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Alisa B Goldberg - One of the best experts on this subject based on the ideXlab platform.
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a randomized comparison of intravenous sedation using a dosing algorithm compared to standard care during first trimester Surgical Abortion
Contraception, 2018Co-Authors: Kari P Braaten, Richard D Urman, Rie Maurer, Jennifer Fortin, Alisa B GoldbergAbstract:Abstract Objective The objective was to compare the safety and efficacy of an algorithm for Abortion intravenous sedation dosing (AAID) to standard dosing during first-trimester Surgical Abortion. Study design This was a randomized, single-blinded, controlled trial in which women undergoing first-trimester Surgical Abortion received fentanyl and midazolam dosed per either an algorithm or clinic standard. Patient-level factors including weight, airway risk, anxiety, and drug and alcohol use determined AAID doses. The primary outcome was pain with suction curettage measured immediately on a 21-point verbal numerical rating scale ranging from 0 to 100. Secondary outcomes included pain with cervical dilation and postprocedure, intraoperative pain as recalled postprocedure, need for additional doses of medication, oxygen saturation Results We enrolled 196 women and randomized 98 to the AAID and 98 to standard care. Baseline factors were similar between groups. Median intraoperative pain scores did not differ between groups when measured immediately (47.5 vs. 50, p=.81) or on recall (30 in both arms, p=.68). There were no significant differences in other secondary outcomes. Women with a body mass index (BMI) 30–35 trended toward improved pain control with the algorithm (60 vs. 27.5, p=.07). Conclusions Intravenous sedation determined by an algorithm did not produce differences in pain scores in a setting with highly experienced providers. Implications An intravenous sedation algorithm did not demonstrate significant benefit for the general population of Surgical Abortion patients. Providers with less experience titrating intravenous sedation might find it a helpful tool to guide sedation dosing. A possible benefit in obese patients warrants further study.
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moderate intravenous sedation for first trimester Surgical Abortion a comparison of adverse outcomes between obese and normal weight women
Contraception, 2018Co-Authors: Gillian Horwitz, Alisa B Goldberg, Danielle Roncari, Kari P Braaten, Rie Maurer, Jennifer FortinAbstract:Abstract Objective To determine if obese women experience increased rates of adverse outcomes with moderate intravenous sedation during first trimester Surgical Abortion compared to normal weight women. Study design We performed a retrospective cohort study of all first trimester Surgical Abortions with moderate intravenous sedation at an outpatient facility between September 2010 and June 2015. The primary outcome was supplemental oxygen administration. Secondary outcomes included reversal agent administration, anesthesia-related adverse events, and intraoperative lowest level of consciousness (LLOC). We compared three obesity groups [I (Body Mass Index, BMI=30–34.9), II (BMI=35–39.9), and III (BMI ≥40)] to normal weight women (BMI Results Of 20,381 first trimester Surgical Abortion procedures, 31 (0.15%) utilized supplemental oxygen, 24 (0.12%) utilized a reversal agent, 40 (0.20%) had a presumed anesthesia-related adverse event and 184 of 19,725 (0.93%) had a documented low intraoperative LLOC. One patient (0.005%) required hospital transfer or hospitalization. Supplemental oxygen administration (obesity versus normal weight: obese I, aOR 0.52, 95% CI 0.12–2.27; II/III, aOR 1.51, 95% CI 0.50–4.54), low intraoperative LLOC, and anesthesia-related adverse events were not associated with obesity. The rate of reversal agent administration was lower among obese I, II and III women combined compared to normal weight women (aOR 0.13, 95% CI 0.02–0.96). Conclusions Adverse outcomes were rare across all BMI categories with no detectable increased risk among obese women compared to normal weight women. Implications With appropriate clinical screening, obese women can safely receive moderate intravenous sedation for first trimester Surgical Abortion in an outpatient clinical setting. Restrictions on moderate intravenous sedation based on BMI alone may be unnecessary.
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cervical dilation before first trimester Surgical Abortion 14 weeks gestation
Contraception, 2016Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester Surgical Abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction Abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester Surgical Abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester Surgical Abortion is unclear. Although cervical priming results in reduced Abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction Abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.
