Abortion In Hospital Research Articles

Changes in the numbers of hospital-based abortions and outpatient early medical abortions in Victoria, 2012-22: a retrospective cohort study.

To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 - March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic. Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. All admitted care episodes in Victoria during 1 January 2012 - 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone-misoprostol (MS-2 Step) during 1 January 2015 (date of listing) - 31 March 2022. Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 - March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 - March 2022). The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, -2.92 [95% CI, -3.45 to -2.38] per month); the rate of decline was greater during the pandemic period (slope, -5.74 [95% CI, -10.5 to -0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34-6.34] per month); it declined during the first month of the pandemic (slope, -26.4 [95% CI, -70.1 to -17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 - March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone-misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.

Implementation of Abortion Regulations on Medical Emergency Indications in Hospitals Based on Legal Aspects

Abortion is one method to prevent unwanted births. This method was born along with the development of human life with various reasons and considerations, both legal and medical considerations. Abortion is a crucial law in health law. But abortion for several medical reasons is a legal way to provide solutions to safety problems related to pregnancy. As the executors of the abortion act, namely medical personnel who are closely related to existing regulations or policies, it is still a pro and contra polemic. Therefore, it is necessary to do an analysis to determine the clarity of the legality of the implementation of abortion on indications of medical emergencies in hospitals associated with abortion law regulations. The research design used in this study is qualitative through a descriptive analysis approach related to the legality issue of abortion regulations indicating medical emergencies between the Health Act and the Abortion Criminal Code. The sample in this study was an obstetrician with a medical team, namely midwives who worked in the delivery room. This study aims to determine the factors that influence the implementation of abortion regulations based on indications of medical emergencies in hospitals, specifically referring to Health Law No. 36 of 2009 with the Criminal Code on abortion. The factors that influence the implementation of abortion in hospitals are: the discovery of indicators or triggers that an abortion must be carried out in accordance with the Health Law Number 36 of 2009; it must be carried out as soon as possible because it endangers the patient’s life; carried out according to health standards and applicable laws; and the approval of both the parties to carry out official and legal abortion procedures and mechanisms according to legal and applicable rules. Based on this, abortions with indications of medical emergencies are often carried out in hospitals and can be justified by the principle of legitime defense. Legal issues regarding the regulation of abortion indicative of a medical emergency, as long as they refer to the procedures according to the Health Law, the legal issue of the Criminal Code cannot be brought to the surface, because abortion on the indication of a medical emergency is a medical action that must be carried out.
 Keywords: abortion, health law, hospital

Performance, Protest, and Feminism in Latin America

How do activists in Latin America fight for change both online and in the streets? This piece narrates a course on Feminist Protest and Performance in Latin America that explores the limits and possibilities of feminist activism in physical and digital spaces. At this critical historical juncture, feminists across the hemisphere are organizing en masse to demand change and justice, to denounce pervasive misogyny and gender violence, and to envision and realize another world. Drawing on a long history of struggle, they are engaging in performance artivism across multiple platforms including Las Tesis piece El Violador Eres Tu (The rapist is you), under the hashtags #NiUnaMenos (#NotOneWomanLess) and #AbortoLegalYa (#LegalizeAbortionNow), and in massive physical occupations and protests like #OcupaEscola (#OccupyTheSchools). They are mobilizing to condemn femicide, to advocate access to legal abortions in public hospitals, and to introduce comprehensive sex education in public schools. Drawing on these interconnected forms of performance and protest, what Marcela Fuentes refers to as “performance constellations,” women and disidencias sexuales are fighting together for the right to live without fear, to make decisions about their own bodies, and to exist in a more just world. This class asks students to learn from Latin American feminst movements and to connect their insights to our intimate and collective experiences. Beyond the syllabus, this piece offers reflections on the philosophy of co-teaching, transnational activism across the Americas, and modes of embodiment that can happen online. We invite students and educators alike to consider what it might mean to “perform well” in a university class focused on pleasure and solidarity.

Effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly.

To explore the effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. Based on literature review, a self-made general demographic information questionnaire, the Edinburgh Postnatal Depression Scale, the Individual Level Abortion Stigma Scale, the Acceptance and Action Questionnaire-II, the Cognitive Fusion Questionnaire-Fusion, the Responses to Stress Questionnaire and the Perceived Social Support Scale were used to investigate pregnant women with fetal anomaly before abortion in tertiary general hospitals and specialist maternity hospitals in Changsha, to develop a hypothesis model of the factors influencing depressive symptoms before terminating the pregnancy. The hypothesis model was verified by applying structural equation modelling analysis. The structural equation model showed that the stigma directly or indirectly influenced depressive symptoms before terminating the pregnancy via psychological flexibility, social support and avoidance coping. The total effect value was 0.55 (P<0.05), the direct effect value was 0.22 (P<0.05), and the indirect effect value was 0.33 (P<0.05). Psychological flexibility and social support had protective mediating effects, while avoidance coping had harmful mediating effects. Abortion stigma has large positive effect on the depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly. Among direct and indirect effect, the indirect effect is major. Effective measures to reduce the stigma, increase psychological flexibility, improve social support and coping style will have an important influence on the prevention and reduction of depressive symptoms before terminating the pregnancy.

Her Cold War: Women in the U.S. Military 1945–1980 by Tanya L. Roth

<i>Her Cold War: Women in the U.S. Military 1945–1980</i> by Tanya L. Roth

Introducing misoprostol for treatment of incomplete abortion: A feasibility and acceptability study in secondary-level health facilities in Myanmar

ObjectiveTo assess the feasibility and acceptability of misoprostol as a treatment option for incomplete abortion in secondary hospitals in Yangon and Mandalay, Myanmar. MethodsAn explanatory sequential mixed methods study was conducted. Women seeking treatment for an incomplete abortion with a uterine size <12 weeks were eligible to participate in the prospective cohort including sublingual administration of 400 μg misoprostol, clinical assessment 7–10 days after administration, and patient interview. Treatment efficacy was assessed, defined as proportion of participants with complete uterine evacuation with misoprostol alone. After the cohort, provider interviews were conducted to understand how their experiences with misoprostol may have influenced cohort findings. Study sites included seventeen secondary health facilities in four townships in Yangon and Mandalay, Myanmar. ResultsA total of 110 women were enrolled from July 2018 to January 2019; 96 completed follow-up. In 75 % of cases, incomplete abortion was successfully treated with misoprostol. Treatment efficacy varied significantly by region (Yangon 85 %, Mandalay 67 %; p = 0.048), driven by providers’ variable comfort with misoprostol and proclivity to intervene with additional treatment. With experience, all were willing to incorporate the protocol into practice by study end. Patient acceptability and satisfaction were high. ConclusionMisoprostol is an acceptable and feasible treatment option for women seeking postabortion care at secondary facilities in Myanmar. Extensive health provider training and support systems and continued implementation experience are crucial to effectively translate clinical PAC guidelines into practice in Myanmar.

Interaction of polycyclic aromatic hydrocarbon DNA adducts and telomere length on missed abortion

Objective: To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. Methods: From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. Results: The age of the subjects was(29.92±5.69)years old. The M(Q1,Q3)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The M(Q1,Q3)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (Z=-2.10, P=0.036), while the TL was lower than that in the control group (Z=-4.05, P<0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (OR=3.17,95%CI:1.41-7.14;OR=2.85,95%CI:1.25-6.52;OR=2.46,95%CI:1.07-5.64), and long, medium and short levels of TL (OR=2.50,95%CI:1.11-5.63;OR=3.32,95%CI:1.45-7.56;OR=3.22,95%CI:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all P<0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (P=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (OR=7.50,95%CI:1.95-28.82;OR=6.04,95%CI:1.54-23.65;OR=9.05,95%CI:2.34-35.04). The interaction analysis found that the AP was 0.72 (95%CI: 0.46-0.99), and the SI was 5.21 (95%CI: 2.30-11.77). Conclusion: The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.

