Termination of Pregnancy

Objective This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia. Design Systematic review and meta-analysis. Data sources Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines. Eligibility criteria for selecting studies The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis. Data extraction and synthesis The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I 2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16. Results The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination. Conclusions One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.

Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15-49 in PNG. Secondary data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted samples of 6,288 married women were included. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported. The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35-44 years (aOR = 8.54; 95% CI: 1.61-45.26), not working (aOR = 6.17; 95% CI: 2.26-16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60-8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91-16.81) were more likely of pregnancy termination. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17-4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61-14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39-8.18 and aOR = 2.54; 95% CI: 1.18-5.45, respectively) more likely to terminate a pregnancy. The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Maternal age, occupation, mobile phone ownership, place of residence, IPV, unplanned pregnancy, knowledge of modern contraceptive methods, and decisionmaker for contraceptive use were significantly associated with pregnancy termination. Efforts aimed at reducing unplanned pregnancies and terminations should focus on improving easy access to contraceptives and comprehensive sexual and reproductive health education for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services.

Improved living conditions and reproduction techniques in captive animals have increased the longevity and fecundity rates, thus contraception has become very important in zoos. Reproduction control is needed to prevent crowding in the available space, inbreeding, and also to allow normal social interactions among groups of animals. Much of what is known of carnivores reproduction control has been studied in detail in the domestic dog and cat; howerer, due to some physiological differences (e.g. seasonality, ovulation characteristics), results from domestic dogs and cats should be taken with caution before applying in wild carnivores. The aim of this review is to briefly describe the main contraceptive methods available for carnivores.

Although a rare disease, bilateral congenital anomalies of the kidney and urinary tract (CAKUT) are the first cause of end stage renal disease (ESRD) in children. Ultrasound-based prenatal prediction of postnatal renal survival in CAKUT pregnancies is far from accurate. In a prospective multicenter study spanning 178 CAKUT patients, we applied amniotic fluid (AF) peptidome analysis to improve on this prediction. Using a training cohort of 53 CAKUT pregnancies, we identified a signature of 98 endogenous AF peptides, composed for the major part of fragments from extracellular matrix proteins and thymosin-β4, predicting postnatal renal outcome with an AUC of 0.96 in a hold-out validation set of 51 CAKUT patients. The signature was validated in a geographically different setting (AUC 1.00) and displayed high specificity (82% to 94%) in non-CAKUT settings. Modification of AF thymosin-β4 abundance was confirmed with ELISA. Invalidation of thymosin-β4 in zebrafish altered proximal and distal tubule pronephros development. The introduction of this AF peptide signature in the diagnostic workup of prenatally detected CAKUT fetuses can provide a long-sought evidence base for accurate management of the CAKUT disorder that is currently unavailable.

Sirenomelia, also known as mermaid syndrome, is a very rare lethal congenital disorder with multisystem malformations, characterized by fusion of the lower limbs. Here we report a preterm neonate with fusion of the lower limbs. The baby was born by cesarean section to a 27-year-old primigravida mother at 35 weeks and 3 days’ gestation. There was no maternal history of hypertension, heart disease, asthma, or diabetes mellitus. At birth, the infant did not cry, had weak tone, a heart rate (HR) of <60 beats per minute (BPM), an Apgar score of 1/2, and a birth weight of 2,300 grams. The infant had an imperforate anus and no urogenital openings or external genitalia. There was a small penis-like protrusion without an aperture, such as in cases of ambiguous genitalia. The two lower limbs were fused, with five toes on each foot. Despite neonatal resuscitation, the infant died within 75 minutes of birth. The child was diagnosed with sirenomelia. This case report aims to emphasize the imp...

Objective: Our purpose was to determine whether intracervical placement of laminaria stalks would improve the effectiveness of inducing termination of pregnancies in the second trimester by intra-amniotic injection of prostaglandin F 2 alpha. Study design: This is a prospective randomized clinical trial conducted at Gynecology Department, Lis Maternity Hospital. Fifty women admitted for indicated second trimester pregnancy termination were randomly assigned to receive either intracervical placement of laminaria (n ¼ 25) or not (n ¼ 25), with concurrent use of intra-amniotic injection of prostaglandin F 2 alpha and concentrated oxytocin. The outcome measures were: time from induction to delivery and the side effects and complications of treatment. Results: There was no significant difference in the mean interval from induction to delivery in the laminaria and no laminaria groups, being 20 AE 1:3 ð8À30Þ h versus 19 AE 1:0 ð8À26Þ h, respectively. In addition, this interval was not different in subgroups of primiparas or multiparas. Other outcome measures such as retained placenta (4% in both groups), post-partum hemorrhage (4% in both groups) gastro-intestinal side effects, fever, and use of analgesia were not significantly different between both groups. Conclusion: We found no additional value in placing laminaria stalks when using intra-amniotic injection of prostaglandin F 2 alpha followed by concentrated oxytocin infusion for second trimester termination of pregnancy.

In this present time, the debate about abortion in Indonesia is increasingly crowded. Abortion is also carried out by women-victims of rape to reduce the burden they suffered. The regulation on abortion in Indonesia has been regulated in the statutory regulations, namely the Criminal Code, especially in Article 346, Article 347, Article 348, and Article 349. In the RKUHP (Draft of Criminal Code), abortion regulation is regulated in two chapters namely, Chapter XIV Article 501 and Chapter XIX Articles 589, 590, 591, 592. In addition, the government has also issued several regulations governing abortion such as Government Regulation No. 61 of 2014 concerning Reproductive Health and also Law No. 36 of 2009 concerning health. However, the various regulations that exist between the Criminal Code, RKUHP, PP and the Act actually contradict to each other. There is no synchronization between the regulations regarding abortion by women rape victims. The KUHP and RKUHP clearly do not allow abortion in Indonesia and do not legalize it without any exception, including abortion carried out by women victims of rape. Whereas in Law Number 36 of 2009 concerning health, abortion can be carried out on an indication of medical emergencies and pregnancy due to rape that causes psychological trauma, so abortionists cannot be prosecuted as criminal.

