First-trimester Abortion Research Articles

IUD in First-Trimester Abortion: A Short Review Focusing on Immediate Insertion of IUD versus Delayed Insertion of IUD After the Next Menstruation

IUD in First-Trimester Abortion: A Short Review Focusing on Immediate Insertion of IUD versus Delayed Insertion of IUD After the Next Menstruation

Lower complication rates with office-based D&C under ultrasound guidance for missed abortion.

Missed abortion (MA) can be managed expectantly, medically or surgically. Surgical management has been performed safely in the office setting by suction dilation and curettage (D&C). Prior studies suggest that intraoperative ultrasound guidance (USG) may reduce complications for first-trimester therapeutic abortion. The aim of this study was to evaluate the safety of office D&C for MA using real-time USG. This retrospective cohort study included 255 patients who underwent office D&C under USG for first trimester MA at a single university-affiliated fertility clinic during January 2011-December 2013. Transabdominal USG was utilized during the procedure and was immediately followed by a transvaginal ultrasound examination to confirm full evacuation. Intra- and postoperative complication rates were compared to previously published data. There were no intraoperative complications, including excessive blood loss or uterine perforation. Two of the 255 patients (0.87%) were diagnosed with RPOCs requiring uterine re-evacuation. This rate of RPOCs was superior to rates previously reported for D&Cs without USG (2.6-4.9%, P=0.046). There were no other post procedure complications identified. We observed very low complications rate in Office-based D&C under USG, lower than those reported in the literature with unguided D&C.

Trisomy 8 Mosaicism Syndrome with Pigmentation Anomalies: A Case Report

Trisomy 8 Mosaicism syndrome, also known as Warkany syndrome 2, is a rare genetic event with an estimated frequency of about 1:25,000 to 1:50,000 births. Complete trisomy 8 is usually lethal, causing 0.70% of first-trimester abortions. However, mosaic trisomy 8 syndrome has extremely variable phenotypes, with a wide range of clinical manifestations, including cranio-facial dysmorphism, mild to severe intellectual disability, multiple skeletal abnormalities, deep palmar-plantar creases, and cardiac-renal abnormalities. A few cases of skin pigmentary anomalies have also been reported. We report on a 36 year old male case with mosaic trisomy 8. He has mild clinical findings and palmo-plantar hypopigmentation, which appears as a demarcating line between his hands’ dorsal and palmar regions. We report this case to investigate palmo-plantar pigmentation anomalies.

Роль искусственного прерывания беременности в первом триместре в формировании вторичного бесплодия

Роль искусственного прерывания беременности в первом триместре в формировании вторичного бесплодия

Medical abortion in early first trimester Is the hospital stay necessary?

Purpose: To investigate the possibility of pregnancy termination based on medical administration without hospital stay.

Chlamydia trachomatis and neisseria gonorrhoeae screen-and-treat protocol among young women seeking first-trimester medical or surgical abortion at an urban, public hospital

Chlamydia trachomatis and neisseria gonorrhoeae screen-and-treat protocol among young women seeking first-trimester medical or surgical abortion at an urban, public hospital

Disparities in access to first-trimester legal abortion in the public sector in Mexico City: who presents past the gestational age limit?

Disparities in access to first-trimester legal abortion in the public sector in Mexico City: who presents past the gestational age limit?

Long-acting reversible contraceptive uptake before and after the Affordable Care Act contraceptive mandate among women undergoing first-trimester surgical abortion

Long-acting reversible contraceptive uptake before and after the Affordable Care Act contraceptive mandate among women undergoing first-trimester surgical abortion

Use of emergency contraceptive pills in the 6 months after advance provision at time of first-trimester aspiration abortion

Use of emergency contraceptive pills in the 6 months after advance provision at time of first-trimester aspiration abortion

A survey study of marijuana use for pain management during first-trimester medical abortion

A survey study of marijuana use for pain management during first-trimester medical abortion

Democratic commitments are not always credible: Abortion and German reunification

Can states make credible commitments to respect concessions they make as part of national reunification agreements? German leaders negotiating reunification in 1990 had to reconcile West Germany’s more restrictive abortion policy with East Germany’s more permissive one, and agreed in 1990 to a compromise that seemed to preserve first-trimester abortion on demand in the Eastern states. By 1993, however, that compromise had been undone and the formerly West German policy prevailed throughout the country. This history challenges the theory that commitments made by democratic regimes are credible, especially since there were a number of international and domestic factors present in this case that other scholars have identified as enhancing credibility. We investigate the trajectory of unification-era German abortion policy and make two arguments: the decision by West German leaders to undo their earlier concessions was conscious rather than accidental, and despite Western attempts to reach a compromise that Easterners would see as credible the prevailing view in the East during the negotiations was that the Western commitment was uncertain at best. We conclude with some broader speculation about reunification, and suggest that promises made by a larger partner during negotiations over national reunification have inherent credibility problems that democratic institutions cannot by themselves solve. This implies that future reunifications, for example between North and South Korea or China and Taiwan, may be even more difficult to negotiate than currently recognized.

