1.  Peer Reviewed Title: Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. Author: Allen RH; Fitzmaurice G; Lifford KL; Lasic M; Goldberg AB Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):276-83. Abstract: OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I. Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | EVALUATION INDEXES | KAP SURVEYS | PREGNANT WOMEN | ANESTHESIA | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ADMINISTRATION AND DOSAGE | PAIN | SIDE EFFECTS | SATISFACTION | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Drugs | Signs and Symptoms | Diseases | Psychological Factors | Behavior Document Number: 330360 Notification |
| 2. Peer Reviewed Title: Second-trimester abortions and sex-selection of children in Hanoi, Vietnam. Author: Belanger D; Oanh KT Source: Population Studies. 2009 Jul;63(2):163-71. Abstract: Because sex-selective abortions are generally conducted during the second term of the pregnancy, timing of abortion can be used as an indirect way of studying sex-selection by abortion. We examined the likelihood of having a first-trimester vs. second-trimester abortion among a group of 885 married women who had an abortion in an obstetric hospital in Hanoi in 2003. In the absence of sex-selection by abortion, the number and sex of living children should not affect the timing of abortion. Results indicate that women with more children, particularly those with more daughters or without a son, were more likely to undergo a second-term abortion than a first-term abortion. We estimate that, in 2003, 2 per cent of all abortions to women with at least one living child were intended to avoid the birth of a female. Language: English Keywords: VIETNAM | URBAN AREAS | RESEARCH REPORT | ABORTION | CURRENTLY MARRIED | SONS | PREGNANCY, FIRST TRIMESTER | PREGNANCY, SECOND TRIMESTER | SEX PRESELECTION | SEX PREFERENCE | SEX RATIO | POPULATION POLICY | Asia, Southeastern | Asia | Developing Countries | Geographic Factors | Population | Fertility Control, Postconception | Family Planning | Marital Status | Nuptiality | Demographic Factors | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Pregnancy | Reproduction | Reproductive Technologies | Value Orientation | Psychological Factors | Behavior | Sex Distribution | Sex Factors | Population Characteristics | Social Policy | Policy | Political Factors Document Number: 342945 Notification |
| 3. Peer Reviewed Title: Provision of abortion by mid-level providers: international policy, practice and perspectives. Author: Berer M Source: Bulletin of the World Health Organization. 2009 Jan;87(1):58-63. Abstract: Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice. Language: English Keywords: DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | RECOMMENDATIONS | COMPARATIVE STUDIES | CLINICAL RESEARCH | HEALTH PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | TRAINING PROGRAMS | Studies | Research Methodology | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Health Services | Education Document Number: 341127 |
| 4. Peer Reviewed Title: Rural Gambian women's reliance on health workers to deliver sulphadoxine-pyrimethamine as recommended intermittent preventive treatment for malaria in pregnancy. Author: Brabin L; Stokes E; Dumbaya I; Owens S Source: Malaria Journal. 2009;8:25. Abstract: BACKGROUND: The use of most anti-malarial medications is restricted during pregnancy, but two doses of sulphadoxine-pyrimethamine are recommended after the first trimester as intermittent preventive treatment in pregnancy (IPTp). In The Gambia, only 32% of women receive two doses and very little research has been conducted on women's awareness of drug safety during pregnancy. The objective of this paper was to assess whether rural Gambian women were aware of the importance of the timing of the two-dose IPT dose schedule and its relevance to drug safety. METHODS: This was a qualitative study in which 41 interviews and 16 focus group discussions with women, adolescents, men and traditional birth attendants were conducted. A generic qualitative approach was used to generate a theory as to why women might not participate in IPTp as recommended. RESULTS: Although most women used calendar months to count their stage of pregnancy, these months did not correlate with their concept of foetal development. Foetal growth was described following Islamic tradition as water, clot, piece of meat and human being, although there was little consensus about the order or timing in which these stages occurred. Common signs and conditions of malaria were known. Women were anxious about miscarriage and recognized that some medicines should not be taken in the first trimester, but were urged by men and traditional birth attendants to attend for antenatal care in the first trimester to "start treatment." General knowledge about the purpose of pregnancy medications and when they should be taken was poor among both men and women. One important result was that women relied entirely on health workers to provide safe drugs, at the correct time. CONCLUSION: Women did not have relevant information to judge the safety and appropriate timing of pregnancy drugs, which made them over-reliant on health workers. They should be encouraged to date their own pregnancies in culturally relevant terms and to anticipate when and which medications they should receive. Language: English Keywords: GAMBIA | RESEARCH REPORT | QUALITATIVE RESEARCH | PREGNANT WOMEN | MEN | TRADITIONAL BIRTH ATTENDANTS | ADOLESCENTS, FEMALE | PREGNANCY, FIRST TRIMESTER | MALARIA PREVENTION | ANTIMALARIAL DRUGS | INFORMATION | KNOWLEDGE | TREATMENT | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Pregnancy | Reproduction | Malaria | Parasitic Diseases | Diseases | Sociocultural Factors | Medical Procedures | Medicine | Health Services Document Number: 330897 |
| 5. Title: Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial. Author: Chawdhary R; Rana A; Pradhan N Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):78-85. Abstract: AIM: To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. METHOD: This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy < or =63 days gestation by transvaginal ultrasound, an equal number of women (50) were randomized into (i) group A, women who received 200 mg oral mifepristone (RU 486) on day 1 and vaginal misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. RESULTS: Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). CONCLUSION: Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RU-486 | MISOPROSTOL | ABORTION | VAGINA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Population Dynamics | Contraceptive Agents | Contraception | Pregnancy | Reproduction Document Number: 341125 |
