Early abortion and breast cancer risk among women under age 40.

In New York State, incidence of cancer and fetal death are reportable health events mandated by state law. These data enabled a population-based record linkage study of the effect of early pregnancy termination on breast cancer risk to be conducted. In upstate New York 1451 cases under age 40 were reported to the Cancer Registry during 1976-1980. Cases were matched with 1451 population controls by year of birth and by residence using zip codes. All names including those changed by marriage were matched with the reports of fetal deaths occurring between 1971 and 1980. Matched pairs analyses revealed an excess of early pregnancy terminations among cases in all categories. Odds ratios (OR) were significantly elevated among those with an induced abortion (OR = 1.9) and a spontaneous abortion (OR = 1.5). Elevated risks were also noted for consecutive abortion events without intervening livebirths.

Fatal septic abortion in the United States, 1975-1977.

In 1975 through 1977, 36 women in the United States died of septic abortion (12 legal, 15 spontaneous, 8 illegal, and 1 unclassified). The respective estimated death-to-case rates for septic abortion are 0.4 and 0.6 deaths per 100,000 legal and spontaneous abortions. Unmarried teenagers who undergo incomplete abortion at 16 weeks' gestation or more by intrauterine placement of a foreign body appear to have the highest risk of death from infection after legal abortion. Three of these risk factors (gestational age at the time of abortion, method, and completeness of abortion) can be influenced by medical personnel. Complete abortion by safe techniques early in pregnancy can help eliminate deaths from infection after legal abortion.

Symptomatic intrauterine retention of fetal bones.

Four patients with symptomatic intrauterine retention of fetal bones are discussed. Presenting complaints included infertility, irregular vaginal bleeding, vaginitis, and spontaneous passage of fetal bones. Two patients had uterine anomalies; 1 patient had a retained twin pregnancy. Pelvic ultrasound and x-ray films of the pelvic cavity are helpful in making a diagnosis. Hysteroscopy is invaluable both in confirming the diagnosis and in achieving successful removal of fetal bone.

Predictability of pregnancy outcome in preterm delivery.

Multivariate models have great potential value in enhancing the understanding of why some pregnancies have poor outcomes. Recently, such models have been advocated as a basis for predictive scoring systems that attempt to classify patients into high-risk and low-risk groups. In this report the usefulness of such an approach was assessed by studying the predictability of preterm delivery at The Johns Hopkins Hospital during 1980, using a multiple logistic model. Choosing a cutoff point (or probability of preterm delivery) of 10%, 697 of 2865 patients were placed in the high-risk group. The sensitivity, specificity, and positive predictive value of the model, as applied to this select population, were 62.2, 79.4, and 22.7%, respectively. Thus, only 23% of patients predicted to have preterm deliveries in fact delivered preterm. The predictive value could have been improved by increasing the cutoff point, but only at the expense of markedly reducing the sensitivity of the model. It was concluded that the potential value of multivariate analyses of pregnancy outcome as a predictive, risk-classification technique is limited. Nevertheless, such studies may aid the clinical evaluation of each individual patient by providing a better understanding of the etiologies of poor outcome.

Cortical blindness and Anton syndrome in a patient with obstetric hemorrhage.

BACKGROUND: Cortical blindness is characterized by loss of vision in the presence of intact anterior visual pathways. Anton syndrome, a form of anosognosia, is a rare complication of cortical blindness involving compromise of the visual association centers, with resulting patient denial of blindness. Both syndromes have been associated with computed tomography findings of localized cortical ischemia. In most cases, both the clinical and radiologic features are reversible. CASE: A woman with hemorrhage from an incomplete abortion at 21 weeks experienced cortical blindness and visual anosognosia. CONCLUSION: Cortical blindness and anosognosia are unusual manifestations of severe hemorrhage but should be considered in the differential diagnosis of a patient with atypical visual symptoms.

Intrauterine bone contraceptive device: an accident of nature.

Ultrasonography and hysterosalpingography led to discovery of four bony plates retained in the uterine fundus after an abortion 33 months earlier and which had apparently led to secondary infertility in a 26-year-old woman. Removal of the bony plates was soon followed by a successful pregnancy.

PIP: The case is described of a 26-year olf woman, gravida 2, para 1, who presented with failure to conceive 18 months after revomal of a Lippes Loop IUD worn for 12 months. The IUD had been inserted following a miscarriage at 18 weeks gestation, in which vaginal evacuation was bloody and difficult. The patient had a normal menstrual cycle and normal blood loss. The pulse, blood pressure, temperature, and pelvic examination were normal. A postcoital test was satisfactory, the tubes were patent, and serum levels of follicle stimulating hormone, luteinizing hormone, prolaction, progesterone at days 18 and 22, and testosterone were all normal. The pelvic ultrasonogram showed a persistent focus of intrauterine illumination, and hysterosalpingography revealed an irregularity in the right cornu. Results of laparoscopy were negative. 4 thin plates of bone, each 10 mm in the long axis, were removed at an exploratory dilatation and curettage. Microscopic examination showed necrotic bony trabeculae and bone marrow in the intervening spaces. A pregnancy test was positive 3 months later and patient gave birth to a health female weighing 3.3 kg. In both this and a similar previously reported case, the bone fragments were located in the fundus. The contraceptive action was possibly related to an increase of prostaglandin concentration in the fundal endometrium, which is a common site for blastocyst implantation. Prolonged intrauterine retention of fetal skeletal parts should be added to the list of possible causes fo secondary infertility.

