Socioeconomic and demographic characteristics of induced abortion cases

The age, parity, marital and socioeconomic status, education, religion, profession and the period of gestation of 200 patients who applied for legal abortions are analyzed. In this study 74% of the women were more than 20 years of age, 75% had attended secondary school, 63% were students or clerks, 53% came from lower- or middle-class families, 40% were Roman Catholics, 45% were unmarried, 40% were nulliparous and 57% had little or no knowledge of contraception.     

药物流产与人工流产在终止早期妊娠的对比分析

目的:观察药物流产与人工流产在终止早期妊娠的临床比较。方法:选择450例育龄妇女妊娠8周内要求终止妊娠的孕妇,随机分成甲、乙两组。甲组用药物流产,乙组用负压吸宫流产。结果:甲组完全流产207例,完全流产率92%,乙组安全流产219例,完全流产97.3%,两组完全流产率经统计学处理无显著性差异。甲组阴道流血天数12.73±4.46天,乙组11.62±5.93天,经统计学处理无显著性差异,阴道流血量;甲组78±15.14ml,乙组72.67±9.98ml,流血量经统计学处理,有显著性差异。结论:两组完全流产效果及流血天数均无显著性差异。药物流产简单易行,局部无创伤,能避免子宫穿孔,宫腔内感染,宫腔黏连等危险因素,是一种较为简便,安全有效的理想方法。     

Missed Opportunities for Discussing Contraception in Adolescent Primary Care

BackgroundOver half of adolescents are sexually active by age 18 years and represent half of sexually transmitted infections (STI). These individuals often do not obtain routine medical care, so discussing contraception at each visit becomes imperative. Our study objectives were to determine the frequency of visits before contraception was discussed/initiated, and to assess factors affecting primary care contraception provision.MethodsA retrospective chart review (January 2009-June 2019) was conducted for preventive, follow-up, and sick visits; Title X confidential visits were excluded. Questions were asked about method at start and end of the visit. Nonparametric median tests for continuous variables and chi-squared tests for categorical variables assessed for differences for patient age, race, gender, insurance type, visit type, and provider gender. The institutional review board approved the study as exempt.ResultsPatients (n = 12,619; median = 15 years; 58% female) were seen in primary care clinic. Providers asked about contraception for 82% of visits, and averaged 3 visits before contraception was discussed. For patients asked about contraception, 60% were using a contraceptive method, 15% left the visit on a new method (24.9% long-acting reversible contraception [LARC]). For patients not using contraception, 39.9% left the visit on a method. Patients asked about contraception were female, older, Hispanic, had public insurance, and were seen by female providers (P < .001). Follow-up/sick visits represented <20% of patients asked about contraception.ConclusionsMultiple visits occur before contraception is discussed in adolescent primary care, and factors including age, race, and gender affect these discussions. Strategies to increase contraception discussions at all visits is essential, as adolescents do not always present for yearly visits.     

Contraception prior to counselling for termination of pregnancy

Objective This study investigates the methods of contraception used by women attending for pregnancy counselling at the time of an unintended pregnancy.

Method Women attending three pregnancy counselling clinics in Birmingham were asked to fill in a questionnaire which was designed to obtain demographic data and history of women's methods of contraception, prior to attending for termination of pregnancy.

Results The contraceptive methods used most widely by women presenting for termination of pregnancy were the condom (n= 188; 43%) and the oral contraceptive pill (n = 96; 22%). A proportion of women did not use any contraception (n = 117; 27%). Women who had undergone a previous termination of pregnancy (29%) had similar contraceptive patterns to those with no history of termination of pregnancy. Women aged 19 and under were less likely to be using contraception (non-users 30/90; 33%) compared with women aged 20 and over (non-users 82/324; 25%), but this difference was not statistically significant. Forty per cent (n = 31) of Afro-Caribbeans did not use any contraception; this was statistically significant when compared with the percentage of Caucasians not using contraception. Only 30% of those eligible had actually presented for post-coital emergency contraception. However, the uptake of emergency contraception was similar in the different age groups.

