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Cohen A, Karavani G, Zamir A, Hadar A, Chill HH, Zini A. Does ultrasound guidance during dilation and curettage for first trimester missed abortion reduce complication rates? Minerva Obstet Gynecol 2024; 76:238-243. [PMID: 36345905 DOI: 10.23736/s2724-606x.22.05192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Dilation and curettage (D&C) may be performed with or without transabdominal ultrasound guidance. The aim of this study was to evaluate the association between the use of ultrasound guidance during D&C for first trimester missed abortion (MA) and D&C related complication rates. METHODS A retrospective cohort study included women in the age of 20-45 years, who underwent D&C for first-trimester MA in a hospital-based setting between 2013-2019. The study population was divided into two groups: the study group which included women who underwent D&C with ultrasound guidance (US group) and the control group, which included women who underwent D&C without ultrasound guidance (N-US group). Gynecologic, obstetric, and operative related data were collected from electronic medical records. RESULTS Three-hundred and seventy-eight women were included in the study, 86 women in the US group and 292 women in N-US group. Baseline maternal characteristics and procedure-related characteristics did not differ between the groups. No significant difference between the US group and N-US group was shown when comparing D&C related complications, including retained products of conception rate (2.3% vs. 5.5%, respectively; P=0.385), uterine perforation rate (1.2% vs. 0.3%, respectively; P=0.404), and the total complication rate (8.1% vs. 12.3%, respectively; P=0.338). In a multivariate analysis, the use of ultrasound guidance during D&C was not found to be associated with lower complication rate (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.468 [0.578-3.729], P=0.419). CONCLUSIONS Performance of D&C under ultrasound guidance for first-trimester MA, in a hospital-based setting, was not associated with lower complication rate, suggesting that the common practice of performing D&C without the use of ultrasound is an acceptable approach.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Zamir
- Department of Obstetrics and Gynecology, Kaplan Medical Center Affiliated to the Hebrew University-Hadassah School of Medicine, Rehovot, Israel
| | - Ayalon Hadar
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Henry H Chill
- Pritzker School of Medicine, Division of Urogynecology, University of Chicago, NorthShore University Health System, Skokie, IL, USA
| | - Avraham Zini
- Faculty of Dental Medicine, Hebrew University Medical School, Jerusalem, Israel
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Marzan MB, Johnson E, Moore P, Jiang H, Hui L. Changes in the numbers of hospital-based abortions and outpatient early medical abortions in Victoria, 2012-22: a retrospective cohort study. Med J Aust 2024; 220:145-153. [PMID: 38305486 DOI: 10.5694/mja2.52203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 - March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. SETTING, PARTICIPANTS All admitted care episodes in Victoria during 1 January 2012 - 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone-misoprostol (MS-2 Step) during 1 January 2015 (date of listing) - 31 March 2022. MAIN OUTCOME MEASURES Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 - March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 - March 2022). RESULTS The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, -2.92 [95% CI, -3.45 to -2.38] per month); the rate of decline was greater during the pandemic period (slope, -5.74 [95% CI, -10.5 to -0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34-6.34] per month); it declined during the first month of the pandemic (slope, -26.4 [95% CI, -70.1 to -17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 - March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). CONCLUSIONS The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone-misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.
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Affiliation(s)
- Melvin B Marzan
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Eleanor Johnson
- Northern Centre for Health Education Research, Northern Health, Melbourne, VIC
| | - Patricia Moore
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Royal Women's Hospital, Melbourne, VIC
| | - Heng Jiang
- La Trobe University, Melbourne, VIC
- Centre for Health Equity, the University of Melbourne, Melbourne, VIC
| | - Lisa Hui
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
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González-Pérez LA, Barrios Arroyave FA. Recurrent voluntary termination of pregnancy. Prevalence study and exploration of associated factors. Antioquia, Colombia, 2015 – 2021. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:276-286. [PMID: 38421227 PMCID: PMC10911419 DOI: 10.18597/rcog.4018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024]
Abstract
Objectives To describe the prevalence of recurrent voluntary termination of pregnancy (VTP) and to explore associated factors. Materials and methods Descriptive, cross-sectional cohort study which included women seen between 2015 and 2021 in five sites of an institution located in the Department of Antioquia which promotes sexual and reproductive health (SRH) care in Colombia. Measured variables included sociodemographics, SRH, recurrent performance of VTP, type of procedure used in the first VTP and contraception method selected afterwards. The prevalence of global and yearly recurrent abortion period is presented. Associated factors were explored using a multivariate analysis. The research committee of the institution approved the study. Results In total, 20,423 women were included. The prevalence of recurrent VTP was 4.07% (n = 831) during the entire period, ranging between 2.3 and 6% over the 7 years. The most commonly used method for recurrent VTP was pharmacological induction (48.50%). After the first VTP, 69.81% of women used contraceptive methods classified as “very effective” according to the World Health Organization. The risk factors identified as being associated with recurrent VTP included being part of the state-subsidized health insurance system (adjusted odds ratio [aOR] = 1.35; 95 % CI:1.05-1.72) and having had two or more pregnancies (aOR = 1.23; 95% CI: 1.06 - 1.44). Protective factors were identified and included out-of-pocket payment for VTP service (aOR = 0.71; 95% CI: 0.61-0.82), a history of late VTP (aOR = 0.30; 95% CI: 0.11-0.81), and the selection of a subdermal implant for contraception following the first abortion (sOR = 0.64; 95% CI: 0.49 – 0.83). Conclusions It is possible that the prevalence of recurrent VTP is increasing. Prospective studies are required in order to determine whether there is a growing trend and to verify potential association hypotheses derived from this work.
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Hersey AE, Potter-Rutledge JM, Brown BP. Abortion policies at the bedside: incorporating an ethical framework in the analysis and development of abortion legislation. JOURNAL OF MEDICAL ETHICS 2023; 50:2-5. [PMID: 36585243 DOI: 10.1136/jme-2022-108412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the USA, over the last decades-even before Dobbs v. Jackson Women's Health Organization overturned the federal right to abortion-various states have sought to restrict abortion access. Often times, this legislation has been advanced based on legislators' personal moral values. At the bedside, in contrast, provision of abortion care should adhere to the normative principles of medical ethics and reproductive justice, centreing patients and their individual reproductive intentions and desires. Abortion regulations, through their influence on patients and providers, may facilitate or impede such ethical care at the bedside. In this paper, we present a framework to model how abortion legislation should fit into the patient-provider relationship and to clarify the dynamics by which legislation may affect healthcare encounters. Our proposed framework serves as a tool to analyse the ethical impact of abortion regulations. We propose a model for assessing abortion policies based not on legislators' or advocates' individual moral claims, but on the shared, normative framework of clinical medical ethics. Through contrasting case studies, we demonstrate how a robust normative ethical framework can recentre patients and their reproductive needs. Our model is one way to account for-and safeguard-patients' diverse viewpoints and needs in the development of abortion policy, and it can serve to ground narratives for advocacy by healthcare workers and their professional organisations.