Novel treatment of a patient with secondary infertility due to retained fetal bone.

OBJECTIVE: To describe a simple and previously unreported treatment for retained fetal bone fragments as a cause of secondary infertility. SETTING: Fertility center at a Canadian teaching hospital. DESIGN: Case report. PATIENT(S): A 36-year-old woman with a 15-year history of secondary infertility. INTERVENTION(S): A second dilation and curettage (D+C) performed under abdominal ultrasound guidance was performed where the curette could be directed for the removal of echogenic endometrial foci. MAIN OUTCOME MEASURE(S): Resolution of long-term infertility. RESULT(S): Spontaneous pregnancy 4 months after ultrasound-guided D+C and subsequent term delivery. CONCLUSION(S): If an echogenic area is discovered in the endometrium, it is now standard to look at the uterine cavity by hysteroscopy. However, if the hysteroscopy is normal, we suggest that a D+C with intraoperative abdominal ultrasound assistance be done to ensure that all the abnormal tissue is removed.

Acute intravascular hemolysis with minimal renal impairment in Clostridium perfringens infection.

We report here a case of post-abortal clostridium prefringens infection in which there was severe intravascular hemolysis with black urine, but only minor abnormalities of the clotting mechanism and mild renal failure. The patient recovered following supportive therapy only.

Post-abortion endometritis-myometritis and HIV infection.

The objective was to explore if HIV-1 infection is a risk factor for post-abortion endometritis-myometritis (PAEM) in an urban hospital in Kampala, Uganda. HIV-1 seroprevalence in women with and without post-abortion infection was established using two standard enzyme-linked immunosorbent assays. Fifty-two women with PAEM and 106 without PAEM infection were recruited. The HIV-1 seroprevalence was 17 (32.7%) among women with PAEM and 38 (36.5%) among women without post-abortion infection. HIV infection was not found to correlate with the risk for PAEM. HIV-1 seroprevalence in both groups was double that among antenatal clients in the same hospital, 14.6% in 1997. Life-threatening infections such as septicaemia, peritonitis and pelvic abscesses were observed among 12 cases (23%). HIV-1 infection was not shown to be a risk factor for PAEM, but women with abortions with and without PAEM have a higher prevalence of HIV-1 than antenatal clients.

Ultrasonography in extended placental retention and intra-uterine adhesions; a case report.

A case report of extended placental retention and subsequent intra-uterine adhesions is presented. Three months after a second trimester abortion, ultrasonography was used to confirm the diagnosis of placental retention and to guide emptying of the uterus when normal curettage had failed. Later ultrasonic guidance was also used in the application of an IUD for the treatment of intra-uterine adhesions.

Haemophilus influenzae bacteremia following first trimester abortion.

While genital tract infections with Haemophilus influenza (H. influenzae) are recognized with increasing frequency, this organism still remains an uncommon cause of maternal infection. The association of this pathogen with spontaneous abortion is extremely rare and has been described only in cases of midtrimester abortion. We report a case of H. influenzae bacteremia following first trimester spontaneous abortion and review the literature.

Study of "spontaneous" abortion in Thailand.

This analysis includes data on 3 530 patients with septic or incomplete, inevitable or threatened abortions who were treated at the Siriraj Hospital in Bangkok between January 1972 and December 1973. Data on the patients' socio-demographic characteristics; their reproductive, abortion, and medical histories; their pre- and postabortion contraceptive acceptance; and a clinical profile of their abortion treatment, including procedure time, length of hospitalization, and immediate and delayed postoperative complications are analyzed.

Evaluation of prophylactic use of tetracycline after evacuation in abortion in Harare Central Hospital.

A randomised controlled trial involving 140 non-septic incomplete abortions was performed to determine the efficacy of prophylactic tetracycline as practiced in these cases in Harare Central Hospital. The treatment group (62) received tetracycline (500 mg four times daily) for a week. The remainder acted as controls. No significant difference in sepsis rate between treatment and control groups was noted. The high sepsis recorded in the treatment group was thought to be due to poor compliance. A new prophylaxis regimen has been suggested.

