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Escobar-Vidarte MF, Fernandez PA, Galindo JS, Valencia-Orozco A, Libreros-Peña L, Peña-Zarate EE, Castro R, Lara BD, Carvajal JA. Factors associated with infection-related severe maternal outcomes in pregnant and recently pregnant women: A secondary analysis of the WHO global maternal sepsis study. Int J Gynaecol Obstet 2024. [PMID: 39148250 DOI: 10.1002/ijgo.15857] [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: 04/18/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE The aim of the present study was to identify the risk factors for severe maternal outcomes (SMO) of women with suspected or confirmed infections using the data from the WHO global maternal sepsis study (GLOSS). METHODS We conducted a secondary analysis of the GLOSS cohort study, which involved pregnant or recently pregnant women with suspected or confirmed infection around 713 health facilities in 52 low- and middle-income countries, and high-income countries. A nested case-control study was conducted within the GLOSS cohort. Cases included infection-related maternal deaths or near misses, while controls represented non-SMO. Logistic mixed models, adjusting for country variations, were employed. Using univariate analysis, we calculated crude odds ratios (crude OR) and their 95% confidence interval (95% CI). Variables were identified with less than 16% missing data, and P values less than 0.20 were used to perform the multivariate logistic model multilevel. RESULTS A total of 2558 women were included in the analysis. As for the cases, 134 patients were found in the pregnant in labor or not in labor group and 246 patients in the postpartum or postabortion group. Pregnant women with prior childbirths faced a 64% increased risk of SMO. Ante- or intrapartum hemorrhage increased risk by 4.45 times, while trauma during pregnancy increased it by 4.81 times. Pre-existing medical conditions elevated risk five-fold, while hospital-acquired infections increased it by 53%. Secondary infections raised risk six-fold. Postpartum/postabortion women with prior childbirths had a 45% elevated risk, and pre-existing medical conditions raised it by 2.84 times. Hospital-acquired infections increased risk by 93%. Postpartum hemorrhage increased risk approximately five-fold, while abortion-related bleeding doubled it. Previous cesarean, abortion, and stillbirth also elevated risk. CONCLUSIONS Key risk factors for SMO include prior childbirths, hemorrhage, trauma, pre-existing conditions, and hospital-acquired or secondary infections. Implementing effective alert systems and targeted interventions is essential to mitigate these risks and improve maternal health outcomes, especially in resource-limited settings.
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Affiliation(s)
- Maria F Escobar-Vidarte
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | - Juan Sebastian Galindo
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | - Rigoberto Castro
- Department of Obstetrics and Gynecology, Hospital Dr. Roberto Suazo Cordova, La Paz, Honduras
- Health Surveillance Unit, Ministry of Public Health of Honduras (SESAL), Tegucigalpa, Honduras
| | - Bredy D Lara
- Department of Obstetrics and Gynecology, Hospital Dr. Roberto Suazo Cordova, La Paz, Honduras
- Health Surveillance Unit, Ministry of Public Health of Honduras (SESAL), Tegucigalpa, Honduras
| | - Javier A Carvajal
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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Chervenak FA, Stajonevic M, Grünebaum A. The IAPM New York 2024 declaration on professional responsibility and abortion. J Perinat Med 2024; 0:jpm-2024-0301. [PMID: 39029100 DOI: 10.1515/jpm-2024-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
The International Academy of Perinatal Medicine (IAPM) firmly supports abortion as a fundamental reproductive right, as declared at their annual meeting on June 28, 2024, in New York City. This stance, grounded in professional responsibility, respects both autonomy and beneficence-based obligations to pregnant patients and fetal patients. The IAPM asserts that access to safe, legal abortion services is essential for gender equality, public health, and social justice. Their declaration aligns with international human rights standards, advocating for abortion legalization up to fetal viability and beyond in cases of maternal health risks or severe fetal anomalies. This comprehensive approach underscores the critical role of healthcare professionals in providing compassionate reproductive healthcare, aiming to reduce maternal mortality and improve public health outcomes globally.
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Affiliation(s)
- Frank A Chervenak
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, New Hyde Park, NY, USA
| | - Milan Stajonevic
- Department of Obstetrics and Gynecology Medical School University of Zagreb, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Amos Grünebaum
- Northwell, New Hyde Park, NY, USA
- Zucker School of Medicine, Northwell, New Hyde Park, NY, USA
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Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank. HEALTH DATA SCIENCE 2024; 4:0147. [PMID: 39011272 PMCID: PMC11246836 DOI: 10.34133/hds.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/13/2024] [Indexed: 07/17/2024]
Abstract
Background: Concerns have been raised about the increasing prevalence of both spontaneous and induced abortions worldwide, yet their effect on premature mortality remains poorly understood. We aimed to examine the associations between abortion and all-cause and cause-specific premature mortality, and the potential effect modification by maternal characteristics. Methods: Women aged 39 to 71 years at baseline (2006 to 2010) with prior pregnancies were derived from the UK Biobank and categorized as no abortion history, spontaneous abortion alone, induced abortion alone, and both spontaneous and induced abortions. All-cause and cause-specific mortality were ascertained through linkage to death certificate data, with premature death defined as occurring before the age of 70. Results: Of the 225,049 ever gravid women, 43,418 (19.3%) reported spontaneous abortion alone, 27,135 (12.1%) reported induced abortion alone, and 10,448 (4.6%) reported both spontaneous and induced abortions. During a median of 14.4 years of follow-up, 5,353 deaths were recorded, including 3,314 cancer-related and 1,444 cardiovascular deaths. Compared with no abortion history, spontaneous abortion alone was associated with an increased risk of all-cause premature mortality (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 1.02 to 1.17), and induced abortion alone was associated with increased risks of all-cause (aHR 1.12, 95% CI 1.04 to 1.22) and cardiovascular mortality (aHR 1.27, 95% CI 1.09 to 1.48). The aHRs for all-cause and cardiovascular mortality were higher for recurrent abortions, whether spontaneous or induced (P trend < 0.05). The increased risk of all-cause mortality associated with induced abortion was higher in women with hypertensive disorders of pregnancy than in those without (40% vs. 9%, P interaction = 0.045). Conclusions: Either spontaneous or induced abortion alone was associated with an increased risk of premature mortality, with induced abortion alone particularly linked to cardiovascular death. Future studies are encouraged to explore the underlying mechanisms.
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Affiliation(s)
- Shaohua Yin
- Department of Medical Engineering,
Peking University Third Hospital, Beijing, China
| | - Yingying Yang
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine,
Tongji University, Shanghai, China
| | - Qin Wang
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Wei Guo
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Qian He
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Lei Yuan
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Environmental Health, School of Public Health,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Starosta A, Harris J, Gariepy A, Pathy S, Cron J. Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:76-84. [PMID: 38661101 DOI: 10.1111/psrh.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recent legal changes have led to mounting abortion restrictions in the United States (US), disproportionately impacting adolescents, who already face multifaceted barriers to abortion care. Informed by the framework of reproductive justice, adolescents who become pregnant deserve comprehensive, unbiased, and non-judgmental pregnancy options counseling, inclusive of all choices for pregnancy continuation and termination. Pediatric primary care providers are at the front lines of caring for adolescent patients' reproductive health needs and frequently diagnose pregnancy, provide pregnancy options counseling, and assist patients in accessing abortion care. They are uniquely poised to provide this care given their trusted, ongoing relationships with adolescent patients and their families, and their values of deep respect for adolescents' individuality and autonomy. METHODS In this commentary, we aim to describe the medical and legal landscape of adolescent abortion access in the US and provide recommendations to support pediatric primary care providers' involvement in abortion care. We focus on medication abortion, as the provision of medication abortion has the potential to encompass a broad group of clinicians, including pediatric primary care providers. RESULTS We discuss the importance of providing options counseling to adolescents within the reproductive justice framework, improving abortion education for pediatric providers, and expanding access to abortion care by supporting providers at an institutional level if they opt to provide medication abortions. CONCLUSION In light of the current legal landscape, the role of pediatric primary care providers in ensuring adolescent access to abortion care is ever more critical. Although many pediatric and adolescent providers already provide this important care, we, a team of obstetricians/gynecologists and adolescent medicine physicians, echo prior calls for improved training and institutional support for pediatric providers to counsel about and provide abortion-related care. We hope that highlighting the role of pediatric providers in this sphere will help center the needs of adolescent patients and help them fulfill their family planning goals.
