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Wahl KJ, Brooks M, Trenaman L, Desjardins-Lorimer K, Bell CM, Chokmorova N, Segall R, Syring J, Williams A, Li LC, Norman WV, Munro S. User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study. J Med Internet Res 2024; 26:e48793. [PMID: 38625731 PMCID: PMC11061794 DOI: 10.2196/48793] [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: 05/07/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. OBJECTIVE We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. METHODS We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. RESULTS A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. CONCLUSIONS We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.
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Affiliation(s)
- Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | | | - Carolyn M Bell
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Nazgul Chokmorova
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Romy Segall
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Janelle Syring
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Taghinejadi N, McCulloch H, Krassowski M, McInnes-Dean A, Whitehouse KC, Lohr PA. Opt-in versus universal codeine provision for medical abortion up to 10 weeks of gestation at British Pregnancy Advisory Service: a cross-sectional evaluation. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:114-121. [PMID: 38296263 DOI: 10.1136/bmjsrh-2023-201893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/29/2023] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To assess patient experiences of pain management during medical abortion up to 10 weeks' gestation with opt-in versus universal codeine provision. METHODS We invited patients who underwent medical abortion up to 10 weeks of gestation to participate in an online, anonymous, English-language survey from November 2021 to March 2022. We performed ordinal regression analyses to compare satisfaction with pain management (5-point Likert scale) and maximum abortion pain score (11-point numerical rating scale) in the opt-in versus universal codeine provision groups. RESULTS Of 11 906 patients invited to participate, 1625 (13.6%) completed the survey. Participants reported a mean maximum pain score of 6.8±2.2. A total of 1149 participants (70.7%) reported using codeine for pain management during their abortion. Participants in the opt-in codeine provision group were significantly more likely to be satisfied with their pain management than those in the universal group (aOR 1.48, 95% CI 1.12 to 1.96, p<0.01). Maximum abortion pain scores were lower on average among the opt-in codeine provision group (OR 0.80, 95% CI 0.66 to 0.96, p=0.02); however, this association was not statistically significant in the model adjusted for covariates (aOR 0.85, 95% CI 0.70 to 1.03, p=0.09). CONCLUSION Our findings suggest that patients have a better experience with pain management during medical abortion when able to opt-in to codeine provision following counselling versus receiving this medication routinely.
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Affiliation(s)
- Neda Taghinejadi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah McCulloch
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
| | - Michał Krassowski
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Amelia McInnes-Dean
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
| | - Katherine C Whitehouse
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
| | - Patricia A Lohr
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
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Purcell C, Newton VL, Bloomer F, Hoggart L. Foregrounding pain in self-managed early medication abortion: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202198. [PMID: 38429082 DOI: 10.1136/bmjsrh-2023-202198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain. METHODS From late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software. RESULTS Focused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising 'period-like pain'. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to 'period pain' can be misleading and a source of additional uncertainty at a potentially already challenging time. CONCLUSIONS For some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of 'period-like pain' do not clarify expectations and should be avoided.
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Affiliation(s)
- Carrie Purcell
- Faculty of Wellbeing, Education and Language Studies, The Open University in Scotland, Edinburgh, UK
| | - Victoria Louise Newton
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
| | - Lesley Hoggart
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
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Agostini A, Miquel L, Herman-Demars H, Frantz S, Sicot M. Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings. Pain Ther 2023; 12:563-574. [PMID: 36840805 PMCID: PMC10036711 DOI: 10.1007/s40122-023-00477-2] [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: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France. METHODS This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI) through a five-level Likert scale (absence, mild, moderated, severe, extreme). Modalities of analgesic prophylaxis prescription (APP) and intake (API) and CAI were collected. Risk factors were investigated using ordinal logistic regression (for pain) or logistic regression (for CAI) with stepwise selection of variables. RESULTS APP was prescribed to 657 (73.7%) women irrespective of the gestational age, among whom 386 (73.7%) took the treatment. Out of 740 women who documented their pain symptoms prior to any CAI, few declared no pain (n = 94, 12.7%) or intense pain (n = 88, 11.9%). The majority reported mild or moderate pain (n = 558, 75.4%). On multivariate analysis adjusted on gestational age, increasing initial [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.47] or total dose (OR 1.15, 95% CI 1.05-1.26) of misoprostol taken were independent factors associated with risk of more pain. When adjusting for gestational age, initial dose of misoprostol (OR 1.69, 95% CI 1.45-2.66) and pain experienced (OR 3.58, 95% CI 2.82-4.55) were significantly associated with higher risk of CAI while API (OR 0.52, 95% CI 0.36; 0.75) was negatively associated. CONCLUSIONS Most of the women received an APP, but not all used it. API and gestational age were not related to different risks of more pain following MToP, whereas history of at least one child showed a negative association. Higher doses of misoprostol were strongly associated with both pain and CAI. API was associated with a decreased risk of CAI.
