Aspiration Abortion Research Articles

Contraception Initiation after Early Abortion in a Family Medicine Setting: A Retrospective Chart Review.

Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status. Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

What attributes of abortion care affect people's decision-making? Results from a discrete choice experiment

ObjectivesWe aimed to measure both stated and experimentally “revealed” abortion provision preferences among US people with capacity for pregnancy. Study designIn July 2022, we recruited US residents assigned female sex at birth and aged 18 to 55 years using Prolific, an online survey hosting platform. We asked participants what first-trimester abortion method and delivery model they would prefer. We also assessed abortion care preferences with a discrete choice experiment, which examined the relative importance of the following care attributes: method, distance, wait time for appointment, delivery model (telehealth vs in-clinic), and cost. ResultsMore than half of the 887 respondents (59%) self-reported a slight (22%) or strong (37%) preference for medication compared to aspiration abortion; 11% stated no preference. Our discrete choice experiment found that cost and wait time had a greater effect on hypothetical decision-making than did method and delivery model (discrete choice experiment average importances = 44.3 and 23.2, respectively, compared to 15.9 and 8.2, respectively). Simulations indicated that holding other attributes constant, respondents preferred medication to aspiration abortion and telehealth to in-clinic care. ConclusionsThis study, the first to examine abortion preferences in the United States, using a discrete choice experiment, demonstrates the importance of wait time and cost in abortion care decision-making. Our work indicates that for this population, factors related to health care financing and organization may matter more than clinical aspects of care. ImplicationsAlthough people in this study preferred medication to aspiration abortion and telehealth to in-clinic care, wait time and cost of care played a greater role in care decision-making. Focusing solely on clinical aspects of care (i.e., method, delivery model) may ignore other attributes of care that are particularly important for potential patients.

Public perceptions of abortion complications

Misinformation contributes to the perception that abortion has substantial health risks, despite the known safety of medication and aspiration abortion. We lack detailed information about which health risks the public believes are most likely. This study aimed to describe public perception of short- and long-term risks of abortion. We conducted a cross-sectional survey of US residents aged ≥18 years using Amazon Mechanical Turk (MTurk). We collected information regarding participant demographics, reproductive history, political views, and position on abortion restrictions. We provided participants with a list of 9 short-term and 15 long-term possible complications and asked them to indicate whether they occurred never (0%), very rarely (<1%), rarely (1%-5%), occasionally (5%-20%), or frequently (>20%) following abortion. We used descriptive statistics to understand our population demographics and to capture the perceived incidence of all complications. We created a binary indicator of answering all risk estimates incorrectly vs at least 1 estimate correctly, separately for all long-term possible complications, and the 2 short-term risks of infection and bleeding. We determined the proportion of individuals who responded incorrectly to all questions in each category and used multivariable logistic regression to identify factors associated with incorrect perceptions about the risks of abortion. For all listed complications, participant (N=1057) estimates of risk were higher than the known incidence. For both short-term risks of bleeding and infection, over 40% of participants reported that these outcomes occur occasionally or frequently. Similarly, for both long-term risks of depression and anxiety, over 60% of respondents reported that these outcomes occur occasionally or frequently after abortion. Participants reported that possible complications known to not be associated with abortion, including hair loss, future pregnancy complications, breast cancer, and cosmetic disfigurement, occurred at least rarely. Nearly one-quarter of participants responded that death occurs occasionally or frequently (in over 5% of abortions), and 79% of participants responded that breast cancer can result from abortion. One-quarter (24.9%) of participants incorrectly overestimated both short-term outcomes of infection and bleeding, whereas 19.5% answered all long-term complication questions incorrectly, including outcomes that never occur. On multivariable analyses, we identified that the participants most likely to incorrectly identify risks of abortion identified as Asian or Black race/ethnicity, were from rural communities, or believed that abortion should have more legal restrictions. The public perceives abortion to be much riskier than it actually is. This information can be used to develop targeted clinical and public health efforts to disseminate the true risks of abortion.