| 6. Peer Reviewed Title: Effect of previous live birth and prior route of delivery on the outcome of early medical abortion. Author: Chien LW; Liu WM; Tzeng CR; Au HK Source: Obstetrics and Gynecology. 2009 Mar;113(3):669-74. Abstract: OBJECTIVE: To determine the association between type of previous delivery (vaginal compared with cesarean) on the success of medical abortion with mifepristone-misoprostol in early pregnancy. METHODS: The records of 879 women with intrauterine pregnancies at or before 56 days of gestation who underwent medical abortions were reviewed. Medical treatment consisted of 600 mg mifepristone orally followed 48 hours later with oral misoprostol. An ultrasound examination was performed 14-21 days after treatment, and a successful medical abortion was defined as an empty uterus without surgical intervention. Univariable and multivariable logistic regressions were used to determine risk factors for failure of medical abortion. RESULTS: A total of 797 (90.7%) women had successful medical abortions; 82 (9.3%) had failed medical abortions. Multivariable logistic regression indicated that women with gestational ages greater than 42 days (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.55-4.05) had higher odds of failed abortion compared with a gestational age less than 43 days. Parous women (OR> or =3.94, 95% CI 1.83-8.53) and those with prior cesarean delivery (OR 9.59, 95% CI 4.30-21.39) were more likely to have failed abortions compared with nulliparous women. Among 523 parous women (68 had failed abortion), those with gestational ages greater than 42 days (OR 2.07, 95% CI 1.22-3.50) and prior cesarean delivery (OR 3.33, 95% CI 1.95-5.69) were more likely to have failed abortions compared with those with gestational ages less than 43 days or with prior vaginal delivery. CONCLUSION: Parous women are at increased risk for failed medical abortion in comparison with nulliparous women. Prior cesarean delivery is significantly associated with failed medical abortion. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | CHILDBIRTH | ABORTION | CESAREAN SECTION | RU-486 | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins Document Number: 331067 Notification |
| 7. Peer Reviewed Title: Insertion of intrauterine contraceptives immediately following first- and second-trimester abortions. Author: Drey EA; Reeves MF; Ogawa DD; Sokoloff A; Darney PD; Steinauer JE Source: Contraception. 2009 May;79(5):397-402. Abstract: BACKGROUND: The study was conducted to assess the continuation and patient satisfaction with intrauterine contraception (IUC) insertion immediately after elective abortion in the first and second trimesters in an urban, public hospital-based clinic. STUDY DESIGN: A cohort of 256 women who elected to have insertion of a copper-T IUC (CuT380a) or a levonorgestrel-releasing IUC (LNG-IUC) were followed postoperatively by phone calls or chart review to evaluate satisfaction and continuation with the method. RESULTS: Of our 256 subjects, 123 had first-trimester abortions and 133 had second-trimester abortions (14 or more weeks). Median time to follow-up was 8 weeks (range 7-544 days). Nineteen discontinuations occurred: eight (6.5%, 95% CI 2.8-12.4%) following first-trimester and 11 (8.3%, 95% CI 4.2-14.3%) following second-trimester abortion (p=.6). Five women reported expulsion; one (0.8%, 95% CI 0.0-4.4%) in the first-trimester group and four (3.0%, 95% CI 0.8-7.5%) in the second-trimester group. (p=.4) Seven infections resulting in discontinuation occurred (2.7%, 95% CI 1.1-5.6%); none were positive for gonorrhea or chlamydia at time of insertion. No perforations occurred. Nearly all (93.8%) of the women were satisfied with IUC. Rates of satisfaction between women after first- and second-trimester abortions were equal. CONCLUSION: In an urban clinic, IUC has high initial continuation and high patient satisfaction when inserted immediately following either first- or second-trimester abortions. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN | URBAN POPULATION | POSTABORTAL PROGRAMS | UTERUS | PREGNANCY, SECOND TRIMESTER | IUD, COPPER RELEASING | CONTRACEPTION CONTINUATION | SATISFACTION | IUD, HORMONE RELEASING | LEVONORGESTREL | PREGNANCY, FIRST TRIMESTER | IUD EXPULSION | Developed Countries | North America | Americas | Family Planning Surveys | Family Planning | Demographic Factors | Population | Population Characteristics | Family Planning Programs | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Pregnancy | Reproduction | IUD | Contraceptive Methods | Contraception | Contraceptive Usage | Psychological Factors | Behavior | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents Document Number: 330942 |
| 8. Title: Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database. Author: Einarson A; Choi J; Einarson TR; Koren G Source: Journal of Obstetrics and Gynaecology Canada. 2009 May;31(5):452-6. Abstract: OBJECTIVE: The use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in early pregnancy. METHODS: In a cohort of women who contacted the Motherisk program during pregnancy, we compared two groups of women, one exposed and the other not exposed to antidepressants during pregnancy, and calculated the associated rates of SA and TA. RESULTS: Among 937 women exposed to antidepressants prior to and during early pregnancy, there were 122 SAs (13.0%) including three ectopic pregnancies, and in the comparison group there were 75 SAs (8.0%) and no ectopic pregnancies. The relative risk was 1.63 (95% CI 1.24-2.14). Three-fold more women reported a TA in the exposed group, 26 (2.4%) compared to 8 (0.7%) in the non-exposed group (RR 3.25; 95% CI 1.48-7.14). A sub-analysis revealed that in both groups, of 338 women with a prior SA, 58 (17.2%) reported having a SA in the current pregnancy, compared with 61/652 (9.4%) with no prior SA (chi square = 12.09, P lt; 0.001). In the antidepressant group, the incidence was 20.7%, and in the non-exposed group, it