1
|
Chandrasekaran S, Ruggiero S, Goodrick G. Outpatient medical management of later second trimester abortion (18-23.6 weeks) with procedural evacuation backup: A large case series. Contracept X 2024; 6:100104. [PMID: 38515629 PMCID: PMC10950721 DOI: 10.1016/j.conx.2024.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation. Study design We conducted a retrospective medical records review of adult patients who received mifepristone and repeated misoprostol for second trimester abortion with procedural evacuation backup at an Arizona clinic between October 2017 and November 2021. We extracted patient demographics; pregnancy and medical history; and preoperative, intraoperative, and postoperative data. We assessed abortion outcomes, including procedure timing, mode of completion (medication alone or medications and procedural evacuation), and safety. Results All 359 patients had a complete abortion with 63.5% of patients completing with medication alone and 36.5% with procedural evacuation backup. The median time from first dose of misoprostol to fetal expulsion was six hours, among those who completed the abortion with medications alone. Of those who received procedural evacuation as backup, the median time for procedural evacuation was 10 minutes. The vast majority of patients (99.4%) did not have any adverse events. Two safety incidents (0.6%) occurred, a broad right ligament tear and a uterine rupture. Conclusion Patients in one outpatient setting safely and effectively received medical management of second trimester abortion with procedural evacuation backup, and two thirds completed with medications alone. Implications Outpatient settings may consider medical management of abortion between 18 and 24 weeks with procedural evacuation back-up as a safe, effective, and manageable second trimester abortion option. Additional research is needed on patient experience and satisfaction.
Collapse
|
2
|
Wollum A, De Zordo S, Zanini G, Mishtal J, Garnsey C, Gerdts C. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds. Reprod Health 2024; 21:7. [PMID: 38221617 PMCID: PMC10789034 DOI: 10.1186/s12978-023-01729-2] [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: 11/30/2022] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. METHODOLOGY We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. RESULTS Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. DISCUSSION These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care.
Collapse
Affiliation(s)
- Alexandra Wollum
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA.
| | - Silvia De Zordo
- Department of Anthropology, University of Barcelona, Montalegre 6-8, 08001, Barcelona, Spain
| | - Giulia Zanini
- Department of Philosophy and Cultural Heritage, Ca' Foscari University of Venice, Venice, Italy
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, 4297 Andromeda Loop, Orlando, FL, 32816, USA
| | - Camille Garnsey
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Hill MG, Brighton A, Burgess W. Placental abruption leading to disseminated intravascular coagulation: a clinical case and short review. AJOG GLOBAL REPORTS 2023; 3:100247. [PMID: 37456143 PMCID: PMC10345462 DOI: 10.1016/j.xagr.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
We present the case of a primigravida with disseminated intravascular coagulation at 21 weeks' gestation. Furthermore, we performed a short review of the evidence-based management of the condition. The patient presented with pain and vaginal bleeding. Clinical examination, laboratory studies, and an abdominal ultrasound produced inconclusive results about the origin of her disseminated intravascular coagulation. She was transferred to a tertiary facility where blood and plasma product transfusions were performed, and further investigations revealed fetal demise caused by placental abruption as the underlying cause of her disseminated intravascular coagulation. Cervical preparation was conducted with a balloon catheter and misoprostol. Surgical evacuation of her uterus was performed and she made a full recovery.
