• 1 Legal abortion for mental health indications. 复制标题 收藏 收藏

    【精神卫生指征的合法堕胎。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijgo.2006.07.002 复制DOI
    作者列表:Cook RJ,Ortega-Ortiz A,Romans S,Ross LE
    BACKGROUND & AIMS: :Where legal systems allow therapeutic abortion to preserve women's mental health, practitioners often lack access to mental health professionals for making critical diagnoses or prognoses that pregnancy or childcare endangers patients' mental health. Practitioners themselves must then make clinical assessments of the impact on their patients of continued pregnancy or childcare. The law requires only that practitioners make assessments in good faith, and by credible criteria. Mental disorder includes psychological distress or mental suffering due to unwanted pregnancy and responsibility for childcare, or, for instance, anticipated serious fetal impairment. Account should be taken of factors that make patients vulnerable to distress, such as personal or family mental health history, factors that may precipitate mental distress, such as loss of personal relationships, and factors that may maintain distress, such as poor education and marginal social status. Some characteristics of patients may operate as both precipitating and maintaining factors, such as poverty and lack of social support.
    背景与目标: : 在法律制度允许治疗性流产保留妇女精神卫生的地方,从业人员往往无法获得精神卫生专业人员的帮助,无法做出怀孕或育儿危及患者精神卫生的关键诊断或预后。然后,从业者自己必须对持续怀孕或育儿对患者的影响进行临床评估。法律只要求从业人员真诚地以可信的标准进行评估。精神障碍包括由于意外怀孕和育儿责任造成的心理困扰或精神痛苦,或者例如预期的严重胎儿损害。应考虑使患者容易遭受困扰的因素,例如个人或家族精神卫生史,可能导致精神困扰的因素 (例如人际关系的丧失) 以及可能维持困扰的因素 (例如教育水平低下和边缘社会地位。患者的某些特征可能既是促成因素又是维持因素,例如贫困和缺乏社会支持。
  • 【复发性自然流产与记忆T卵泡辅助细胞关系的研究。】 复制标题 收藏 收藏
    DOI:10.1111/aji.12714 复制DOI
    作者列表:Luan X,Kang X,Li W,Dong Q
    BACKGROUND & AIMS: PROBLEM:Immune tolerance with respect to a semi-allogeneic fetus plays a key role in the establishment of a pregnancy. Memory T follicular helper (Tfh) cells have a central role in the regulation of the adaptive immune response. Much of our knowledge of memory Tfh cells' function comes from immune-related diseases. However, the true physiological characteristics of memory Tfh cells and their mode of action in pregnancy remain unclear. METHODS OF STUDY:Deciduas and blood were obtained from 25 recurrent spontaneous abortion (RSA) patients undergoing surgical abortion and 19 normal women in early pregnancy undergoing elective termination. RSA patients were grouped into antibody-positive patients and antibody-negative patients, respectively. The memory Tfh cells with the CD4+ CXCR5+ PD1+ CCR7- and CD4+ CXCR5+ PD-1+ ICOS+ phenotypes were assessed by flow cytometry. The B cells were evaluated by flow cytometry. A correlation analysis of the subsets of memory Tfh cells and B cells in antibody-positive RSA patients was made by the Pearson test. RESULTS:Memory Tfh cells with the CD4+ CXCR5+ PD1+ CCR7- and CD4+ CXCR5+ PD-1+ ICOS+ phenotypes showed a significant increase in RSA patients compared to women with a normal pregnancy who had chosen termination. When RSA patients were grouped according positive or negative antibodies, it was surprising to find that decidual CD4+ CXCR5+ PD-1+ ICOS+ memory Tfh cells significantly increased in RSA patients with positive antibody compared to RSA patients with negative antibody. However, the percentages of CD4+ CXCR5+ PD1+ CCR7- memory Tfh cells did not change in the deciduas of the two groups. Circulating and decidual B cells significantly increased in antibody-positive RSA patients compared with antibody-negative RSA patients. Correlation analysis indicated a strong association between the decidual CD4+ CXCR5+ PD-1+ ICOS+ memory Tfh cells and B cells in antibody-positive RSA patients. CONCLUSION:These new findings provide unique insights into memory Tfh cells in mediating feto-maternal immune tolerance.
