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Gouy G, Attali L, Voillot P, Fournet P, Agostini A. Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study. JMIR INFODEMIOLOGY 2024; 4:e49335. [PMID: 38696232 PMCID: PMC11099808 DOI: 10.2196/49335] [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: 05/30/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Abortion (also known as termination of pregnancy) is an essential element of women's reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women's needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. OBJECTIVE This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. METHODS A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. RESULTS Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. CONCLUSIONS Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women's feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion.
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Affiliation(s)
- Giulia Gouy
- Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, Lyon, France
| | - Luisa Attali
- Pôle de Gynécologie-Obstétrique et Fertilité, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | | | | | - Aubert Agostini
- Service de Gynécologie et d'Obstétrique, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Hauss AS, Kiehl A, Arnalsteen C, Deshaies A, Deruelle P, Bettahar K, Koch A. [Pain assessment during medical abortion up to 14 weeks: A 1-year prospective comparative study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:511-516. [PMID: 37597754 DOI: 10.1016/j.gofs.2023.07.007] [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: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Pain assessment of patients requesting a medical abortion according to the term, up to 14 weeks, by a numerical rating scale (NRS). METHODS This was a single-centre prospective observational study conducted at the University Hospitals of Strasbourg from 1st October 2019 to 31st December 2020. RESULTS There was no significant difference in pain assessed by the NRS for medical abortion performed between 7-9 weeks and those performed between 9-14 weeks (6.5±2.5 vs. 6.6±2.2, P=0.85). Regardless of the term (before 7 weeks, between 7-9 weeks and between 9-14 weeks), patients felt relieved by taking painkillers in the case of medical abortion in 88.9%, 80.3% and 87.3% of cases respectively (P=0.18). The use of analgesics allowed a decrease of 3 points of the NRS in the 3 groups (P=0.67). Patients were more painful in case of medical protocol vs. surgical (maximum pain at 6.0±2.6 vs. 1.4±2.0, P<0.01), but declared to be relieved by analgesics in 85.1 and 94.3% of cases (P=0.24). CONCLUSIONS As pain is similar whatever the term in the case of medical abortion, and its management by analgesics seems to be effective, this criterion should not guide the professional in the choice of method, particularly between 9 and 14 weeks. This choice must be made by the patient.
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Affiliation(s)
- Anne-Sophie Hauss
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France.
| | - Amélie Kiehl
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - Charlotte Arnalsteen
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - Anne Deshaies
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - Philippe Deruelle
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - Karima Bettahar
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - Antoine Koch
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
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Jiao Y, Xue N, Shui X, Yu C, Hu C. Application of ultrasound multimodal score in the assessment of endometrial receptivity in patients with artificial abortion. Insights Imaging 2020; 11:29. [PMID: 32115671 PMCID: PMC7049539 DOI: 10.1186/s13244-020-0840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the value and feasibility of ultrasound multimodal score in the evaluation of endometrial receptivity in patients with artificial abortion (AA). METHODS Sixty-eight patients with AA (AA group) and 70 women of the childbearing age without any history of abortion (control group) were recruited between January 2018 and December 2018. All subjects received the examination of endometrium in the middle luteum phase (7-9 days after ovulation) with two-dimensional gray-scale ultrasound, two-dimensional color Doppler ultrasound, and three-dimensional ultrasound, and the quantitative scores were obtained and compared between two groups. RESULTS The quantitative score of endometrial receptivity was 10.46 ± 2.99 in the AA group and 13.49 ± 2.21 in the control group showing significant difference (p < 0.05). CONCLUSIONS Ultrasound multimodal quantitative scores can be used to evaluate the endometrial receptivity of patients with AA.
