A dose of 50 microgram anti-D immunoglobulin was administered as rhesus immunoprophylaxis following induced abortion performed by suction curettage before the thirteenth week of pregnancy in 463 consecutive patients. A feto-maternal blood loss of less than 2 ml was detected in 44 women (12%). After 6 months, a follow-up of 381 patients (82%) established that none of these patients was rhesus immunized with in vitro demonstrable antibodies. It is concluded that the low dose of anti-D administered is to be recommended for rhesus immunoprophylaxis after first trimester abortion.
During recent years, the use of steroid anesthesia has rapidly increased. In our hospital, a number of surgical procedures have been performed under Althesin anesthesia, and in some cases the peroperative bleeding seemed to be rather profuse. Blood loss was studied in 90 healthy women in the first trimester of pregnancy undergoing therapeutic abortion using different types of anesthesia. The patients were divided into three equal groups according to the duration of pregnancy. In each group, 10 patients underwent operation under local anesthesia, 10 under thiopental anesthesia and 10 under Althesin. In all three groups, blood loss was the smallest when local anesthesia was used (Fig 1). Amounting to only one third to one half of that occurring under thiopental anesthesia. Under thiopental anesthesia the blood loss gradually increased with increasing gestational age with moderate variations. Alternatively, in this investigation, Althesin anesthesia was characterized by pronounced blood loss, particularly in the ninth and tenth weeks of pregnancy, and in some cases by rather profuse bleeding. We find that Althesin anesthesia should be used for gynecological surgery only in departments which are equipped to control profuse bleeding and possible cardiovascular complications.
The incidence of complications associated with therapeutic termination of pregnancy was analysed in 1349 patients, whose average age was 26.3 years. Of the patients, 51.8% were 25 years or under; 56.3% were seen in or before the 8th week of pregnancy, and 17.4% had previously had one or more legal abortions. All the operations were performed under local anaesthesia and by the same doctor, who was an experienced gynaecologist. Complications associated with the operation occurred in 14 patients (1%), viz. infections in the uterus and tubes, 9 cases; incomplete abortion necessitating repeat curettage, 4 cases; and profuse bleeding requiring blood transfusion, 1 case. No uterine perforations or cervical ruptures were encountered. Questioned about subjective discomforts of the opeation, 7.4% of the women answered that the discomfort had been considerable, whereas 62.6% described it as only slight; 4.8% would have perferred general anaesthesia. We conclude that therapeutic abortion can be performed safely and with an acceptably low incidence of complications in out-patients, provided the operations are performed by an experienced gynaecologist.
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