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intramuscular ketorolac versus oral ibuprofen for pain relief in first trimester Surgical Abortion a randomized clinical trial
Contraception, 2014Co-Authors: Kari P Braaten, Jennifer Fortin, Shelley Hurwitz, Alisa B GoldbergAbstract:Abstract Objective Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester Surgical Abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in Abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester Surgical Abortion. Study Design This was a randomized, double-blind, controlled trial. Women undergoing first-trimester Surgical Abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60–90 min preprocedure, or intramuscular ketorolac, 60 mg given 30–60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0–100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction. Results Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p Conclusions Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester Surgical Abortion. Implications Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester Surgical Abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs.
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buccal misoprostol compared with synthetic osmotic cervical dilator before Surgical Abortion a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Deborah Bartz, Rebecca H Allen, Rie Maurer, Jennifer Fortin, Bernice Kuang, Alisa B GoldbergAbstract:OBJECTIVE: To compare the efficacy and acceptability of buccal misoprostol or a synthetic osmotic cervical dilator for cervical preparation before same-day late first-trimester and early second-trimester Surgical Abortion. METHODS: In this randomized, double-blind trial, we compared 400 micrograms of buccal misoprostol with one synthetic osmotic cervical dilator administered 3-4 hours before Surgical Abortion among women at 12-15 weeks of gestation. The primary outcome was mean cervical circumferential dilation at the time of surgery. Randomization was stratified by parity and sample size calculated to detect a 3-French difference between groups with 90% power with a two-sided α of .05. Secondary outcomes included ease of further mechanical dilation, procedure time, complications, ripening and procedural pain, and participants' satisfaction. RESULTS: One hundred twenty-five women were randomized with a mean gestational age of 13 3/7 weeks. Treatment with the synthetic osmotic dilator and buccal misoprostol resulted in similar preoperative dilation (mean French 33.9 compared with 32.1, P=.065). Procedure time, procedural pain, number of complications, and participants' satisfaction and preferences did not differ between treatment groups. Misoprostol participants experienced more pain during ripening (P=.008). All but six participants, three in each arm, required mechanical dilation at the time of the procedure. This manual dilation was subjectively easier in participants who received the synthetic osmotic cervical dilator (P=.015). All participants were able to have their procedure in 1 day without further cervical preparation. CONCLUSION: Either buccal misoprostol or a synthetic osmotic cervical dilator provides adequate dilation for same-day late first-trimester and early second-trimester Abortion. Despite more pain with misoprostol, patient satisfaction with misoprostol and the synthetic dilator is similar. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00835731. LEVEL OF EVIDENCE: I.
Rebecca H Allen - One of the best experts on this subject based on the ideXlab platform.
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cervical dilation before first trimester Surgical Abortion 14 weeks gestation
Contraception, 2016Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester Surgical Abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction Abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester Surgical Abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester Surgical Abortion is unclear. Although cervical priming results in reduced Abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction Abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.
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buccal misoprostol compared with synthetic osmotic cervical dilator before Surgical Abortion a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Deborah Bartz, Rebecca H Allen, Rie Maurer, Jennifer Fortin, Bernice Kuang, Alisa B GoldbergAbstract:OBJECTIVE: To compare the efficacy and acceptability of buccal misoprostol or a synthetic osmotic cervical dilator for cervical preparation before same-day late first-trimester and early second-trimester Surgical Abortion. METHODS: In this randomized, double-blind trial, we compared 400 micrograms of buccal misoprostol with one synthetic osmotic cervical dilator administered 3-4 hours before Surgical Abortion among women at 12-15 weeks of gestation. The primary outcome was mean cervical circumferential dilation at the time of surgery. Randomization was stratified by parity and sample size calculated to detect a 3-French difference between groups with 90% power with a two-sided α of .05. Secondary outcomes included ease of further mechanical dilation, procedure time, complications, ripening and procedural pain, and participants' satisfaction. RESULTS: One hundred twenty-five women were randomized with a mean gestational age of 13 3/7 weeks. Treatment with the synthetic osmotic dilator and buccal misoprostol resulted in similar preoperative dilation (mean French 33.9 compared with 32.1, P=.065). Procedure time, procedural pain, number of complications, and participants' satisfaction and preferences did not differ between treatment groups. Misoprostol participants experienced more pain during ripening (P=.008). All but six participants, three in each arm, required mechanical dilation at the time of the procedure. This manual dilation was subjectively easier in participants who received the synthetic osmotic cervical dilator (P=.015). All participants were able to have their procedure in 1 day without further cervical preparation. CONCLUSION: Either buccal misoprostol or a synthetic osmotic cervical dilator provides adequate dilation for same-day late first-trimester and early second-trimester Abortion. Despite more pain with misoprostol, patient satisfaction with misoprostol and the synthetic dilator is similar. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00835731. LEVEL OF EVIDENCE: I.
