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An evaluation of oral midazolam for anxiety and pain in first-trimester surgical abortion: a randomized controlled trial
Abstracts / Contraception 90 (2014) 292–297 participant etonogestrel levels were above the threshold required to inhibit ovulation (90 pg/mL); the lowest level recorded was 117 pg/mL. Conclusions: For women of any BMI, etonogestrel levels remain above the levels required to inhibit ovulation, even after 3 years of use. These results support published high contraceptive efficacy rates for contraceptive implant users across BMI categories.
293
Rocca C University of California, San Francisco, San Francisco, CA, USA
Results: There were no significant differences in demographic characteristics or baseline pain or anxiety between the groups (N=124). Compared with those who received a placebo, subjects who received midazolam had significantly less anxiety preoperatively (room entry: 51.4 mm vs. 34.5 mm, pb.001; positioning: 56.6 mm vs. 45.5 mm, p=.02). However, there was no difference in pain (74.3 mm placebo vs. 70.1 mm midazolam, p=.28) or anxiety (68.2 mm vs. 60.9 mm, p=.14) during uterine aspiration or at other procedural time points. A significantly greater number of subjects in the midazolam group reported partial amnesia (50.8% vs. 26.2%, p=.005). Subjects who received midazolam were more likely to report dizziness (p=.03) and postoperative sleepiness (pb.001), while those who received a placebo reported more postoperative nausea (p=.004). There was no difference in overall satisfaction (p=.88). Conclusions: Although oral midazolam reduces preprocedural anxiety, it does not reduce pain or anxiety with uterine aspiration during first-trimester surgical abortions.
Thompson K, Stern L, Speidel J, Harper C
http://dx.doi.org/10.1016/j.contraception.2014.05.206
Objectives: Despite sustained efforts, racial and ethnic disparities in contraceptive knowledge, use and unintended pregnancy persist. We evaluated the impact of a clinic-wide provider long-acting reversible contraceptive (LARC) training on patient outcomes and assessed racial/ethnic differences. Methods: Data were from a cluster trial of 40 Planned Parenthood clinics, randomized to intervention (provider training on evidence-based LARC eligibility and counseling) and control (standard care). We recruited 1500 participants aged 18–25 who did not desire pregnancy within a year. Using multivariable logistic regression with generalized estimating equations for clustering, we investigated the association between the intervention and patient race and ethnicity on receipt of LARC counseling, selection of a LARC method and actual LARC initiation over 1 year. We tested interaction terms for differences in intervention effects by race/ethnicity. Results: Participants at intervention clinics were more likely to receive LARC counseling [70% vs. 39%, adjusted odds ratio (aOR)=3.9 (2.8–5.4)], with no differences in frequency of LARC counseling by race/ethnicity in either study arm. Participants at intervention sites were more likely to select [28% vs. 17%, aOR=2.3 (1.7–3.1)] and actually initiate LARC [22% vs. 18%, aOR=1.4 (1.0–2.0)] than those at control sites. Although there were no racial/ethnic differences in LARC selection, black women (16%) were less likely to actually initiate use than Latinas (25%) and whites [19%, aOR=0.6 (0.3–0.9)]. Most Latinas (75%) and whites (61%) who selected LARC initiated the method, while only 47% of blacks did. Conclusions: The provider LARC training increased LARC selection among all groups evenly, but disparities remained for LARC initiation. Research is needed to assess women's reasons for noninitiation and potential structural barriers that may explain observed differences.