    背景与目标:
  • 【阴道和舌下米索前列醇治疗中期流产的比较: 随机对照等效试验。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/den328 复制DOI
    作者列表:
    BACKGROUND & AIMS: BACKGROUND:To identify an effective misoprostol-only regimen for the termination of second trimester pregnancy, we compared sublingual and vaginal administration of multiple doses of misoprostol in a randomized, placebo-controlled equivalence trial. METHODS:Six hundred and eighty-one healthy pregnant women requesting medical abortion at 13-20 weeks' gestation were randomly assigned within 11 gynaecological centres in seven countries into two treatment groups: 400 microg of misoprostol administered either sublingually or vaginally every 3 h up to five doses, followed by sublingual administration of 400 microg misoprostol every 3 h up to five doses if abortion had not occurred at 24 h after the start of treatment. We chose 10% as the margin of equivalence. The primary end-point was the efficacy of the treatments to terminate pregnancy in 24 h. Successful abortion within 48 h was also considered as an outcome along with the induction-to-abortion-interval, side effects and women's perceptions on these treatments. RESULTS:At 24 h, the success (complete or incomplete abortion) rate was 85.9% in the vaginal administration group and 79.8% in the sublingual group (difference: 6.1%, 95% CI: 0.5 to 11.8). Thus, equivalence could not be concluded overall; the difference, however, was driven by the nulliparous women, among whom vaginal administration was clearly superior to sublingual administration (87.3% versus 68.5%), whereas no significant difference was observed between vaginal and sublingual treatments among parous women (84.7% versus 88.5%). The rates of side effects were similar in both groups except for fever, which was more common in the vaginal group. About 70% of women in both groups preferred sublingual administration. CONCLUSIONS:Equivalence between vaginal and sublingual administration could not be demonstrated overall. Vaginal administration showed a higher effectiveness than sublingual administration in terminating second trimester pregnancies, but this result was mainly driven by nulliparous women. Fever was more prevalent with vaginal administration. Registered with International Standard Randomized Controlled Trial number ISRCTN72965671.
    背景与目标:
  • 【人工流产: 莫桑比克马普托和奎利马内市对新堕胎法的认识和态度的横断面研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12905-020-00988-6 复制DOI
    作者列表:Frederico M,Arnaldo C,Decat P,Juga A,Kemigisha E,Degomme O,Michielsen K
    BACKGROUND & AIMS: BACKGROUND:Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities. METHODS:A cross-sectional household survey among women aged 15-49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied. RESULTS:A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women's health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law. CONCLUSION:Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women's health. There is a need for widespread sensitization about the new law and its benefits.
    背景与目标:
  • 【堕胎: 公开的秘密?布基纳法索的堕胎和社交网络参与。】 复制标题 收藏 收藏
    DOI:10.1016/S0968-8080(07)30313-3 复制DOI
    作者列表:Rossier C
    BACKGROUND & AIMS: :Abortion in Burkina Faso is a subject that neither abortion providers nor women want to talk about. Abortion providers fear criminal prosecution; women's silence is dictated more by the wish to avoid the stigma of a "shameful" pregnancy. Qualitative investigations in Burkina Faso among 13 key informants in a rural village in 2000 and 30 women and men aware of experience of abortion in the capital Ouagadougou in 2001, explored two paradoxes: what prompts women and providers to reveal something they want to be kept totally secret, and how do women keep their abortion secret while nevertheless talking to others about it? The study found that young women in Burkina Faso are impelled to talk to their boyfriends, friends and in fewer cases women relatives about their unplanned pregnancy, first to decide to have an abortion and then to get help in finding a clandestine provider. Abortion is also kept secret because it is a subject on which there is no social consensus, alongside extra-marital sexual activity, contraceptive use by young people and out-of-wedlock pregnancies. The key to keeping a secret lies in the choice of those with whom to share it; good confidants are those who are bound by secrecy through the bonds of intimacy or shared transgression.