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Affiliation(s)
- Anabel Starosta
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julen Harris
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Aileen Gariepy
- Department of Obstetrics & Gynecology, Division of Complex Family Planning, Weill Cornell Medical College, New York, New York, USA
| | - Shefali Pathy
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julia Cron
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
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Upadhyay UD, Adkins CE. Deception by obfuscation: Studnicki et al.'s retracted longitudinal cohort study of emergency room utilization following abortion. Contraception 2024; 134:110417. [PMID: 38494149 DOI: 10.1016/j.contraception.2024.110417] [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: 12/12/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES In November 2022, the anti-abortion advocacy group Alliance for Hippocratic Medicine filed a lawsuit against the U.S. Food and Drug Administration challenging the initial 2000 approval of mifepristone and its subsequent approvals, which removed unnecessary restrictions on its use, by disputing the medication's safety record. Such challenges relied on a study examining the incidence of emergency room visits following medication abortion with mifepristone and procedural abortion using Medicaid claims data from 1999-2015. In February 2024 that study was retracted by its publisher. In this paper, we analyzed the methods and presentations of the data used in the study. STUDY DESIGN We drew upon commonly accepted principles in responsible epidemiologic and scientific research to evaluate the methods and presentations of the data and organized our findings into themes. RESULTS We found multiple instances of methodological flaws, mischaracterizations, and obfuscations of data in this study, including use of a misleading research question and framing, analytic flaws, inappropriate use of an unvalidated proxy measure for outcomes of interest, and inappropriate and deceptive visualizations of data. In each instance, the resulting effect obfuscated and misrepresented the safety of medication abortion with mifepristone. CONCLUSIONS The misrepresentation and exaggeration of data promoted and exacerbated misinterpretations about the study's findings, resulting in substantial harm before it was retracted. Recognizing that ongoing judicial proceedings threaten access to conventional reproductive health care in the United States, public health policies must be informed by scientific and medical literature that is comprehensive, methodologically sound, and absent any obfuscations or misrepresentations. IMPLICATIONS Studnicki et al.'s study of emergency room visits after abortion misrepresented the safety of mifepristone with multiple instances of methodological flaws and obfuscations of data. While the study has now been retracted, it led to irrevocable harm, threatening access to medication abortion, which has an established safety record.
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Affiliation(s)
- Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - Chris E Adkins
- Department of Pharmaceutical Sciences, School of Pharmacy, South University, Savannah, GA, United States
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Arey W, Lerma K, White K. Self-diagnosing the end of pregnancy after medication abortion. CULTURE, HEALTH & SEXUALITY 2024; 26:405-420. [PMID: 37211833 PMCID: PMC10663384 DOI: 10.1080/13691058.2023.2212298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/06/2023] [Indexed: 05/23/2023]
Abstract
This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state's only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy. We compared this to how people use biomedical knowledge such as pregnancy tests, ultrasounds, and clinical examinations to confirm their self-diagnoses. We found that most people felt confident that they could identify the beginning and end of pregnancy through embodied knowledge, especially when combined with the use of home pregnancy tests that confirmed their symptoms, experiences, and visual evidence. All participants concerned about symptoms sought follow-up care at a medical facility, whereas people who felt confident of the successful end of the pregnancy did so less often. These findings have implications for settings of restricted abortion access that have limited options for follow-up care after medication abortion.
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Affiliation(s)
- Whitney Arey
- Texas Policy Evaluation Project, University of Texas at Austin, Austin, TX, USA
| | - Klaira Lerma
- Texas Policy Evaluation Project, University of Texas at Austin, Austin, TX, USA
| | - Kari White
- Texas Policy Evaluation Project, University of Texas at Austin, Austin, TX, USA
- Department of Sociology, The University of Texas at Austin, Austin, TX, USA
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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7
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Xu S, Zhao W, Zhang Y, Qiang C, Zhang C. The effect of previous induced abortion history on the assisted reproduction outcomes. Arch Gynecol Obstet 2024; 309:469-474. [PMID: 36708427 DOI: 10.1007/s00404-023-06928-7] [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: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To study whether the history of induced abortion has an effect on the assisted reproduction outcomes in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS 3045 patients who underwent IVF-ET in the Department of Human Reproductive Center of Renmin Hospital from January 2017 to June 2021. They were divided into two groups according to whether there was a history of induced abortion in the past, and the outcomes were compared between the two groups. RESULTS The clinical pregnancy rate in the group with induced abortion history was lower than that in the group without induced abortion history (63.1% vs 67.1%), but the difference was not statistically significant (P = 0.059). The spontaneous abortion rate in the group with induced abortion history was higher than that in the group without induced abortion history (14.9% vs 11.2%) (P = 0.044). The live birth rate in the group with induced abortion history was lower than that in the group without induced abortion history (52.8% vs 59.0%) (P = 0.006). Stepwise logistic regression analysis showed that endometrial thickness (OR = 0.928, 95% CI = 0.886 ~ 0.972, P = 0.002) and live birth rate (OR = 0.682, 95% CI = 0.495 ~ 0.939, P = 0.019) were negatively correlated with induced abortion history. The rate of spontaneous abortion (OR = 1.452, 95% CI = 1.042 ~ 2.024, P = 0.028) was positively correlated with the history of induced abortion. CONCLUSIONS The previous history of induced abortion is related to the outcomes of IVF /ICSI-ET, the endometrial thickness on HCG trigger day decreased, the risk of spontaneous abortion increased and the live birth rate decreased in patients with induced abortion history when undergoing IVF/ICSI-ET.
