The transition from abortion to miscarriage to describe early pregnancy loss in British medical journals: a prescribed or natural lexical change?

In British medical research, the transition from abortion to miscarriage, to describe early pregnancy loss, occurred in the late twentieth century. A 1985 letter to The Lancet by a group of eminent obstetricians was long considered unilaterally to have prompted this shift. More recently, however, this conclusion was challenged, and it was suggested instead that the transition constituted natural language change, as medical professionals responded to their changing social and professional milieu. This paper, however, uses a pioneering statistical modelling technique to demonstrate decisively that the 1985 Lancet letter was indeed pivotal in promoting miscarriage as an acceptable variant for use in medical journals. The abrupt nature of the vocabulary shift in question is made clear through the pioneering application of the statistical modelling technique change point analysis. This methodological innovation demonstrates clearly the decisive impact of the 1985 letter, while also showcasing the remarkable suitability of change point analysis to the study of such sudden linguistic changes. With an increasing emphasis on patient-centred models of care, it is likely that further prescriptive interventions relating to medical language will be made in coming years. Indeed, beyond the medical profession, there are already increasing calls for further reform to the language of pregnancy loss. To understand how such language reforms might successfully be enacted, and to ensure that linguistic prescriptivism is employed only where change is appropriate, proportionate, and evidence-based, it is necessary to understand fully this historical precedent. Against the backdrop of recent 'lay' demands for reforms, this paper affirms the decisive impact of the 1985 intervention, and considers the ramifications of this finding for the study of linguistic prescriptivism and future medical language reform.

Inactivated influenza vaccine and spontaneous abortion in the Vaccine Safety Datalink in 2012-13, 2013-14, and 2014-15.

INTRODUCTION: A recent study reported an association between inactivated influenza vaccine (IIV) and spontaneous abortion (SAB), but only among women who had also been vaccinated in the previous influenza season. We sought to estimate the association between IIV administered in three recent influenza seasons and SAB among women who were and were not vaccinated in the previous influenza season. METHODS: We conducted a case-control study over three influenza seasons (2012-13, 2013-14, 2014-15) in the Vaccine Safety Datalink (VSD). Cases (women with SAB) and controls (women with live births) were matched on VSD site, date of last menstrual period, age group, and influenza vaccination status in the previous influenza season. Of 1908 presumptive cases identified from the electronic record, 1236 were included in the main analysis. Administration of IIV was documented in several risk windows, including 1-28, 29-56, and >56 days before the SAB date. RESULTS: Among 627 matched pairs vaccinated in the previous season, no association was found between vaccination in the 1-28 day risk window and SAB (adjusted odds ratio (aOR) 0.9; 95% confidence interval (CI) 0.6-1.5). The season-specific aOR ranged from 0.5 to 1.7 with all CIs including the null value of 1.0. Similarly, no association was found among women who were not vaccinated in the previous season; the season-specific aOR in the 1-28 day risk window ranged from 0.6 to 0.7 and the 95% CI included 1.0 in each season. There was no association found between SAB and influenza vaccination in the other risk windows, or when vaccine receipt was analyzed relative to date of conception. CONCLUSION: During these seasons we found no association between IIV and SAB, including among women vaccinated in the previous season. These findings lend support to current recommendations for influenza vaccination at any time during pregnancy, including the first trimester.

El martillo de las brujas al caso Belén / From Hammer of Witches to Belen's case / Del martell de les bruixes al cas Belén

El presente texto parte de la existencia de una íntima relación entre el modo de definir lo ilícito y el procedimiento que se establece para su persecución. Desde esa perspectiva, analiza las previsiones del Malleus Maleficarum ("Martillo de las Brujas") para la tortura de una mujer acusada de brujería. Luego explora las continuidades entre el Malleus y el proceso penal del caso "Belén", con referencias al uso del lenguaje en la doctrina jurídica argentina en referencia al abuso sexual y otros delitos. Por último, plantea interrogantes en cuanto a los significados subyacentes de la punición del aborto que aun rige en la Argentina

The present article originates in the existence of an intimate relationship between the way in which crime is defined, and the procedure prescribed for its prosecution. From this perspective, it begins with an analysis of the guidelines provided in the Malleus Maleficarum ("Hammer of Witches") for the torture of a woman charged with witchcraft. Then, it explores the connections between the content of the Malleus and the criminal prosecution of "Belen's case", focusing on the use of language in Argentinian doctrine about sexual abuse and other crimes. Finally, it poses questions about the underlying significances meanings in the prosecution of abortion, which still prevails in Argentinian current law

Aquest article parteix de l'existència d'una íntima relació entre la manera de definir l'il·lícit penal i el procediment que s'estableix per a la seva persecució. Des d'aquesta perspectiva, s’hi analitza les previsions del Malleus Maleficarum ("Martell de les Bruixes") per a la tortura d'una dona acusada de bruixeria. A continuació, s’hi estudia la continuïtat entre el Malleus i el procés penal del cas Belén, amb referències a l'ús del llenguatge en la doctrina jurídica argentina sobre l'abús sexual i altres delictes. Finalment, s’hi plantegen diferents interrogants en quant al significat subjacent a la punició de l'avortament que regeix a l'Argentina

Temporal changes in chromosome abnormalities in human spontaneous abortions: Results of 40 years of analysis.