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Affiliation(s)
- Alicia E Hersey
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | | | - Benjamin P Brown
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
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McLaren H, Hennessey C. First-trimester Procedural Abortion. Clin Obstet Gynecol 2023; 66:676-684. [PMID: 37750678 DOI: 10.1097/grf.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient's risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing a manual vacuum aspirator or electric vacuum aspirator. Complications occur rarely and are often easily managed at the time of diagnosis.
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Affiliation(s)
- Hillary McLaren
- Department of Obstetrics and Gynecology, Section of Complex Family Planning, University of Chicago, Chicago, Illinois
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Oviedo J, Denny CC. Pain Management in Abortion Care. Clin Obstet Gynecol 2023; 66:665-675. [PMID: 37750662 DOI: 10.1097/grf.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Both medication and procedural abortion are associated with pain. The experiences of pain depend on both physical and emotional factors. Several pain management options are available for abortion, depending on abortion type, clinical setting, and patient considerations, and a comprehensive approach is necessary to optimize pain management.
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Affiliation(s)
- Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
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Eckersberger E, Dijkerman S, Perkins M, Overholt T, Asport S, Aziz H, Barata I, Gulati S, Chekol BM, Mulase L, Mulunda JC, Oginni A, Smith M, Powell B, Kapp N. Examining reuse and replacement procedures for Ipas manual vacuum aspiration and cannulae in nine countries. Int J Gynaecol Obstet 2023; 163:651-659. [PMID: 37341207 DOI: 10.1002/ijgo.14905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/23/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To determine how many times Ipas manual vacuum aspiration (MVA) instruments are reused, for what reasons, when the instruments are replaced and/or discarded, and what the barriers are to replacing them. METHODS We conducted a mixed-methods cross-sectional study of health care providers who provide MVA services and key stakeholders in the supply chain to understand reuse and replacement of Ipas MVA aspirators and cannulae. Qualitative interviews focused on procurement and replacement of Ipas MVA instruments. RESULTS The authors interviewed 352 health care providers from nine countries from 2019 to 2021. Providers reported reusing MVA instruments an average of 34.4 times (standard deviation, 45). The reuse averages ranged from one time (Democratic Republic of the Congo) to 500 times (India), with figures varying between providers within the same country. Instrument malfunctioning rather than a specific number of uses drove reuse and subsequent replacement. The decision to replace was most commonly made by the provider during use. Half of the providers said that they knew of no issues with the supply chain, and 85% said they were always able to replace Ipas MVA instruments when needed. CONCLUSION Tracking reuse of MVA instruments was uncommon at participating providers' health facilities. Providers' estimates revealed great variability in reuse frequency and tracking procedures.
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Affiliation(s)
| | | | | | | | | | - Hina Aziz
- Indus Hospital & Health Network, Karachi, Pakistan
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Volkert A, Stöcker A, Pfaff H, Scholten N. What organisational and regional factors influence the outpatient provision of curettages in Germany? A longitudinal secondary data analysis using hospital quality reports data from 2013 to 2019. BMJ Open 2023; 13:e072887. [PMID: 37802629 PMCID: PMC10565183 DOI: 10.1136/bmjopen-2023-072887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES The rate of outpatient therapeutic curettage is lower in Germany than in other countries, although there are no differences in patient safety between outpatient and inpatient management. In this context, outpatient surgery is economically advantageous and efficient. This study aims to identify organisational and regional factors that determine the rate of outpatient curettage in German hospitals. METHODS We analysed the hospital quality reports for 2013-2019, which include data from all German hospitals with gynaecology departments (n=709). These organisational data (teaching status, size, ownership, department type and hospital group) are enhanced by contextual data (degree of urbanisation, market concentration and population income). We calculated a zero-one inflated beta regression model to identify factors that influence the rate of outpatient curettages in 2019. RESULTS Increasing numbers of curettages are provided on an outpatient basis; accordingly, the number of inpatient curettages declined during the analysis period. In 2019, 69.6% of in-hospital curettages were performed as outpatient surgery. Hospital size is significantly negative and outpatient physician department type is significantly positively associated with outpatient curettage rates. We found no effects of hospital ownership type, degree of urbanisation or market concentration. A high income in the surgical district's population is also associated with a higher rate of outpatient curettages. CONCLUSIONS The analyses demonstrate that organisational factors are associated with the outpatient curettage rate. This indicates that external elements, such as reimbursements and regulations, influence outpatient surgical events in Germany, and current regulations do not incentivise hospitals to significantly increase their rate of outpatient curettages.
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Affiliation(s)
- Anna Volkert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Arno Stöcker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, Cologne, Germany
- University of Cologne, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, Cologne, Germany
- University of Cologne, Faculty of Human Sciences, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
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Chaiken SR, Darney BG, Schenck M, Han L. Public perceptions of abortion complications. Am J Obstet Gynecol 2023; 229:421.e1-421.e8. [PMID: 37467839 DOI: 10.1016/j.ajog.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Misinformation contributes to the perception that abortion has substantial health risks, despite the known safety of medication and aspiration abortion. We lack detailed information about which health risks the public believes are most likely. OBJECTIVE This study aimed to describe public perception of short- and long-term risks of abortion. STUDY DESIGN We conducted a cross-sectional survey of US residents aged ≥18 years using Amazon Mechanical Turk (MTurk). We collected information regarding participant demographics, reproductive history, political views, and position on abortion restrictions. We provided participants with a list of 9 short-term and 15 long-term possible complications and asked them to indicate whether they occurred never (0%), very rarely (<1%), rarely (1%-5%), occasionally (5%-20%), or frequently (>20%) following abortion. We used descriptive statistics to understand our population demographics and to capture the perceived incidence of all complications. We created a binary indicator of answering all risk estimates incorrectly vs at least 1 estimate correctly, separately for all long-term possible complications, and the 2 short-term risks of infection and bleeding. We determined the proportion of individuals who responded incorrectly to all questions in each category and used multivariable logistic regression to identify factors associated with incorrect perceptions about the risks of abortion. RESULTS For all listed complications, participant (N=1057) estimates of risk were higher than the known incidence. For both short-term risks of bleeding and infection, over 40% of participants reported that these outcomes occur occasionally or frequently. Similarly, for both long-term risks of depression and anxiety, over 60% of respondents reported that these outcomes occur occasionally or frequently after abortion. Participants reported that possible complications known to not be associated with abortion, including hair loss, future pregnancy complications, breast cancer, and cosmetic disfigurement, occurred at least rarely. Nearly one-quarter of participants responded that death occurs occasionally or frequently (in over 5% of abortions), and 79% of participants responded that breast cancer can result from abortion. One-quarter (24.9%) of participants incorrectly overestimated both short-term outcomes of infection and bleeding, whereas 19.5% answered all long-term complication questions incorrectly, including outcomes that never occur. On multivariable analyses, we identified that the participants most likely to incorrectly identify risks of abortion identified as Asian or Black race/ethnicity, were from rural communities, or believed that abortion should have more legal restrictions. CONCLUSION The public perceives abortion to be much riskier than it actually is. This information can be used to develop targeted clinical and public health efforts to disseminate the true risks of abortion.
