use of RU 486 as an abortifacient is legal in Guadeloupe under the French Abortion Law since June 1991. Addition of a low dose of prostaglandin is necessary to obtain satisfactory results from RU486 for termination of early pregnancy. Injections of Sulprostone (Nalador), used at first, were abandoned in July, 1992. Since September, 1992, pills of Misoprostol (Citotec) have been combined with RU 486 under a simplified protocol. This study concerns 345 cases in which RU 486/Misoprostol was used to terminate early pregnancy in Guadeloupe between September, 1992 and October, 1993 in the main city public hospital and in a private clinic, representing 84 percent of all RU 486 used in Guadeloupe during this period. Efficiency reached 95 percent, a result similar to those found in other surveys. For 22 percent of the patients, bleeding occurred 48 hours after taking RU 486, thus before taking of Misoprostol. In 68 percent of cases, bleeding occurred five hours or less after taking Misoprostol. Only 4 percent needed to take the third pill of Misoprostol. Metrorrhagia was reported for 30 percent of cases. Overall the method is efficient, simple, easy to use and does not require hospitalization. The cost is relatively low: US$50.00 for the three pills of RU 486 and US$1.00 for the three Misoprostol pills. There were no episodes of infection, accidents or trauma to the uterus, but menorrhagia was frequently seen. Based upon this experience, we believe that for termination of early pregnancy RU 486/Misoprostol is a better alternative to suction, dilatation and curettage (AU)

Rapport discussieavond "Ongewenste zwangerschappen en hun medische en maatschappelijke consequenties": Informatie en standpunten over abortus in Suriname / Report discussion night "Unwanted pregnancies and their medical and social consequences": Information and points of view concerning abortion in Suriname

Unwanted pregnancies occur in all social and economic classes and ethnic groups. They have excessive emotional consequences, affecting both the immediately involved and the total community. Abortus provocatus (induced abortion) as a possible solution for unwanted pregnancies usually arouses a great deal of commotion. A pro-choice and a pro-life movement exist, both representing opposite points of view. The "Stichting Lobi" (Foundation for sex education and family planning in Suriname) tries to prevent unwanted pregnancies. This report serves as an impulse for better management of this problem. Various speakers presented the subject from medical, legal and religious angles

Evaluation of tubal patency in post-abortal infertile women

The status of the fallopian tubes was investigated by laparoscopy in 113 infertile women with and without previous abortions. Bilateral tubal block occurred in 67 percent of post-abortal patients, compared to 38 percent of those without previous abortions. The risk was significantly greater when the abortion was induced by instrumentation. Performing a prior hysterosalpingography in 26 of these patients, the false positive rate of the x-ray was found to be high, and it is concluded that while the salpingogram may be safely deleted, laparoscopic examinations remains the preferred method of assessing tubal patency in post-abortal infertile women (AU)

Pregnancy in patients after homograft cardiac valve replacement

Thirteen pregnancies in ten patients with homograft cardiac valves resulted in 11 healthy infants, one spontaneous abortion, one elective termination of pregnancy, and the stillbirth of one member of a twin pregnancy. Two forceps deliveries and three cesarean section were performed and routine antibiotic prophylaxis at the time of delivery was utilized to prevent infective endocarditis in all patients. No hemorrhagic or teratogenic complications were observed, and this was considered directly related to the fact that anticoagulant therapy was rendered unnecessary with the homograft valve - a distinct advantage. A more permissive policy of allowing pregnancy in young women with homograft cardiac valves is suggested by the satisfactory outcome of the pregnancies reported here (AU)

Termination of pregnancy by vaginal administration of prostaglandin F2O

Vaginal administration of a single 10 mg pessary of (15S)-15 methyl prostaglandin F2O methyl ester to effect abortion is reported in 20 patients. Ninety per cent of the patients aborted completely, 75 percent within 48 hours. The major side-effects were gastro-intestinal. The acceptability of this method of abortion was high and the morbidity was negligible (AU)

National survey of doctors, nurses and social workers on liberalization of the Barbados abortion law

A postal questionnaire was sent to a representative sample of Barbados' doctors, nurses and social workers requesting their opinions on the liberalisation of the country's 108-year-old Abortion Law, and the possible effects of this. The survey showed that there were very few conscientious objectors. Eighty-five per cent of doctors and social workers thought the law should be liberalised, as against thirty per cent of nurses. Eighteen per cent of doctors and social workers felt that women would lose interest in family planning as a result of a liberalised law, while sixty per cent of nurses were of this view. Ninety per cent of nurses and sixty per cent of doctors and social workers held reservations about abortion on demand. These statistically significant differences of opinion between doctors and social workers on one hand and nurses on the other show that there is a need for advanced planning and education to minimize problems which may arise out of any Abortion Law Reform (AU)

Factors relating to induced abortion as seen in the Georgetown Hospital, Guyana, July 1, to August 15, 1976: an exploratory study

It would seem from this study that there is a need for family planning education as well as the expansion of the present family planning services which are very limited. Women are aware of contraceptives, appear eager to control their family size, but they need clarification on how contraceptives work, and reassurance about the safety of various methods (AU)

Evaluation of some aspects of maternal and child health service in the Moneague area of St. Ann from 1969 to 1974

The author has tried to evaluate some aspects of Maternal and Child Health Services in the Moneague area over a period of 6 years. Some strengths and weaknesses in the quality of care of mothers and children have been identified. Proper data collection is necessary. Policies and procedures on the care of mother and child are required. Needed too, is proper planning with clearly defined goals and objectives. More trained personnel are needed. It shows the need for periodic evaluation of the services. There must be utilization of the findings at all levels to remedy existing ills in the services and reinforce what is good. (AU)