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women s preferences for pain control during first trimester Surgical Abortion a qualitative study
Contraception, 2012Co-Authors: Rebecca H Allen, Alisa B Goldberg, Jennifer Fortin, Deborah Bartz, Melissa A ClarkAbstract:Abstract Background To explore women's preferences for pain control during first-trimester Surgical Abortion. Study Design Pre- and postoperative semistructured individual interviews were conducted with 40 women divided into eight strata by anesthesia choice, age and prior vaginal delivery status. We identified key themes in the interviews and analyzed baseline characteristics and responses to close-ended questions within and across the strata. Results For most women, pain control options were not the primary concern in choosing a clinic for an Abortion. Women who received intravenous (IV) sedation had lower pain scores and were more likely to report that they would recommend that method to a friend than women who received local anesthesia alone. Women described the pain as a cramping, tugging, pulling and scraping sensation. Respondents recommended IV sedation for a woman who was very anxious or could not tolerate pain, even though more nausea and vomiting may occur. Conclusions Most women felt that pain control decisions should be individualized.
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oral compared with intravenous sedation for first trimester Surgical Abortion a randomized controlled trial
Obstetrics & Gynecology, 2009Co-Authors: Rebecca H Allen, Garrett M Fitzmaurice, Karen L Lifford, Morana Lasic, Alisa B GoldbergAbstract: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.
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cervical dilation before first trimester Surgical Abortion 14 weeks gestation sfp guideline 20071
Contraception, 2007Co-Authors: Rebecca H Allen, Alisa B GoldbergAbstract:First-trimester Surgical Abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for cervical priming reduces the risk of cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide cervical dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction Abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing cervical softening and dilation preoperatively, there are not enough data to conclude that routine cervical priming is necessary to reduce complications of first-trimester Surgical Abortion. Cervical priming increases preoperative cervical dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how cervical priming affects women's quality of life in relation to Abortion. Based on existing evidence, the Society of Family Planning does not recommend routine cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider cervical priming only for women who may be at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be difficult due to either patient factors or provider experience.
Lisbeth Nilas - One of the best experts on this subject based on the ideXlab platform.