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Affiliation(s)
- Sarina R Chaiken
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI.
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; OHSU-PSU School of Public Health, Portland, OR; National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - Marta Schenck
- Family Medicine Department, University of Utah, Salt Lake City, UT
| | - Leo Han
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Gouret G, Faucher P, Kayem G, Pinton A. [Induced abortion between 14 and 16th: Clinical context and complications]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:415-419. [PMID: 37406810 DOI: 10.1016/j.gofs.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE This study aims to characterize the women's health care pathway and to evaluate the rate of complications during a surgical abortion according to the technique of dilatation and evacuation between 14 and 16 SA. METHOD Single-center prospective study at the Armand Trousseau Hospital with inclusion of women who had an abortion between 14 and 16 GA in the Obstetrics & Gynecology Department of the Armand Trousseau Hospital between March 2 and October 31, 2022. RESULTS Forty-six women underwent an abortion during this 8-month period. The average gestational age at which the abortions were performed was 15 weeks' gestation with an median delay of 14.0 days between the date of discovery of the pregnancy and the date of the abortion with more than half of the women (65.2 %, N=30) having consulted for the first time for an abortion request before 14 weeks' gestation. Of these women, 22 (48.9%) had to consult several hospitals before being treated. One woman (2.2% 95% CI [0.0-6.4]) had a haemorrhage defined by bleeding more than 500ml. Cervical suture for cervical tear was performed in four women (8.7% 95% CI [0.0-16.8]). There were no complications such as perforation, postoperative infection or surgical revision. No women were transfused. CONCLUSION The introduction in our center of surgical abortion using the dilatation and evacuation technique performed between 14 and 16 weeks' gestation wasn't accompanied by significant morbidity. The women's pathway before the procedure probably contributed to the later performance of the abortion.
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Affiliation(s)
- Gladys Gouret
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Philippe Faucher
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Gilles Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France
| | - Anne Pinton
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France.
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11
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Spingler T, Sonek J, Hoopmann M, Prodan N, Abele H, Kagan KO. Complication rate after termination of pregnancy for fetal defects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:88-93. [PMID: 36609996 DOI: 10.1002/uog.26157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the risk of complications in women undergoing termination of pregnancy (TOP) for fetal defects and to examine the impact of gestational age on the complication rate. METHODS This was a retrospective study of women with a singleton pregnancy undergoing TOP at the University Hospital of Tübingen, Germany, between 2018 and 2021. TOP was performed by experienced operators according to the national protocol; dilatation and curettage (D&C) or evacuation (D&E) was used in the first and early second trimesters and induction was used later in pregnancy. The following were considered to be significant procedure-related complications: blood loss of more than 500 mL, uterine perforation, need for blood transfusion, allergic reaction, creation of a false passage (via falsa), systemic infection, readmission to hospital, any unplanned surgical procedure, such as repeat D&C/D&E or hysterectomy, and maternal death. RESULTS The search of the hospital database identified 416 pregnancies that met the study criteria. Median maternal and gestational age at termination were 34.1 years and 17.4 weeks, respectively. In the first, second and third trimesters, respectively, 84 (20.2%), 278 (66.8%) and 54 (13.0%) pregnancies were terminated, for which D&C or D&E was used in 80 (95.2%), 21 (7.6%) and 0 (0.0%) cases. Seventy-seven (18.5%) women had at least one previous Cesarean section and 169 (40.6%) had at least one previous spontaneous delivery. Overall, 95 (22.8%) women had complications during or after TOP. A significantly higher complication rate was noted for terminations performed later in pregnancy. The median gestational age at termination was 16.6 weeks in women who did not experience complications and 20.7 weeks in those with complications (P < 0.001). The respective complication rates in the first, second and third trimesters were 6.0%, 27.0% and 27.8%. CONCLUSION In women undergoing TOP for fetal defects, the risk of complications increases with advancing gestational age. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Spingler
- Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - J Sonek
- Fetal Medicine Foundation USA, Dayton, OH, USA
- Division of Maternal-Fetal Medicine, Wright State University, Dayton, OH, USA
| | - M Hoopmann
- Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - N Prodan
- Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - H Abele
- Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - K O Kagan
- Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany
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Manning S, Kuhn D. Spontaneous and Complicated Therapeutic Abortion in the Emergency Department. Emerg Med Clin North Am 2023; 41:295-305. [PMID: 37024165 DOI: 10.1016/j.emc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Pregnancy-related emergency department visits are common in the United States. Although typically managed safely in the outpatient setting, patients with spontaneous abortion may also present with life-threatening hemorrhage or infection. Management strategies for spontaneous abortion are similarly wide-ranging from expectant management to emergent surgical intervention. Surgical management of complicated therapeutic abortion is similar to that of spontaneous abortion. The dramatic changes in the legal status of abortion in the United States may have significant influence on the incidence of complicated therapeutic abortion, and we encourage emergency physicians to familiarize themselves with the diagnosis and management of these conditions.
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Jung C, Oviedo J, Nippita S. Abortion Care in the United States - Current Evidence and Future Directions. NEJM EVIDENCE 2023; 2:EVIDra2200300. [PMID: 38320010 DOI: 10.1056/evidra2200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Abortion Care in the United StatesAbortion services are a vital component of reproductive health care. Jung and colleagues review medication abortion and procedural abortion as well as implications of increasing restrictions on access in the United States.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
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14
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Zippl AL, Aulitzky A, Braun AS, Feil K, Toth B. Gestörte Frühgravidität. GYNAKOLOGISCHE ENDOKRINOLOGIE 2023. [DOI: 10.1007/s10304-022-00486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ZusammenfassungEine Schwangerschaft kann intrauterin, ektop oder an einem unklaren Ort liegen und entwicklungsphysiologisch vital oder gestört sein. Die transvaginale Sonographie ermöglicht die Darstellung einer intrauterinen Schwangerschaft ab einem Schwellenwert des humanen Choriongonadotropins (hCG) von 1000 IU/l in der etwa sechsten Schwangerschaftswoche (SSW). Ektope Schwangerschaften sind abhängig von der SSW gegebenenfalls erschwert sonographisch erkennbar. Der Verlauf des hCG-Werts kann hilfreich dabei sein, eine physiologische von einer gestörten Frühschwangerschaft zu unterscheiden, muss aber immer in Zusammenschau mit der Klinik und dem Ultraschallbefund interpretiert werden. Bei einem frühen Abort kann abhängig von der Klinik exspektativ oder medikamentös vorgegangen werden. Die Indikation zur Kürettage sollte insgesamt zurückhaltend gestellt werden. Bei einer ektopen Schwangerschaft sollte abhängig von SSW und Klinik eine operative Therapie oder eine Methotrexattherapie durchgeführt werden.