Collapse
Affiliation(s)
- Meghan G. Hill
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand (Drs Hill and Burgess)
| | - Aimee Brighton
- Department of Obstetrics and Gynaecology, Te Toka Tumai Auckland, Auckland, New Zealand (Ms Brighton)
| | - Wendy Burgess
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand (Drs Hill and Burgess)
| |
Collapse
|
5
|
Anderson CM, Tschann M, Whitehouse K, Soon R, Fontanilla T, Kaneshiro B. Oxytocin and Hypotension During Dilation and Evacuation Procedures at 18-24 Weeks Gestation. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:328-332. [PMID: 36504503 PMCID: PMC9727702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Oxytocin is a neurohormone that is routinely administered to patients during dilation and evacuation procedures (D&E) to control bleeding despite minimal evidence in support of this common practice. In this study, the authors sought to evaluate patients with hypotension after receiving oxytocin during D&E procedures. The secondary data from a double-blind, randomized, placebo-controlled trial involving 112 patients who underwent a D&E at 18-24 weeks gestation and prophylactically received an intravenous bolus of either 30 units of oxytocin in 500 mL of normal saline or 500 mL of saline alone at the start of the procedure were analyzed. Anesthesia providers measured blood pressure before, at the time of, and after study medication administration in 5-minute increments until the end of the procedure. No differences in demographic characteristics or mean blood pressure between the 2 groups were observed. The proportion of hypotensive patients was not statistically different at 5 minutes following fluid bolus (oxytocin 25% versus placebo 13%, P=.09). The proportion of hypotensive patients was similar by 10 minutes (oxytocin 20% versus placebo 16%, P=.62). A sample size of 112 provided the ability to detect a 23% difference in the proportion of patients who experienced hypotension (2-sided 95% CI, power of 80%). These findings suggest that oxytocin may have a transient hypotensive effect.
Collapse
Affiliation(s)
- Clare-Marie Anderson
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Mary Tschann
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Katherine Whitehouse
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Reni Soon
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Tiana Fontanilla
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Bliss Kaneshiro
- Department of Obstetrics and Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| |
Collapse
|
6
|
Using Prophylactic Antihemorrhagic Medications in Second-Trimester Surgical Abortions. Obstet Gynecol 2022; 140:663-666. [PMID: 36075063 DOI: 10.1097/aog.0000000000004922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/17/2022] [Indexed: 01/05/2023]
Abstract
We aimed to estimate the association of prophylactic antihemorrhagic medication use during dilation and evacuation (D&E) with operative hemorrhage and estimated blood loss (EBL). Records for all pregnant patients between 14 and less than 22 weeks of gestation who had a D&E procedure from January 2012 to December 2019 were retrospectively reviewed. Prophylactic antihemorrhagic medication use was defined as receiving vasoconstrictors, uterotonics, or both before identification of hemorrhage during a D&E procedure. Overall, 147 D&E procedures were completed at a mean of 16.4 (±2.2) weeks of gestation. Prophylactic medications were used in 72.1% (n=106) of D&E procedures. Prophylactic medication use was associated with lower operative hemorrhage (21.7% vs 51.2%, P <.01) and lower EBL (336.9 mL vs 551.3 mL, P <.01).
Collapse
|
7
|
Stifani BM, Mei Hwang S, Rodrigues Catani R, Borges Martins da Silva Paro H, Benfield N. Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls. Front Glob Womens Health 2022; 3:811412. [PMID: 35274107 PMCID: PMC8901725 DOI: 10.3389/fgwh.2022.811412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Dilation and evacuation (D&E) is the recommended surgical procedure for uterine evacuation in the second trimester. Despite its established safety record, it is not routinely available in most countries around the world. In this paper, we describe the multi-phase capacity-building project we undertook to introduce D&E in Brazil. First, we invited a highly motivated obstetrician-gynecologist and abortion provider to complete an observership at an established D&E site in the United States. We then organized a month-long clinical training for two experienced gynecologists in Brazil, followed by ongoing remote mentorship. Almost all patients we approached during the training opted for D&E, and all expressed satisfaction with their experience. Despite the restrictive legal setting and prevailing abortion stigma in Brazil, our training was well-received, and we did not experience any overt resistance from hospital staff. We learned that obtaining institutional support is essential; and that presenting scientific evidence during dedicated didactic times was an important strategy to obtain buy-in from other local healthcare providers. An important challenge we encountered was low case volume given the restrictive legal setting. We addressed this by partnering with nearby hospitals and non-profit organizations for patient referrals. We also rescheduled, adapted and optimized this project for implementation in the midst of the COVID-19 pandemic. Despite the challenges we faced, this project led to the successful introduction of D&E up to 16–18 weeks at two sites in Brazil. In the future, we plan additional training to increase capacity for D&E at more advanced gestational ages.