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Affiliation(s)
- Shaoyuan Xu
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Wenxian Zhao
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Ying Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Cancan Qiang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.
| | - Changjun Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
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Lazow SP, Kent TS, Neill S. General Surgeons and Abortion: An Opportunity to Advocate for our Patients and Colleagues. Ann Surg 2024; 279:228-230. [PMID: 37870258 DOI: 10.1097/sla.0000000000006139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Stefanie P Lazow
- Department of Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA
| | - Sara Neill
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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Palacios-Jaraquemada JM, Nieto-Calvache Á, Aryananda RA, Basanta N. Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location. J Matern Fetal Neonatal Med 2023; 36:2183764. [PMID: 36966802 DOI: 10.1080/14767058.2023.2183764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
OBJECTIVE To demonstrate the surgical and morbidity differences between upper and lower parametrial placenta invasion (PPI). MATERIALS AND METHODS Forty patients with placenta accreta spectrum (PAS) into the parametrium underwent surgery between 2015 and 2020. Based on the peritoneal reflection, the study compared two types of parametrial placental invasion (PPI), upper or lower. Surgical approach to PAS follows a conservative-resective method. Before delivery, surgical staging by pelvic fascia dissection established a final diagnosis of placental invasion. In upper PPI cases, the team attempted to repair the uterus after resecting all invaded tissues or performing a hysterectomy. In cases of lower PPI, experts performed a hysterectomy in all cases. The team only used proximal vascular (aortic occlusion) control in cases of lower PPI. Surgical dissection for lower PPI started finding the ureter in the pararectal space, ligating all the tissues (placenta and newly formed vessels) to create a tunnel to release the ureter from the placenta and placenta suppletory vessels. Overall, at least three pieces of the invaded area were sent for histological analysis. RESULTS Forty patients with PPI were included, 13 in the upper parametrium and 27 in the lower parametrium. MRI indicated PPI in 33/40 patients; in three, the diagnosis was presumed by ultrasound or medical background. The intrasurgical staging categorizes 13 cases of PPI performed and finds diagnosis in seven undetected cases. The expertise team completed a total hysterectomy in 2/13 upper PPI cases and all lower PPI cases (27/27). Hysterectomies in the upper PPI group were performed by extensive damage of the lateral uterine wall or with a tube compromise. Ureteral injury ensued in six cases, corresponding to cases without catheterization or incomplete ureteral identification. All aortic vascular proximal control (aortic balloon, internal aortic compression, or aortic loop) was efficient for controlling bleeding; in contrast, ligature of the internal iliac artery resulted in a useless procedure, resulting in uncontrollable bleeding and maternal death (2/27). All patients had antecedents of placental removal, abortion, curettage after a cesarean section, or repeated D&C. CONCLUSIONS Lower PAS parametrial involvement is uncommon but associated with elevated maternal morbidity. Upper and lower PPI has different surgical risks and technical approaches; consequently, an accurate diagnosis is needed. The clinical background of manual placental removal, abortion, and curettage after a cesarean or repeated D&C could be ideally studied to diagnose a possible PPI. For patients with high-risk antecedents or unsure ultrasound, a T2 weight MRI is always recommended. Performing comprehensive surgical staging in PAS allows the efficient diagnosis of PPI before using some procedures.
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Czarnecki D, Bessett D, Gyuras HJ, Norris AH, McGowan ML. State of Confusion: Ohio's Restrictive Abortion Landscape and the Production of Uncertainty in Reproductive Health Care. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:470-485. [PMID: 37265209 DOI: 10.1177/00221465231172177] [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] [Indexed: 06/03/2023]
Abstract
This study examines an underexplored source of medical uncertainty: the political context of care. Since 2011, Ohio has passed over 16 abortion-restrictive laws. We know little about how this legislation affects reproductive health care outside of abortion clinics. Drawing on focus groups and interviews with genetic counselors and obstetrician-gynecologists, we examine how abortion legislation impacts their work. We find that interpretation and implementation of legislation is not straightforward and varies by institution and region of the state. An ever-changing legislative landscape combined with uneven implementation of restrictions into policy produces uncertainty in reproductive health care. We also found uncertainty about the legal consequences of abortion in restrictive contexts, with obstetrician-gynecologists reporting greater concerns given their proximity to care provision. We argue that uncertainty can result in stricter interpretations of regulations than necessitated by the law, thereby amplifying the impacts of an already restrictive context for abortion care.
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Affiliation(s)
| | | | | | | | - Michelle L McGowan
- University of Cincinnati, Cincinnati, OH, USA
- Mayo Clinic, Rochester, MN, USA
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Jung C, Nippita S. Self-managed Medication Abortion in the United States. Clin Obstet Gynecol 2023; 66:739-748. [PMID: 37750672 DOI: 10.1097/grf.0000000000000810] [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
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
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Sun H, Mao J, Su X, Du Q. Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies. BMC Public Health 2023; 23:2360. [PMID: 38031055 PMCID: PMC10685546 DOI: 10.1186/s12889-023-17264-5] [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: 04/15/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND At present, there are several studies on abortion history and perinatal outcomes, but there is no unified conclusion whether the history of abortion and different types of abortion are related to perinatal complications of subsequent pregnancy. We aim to study the impact of different types of abortion history on perinatal outcomes of singleton pregnancies. METHODS This was a retrospective study from a maternity and infant hospital in Shanghai, China from 2016 to 2020. Pregnant women who gave birth to live singleton infant were included (n = 75,773). We classified abortion into spontaneous abortion (SAB) and induced abortion (IA). We compared the perinatal outcomes of singleton pregnancies with different abortion histories and used Logistic regression analysis to evaluate the associations between pre-pregnancy abortion history with perinatal outcomes. RESULTS We observed that pregnant women with a history of abortion were more likely to have a premature delivery (0.99% VS 0.45%), gestational diabetes mellitus (GDM) (13.40% VS 10.29%), placenta abnormality (8.16% VS 5.06%), placenta previa (5.65% VS 3.75%), placenta accreta (0.18% VS 0.04%), and placenta adhesion (2.79% VS 1.03%) than those who obtained singleton pregnancies without a history of abortion. When confounding factors were adjusted, differences in placenta abnormality still existed (excluding placenta abruption). The odds ratios and 95% confidence interval of placenta previa, placenta accreta, and placenta adhesion in pregnant women with only SAB history, only IA history, and both abortion history were 1.294(1.174-1.427), 1.272(1.159-1.396), and 1.390(1.188-1.625), 2.688(1.344-5.374), 2.549(1.268-5.125), and 5.041(2.232-11.386), 2.170(1.872-2.515), 2.028(1.738-2.366), and 3.580(2.917-4.395), respectively. CONCLUSIONS Our research showed that pregnant women who have a history of abortion before pregnancy were more likely to have premature birth, GDM, placenta previa, placenta accreta, and placenta adhesion. After adjusting for confounding factors, we found that the history of SAB, IA, and both SAB and IA history were related to the increased risk of placenta previa, placenta accreta, and placenta adhesion.
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Affiliation(s)
- Hanxiang Sun
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jing Mao
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qiaoling Du
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Flores L, Kelani Z, Chandwani C, Young SD. Internet Searches for Self-Managed Abortion After Roe v Wade Overturned. JAMA Surg 2023; 158:976-977. [PMID: 37405767 PMCID: PMC10323758 DOI: 10.1001/jamasurg.2023.2410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/23/2023] [Indexed: 07/06/2023]
Abstract
This cross-sectional study used search data from Google Trends to estimate public interest in self-managed abortion.
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Affiliation(s)
- Lidia Flores
- Department of Informatics, University of California, Irvine, Irvine
| | - Zeyad Kelani
- Department of Informatics, University of California, Irvine, Irvine
| | - Carrie Chandwani
- Department of Emergency Medicine, University of California, Irvine
| | - Sean D. Young
- Department of Informatics, University of California, Irvine, Irvine
- Department of Emergency Medicine, University of California, Irvine
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14
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Sangtani A, Owens L, Broome DT, Gogineni P, Herman WH, Harris LH, Oshman L. The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes. Curr Diab Rep 2023; 23:175-184. [PMID: 37213059 DOI: 10.1007/s11892-023-01512-4] [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] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. RECENT FINDINGS Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.
