Abortion occurs during double fertilisation and ovule development in Paeonia ludlowii

Paeonia ludlowii, a rare and endangered species, is indigenous to Tibet, China and propagated only by seed. Its natural reproduction is constrained by low fecundity. Excess seed abortion is a key factor restricting its natural reproduction, cultivation, introduction, and protection. In this study, we examined the characteristics of aborted ovules, developmental differences after flowering of normal and aborted ovules, and their ratios at different positions in P. ludlowii ovary. During pollination, fertilisation, and seed development, ovule abortion was frequent, with a random abortion position. There were four types of abortion, namely, abnormal pistil, sterile ovules, abnormal embryo sac, embryo and endosperm abortions. Of these, embryo and endosperm abortions could be divided into early abortion, middle abortion, and late abortion. The early aborted ovules stopped growing on day 12, the endoblast and endosperm in the embryo sac aborted gradually. Furthermore, the shape of the embryo sac cavity changed. The volume of aborted ovules was significantly different from that of fertile ovules. At ripening, the external morphology of different types of aborted seeds was significantly different.

An Exceptional Case of Uterine Rupture on a Scarred Uterus Discovered Following a Late Abortion

Uterine rupture (UR) is a life-threatening peripartum complication with a high incidence of maternal morbidity and mortality. It is quite common in the third trimester of pregnancy ranging from 1 / 8,000 to 1 / 15,000 pregnancies. Its true incidence in the first trimester is unknown as most of the reports are case reports or small series of cases. We report an exceptional case of uterine rupture at 13 weeks of amenorrhea in a 34-year-old patient with a history of a cesarean delivery 2 years ago, discovered following a late abortion due to persistent bleeding and failure of aspiration. Through this observation we would like to draw the attention of practitioners to this diagnosis, which is often overlooked in the first trimester.

Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature

Brain injury of the surviving twin from monochorionic pregnancies following intrauterine fetal demise during the second and third trimesters is a rare but severe complication. Monochorionicity and gestational age at the time of stillbirth seem to be decisive factors in terms of long-term neurologic outcome prediction for the survivor. Magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) in particular, seem to bring the earliest and most accurate diagnosis. Ultrasound detection of brain damage is possible in later stages of fetal brain injury. It is essential to provide early diagnosis and multidisciplinary counsel to the parents to ensure informed decision making. For couples who choose to terminate pregnancy legislation related to late abortion might lead to further distress. Our paper aims to stress the importance of MRI DWI in the evaluation of surviving twins following single intrauterine fetal demise in monochorionic pregnancies and the delicate context of the medical professionals and parents facing this clinical situation, sometimes complicated by legal constraints.

THU0562 ECONOMIC IMPACT ASSOCIATED WITH COMPLICATIONS OF WOMEN IN REPRODUCTIVE AGE LIVING WITH INFLAMMATORY IMMUNE-MEDIATED DISEASES (PSO, PSA, RA, AXSPA) IN SPAIN

Background:Cost of the complications that may appear during reproductive age in women living with inflammatory immune-mediated diseases have scarcely been studied.Objectives:To obtain an expert consensus in the use of resources associated to complications of women in reproductive age living with immune-mediated diseases: psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) and estimate an economic impact.Methods:A cost-analysis was developed to estimate the impact associated with the complications of women of reproductive age with PSO, PsA, RA and axSpA.The analysis considered the complications during fertility and conception (preconception consultation and assisted reproduction), in pregnancy (miscarriage in the first trimester, late abortion in the second trimester, preeclampsia, delayed or restricted intrauterine growth and threat of premature delivery) and in the postpartum (admissions in neonatology of premature infants).An online questionnaire was designed for the validation of the inputs used in the cost-analysis. Subsequently, the questionnaire was sent to a multidisciplinary panel composed of, rheumatologist, gynecologists, neonatologists and dermatologist. A consensus meeting was carried out to validate and agree the parameters used in the analysis.Unitary cost for resources (€,2019) were obtained from national local databases.The perspective of analysis was the National Healthcare System and the time horizon was one year.Results:During fertility and conception, an annual cost per patient of € 229 was estimated for a preconception consultation in a patient with PSO, of € 3,642 for a preconception consultation in patients with PsA, RA and axSpA and € 4,339 for assisted reproduction.Women with complications in pregnancy had an annual cost per patient of € 1,214 for a miscarriage in the first trimester, € 4,419 for a late abortion in the second trimester, € 11,251 for preeclampsia € 3,183 for delayed or restricted intrauterine growth and € 12,122 for the threat of premature delivery.In the postpartum complications, an annual cost per patient of € 120,364, € 44,709 and € 5,507 were estimated associated with admissions in neonatology of premature infants of <28 weeks, from 28 to 32 weeks and from 33 to 37 weeks, respectively.Conclusion:This modeling provides insight on the economic burden of complications associated with women in reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.Disclosure of Interests:Julia Martínez-Barrio Consultant of: UCB Pharma, Olga Villar Consultant of: UCB Pharma, Oníca Armijo Consultant of: UCB Pharma, María Castellanos Consultant of: UCB Pharma, Natalia Marín Huarte Consultant of: UCB Pharma, María Mareque Consultant of: UCB Pharma, Miguel Angel Casado Consultant of: UCB Pharma, Nuria Martínez Consultant of: UCB Pharma