was 13.3%. Logistic regression confirmed that only antidepressant exposure and prior SA were significantly associated with current SA. CONCLUSION: Exposure to antidepressants in the first trimester of pregnancy appears to be associated with a small but statistically significant increased risk of SA and decision to terminate a pregnancy. The risk for SA is further elevated with a history of previous SA. However, any underlying depression must be taken into consideration when evaluating these results. Language: English Keywords: CANADA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | ABORTION, SPONTANEOUS | ABORTION | RISK FACTORS | DEPRESSION | DRUGS | PREGNANCY, FIRST TRIMESTER | INCIDENCE | INTERVIEWS | Developed Countries | North America, Northern | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Health | Mental Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Pregnancy | Reproduction | Measurement | Data Collection Document Number: 342785 Notification |
| 9. Peer Reviewed Title: Use of combined oral contraceptives post abortion. Author: Gaffield ME; Kapp N; Ravi A Source: Contraception. 2009 Oct;80(4):355-62. Abstract: BACKGROUND: Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method. STUDY DESIGN: We conducted a systematic review, searching MEDLINE and The Cochrane Library for articles in any language concerning COC use following spontaneous, induced (medical or surgical) or septic abortion, from 1966 through June 2008. Seven articles were identified and evaluated using the United States Preventive Services Task Force system. RESULTS: Immediate COC initiation after first-trimester medical or surgical induced abortion did not increase side effects or prolong vaginal bleeding compared with use of a placebo, copper-bearing intrauterine device (IUD), nonhormonal contraceptive method or COC initiation at a later time. Initiating COCs after first-trimester surgical abortion produced small increases in coagulation parameters compared with IUD use; although they are statistically significant, their clinical relevance is unlikely. No study examined second-trimester induced or spontaneous abortion, or septic abortion. CONCLUSIONS: Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy. Language: English Keywords: GLOBAL | LITERATURE REVIEW | ABORTION | ABORTION, SPONTANEOUS | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE SAFETY | MENSTRUATION | ORAL CONTRACEPTIVES, SIDE EFFECTS | BLOOD COAGULATION EFFECTS | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Safety | Public Health | Hematological Effects | Hemic System | Physiology | Biology Document Number: 342771 Notification |
| 10. Title: Choosing medical or surgical terminations of pregnancy in the first trimester: what is the difference? Author: Goodyear-Smith F; Knowles A Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):211-5. Abstract: BACKGROUND: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. AIMS: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone-misoprostol interval from two to one day impacted on outcomes. METHODS: Retrospective audit of two consecutive years (December 2005-November 2006 and December 2006-November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. RESULTS: A total of 1495 terminations were performed in 2005-2006 and 1588 in 2006-2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. CONCLUSIONS: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes. Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | ANALGESIA | Oceania | Developed Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342383 Notification |
| 11. Title: Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City. Author: Hu D; Grossman D; Levin C; Blanchard K; Goldie SJ Source: BJOG. 2009 May;116(6):768-79. Abstract: OBJECTIVE: To assess the comparative health and economic outcomes associated with three alternative first-trimester abortion techniques in Mexico City and to examine the policy implications of increasing access to safe abortion modalities within a restrictive setting. DESIGN: Cost-effectiveness analysis. SETTING: Mexico City. POPULATION: Reproductive-aged women with unintended pregnancy seeking first-trimester abortion. METHODS: Synthesising the best available data, a computer-based model simulates induced abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for first-trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical abortion using vaginal misoprostol. MAIN OUTCOME MEASURES: Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy. RESULTS: In comparison to the magnitude of health gains associated with all safe abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe abortion was always more influential than shifting between safe abortion modalities. CONCLUSIONS: This study demonstrates that the provision of safe abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical abortion will have the best chance to minimise abortion-related morbidity and mortality. Language: English Keywords: MEXICO | RESEARCH REPORT | COST EFFECTIVENESS | ABORTION | PREGNANCY, FIRST TRIMESTER | HEALTH | ECONOMIC FACTORS | SAFETY | North America | Americas | Developing Countries | Evaluation Indexes | Quantitative Evaluation | Evaluation | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health Document Number: 342068 Notification |
| 12. Title: Acceptability and feasibility of medical abortion in Nepal. Author: Karki C; Pokharel H; Kushwaha A; Manandhar D; Bracken H; Winikoff B Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3; Abstract: OBJECTIVE: To test the feasibility and acceptability of a simplified mifepristone-misoprostol regimen for early abortion in 2 tertiary teaching hospitals and 2 family planning clinics in Nepal. METHODS: Consenting pregnant women (n=400) with amenorrhea of 56 days or less seeking termination of pregnancy received 200 mg of oral mifepristone followed 48 hours later with 400 microg of oral misoprostol, administered either at home or at the clinic. Prospective data were collected to determine the women's experience, abortion outcome, and the operational requirements for providing the method. RESULTS: Most (91.3%) of the 367 women with known outcomes had successful medical abortions. Given the option, most (89.7%) women elected to administer the misoprostol at home. CONCLUSION: A simplified medical abortion protocol, including home administration of misoprostol, can be successfully integrated into clinical services in Nepal, where abortion services were recently legalized. Language: English Keywords: NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ABORTION | RU-486 | MISOPROSTOL | PREGNANCY, FIRST TRIMESTER | ADMINISTRATION AND DOSAGE | TIME FACTORS | ORAL CONTRACEPTIVES | HOME CARE | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Pregnancy | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Contraceptive Methods | Contraception | Care and Support Document Number: 341464 |