    背景与目标: : 布基纳法索的堕胎是堕胎提供者和妇女都不想谈论的话题。堕胎提供者担心受到刑事起诉; 妇女的沉默更多地取决于避免 “可耻” 怀孕的耻辱。布基纳法索对一个乡村2000年的13名主要线人和30名了解首都瓦加杜古2001年堕胎经历的男女进行了定性调查,探讨了两个悖论: 是什么促使妇女和提供者揭示了他们想要完全保密的东西,妇女如何在与他人谈论堕胎的同时保持堕胎的秘密?研究发现,布基纳法索的年轻女性被迫与男友,朋友以及更少的女性亲戚谈论计划外怀孕,首先决定堕胎,然后寻求帮助以寻找秘密提供者。堕胎也是保密的,因为这是一个没有社会共识的话题,除了婚外性活动、年轻人使用避孕药和非婚生怀孕。保守秘密的关键在于选择与之分享的人; 好的知己是那些通过亲密关系或共同的违法行为而受到秘密约束的人。
  • 【米非司酮后1、2或3天阴道米索前列醇用于早期药物流产: 一项随机试验。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2000-10-18
    来源期刊:JAMA
    DOI:10.1001/jama.284.15.1948 复制DOI
    作者列表:Schaff EA,Fielding SL,Westhoff C,Ellertson C,Eisinger SH,Stadalius LS,Fuller L
    BACKGROUND & AIMS: CONTEXT:The conventional timing of misoprostol administration after mifepristone for medical abortion is 2 days, but more flexible intervals, which may make the regimen more convenient, have not been studied. OBJECTIVE:To determine whether vaginal misoprostol administered 1, 2, or 3 days after mifepristone influences safety or effectiveness for abortion at up to 56 days' gestation. DESIGN:Prospective, randomized, open-label trial conducted from March 1998 to June 1999. SETTING:Sixteen US primary care and referral abortion facilities. PATIENTS:A total of 2295 healthy patients aged 18 years or older who were 56 or fewer days pregnant. Forty (1.7%) were lost to follow-up. INTERVENTIONS:Patients received 200 mg of oral mifepristone and were randomly assigned to self-administer 800 microg of vaginal misoprostol at home 1 (n = 745), 2 (n = 778), or 3 (n = 772) days later. Women returned to the clinic up to 8 days after mifepristone for ultrasonographic evaluation. A second dose of misoprostol was administered if the abortion was not complete. Patients with continuing pregnancy, excessive bleeding, or retained pregnancy tissue 5 weeks later received an aspiration curettage. MAIN OUTCOME MEASURES:Effectiveness of the procedure (ie, a complete medical abortion without surgical intervention), adverse effects, acceptability of the procedure based on patient questionnaires, reasons for surgical intervention, and adverse outcomes, compared among the study groups. RESULTS:Of the 2255 women completing follow-up, complete medical abortion rates were 98% (95% confidence interval [CI], 97%-99%) among those using misoprostol after 1 day, 98% (95% CI, 97%-99%) for those using misoprostol after 2 days, and 96% (95% CI, 95%-97%) among those using misoprostol after 3 days. Fifty-five subjects aborted before taking misoprostol, 9 had early surgery, and 103 did not take misoprostol on their assigned day. No blood transfusions were required. Cramping and nausea were the most common adverse effects reported, with similar percentages of patients in all 3 groups reporting such effects. Thirteen unexpected or serious adverse events occurred: 6 in those using misoprostol after 1 day; 4 in those using it after 2 days; and 3 in those using it after 3 days. Nearly all women (>90%) found the procedure to be acceptable. CONCLUSIONS:Our results suggest that vaginal misoprostol, 800 microg, can be used from 1 to 3 days after mifepristone, 200 mg, for early medical abortion, and need not be administered strictly 48 hours after mifepristone. JAMA. 2000;284:1948-1953.