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Medical versus Surgical Abortion: comparing satisfaction and potential confounders in a partly randomized study
2015Co-Authors: Christina Rorbye, Mogens Norgaard, Lisbeth NilasAbstract:BACKGROUND: The aim of the study was to compare satisfaction with medical and Surgical Abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA) #63 days had either a medical (600 mg mifepristone followed by 1 mg gemeprost) or a Surgical Abortion (vacuum aspiration in general anaesthesia). The procedure was determined either by randomization (n 5 111) or by choice (n 5 922). Data on satisfaction, side effects and expectations were collected from questionnaires 2 and 8 weeks after termin-ation. RESULTS: More women were very satisfied or satisfied after a Surgical than a medical Abortion both after choosing method (92 % vs 82%, P < 0.0001), and after randomization (94 % vs 68%, P < 0.001). Satisfaction was higher after choosing a medical procedure than after randomization to the same procedure; 82 % and 68%, respectively, P < 0.05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the Surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed Surgical Abortion were satisfied (17 % vs 62%), P < 0.05. CONCLUSIONS: Satisfaction with both medical and Surgical Abortions is high, although higher with the Surgical than the medical procedure, and higher after choosing method than after randomization. Key words: Abortion/medical/randomization/satisfaction/surgica
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medical versus Surgical Abortion comparing satisfaction and potential confounders in a partly randomized study
Human Reproduction, 2005Co-Authors: Christina Rorbye, Mogens Norgaard, Lisbeth NilasAbstract:ation. RESULTS: More women were very satisfied or satisfied after a Surgical than a medical Abortion both after choosing method (92% vs 82%, P< 0.0001), and after randomization (94% vs 68%, P< 0.001). Satisfaction was higher after choosing a medical procedure than after randomization to the same procedure; 82% and 68%, respectively, P< 0.05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the Surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed Surgical Abortion were satisfied (17% vs 62%), P< 0.05. CONCLUSIONS: Satisfaction with both medical and Surgical Abortions is high, although higher with the Surgical than the medical procedure, and higher after choosing method than after randomization.
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medical versus Surgical Abortion efficacy complications and leave of absence compared in a partly randomized study
Contraception, 2004Co-Authors: Christina Rorbye, Mogens Norgaard, Lisbeth NilasAbstract:To provide optimal information to women choosing between early medical and Surgical Abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a Surgical Abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for Abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but Surgical Abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p < .01] and also with a higher risk of antibiotic treatment than medical Abortion [7.8% (37/467) vs. 3.7% (13/356), p < .05]. The median leave of absence was shorter in women choosing a medical (1 day) than a Surgical termination (2 days), p < .05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a Surgical Abortion in general anesthesia compared to a medical Abortion induced with 600 mg mifepristone and 1 mg gemeprost. A Surgical Abortion is associated with an increased risk of antibiotic treatment compared to medical Abortion. The women's need for follow-up might be higher than we expect.
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original research article medical versus Surgical Abortion efficacy complications and leave of absence compared in a partly randomized study
2004Co-Authors: Christina Rbrbye, Mogens Nbrgaard, Lisbeth NilasAbstract:To provide optimal information to women choosing between early medical and Surgical Abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) V63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a Surgical Abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for Abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but Surgical Abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), pb.01] and also with a higher risk of antibiotic treatment than medical Abortion [7.8% (37/467) vs. 3.7% (13/356), pb.05]. The median leave of absence was shorter in women choosing a medical (1 day) than a Surgical termination (2 days), pb.05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA V63 days is higher after a Surgical Abortion in general anesthesia compared to a medical Abortion induced with 600 mg mifepristone and 1 mg gemeprost. A Surgical Abortion is associated with an increased risk of antibiotic treatment compared to medical Abortion. The women’s need for follow-up might be higher than we expect.
Steve E Lichtenberg - One of the best experts on this subject based on the ideXlab platform.
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second trimester Surgical Abortion practices in the united states
Contraception, 2018Co-Authors: Katharine Oconnell White, Heidi E Jones, Steve E Lichtenberg, Edith Guilbert, Jade M Shorter, Wendy V Norman, Maureen PaulAbstract:Abstract Objective To assess whether second-trimester Surgical Abortion practices of U.S. providers agree with evidence-based policy guidelines. Study Design We conducted a cross-sectional survey of Abortion facilities in the U.S. identified via publicly available resources and professional networks from June through December 2013. Results Of 703 identified facilities, 383 (54%) participated, including 172 clinicians providing second-trimester Surgical Abortions (dilation and evacuations [D&Es]). The majority of clinicians were obstetrician–gynecologists (87%), female (67%), and less than 50 years old (62%). Most clinicians (93%) ever use misoprostol as a cervical preparation agent, including in the setting of a uterine scar (87%). Some clinicians refer to a hospital-based provider if the patient has a placenta previa and a history of cesarean section (31%) or a complete previa alone (17%). Many clinicians have weight or body mass index restrictions for cases performed under iv moderate sedation (32/97, 33%) or deep sedation (23/50, 46%). Most clinicians (69%) who report performing D&Es at 18 weeks last menstrual period or greater do not routinely induce fetal demise preoperatively. Clinicians employ routine intraoperative ultrasound (79%) more commonly than routine postoperative ultrasound (47%), with no difference by years of provider experience. Most clinicians routinely use prophylactic uterotonic agents, most often postoperatively. Most clinicians (80%) routinely give perioperative antibiotics, most often doxycycline (75%). Conclusion Overall, the second-trimester Surgical Abortion practices revealed in our survey agree with professional evidence-based policy guidelines. Wider variability was reported for practices lacking a strong evidence base. Implications In this third cross-sectional survey of U.S. Abortion practices (prior 1997 and 2002), second-trimester Surgical Abortion providers are younger than before, reflecting an improvement in the “graying” of the Abortion provider workforce. Facility restrictions on gestational age along with hospital restrictions on referrals pose barriers to outpatient Abortion access.
