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Anesthesia for Medical Termination of Pregnancy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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White K, Grossman D, Stevenson AJ, Hopkins K, Potter JE. Does information about abortion safety affect Texas voters' opinions about restrictive laws? A randomized study. Contraception 2017; 96:381-387. [PMID: 28867442 DOI: 10.1016/j.contraception.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to assess whether information about abortion safety and awareness of abortion laws affect voters' opinions about medically unnecessary abortion regulations. STUDY DESIGN Between May and June 2016, we randomized 1200 Texas voters to receive or not receive information describing the safety of office-based abortion care during an online survey about abortion laws using simple random assignment. We compared the association between receiving safety information and awareness of recent restrictions and beliefs that ambulatory surgical center (ASC) requirements for abortion facilities and hospital admitting privileges requirements for physicians would make abortion safer. We used Poisson regression, adjusting for political affiliation and views on abortion. RESULTS Of 1200 surveyed participants, 1183 had complete data for analysis: 612 in the information group and 571 in the comparison group. Overall, 259 (46%) in the information group and 298 (56%) in the comparison group believed that the ASC requirement would improve abortion safety (p=.008); 230 (41%) in the information group and 285 (54%) in the comparison group believed that admitting privileges would make abortion safer (p<.001). After multivariable adjustment, the information group was less likely to report that the ASC [prevalence ratio (PR): 0.82; 95% confidence interval (CI): 0.72-0.94] and admitting privileges requirements (PR: 0.76; 95% CI: 0.65-0.88) would improve safety. Participants who identified as conservative Republicans were more likely to report that the ASC (82%) and admitting privileges requirements (83%) would make abortion safer if they had heard of the provisions than if they were unaware of them (ASC: 52%; admitting privileges: 47%; all p<.001). CONCLUSIONS Informational statements reduced perceptions that restrictive laws make abortion safer. Voters' prior awareness of the requirements also was associated with their beliefs. IMPLICATIONS Informational messages can shift scientifically unfounded views about abortion safety and could reduce support for restrictive laws. Because prior awareness of abortion laws does not ensure accurate knowledge about their effects on safety, it is important to reach a broad audience through early dissemination of information about new regulations.
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Affiliation(s)
- Kari White
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave. South RPHB 320, Birmingham, AL, 35294.
| | - Daniel Grossman
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100,Oakland, CA, 94612
| | - Amanda Jean Stevenson
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, UCB 327 Ketchum 195, Boulder, CO 80309
| | - Kristine Hopkins
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
| | - Joseph E Potter
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
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Taylor D, Upadhyay UD, Fjerstad M, Battistelli MF, Weitz TA, Paul ME. Standardizing the classification of abortion incidents: the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework. Contraception 2017; 96:1-13. [PMID: 28578150 DOI: 10.1016/j.contraception.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/30/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. STUDY DESIGN As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. RESULTS The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). CONCLUSIONS Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. IMPLICATIONS The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first-trimester aspiration abortion procedures. Standardization will assist healthcare providers, researchers and policymakers to anticipate morbidity and prevent abortion adverse events, improve care metrics and enhance abortion quality.
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Affiliation(s)
- Diana Taylor
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, and School of Nursing, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612.