Patient concerns about accessing sexual and reproductive health services outside of primary care: A survey in rural and urban settings in the Pacific Northwest

ObjectivesWhile primary care providers are a major source of sexual and reproductive health (SRH) services in the United States, particularly in rural areas, not all primary care settings offer a full range of SRH services. We aimed to understand primary care patient concerns regarding accessing SRH services, including abortion care, outside of their primary care clinic and if those concerns differed by urban or rural setting. Study designAn anonymous survey was distributed over a 2-week period between December 2019 to March 2020 to all adult patients in four primary care clinics in Idaho, Washington, and Wyoming. The survey assessed patient concerns regarding accessing SRH services outside of their primary care clinic and their willingness to travel to access SRH services. ResultsThe overall response rate was 69% (745/1086). Over 85% of respondents identified at least one concern to seeking SRH services outside of a primary care setting, with cost, insurance coverage, length of wait time, and lack of an established relationship being the most frequently reported concerns. A majority of respondents were willing to travel a maximum of 1 hour for most SRH services. Respondents from rural-serving clinics were significantly more likely to be willing to travel longer amounts of time for medication abortion, aspiration abortion, and intrauterine device placement. ConclusionOur findings highlight that a majority of both urban and rural primary care patients have concerns regarding accessing SRH services outside of their primary care clinic and are unwilling to travel more than 1 hour to access most SRH services. ImplicationsA majority of primary care patients have concerns regarding accessing SRH services outside of primary care settings. Health care policy changes should aim to strengthen the SRH services available in primary care settings to alleviate the burdens primary care patients face in accessing SRH services outside of their primary care clinic, particularly for rural populations.

A Canadian survey of patients’ attitudes toward donation of products of conception for research at the time of their aspiration abortion

ObjectiveWe explored patients’ attitudes toward donating products of conception for research at the time of their aspiration abortion. Study designWe surveyed patients presenting for first or second trimester aspiration abortion to the abortion service at British Columbia Women's Hospital over a 6-month period in 2018. Questions explored demographics, attitudes toward tissue donation, willingness to donate products of conception for research, and how the option of donating tissue influenced patients’ perception of their abortion. We analyzed quantitative data using descriptive statistics and answers to open-ended questions using content analysis. ResultsThe partially tracked response rate to our survey was n = 35 of 46 (76%). Of 98 respondents included for analysis 77 (79%) were willing to donate their products of conception to research. Most respondents (n = 85, 93%), 49 (54%) of whom had ever been offered to actually donate tissue, reported that tissue donation would either positively change (n = 33, 36%) or not change (n = 52, 57%) how they felt at the time of their abortion. The majority of respondents (n = 25, 60%) who were not invited to donate their products of conception would have liked the opportunity to do so. Content analysis of open-ended responses from those willing to donate identified the categories of helping others, contributing to research and providing meaning beyond the respondents’ individual experience. ConclusionPatients’ willingness to donate products of conception to research and their associated positive attitudes provide important support for researchers and clinicians who are involved in research that uses products of conception. ImplicationsOur data may inform research programs and abortion clinics involved in research using products of conception by better understanding the patient experience of being involved in this type of research.

Patient opinions on sexual and reproductive health services in primary care in rural and urban clinics

ObjectivesPrimary care providers are a major source of sexual and reproductive health care in the United States, particularly in rural areas, and not all providers offer the same services. This study aimed to understand patient preferences and expectations around reproductive health services including abortion care in a primary care setting and if those expectations differed by urban or rural setting. Study DesignAn anonymous survey was distributed to all patients 18 years or older in 4 primary care clinics in Idaho, Washington, and Wyoming over a 2-week period. The survey asked patients about which reproductive health services should be available in primary care. ResultsThe overall response rate was 69% (745/1086). For all queried reproductive health services except for aspiration abortion, the majority of respondents reported that primary care clinics should have that service available. Forty-two percent of respondents reported that aspiration abortion should be available in primary care. Overall, most respondents reported that medication abortion (58%) and miscarriage management (65%) should be available in primary care. More respondents in urban clinics thought IUD services (84% vs 71%), medication abortion (74% vs 37%), and aspiration abortion (52% vs 28%) should be accessible in primary care compared to those in rural-serving clinics. ConclusionsThis study of 4 primary care clinics in Idaho, Washington, and Wyoming, spanning urban and rural settings, highlights that most patients desire contraception services and miscarriage management to be available in primary care. ImplicationsIncreasing training may help meet patient desires for access to reproductive services in primary care, however, further exploration of barriers to this care is warranted. High rates of respondents desiring miscarriage management access highlights the need to train more primary care clinicians to provide full spectrum miscarriage management options.

