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Daniel Grossman - One of the best experts on this subject based on the ideXlab platform.
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an analysis of delays among women accessing Second Trimester Abortion in the public sector in south africa
Contraception, 2019Co-Authors: Deborah Constant, Jane Harries, Judy Kluge, Daniel GrossmanAbstract:Abstract Objectives To identify key delays and associated factors in women's pathway to Second-Trimester Abortion that could inform strategies to increase earlier presentation. Study design We performed a Secondary analysis using data collected from May 2012 to June 2013 as part of a randomized controlled trial among women having Abortion at 13.0–20.0 weeks at a public hospital in South Africa. We used ultrasound and participant interview data to calculate 3 key intervals: (1) conception to suspicion of pregnancy, (2) suspicion to first healthcare visit for Abortion, and (3) first healthcare visit to Abortion procedure. We compared intervals for women at 13–15.0 weeks versus 15.1–20.0 weeks gestation at Abortion using Wilcoxon rank-sum tests and tested for associations between gestational age at key events using multivariable linear regression. Results Median (interquartile range[IQR]) durations for the 3 intervals among women at 13–15 weeks (n=93) compared to 15.1–20 weeks (n=63) gestation were: (1) 36 days (IQR 21–53 days) versus 62 days (36–71 days), p Conclusion The only differences in delay in obtaining Second Trimester Abortion between South African women having an earlier and later Second Trimester procedure is due to longer time to suspect pregnancy. Implications Interventions to improve early pregnancy recognition should be explored and referral processes should be streamlined to avoid unnecessary delays accessing Abortion care and possibly reduce the proportion of Abortions performed later in the Second Trimester in South Africa.
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change in Second Trimester Abortion after implementation of a restrictive state law
Obstetrics & Gynecology, 2019Co-Authors: Kari White, Sarah E Baum, K Hopkins, Joseph E Potter, Daniel GrossmanAbstract:OBJECTIVE To assess whether indicators of limited access to services explained changes in rates of Second-Trimester Abortion after implementation of a restrictive Abortion law in Texas. METHODS We used cross-sectional vital statistics data on Abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' Abortion law. We conducted monthly mystery client calls for information about Abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open Abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining Abortion care after the law's implementation and having a Second-Trimester Abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times. RESULTS Overall, 64,902 Texas-resident Abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of Abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P<.001; unadjusted odds ratio [OR] 1.45; 95% CI 1.40-1.50). Adjusting for distance to the nearest facility and facility network size reduced the odds of having a Second-Trimester Abortion after implementation (OR 1.17; 95% CI 1.10-1.25). Women living 50-99 miles from the nearest facility (vs less than 10 miles) had higher odds of Second-Trimester Abortion (OR 1.24; 95% CI 1.11-1.39), as did women in regions with less than one facility per 250,000 reproductive-aged women compared with women in areas that had 1.5 or more facilities (OR 1.57; 95% CI 1.41-1.75). After implementation, women waited 1 to 14 days for a consultation visit; longer waits were associated with higher odds of Second-Trimester Abortion. CONCLUSION Increases in Second-Trimester Abortion after the law's implementation were due to women having more limited access to Abortion services.
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Change in Second-Trimester Abortion After Implementation of a Restrictive State Law.
Obstetrics and gynecology, 2019Co-Authors: Kari White, Sarah E Baum, K Hopkins, Joseph E Potter, Daniel GrossmanAbstract:OBJECTIVE To assess whether indicators of limited access to services explained changes in rates of Second-Trimester Abortion after implementation of a restrictive Abortion law in Texas. METHODS We used cross-sectional vital statistics data on Abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' Abortion law. We conducted monthly mystery client calls for information about Abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open Abortion facilities in women's region of residence (facility network size), and days until the next consultation visit. We estimated mixed-effects logistic regression models to assess the association between obtaining Abortion care after the law's implementation and having a Second-Trimester Abortion (12 weeks of gestation or more), after adjustment for distance, network size, and wait times. RESULTS Overall, 64,902 Texas-resident Abortions occurred in the period before the law was introduced and 53,174 occurred after its implementation. After implementation, 14.5% of Abortions were performed at 12 weeks of gestation or more, compared with 10.5% before the law (P
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Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
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Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
Deborah Constant - One of the best experts on this subject based on the ideXlab platform.
