Effect of vaginal bleeding in early pregnancy on outcome.

The effect of vaginal bleeding in the first half of pregnancy on fetal outcome is retrospectively analyzed in 523 cases and compared with a control group of 6706. Early-pregnancy bleeding was found to be associated with more preterm deliveries and lower birth weight. The frequency of congenital anomalies and growth-retarded infants was unaffected. Neonatal death and low Apgar scores were seen more often than expected, but stillbirth rates were not significantly increased. These data suggest that vaginal bleeding in early pregnancy is a useful indicator of risk for suboptimal outcome.

Continued pregnancy after failed first-trimester abortion.

By means of simple changes in the observation and recording process after induced first-trimester abortion, it has been possible to reduce the frequency of failed abortion to one third its former incidence. The operator is merely required to note whether the amniotic sac and fetal parts are actually seen on gross examination and flotation in fluid. This formal requirement appears to serve as an alert mechanism to ensure that women at risk will be effectively evaluated and managed.

Continued pregnancy after failed first trimester abortion.

Forty-six patients with unintentional continued pregnancy were detected among a series of 65,045 first trimester abortions. Patients at greatest risk are those with very early pregnancy and those with marked uterine anteversion or retroversion or with uterine anomaly. Attention to gestational duration and uterine size as related to the amount and character of the evacuated tissue, particularly stressing identification of villi and fetal tissues, may help avoid this problem.

PIP: A study of 65,045 abortions performed in 5 freestanding surgical units over 100 months time found 46 cases of incomplete abortion. Nearly 3/4 were 8 week or less pregnancies (dating from last monthly period), 20% were 6 weeks or less. Among the successfully completed abortions 44% were 8 weeks or less and 6% were less than 6 weeks. Risk of failure is 6x greater at 6 weeks than at 9 or more. The last monthly period gestational age estimation was found to be correct in 95.6% of 45 cases. Among 30 cases, 53.3% were physician misjudgements of gestational age. Anatomic reasons for failed abortion described 13 patients. Gross observation of the villi and getal parts occurred in only 22 cases and did not reveal the incomplete abortion. Pathologists should examine removed tissue and report any discrepancy to the physician. Follow-up examinations (2 weeks after operation) detected failed abortion in 22% of cases. Patients who said they still felt pregnant were ignored in 1/2 the cases. Early detection and diagnosis of failed abortion is necessary to avoid the more complex procedures required in later stages of pregnancy. One patient carried the fetus to term and delivered a normal infant.

Comparison of women seeking early and late abortion.

The differential characteristics of 697 women desiring induced abortion were studied according to when in pregnancy they presented. Age, marriage, and level of formal education were inversely related, those with greatest delay tending to be young, unmarried, and minimally educated. Religion was relevant, but generally was not. Nulliparity was only a weak correlate of delay. Contributory factors of denial, ambivalence, fear, and preceding menstrual irregularity accounted for two thirds of cases; they were uniformly distributed over the range of gestational age, but constituted the greatest proportion of reasons among those delaying decision longest. Physician delay and laboratory error accounted for all but one tenth of the remainder; they were concentrated particularly among gravidas presenting for care in the early part of the midtrimester. Fear characterized the young, poorly informed noncontraceptors, and had the greatest relative impact in protracted delays; denial was more likely to be found among older and ostensibly better informed women.