To evaluate if limiting factors of intrauterine magnetic resonance imaging (iuMRI) performed in the early second trimester of pregnancy (19-23 weeks) affect its accuracy in comparison to postmortem MRI (pmMRI) in fetuses that underwent termination of pregnancy (TOP) for central nervous system (CNS) defects. Study design: This is a secondary analysis of a 10 years prospective observational study. Cases of TOP < 23 weeks for CNS malformation that had undergone neurosonography (NSG), iuMRI, pmMRI and autopsy were included. The agreement between iuMRI and pmMRI was calculated. The autopsy represented the gold-standard. Results: Overall, 143 TOPs for fetal congenital anomaly underwent the post-mortem diagnostic protocol. Of these, 31 cases underwent iuMRI and pmMRI for CNS abnormality. Three cases were excluded due to brain autolysis at autopsy. Corpus callosum defects were the most represented (16/28; 57 %). In only one case of posterior fossa defect, pmMRI identified the presence of vermian hypoplasia not diagnosed at iuMRI. In 2 cases (7%), iuMRI added clinically relevant additional findings to NSG, that were posteriorly confirmed by pmMRI. The study shows that, at 19-23 weeks and for CNS defects, limiting factors that might influence the performance of iuMRI have little influence on iuMRI accuracy. This finding is particularly important for professionals who work in countries with legal bound for TOP in the early second trimester.

Objective To compare the efficacy and side effects of three regimens of intravaginal misoprostol for second-trimester abortion. Methods A total of 118 women requiring second-trimester pregnancy termination were randomly assigned to one of three treatment groups: 400 mg 3-hourly in group A (n ¼ 39), 600 mg 6-hourly in group B (n ¼ 39), and 800 mg 12-hourly in group C (n ¼ 40). Misoprostol tablets moistened with 3 ml of 5% acetic acid were placed into the posterior vaginal fornix. Results The median induction-abortion times in groups A (8 h [range: 3-64]) and B (9 h [4-81]) were significantly shorter (p 5 0.01 and p 5 0.05, respectively) than in group C (12.5 [3-72]). Moreover, expulsion rates within 24 hours in groups A (92.3%) and B (92.3%) were significantly higher (p 5 0.05 in both cases) than that of group C (75%). Expulsion rate within 48 hours, number of tablets used, number of patients with retained placenta and side effects did not differ between groups. Conclusions Misoprostol moistened with acetic acid is effective for second-trimester pregnancy termination when given vaginally 3-hourly, 6-hourly or 12-hourly. The former two regimens are significantly more effective than the latter.

Objective-To review the safety and pharmacokinetics of antibiotics recommended for anthrax post-exposure prophylaxis and treatment in pregnant women. Data Sources-Articles were identified in the PUBMED database from inception through December 2012 by searching the keywords (["pregnancy]" and [generic antibiotic name]). Additionally, hand searches of references from REPROTOX, TERIS, review articles and Briggs' Drugs in Pregnancy and Lactation were performed. Selection-Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of five antibiotics recommended for anthrax post-exposure prophylaxis and treatment (ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, amoxicillin), and of nine additional antibiotics recommended as part of the treatment regimen (penicillin, ampicillin, linezolid, clindamycin, meropenem, doripenem, rifampin, chloramphenicol, or vancomycin). Tabulation, Integration and Results-The PUBMED search identified 3850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria. Conclusions-Overall, safety and pharmacokinetic information is limited for these antibiotics. Although small increases in risks for certain anomalies have been observed with some antibiotics recommended for prophylaxis and treatment of anthrax, the absolute risk of these antibiotics appears low. Given the high morbidity and mortality associated with anthrax, antibiotics should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the beta lactam antibiotics and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the beta lactam antibiotics, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, as these antibiotics may provide additional fetal benefit

Background: Pregnancy-associated Intimate Partner violence (IPV) is a significant public health problem in Uganda impacting on maternal and newborn health outcomes adversely. However, IPV disclosure and related factors among gravid women have remained poorly documented in southwestern Uganda. Methods: In a cross-sectional design, 283 women attending Mbarara City Hospital Antenatal Clinic (ANC) were recruited into the study. The current analysis included 199 women reporting emotional, physical and sexual violence experiences through the present pregnancy. Results: Of the 199 (70.3%) women who experienced IPV, 99(49.7%) disclosed it to someone. Majority (66.7%) disclosed IPV to their family of birth, 55.5% to friends, 35.3% to husband’s family member, 12.1% to neighbors, 9.1% to the healthcare providers, 8.1% to religious leaders, and 3.1% to police. Gravidity, OR= 1.9[95%CI: 1.07-3.31, p=0.027], parity OR=1.9[95%CI: 1.08-3.34, p=0.026] and witnessed IPV OR: 5.4[95%CI: 1.93-14.96; p=0...

Background
Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15–49 years in PNG.

Methods
Secondary data from the 2016–2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported.

Results
The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35–44 years (aOR = 8.54; 95% CI: 1.61–45.26), not working (aOR = 6.17; 95% CI: 2.26–16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60–8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91–16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17–4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61–14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39–8.18 and aOR = 2.54; 95% CI: 1.18–5.45, respectively) more likely to terminate a pregnancy.