Impact of COVID-19 on abortion method under ten weeks gestational age in Southern California

ObjectiveWe assessed the proportion of medication versus suction aspiration abortions before and after the onset of the COVID-19 pandemic in a health system that did not limit access to abortion. Study DesignWe conducted an interrupted time series analysis among patients having an abortion at 10 weeks gestation or less at Planned Parenthood health centers in San Diego, Imperial, and Riverside Counties in California. Centers required in-person follow up for medication abortion throughout the pandemic. We compared the nine months prior to the pandemic (June 2019 to February 2020) to the first nine months of the pandemic (April 2020 to December 2020), with March 2020 as a washout period. ResultsThere was an average monthly increase of 0.78% in the proportion of medication abortions from June 2019 to February 2020 (p = 0.01, pre-pandemic trend). Immediately following the start of the pandemic, there was an estimated increase in the proportion of medication abortions of 2.58% (p = 0.23, post-level change). However, the monthly pre-pandemic trend towards medication abortions reversed by 1.07% after the start of the pandemic (p = 0.02, post-trend change), for an average monthly decrease in the proportion of medication abortions of 0.29% from April to December 2020 (p = 0.37, pandemic trend). ConclusionsThe trend towards medication abortions that was present before the COVID-19 pandemic reversed after an initial increase in medication abortions at the start of the pandemic. ImplicationsBoth types of abortion should remain available during public health emergencies. Further research is needed to understand how the pandemic affected abortion methods in areas with limited access and in health centers that did not require two in-person appointments for medication abortions.

Implementation of an interprofessional health education course on abortion care

BackgroundContent on abortion history and methods is notably absent from many health care education programs in Canada. A team of multi-disciplinary professionals and academics launched a minicourse on abortion at a Canadian university as part of the interprofessional education requirement for health professional students. The minicourse covered the legal history of abortion in Canada, clinical guidelines for medication and aspiration abortion, socio-emotional and therapeutic support, and information on contraception. ResultsStudents gained knowledge through both didactic instruction and small group discussion, giving attendees an opportunity to understand their role in supporting patients in collaboration with other health professionals. In response to student feedback, facilitators added content about Indigenous and LGBTQ+ health to the course. ConclusionStudents learned the clinical content and history of abortion with their peers through a framework of social determinants of health. The course will continue to adapt to reflect best practices and socio-political changes.

POSTER ABSTRACTS: P32 ABORTION PROVISION AFTER ROUTINE ABORTION TRAINING IN FAMILY MEDICINE RESIDENCY PROGRAMS

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.

ORAL ABSTRACTS: O5 PUBLIC PERCEPTIONS OF ABORTION COMPLICATIONS: A NATIONAL SURVEY

Objectives: Widespread misinformation has contributed to belief that abortion has substantial risks, despite the known safety of medication and aspiration abortion. Information is lacking on which complications concern the public most. Our objective was to better understand public perception of short and long-term risks of abortion.

Transcutaneous Electrical Nerve Stimulation for Pain Management of Aspiration Abortion up to 83 Days of Gestation: A Randomized Controlled Trial.

To evaluate high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) as an inexpensive, noninvasive pain management approach for first-trimester aspiration abortion. We conducted a noninferiority, single-blind, randomized controlled trial of patients seeking aspiration abortion at up to 83 days of gestation. Participants received TENS (placed posteriorly, T10-L1 and S2-S4) or intravenous (IV) sedation (fentanyl, midazolam). The primary outcome was pain with aspiration, as self-reported by visual analog scale (VAS, 100 mm). To detect at least a 15 mm mean difference on the 100 mm VAS with 90% power and a significance level of .05, a total of 90 participants were required. Between January 2018 and October 2019, we enrolled 109 participants (55 TENS, 54 IV). Participant median gestation was 53 days (range 36-82) in the TENS group and 58 days (range 35-82) in the IV group (P=.65). Group demographics and clinical histories were similar. Intention-to-treat analysis (n=109) yielded noninferior results for the primary outcome (mean difference 4.8 mm, 95% CI -5.9 to 13.5 mm). In the per-protocol analysis, 9 (16%) in the TENS group were excluded after receiving IV sedation; 100 participants were included (46 TENS, 54 IV). Median (range) reported VAS for aspiration was 73 mm (13-97) and 66 mm (0-99) in the TENS and IV groups, respectively (P=.40). With a mean difference of 4.4 mm (95% CI -5.6 to 14.5 mm), we found TENS to be noninferior to IV. Physicians underestimated participant pain, perceiving pain to be 34 mm (6-91) in the TENS group and 25 mm (0-83) in the IV group (P=.003). We found TENS to be a noninferior alternative to IV sedation for aspiration pain during first-trimester abortion. Expanding pain management options can improve quality of and access to abortion. Transcutaneous electrical nerve stimulation could be a standalone or adjunct approach for abortion pain management for those without access to or are ineligible to receive IV sedation due to the lack of sedation practitioner, designated driver, or local restrictions. ClinicalTrials.gov, NCT03187002.

