Survey of men and women residents entering United States obstetrics and gynecology programs in 1981.

In July 1981, questionnaires were distributed to 1,128 residents entering the field of obstetrics and gynecology throughout the United States; 546 (48%) were returned and evaluated, 229 from women (42%) and 317 from men (58%). Factors that related to the choice of the specialty showed a universal interest in the birthing process and the surgical aspects of the specialty, with a large majority also interested in health education, endocrinology, primary care of young people, and achievement of a greater understanding of sexuality. Private partnership practice was favored by most of the respondents. Men attributed a greater importance to income than did women, who were more interested in a salaried practice and less irregularity of hours. Women tended to be more liberal on questions that were related to controversial medical and ethical issues in the field of obstetrics and gynecology. Role models, half of whom were teachers, were equally common to men and women (66%).

Chlamydia trachomatis and cervical neoplasia.

We tested 383 women with and 500 women without cervical neoplasia for antibodies against Chlamydia trachomatis or herpes simplex virus (HSV). Exposure to both agents was related to sexual activity, with the highest prevalence of antibodies found in women with more sex partners and who had first coitus at an earlier age. When subjects were matched for several risk factors (age, race, marital status, parity, number of sex partners, and history of venereal disease), a significant excess of antibodies against C trachomatis was found in cases as compared with control subjects (76.5% v 58.4%, respectively; n = 149). Because matched-pair analysis lost a substantial proportion of women with neoplasia (largely because they were older), linear logistic analysis was performed. This also showed an excess of antichlamydial antibody in cases, with an estimated odds ratio of approximately 2 for the association of antichlamydial antibody and the risk of being a case. Neither analysis found an excess of antibodies to HSV type 2 in cases.

The impact of midtrimester abortion techniques on patients and staff.

We studied 250 midtrimester abortions by dilatation and extraction (D and E) under general anesthesia and compared them with abortions by the intra-amniotic injection of prostaglandin (amnio) in order to assess the physical and emotional changes experienced by patients and staff under the different circumstances represented by each procedure. We found patients undergoing D and E abortions had fewer physical complications and described the procedure as minor surgery which went smoothly. The patients who had amnio abortions had more pain and reacted with more anger and depression afterward. Nurses were more disturbed by amnio abortions in which they played major roles in supporting the patient as well as in her abortion. Physicians reported the D and E procedures to be emotionally difficult which may limit the adoption of this procedure despite its value to patients.

PIP: A comparison was made between the physical and emotional changes experienced by patients, nursing personnel, and physicians with 2 different mid-trimester abortion techniques. 250 dilatation and extraction (D and E) procedures under general anesthesia were compared with abortions by intraamniotic injection of prostaglandins. The only major difference between the 2 sets of patients was that the amnio patients were further along in their pregnancies. At a 3-week follow-up interview, the patients differed significantly in their reactions. The D and E group had fewer complications and described the procedure as minor surgery which went smoothly. The amnio group had experienced more pain and had greater feelings of guilt, anger, and depression. The floor nursing personnel felt anger at being abandoned by the doctors to deal alone, usually in the middle of the night, with the difficult experience of an amnio delivery of a dead fetus. Operating room nurses and doctors found the D and E procedure distasteful and emotionally disturbing. Doctors perferred to perform amnio procedures and not be involved at the time of delivery. The authors' experience leads them to conclude that the D and E procedure is safer, less painful, quicker, more convenient, and less expensive for the patient than the amnio procedure. The psychological problems doctors experience with dismemberment of the fetus may be relieved with development of new techniques.

Experience with 276 intra-amniotic prostaglandin F2alpha induced midtrimester abortions.

Induction of midtrimester abortion using 40 mg intra-amniotic prostaglandin F2alpha was performed on 276 patients. Gestational age and fetal status had no effect on injection-to-abortion time while multiparity and the concomitant use of laminaria appeared to decrease the abortion time. The side effect and complication rates were acceptable and the results compare favorably with those of other midtrimester abortion techniques.

A fluid-filled intrauterine device: initial clinical trials.

Initial clinical trials of a saline-filled IUD were conducted with 697 women (397 nulliparas and 307 multiparas) experiencing 6,672 woman-months of use. The cumulative rates for multiparas were: pregnancy 1.5, expulsion 10.5, medical removal 10.9, continuation 68. For nulliparous women the rates were: pregnancy 4.3, expulsion 19.4, medical removal 14.3, continuation 58. Efforts are being made to modify the geometry and content of this IUD to decrease the expulsion rate and removals for bleeding.

Karman catheter.

PIP: In their recent communication in brief on the Karman catheter, Beric and his coauthors ignored 2 recent papers on the use of this flexible cannula. They reported retention of tissue in large numbers of patients even early in pregnancy but did not note the quantity of the retained material, without which its significance cannot be evaluated. Goldsmith and Margolis had no such problems, while Lewis and colleagues reported retained tissue, primarily in their initial patients. This problem resolved itself with further experience and increased expertise. In carrying out an abortion procedure, great stress must be placed on efforts to decrease cervical trauma and subsequent cervical incompetence. Data from Eastern Europe, Japan, and the United Kingdom suggest an increase in premature labor subsequent to induced abortion. Narrow-diameter flexible cannulas can play an important role in early abortion and can be used into the 9th week of pregnancy (from the date of the last menstrual period) without problem. It is most important to the welfare of women that use be made of such minimum dilatation techniques in early abortion procedures.^ieng

Forane increases bleeding in therapeutic suction abortion.

PIP: The effect of forane, an anesthetic, upon uterine bleeding during therapeutic abortions was examined in 13 women, ranging in age from 19-36 years, who were 8-13 weeks pregnant. 9 received forane-70%nitrous oxide-oxygen maintained at 1.0% or .5%. 4 women received a 1.4% concentration of forane-oxygen. No patients moved during the abortion, performed by the suction technique. The average blood loss was 208 plus or minus 43 ml. In pregnancies of less than 10 weeks, average blood loss was 181 plus or minus 61 ml, while women who were more than 10 weeks pregnant had an average blood loss of 251 plus or minus 55 ml. There was a tendency toward less bleeding (85 plus or minus 13 ml) in the 4 women who received forane without nitrous oxide as compared with the blood loss of the group who used forane with nitrous oxide (262 plus or minus 53 ml). Forane was judged to increase uterine bleeding and was therefore unacceptable as an anesthetic during suction abortions.^ieng