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Affiliation(s)
- Ajleeta Sangtani
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David T Broome
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Gogineni
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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15
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Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [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: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
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16
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Karlin J, Joffe C. Self-Sourced Medication Abortion, Physician Authority, and the Contradictions of Abortion Care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:603-627. [PMID: 36693174 DOI: 10.1215/03616878-10449932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The growing acknowledgment of the phenomenon of individuals terminating their pregnancies by obtaining the medications necessary for an abortion-which this article refers to as "self-sourced medication abortion" (SSMA)-has shed light on the current contradictions in the world of abortion provision. This article offers a brief historical overview of the relationship between abortion provision and mainstream medicine, pointing to the factors that have led to the marginalization of abortion care. It then discusses interviews with 40 physicians who provide abortions about their perspectives on SSMA, and it explores how this group responds to the contradictions presented by SSMA. In doing so, it interrogates the changing meaning of "physician authority" among this subset of physicians. The authors suggest that these interviewees represent an emergent sensibility among this generation of abortion physicians, a sensibility strongly tied to a commitment to social justice.
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17
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Feng C, Fay KE, Burns MM. Toxicities of herbal abortifacients. Am J Emerg Med 2023; 68:42-46. [PMID: 36924751 PMCID: PMC10192026 DOI: 10.1016/j.ajem.2023.03.005] [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: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In the post-Roe era, barriers to facility-based abortions may lead to an increased incidence of self-managed abortions. While misoprostol-based medication abortions have significant literature supporting its safety profile, there is a knowledge deficit within the medical community regarding the toxicities of commonly used herbal abortifacients. METHODS This is a narrative review, based on a MEDLINE and HOLLIS database search, of self-managed abortion methods with herbal abortifacients and their associated toxicities. RESULTS Common herbal abortifacients with significant morbidity and mortality implications include pennyroyal, blue cohosh, rue, and quinine. Other commonly reported abortifacients considered to be less toxic also are discussed in brief. Special considerations for hepatic, cardiac, renal, and hematologic toxicities are important in patients with significant exposures to these herbal substances. CONCLUSION There is an anticipated increase in the utility of herbal xenobiotics for self-managed abortions with post-Roe restrictions to standard mifepristone-misoprostol protocols. Frontline providers should be aware of the associated toxicities and have special considerations when treating a poisoned patient in this population.
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Affiliation(s)
- Chris Feng
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Kathryn E Fay
- Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Boston, MA, USA
| | - Michele M Burns
- Harvard Medical Toxicology, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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18
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Gaffney A, Himmelstein DU, Dickman S, Myers C, Hemenway D, McCormick D, Woolhandler S. Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights. JAMA Netw Open 2023; 6:e2315578. [PMID: 37289459 PMCID: PMC10251209 DOI: 10.1001/jamanetworkopen.2023.15578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 06/09/2023] Open
Abstract
Importance Several recent US Supreme Court rulings have drawn criticism from the medical community, but their health consequences have not been quantitatively evaluated. Objective To model health outcomes associated with 3 Supreme Court rulings in 2022 that invalidated workplace COVID-19 vaccine or mask-and-test requirements, voided state handgun-carry restrictions, and revoked the constitutional right to abortion. Design, Setting, and Participants This decision analytical modeling study estimated outcomes associated with 3 Supreme Court rulings in 2022: (1) National Federation of Independent Business v Department of Labor, Occupational Safety and Health Administration (OSHA), which invalidated COVID-19 workplace protections; (2) New York State Rifle and Pistol Association Inc v Bruen, Superintendent of New York State Police (Bruen), which voided state laws restricting handgun carry; and (3) Dobbs v Jackson Women's Health Organization (Dobbs), which revoked the constitutional right to abortion. Data analysis was performed from July 1, 2022, to April 7, 2023. Main Outcomes and Measures For the OSHA ruling, multiple data sources were used to calculate deaths attributable to COVID-19 among unvaccinated workers from January 4 to May 28, 2022, and the share of these deaths that would have been prevented by the voided protections. To model the Bruen decision, published estimates of the consequences of right-to-carry laws were applied to 2020 firearm-related deaths (and injuries) in 7 affected jurisdictions. For the Dobbs ruling, the model assessed unwanted pregnancy continuations, resulting from the change in distance to the closest abortion facility, and then excess deaths (and peripartum complications) from forcing these unwanted pregnancies to term. Results The decision model projected that the OSHA decision was associated with 1402 additional COVID-19 deaths (and 22 830 hospitalizations) in early 2022. In addition, the model projected that 152 additional firearm-related deaths (and 377 nonfatal injuries) annually will result from the Bruen decision. Finally, the model projected that 30 440 fewer abortions will occur annually due to current abortion bans stemming from Dobbs, with 76 612 fewer abortions if states at high risk for such bans also were to ban the procedure; these bans will be associated with an estimated 6 to 15 additional pregnancy-related deaths each year, respectively, and hundreds of additional cases of peripartum morbidity. Conclusions and Relevance These findings suggest that outcomes from 3 Supreme Court decisions in 2022 could lead to substantial harms to public health, including nearly 3000 excess deaths (and possibly many more) over a decade.
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Affiliation(s)
- Adam Gaffney
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - David U. Himmelstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- Hunter College, City University of New York, New York, New York
- Public Citizen Health Research Group, Washington, DC
| | | | | | - David Hemenway
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danny McCormick
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Steffie Woolhandler
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- Hunter College, City University of New York, New York, New York
- Public Citizen Health Research Group, Washington, DC
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19
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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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20
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Zhang LL, Sheng F, Yang Y, Hu YF, Li W, Huang GY, Wu MY, Gong Y, Zhang P, Zou L. Integrative transcriptomics and proteomics analyses to reveal the therapeutic effect and mechanism of Buxue Yimu Pills in medical-induced incomplete abortion rats. JOURNAL OF ETHNOPHARMACOLOGY 2023; 305:116113. [PMID: 36581165 DOI: 10.1016/j.jep.2022.116113] [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: 10/05/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Medical abortions using mifepristone and misoprostol have been approved in many countries for early pregnancy loss. Despite its high success rate, this medication regimen can result in incomplete abortion, which is responsible for endometrial damage, prolonged uterine bleeding, abdominal pain, etc. Buxue Yimu Pills (BYP) is a famous Chinese medicine prescription that is widely used in the field of gynecology and obstetrics for treating patients with postpartum complications. However, the therapeutic effect and mechanism of BYP remain to be explored. AIM OF THE STUDY This study aimed to clarify the therapeutic effect and mechanism of action of BYP in postpartum complications using mifepristone and misoprostol-induced incomplete abortion in rats. MATERIALS AND METHODS Experimental medical-induced incomplete abortion model rats were constructed using mifepristone and misoprostol, and further treated with saline or BYP by intragastric administration. Detailed information regarding the changes in mRNA and protein levels in the uterine tissues of rats regulated by BYP was illustrated by RNA sequencing (RNA-seq) analysis and quantitative proteomics analysis. The differentially expressed genes and proteins were further subjected to Gene Ontology (GO) and pathway enrichment analyses and further verified using quantitative Real-time PCR (qRT-PCR) analysis and western blot assay. RESULTS BYP administration markedly alleviated the increase in serum prostaglandin F2α (PGF2α) and expression of PGF2α receptor (PGF2αR) in uterine tissues and inhibited the decrease in serum chorionic gonadotrophin (CG). Compared with the model group, 674 genes were upregulated and 344 genes were downregulated by BYP administration; 108 proteins were upregulated and 48 proteins were downregulated by BYP administration. qRT-PCR analysis of the uterine tissues showed that BYP treatment reversed the variation tendency of genes, including Mmp7, Mmp14, Timp2, Col6a4, Jak2, Wnt7a, and Mylk compared with the model group. Western blot analysis showed that BYP administration affected PKCδ, Collagen VI, MMP7, TIMP2, MLCK, and p-MLC protein levels. CONCLUSION BYP administration facilitated uterine recovery in medical-induced incomplete abortion rats, and this therapeutic effect involved various targets and biological processes, including the TIMP2/MMP7 and MLCK/p-MLC signaling pathways, etc.
