Abortion Outcomes Research Articles

No-Test Medication Abortion: A Systematic Review

ABSTRACT The use of medication abortion has increased significantly in the past several years, in part due to the increased adoption of telemedicine during the COVID-19 pandemic. Several leading organizations have established recommendations for the practice of providing a medication abortion without a prior pelvic examination or ultrasonogram (no-test medication abortion). Evidence demonstrates that gestational age can be accurately measured with patient screening questions and the risk of ectopic pregnancy among women seeking medication abortion is very low. Given this paradigm shift in abortion access, increasing numbers of health care professionals worldwide have adopted these practices and published their results. This systematic review aimed to summarize the efficacy and safety outcomes of medication abortion performed without prior pelvic examination or ultrasound. Ongoing and published clinical trials were identified, and randomized control trials and comparative cohort trials discussing the provision of no-test medication abortion were eligible. The primary study outcome was successful medication abortion, defined as complete abortion without the need for surgical management. Failure was thus defined as the need for surgical intervention to complete the abortion. Medication regimens, efficacy rates, complication rates, and adverse events were abstracted from eligible studies. A total of 21 studies were included in this review, including cases performed in over 24 countries. Ultimately, 15 studies were sufficiently homogenous in terms of design and comparator to create aggregate data with summary statistics for the primary outcome. The overall efficacy rate of no-test medication abortion was found to be 96.4% (95% confidence interval [CI], 96.0–96.7) in the 10,693 patients included in this review. Among pregnancies at less than 70 days' gestation (n = 8166), the efficacy rate was 95.2% (95% CI, 94.7–95.7). The rate of surgical intervention was 4.4% (95% CI, 4.0–4.9), and at less than 70 days' gestation was 3.8% (95% CI, 3.3–4.3). The ectopic pregnancy rate was 0.06% (95% CI, 0.02–0.15), blood transfusion rate ranged from 0% to 0.7%, and there were no deaths reported. The results of this systematic review encompassing data on 10,693 patients showed demonstrate that no-test medication abortion is likely effective and safe. The rates of surgical evacuation and complication were comparable with the rate among those undergoing medication abortion with pretreatment ultrasound, and significantly lower than the rates seen with unsafe methods of abortion.

An examination of loss to follow-up and potential bias in outcome ascertainment in a study of direct-to-patient telemedicine abortion in the United States

ObjectivesTo examine associations between factors associated with loss to follow-up and effectiveness in the TelAbortion project, which provided medication abortion by direct-to-patient telemedicine and mail in the United States. Study designThe study population for this descriptive analysis included abortions among participants enrolled in the TelAbortion study with data present in a web-based database tool from November 2018 to September 2021 who were mailed a medication package. The analysis included information on abortions across nine sites. In this analysis, we used generalized estimating equations to examine factors associated with loss to follow-up and effectiveness. ResultsOf the 1831 abortions included in this analysis, 1553 (84.8%) were classified as having complete follow-up and 278 (15.2%) were classified as lost to follow-up. In a multivariable analysis, factors significantly associated with loss to follow-up included history of medical abortion, education, gestational age, study site, and whether the TelAbortion was performed pre- or post-COVID-19 onset (p < 0.05). The rate of treatment failure (i.e., abortions resulting in continuing pregnancy or uterine evacuation) reported in this study was 5.1%. The only covariate associated with both loss to follow-up and treatment failure was higher gestational age. However, using gestational age to impute missing abortion outcomes did not substantially change the estimated failure rate. ConclusionsAbortions that were lost to follow-up differed substantially from those with complete follow-up, which could bias the effectiveness estimate. However, imputing outcomes based on available and appropriate pretreatment data did not substantially affect the estimate. This finding is encouraging, although it does not exclude the possibility of bias due to unmeasured factors. ImplicationsSignificant differences between abortion cases with complete follow-up and those lost to follow-up provide insights into abortion cases that may be at a higher risk for being lost. The low treatment failure rate indicates that the telemedicine provision of medication abortion is effective.

Self-managed abortion via the internet: Analysis of one year of service delivery data from Women Help Women.