Conclusion
The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country’s legal framework and added as an important component of existing sexual and reproductive health services.

To evaluate the outcome of induction of late abortion with vaginal misoprostol. This prospective study of misoprostol induced late abortion at gestational age of 13-27 weeks was conducted in 3 Lagos hospitals. Following a decision to induce, 200mcg of Misoprostol was inserted into the posterior fornix and repeated 12 hourly until expulsion of the fetus. Statistical analysis was performed using SPSS for windows version 7.0. Out of 102 patients, induction of late abortion was done mainly for fetal abnormalities (n=40, 39.2%) and intrauterine death (n=35, 34.3%). The age of the women ranged from 21 to 39 years. The modal gestational age was 15 weeks with a range of 13 to 27 weeks. Majority of the patients were multiparae (65.7%). The dose required to achieve expulsion ranged from 200 to 1000mcg with a mean of 364.7±102.4mcg.The mean induction expulsion interval (IEI) was 16±4 hours and 78.4% (80/102) expelled within 24 hours. The multiparous patients and cases of fetal deaths were associated with significantly shorter IEI. Gestational age more than 23 weeks was associated with fewer retained product rate Linear logistic regression analysis shows that multiparity (p<0.01), advanced gestation age (p=0.00) and fetal status (p<0.01) had independent association with IEI. Complete abortion rate was independently associated with gestational age (p<0.001) but not with parity and fetal status. Vaginal misoprostol alone is a safe and effective method of late abortion termination in areas were mifepristone is not available. Misoprostol, Late Abortion, Miscarriage, Retained Products of Conception.

95% in Angola. The indications for IOL should be specific and justifiable. These indications are grouped into maternal and foetal indications. The maternal indications include; hypertensive disorders of pregnancy, abruption placentae, premature rupture of membranes, chorioamnionitis, polyhydramnios, diabetes mellitus and renal disease. Foetal indications include post-term, hemolytic disease, intrauterine growth

Although safe abortion is a human right, some research indicates that abortion can be considered a life event that could trigger an adverse psychological reaction, including mental ill health, particularly in vulnerable women. Unplanned pregnancies and abortions affect women's mental and physical health while increasing psychological risk; hence, measures are needed to improve the quality of life (QoL) of women post termination of pregnancy (ToP). The purpose of this study was to explore the psychological effects of abortion on women provided with this service in Rwanda, and factors surrounding QoL after service provision. Methods An interpretive description design was used. Focus group discussions were used to hear the voices of 30 women and girls who had sought ToP services. The six steps of interpretive description together with framework analysis guided the analysis. From responses provided by the participants with experience of ToP services five themes and six sub-themes were generated, (1) Ambivalence with mixed feelings and uncertainty, anger, wonder, and frustration; (2) Insecurity and abortion stigma, with judgement and inadequacy; (3) Personalized care with respectful care and dignity and self-reliance; (4) Lack of connection with relationships, coping, and a sense of belonging; (5) Wellness and preferences for care with hope and positive physical health. The lack of psychological support post ToP negatively affects QoL and indicates an opportunity to include a psychological support package in the ToP service provision, which is the predictor of positive mental health to improve QoL in Rwanda.

Sirenomelia is a congenital birth defect that is featured as fused lower limbs, thoracolumbar anomalies, sacrococcygeal agenesis, genitourinary and anorectal atresia and Potter facies. This is a case of sirenomelia in an unsuccessful MTP. A 30-year-old came to emergency at 34 weeks with severe oligohydramnios and FGR. She had MTP pill intake in the first trimester. Her blood sugars were normal. There was no teratogen exposure. She delivered a 1.5kg male baby. In the infant there was fused lower limb, malformed genitalia with absent anogenital opening, rudimentary tail, excessive lanugo, short neck, potter's facies with prominent epicanthal folds, downward flat nose, receding chin, low set soft dysplastic ears and small slit-like mouth; suggestive of sirenomelia. Maternal diabetes is the most established etiological factor. Cocaine abuse, tobacco, misoprostol, trimethoprim, phenobarbital and carbamazepine use have reported cases of sirenomelia. Our case had MTP pill intake. Unregulated over-the-counter intake of MTP drugs should be discouraged.

The efficacy of cabergoline solely or combined with a PGF2a analogue in inducing abortion at different stages of pregnancy was investigated in 18 queens. The queens were assigned to two treatments: Group I (n ¼ 10)-cabergoline (15 mg/kg; daily, orally) and Group II (n ¼ 8)-cabergoline (15 mg/kg; daily, orally) combined with alfaprostol (10 mg/kg; every other day, subcutaneously). Each group was divided into two subgroups according to the duration of pregnancy when treatments started: Group IA (n ¼ 8) included queens from Days 34 to 42 after mating. Group IB cats (n ¼ 2) started treatments on Day 45 post-mating. Similarly, the combination of cabergoline and PGF2a analogue was first given to Group IIA (n ¼ 6) from Days 25 to 40 of pregnancy and to Group IIB (n ¼ 2) on Days 45 and 47, respectively. Termination of pregnancies was successful in all cats of Group IA, while treatments failed in both cats of Group IB, even though seven and eight treatments, respectively, were given. Mean (AES.D.) plasma progesterone concentrations before the start of treatments were 85:0 AE 12:3 nmol/l and decreased within 3 days to 8 nmol/l and subsequently to basal values, when the queens aborted (Group IIA, n ¼ 6) or gave birth prematurely (Group IIB, n ¼ 2). When abortions failed (Group IB, n ¼ 2), progesterone concentrations remained elevated (16.9 and 9.8 nmol/l). Duration of combined therapy during late pregnancy in Group IIB (n ¼ 2) lasted about 10 days. In both cases, premature birth occurred and the kittens died within 16 h after birth. Overall, treatments starting on Days 25-42 of pregnancy (Groups IA and IIA) had abortion Theriogenology 61 (2004) 1471-1475

