Towards the disappearance of therapeutic abortion

Therapeutic abortions are defined as abortions performed on women whose health or lives would be gravely threatened by the maintenance of pregnancy. The indications for therapeutic abortions have been progressively reduced over the past 4 decades because of progress in treating various pathologic states better prenatal care increased use of contraception to prevent undesirable pregnancies and occasionally the refusal of women at high risk who want a child at any cost to terminate their pregnancies. Among 314 protocols for medical abortions sent to the Council of the Order of Physicians between 1971-80 149 referred to therapeutic abortions in the strict sense. Neuropsychiatric indications accounted for 68 therapeutic abortions in 30 cases for neurologic causes such as cerebral tumors cerebrovascular accidents and various neurologic traumas and maladies especially sclerosis and related conditions. 28 therapeutic abortions were performed for psychiatric causes including schizophrenia suicidal depression and profound disturbances. 11 of 19 therapeutic abortions for cardiovascular indications were for valvulopathies but such indications are becoming unusual because of medical progress. In many cases cardiac surgery rather than contraindicating pregnancy now seems to make it possible to bring a pregnancy to term. A few formal contraindications to pregnancy still remain among cardiac patients such as congenital cyanogenic cardiopathy with pulmonary hypertension. Nephrologic indications accounted for 19 therapeutic abortions but in the past decade they have become more unusual. Today it is not unusual for women with kidney transplants to have term pregnancies. Although 4 diabetics with retinopathy and renal insufficiency had therapeutic abortions at present diabetics who are followed carefully and correctly managed can have term pregnancies. In cases of undisciplined patients lacking proper medical care a therapeutic abortion may be advisable. The problem of cancer during pregnancy occurs rarely. Pregnancy during cancer treatment has become unusual because of better contraceptive surveillance among women under treatment. In most cases cancer is not aggravated by pregnancy and it is usually possible to provide complete cancer treatment while preserving the pregnancy. There are rare cases in which pelvic radiation or chemotherapy with a teratogenic risk make therapeutic abortion advisable.