| 13. Title: First trimester procedural abortion in family medicine. Author: Lyus RJ; Gianutsos P; Gold M Source: Journal of the American Board of Family Medicine. 2009 Mar-Apr;22(2):169-74. Abstract: Unintended pregnancy is common, and in the United States almost half of all women will have at least one abortion during their lifetime. The majority of abortions are performed in the first trimester. Although advances have been made in the provision of medical abortion in the family medicine setting, procedural methods remain the cornerstone of abortion care. We present a step-wise review of first trimester procedural abortion using the manual vacuum aspirator to demonstrate the feasibility of incorporating this service into a primary care setting. Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | PREGNANCY, FIRST TRIMESTER | ABORTION | MEDICAL PROCEDURES | COUNSELING | CERVICAL DILATATION | CURETTAGE | ANALGESIA | ANESTHESIA | FETAL MEMBRANES | PRIMARY HEALTH CARE | Developed Countries | North America | Americas | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment | Obstetrical Surgery | Surgery | Fetus Document Number: 342001 Notification |
| 14. Peer Reviewed Title: Rates of follow-up and repeat pregnancy in the 12 months after first-trimester induced abortion. Author: Madden T; Westhoff C Source: Obstetrics and Gynecology. 2009 Mar;113(3):663-8. Abstract: OBJECTIVE: To estimate the proportion of women who returned for a routine follow-up visit after elective abortion and to identify factors associated with repeat pregnancy in the subsequent year. METHODS: We performed a historical cohort study of 865 women who underwent first-trimester surgical abortion at a hospital-based family planning clinic between March 2003 and February 2004. We collected demographic and clinical data from procedure notes and a computerized hospital patient database. We used univariable and multivariable logistic regression to analyze associations between patient characteristics and repeat pregnancy within 1 year. RESULTS: There were a total of 865 women in our cohort. Of these, 753 (87%) returned to the medical center for care; 485 women returned on time, 268 women returned late, and 112 had no further visit. There were 161 repeat pregnancies; 87 (17.9%) in the on-time group and 74 (27.6%) in the late group (P<.001). There were 85 repeat abortions; 42 (8.7%) in the on-time group and 43 (16.0%) in the late group (P<.001). Multivariable analysis demonstrated that on-time follow-up was associated with a reduction in repeat pregnancy (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.37-0.77) and repeat abortion (OR 0.53, 95% CI 0.33-0.86). A total of 130 women received injectable depot medroxyprogesterone acetate (DMPA) at the time of abortion. The rates of repeat pregnancy and abortion in these women were 13.7% and 6.2%, respectively. Women who received DMPA had a decrease in rates of repeat pregnancy (OR 0.41, 95% CI 0.23-0.73) and repeat abortion (OR 0.45, 95% CI 0.20-0.99). CONCLUSION: Timely follow-up and immediate administration of DMPA are associated with a decrease in repeat pregnancy in the 12 months after first-trimester elective abortion. Language: English Keywords: NEW YORK | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | MULTIVARIATE ANALYSIS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | TIME FACTORS | PREGNANCY RATE | DEPO-PROVERA | POSTABORTAL PROGRAMS | Developed Countries | United States of America | North America | Americas | Research Methodology | Data Analysis | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Population Dynamics | Fertility Measurements | Fertility | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Family Planning Programs Document Number: 331068 |
| 15. Peer Reviewed Title: Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. Author: Mankowski JL; Kingston J; Moran T; Nager CW; Lukacz ES Source: Obstetrics and Gynecology. 2009 May;113(5):1052-7. Abstract: OBJECTIVE: To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage. METHODS: A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05. RESULTS: For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16). CONCLUSION: For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ABORTION | OBSTETRICAL SURGERY | CONTRACEPTIVE USE-EFFECTIVENESS | PAIN | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Effectiveness | Contraception | Signs and Symptoms | Diseases Document Number: 341343 |
| 16. Title: Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. Author: McEwing RL; Anderson NG; Meates JB; Allen RB; Phillipson GT; Wells JE Source: Journal of Ultrasound In Medicine. 2009 May;28(5):579-86. Abstract: OBJECTIVE: The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. METHODS: Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. RESULTS: There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1-29 mm] versus 15.3 mm [range, 1.8-34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. CONCLUSIONS: Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP. Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | PRODUCTS OF CONCEPTION, RETENTION | SIGNS AND SYMPTOMS | ENDOMETRIAL EFFECTS | ULTRASONICS | HISTOLOGY | Oceania | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Complications | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 341998 Notification |