Background: Down syndrome (DS), characterized by an extra free chromosome 21 is the most common genetic cause for congenital malformations and learning disability. It is well known that the extra chromosome 21 originates from the mother in more than 90% of cases, the incidence increases with maternal age and there is a high recurrence in young women. In a previous report we have presented data to indicate that maternal trisomy 21 (T21) ovarian mosaicism might provide the major causative factor underlying these patterns of DS inheritance. One important outstanding question concerns the reason why the extra chromosome 21 in DS rarely originates from the father, i.e. in less than 10% of T21 DS cases. We here report data indicating that one reason for this parental sex difference is a very much lower degree of fetal testicular in comparison to ovarian T21 mosaicism. Results: We used fluorescence in situ hybridisation (FISH) with two chromosome 21-specific probes to determine the copy number of chromosome 21 in fetal testicular cell nuclei from four male fetuses, following termination of pregnancy for a non-medical/social reason at gestational age 14-19 weeks. The cells studied were selected on the basis of their morphology alone, pending immunological specification of the relevant cell types. We could not detect any indication of testicular T21 mosaicism in any of these four male fetuses, when analysing at least 2000 cells per case (range 2038-3971, total 11.842). This result is highly statistically significant (p < 0.001) in comparison to the average of 0.54% ovarian T21 mosaicism (range 0.20-0.88%) that we identified in eight female fetuses analysing a total of 12.634 cells, as documented in a previous report in this journal. Based on these observations we suggest that there is a significant sex difference in degrees of fetal germ line T21 mosaicism. Thus, it would appear that most female fetuses are T21 ovarian mosaics, while in sharp contrast most male fetuses may be either very low grade T21 testicular mosaics or they may be non-mosaics. We further propose that this sex difference in germ line T21 mosaicism may explain the much less frequent paternal origin of T21 DS than maternal. The mechanisms underlying the DS cases, where the extra chromosome 21 does originate from the father, remains unknown and further studies in this respect are required.

ObjectiveCloacal dysgenesis sequence is a lethal malformation, which usually requires termination. In this study, our aim was to evaluate the prenatal and postnatal diagnostic features of cloacal dysgenesis sequence and review the management of the patients.Material and MethodsThe data of six cases of cloacal dysgenesis sequences were collected from the ultrasonography and neonatal records. The findings were evaluated in prenatal and postnatal periods. Chromosomal analysis was performed in all the cases. The evaluation of primary and secondary malformations was done. Coexisting anomalies were searched for by radiology and histopathology.ResultsMalformations in six cases (two females and four males) were described. The absence of anal, genital, and urinary openings with intact perineum covered by smooth skin were common findings. These features were considered as primary malformations for cloacal dysgenesis sequence. Secondary anomalies (urinary and gastrointestinal system malformati...

Objective: To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness. Design: Prospective, randomized clinical trial. Setting: University hospital. Patient(s): One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy. Intervention(s): Manual vacuum aspiration (control and study groups) plus 400 mg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure. Main Outcome Measure(s): Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure. Result(s): Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group. In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.

Objective: To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness. Design: Prospective, randomized clinical trial. Setting: University hospital. Patient(s): One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy. Intervention(s): Manual vacuum aspiration (control and study groups) plus 400 mg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure. Main Outcome Measure(s): Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure. Result(s): Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group. In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.

Objective To investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy. Design A retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study.

Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7-9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (#6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (#6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans.

Our studies have shown that the administration of antibodies to chicken riboflavin carrier protein (cRCP) or disulfide-reduced carboxymethylated cRCP (RCM-RCP) leads to termination of pregnancy in mice. In an attempt to delineate the bioneutralizin9 epitopes, a combination of chemical modification andpredictive methods was used. The results led to the identification of the region 10-24 of cRCP as a potential candidate. A single injection of antipeptide antibodies to pregnant mice on day 11 resulted in 100% pregnancy termination. This was accompanied by a drastic reduction in circulatory progesterone as early as 24 h after the antibody administration. These results thus demonstrate that the amino acid sequence 10-24 of cRCP harbours a bioneutralizin9 epitope of cRCP.

The acceptability of prenatal diagnosis for Down's syndrome has been extensively studied over the last 15 years but that of other pathologies remains largely unexplored. The main goals of this study were to approach physicians' opinions on six reasons for termination of pregnancy showing different deficiencies, i.e., Down's, Turner and Klinefelter syndromes, cystic fibrosis, spina bifida, and haemophilia, and to identify the origins of reserves. The influence of sociodemographic and professional characteristics of physicians on their opinions and attitudes during the consultation were studied. The data presented are based on information gathered in 1985 by a mailed questionnaire answered by 853 general practitioners, gynaecologists, obstetricians, and pediatricians in the Marseilles Genetic Centre's region. Stepwise logistic regression was used for the multivariate analysis. The results showed that 78 per cent of those answering favour termination of pregnancy for Down's syndrome and that only moral reticences were mentioned by the physicians opposed. Conversely, for haemophilia, only 21 per cent of the physicians considered this indication justified; those opposed were for the most part concerned that severity of illness did not justify termination of pregnancy. Overall, 33 per cent of physicians would voice their personal opinion on termination of pregnancy if so requested by consultees. Results on the influence of age and specialty evidenced their role on physicians' opinions. Indeed, 30 per cent of physicians opposed to pregnancy termination for one of the six fetal anomalies retained herein would modify their positions if diagnosis were possible in the first trimester of pregnancy. KEY WORDS Acceptability of prenatal diagnosis Physicians' attitudes Diffusion of prenatal diagnosis