Background: To better comprehend the demand for online medication abortion and to inform service delivery practice, we conducted an analysis of Women Help Women (WHW) service delivery statistics. The primary goals were to understand their user profile, evaluate self-reported outcomes and use of other medical services, and assess the overall experience both with the abortion itself and with the counseling and care provided by WHW. Methods: We retrospectively evaluated user characteristics, abortion outcomes, and acceptability of both the medication abortion and WHW's services, using consultation data and corresponding evaluation data from a one-year period. For users who did not complete the evaluation form, WHW staff reviewed email correspondences to identify key outcomes. Results: From August 2016-July 2017, 3,307 individuals received abortion pills from WHW. Users were geographically located in thirty countries and correspondence was conducted in seven languages. Most reported their gestational age to be less than eight weeks. Of the 2,295 who took the pills and provided outcome information, almost all (99.1%, n=2275) reported that they were no longer pregnant. The majority (84.1%, n=1576/1875) used symptoms to confirm outcome; one fourth (22.8%, n=428) sought an ultrasound and one sixth (18.0%, n=338) used urine and/or serum testing. One in eight users (12.6%, n=292/2317) reported seeking additional medical care after taking the abortion pills. Most (87.5%, n=1551/1773) reported being satisfied or very satisfied with the abortion. Conclusions: Our study confirms that self-managed abortion is a process that people can do safely and effectively with community support and without medical supervision. In the context of a global backlash against abortion rights, self-managed abortion is an integral part of a spectrum of options for abortion care that must be made available to all.

Chlamydia trachomatous antibodies cross reaction with seropositive Toxoplasma gondii and Cytomegalovirus among women with abortion and outcomes of congenital abnormalities in Kirkuk City

From 1st Jan2009 to31th of Dec 2009 a total of 1406 women sera with abortions and outcomes of congenital abnormalities in Kirkuk city were screened for infections like Chlamydia trachomatis, Toxoplasma gondii and cytomegalovirus (CMV).These agents were determined in sera using commercial Elisa diagnostic kits.&#x0D; Results of the study showed that CMV infection was more prevalent 39.74 % followed by Toxoplasmosis 16.37 %and Chlamydial infection 14.67 %.High rates of Toxoplasmosis and CMV were recorded among women aging from 15 to 25 year, while high of Chlamydial infection was recorded among women aging 26 to 35 years P&lt;0.05. Sera of non-pregnant women reveal high rate of Chlamydial infection, while toxoplasmosis and CMV were exert in sera of pregnant women. High rates of IgM antibodies 8.33 %and 11.41 % were recorded with CMV and Chlamydia respectively compare to 3.84 % for toxoplasmosis ,P&lt;0.05. Cross reactions rate among three microorganisms were detected in 29 sera with the rate 2.52 %, which divided in to 2.10 % for Chlamydia pulse Toxoplasma and 0.69 % for Chlamydia pulse CMV. Two serum samples show 0.54% of mixed IgM antibodies of Chlamydia, toxoplasma, CMV and rubella, the rate was 0.14 %.&#x0D; Conclusion: The present study demonstrates a strong association between the infectious agents (Chlamydia, Toxoplasma and CMV) and women abortion and congenital outcomes. It is therefore recommended that all antenatal cases with such history should be routinely screened for these agents. Chlamydia IgM test should be added to preventive tests prior to marriage and parallel to toxoplasma test, CMV and rubella during screening for women abortion and congenital anomalies.

Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States.

To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.

Effects of quercetin on immune regulation at the maternal-fetal interface.

The imbalance of immune homeostasis at the maternal-fetal interface is closely related to adverse pregnancy outcomes, so it has become one of the hot research topics in the reproductive field. Quercetin is rich in common TCM kidney-tonifying herbs such as dodder and lorathlorace, and has shown pregnancy protection function. As a common flavonoid, quercetin has powerful anti-inflammatory, antioxidant, estrogen-like effects; and it can regulate the functions of maternal-fetal interface immune cells (such as decidual natural killer cells, decidual macrophages, T cells, dendritic cells and myeloid-derived suppressor cells), exovillous trophoblast cells, decidual stromal cells, and the activities of their cytokines. Quercetin maintains the dynamic balance of maternal and fetal immunity by attenuating cytotoxicity, reducing excessive apoptosis of the tissue cells and inhibiting excessive inflammatory reactions. In this article, the role and molecular mechanism of quercetin in the immunomodulatory process of the maternal and fetal interface are reviewed to provide reference for the treatment of recurrent spontaneous abortion and other adverse pregnancy outcomes.