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Mary Fjerstad
- National Abortion Federation, 1090 Vermont Avenue NW #1000, Washington, DC 20005
| | - Molly F Battistelli
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Tracy A Weitz
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Maureen E Paul
- Beth Israel Deaconess Medical Center, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
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Topfedaisi Özkan N, Erkan Sarı M, Görkem Ü, Bayramoğlu H, Akbay S, Mutlu Meydanlı M, Güngör T. Iatrogenic implantation of placental tissue after first trimester dilatation and curettage presenting as a uterine mass: A report of two cases. J OBSTET GYNAECOL 2017; 37:801-803. [PMID: 28325128 DOI: 10.1080/01443615.2017.1286301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nazlı Topfedaisi Özkan
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Mustafa Erkan Sarı
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Ümit Görkem
- b Department of Obstetrics and Gynecology , Faculty of Medicine, Hitit University , Çorum, Turkey
| | - Hatice Bayramoğlu
- c Zekai Tahir Burak Women Health Education and Research Hospital, Pathology Department , Ankara, Turkey
| | - Serap Akbay
- c Zekai Tahir Burak Women Health Education and Research Hospital, Pathology Department , Ankara, Turkey
| | - Mehmet Mutlu Meydanlı
- a Zekai Tahir Burak Women's Health , Education and Research Hospital, Gynecologic Oncology Unit , Ankara, Turkey
| | - Tayfun Güngör
- b Department of Obstetrics and Gynecology , Faculty of Medicine, Hitit University , Çorum, Turkey
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Kaneshiro B, Tschann M, Jensen J, Bednarek P, Texeira R, Edelman A. Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated patients: a case series. Contraception 2017; 96:14-18. [PMID: 28288789 DOI: 10.1016/j.contraception.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe estimated blood loss (EBL) with surgical abortion ≤14 weeks' gestation in anticoagulated patients. STUDY DESIGN We invited 170 clinicians involved in a professional listserv to report cases when they performed a surgical abortion on a patient ≤14 weeks' gestation taking an anticoagulant. Clinicians reported EBL and bleeding-related complications (need for a blood transfusion, additional surgical procedures to treat bleeding). We contacted clinicians 30 days postprocedure to capture postoperative complications. RESULTS Clinicians reported 52 cases between February 2011 and October 2013. Thirty percent of patients (16/52) stopped the anticoagulant with adequate time for the effects to abate prior to surgery (6 h for heparin, 24 h for low-molecular-weight heparin, International Normalized Ratio ≤1.7 the day prior to surgery for warfarin), while 69% (36/52) continued the anticoagulant either at therapeutic (25/36) or subtherapeutic (16/36) doses. Seventy-eight percent (28/36) of patients who continued the anticoagulant had an EBL of 50 mL or less compared to 88% (14/16) of those who stopped the anticoagulant with adequate time for its effects to abate (p=.73). Bleeding-related complications occurred in four anticoagulated patients and none of the patients who discontinued anticoagulant therapy. CONCLUSION Continuation of anticoagulation for planned surgical abortion under 84 days does not appear to be associated with heavy bleeding.
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Affiliation(s)
- Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA.
| | - Mary Tschann
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA
| | - Jeffrey Jensen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Paula Bednarek
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Ronnie Texeira
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Honolulu, HI 96826, USA
| | - Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Ganer Herman H, Kerner R, Gluck O, Feit H, Keidar R, Bar J, Sagiv R. Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial. Arch Gynecol Obstet 2017; 295:943-950. [PMID: 28255768 DOI: 10.1007/s00404-017-4329-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions. METHODS In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0-14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects. RESULTS From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant. CONCLUSION The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.
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Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel.
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel.
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
| | - Hagit Feit
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O.B 5, 58100, Holon, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel
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57
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Linet T. Interruption volontaire de grossesse instrumentale. ACTA ACUST UNITED AC 2016; 45:1515-1535. [DOI: 10.1016/j.jgyn.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
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Vigoureux S. Épidémiologie de l’interruption volontaire de grossesse en France. ACTA ACUST UNITED AC 2016; 45:1462-1476. [DOI: 10.1016/j.jgyn.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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White K, Potter JE, Stevenson AJ, Fuentes L, Hopkins K, Grossman D. Women's Knowledge of and Support for Abortion Restrictions in Texas: Findings from a Statewide Representative Survey. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:189-197. [PMID: 27082099 PMCID: PMC5065764 DOI: 10.1363/48e8716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 06/05/2023]
Abstract
CONTEXT States have passed numerous laws restricting abortion, and Texas passed some of the most restrictive legislation between 2011 and 2013. Information about women's awareness of and support for the laws' provisions could inform future debates regarding abortion legislation. METHODS Between December 2014 and January 2015, some 779 women aged 18-49 participated in an online, statewide representative survey about recent abortion laws in Texas. Poisson regression analysis was used to assess correlates of support for a law that would make obtaining an abortion more difficult. Women's knowledge of specific abortion restrictions in Texas and reasons for supporting these laws were also assessed. RESULTS Overall, 31% of respondents would support a law making it more difficult to obtain an abortion. Foreign-born Latinas were more likely than whites to support such a law (prevalence ratio, 1.5), and conservative Republicans were more likely than moderates and Independents to do so (2.3). Thirty-six percent of respondents were not very aware of recent Texas laws, and 19% had never heard of them. Among women with any awareness of the laws, 19% supported the requirements; 42% of these individuals said this was because such laws would make abortion safer. CONCLUSIONS Many Texas women of reproductive age are unaware of statewide abortion restrictions, and some support these requirements because of misperceptions about the safety of abortion. Advocates and policymakers should address these knowledge gaps in efforts to protect access to legal abortion.