The acceptability of prenatal diagnosis for Down's syndrome has been extensively studied over the last 15 years but that of other pathologies remains largely unexplored. The main goals of this study were to approach physicians' opinions on six reasons for termination of pregnancy showing different deficiencies, i.e., Down's, Turner and Klinefelter syndromes, cystic fibrosis, spina bifida, and haemophilia, and to identify the origins of reserves. The influence of sociodemographic and professional characteristics of physicians on their opinions and attitudes during the consultation were studied. The data presented are based on information gathered in 1985 by a mailed questionnaire answered by 853 general practitioners, gynaecologists, obstetricians, and pediatricians in the Marseilles Genetic Centre's region. Stepwise logistic regression was used for the multivariate analysis. The results showed that 78 per cent of those answering favour termination of pregnancy for Down's syndrome and that only moral reticences were mentioned by the physicians opposed. Conversely, for haemophilia, only 21 per cent of the physicians considered this indication justified; those opposed were for the most part concerned that severity of illness did not justify termination of pregnancy. Overall, 33 per cent of physicians would voice their personal opinion on termination of pregnancy if so requested by consultees. Results on the influence of age and specialty evidenced their role on physicians' opinions. Indeed, 30 per cent of physicians opposed to pregnancy termination for one of the six fetal anomalies retained herein would modify their positions if diagnosis were possible in the first trimester of pregnancy. KEY WORDS Acceptability of prenatal diagnosis Physicians' attitudes Diffusion of prenatal diagnosis

Sirenomelia is a rare congenital malformation, characterized by early fusion (symelia) of the lower limbs, either complete or incomplete, resulting in a single limb resembling a mermaid. It is frequently associated with other malformations such as bilateral renal agenesis, anal imperforation, lumbosacral agenesis, single umbilical artery, renal or external genital dysplasia, as well as cardiac or neurological abnormalities. This malformation is fatal due to pulmonary hypoplasia or complications from associated anomalies. In this case, we report a rare case of sirenomelia in a 1-day-old newborn, hospitalized for the management of sirenomelia diagnosed postnatally, who presented with total symelia, absence of anus and genital organs, agenesis of internal organs, both kidneys, and the renal tract, and passed away on the second day of life, to highlight a rare malformation and the importance of prenatal diagnosis for obstetric monitoring, as well as the need to raise awareness about genetic counseling.

Misoprostol (Cytotec), a synthetic prostaglandin E 1 analog, has become an important drug in the practice of obstetrics and gynecology because of its ability to bring about cervical changes and uterine contractions. Although useful in the induction of labor at term, it has also been found to be an effective agent for producing medical abortion both in the first and second trimesters. For first-trimester medical abortions, misoprostol is used most often with mifepristone or methotrexate. In pregnancy terminations in the second trimester, misoprostol offers an effective alternative to the surgical option of cervical dilatation and extraction of the fetus. Although several studies have been done comparing misoprostol with other more traditional methods of midtrimester induction of labor, the optimal dosage and route of administration have not been delineated. Zieman et al 1 demonstrated that misoprostol is absorbed more rapidly when given orally, resulting in higher initial peak serum concentrations compared with vaginal administration. With vaginal administration, however, although the peak concentrations were not as high, the decline in the plasma concentration was more gradual than that seen with oral administration. The change in misoprostol pharmacokinetics achieved by vaginal administration might result in several benefits to the patient. It may result in a more rapid completion of the abortion process, the use of a lower dosage to achieve abortion, and the occurrence of fewer side effects. The objective of this study was to compare the efficacy of misoprostol administered orally or vaginally for the induction of midtrimester termination of pregnancy. The hypothesis was that vaginally administered misoprostol would result in a shorter induction-to-delivery interval compared with orally administered misoprostol.

The Criminal Code regulates the offense or criminal act of abortion which can also be called abortion, this is regulated in Articles 299, 346, 347, and 348 and Article 349. This article expressly prohibits abortion for any reason. Abortion or artificial abortion is divided into two types, namely: legal (abortus provocatus therapeuticus) and illegal (abortus provocatus criminalis). The main problems in this thesis research are as follows. First, what is the punishment for the perpetrator of abortion contained in decision number 57-K/PM. III-19/AD/III/2021 which is regulated in the law is commensurate with his actions. Second, how to determine the punishment for the perpetrator of abortion contained in decision number 57-K/PM. III-19/AD/III/2021 guided by the theory of joint crime. The purpose of writing this thesis is to find out whether the punishment handed down by the judge to the perpetrator is commensurate with his actions and to find out how the perpetrator is legally accountable for the actions he committed by being guided by the theory of joint criminality. This study uses a normative juridical legal research method, which is to trace regulations and literature related to the problem being studied, such as laws and regulations, law books, legal journals, and other documents related to the research. The results of this study in the Criminal Code Article 299 Paragraph (1) of the Criminal Code the legal arrangements imposed on the perpetrator of the crime of abortion provocatus are less commensurate with his actions and the legal liability commensurate with the act of the perpetrator of the crime of abortion provocatus must be heavier than 1 (one year). This is when reviewed with the theory of combined crime whose purpose of the crime is to avenge the mistakes of criminals and is also aimed at protecting the community.