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an analysis of delays among women accessing Second Trimester Abortion in the public sector in south africa
Contraception, 2019Co-Authors: Deborah Constant, Jane Harries, Judy Kluge, Daniel GrossmanAbstract:Abstract Objectives To identify key delays and associated factors in women's pathway to Second-Trimester Abortion that could inform strategies to increase earlier presentation. Study design We performed a Secondary analysis using data collected from May 2012 to June 2013 as part of a randomized controlled trial among women having Abortion at 13.0–20.0 weeks at a public hospital in South Africa. We used ultrasound and participant interview data to calculate 3 key intervals: (1) conception to suspicion of pregnancy, (2) suspicion to first healthcare visit for Abortion, and (3) first healthcare visit to Abortion procedure. We compared intervals for women at 13–15.0 weeks versus 15.1–20.0 weeks gestation at Abortion using Wilcoxon rank-sum tests and tested for associations between gestational age at key events using multivariable linear regression. Results Median (interquartile range[IQR]) durations for the 3 intervals among women at 13–15 weeks (n=93) compared to 15.1–20 weeks (n=63) gestation were: (1) 36 days (IQR 21–53 days) versus 62 days (36–71 days), p Conclusion The only differences in delay in obtaining Second Trimester Abortion between South African women having an earlier and later Second Trimester procedure is due to longer time to suspect pregnancy. Implications Interventions to improve early pregnancy recognition should be explored and referral processes should be streamlined to avoid unnecessary delays accessing Abortion care and possibly reduce the proportion of Abortions performed later in the Second Trimester in South Africa.
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Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
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Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
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the costs of accessing Abortion in south africa women s costs associated with Second Trimester Abortion services in western cape province
Contraception, 2015Co-Authors: Naomi Lincederoche, Kelly Blanchard, Deborah Constant, Jane Harries, Edina Sinanovic, Daniel GrossmanAbstract:Abstract Objectives To assess women’s costs of accessing Second-Trimester labor induction and dilation and evacuation (DE 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0–3.0] to the study facility, while D&E women reported two required visits [IQR 1.0–2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor’s fees. The total median cost incurred per woman was $21.23 [IQR 11.94–44.68]. Roughly half (49.0%) received help with these costs. Conclusions Although technically offered freely or low cost in the public sector, women accessing Second-Trimester Abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. Implications Limited access to Second-Trimester, safe Abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an Abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies.
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self induction of Abortion among women accessing Second Trimester Abortion services in the public sector western cape province south africa an exploratory study
South African Medical Journal, 2014Co-Authors: Deborah Constant, Daniel Grossman, Naomi Lince, Jane HarriesAbstract:Background. Despite South Africa’s liberal Abortion law permitting Abortion on request in the first Trimester and under restricted conditions for Second-Trimester pregnancies, the practice of unsafe self-induced Abortion persists. However, the prevalence of this practice, the methods used and the reasons behind it are relatively under-researched. As part of a larger study seeking to improve Abortion services in the Western Cape Province, we explored reports of prior attempts to self-induce Abortion among women undergoing legal Second-Trimester Abortion. Objectives. To describe the prevalence and methods of and factors related to unsuccessful attempts at self-induction of Abortion by women presenting without complications and seeking Second-Trimester Abortion at public health facilities in the Western Cape. Methods. In a cross-sectional study from April to August 2010, 194 consenting women undergoing Second-Trimester Abortion were interviewed by trained fieldworkers using structured questionnaires at four public sector facilities near Cape Town. Results. Thirty-four women (17.5%; 95% confidence interval 12.7 - 23.4) reported an unsuccessful attempt to self-induce Abortion during the current pregnancy before going to a facility for Second-Trimester Abortion. No factors were significantly associated with self-induction, but a relatively high proportion of this small sample were unemployed and spoke an indigenous African language at home. A readily available herbal product called Stametta was most commonly used; other methods included taking tablets bought from unlicensed providers and using other herbal remedies. No use of physical methods was reported. Conclusions. The prevalence of unsafe self-induction of Abortion is relatively high in the Western Cape. Efforts to inform women in the community about the availability of free services in the public sector and to educate them about the dangers of self-induction and unsafe providers should be strengthened to help address this public health issue.
