New, simple termination of pregnancy

Press, Volume CXIV, Issue 33426, 7 January 1974, Page 6

New, simple termination of pregnancy

'By

JANE C. BRODY)

HONOLULU. A new method of ending an unwanted pregnancy, developed by a psychologist, promoted by women's groups, and surrounded by intense medical controversy, is now being studied carefully by physicians throughout the world. The technique, a modification of the standard suction abortion, has many names, among them menstrual regulation. induction or extraction, endometrial aspiration, and mini-abortion. it is usually performed within two weeks of a missed menstrual period, a time when traditional pregnancy tests are often unable to detect conception According to participants in the First International Conference on Menstrual Regulation, which was held recently in Honolulu, the advantages of the method include its simplicity, rapidity, low cost, very low complication rate, and the fact that it can be performed in a doctor’s office by paramedical staff. "It is something we will be able to bring virtually into the rice paddy.” said a doctor from the Philippines, one of 50 countries represented at the three-day conference sponsored by the University of Hawaii. Menstrual regulation was used under field conditions by paraprofessionals to treat Bangladesh women who had. been raped by Pakistani soldiers during the civil war in 1971. The method is expected to be in use in j virtually all countries by the end of next year. According to Merle Goldberg. executive director of the National Women’s Health Coalition in New York, which did much to promote the method, menstrual-regulation

services are now available in 45 states at a maximum cost of $BO. ESSENCE OF METHOD The procedures differ from menstrual extraction, promoted by some feminist groups to shorten menstrual flow each month, whether the period is late or not. Doctors here regard the extraction procedure as unnecessary and dangerous. The essence of menstrual tegulation is the use of a narrow, flexible plastic suction curette, or cannula, developed by Harvey Karman, a Los Angeles psychologist. This disposable flexible' tube, which resembles a soda straw with two openings near a blunt, closed tip, is far less likely to damage the uterus than traditional hard metal curettes, doctors at Honolulu reported. Flexible cannulas have begun to replace metal ones in suction abortions performed up to 10 weeks of pregnancy, enhancing the safety of the procedures. The cannula is inserted through the cervix into the uterus and attached to a vacuum source — either a low-cost plastic syringe, a manually-operated pump, or a standard electric suction pump. The flexible cannula, when used in the early weeks of pregnancy usually requires little or no stretching of the cervical opening, thus minimising pain and the need for anaesthesia, reported Dr Malcolm Potts, director of i the International Planned Parenthood Federation in ' London. •LUNCH-HOUR ABORTION’ He said that the vast majority of patients were able to go about their normal activities within minutes of the procedure, a fact that has led to its being known as “lunch-hour abortion.” To date, studies involving thousands of menstrual regulation procedures performed

under a variety of conditions here and abroad indicate that | major complications are virtually non-existent and minorl ones occur one-tenth to onehundredths as often as with ordinary suction abortions. Accordingly, said Dr Alan J. .Margolis, obstetrician-gynal-cologist at the University of California in San Francisco, it is not necessary to keep elaborate emergency equipment on hand or to do extensive laboratory tests before a menstrual regulation procedure. Dr Richard J. Scotti, who works With Dr Karman at the Women's Community Service Centre in West Los Angeles, said that eight paraprofessionals had beer} trained there to do menstrual regulation. Paraprofessionals are also being trained at Western Pennsylvania Hospital in Pittsburgh. Despite these apparent advantages, menstrual regulation remains locked in controversy in some quarters and surrounded by many unresolved questions. QUESTIONS RAISED Questions raised at the Honolulu meeting include the following: Should menstrual regulation be performed on patients who have a negative pregnancy test, or should the women be urged to wait until I about two weeks after the missed period (the sixth week of pregnancy) when pregnancy tests are far more ■ accurate? When performed

within the.first two weeks. ■ about half the women turn 'out not to have been preg- x nant. The method is also more likely to fail to end an existing pregnancy when it is performed very early. What, if any, are the longterm complications of menstrual regulation, and how often can the procedure be safely repeated? Women ' with irregular periods or those who are extremely | anxious about the possibility of pregnancy might seek the procedure several times a ■year. ' Should there be such a great difference in price between menstrual regulations and other suction abortions performed later in pregnancy?; Several doctors — including Dr Jane Hodgson of Preterm.. an abortion clinic in Wash-! Jngton, D.C. — said that the; extreme price differential; ■ encouraged many women to I undergo menstrual regulation! when they really did not' ■ need it, instead of waiting to I be sure they are pregnant. PERPLEXING QUESTION But perhaps the most perplexing question remaining at the end of the conference was what menstrual regulation should be called. While some participants objected to what they regard as a euphemism for abortion,! others suggested that the! name would have to differ; from country to country, de- 1 pending upon the legal status of abortion and its social and religious acceptability. — Copyright, 1974, New York Times News Service.