Failed ultrasonographic visualization of nasal bones is associated with an increased risk of fetal malformations. Maternal ethnicity and chromosomal abnormalities influence the incidence and visualization rate of nasal bones. A case of absent nasal bones with fronto‐nasal dysplasia and septated cystic hygroma identified at 13+5 weeks’ gestation in a trisomy 18 fetus is reported. The crown–rump length was 82 mm and the absent nasal bones were associated with micrognathia and a flattened face. The risks for trisomy 21 and 18 were subsequently calculated. The couple refused chorionic villus sampling. At 19 weeks’ gestation a follow‐up scan revealed, apart from the resolution of septated cystic hygroma, hypertelorism, a large interventricular septum defect with an atrio‐ventricular canal and an abnormal A wave Doppler pulsation at the level of the ductus venosus. Bilateral choroid plexus cysts were additional ultrasound findings. At that time, an uneventful cordocentesis was performed s...

A 32-year-old gravida 2, para 1 woman, with a previous uneventful pregnancy, underwent first trimester ultrasound screening for Down syndrome at 13 weeks according to the Fetal Medicine Foundation guidelines (). The ultrasound showed increased nuchal translucency (NT) of 8.9 mm with an estimated risk of Down syndrome of 1:8. Fetal karyotype was normal 46,XX by chorionic villus sampling. The patient underwent weekly ultrasound and at 19 weeks of gestation, a dilatation of the 4th ventricle with partial agenesis of the cerebellar vermis and normal posterior fossa were observed by transvaginal transcerebellar section of the fetal head. This finding was consistent with a diagnosis of Dandy-Walker variant and the patient opted for termination of pregnancy after extensive counselling. Autoptic examination confirmed the prenatal ultrasonographic findings and revealed signs of an underlying cerebro-fronto-facial syndrome due to the presence of facial dysmorphisms consistent with horizontal eyelid, high nasal root, low set ears and a wide forehead. Increased NT is not only a common phenotypic expression of chromosomal abnormalities, but is also associated with a wide range of fetal defects and genetic syndromes. Careful ultrasonographic follow-up is mandatory in all cases of increased first trimester nuchal translucency with normal karyotype in order to identify associated anomalies.

dziecko z zespołem wad letalnych: od diagnozy do końca życia. Doświadczenia personelu medycznego oraz rodziców w ramach perinatalnej opieki paliatywnej [A fetus or child with a lethal defect syndrome: from diagnosis to the end of life. Experiences of medical staff and parents in perinatal palliative care]

Results: A D and C was performed in 74 (3.4%) of 2,208 women. Increasing parity was predictive for D and C in univariate analysis and continued to be predictive in multivariate analysis (aOR 1.24 per birth, 95% CI 1.05, 1.46). Multivariate analysis found Hispanic ethnicity (aOR 2.40, 95% CI 1.12, 5.17) also to be predictive for D and C. Gestational age, prior cesarean section, age, smoking, study site, and weight were not predictive for D and C. Dilation and curettage is an uncommon outcome in medical abortion. Prior delivery, regardless of route, is a predictive variable for D and C. Further, Hispanic ethnicity appears to be a predictor for D and C for unclear reasons. Communication barriers may be a possible explanation for this finding.

Results: A D and C was performed in 74 (3.4%) of 2,208 women. Increasing parity was predictive for D and C in univariate analysis and continued to be predictive in multivariate analysis (aOR 1.24 per birth, 95% CI 1.05, 1.46). Multivariate analysis found Hispanic ethnicity (aOR 2.40, 95% CI 1.12, 5.17) also to be predictive for D and C. Gestational age, prior cesarean section, age, smoking, study site, and weight were not predictive for D and C. Dilation and curettage is an uncommon outcome in medical abortion. Prior delivery, regardless of route, is a predictive variable for D and C. Further, Hispanic ethnicity appears to be a predictor for D and C for unclear reasons. Communication barriers may be a possible explanation for this finding.

Uterine rupture is an obstetric mishap with associated morbidity and mortality consequences for the fetus and the mother. Promptness and accuracy of diagnosis of uterine rupture will help in instituting interventions to reduce these complications. Sometimes, the clinical presentations such as abdominal pain, abnormal fetal heart rate or intrauterine fetal death, bleeding per vaginam and loss of previously noted fetal station in a parturient may not be typical in uterine rupture. Previous uterine surgeries such as caesarean section, dilatation and curettage, myomecctomy or use of uterotonic agents for induction or augmentation of labour are the prominent risk factors. This case is unique because she has no such risk factors. However, there was sudden onset of generalized abdominal pain, readily palpable fetal parts, no fetal heart tone with ultrasound confirmation of intrauterine fetal death and the maternal hemodynamic status deteriorated rapidly raising the suspicion of a very rare occurrence of spontaneous uterine rupture with no obvious prior uterine scar. This atypical presentation delayed the diagnosis which might have accounted for the fetal loss, but emergency exploratory laparotomy saved the women with a maternal near-miss experience.

Background: Previous studies quantified that women who experienced intimate partner violence (IPV) had a higher
risk of spontaneous abortion than women who did not experience IPV. However, there is limited evidence documenting
the experiences of women in Northern Ethiopia who have been subjected to partner violence and who had spontaneous
abortions. This evidence is critical for policymakers looking to improve women’s access to maternity care.
Objectives: This study aimed to explore the lived experiences of IPV survivors during pregnancy who had spontaneous
abortions in Northern Ethiopia.
Design: A phenomenological qualitative study design was used to explore the lived experiences of survivors of IPV who
had spontaneous abortions.
Methods: A total of 16 interviews were conducted between April 23 and June 5, 2020. Eight in-depth interviews and
eight key informant interviews were conducted with eligible mothers who received the required service, Adigrat General
Hospital service providers, zonal women’s affairs experts, and legal professionals. The purposive sampling technique was
used to select study participants, and the sample size was determined using the information saturation principle. The
data were analyzed through open coding and thematic content analysis.
Result: The themes that emerged in this study included opinions toward IPV, mothers’ and experts’ experiences of
partner support during pregnancy, attitudes toward IPV, and understanding of spontaneous abortion. Physical, emotional,
sexual, and economic pressure were identified as the most common forms of IPV. Participants in the study believed
that physical violence and stress were associated with spontaneous abortion. They also mentioned various strategies
for preventing IPV, such as providing job opportunities for women, punishing perpetrators, and encouraging mutual
tolerance.
Conclusion: This study found that spontaneous abortion is linked to any type of IPV, including physical IPV during
pregnancy. IPV is a community-supported event that necessitates strategies and legal frameworks to prevent and mitigate
its effects.