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Affiliation(s)
- Le-Le Zhang
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Feiya Sheng
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Yong Yang
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Ying-Fan Hu
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Wei Li
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Guo-Ying Huang
- Department of Pharmacy, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China
| | - Meng-Yao Wu
- Department of Pharmacology, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Yun Gong
- Department of Pharmacology, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Peng Zhang
- Department of Pharmacology, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China.
| | - Liang Zou
- School of Food and Bioengineering, Chengdu University, Chengdu, China.
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21
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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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22
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Najmi Z, Dabiri Oskoei A, Tofighi S, Gholami H, Garrosi L, Amini F. Efficacy of Ibuprofen Lysine on First-Trimester AbortionRelated Pain and Hemorrhage: A Randomized TripleBlinded Clinical Trial. ARCHIVES OF IRANIAN MEDICINE 2023; 26:212-217. [PMID: 38301081 PMCID: PMC10685749 DOI: 10.34172/aim.2023.32] [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: 07/04/2022] [Accepted: 02/12/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Some recent trials have reported high efficacy for nonsteroidal anti-inflammatory drugs (NSAIDs) in relieving medical abortion-related pain. The aim of this study was to determine the beneficial effect of oral NSAIDs (ibuprofen lysine) in reduction of pain and hemorrhage in first-trimester medical abortion. METHODS This randomized triple-blinded clinical trial was performed on 98 pregnant women who were candidate for medical abortion within the first-trimester period (gestational age<12 weeks). The participants were randomly assigned to receive ibuprofen lysine (684 mg orally every 4 hours) or placebo. All patients were initially treated with misoprostol (800 µg every 3 hours). Pain intensity and rate of hemorrhage were assessed every hour up to 15 hours after receiving the first dose of misoprostol by visual analogue scaling (VAS) and pictorial blood loss assessment chart (PBAC), respectively. RESULTS Assessing the mean pain score within 15 hours of receiving misoprostol showed significantly lower pain intensity within the first 10 hours of assessment in the group receiving NSAID in comparison with the control group (P<0.001). The bleeding rate was also significantly lower in the NSAID group at the fifth (P=0.013) and ninth (P=0.040) hour of receiving misoprostol compared to the control group. We found no difference in abortion-related complication rate between the NSAID and placebo groups (8.3% versus 8.0%, P=0.952). CONCLUSION The use of NSAIDs (ibuprofen lysine) is a good pharmacological analgesic option for relieving medical abortionrelated pain and hemorrhage.
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Affiliation(s)
- Zahra Najmi
- Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Atousa Dabiri Oskoei
- Department of Obstetrics and Gynecology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Shabnam Tofighi
- Department of Obstetrics and Gynecology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hamideh Gholami
- Department of Oncology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Lida Garrosi
- Department of Obstetrics and Gynecology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Faranak Amini
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
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23
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Hinojosa-Millán S, Suarez-Orozco L, Gómez-Jaramillo V, Sánchez-Duque JA. La pandemia ignorada del aborto inseguro: una llamada a la acción. Semergen 2023; 49:101909. [PMID: 36527752 DOI: 10.1016/j.semerg.2022.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Affiliation(s)
- S Hinojosa-Millán
- Semillero de investigación Ginecología y Obstetricia. Departamento de Obstetricia y Ginecología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - L Suarez-Orozco
- Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - V Gómez-Jaramillo
- Facultad de Ciencias Jurídicas, Sociales y Humanísticas, Fundación Universitaria del Área Andina, Sede Pereira, Pereira, Risaralda, Colombia
| | - J A Sánchez-Duque
- Grupo de Investigación Salud, Familia y Sociedad, Departamento de Medicina Social y Salud Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia.
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24
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Verma N, Grossman D. Self-Managed Abortion in the United States. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:70-75. [PMID: 37305376 PMCID: PMC9989574 DOI: 10.1007/s13669-023-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Purpose of Review This review aims to provide up-to-date information about self-managed abortion in the USA. Recent Findings Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective. Summary Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.
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Affiliation(s)
- Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF), 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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25
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Schreiber CA, Khabele D, Gehrig PA. The Dobbs v Jackson Women's Health Organization Supreme Court Decision-Concerns, Challenges, and Consequences for Health Care. JAMA Surg 2023; 158:229-230. [PMID: 36318215 DOI: 10.1001/jamasurg.2022.5714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This Viewpoint discusses potential consequences that the US Supreme Court ruling in Dobbs v Jackson Women’s Health Organization may have for patient outcomes, public health, training and legal challenges for health care professionals, and the patient-practitioner relationship.
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Affiliation(s)
- Courtney A Schreiber
- Division of Family Planning, Penn Medicine Pregnancy Early Access Center, University of Pennsylvania, Philadelphia
| | - Dineo Khabele
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Paola A Gehrig
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville
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26
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Johnson DM, Michels-Gualtieri M, Gomperts R, Aiken ARA. Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:4-11. [PMID: 36744631 DOI: 10.1363/psrh.12219] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. STUDY DESIGN We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. RESULTS During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. CONCLUSIONS Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.