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misoprostol 1 to 3 h preprocedure vs overnight osmotic dilators prior to early second trimester Surgical Abortion
Contraception, 2015Co-Authors: Shanthi Ramesh, Ashlesha Patel, Steve E Lichtenberg, Alicia Roston, Lindsay Zimmerman, Julie ChorAbstract:Abstract Objectives We sought to compare the effectiveness of at least 1 h of 400 mcg of buccal misoprostol to overnight osmotic dilators for early second-trimester Surgical Abortion cervical preparation. Design We conducted a retrospective cohort study, reviewing 145 consecutive charts to compare procedure duration for women who received 400 mcg of buccal misoprostol at least 1 h preprocedure vs. overnight osmotic dilators before dilation and evacuation between 14 weeks, 0 days and 15 weeks, 6 days' gestation. Primary outcome was procedure duration and secondary outcomes included maximum mechanical dilator size, estimated blood loss and side effects. Results Sixty-four women (44.1%) received buccal misoprostol (mean 1.6 h), and 81 women (55.9%) received overnight osmotic dilators. Groups did not differ regarding mean gestational age or gynecologic history. All procedures in both groups were completed. Procedure duration was not significantly different between the misoprostol and osmotic dilator groups (median 11.0 min vs. 10.0 min, p=.22), even after multivariable linear regression (p=.17). The mean total cervical preparation duration was 1.6 h for women in the misoprostol group compared to 20.3 h in the osmotic dilator group (p Conclusions We found that at least 1 h of preprocedure misoprostol decreased the duration of cervical preparation for early second-trimester procedures performed by an experienced surgeon. Implications In this small, retrospective review, at least 1 h of preprocedure buccal misoprostol decreased the duration from cervical preparation initiation to procedure completion in early second-trimester procedures performed by an experienced surgeon. These results should be considered as a pilot evaluation, and further prospective study is needed to further clarify whether this short interval could be applied in general practice.
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first trimester Surgical Abortion practices a survey of national Abortion federation members
Contraception, 2008Co-Authors: Katharine Oconnell, Heidi E Jones, Melissa A Simon, Vicki A Saporta, Maureen Paul, Steve E LichtenbergAbstract:Abstract Background The objective of this analysis was to assess the second-trimester Surgical Abortion practices of National Abortion Federation (NAF) members in North America and Australia. Study Design In 2002, questionnaires were mailed to 364 active member clinics of NAF for completion by their clinic administrators and individual providers. Results Two hundred eighty-nine (79%) clinics responded. Most NAF clinics (72%) offer second-trimester Abortion services. The majority of second-trimester providers are obstetrician/gynecologists (63%), male (62%) and at least 50 years old (63%). We describe second-trimester Surgical Abortion practices in terms of patient eligibility, cervical ripening, ultrasound use, anesthesia and postoperative care. Conclusions Surgical techniques and postoperative practices for second-trimester Abortions are similar among these respondents, suggesting that NAF's efforts to promulgate best practices using evidence-based guidelines are succeeding. The aging of skilled practitioners raises concerns about the future availability of second-trimester Abortion.
