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A survey study of marijuana use for pain management during first-trimester medical abortion
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Abstracts / Contraception 94 (2016) 387–434
Conclusions: Findings suggest intervention areas to support fuller integration of options counseling and abortion referrals into primary care by targeting PCPs who are the least likely to provide these services. http://dx.doi.org/10.1016/j.contraception.2016.07.044
P5
significance (p=.09); there were no differences in procedure time when controlling for parity (p=.91), age (p=.48) or previous cesarean section (p=.73). Conclusions: These results suggest that surgical abortion remains a safe procedure for women with a BMI ≥30. Our results also suggest that obese women present at later gestations for abortion and longer procedure times may be associated with higher gestational age. Future research is needed to confirm this finding and identify ways to facilitate earlier presentation for abortion among obese women.
A SURVEY STUDY OF MARIJUANA USE FOR PAIN MANAGEMENT DURING FIRST-TRIMESTER MEDICAL ABORTION
http://dx.doi.org/10.1016/j.contraception.2016.07.046
Louie K Gynuity Health Projects, New York, NY, USA
P7
Chong E, Ginde S, Kuehl L, Washington S, GatterM, Winikoff B Objectives: Pain during medical abortion is sometimes severe, and current approaches for management may be inadequate. Some women may use marijuana in addition to or in lieu of pain medications prescribed for the abortion. We surveyed women who underwent first-trimester mifepristone–misoprostol medical abortion to investigate their methods of managing pain during the procedure, including marijuana use. We used the data to determine the prevalence, patterns and perceived effectiveness of marijuana use for pain control in medical abortion. Methods: We enrolled 384 women in states where marijuana is legal for medicinal or recreational purposes on the day they returned to the clinic for medical abortion follow-up. After providing informed consent, women completed a short anonymous Internet-based survey. Results: Preliminary analysis (n=226) revealed that women utilized multiple strategies to manage pain during medical abortion, and 19% reported marijuana use. All of those women (43/43) found it to be at least somewhat effective at relieving pain and cramps. About half used marijuana after ingesting mifepristone, and half used it within 24 h after administering the misoprostol. The majority (75%) smoked the marijuana, and almost all would use it again if they were to have another abortion. Conclusions: Initial findings suggest that a sizable proportion of women in states with progressive marijuana policies use marijuana during first-trimester medical abortion and find it helpful in managing pain. Further research is needed to investigate the clinical effectiveness of marijuana in relieving pain in this population. http://dx.doi.org/10.1016/j.contraception.2016.07.045
P6 BODY MASS INDEX (BMI) AND PROCEDURE TIME IN FIRST- AND SECOND-TRIMESTER ABORTION: A RETROSPECTIVE CHART REVIEW Lyons K Department of Obstetrics & Gynecology, Division of Family Planning Services and Research, Stanford University School of Medicine, Stanford, CA, USA
SHARED DECISION-MAKING AND DECISION SATISFACTION IN DILATION AND EVACUATION VERSUS INDUCTION OF LABOR AMONG WOMEN UNDERGOING ABORTION FOR PREGNANCY COMPLICATIONS Mengesha B University of California, San Francisco, San Francisco, CA, USA Cassidy A, Pearlson G, Kerns J Objectives: We aimed to evaluate differences in shared decision-making, decision satisfaction and quality of counseling among women who underwent dilation and evacuation (D&E) versus induction of labor (IOL) for pregnancy complications. Methods: We conducted a cross-sectional study of English-speaking women in the United States aged 18 or older who underwent abortion for pregnancy complications. We recruited participants online through Facebook and other support groups and asked about counseling experiences, stigma, demographic characteristics and psychosocial issues. Our primary predictor was procedure type, and the primary outcome was shared decision-making. Secondary outcomes were quality of counseling and decision satisfaction. We used t tests for unadjusted analyses and multivariable regression for adjusted analyses. Results: Of the 164 respondents who completed the survey, 123 provided adequate data for this analysis [81 D&E (66%) and 42 IOL (34%)]. Respondents were mostly White, suburban and well educated. Gestational age differed between the two groups (19.0 weeks D&E vs. 21.1 weeks IOL, pb.0001). In unadjusted analyses, there