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15
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Woodruff K, Berglas N, Herold S, Roberts SCM. Disseminating Evidence on Abortion Facilities to Health Departments: A Randomized Study of E-mail Strategies. HEALTH COMMUNICATION 2023; 38:61-70. [PMID: 34061693 DOI: 10.1080/10410236.2021.1932109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November-December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p < .05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported.
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Affiliation(s)
- Katie Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Nancy Berglas
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Stephanie Herold
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Sarah C M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
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16
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Chen S, Gu X, Qi L, Qi Q, Zhou J, Wang L. Reflections on abortion rights: From policy to medicine. Biosci Trends 2022; 16:455-458. [PMID: 36450578 DOI: 10.5582/bst.2022.01354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
On June 24, 2022, the US Supreme Court overturned Roe v. Wade, which marked a further restriction on women's abortion rights in the US. It has sparked a wide range of societal reactions around the world. Women in different countries enjoy diverse abortion rights due to conditions in their respective nations and cultures. Abortion protects women's rights to a certain extent, and especially in the event of unintended pregnancy. An inappropriate abortion ban will affect women's health and lives and all aspects of medicine, including the lives of doctors, patient access, and the development of medical technology. This review provides a gynecologist's perspective on the impact of abortion policies on women's health and the medical system. This review also attempts to determine the reason for the government's abortion ban.
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Affiliation(s)
- Song Chen
- Postdoctoral Station of Xiamen University, Fujian, China.,College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China.,Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture & Moxibustion, Wuhan, Hubei, China
| | - Xiaolei Gu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China.,Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture & Moxibustion, Wuhan, Hubei, China
| | - Long Qi
- New drug screening center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Qing Qi
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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17
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Bridwell R, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med 2022; 23:919-925. [DOI: 10.5811/westjem.2022.8.57929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.
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Affiliation(s)
- Rachel Bridwell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Tim Montrief
- Jackson Memorial Health System, Department of Emergency Medicine, Miami, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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18
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Boraas CM, Carroll A, Hesse SP, Norkett E, Ralph JA. Management of Surgical Abortion Complications. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Christy M. Boraas
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anna Carroll
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steven P. Hesse
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Emily Norkett
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jessika A. Ralph
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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19
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Pek Z, Heil E, Wilson E. Getting with the times: A review of peripartum infections and proposed modernized treatment regimens. Open Forum Infect Dis 2022; 9:ofac460. [PMID: 36168554 PMCID: PMC9511119 DOI: 10.1093/ofid/ofac460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
This article provides a review of peripartum infections, including intra-amniotic infection, postpartum endometritis, and postabortal infections. We present a case of postabortal infection to frame the review. The microbiology, pathogenesis, risk factors, diagnosis, and treatment of peripartum infections are reviewed, and a critical appraisal of the literature and available guidelines is provided. There is a focus on discussing optimal antimicrobial therapy for treating these infections.
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Affiliation(s)
- Zachary Pek
- University of Maryland Medical Center Division of Infectious Diseases Baltimore , MD , USA
| | - Emily Heil
- University of Maryland Medical Center Department of Pharmacy Baltimore , MD , USA
| | - Eleanor Wilson
- University of Maryland Medical Center Division of Infectious Diseases Baltimore , MD , USA
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20
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Brown JA, Cansino C. Anesthesia for Abortion Procedures. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Jewel A. Brown
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California, USA
| | - Catherine Cansino
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California, USA
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21
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Sharpless KE, Pappas II, Dobrow EM, Moccia M, Bates A, Pinette MG, Paul M. Severe hemorrhage due to acquired uterine arteriovenous malformation/fistula following first-trimester aspiration abortion: A case report. Case Rep Womens Health 2022; 34:e00410. [PMID: 35479418 PMCID: PMC9035398 DOI: 10.1016/j.crwh.2022.e00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Uterine arteriovenous malformation/arteriovenous fistula is a rare, but potentially life-threatening, cause of severe hemorrhage. A case of uterine arteriovenous malformation/fistula causing severe hemorrhage following a first-trimester aspiration abortion procedure in a patient with a history of prior cesarean sections is presented. In this case, the patient was promptly diagnosed and effectively treated with uterine artery embolization. Consideration of uterine arteriovenous malformation/fistula in the differential diagnosis of severe hemorrhage following first-trimester aspiration abortion, especially in women with risk factors, can lead to timely recognition and appropriate treatment. Uterine arteriovenous malformation/arteriovenous fistula is a vascular anomaly that can cause life-threatening hemorrhage. Acquired uterine arteriovenous malformation/arteriovenous fistula is a rare cause of hemorrhage following aspiration abortion. The diagnosis should be considered when hemorrhage fails to resolve with additional suction curettage and uterotonic administration. Uterine artery embolization is the treatment of choice for hemodynamically stable patients who want to preserve fertility.
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Affiliation(s)
- Kathryn E. Sharpless
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
| | - India I. Pappas
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
| | - Ethan M. Dobrow
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
- VA Maine Healthcare System, 1 VA Ctr., Augusta, ME 04330, USA
| | - Matthew Moccia
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
| | - Alison Bates
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
| | | | - Maureen Paul
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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22
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Blood Loss With Inhaled Anesthetic During First-Trimester Spontaneous Abortion Evacuation. Obstet Gynecol 2022; 139:443-445. [DOI: 10.1097/aog.0000000000004678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
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23
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Bi SJ, Huang YX, Feng LM, Yue SJ, Chen YY, Fu RJ, Xu DQ, Tang YP. Network pharmacology-based study on immunomodulatory mechanism of danggui-yimucao herb pair for the treatment of RU486-induced abortion. JOURNAL OF ETHNOPHARMACOLOGY 2022; 282:114609. [PMID: 34508802 DOI: 10.1016/j.jep.2021.114609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Danggui-Yimucao herb pair (DY) is a classic combination in Chinese herbal formulas, consisting of the root of Angelica sinensis (Oliv.) Diels and the aerial parts of Leonurus japonicus Houtt. DY first appeared in "Zhulinsi fuke mifang" in the Jin Dynasty, and it has a long history as a drug for the treatment of abortion. However, its underlying immunomodulatory mechanisms involved are still unclear. AIM OF THE STUDY In this study, network pharmacology and pharmacological experiments were used to explore the role and mechanism of DY in the treatment of medical abortion. MATERIALS AND METHODS Network pharmacology was used to establish the relationship between the components of DY and abortion-related targets, and to enrich important pathways and biological process for verification. ELISA was used to assess progesterone levels. Flow cytometry was used to detect the degree of differentiation of Th1/Th2 cells. Immunohistochemical methods and qPCR were used to measure the expression levels of T-bet, GATA-3 and IL-4. RESULTS Through the prediction analysis of network pharmacology, we found that key pathway for DY treatment of abortion, such as anemia, pelvic infection, immune disorders, and coagulation disorders, was Th1/Th2 cell differentiation pathway. The pharmacological results revealed that DY greatly corrected the imbalance of Th cell subsets in abortion mice, significantly inhibited the differentiation of Th2 cells, and resulted in an increase in the Th1/Th2 ratio. In addition, the concentration of progesterone in the serum of mice after abortion was significantly reduced. We also found that DY upregulated spleen T-bet and downregulated IL-4 gene expression in mice. Besides, immunohistochemical results showed that DYE could up-regulate T-bet but inhibit GATA-3 expression. CONCLUSIONS Our results showed that after RU486-induced abortion, progesterone and Th1/Th2 paradigm were disordered in mice, but DY could make mice recover more quickly, which indicated that DY had great development value in immunoregulation.