    背景与目标:
  • 【引入社会销售的药物堕胎产品后,柬埔寨妇女的堕胎选择。】 复制标题 收藏 收藏
    DOI:10.1002/ijgo.12022 复制DOI
    作者列表:Sotheary K,Long D,Mundy G,Madan Y,Blumenthal PD
    BACKGROUND & AIMS: OBJECTIVE:To assess whether a social marketing initiative focusing on medicated abortion via a mifepristone/misoprostol "combipack" has contributed to reducing unsafe abortion in Cambodia. METHODS:In a questionnaire-based cross-sectional study, annual household surveys were conducted across 13 Cambodian provinces in 2010, 2011, and 2012. One married woman of reproductive age who was not pregnant and did not wish to be within the next 2 years in each randomly selected household was approached for inclusion. Participants were interviewed using a structured questionnaire. RESULTS:The questionnaire was completed by 1843 women in 2010, 2068 in 2011, and 2059 in 2012. Manual vacuum aspiration was reported by 61 (72.6%) of 84 women surveyed in 2010 who reported an abortion in the previous 12 months, compared with only 28 (52.8%) of 53 in 2012 (P=0.001). The numbers of women undergoing medicated abortion increased from 22 (26.2%) of 84 in 2010 to 27 (49.1%) of 53 in 2012 (P=0.003), whereas the numbers undergoing unsafe abortion decreased from 4 (4.8%) in 2010 to 0 in 2012 (P=0.051). CONCLUSION:Social marketing of medication abortion coupled with provider training in clinical and behavioral change could have contributed to a reduction in the prevalence of unsafe abortion and shifted the types of abortion performed in Cambodia, while not increasing the overall number of abortions.
    背景与目标:
  • 【荚膜多糖在高毒空肠弯曲菌诱导全身感染和流产中的关键作用。】 复制标题 收藏 收藏
    DOI:10.1128/IAI.00001-17 复制DOI
    作者列表:Sahin O,Terhorst SA,Burrough ER,Shen Z,Wu Z,Dai L,Tang Y,Plummer PJ,Ji J,Yaeger MJ,Zhang Q
    BACKGROUND & AIMS: :Campylobacter jejuni is a zoonotic pathogen, and a hypervirulent clone, named clone SA, has recently emerged as the predominant cause of ovine abortion in the United States. To induce abortion, orally ingested Campylobacter must translocate across the intestinal epithelium, spread systemically in the circulation, and reach the fetoplacental tissue. Bacterial factors involved in these steps are not well understood. C. jejuni is known to produce capsular polysaccharide (CPS), but the specific role that CPS plays in systemic infection and particularly abortion in animals remains to be determined. In this study, we evaluated the role of CPS in bacteremia using a mouse model and in abortion using a pregnant guinea pig model following oral challenge. Compared with C. jejuni NCTC 11168 and 81-176, a clone SA isolate (IA3902) resulted in significantly higher bacterial counts and a significantly longer duration of bacteremia in mice. The loss of capsule production via gene-specific mutagenesis in IA3902 led to the complete abolishment of bacteremia in mice and abortion in pregnant guinea pigs, while complementation of capsule expression almost fully restored these phenotypes. The capsule mutant strain was also impaired for survival in guinea pig sera and sheep blood. Sequence-based analyses revealed that clone SA possesses a unique CPS locus with a mosaic structure, which has been stably maintained in all clone SA isolates derived from various hosts and times. These findings establish CPS as a key virulence factor for the induction of systemic infection and abortion in pregnant animals and provide a viable candidate for the development of vaccines against hypervirulent C. jejuni.
