Time Of Abortion Research Articles

Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

Objectives: To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.Methods: This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.Results: This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3–5) the mean number of the first trimesteric abortion was 2 with range (2–2) the mean number of second trimesteric abortion was 2 with range (1–2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.Conclusions: It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Interpregnancy Interval After Termination of Pregnancy and the Risks of Adverse Outcomes in Subsequent Birth

Interpregnancy Interval After Termination of Pregnancy and the Risks of Adverse Outcomes in Subsequent Birth

Assessment of the level of knowledge regarding safe abortion among reproductive age group women, a short cross sectional study in lekhnath, kaski

Introduction: Overall situation of reproductive health and the quality of life of females are not satisfactory in developing countries. Complications from unsafe abortion result in maternal deaths and abortion-related morbidities worldwide, placing high strain on limited health system resources and leading to severe physical, psychological, and financial consequences for women1. Methods: A cross sectional descriptive study carried out in 50 reproductive age group women living in Lekhnath municipality-12 at Kaski, Nepal and sample size was determined by using non probability purposive sampling where data were taken under the consent of individual using semi structured interview schedule and were analyzed using SPSS version 11.5. Result: Regarding the type of the abortion, 40% knew about induced abortion, 16% knew about spontaneous abortion whereas 44% knew about both induced and spontaneous abortion. Among the respondents who heard about safe abortion, only 28% gave the correct meaning about safe abortion whereas rest 72% gave incorrect meaning about the safe abortion. The respondents who heard about safe abortion, there was only 51% knows about the legal period of safe abortion for women and remaining 49% of them did not have any idea for legal time of legal abortion. In addition, 40% of respondents had high as well as fair level of knowledge about safe abortion and 20% of the respondents had low level of knowledge regarding safe abortion. Conclusion: Reproductive rights are the rights of individuals to decide whether to reproduce and have reproductive health. The present study highlights the knowledge on reproductive age group women of Lekhnath, Kaski and knowing about safe abortion is important as it helps to enhance equity and gender equality, share the burden of preventing diseases and health complications, promote satisfying sexual lives for men and women.

Blood loss at the time of surgical abortion up to 14 weeks in anticoagulated patients: a case series

ObjectiveTo describe estimated blood loss (EBL) with surgical abortion ≤14 weeks’ gestation in anticoagulated patients. Study designWe invited 170 clinicians involved in a professional listserv to report cases when they performed a surgical abortion on a patient ≤14 weeks’ gestation taking an anticoagulant. Clinicians reported EBL and bleeding-related complications (need for a blood transfusion, additional surgical procedures to treat bleeding). We contacted clinicians 30 days postprocedure to capture postoperative complications. ResultsClinicians reported 52 cases between February 2011 and October 2013. Thirty percent of patients (16/52) stopped the anticoagulant with adequate time for the effects to abate prior to surgery (6 h for heparin, 24 h for low-molecular-weight heparin, International Normalized Ratio ≤1.7 the day prior to surgery for warfarin), while 69% (36/52) continued the anticoagulant either at therapeutic (25/36) or subtherapeutic (16/36) doses. Seventy-eight percent (28/36) of patients who continued the anticoagulant had an EBL of 50 mL or less compared to 88% (14/16) of those who stopped the anticoagulant with adequate time for its effects to abate (p=.73). Bleeding-related complications occurred in four anticoagulated patients and none of the patients who discontinued anticoagulant therapy. ConclusionContinuation of anticoagulation for planned surgical abortion under 84 days does not appear to be associated with heavy bleeding.

Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases.

Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion. Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion. Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014. Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups. Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua.

FERTILITY RISK IN THE LIFE CYCLE

In this article, I study fertility decisions with special emphasis on the timing of births and abortions over the life cycle. Given the policy debate regarding abortion availability and recent evidence of its positive impact on women's outcomes, understanding the fertility process should help guide the discussion. Here, I present a life‐cycle model of consumption–savings and fertility decisions in an environment with uninsurable income shocks and imperfect fertility control. My model presents a framework in which both opportunity costs of child rearing and technological restrictions (in the form of contraception effectiveness) have roles shaping lifetime fertility choices.

