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Menstrual extraction
Correspondence 235
Volume 153 Number 2
6.
7. 8.
9.
Thomas DB. Method of delivery and developmental outcome at five years of age. Med J Aust 1979; 1:301. O'Driscoll K, Meagher D, MacDonald D, Geoghegan F. Traumatic intracranial haemorrhage in firstborn infants and delivery with obstetric forceps. Br J Obstet Gynaecol 1981;88:577. Chiswick ML, James DK. Kielland's forceps: association with neonatal morbidity and mortality. Br Medj 1979; 1:7. Chiswick ML. Forceps delivery: neonatal outcome. In: Beard RW, Paintin DB, eds. Outcomes of obstetric intervention in Britain. London: Royal College of Obstetricians and Gynaecologists, 1980. Traub AI, Morrow RJ, Ritchie JWK, Dornan KJ. A continuing use for Kielland's forceps? Br J Obstet Gynaeol l 984;91:894.
Reply To the Editors:
The stridency of Mr. Kadar's letter has enveloped him in the fallacy of ignoratio elenchi by which he attempts to undermine the results of our study by using arguments dealing with issues either not addressed or irrelevant. The only matter on which he is perhaps on more logically acceptable grounds is that pertaining to the limited number of controlling factors invoked for the case-matching process. Although they constitute more than any heretofore used, it is patently clear that they are not all-encompassing. To rail against universally accepted basic statistical design and principles, however, is hardly fitting. As indicated in the paper, the report is merely a small part of a much larger study in which the fetal impact of a very large number of risk factors (2441 in all) is being examined by a series of more sophisticated analytic techniques, including logistic regression modeling. As this mammoth investigation nears completion, it appears the results will be the same. Given the closely held biases expressed in the letter, even that may not be enough to convince. Emanuel A. Friedman, M.D. Department of Obstetrics and Gynecology Beth Israel Hospital 300 Brookline Avenue Boston, Massachusetts 02215 Menstrual extraction
caust was in part brought about in our land by linguistic perversions such as "menstrual extraction" and "she has a right over her own body." Marshall D. Matthews, M.D. 840 Hill Avenue Moses Lake, Washington 98837
Reply To the Editors:
Menstruation is defined as a periodic hemorrhage arising from the endometrium. Infrequent, irregular menstruation (oligomenorrhea) and vaginal bleeding in ovulatory women are also considered menses notwithstanding the fact that, etymologically, the Latin root means monthly. Menstrual induction has for some time been the accepted term for describing a suction aspiration curettage in women with delayed menses because proof of pregnancy was not always needed or forthcoming. Several other similar terms have been invoked to describe this procedure, such as menstrual extraction, menstrual regulation, and menstrual aspiration. At the present time, menstrual extraction or induction is used to describe a pregnancy termination that does not require extensive surgical manipulation (that is, cervical dilatation). In our study we merely reported our findings with use of prostaglandin F20 instead of suction aspiration. As clearly stated in the title, the medication was given to women known to be pregnant (postconceptional). In the section on material and methods, we specified that a positive pregnancy test was a prerequisite for including subjects. At no time was it our intention to mislead any reader. We are certain we have not done so. Clarity and consistent terminology facilitate communication and understanding. Inflammatory shibboleths (for example, abortion holocaust) do not. Max Borten, M.D. Emanuel A. Friedman, M.D., Sc.D. Department of Obstetrics and Gynecology Harvard Medical School Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts 02215
To the Editors:
I want to draw your attention to the incorrect title given to an article by Borten and Friedman on the use of prostaglandins for performing early abortions (Postconceptual induction of menses with double prostaglandin F2• impact. AM J 0BSTET GYNECOL 1984; 150: 1006). Menstrual flow is not the result of postconception prostaglandin use. The result is the expulsion and death of a human embryo. Whatever your moral position on abortion (if any), you owe your readers at least a dedication to the proper use of language-because failure results in faulty communication and subjects your readers to influences other than the intrinsic persuasion of scientific truth. It need hardly be pointed out that the abortion halo-
Placentas of small-for-dates infants from Mexico City, Mexico
To the Editors:
I have read with great interest the paper by Davies et al. (AMJ OBSTET GYNECOL 1984;149:731) in which they report an increased number of villi with fibrinoid necrosis as well as a higher frequency of atherosis in placentas from cases of intrauterine growth-retarded infants with marginal insertion and a normal or thick cord. These infants had the most severe growth retardation and, their mothers experienced a higher frequency of preeclampsia. In this study of small numbers, the authors did not find one case of villitis.
