The Comparative Safety of Legal Induced Abortion and Childbirth in the United States
Hackley Lakes OB/GYN, Muskegon, Michigan (Cree) West Michigan Obstetricians and Gynecologists, Grand Rapids, Michigan (Jelsema).Obstetrics and Gynecology (Impact Factor: 5.18). 06/2012; 119(6):1271; author reply 1271-2. DOI: 10.1097/AOG.0b013e318258c81f
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ABSTRACT: Objective Later second trimester abortion (gestational age ≥ 19 weeks) is higher-risk, more expensive, and more difficult to access than abortion earlier in pregnancy. We sought to enumerate barriers to care described by women seeking abortion in the latter half of the second trimester. We also assessed the accuracy of later second trimester abortion patients’ perceptions of their pregnancies’ gestational ages. Study Design Retrospective analysis of data from 232 women served by a referral program for women seeking abortion care between 19 and 24 weeks gestational age. Data collected included: demographics, pregnancy history, gestational age by ultrasound, perceived gestational age, barriers to abortion care experienced, and time lapsed from pregnancy recognition to presentation for care. Results Difficulty deciding whether to terminate (44.8%), financial barriers to care (22.0%), and the patient having recently realized she was pregnant (21.6%) were the most common delaying barriers cited. Nearly half (46.6%) of women underestimated their own gestational ages by greater than four weeks. Risk factors for experiencing at least three months time lapsed from pregnancy recognition to program referral included difficulty deciding whether to terminate (OR 4.08, 95% CI 2.51, 8.70), and non-white race/ethnicity (OR 2.04, 95% CI 1.16, 3.57). Conclusions Women seeking abortion care in the latter half of the second trimester encounter many of the same barriers previously identified among other abortion patient populations. Because many risk factors for delayed presentation for care are not amenable to intervention, abortion must remain available later in the second trimester. Implications Women presenting for abortion in the later second trimester are delayed by structural and individual-level barriers, and many substantially underestimate their own gestational age. Removing financial barriers may help reduce abortion delay; however, many risk factors are non-modifiable, underscoring the need to ensure access to later second trimester abortion.
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ABSTRACT: New data have emerged to support changes in first-trimester abortion practice in regard to antibiotic prophylaxis, cervical ripening, the use of manual vacuum aspiration, and pain management. This article addresses these new recommendations and reviews techniques in performing manual and electric vacuum uterine aspiration procedures before 14 weeks' gestation, including very early abortion (<7 weeks' gestation), technically difficult abortions, management of complications, and postabortal contraception. The information discussed also applies to miscarriage management.
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