Background: Previous studies quantified that women who experienced intimate partner violence (IPV) had a higher
risk of spontaneous abortion than women who did not experience IPV. However, there is limited evidence documenting
the experiences of women in Northern Ethiopia who have been subjected to partner violence and who had spontaneous
abortions. This evidence is critical for policymakers looking to improve women’s access to maternity care.
Objectives: This study aimed to explore the lived experiences of IPV survivors during pregnancy who had spontaneous
abortions in Northern Ethiopia.
Design: A phenomenological qualitative study design was used to explore the lived experiences of survivors of IPV who
had spontaneous abortions.
Methods: A total of 16 interviews were conducted between April 23 and June 5, 2020. Eight in-depth interviews and
eight key informant interviews were conducted with eligible mothers who received the required service, Adigrat General
Hospital service providers, zonal women’s affairs experts, and legal professionals. The purposive sampling technique was
used to select study participants, and the sample size was determined using the information saturation principle. The
data were analyzed through open coding and thematic content analysis.
Result: The themes that emerged in this study included opinions toward IPV, mothers’ and experts’ experiences of
partner support during pregnancy, attitudes toward IPV, and understanding of spontaneous abortion. Physical, emotional,
sexual, and economic pressure were identified as the most common forms of IPV. Participants in the study believed
that physical violence and stress were associated with spontaneous abortion. They also mentioned various strategies
for preventing IPV, such as providing job opportunities for women, punishing perpetrators, and encouraging mutual
tolerance.
Conclusion: This study found that spontaneous abortion is linked to any type of IPV, including physical IPV during
pregnancy. IPV is a community-supported event that necessitates strategies and legal frameworks to prevent and mitigate
its effects.

Background: Wishful termination of pregnancy is among the many rights of women’s health care and while the rate
of abortions is much more in the first trimester, morbidity and complications increases as the pregnancy advances are
much more in the second trimester. We assessed the various methods of second trimester abortion available in a tertiary
care centre while evaluating the efficacy and safety profile of these methods.
Methods: We conducted a retrospective cohort study in 50 patients of age group 16-36-year admitted for spontaneous
abortion or medical termination of pregnancy (MTP). Demographics, gestational age, parity and indication for abortion
was evaluated and appropriate method offered. Induction abortion interval and various complications were noted and
managed appropriately.
Results: Fifty patients of age group 16-36-year were included in this study. Majority of them were married and
multiparous and presented early in second trimester between 12-16 weeks of gestation. Spontaneous abortion was seen
in 14 cases and 9 cases had fetal anomalies requiring abortion. We found the mean abortion induction interval to be 15
hours and 8 min and the most common complication was fever seen in 12% of the patients.
Conclusions: Safe abortion services, particularly in second trimester should be made available to every women and
improved policies and monitored services should be rendered for the same to decrease morbidity and mortality
associated with it and give overall better outcome for the patient.
Keywords: Pregnancy, Abortion, Gestational age, Morbidity, Female

Building upon Lisa Dive, Isabella Holmes, and Ainsley J. Newson’s (2023) conclusions in “Is it Just for a Screening Program to Give People All the Information They Want?” our Open Peer Commentary argues that a more limited scope regarding return of results in public screening programs can further support disability justice by counteracting medical science’s tendency to pathologies human variation by interpreting anomaly and diversity as disease. Drawing upon our background as disability bioethicists trained in literary studies and rhetoric explore what the stories about genomic screening results can do in the world.

To assess obstetric and virological characteristics of HIVinfected women who underwent termination of pregnancy (TOP) in the era of highly active antiretroviral pregnancy (HAART). STUDY DESIGN: A retrospective cohort study was carried out among 399 HIV-infected pregnant women who attended a single center from Jan 2000 until Dec 2009. RESULTS: A total of 89 out of 399 HIV-infected pregnant women asked for a voluntary TOP during the study period (22.3%). Median maternal age was 32 years old. A 37.5% (30/80) of women were HCV-co infected. Active or past injection drug use was reported in 21 cases (27.3%). Cocaine use was declared in 6 cases. Most women had previous pregnancies (78/85; 91.2%). In 30 cases (33.71%) a previous TOP had been performed, including 13 women who underwent TOP more than once during the study period. According to HIV infection parameters, sixty-five out of 89 women were taking HAART (73%). Detectable viral load was present in 47.5% of HIV-pregnant women (29/61), though being 11 of them under HAART. Indications for termination of pregnancy included exposure to teratogenic agents (13/ 89; 14.6%), fetal abnormalities (4/89; 4.5%), maternal severe illness (4/89; 4.5%), obstetric complications (2/89; 2.2%), and in 66 cases (74.2%) there was no other reason apart from HIV infection for TOP. Among those women who considered HIV as a sufficient indication for TOP, 21 of them did not need or did not use HAART (31.8%). Median gestational age at the procedure was 10 weeks (range 6.0-20.0). In 64 cases (71.9%) curettage was performed before 12 weeks. After 12 weeks, medical termination of pregnancy was performed, and in 8 cases curettage was also required. CONCLUSIONS: A 22.3% of HIV-infected pregnant women underwent pregnancy termination, not infrequently in the second trimester of pregnancy (25/89; 28.1%). There was no other reason for TOP apart from the HIV infection in 74.2% of cases. Two thirds of the study population had previous TOP. Efforts should be made in family planning policies to avoid unintended pregnancies among HIV-infected women.