Volume 153 Number 2
6.
7. 8.
9.
Thomas DB. Method of delivery and developmental outcome at five years of age. Med J Aust 1979; 1:301. O'Driscoll K, Meagher D, MacDonald D, Geoghegan F. Traumatic intracranial haemorrhage in firstborn infants and delivery with obstetric forceps. Br J Obstet Gynaecol 1981;88:577. Chiswick ML, James DK. Kielland's forceps: association with neonatal morbidity and mortality. Br Medj 1979; 1:7. Chiswick ML. Forceps delivery: neonatal outcome. In: Beard RW, Paintin DB, eds. Outcomes of obstetric intervention in Britain. London: Royal College of Obstetricians and Gynaecologists, 1980. Traub AI, Morrow RJ, Ritchie JWK, Dornan KJ. A continuing use for Kielland's forceps? Br J Obstet Gynaeol l 984;91:894.
Reply To the Editors:
The stridency of Mr. Kadar's letter has enveloped him in the fallacy of ignoratio elenchi by which he attempts to undermine the results of our study by using arguments dealing with issues either not addressed or irrelevant. The only matter on which he is perhaps on more logically acceptable grounds is that pertaining to the limited number of controlling factors invoked for the case-matching process. Although they constitute more than any heretofore used, it is patently clear that they are not all-encompassing. To rail against universally accepted basic statistical design and principles, however, is hardly fitting. As indicated in the paper, the report is merely a small part of a much larger study in which the fetal impact of a very large number of risk factors (2441 in all) is being examined by a series of more sophisticated analytic techniques, including logistic regression modeling. As this mammoth investigation nears completion, it appears the results will be the same. Given the closely held biases expressed in the letter, even that may not be enough to convince. Emanuel A. Friedman, M.D. Department of Obstetrics and Gynecology Beth Israel Hospital 300 Brookline Avenue Boston, Massachusetts 02215 Menstrual extraction
caust was in part brought about in our land by linguistic perversions such as "menstrual extraction" and "she has a right over her own body." Marshall D. Matthews, M.D. 840 Hill Avenue Moses Lake, Washington 98837
Reply To the Editors:
Menstruation is defined as a periodic hemorrhage arising from the endometrium. Infrequent, irregular menstruation (oligomenorrhea) and vaginal bleeding in ovulatory women are also considered menses notwithstanding the fact that, etymologically, the Latin root means monthly. Menstrual induction has for some time been the accepted term for describing a suction aspiration curettage in women with delayed menses because proof of pregnancy was not always needed or forthcoming. Several other similar terms have been invoked to describe this procedure, such as menstrual extraction, menstrual regulation, and menstrual aspiration. At the present time, menstrual extraction or induction is used to describe a pregnancy termination that does not require extensive surgical manipulation (that is, cervical dilatation). In our study we merely reported our findings with use of prostaglandin F20 instead of suction aspiration. As clearly stated in the title, the medication was given to women known to be pregnant (postconceptional). In the section on material and methods, we specified that a positive pregnancy test was a prerequisite for including subjects. At no time was it our intention to mislead any reader. We are certain we have not done so. Clarity and consistent terminology facilitate communication and understanding. Inflammatory shibboleths (for example, abortion holocaust) do not. Max Borten, M.D. Emanuel A. Friedman, M.D., Sc.D. Department of Obstetrics and Gynecology Harvard Medical School Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts 02215
To the Editors:
I want to draw your attention to the incorrect title given to an article by Borten and Friedman on the use of prostaglandins for performing early abortions (Postconceptual induction of menses with double prostaglandin F2• impact. AM J 0BSTET GYNECOL 1984; 150: 1006). Menstrual flow is not the result of postconception prostaglandin use. The result is the expulsion and death of a human embryo. Whatever your moral position on abortion (if any), you owe your readers at least a dedication to the proper use of language-because failure results in faulty communication and subjects your readers to influences other than the intrinsic persuasion of scientific truth. It need hardly be pointed out that the abortion halo-
Placentas of small-for-dates infants from Mexico City, Mexico
To the Editors:
I have read with great interest the paper by Davies et al. (AMJ OBSTET GYNECOL 1984;149:731) in which they report an increased number of villi with fibrinoid necrosis as well as a higher frequency of atherosis in placentas from cases of intrauterine growth-retarded infants with marginal insertion and a normal or thick cord. These infants had the most severe growth retardation and, their mothers experienced a higher frequency of preeclampsia. In this study of small numbers, the authors did not find one case of villitis.