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Affiliation(s)
- Shi-Jie Bi
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Yu-Xi Huang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Li-Mei Feng
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Yan-Yan Chen
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, and Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi Province, China.
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24
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Musik T, Grimm J, Juhasz-Böss I, Bäz E. Treatment Options After a Diagnosis of Early Miscarriage: Expectant, Medical, and Surgical. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:789-794. [PMID: 34696822 DOI: 10.3238/arztebl.m2021.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/21/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 12% of pregnancies end in an early miscarriage (up to week 12 + 0 of pregnancy). Over the past 10 to 15 years, two alternatives to curettage have appeared in the pertinent international treatment guidelines: expectant treatment and medical (drug) treatment. In this review, we discuss the advantages and disadvantages of each of these therapeutic options. METHODS This review is based on pertinent publications (January 2000 to February 2021) retrieved by a selective search in PubMed, as well as on the guidelines of the American College of Obstetrics and Gynecologists, the Association of the Scientific Medical Societies in Germany, the National Institute for Health and Care Excellence/Royal College of Obstetricians and Gynaecologists, and the International Federation of Gynaecology and Obstetrics. RESULTS Three effective and safe treatment options are available after a diagnosis of early miscarriage. Expectant treatment yields success rates of 66-91%, depending on the type of miscarriage. Its complications include hemorrhage requiring blood transfusion in 1-2% of cases. If expectant therapy fails, subsequent treatment with misoprostol or curettage is indicated. Drug therapy with misoprostol yields a complete termination in 81-95% of cases and is thus a valid alternative to expectant therapy, with the advantage of better planning capability. The vaginal application of misoprostol is the most effective means of administration, with the fewest side effects. Curettage is needed in 5-20% of cases. Suctional curettage has a success rate of 97-98%, with an associated anesthesia-related risk of 0.2%, a 0.1% risk of perforation, and a 2-3% rate of repeat curettage. CONCLUSION If there is no acute indication for the surgical treatment of an early miscarriage, the patient can choose among three treatment options. Expectant and medical treatment can be provided on an outpatient basis. Curettage is the treatment of choice in the presence of infection, marked and persistent bleeding, hemodynamic instability, or a pre-existing coagulopathy.
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25
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Redd SK, Hall KS, Aswani MS, Sen B, Wingate M, Rice WS. Variation in Restrictive Abortion Policies and Adverse Birth Outcomes in the United States from 2005 to 2015. Womens Health Issues 2021; 32:103-113. [PMID: 34801349 DOI: 10.1016/j.whi.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes. METHODS We created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects. RESULTS Among 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1-SD increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04-0.45; p < .01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12-2.35; p < .05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01-0.25; p < .05). CONCLUSION Variation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions.
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Affiliation(s)
- Sara K Redd
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia; Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia.
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Monica S Aswani
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bisakha Sen
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha Wingate
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Whitney S Rice
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, Atlanta, Georgia; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
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26
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Greubel AD. Benevolent Sexism in the Targeted Regulation of Abortion Providers (TRAP): A Case Study of Texas House Bill 2. SEX ROLES 2021. [DOI: 10.1007/s11199-021-01244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Cansino C, Denny C, Carlisle AS, Stubblefield P. Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia. Contraception 2021; 104:583-592. [PMID: 34425082 DOI: 10.1016/j.contraception.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
Analgesic options for surgical abortion (also called procedural abortion) beyond local anesthesia and minimal sedation include moderate sedation, deep sedation and general anesthesia. These clinical recommendations review the effectiveness of various moderate sedation, deep sedation, and general anesthesia regimens for pain control during abortion; medication regimens used to induce analgesia and anesthesia; patient factors affecting anesthesia safety; preoperative and intraoperative protocols to reduce anesthesia risks; personnel qualifications for administration; recommended patient monitoring protocols; and general risks of anesthesia in the context of abortion care. The scope of these recommendations is based on limited available evidence and considerably relies on existing professional society guidelines and recommendations developed by content experts and reviewers. Further research to compare the efficacy and safety of different regimens is needed.
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Affiliation(s)
- Catherine Cansino
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
| | - Colleen Denny
- Department of Obstetrics and Gynecology, New York University, New York, NY, United States
| | - A Sue Carlisle
- Department of Anesthesia, University of California, San Francisco, CA, United States
| | - Phillip Stubblefield
- Department of Obstetrics and Gynecology, Boston University, Boston, MA, United States
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28
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Gallo MF, Casterline JB, Chakraborty P, Norris A, Bessett D, Turner AN. Passage of abortion ban and women's accurate understanding of abortion legality. Am J Obstet Gynecol 2021; 225:63.e1-63.e8. [PMID: 33577763 DOI: 10.1016/j.ajog.2021.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Legislative and judicial procedures related to banning abortion after 6 weeks of gestation in Ohio occurred from November 2018 to July 2019. These activities could have increased the belief that abortion has become illegal even though the 6-week abortion ban has never been in effect to date. OBJECTIVE We sought to determine the prevalence and correlates of holding the belief that abortion is illegal in Ohio and to evaluate whether this belief increased over the time in which the 6-week abortion ban was introduced, passed twice, and then blocked in Ohio. STUDY DESIGN We analyzed data from the first wave of the Ohio Survey of Women, a population-based survey of adult, reproductive-aged Ohioan women conducted from October 2018 to June 2019. During each of the 8 survey months, a median of 240 women (range, 70-761) completed the survey, including the survey question "Based on what you know or have heard, is it legal to get an abortion in your state?" We used multivariable logistic regression to assess the prevalence and correlates of believing that abortion is illegal in the state of Ohio. In addition, we used multinomial logistic regression to evaluate whether this belief increased over the interval during which women completed the survey, which roughly corresponded to the interval marked by legislative and judicial activities surrounding the 6-week abortion ban. RESULTS Most of the 2359 participants understood that abortion is legal in the state of Ohio (64.0%) with the remainder believing it to be illegal (9.8%) or being unsure (26.2%). Correlates of believing abortion to be illegal included younger age, lower socioeconomic status, never married or married status, and Black, non-Hispanic race and ethnicity. Being unsure about legality did not change over time; however, the proportion of women who believed that abortion is illegal increased from the first month (4.5%) to the last month (15.9%) of the study period. Each additional study month was associated with a 17% increase in the odds of believing abortion to be illegal, in both unadjusted and adjusted models (odds ratio, 1.17; 95% confidence interval, 1.08-1.27). CONCLUSION Attempts to restrict abortion access could contribute to women mistakenly believing that abortion is illegal despite it being unsuccessful.