| 17. Peer Reviewed Title: Expressions of steroid receptors and Ki67 in first-trimester decidua and chorionic villi exposed to levonorgestrel used for emergency contraception. Author: Meng CX; Cheng LN; Lalitkumar PG; Zhang L; Zhang HJ; Gemzell-Danielsson K Source: Fertility and Sterility. 2009 Apr;91(4 Suppl):1420-3. Abstract: Levonorgestrel (1.5 mg) is commonly used for emergency contraception to prevent an unwanted pregnancy after an unprotected intercourse. We found that postovulatory administration of 1.5 mg of levonorgestrel to women with a subsequent or existing early pregnancy did not affect the immunohistochemical expressions of estrogen receptors (ER(alpha), ER(beta)), P receptors (PR(B), PR(A+B)), androgen receptor (AR), or proliferation index Ki67 in the first-trimester decidua and chorionic villi. Language: English Keywords: SWEDEN | RESEARCH REPORT | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | EMERGENCY CONTRACEPTION | HORMONE RECEPTORS | METABOLIC EFFECTS | Developed Countries | Europe, Northern | Europe | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Contraception | Family Planning | Membrane Proteins | Physiology | Biology Document Number: 331189 |
| 18. Title: Maternal Use of Oral Contraceptives During Early Pregnancy and Risk of Hypospadias in Male Offspring. Author: Norgaard M; Wogelius P; Pedersen L; Rothman KJ; Sorensen HT Source: Urology. 2009 Jul 8; Abstract: OBJECTIVES: To examine the association between maternal use of oral contraceptives in early pregnancy and increased prevalence of hypospadias in male offspring. METHODS: We conducted a nationwide population-based case-control study using data from nationwide medical databases. Among live male births between January 1, 1996, and December 31, 2005, we identified all cases of hypospadias recorded anytime postpartum (n = 1683) and randomly selected 10 controls per case without such a diagnosis (n = 15 650), matched by year and hospital of birth. We used conditional logistic regression to estimate prevalence ratios stratified according to time of diagnosis (within 6 months postpartum, >6 months postpartum), controlling for potential confounding factors including maternal age, birth order, maternal smoking, prescriptions for ovulation-inducing drugs, antiepileptics, and antidiabetics, and a maternal diagnosis of pre-eclampsia. RESULTS: We included 1683 cases of hypospadias and 15 650 population controlsduring 1996-2005. Among the 1186 boys who had their hypospadias diagnosis recorded within 6 months postpartum, 28 (2.4%) had been exposed to oral contraceptives between 30 days before conception until the end of the first trimester. Among the controls, 307 (2.8%) were similarly exposed, corresponding to a prevalence ratio of 0.85 (95% CI: 0.57-1.27) after adjusting for possible confounders. For a diagnosis registered >6 months postpartum, the adjusted prevalence ratio was 1.12 (95% CI: 0.61-2.06). CONCLUSIONS: Our data do not support the hypothesis that maternal use of oral contraceptives around conception is associated with an increased prevalence of hypospadias in the offspring. Language: English Keywords: DENMARK | RESEARCH REPORT | CONTROL GROUPS | STATISTICAL REGRESSION | INFANT | BIRTH DEFECTS | GENITAL EFFECTS, MALE | UROGENITAL EFFECTS | PREVALENCE | RISK FACTORS | ORAL CONTRACEPTIVES, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developed Countries | Europe, Northern | Europe | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Neonatal Diseases and Abnormalities | Diseases | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Measurement | Health | Contraceptive Safety | Safety | Public Health | Pregnancy | Reproduction Document Number: 342127 |
| 19. Peer Reviewed Title: First-trimester surgical abortion practices: a survey of National Abortion Federation members. Author: O'Connell K; Jones HE; Simon M; Saporta V; Paul M; Lichtenberg ES Author: National Abortion Federation Members Source: Contraception. 2009 May;79(5):385-92. Abstract: BACKGROUND: Designated providers in specialized clinics perform the majority of approximately 1.1 million first-trimester abortions carried out in the United States each year. Our objective was to assess the first-trimester surgical abortion practices of National Abortion Federation (NAF) members. STUDY DESIGN: We mailed questionnaires to NAF administrators and providers at their 364 active-member facilities in 2002. RESULTS: Two hundred eighty-nine (79%) facilities responded; we received administrative questionnaires from 273 facilities and 293 individual clinicians. NAF facilities provided at least 325,000 first-trimester surgical abortions in the United States in 2001. The majority of providers are obstetrician-gynecologists (63%), male (62%) and at least 50 years old (64%). Half of clinicians (49%) selectively utilize manual vacuum aspiration. Almost half (47%) routinely use a metal curette to verify procedure completion; these providers are more likely to be over 50 years of age or to have 20 years or more of abortion experience. Other practices are more uniform, including routine tissue examination (93%), postoperative antibiotics (88%) and contraceptive provision (oral contraceptives, 99%; depot medroxyprogesterone acetate, 79%). CONCLUSIONS: Most perioperative practices for first-trimester abortions are similar among these respondents, in accord with evidence-based guidelines. The aging of skilled practitioners raises concerns about the future availability of surgical abortion. Language: English Keywords: CANADA | UNITED STATES OF AMERICA | RESEARCH REPORT | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | CERVICAL DILATATION | SURGERY | Developed Countries | North America, Northern | Americas | North America | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342084 Notification |
| 20. Title: Expectant management of incomplete abortion in the first trimester. Author: Pauleta JR; Clode N; Graca LM Source: International Journal of Gynaecology and Obstetrics. 2009 Mar 28; Abstract: OBJECTIVE: To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. METHODS: A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. RESULTS: The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. CONCLUSION: Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion. Language: English Keywords: PORTUGAL | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | PREGNANT WOMEN | ABORTION | PREGNANCY, FIRST TRIMESTER | ABORTION, SPONTANEOUS | MISOPROSTOL | ULTRASONICS | TIME FACTORS | BLEEDING | PAIN | INFECTIONS | Developed Countries | Europe, Southwestern | Europe | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Pregnancy Complications | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Signs and Symptoms Document Number: 341468 |