Pain Control of Medical Abortion with Misoprostol in the First Trimester of Pregnancy

Background: Abortion is the most common subjects of obstetric which has applied two methods including surgical and medical approaches. Pain is the most common complication of medical abortion and pain relief is one the most important items in these patients. Objectives: Evaluated the effect of three non-steroidal anti-inflammatory drugs in pain reduction of medical abortion in less than 14 weeks gestation with forensics declaration. Methods: This study was a retrospective cohort in 66 pregnant women with less than 14 weeks gestation referred to Yas hospital for medical abortion that were assigned to three groups based on sedative drugs: A) Mefenamic acid capsules 250 mg, B) Diclofenac tablets 100 mg and C) Ibuprofen tablets 400 mg. The standardized visual assessment scale was assessed before and after drug administration that presented in medical records of patients. Results: Comparison of visual assessment scale means before and after using of three non-steroidal antiinflammatory drugs demonstrated that all three drugs lead to pain relief after the abortion that was significant statistically (P value=0.001). There was a significant difference in termination time of pregnancy between three groups, (P value= 0.016). In the case of hemoglobin drop, diclofenac lead to the lowest hemoglobin drop (P value=0.004). The amount of receiving narcotic among three groups revealed the significant difference (P value= 0.000). There were not significant differences in pain relief (P value=0.327) and demographic data between three groups. Conclusion: It was indicated that the three NSAIDs drugs, had a significant effect on the management of pain, diclofenac expended less termination time of pregnancy, narcotic drug usage and also hemoglobin drop than other groups. What does this study add? Non-steroidal anti-inflammatory drugs are effective in pain management of medical abortion and some of them are preferred to others. Diclofenac can reduce abortion time and also hemoglobin drop after abortion and additional dose of other narcotics too.

Differences on the microsporogenesis and tapetal development of male fertile and cytoplasmic male sterile pepper (Capsicum annuum L.)

To clarify the time and cause of pollen abortion, differences on the microsporogenesis and tapetum development in the anthers of male fertile maintainer line and cytoplasmic male sterile (CMS) line pepper were studied using transmission electron microscopy. The results showed that CMS line anthers appeared to have much greater variability in developmental pattern than male fertile maintainer line ones. The earliest deviation from normal anther development occurred in CMS line anthers at prophase I was cytomixis in some microspore mother cells (MMCs), and vacuolisation in tapetal cells. Then, MMCs in CMS line anthers developed asynchronously and a small part of ones at the different stage degenerated in advance appearing to have typical morphological features of programmed cell death (PCD). Most MMCs could complete the meiosis, but formed non-tetrahedral tetrad microspores with irregular shape and different size and uncertain number of nuclei, and some degenerated ahead of time as well. Tapetal cells in CMS line anther degenerated during meiosis, and were crushed at the tetrad stage, which paralleled the collapse of pollens. Pollen abortion in CMS line anthers happened by PCD themselves, and the premature PCD of tapetal cells were closely associated with male sterility.

Injectable contraception: updates and innovation.

Injectable contraception is a highly effective form of birth control that is globally popular. Recent research has focused on ways to make injectables such as depot medroxyprogesterone acetate (DMPA) more accessible and to improve the side-effect profile of injectables. This review will focus on new directions and approaches to the use of injectable contraception. Research in the area of injectable contraception has focused on improving access for women through home or self-injection, and also task-shifting and community-based distribution in low-resource areas. Specific to DMPA, studies have focused on lowering the overall dose of medication while maintaining efficacy, and improving drug-delivery systems. More research into the association between DMPA and HIV is needed, and also the effects of administration of DMPA at the time of medication abortion. Injectable contraceptives are an important part of the global method mix of highly effective birth control. Improving the accessibility and side effect profile of commodities such as DMPA will make injectables even more valuable for women seeking effective contraception.

Two cervical preparation regimens prior to surgical abortion at 10–14 weeks of gestation: A randomized clinical trial

Background: The aim of the study was to determine whether same-day cervical preparation with an osmotic dilator and misoprostol was as effective and safe as overnight cervical preparation for surgical abortions at 10–14 weeks.Methods: Seventy women seeking surgical abortion at 10–14 weeks were allocated to receive one osmotic dilator 16–17 h or 6–7 h prior to an abortion. All women received misoprostol 400 μg orally 2 h before the abortion.Results: The abortion time of the same-day group was 7.42 ± 1.73 min, and that of the overnight group was 8.00 ± 2.19 min (p = 0.23). The blood loss volume of the same-day group was 20.6 ± 10.6 mL, and that of the overnight group was 16.3 ± 7.0 mL (p = 0.55). The degree of cervical dilation for the same-day group was inferior to the overnight group (p = 0.02).Conclusions: Same-day cervical preparation with misoprostol and an osmotic dilator shortens the hospitalization days, suggesting same-day cervical preparation is safe, effective, and feasible for surgical abortion at 10–14 weeks of gestation.

