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UGANDA MARTYRS SEMINARY, NAMUGONGO. NAME: AHUMUZA ROLIN. DATE: Wednesday, 27TH July, 2011. REG. NO: J11/DGC/UMSN/001.

COURSE: DIPLOMA IN GUIDANCE AND COUNSELLING. COURSE UNIT: COUNSELLING ETHICS. LECTURER: REV. SIMON SERWANJA. ASSIGNMENT: WRITE NOTES ON ABORTION.

ABORTION. According to Wikipedia the free encyclopedia, abortion is technically defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo before fetal viability; however, the term is sometimes defined more broadly to include any termination of pregnancy other than birth. In medicine, an abortion is the premature exit of the products of conception (the fetus, fetal membranes, and placenta) from the uterus. It is the loss of a pregnancy and does not refer to why that pregnancy was lost. Types. 1. Induced abortion. Induction abortion is a procedure that uses salt water, urea, or potassium chloride to terminate the viability of the pregnancy. Or can be defined as the use of drugs or instruments to stop the normal course of pregnancy. Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion. A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses. Specific procedures may also be selected due to legality, regional availability, and doctor or patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly

increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy. An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons. The following are the types; Medical abortion. "Medical abortions" are non-surgical abortions that use pharmaceutical drugs, categorically called abortifacients. In 2005, medical abortions constituted 13% of all abortions in the United States; in 2010 the figure increased to 17%. Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention. Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, surgical abortion must be use to complete the procedure. Surgical abortion. A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization). In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.[22] Manual vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. Menstrual Extraction (endometrial or vacuum aspiration) (MVA). This method is used for most abortions performed during

the first trimester also known as "mini-suction". It is done by suctioning out the lining of the uterus (endometrium) through a thin opening of the undilated cervix. It is a method used after a woman has just missed a period, or anytime up to about the eight week or pregnancy or in very early pregnancy, and does not require cervical dilation. It can be performed safely in the doctor's office and has a very low rate of mortality. Dilation and Evacuation (D & E) (also called vacuum suction or suction curettage) and Dilation and Curettage (D & C). This is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. This method is commonly used for late first trimester or early second trimester abortions. In this method suction is used to remove the fetus and placenta. The cervix is first dilated under local anesthesia using a suction tube that is firm, and a stronger suction is used than in menstrual extraction. Another way of dilating the cervix is the use of a type of dried seaweed, called laminaria, which expands as it absorbs moisture. Some doctors use a hollow, spoon-shaped knife, or curette, to ensure that all the placental tissues are removed by scraping the uterine walls. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable. From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. Prostaglandin or Saline Administration. This method is done by injecting prostaglandins or saline solution through the uterine wall and into the amniotic sac holding the fetus to induce labor and delivery of a nonviable fetus. This procedure is commonly used for second trimester abortions. Prostaglandins may cause nausea, elevated temperatures, and vomiting but are safer than the saline solution or urea. Mortality rate for second trimester abortions performed by this method is approximately 20 per 100,000 abortions. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called

intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion," which has been federally banned in the United States. Hysterotomy. This method is similar to caesarian section, the uterus is opened through a small abdominal incision and the fetus is removed. Hysterotomy is usually performed only when other methods have failed repeatedly; it is performed under general anesthesia. It's because it requires a smaller incision than a caesarean section and is used during later stages of pregnancy. It is used between the 12th and the 24th week of pregnancy. This method has the greatest risk of complications out of all the abortion procedures; maternal mortality rate is approximately 200 per 100,000 abortions. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). The Royal College of Obstetricians and Gynaecologists has recommended that an injection be used to stop the fetal heart during the first phase of the surgical abortion procedure to ensure that the fetus is not born alive. 2. Spontaneous abortion. Abortion is the spontaneous. It may be occur during the first trimester. Spontaneous abortion has various types such as