Jane Harries - One of the best experts on this subject based on the ideXlab platform.
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an analysis of delays among women accessing Second Trimester Abortion in the public sector in south africa
Contraception, 2019Co-Authors: Deborah Constant, Jane Harries, Judy Kluge, Daniel GrossmanAbstract:Abstract Objectives To identify key delays and associated factors in women's pathway to Second-Trimester Abortion that could inform strategies to increase earlier presentation. Study design We performed a Secondary analysis using data collected from May 2012 to June 2013 as part of a randomized controlled trial among women having Abortion at 13.0–20.0 weeks at a public hospital in South Africa. We used ultrasound and participant interview data to calculate 3 key intervals: (1) conception to suspicion of pregnancy, (2) suspicion to first healthcare visit for Abortion, and (3) first healthcare visit to Abortion procedure. We compared intervals for women at 13–15.0 weeks versus 15.1–20.0 weeks gestation at Abortion using Wilcoxon rank-sum tests and tested for associations between gestational age at key events using multivariable linear regression. Results Median (interquartile range[IQR]) durations for the 3 intervals among women at 13–15 weeks (n=93) compared to 15.1–20 weeks (n=63) gestation were: (1) 36 days (IQR 21–53 days) versus 62 days (36–71 days), p Conclusion The only differences in delay in obtaining Second Trimester Abortion between South African women having an earlier and later Second Trimester procedure is due to longer time to suspect pregnancy. Implications Interventions to improve early pregnancy recognition should be explored and referral processes should be streamlined to avoid unnecessary delays accessing Abortion care and possibly reduce the proportion of Abortions performed later in the Second Trimester in South Africa.
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Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
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Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
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the costs of accessing Abortion in south africa women s costs associated with Second Trimester Abortion services in western cape province
Contraception, 2015Co-Authors: Naomi Lincederoche, Kelly Blanchard, Deborah Constant, Jane Harries, Edina Sinanovic, Daniel GrossmanAbstract:Abstract Objectives To assess women’s costs of accessing Second-Trimester labor induction and dilation and evacuation (DE 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0–3.0] to the study facility, while D&E women reported two required visits [IQR 1.0–2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor’s fees. The total median cost incurred per woman was $21.23 [IQR 11.94–44.68]. Roughly half (49.0%) received help with these costs. Conclusions Although technically offered freely or low cost in the public sector, women accessing Second-Trimester Abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. Implications Limited access to Second-Trimester, safe Abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an Abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies.
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self induction of Abortion among women accessing Second Trimester Abortion services in the public sector western cape province south africa an exploratory study
South African Medical Journal, 2014Co-Authors: Deborah Constant, Daniel Grossman, Naomi Lince, Jane HarriesAbstract:Background. Despite South Africa’s liberal Abortion law permitting Abortion on request in the first Trimester and under restricted conditions for Second-Trimester pregnancies, the practice of unsafe self-induced Abortion persists. However, the prevalence of this practice, the methods used and the reasons behind it are relatively under-researched. As part of a larger study seeking to improve Abortion services in the Western Cape Province, we explored reports of prior attempts to self-induce Abortion among women undergoing legal Second-Trimester Abortion. Objectives. To describe the prevalence and methods of and factors related to unsuccessful attempts at self-induction of Abortion by women presenting without complications and seeking Second-Trimester Abortion at public health facilities in the Western Cape. Methods. In a cross-sectional study from April to August 2010, 194 consenting women undergoing Second-Trimester Abortion were interviewed by trained fieldworkers using structured questionnaires at four public sector facilities near Cape Town. Results. Thirty-four women (17.5%; 95% confidence interval 12.7 - 23.4) reported an unsuccessful attempt to self-induce Abortion during the current pregnancy before going to a facility for Second-Trimester Abortion. No factors were significantly associated with self-induction, but a relatively high proportion of this small sample were unemployed and spoke an indigenous African language at home. A readily available herbal product called Stametta was most commonly used; other methods included taking tablets bought from unlicensed providers and using other herbal remedies. No use of physical methods was reported. Conclusions. The prevalence of unsafe self-induction of Abortion is relatively high in the Western Cape. Efforts to inform women in the community about the availability of free services in the public sector and to educate them about the dangers of self-induction and unsafe providers should be strengthened to help address this public health issue.
