Dilation and Evacuation Training in Maternal-Fetal Medicine Fellowships
Many maternal-fetal medicine (MFM) specialists provide dilation and evacuation (D&E) procedures for their patients with fetal or obstetrical complications. Our study describes the D&E training opportunities available to MFM trainees during their fellowship.
National surveys of MFM fellows and fellowship program directors assessed the availability of D&E training in fellowship. Univariate and multivariate comparisons of correlates of D&E training and provision were performed.
Of the 270 MFM fellows and 79 fellowship directors contacted, 92 (34%) and 44 (56%) responded, respectively. More than half of fellows (60/92) and almost half of fellowship programs (20/44) report organized training opportunities for D&E. Three-quarters of fellows surveyed believe that D&E training should be part of MFM fellowship, and a third of fellows who have not yet been trained would like training opportunities. Being at a fellowship that offers D&E training is associated with 7.5 times higher odds of intending to provide D&E after graduation. (p=0.005, 95% CI 1.8 – 30)
MFM physicians are in a unique position to provide termination services for their patients with pregnancy complications. Many MFMs provide D&E services during fellowship and plan to continue after graduation. MFM fellows express a strong interest in D&E training, and D&E training opportunities should be offered as a part of MFM fellowship.
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ABSTRACT: The incidence of abortion has declined nearly every year between 1990 and 2005, but this trend may be ending, or at least leveling off. Access to abortion services is a critical issue, particularly since the number of abortion providers has been falling for the last three decades. In 2009 and 2010, all facilities known or expected to have provided abortion services in 2007 and 2008 were contacted, including hospitals, clinics and physicians' offices. Data on the number of abortions performed were collected and combined with population data to estimate national and state-level abortion rates. Abortion incidence, provision of early medication abortion, gestational limits, charges and antiabortion harassment were assessed by provider type and abortion caseload. In 2008, an estimated 1.21 million abortions were performed in the United States. The abortion rate increased 1% between 2005 and 2008, from 19.4 to 19.6 abortions per 1,000 women aged 15-44; the total number of abortion providers was virtually unchanged. Small changes in national abortion incidence and number of providers masked substantial changes in some states. Accessibility of services changed little: In both years, 35% of women of reproductive age lived in the 87% of counties that lacked a provider. Fifty-seven percent of nonhospital providers experienced antiabortion harassment in 2008; levels of harassment were particularly high in the Midwest (85%) and the South (75%). The long-term decline in abortion incidence has stalled. Higher levels of harassment in some regions suggest the need to enact and enforce laws that prohibit the more intrusive forms of harassment.Perspectives on Sexual and Reproductive Health 03/2011; 43(1):41-50. DOI:10.1363/4304111 · 2.00 Impact Factor
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ABSTRACT: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 1999-2008. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2008, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during 1999-2008. Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. A total of 825,564 abortions were reported to CDC for 2008. Of these, 808,528 abortions (97.9% of the total) were from the 45 reporting areas that provided data every year during 1999-2008. Among these same 45 reporting areas, the abortion rate for 2008 was 16.0 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 234 abortions per 1,000 live births. Compared with 2007, the total number and rate of reported abortions for these 45 reporting areas essentially were unchanged, although the abortion ratio was 1% higher. Reported abortion numbers, rates, and ratios remained 3%, 4%, and 10% lower, respectively, in 2008 than they had been in 1999. Women aged 20-29 years accounted for 57.1% of all abortions reported in 2008 and for the majority of abortions during the entire period of analysis (1999-2008). In 2008, women aged 20-29 years also had the highest abortion rates (29.6 abortions per 1,000 women aged 20-24 years and 21.6 abortions per 1,000 women aged 25-29 years). Adolescents aged 15-19 years accounted for 16.2% of all abortions in 2008 and had an abortion rate of 14.3 abortions per 1,000 adolescents aged 15-19 years; women aged ≥35 years accounted for a smaller percentage (11.9%) of abortions and had lower abortion rates (7.8 abortions per 1,000 women aged 35-39 years and 2.7 abortions per 1,000 women aged ≥40 years). Throughout the period of analysis, abortion rates decreased among adolescents aged ≤19 years, whereas they increased among women aged ≥35 years. Among women aged 20-24 years abortion rates decreased during 1999-2003 and then leveled off during 2004-2008. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2008 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30-39 years. Abortion ratios decreased during 1999-2008 for women in all age groups except for those aged <15 years; however, the steady decrease was interrupted from 2007 to 2008 when abortion ratios increased among women in all age groups except for those aged ≥40 years. In 2008, most (62.8%) abortions were performed at ≤8 weeks' gestation, and 91.4% were performed at ≤13 weeks' gestation. Few abortions (7.3%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. During 1999-2008, the percentage of abortions performed at ≤13 weeks' gestation remained stable, whereas abortions performed at ≥16 weeks' gestation decreased 13%-17%. Moreover, among the abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of abortions performed at ≤6 weeks' gestation increasing 53%. In 2008, 75.9% of abortions were performed by curettage at ≤13 weeks' gestation, and 14.6% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation); 8.5% of abortions were performed by curettage at >13 weeks' gestation. Among the 62.8% of abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 22.5% were completed by this method. The use of medical abortion increased 17% from 2007 to 2008. Deaths of women associated with complications from abortions for 2008 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2007, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 1999-2008, the total number and rate of reported abortions essentially did not change from 2007 to 2008. This finding is consistent with the recent leveling off from steady decreases that had been observed in the past. In contrast, the abortion ratio increased from 2007 to 2008 after having decreased steadily. In 2007, as in previous years, reported deaths related to abortion were rare. This report provides the data for examining trends in the number and characteristics of women obtaining abortions. This information is needed to better understand the reasons why efforts to reduced unintended pregnancy have stalled and can be used by policymakers and program planners to guide and evaluate efforts to prevent unintended pregnancy.MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2011; 60(15):1-41.
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ABSTRACT: Objective Most abortions for pregnancy complications occur in the second trimester. Little is known about whether maternal-fetal medicine subspecialists (MFMs) perform terminations for these women.Study Design We surveyed all members of Society of Maternal Fetal Medicine by e-mail or mail regarding second-trimester abortion provision. We conducted analyses of whether MFMs perform abortions, by what method, and how frequently.Results Our response rate was 32.4% (689/2,125). Over two-thirds of respondents perform either dilation and evacuation (D&E) or induction; 31% perform D&Es. Male gender, frequent chorionic villus sampling provision, and being trained in D&E during fellowship are associated with performing D&Es. Nonprovision of any second-trimester abortion is significantly associated with age over 50, nonacademic practice setting, and less supportive abortion attitudes (p < 0.001). A nonsignificant trend toward association between south/southeast region and nonprovision of any second-trimester abortion is seen (p = 0.09).Conclusion Many MFMs include D&E and induction termination services in their practice. Supporting current D&E providers and expanding training options for MFMs may optimize care for women diagnosed with serious pregnancy complications.American Journal of Perinatology 05/2012; 29(9):709-16. DOI:10.1055/s-0032-1314893 · 1.60 Impact Factor