Threatened abortion: It may be occur during the first half of pregnancy or before the 20th week of gestation. Usually 20% of pregnant women have vaginal spotting or actual bleeding early in pregnancy. The patient usually experiences vaginal bleeding with or without some cramps, and the cervix is closed. Bed rest is usually the only treatment needed. In a few cases the symptoms disappear and the rest of the pregnancy is normal. Inevitable abortion: It is when the bleeding continues and becomes heavy, it usually means that the cervix is dilating and the contents of the uterus are being expelled. Pregnant women will experience lower abdominal cramping and

bleeding. In which, membranes rupture and the cervix dilates. Incomplete abortion: In which, uterus retains part or the entire placenta. Before the 10th week of gestation, the fetus and placenta usually are expelled together. Because part of the placenta may adhere to the uterine wall, bleeding continues because the uterus does not contract to seal the large blood vessels that feed the placenta. The usual treatment is a drug that induces labor by stimulating uterine contractions, a surgical procedure called curettage can also be done to remove the remaining material from the uterus, the goal of this treatment is to prevent prolonged bleeding or infection. Complete abortion: It is when all the contents are expelled. There is no treatment other than rest is usually needed. All of the tissues that came out should be saved for examination by a doctor to make sure that the abortion is complete. The laboratory examination of the saved tissue may determine the cause of abortion. Minimal bleeding usually accompanies complete abortion because the uterus contracts and compresses maternal blood vessels that fed the placenta. Missed abortion: is a case in which an intrauterine pregnancy is present but is no longer developing normally. Before widespread use of ultrasonography, the term missed abortion was applied to pregnancies with no uterine growth over a prolonged period of time, typically 6 weeks or 2 months after its (fetus) death. A missed abortion is usually indicated by the disappearance of the signs of pregnancy except for the continued absence of menstrual periods. Missed abortions are usually treated by induction of labor by dilation (or dilatation) and curettage (D & C). Uterine growth ceases; uterine size may even seem to decrease. Habitual abortion: In which, if you loss spontaneous three or more consecutive pregnancies then it constitutes habitual abortion. Septic abortion: It may be occur with spontaneous abortion but usually results from an illegal abortion. It's related to any remaining fetal or placental tissue in the uterus.

It is a therapeutic expulsion of the products of conception from the uterus before 20 weeks gestation. Mostly up to 15% of all pregnancies and approximately 30% of first pregnancies end in spontaneous abortion and about 85% of miscarriages occur due to the first trimester. Causes of Abortion Spontaneous abortion may be occurring due to various factors such as fetal, placental, or maternal. Fetal factors, in which it usually cause such abortions up to 12 weeks gestation such as

Defective embryologic development resulting from abnormal chromosome division Faulty implantation of the fertilized ovum Failure of the endometrium to accept the fertilized ovum.

Other Placental factors usually cause abortion around the 14th week of gestation. These factors such as

Premature separation of the normally implanted placenta Abnormal placental implantation

Maternal factors mostly cause abortion between the 11th and 19th week of gestation and such as

Maternal infection Endocrine problems Trauma Antiphospholipid antibody syndrome. Blood group incompatibility Drug ingestion

Signs and symptoms of Abortion Abnormal uterine bleeding may be occur due to various symptoms such as: 1. Pink discharge for several days

2. Cramps 3. Increased vaginal bleeding Treatment of Abortion

You may have an accurate evaluation of uterine contents, because it is necessary before a treatment plan can be formulated. You can not prevented the progression of spontaneous abortion, except in some cases that may be caused by an incompetent cervix. So for those cases where the progression of spotaneous abortion can't be stopped, then you should be used the treatment such as patient must be hospitalized to control severe hemorrhage. If bleeding is severe, then you should be use transfusion with packed red blood cells or whole blood. In which, the patient receives oxytocin I.V., and it stimulates uterine contractions. D&E is also performed in first all second-trimester therapeutic abortions. In second-trimester therapeutic abortions, the insertion of a prosta glandin vaginal suppository induces labor and the expulsion of uterine contents. The patient should not have bathroom privileges because she may expel uterine contents without knowing it. So after she uses the bedpan, then inspect the contents carefully for intrauterine material.