“Adoption is just not for me”: How abortion patients in Michigan and New Mexico factor adoption into their pregnancy outcome decisions

ObjectivesIn public discourses in the United States, adoption is often suggested as a less objectionable, equal substitute for abortion, despite this pregnancy outcome occurring much less frequently than the outcomes of abortion and parenting. This qualitative study explores whether and how abortion patients weighed adoption as part of their pregnancy decisions and, for those who did, identifies factors that contributed to their ultimate decision against adoption. Study designWe interviewed 29 abortion patients from 6 facilities in Michigan and New Mexico in 2015. We conducted a thematic analysis using both deductive and inductive approaches to describe participants’ perspectives, preferences, and experiences regarding the consideration of adoption for their pregnancy. ResultsParticipants’ reasons why adoption was not an appropriate option for their pregnancy were grounded in their ideas of the roles and responsibilities of parenting and fell into three themes. First, participants described continuing the pregnancy and giving birth as inseparable from the decision to parent. Second, choosing adoption would represent an irresponsible abnegation of parental duty. Third, adoption could put their child’s safety and well-being at risk. ConclusionsAdoption was not an equally acceptable substitute for abortion among abortion patients. For them, adoption was a decision that represented taking on, and then abdicating, the role of parent. This made adoption a particularly unsuitable choice for their pregnancy. ImplicationsRhetoric suggesting that adoption is an equal alternative to abortion does not reflect the experiences, preferences, or values of how abortion patients assess what options are appropriate for their pregnancy.

Retracted: Influence of Bushen Tiaochong Cycle Therapy on Th1/Th2 Deviation, Sex Hormone Level, and Pregnancy Outcome of Alloimmune Recurrent Spontaneous Abortion.

[This retracts the article DOI: 10.1155/2021/8624414.].

Prevalence of Listeria monocytogenes infection in women with spontaneous abortion, normal delivery, fertile and infertile

BackgroundListeria monocytogenes with a vast range of natural reservoirs is more known for being a food-borne pathogen. Human infections have shown an impact on pregnancy outcomes, so, this study surveyed the frequency of L. monocytogenes infection involving different groups of women.MethodsThis study enrolled a total sample consisting of 109 women with spontaneous abortion, 109 women with normal delivery, 100 fertile women, and 99 infertile women aged 19–40 years and willing to participate in the study. The research tool in this study was a questionnaire and Polymerase chain reaction (PCR) test.ResultsAccording to the results, the frequency of L. monocytogenes infection was 4/109 (3.66%) observed among women with spontaneous abortion, 2/109 (1.83%) among women with normal delivery, 3/100 (3%) among fertile women, and 0/99 (0%) among infertile women.ConclusionThere was no significant relationship between Listeria monocytogenes infection and pregnancy outcomes of spontaneous abortion and infertility.

Single dose letrozole and misoprostol for termination of pregnancy through 63 days’ gestation: A pilot study

ObjectivesWe conducted a pilot study to evaluate a single dose of letrozole 30 mg prior to misoprostol 800 mcg buccally for medication abortion Study designWe enrolled 40 participants seeking medication abortion up to 63 days’ gestation at a site in Salt Lake City, UT. Participants received a single dose of letrozole 30 mg in-clinic followed 2 days later by misoprostol 800 mcg buccally at home. They took a second dose of misoprostol if they had no bleeding within 24 hours of the first. Participants returned 7 to 10 days later for assessment of abortion outcome and side effects ResultsThirty-seven participants (93%) returned for follow-up and 2 (5%) went to another facility from which research staff obtained outcome data. Three-fourths (29/39, 74%, 95% CI: 60%−89%) had a complete abortion; 4 (10%, 95% CI: 0.3%−20%) had an incomplete abortion and opted for aspiration, and 6 (15%, 95% CI: 4%−27%) had an ongoing pregnancy. All subjects with follow-up reported taking the first dose of misoprostol. Ten (27%) took the second dose as well; only three did so due to no bleeding. Nineteen participants (51%) reported side effects after letrozole prior to misoprostol and two people (5%) rated these effects as severe. Side effects following misoprostol occurred in 33 participants (89%) and were as expected based on previous literature. No serious adverse events were reported ConclusionA single dose of letrozole 30 mg followed by misoprostol had lower than desirable efficacy and does not warrant further study. ImplicationsA single dose of letrozole does not appear to be an effective adjunct to misoprostol for medication abortion.

