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Appendix B GLOSSARY ABORTION Abortion, Incomplete Abortion, Septic Abortion, Spontaneous The termination of a pregnancy before the fetus is viable, that is before the fetus is independently capable of sustaining extrauterine life. As generally used by the medical profession, abortion is the expul- sion or removal of a fetus weighing less than 500 grams. In the absence of known weight, an estimated length of gestation of less than 20 completed weeks, calculated from the first day of the last normal menstrual period may be used. Expulsion or removal of some but not all of the products of conception before a fetal weight of 500 grams is attained. This results in various degrees of continued bleeding. An incomplete abortion can result from an induced legal, illegal or spon- taneous abortion. An abortion in which the uterine cavity, and/or its contents, or other abdominal organs become infected. There are degrees of infection ranging from fever to septi- cemia. Septic abortion can result from an induced legal or spontaneous abortion, but probably most often results from illegally induced abortion. An abortion that occurs naturally, without being deliberately induced; also known by the non-medical term of miscarriage. Spontaneous abortion may be caused by such internal causes as hormonal imbalance or the presence of a defective fetus. External causes such as high fever, falling, other trauma, or psychological stress may likewise 132
133 cause spontaneous abortion. A woman can mis- carry in the first or second trimester. In the early part of the first trimester, mis- carriage may be accompanied by comparatively minor symptoms and may occur as a heavy menstrual flow. The woman may not even be aware that she was pregnant and has miscarried. Late first trimester or second trimester miscarriage will often be accom- panied by severe cramping and bleeding. Without medical attention, infection can result. Abortion, Therapeutic Therapeutic abortion was originally defined as an induced abortion required to save the life, or at the very least the health, of the pregnant woman. (A few states and physicians interpreted health to include mental well- being in addition to physical health.) In 1957, the American Law Institute redefined therapeutic abortion in its Model Abortion Law as follows: "A licensed physician is justified in terminating a pregnancy if he believes that there is substantial risk that continuance of the pregnancy would gravely impair the physical or mental health of the mother or that the child would be born with grave physical or mental defect, or that the pregnancy resulted from rape, incest or other felonious intercourse." The current definition used by the American College of Obstetricians and Gynecologists defines a therapeutic abortion as the interruption of pregnancy before the 20th completed week of gestation for legally acceptable or medically approved indications. These different definitions of therapeutic abortion evolved as the laws regulating abortion became less restrictive. The first definition was applicable nationwide until the late 1960s and early 1970s when several states adopted the American Law Institute Model Abortion Law. Since the January 1973 Supreme Court decision, abortion on request has been theoretically available to all women prior to the stage of fetal viability.
134 ABORTION RATE ABORTION RATIO AFTERBIRTH AMNIOCENTESIS AMNIOTIC FLUID AUTOSOMAL DISORDER BIRTH RATE CHROMOSOMAL ABNORMALITY CHROMOSOME COLPOTOMY DILATATION AND CURETTAGE The annual number of abortions per 1,000 women 15-44 years of age during a specified period of time. The number of abortions per 1,000 births occurring during the same period of time. A more accurate measurement is the number of abortions per 1,000 births occurring six months later. Some demographers employ this latter form of measurement. See Placenta. A procedure in which a needle is inserted through the abdominal wall into the uterine cavity of a pregnant woman and a sample of amniotic fluid is withdrawn. The cell and liquid components within the amniotic fluid are analyzed for constituents indicating fetal disease, sex; and fetal and lung maturity. This procedure is usually performed after 14 weeks of pregnancy under local anesthesia. The fluid within the amniotic sac that sur- rounds and cushions the fetus. A disorder due to a genetic defect in a chromosome other than the X or Y (sex) chromosome. The annual number of live births per 1,000 population (known as the crude birth rate). An abnormal chromosomal pattern resulting from the loss, duplication, or rearrangement of genetic material. A structure in the cell nucleus composed of nucleic acids and protein. The deoxyribonu- cleic acid (DNA) in chromosomes is responsible for the determination and transmission of all hereditary characteristics, including a wide variety of diseases. See Sterilization. See Methods of Abortion.