Conclusion Effective contraception is important in the prevention of unwanted pregnancies and, although it will not prevent all conceptions, it will contribute significantly to a reduction in unintended pregnancies. This study indicates that there is a need to consider and be sensitive to the different cultural needs of ethnic groups in the development and presentation of future contraceptives.     

Early IUD insertion after medically induced abortion

Objective: There is insufficient evidence on the continuation, safety and acceptability of immediate insertion of the intrauterine device (IUD) after medical abortion. The objective of the present study was to evaluate clinical outcomes of early IUD insertion, compared with those of delayed IUD insertion, following medical abortion.

Methods: Women undergoing medical abortion with mifepristone and misoprostol up to 49 days’ gestation and opting for Copper T 380A IUD contraception underwent early (5–14 days after mifepristone) or delayed insertion (3–4 weeks after mifepristone). The primary outcome measure was 6 month IUD continuation rate after medical abortion. Secondary outcome measures included user acceptability and safety.

Results: Between October 2015 and October 2016, post-medical abortion IUD insertion was performed in 120 eligible women fulfilling the inclusion and exclusion criteria. There was no statistically significant difference in the continuation rates of the early and delayed IUD insertion groups at 6 months (76.7 versus 83.3%, p?=?.75). The 6 month IUD expulsion rates were 6.7 and 3.3% in the early and delayed insertion groups, respectively (p?=?.56). There were 10 (16.7%) removals in the early and eight (13.3%) in the delayed insertion groups (p?=?.77). Level of satisfaction with postabortal IUD use was comparable in both groups. Adverse events were rare and did not differ significantly between the two groups.

Conclusion: We demonstrated high continuation rates, safety and acceptability of early IUD insertion after medical abortion.     

Profile of women seeking medical termination of pregnancy in South India

Objective

To investigate the demographic and obstetric profile of women seeking medical termination of pregnancy (MTP) in South India in accordance with the MTP Act of India.

Methods

A registry-based retrospective study was carried out at a tertiary care teaching hospital in South India. The hospital records of all pregnant women seeking MTP over a 2-year period between January 2011 and December 2012 were reviewed.

Results

A total of 244 women underwent MTP during the study period. More than one-third (37.8%) were aged between 26 and 30 years. The majority of women underwent MTP during the first trimester (79.5%). Medical reasons were cited as the most common reason for undergoing MTP (39.3%), followed by unplanned pregnancy (34.8%). The majority of women were seeking MTP for the first time (84.8%). More than half of the women (52.9%) opted for post-MTP contraception.

Conclusion

MTP for unplanned pregnancy can be prevented if people are well informed about methods of contraception. MTP is an opportunity for healthcare professionals to discuss fertility needs and need for contraception with women seeking MTP so that appropriate decisions can be taken for suitable family planning.     

Sexual dysfunction after a first trimester induced abortion in a Chinese population

Objective

To evaluate the short-term effect of a first trimester induced abortion on sexuality in a Chinese population.

Study design

This is a cross-sectional study. One hundred and four women attending the post-abortion clinic 3–4 months after a first trimester induced abortion were recruited. They completed a self-administered questionnaire anonymously. The associations of various factors with sexual behavior after abortion were analyzed by the Chi-square test.

Results

More than 30% of the women reported a reduction in both frequency of vaginal intercourse and sexual desire. Their partners also had a reduction in sexual desire. The reduction of vaginal intercourse is more significant among young, unmarried women and those not having sterilization (P = 0.01). In addition, the prevalence of reduction in sexual desire and enjoyment among those women who had repeated abortion was significantly higher (P < 0.01).

Conclusion

The sexuality of both women and their partners are affected after abortion. It may be due to both psychological trauma and the worry of another unwanted pregnancy. Proper counseling may relieve their anxiety and improve sexual lives.     

