Abstract
Objectives: RHEDI, Reproductive Health Education in Family Medicine, supports family medicine residency programs to establish a required rotation in reproductive health, including abortion and comprehensive family planning. To evaluate the long-term effects of this training, we examined the practice patterns of family physicians two to five years after residency graduation. Methods: 763 family physicians who completed residency training from 2015 through 2018 at programs with routine abortion training were invited to complete an anonymous online survey about residency training and current provision of abortion and other reproductive health services. Results: 298 respondents completed the survey, for a response rate of 39%. Of the eligible respondents who received routine abortion training during residency (n=249), 29% had provided abortion after residency and 21% had done so in the past year. This rate is much higher than the 3% rate found in a recent representative study of family physicians1. More respondents had provided medication than aspiration abortion, 28% vs 20%, and those who trained in abortion within family medicine settings, as compared to only at high volume settings, were significantly more likely to have provided abortion after residency. In addition, over 80% of respondents also provided a range of LARC and miscarriage management services.1. Patel P Narayana S et al. Abortion Provision Among Recently Graduated Family Physicians. Fam Med. 2020 Nov;52(10):724-729. Conclusions: Abortion training during residency is strongly linked to post-residency abortion provision, and is crucial in preparing family physicians to meet the full range of their patients’ reproductive health care needs.
Highlights
To understand if patient safety differs by physician specialty, we compared major and any abortion-related morbidity and adverse events in abortion care provided by physicians of other specialties versus obstetrician-gynecologist physicians (Ob-Gyn)
The study cohort included 34,633 patients who had 35,272 abortions; 4,708 (13.3%) abortions provided by physicians of other specialties and 30,564 (86.7%) abortions provided by Ob-Gyns
There was no statistically significant difference in major abortion-related morbidity or adverse events comparing physicians of other specialties versus Ob-Gyns (adjusted OR 0.98,), and no statistically significant difference in any abortion-related morbidity or adverse events comparing physicians of other specialties versus Ob-Gyn (adjusted OR 0.92,)
Summary
Compare induction to delivery intervals and complications in second trimester labor induction using mifepristone with misoprostol vs misoprostol alone. Methods: A retrospective analysis was performed of second trimester induction terminations at two urban medical centers over ten years. Inclusion criteria were pregnancies between 14.0 weeks and 23.6 weeks gestation without evidence of labor, intrauterine infection, or ruptured membranes upon admission. Comparisons between mifepristone plus misoprostol or misoprostol alone were performed, including composite complications (retained placenta requiring surgery, infection, hemorrhage, blood transfusion, failed induction, ICU admission, and readmission), total misoprostol dosage, and induction to delivery intervals. Results: The final analysis included 406 patients, 286 (66%) at gestational age > 20 weeks. Most were for fetal anomalies (196, 48.3%) or intrauterine fetal demise (199, 49.0%). Thirty-two percent (n=133) received mifepristone plus misoprostol and sixty-seven percent (n= 273) received misoprostol alone
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