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Affiliation(s)
- Dana M Johnson
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
| | | | | | - Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
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27
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Hogue CJ. The War on Reproductive Health Care in the United States. Ann Intern Med 2023; 176:276-277. [PMID: 36592460 DOI: 10.7326/m22-3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Arvisais-Anhalt S, Ravi A, Weia B, Aarts J, Ahmad HB, Araj E, Bauml JA, Benham-Hutchins M, Boyd AD, Brecht-Doscher A, Butler-Henderson K, Butte AJ, Cardilo AB, Chilukuri N, Cho MK, Cohen JK, Craven CK, Crusco S, Dadabhoy F, Dash D, DeBolt C, Elkin PL, Fayanju OA, Fochtmann LJ, Graham JV, Hanna JJ, Hersh W, Hofford MR, Hron JD, Huang SS, Jackson BR, Kaplan B, Kelly W, Ko K, Koppel R, Kurapati N, Labbad G, Lee JJ, Lehmann CU, Leitner S, Liao ZC, Medford RJ, Melnick ER, Muniyappa AN, Murray SG, Neinstein AB, Nichols-Johnson V, Novak LL, Ogan WS, Ozeran L, Pageler NM, Pandita D, Perumbeti A, Petersen C, Pierce L, Puttagunta R, Ramaswamy P, Rogers KM, Rosenbloom ST, Ryan A, Saleh S, Sarabu C, Schreiber R, Shaw KA, Sim I, Sirintrapun SJ, Solomonides A, Spector JD, Starren JB, Stoffel M, Subbian V, Swanson K, Tomes A, Trang K, Unertl KM, Weon JL, Whooley MA, Wiley K, Williamson DFK, Winkelstein P, Wong J, Xie J, Yarahuan JKW, Yung N, Zera C, Ratanawongsa N, Sadasivaiah S. Paging the Clinical Informatics Community: Respond STAT to Dobbs v. Jackson's Women's Health Organization. Appl Clin Inform 2023; 14:164-171. [PMID: 36535703 PMCID: PMC9977563 DOI: 10.1055/a-2000-7590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Simone Arvisais-Anhalt
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, United States
| | - Akshay Ravi
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Benjamin Weia
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Jos Aarts
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hasan B. Ahmad
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - Ellen Araj
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Julie A. Bauml
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Marge Benham-Hutchins
- College of Nursing and Health Science, Texas A&M University, Corpus Christi, Corpus Christi, Texas, United States
| | - Andrew D. Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Aimee Brecht-Doscher
- Department of Obstetrics and Gynecology, Ventura County Healthcare Agency, Ventura, California, United States
| | | | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States
| | - Anthony B. Cardilo
- Department of Emergency Medicine, NYU Langone Health, New York, New York, United States
| | - Nymisha Chilukuri
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Mildred K. Cho
- Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, California, United States
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California, United States
| | - Jenny K. Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Catherine K. Craven
- Division of Clinical Research Informatics, Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Salvatore Crusco
- The Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, New York, United States
| | - Farah Dadabhoy
- Department of Emergency Medicine, Mass General Brigham, Boston, Massachusetts, United States
| | - Dev Dash
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Claire DeBolt
- Department of Pulmonary Critical Care, University of Virginia, Charlottesville, Virginia, United States
- Department of Clinical Informatics, University of Virginia, Charlottesville, Virginia, United States
| | - Peter L. Elkin
- Department of Biomedical Informatics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Oluseyi A. Fayanju
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Laura J. Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, United States
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, United States
| | | | - John J. Hanna
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - William Hersh
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Mackenzie R. Hofford
- Division of General Medicine, Department of Medicine, Washington University in St. Louis, St Louis, Missouri, United States
| | - Jonathan D. Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sean S. Huang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Brian R. Jackson
- Department of Pathology, University of Utah, Salt Lake City, Utah, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Bonnie Kaplan
- Bioethics Center, Information Society Project, Solomon Center for Health Care Policy, Yale University Center for Medical Informatics, New Haven, Connecticut, United States
| | - William Kelly
- Department of Biomedical Informatics, University at Buffalo, Buffalo, New York, United States
| | - Kyungmin Ko
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, United States
- Department of Pathology, Texas Children's Hospital, Houston, Texas, United States
| | - Ross Koppel
- Department of Medical informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Medical informatics, University at Buffalo, Buffalo, New York, United States
| | - Nikhil Kurapati
- Department of Family Medicine Soin Medical Center, Kettering Health, Dayton, Ohio
| | - Gabriel Labbad
- Enterprise Information Systems, Cedars Sinai, Los Angeles, California, United States
| | - Julie J. Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Stefano Leitner
- Department of Hospital Medicine, University of California San Francisco, San Francisco, California, United States
| | | | - Richard J. Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Edward R. Melnick
- Department of Emergency Medicine and Biostatistics (Health Informatics), Yale School of Medicine, New Haven, Connecticut, United States
| | - Anoop N. Muniyappa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Sara G. Murray
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Aaron Barak Neinstein
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Victoria Nichols-Johnson
- Department of OB/Gyn (Emerita), Southern Illinois University School of Medicine, Springfield, Illinois, United States
| | - Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - William Scott Ogan
- Division of Bioinformatics, Department of Medicine, University of California San Diego Health, La Jolla, California, United States
| | - Larry Ozeran
- Clinical Informatics, Inc., Yuba City, California, United States
| | - Natalie M. Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Deepti Pandita
- Department of Medicine, Hennepin HealthCare, Minneapolis, Minnesota, United States
| | - Ajay Perumbeti
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, United States
| | - Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Logan Pierce
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Raghuveer Puttagunta
- Department of Internal Medicine, Geisinger Health, Danville, Pennsylvania, United States
| | - Priya Ramaswamy
- Department of Anesthesiology and Critical Care, University of California San Francisco, San Francisco, California, United States
| | - Kendall M. Rogers
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Angela Ryan
- Australasian Institute of Digital Health, Sydney, New South Wales, Australia
| | - Sameh Saleh
- Department of Biomedical and Health Informatics/Department of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Chethan Sarabu
- Department of Information Services, Penn State Health, Hershey, Pennsylvania, United States
| | - Richard Schreiber
- Department of Information Services, Penn State Health, Hershey, Pennsylvania, United States
- Department of Medicine, Penn State Health, Hershey, Pennsylvania, United States
| | - Kate A. Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
- University of California San Francisco University of California Berkeley Joint Program in Computational Precision Health, University of California San Francisco and University of California Berkeley, San Francisco, California, United States
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Anthony Solomonides
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Jacob D. Spector
- Information Services Department, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Justin B. Starren
- Division of Health and Biomedical Informatics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Michelle Stoffel
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, Arizona, United States
| | - Karl Swanson
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Adrian Tomes
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Karen Trang
- Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Kim M. Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jenny L. Weon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mary A. Whooley
- Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
| | - Kevin Wiley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Columbia, South Carolina, United States
| | - Drew F. K. Williamson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Peter Winkelstein
- Institute for Healthcare Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Jenson Wong
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States
| | - James Xie
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Julia K. W. Yarahuan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Nathan Yung
- Department of Hospital Medicine, University of California San Diego Health, La Jolla, California, United States
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Neda Ratanawongsa
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco Center for Vulnerable Populations, San Francisco, California, United States
| | - Shobha Sadasivaiah
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
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29
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Zhang Z, Yu Y, Yang B, Huang W, Zhang Y, Luo Y, Bloom MS, Qian Z, Arnold LD, Boyd R, Wu Q, Liu R, Dong G, Yin C. Association between Pet Ownership and Threatened Abortion in Pregnant Women: The China Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16374. [PMID: 36498445 PMCID: PMC9739756 DOI: 10.3390/ijerph192316374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to assess the association between pet ownership and threatened abortion (TA) in pregnant Chinese women. Materials and Methods: We enrolled pregnant women from 18 provinces and autonomous regions across China between November 2017 and December 2020. Participants were grouped based on the presence or absence of pet ownership. Pet owners were further sub-grouped based on the presence or absence of close contact with their pets. Pet species included cats, dogs, and both. Generalised linear mixed models, with province as a random effect, were used to estimate the associations between pet ownership and TA. Results: Pet ownership, whether or not one had close contact with pets, was associated with greater odds of TA (OR: 1.30, 95% CI: 1.21, 1.40). Keeping pet cats (OR: 1.24, 95% CI: 1.11, 1.40), dogs (OR: 1.29, 95% CI: 1.18, 1.41), or both cats and dogs (OR: 1.36, 95% CI: 1.04, 1.68) during pregnancy were all risk factors for TA. We observed significant group differences (p for difference < 0.05) in pre-pregnancy body mass index, education levels, and annual household income. Conclusions: Cat or dog ownership during pregnancy was associated with an increased risk of TA, especially among overweight, less educated, or lower-income participants.