Chraniorachischisis totalis

Chraniorachischisis totalis is a lethal, non-syndromic anomaly. This anomaly is a rare condition seen in neural tube defects, characterized by anencephaly (absence of brain and cranial vault and lack of skin covering), and bony defect of the cervical spine (without covering of meninges on neural tissue). The prevalence of Chraiorachischisis in Europe is 0.1 to 10.7 per 10000 live births. Many of the fetuses are born either stillborn or result in termination of pregnancy if diagnosed prenatally. A study on non-genetic risk factors in Chraniorachischisis totalis is hard-hitting because of its rarity. A recent chromosomal study showed mutation of the SCRIB and CELSR1 genes leads to Chraniorachischisis totalis. Adequate supplementation of folic acid before conceiving and in the antenatal period can lead to uppermost hand for the prevention of Chraniorachischisis up to 75%. Antenatal diagnosis and termination of pregnancy are the main reasons that have helped Chraniorachischisis become uncommon. We report a clinical image of the male fetus with Chraniorachischisis totalis. The gestational age of the fetus was 14 weeks, with the crown to Rumph length of 120 millimetres. This fetus has spina bifida without a brain and covering of meninges, followed by spontaneous abortion in the institutional hospital of Maharashtra state in Central India. The obstetric history was not available. This condition is not compatible with life so the fetus undergoes spontaneous abortion in the initial few weeks of gestation itself.

Impact of COVID-19 pandemic in safe abortion and safe motherhood services in provincial hospital of rural Nepal: comparison of 3 waves of COVID-19

Introduction: The COVID-19 pandemic has challenged the whole world with a major public health crisis, both directly due to the disease and indirectly in all dimensions of the health care system. This included safe abortion services and safe motherhood services but data quantifying this in a lower resource setting is lacking. This study analyzed the trends of safe abortion services, post abortion contraception opted during pandemic and safe motherhood services at a provincial hospital in rural Nepal during 25 months of COVID-19 pandemic, comparing data of three major waves.&#x0D; Method: This is a retrospective observational study conducted at Pashupati Chaulagain Memorial Hospital. The data were collected from records of abortion and safe motherhood service registers. We compared the overall trends of safe abortion, family planning and safe motherhood services during first, second and third waves of COVID-19 pandemic and analyzed the sociodemographic profile of patients. Data analysis was done using SPSS 25 version.&#x0D; Result: During the study period from February 2020 to February 2022, a total of 634 and 2054 clients received safe abortion services and safe motherhood services respectively. There was reductions in clients visiting for safe abortion services during lockdown periods of first and second waves, but no differences noted during the third wave. More numbers of women opted for condoms as a family planning method during lockdown period of first and second waves with less intake of Long Acting Reversible Contraceptives and permanent methods compared to non-lockdown period.&#x0D; Conclusion: Utilization of safe abortion services was seriously affected in the first two waves due to COVID-19 pandemic presumably due to lockdowns, travel restrictions, home isolation, patient fear of going to hospitals, and health facilities prioritizing only COVID-19 and other emergencies. However, there was no impact in third wave for reproductive and safe motherhood services.

Right to abortion &amp; safe abortion will reduce maternal mortality

Recent report of the United Nations population fund’s state of the world population says that around 08 women die every day in India because of unsafe abortion. There are many reasons behind the deaths such as taking abortion pills without consulting doctor, abortion carried out by untrained personals, abortion in hospitals without facilities settings etc. Married women have the right to abortion but what about the unmarried pregnant women; this case is one of the major cause of unsafe abortion especially in our country India. Right to abortion simply means one can go for safe abortion i.e. the abortion will be carried out by a trained doctor in a hospital approved for pregnancy termination having facilities settings. Time to time amendments in Medical termination of Pregnancy act took place but no right provided to unmarried. Supreme Court in its judgment on 29th September 2022 gave right to abortion to unmarried pregnant women too up to 20 weeks from the date of gestation. This judgement came in a case that filed on July 2022 by 25 years old pregnant women. The judgement is a revolution and save many lives of women because it will stop or reduce the number of unsafe abortions. The article discussed about the impact of this decision on women in near future, unsafe abortion, medical abortion using medications, actions and adverse effects of medications used for abortion, medical termination of pregnancy act 1971, amendment in act and effect of Supreme Court’s judgement on women’s health and mortality.