Collapse
Affiliation(s)
- Bianca M. Stifani
- Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, United States
- Department of Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States
- *Correspondence: Bianca M. Stifani
| | | | - Renata Rodrigues Catani
- Department of Obstetrics & Gynecology, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | | | - Nerys Benfield
- Department of Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States
| |
Collapse
|
8
|
Abstract
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques. Ultrasound (US) is a portable and safe imaging method that uses high frequency sound waves to visualize structures within the body. While most US examinations are done outside the body there is an emerging field which uses US devices within the body during surgery to aid complex procedures. This review examines the published literature on this technique in benign gynecology and in gynecological oncology. This review demonstrates the use of intraoperative US improves visualization and minimizes surgical complications.
Collapse
|
9
|
De Zordo S, Mishtal J, Zanini G, Gerdts C. Consequences of gestational age limits for people needing abortion care during the COVID-19 pandemic. Sex Reprod Health Matters 2020; 28:1818377. [PMID: 33003990 PMCID: PMC7887947 DOI: 10.1080/26410397.2020.1818377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Silvia De Zordo
- Ramón y Cajal Researcher and ERC Stg PI, Department of Anthropology, University of Barcelona, Barcelona, Spain
| | - Joanna Mishtal
- Professor, Department of Anthropology, University of Central Florida, Orlando, FL, USA
| | - Giulia Zanini
- Post-doctoral Researcher, Department of Anthropology, University of Barcelona, Barcelona, Spain
| | - Caitlin Gerdts
- President for Research, Ibis Reproductive Health, Oakland, CA, USA
| |
Collapse
|
10
|
Fallet-Bianco C, De Bie I, Désilets V, Oligny LL. No. 365-Fetal and Perinatal Autopsy in Prenatally Diagnosed Fetal Abnormalities with Normal Chromosome Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1358-1366.e5. [PMID: 30390949 DOI: 10.1016/j.jogc.2018.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review the information on fetal and perinatal autopsies, the process of obtaining consent, and the alternative information-gathering options following a prenatal diagnosis of non-chromosomal anomalies in order to assist health care providers in providing postnatal counselling regarding diagnosis and potential recurrence risks. OUTCOMES To provide better counselling about fetal and perinatal autopsies for women and families who are dealing with a prenatally diagnosed non-chromosomal fetal anomaly. EVIDENCE Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2010, 2011, and 2017, using appropriate key words (fetal autopsy postmortem, autopsy, perinatal postmortem examination, autopsy protocol, postmortem magnetic resonance imaging, autopsy consent, tissue retention, autopsy evaluation). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Additional publications were identified from the bibliographies of these articles. There were no date or language restrictions. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. BENEFITS, HARMS, AND COSTS This update educates readers about (1) the benefits of a fetal perinatal autopsy, (2) the consent process, and (3) the alternatives when the family declines autopsy. It also highlights the need for a standardized approach to fetal and perinatal autopsies, emphasizing pertinent additional sampling when indicated. The authors recognize that there is variability across Canada in access to the cited services and resources. As such, these recommendations were developed in an attempt to promote access and to provide a minimum standard for all provinces and territories across the country. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). RECOMMENDATIONS
Collapse
|
11
|
Akdag Topal C, Terzioglu F. Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspect Psychiatr Care 2019; 55:618-623. [PMID: 31004351 DOI: 10.1111/ppc.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine the levels of anxiety, depression, social support, and nursing care needed by women undergoing therapeutic abortion. DESIGNS AND METHODS Sixty women were administered a sociodemographic form, the Hospital Anxiety Depression Scale and the Multidimensional Perceived Social Support Scale. RESULTS More than half of the women experienced anxiety (61.7%). Anxiety scores were high (10.8 ± 3.7), and most of the women had depression (85.0%). Social support from family and friends of the women decreased the women's anxiety and depression levels significantly; social support from their partners also decreased the women's anxiety levels (P < 0.05). PRACTICE IMPLICATIONS Support from family and friends after therapeutic abortion is a fundamental affective variable on anxiety scores.