| 21. Title: Pain control in first trimester surgical abortion. Author: Renner RM; Jensen JT; Nichols MD; Edelman A Source: Cochrane Database of Systematic Reviews. 2009;(2):CD006712. Abstract: BACKGROUND: First trimester abortions especially cervical dilation and suction aspiration are associated with pain, despite various methods of pain control. OBJECTIVES: Compare different methods of pain control during first trimester surgical abortion. SEARCH STRATEGY: We searched multiple electronic databases with the appropriate key words, as well as reference lists of articles, and contacted professionals to seek other trials. SELECTION CRITERIA: Randomized controlled trials comparing methods of pain control in first trimester surgical abortion at less than 14 weeks gestational age using electric or manual suction aspiration. Outcomes included intra- and postoperative pain, side effects, recovery measures and satisfaction. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data. Meta-analysis results are expressed as weighted mean difference (WMD) or Peto Odds ratio with 95% confidence interval (CI). MAIN RESULTS: We included forty studies with 5131 participants. Due to heterogeneity we divided studies into 7 groups:Local anesthesia: Data was insufficient to show a clear benefit of a paracervical block (PCB) compared to no PCB or a PCB with bacteriostatic saline. Pain scores during dilation and aspiration were improved with deep injection (WMD -1.64 95% CI -3.21 to -0.08; WMD 1.00 95% CI 1.09 to 0.91), and with adding a 4% intrauterine lidocaine infusion (WMD -2.0 95% CI -3.29 to -0.71, WMD -2.8 95% CI -3.95 to -1.65 with dilation and aspiration respectively).PCB with premedication: Ibuprofen and naproxen resulted in small reduction of intra- and post-operative pain.Analgesia: Diclofenac-sodium did not reduce pain.Conscious sedation: The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain.General anesthesia (GA): Conscious sedation increased intraoperative but decreased postoperative pain compared to GA (Peto OR 14.77 95% CI 4.91 to 44.38, and Peto OR 7.47 95% CI 2.2 to 25.36 for dilation and aspiration respectively, and WMD 1.00 95% CI 1.77 to 0.23 postoperatively). Inhalation anesthetics are associated with increased blood loss (p<0.001).GA with premedication: The COX 2 inhibitor etoricoxib, the non-selective COX inhibitors lornoxicam, diclofenac and ketorolac IM, and the opioid nalbuphine were improved postoperative pain.Non-pharmacological intervention: Listening to music decreased procedural pain.No major complication was observed. AUTHORS' CONCLUSIONS: Conscious sedation, GA and some non-pharmacological interventions decreased procedural and postoperative pain, while being safe and satisfactory to patients. Data on the widely used PCB is inadequate to support its use, and it needs to be further studied to determine any benefit. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | ABORTION | PREGNANCY, FIRST TRIMESTER | PAIN | SURGERY | DRUGS | TREATMENT | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341721 Notification |
| 22. Title: Sonographic and multiplanar computed tomographic findings of large uterine perforation 2 weeks after first-trimester pregnancy termination. Author: Sherer DM; Novac S; Dalloul M; Salame G; Zinn H; Farnaz S; Abulafia O Source: Journal of Ultrasound In Medicine. 2009 May;28(5):699-701. Abstract: This case report illustrates the importance of maintaining a high index of suspicion of iatrogenic injury to the uterus subsequent to termination of pregnancy. It also stresses the importance of substantial contribution of sonography and computed tomography in the imaging diagnosis of uterine perforation remote from the procedure. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | UTERINE PERFORATION | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | ULTRASONICS | LAPAROTOMY | MYOMETRIAL EFFECTS | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | Developed Countries | North America | Americas | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Perforations | Diseases | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Drugs Document Number: 341997 Notification |
| 23. Peer Reviewed Title: Barriers associated with the failure to return for intrauterine device insertion following first-trimester abortion. Author: Stanek AM; Bednarek PH; Nichols MD; Jensen JT; Edelman AB Source: Contraception. 2009 Mar;79(3):216-20. Abstract: BACKGROUND: The aim of the study was to identify barriers associated with the failure to return for delayed intrauterine device (IUD) insertion postabortion. STUDY DESIGN: This study had two components: (a) a retrospective cohort study of women who chose an IUD as their postabortion contraceptive method to compare characteristics of those who did and did not receive a device within 6 months of the procedure and (b) a prospective survey of women intending IUD use postabortion to assess actual IUD use at 6 weeks, barriers to access and attitudes on insertion timing. RESULTS: Of the 500 abortion patient charts available for review during the study period, 53 women intended IUD use postabortion. At 6 months, only 32% intending an IUD received one, and there were no significant demographic differences between the groups. For the prospective portion, the response rate at 6 weeks was 54% (27/50), with only 26% (7/27) of responders reporting IUD insertion by this time. The principal reported barrier to IUD insertion was time needed for an additional visit (41%). Most women (67%) desired immediate insertion and believed that they would be more likely to have an IUD inserted if it is performed immediately postabortion (63%). Monthly income was the only statistically significant difference between those who responded to the 6-week follow-up (US$1409.50) and those who did not (US$937.50, p=.05). CONCLUSION: A significant number of women that express a preference for IUD use after first-trimester abortion do not return to obtain a device. Most would prefer to have the option of immediate insertion. Language: English Keywords: OREGON | RESEARCH REPORT | KAP SURVEYS | COHORT ANALYSIS | RETROSPECTIVE STUDIES | WOMEN | POSTABORTION | IUD | TIME FACTORS | CONTRACEPTIVE USAGE | PROGRAM ACCESSIBILITY | ATTITUDES | CONTRACEPTIVE PREVALENCE | PREGNANCY, FIRST TRIMESTER | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior | Pregnancy Document Number: 341128 |