Magnitude of second-trimester-induced abortion and associated factors among women who received abortion service at public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia: A cross-sectional study.

IntroductionSecond-trimester abortion accounts for 10–15% of all induced abortions, with varying rates across countries, and is responsible for two-thirds of major abortion complications. It is also associated with higher medical costs, morbidity, and mortality rates than first-trimester abortion. Even though it is a significant burden, there is a lack of adequate information about second-trimester-induced abortion, especially in the study area. As a result, the primary purpose of this study is to fill this research gap and assess the magnitude and associated factors of second-trimester-induced abortion in the public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia.MethodsA facility-based cross-sectional study was conducted. Systematic sampling was used to select 353 study participants. Data were collected through face-to-face interviews using a structured questionnaire and record review by using Kobo collect version 3.1. Analysis was done by STATA 14. Logistic regression was used to identify associated factors of the second-trimester-induced abortion.ResultsThe magnitude of second-trimester-induced abortion in the study setting was 23% (95%CI: 18.5%, 27.4%). The factors associated with second-trimester-induced abortion among women received abortion care services were respondent's age 25–29 and 30–34 years old (AOR = 0.38, 95%CI:0.15, 0.96 and (AOR = 0.31, 95%CI:0.10, 0.97, respectively), planned pregnancy (AOR = 0.22, 95%CI:0.11, 0.44), and delay confirming pregnancy (AOR = 2.21, 95%CI:1.15, 4.23).ConclusionThis study showed that more than one-fifth of women who presented for abortion care services had second-trimester-induced abortions. Health institution organizations working on maternal health at various levels should provide counseling to women to help them early confirm their pregnancy and make decisions about whether or not to continue it as early as possible.

Uptake of long-acting reversible contraception after telemedicine delivered abortion during Covid-19

Background During COVID-19, early medical abortion (EMA) at home in Scotland was largely delivered by telemedicine. Short-acting post-abortion contraception was provided with EMA medications, but long-acting reversible contraception (LARC) (implant, injectable and intrauterine device) required an in-person visit. We wished to assess LARC uptake following telemedicine abortion, and factors associated with method receipt. Methods A prospective observational cohort study of patients accessing abortion via NHS Lothian (October 2020 to February 2021). Patients were offered contraception at telemedicine consultation and their choice was recorded in their clinical notes. Those wishing LARC were directed to the service’s rapid-access LARC clinic. We reviewed electronic patient records six weeks post-abortion to determine whether patients received their chosen method. Results 944 patients had an abortion; 768 (81.4%) had EMA, 131 (13.9%) had a medical or surgical abortion in hospital. The most popular contraceptive method was the progestogen-only pill (n = 324, 34%). 330 patients (35%) requested LARC but less than half (153/330; 46%) received this. Of patients choosing LARC, those who attended the clinic for a pre-abortion ultrasound, or had an abortion in hospital, were more likely to initiate LARC than those having full telemedicine EMA. Nulliparity, gestation over 7 weeks, and age under-26 years were also positively associated with initiating LARC. Conclusion During COVID-19 there was demand for post-abortion LARC but less than half of patients received this by six weeks. Provision was enhanced when in-person clinical interactions took place. Interventions are required to facilitate timely access and initiation of LARC with telemedicine delivered abortion care.

Support Systems and Limitations in Therapeutic Abortion Care by the Gynecologist-Obstetrician of Public Hospitals in Peru.

