Therapeutic abortions. A review of 567 cases.

PIP: 567 consecutive cases of therapeutic abortion performed at the University Hospital of San Diego County between December 1967 and December 1969 are reviewed as a guide to planning an abortion program that can manage the complicated logistical problems involved and the psychological stresses for the patient that occur. Each abortion applicant has to pass through several stages of examination and consultation resulting in a 2 week delay between the first physician contact and the operation itself. All of the patients of 13 weeks gestation or less were aborted by suction curettage; 76.5% of those over 14 weeks gestation were aborted by intraamniotic injection of hypertonic saline. The rest were aborted by hysterectomy or hysterotomy, usually when concomitant sterilization was desired. Most of the patients were referred from private physicians, were 20-29 years old, single, white and primigravid. 97% of the procedures were performed for protection of the patients' mental health. Of the 431 cases of suction curettage, 5.5% had operative complications and 5.5% had postoperative complications. Of the 104 cases of hypertonic saline injection the comparable figures were 22% and 17%. For hysterectomy-hysterotomy the total complications rate ranged from 49.7% for primary operations to 64.5% for secondary operations following saline failure. Most of the complications with suction curettage were minor but retained placentae was a major problem with saline inductions. Complications were more frequent in patients over 30 and patients with high gravidity or advanced gestation. The average hospital stay for suction curettage was 2 days, for saline inductions 3-4 days, and for the surgery 5-7 days. Psychological stress is great for the patient at the times of admission and discharge. The abortion is particularly more difficult for saline induction or surgery patients. Careful attention must be paid to assisting, counseling, and educating the abortion patient during her hospital stay to ease the psychological stress. Legal obstacle should be further liberalized to give the reluctant or confused woman freer access to abortion.^ieng

Tay-Sachs disease: prenatal diagnosis.

Fifteen pregnant women with a 25 percent risk of delivering a child with Tay-Sachs disease were monitored by amniocentesis and hexosaminidase A assays of amniotic fluid, uncultured amniotic cells, and cultured amniotic cells. Tay-Sachs disease was diagnosed prenatally in six fetuses; the diagnosis was confirmed in one child after birth and in five fetuses after therapeutic abortion. Prenatal diagnosis indicated the absence of Tay-Sachs disease in nine other fetuses; this diagnosis was confirmed postnatally in six, three are still in utero.