Studies during the past 50 years demonstrate the importance of chromosome abnormalities to the occurrence of early pregnancy loss in humans. Intriguingly, there appears to be considerable variation in the rates of chromosome abnormality, with more recent studies typically reporting higher levels than those reported in early studies of spontaneous abortions. We were interested in examining the basis for these differences and accordingly, we reviewed studies of spontaneous abortions conducted in our laboratories over a 40-year-time span. Our analyses confirm a higher rate of abnormality in more recent series of spontaneous abortions, but indicate that the effect is largely, if not entirely, attributable to changes over time in the maternal age structures of the study populations. © 2016 Wiley Periodicals, Inc.

Miscarriage, abortion or criminal feticide: understandings of early pregnancy loss in Britain, 1900-1950.

This paper explores the close links in medical understandings of miscarriage and abortion in the first half of the twentieth century in Britain. In the absence of a clear legal framework for abortion, and the secrecy surrounding the practice, medical literature suggests contradictory and confused views about women presenting with clinical signs of pregnancy loss. On one hand, there was a lack of clarity as to whether pregnancy loss was natural or induced, with a clear tendency to assume that symptoms of miscarriage were the result of criminal interference gone wrong. On the other hand, women who did not present for treatment when miscarriage was underway were accused of neglecting their unborn children. The paper suggests that discourses around pregnancy loss were class-based, distrustful of female patients, and shaped by the wider context of fertility decline and concerns about infant mortality. The close historical connection between miscarriage and abortion offers some insight into why both the pro-life movement and miscarriage support advocates today draw on similar imagery and rhetoric about early fetal loss.

The demand for pregnancy testing: the Aschheim-Zondek reaction, diagnostic versatility, and laboratory services in 1930s Britain.

The Aschheim-Zondek reaction is generally regarded as the first reliable hormone test for pregnancy and as a major product of the 'heroic age' of reproductive endocrinology. Invented in Berlin in the late 1920s, by the mid 1930s a diagnostic laboratory in Edinburgh was performing thousands of tests every year for doctors around Britain. In her classic history of antenatal care, sociologist Ann Oakley claimed that the Aschheim-Zondek test launched a 'modern era' of obstetric knowledge, which asserted its superiority over that of pregnant women. This article reconsiders Oakley's claim by examining how pregnancy testing worked in practice. It explains the British adoption of the test in terms less of the medicalisation of pregnancy than of clinicians' increasing general reliance on laboratory services for differential diagnosis. Crucially, the Aschheim-Zondek reaction was a test not directly for the fetus, but for placental tissue. It was used, less as a yes-or-no test for ordinary pregnancy, than as a versatile diagnostic tool for the early detection of malignant tumours and hormonal deficiencies believed to cause miscarriage. This test was as much a product of oncology and the little-explored world of laboratory services as of reproductive medicine.

'Miscarriage or abortion?' Understanding the medical language of pregnancy loss in Britain; a historical perspective.

Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term 'miscarriage' instead of 'abortion' to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage.

[Abortion in the Castilian medical literature of the 16th century]. / El aborto en la literatura médica castellana del siglo XVI.

This article analyzes the causes of abortion according to the medical and surgical literature that circulated in Castilian in the fifteenth and sixteenth centuries. These works not only explain the medical causes of the death of foetuses but also show how female health was discriminated against and how doctors were able to produce an incipient causal theory in accordance with the medical and social problems of their time.

The evidence that lead increases the risk for spontaneous abortion.

BACKGROUND: Reports from a period spanning more than a century, and covering occupationally exposed women in several countries, support an increase in pregnancy loss from high maternal lead exposures. Nevertheless, most studies conducted among populations with low/moderate exposures have provided little evidence of an association with pregnancy loss, or in particular, spontaneous abortions. METHODS: A critique of these low/moderate level studies reveals small sample sizes, problems in definition or ascertainment of outcome, lack of control for confounding, and/or deficiencies in the exposure assessment. For estimating exposure, either an ecologic measure was used, or individual biologic specimens were taken but attention was not paid to the timing of measurement of lead levels in these samples. A prospective study that overcame most of the deficiencies of previous studies enrolled pregnant women in Mexico City with low-to-moderate-level lead exposures, collected blood specimens during their first trimester, and ascertained spontaneous abortions by week 20. A key design element of this study was the use of incidence-density-matched controls in order to achieve comparable opportunity for the outcome and comparable timing of exposure measurements. The latter is especially important because blood lead levels are altered by pregnancy. RESULTS: In the prospective Mexico City Study, a striking dose-response relation between blood lead and risk of spontaneous abortion was found: the odds ratio for spontaneous abortion was 1.8 (95% confidence interval = 1.1-3.1) for every 5 microg/dL increase in blood lead. CONCLUSIONS: Low-to-moderate lead exposures may increase the risk for spontaneous abortion at exposures comparable to U.S. general population levels during the 1970s and to many populations worldwide today; these are far lower than exposures encountered in some occupations. Further research is needed to confirm the association, to delineate the role of maternal vs. paternal exposures, and to assess increases in menstrual variability as an explanation for this finding.