O6
http://dx.doi.org/10.1016/j.contraception.2014.05.204
O4 Racial and ethnic disparities in LARC selection and use: results from a cluster randomized provider training trial
http://dx.doi.org/10.1016/j.contraception.2014.05.205
O5 An evaluation of oral midazolam for anxiety and pain in first-trimester surgical abortion: a randomized controlled trial Bayer L Oregon Health and Science University, Portland, OR, USA
A randomized double-blinded comparison of same-day mifepristone and misoprostol with misoprostol only for cervical preparation in second-trimester surgical abortion Casey F VCU Medical Center, Richmond, VA, USA Moreno-Ruiz N, Dinneen J, Perritt J, Hathaway M, Reeves M Objectives: To evaluate the addition of oral mifepristone to vaginal misoprostol as part of cervical preparation prior to second-trimester dilation and evacuation (D&E). Methods: Women desiring abortion between gestational ages 14 weeks 0 days and 19 weeks 6 days were randomized to 200 mg mifepristone or identical placebo with 400 mcg misoprostol vaginally 4–6 h prior to D&E. Primary outcome was cervical dilation assessed by the largest Hegar dilator accepted without resistance. Secondary outcomes included total procedure time and patient and provider perceptions. The study was powered to detect a 2-mm difference in cervical dilation with 48 participants in each arm. Results: Of 100 women enrolled, 96 were randomized and completed the study. Age, race, gestational age (mean 17.4 weeks, SD 1.3), parity and anesthesia did not significantly differ. Mean initial Hegar dilation was 11.7 and 10.9 mm in the mifepristone and placebo groups, respectively, with a difference of 0.8 mm [95% confidence interval (CI) −0.4 to 2.00. Total procedure times were 11.8 and 13.0 min in the mifepristone and placebo groups, respectively, with a difference of 1.2 min (95% CI −2.4 to 4.8]. Each additional 1 mm of dilation was associated with a procedure time reduction of 0.6 min (pb.05). Patient and provider perceptions did not differ. All 96 procedures were completed without hemorrhage, cervical laceration or other observed complications. Conclusions: Vaginal misoprostol is safe and effective as part of cervical preparation 4–6 h prior to D&E at 14 weeks through 19 weeks 6 days, with or without concurrent oral mifepristone. Greater initial dilation is associated with shorter procedure times. http://dx.doi.org/10.1016/j.contraception.2014.05.207
Edelman A, Nichols M, Bednarek P, Fu R, Lambert W, Jensen J
O7 Objectives: To estimate the effect of oral midazolam on patient pain and anxiety perception during first-trimester surgical abortion. Methods: We conducted a randomized, double-blinded, placebo-controlled trial. Patients between 6 0/7 and 10 6/7 weeks' gestation received 10 mg of oral midazolam or a placebo 30–60 min before surgical abortion. All subjects received ibuprofen and a paracervical block. We powered the study (β=80%; α=.025) to detect a 15-mm difference in our two a priori primary outcomes of pain and anxiety at time of uterine aspiration (100-mm visual analog scale). Secondary outcomes were pain and anxiety at additional time points, memory, satisfaction, side effects and adverse events.
Defining and tracking abortion complications: how do we do it, and why does that matter? Taylor D University of California, San Francisco, San Francisco, CA, USA Upadhyay U, Desai S, James EA, AbiSamra R Objectives: To develop standardized classification for abortion-related complications and apply it to multiple data sources to improve complication
293
Rocca C University of California, San Francisco, San Francisco, CA, USA
Results: There were no significant differences in demographic characteristics or baseline pain or anxiety between the groups (N=124). Compared with those who received a placebo, subjects who received midazolam had significantly less anxiety preoperatively (room entry: 51.4 mm vs. 34.5 mm, pb.001; positioning: 56.6 mm vs. 45.5 mm, p=.02). However, there was no difference in pain (74.3 mm placebo vs. 70.1 mm midazolam, p=.28) or anxiety (68.2 mm vs. 60.9 mm, p=.14) during uterine aspiration or at other procedural time points. A significantly greater number of subjects in the midazolam group reported partial amnesia (50.8% vs. 26.2%, p=.005). Subjects who received midazolam were more likely to report dizziness (p=.03) and postoperative sleepiness (pb.001), while those who received a placebo reported more postoperative nausea (p=.004). There was no difference in overall satisfaction (p=.88). Conclusions: Although oral midazolam reduces preprocedural anxiety, it does not reduce pain or anxiety with uterine aspiration during first-trimester surgical abortions.