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Affiliation(s)
- Aubert Agostini
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France.
| | - Laura Miquel
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France
| | | | - Sandrine Frantz
- CHU de Bordeaux, Endocrinology and Metabolism, Reproductive Medicine Unit, Bordeaux, France
| | - Marie Sicot
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France
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Osuga Y, Shirasu K, Tsushima R, Ishitani K. Short‐term efficacy and safety of early medical abortion in Japan: A multicenter prospective study. Reprod Med Biol 2023; 22:e12512. [PMID: 37013166 PMCID: PMC10066193 DOI: 10.1002/rmb2.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the short‐term efficacy and safety of a combined mifepristone‐misoprostol regimen in individuals seeking medical abortion at up to 63 days of gestational age. Methods This open‐label, multicenter, prospective study evaluated the short‐term efficacy and safety of medical abortion, with the primary outcome being the abortion success rate 24 h after misoprostol administration. The participants received 200 mg of mifepristone orally and 800 μg of misoprostol buccally in the hospital/clinic 36–48 h later. Bleeding and lower abdominal pain, which are the main symptoms associated with medical abortion, were recorded. Results The abortion success rate was 93.3% (95% confidence interval [CI]: 87.3–97.1%) within 24 h of misoprostol administration, 63.3% (95% CI: 54.05–71.94%) within 4 h, and 90.0% (95% CI: 83.18–94.73%) within 8 h. The median time from misoprostol administration to a successful abortion was 3.93 h. Bleeding was most commonly observed 0–4 h prior to the confirmation of gestational sac (GS) expulsion. The most intense lower abdominal pain occurred 0–1 h before the confirmation of GS expulsion. Conclusion The combined regimen of mifepristone and buccal misoprostol for medical abortion showed short‐term efficacy and a favorable safety profile.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kazuhiro Shirasu
- Division of Review Board ManagementKanagawa National Health Insurance OrganizationKanagawaJapan
| | - Ruriko Tsushima
- Tsushima Ruriko Women’s Life Clinic Ginza Medical Corporation Women’s WellnessTokyoJapan
| | - Ken Ishitani
- Department of Obstetrics and GynecologyNippon Koukan HospitalKanagawaJapan
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How much will it hurt? Factors associated with pain experience in women undergoing medication abortion during the first trimester. Contraception 2023; 119:109916. [PMID: 36470325 DOI: 10.1016/j.contraception.2022.11.007] [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: 07/11/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Few studies have investigated the features associated with pain levels during abortion. We aimed to investigate the risk factors for experiencing pain during medication abortion, focusing on women's psychological distress and anxiety levels. STUDY DESIGN We carried out this observational study at two centers in Bologna, Italy. We included women aged 18 years or more with a viable intrauterine pregnancy of up to 63 days of amenorrhea, who chose medication abortion. Women received 600 mg of Mifepristone orally and after 48 hours 400 mcg of buccal misoprostol, repeated after 3 hours according to local and regional medication abortion guidelines, as well as prophylactic analgesia. We evaluated the clinical characteristics which may represent risk factors for severe pain (Visual Analogue Scale ≥ 70) through a multivariate model. RESULTS Two hundred forty-two patients were included in our analysis; 92 (38.0%) reported severe pain during medication abortion. Women with higher baseline anxiety levels (General Health Questionnaire 12 score ≥ 6 and General Anxiety Disorder 7 score ≥ 10) had a higher probability of experiencing pain with a Visual Analogue Scale ≥70 (OR = 3.33, 95% CI 1.43-7.76), as well as those who reported dysmenorrhea in the past year (OR = 6.30, 95% CI 2.66-14.91). Previous vaginal deliveries were inversely correlated with pain intensity (OR 0.26, 95% CI 0.14 - 0.50). CONCLUSIONS Increased baseline anxiety levels, dysmenorrhea and no previous vaginal deliveries are associated with severe pain in women undergoing medication abortion. IMPLICATIONS The identification of women at risk for severe pain based on clinical and historical factors as well as the definition of an adequate analgesic regimen may help to improve women's care and pain management during medication abortion.
