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  • Title: Short and long-term results of pregnancy termination by different methods.
    Author: Sotnikova EI.
    Journal: Acta Med Hung; 1986; 43(2):139-43. PubMed ID: 3588157.
    Abstract:
    Different methods of pregnancy termination such as curettage, prostaglandins and vacuum aspiration have been compared with respect to the subsequent reproductive function in 560 patients. The first year of the 5 year follow-up was characterized by inflammation changes. A high rate of ovarian dysfunction was found in the first post-abortion menstrual cycles. The post-abortion period is considered a high risk condition. The frequency of short and long term complications of artificial pregnancy termination were studied to identify a group of high risk patients in relation to the development of postabortion complications. The goal was to determine the optimum time for conducting rehabilitative measures. Group 1 was composed of 250 women whose pregnancy was terminated by curettage (n=100), prostaglandins (n=100), and vacuum aspiration (n=50). Reproductive function was assessed in this group for 12 months after artificial abortion (1, 3, 6, 12 cycles). Group 2 consisted of 400 women: pregnancy was terminated instrumentally in 250 of the women, and it was done by prostaglandins in 150 women. The assessment of reproductive function was conducted 5 years after artificial abortion. Gynecological diseases were observed in 16 patients of group 1 (6.4%): in 12 of 100 women with instrumental abortion (12%), in 2 of 100 women with prostaglandin-induced abortion (2%), and in 2 of 50 women with vacuum aspiration (4%). In most of the women complications were expressed in the form of uterine subinvolution (2.4%), metroendometriosis, salpingoophoritis (2.4%), and in the form of metrorrhagia (1.6%). Followup of group 1 revealed no regularity in the time of development of the disorders since their rate of appearance was equal 1, 3, 6, and 12 months after abortion. The 1st menstrual cycle after both surgical and prostaglandin abortion was biphasic in 88% (220 of the 250 women). Yet, an insufficient luteal phase in the 1st menstrual cycle developed in 20% of women with surgical abortion and in only 10% of the subgroup with prostaglandin-induced abortion. The 2nd menstrual cycle was characterized by the recovery of hormonal parameters and tests of functional diagnosis. Examination of the 2nd group revealed reproductive dysfunction in 131 of the 400 women studied (32.7%). The primary complaint was infertility. 3 groups of disorders were identified: hypothalamopituitary dysfunction expressed in anovulation (33 women); hypothalamopituitary dysfunction manifested by insufficient luteal phase (80 women); and adnexitis (18 women). The rate of postabortion complications in the long term increased by more than 3-fold. Postabortion complications were more frequent in women with a late menarche and with a history of genital inflammation. Investigation of the menstrual pattern in women suffering from secondary infertility after artificial abortion showed that 36.6% of the patients preserved the regular menstrual pattern, yet an insufficient luteal phase revealed by functional tests led to infertility. Impairment of the ovulatory process was the leading symptom in the women with secondary infertility. Ovarian dysfunction was expressed as an insufficient luteal phase 2.4 times more often than anovulation.
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