Therapeutic Abortion

Abortion has long occupied the legal discussions in both Brazilian and international law. It is asubject of immense complexity, which in its interdisciplinarity, generates intense discussions among lawyers, doctors, scientists, philosophers and the civil society. In this environment, the question concerning the possibility or not of the termination of the anencephalic pregnancy occupies the halls of the Brazilian Constitutional Court, which has enabled the clash of ideas and the full participation of all stakeholders. Through the trial of ADPF 54, all the peculiarities of this "type of abortion" are being teased out. However, the issue should be constitutionally interpreted by the hermeneutist. In a moment of contemporary constitutionalism that values the fundamental principles of the citizenship, dignity, freedom and health of the mother should be placed in prominence, even making use of instruments of constitutional hermeneutics, as the consistent interpretation and reflection. Thus, the legal treatment of anencephalic pregnancy must face the interruption as a therapeutic guarantor of human dignity for women, and never as abortion.

Interstitial pregnancy is an unusual and potentially life-threatening form of ectopic pregnancy, accounting for approximately 1-6% of all ectopic pregnancies, with a maternal mortality rate of 2-2.5%. Implantation happens in the proximal portion of the fallopian tube as it passes through the myometrium. The resolution of interstitial pregnancy after medical treatment should be assessed by a decline in serum β-hCG, which occurs in about 85-90% of cases. Nonetheless, its effectiveness and consequences have been presented through case reports and case series. However, few cases of interstitial pregnancies treated totally medically with the use of methotrexate and mifepristone have been presented in the literature. Complications of this medical treatments have also never been reviewed before. In the present manuscript, we present a case of interstitial pregnancy treated with methotrexate and mifepristone. The patient after treatment developed a uterine arteriovenous malformation, treated with uterine artery embolization. Furthermore, we performed a systematic review of the literature using Scopus, PubMed and Google Scholar. A total of 186 papers were found, and 7 papers which included 10 cases were assessed for eligibility. The systemic medical treatment with the use of methotrexate and mifepristone was effective in 7 of the 10 cases. Two cases of hemoperitoneum following combined methotrexate and mifepristone treatment were reported. The applicability of this medical conservative treatment should be tailored to the patient, taking into account their obstetric history, gestational age at diagnosis and desire for future pregnancies. Complete resolution after this treatment was achieved in most of the cases reported without major complications. The appearance of uterine arteriovenous malformation can be managed conservatively, and we propose uterine artery embolization as an effective treatment of this rare complication.

Uterine perforation is a rare complication of abortion. It becomes much rarer when associated with a small bowel incarceration at the uterine breach. Its diagnosis can be suspected clinically, but radiology remains more sensitive for diagnosis. Surgery is the cornerstone in treating this entity as it provides both diagnostic and therapeutic management. A multidisciplinary therapeutic approach should be immediately performed to ensure a good prognosis. In this report, we describe a case of small intestine incarceration in the breach of a uterine perforation that occurred in the weeks following a clandestine abortion.

The document tells the story of Stefano, who finds himself taking care of Ludovica's brother, Andrea, suffering from Down syndrome. The story highlights the joy and unpredictability of Andrea, challenging the prejudices. The text also raises concerns about projects in Denmark and England who aim to eliminate children with down syndrome through therapeutic abortions. The importance of accepting imperfection is underlined and the culture of refusal of people with disabilities is criticized. The document invites us to reflect on happiness and love, underlining the importance of breaking down the walls of intolerance.

We report two patients with bilateral pulmonary embolism who presented to our county hospital reproductive health services clinic. Both patients underwent an uncomplicated first-trimester aspiration abortion while on therapeutic unfractionated heparin therapy. Anticoagulation therapy may be modified to safely perform first-trimester surgical termination without significant blood loss.

