Histopathologic evaluation of uteri curetted by flexible suction cannula.

A prospective study was undertaken to evaluate the use of the flexible plastic cannula for obtaining endometrial specimens for diagnostic purposes. Suction curettage was performed immediately prehysterectomy, the specimens evaluated, and then compared to similar specimens obtained by a metal curette. Another group of patients had suction curettage performed as an office procedure 24 to 72 hours before hysterectomy. The results of our study confirm the adequacy of this method for obtaining endometrial samples.

Rapid hCG-specific radioimmunoassay for menstrual aspiration.

Fifty-one women with missed periods ranging from 5 to 14 days who suspected a pregnancy underwent an aspiration curettage with a flexible soft-tipped cannula attached to a Karman-type syringe. Sera from these women were measured for human chorionic gonadotropin (hCG) by a rapid 2-hour solid phase radioimmunoassay using an antibody with a specificity for the beta subunit of hCG. The sensitivity and specificity of this assay insured detection of bCG with 100% accuracy at the time of the missed period. Of the 51 women, 33 (64.7%) were found to have hCG in their serum, and 29 (56.8%) had histologic evidence diagnostic of pregnancy.

PIP: Aspiration curettage was performed on 51 women who suspected pregnancy and had missed periods from 5 to 14 days. Sera obtained from the patients were analyzed for human chorionic gonadotropin (HCG) by a rapid, 2-hour solid-phase radioimmunoassay using an antibody with a specificity for the beta subunit of HCG. 33 of the women (64.7%) were found to have serum values ranging from 8 mIU/m1 to 3997 mIU/m1. 29 of the women (56.8%) showed histologic evidence of pregnancy. Generally, more women had HCG in their serum as the number of days following the missed period increased. The test can detect HCG with 100% accuracy at the time of the missed period.

Pregnancy planning in Hawaii.

PIP: Figures from the 1970 National Fertility Study indicate an improvement in preventing unwanted fertility during the previous decade. A 1970-1971 study of fertility in Hawaii revealed that only 46% of conceptions and 56% of eventual live births had been planned. Married women over 35 and teen-agers, both married and unmarried, had the greatest proportion of unplanned conceptions. The figures revealed a great unmet need for family planning among unmarried women and teen-agers generally. There exists a differential access to abortion, with younger women having less access. In Hawaii unmarried women terminated unwanted pregnancies more often than married women. Most unwanted pregnancies were found to result from nonuse or inconsistent use of birth control rather than from contraceptive failure. Timing failures, especially for the 1st birth, should receive more attention from family planners.^ieng

Intra-amniotic prostaglandin PGF2alpha (THAM salt) and the laminaria tent in midtrimester termination of pregnancy.

PIP: 20 patients underwent intraamniotic administration of PGF2alpha for termination of pregnancies ranging from 14-20 weeks gestation. Success was achieved in 18 patients (90%) with this method. The 2 failures were terminated vaginally with adjunctive use of intracervical laminaria and intravenous pitocin induction. 10 of the patients had intracervical laminaria placed 4-24 hours prior to drug administration. This latter group was noted to have a shorter induction-abortion interval, shorter onset of uterine contractions, and a decreased incidence of vaginal bleeding prior to abortion. No serious side effects occurred in either group of patients. Clinical toxicity in the form of gastrointestinal symptoms such as nausea and vomiting were common but could generally be controlled with antiemetics. No significant changes were recorded in blood counts, platelet counts, liver function tests, and renal function tests from pretreatment values and at 24 and 48 hours posttreatment. There were no instances of hemorrhage, fever, or infection which occur as complications of hypertonic saline abortion.^ieng

A midtrimester procedure, not without its risks... Saline abortion: a review of the experience at Kapiolani hospital.

PIP: The experience with 107 saline instillation abortions at Kapiolani Maternity and Gynecologic Hospital in Honolulu, during the first 7 months of 1972 is reviewed. 57.9% of the patients were primigravidas and 40.2% were multigravidas. Estimated length of gestation ranged from 14 to 23 weeks, with a mean of 17.7. 87/8% of the women were successfully aborted on the initial attempt, while technical difficulty with amniocentesis prevented the instillation of saline in 10.3%, and the method itself failed for 2. 30% of the primary attempts at abortion failed when gestation length was estimated at 15 to 16 weeks compared to a 7% failure rate at 17 to 18 weeks; no failures occurred at 19 weeks or more. Mean induction-abortion interval was 25.7 hours; gravidity appeared to exert little influence. 32.7% of the patients displayed postabortive complications which were defined by the following criteria: 1) failure of amniocentesis or failure to abort; 2) accidental intravascular injection of saline and immediate reaction consistent with this clinical syndrome; 3) fever, any recorded temperature of 100.6 degrees Farenheit or greater; 4) retained tissue; 5) hemorrhage, a decrease in hemoglobin of 2 gm or more. 14% of the women developed fever while failed abortion occurred for 12.1% and 10.3% displayed more than 1 complication. The highest complication rate (40%) occurred in 13-16 week gestation group; the lowest (29.6%) in the 17-20 weeks interval. A greater risk was found to exist for the very young patient (15 years and under) and the older patient (age 30 and over); complication rates were 50% and 40% respectively, compared to a rate of 25% for age 29. The group of patients having greater than 150 cc of amniotic fluid removed and greater than 150 cc of hypertonic saline instilled had the shortest interval to abortion. While complications encountered in this series of 107 patients were mainly minor, it should be noted that the incidence of these complications as well as the induction-abortion interval determine the length of hospitalization and consequently the cost of the procedure. Early abortion procedures reduce both cost and risk of complications.^ieng

Innovative methods in prevention of the need for abortion.

PIP: Since conception often occurs as an unplanned consequence of coital behavior, there is a need for postconceptive family planning. 1 survey of women seeking abortion (Washington State) showed that 74% were not using contraceptives at the time of conception. Postconceptive methods currently available include the morning-after pill, dilatation and curettage, suction curettage, intra or extraovular manipulation, and hysterotomy and hysterectomy. New techniques of inducing endometrial shedding even before pregnancy has been ascertained should be explored and communicated. Prostaglandins may be 1 method.^ieng