Collapse
Affiliation(s)
- Cansu Akdag Topal
- Department of Obstetrics and Gynecologic Nursing, Faculty of Nursing, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Fusun Terzioglu
- Department of Nursing, Faculty of Health Sciences, Atilim University, Golbasi, Ankara, Turkey
| |
Collapse
|
12
|
Fallet-Bianco C, De Bie I, Désilets V, Oligny LL. N° 365 -Autopsies fœtales et périnatales en cas d'anomalies fœtales diagnostiquées avant la naissance avec une analyse chromosomique normale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1367-1377.e6. [PMID: 30390950 DOI: 10.1016/j.jogc.2018.08.006] [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: 11/26/2022]
Abstract
OBJECTIF Examiner les données sur les autopsies fœtales et périnatales, le processus de consentement et les options de collecte de renseignements à la suite d'un diagnostic prénatal d'anomalies non chromosomiques afin d'aider les fournisseurs de soins à offrir du conseil postnatal au sujet du diagnostic et des éventuels risques de récurrence. RéSULTATS: Offrir de meilleurs conseils sur les autopsies fœtales et périnatales aux femmes et aux familles qui ont reçu un diagnostic prénatal d'anomalie fœtale non chromosomique. ÉVIDENCE: Nous avons examiné des études publiées récupérées au moyen de recherches dans PubMed, Medline, CINAHL et la Bibliothèque Cochrane en 2010, en 2011 et en 2017 à l'aide de mots-clés appropriés (« fetal autopsy postmortem », « autopsy », « perinatal postmortem examination », « autopsy protocol », « postmortem magnetic resonance imaging », « autopsy consent », « tissue retention » et « autopsy evaluation »). Nous n'avons tenu compte que des résultats provenant de revues systématiques, d'essais cliniques, randomisés ou non, et d'études observationnelles. D'autres publications ont été repérées dans les bibliographies de ces articles. Aucune restriction de date ou de langue n'a été employée. Nous avons également tenu compte de la littérature grise (non publiée) trouvée sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes liés aux technologies de la santé, dans des collections de directives cliniques et dans des registres d'essais cliniques, et obtenue auprès d'associations nationales et internationales de médecins spécialistes. AVANTAGES, DéSAVANTAGES ET COUTS: La présente mise à jour renseigne les lecteurs sur : 1) les avantages de l'autopsie fœtale ou périnatale; 2) le processus de consentement; et 3) les autres options offertes aux familles qui refusent l'autopsie. Elle met également en évidence la nécessité d'adopter une démarche normalisée pour la réalisation des autopsies fœtales et périnatales, et met l'accent sur les prélèvements additionnels qui peuvent être pertinents. Les auteurs sont conscients que l'accès aux ressources et aux services mentionnés varie d'un endroit l'autre au Canada; les recommandations formulées ont donc pour but de promouvoir l'accès et de fournir une norme minimale aux provinces et aux territoires du pays. VALEURS La qualité des données a été évaluée au moyen des critères énoncés dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (tableau). RECOMMANDATIONS.