Other methods. Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle. Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion). The use of herbs in such a manner can cause serious even lethalside effects, such as multiple organ failure, and is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[30] Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available. Complications following abortion. The health risks of abortion depend on whether the procedure is performed safely or unsafely. The World Health Organization defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Safe abortion. Abortion, when performed in the developed world in countries where abortion is legal, is among the safest procedures in medicine. In the US, the risk of maternal death from abortion is 0.567 per 100,000 procedures, making abortion approximately 14 times safer than childbirth (7.06 maternal deaths per 100,000 live births). The risk of abortion-related mortality increases with increasing gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation. Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate. Preventive antibiotics (such as doxycycline or metronidazole) are typically

given before elective abortion, as they are believed to substantially reduce the risk of postoperative uterine infection. Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. A 2008 Cochrane Library review found that dilation and evacuation was safer than other means of secondtrimester abortion. Medical abortion with mifepristone and misoprostol is effective through 49 days of gestational age. It has been used in women up to 63 days of gestational age, albeit with an increased risk of failure (requiring surgical abortion). Medical abortion is generally considered as safe as surgical abortion in the first trimester, but is associated with more pain and a lower success rate (requiring surgical abortion). Overall, the risk of uterine infection is lower with medical than with surgical abortion, although in 2005 four deaths after medical abortion were reported due to infection with Clostridium sordellii. As a result, some abortion providers have begun using preventive antibiotics with medical abortion. Unsafe abortion An unsafe abortion is the termination of an unwanted pregnancy by persons lacking the necessary skills, or in an environment lacking minimal medical standards, or both. For example, an unsafe abortion may refer to an extremely dangerous life-threatening procedure that is self-induced in unhygienic conditions, or it may refer to a much safer abortion performed by a medical practitioner who does not provide appropriate post-abortion attention. Unsafe abortion is a significant cause of maternal mortality and morbidity in the world. Most unsafe abortions occur where abortion is illegal, or in developing countries where affordable well-trained medical practitioners are not readily available, or where modern contraceptives are unavailable. About one in eight pregnancy-related deaths worldwide are associated with unsafe abortion.

In contrast, unsafe abortion is a major cause of injury and death among women worldwide. Unsafe abortion is believed to result in approximately 68,000 deaths and millions of injuries annually. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries. The legal status of abortion is believed to play a major role in the frequency of unsafe abortion. For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications, with abortionrelated deaths dropping by more than 90%. Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services. Breast cancer. The abortionbreast cancer hypothesis posits that induced abortion increases the risk of developing breast cancer.[1] In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposes that if this process is interrupted by an abortionbefore full maturity in the third trimesterthen more relatively vulnerable immature cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer over time. This mechanism was first proposed and explored in rat studies conducted in the 1980s. The abortion-breast cancer hypothesis has been the subject of extensive scientific inquiry, and the scientific community has concluded that abortion does not cause breast cancer. This consensus is supported by major medical bodies, including the World Health Organization, the U.S. National Cancer Institute, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the Royal College of Obstetricians and Gynaecologists.

Pro-life activists have continued to advance a causal abortionbreast cancer link, and in the United States they have sought legal action to present abortion as a cause of breast cancer when counseling women seeking abortion. This political intervention culminated when the George W. Bush Administration altered the National Cancer Institute website to suggest that abortion might cause breast cancer. In response to public concern over this intervention, the NCI convened a 2003 workshop bringing together over 100 experts on the issue. This workshop concluded that while some studies reported a statistical correlation between breast cancer and abortion, the strongest scientific evidence from large prospective cohort studies demonstrates that abortion is not associated with an increase in breast cancer risk, and the positive findings were hypothesized to be due to response bias. The ongoing promotion of a link between abortion and breast cancer is seen by others as part of the pro-life "woman-centered" strategy against abortion. Pro-life groups maintain they are providing legally necessary informed consent, a concern shared by some politically conservative politicians. The abortion-breast cancer issue remains the subject of political controversy. Mental health. The relationship between induced abortion and mental health is an area of controversy. The issue has been part of the political debate over abortion, dating to 1988 when President Ronald Reagan directed U.S. Surgeon General C. Everett Koop to produce a report on the physical and psychological effects of abortion in the expectation that such a report could be used to justify restricting access to abortion There is no scientific evidence of a causal relationship between abortion and poor mental health. Preexisting factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion. In 1990, the American Psychological Association (APA) found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses." The APA revised

