Mifepristone and misoprostol for medical termination of pregnancy: the effectiveness of a flexible regimen.
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BACKGROUND: Mifepristone, followed 48 hours later by administration of misoprostol, is a well-established regimen for medical termination of pregnancy (TOP). Although this regimen is effective, its inflexibility may limit its provision in an outpatient service. OBJECTIVE: To confirm that misoprostol administration is effective whether administered 24, 48 or 72 hours after oral mifepristone. DESIGN: Observational study of 234 consecutive women with pregnancies up to 83 days' gestational age in whom medical TOP was performed during the period December 2000-July 2001. SETTING: Women's Health Care Department, Royal Bolton Hospital, Bolton, UK. RESULTS: There was a high success rate for complete abortion in all groups whether mifepristone was administered 24, 48 or 72 hours prior to misoprostol. CONCLUSION: This study suggests that a more flexible regimen of mifepristone/misoprostol administration for medical TOP is effective in routine clinical practice. (+info)
Mesenchymal stem cells in human second-trimester bone marrow, liver, lung, and spleen exhibit a similar immunophenotype but a heterogeneous multilineage differentiation potential.
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BACKGROUND AND OBJECTIVES: We previously found that human fetal lung is a rich source of mesenchymal stem cells (MSC). Here we characterize and analyze the frequency and function of MSC in other second-trimester fetal tissues. DESIGN AND METHODS: Single cell suspensions of fetal bone marrow (BM), liver, lung, and spleen were made and analyzed by flow cytometry for the expression of CD90, CD105, CD166, SH3, SH4, HLA-ABC, HLA-DR, CD34 and CD45. We assessed the frequency of MSC by limiting dilution assay. RESULTS: The frequency of MSC in BM was significantly higher than in liver, lung, and spleen (p<0.05). On primary non-expanded cells from fetal liver, lung and spleen the number of cells positive for mesenchymal markers was significantly higher within the CD34 positive population than within the CD34 negative population. The phenotype of the culture-expanded MSC was similar for all fetal tissues, i.e. CD90, CD105, CD166, SH3, SH4 and HLA-ABC positive and CD34, CD45 and HLA-DR negative. Culture-expanded cells from all tissues were able to differentiate along adipogenic and osteogenic pathways. However, adipogenic differentiation was less in MSC derived from spleen, and osteogenic differentiation was reduced in liver-derived MSC (p<0.05). INTERPRETATION AND CONCLUSIONS: Our results indicate that culture-expanded MSC derived from second-trimester fetal tissues, although phenotypically similar, exhibit heterogeneity in differentiating potential. We speculate that these differences may be relevant for the clinical application of MSC. (+info)
Commentary: the public health consequences of restricted induced abortion--lessons from Romania.
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The question of whether abortion should be legal is currently being decided in many countries. Although much of the discussion has focused on ethical issues, the public health consequences should not be overlooked and should be addressed realistically and responsibly. Nowhere are the public health manifestations of restricted abortion more apparent than in Romania. The pronatalist policies of the Ceaucescu regime resulted in the highest maternal mortality rate in Europe (approximately 150 maternal deaths per 100,000 live births) and in thousands of unwanted children in institutions. (+info)
The search for meaning: RU 486 and the law of abortion.
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The advent of RU 486 (mifepristone), a steroid analogue capable of inducing menses within 8 to 10 weeks of a missed menstrual period, has provoked a firestorm of concern and controversy. When used in conjunction with prostaglandin (RU 486/PG), it is at least 95% effective. Used in France principally to terminate confirmed pregnancies very early in the process of gestation, RU 486 raises many interesting legal questions. This article focuses on whether and how RU 486/PG can be accommodated within the framework of the world's current abortion laws. Four avenues are explored and conclusions drawn. First, it is clear that RU 486/PG can be used readily, if approved, within the regimens established by liberal abortion laws, as has been the experience in France, the United Kingdom, and even China. Second, although unlikely, the introduction of this new technology may inspire a reexamination of restrictive abortion statutes themselves. Third, some of the presently restrictive laws may be interpreted to permit RU 486/PG use as a legal procedure, for a very narrow range of reasons. Finally, in some settings the early use of RU 486/PG (before pregnancy can be confirmed) may fall outside the reach of abortion legislation and hence be acceptable from a legal point of view. (+info)
The Supreme Court, abortion, and the jurisprudence of class.
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The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a woman's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's methods do not create an "undue burden" on the decision. Any restriction on abortion is a burden; whether it is "undue" (and therefore unconstitutional) depends on one's circumstances. The Court appears to view the difference between an undue burden and mere inconvenience from the perspective of privilege. The restrictions that were upheld may not significantly affect middle-class access to abortion, but they could prove insurmountable for many less privileged women. (+info)
The American College of Obstetricians and Gynecologists and the evolution of abortion policy, 1951-1973: the politics of science.
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The autonomy granted to physicians is based on the claim that their decisions are grounded in scientific principles. But a case study of the evolution of the American College of Obstetricians and Gynecologists' abortion policy between 1951 and 1973 shows that decisions were only secondarily determined by science. The principal determinant was the need to preserve physician autonomy over the organization and delivery of services. As a result, the organization representing physicians who specialized in women's reproductive health was marginal to the struggle for legalized abortion. But, the profession was central to decisions about whether physicians would perform abortions and how they would be done. This case study finding has implications for understanding the role that organized medicine might take in the ongoing debates about national health policy. (+info)
PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data reported to CDC regarding legal induced abortions obtained in the United States in 2000. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these areas were not estimated. In 2000, Oklahoma again reported these data, increasing the number of reporting areas to 49. RESULTS: A total of 857,475 legal induced abortions were reported to CDC for 2000 from 49 reporting areas, representing a 0.5% decrease from the 861,789 legal induced abortions reported by 48 reporting areas for 1999 and a 1.3% decrease for the same 48 reporting areas that reported in 1999. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2000 (for the same 48 reporting areas as 1999), compared with 256 reported for 1999. This represents a 3.8% decline in the abortion ratio. The abortion rate (for the same 48 reporting areas as 1999) was 16 per 1,000 women aged 15-44 years for 2000. This was also a 3.8% decrease from the rate reported for procedures performed during 1997-1999 for the same 48 reporting areas. The highest percentages of reported abortions were for women aged <25 years (52%), women who were white (57%), and unmarried women (81%). Fifty-eight percent of all abortions for which gestational age was reported were performed at < or =8 weeks of gestation, and 88% were performed before 13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2000, steady increases have occurred in the percentage of abortions performed at < or =6 weeks of gestation. Few abortions were performed after 15 weeks of gestation; 4.3% were obtained at 16-20 weeks and 1.4% were obtained at > or =21 weeks. A total of 31 reporting areas submitted data stating that they performed medical (nonsurgical) procedures, making up 1.0% of all reported procedures from the 42 areas with adequate reporting on type of procedure. In 1998 and 1999 (the most recent years for which data are available), 14 women died as a result of complications from known legal induced abortion. Ten of these deaths occurred in 1998 and four occurred in 1999; no deaths were associated with known illegal abortion. INTERPRETATION: From 1990 through 1997, the number of legal induced abortions gradually declined. In 1998 and 1999, the number of abortions continued to decrease when comparing the same 48 reporting areas. In 2000, even with one additional reporting state, the number of abortions declined slightly. In 1998 and 1999, as in previous years, deaths related to legal induced abortions occurred rarely (<1 death per 100,000 abortions). PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and for increasing understanding of one additional aspect of the spectrum of pregnancy outcomes. Policy makers and program planners need these data to improve the health and well-being of women and infants. (+info)