Reducing pain of first trimester abortion under local anaesthesia.

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

PIP: The World Health Organization has urged a reduction in the number of first-trimester induced abortions performed under general anesthesia. To determine the implications of this recommendation for pain control, 181 women undergoing first-trimester abortion under local anesthesia and 198 aborted under general anesthesia at University Hospital in Rome, Italy, were interviewed 1 hour after the procedure. Pain intensity was assessed through both the visual analogue and verbal rating scales. Women who selected or were assigned to general anesthesia tended to be younger (mean age, 27 years) and nulliparous. Over 50% of local anesthesia patients described their pain during the procedure as mild or moderate, 30% rated it severe, and 18% characterized it as distressing but time-limited. 60 minutes after the abortion, pain scores were higher in the general anesthesia group. Logistic regression analysis identified four significant predictors of pain: time interval less than 2 minutes from local anesthetic injection to the beginning of the procedure (relative risk (RR), 3.0), lack of choice between general or local anesthesia (RR, 1.9), history of frequent use of analgesics (RR, 1.9), and nulliparity (RR, 1.7). 91% of general anesthesia and 73% of local anesthesia patients stated they would recommend their method of anesthesia to a friend undergoing abortion. These findings suggest that local anesthesia, less costly and with a lower risk of complications than general anesthesia, is feasible for pain control, especially if administered 2-5 minutes before the procedure begins.

[Contraception and voluntary termination of pregnancy. Survey of a sample of 500 women]. / Contraccezione e interruzione volontaria della gravidanza. Indagine conoscitiva su di un campione di 500 donne.

In order to better evaluate the link between contraceptive attitudes and induced abortion, 500 women who underwent voluntary termination of pregnancy (VTP) at the First Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza" were interviewed. They were young (median age 28 years), medium to high educated (61%), non married (52.4%), nulliparous (59.2%) women. Forty-two percent of them had the first sexual intercourse before 18 years of age and 72.6% at least five years before. Ninety-five women (19%) admitted a previous voluntary termination of pregnancy. Withdrawal (305 women), oral contraceptives (246 women) and condom (223 women) were the most widely used methods of fertility regulation, but the pill had been taken only for short periods of time, never exceeding one year. Withdrawal resulted to be the most utilized method during the cycle in which conception occurred (49.4%); no method had been employed by 34.8% of the women. The diffusion of modern methods of fertility regulation greatly influences the number of induced abortions in Italy, as clearly indicated by the progressive reduction of VIP starting from 1982 paralleled by a constant increase in OCs diffusion. Our data, although limited in number, confirm that induced abortion is the consequence of an insufficient use of modern methods of fertility regulation.

Nausea, vomiting and thyroid function before and after induced abortion in normal pregnancy.

Thyroid function in early pregnancy has been reported to be slightly different from that in second or third trimester. We assessed thyroid function before and after induced abortion in normal pregnant women. A significant increase in serum Free T4 and a decrease in serum TSH were observed before abortion and these changes, apart from the contemporary significance of serum hCG-beta, were especially marked in pregnant women with nausea and vomiting. On the other hand, an increased level of Free T4 and a reduced level of TSH returned to the normal ranges 7-10 days after induced abortion. Furthermore, serum hCG-beta was significantly reduced. These results suggest that, in normal early pregnancy, thyroid function may be related to serum hCG-beta concentration and its increased level, which induces gestational emesis.

PIP: At the Institutes of Gynecology and Obstetrics of the University of Rome (La Sapienza), Italy, serum levels of free thyroxine (FT4), FT3, thyroid stimulating hormone (TSH), and the beta subunit of human chorionic gonadotropin (hCG-beta) were compared before and 7-10 days after induced abortion in 19 normal women in their first trimester of pregnancy. The women were divided into those with nausea and vomiting (7) and those without these symptoms (12). The aim was to distinguish slight transient hyperthyroidism associated with nausea and vomiting in normal early pregnancy with pre-existing thyrotoxicosis or hyperemesis gravidarum. In both groups of women, serum hCG-beta levels were significantly lower 7-10 days after the induced abortion than before (p 0.01) while serum TSH levels were significantly higher (p 0.02). The serum levels of FT4 were higher before than after abortion in both groups of women, but were significantly so in women with nausea and vomiting (p 0.001). After induced abortion, serum levels of FT4 and TSH returned to normal levels. Earlier research found that hCG peaks at 10-13 weeks gestation and decreases to a stable level by 20 weeks gestation and that hCG is associated with thyroid hormone levels. This study's findings support those of earlier research since women in the nausea and vomiting group had higher levels of FT4 and hCG-beta and lower levels of TSH before the induced abortion than after it. Perhaps, hCG physiologically activates the thyroid gland in early pregnancy, which may in turn induce vomiting during early pregnancy.