Self-reporting of induced abortion by women attending prenatal clinics in urban Nigeria

Objective

To determine the proportion of all clinically confirmed pregnancies that end as induced abortion in a cohort of pregnant women in Nigeria.

Methods

A total of 490 women who attended prenatal clinics at the University of Benin Teaching Hospital were interviewed with the preceding birth technique (PBT) on the outcomes of their previous pregnancies, including abortions.

Results

Of the 490 women, 384 women (78.4%) reported previous abortions. A total of 1883 previous pregnancies were reported by the women, of which 914 ended in abortion, 545 in live births, and 421 in stillbirths, with 3 unclassified. The total abortion ratio was 914/1842 (49.6%), when 41 women who reported no previous pregnancies were excluded. Of the 914 abortions, 751 (82.25) were induced abortions, 146 (16.0%) were spontaneous abortions, 9 (0.98%) were missed abortions, and 8 were unclassified. Results of logistic regression analysis showed that women aged 25-29 years were 4 times more likely to report induced abortion compared with older women.

Conclusion

Induced abortion was found to be highly prevalent in this region of Nigeria, according to self-reports of women who were asked questions on abortion in the context of medical care.     

Best practices in surgical abortion

Surgical abortion in the first trimester comprises the majority of voluntary pregnancy interruptions performed in the United States. The majority of these procedures are done in outpatient settings with the patient under local anesthesia. Appropriate volume of and deep injection of local anesthetic can reduce pain associated with the procedure. Waiting between administration of the paracervical block and initiating the procedure does not affect pain. Intravenous administration of sedation and analgesia improves patient satisfaction but does not significantly affect pain ratings. Antibiotic prophylaxis is warranted. Vasopressin is useful for prevention of hematometra and hemorrhage. Less evidence supports the routine use of ergots. Preoperative cervical priming reduces the risk of cervical injury and uterine perforation. Attention to operative technique can reduce the risk of incomplete abortion. Routine postoperative care at 2 or 3 weeks is timed to identify complications and to reinforce pregnancy and sexually transmitted disease prevention.     

Louisiana and Mississippi Family Physicians' Contraception Counseling for Adolescents with a Focus on Intrauterine Contraception

Study ObjectiveThe adolescent pregnancy rate in Louisiana (LA) and Mississippi (MS) is one of the highest in the United States. One approach to decrease that rate is to increase contraceptive use. We sought to characterize LA and MS family physicians' (FPs) contraception counseling for adolescents with a focus on the intrauterine contraceptive device (IUD).Design, Setting, Participants, Interventions, and Main Outcome MeasuresOnline survey of resident and practicing physician members of the LA and MS Academy of FPs.ResultsThree hundred ninety-eight of 1616 invited FPs responded; 244 were included in our analysis. When counseling adolescents about contraception, respondents “frequently discussed” oral contraceptives and condoms 87.5% (210/240) and 83.8% (202/241) of the time, respectively. Newer and more highly effective contraceptives such as the ring, patch, IUD, and implant were “frequently discussed” only 34.6% (82/237)-39.3% (92/234) of the time. In the previous 6 months, 56% (136/243) of respondents ever discussed an IUD with an adolescent. Respondents were more likely to have discussed IUDs if they learned IUD insertion during residency, had on-site access to IUD inserters, believed they were competent and/or comfortable with IUD counseling. In 5 clinical scenarios asking whether the respondent would recommend an IUD to a 17- or a 27-year-old patient (in all scenarios patients were eligible for an IUD), respondents were restrictive overall and significantly fewer would recommend an IUD for the adolescent.ConclusionOur results suggest that there are missed opportunities for full-scope contraception counseling by LA and MS FPs. When these FPs counsel adolescents about contraception they less frequently discuss newer methods and more highly effective methods. Additionally many LA and MS FPs use overly restrictive eligibility criteria when considering IUDs.     