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Affiliation(s)
- Kari White
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama, Birmingham
| | - Joseph E Potter
- Department of Sociology and at the Population Research Center, University of Texas, Austin
| | - Amanda J Stevenson
- Department of Sociology and at the Population Research Center, University of Texas, Austin
| | | | - Kristine Hopkins
- Department of Sociology and at the Population Research Center, University of Texas, Austin
| | - Daniel Grossman
- Department of Obstetrics, Gynecology Reproductive Sciences, University of California, San Francisco
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Faucher P. [Complications of termination of pregnancy]. ACTA ACUST UNITED AC 2016; 45:1536-1551. [PMID: 27816250 DOI: 10.1016/j.jgyn.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/15/2022]
Abstract
The legalization of abortion in France allowed to disappear almost maternal deaths caused by induced abortions. Nevertheless, the practice of abortion in a medical framework is encumbered with a number of immediate complications. Similarly, the late consequences of the practice of surgical abortion have generated an abundant literature, which it is important to analyse, both to meet the legitimate concerns of patients as to prevent any spread of false ideas under the influence of movements opposed to abortion.
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Affiliation(s)
- P Faucher
- Unité fonctionnelle d'orthogénie, hôpital Trousseau, 26, rue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
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61
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Ensuring Access to Safe, Legal Abortion in an Increasingly Complex Regulatory Environment. Obstet Gynecol 2016; 128:171-5. [DOI: 10.1097/aog.0000000000001490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gonçalves-Pinho M, Santos JV, Costa A, Costa-Pereira A, Freitas A. The impact of a liberalisation law on legally induced abortion hospitalisations. Eur J Obstet Gynecol Reprod Biol 2016; 203:142-6. [PMID: 27285305 DOI: 10.1016/j.ejogrb.2016.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/22/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Legal abortion based purely in maternal option without fetal/maternal pathology was liberalised in Portugal in 2007 and since then abortion rates have increased substantially. The aim of this paper was to study the impact of the liberalisation of abortion by maternal request on total legal abortion related hospitalisation trends. STUDY DESIGN We considered hospitalisations of legal abortion (ICD-9-CM codes 635.x) with discharges from 2000 to 2014. Data was obtained from a Portuguese administrative database, which contains all registered public hospitalisations in mainland Portugal. Performed legal abortions during the same period were obtained from INE (National Statistics Institute). Hospitalisations per abortion were calculated by dividing the number of legal abortions hospitalisations per the number of legal abortions, mean ages, number of hospitalisations per age group, complications, admission type and length of stay were also analysed, throughout the study period. RESULTS Hospitalisations rose during the study period, (from 618 episodes in 2000 to 1,259 in 2014, with a peak of 1,603 in 2010). Since the liberalisation law was passed there was a significant decrease in the number of hospitalisations per abortion: from 1.07 in 2000 to 0.11 in 2014 (p<0.001). Furthermore, the mean age maintained stable since liberalisation (30.8 years before 2007 and 31.0 after). Abortion related hospitalisations are more frequent in women aged 25-39. A significant decrease from the emergent to the scheduled type of admission occurred from 2000 to 2014 (from 83.5% to 56.7% of emergent admissions) (p<0.001). Complications remained stable between 2000 and 2014 and delayed or excessive haemorrhage was the most frequent (4.6%). CONCLUSIONS Since the liberalisation, hospitalisations per abortion have decreased, reflecting the major impact that the liberalisation of legal abortion by maternal request had on abortion trends nationwide. Before the liberalisation, each abortion led to approximately one hospitalisation while after the liberalisation this trend shifted to approximately 10% of the number of abortions. Legal abortion related hospitalisations are more frequent in women aged between 25 and 39 years old, an older age group when compared to the one registered in all cases of legal abortions, reflecting the differences between those hospitalised and those who are not. Our study shows the impact that legal abortion by maternal request liberalisation law can bring to abortion and to hospitalisation trends.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal.