    背景与目标: 空肠弯曲菌是一种人畜共患的病原体,最近在美国出现了一种名为克隆SA的高毒力克隆,是绵羊流产的主要原因。为了引起流产,口服摄入的弯曲杆菌必须在整个肠上皮中转位,在循环中全身扩散,并到达胎盘组织。参与这些步骤的细菌因素尚不清楚。空肠杆菌可产生荚膜多糖 (CPS),但CPS在全身感染尤其是动物流产中的具体作用仍有待确定。在这项研究中,我们使用小鼠模型评估了CPS在菌血症中的作用,并在口服攻击后使用怀孕的豚鼠模型评估了CPS在流产中的作用。与空肠杆菌NCTC 11168和81-176相比,克隆SA分离物 (IA3902) 在小鼠中导致明显更高的细菌计数和明显更长的菌血症持续时间。在IA3902中,通过基因特异性诱变导致胶囊产生的损失导致小鼠菌血症的完全消除和怀孕豚鼠的流产,而胶囊表达的互补几乎完全恢复了这些表型。胶囊突变株在豚鼠血清和绵羊血液中的存活也受到损害。基于序列的分析表明,克隆SA具有独特的CPS基因座,具有镶嵌结构,在来自各种宿主和时间的所有克隆SA分离株中均保持稳定。这些发现将CPS确定为诱导妊娠动物全身感染和流产的关键毒力因子,并为开发针对高毒性空肠杆菌的疫苗提供了可行的候选者。
  • 【自发性反复流产的妇女进行同种异体免疫后,抑制了细胞介导的免疫以及单核细胞和自然杀伤细胞的活性。】 复制标题 收藏 收藏
    DOI:10.1023/a:1027372409361 复制DOI
    作者列表:Gafter U,Sredni B,Segal J,Kalechman Y
    BACKGROUND & AIMS: Spontaneous recurrent abortion (SRA) has been treated by means of immunization with paternal or third-party white blood cells, yet the immunological basis for SRA and for the role of immunization protocols in pregnancy outcome remains controversial. To elucidate this question, nine women with SRA were immunized with paternal mononuclear cells and studied before and 2 weeks after immunization. Seven women who became pregnant gave birth to live newborns. Secretion of the T helper 1 cytokines IL-2 and interferon-gamma by patients, mononuclear cells decreased, while production of IL-10 increased. The levels of natural killer and lymphokine-activated killer cell-mediated cytotoxicity were markedly decreased. Monocyte functions such as secretion of IL-1 alpha, tumor necrosis factor alpha, IL-6, and cytotoxic activity decreased concurrently with elevations in IL-10 and transforming growth factor beta secretion. Production of IL-12, a pivotal regulatory cytokine, decreased. Furthermore, B7/1 expression on patients' mononuclear cells was downregulated. This resulted in a decrease in monocyte costimulatory activity of purified T cells with soluble anti-CD3, paralleled by a decline in allogeneic proliferative responses. These results suggest that the improved pregnancy success rate in women with SRA following immunization may be partly related to suppression of cell-mediated immunity and monocyte and natural killer cell activity.

    背景与目标: 自发性复发性流产 (SRA) 已通过父亲或第三方白细胞预防接种进行治疗,但SRA的免疫学基础以及预防接种方案在妊娠结局中的作用仍存在争议。为了阐明这个问题,对9名患有SRA的妇女进行了父本单核细胞免疫,并在免疫前和免疫后2周进行了研究。七名怀孕的妇女生下了活新生儿。T辅助细胞因子IL-2和干扰素-γ 的分泌由患者,单核细胞减少,而IL-10的产生增加。自然杀伤和淋巴因子激活的杀伤细胞介导的细胞毒性水平显着降低。单核细胞功能 (例如IL-1 α,肿瘤坏死因子 α,IL-6和细胞毒性活性的分泌) 随着IL-10和转化生长因子 β 分泌的升高而降低。IL-12 (一种关键的调节细胞因子) 的产生减少。此外,B7/1在患者单核细胞上的表达下调。这导致具有可溶性anti-CD3的纯化T细胞的单核细胞共刺激活性降低,同时同种异体增殖反应下降。这些结果表明预防接种后SRA妇女的妊娠成功率提高可能部分与抑制细胞介导的免疫,单核细胞和自然杀伤细胞活性有关。
  • 10 Is there a 'new ethics of abortion'? 复制标题 收藏 收藏

    【是否有 “新的堕胎伦理”?】 复制标题 收藏 收藏
    DOI:10.1136/jme.27.suppl_2.ii5 复制DOI
    作者列表:Gillon R
    BACKGROUND & AIMS: :This paper argues that the central issue in the abortion debate has not changed since 1967 when the English parliament enacted the Abortion Act. That central issue concerns the moral status of the human fetus. The debate here is not, it is argued, primarily a moral debate, but rather a metaphysical debate and/or a theological debate--though one with massive moral implications. It concerns the nature and attributes that an entity requires to have "full moral standing" or "moral inviolability" including a "right to life". It concerns the question when, in its development from newly fertilised ovum to unequivocally mature, autonomous morally inviolable person does a human being acquire that nature and those attributes, and thus a "right to life". The paper briefly reviews standard answers to these questions, outlining some problems associated with each. Finally there is a brief discussion of one way in which the abortion debate has changed since 1967--notably in the increasingly vociferous claim, especially from disability rights sectors, that abortion on grounds of fetal abnormality implies contempt for and rejection of disabled people--a claim that is rebutted.