To identify the barriers to provide to women and adequately train physicians on therapeutic abortions in public hospitals in Peru. Descriptive cross-sectional survey-based study. We invited 400 obstetrics and gynecology specialists from 7 academic public hospitals in Lima and 8 from other regions of Peru. Expert judges validated the survey. We collected survey results from 160 participants that met the inclusion criteria. Of those, 63.7% stated that the hospital where they work does not offer abortion training. Most of the participants consider that the position of the Peruvian government regarding therapeutic abortion is indifferent or deficient. The major limitations to provide therapeutic abortions included Peruvian law (53.8%), hospital policies (18.8%), and lack of experts (10.6%). Most surveyed physicians supported therapeutic abortions and showed interest in improving their skills. However, not all hospitals offer training and education. The limited knowledge of the physicians regarding the law and institutional policies, as well as fear of ethical, legal, and religious repercussions, were the main barriers for providing abortions.

Determinants of induced abortion among women received maternal health care services in public hospitals of Arba Minch and Wolayita Sodo town, southern Ethiopia: unmatched case\u2013control study

BackgroundAbout 210 million women become pregnant per year, with one out of every ten pregnancies terminating unsafely worldwide. In developing countries, unsafe induced abortion is a leading cause of maternal mortality and morbidity. In addition, the burden of public health is also greatest in developing regions. In Ethiopia, abortion was responsible for 8.6% of maternal deaths. Despite the problem's significance, little is known about the factors that lead to women terminating their pregnancies. Therefore, this study aims to identify the factors associated with having induced abortion in public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia.MethodsAn institutional-based unmatched case–control study was conducted among 413 women from 15th April to 15th June 2021 in selected public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia. Cases were women who received induced abortion care services or who received post-abortion care services after being presented to the selected public hospital with an attempt of induced abortion whereas controls were women who came for maternal health care (antenatal or postnatal care) services in selected public hospitals and never had history of induced abortion. The data were collected by pretested and structured questionnaires with face-to-face interviews via Kobo Collect v3.1 mobile tools and analyzed by STATA version14. Logistic regression model was used to identify factors associated with induced abortion. In this study P-value less than 0.05 with 95% CI was declared a result as statistically significant.ResultsIn this study, 103 cases and 309 controls were participated. Urban residence (AOR = 2.33, 95%CI:1.26, 4.32), encountered first sex at age of 20–24 years (AOR = 0.51, 95%CI:0.27,0.97), multiple sexual partner (AOR = 5.47, 95%CI: 2.98,10.03), women who had one child (AOR = 0.32, 95%CI: 0.10, 0.99), and good knowledge of contraceptives (AOR = 0.12, 95%CI: 0.03, 0.46) were identified as determinants of induced abortion.ConclusionsInterventions focusing on those identified factors could probably reduce the burden and consequences of induced abortion. Sexual and reproductive health education and family planning programs would target urban dwellers, women who start sexual intercourse between the ages of 15 and 19, women with more than one sexual partner, women with a desire to limit childbearing, and women with poor contraceptive knowledge in order to reduce induced abortion.

Review: From Back Alley to the Border: Criminal Abortion in California, 1920–1969, by Alicia Gutierrez-Romine

Review: <i>From Back Alley to the Border: Criminal Abortion in California, 1920–1969</i>, by Alicia Gutierrez-Romine

Application of FOCUS-PDCA in Management of Patients after Induced Abortion

Objective To explore the effect of FOCUS-PDCA applied in the management of patients after induced abortion. Methods A total of 2930 patients undergoing induced abortion in Shaanxi Provincial People's Hospital from January 2019 to December 2020 were enrolled in the study, who were divided into control group and observation group in chronological order. The control group was given routine preoperative education and postoperative management, while the observation group introduced the FOCUS-PDCA program on the basis of the conventional process. The contraceptive knowledge level, PAC related knowledge (including the precautions of nursing after induced abortion and the harm of induced abortion to female reproductive health), recovery rate of sexual life and repeated abortion rate were observed and compared between two groups. Results The familiarities of contraceptive knowledge and PAC related knowledge in observation group were significantly improved compared with that before intervention (P < 0.05), the recovery rate of sexual life within 1 month after surgery decreased (P<0.05), and repeated abortion within 1 year of follow-up also decreased (P<0.05). Conclusion FOCUS-PDCA can significantly improve the quality of long-term management of induced abortion patients, which is worthy of promotion in clinic.

