[Problems for discussion on contraception for women after childbirth]. / Diskussionnye voprosy kontratseptsii u zhenshchin posle rodov.

PIP: Questionnaires were administered to 300 postpartum women in 3 delivery wards in Moscow to determine their opinions about contraceptives. Similarly, 100 gynecologists-obstetricians were queried in 2 wards, at 2 counseling sites for women, and at regional seminars of gynecologists-obstetricians. 52% of the physicians recommended the condom to nursing mothers whenever sexual activity was resumed and the IUD from the 3rd and 4th month on. 60% of the doctors thought that women who were not breast feeding could similarly start using the condom and from the 3rd and 4th month either the IUD (82%) or oral contraceptives (36%). 71.1% of the women were under 30 years of age, and were relatively well educated. 68% of them had their first birth, 28.3% had their second, only 3.7% had their third or higher order of births. 35% of the women did not plan the present pregnancy. 81% of the women were using contraception up to the time of the present pregnancy, and the most popular methods were coitus interruptus (36.3%), the rhythm method (35.3%), the condom (28.3%), the IUD (13%), and hormonal methods (10.6%). Although 46.3% of the women preferred the IUD after birth, only 7.3% of them preferred hormonal preparations. In this study 71.5% of the mothers were breast feeding their infants. 13.5% of the women had gestosis in the 2nd half of the pregnancy, 5.8% had anemia, and 21.3% experienced the threat of miscarriage. In 12.9% of the cases there were other pathologies unrelated to pregnancy, and 14% of the births were accomplished by means of cesarean section. Only 12.1% and 13% of the women, respectively, received information about postpartum contraception at the women's counseling sites and delivery wards. 46.3% of the women wanted to use IUDs, but only 7.3% wanted to use hormonal preparations. Only about half of the women expressed their opinion about sterilization: 23% were against it, while 29.7% were for it. The results indicated that the preparation of women for postpartum contraception should already start at the counseling place during pregnancy.^ieng

[The organizational aspects of reducing mortality from abortions]. / Organizatsionnye aspekty snizheniia smertnosti ot abortov.

PIP: Maternal mortality in the USSR in 1988 stood at 43/100,000 population. this figure broke down into mortality from ectopic pregnancy (5%); from induced and self-induced abortion (29.1%); and, from 28 weeks of gestation, mortality from births as well as during the postpartum period (65.9%). Prior to 1991, in 3 years 2020 women died of abortion-related causes, 76.7% of them in connection with non-medical abortions. The original medical documentation of 342 women who died of abortion was analyzed. 69.6% of the women died in connection with non-medical abortion. 72.6% of these women died during the period of 13-27 weeks of gestation. It was especially noteworthy that 58.8% of the women died in cases where their pregnancy was up to 12 weeks of duration and termination of pregnancy could have been performed. Contributory factors were intervention with the purpose of abortion outside of a medical facility, belated provision of medical help, and inadequate equipment at the medical facility. 78/1% of the deaths of non-medical abortions were caused by introduction of catheters or solutions into the uterine cavity and by the opening of the fetal sack through the use of drugs. 32 women carried out the intervention themselves, and 34 were done by strangers, including 18 medical personnel. Sepsis and peritonitis caused 88.6% of the deaths, and hemorrhage caused 6.7%. After induced medical abortions, 44.2% of women died from peritonitis and sepsis, 17.4% from extragenital diseases, and 26.9% from other causes. Only 22.7% of the cases were selected as case studies for medical conferences. Measures regarding the lowering of mortality from abortions have to be directed primarily at the prevention of non-medical or criminal abortions.^ieng

[Abortion as a cause of maternal mortality]. / Abort kak prichina materinskoi smertnosti.

It has been shown that 65.8% of 343 women died in the second trimester and 69.6% after an illegal abortion. Sepsis and peritonitis were the main causes in the general population (73.9%) and in women who died from illegal abortions (88.6%). Defects in medical care were found.

PIP: The medical documents of 342 women who died as a result of abortion (induced, self-induced, and outside of hospitals) were analyzed. 24.2% of the women were under 24 years of age, 51.3% were 25-34 years old, and the rest were 35 or older. 69.9% of the women died after abortion outside of hospitals and the rest after self-induced and induced abortions. 65.8% of the women were pregnant at 13-27 weeks of gestation. The death of 186 of 238 women was due to abortions performed outside of hospitals. Most of these were the result of invasive methods (the introduction of the catheter, solutions, rupture of the amniotic sac). These women subsequently received medical assistance. 93.3% of them were hospitalized with delay, and only 2.6% were admitted in satisfactory condition. In a significant proportion of patients the examination was belated and inadequate. Various laboratory hematological tests that were essential for diagnosis and determination of the severity of the process were not done. The bacteriological tests to select the appropriate antibacterial drug were rarely performed--the tests were done for only 19.8% of women who had died of sepsis and for 14.3% of those who had died of peritonitis. Inadequate care manifested itself in the fact that diagnosis was established for only 46.8% of patients. Sepsis and peritonitis were the cause of death for 73.9% of all women and for 88.6% of those who died of abortion outside the hospital. Hemorrhage was the second most frequent cause, with 42 women dying because of it. Other causes were anaphylactic shock and thromboembolism of the pulmonary arteries. The elimination of such causes of death mandate goal-oriented preventive measures accompanied by diagnosis and therapy and the raising of the knowledge level of the medical personnel about purulent-septic infections. A radical improvement in bacteriological care also must be effected.

[Parturient and puerperal mortality in preterm labor]. / Smertnost' rozhenits i rodil'nits pri prezhdevremennykh rodakh.

The peculiarities of mortality patterns in preterm labour are overviewed, including early and late, induced and spontaneous labour. The revealed drawbacks in the management of future mothers, both in counseling centers and maternity clinics, are discussed.