THERAPEUTIC ABORTIONS

Therapeutic abortions are usually recommended when certain pathologic conditions exist, the most common being serious cardiac conditions, tuberculosis, certain malignancies, diabetes, some kidney diseases, and certain mental diseases. Less common justifications for therapeutic abortions are German measles during the first three months of pregnancy, Rh factors in certain cases, and amaurotic familial idiocy.

Therapeutic abortions are performed in several ways. These are some of the most frequently used techniques:

X-ray radiation is administered, halting the development of the embryo. Spontaneous expulsion then follows within a week or two. The extent of damage to the reproductive organs by radiation cannot be predicted, and the method is seldom resorted to for this reason. X-ray used on a pregnant woman in an unsuccessful attempt at abortion, or for any other reason, is a grave hazard to the child. Research evidence indicates that there is a 50% higher death rate from cancer among children who had been X-rayed in utero than among those who had not.

Antagonists and antimetabolites are used to affect or interfere with cell growth and folic acid metabolism, thus ultimately killing the fetus. There are sometimes undesirable consequences, however, such as the development of anomalies in the fetus rather than its destruction. The use of these drugs may also affect the mother's bone marrow or cause other physical difficulties for her.

Laminaria is a procedure wherein a pencil-shaped object made of seaweed is inserted into the cervix. The plug-like insert swells when it becomes moist and gradually dilates the mouth of the womb. At the same time the upper end of the plug acts as a foreign body in the corpus of the uterus, and after two or three days the uterus contracts and expels both plug and fetus. Although this method is not used in America, it is employed extensively in Europe, reportedly with success.

The procedure of dilation and curettage ("D and C," as it is called in medical circles) is frequently performed if pregnancy has not progressed beyond the twelfth week. This procedure should be performed in a hospital with the patient under anesthesia. The cervix is dilated by inserting graduated sizes of instruments to stretch the opening, the largest dilator being about the size and shape of a small cigar. Once dilation is accomplished, a spoon-like instrument, a curette, is used to scrape the implanted embryo or early fetus from the uterus. The embryo or fetus is usually broken up into small pieces in the process of raking out the uterine material. Care must be taken not to perforate the wall of the uterus.

Hysterotomy is a method used after pregnancy has reached twelve weeks. One technique is actually a minor Caesarean section. This surgical procedure is resorted to because the fetus is too large for usual vaginal methods of removal. Another technique entails a vaginal incision near the cervix, a slit then being made in the lower part of the uterus through which the fetus is removed.

In Sweden, a new method has been developed for abortion after the third month of pregnancy. A needle is used to withdraw a certain amount (usually 200 cc) of amniotic fluid through the wall of the abdomen. The fluid is then replaced with an identical amount of salt solution of a specified strength. Abortion occurs spontaneously, usually within twenty-four hours.

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