Thompson K, Stern L, Speidel J, Harper C
http://dx.doi.org/10.1016/j.contraception.2014.05.206
Objectives: Despite sustained efforts, racial and ethnic disparities in contraceptive knowledge, use and unintended pregnancy persist. We evaluated the impact of a clinic-wide provider long-acting reversible contraceptive (LARC) training on patient outcomes and assessed racial/ethnic differences. Methods: Data were from a cluster trial of 40 Planned Parenthood clinics, randomized to intervention (provider training on evidence-based LARC eligibility and counseling) and control (standard care). We recruited 1500 participants aged 18–25 who did not desire pregnancy within a year. Using multivariable logistic regression with generalized estimating equations for clustering, we investigated the association between the intervention and patient race and ethnicity on receipt of LARC counseling, selection of a LARC method and actual LARC initiation over 1 year. We tested interaction terms for differences in intervention effects by race/ethnicity. Results: Participants at intervention clinics were more likely to receive LARC counseling [70% vs. 39%, adjusted odds ratio (aOR)=3.9 (2.8–5.4)], with no differences in frequency of LARC counseling by race/ethnicity in either study arm. Participants at intervention sites were more likely to select [28% vs. 17%, aOR=2.3 (1.7–3.1)] and actually initiate LARC [22% vs. 18%, aOR=1.4 (1.0–2.0)] than those at control sites. Although there were no racial/ethnic differences in LARC selection, black women (16%) were less likely to actually initiate use than Latinas (25%) and whites [19%, aOR=0.6 (0.3–0.9)]. Most Latinas (75%) and whites (61%) who selected LARC initiated the method, while only 47% of blacks did. Conclusions: The provider LARC training increased LARC selection among all groups evenly, but disparities remained for LARC initiation. Research is needed to assess women's reasons for noninitiation and potential structural barriers that may explain observed differences.
O6
http://dx.doi.org/10.1016/j.contraception.2014.05.204
O4 Racial and ethnic disparities in LARC selection and use: results from a cluster randomized provider training trial
http://dx.doi.org/10.1016/j.contraception.2014.05.205
O5 An evaluation of oral midazolam for anxiety and pain in first-trimester surgical abortion: a randomized controlled trial Bayer L Oregon Health and Science University, Portland, OR, USA
A randomized double-blinded comparison of same-day mifepristone and misoprostol with misoprostol only for cervical preparation in second-trimester surgical abortion Casey F VCU Medical Center, Richmond, VA, USA Moreno-Ruiz N, Dinneen J, Perritt J, Hathaway M, Reeves M Objectives: To evaluate the addition of oral mifepristone to vaginal misoprostol as part of cervical preparation prior to second-trimester dilation and evacuation (D&E). Methods: Women desiring abortion between gestational ages 14 weeks 0 days and 19 weeks 6 days were randomized to 200 mg mifepristone or identical placebo with 400 mcg misoprostol vaginally 4–6 h prior to D&E. Primary outcome was cervical dilation assessed by the largest Hegar dilator accepted without resistance. Secondary outcomes included total procedure time and patient and provider perceptions. The study was powered to detect a 2-mm difference in cervical dilation with 48 participants in each arm. Results: Of 100 women enrolled, 96 were randomized and completed the study. Age, race, gestational age (mean 17.4 weeks, SD 1.3), parity and anesthesia did not significantly differ. Mean initial Hegar dilation was 11.7 and 10.9 mm in the mifepristone and placebo groups, respectively, with a difference of 0.8 mm [95% confidence interval (CI) −0.4 to 2.00. Total procedure times were 11.8 and 13.0 min in the mifepristone and placebo groups, respectively, with a difference of 1.2 min (95% CI −2.4 to 4.8]. Each additional 1 mm of dilation was associated with a procedure time reduction of 0.6 min (pb.05). Patient and provider perceptions did not differ. All 96 procedures were completed without hemorrhage, cervical laceration or other observed complications. Conclusions: Vaginal misoprostol is safe and effective as part of cervical preparation 4–6 h prior to D&E at 14 weeks through 19 weeks 6 days, with or without concurrent oral mifepristone. Greater initial dilation is associated with shorter procedure times. http://dx.doi.org/10.1016/j.contraception.2014.05.207
Edelman A, Nichols M, Bednarek P, Fu R, Lambert W, Jensen J
O7 Objectives: To estimate the effect of oral midazolam on patient pain and anxiety perception during first-trimester surgical abortion. Methods: We conducted a randomized, double-blinded, placebo-controlled trial. Patients between 6 0/7 and 10 6/7 weeks' gestation received 10 mg of oral midazolam or a placebo 30–60 min before surgical abortion. All subjects received ibuprofen and a paracervical block. We powered the study (β=80%; α=.025) to detect a 15-mm difference in our two a priori primary outcomes of pain and anxiety at time of uterine aspiration (100-mm visual analog scale). Secondary outcomes were pain and anxiety at additional time points, memory, satisfaction, side effects and adverse events.
Defining and tracking abortion complications: how do we do it, and why does that matter? Taylor D University of California, San Francisco, San Francisco, CA, USA Upadhyay U, Desai S, James EA, AbiSamra R Objectives: To develop standardized classification for abortion-related complications and apply it to multiple data sources to improve complication