Kelly Blanchard - One of the best experts on this subject based on the ideXlab platform.
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Contextualizing Medicaid reimbursement rates for Abortion procedures.
Contraception, 2020Co-Authors: Yves-yvette Young, Terri-ann Thompson, David S. Cohen, Kelly BlanchardAbstract:Abstract Objective Low Medicaid reimbursement rates have been cited as a key threat to Abortion clinic sustainability in the United States. This study examines differences between Medicaid and Medicare reimbursements for Abortion and miscarriage management procedures under a fee-for-service (FFS) model. Study design Using 2017 Medicaid and Medicare Physician fee schedules, we extracted reimbursement data for the two most commonly-billed Abortion procedures and two miscarriage management procedures for 45 states and the District of Columbia (DC). We compared Medicaid and Medicare reimbursement rates for each procedure by state. Results Medicaid reimbursement rates for both procedures varied widely across the states. Medicaid rates for Second-Trimester Abortion procedures had the widest range; $79–$626. Median Medicaid reimbursement rates were lower than median Medicare rates for first- and Second-Trimester Abortion procedures. Median reimbursement rates for first-Trimester induced Abortion were lower than median reimbursement rates for miscarriage management for both Medicaid and Medicare. Conclusion Our findings indicate that Medicaid reimbursement rates for Abortion are low; the median patient cost for a first- and Second-Trimester Abortion have been reported as $490 and $750, respectively. Median Medicaid reimbursement rates for a first- and Second-Trimester Abortion covers approximately 37% and 41% of patient costs for a first- and Second-Trimester Abortion. Further, while induced Abortion procedures are similar to miscarriage management procedures, Medicaid and Medicare reimbursement rates are lower for first- and Second-Trimester Abortion procedures. Implication statement Ensuring reimbursement rates are closely aligned with procedural costs bolsters provider willingness to accept Medicaid. Data that highlights the potential impact of fee-for-service reimbursement rates on healthcare provision and ultimately patient access can help inform healthcare policies. This is especially important as more states consider expanding Medicaid coverage of Abortion.
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Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Resources used for D&E and medical induction Second-Trimester Abortion procedures in Western Cape, South Africa.
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Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
2018Co-Authors: Naomi Lince-deroche, Kelly Blanchard, Deborah Constant, Jane Harries, Judith Kluge, Edina Sinanovic, Daniel GrossmanAbstract:Average cost per outcome and total costs (USD 2015) for Second-Trimester Abortion procedures in Western Cape, South Africa.
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Mixed-methods investigation of women's experiences with Second-Trimester Abortion care in the Midwest and Northeast United States.
Contraception, 2017Co-Authors: Kelly Blanchard, Jill L. Meadows, Hialy R. Gutierrez, Curtiss Hannum, E. Douglas-durham, Amanda DennisAbstract:Abstract Objective(s) We studied women's experiences seeking and receiving Second-Trimester Abortion care in two geographically and legislatively different settings to inform ways to improve Abortion care access and services. Study design We conducted in-depth interviews with women who obtained Second-Trimester Abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received Second-Trimester Abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. Results We interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their Abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about Abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of Abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. Conclusion(s) Women seeking Second-Trimester Abortion in these locations reported positive Abortion experiences. However, they had to overcome significant obstacles to obtain care. Implications This is the first study to systematically research women's Second-Trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with Second Trimester Abortion care.