The seasonality of abortion in Kentucky

ObjectivesAbortion incidence is correlated with seasonal trends in conceptions and births. This retrospective review looks at monthly abortion incidence to detect a seasonal trend. Study designData on abortion incidence in 2012 were obtained from the Kentucky Department of Vital Statistics. A regression analysis was performed to detect differences in abortion annualized rates by month. ResultsA total of 3810 abortions analyzed showed a trend in abortion incidence peaking in February and March with 444 and 378 abortions per month, respectively, compared to a mean of 299 in other months (p<.001). This trend persisted for second-trimester abortions with 64 and 56 abortions per month in February and March, respectively, compared to a mean of 30 in other months (p<.001). ConclusionThe peak in first-trimester abortions correlate with the expected peaks of December conceptions. However, the same trend in second-trimester abortions suggests that women are delaying care.

Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial.

To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block. We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively. From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured. Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion. ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.

Abortion training in Canadian obstetrics and gynecology residency programs

ObjectiveTo evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Study designSurveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. ResultsWe distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had “opt-in” abortion training, and half of the programs had “opt-out” abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. ConclusionAbortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. ImplicationsAbortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty.

Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors

ObjectivesAlthough nurse practitioners (NPs) play a critical role in the delivery of reproductive health services in Canada, there is a paucity of published information regarding the reproductive health education provided in their training programs. Our study aimed to understand better the didactic and curricular coverage of abortion in Canadian NP programs. Study designIn 2014, we conducted a 3-contact, bilingual (English–French) mailed survey to assess the coverage of, time dedicated to and barriers to inclusion of 17 different areas of reproductive health, including abortion. We also asked respondents to speculate on whether or not mifepristone would be incorporated into the curriculum if approved by Health Canada for early abortion. We analyzed our results with descriptive statistics and used inductive techniques to analyze the open-ended questions for content and themes. ResultsSixteen of 23 (70%) program directors or their designees returned our survey. In general, abortion-related topics received less coverage than contraception, ectopic pregnancy management and miscarriage management. Fifty-six percent of respondents reported that their program did not offer information about first-trimester abortion procedures and/or post-abortion care in the didactic curriculum. Respondents expressed interest in incorporating mifepristone/misoprostol into NP education and training. ConclusionReproductive health issues receive uneven and often inadequate curricular coverage in Canadian NP programs. Identifying avenues to expand education and training on abortion appears warranted. Embarking on curricular reform efforts is especially important given the upcoming introduction of mifepristone into the Canadian health system for early abortion. ImplicationsOur findings draw attention to the need to integrate abortion-related content into NP education and training programs. The approval of Mifegymiso® may provide a window of opportunity to engage in curriculum reform efforts across the health professions in Canada.

Early pregnancy angiogenic markers and spontaneous abortion: an Odense Child Cohort study

Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. We investigated the association between maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week <22 (median 83 days of gestation, interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum <22+0 gestational weeks, and the prevalence was 3.52% (59 cases). The time-dependent effect of maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor on subsequent late first-trimester or second-trimester spontaneous abortion (n= 59) was evaluated using a Cox proportional hazards regression model, adjusting for body mass index, parity, season of blood sampling, and age. Furthermore, receiver operating characteristics were employed to identify predictive values and optimal cut-off values. In the adjusted Cox regression analysis, increasing continuous concentrations of both soluble Fms-like kinase 1 and placental growth factor were significantly associated with a decreased hazard ratiofor spontaneous abortion: soluble Fms-like kinase 1, 0.996 (95% confidence interval, 0.995-0.997), and placental growth factor, 0.89 (95% confidence interval, 0.86-0.93). When analyzed by receiver operating characteristic cut-offs, women with soluble Fms-like kinase 1 <742 pg/mL had an odds ratio for spontaneous abortion of 12.1 (95% confidence interval, 6.64-22.2), positive predictive value of 11.70%, negative predictive value of 98.90%, positive likelihood ratio of 3.64 (3.07-4.32), and negative likelihood ratio of 0.30 (0.19-0.48). For placental growth factor <19.7 pg/mL, odds ratio was 13.2 (7.09-24.4), positive predictive value was 11.80%, negative predictive value was 99.0%, positive likelihood ratio was 3.68 (3.12-4.34), and negative likelihood ratio was 0.28 (0.17-0.45). In the sensitivity analysis of 54 spontaneous abortions matched 1:4 to controls on gestational age at blood sampling, the highest area under the curve was seen for soluble Fms-like kinase 1 in prediction of first-trimester spontaneous abortion, 0.898 (0.834-0.962), and at the optimum cut-off of 725 pg/mL, negative predictive value was 51.4%, positive predictive value was 94.6%, positive likelihood ratio was 4.04 (2.57-6.35), and negative likelihood ratio was 0.22 (0.09-0.54). A strong, novel prospective association was identified between lower concentrations of soluble Fms-like kinase 1 and placental growth factor measured in early pregnancy and spontaneous abortion. A soluble Fms-like kinase 1 cut-off <742 pg/mL in maternal serum was optimal to stratify women at high vs low risk of spontaneous abortion. The cause and effect of angiogenic factor alterations in spontaneous abortions remain to be elucidated.

Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section

Study ObjectiveTo show the possibility of laparoscopic management of uterine rupture. DesignVideo with explanations. SettingIn the medical management with misoprostol for termination of pregnancy at any time the risk of uterine rupture may be possible. The risk is likely higher in women with a previous uterus surgery. In a systematic review of available studies, the risk of rupture was .28% among women with a prior cesarean delivery who were undergoing second-trimester misoprostol-induced abortion, meaning if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, 1 would experience uterine rupture. Uterine rupture has only been reported 3 times in first-trimester abortion and only once managed via laparoscopy: a missed abortion reported in 2005, a case of a ruptured unscarred uterus in a women undergoing medical abortion, and a case of a delayed miscarriage at 8 weeks’ gestation after misoprostol managed by laparotomy and sharp curettage. InterventionsTotal laparoscopic management in a patient with uterine tear after misoprostol treatment. ConclusionEarly second-trimester medical abortions with misoprostol can cause uterine rupture. In hemodynamically stable cases, total laparoscopic management is possible approach.

Expression of centromere protein-C (CENP-C) in villus tissue of the first-trimester spontaneous abortion and its correlation with chromosome segregation

Objective To investigate the expression of centromere protein-C (CENP-C) in villus tissue of the first-trimester spontaneous abortion (SA) and the correlation study of CENP-C expression with chromosome segregation. Methods Fluorescence in situ hybridization (FISH) and G-banded karyotype analysis were used to detect the numerical chromosome abnormality in 94 villus tissues of women with SA. The participants were separated into case group (n=30) and control group (n=30) according to the results with FISH. The qRT-PCR and Western blotting analysis were used to assess the expression level of CENP-C. Results Forty-eight (51.06%) cases had observed the numerical chromosome abnormality, including 30 positive cases and the positive rate was 31.91%. The main types of variation included trisomy 16, 21, 22, X monosomy and triploid. The expression levels of CENP-C mRNA and protein in case group were statistically higher than that in control group (P Conclusion Expression of CENP-C in the villus tissues of women might be related to SA induced by chromosomal aneuploid.

Variation in Pregnancy Options Counseling and Referrals, And Reported Proximity to Abortion Services, Among Publicly Funded Family Planning Facilities.

As frontline providers, publicly funded family planning clinics represent a critical link in the health system for women seeking information about pregnancy options, yet scant information exists on their provision of relevant services. Understanding their practices is important for gauging how well these facilities serve patients' needs. A 2012 survey of 567 publicly funded family planning facilities in 16 states gathered information on referral-making for adoption and abortion services, and perceived proximity to abortion services. Chi-square, multivariable logistic regression and multinomial logistic regression analyses were performed to assess differences among facilities in referral-making and reported proximity to abortion services. Abortion referrals were provided by a significantly smaller proportion of providers than were adoption referrals (84% vs. 97%). Health departments and community health centers were significantly less likely than comprehensive reproductive health centers to refer for abortion services and to have a list of abortion providers available (odds ratios, 0.1-0.2). Rural facilities were more likely than urban ones to report a distance of more than 100 miles to the closest first-trimester abortion provider (relative risk ratio, 11.4), second-trimester abortion provider (8.7) and medication abortion provider (8.0). Health departments were more likely than comprehensive reproductive health centers not to know the location of the closest first-trimester, second-trimester or medication abortion provider (2.5-3.5). A better understanding of disparities in provision of pregnancy options counseling and referrals at publicly funded family planning clinics is needed to ensure that women get timely care.

SALSA: Self-administered lidocaine gel for first-trimester surgical abortion: a randomized trial

SALSA: Self-administered lidocaine gel for first-trimester surgical abortion: a randomized trial