POSTER ABSTRACTS: P19 A NEW ABORTION SERVICE IN THE MIDST OF A PANDEMIC: GENERAL PRACTITIONERS’ PERSPECTIVES ON COVID-19 AND COMMUNITY-BASED PROVISION OF EARLY MEDICAL ABORTION IN IRELAND

Objectives: Community-based provision of early medical abortion (EMA) was introduced in Ireland in early 2019. Multiple visits are required by law, and a telemedicine option was permitted in the context of the COVID-19 pandemic. We sought to describe Irish General Practitioners’ (GPs) experiences with EMA provision during the pandemic. Methods: We invited Irish GPs to participate in a web-based survey through the professional listserve of the Irish College of General Practitioners. Results: A total of 208 eligible GPs responded to the survey (34% response rate). Of these, 140 were EMA providers. Most (82%) GPs reported that COVID-19 had no impact on their willingness to provide EMA. Estimates of changes in patient volume varied, with 19% reporting an increase, 35% reporting a decrease, and 34% reporting no change. More than half (56%) reported that they used telemedicine often or all the time to provide visit 1 and/or visit 2 of EMA. Most providers (80%) felt that the best way to provide EMA in the future would be via a combination of in-person visits and telemedicine, and 57% recommended one in-person visit as the ideal number of in-person visits for EMA. None recommended that EMA be provided entirely via telemedicine. Most respondents reported that COVID-19 did not impact access to EMA in the community, early pregnancy ultrasound, hospital abortion services, or postabortion contraception. Conclusions: Irish GPs reported ongoing access to EMA services during the COVID-19 pandemic, with many visits being conducted via telemedicine. Most of them endorsed a hybrid in-person/telemedicine model for EMA provision in the future.

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico.

Objectives:Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico.Methods:We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators.Results:Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients.Conclusion:Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

Intra-cardiac lidocaine administration to induce fetal demise before late second-trimester abortion: Retrospective review.

To determine the efficacy and safety of intra-cardiac lidocaine administration to induce fetal demise before second-trimester medication abortion in a teaching hospital in Addis Ababa, Ethiopia. We performed a retrospective chart review to collect selected sociodemographic and clinical information. All patients who received fetal intra-cardiac lidocaine between January 1, 2019 and April 30, 2019 were included in the study. Fetal demise was considered successful if achieved within 24hours after fetal intra-cardiac lidocaine administration. We analyzed the data using SPSS version 20. We used frequency tables to describe the data and performed a multivariable analysis to determine associations between variables. A total of 80 fetuses were given intra-cardiac lidocaine.The mean gestational age was 23+1 weeks (range 21+0 -27+5 weeks). Twenty-four hours after lidocaine administration 76 (95%) pregnancies showed negative fetal cardiac activity. Fetuses at gestational ages of 21-23+6 weeks were five times more likely to have negative cardiac activity compared with those with gestational ages between 24 and 28weeks (P=0.001). Two women developed nausea, vomiting, and a metallic taste, but no serious adverse events were reported. Intra-cardiac lidocaine is effective at inducing fetal demise before late second-trimester medication abortion with no associated serious adverse events or complications.

VP59.02: Evaluation of risk factors, early diagnosis and preferred treatment method for missed abortion in a tertiary hospital in Afghanistan

VP59.02: Evaluation of risk factors, early diagnosis and preferred treatment method for missed abortion in a tertiary hospital in Afghanistan