人工流产术后继发性不孕原因分析及对女性性激素的影响

目的 研究分析人工流产术后继发性不孕原因及对女性性激素的影响.方法 选取46例行人工流产术后继发性不孕患者为研究组;另选同期40例人工流产术后正常受孕者为对照组.分析继发性不孕影响因素以及对女性性激素的影响.结果 两组患者年龄、手术方法、流产次数以及月经不调发生率比较,差异无统计学意义(P＞0.05),而宫腔粘连、慢性...     

Induced Abortion According to Socioeconomic Status in Chile

Study ObjectiveThe Chilean legislation forbids induced abortion, so little is known of the young women who have abortions and what determinants are associated with this practice. In this study we examined the association between adolescents and young women who have had induced abortions and socioeconomic status and compared them with counterparts who reported not having a history of abortion.Design, Setting, Participants, and Main Outcome MeasuresDrawing on the 2015 Chilean National Youth Survey, a population-based sample of general community youth aged 15-29 years, we conducted a study on 2439 sexually active females. Bivariate and multiple logistic regression was used to examine the relationship between participants who had induced abortions and participants that had not according to socioeconomic status (low, middle, high), while controlling for demographic, sexual behavior, and cultural covariates.Results5.15% (n = 129) of participants declared having induced an abortion in the past. Participants with high socioeconomic status had 4.89 (95% confidence interval, 1.44-16.51) higher odds of induced abortion compared with participants with low socioeconomic status. Those with middle socioeconomic status had 1.8 (95% confidence interval, 1.02-3.24) higher odds of induced abortion compared with those with low socioeconomic status. Urban or rural residence, indigenous identification, age of sexual debut, contraceptive use at the time of sexual debut, adolescent pregnancy, and religious and political identification did not correlate with induced abortion rates.ConclusionIn Chile, where induced abortion is legally restricted, a social gradient was found in the chance of having had an induced abortion according to socioeconomic status; adolescent and young women with higher socioeconomic advantage reported more induced abortions compared with those with low socioeconomic status.     

Metronidazole and prostaglandin induced abortion

Since the majority of patients requesting induced abortion are nulliparous, it is important that the procedure not endanger future fertility. Infection and uterocervical trauma are 2 possible abortion-related complications which might affect furture fertility. A clinical study was conducted to assess the efficacy of prophylactic use of an antibiotic as a routine accompaniment of induced abortion. Patients selected for the study had been accepted for elective 1st-trimester abortion under the 1967 British Abortion Act. All were aborted with intrauterine extraamniotic PG(prostaglandin) administration supplemented by curettage. 142 of the women received no prophylactic; 145 received 1200 mg metronidazole by mouth 2 hours before the procedure and 400 mg 3 times daily for 2 days thereafter. Population characteristics in the 2 groups were comparable. 24% of the nonantibiotic group as compared to only 4% of the antibiotic group developed postoperative pyrexia. 12% in the nonantibiotic group as compared to 2% of the antibiotic group developed vague symptoms suggestive of pelvic sepsis or of incompleted evacuation. There was no evidence of cervical or uterine trauma in either group. It is concluded that prophylactic antibiotics should be administered with pregnancy termination procedures.     

Why prevention of repeat abortion is so challenging: psychosocial characteristics of women at risk

Objectives: Abortion rates have declined in recent decades; however, the rate of repeat abortion remains high. In order to identify keys to making efficient interventions against repeat abortion, our objectives were: to assess the percentage of repeat abortions in women opting for termination of pregnancy over a period of 1 year; to identify the risk factors for repeat abortion; and to assess the characteristics of women who opted for a further pregnancy termination despite having received standard post-abortion care.

Methods: A retrospective cross-sectional survey was carried out among 362 women who underwent pregnancy termination during a 1-year period. Women with and without repeat abortion were compared with regard to age, nationality, marital status, parity and use of contraception. In a subsample of 160 women who were available for follow-up over 4 years, those who underwent a further pregnancy termination during the observation period were also analysed qualitatively.

Results: The rate of repeat abortion was 30.1% in the survey population. Age and immigrant status were identified as risk factors. The use of long-acting reversible contraception (LARC) was significantly higher after repeat abortion than after a first termination of pregnancy. Among women with repeat abortion in the follow-up group, those with psychological problems tended to discontinue contraception and those with partnership conflicts were prone to using unreliable contraceptive methods.

Conclusion: Aside from promoting LARC methods, strategies to reduce repeat abortion should consider the psychosocial risk factors and characteristics of women at risk identified in this study. An interdisciplinary approach including social care and counselling would be the most appropriate means to enable this.     

Follow-up Rates and Contraceptive Choices after Medical Abortion in Adolescents at Cook County Hospital

Study ObjectiveTo determine follow-up rates for adolescent patients who underwent medical abortion compared with adult patients, identify patient factors associated with follow-up, and evaluate contraceptive choices at the time of follow-up.Design, Setting, and ParticipantsA retrospective cohort study of adolescent patients (ages 15-19 years) who underwent first-trimester medical abortions at John H. Stroger, Jr. Hospital of Cook County from 2014 through 2017.InterventionsNone.Main Outcome MeasuresRate of follow-up after medical abortion, demographic factors associated with higher follow-up rates, and contraceptive choices by adolescents at follow-up encounters.ResultsDuring the study period, 8111 medication abortions were performed in our clinic. Adolescents accounted for 446 of these patients (446/8111; 5.5%). Among adolescents, the follow-up rate was 231/446 (51.8%). We determined the follow-up rates among a random sample of patients ages 20-24 years (n = 494) and 25-39 years (n = 397) to be 213/494 (43.1%), and 161/397 (40.5%), respectively. African American adolescents were significantly less likely to follow-up compared with their Hispanic and white counterparts (relative risk, 0.76; 95% confidence interval, 0.66-0.89). Those enrolled in college were significantly more likely to follow-up compared with those who reported lower levels of education (relative risk, 1.4; 95% confidence interval, 1.0-1.9). Only 2.5% of adolescents reported ever using a tier 1 contraception option before presenting for an abortion and among those who did follow-up, only 18% chose a tier 1 option for ongoing pregnancy prevention.ConclusionApproximately half of our adolescent study population is at risk for undetected failed medical abortion and subsequent unplanned pregnancy.     

Induced abortion frequency in Ankara,Turkey, before and after the legal regulation of induced abortion

Objective To determine the effects of the 1983 law that legalized induced abortion on the number and place of abortions, and on the use of family planning (FP) methods before and after abortion, and to determine the demographic characteristics and reproductive health features according to the order of abortion.

Method This study included 2455 married, widowed or divorced women presenting at Mother and Child Health-Family Planning Centres in Ankara. A questionnaire was used for data collection.

Result Nearly three out of 10 (28.7%) of the women had undergone at least one induced abortion. In the age groups 45–54 and 55–64, 49 and 37.3%, respectively, had had one or more terminations of pregnancy (TOPs). The induced abortion rate increased following the enacting of the law. In the 15–24 and in the 55–64 age group, 55.6 and 89%, respectively, of the women had been aborted by a private physician. Before the index pregnancy, 63.1% were not using contraception compared with 37.3% thereafter. The rate of use of FP increased after the law was passed.

Conclusion Although the most common reason for having an abortion was unwanted pregnancy in all age groups and nearly 60.0% of the women aged less than 55 reported that they were not using any FP method at the time of the TOP, the proportion of women having undergone at least one of these procedures increased after the law was passed, indicating that abortion is used as a FP method.     

Emergency Contraception Use in School-Based Health Centers: A Qualitative Study

Study Objective

To understand contraceptive behaviors and decision-making in school-based health center (SBHC) female patients who have used emergency contraception (EC).