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Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH.
| | - John B Casterline
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, OH
| | - Payal Chakraborty
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Danielle Bessett
- Department of Sociology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH
| | - Abigail Norris Turner
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH
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Lee JK, Zimrin AB, Sufrin C. Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion. Contraception 2021; 104:119-127. [PMID: 33766610 DOI: 10.1016/j.contraception.2021.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
Individuals who have bleeding disorders, thrombophilias, a history of venous thromboembolism (VTE), or who are taking anticoagulation medication for other reasons may present for abortion. Clinicians should be aware of risk factors and histories concerning for excessive bleeding and thrombotic disorders around the time of abortion. This document will focus on how to approach abortion planning in these individuals. For first-trimester abortion, procedural abortion (sometimes called surgical abortion) is generally preferred over medical management for individuals with bleeding disorders or who are on anticoagulation. First-trimester procedural abortion in an individual on anticoagulation can generally be done without interruption of anticoagulation. The decision to interrupt anticoagulation for a second-trimester procedure should be individualized. Individuals at high risk for VTE can be offered anticoagulation post-procedure. Individuals with bleeding disorders or who are anticoagulated can safely be offered progestin intrauterine devices. Future research is needed to better assess quantitative blood loss and complications rates with abortion in these populations.
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Affiliation(s)
- Jessica K Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Ann B Zimrin
- University of Maryland Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States
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Miscarriage Treatment-Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings. J Patient Saf 2021; 16:e317-e323. [PMID: 30516583 PMCID: PMC7678655 DOI: 10.1097/pts.0000000000000553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types. METHODS A retrospective cohort study compared miscarriage treatment-related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within 6 weeks of miscarriage treatment. Secondary outcomes were major events and infections. RESULTS A total of 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. A total of 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference between ASCs and office-based settings was no longer significant for miscarriages treated with procedures. CONCLUSIONS Although there seem to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.
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Orlowski MH, Soares WE, Kerrigan KA, Zerden ML. Management of Postabortion Complications for the Emergency Medicine Clinician. Ann Emerg Med 2020; 77:221-232. [PMID: 33341294 DOI: 10.1016/j.annemergmed.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023]
Abstract
Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges. This article reviews the epidemiology and background of abortion care, including the range of symptoms and adverse effects that are within the scope of an uncomplicated procedure. This review also offers a comprehensive overview of management of abortion complications, including algorithms for more common complications and descriptions of less common but more severe adverse events. The article concludes with a recognition of the social stigma and legal regulations unique to abortion care.
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Affiliation(s)
| | - William E Soares
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Kathleen A Kerrigan
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Matthew L Zerden
- Planned Parenthood South Atlantic, Chapel Hill, and WakeMed Health & Hospitals, Raleigh, NC
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Affiliation(s)
- Laura Schummers
- Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
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Leslie DL, Liu G, Jones BS, Roberts SCM. Healthcare costs for abortions performed in ambulatory surgery centers vs office-based settings. Am J Obstet Gynecol 2020; 222:348.e1-348.e9. [PMID: 31629727 DOI: 10.1016/j.ajog.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/06/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.
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Affiliation(s)
- Douglas L Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Bonnie Scott Jones
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Kapp N, Lohr PA. Modern methods to induce abortion: Safety, efficacy and choice. Best Pract Res Clin Obstet Gynaecol 2020; 63:37-44. [DOI: 10.1016/j.bpobgyn.2019.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/22/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
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First trimester termination of pregnancy. Best Pract Res Clin Obstet Gynaecol 2020; 63:13-23. [DOI: 10.1016/j.bpobgyn.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
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Rouse CE, Eckert LO, Muñoz FM, Stringer JSA, Kochhar S, Bartlett L, Sanicas M, Dudley DJ, Harper DM, Bittaye M, Meller L, Jehan F, Maltezou HC, Šubelj M, Bardaji A, Kachikis A, Beigi R, Gravett MG. Postpartum endometritis and infection following incomplete or complete abortion: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2019; 37:7585-7595. [PMID: 31783980 PMCID: PMC6891249 DOI: 10.1016/j.vaccine.2019.09.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C E Rouse
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - L O Eckert
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - F M Muñoz
- Department of Pediatrics, Section on Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - J S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - S Kochhar
- Global Healthcare Consulting; University of Washington, Seattle, USA; Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L Bartlett
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - M Sanicas
- Sanofi Pasteur, Asia and JPAC Region, Singapore
| | - D J Dudley
- University of Virginia, Department of Obstetrics and Gynecology, Charlottesville, VA, USA
| | - D M Harper
- University of Michigan, Departments of Family Medicine and Obstetrics and Gynecology, Department of Epidemiology, Ann Arbor, MI, USA
| | - M Bittaye
- Edward Francis Small Teaching Hospital/University of The Gambia and Medical Research Council, The Gambia at London School of Hygiene and Tropical Medicine, USA
| | - L Meller
- Safety & Pharmacovigilance, Syneos Health, Raleigh, NC, USA
| | - F Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - H C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - M Šubelj
- National Institute of Public Health, Ljubljana, Slovenia
| | - A Bardaji
- Barcelona Institute for Global Health, Barcelona, Spain
| | - A Kachikis
- Department of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - R Beigi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M G Gravett
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA.
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Costescu D, Guilbert É. No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:750-783. [PMID: 29861084 DOI: 10.1016/j.jogc.2017.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care. INTENDED USERS Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs. TARGET POPULATION Women with an unintended or abnormal first or second trimester pregnancy. EVIDENCE PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched. VALUES The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request. BENEFITS, HARMS, AND/OR COSTS IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.
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Chang L, Yu H, Miao X, Zhang J, Li S. Development and comprehensive evaluation of a noninvasive prenatal paternity testing method through a scaled trial. Forensic Sci Int Genet 2019; 43:102158. [PMID: 31479931 DOI: 10.1016/j.fsigen.2019.102158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To eliminate the miscarriage risks caused by traditional invasive sampling methods, we develop a noninvasive prenatal paternity testing (NIPPT) method and evaluate its efficiency, reliability and sensitivity based on a scaled trial. METHODS We use maternal cell-free DNA and massive parallel sequencing to obtain NIPPT genotypes for parents and fetuses based on quality-controlled genome-wide single nucleotide polymorphisms (SNPs). In a preliminary testing, data from 14 pregnant women and 7 negative controls are used for setting threshold of fetal genotyping in reference to postpartum children. After that, those from 349 cases with pregnancies of 6-35 gestational weeks (GW) and 9 negative controls from non-pregnant women who have fertility experience previously are in-depth evaluated. RESULTS In all cases, the biological fathers have been successfully identified from unrelated with a combined paternity index (CPI) of 3.58 × 1018 - 1.46 × 10165 for the cases versus 1.52 × 10-22 - 2.30 × 10-839 for the controls. For negative controls, fetal SNPs originating from previous pregnancies could not be detected. Our NIPPT results completely aligned with the invasive prenatal test results using PCR-CE STR methods. CONCLUSION NIPPT can be applied to determine paternity accurately from 6 weeks after conception until birth and may serve as an alternative prenatal paternity test advantageous to the currently-used methods.