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original research article first trimester Surgical Abortion practices a survey of national Abortion federation members
Contraception, 2001Co-Authors: Katharine Oconnell, Heidi E Jones, Melissa A Simon, Vicki A Saporta, Maureen Paul, Steve E LichtenbergAbstract:The objective of this study was to survey first trimester Surgical Abortion practices of North American providers. A survey was mailed to the 310 active member clinics of the National Abortion Federation, the professional organization of Abortion providers in North America. The 236 respondents (76%) comprising the study group provided approximately 30% and 33% of all first trimester Abortions in the US and Canada, respectively. Of the 529 practitioners who perform most Abortions at the clinics, 68% are obstetrician-gynecologists, and 18% are family physicians; 51% are at least 50 years old. The majority of respondents (156 of 236, 66%) confirm gestational age with ultrasonography. Of the 202 clinics that favor one method of anesthesia, 58% use local cervical block with or without oral pre-medication, 32% combine local anesthesia with intravenous sedation, and 10% use general anesthesia. Most clinics open the cervix with tapered dilators (207 of 233, 89%), evacuate the uterus by using curved rigid plastic cannulas (157 of 229, 69%) and an electric vacuum source (191 of 233, 82%), and explore the uterus with a metal curette following aspiration (133 of 232, 57%). A large majority of respondents examine the uterine aspirate on-site (91%), prescribe antibiotics (91%), and offer oral contraceptives (95%) when requested. Although variations exist, Surgical techniques and postoperative practices are quite uniform among clinics. Local anesthesia is presently the most frequent method of pain control. Ultrasonographic dating before Abortion is common practice. The “graying” of skilled practitioners raises concerns about the future availability of Abortion. © 2002 Elsevier Science Inc. All rights reserved.
Melissa Gilliam - One of the best experts on this subject based on the ideXlab platform.
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Women's experiences with doula support during first-trimester Surgical Abortion: a qualitative study.
Contraception, 2015Co-Authors: Julie Chor, Phoebe Lyman, Ashlesha Patel, Megan Tusken, Melissa GilliamAbstract:Abstract Objective To explore how doula support influences women's experiences with first-trimester Surgical Abortion. Study Design We conducted semistructured interviews with women given the option to receive doula support during first-trimester Surgical Abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in Abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented. Results Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in Abortion care, including addressing informational and emotional needs before and after the procedure. Conclusion Women receiving first-trimester Surgical Abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postAbortion informational and emotional needs. Implications In a setting that does not allow family or friends to be present during the Abortion procedure, women highly valued the presence of trained Abortion doulas. This study speaks to the importance of providing support to women during Abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that otherwise do not permit support people in the procedure room or for women who do not have a support person and desire one.
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Doula support during first-trimester Surgical Abortion: a randomized controlled trial.
American journal of obstetrics and gynecology, 2014Co-Authors: Julie Chor, Ashlesha Patel, Brandon J. Hill, S. Martins, Stephanie Q. Mistretta, Melissa GilliamAbstract:Objective The objective of the study was to evaluate the impact of doula support on first-trimester Abortion care. Study Design Women were randomized to receive doula support or routine care during first-trimester Surgical Abortion. We examined the effect of doula support on pain during Abortion using a 100 mm visual analog scale. The study had the statistical power to detect a 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Results Two hundred fourteen women completed the study: 106 received doula support, and 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6 [±26.3 mm] vs 43.6 mm [±25.9 mm], P = .18) or procedure completion (68.2 [±28.0 mm] vs 70.6 mm [±23.5 mm], P = .52). Procedure duration (3.39 [±2.83 min] vs 3.18 min [±2.36 min], P = .55) and patient satisfaction (75.2 [±28.6 mm] vs 74.6 mm [±27.4 mm], P = .89) did not differ between the doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for Abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls ( P Conclusion Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support therefore may address patient psychosocial needs.
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first trimester Surgical Abortion
Clinical Obstetrics and Gynecology, 2009Co-Authors: Sigrid Tristan, Melissa GilliamAbstract: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.