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the costs of accessing Abortion in south africa women s costs associated with Second Trimester Abortion services in western cape province
Contraception, 2015Co-Authors: Naomi Lincederoche, Kelly Blanchard, Deborah Constant, Jane Harries, Edina Sinanovic, Daniel GrossmanAbstract:Abstract Objectives To assess women’s costs of accessing Second-Trimester labor induction and dilation and evacuation (DE 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0–3.0] to the study facility, while D&E women reported two required visits [IQR 1.0–2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor’s fees. The total median cost incurred per woman was $21.23 [IQR 11.94–44.68]. Roughly half (49.0%) received help with these costs. Conclusions Although technically offered freely or low cost in the public sector, women accessing Second-Trimester Abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. Implications Limited access to Second-Trimester, safe Abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an Abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies.
Nergesh Tejani - One of the best experts on this subject based on the ideXlab platform.
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Effect of causing fetal cardiac asystole on Second-Trimester Abortion.
Obstetrics and gynecology, 1999Co-Authors: Andrew Elimian, Uma Verma, Nergesh TejaniAbstract:Abstract Objective: To compare Second-Trimester Abortions with prostaglandin (PG) E2, with and without pretreatment-induced fetal death. Methods: A retrospective chart review of all vaginal PG E2-induced Abortions at Westchester Medical Center between January 1996 and April 1998 was done. Only women who sought terminations between 18 and 24 weeks’ gestation by prostaglandin induction were included. These Abortions were predominantly Secondary to fetal structural and chromosomal anomalies. The study population was subdivided into groups based on the use of pretreatment cardiac puncture with potassium chloride. The groups were compared for maternal, fetal, and procedural characteristics. The χ2 test, Student t test, and Wilcoxon rank-sum test were used for analysis. Results: There were no differences between the cardiac puncture and control groups when compared for various maternal and procedural characteristics, fetal weight, and the need for curettage for retained products of conception. However, the required median doses of PG E2 and the initiation to expulsion interval were significantly lower in the cardiac puncture group compared with the control group (2.0 doses compared with 3.0 doses, P Conclusion: Pretreatment-induced fetal death significantly reduced the interval to expulsion and doses of PG E2 required for late Second-Trimester Abortion.
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Recurrent chorioamnionitis and Second-Trimester Abortion because of an enterouterine fistula
Obstetrics & Gynecology, 1995Co-Authors: F. Michael Shaw, John F. Reinus, Enid L. Leikin, Nergesh TejaniAbstract:Background Chorioamnionitis, a common cause of Second-Trimester Abortion, is usually Secondary to an ascending infection. Recurrent chorioamnionitis with Second-Trimester Abortion Secondary to an occult enterouterine fistula has not been reported previously. Case A 26-year-old Indian woman, para 0-0-2-0, presented with two spontaneous Second-Trimester losses. Her third pregnancy carried to 24 weeks, but she delivered after the development of pneumonia, bacteremia, preterm labor, and chorioamnionitis. The patient passed melena containing blood clots after the delivery. After the last pregnancy, laparoscopy and laparotomy revealed an ileal-uterine fistula and a foreign body (necrotic cartilage). The blind loop of bowel was resected and the fistulous tract excised. Conclusion Our patient's recurrent pregnancy wastage was caused by chorioamnionitis Secondary to an enterouterine fistula resulting from foreign body ingestion. A complete reversal of this problem is anticipated.
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Recurrent chorioamnionitis and Second-Trimester Abortion because of an enterouterine fistula.
Obstetrics and gynecology, 1995Co-Authors: F. Michael Shaw, John F. Reinus, Enid L. Leikin, Nergesh TejaniAbstract:Chorioamnionitis, a common cause of Second-Trimester Abortion, is usually Secondary to an ascending infection. Recurrent chorioamnionitis with Second-Trimester Abortion Secondary to an occult enterouterine fistula has not been reported previously. A 26-year-old Indian woman, para 0-0-2-0, presented with two spontaneous Second-Trimester losses. Her third pregnancy carried to 24 weeks, but she delivered after the development of pneumonia, bacteremia, preterm labor, and chorioamnionitis. The patient passed melena containing blood clots after the delivery. After the last pregnancy, laparoscopy and laparotomy revealed an ileal-uterine fistula and a foreign body (necrotic cartilage). The blind loop of bowel was resected and the fistulous tract excised. Our patient's recurrent pregnancy wastage was caused by chorioamnionitis Secondary to an enterouterine fistula resulting from foreign body ingestion. A complete reversal of this problem is anticipated.