Synthetic osmotic dilator prior to medical or surgical abortion: interim outcomes from international observational E-registry

Objective: The aim of this study is to document post marketing clinical application of synthetic osmotic dilators for cervical priming prior to abortion. The primary outcome was the number of dilators used and the duration of cervical priming in relation to gestational age. Secondary outcomes were the induction-to-abortion time for medical abortion, surgery procedure time and need for additional cervical dilation in surgical abortions, and safety. Methods: This is an interim analysis of a 2-year prospective observational international multicenter data collection involving 4 sites in 3 countries. Demographic and procedural details, and post-abortion complications for women undergoing medical or surgical abortion from 6 to 24 weeks of gestation where osmotic dilators were used were recorded on a standardised form and entered into an electronic data capture system for analysis. Results: Between 1 May 2015 and 17 January 2016, 97 women were enrolled. The average age was 27 years. 38% had a previous abortion and 18% had a previous Caesarean section. The mean number of inserted dilators in women at 6–13 weeks of gestation (n = 26) was 1.67. The mean number of inserted dilators in women at 14–24 weeks of gestation (n = 71) was 2.99. The mean duration of cervical priming was 7.55 h for medical abortion (n = 40) and 4.24 h for surgical abortion (n = 57). The overall mean duration of cervical priming was 5.84 h and did not differ by respect to gestational age. For medical abortions, the mean induction-to-abortion interval was 7.89 h in women at 6–13 weeks of gestation (n = 14) and 16.74 h in women at 14–24 weeks of gestation (n = 26). Additional cervical dilation was needed in 25% of women at 6–13 weeks of gestation (n = 12) and in 18% of women at 14–24 weeks of gestation (n = 45) undergoing surgical abortion. Mean procedure time was 13.4 min and 12.4 min, respectively. Mild complications or discomfort during cervical priming were reported in 6% of women. No infectious complications were observed in this analysis. Conclusion: We were able to show that the application of synthetic osmotic dilators is a safe and efficient method of cervical priming prior to surgical as well as medical abortions. No serious adverse outcome associated with the use of synthetic osmotic dilators was reported. The fast mode of their action enables one-day procedures.

Trends in gestational age at time of surgical abortion for fetal aneuploidy and structural abnormalities

Screening for fetal aneuploidy has evolved over the past 2 decades. Whether these advances impact gestational age at abortion has received little study. We sought to describe trends in the gestational age at the time of abortion by fetal diagnosis over an 11-year study period. We hypothesized that gestational age at time of abortion would decrease for fetal aneuploidy but remain unchanged for structural abnormalities. We conducted a retrospective case series of all women undergoing surgical abortion for fetal aneuploidy or structural abnormalities up to 24 weeks' gestation from 2004 through 2014 in a hospital operating room setting at a single, urban medical center. We excluded labor induction abortions (<1% of abortions at our medical center) and suction aspirations performed in the office practice. We performed suction aspiration up to 14 weeks and dilation and evacuation after that gestational age. We describe the median gestational age at abortion by fetal indication and year. For women undergoing abortion for fetal aneuploidy (n= 392), the median gestational age at time of abortion decreased from 19.0 weeks (interquartile range 18.0-21.0) in 2004 to 14.0 weeks (interquartile range 13.0-17.0) in 2014 (Kruskal-Wallis P < .0001). For women undergoing abortion for fetal structural abnormalities (n= 586), the median gestational age was ≥20 weeks for each year during the study interval (P= .1). As gestational age decreased in the fetal aneuploidy group, fewer women underwent dilation and evacuation and more became eligible for suction aspiration (<14 weeks). In 2004, >90% of women underwent dilation and evacuation for either indication. By 2014, 31% of women with fetal aneuploidy were eligible for suction aspiration compared to 11% of those with structural anomalies. Gestational age at the time of abortion for fetal aneuploidy decreased substantially from 2004 through 2014; earlier abortion is safer for women. In contrast, women seeking abortion for fetal structural abnormalities did not experience a change in timing. Legislation restricting gestational age at the time of abortion could disproportionately affect women with fetal structural abnormalities.