135 DOMINANT CONDITION DOWN'S SYNDROME (Mongolism) ECTOPIC PREGNANCY A genetic factor that must be acquired from only one parent to be expressed in the off- spring. Each conception has a 50 percent chance of being affected by a dominant genetic condition, whether it is a gene for brown eyes or for muscular dystrophy. .A disease due to the presence of an extra chromosome; instead of two number 21 chromo- somes, there are three. Women who become pregnant after age 35 have a higher proba- bility of conceiving a fetus with Down's syndrome. A child born with this syndrome is usually mentally retarded, suffers from the malformation of one or more vital organs, and has an accelerated aging process and reduced life expectancy. A pregnancy that results from the implanta- tion of a fertilized ovum (egg) outside the uterine cavity, usually in the fallopian tube and much more rarely in the abdominal cavity, ovary, or cervix. Such pregnancies frequently terminate by rupturing, and if appropriate medical care is not obtained, death may result. (See diagram below.) abdominal ovarian infundibular (ostial)
136 EMBOLISM Embolism, Pulmonary EMBOLUS EMBRYO ENDOMETRITIS ENDOMETRIUM FALLOPIAN TUBES FERTILITY RATE FETAL DEATH FETOSCOPY FETUS GENE The sudden blocking of a blood vessel obstructing the flow of blood. The obstructing material (embolus) is most often a blood clot, but may be a fat globule, air bubble (air embolism), piece of tissue or clump of bacteria. The obstruction of one or more of the pulmonary arteries, which are the blood vessels leading from the heart to the lungs. A clot of blood or plug of material that can obstruct the flow of blood in a vein or artery. The products of conception from two weeks after conception until approximately eight weeks development, at which time they are known as a fetus. This distinction between fetus and embryo is becoming less common. Inflammation of the endometrium, which is the mucous membrane that lines the cavity of the uterus. This is one of the more frequent forms of pelvic infection. The lining of the uterus. Two hollow muscular passages connected to both sides of the uterus that transport ova (eggs) from the ovaries to the uterine cavity. The annual number of births per 1,000 women of reproductive age, usually defined as age 15 to 44. A pregnancy beyond 500 grams weight which terminates in death of the fetus prior to birth. Direct visualization of a fetus in utero by means of a miniature lens attached to a needle inserted through the abdominal wall, or through the cervix. The products of conception from eight weeks development until birth. A biologic unit of heredity located on the chromosome. Acting with the environment and other genes it produces one or more charac- teristics of the organism.
137 GRAVID HEALTH HYSTEROTOMY HYSTERECTOMY IMPLANTATION INBORN ERROR OF METABOLISM INCOMPLETE ABORTION INFANT DEATH JURIDICAL INDICATION LAPAROSCOPE Laparoscopic Sterilization Pregnant. As defined by World Health Organization, "health is a state of complete physica1, mental and social well-being and not merely the absence of disease or infirmity." See Methods of Abortion. See Methods of Abortion and Sterilization. The attachment of the fertilized egg to the endometriura (the wall of the uterus) which usually occurs six to seven days after fertilization. A genetically determined biochemical disorder resulting in an enzyme defect that produces a metabolic block having pathological consequences. See Abortion, Incomplete. The death of a liveborn infant at any time from the moment of birth to the end of the first year of life. A legal term that denotes the condition or termination of a pregnancy resulting from rape or incest. An instrument with a series of lenses running the length of a long slender tube. When inserted into the abdominal cavity through a very small incision in the abdo- men, it permits visualization of the cavity for diagnosis of tumors or disease. Tubal ligation and other operative procedures can be performed through the laparoscope. See Sterilization. LEGAL TERMS Restrictive Legislation Legislation that prohibits all induced abortion oÂ£ only allows it to save the life of the pregnant woman, or to terminate a pregnancy resulting from rape or incest.
138 Moderately Restrictive Legislation Non-restrictive Legislation Legislation that permits abortions for various therapeutic reasons, e.g. to save the life or health of the woman, to preserve the woman's physical or mental health, to prevent the birth of a child with fetal defects, to terminate a pregnancy caused by rape or incest, or to comply with socio-economic needs for an abortion. Requirements such as psychiatric endorsements or the approval of more than one physician are generally needed. Legislation that allows abortion on request in the first trimester or permits abortion under such broad conditions that, in practice, it approximates abortion-on-request. In some countries, first-trimester abortion may be allowed only to save the life of the pregnant woman, but in other countries second-trimester abortion is permitted under certain extenuating circumstances such as age or parity of the woman. (Non-restrictive legisla- tion is also known as elective abortion or abortion-on-request.) METHODS OF ABORTION Dilatation and Curettage Hysterectomy Hysterotomy (Also known as D&C, surgical curettage or sharp curettage.) Induced abortion, usually performed in the first trimester by dilata- tion of the cervix as in suction, although usually to a larger diameter. The fetal and placental tissues are then scraped out with a curette, which resembles a small spoon. This method of abortion is performed in the first or second trimester. It removes the uterus either with the fetus inside or after the fetus is removed. It is usually performed only when a pathological condition of the uterus, such as fibroid tumors, warrants its removal or when a woman desires sterilization. Induced abortion performed in the first or second trimester. It involves surgical entry into the uterus, as in a cesarean section, that removes a fetus that is too small to survive even with extraordinary life support measures. It is usually performed only if other abortion procedures fail.
