The problems of interpreting legislation concerning abortion are discussed. Legislation permitting abortion has tried to accommodate the needs of pregnant women while maintaining a standard of decency. Abortion was originally performed with no moral qualms by physicians when it was ''necessary'' to save the mother's medical health, although the operation may have been personally unpleasant for the doctor to perform. Through the years and the various amendments (in 1939 and 1956) of the 1937 Danish abortion law, the word ''necessary'' was interpreted differently and the conception of ''health'' expanded to include psychiatric and social factors as well as physical ones. This left much of the decision concerning the suitability of abortion up to the physician, psychiatrist, or counselor. This, plus various financial pressures caused by the compensation system set up by the federal government for abortion, caused the state to lose revenue, since they still had to pay if a patient from their district went to another hospital with more relaxed stanards to abtain an abortion. The absence of a stanard definition for when life begins had created difficulties. The liberalization of the abortion law had caused rather farfetched psychosocial reasons for abortion and has contributed to a laxity in the use of contraceptives. Often surgeons performing the operations are blamed for mortalities due to abortion, while those who recommended the abortion or approved it are blameless. Some compromise must be reached between the unwillingness of the surgeon to spend most of his time performing abortions and the freedom for women to have them. Responsibility is the answer; women should seek abortion only when necessary, and it should be granted only when necessary, which requires responsibility on the part of the patient, the counselors, and the surgeons.
At the Department of Obstetrics and Gynecology in Helsingborg, the experience has differed somewhat from what was found at Silkeborg Central Hospital in Denmark concerning vacuum aspiration tissue. The amount of tissue aspiration from 1902 patients was investigated in the same way. In agreement with the Danish authors, it is concluded that a relationship exists between tissue quantity and gestational age and that a range exists in the various groups, though not to the same extent as they found. The mean quality of tissue taken from 1902 was measured and then the range in 488 patients from the previous year was studied. 8 reevacuations were performed, all with primarily less tissue than expected and all with placental tissue on the 2nd occasion. 9 of 33 patients with an infection postabortum also had less tissue than expected. The total infection rate was 6.3%. 1 case of ectopic pregnancy was found, accidentally discovered at sterilization performed on the same occasion as the vacuum aspiration. In sum, a definite relationship was found between tissue quantity and gestional age, but the range in tissue quantity was not to the same extent as with the Danish material.
During 1983, 823 first trimester therapeutic abortions were performed at the University Hospital of Trondheim, Norway. Of these patients, 229 had an IUD inserted at the end of the operative procedure. The remaining 594 patients served as controls. Microbiological samples were taken from the cervix and the urethra. No prophylactic antibiotic treatment was given. Compared to the group of patients not selecting an IUD as contraception, there was no increase in readmission frequency due to immediate postabortal IUD insertion. There were no positive cultures for N. gonorrhoeae, and the relative number of positive chlamydia cultures was the same in both groups. In the IUD group we did not find any increase in complications such as bleeding, pain, perforations or infections. During the first year of observation, 3 pregnancies occurred in the IUD group, giving a Pearl index of 1.3 pregnancies per year. Continuation rate after one year was 72.8%. We recommend immediate postabortal insertion of an IUD after first trimester abortion as a practical and safe procedure.