Comparison among measures to prevent intrauterine adhesions after artificial abortion

To investigate the clinical efficacy of oral medicine and sodium hyaluronate in prevention of intrauterine adhesions after artificial abortion. A total of 572 patients with early pregnancy termination through artificial abortion, who experienced two or more times of abortion, were retrospectively analyzed. Patients were randomly and voluntarily divided into 4 groups: an artificial cycle group, a drospirenone and ethinylestradiol tablets group, a sodium hyaluronate group, and a control group. The thickness of the endometrium, return time of menses, and the status of intrauterine adhesions were observed. The thickness of the endometrium in the artificial period group was greater than that in the control group (P<0.001). It was less in the drospirenone and ethinylestradiol tablets group comparing with that in the control group (P<0.001). There was no significant difference in the thickness of the endometrium between the sodium hyaluronate group and the control group (P=0.717). Return time of menses in the artificial menstrual cycle group and the drospirenone and ethinylestradiol tablets group was shorter than that in the control group (P<0.001). There was no significant difference in return time of menses between the sodium hyaluronate group and the control group (P=0.813). The incidence of intrauterine adhesions could be reduced by the 3 preventive measures (All P<0.01). Drugs for artificial cycle and drospirenone and ethinylestradiol tablets medication immediately after artificial abortion can effectively promote endometrial repair and reduce the incidence of intrauterine adhesions. However, for the patients with poor compliance, drospirenoneand ethinylestradiol tablets are the first choice for prevention of intrauterine adhesion.

Sero-Surveillance of Brucellosis in Cattle of Chitwan District, Nepal

A cross sectional study was conducted in Eastern and Western parts of Chitwan district from November 2015 to April, 2016 in two parts, the social study followed by biological to determine and compare the prevalence, distribution of antibodies, and level of awareness of farmers against Brucella abortus in cattle of the two regions of same district. Altogether blood samples of 92 cattle were taken for detection of Brucella antibodies by using RBPT test and the positive samples were further retested by Indirect ELISA test through ID Vet iELISA kit 2016. The samples which showed positive on both tests were confirmed as seropositive. Chi -square test and Fisher Exact test was used to find out the association between various variables. The result showed that 14.13% (13/92) and 10.86% (10/92) sample were positive by RBPT and iELISA test respectively. There was no significant prevalence differences (p&gt;0.05) on location, age group, breed type, and method of service (artificial and natural) used in cattle. Comparing abortion with prevalence of Brucellosis, there was significant differences (p&lt;0.05) in the result of both RBPT and iELISA test. Inferring from this result, there is association between the abortion and occurrence of Brucellosis. The higher significant prevalence differences (p&lt;0.01) was according to the time of abortion where higher seropositivity was obtained in the cattle aborted on 5-7th month of pregnancy and cattle of 3rd parity. The study showed the existence of Brucellosis in Chitwan district with no adoption of any preventive measures against this disease, so here is current need of the strategies for its prevention and control in order to mitigate such overwhelming situation.Int J Appl Sci Biotechnol, Vol 4(3): 365-371

Contraceptive behaviour of Christian and Muslim teenagers at the time of abortion and post-abortion in Thrace, Greece

Objectives: The aims of the study were to compare the contraceptive behaviour of Christian and Muslim adolescents who had an abortion in Thrace, Greece, and to examine whether extensive contraceptive counselling at the time of abortion modified their subsequent contraceptive practices.Methods: Adolescents, aged 14–19 years, who had undergone an elective abortion in our department, were included in a prospective 12-year study. Extensive contraceptive counselling was offered before discharge from the hospital. Attitudes to contraception were assessed by means of a simple questionnaire at the time of abortion and at 1-year follow-up.Results: The study population comprised of 95 Christian Orthodox adolescents (Group A) and 79 Muslim adolescents (Group B). At the time of abortion, contraceptive behaviour differed significantly between the two groups (p = .004). Contraceptive methods used in Group A in comparison with Group B were as follows: oral contraceptives (27.4% vs. 12.7%), condoms (22.1% vs. 38.0%), interrupted coitus (18.9% vs. 20.3%), periodic abstinence (16.8% vs. 25.3%) and emergency contraception (14.7% vs. 3.8%). The commonest source of information on contraception in Group A was the gynaecologist (17.9%) and family planning clinic (15.8%), whereas in Group B it was the individual’s partner (25.3%) and parents (16.4%). Contraceptive behaviour was significantly modified in both groups at post-abortion follow-up (both p < .001). The original difference between the groups, however, persisted (p = .006). In Group A, oral contraceptives were the dominant method (48.4%), followed by condoms (30.5%), whereas in Group B, the order was still the reverse (24.1% and 46.8%, respectively).Conclusion: Cultural differences significantly affect the contraceptive behaviour. Nevertheless, interventions that promote contraception can still be successful in different populations.

Negotiating masculinities in the experiences of male partners accompanying women at the time of abortion: results from a qualitative study

Negotiating masculinities in the experiences of male partners accompanying women at the time of abortion: results from a qualitative study

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

Gene Cloning, Expression and Enzyme Activity of Vitis vinifera Vacuolar Processing Enzymes (VvVPEs).