was a trend toward increased shared decision-making in the IOL group (p=.06); the proportions reporting decision satisfaction and good quality of counseling were higher among the IOL group (p=.003, pb.05, respectively). However, in adjusted analyses, there was no association between method type and the outcomes. Conclusions: Although there were no differences in outcomes by abortion method, the mean shared decision-making score among all women was 3.1 (range: 0–5), reflecting an opportunity for improvement in counseling. These results should encourage providers to explore strategies for enhancing shared decision-making for women deciding between D&E or IOL. http://dx.doi.org/10.1016/j.contraception.2016.07.047
Lerma K, Shaw K Objectives: We aimed to evaluate surgical abortion procedure time among obese women [body mass index (BMI) ≥ 30]. Methods: We conducted a retrospective chart review of women presenting for first- and second-trimester surgical abortion at Stanford Hospital and Clinics from 2013 to 2014. Primary outcome was total procedure time. Secondary outcomes included complication rates and estimated blood loss (EBL). Results: Some 383 patients were included in the analysis, of which 61 (15.9%) were obese and 322 (84.1%) were nonobese. Mean gestational age was different between the obese and nonobese groups, 17.50 weeks (±3.95) and 16.07 weeks (±4.67), respectively (p=.01). Mean procedure times differed significantly between the nonobese (20.07 min, ±10.38) and obese (24.11 min, ±13.96) groups (p=.04). Complication rates did not differ significantly (p=1.00). EBL was different between groups (p=.002); 16% of nonobese patients had EBL ≥100 cc (n=51), whereas 36% of obese patients had EBL ≥100 cc (n=22). In multivariable analysis, only gestational age was a predictor of procedure time (pb.001), and BMI trended toward
P8 SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) TREND WITHIN THE FIRST FEW DAYS AFTER MEDICATION ABORTION: A PROSPECTIVE STUDY Pocius K Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA Bartz D, Maurer R, Stenquist A, Fortin J, Goldberg A Objectives: We aimed to prospectively describe the decline in serum hCG in the first 5 days after complete medication abortion and evaluate the influence of initial hCG and gestational duration. Methods: This is a prospective, physiologic study of women less than 63 days' gestation who underwent medication abortion with 200-mg mifepristone and
Abstracts / Contraception 94 (2016) 387–434
Conclusions: Findings suggest intervention areas to support fuller integration of options counseling and abortion referrals into primary care by targeting PCPs who are the least likely to provide these services. http://dx.doi.org/10.1016/j.contraception.2016.07.044
P5
significance (p=.09); there were no differences in procedure time when controlling for parity (p=.91), age (p=.48) or previous cesarean section (p=.73). Conclusions: These results suggest that surgical abortion remains a safe procedure for women with a BMI ≥30. Our results also suggest that obese women present at later gestations for abortion and longer procedure times may be associated with higher gestational age. Future research is needed to confirm this finding and identify ways to facilitate earlier presentation for abortion among obese women.
A SURVEY STUDY OF MARIJUANA USE FOR PAIN MANAGEMENT DURING FIRST-TRIMESTER MEDICAL ABORTION
http://dx.doi.org/10.1016/j.contraception.2016.07.046
Louie K Gynuity Health Projects, New York, NY, USA
P7
Chong E, Ginde S, Kuehl L, Washington S, GatterM, Winikoff B Objectives: Pain during medical abortion is sometimes severe, and current approaches for management may be inadequate. Some women may use marijuana in addition to or in lieu of pain medications prescribed for the abortion. We surveyed women who underwent first-trimester mifepristone–misoprostol medical abortion to investigate their methods of managing pain during the procedure, including marijuana use. We used the data to determine the prevalence, patterns and perceived effectiveness of marijuana use for pain control in medical abortion. Methods: We enrolled 384 women in states where marijuana is legal for medicinal or recreational purposes on the day they returned to the clinic for medical abortion follow-up. After providing informed consent, women completed a short anonymous Internet-based survey. Results: Preliminary analysis (n=226) revealed that women utilized multiple strategies to manage pain during medical abortion, and 19% reported marijuana use. All of those women (43/43) found it to be at least somewhat effective at relieving pain and cramps. About half used marijuana after ingesting mifepristone, and half used it within 24 h after administering the misoprostol. The majority (75%) smoked the marijuana, and almost all would use it again if they were to have another abortion. Conclusions: Initial findings suggest that a sizable proportion of women in states with progressive marijuana policies use marijuana during first-trimester medical abortion and find it helpful in managing pain. Further research is needed to investigate the clinical effectiveness of marijuana in relieving pain in this population. http://dx.doi.org/10.1016/j.contraception.2016.07.045