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Affiliation(s)
- Liao Chang
- College of Medicine and Forensics, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Huiyun Yu
- BGI-shenzhen, Shenzhen, 518083, China
| | - Xinyao Miao
- College of Medicine and Forensics, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jianbo Zhang
- College of Medicine and Forensics, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shengbin Li
- College of Medicine and Forensics, Xi'an Jiaotong University, Xi'an, 710061, China; BGI-shenzhen, Shenzhen, 518083, China.
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Powell B, Kapp N. Validation of instrument reprocessing methods for the Ipas manual vacuum aspiration devices. Int J Gynaecol Obstet 2019; 147:89-95. [PMID: 31294825 DOI: 10.1002/ijgo.12908] [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: 02/04/2019] [Revised: 05/10/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To validate recommended reprocessing methods for Ipas manual vacuum aspiration (MVA) devices. METHODS All recommended reprocessing methods for Ipas MVA devices were tested for effectiveness in cleaning, achieving high-level disinfection (HLD) and/or sterilization, and any physical effects on instruments. Worst-case scenario testing was performed using artificial soil and microorganisms. Study protocols replicated standard steps for reprocessing. The specified method for reprocessing was performed 25 times on multiple devices, including controls. After runs 1, 2, 3, 15, and 25, devices and controls were analyzed for: microbial growth; residual soils; surface damage; and functionality. RESULTS All samples were negative for microbial growth and residual soils. On inspection and functionality testing, no damage was observed for aspirators and cannulae except with STERRAD and Cidex OPA. Other methods of HLD and sterilization did not affect surfaces or functionality through 25 cycles. DISCUSSION Ipas MVA devices were not negatively affected following validated instrument reprocessing methods for HLD or sterilization for up to 25 reuse cycles. STERRAD and Cidex OPA did not meet assessed standards and are therefore not recommended. Strict adherence to guidance is critical for effective reprocessing of instruments.
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Affiliation(s)
- Bill Powell
- Technical Innovation and Evidence, Ipas, Chapel Hill, NC, USA
| | - Nathalie Kapp
- Technical Innovation and Evidence, Ipas, Chapel Hill, NC, USA
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Norman WV, Munro S, Brooks M, Devane C, Guilbert E, Renner R, Kendall T, Soon JA, Waddington A, Wagner MS, Dunn S. Could implementation of mifepristone address Canada's urban-rural abortion access disparity: a mixed-methods implementation study protocol. BMJ Open 2019; 9:e028443. [PMID: 31005943 PMCID: PMC6500320 DOI: 10.1136/bmjopen-2018-028443] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In January 2017, mifepristone-induced medical abortion was made available in Canada. In this study, we will seek to (1) understand facilitators and barriers to the implementation of mifepristone across Canada, (2) assess the impact of a 'community of practice' clinical and health service support platform and (3) engage in and assess the impact of integrated knowledge translation (iKT) activities aimed to improve health policy, systems and service delivery issues to enhance patient access to mifepristone. METHODS AND ANALYSIS This prospective mixed-methods implementation study will involve a national sample of physicians and pharmacists recruited via an online training programme, professional networks and a purpose-built community of practice website. Surveys that explore constructs related to diffusion of innovation and Godin's behaviour change frameworks will be conducted at baseline and at 6 months, and qualitative data will be collected from electronic interactions on the website. Survey participants and a purposeful sample of decision-makers will be invited to participate in in-depth interviews. Descriptive analyses will be conducted for quantitative data. Thematic analysis guided by the theoretical frameworks will guide interpretation of qualitative data. We will conduct and assess iKT activities involving Canada's leading health system and health professional leaders, including evidence briefs, Geographical Information System (GIS)maps, face-to-face meetings and regular electronic exchanges. Findings will contribute to understanding the mechanisms of iKT relationships and activities that have a meaningful effect on uptake of evidence into policy and practice. ETHICS AND DISSEMINATION Ethical approval was received from the University of British Columbia Children's and Women's Hospital Ethics Review Board (H16-01006). Full publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to research participants through newsletters and media interviews, and to policy-makers through invited evidence briefs and face-to-face presentations.
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Affiliation(s)
- Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Munro
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Courtney Devane
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edith Guilbert
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamil Kendall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Waddington
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Marie-Soleil Wagner
- Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Sheila Dunn
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Induced Abortion Provision Among a National Sample of Obstetrician–Gynecologists. Obstet Gynecol 2019; 133:477-483. [DOI: 10.1097/aog.0000000000003110] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Woodruff K. Coverage of Abortion in Select U.S. Newspapers. Womens Health Issues 2019; 29:80-86. [PMID: 30309695 PMCID: PMC6295238 DOI: 10.1016/j.whi.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES News coverage can shape public understanding of policy issues in important ways. In the last decade, many new state-level abortion restrictions have been passed, often based on claims about the safety of abortion care, yet little is known about recent news coverage of abortion. This study analyzes a sample of news on abortion in the United States and explores the implications for reproductive health policymakers, practitioners, and advocates. METHODS We analyzed a sample of news and opinion articles containing the term "abortion" published in three major U.S. newspaper sources in 2013 and 2016. The total sample was 783 unique pieces. We coded for story topics, references to fetal personhood, women's stories, and basic abortion facts. Three trained coders conducted the coding, with intercoder reliability rates ranging from 0.777 to 1.0. FINDINGS Most of the time abortion appears in the news, it is merely mentioned, rather than discussed substantively. Abortion is covered as a political issue more than a health issue. The personal experiences of people who get abortions are present in only 4% of the sample, and language personifying the fetus appears more often than women's abortion stories. State abortion restrictions are newsworthy, yet basic facts on the commonality and safety of abortion are virtually absent. CONCLUSIONS This study suggests that the news does not support public understanding of abortion as a common, safe part of reproductive health care. Such framing may undermine public support for policies that protect access to this common health care service.
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Affiliation(s)
- Katie Woodruff
- Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, California.
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Abstract
When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman’s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.
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Affiliation(s)
- Sharon Cameron
- Chalmers Centre, NHS Lothian & University of Edinburgh, 2a Chalmers Street, Edinburgh, EH3 9ES, UK
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Abstract
Patients commonly present with unintended pregnancy in the primary care setting, and 1 in 4 women has an abortion in her lifetime. Early abortion services can be safely provided in the primary care setting. Abortion options provided in primary care settings include both medication abortion and early uterine aspiration abortion. Medication abortion, provided up to 10 weeks' gestational age, includes mifepristone (a progestin antagonist) and misoprostol (a prostaglandin). Uterine aspiration can be provided via manual or electronic vacuum in the first trimester.
