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White K.,University of Alabama at Birmingham | Carroll E.,University of Alabama at Birmingham | Grossman D.,Ibis Reproductive Health
Contraception | Year: 2015

Objective We conducted a systematic review to examine the prevalence of minor and major complications following first-trimester aspiration abortion requiring medical or surgical intervention. Study Design We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus and the Cochrane Library for articles published between 1980 and April 2015 that reported on repeat aspiration, hemorrhage, infection, cervical/vaginal trauma, uterine perforation, abdominal surgery, hospitalization, anesthesia-related complications and death. We limited our review to studies that included ≥ 100 abortions performed by physicians in North America, Western Europe, Scandinavia and Australia/New Zealand. We compared the prevalence of complications that required additional interventions for abortions performed in office-based clinics and surgical center or hospital clinic settings. Results From 11,369 articles retrieved, 57 studies met our inclusion criteria. Evidence from 36 studies suggests that ≤ 3.0% of procedures performed in any setting necessitates repeat aspiration. Hemorrhage not requiring transfusion occurred in 0-4.7% of office-based procedures and 0-4.1% of hospital-based procedures but was ≤ 1.0% in 23 studies. Major complications requiring intervention, including hemorrhage requiring transfusion and uterine perforation needing repair, occurred in ≤ 0.1% of procedures, and hospitalization was necessary in ≤ 0.5% of cases in most studies. Anesthesia-related complications occurred in ≤ 0.2% of procedures in six office-based studies and ≤ 0.5% of procedures performed in surgical centers or hospital-based clinics. No abortion-related deaths were reported. Conclusions The percentage of first-trimester aspiration abortions that required interventions for minor and major complications was very low. Overall, the prevalence of major complications was similar across clinic contexts, indicating that this procedure can be safely performed in an office setting. Implications Laws requiring abortion providers to have hospital admitting privileges or facilities to meet ambulatory surgical center standards would be unlikely to improve the safety of first-trimester aspiration abortion in office settings. © 2015 Elsevier Inc. Source

White K.,University of Alabama at Birmingham | Potter J.E.,University of Texas at Austin | Hopkins K.,University of Texas at Austin | Grossman D.,Ibis Reproductive Health
Contraception | Year: 2014

Objective The National Survey of Family Growth has been a primary data source for trends in US women's contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms. Study Design We used the Pregnancy Risk Assessment Monitoring System, a survey of women who are 2-4 months postpartum. Information on women's current method was available for 18 reporting areas from 2000 to 2009. Using the two most recent years of data, we computed the weighted proportion of women using specific contraceptive methods according to payment for delivery (Medicaid or private insurance) and examined differences across states. We used log binomial regression to assess trends in method use in 8 areas with consecutive years of data. Results Across states, there was a wide range of use of female sterilization (7.0-22.6%) and long-acting reversible contraception (LARC; 1.9-25.5%). Other methods, like vasectomy and the patch/ring, had a narrower range of use. Women with Medicaid-paid deliveries were more likely to report female sterilization, LARC and injectables as their method compared to women with private insurance. LARC use increased ≥ 18% per year, while use of injectables and oral contraceptives declined by 2.5-10.6% annually. Conclusions The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix. Implications There is considerable variation in contraceptive method use across states, which may result from differences in state policies and funding for family planning services, local medical norms surrounding contraceptive practice, and women's and couples' demand or preference for different methods. © 2014 Elsevier Inc. Source

Harris L.H.,University of Michigan | Grossman D.,Ibis Reproductive Health
International Journal of Gynecology and Obstetrics | Year: 2011

Unsafe abortion accounts for approximately 13% of maternal deaths worldwide-roughly 47 000 deaths per year. Most deaths from unsafe abortion occur in low-resource countries. Second-trimester abortion carries a higher risk of morbidity and mortality compared with first-trimester abortion and, although the former comprises the minority of abortion procedures worldwide, it is responsible for the majority of serious complications and death where unsafe abortion is prevalent. Therefore, improving access to safe second-trimester abortion must be a priority in low-income regions of the world if the majority of deaths from unsafe abortion are to be prevented. In the present paper, we consider a variety of barriers to second-trimester care, including healthcare provider training and abortion stigma, which may lead to neglect of unmet need for second-trimester services. © 2011 International Journal of Gynecology and Obstetrics. Source

Grossman D.,Ibis Reproductive Health | Grindlay K.,Ibis Reproductive Health
Contraception | Year: 2011

Background: Requiring a follow-up visit with ultrasound evaluation to confirm completion after medication abortion can be a barrier to providing the service. Study Design: The PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials and POPLINE databases were systematically searched in October and November 2009 for studies related to alternative follow-up modalities after first-trimester medication abortion to diagnose ongoing pregnancy or retained gestational sac. We calculated the sensitivity, specificity, positive predictive value and negative predictive value compared with ultrasound or clinician's exam. We also calculated the proportion of cases in each study with a positive screening test. Results: Our search identified eight articles. The most promising modalities included serum human chorionic gonadotropin measurements, standardized assessment of women's symptoms combined with low-sensitivity urine pregnancy testing and telephone consultation. These follow-up modalities had sensitivities ≥90%, negative predictive values ≥99% and proportions of "screen-positives" ≤33%. Conclusions: Alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. Additional research is needed to demonstrate the accuracy, acceptability and feasibility of alternative follow-up modalities in practice, particularly of home-based urine testing combined with self-assessment and/or clinician-assisted assessment. © 2011 Elsevier Inc. All rights reserved. Source

Dennis A.,Ibis Reproductive Health | Blanchard K.,Ibis Reproductive Health
Women's Health Issues | Year: 2012

Objectives: The Hyde Amendment prohibits federal Medicaid funding for abortion except when a woman is seeking an abortion for a pregnancy that is the result of rape or incest, or that threatens her life. We investigated how Medicaid staff in 17 states responded to inquiries about coverage for abortion in the few circumstances that qualify for federal Medicaid funding. Methods: Using a mystery caller approach, we surveyed Medicaid staff about the availability of abortion coverage, the process for obtaining coverage, and the associated costs for an abortion in circumstances of rape and life endangerment in five states where Medicaid coverage should be available to cover most abortions and in 12 states with restrictions on the circumstances under which Medicaid funding can be used for abortion. Findings: We were able to complete 82% of surveys. Medicaid staff definitively provided information about the availability of coverage that was consistent with state policies in 64% of surveys. However, 52% of staff reported that coverage could be difficult to obtain and that rigorous documentation of the circumstances of the abortion was required. Information about copays for abortion was given in 78% of surveys. We subjectively rated the caller's experience with Medicaid staff as excellent during 32% of the surveys, adequate in 61% of surveys, and poor in 7% of surveys. Conclusion: Medicaid staff provided inconsistent information that was often discouraging of women seeking abortion coverage, suggesting that women may have difficulties obtaining accurate information about Medicaid coverage of abortion, which may deter access to care. © 2012 Jacobs Institute of Women's Health. Source

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