P6 BODY MASS INDEX (BMI) AND PROCEDURE TIME IN FIRST- AND SECOND-TRIMESTER ABORTION: A RETROSPECTIVE CHART REVIEW Lyons K Department of Obstetrics & Gynecology, Division of Family Planning Services and Research, Stanford University School of Medicine, Stanford, CA, USA
SHARED DECISION-MAKING AND DECISION SATISFACTION IN DILATION AND EVACUATION VERSUS INDUCTION OF LABOR AMONG WOMEN UNDERGOING ABORTION FOR PREGNANCY COMPLICATIONS Mengesha B University of California, San Francisco, San Francisco, CA, USA Cassidy A, Pearlson G, Kerns J Objectives: We aimed to evaluate differences in shared decision-making, decision satisfaction and quality of counseling among women who underwent dilation and evacuation (D&E) versus induction of labor (IOL) for pregnancy complications. Methods: We conducted a cross-sectional study of English-speaking women in the United States aged 18 or older who underwent abortion for pregnancy complications. We recruited participants online through Facebook and other support groups and asked about counseling experiences, stigma, demographic characteristics and psychosocial issues. Our primary predictor was procedure type, and the primary outcome was shared decision-making. Secondary outcomes were quality of counseling and decision satisfaction. We used t tests for unadjusted analyses and multivariable regression for adjusted analyses. Results: Of the 164 respondents who completed the survey, 123 provided adequate data for this analysis [81 D&E (66%) and 42 IOL (34%)]. Respondents were mostly White, suburban and well educated. Gestational age differed between the two groups (19.0 weeks D&E vs. 21.1 weeks IOL, pb.0001). In unadjusted analyses, there was a trend toward increased shared decision-making in the IOL group (p=.06); the proportions reporting decision satisfaction and good quality of counseling were higher among the IOL group (p=.003, pb.05, respectively). However, in adjusted analyses, there was no association between method type and the outcomes. Conclusions: Although there were no differences in outcomes by abortion method, the mean shared decision-making score among all women was 3.1 (range: 0–5), reflecting an opportunity for improvement in counseling. These results should encourage providers to explore strategies for enhancing shared decision-making for women deciding between D&E or IOL. http://dx.doi.org/10.1016/j.contraception.2016.07.047
Lerma K, Shaw K Objectives: We aimed to evaluate surgical abortion procedure time among obese women [body mass index (BMI) ≥ 30]. Methods: We conducted a retrospective chart review of women presenting for first- and second-trimester surgical abortion at Stanford Hospital and Clinics from 2013 to 2014. Primary outcome was total procedure time. Secondary outcomes included complication rates and estimated blood loss (EBL). Results: Some 383 patients were included in the analysis, of which 61 (15.9%) were obese and 322 (84.1%) were nonobese. Mean gestational age was different between the obese and nonobese groups, 17.50 weeks (±3.95) and 16.07 weeks (±4.67), respectively (p=.01). Mean procedure times differed significantly between the nonobese (20.07 min, ±10.38) and obese (24.11 min, ±13.96) groups (p=.04). Complication rates did not differ significantly (p=1.00). EBL was different between groups (p=.002); 16% of nonobese patients had EBL ≥100 cc (n=51), whereas 36% of obese patients had EBL ≥100 cc (n=22). In multivariable analysis, only gestational age was a predictor of procedure time (pb.001), and BMI trended toward
P8 SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) TREND WITHIN THE FIRST FEW DAYS AFTER MEDICATION ABORTION: A PROSPECTIVE STUDY Pocius K Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA Bartz D, Maurer R, Stenquist A, Fortin J, Goldberg A Objectives: We aimed to prospectively describe the decline in serum hCG in the first 5 days after complete medication abortion and evaluate the influence of initial hCG and gestational duration. Methods: This is a prospective, physiologic study of women less than 63 days' gestation who underwent medication abortion with 200-mg mifepristone and