Clinics in obstetrics and gynaecology
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Clin Obstet Gynaecol · Mar 1986
Surgical techniques of uterine evacuation in first- and second-trimester abortion.
Induced abortion is an ancient procedure. Vacuum curettage is a recent innovation and is demonstrably superior to other methods for first-trimester abortions. Patient selection, patient preparation and the necessary instruments are described. ⋯ Evacuation is by means of large-bore vacuum cannula system and large ovum forceps. General anaesthesia is avoided because it increases the risk of perforation and haemorrhage. Adjuncts to D&E are described: intraoperative real-time ultrasound, intracervical vasopressin, two days' treatment with laminaria tents, and Hern's technique combining laminaria with intra-amniotic infusion of urea prior to D & E.
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Abortion is a universal phenomenon, occurring throughout recorded history and at all levels of societal organization. Techniques are highly varied, as are the circumstances under which it is practised. The status of and attitudes towards abortion in Western civilization are variable and have, in most cases, been changing. ⋯ More recent polls demonstrate little attitudinal change since 1972-1973: between 80% and 90% of Americans approve of abortion in the case of poor health, a seriously defective fetus, or rape, and between 40% and 50% indicate approval for all other reasons as well. Only 10% of the American population would like to see abortion prohibited under all circumstances. Sociodemographic analyses indicate that individuals who disapprove of abortion differ from those who approve of its availability in that they are more likely to be Roman Catholic or fundamentalist Protestant; are, in general, more strongly committed to organized religion; are on the traditional/conservative end of the spectrum with regard to women's role in life, premarital sex, sex education and civil liberties; and tend to have achieved a relatively low educational level. 'Pro-life' and 'pro-choice' activists tend to be women who are completely different from one another in sociodemographic characteristics and in overall values, particularly as these relate to traditional versus modern female roles.
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Clin Obstet Gynaecol · Dec 1984
The Royal College of General Practitioners' Oral Contraception Study: some recent observations.
The Royal College of General Practitioners' Oral Contraception Study is a continuing cohort survey of the effects of oral contraceptives on the health of users. Neurotic depression is associated with the oestrogen content of combined oral contraceptives, but the risk is small in general, and there is no excess risk associated with oestrogen doses of 35 micrograms or less. It now appears likely that, in the long-term, oral contraceptives are not associated with any increased risk of gallbladder disease, although there is an acceleration of the disease in those women susceptible to it. ⋯ In the author's opinion, there is no convincing evidence that oral contraceptive use increases the risk of breast cancer. The evidence for an association with cervical cancer is firmer, but, if confirmed, is unlikely to affect more than one in 3000 users a year. Increased safety in the use of oral contraceptives in future is likely to be achieved through the use of tests which will allow the adjustment of dose to be made to each patient's particular requirements.
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In recent years the trends in the obstetric management of preterm labour have moved in the direction of more active policies with greater use of fetal heart monitoring and Caesarean section to avoid traumatic and asphyxial damage to the baby. Conservative management still has an important place, especially in association with extreme prematurity. ⋯ Future developments in the obstetric management of preterm labour will depend upon careful evaluation studies which examine not only the short-term mortality statistics but also the long-term effects in respect of neurological and developmental handicap. This task is one of the major challenges for obstetricians to tackle over the next two decades.