Collapse
|
13
|
De Zordo S. From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña. Glob Public Health 2017; 13:711-723. [DOI: 10.1080/17441692.2017.1293707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Silvia De Zordo
- Department of Anthropology, University of Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Marecek J, Macleod C, Hoggart L. Abortion in legal, social, and healthcare contexts. FEMINISM & PSYCHOLOGY 2017. [DOI: 10.1177/0959353516689521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Boecking CA, Drey EA, Kerns JL, Finkbeiner WE. Correlation of Prenatal Diagnosis and Pathology Findings Following Dilation and Evacuation for Fetal Anomalies. Arch Pathol Lab Med 2016; 141:267-273. [PMID: 27763778 DOI: 10.5858/arpa.2016-0029-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Despite increased use of dilation and evacuation in the setting of fetuses with developmental anomalies, the pathology examination of fragmented specimens obtained by this technique has been understudied. OBJECTIVES -To correlate pathologic findings in second-trimester fetal dilation and evacuation specimens with prenatal diagnoses established through ultrasound and/or chromosome studies to determine the value of pathology examination for supplementing or correcting clinical diagnoses. DESIGN -In this retrospective study, clinical and pathology findings were correlated in 448 dilation and evacuation specimens performed for second-trimester termination of pregnancy for fetal anomalies discovered on ultrasound examination (278 cases) or chromosome analysis (170 cases). RESULTS -In 109 of the 170 cases with chromosomal abnormalities (64%), pathologists identified at least 1 congenital defect associated with the respective karyotype. In 278 cases with ultrasound-detected anomalies, pathologists confirmed the major congenital defect in 116 fetal specimens (42%). Evaluating for congenital central nervous system and body wall/diaphragm pathologic findings proved challenging owing to tissue disruption. However, taking all categories into account, pathology studies corrected ultrasound diagnoses in 152 of 413 cases (37%) and yielded additional diagnostic findings in 137 cases (33%). CONCLUSIONS -In a substantial number of cases, examination of fragmented fetuses corrected or refined prenatal diagnoses, demonstrating a role for detailed pathology examination of dilation and evacuation specimens in quality control of prenatal imaging studies and for potentially aiding subsequent genetic counseling.
Collapse
|
16
|
Gerdts C, DeZordo S, Mishtal J, Barr-Walker J, Lohr PA. Experiences of women who travel to England for abortions: an exploratory pilot study. EUR J CONTRACEP REPR 2016; 21:401-7. [DOI: 10.1080/13625187.2016.1217325] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Silvia DeZordo
- Department of Anthropology, University of Sussex, Brighton, UK
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, Orlando, FL, USA
| | | | | |
Collapse
|
17
|
Pongsatha S, Tongsong T. Randomized controlled trial comparing efficacy between a vaginal misoprostol loading and non-loading dose regimen for second-trimester pregnancy termination. J Obstet Gynaecol Res 2013; 40:155-60. [PMID: 24033985 DOI: 10.1111/jog.12147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to compare the efficacy of vaginal misoprostol loading dose regimen with non-loading dose regimen for termination of second-trimester pregnancy with live fetuses. MATERIAL AND METHODS A randomized controlled trial was conducted on pregnant women with a live fetus at 14-28 weeks. The patients were randomly allocated to receive either the vaginal misoprostol loading dose regimen (600 mcg, then 400 mcg every 6 h) or the non-loading dose regimen (400 mcg every 6 h). Failure to abort within 48 h was considered to be a failure. RESULTS Of 157 recruited women, 77 were assigned to be in group 1 (loading group) and 80 were in group 2 (non-loading group). The median abortion time was not statistically different between the groups (14.08; 95% confidence interval: 12.45-17.77 h and 14.58; 95% confidence interval: 12.8-17.27 h, P > 0.05). The rates of abortion within 24 h and 48 h were also comparable between the groups. Fever and chills were more common in the loading group. No other serious complications, such as postpartum hemorrhage and uterine rupture, were found. CONCLUSION Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.
Collapse
Affiliation(s)
- Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | |
Collapse
|
18
|
Abstract
There is a fundamental inconsistency in Western society's treatment of non-human animals on the one hand, and of human foetuses on the other. While most Western countries allow the butchering of animals and their use in experimentation, this must occur under carefully controlled conditions that are intended to minimize their pain and suffering as much as possible. At the same time, most Western countries permit various abortion methods without similar concerns for the developing fetus. The only criteria for deciding which abortion method is used centre in the stage of the pregnancy, the size of the fetus, the health of the pregnant woman and the physician's preference. This is out of step with the underlying ethos of animal cruelty legislation, cannot be justified ethically and should be rectified by adjusting abortion methods to the capacity of the fetus to experience nociception and/or pain.