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Affiliation(s)
- Zheng Zhang
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Boyi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wenzhong Huang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yunting Zhang
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yana Luo
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Lauren D. Arnold
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Rienna Boyd
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Qingqing Wu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Guanghui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chenghong Yin
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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30
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Casas RS, Horvath SK, Schwarz EB, Bachorik AE, Chuang CC. Managing Undesired Pregnancy After Dobbs. J Gen Intern Med 2022; 37:4272-4275. [PMID: 36220947 PMCID: PMC9553298 DOI: 10.1007/s11606-022-07833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 01/04/2023]
Abstract
Although both medication abortion (MAB) and aspiration procedures are safe and effective, the Supreme Court decision in Dobbs v. Jackson Women's Health Organization removed federal protection of access to abortion services. Abortion access is now illegal or severely limited in many states, leading to delays in abortion care for patients in all states. In this rapidly evolving landscape, primary care physicians (PCPs) must be familiar with laws surrounding abortion care in their own and neighboring states. PCPs must also be prepared to expedite abortion care by sharing resources, obtaining testing when needed, and counseling patients about expected outcomes following abortion.
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Affiliation(s)
- Rachel S Casas
- Division of General Internal Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA.
| | - Sarah K Horvath
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Eleanor Bimla Schwarz
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Cynthia C Chuang
- Division of General Internal Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA
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31
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Samuels-Kalow ME, Agrawal P, Rodriguez G, Zeidan A, Love JS, Monette D, Lin M, Cooper RJ, Madsen TE, Dobiesz V. Post-Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med 2022; 29:1414-1421. [PMID: 36268814 PMCID: PMC9772035 DOI: 10.1111/acem.14609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Rodriguez
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
| | - Richelle J Cooper
- Department of Emergency Medicine, University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medial School of Brown University, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Valerie Dobiesz
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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32
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Madera M, Johnson DM, Broussard K, Tello-Pérez LA, Ze-Noah CA, Baldwin A, Gomperts R, Aiken AR. Experiences seeking, sourcing, and using abortion pills at home in the United States through an online telemedicine service. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100075. [PMID: 37503356 PMCID: PMC10372773 DOI: 10.1016/j.ssmqr.2022.100075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
A growing number of people in the United States seek to self-manage their abortions by self-sourcing abortion medications online. Prior research focuses on people's motivations for seeking self-management of abortion and experiences trying to obtain medications. However, little is known about the experiences of people in the U.S. who actually complete a self-managed abortion using medications they self-sourced online. We conducted anonymous in-depth interviews with 80 individuals who sought abortion medications through Aid Access, the only online telemedicine service that provides abortion medications in all 50 U.S. states. Through grounded theory analysis we identified five key themes: 1) participants viewed Aid Access as a "godsend"; 2) Fears of scams, shipping delays, and surveillance made ordering pills online a "nerve-racking" experience; 3) a "personal touch" calmed fears and fostered trust in Aid Access; 4) participants were worried about the "what ifs" of the self-managed abortion experience; and 5) overall, participants felt that online telemedicine met their important needs. Our findings demonstrate that online telemedicine provided by Aid Access not only provided a critical service, but also offered care that participants deemed legitimate and trustworthy.
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Affiliation(s)
| | | | | | | | | | - Aleta Baldwin
- California State University, Sacramento, Sacramento, CA, USA
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33
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Anand A, Gupta A, Yadav P, Rijal P. Suspected illegal abortion and unsafe abortion leading to uterine rupture and incomplete abortion: A case report. Ann Med Surg (Lond) 2022; 84:104933. [PMID: 36582916 PMCID: PMC9793220 DOI: 10.1016/j.amsu.2022.104933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Unsafe abortions are more prevalent in developing countries and countries with restrictive abortion laws, and can lead to significant maternal mortality. Usually, the presentation includes abdominal pain, fever and vaginal bleeding. Case presentation We reported the case of a female in her twenties in her second trimester of pregnancy following unsafe abortion. The patient had abdominal pain, and laboratory investigations revealed anemia and leucocytosis. The patient opted for abortion as the foetus was identified as female by a service provider. Due to unsafe and illegal abortion, the patient developed complications of incomplete abortion and uterine rupture. She was successfully managed by emergency laparotomy followed by repair of uterine rupture and symptomatic management. Clinical discussion Unsafe abortion can lead to complications such as incomplete abortion and uterine rupture. Complications due to abortion are more frequent if not performed by experienced surgeons. In our case, the manual vacuum and aspiration technique was used during the second trimester of pregnancy, which led to uterine perforation. Conclusion Our case highlighted the importance of safe abortion practices and the approach to clinical management of complications of unsafe abortion. Also, global health problems such as unsafe abortion, illegal abortion, sex-selective abortion, and violation of ethical conduct need to be addressed to curb unsafe abortion.
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Affiliation(s)
- Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
- Corresponding author.
| | - Ashwini Gupta
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Punita Yadav
- Department of Obstetrics and Gynaecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pappu Rijal
- Department of Obstetrics and Gynaecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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34
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Raymond-Flesch M, Koyama A, Dhar CP, Brittner M, Chulani VL, Svetaz MV, Baca MA, Barral RL, Hwang LY. Adolescent Medicine Providers: A Critical Extension of the Abortion Service Network. J Adolesc Health 2022; 71:526-529. [PMID: 36088230 PMCID: PMC10317520 DOI: 10.1016/j.jadohealth.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marissa Raymond-Flesch
- Division of Adolescent and Young Adult Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.
| | - Atsuko Koyama
- Department of Child Health Camelback Family Planning, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Cherie Priya Dhar
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mindy Brittner
- Family Medicine and Community Health Icahn School of Medicine at Mount Sinai, The Institute for Family Health, New York, New York
| | - Veenod L Chulani
- Department of Child Health, Chief, Section of Adolescent Medicine, University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, , Phoenix, Arizona
| | - María Verónica Svetaz
- Department of Family and Community Medicine, Teaching Faculty, University of Minnesota, Hennepin Healthcare Whittier Clinic, Minneapolis, Minnesota
| | - Melanie A Baca
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Medical Director of Bernalillo County Youth Services Center, Albuquerque, New Mexico
| | - Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Kansas City, University of Missouri Kansas City, University of Kansas Medical Center, Kansas City, Michigan
| | - Loris Y Hwang
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles (UCLA), David Geffen School of Medicine at UCLA, Mattel Children's Hospital UCLA, Los Angeles, California
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35
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Abortion as Essential Health Care and the Critical Role Your Practice Can Play in Protecting Abortion Access. Obstet Gynecol 2022; 140:729-737. [PMID: 35947856 PMCID: PMC9575566 DOI: 10.1097/aog.0000000000004949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023]
Abstract
Few obstetrician-gynecologists (ob-gyns) provide abortion care, resulting in abortion being separated from other reproductive health care. This segregation of services disrupts the ob-gyn patient-clinician relationship, generates needless costs, delays access to abortion care, and contributes to stigma. General ob-gyns have both the skills and the knowledge to incorporate abortion into their clinical practices. In this way, they can actively contribute to the protection of abortion access now with the loss of federal protection for abortion under Roe v Wade . For those who live where abortion remains legal, now is the time to start providing abortions and enhancing your abortion-referral process. For all, regardless of state legislation, ob-gyns must be leaders in advocacy by facilitating abortion care-across state lines, using telehealth, or with self-managed abortion-and avoiding any contribution to the criminalization of those who seek or obtain essential abortion care. Our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care to the fullest extent.
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Brubaker L, Bibbins-Domingo K. Health Care Access and Reproductive Rights. JAMA 2022; 328:1707-1709. [PMID: 36318152 DOI: 10.1001/jama.2022.19172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Linda Brubaker
- University of California San Diego, La Jolla, California
- Associate Editor, JAMA
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Abstract
This Viewpoint details how clinicians can treat patients who have self-managed an abortion without putting the patient at risk for criminalization.