Vacuolar processing enzymes (VPEs) have received considerable attention due to their caspase-1-like activity and ability to regulate programmed cell death (PCD), which plays an essential role in the development of stenospermocarpic seedless grapes ovules. To characterize VPEs and the relationship between stenospermocarpic grapes and the VPE gene family, we identified 3 Vitis vinifera VPE genes (VvβVPE, VvγVPE, and VvδVPE) from the PN40024 grape genome and cloned the full-length complementary DNAs (cDNAs) from the ‘Vitis vinifera cv. Pinot Noir’ and ‘Vitis vinifera cv. Thompson Seedless’ varietals. Each of the VPEs contained a typical catalytic dyad [His (177), Cys (219)] and substrate binding pocket [Arg (112), Arg (389), Ser (395)], except that Ser (395) in the VvγVPE protein sequence was replaced with alanine. Phylogenetic analysis of 4 Arabidopsis thaliana and 6 Vitis vinifera VPEs revealed that the 10 VPEs form 3 major branches. Furthermore, the 6 grapevine VPEs share a similar gene structure, with 9 exons and 8 introns. The 6 grapevine VPEs are located on 3 different chromosomes. We also tested the enzymatic activity of recombinant VPEs expressed in the Pichia Pastoris expression system and found that the VvVPEs exhibit cysteine peptidase activity. Tissue-specific expression analysis showed that VvδVPE is only expressed in flowers, buds and ovules, that VvγVPE is expressed in various tissues, and that VvβVPE was expressed in roots, flowers, buds and ovules. The results of quantitative real-time PCR (qRT-PCR) suggested that VvβVPE in seeded grapes increased significantly at 30 days after full-bloom (DAF), close to the timing of endosperm abortion at 32 DAF. These results suggested that VvβVPE is related to ovule abortion in seedless grapes. Our experiments provide a new perspective for understanding the mechanism of stenospermocarpic seedlessness and represent a useful reference for the further study of VPEs.

Mifepristone and misoprostol is safe and effective method in the second-trimester pregnancy termination.

The second-trimester medical abortions constitute 10-15% of all induced abortions worldwide, but are responsible for two-thirds of major abortion related complications. During the last decade, medical methods for the second-trimester-induced abortion have been become safer and more accessible. The aim of this study is to evaluate factors affecting clinical effectiveness of the second-trimester medical terminations using mifepristone and misoprostol combination. In this retrospective observational study, 142 consecutive women underwent medical abortion on 12-24weeks of gestation. Clinical data were collected from Oulu University Hospital patients' records for the period between January 2008 and June 2011. The associations between patient characteristics and different outcomes were evaluated using the standard statistical test for correlation. The majority (92%) of women aborted successfully within 24h and were considered as day cases with small complication rate, as compared to hospitalized patients. In nulliparous patients, the time for complete abortion was longer than in other groups (P<0.0019). Nulliparous women and women with gestation more than 16weeks required opiate analgesia more often (P=0.003 and <0.001, respectively). Women with previous live births aborted more often within 8h than women with no previous births. Mifepristone and misoprostol is safe and effective method for the second-trimester pregnancy termination. The second-trimester medical abortion can be provided by a nurse-midwife with the back-up of a gynecologist.

P048 What factors cause delay in termination of pregnancy? A literature review of the evidence

Background/introduction Although abortions performed at earlier gestations are relatively medically safer and less costly, nonetheless in many settings there exists a small minority of women who receive abortions in the second trimester. The difficult circumstances faced by women seeking later abortions have been highlighted, but it is not always clear what factors lead to abortions being performed later in pregnancy. Aim(s)/objectives To identify the causative factors of later (second trimester) abortion, analyse the impact of service provision on timing of abortion and highlight other factors relevant to delay in seeking or obtaining abortion. Methods A literature search was conducted using Medline and Embase databases, and results were limited to English language studies from the last 20 years in settings where termination of pregnancy was legally available. Results Most delays tended to act on one or more of three periods: identification of pregnancy, decision-making, and obtaining an abortion having made a decision. Delays in suspecting or confirming the pregnancy were key drivers in later termination and were particularly pronounced in young people; service-related delays were common, though small, and were often compounded by logistical factors such as financial difficulties. Discussion/conclusion The causes of later abortion are many and complex, and very commonly overlap; more research is needed to analyse how these factors interact to cause delay. The association of low socioeconomic status with increased abortion delay suggests more must be done to ensure the accessibility of abortion services.