Decreased histidine-rich glycoprotein and increased complement C4-B protein levels in follicular fluid predict the IVF outcomes of recurrent spontaneous abortion

BackgroundRecurrent spontaneous abortion (RSA) is a common and complicated pregnancy-related disease that lacks a suitable biomarker to predict its recrudescence.MethodsTandem mass tag (TMT) analysis was conducted to obtain quantitative proteomic profiles in follicular fluid from patients with a history of RSA and from control group. ELISA validation of candidate differentially expressed proteins was conducted in a larger group of patients.ResultsA total of 836 proteins were identified by TMT analysis; 51 were upregulated and 47 were downregulated in follicular fluid from cases of RSA versus control group. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis revealed several important pathways were enriched, involving a dysregulated immunoglobulin Fc receptor signaling pathway and overactivated complement cascade pathways. ELISA validated the differential expression of two proteins, histidine-rich globulin (HRG) and complement C4-B (C4B), which were downregulated and upregulated, respectively, in follicular fluid of patients with RSA. We performed receiver operating characteristic curve analysis of the ELISA results with the outcomes of current IVF cycles as classification variables. The area under the curve results for HRG alone, C4B alone and HRG-C4B combined were 0.785, 0.710 and 0.895, respectively.ConclusionsTMT analysis identified 98 differentially expressed proteins in follicular fluid from patients with RSA, indicating follicle factors that act as early warning factors for the occurrence of RSA. Among them, HRG and C4B provide candidate markers to predict the clinical outcomes of IVF/ICSI cycles, and the potential for modeling an early detection system for RSA.

P035“No test” medication abortion: A systematic review

<h3>Objectives</h3> To summarize the effectiveness and safety outcomes of medication abortion performed without prior pelvic examination or ultrasound ("no test" medication abortion). <h3>Methods</h3> We searched Medline, Scopus, Web of Science, Cochrane, CINAHL, Global Index Medicus, and CAB Direct databases to identify relevant studies prior to April 2022 using a peer-reviewed search strategy including terms such as "medication abortion" and "ultrasonography." Experts in the field were contacted for unpublished data and ongoing studies. 2,423 studies were reviewed using Colandr. Studies were included if they presented clinical outcomes of medication abortion performed without prior pelvic examination or ultrasound. Studies with duplicate data were excluded. We abstracted successful abortion rates overall, as well as rates by gestational age through 63 days, 70 days and past 84 days. We abstracted complication rates, including the need for surgical evacuation, additional medications, blood transfusion, and ectopic pregnancy. <h3>Results</h3> We included 21 studies with a total of 10,693 patients with outcome data reported. The overall efficacy of "no test" medication abortion was 96.4%, 93.8% through 63 days of gestation and 95.2% through 70 days of gestation. The overall rate of surgical evacuation was 4.4%, need for additional misoprostol 2.2%, need for blood transfusion was 0.5%, and ectopic pregnancy was 0.06%. <h3>Conclusions</h3> Medication abortion performed without prior pelvic examination or ultrasound is a safe and effective option for pregnancy termination.

O03Safety and effectiveness of synchronous and asynchronous telehealth medication abortion provided by us virtual clinics

<h3>Objectives</h3> In 2021, new virtual clinics proliferated, offering remote-only telehealth abortion care with synchronous (phone or video) or asynchronous (messaging) communication and mailed pills. However, few large US studies have evaluated their safety and effectiveness. <h3>Methods</h3> We evaluated the safety and effectiveness of medication abortions provided by three virtual clinics operating in 21 states. We reviewed electronic health records for consecutive patients served between April 2021 and January 2022 and also invited the patients to participate in longitudinal surveys. We used multivariable mixed-effects models to estimate effectiveness and safety rates. <h3>Results</h3> Among the 6,134 included medication abortion patients, 73% received asynchronous services. Among the 5,036 (82%) abortion patients with follow-up data, 18 (0.44%, 95% CI: 0.36%-0.52%) had abortions that were followed by a serious adverse event. Abortion outcomes were confirmed for 4,106 (67%) cases, among whom 114 (2.8%, 95% CI: 2.3%-3.3%) required additional intervention to complete the abortion and 7 (0.21%, 95% CI: 0.06%-0.37%) were diagnosed with ectopic pregnancies. Rates of effectiveness (3.0% vs. 2.1%, p=0.187) and serious adverse events (0.44% vs. 0.44%, p=0.991) were similar between asynchronous and synchronous care. Among the 1,592 survey participants, 29 (2%) reported they would have had to continue the pregnancy had they not had access to telehealth abortion. Among survey participants, 47 received medications but did not take them, and among those, 36 still had the pills. <h3>Conclusions</h3> This real-world evidence shows that telehealth medication abortion care is safe and effective. Telehealth can increase access to this vital service while maintaining patient safety.