and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that termination of a first, unplanned pregnancy did not lead to an increased risk of mental health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while studies with methodologic flaws and other quality problems were more likely to report negative consequences. As of August 2008, the United Kingdom Royal College of Psychiatrists is also performing a systematic review of the medical literature to update their position statement on the subject, which is expected to be published in autumn 2011. Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome." However, the existence of "postabortion syndrome" is not recognized by any medical or psychological organization, and some physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes. Some U.S. state legislatures have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the scientific literature. No scientific research has demonstrated that abortion is a cause of poor mental health in the general population. However there are groups of women who may be at higher risk of coping with problems and distress following abortion. Some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.[57] The American Psychological Association (APA) concluded that first trimester abortion does not lead to increased mental health problems, and

further research has concluded that later abortions are no different. Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome". However, the existence of "postabortion syndrome" is not recognized by any medical or psychological organization. Causes of abortion. The main problem of the abortion is psychological and is fear: Fear for Financial difficulty to raise the child. This is a consequence of lack of confidence in God since the most beautiful and desired for a mother should be her own son. Unfortunately this consumer and false values society we all are living in, has devalued the baby who must come to this world and with its rationalism has created a false fear. Let us see a great example: Kay James, a Public Relations Officer for PRO-LIFE MOVEMENT in the United States speaks of a terribly poor black woman, who was ditched by her alcoholic husband, who had his fourth baby on a table. "I was that baby", says Mrs. James who is graduated at the University and mother of 3 children. Fear to what people or parents might think or say. (When getting pregnant during the engagement). Actually, human concepts and reasonings, including those of parents or third parties must not prevent a creature from coming to this world. Life is given by God and God is above all concept. "I was going to be the seventh son and my mother was determined not to let to me be born. Then something wonderful happened. My aunt made her change her mind and that's why I could be born. It could be said that I am a miracle ". Arthur Rubenstein, pianist.

Fear to the 9 months of pregnancy and to the pain during the labor. Actually, the greatest mission of every woman, is to be mother and to bring children to the world. If animals that are irrational do not deny this right, Why is the woman going to be scared, if it is a natural function that corresponds to her feminine nature? Health problems. Let's remember Beethoven's case, the great musician who astonished with his divine music, and who is still listened by those who want to give food and breath to their soul; His mother was diagnosed with tuberculosis and his father was alcoholic. Rape. Rape is a horrible abuse with traumatic effects for many of its victims. For a woman who carries in her entrails a creature fruit of a rape is not helpful at all, to know that pregnancy rarely happens in these cases. Nevertheless, Should we make an innocent creature pay for his father's crime? A raped woman who wrote anonymously to a magazine, said that she had an appointment to be done an abortion but canceled it. "I knew that what I had in my entrails was my baby. Now I have a daughter, a precious girl. I thank God daily for not to have aborted". Hormonal contraceptives. A Woman who takes either tablets, injections or implants, has certainly determined not to have a child and if she gets pregnant then she feels frustrated in her intentions and often she resorts to abortion. These contraceptives are one of the main causes of abortion nowadays. Genetic abnormalities in the fetus that may result in abortion are not very frequently diagnosed, and these usually occur as an individual cow problem rather than as a herd outbreak. These abnormalities, which may not cause a change in the outward appearance of the fetus, may result in abortion because of the growing fetus' inability to develop properly in the uterus. Genetic