Changes to medication abortion clinical practices in response to the COVID-19 pandemic

ObjectivesTo document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. Study designLongitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. ResultsSeventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. ConclusionsSites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. Implications statementMedication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.

SOCIAL SCIENCE ORAL ABSTRACTS: Trends in self-pay costs and insurance acceptance for abortion across the United States, 2017 to 2020

<h3>Introduction</h3> Abortion cost can be a significant financial burden and a barrier to care. The Hyde Amendment prevents Federal funding from being used for abortion care, forcing many low-income people to pay for abortion out of pocket rather than using their Medicaid coverage. Current data on self-pay abortion costs are limited to national estimates or small sample sizes. We provide data on trends in self-pay abortion costs by region for medication abortion and first and second trimester procedures using a national database of abortion clinics in the United States. We also examine the proportion of clinics that accept any type of insurance. <h3>Method</h3> We used data from University of California San Francisco (UCSF)/Advancing New Standards in Reproductive Health (ANSIRH's) abortion facility database which includes data on publicly advertising abortion clinics and is updated each year. We used Chrome browser's incognito mode to search for clinics by State and City using the key words: "Abortion clinic in [State]", "Abortion clinic in [City]" for all cities with a population of 100,000 or larger in each state, and the 3 largest cities for states that did not have a city of that size. We examined links to clinics from the first 3 pages of results for states and first 2 pages for cities. We then conducted mystery shopper phone calls to clinics to supplement any missing data not found on facility web pages. Mystery callers did not make clinic appointments. Clinics were only included if they reported being open and providing abortions for a given year. Abortion training sites such as teaching hospitals were only included if they publicly advertised abortion services. To estimate mean costs of abortion for clinics that gave a range of prices for a certain abortion type (e.g., second trimester) we first averaged the prices for that procedure type per clinic. Then, clinic mean prices were averaged by region to develop regional means. We reported the number and percentage of clinics in each region that reported accepting any insurance. <h3>Results</h3> We identified 751 to 776 publicly advertising abortion clinics per year in the United States: 776 in 2017, 751 in 2018, 758 in 2019, and 765 in 2020. The national mean self-pay price for medication abortion increased from $511 in 2017 to $644 in 2020. Mean price for medication abortion varied greatly by region, the lowest cost in 2020 being $489 in the South Atlantic and the highest being $873 in the Pacific. Nationally, mean first-trimester aspiration abortion costs also increased over time, from $489 to $715 between 2017 and 2020. Mean price for first-trimester aspiration abortion varied greatly by region, with the lowest cost in 2020 being $493 in the South Atlantic and the highest cost being $1191 in New England. In contrast, mean second trimester abortion costs decreased nationally, from $1180 in 2017 to $1068 in 2020. This decrease was mostly concentrated in the Pacific, East North Central, and New England regions, while other regions saw an increase in the same period. There was a sharp national decline in the proportion of clinics that accepted insurance from 88% to 80% between 2018 and 2019, which was sustained in 2020. This decline was observed in all regions. <h3>Conclusions</h3> An improved understanding of patient costs for an abortion and how that varies by region and state is a crucial first step to reducing financial barriers and to inform public and private insurance coverage policy. Abortion costs are increasing over time, while the proportion of clinics that accept insurance is decreasing. This may be because public and private insurance reimbursement rates do not cover the full costs of providing abortion care. Insurance reimbursement rates must be increased to reflect actual clinic costs. Additionally, repealing the Hyde Amendment would have profound impacts on people who have abortions in the United States.