Collapse
Affiliation(s)
- Eike-Henner W Kluge
- Department of Philosophy, University of Victoria, Victoria, BC, V8W 3P4, Canada,
| |
Collapse
|
19
|
Murphy LA, Thornburg LL, Glantz JC, Wasserman EC, Stanwood NL, Betstadt SJ. Complications of surgical termination of second-trimester pregnancy in obese versus nonobese women. Contraception 2012; 86:402-6. [DOI: 10.1016/j.contraception.2012.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/01/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
|
20
|
York S, Lichtenberg ES. Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion. Contraception 2012; 85:489-95. [DOI: 10.1016/j.contraception.2011.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/23/2011] [Accepted: 09/30/2011] [Indexed: 10/15/2022]
|
21
|
Chambers DG, Willcourt RJ, Laver AR, Baird JK, Herbert WY. Comparison of Dilapan-S and laminaria for cervical priming before surgical pregnancy termination at 17-22 weeks' gestation. Int J Womens Health 2011; 3:347-52. [PMID: 22114527 PMCID: PMC3220316 DOI: 10.2147/ijwh.s25551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Indexed: 11/23/2022] Open
Abstract
Methods: A retrospective analysis of medical records of three consecutive cohorts of women. All cohorts received a digoxin feticide injection on Day 1. Two cohorts were treated with laminaria, cohort A of 151 women over 1–2 days and cohort B of 52 women over 1–3 days, and cohort C of 151 women was treated with Dilapan-S over 1–3 days. Results: Adequate cervical priming for dilatation and evacuation (D&E) on Day 2 was achieved in 98% of the Dilapan-S cohort and 56% of cohort A and 40% of the cohort B laminaria cohorts. Return to theater for D&E 3–4 hours after dilator insertion on Day 2 occurred in 62.3% of Dilapan-S cohort C and 9.3% of cohort A and 4% of cohort B laminaria cohorts (P = 0.001). A mean D&E theater time of 19 minutes for laminaria cohort A was reduced by 10.1% in the Dilapan-S cohort C (P = 0.02). The incidence of unscheduled overnight delivery outside the clinic was 0% for Dilapan-S and 1.3% for cohort A and 3.8% for cohort B laminaria cohorts (P = 0.14). Conclusion: Dilapan-S osmotic dilators are superior to laminaria in producing more cervical priming and dilatation in a shorter time. This enables 17–22 week D&E procedures to be carried out in fewer days and in shorter theater times. They also eliminate the risk of an unscheduled overnight delivery outside the clinic.
Collapse
Affiliation(s)
- Dennis G Chambers
- The Queen Elizabeth Hospital, Pregnancy Advisory Centre, Woodville Park, Adelaide, South Australia, Australia
| | | | | | | | | |
Collapse
|
22
|
Obstetric performance following an induced abortion. Best Pract Res Clin Obstet Gynaecol 2010; 24:667-82. [DOI: 10.1016/j.bpobgyn.2010.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/15/2010] [Indexed: 11/22/2022]
|
23
|
Lee VC, Ng EH, Ho P. Issues in second trimester induced abortion (medical/surgical methods). Best Pract Res Clin Obstet Gynaecol 2010; 24:517-27. [DOI: 10.1016/j.bpobgyn.2010.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 02/04/2010] [Indexed: 11/30/2022]
|
24
|
Bygdeman M, Gemzell-Danielsson K. An Historical Overview of Second Trimester Abortion Methods. REPRODUCTIVE HEALTH MATTERS 2008; 16:196-204. [DOI: 10.1016/s0968-8080(08)31385-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|