abnormalities may also cause obvious physical changes in the fetus, just as other infectious agents may (see below). Heat stress can affect reproductive performance in a dairy herd, although it will generally cause conception problems rather than abortions. While there is some evidence to suggest that a very sudden increase in environmental temperature may result in abortions, there is little evidence to support heat stress as a common cause of abortions. Similarly, on rare occasions a cow that develops a very high fever due to an infection may abort her fetus. Toxic agents may also cause abortions or early embryonic deaths. Cattle are susceptible to fertilizer nitrites and nitrates or the nitrates found in plants under certain conditions (e.g. drought-stress). If a cow is exposed to sufficiently high levels of nitrates/nitrites (~.55 % or greater nitrate in forage), abortions may occur, especially in late gestation. Some experimental studies have shown that mycotoxins such as zearalenone in very high levels can cause abortions in cattle, although these levels are not normally found in "naturally contaminated" feedstuffs. Likewise, the only reports of abortions associated with aflatoxin appear to be situations where the health of the cow was also severely compromised by the toxin. Ergot alkaloids are toxins produced by the Claviceps fungus, which grows in the seeds of various grasses and small grains such as fescue, bromegrass, wheat, oat and rye. These toxins have been associated with abortions in dairy cattle as well as other health problems. Although the cause of many abortions is never determined, infectious agents represent the most commonly diagnosed cause of abortions in many laboratories. Bacteria Which Can Cause Abortion. Actinomyces pyogenes, Bacillus, Streptococcus spp. and other common bacteria found in the environment can be the

cause of sporadic abortions in a dairy herd. These organisms usually get to the placenta and fetus by way of the cow's circulatory system. While these bacteria may not cause disease symptoms in the cow, the fetus appears to be more susceptible, in large part because of its immature immune system. The resulting growth of bacteria can cause the death of the fetus, which in turn results in it being expelled (aborted) from the uterus. Some laboratory data suggests that these bacteria are the most commonly identified cause of bacterial abortions in dairy cattle. Brucella abortus (Brucellosis, Bang's disease) Whereas this bacteria once caused very significant reproductive problems on dairy farms, brucellosis is now a disease that is primarily of historical significance. Virginia, as most states, is officially brucellosis-free. Effective Brucella abortus vaccines are available, although wide-scale use of the vaccine is decreasing in many parts of the country. Haemophilus somnus is not considered to be an important cause of abortion in cattle, although there are reports of abortions following experimental infection. It is also reported to cause infertility, although some controversy exists about its importance. Other, more common causes of infertility should be pursued before considering Haemophilus somnus. Leptospira spp. L. hardjo (hardjo-bovis) and L. pomona are the two serovars of Leptospira that are the most important in North America. L. pomona is usually associated with abortion outbreaks in the last trimester of gestation. These occur sporadically since the cow is not its main host, and it is introduced to the herd from infected wildlife or swine - usually by means of water that becomes contaminated with the urine of these animals. Cattle, however, are the main host for L. hardjo (hardjo-bovis) and the organisms can establish as a chronic infection in the kidneys or reproductive tract of cows. Subsequently they can be shed intermittently during the life of the animal. These chronic infections can cause early embryonic death, abortions, stillbirths, or the birth of premature, weak calves. Aborted fetuses are often severely autolysed. Leptospira hardjo organisms can be passed

from cow to cow or cow to calf by contact with infected urine, milk or placental fluids, or directly to the calf across the placenta before birth. Vaccines are available against many different serovars; however, it appears that the protection offered is not very long-lasting and twice yearly boosters are usually recommended in high risk herds. Listeria monocytogenes can cause abortions in addition to some of the common diseases seen due to infection with this bacteria (eg. 'circling disease'). Listeria can be found in many places in the environment on dairy farms, although disease outbreaks are often associated with high bacterial numbers found in poor-quality or spoiled silage. Abortions occur approximately one week after exposure, and occur most commonly during the last trimester of pregnancy, although they may occur as early as the 4th month of gestation. The aborted fetus is often autolyzed. The cows may show clinical signs of disease as well, although once returned to health appear to resist reinfection. This organism may be the most common bacterial cause of multiple abortions in herds. Ureaplasm diversum and Mycoplasma bovigenitalium are generally thought to be relatively uncommon causes of abortions, although Ureaplasm can cause an outbreak of abortions if it is introduced into a 'clean' herd. These organisms have also been implicated as infectious causes of infertility. However, it is often difficult to determine if one of these agents is the cause of an abortion or infertility problem since they can also be found in the reproductive tract of 'normal' healthy cows. Viruses Which Can Cause Abortion. Bovine Viral Diarrhea virus (BVD) - BVD can cause a whole range of disease syndromes in cows. When the virus circulates in the cow, it is able to reach the growing fetus through the placenta. If a cow who is not immune is exposed to the BVD virus in the first trimester, an early embryonic death or abortion may occur, and if the calf is not expelled from the uterus, it may become mummified. However, if the calf is exposed to the BVD