| | - João V Santos
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, s/n, 4200-450 Porto, Portugal; Obstetrics and Gynecology Department, Hospital São João, Alameda Hernâni Monteiro, s/n, 4200-450 Porto, Portugal
| | - Altamiro Costa-Pereira
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Ohannessian A, Baumstarck K, Maruani J, Cohen-Solal E, Auquier P, Agostini A. Mifepristone and misoprostol for cervical ripening in surgical abortion between 12 and 14 weeks of gestation: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 201:151-5. [PMID: 27132200 DOI: 10.1016/j.ejogrb.2016.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/29/2016] [Accepted: 04/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Misoprostol and mifepristone are the two substances recommended for cervical preparation during first-trimester surgical abortions to decrease intraoperative bleeding and complications. The objective of the study was to evaluate whether the combination of mifepristone and misoprostol for cervical preparation in an elective surgical abortion between 12 and 14 weeks of gestation can reduce blood loss in comparison to misoprostol or mifepristone alone. STUDY DESIGN A randomized controlled trial was performed in Marseille, France between May 2013 and May 2014. Women requesting a surgical abortion under general anesthesia between 12 and 14 weeks of gestation were 198, randomized into three groups: one received 400μg oral misoprostol 3h before surgery, one 200mg oral mifepristone 36h before surgery, and the other, both treatments. The main outcome was the quantity of intraoperative bleeding. The secondary outcomes were duration of intervention, ease of dilatation, and complications. RESULTS The quantity of intraoperative bleeding differed significantly between the groups (p=0.001): 222±64mL in the combination group, 329±129mL in the misoprostol group, and 276±119mL in the mifepristone group. The combination was associated with a shorter operative duration (p=0.001): 5±2min in the combination group, 7±5min in the misoprostol group, and 7±3min in the mifepristone group. A hemorrhage was observed for 5 of 55 women (9%) in the combination group, 13 of 51 (25%) in the misoprostol group, and 9 of 56 (16%) in the mifepristone group (p=0.08). No cervical laceration or uterine perforation was reported. CONCLUSIONS The combination of mifepristone and misoprostol in cervical preparation for elective surgical abortions between 12 and 14 weeks of gestation significantly reduced blood loss in comparison to misoprostol or mifepristone alone.
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Affiliation(s)
- Alexandra Ohannessian
- Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France
| | - Karine Baumstarck
- Department of Public Health, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 boulevard Jean Moulin, 13005 Marseille, France
| | - Julia Maruani
- Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France
| | - Emmanuelle Cohen-Solal
- Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France
| | - Pascal Auquier
- Department of Public Health, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 boulevard Jean Moulin, 13005 Marseille, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, La Conception Hospital, 147 boulevard Baille, 13005 Marseille, France.
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Abstract
OBJECTIVE This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. INTENDED USERS Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. TARGET POPULATION Women with an unintended first trimester pregnancy. EVIDENCE Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). BENEFITS, HARMS AND/OR COSTS Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. SUMMARY STATEMENTS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care RECOMMENDATIONS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care.
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