Our aim of the study was to evaluate the efficacy and complication rate of our inpatient medical management protocol for missed miscarriages. Three-hundred and ninety women hospitalised at our tertiary centre because of a missed miscarriage/anembryonic pregnancy in 2012-2013 were included in this retrospective study. The women underwent either a low (until 9 þ 0 weeks of gestation) or high gestational age (from 9 þ 1 until 15þ 6 weeks of gestation) management protocol. The success rate, curettage in the first 48 hours after the procedure, the complication rate and the factors that might influence these outcomes were evaluated. The overall success rate was 83.3%. The curettage in the first 48 hours after the procedure was performed in 7.4% of the patients and was more often in the high gestational age protocol. Complications that required another outpatient visit or hospitalisation occurred in 9% of the patients. Higher beta-hCG values 14 days after the procedure and the absence of evacuation of products of conception during hospitalisation were associated with a higher complication rate. What is already known on this subject? As much as 10-20% of clinically recognised pregnancies end in a spontaneous abortion. A missed miscarriage and a blighted ovum represent a form of spontaneous abortion, which has long been treated with surgical evacuation. However, nowadays, medical management represents a well-established alternative with very high success rates and is considered as an equivalent and safe method that is also very well accepted by patients. What do the results of this study add? According to our results, a medical management of a first trimester missed miscarriage and a blighted ovum is very effective with an overall success rate of 83.3% and a very low percentage of curettage in the first 48 hours after the procedure (7.4%). Our study was also able to identify higher beta-hCG values 14 days after procedure and absence of evacuation of products of conception during hospitalisation as risk factors for complication occurrence. What are the implications of these findings for clinical practice and/or further research? Our study helps to identify patients who are at greater risk for developing complications after the medical management of a first trimester missed miscarriage.

We report the successful anaesthetic management of therapeutic abortion under spinal anaesthesia in a 32-yr-old woman with Takayasu's disease. The pathology and pathophysiology of this syndrome and their impact on anaesthesia are discussed. (Br.

INTRODUCTION Every woman, regardless of age, race or background with an unwanted pregnancy who considers abortion as an option has a need for objective and professional counselling. Legislation provides for pre-abortion counselling for the pregnant woman who requests abortion (Howes & Green, 1997:18; Taylor, 1997:vi). The literature confirms the importance of pre-abortion counselling for the pregnant woman who considers abortion as an option (Howes

Background Recent surgical advances have resulted in fetal surgery becoming an option for children with myelomeningocele (MMC). However, there is little information about the parents' attitudes towards such therapy. Methods Following a lecture on the current status and problems of fetal surgery for MMC, a 12-item questionnaire was administered to 58 parents of children with MMC. Questionnaire topics included knowledge of the disease and treatment options, as well as attitudes and concerns towards fetal surgery or termination of pregnancy. Results Following the lecture, 14 (out of 58) parents felt that knowledge of the disease would allow for abortion to be an option, while 18 were uncertain. Once informed of potential risks and benefits of fetal surgery, 34 parents had a positive or rather positive attitude towards this procedure. Conclusions On the basis of these results, it was concluded that this population is potentially interested in the use of fetal surgery.

Breast cancer might occur in one of every one thousand pregnancies. This association has an incidence from 0.2 to 3%. It is considered when it develops during pregnancy and in the first year after delivery. Traditionally this association has been considered an adverse prognostic factor, since usually these patients have larger tumor and frequency of positive metastatic axillary nodes, as opposed to those who have breast cancer and are not pregnant. It is estimated that breast cancer associated with pregnancy increased the likelihood of to death 3.26 times. Treatment decision is based on the stage of the disease in accordance to that of a nonpregnant woman. Multiple anti-tumoral drugs, surch as 5FU, adriamycin, cyclophosphamide, methotrexate, and taxanes have been used for treatment. Physiological changes that occur during pregnancy affect the distribution and elimination of these agents, potentially modifying efficacy and/or toxicity. Depending on the gestational age, administration of chemotherapy could produce secondary effects in the product, abortion, malformation, and delayed effects. It is necessary for oncologists facing this situation to carefully and individually evaluate each case, to fully understand the pharmacological behavior of each drug, and to communicate benefits and risks involved for the mother, her partner, and their families about the effects to the mother and product. Hospitals should include an ethics committee to help physicians, patients, and relatives choose the best therapeutic option.