virus between 42 and 125 days of gestation, and if it does not die, it may be born as a "persistently infected" calf. During the second 3 months of gestation, an infection may result in an abortion, or a calf which will be born with birth defects. Generally if a calf is exposed in the uterus during the last trimester, the virus will have no effect on the calf, except that it will be born with antibodies to BVD in its blood. Occasionally a late-gestation abortion may result from a BVD virus infection. While immunity in the cow (by exposure or vaccination) should help to protect the developing fetus, the protection offered is not 100% since there are different strains of BVD virus and only a few virus particles need to get to the fetus to cause an infection. The use of an effective BVD vaccine should be a routine part of a herd disease prevention program. Infectious Bovine Rhinotracheitis virus (IBR, BHV-1) is a serious contagious herpes virus disease of cattle that can cause a variety of different disease syndromes, the most common of which is respiratory disease (pneumonia, "red nose"). It remains the most commonly diagnosed viral cause of abortions in cattle. Abortions most commonly occur from 4 months to term, and may occur weeks after the disease has gone through the herd. The use of effective IBR vaccines should be a routine part of a herd disease prevention program. A cow can also abort if she develops an infectious condition that does not directly affect the fetus. For example, an acute case of coliform mastitis caused by the Escherichia coli (E. coli) bacteria can cause a massive release of endotoxins into the udder and bloodstream of the cow. (This endotoxin is largely responsible for the clinical signs observed, such as the depressed attitude, the lack of rumen motility, and the high temperature.) This endotoxin may result in the release of prostaglandins or other hormones in the cow that can in turn result in the occurrence of an abortion. Some recent research from the University of Florida has shown that cows with clinical mastitis were almost 2 times as likely to abort as cows that had not experienced any clinical mastitis.

Vaccination with modified live vaccines during pregnancy can also cause cows to abort. Modified live vaccines contain live viruses or bacteria that are 'altered' to prevent them from causing clinical disease while still stimulating the immune system. However, there is clinical evidence that using these vaccines in pregnant animals can cause abortions and vaccine manufacturers do not recommend that they be used in this fashion. Recently there has been some discussion about abortions occurring after vaccination with Leptospira vaccines. It appears that this is very occasionally observed in herds that are vaccinating more than twice a year. In these situations the vaccine itself may not be causing the abortion, but the cows reaction to the frequent vaccination. Similarly, various veterinarians have observed side-effects of administering too many "gram-negative" bacterial vaccines (Eg. E. coli, Salmonella) at one time. Other Agents Which Can Cause Abortion. Fungi can also cause abortions in dairy cattle, most often in the last 2 months of gestation, although they have been observed to occur as early as 60 days. These usually occur during the winter and spring months, since this is when cows are often kept in total confinement and can be exposed to moldy hay or silage. The mold spores are thought to reach the placenta and fetus through the blood supply of the cow, although the way that they gain access to the circulatory system is not well understood. Rarely, before or after an abortion due to Mortierella wolfii, the cow may develop a severe pneumonia. Fungal abortions tend to occur sporadically although on some occasions a significant percentage (10-20 %) of the pregnant animals in a herd may be affected. Neospora caninum is a protozoal parasite that does not appear to cause any disease in mature cattle, except for abortions. Abortions due to Neospora usually occur sporadically in a herd in the middle of gestation (4-5 months), although they can occur anywhere from about 3 months onward. Usually, Neosporacaused abortions do not present as an "abortion storm," although this does occasionally occur. Many cows in a herd can be infected with Neospora and not abort, although they are more likely to do so than their uninfected herdmates. Also, animals that have