Auricular acupressure and auricular acupuncture as an adjunct for pain management during first trimester aspiration abortion: A randomized, double-blinded, three-arm trial

ObjectivesTo measure pain and anxiety during first trimester uterine aspiration when using auricular acupressure or acupuncture as an adjunct to usual care. MethodsThis randomized, double-blinded, three-arm trial enrolled patients undergoing an aspiration procedure for an induced abortion, a miscarriage, or other abnormal intrauterine pregnancy. Trial participants received auricular acupressure, auricular acupuncture, or placebo immediately prior to their procedures. The study began with 1:1:1 randomization, but later overenrolled into the acupressure group after providing retraining for greater fidelity to that intervention. All participants received ibuprofen and a paracervical block. Participants reported pain and anxiety levels via visual analog scores (0–100). Our analysis compared pain scores of those receiving acupressure versus placebo, and those receiving acupuncture versus placebo. ResultsWe randomized 177 participants over nine months and excluded data from four participants. We analyzed data from 70 participants who received acupressure, 51 who received acupuncture, and 52 who received placebo. The groups had similar baseline characteristics, including baseline pain and anxiety scores. For acupressure, acupuncture, and placebo groups, respectively, immediate post-procedure median pain scores were 50, 55, 47.5 (p = 0.88); maximum pain scores during the procedure were 77, 79, 79.5 (p = 0.96); postprocedure anxiety scores were 26, 28, and 21 (p = 0.47). The acupressure group results were similar before and after retraining. ConclusionsReceiving auricular acupressure or acupuncture did not result in lower pain or anxiety scores among women undergoing vacuum aspiration compared to a placebo group. ImplicationsThe results of this trial were null, thus differing from our previous study that had shown a benefit from auricular acupuncture. Given the conflicting results, incorporating these acupuncture techniques into abortion practice would be premature.

Gender diversity among aspiration-abortion patients

ObjectiveDescribe the array of gender identities among procedural abortion patients. Study DesignCross-sectional survey of abortion patients in three clinics in Massachusetts. Following aspiration abortion procedures and prior to discharge, patients self-administered a survey on a tablet. ResultsFrom November 2017 through July 2018, 1,553 aspiration abortion patients completed the survey (participation rate: 82%). Patients reported several gender identities. Non-binary (0.4%) and agender (0.4%) were the most common identities after female (91.1%) and woman (6.0%). Overall, 2.7% of patients identified as a gender other than female or woman. ConclusionAspiration abortion patients have a variety of gender identities. To promote quality of care for all patients, abortion providers can ensure their names, marketing materials, patient forms, and clinical environments are gender inclusive rather than focusing on women’s health.

Introduction of telemedicine for medication abortion: Changes in service delivery patterns in two U.S. states

Objective(s)Telemedicine for medication abortion (teleMAB) is safe and effective, yet little is known about how its introduction affects service delivery. We assessed changes in service delivery patterns 1 year after introducing teleMAB at Planned Parenthood in 2 U.S. states. Study DesignRetrospective records analysis using electronic health record data from Planned Parenthood health centers in Montana and Nevada from 2015 to 2018. We included all patients receiving medication or aspiration abortion in the year before and after introducing site-to-site teleMAB. Outcomes included: the proportion of medication abortions (vs. aspiration); gestational age at abortion; time to appointment; and distance traveled. We compared outcomes pre- and postimplementation using χ2, t tests, and Mann-Whitney U tests. ResultsWe analyzed data for 3,038 abortions: 1,314 pre- and 1,724 postimplementation. In Montana, the proportion of medication abortions increased postimplementation (60% vs. 65%, p = 0.04). Mean gestational age was similar: 58 versus 57 days (p = 0.35). Mean time to appointment decreased (14 vs. 12 days, p < 0.0001), as did one-way distance traveled by patients (134 vs. 115 miles, p = 0.03). In Nevada, where Planned Parenthood only provided medication abortion, total medication abortions increased (461 vs. 735). Mean gestational age remained stable (51 vs. 51 days, p = 0.33), as did time to appointment (8 vs. 8 days, p = 0.76). Mean one-way distance traveled was 47 miles in the preperiod versus 34 miles in the postperiod (p = 0.22). Conclusion(s)Medication abortion increased after the introduction of telemedicine in both states, though we cannot account for abortions performed by other providers. Telemedicine has the potential to improve access to medication abortion. ImplicationsTelemedicine has the potential to improve or maintain access to medication abortion and should be taken to scale where feasible. Continued efforts are needed to mitigate or reverse policy restrictions on telemedicine for medication abortion.