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The experience of pain in real-time during medication abortion. Contraception 2022; 110:71-75. [DOI: 10.1016/j.contraception.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
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Transcutaneous Electrical Nerve Stimulation to Reduce Pain With Medication Abortion: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:100-107. [PMID: 33278292 DOI: 10.1097/aog.0000000000004208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether high-frequency transcutaneous electrical nerve stimulation (hfTENS) reduces pain during medication abortion. METHODS We conducted a randomized, placebo-controlled trial. Participants who were undergoing medication abortion with mifepristone and misoprostol through 70 days of gestation either received active 80 Hz hfTENS or sham to use for a minimum of 60 minutes within 8 hours of misoprostol. Maximum pain on an 11-point numerical rating scale at 8 hours after misoprostol was the primary outcome. We estimated 20 per group for 80% power to detect a 2-point difference and up to 10% attrition. Secondary outcomes included a maximum pain score at 24 hours, additional analgesia use, the difference in score before and after treatment, the experience of side effects, abortion outcomes, and acceptability. We collected data at baseline, time of misoprostol (0-hour), 8-hour and 24 hours using real-time electronic surveys, and at follow-up. RESULTS Between June 2019 and March 2020, we screened 251 patients and randomized 40-20 each to hfTENS or sham-with one postrandomization exclusion and two patients lost to follow-up. Baseline characteristics were similar. Median maximum pain scores at 8 hours were 7.0 (interquartile range 3.0) and 10.0 (interquartile range 3.0) for hfTENS and sham, respectively. The distribution of these scores was lower among hfTENS users compared with sham (mean rank 15.17 vs 22.63, P=.036). High-frequency TENS users also experienced a significant reduction in posttreatment pain score (-2.0 [interquartile range 2.5] vs 0 [interquartile range 1.5], P=.008). We found no statistically significant differences in use of additional analgesia, distribution of maximum pain scores at 24 hours, side effects, or measures of acceptability. CONCLUSION High-frequency TENS reduced maximum pain scores within 8 hours of misoprostol and reduced pain scores immediately after treatment compared with placebo. High-frequency TENS offers an effective nonpharmacologic option for pain management during medication abortion. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03925129.
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Fix L, Seymour JW, Sandhu MV, Melville C, Mazza D, Thompson TA. At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:172-176. [PMID: 32665231 DOI: 10.1136/bmjsrh-2020-200612] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This study aimed to explore patient experiences obtaining a medical abortion using an at-home telemedicine service operated by Marie Stopes Australia. METHODS From July to October 2017, we conducted semistructured in-depth telephone interviews with a convenience sample of medical abortion patients from Marie Stopes Australia. We analysed interview data for themes relating to patient experiences prior to service initiation, during an at-home telemedicine medical abortion visit, and after completing the medical abortion. RESULTS We interviewed 24 patients who obtained care via the at-home telemedicine medical abortion service. Patients selected at-home telemedicine due to convenience, ability to remain at home and manage personal responsibilities, and desires for privacy. A few telemedicine patients reported that a lack of general practitioner knowledge of abortion services impeded their access to care. Most telemedicine patients felt at-home telemedicine was of equal or superior privacy to in-person care and nearly all felt comfortable during the telemedicine visit. Most were satisfied with the home delivery of the abortion medications and would recommend the service. CONCLUSION Patient reports suggest that an at-home telemedicine model for medical abortion is a convenient and acceptable mode of service delivery that may reduce patient travel and out-of-pocket costs. Additional provider education about this model may be necessary in order to improve continuity of patient care. Further study of the impacts of this model on patients is needed to inform patient care and determine whether such a model is appropriate for similar geographical and legal contexts.