Background: We report an unusual case involving vaginal perforation associated with second trimester dilation and evacuation. Review of the literature fails to identify additional reports. Case: A 22 year G3P1011 female at 16 weeks gestation referred for evaluation following incomplete dilation and evacuation was found to have vaginal perforation, and communication with the peritoneal cavity on pelvic examination. Examination under anesthesia and laparoscopy confirmed multiple vaginal perforations with intraperitoneal defects and hematomas but no viscus involvement. Cervical dilation was accomplished with osmotic dilators placed under ultrasound guidance during exam under anesthesia, with evacuation completed approximately 16 hours later without further complication. Conclusion: This is the first case of vaginal perforation at time of dilation and evacuation reported in the literature. Laparoscopy should be performed to evaluate for intraabdominal injury to bowel, bladder and/or blood vessels. Use of osmotic dilators during the second trimester could potentially decrease the risk of vaginal perforation during the dilation portion of the procedure.

OBJECTIVES 1) To determine trends in prevalence of neural tube defects and the impact of therapeutic abortion. 2) To review perinatal management of spina bifida. DESIGN All spontaneous and therapeutic abortions, still births and live births affected by neural tube defects registered in Alfredo da Costa Maternity in Lisbon, from 1983 to 1992, were retrospectively analysed. RESULTS Eighty-two cases with neural tube defects are reported and myelomeningocele and anencephaly++ were the most frequent ones. Total prevalence for all defects was 0.78:1000 births with a small upward trend during the last two years. Birth prevalence was 0.6:1000, with a clear downward trend, due to therapeutic abortion. Prenatal diagnosis improved significantly, from 9% of all defects detected in 1983-87 to 77.5% in 1988-92. Since 1989, all cases of anencephaly were detected before birth. Most cases of spina bifida were vaginally delivered, and elective cesarean section occurred in 4. Early closure of the defe...

Background: Dissolution of pregnancy in the first trimester for several maternal as well as foetal concerns (therapeutic abortion) is a common obstetrical issue. However, induction of abortion demands thorough and effective care, just as women in labour with childbirth. World Health Organization estimates that 13% of all the maternal deaths in South-Asia are associated with abortion procedures. The current recommended approach is 800 µg misoprostol administered vaginally repeated at 3 hours intervals for a maximum of 3 doses with a reported frequency of 85% for complete expulsion of products of conception within 24 hours after administration. There are studies which claim a single vaginal dose of 800µg misoprostol to be equally effective, but more convenient and safe. However, there was controversy surrounding the efficacy of this single dose regimen. Aim: To determine the efficacy of single dose of 800 µg vaginal misoprostol in the induction of first trimester abortion. Methods: Th...

A woman aged 35 years was diagnosed with triplenegative breast cancer in October 2012. During the investigation, it was discovered that she was pregnant, the patient decided to have an abortion. She was submitted to a radical modified mastectomy and adjuvant chemotherapy followed by adjuvant breast radiotherapy of the left breast. 2 months after the adjuvant treatment, she began to have headaches and dizziness. The cranial MRI (head MRI) showed brain metastasis. She was then treated with whole brain radiotherapy, stereotactic radiosurgery and concomitant temozolomide which resulted in complete response. 1.5 year later, she was able to get pregnant and gave birth to a baby without complications. The previous imaging reassessment performed in September 2016 shows no evidence of recurrent breast cancer.