Serum human chorionic gonadotropin decline following aspiration abortion in early pregnancy less than 42 days gestation

ObjectiveTo define serum human chorionic gonadotropin (hCG) decline following complete aspiration abortion. Study DesignWe performed a secondary analysis of 86 patients who underwent uncomplicated aspiration abortion for ultrasound-confirmed pregnancy ≤42 days gestation and had serum hCG at the time of aspiration and within 3 days postprocedure. ResultsMedian hCG declines were 72.9% by day 1 (n = 14), 87.6% by day 2 (n = 50), and 92.8% by day 3 (n = 22). Ninetieth percentile declines were 67.8%, 81.5%, and 90.8%. Minimum hCG declines were 56.2%, 77.3%, and 83.2%. Trends did not vary by gestational age or by initial hCG <3000 mIU/mL. ConclusionPostprocedure hCG trend varies over the first few days in early gestation. At ≤42 days gestation, serial hCG decline at 1 day after completed aspiration abortion is greater than 50%, consistent with the decline observed in medication abortion. ImplicationsThis study confirms previously estimated human chorionic gonadotropin decline after aspiration abortion of at least 50% at 24 hours for completed procedure in very early gestations. Minimum declines on days 2 and 3 are approximately 70% and 80%.

First-Trimester Abortion Complications: Simulation Cases for OB/GYN Residents in Sepsis and Hemorrhage

IntroductionSerious complications associated with first-trimester abortions are rare. The US mortality rate for these procedures is 0.7 per 100,000, primarily due to infection and hemorrhage. While complications are unlikely to arise during training, residents must be prepared to manage them in practice. To address this, we developed a 2-hour simulation-based abortion complication curriculum for OB/GYN resident learners.MethodsOB/GYN residents participated in three sessions: a case-based didactic reviewing institutional aspiration abortion practice and preop preparation; an in-vivo aspiration abortion hemorrhage simulation; and an interdepartmental postabortal sepsis simulation. Participants completed surveys before and after their participation that evaluated clinical knowledge, and self-rated competence in, and preparedness for, managing first-trimester abortion complications.ResultsResident learners (N = 26) represented all four classes of OB/GYN residents. Residents initially showed stronger clinical knowledge in managing postabortal hemorrhage than sepsis (90% vs. 62%, p < .001). Clinical knowledge improved following the sepsis simulation (62% to 91%, p < .001), and remained strong but unchanged after the hemorrhage simulation (90% to 87%, p = .3). Resident self-assessments of competence and preparedness were significantly improved after both the hemorrhage (p = .006) and sepsis (p = .002) simulations. Learners reported that the simulation increased their level of comfort in managing these complications in their future practice.DiscussionPostabortal hemorrhage and sepsis simulations increased OB/GYN residents' knowledge, comfort, and preparedness for managing rare complications of first-trimester abortions. In-vivo simulation and interdepartmental collaboration were novel aspects of these simulations that may facilitate increased preparedness and management skills.

Interest in Medication and Aspiration Abortion Training among Colorado Nurse Practitioners, Nurse Midwives, and Physician Assistants.

We examined advanced practice clinicians' (APCs: nurse practitioners [NPs], certified nurse midwives [CNMs], physician assistants) interest in training to provide medication and aspiration abortion in Colorado, where abortion provision by APCs is legal. We surveyed a stratified random sample of APCs, oversampling women's health (CNMs/women's health nurse practitioners [WHNPs]) and rural APCs. We examined prevalence and predictors of interest in abortion training using weighted χ2 tests. Of 512 participants (21% response), the weighted sample is 50% NPs, 41% physician assistants, and 9% CNMs/WHNPs; 55% provide primary care. Only 12% are aware they can legally provide abortion. A minority of participants disagree that medication abortion (15%) or aspiration abortion (25%) should be in APC scope of practice. Almost one-third (29%) are interested in medication abortion training and 16% are possibly interested; interest is highest among CNMs/WHNPs (52%) (p<.01). Interest in aspiration abortion training is 15% with another 11% who are possibly interested; interest is highest among CNMs/WHNPs (34%) (p<.01). There are no significant differences in abortion training interest by rural practice location or by receipt of abortion education in graduate school. Participants not interested in medication and aspiration abortion training cited abortion being outside their specialty practice scope (44% and 38%, respectively) and religious or personal objections (42% and 34%). Among clinicians interested in medication abortion training, 33% believe their clinical facility is likely to allow them to provide this service, compared with 16% for aspiration abortion. Interest in abortion training among Colorado APCs is substantial. However, facility barriers to abortion provision must be addressed to increase abortion access with APCs.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract