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Background Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion. Methods Retrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011–2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care. Results There were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 – 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 – 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 – 17.4). Conclusions Reversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.

This study compares the performances of four physicians using two types of plastic cannulae (flexible and rigid) for 1100 vacuum aspiration procedures. The criteria for assessing physician performance by cannula type were: (a) frequency of cannula obstructions, (b) amount of retained tissue obtained by sharp curettage after vacuum aspiration, (c) estimated blood loss during the procedure and (d) time required to perform the procedure. Data for each physician were compared and yielded significantly different results. The length of time required to use the cannula differed significantly among physicians; two of them had significantly shorter cannula times with the flexible instrument. The others had the lowest distributions of blood loss and the most difference between cannula usage. Consistent grouping over several variables suggests that differences in these criteria are more likely to be attributable to subtle distinctions in operator technique than to variations in equipment.

Warning against Excision of the Patella for Recurrent Dislocation SIR.-Recently Mr. Ralph Brooke published' 2 and showed the results of excision of the fractured patella. Since that time I have seen two cases in which different surgeons had removed the patella for recurrent dislocation. In each the symptoms of recurrent dislocation of the extensor apparatus continued after the operation. Case 1.-A maidservant, aged 23, had begun six years previouslv to suffer from attacks of locking of the left knee with outward displacement of the kneecap. The patella had been excised on this account thirteen months before I saw her. A month after operation the attacks of locking had returned, with all their previous characteristics, except that the patella itself was absent. Elmslie's operation of realignment of the extensor apparatus was performed five months ago, and there has been no recurrence of the symptoms since. Case 2.-A girl, aged 16, a leather worker, had first experienced giving way of the right knee, with locking, two years before. This had continued to happen about once a week, sometimes in bed, and she had discovered that the event was accompanied by outward displacement of the kneecap. Reduction would be achieved by a kicking movement. She had been treated at first with a walking caliper and later by excision of the patella. Six or seven weeks after the operation the symptoms had returned, attacks occurring with about the same frequency as before. Realignment of the extensor apparatus has been advised. Neither patient showed knock-knee or any radiological abnormality of the external femoral condyle. This note is written as a matter of urgency, in the hope that surgeons contemplating removal of the patella for recurrent dislocation will be dissuaded, and perform rather a physiological operation of realignment of the extensor apparatus on the lines of Elmslie's' operation.-I am, etc., H.

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