    背景与目标: : 本文认为,当英国议会颁布《堕胎法》时,堕胎辩论的中心问题并没有1967年改变。这个中心问题涉及人类胎儿的道德状况。有人认为,这里的辩论主要不是道德辩论,而是形而上学的辩论和/或神学辩论-尽管具有巨大的道德含义。它涉及实体要求具有 “完全道德地位” 或 “道德不可侵犯” (包括 “生命权”) 的性质和属性。它涉及的问题是,在从新受精的卵子发展到明确成熟的,道德上不可侵犯的自主的人是否获得了自然和那些属性,从而获得了 “生命权”。本文简要回顾了这些问题的标准答案,概述了与每个问题相关的一些问题。最后,简要讨论了自1967年以来堕胎辩论发生变化的一种方式-特别是在日益激烈的主张中,尤其是来自残疾人权利部门的主张,即基于胎儿异常的堕胎意味着对残疾人的蔑视和拒绝-被驳回。
  • 【[内分泌因素在ivf-et后自然流产发病机制中的作用]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Paszkowski T,Wrona W,Szkodziak P
    BACKGROUND & AIMS: :There is large body of evidence to show that the risk of early pregnancy loss is higher after IVF-ET than after natural conception. Several hypotheses have been proposed to explain this phenomenon. One of the possible etiopathogetic factors is the patient's age which is significantly higher in women undergoing IVF than in the general population of naturally conceiving women. Immunologic factors have also been suggested. It seems that procedures like ICSI do not increase the risk of spontaneous abortion (SAB) after IVF-ET. Moreover, the proportion of products of conception with chromosomal aberration in cases of SAB following ICSI procedure is not elevated. Many authors point to the problem of iatrogenic luteal defect after IVF-ET. The use of luteal support after IVF-ET is widely recommended. Interestingly, firm evidence is lacking regarding the efficacy of progestagen or hCG supplementation on the risk of SAB after IVF-ET. However the issue of the effectiveness of progesterone support in decreasing the risk of SAB after ART procedures is far from being conclusively resolved--it deserves well planned, randomized studied to be performed.
    背景与目标: : 大量证据表明,ivf-et后早期妊娠流产的风险高于自然受孕后。已经提出了几种假设来解释这种现象。可能的病因因素之一是患者的年龄,在接受IVF的妇女中,其年龄明显高于自然受孕妇女的一般人群。还提出了免疫因素。似乎像ICSI这样的程序不会增加ivf-et后自然流产 (SAB) 的风险。此外,在ICSI程序后的SAB病例中,具有染色体畸变的受孕产物的比例并未升高。许多作者指出了ivf-et后医源性黄体缺陷的问题。广泛推荐在ivf-et后使用黄体支持。有趣的是,缺乏关于孕激素或hCG补充对ivf-et后SAB风险的疗效的确凿证据。然而,在ART手术后,孕酮支持在降低SAB风险方面的有效性问题远未得到最终解决-值得进行精心计划的随机研究。
  • 【妇产科医生堕胎培训的经验: 来自定性研究的医生见解。】 复制标题 收藏 收藏
    DOI:10.1016/j.contraception.2010.01.003 复制DOI
    作者列表:Freedman L,Landy U,Steinauer J
    BACKGROUND & AIMS: BACKGROUND:Abortion is one of the most contested, yet common surgical procedures in the United States and a required component of obstetrics and gynecology resident education. Approaches to abortion training are variable. STUDY DESIGN:We conducted in-depth interviews with 30 physicians who had graduated 5-10 years prior from four US residency programs with routine abortion training. Interviews focused on their experiences with abortion during training and in practice. RESULTS:Graduates' positive and negative experiences demonstrated that many valued teaching about the social issues surrounding abortion as well as training in surgical skills. Respondents found training rewarding when attending physicians openly discussed their personal commitment to abortion practice, respected differences of opinions about abortion and demonstrated high regard for abortion training. Some residents who opted out of surgical training for abortion valued partially participating in the rotation. CONCLUSIONS:Many physicians-in-training consider didactics related to the social context of care and respect for moral boundaries important components of abortion training.
