Views and attitudes. towards termination of pregnancy have shown con siderable evolution over the past few decades. Along with these changes has come a growing concern to adopt means and methods which could make termination easier, safer and more effective. In this evolution, termination in the second trimester in par~icular is notable as being responsible for a dis proportionate share ofthe complications and adverse experiences associated with pregnancy termination. Although the almost universal shift towards earlier abortion has reduced the number of second trimester procedures as a percentage of the whole, the problems of interrupting pregnancy in the second trimester remain conspicuous. Delay in either seeking or obtaining abortion is still, in many parts of the world, all too frequent. AdditiDnally, recent developments in the prenatal diagnosis of fetal malformations, alphafeto protein screening programmes and changes in the pattern of and approaches to intrauterine fetal death now also place greater emphasis on the need for adequate methods of interrupting pregnancy in the second trimester. Unlike the first trimester in which vacuum aspiration is universally con sidered to be the method of choice, in the second trimester of pregnancy the clinician is faced with alternatives; one method may be more appropriate than another in a particular circumstance and no single method is unequivocall~ accepted as best. Neither do second trimester terminations form a neatly defined single category.

Klappentext

Views and attitudes. towards termination of pregnancy have shown con­ siderable evolution over the past few decades. Along with these changes has come a growing concern to adopt means and methods which could make termination easier, safer and more effective. In this evolution, termination in the second trimester in par~icular is notable as being responsible for a dis­ proportionate share ofthe complications and adverse experiences associated with pregnancy termination. Although the almost universal shift towards earlier abortion has reduced the number of second trimester procedures as a percentage of the whole, the problems of interrupting pregnancy in the second trimester remain conspicuous. Delay in either seeking or obtaining abortion is still, in many parts of the world, all too frequent. AdditiDnally, recent developments in the prenatal diagnosis of fetal malformations, alphafeto­ protein screening programmes and changes in the pattern of and approaches to intrauterine fetal death now also place greater emphasis on the need for adequate methods of interrupting pregnancy in the second trimester. Unlike the first trimester in which vacuum aspiration is universally con­ sidered to be the method of choice, in the second trimester of pregnancy the clinician is faced with alternatives; one method may be more appropriate than another in a particular circumstance and no single method is unequivocall~ accepted as best. Neither do second trimester terminations form a neatly defined single category.

Inhalt

1. Midtrimester abortion: a global view.- 2. Second trimester abortion as a social problem: delay in abortion seeking behaviour and its causes.- 3. Legal aspects of pregnancy termination in Europe.- 4. A review of abortion practices and their safety.- 5. The trimester threshold for pregnancy termination: myth or truth?.- 6. Aspirotomy for outpatient termination of pregnancy in the second trimester.- 7. Instrumental abortion in the second trimester: an overview.- 8. Intra-amniotic hypertonic saline instillation in the second trimester.- 9. Extra-amniotic ethacridine (Rivanol®)-catheter technique for midtrimester abortion.- 10. Fact and fancy in the termination of molar pregnancy with particular reference to uterine stimulants.- 11. Natural prostaglandins alone or in combination for termination of pregnancy.- 12. Termination of second trimester pregnancy with prostaglandin analogues.- 13. Prostaglandin therapy for second trimester abortion: an overview of current status and recent trends.- 14. Termination of pregnancy after intrauterine foetal death.- 15. Complications of second trimester abortion.- 16. Prevention of Rhesus (D) isoimmunization after abortion.- 17. Contraception following second trimester abortion.- 18. Sterilization combined with midtrimester abortion.- 19. Somatic sequelae and future reproduction after pregnancy termination.- 20. Some considerations on the psychosocial aspects of pregnancy termination.- Index of subjects.