1
|
Nandi P, Roncari DM, Werner EF, Gilbert AL, Ramos SZ. Navigating Miscarriage Management Post-Dobbs: Health Risks and Ethical Dilemmas. Womens Health Issues 2024; 34:449-454. [PMID: 38925991 DOI: 10.1016/j.whi.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Preetha Nandi
- Division of Family Planning, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Danielle M Roncari
- Division of Family Planning, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Sebastian Z Ramos
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts.
| |
Collapse
|
2
|
Premkumar A, Huysman B, Cheng C, Einerson BD, Moayedi G. Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care. Am J Obstet Gynecol 2024:S0002-9378(24)00820-2. [PMID: 39117028 DOI: 10.1016/j.ajog.2024.07.045] [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: 03/14/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
Given the limitations in perioperative management strategies available at freestanding abortion clinics, abortion providers must commonly discern which patients are too complicated for procedural abortions at their center and must be referred for a hospital-based abortion. The need to transition from freestanding clinics to hospital-based abortion care can lead to delays in completing an abortion and significant social, economic, and psychological repercussions for the pregnant individual. One significant clinical problem that exemplifies the issue of who can be safely taken care of at a freestanding abortion clinic is when the placenta accreta spectrum is suspected. Placenta accreta spectrum is one of the major contributors to maternal morbidity and mortality in the United States, requiring coordinated multidisciplinary management to ensure the safest outcome for the pregnant individual. In this Clinical Opinion, we review the literature focused on identifying individuals at risk for placenta accreta spectrum >14+0 weeks gestation, delineate an algorithm to improve the frequency of timely referrals to hospital-based abortion providers, and propose next steps for future training goals and research on placenta accreta spectrum in the second trimester between complex family planning and maternal-fetal medicine subspecialists.
Collapse
Affiliation(s)
- Ashish Premkumar
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago IL.
| | - Bridget Huysman
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis MO
| | - CeCe Cheng
- Department of Obstetrics and Gynecology, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | | |
Collapse
|
3
|
Moayedi G, Osamba A, Koyama A. Abortion Bans Harm Not Just Pregnant People-They Harm Newborns and Infants Too. JAMA Pediatr 2024; 178:748-750. [PMID: 38913338 DOI: 10.1001/jamapediatrics.2024.1792] [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: 06/25/2024]
Affiliation(s)
| | | | - Atsuko Koyama
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix
- Camelback Family Planning, Phoenix, Arizona
| |
Collapse
|
4
|
Meyer R, Toussia-Cohen S, Shats M, Segal O, Mohr-Sasson A, Peretz-Bookstein S, Amitai-Komem D, Sindel O, Levin G, Mashiach R, Blumenthal PD. 24-Hour Compared With 12-Hour Mifepristone-Misoprostol Interval for Second-Trimester Abortion: A Randomized Controlled Trial. Obstet Gynecol 2024; 144:60-67. [PMID: 38781593 DOI: 10.1097/aog.0000000000005535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/18/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To compare 24-hour and 12-hour mifepristone-to-misoprostol intervals for second-trimester medication abortion. METHODS We conducted a prospective randomized controlled trial. Participants were allocated to receive mifepristone either 24 hours or 12 hours before misoprostol administration. The primary outcome was the time from the first misoprostol administration to abortion (induction time). Secondary outcomes included the time from mifepristone to abortion (total abortion time); fetal expulsion percentages at 12, 24, and 48 hours after the first misoprostol dose; side effects proportion; and pain and satisfaction scores. A sample size of 40 per group (N=80) was planned to compare the 24- and 12-hour regimens. RESULTS Eighty patients were enrolled between July 2020 and June 2023, with 40 patients per group. Baseline characteristics were comparable between groups. Median induction time was 9.5 hours (95% CI, 10.3-17.8 hours) and 12.5 hours (95% CI, 13.5-20.2 hours) in the 24- and 12-hour interval arms, respectively ( P =.028). Median total abortion time was 33.0 hours (95% CI, 34.2-41.9 hours) and 24.5 hours (95% CI, 25.7-32.4 hours) in the 24- and 12-hour interval groups, respectively ( P <.001). At 12 hours from misoprostol administration, 25 patients (62.5%) in the 24-hour arm and 18 patients (45.0%) in the 12-hour arm completed abortion ( P =.178). At 24 hours from misoprostol administration, 36 patients (90.0%) in the 24-hour arm and 30 patients (75.0%) in the 12-hour arm had complete abortion ( P =.139). The need for additional medication or surgical treatment for uterine evacuation, pain scores, side effects, and satisfaction levels were not different between groups. CONCLUSION A 24-hour mifepristone-to-misoprostol regimen for medication abortion in the second trimester provides a median 3-hour shorter induction time compared with the 12-hour interval. However, the median total abortion time was 8.5-hours longer in the 24-hour interval regimen. These findings can aid in shared decision making before medication abortion in the second trimester. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04160221.