Purpose The main purpose of this article is to analyze the way in which young physicians analyze and address the issue of therapeutic abortion. Methods A multi-institutional survey was conducted using an online questionnaire containing 10 items. Results Most respondents agreed with therapeutic abortion (1) if the fetus is not yet viable and the mother is put at immediate risk by the continuation of the pregnancy, and (2) when the pregnancy is over 14 weeks and the prenatal screening identifies a very severe malformation. The lowest rate of acceptance was obtained by the option to terminate the pregnancy after 14 weeks for a minor malformation (polydactyly). The vast majority agreed that the OG physician should be permitted to refuse an abortion on moral grounds, even if permitted by law. Conclusions Our study reveals that the main reasons for conducting therapeutic abortion (TA) in the 2nd or 3rd trimester are: (1) if the mother is put in immediate risk by the continuation of the pregnancy and (2) if the congenital anomaly is extremely severe. Even though the number of respondents considering Down syndrome to be a congenital malformation severe enough to allow TA, the value much lower compared with other low and middle income countries. The main reasons for refusing TA in the 2nd or 3rd trimester are the presence of a minor congenital anomaly or if it is against the moral principles of the physician.

que "Sólo con fines terapéuticos se podrá interrumpir un embarazo o practicar una intervención para hacer estéril a una mujer. Para proceder a estas intervenciones se requiere la opinión documentada de tres facultativos" (Artículo 226 del Código Sanitario adoptado en mayo de 1931). * Consigna latinoamericana.

OBJECTIVE The aim of this work was to identify risk predictors of a negative psychological outcome among personal, situational and systemic characteristics of women who choose to interrupt a pregnancy by elective (e.g., not feeling ready for giving birth) or therapeutic means (e.g., fetal abnormalities). METHODS A prospective study on two cohorts were conducted and focused on a group of women: the first recurred to elective abortion (VTP) (n=20) and the second recurred to therapeutic abortion (TTP) (n=30). The psychological distress was measured before and after abortion through the administration of two psychometric tests: SCL-90-r and CES-D. Dependent samples t-test was used to evaluate the tendency of the two cohorts' mean scores before and after abortion; repeated measures analysis of variance (ANOVA) was used to analyze the variance of mean scores of subgroups isolated for variables of interest before and after abortion. RESULTS After the termination of pregnancy, in VTP a ...

Martin Rhonheimer uważa, że zabijanie człowieka jest absolutnie moralnie zakazane tylko wtedy, kiedy jest niesprawiedliwe, co wyraża nauczanie moralne Kościoła katolickiego jako absolutny zakaz bezpośredniego zabijania niewinnych istot ludzkich. Istnieją jednak pewne przypadki konfliktów życiowych, takich jak ciąże pozamaciczne czy tragiczny poród spowodowany zaklinowaniem się dziecka w kanale rodnym, gdzie nie da się uratować dziecka. Wówczas spowodowanie śmierci dziecka w wyniku podjęcia medycznej interwencji nie pozbawia dziecka czegoś, czego nie utraciłoby, gdyby nie podjęto letalnego działania. A zatem w ten sposób nie powoduje się niesprawiedliwości wobec człowieka, którego śmierć jest tak czy inaczej nieunikniona w przypadku konfliktu życiowego. Pozostając poza porządkiem sprawiedliwości, śmiercionośna interwencja w takich przypadkach nie może być jednak uzasadniona jako norma moralna, lecz jest usprawiedliwiona przez uniewinnienie sprawcy, wskazując na brak jego odpowiedzial...

que "Sólo con fines terapéuticos se podrá interrumpir un embarazo o practicar una intervención para hacer estéril a una mujer. Para proceder a estas intervenciones se requiere la opinión documentada de tres facultativos" (Artículo 226 del Código Sanitario adoptado en mayo de 1931). * Consigna latinoamericana.

We report the case of a 15-year-old girl with a large gluteal and perineal rhabdomyosarcoma diagnosed at 24 weeks of pregnancy, whose management posed a great clinical dilemma for us. The patient refused to consider a therapeutic abortion, so we opted for a customized treatment with mild doses of chemotherapy administered weekly to control tumor growth while minimizing fetal and perinatal complications. After the delivery of a healthy female, we adopted a more intensive chemotherapy regimen plus irradiation. Despite an initially good response, the disease unfortunately progressed and the patient died of her disease.