aborted once due to Neospora are at increased risk of doing so again if they remain in the herd and become pregnant again. Fetuses that are not aborted, while usually appearing to be normal calves, are often infected with the protozoa for life. A survey conducted by researchers at the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech in 19971998 suggests that Neospora may not be a significant problem on most Virginia dairy farms. A commercially-produced Neospora vaccine has recently become available. There is not yet enough information to decide if and when it's economically advantageous for herds to use this product. Bovine Venereal Diseases. These diseases have generally been of very minor concern to the dairy industry because of the widespread adoption of artificial insemination. However, with the increased use of natural service in many dairy herds, the potential exists for venereal diseases to affect reproductive performance. Trichomonas foetus (Genital trichomoniasis) and Campylobacter fetus ss. venerealis ("Vibrio") are the two organisms that are most often associated with venereal disease in cattle. Once the organisms are present in the herd, they can be passed from cow to cow by the herd bull(s) or by contaminated breeding equipment. Young bulls usually 'clear' the organisms quite rapidly, but become reinfected upon breeding a cow that is carrying an infection. Older bulls (4-5+ yrs) are more often chronically infected. Cows are able to develop immunity to these organisms, although they can still be infected for up to 3 weeks before the infection is cleared. A 'dirty' white vaginal discharge can occur 1-2 weeks after becoming infected at breeding time. Trichomonas and Campylobacter infections can cause early embryonic death or first trimester abortions. Campylobacter is occasionally associated with abortion during months 4-7 of gestation.

Agent Bacteria Leptospira spp.

Stage of Gestation usually affected

Means of spread

Comments

Third trimester (L. pomona) or anytime (other serovars) Listeria 2nd or more monocytogene commonly 3rd s trimester Ureaplasm Any? diversum Mycoplasma bovigenitalium

Water Duration of contaminated by efficacy of wildlife, or other currently available cattle (L. hardjo) vaccines is limited. Most commonly found in poorquality or spoiled silage. Infected animals Can be found in (esp. bulls) repro tracts of introduced into normal, healthy clean herds; cows. May cause poor AI practices abortion storms in previously uninfected herds. Calves may BVD viral vaccines become are commonly chronically available. infected prior to birth. May be introduced into the herd by an infected animal. Animal to animal Abortion is usually contact with in addition to other some aerosol disease spread. manifestations (pneumonia). IBR vaccines are

Viruses Bovine Virus Diarrhea

1st or 2nd trimester

Infectious 2nd or 3rd Bovine trimester Rhinotracheiti s

commonly available. Other Neospora caninum 2nd or 3rd trimester (often 4-5 months) Canines play a role in the transmission of Neospora. Animals that abort due to Neospora are at increased risk of aborting again. Does not usually cause abortion storms. A vaccine has recently become available.

Trichomonas foetus Campylobacte r fetus

1st trimester, occ. during 4-7 months (Campylobacte r)

Bulls are the main mode of transmission (esp. older ones). Infected cows can reinfect clean bulls. AI equipment may transmit infection

Who Is At Risk? Some women should not have a medical abortion. This includes women who:

Had the first day of their last period more than 4963 days ago (depending on the method) Have or might have an ectopic pregnancy. Have chronic adrenal failure. Have a seizure disorder that is not controlled. Take a medicine to thin their blood. Have a bleeding problem. Take certain steroid medicines.

Cannot attend all doctor visits or understand the effects of treatmen. Have an allergy to the medicines used. Do not have access to emergency care. Have an intrauterine device (IUD) in place.

A medical abortion may not be an option for women with severe liver, kidney, or lung disease, high blood pressure that is not well controlled, diseases of the heart and blood vessels or severe anemia. Women who find the process of medical abortion difficult may want to consider surgery. Do I Need Anyones Permission or Consent? Abortion has been legal in the United States since 1973. However, no doctor is required to perform an abortion. In some states, there are special legal requirements and waiting periods. For instance, most states require that minors get consent from their parents, tell their parent(s), or gain court approval before they can have an abortion. Risks Abortion is a lowrisk procedure. An early abortion has less risk than a later one. Fewer than 1 in 100 women have complications from an early abortion. For later abortions, up to 2 in 100 women have complications. Although an abortion is low risk, as with any surgery or medicine, problems may occur. Incomplete Abortion Although rare, in some cases the pregnancy is not removed completely. Bleeding and infection may occur. If the abortion is incomplete, the doctor may need to perform followup curettage. Infection An infection can occur if bacteria from the vagina or the cervix get into the uterus after an abortion. The doctor will prescribe drugs to prevent this and can treat the infection if it happens.