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Affiliation(s)
- Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Nisha Verma
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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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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Watson K, Paul M, Yanow S, Baruch J. Supporting, Not Reporting - Emergency Department Ethics in a Post- Roe Era. N Engl J Med 2022; 387:861-863. [PMID: 36053234 DOI: 10.1056/nejmp2209312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Katie Watson
- From the Departments of Medical Education, Medical Social Sciences, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.W.); the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (M.P.); Women Help Women, Amsterdam (S.Y.); and the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI (J.B.)
| | - Maureen Paul
- From the Departments of Medical Education, Medical Social Sciences, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.W.); the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (M.P.); Women Help Women, Amsterdam (S.Y.); and the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI (J.B.)
| | - Susan Yanow
- From the Departments of Medical Education, Medical Social Sciences, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.W.); the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (M.P.); Women Help Women, Amsterdam (S.Y.); and the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI (J.B.)
| | - Jay Baruch
- From the Departments of Medical Education, Medical Social Sciences, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.W.); the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (M.P.); Women Help Women, Amsterdam (S.Y.); and the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI (J.B.)
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Lahat A, Klang E. US supreme court decision: the gastroenterological perspective. Therap Adv Gastroenterol 2022; 15:17562848221116935. [PMID: 36035307 PMCID: PMC9403450 DOI: 10.1177/17562848221116935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Eyal Klang
- DeepVision Lab, Sheba Medical Center, Tel HaShomer,
Israel,Department of Diagnostic Imaging, Sheba Medical Center,
Tel HaShomer, Israel,Sackler Medical School, Tel Aviv University, Tel Aviv,
Israel
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Paltrow LM, Harris LH, Marshall MF. Beyond Abortion: The Consequences of Overturning Roe. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:3-15. [PMID: 35652910 DOI: 10.1080/15265161.2022.2075965] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.
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Affiliation(s)
- Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | | | - Deborah Grady
- Department of Medicine, University of California, San Francisco.,Deputy Editor, JAMA Internal Medicine
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Cohen RH, Teal SB. Medication for Early Pregnancy Termination. JAMA 2022; 327:2446-2447. [PMID: 35653130 DOI: 10.1001/jama.2022.6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rebecca H Cohen
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - Stephanie B Teal
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Departments of Obstetrics and Gynecology and Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Harris LH. Navigating Loss of Abortion Services - A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade. N Engl J Med 2022; 386:2061-2064. [PMID: 35544368 DOI: 10.1056/nejmp2206246] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lisa H Harris
- From the Departments of Obstetrics and Gynecology and Women's and Gender Studies, University of Michigan, Ann Arbor
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Gordon MR, Coverdale J, Chervenak FA, McCullough LB. Undue burdens created by the Texas Abortion Law for vulnerable pregnant women. Am J Obstet Gynecol 2022; 226:529-534. [PMID: 34954218 DOI: 10.1016/j.ajog.2021.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a "medical emergency necessitated the abortion." These and other provisions of the statute are to be enforced through "civil actions" brought by private citizens. This article identifies 3 populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 US Supreme Court case, Planned Parenthood v. Casey of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for 3 populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these 3 populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these 3 populations of vulnerable women. For these women, it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Planned Parenthood v. Casey because a "significant number of women will likely be prevented from obtaining an abortion." Federal courts should therefore strike down this law.
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Baldwin A, Johnson DM, Broussard K, Tello-Pérez LA, Madera M, Ze-Noah C, Padron E, Aiken ARA. U.S. Abortion Care Providers' Perspectives on Self-Managed Abortion. QUALITATIVE HEALTH RESEARCH 2022; 32:788-799. [PMID: 35322703 PMCID: PMC9152602 DOI: 10.1177/10497323221077296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University
Sacramento, USA
| | - Dana M. Johnson
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | | | | | - Melissa Madera
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | - Carol Ze-Noah
- Department of Political Science, University of California Berkeley, USA
| | | | - Abigail R. A. Aiken
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
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Biggs MA, Ralph L, Morris N, Ehrenreich K, Perritt J, Kapp N, Blanchard K, White K, Barar R, Grossman D. A cross-sectional survey of U.S. abortion patients’ interest in obtaining medication abortion over the counter. Contraception 2022; 109:25-31. [DOI: 10.1016/j.contraception.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
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Wolfe T, van der Meulen Rodgers Y. Abortion During the COVID-19 Pandemic: Racial Disparities and Barriers to Care in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:541-548. [PMID: 33777258 PMCID: PMC7983965 DOI: 10.1007/s13178-021-00569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 05/06/2023]
Abstract
This article draws on first-hand experience as well as scholarly research to illuminate how COVID-19 has impacted an already-embattled medical service in the USA, subsequently affecting the reproductive health and experiences of diverse individuals navigating an unfamiliar health and economic environment. COVID-19's introduction into a landscape of abortion restrictions has intensified the barriers that providers and communities already face, with disproportionate impacts on Black and Hispanic abortion seekers. Relaxing existing restrictions on medication abortions and telemedicine delivery models may be one way to ease the tension between keeping people home and getting them the treatment they need.
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Affiliation(s)
- Taida Wolfe
- Department of Women’s, Gender, and Sexuality Studies, Rutgers University, 162 Ryders Lane, New Brunswick, NJ 08901 USA
| | - Yana van der Meulen Rodgers
- Department of Women’s, Gender, and Sexuality Studies, Rutgers University, 162 Ryders Lane, New Brunswick, NJ 08901 USA
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Goemans SL, Singh A, Yadav AK, McDougal L, Raj A, Averbach SH. The association between intimate partner violence and recent self-managed abortion in India. AJOG GLOBAL REPORTS 2021; 1. [PMID: 35291317 PMCID: PMC8920295 DOI: 10.1016/j.xagr.2021.100029] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have shown that women who experience intimate partner violence have higher rates of unintended pregnancy and abortion—but whether there are differences between the types of abortion care accessed is unknown. Understanding the predictors of self-managed abortion is important for providing risk-mitigating information and resources to those at highest risk for unintended pregnancy and intimate partner violence. With access to information and medication abortion drugs, it is possible that self-managed abortion can be performed safely, increasing reproductive autonomy for women. OBJECTIVE The purpose of this study is to evaluate the association between experiencing intimate partner violence and using self-managed abortion. STUDY DESIGN This is a cross-sectional analysis of responses of 57,090 married women to the National Family Health Survey-4 conducted across India from 2015 to 2016. The association between the type of intimate partner violence and self-managed abortion was analyzed using multivariable multinomial logistic regression. RESULTS Women who have ever experienced physical intimate partner violence were more likely to have any abortion (adjusted relative risk=1.5; 95% confidence interval, 1.2–2.0) and use self-managed abortion (adjusted relative risk=1.7; 95% confidence interval, 1.1–2.6) than women who have not experienced physical intimate partner violence. Women who have ever experienced sexual intimate partner violence may have been more likely to use self-managed abortion, though this association was not statistically significant (adjusted relative risk=2.7; 95% confidence interval, 0.7–10.4). CONCLUSION Women who have experienced physical intimate partner violence disproportionately use abortion care, both facility-based and self-managed. Women who have experienced sexual intimate partner violence may also be more likely to use self-managed abortion. Although abortion is legal, self-managed abortion is commonly occurring in India. Self-managed abortion represents an additional choice and enhances reproductive autonomy in settings where abortion is legal. The implementation of risk-mitigation resources and policies regarding self-managed abortion would provide protection and enhanced autonomy to susceptible groups across India.
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