PIP: The purpose of this randomized, controlled study was to determine the efficacy of tetracycline as a prophylactic antibiotic therapy in treating nonseptic, incomplete abortion patients in Zimbabwe. In 1984, the gynecology emergency unit of Harare Central Hospital admitted 3240 cases of incomplete abortion, of which 2891 were nonseptic on admission. For this prospective study, patients presenting with nonseptic, incomplete abortion (n = 140) from February through May 1985 were recruited at Harare Central. These patients were randomly divided into treatment and control groups, and all patients received aseptic evacuation procedures. Following evacuation, the treatment group (n = 62) was given tetracycline (500 mg 4 times daily to be taken for a week). The remainder (n = 78) acted as controls. Diagnosis for sepsis, based on defined parameters, was performed a week later by the author, who did not know the group to which the patient belonged. The majority of the patients in both groups were 15-24 years old and of parity 1-4. An overall sepsis rate of 35.6% was obtained in this study. No significant difference in sepsis rates between treatment and control groups was noted. The apparent higher proportion of sepsis recorded in the treatment group (25/62, or 40.32%) in comparison to the control group (23/78, or 29.5%) was not significant. Although all patients insisted they took their drugs as instructed, further questioning and counting of remaining capsules revealed that the majority (82.6%) had not taken any or part of the course; the patients who did complete the course had not followed the instructions properly. Thus, the lack of significant reduction in the sepsis rate with the use of prophylactic tetracycline was thought to be due to poor compliance. The author argued that this was due to the young age, low socioeconomic status, and lack of understanding of the regimen among the patients. Thus, it is suggested that tetracycline treatment be replaced with a cheap, single-dose, hospital-administered prophylaxis regimen, such as doxycycline, that covers a wide range of organisms.

A strange condition: postmenopausal pregnancy.

Climacterium is characterized by symptoms that occur as a result of the differentiation of hormonal equilibrium. It begins around the age of 40 and continues up to the age of 60. In this period cycles are usually anovulatory. This paper presents a case which may be diagnosed as abortus incompletus despite the patient being in menopause for five years previously.

Biosocial profile of women with incomplete abortions in Ga-Rankuwa Hospital, Medunsa, RSA.

OBJECTIVES: 1. To obtain information on the nature and extent of the problems of incomplete abortion in Ga-Rankuwa Hospital. 2. To gain a better understanding of women's attitudes regarding abortions in the Ga-Rankuwa community. 3. To identify the predominant biosocial factors that might influence outcome, morbidity, mortality, management and cost among those who induce abortion. DESIGN: Cross sectional descriptive observational study. SETTING: Ga-Rankuwa Hospital which is a tertiary hospital approximately 40 km from Pretoria. SUBJECTS: 355 women of various ages and gestational ages were studied. MAIN OUTCOME MEASURES: It was noted from this study that women in the younger age group, of less parity, single and unemployed were found more likely to interfere with their pregnancies and thus induce abortion. RESULTS: There was no statistical difference between those who induced abortion and those who had spontaneous abortion, in terms of gestational age at which the abortion occurred. More of those who had interfered with their pregnancies were admitted for septic incomplete abortion, whereas those with no evidence of intervention were admitted to inevitable and spontaneous abortion (p < 0.001). Of those who had induced abortion 98.5pc stated that they did not want their pregnancies, compared with 39.3pc of those who did not interfere with their pregnancies (p < 0.001). CONCLUSION: The study highlights the importance and relevance of the abortion issue particularly in RSA where abortion is about to be legalized. Whether the legalization will decrease morbidity and mortality associated with criminally induced abortions remains to be established. The study also shows that those who induce abortion are worse off in terms of morbidity and other sequelae as well as cost to the health care system. Strategies for reducing the rate of abortion have been discussed.

Right-sided endocarditis following abortion--underdiagnosed condition case report.

We have presented a patient who followed abortion went on to develop septicemia, right-sided endocarditis and septic pulomonary emboil. Such potentially fatal condition should be prevented and diagnosed early to prevent morbidity and mortality.

[Bret's plastic operation on the uterus (author's transl)]. / Hystéroplasties de Bret.

A comparison of our results with those in the literature confirms that Bret's plastic operation on the uterus is valuable in the cure of septate uterus with two cavities in infertile patients who have had several spontaneous abortions. In spite of this it is advisable to take care to select cases and to be guided by the classical indications for plastic operation on the uterus. The number of abortions (more than 2) is the major criterion but it is often difficult to confirm that the infertility which results is due to the malformation and not to associated pathology. The problem is even more complex when it is a question of sterility rather than repeated abortions.

Massive haematochezia after uterine evacuation: an uncommon cause of lower gastrointestinal bleeding.

We report a case of a 30-year-old Para 2 + 1 who presented with massive haematochezia 7 days after uterine evacuation for an incomplete abortion. Difficulty in pre-operative diagnosis in this type of presentation and treatment is highlighted and the literature reviewed.

[Retained fetal bones in uterus]. / Retinerede føtale knoglerester i uterus.

We report a case of menorrhagia caused by retained fetal bones after a missed abortion in the second trimester. By hysteroscopy several bone fragments were removed. The patient got pregnant two months later.