Hemorrhage Some bleeding after an abortion is normal. Bleeding is rarely heavy enough to require a blood transfusion. Damage to the Uterus During a surgical abortion, the tip of a device may pass through (perforate) the wall of the uterus or tear the cervix. If this happens, further surgery may be needed. Other organs, such as the bowel and bladder, also can be injured if this occurs. In these cases, surgery will be needed to repair the organ. The risk of perforation or tear of the cervix is less than 1 in 1,000 abortions. The risk increases with the length of the pregnancy. Death The risk of death from abortion is lower than 1 in 100,000 women who have suction curettage. For women who have a medical abortion, the risk of death is about 1 in 100,000. The risk of a woman dying from giving birth is at least 10 times greater than the risk from an early abortion. Afterward Effects after abortion vary. Many women have a wide range of feelings about having an abortion. It can be a stressful time. Some women may feel relieved, sad, or both at the same time. If unhappy feelings do not go away, counseling may be needed. Some side effects may occur with induced abortion:

Abdominal pain and cramping Nausea Vomiting Diarrhea Bleeding

In most cases, it is safe to resume normal activities after an abortion. The doctor will explain any limits to activity.

If any of these problems occur, it may be necessary to call the doctor:


Severe abdominal or back pain Bleeding that is heavier than a normal period Foulsmelling discharge A fever (above 100.4F)

Normal menstruation usually starts again 46 weeks after an abortion. Pregnancy is possible soon after the abortion, so birth control is needed right away. Choosing a method depends on many factors, such as age, health, and how likely it is to be used consistently and correctly. Among the most effective methods are birth control pills and the IUD. Condoms also should be used to prevent sexually transmitted diseases. Most doctors agree that one abortion does not affect future pregnancies. There have been reports that women who have an abortion have an increased risk of breast cancer. Recent studies have not found a link between abortion and breast cancer. Why a woman develops breast cancer is based on many other factors besides abortion. Family history, health habits, age, and number of pregnancies also seem to play a role. Finally . . . Having an abortion is a big decision that should be well thought out. The earlier you seek advice, the better. Get care as soon as possible. Make sure that all your questions are answered before, during, and after any procedure. Follow up with medical care, and use birth control if you do not want to become pregnant. Glossary. Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron. Anesthesia: Relief of pain by loss of sensation.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina. Ectopic pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes. Embryo: The developing fertilized egg from the time it implants in the uterus up to 8 completed weeks of pregnancy. Fetus: The developing offspring in the uterus from the ninth week of pregnancy until the end of pregnancy. Prostaglandin: A chemical that is made by the body that has many effects, including causing the muscle of the uterus to contract, usually causing cramps. Sedatives: Agents or drugs that ease nervousness or tension. Speculum: An instrument used to spread the walls of the vagina. Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus. Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy. Vagina: A tubelike structure surrounded by muscles leading from the uterus to the outside of the body.

Bibliography.

Gynecologists The American College of Obstetricians and Patient Education Pamphlet. [Book]. washington : [s.n.], 2011. - Vol. 1. http://www.pregnancy-calendars.org/diseases/abortion. http://len7288.hubpages.com/hub/Types-of-Abortion. http://pubs.ext.vt.edu/404/404-288/404-288.html. http://www.anael.org/english/abortion/ http://women.webmd.com/tc/abortion-reasons-womenchoose-abortion. http://www.acog.org/publications/patient_education/bp043 .cfm. http://medicineworld.org/obgyn/spontaneous-abortionmiscarriage.html. http://www.americanpregnancy.org/pregnancycomplicatio ns/miscarriage.html. http://theaetetus.tamu.edu/phil-111/notes/abortionnotes.html. http://www.jstor.org/pss/2172502. http://en.wikipedia.org/wiki/Abortion#cite_note-lancetgrimes-1. http://www.merriam-webster.com/dictionary/abortion. http://search.medicinenet.com/search/search_results/defa ult.aspx? Searchwhat=1&query=+ABORTION+NOTES&I1=Search. http://wholeworldinhishands.com/world/definition_of_abort ion.html