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Affiliation(s)
- Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | - Jane W Seymour
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | | | | | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Vodopivec S, Bokal EV, Pinter B. Counselling before first trimester abortion and acceptability of the procedure: results from a Slovenian cross-sectional study. EUR J CONTRACEP REPR 2019; 24:487-493. [PMID: 31584298 DOI: 10.1080/13625187.2019.1670346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: In Slovenia, first-trimester abortion is performed at the woman's request, either surgically under general anaesthesia or medically with mifepristone and misoprostol, in a public hospital. Our study aimed to evaluate pre-abortion counselling and to reveal differences in acceptability and satisfaction with the two abortion methods.Methods: A cross-sectional study was carried out at Ljubljana University Medical Centre between January and June 2015. Women requesting termination of a pregnancy up to 10 weeks' gestation voluntarily completed an anonymous questionnaire after the procedure and were divided into a surgical and a medical abortion group.Results: Of the 266 women who were invited to take part, 229 accepted; 16.6% chose a surgical abortion, 83.4% a medical abortion. The most frequent reason cited for requesting an abortion was economic/housing problems. Most women who chose a surgical abortion did so because it was faster, whereas most women who chose a medical abortion did so on the advice of a primary care gynaecologist. Women choosing a surgical abortion had more previous pregnancies and presented with a higher gestational age pregnancy. The choice of method was not related to the woman's age. There were no differences in acceptability of the two procedures. Pain during the procedure was, however, more severe in the medical abortion group (p = .026), along with bleeding, nausea and chills; there were no differences in severity of vomiting, diarrhoea, dizziness or headache between the groups. Women in the surgical abortion group reported higher satisfaction with the method (p < .001). The study revealed a low frequency of pre-abortion contraceptive counselling.Conclusion: The most common reason given for choosing a surgical abortion was the speed of the procedure; for a medical abortion, it was on the advice of a primary care gynaecologist. Satisfaction was higher with the surgical abortion method. There were no differences in general acceptability of the methods.
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Affiliation(s)
- Sara Vodopivec
- Division of Obstetrics and Gynaecology, Department of Human Reproduction, Ljubljana University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik Bokal
- Division of Obstetrics and Gynaecology, Department of Human Reproduction, Ljubljana University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bojana Pinter
- Division of Obstetrics and Gynaecology, Department of Human Reproduction, Ljubljana University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Fiala C, Agostini A, Bombas T, Cameron S, Lertxundi R, Lubusky M, Parachini M, Saya L, Trumbic B, Gemzell Danielsson K. Management of pain associated with up-to-9-weeks medical termination of pregnancy (MToP) using mifepristone–misoprostol regimens: expert consensus based on a systematic literature review. J OBSTET GYNAECOL 2019; 40:591-601. [DOI: 10.1080/01443615.2019.1634027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- C. Fiala
- Gynmed Clinic, Vienna, Austria
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - A. Agostini
- Obstetric and Gynecology Department, La Conception Hospital, Marseille, France
| | - T. Bombas
- Obstetric Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - S. Cameron
- Chalmers Centre, NHS Lothian, Edinburgh, Scotland
| | | | - M. Lubusky
- Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc, Czech Republic
| | | | - L. Saya
- Altius Pharma CS, Paris, France
| | | | - K. Gemzell Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Fiala C, Cameron S, Bombas T, Parachini M, Agostini A, Lertxundi R, Gemzell-Danielsson K. Pain management for up to 9 weeks medical abortion – An international survey among abortion providers. Eur J Obstet Gynecol Reprod Biol 2018; 225:181-184. [DOI: 10.1016/j.ejogrb.2018.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
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