139 Menstrual Regulation Prostaglandin Abortion Saline Amniotic Fluid Exchange Suction (Also known as menstrual induction, menstrual extraction, or endometrial aspiration.) A type of suction abortion, usually performed five to six weeks after the last menstrual period (i.e. during the two week interval following the expected onset of a missed menstrual period). Current pregnancy tests are not accurate until six weeks after the first day of the last menstrual period. During the procedure, which usually does not require anesthesia or dilatation of the cervix, a flexible plastic tube is inserted into the uterine cavity through the cervix, connected either to a hand operated syringe or to an electric pump, and the contents of the uterus are suctioned out. A second-trimester abortion induced usually by injecting a prostaglandinâa substance with hormone-like activityâinto the uterine cavity through a needle inserted through the abdominal wall. (Other routes of application are being explored.) The interval between injection and expulsion of the fetus tends to be shorter than in a saline abortion. (Also known as saline abortion and intra- amniotic instillation.) The most frequently used second-trimester method of induced abortion, usually performed at or after 15 weeks of pregnancy. It entails withdrawing a portion of the amniotic fluid from the uterine cavity by a needle inserted through the abdominal wall and replacing this fluid with a concentrated salt solution. This process induces labor, which results in the expulsion of the usually dead fetus approxmately 24 to 48 hours later. (Also know as vacuum aspiration, or suction curettage.) Induced abortion usually per- formed in the first trimester. The cervical canal is dilated by the successive insertion of instruments of increasing diameter, called dilators. When the opening is large enough, a flexible tube (cannula) is inserted into the uterine cavity and the fetal and placen- tal tissue are then suctioned out by an electric vacuum pump.
140 MISCARRIAGE MODERATELY RESTRICTIVE LEGISLATION MONGOLISM MORTALITY RATE MORTALITY RATIO MULTIGRAVIDA MULTIPAROUS OR MULTIPARA NEONATAL NEONATAL DEATH NEURAL TUBE DEFECTS NON-RESTRICTIVE LEGISLATION NULLIPAROUS OVULATION OVUM OXYTOCIN See Abortion, Spontaneous See Legal Terms See Down's Syndrome. The annual number of deaths per 1,000 popula- tion. The number of deaths from a specific cause per 100,000 cases or procedures. In this report, abortion mortality ratio is used to refer to the number of deaths per 100,000 induced abortions. A woman who has been pregnant more than one time. A woman who is giving birth for the second or third time or who has given birth to two or more children. The term usually refers to a woman who has borne several children. Pertaining to the period in the infant's life from birth to the 28th day of life. The death of a live-born infant within 28 days of birth. Developmental defects of the central nervous system in a fetus, e.g., spina bifida. See Legal Terms A woman who has never given birth to a fetus over 500 grams. The release of an unfertilized egg from one of the ovaries which usually occurs approximately once a month in women during their reproductive years. The female reproductive cell or "egg" which is produced in the ovaries. A hormone that stimulates uterine contractions. It is sometimes used in saline abortion to hasten the expulsion of the fetus.
141 PARITY PAROUS PERINATAL PERINATAL DEATH PERITONEUM PERITONITIS PHENYLKETONURIA (PKU) PLACENTA POSTPARTUM A word used to indicate the number of children beyond 500 grams borne by a particular woman. High parity indicates a woman who has borne a large number of children and low parity is used to describe a woman who has had only one or two children. A woman who has given birth. The time period from approximately a fetal weight of 500 grams to the first 28 days after birth. Death of a fetus or newborn occurring during the period of time from a fetal weight of about 500 grams to 28 days after delivery. The membrane which lines the interior of the abdominal cavity and the organs contained therein. Inflammation of the peritoneum (the membrane which lines the interior of the abdominal cavity), attended by abdominal pain, vomiting, and fever. A hereditary recessive condition involving an inborn error of metabolism in which the metabolism of the amino acid phenylalanineâ a constituent of most proteinsâis blocked by a deficiency or defects in phenylalanine hydroxylase. This enzyme catalyzes the conversion of phenylalanine to tyrosine, another amino acid. Children born with this enzyme block are likely to become mentally retarded as phenylalanine accumulates in the brain. However, if recognized in time (as it can be by the routine testing of the urine or blood of newborn infants), a diet as free as possible of phenylalanine can mitigate most of the ill effects. The organ of metabolic interchange betwen the fetus and mother (also known as afterbirth). The woman provides nourishment and oxygen for the fetus through the placenta, which also aids elimination of carbon dioxide and nitro- genous waste from the fetus. Pertaining to, or occurring during, the period following childbirth and delivery.