Herein, we report the unique case of Brucellarelated lumbar vertebral fracture in a Wrst trimester pregnant woman. The unique eVective treatment protocol for the infection is prolonged combined antibiotics and immobilization with follow-up, even in the presence of vertebral fracture related to spinal disease. With the accurate choice of anthiobitics (suitable, non-teratogenic and non-toxic for the fetus) therapeutic abortion is not indicated.

Vacuum aspiration, either manual or electric, has for many years been the most commonly used method for termination of an early pregnancy. More recently, new medical methods have been developed which for many women are attractive alternatives to the surgical procedure. The compounds mainly used are prostaglandin analogues, methotrexate, and mifepristone in combination with a suitable prostaglandin analogue. However, only the last method has been registered for routine clinical use. The treatment schedule mainly used is mifepristone 200 to 600mg followed 36 to 48 hours later by oral misoprostol 0.4 to 0.6mg in pregnancies up to 49 days and vaginal gemeprost 1.0mg or misoprostol 0.8mg if the treatment period is extended to 63 days of amenorrhoea. The ability to compare medical and surgical methods is limited by the fact that there are few randomised studies and the definitions of successful outcome (complete abortion), adverse effects and complications vary from one study to the other. Experience with the method used is also important for the outcome. However, it seems adequate to state that the medical method is equally, or almost

S u m m a r y Combined intra-amniotic urea and simultaneous intravenous oxytocin infusion was used to induce mid-trimester therapeutic abortions. This technique, which was successful in each of a series of 30 patients (there were no serious side-effects), has advantages over those more commonly used at present.

Background: Dissolution of pregnancy in the first trimester for several maternal as well as foetal concerns (therapeutic abortion) is a common obstetrical issue. However, induction of abortion demands thorough and effective care, just as women in labour with childbirth. World Health Organization estimates that 13% of all the maternal deaths in South-Asia are associated with abortion procedures. The current recommended approach is 800 µg misoprostol administered vaginally repeated at 3 hours intervals for a maximum of 3 doses with a reported frequency of 85% for complete expulsion of products of conception within 24 hours after administration. There are studies which claim a single vaginal dose of 800µg misoprostol to be equally effective, but more convenient and safe. However, there was controversy surrounding the efficacy of this single dose regimen. Aim: To determine the efficacy of single dose of 800 µg vaginal misoprostol in the induction of first trimester abortion. Methods: Th...

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls. Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method. Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowle...

We report the case of a 15-year-old girl with a large gluteal and perineal rhabdomyosarcoma diagnosed at 24 weeks of pregnancy, whose management posed a great clinical dilemma for us. The patient refused to consider a therapeutic abortion, so we opted for a customized treatment with mild doses of chemotherapy administered weekly to control tumor growth while minimizing fetal and perinatal complications. After the delivery of a healthy female, we adopted a more intensive chemotherapy regimen plus irradiation. Despite an initially good response, the disease unfortunately progressed and the patient died of her disease.

Introduction. Fetal Acrania is a rare fetal malformation characterized by the complete or partial absence of a skull covering the fetal brain. In the absence of a hard covering of the soft brain tissue, Acrania is known as a universally lethal malformation.  Here we present a Fetal Acrania case detected by sonographic examination at our Center. Case Description. A 36 years old female was referred to the obstetric department to undergo an in-depth sonographic evaluation as a previous examination reveals a potential congenital fetal anomaly. Our sonographic evaluation revealed a singleton, live fetus, 12 weeks gestational age in cephalic presentation and longitudinal lie. One obvious malformation was a well-formed fetal brain without the surrounding cranium (Acrania). The absence of cranium was the main and only malformation. The absence of cranium was evident as the fetal brain was easily compressed on probe pressure, and the brain appeared like floating in the amniotic fluid over th...