Accommodating conscientious objection in the midwifery workforce: a ratio-data analysis of midwives, birth and late abortions in 18 European countries in 2016

Background In recent years the role of a midwife has expanded to include the provision of abortion related care. The laws on abortion in many European countries allow for those who hold a conscientious objection to participating to refrain from such participation. However, some writers have expressed concerns that this may have a detrimental effect on the workforce and limit women’s access to the service. Method The aim of this study was to provide a picture of the potential exposure midwives in Europe have to late abortions, an important factor in the integration of accommodation of conscientious objection to abortion by midwives into workload planning. We collected data from Ministries of Health or government statistical departments in 32 European countries on numbers of: births, abortions, late abortions and midwives in 2016. We conducted a ratio-data analysis in those countries that met the inclusion criteria. Results 18 of the 32 countries provided full data thus our calculations are based on a total of 4,036,633 live births, 49,834 late abortions and a total of 132,071 midwives. The calculated ratios of live births to midwife, abortions to midwife and late abortions to midwife illustrate the wide variations between countries in relation to ratios of midwives to live births (15.22 - 53.99) and late abortions, (0.17-1.47) Conclusions This study provides the first comprehensive insight to ratios relating to birth and abortion, especially late abortion services, with regard to the midwifery workforce. It is essential to improve the reporting of abortion data and access to it within Europe to support evidence-informed decisions on optimising the contribution of the midwifery workforce especially within highly contentious fields such as abortion services. The study’s findings suggest that there should be neither be any difficulty for those who are responsible for workload allocation nor compromises to a women’s right to abortion services.

Accommodating conscientious objection in the midwifery workforce: a ratio-data analysis of midwives, birth and late abortions in 18 European countries in 2016

Background In recent years the role of a midwife has expanded to include the provision of abortion related care. The laws on abortion in many European countries allow for those who hold a conscientious objection to participating to refrain from such participation. However, some writers have expressed concerns that this may have a detrimental effect on the workforce and limit women’s access to the service. Method The aim of this study was to provide a picture of the potential exposure midwives in Europe have to late abortions, an important factor in the integration of accommodation of conscientious objection to abortion by midwives into workload planning. We collected data from Ministries of Health or government statistical departments in 32 European countries on numbers of: births, abortions, late abortions and midwives in 2016. We conducted a ratio-data analysis in those countries that met the inclusion criteria. Results 18 of the 32 countries provided full data thus our calculations are based on a total of 4,036,633 live births, 49,834 late abortions and a total of 132,071 midwives. The calculated ratios of live births to midwife, abortions to midwife and late abortions to midwife illustrate the wide variations between countries in relation to ratios of midwives to live births (15.22 - 53.99) and late abortions, (0.17-1.47) Conclusions This study provides the first comprehensive insight to ratios relating to birth and abortion, especially late abortion services, with regard to the midwifery workforce. It is essential to improve the reporting of abortion data and access to it within Europe to support evidence-informed decisions on optimising the contribution of the midwifery workforce especially within highly contentious fields such as abortion services. However, given our findings, we believe that there should be neither be any difficulty for those who are responsible for workload allocation nor compromises to a women’s right to abortion services.

Controversies in applying the Abortion Act to Down syndrome

Recently published data from the UK pointed out that the number of abortions performed under Ground E of the Abortion Act 1967, which allows abortion for foetal abnormalities, was far lower compared to the number of pregnancy terminations where foetuses had Down syndrome. This prompted calls for the matter to be rectified. This article explores the issues raised and argues that rather than being a concern; the discrepancy is consistent with moral uncertainty or a non-judgmental approach. This is, perhaps fortuitously, in tune with recognized conceptualizations of functioning ability. Debate about what constitutes substantial risk may be resolved in those conditions where a diagnosis can be confirmed. But clinical presentations of those affected can vary and there is no necessary link between functional abilities and suffering. Despite the ambiguities, some practitioners have resolved in favour of late abortion in pregnancies with Down syndrome. It is tempting to develop inferences from these cases, but advancing a convincing argument that may encompass all affected cases requires agreement on underpinning assumptions. Given the polarized debate in this area, it is perhaps best to acknowledge the reality of diverse ethical viewpoints.