| 24. Peer Reviewed Title: First trimester surgical abortion. Author: Tristan SB; Gilliam M Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):151-9. Abstract: First trimester surgical abortion is a very common, effective, and safe procedure. When a woman presents requesting pregnancy termination, counseling regarding pregnancy options and procedural risks, as well as a careful preoperative assessment are vital to a successful outcome. If a patient decides to undergo a surgical abortion, either an electric or manual vacuum aspiration may be performed, based upon provider preference. Complications of first trimester surgical abortion occur in only 0.5% of all cases and include: failed abortion, incomplete abortion, hematometria, hemorrhage, infection, and uterine perforation. Language: English Keywords: UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | ABORTION | PREGNANCY, FIRST TRIMESTER | COUNSELING | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 342249 Notification |
| 25. Peer Reviewed Title: Non-physician clinicians can safely provide first trimester medical abortion. Author: Yarnall J; Swica Y; Winikoff B Source: Reproductive Health Matters. 2009 May;17(33):61-69. Abstract: Mid-level clinicians are integral to provision of pregnancy-related care in many settings. Yet midwives and other non-physician clinicians are excluded from training and from providing medical abortion. A substantial body of evidence exists demonstrating that mid-level providers, including nurses and midwives specialized in pregnancy-related care for women, are either already competently involved in providing medical abortions or have the requisite skills to expand their scope of practice to include medical abortion with a short course of additional training. While additional evidence may be needed to show that second trimester medical abortion can be safely and effectively provided by trained mid-level providers, we argue that for first trimester medical abortion the evidence is sufficient for governments to implement, monitor and evaluate programmes that allow mid-level clinicians to offer first trimester medical abortion independently. Because mid-level clinicians often work in rural or remote areas where physicians are scarce or where there are few surgical facilities or equipment, the expansion of the medical abortion provider pool has the potential to greatly improve the reproductive health of women worldwide. Spanish Abstract: En muchos lugares, el personal médico de nivel intermedio es fundamental en la atención relacionada con el embarazo. No obstante, las parteras profesionales y otros profesionales de la salud no médicos son excluidos de recibir capacitación y proporcionar servicios de aborto con medicamentos. Existe un considerable conjunto de pruebas que demuestran que los prestadores de servicios de nivel intermedio, como las enfermeras y parteras profesionales especializadas en la atención del embarazo, ya participan competentemente en efectuar procedimientos de aborto con medicamentos o cuentan con las habilidades necesarias para realizar abortos con medicamentos si atienden un curso corto de capacitación adicional. Aunque se necesitan más pruebas para demostrar que los profesionales de nivel intermedio capacitados pueden efectuar procedimientos de aborto con medicamentos en el segundo trimestre de manera segura y eficaz, argüimos que para el primer trimestre existe suficiente evidencia para que los gobiernos establezcan, monitoreen y evalúen programas que permitan que los profesionales de la salud de nivel intermedio ofrezcan servicios de aborto con medicamentos de primer trimestre independientemente. Dado que estos profesionales suelen trabajar en zonas rurales o remotas donde los médicos son escasos o donde existen pocos centros o equipos quirúrgicos, al ampliarse el grupo de prestadores de servicios de aborto con medicamentos se podría mejorar notablemente la salud reproductiva de las mujeres del mundo. French Abstract: Les cliniciens de niveau intermédiaire font souvent partie intégrante des soins liés à la grossesse. Pourtant, les sages-femmes et autres cliniciens non médecins sont exclus de la formation et de la pratique de l'avortement médicamenteux. Or, une somme considérable de données montre que les prestataires de niveau intermédiaire, notamment les infirmières et les sages-femmes spécialisées dans les soins liés à la grossesse, sont déjà engagés avec compétence dans les avortements médicamenteux ou possèdent les aptitudes requises pour élargir leur pratique et y inclure l'avortement médicamenteux après une brève formation complémentaire. Si des recherches supplémentaires seront peut-être nécessaires pour montrer que les prestataires de niveau intermédiaire peuvent pratiquer efficacement et en toute sécurité l'avortement médicamenteux du deuxième trimestre, nous estimons qu'il existe suffisamment de preuves pour que les gouvernements appliquent, surveillent et évaluent des programmes qui autoriseront les cliniciens de niveau intermédiaire à proposer de manière indépendante des avortements médicamenteux du premier trimestre. Comme ces cliniciens travaillent souvent dans des zones rurales ou éloignées, où les médecins sont rares ou qui disposent de peu de centres ou d'équipements chirurgicaux, l'expansion du corps de prestataires de l'avortement médicamenteux peut améliorer sensiblement la santé génésique des femmes dans le monde. Language: English Keywords: GLOBAL | CRITIQUE | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | SAFETY | TRAINING PROGRAMS | GESTATIONAL AGE | HEALTH POLICY | LEGISLATION | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health | Education | Fetus | Policy | Political Factors | Sociocultural Factors Document Number: 342015 Notification |