O06Self-managed abortion outcomes for pregnancies of 9–22 weeks’ gestation: Results from a prospective, observational study in three countries

<h3>Objectives</h3> The literature on self-managed abortion at later gestations is sparse, and more information is urgently needed in the US and elsewhere where this practice may become increasingly common. This analysis offers novel results on the effectiveness of self-managed medication abortion among people with pregnancies >9 weeks. <h3>Methods</h3> In 2019–2020, as a part of The Studying Accompaniment Model Feasibility and Effectiveness (SAFE) Study, we recruited callers to safe-abortion hotlines in Argentina, Nigeria, and Southeast Asia who were seeking support for self-managed medication abortion. Via phone, participants completed a baseline survey prior to taking the medications, and up to three follow-up surveys over four weeks to ascertain abortion outcomes. <h3>Results</h3> We recruited 1,351 participants, of which 264 self-managed an abortion for a pregnancy that was 9–22 weeks' gestation; 149 (56%) respondents used mifepristone and misoprostol, while 115 (44%) used misoprostol alone. One week after taking the pills, 222 (91%) participants had a complete abortion — 87% with pills alone, and 4% with additional intervention. At last follow-up, 95% of participants had had a complete abortion (89% with pills alone, 5% with additional intervention; 93% of combined regimen users, and 97% of misoprostol-alone users). A minority of participants sought healthcare at a clinic or hospital at any point (30% of combined regimen users, 15% of misoprostol-alone users). Among those seeking care, most (60%) did so to confirm abortion completion, and a small minority (1.5%) received treatment indicative of a serious complication (blood transfusion). <h3>Conclusions</h3> Self-managed medication abortion can be a safe and effective option for ending a pregnancy at 9+ weeks' gestation.

ORAL ABSTRACTS: O01An updated assessment of clinical outcomes of medication abortion without pretreatment ultrasonography

<h3>Objectives</h3> Routine ultrasound before medication abortion may create an impediment to expanding abortion access. This study examines clinical outcomes among medication abortion patients without pretreatment ultrasound evaluation at Planned Parenthood health centers in multiple states. <h3>Methods</h3> We conducted a secondary analysis among 23 Planned Parenthood affiliates that provided medication abortion without pretreatment ultrasound for eligible patients from March 2020 to December 2021. Affiliates collected and aggregated electronic health record data from 19,041 medication abortion patients at <=77 days' gestation (based on self-report of last menstrual period) without a pretreatment ultrasound. Among patients with follow up (n=10,085, 53%), we calculated the incidence rates and 95% CI of the following outcomes: completed abortion, ongoing pregnancy, surgical intervention, emergency department and hospital admissions associated with medication abortion, and confirmed ectopic pregnancies. <h3>Results</h3> Among medication abortion patients with follow-up, 96.6% had a complete abortion (95% CI, 96.3–97.0%), and 2.0% had an ongoing pregnancy (95% CI, 1.7%–2.3%). Four percent of medication abortion patients had a subsequent surgical procedure (4.0%, 95% CI, 3.6%–4.4%), and 2.3% had a documented emergency department/hospital admission (95% CI, 2.0%–2.6%). About 2 in 1,000 had a confirmed ectopic pregnancy (1.7, 95% CI, 1.0–2.7 per 1,000). <h3>Conclusions</h3> Our calculated incidence rates of clinical outcomes align with rates from the previous literature on medication abortion with pretreatment ultrasonography and from the emerging literature on medication abortion without pretreatment ultrasonography. Findings from this analysis suggest that medication abortion without pretreatment ultrasound is safe and effective for eligible patients.

P051Understanding medication abortion denial among a cohort of abortion clinic patients in southern california

<h3>Objectives</h3> Medication abortion is safe and effective up to 77 days' gestation. It is unknown how often patients who present for medication abortion do not receive one and whether those who are ineligible for medication abortion eventually receive surgical abortion. <h3>Methods</h3> We performed a retrospective cohort study of patients presenting for medication abortion at medication-abortion-only Planned Parenthood of the Pacific Southwest (PPPSW) sites from January to December 2021. PPPSW has 15 such clinics and two that offer surgical abortion. Patients seen at a medication-abortion-only site who were found ineligible after intake ultrasound (>70 days' gestation) were scheduled for an abortion at a surgical location. Electronic medical records were reviewed to determine medication abortion outcomes. <h3>Results</h3> Of 11,684 patients presenting for medication abortion at sites that only offered this service, 2,224 (19%) did not receive a medication abortion: 1,251 (56%) had an intrauterine pregnancy (IUP), 388 (17%) had a pregnancy of unknown location (PUL), and 116 (5%) had a non-viable pregnancy. Among those with an IUP, 426 (34%) presented at >70 days' gestation by ultrasound, and 223 (18%) between 71–77 days' gestation. Of these patients, 324 (76%) went on to receive a surgical abortion (54% dilation and curettage and 22% dilation and evacuation) after an average wait time of 10.5 days. <h3>Conclusions</h3> Even with a referral system in place, one-quarter of those presenting for medication abortion with an IUP at >70 days' gestation were lost to follow-up. Despite safety of medication abortion for patients with PUL, many of these patients did not receive one. Expanding medication abortion eligibility criteria by one week to 77 days' gestation and allowing medication abortion for PUL would expand access.