142 PRODUCTS OF CONCEPTION PROSTAGLANDINS PROSTAGLANDIN ABORTION PSYCHIATRIC PSYCHOLOGICAL PUERPERAL DEATH PUERPERIUM PULMONARY EMBOLISM RECESSIVE CONDITION RESTRICTIVE LEGISLATION SALINE AMNIOTIC FLUID EXCHANGE SALPINGITIS SEPSIS This term includes all the organic/biological parts of the conceptus such as the fetus, placenta, amniotic fluid and cells, and the amniotic sac. These compounds, which are formed from fatty acids, are present in many human organs, with the highest concentration in human semen. They are known to have pharmacological effects on the reproductive system, causing contrac- tions of the uterus, as well as in the nervous, cardiovascular, respiratory, gastrointestinal and renal system. See Methods of Abortion. Referring to mental disturbance or illness. Referring in a general way to a patient's emotional or mental condition. Death of a woman due to the complications of pregnancy, labor or childbirth. The time period from the termination of labor to when the uterus regains its original size and shapeâusually defined as 42 days. See Embolism, Pulmonary. A condition in which the gene responsible for a particular hereditary disease must be obtained from both parents in order for the child to be affected. Both parents are carriers but are usually clinically unaffected. There is a 25 percent risk that each fetus or child of such a couple will be affected. See Legal Terms. See Methods of Abortion. Inflammation of a fallopian tube. It may lead to occlusion of a tube and if bilateral, to sterility. Infection caused by the presence of various microorganisms and/or their toxins which enter the bloodstream or tissues.
143 SEPTIC ABORTION SEPTICEMIA SEQUELA (SEQUELAE, pi.) SICKLE-CELL ANEMIA SPINA BIFIDA SPONTANEOUS ABORTION STERILIZATION Colpotomy Laparoscopic See Abortion, Septic The severest form of sepsis which results when the toxic bacteria and their poisons enter the bloodstream or other organs with the possi- bility that they will further multiply in the bloodstream. Results are usually high fever, chills, prostration, and possible death. Consequences, or aftereffects. This term is usually used to describe changes after a disease, injury, or medical procedure. An inherited recessive form of anemia due to production of abnormal hemoglobin which causes rapid destruction of red blood cells. In the U.S. sickle cell anemia is found predominantly among the Black population. An infant born with this disease suffers acute pain called sickle-cell "crises," anemia, jaundice, mal- functioning organs, leg ulcers, lowered resistance to infections, and sometimes death. A developmental defect in the boney vertebrae that normally encases and protects the spinal cord. See Abortion, Spontaneous Any surgical, chemical or radiological procedure by which an individual is made incapable of reproduction. A method of sterilization in which an incision is made in the vagina to gain access to the abdominal cavity. Tubal ligation may be performed through this incision. Hospital stay is minimal (some colpotomies are per- formed on an outpatient basis), and only five to fifteen minutes is normally required for the operation. A method of sterilization using a laparoscope, an instrument which enables the physician to look directly into the abdominal cavity to observe the abdominal organs and perform a method of tubal sterilization. The technique can be done on an outpatient basis under local or general anesthesia.
144 Hysterectomy Major abdominal surgery involving the removal of the uterus (but not necessarily the ovaries or fallopian tubes). Tubal Ligation Any method of surgery that either ties, blocks, cauterizes, cuts, or clips the fallopian tubes so that the egg which is released each month by the ovary cannot be reached and fertilized by the sperm. SUCTION See Methods of Abortion. TAY-SACHS DISEASE An inherited recessive disease due to an inborn error of metabolism in which lipids accumulate in the brain. It is most fre- quently found in Jews of Eastern European descent. An infant born with this disorder appears "normal" at birth but begins to deteriorate about age one, becoming blind and deaf, suffering from seizures, retarda- tion and spasticity. Death occurs before age five. THERAPEUTIC ABORTION See Abortion, Therapeutic. THROMBUS A clot of blood that forms in one of the blood vessels or cavities of the heart blocking the flow of blood. TUBAL LIGATION See Sterilization.