| 26. Peer Reviewed Title: Mifepristone-induced abortion and placental complications in subsequent pregnancy. Author: Zhu QX; Gao ES; Chen AM; Luo L; Cheng YM; Yuan W Source: Human Reproduction. 2009 Feb;24(2):315-9. Abstract: BACKGROUND: The aim of the study was to explore the effect of first-trimester mifepristone-induced abortion (MA) on placental complications in subsequent pregnancy. METHODS: Two cohorts of nulliparous pregnant women were recruited in China during early pregnancy, one with a history of one MA and the other with no abortion (NA). Women were followed up until delivery. RESULTS: The incidence proportions of abruptio placenta, placenta previa, placenta accreta and retained placenta in the MA group (4673) and NA group (4690) were, respectively, 0.5 and 0.3, 0.8 and 0.9, 0.5 and 0.5, and 0.7 and 0.8% (all differences non-significant). After adjustment for center, age, education, occupation, residence, income, BMI and type of delivery, the incidence rates of placenta previa, accreta and retained placenta in the MA and NA groups showed no significant differences. The risk of abruptio placenta in women with a MA was nearly double that of women with no abortion, although this apparent increased risk was not statistically significant. Furthermore, this increased risk of abruptio placenta was found only in those with a gestational age >6 weeks at abortion (aOR: 2.46; 95% CI: 1.00-6.04), a curettage after abortion (aOR: 3.00; 95% CI: 1.25-7.20) or a longer inter-pregnancy interval (P-value for trend: 0.022). CONCLUSIONS: Mifepristone-induced abortion itself is not associated with placental complications in subsequent pregnancy, but other factors related to medical abortion-such as a gestational age >6 weeks at abortion, a curettage after abortion, and a longer interpregnancy interval-may increase the risk of abruptio placenta. Language: English Keywords: CHINA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | CASE CONTROL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | ABORTION | PREGNANCY COMPLICATIONS | RU-486 | PREGNANCY, FIRST TRIMESTER | RISK FACTORS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Fertility Control, Postconception | Family Planning | Diseases | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Health Document Number: 331074 Notification |
| 27. Title: Mid-level health-care providers are a safe alternative to doctors for first-trimester abortions in developing countries. Author: World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction; World Health Organization [WHO]. Department of Reproductive Health and Research Source: Geneva, Switzerland, WHO, 2008. [2] p. (Social Science Research Policy Briefs) Abstract: In circumstances where the law permits termination of pregnancy, access to safe induced abortion may still be restricted by limited availability of trained health-care providers. In most countries where abortion is legal, only doctors are authorized to provide first-trimester abortions. To increase access to safe first-trimester abortion and conserve scarce health resources, some countries have trained nurses, midwives and mid-level health-care providers such as doctor assistants. These health-care providers are generally cost-effective and may work in areas where doctors are scarce, providing health services to underserved populations. Before this study, however, no comparative assessment of the safety of first-trimester abortion by type of provider had been conducted in developing countries. (excerpt) Language: English Keywords: VIETNAM | SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | HEALTH PERSONNEL | PREGNANCY, FIRST TRIMESTER | ABORTION | SAFETY | BLEEDING | CERVICAL EFFECTS | PELVIC INFECTIONS | Developing Countries | Asia, Southeastern | Asia | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Public Health | Signs and Symptoms | Diseases | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Infections Document Number: 326305 Notification |
| 28. Title: Medical abortion at first trimester of pregnancy with misoprostol. Author: Ayati S; Roudsari FV; Khadem N; Shakeri MT Source: Saudi Medical Journal. 2008 Dec;29(12):1739-42. Abstract: OBJECTIVE: To evaluate the efficacy of medical abortion at first trimester of pregnancy with vaginal misoprostol. METHODS: This is a descriptive analytic study. It was performed on 100 women at first trimester of pregnancy referred to teaching hospitals related to the Medical Sciences of Mashhad University, Mashhad, Iran for termination of pregnancy in 2006. Each patient received first dose of misoprostol (800 microg/vaginal), the second dose (800 microg/vaginal) was administered 24 hours after the first dose if expulsion of conceptus was not successful and curettage was performed if product of conception remained. RESULTS: From 100 patients, 83 women (83%) had successful complete abortion, and 17 cases required curettage. Among them, pregnancy was terminated in 55 (62%) with first dose of misoprostol and 28 (34%) of them required second dose. No important side-effects were noted due to vaginal misoprostol treatment. CONCLUSION: Termination of pregnancy by medical methods at first trimester of pregnancy with vaginal misoprostol is safe, cost effective, and without side-effects. Language: English Keywords: IRAN | RESEARCH REPORT | EVALUATION | MEDICAL PROCEDURES | ABORTION | MISOPROSTOL | PREGNANCY, FIRST TRIMESTER | SAFETY | COST EFFECTIVENESS | Middle East | Developing Countries | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Public Health | Evaluation Indexes | Quantitative Evaluation Document Number: 330871 Notification |
29.  Title: Patterns and determinants of maternity care in Damascus. Author: Bashour H; Abdulsalam A; Al-Faisal W; Cheikha S Source: Eastern Mediterranean Health Journal. 2008 May-Jun;14(3):595-604. Abstract: This descriptive study was designed to describe the patterns and determinants of maternity care among Syrian women living in Damascus. All 39 birth registers in 2 large provinces were used to recruit 500 mothers of healthy newborns. Mothers were interviewed in their homes using a semistructured questionnaire. Multivariate analysis of the determinants of the frequency of use of antenatal care showed the following variables were significant: urban residence and visit to antenatal care in the 1st trimester. The significant variables for an early visit to antenatal care were the woman's level of education; being pregnant with the 1st baby; and number of visits to antenatal care. Being young (age less than 20 years) also correlated with early timing of the 1st antenatal visit. (author's) Language: English Keywords: SYRIA | RESEARCH REPORT | INTERVIEWS | QUESTIONNAIRES | MOTHERS | MATERNAL HEALTH | RESIDENCE CHARACTERISTICS | ANTENATAL CARE | PREGNANCY, FIRST TRIMESTER | EDUCATION | AGE FACTORS | Middle East | Developing Countries | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Health | Population Distribution | Geographic Factors | |