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Affiliation(s)
- Jennifer R Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, MEB 262, New Brunswick, NJ 08901, USA.
| | - Terri L Cheng
- Department of Family Medicine and Public Health, University of California San Diego, 200 West Arbor Drive #8201A, San Diego, CA 92103, USA
| | - Emily M Godfrey
- Family Medicine, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA; Obstetrics and Gynecology, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA
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45
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Roberts SCM, Upadhyay UD, Liu G, Kerns JL, Ba D, Beam N, Leslie DL. Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions. JAMA 2018; 319:2497-2506. [PMID: 29946727 PMCID: PMC6583042 DOI: 10.1001/jama.2018.7675] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Multiple states have laws requiring abortion facilities to meet ambulatory surgery center (ASC) standards. There is limited evidence regarding abortion-related morbidities and adverse events following abortions performed at ASCs vs office-based settings. OBJECTIVE To compare abortion-related morbidities and adverse events at ASCs vs office-based settings. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of women with US private health insurance who underwent induced abortions in an ASC or office-based setting (January 1, 2011-December 31, 2014). Outcomes were abstracted from a large national private insurance claims database during the 6 weeks following the abortion (date of final follow-up, February 11, 2015). EXPOSURES Facility type for abortion (ASCs vs office-based settings, including facilities such as abortion clinics, nonspecialized clinics, and physician offices). MAIN OUTCOMES AND MEASURES The primary outcome was any abortion-related morbidity or adverse event (such as retained products of conception, abortion-related infection, hemorrhage, and uterine perforation) within 6 weeks after an abortion. Two secondary outcomes, both subsets of the primary outcome, were major abortion-related morbidities and adverse events (such as hemorrhages treated with a transfusion, missed ectopic pregnancies treated with surgery, and abortion-related infections that resulted in an overnight hospital admission) and abortion-related infections. RESULTS Among 49 287 women (mean age, 28 years [SD, 7.3]) who had 50 311 induced abortions, (23 891 [47%] first-trimester aspiration, 13 480 [27%] first-trimester medication, and 12 940 [26%] second trimester or later), 5660 abortions (11%) were performed in ASCs and 44 651 (89%) in office-based settings. Overall, 3.33% had an abortion-related morbidity or adverse event; 0.32% had a major abortion-related morbidity or adverse event; and 0.74% had an abortion-related infection. In adjusted analyses, there was no statistically significant difference between ASCs vs office-based settings, respectively, in the rates of abortion-related morbidities or adverse events (3.25% vs 3.33%, difference, -0.08%; [corrected] 95% CI, -0.58% to 0.43%; adjusted OR, 0.97; 95% CI, 0.81-1.17), major morbidities or adverse events (0.26% vs 0.33%; difference, -0.06%; 95% CI, -0.18% to 0.06%; adjusted OR, 0.78; 95% CI, 0.45-1.37), or infections (0.58% vs 0.77%; difference, -0.16%; 95% CI, -0.35% to 0.03%; adjusted OR, 0.75; 95% CI, 0.52-1.09). CONCLUSIONS AND RELEVANCE Among women with private health insurance who had an induced abortion, performance of the abortion in an ambulatory surgical center compared with an office-based setting was not associated with a significant difference in abortion-related morbidities and adverse events. These findings, in addition to individual patient and individual facility factors, may inform decisions about the type of facility in which induced abortions are performed.
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Affiliation(s)
- Sarah C. M. Roberts
- 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
| | - 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
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer L. Kerns
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Djibril Ba
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nancy Beam
- 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
| | - Douglas L. Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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46
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No 360 - Avortement provoqué : avortement chirurgical et méthodes médicales au deuxième trimestre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:784-821. [DOI: 10.1016/j.jogc.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Berglas NF, Roberts SCM. The development of facility standards for common outpatient procedures and implications for the context of abortion. BMC Health Serv Res 2018; 18:212. [PMID: 29580284 PMCID: PMC5870078 DOI: 10.1186/s12913-018-3048-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
Background In recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion. Methods We conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach. Results In contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements. Conclusions If facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3048-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
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48
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Abstract
Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.
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MESH Headings
- Abortion, Criminal/adverse effects
- Abortion, Criminal/mortality
- Abortion, Criminal/prevention & control
- Abortion, Incomplete/diagnosis
- Abortion, Incomplete/mortality
- Abortion, Incomplete/therapy
- Abortion, Induced/adverse effects
- Abortion, Induced/legislation & jurisprudence
- Abortion, Induced/mortality
- Abortion, Induced/trends
- Abortion, Septic/diagnosis
- Abortion, Septic/mortality
- Abortion, Septic/prevention & control
- Abortion, Septic/therapy
- Adolescent
- Adult
- Congresses as Topic
- Female
- Global Health
- Harm Reduction
- Health Services Accessibility
- Humans
- International Agencies
- Maternal Mortality
- Pregnancy
- Pregnancy, Unplanned
- Reproductive Medicine/methods
- Reproductive Medicine/trends
- Young Adult
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Mark KS, Bragg B, Talaie T, Chawla K, Murphy L, Terplan M. Risk of complication during surgical abortion in obese women. Am J Obstet Gynecol 2018; 218:238.e1-238.e5. [PMID: 29074080 DOI: 10.1016/j.ajog.2017.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surgical abortion is a generally safe procedure. Obesity is a known risk factor for complications in other surgical procedures, but insufficient information exists to determine the effects of increasing body mass index on the risk of surgical abortions. OBJECTIVE The purpose of this study was to determine whether obesity is a risk factor for major complications in surgical abortions. METHODS A quality control database from a single outpatient center was analyzed to determine rates of major complications during surgical abortions in relation to obesity class. Complications included hemorrhage, need for repeat evacuation, uterine perforation, cervical laceration, medication reaction, unexpected surgery, or unplanned admission to the hospital. Chi-squared and analysis of variance were used for analysis. RESULTS We included 2468 procedures: 1475 procedures (59.8%) in the first trimester and 993 procedures (40.2%) in the second trimester. The overall complications rate was 2.2%. Second-trimester procedures were more likely than those in the first trimester to have complications (3.1% vs 1.6%; P=.009). Overall, 39.6% of the women were obese, and 9.6% of them met criteria for class 3 obesity (body mass index, >40 kg/m2). Women who underwent second-trimester abortions with class 3 obesity had a rate of complication of 8.7%, which was significantly more than normal weight women (odds ratio, 5.90; 95% confidence interval, 1.93-8.07; P<.001). COMMENT Surgical abortions are overall safe procedures, but class 3 obesity increases the rate of complication in second-trimester procedures.
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50
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Berglas NF, Battistelli MF, Nicholson WK, Sobota M, Urman RD, Roberts SCM. The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review. PLoS One 2018; 13:e0190975. [PMID: 29304180 PMCID: PMC5755935 DOI: 10.1371/journal.pone.0190975] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/23/2017] [Indexed: 11/27/2022] Open
Abstract
Background Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear. Methods and findings We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions. Conclusions More and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.
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Affiliation(s)
- Nancy F. Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
- * E-mail:
| | - Molly F. Battistelli
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
| | - Wanda K. Nicholson
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mindy Sobota
- Rhode Island Hospital, Alpert Medical School at Brown University, Providence, Rhode Island, United States of America
| | - Richard D. Urman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
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