Collapse
Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, the School of Medicine, Tel-Aviv University, Tel-Aviv, and the Department of Obstetrics and Gynecology, Hadassah Medical Center, and the School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; and the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Turk JK, Claymore E, Dawoodbhoy N, Steinauer JE. "I Went Into This Field to Empower Other People, and I Feel Like I Failed": Residents Experience Moral Distress Post- Dobbs. J Grad Med Educ 2024; 16:271-279. [PMID: 38882403 PMCID: PMC11173027 DOI: 10.4300/jgme-d-23-00582.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/09/2024] [Accepted: 03/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background The 2022 Supreme Court ruling in Dobbs v Jackson Women's Health Organization nullified the constitutional right to abortion, which led to effective bans in at least 14 US states and placed obstetrics and gynecology (OB/GYN) residents in dilemmas where they may have to withhold care, potentially causing moral distress-a health care workforce phenomenon less understood among resident physicians. Objective To identify and explore moral distress experienced by OB/GYN residents due to care restrictions post-Dobbs. Methods In 2023, we invited OB/GYN residents, identified by their program directors, training in states with restricted abortion access, to participate in one-on-one, semi-structured interviews via Zoom about their experiences caring for patients post-Dobbs. We used thematic analysis to analyze interview data. Results Twenty-one residents described their experiences of moral distress due to restrictions. We report on 3 themes in their accounts related to moral distress (and 4 subthemes): (1) challenges to their physician identity (inability to do the job, internalized distress, and reconsidering career choices); (2) participating in care that exacerbates inequities (and erodes patient trust); and (3) determination to advocate for and provide abortion care in the future. Conclusions OB/GYN residents grappled with moral distress and identified challenges from abortion restrictions.
Collapse
Affiliation(s)
- Jema K Turk
- is Director of Evaluation, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Emily Claymore
- is Assistant Director of Programs, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nafeesa Dawoodbhoy
- is Program Manager, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; and
| | - Jody E Steinauer
- is Director, Ryan Residency Training Program, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Nambiar A, Pruszynski JE, Thiele L, Santiago-Munoz P, Nelson DB, Spong CY, Baker CC. Abortion reporting following changes in state legislation. Am J Obstet Gynecol 2024; 230:e78-e81. [PMID: 38097029 DOI: 10.1016/j.ajog.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Anjali Nambiar
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Lisa Thiele
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - David B Nelson
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | |
Collapse
|
7
|
Thaxton L, Gonzaga MI, Tristan S. Abortion Policy: Legal, Clinical, and Medical Education Considerations. Clin Obstet Gynecol 2023; 66:759-772. [PMID: 37910072 DOI: 10.1097/grf.0000000000000824] [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: 11/03/2023]
Abstract
Abortion is a frequent topic of policy debate in America and a central issue in politics since the Dobbs v Jackson Women's Health Supreme Court decision. A number of states have completely or nearly completely banned abortion and criminalized health care providers. People seeking abortion care are turning to alternatives outside the formal health care system or traveling to states that have preserved access. Approximately half of US Obstetrics/Gynecology residents will train in a state where abortion is illegal, lending to a frightening future where Obstetrics/Gynecologists are not trained to provide this common, sometimes life-saving, health care.
Collapse
Affiliation(s)
- Lauren Thaxton
- Department of Women's Health University of Texas at Austin Dell Medical School, Austin, Texas
| | | | | |
Collapse
|
8
|
Lerma K, Coplon L, Goyal V. Travel for abortion care: implications for clinical practice. Curr Opin Obstet Gynecol 2023; 35:476-483. [PMID: 37916900 DOI: 10.1097/gco.0000000000000915] [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: 11/03/2023]
Abstract
PURPOSE OF REVIEW Traveling long distances to obtain abortion care due to restrictions and scarce availability is associated with significant obstacles. We review clinical strategies that can facilitate abortion access and outline considerations to ensure person-centered and equitable care. RECENT FINDINGS Establishing a patient's gestational duration prior to travel may be beneficial to ensure they are eligible for their desired abortion method at the preferred facility or to determine if a multiday procedure is required. If a local ultrasound cannot be obtained prior to travel, evidence demonstrates people can generally estimate their gestational duration accurately. If unable to provide care, clinicians should make timely referrals for abortion. Integration of telemedicine into abortion care is safe and well regarded by patients and should be implemented into service delivery where possible to reduce obstacles to care. Routine in-person follow-up care is not necessary. However, for those who want reassurance, formalized pathways to care should be established to ensure people have access to care in their community. To further minimize travel-related burdens, facilities should routinely offer information about funding and practical support, emotional support, and legal resources. SUMMARY There are many opportunities to optimize clinical practice to support those traveling for abortion care.
Collapse
Affiliation(s)
- Klaira Lerma
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Leah Coplon
- Abortion On Demand, Seattle, Washington, USA
| | - Vinita Goyal
- Population Research Center, The University of Texas at Austin, Austin, Texas
| |
Collapse
|
9
|
Panah LG, Menachem JN, Boos EW, Lindley KJ. Pregnancy and Adult Congenital Heart Disease in a Post-Roe World. J Card Fail 2023; 29:1556-1560. [PMID: 37973315 DOI: 10.1016/j.cardfail.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Lindsay G Panah
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan N Menachem
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Elise W Boos
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Kathryn J Lindley
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|