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Affiliation(s)
- Yan Jiao
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.,Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Nianyu Xue
- Department of Diagnostic Ultrasonography, Ningbo First Hospital, Ningbo, 315010, China
| | - Xujuan Shui
- Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Caicha Yu
- Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
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Vayssière C, Gaudineau A, Attali L, Bettahar K, Eyraud S, Faucher P, Fournet P, Hassoun D, Hatchuel M, Jamin C, Letombe B, Linet T, Msika Razon M, Ohanessian A, Segain H, Vigoureux S, Winer N, Wylomanski S, Agostini A. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2018; 222:95-101. [PMID: 29408754 DOI: 10.1016/j.ejogrb.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
The number of elective abortions has been stable for several decades. Many factors explain women's choice of abortion in cases of unplanned pregnancies. Early initiation of contraceptive use and a choice of contraceptive choices appropriate to the woman's life are associated with lower rates of unplanned pregnancies. Reversible long-acting contraceptives should be favored as first-line methods for adolescents because of their effectiveness (grade C). Ultrasound scan before an elective abortion must be encouraged but should not be obligatory (professional consensus). As soon as the embryo appears on the ultrasound scan, the date of pregnancy is estimated by measuring the crown-rump length (CRL) or, from 11 weeks on, by measuring the biparietal diameter (BPD) (grade A). Because reliability of these parameters is ±5 days, the abortion may be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BPD (professional consensus). A medically induced abortion, performed with a dose of 200 mg mifepristone combined with misoprostol, is effective at any gestational age (Level of Evidence (LE) 1). Before 7 weeks, mifepristone should be followed 24-48 h later by misoprostol, administered orally, buccally, sublingually, or even vaginally followed if needed by a further dose of 400 μg after 3 h, to be renewed if needed after 3 h (LE 1, grade A). After 7 weeks, administration of misoprostol by the vaginal, sublingual, or buccal routes is more effective and better tolerated than by the oral route (LE 1). Cervical preparation is recommended for systematic use in surgical abortions (professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 μg (grade A). Vacuum aspiration is preferable to curettage (grade B). A uterus perforated during surgical aspiration should not routinely be considered to be scarred (professional consensus). An elective abortion is not associated with a higher risk of subsequent infertility or ectopic pregnancy (LE 2). The medical consultation before an elective abortion generally does not affect the decision to end or continue the pregnancy, and most women are sufficiently certain about their choice at this time. Women appear to find the method used most acceptable and to be most satisfied when they were able to choose the method (grade B). Elective abortions are not associated with an increased rate of psychiatric disorders (LE 2). However, women with psychiatric histories are at a higher risk of psychological disorders after the occurrence of an unplanned pregnancy than women with such a history (LE 2). For surgical abortions, combined hormonal contraceptives - oral or transdermal - should be started on the day of the abortion, while the vaginal ring should be inserted 5 days afterwards (grade B). For medical abortions, the vaginal ring should be inserted in the week after mifepristone administration, while the combined contraceptives should begin the same day as the misoprostol or the day after (grade C). Contraceptive implants should be inserted on the same day as a surgical abortion, and may be inserted the day the mifepristone is administered for medical abortions (grade B and C respectively). In case of medical abortion, the implant can be inserted the same day the mifepristone is administered (grade C). Both the copper IUDs and levonorgestrel intrauterine system should be inserted on the day of the surgical abortion (grade A). After medical abortions, an IUD can be inserted in 10 days after mifepristone administration, after ultrasound scan verification of the absence of an intrauterine pregnancy (grade C).
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Affiliation(s)
- Christophe Vayssière
- Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France.
| | - Adrien Gaudineau
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Luisa Attali
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Karima Bettahar
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Sophie Eyraud
- 3 rue Pierre d'Artagnan, 92350 Le Plessis-Robinson, France
| | - Philippe Faucher
- Unité fonctionnelle d'orthogénie, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Patrick Fournet
- Service de Gynécologie Obstétrique, Centre Hospitalier du Belvedere 72, rue Louis Pasteur, 76451 Mont Saint Aignan, France
| | | | | | | | - Brigitte Letombe
- Service de Gynécologoe-Obstétrique, Hôpital Jeanne de Flandre, CHRU Lille, 2 av Oscar Lambret, 59000 Lille, France
| | - Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Bd Guerin, 85300, Challans, France
| | - Marie Msika Razon
- MFPF, Mouvement français pour le planning familial, Tour Manto, Bd Massena, 75013 Paris, France
| | - Alexandra Ohanessian
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
| | - Hélène Segain
- Service de Gynécologie-Obstétrique, CHI de Poissy-St-Germain, 45 rue du Champs Gaillard, 78303 Poissy, France
| | - Solène Vigoureux
- Service de gynécologie-obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, Equipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Sophie Wylomanski
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Aubert Agostini
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
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