    背景与目标:
  • 【法国瓜德罗普岛和留尼汪岛的人工流产避孕使用: 人工流产后护理管理的差异。】 复制标题 收藏 收藏
    DOI:10.3109/13625181003782852 复制DOI
    作者列表:Moreau C,Trussell J,Desfreres J,Bajos N
    BACKGROUND & AIMS: OBJECTIVES:The abortion rate varies greatly within the French overseas territories including the Caribbean island of Guadeloupe and La Réunion in the Indian Ocean. We compare women's contraceptive paths surrounding an abortion in both territories. METHODS:The data for this study are part of a nationally representative survey of women undergoing abortion in France in 2007. The analysis included 1,211 women from Guadeloupe and 1531 from La Réunion. RESULTS:Results show differences in women's use of contraception before the abortion by study location. Women in Guadeloupe were more likely not to have used contraception in the month they conceived (40% vs. 32%, p < 0.0001). Among those using no contraception or less effective contraception before the abortion, 74% in Guadeloupe and 86% in La Réunion received a prescription for a very effective method such as a hormonal method or intrauterine device after the procedure. In both settings, women with no health insurance or a government health plan were 70% less likely to have received a prescription for a very effective method. CONCLUSIONS:While this study shows a significant increase in the prescription of very effective methods, it also indicates the ineffectiveness of the health care system in closing the gap in the pre-abortion contraceptive disparities observed between Guadeloupe and La Réunion.
    背景与目标:
  • 【早期药物流产的管理-提供者之间的国际调查。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejogrb.2020.01.022 复制DOI
    作者列表:Fiala C,Bombas T,Parachini M,Agostini A,Lertxundi R,Lubusky M,Saya L,Danielsson KG
    BACKGROUND & AIMS: OBJECTIVE:To record the definition and management of Very Early Medical Abortion (VEMA) in different countries. STUDY DESIGN:An Internet survey was circulated internationally among providers of medical abortion via a website. The questionnaire focused on reasons for performing or delaying medical abortion at a very early gestational age and the perceived advantages and disadvantages of VEMA. RESULTS:Out of 220 completed questionnaires, 50 % came from European abortion providers (n = 110). Most respondents (72 %) defined VEMA as abortion performed in the presence of a positive hCG pregnancy test but with an empty uterine cavity or a gestational sac-like structure, and no signs or symptoms of ectopic pregnancy. A total of 74 % of respondents thought it was not necessary to wait for a diagnosis of intrauterine pregnancy before starting medical abortion. Equally, 74 % were aware of the possibility of an ectopic pregnancy. CONCLUSION:According to European providers of medical abortion, waiting for the diagnosis of an intrauterine pregnancy is not necessary and does not improve treatment of ectopic pregnancy. Providers should know that medical abortion can be performed effectively and safely as soon as the woman has decided. There is no lower gestational age limit.
    背景与目标:
  • 【在可辩护的范围内: 对Simkulet反对基于自然流产的反堕胎观点的论点的回应。】 复制标题 收藏 收藏
    DOI:10.1136/medethics-2017-104688 复制DOI
    作者列表:Friberg-Fernros H
    BACKGROUND & AIMS: :In a recent article, William Simkulet has argued against the anti-abortion view by invoking the fact that many human fetuses die from spontaneous abortion. He argues that this fact poses a dilemma for proponents of the anti-abortion view: either they must abandon their anti-abortion view or they must engage in preventing spontaneous abortion significantly more than at present-either to the extent that they try to prevent induced abortion or at least significantly more than they do today. In this reply, I acknowledge that, if the latter would follow, the anti-abortionist view would imply implausibly strong obligations. My aim with this reply is to demonstrate that anti-abortionists can hold on to their view without having implausibly strong obligations to prevent spontaneous abortion. My conclusion is that Simkulet clearly overstates his position by not sufficiently considering the differences between the act of killing versus death by natural causes and between positive and negative rights.
    背景与目标: : 在最近的一篇文章中,威廉·辛库莱特 (William Simkulet) 反对反堕胎的观点,他援引了许多人类胎儿死于自然流产的事实。他认为,这一事实给反堕胎观点的支持者带来了两难选择: 要么他们必须放弃反堕胎的观点,要么他们必须比目前更多地参与预防自然流产 -- 要么达到他们试图预防人工流产的程度,要么至少比今天多得多。在这份答复中,我承认,如果后者遵循,反堕胎主义的观点将意味着难以置信的强有力的义务。我的答复目的是证明反堕胎主义者可以坚持自己的观点,而不必承担防止自然流产的强大义务。我的结论是,Simkulet没有充分考虑自然原因造成的杀戮行为与死亡行为之间以及积极和消极权利之间的差异,显然夸大了他的立场。

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