The objective of the paper is to know how India can strengthen midwifery services to reduce maternal mortality based on the lessons learnt from Sweden and Sri Lanka. Method The paper is based mainly on the literature review, field visit to Sweden and interaction with maternal health experts from Sweden and Sri Lanka. Conclusion High maternal mortality in India is due to absence of skilled attendance at the time of delivery and poor post-natal care. Seventy percent Indian population is rural and it is not possible to have doctors for all births. Adopting evidencebased interventions such as developing a skilled cadre of locally available midwives backed up by efficient referral and emergency obstetric care services like Sweden and Sri Lanka will help India achieve the goal of reducing maternal mortality with the existing resources. Analysis also shows that establishing quality training, independent regulating body and standardizing midwifery practices in India requires sustained efforts from government, professionals and society, and reorganization of health systems. Creating the scope for career advancement will help to improve status of midwifery as a profession.

Abortion is an act that violates the law because it tries to abort a pregnancy or abort it with various problems and reasons. The reasons for someone having an abortion can be in the form of medical reasons that require an abortion, economic reasons that are not sufficient for the family's needs, social reasons and so on. In (Decision Study Number 333/Pid.Sus/2021/PN Bks), a woman has an abortion on the grounds that if she doesn't have an abortion then she will lose her job while she is the backbone of the family because her husband doesn't work. The purpose of this study is to legally analyze the decision Number 333/Pid.Sus/2021/PN Bks. The research method used is normative juridical with library study data collection methods. The results of this study indicate that the act of abortion is a criminal act regulated in the Health Law and the Criminal Code with several exceptions. The judge decides the case by considering the evidence and facts at trial. The judge in deciding this case was in accordance with the regulations so that the judge's indictment was fair and did not harm the defendant.

Background: This study determined the profile of women seeking termination of pregnancy (TOP) in the Free State and whether TOP was used as a family planning method. Methods: Seven hundred and fifty women (15-47 years old) seeking TOP at the Reproductive Health Unit of the National Hospital in Bloemfontein were included in this cross-sectional study. The women who gave verbal consent completed a questionnaire during counselling. Results: The median age of the participants was 24 years and 77.3% were single. Most participants (73.3%) were not using any family planning method at the time of the study. One-fifth (19.1%) had previously had at least one TOP, while for 80.9% of the participants it was their first visit. Some participants (16.6%) considered TOP a family planning method, 39.7% were unsure and 43.7% indicated that TOP is not a family planning method. Thirty-nine women failed to answer this question. When asked the reason for TOP, 3.5% chose the option "contraceptive method". Conclusions: The relatively high percentage of participants who consider TOP a contraceptive method or are unsure, associated with the fact that most were young, single, not using contraception and had applied for induced abortion just because the conception represented an unwanted pregnancy, implies that some of our population is not aware that termination of pregnancy is not a family planning method.

The principle of respecting patient autonomy underpins the concept and practice of informed consent. Yet current approaches to consent often ignore the ways in which the exercise of autonomy is deeply epistemically dependent.
In this paper, we draw on philosophical descriptions of autonomy “scaffolding” and apply them to informed consent in medicine. We examine how this relates to other models of the doctor patient relationship and other theories (for example, the notion of relational autonomy). A focus on scaffolding autonomy reframes the justification for existing ways of supporting decisions. In other cases, it suggests a need to rethink how, when and where professionals obtain consent. It may highlight the benefit of technology for supporting decisions.
Finally, we consider the implications for some high-stakes decisions where autonomy is thought to be critical, for example termination of pregnancy. We argue that such decisions should not be free from all sources of influence – rather that they should be protected from undesired influence.

Background: Threatened abortion (TA) is associated with adverse pregnancy outcomes. Despite the attention paid to the adverse outcomes of obstetrics, only a few studies have been conducted on the psychological status of women with threatened abortion. This study aimed to compare the symptoms of depression and anxiety in women with TA and those without threatened abortion. Materials and Methods: In a case-control study, 136 women with TA (the case group) and 136 women without TA (the control group), were matched with the case group in terms of gestational age, education level, age, and number of pregnancies, were examined from Obstetric clinics of Babol University of Medical Sciences. Demographic information and pregnancy history were obtained from all participants. Additionally, the women filled out the BSI-18 questionnaire. Statistical analysis was performed using SPSS version 22 software. Results: The results showed that in women with threatened abortion, the likelihood of experiencing depression symptoms was 1.9 times higher [odds ratio (OR)=1.91, 95% confidence interval (CI)=1.13-3.23, P=0.015], anxiety symptoms were 1.8 times higher (OR=1.83, 95% CI=1.08-3.10, P=0.024), and somatization was 2.6 times higher (OR=2.65, 95% CI=1.61-4.37, P<0.001) compared to pregnant women without threatened abortion. Additionally, in women with threatened abortion, the risk of psychological distress was 3.3 times higher (OR=3.30, 95% CI=1.96-5.56, P<0.001) than in women without threatened abortion. Conclusion: This study suggests that gynecologists, midwives, and healthcare providers, in addition to providing medical care for women threatened with abortion, should identify women at risk of experiencing symptoms of depression and anxiety. Providing appropriate psychological support should be prioritized in the management of women with threatened abortion.