P033Patient acceptability of asynchronous vs synchronous telehealth medication abortion care in the US

<h3>Objectives</h3> Despite its recent expansion in the US, little is known about patient experiences with direct-to-patient telehealth abortion care and its role in addressing inequities in access to care. <h3>Methods</h3> We analyzed surveys from patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who received care between April 2021 and January 2022. We described telehealth abortion experiences and used logistic regression to evaluate inequities by race/ethnicity and by whether the patient communicated with the provider by video (synchronous) or messaging (asynchronous). <h3>Results</h3> Across the 1,306 included participants, nearly all (98%) felt they could trust the telehealth provider, 95% said that telehealth abortion was the right experience for them, and 89% were very satisfied. Participants cited privacy (93%) and the ability to get the abortion pills quickly (91%) as benefits. The most common drawbacks were concerns about whether the service was legitimate (37%), not confirming the abortion outcome at a clinic (23%), and not having a screening ultrasound (21%). Compared to white participants, Asian participants were less likely to be very satisfied with their care (OR, 0.5; 95% CI, 0.3–1.0). We found no other differences by race/ethnicity. While patients who received synchronous care were more likely to report that telehealth was right for them (OR, 2.6; 95% CI, 1.0–6.3), we found no differences in satisfaction and trust by communication method. <h3>Conclusions</h3> Telehealth abortion care is highly acceptable, and its benefits include privacy and expediency. However, there may be some differences by race/ethnicity that warrant further exploration.

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

IntroductionAbortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was...

The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future.

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.

Pregnancy outcome and follow-up of offspring of donor oocytes recipient from PCOS patients

BackgroundThe use of donated oocytes (DO) for in vitro fertilization(IVF) treatment in patients with infertility is generally recognized, and females with polycystic ovarian syndrome (PCOS) can participate in oocyte donation programs as donor patients. However, the pregnancy outcomes and offspring follow-up in patients with PCOS as the recipients are unclear. This study was to compare the pregnancy outcomes and follow-up of offspring in PCOS and non-PCOS receptor.MethodsThis was a retrospective cohort study of 62 patients undergoing the oocyte reception program were separated into 2 groups: Group I, PCOS oocyte recipients (n = 30); Group II, non-PCOS recipients (n = 32). Medical records were reviewed, and rates of fertilization, cleavage, high-quality embryos and blastocysts were compared between PCOS and non-PCOS groups. Rates of implantation, pregnancy, ectopic pregnancy, early abortion, multiple pregnancies, and offspring outcomes were calculated using the first single vitrified-warmed blastocyst transfer (SVBT) analysis between the groups.ResultsThe average recipient age and body mass index (BMI) of PCOS and non-PCOS patients was (36.3 ± 2.6 vs. 36.2 ± 2.8, and 23.4 ± 3.9 vs. 23.7 ± 4.0), respectively (P > 0.05). The fertilization, cleavage, high-quality embryos and blastocyst rates were not significantly different between the PCOS and non-PCOS groups. Rates of implantation, pregnancy, ectopic pregnancy, early abortion, and multiple pregnancies were not significantly different in SVBT between the PCOS and non-PCOS groups. The incidence of complications, such as pre-eclampsia or gestational diabetes, between PCOS and non-PCOS groups was similar (11.8% vs.11.1%, 5.9% vs.5.5%; P > 0.05). Preterm births were also similar (11.8% vs.16.7%, P > 0.05). Donor oocytes are more likely to be delivered via cesarean Sect. (80.0% vs. 86.7%: P > 0.05). The mean gestational age, birth weight, and height were comparable between the 2 groups during full-term delivery.ConclusionThere was no difference in the pregnancy outcomes and follow-up of the offspring between the PCOS and non-PCOS groups.