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Demographic trends in women seeking termination of pregnancy for fetal anomaly at a free-standing abortion clinic: a neglected population?
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Abstracts / Contraception 90 (2014) 298–351
P34 DEMOGRAPHIC TRENDS IN WOMEN SEEKING TERMINATION OF PREGNANCY FOR FETAL ANOMALY AT A FREE-STANDING ABORTION CLINIC: A NEGLECTED POPULATION? Linton A Northwestern University, Chicago, IL, USA Lichtenberg ES, Gawron L Objectives: Recent legislation restricting gestational limits may have limited access to safe, affordable procedures. Fetal anomalies are often not detected until after 14 weeks, therefore restrictions disproportionately affect women seeking termination of pregnancy for fetal anomaly. Our aims were to assess trends in this population at a free-standing abortion clinic. Methods: We performed a manual, retrospective chart review collecting social, demographic and medical data from all patients seeking termination of pregnancy for fetal anomaly at 14 weeks or later with a live fetus from 2008 through 2013 at an abortion clinic in Chicago, IL. Descriptive statistics were calculated; we used Poisson regression models and Spearman correlations for trend analyses on Stata Version 12. Results: The sample consisted of 331 women. Patients terminating a pregnancy because of fetal anomaly increased annually from 2.0% (n=49) to 4.3% (n=68), while second-trimester abortions decreased 37% over this period. Participant median age was 32 (range 14–45), parity was 1 (range 0–7) and gestational age 21+3 weeks (range 14–24 weeks). Women identified as Caucasian (58%), married (71%) and college educated (56.5%). Median monthly income was $1200 (range $0–$50,000). Some 69% had private insurance, 23% Medicaid and 55% used coverage. Physicians referred 77% and insurance companies 9%. Median travel distance was 47.5 mi (range 0–634 mi). Trend analyses identified fewer insurance referrals (IRR=0.21, CI 0.04–1.00) and increasing travel distance (p=.0015) as significant changes over this period. Conclusions: Despite a national abortion decline, we found increasing free-standing clinic utilization by women ending a pregnancy because of fetal anomaly. These women, whose social and demographic characteristics vary from national abortion data, were adversely affected by policies that impact provider availability and abortion insurance coverage.
http://dx.doi.org/10.1016/j.contraception.2014.05.055
P35 VAGINAL MISOPROSTOL VERSUS CONCENTRATED OXYTOCIN FOR MIDTRIMESTER LABOR INDUCTION: A RETROSPECTIVE CHART REVIEW McDonald M University of Iowa Hospitals and Clinics, Iowa City, IA, USA Stockdale C, Che W, Castaneda A, Johnson K, Lagneaux A, McConnell L, Hardy-Fairbanks A Objectives: To date, no studies have compared misoprostol versus concentrated oxytocin without concomitant use of vaginal prostaglandins for pregnancy interruption in the midtrimester. We sought to compare efficacy and safety of these two regimens to improve patient counseling and outcomes. Methods: Charts of all midtrimester inductions between 2003 and 2013 were reviewed for demographic characteristics, primary induction agent, indication for induction, time to delivery, need for additional procedures and adverse outcomes.
Results: Some 228 women underwent induction of labor, and 52 (22.8%) were induced with oxytocin. The two groups were similar in race, religious beliefs, education and gestational age at time of induction. Misoprostol was more often used in primigravidas, while oxytocin was more often used in women with prior cesarean delivery. Length of induction was similar between the two groups (11:43 h vs. 11:33 h; p=.91). Women in the oxytocin group were significantly more likely to require dilation and curettage to remove placenta (3.4% vs. 0.0%; pb.0001), to have fever or require antibiotics (32.6% vs. 10.3%, p=.004) and to have any complications secondary to induction (33.3% vs. 6.8%; pb.0001). No uterine ruptures or cervical lacerations occurred in either group. Conclusions: Misoprostol used for labor induction in the midtrimester appears to be safer and associated with less risk for subsequent procedures than concentrated oxytocin. Given these findings, misoprostol appears to be the superior induction agent and should be used preferentially for pregnancy interruption for appropriate patients, even those with a history of prior cesarean delivery.
http://dx.doi.org/10.1016/j.contraception.2014.05.056
P36 “IT'S PERSUASION DISGUISED AS INFORMATION”: THE EXPERIENCES AND ADAPTATIONS OF A BORTION PROVIDERS PRACTICING UNDER A NEW LAW Mercier R Jefferson Medical College, Department of Obstetrics and Gynecology, Philadelphia, PA, USA Bryant A, Buchbinder M, Britton L Objectives: In 2011, North Carolina passed the Women’s Right to Know Act, which mandates a 24-h waiting period and counseling with specific, state-prescribed information prior to abortion. We investigated experiences of abortion providers following implementation of this law. Methods: We conducted semistructured interviews with 31 abortion providers (17 physicians, 9 nurses, 1 physician assistant and 3 clinic administrators) in North Carolina. Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using a grounded theory approach. We identified themes in four general areas: institutional adaptation, provider and patient emotional response, perceived impact on the patient–physician relationship and ethical conflicts. Results: Provider responses to the law were not uniform. While almost all providers described the law in negative terms, there was variation in how the law affected practice and the perceived effect on patients. Many providers described extensive alterations in clinic practices to comply with regulations while simultaneously minimizing burdens for patients. The most troubling aspect of the law for many providers was the state-mandated counseling. Providers indicated that biased language and inappropriate content in counseling could interfere with establishing trust and rapport, though they developed strategies to mitigate the practical and emotional impact on the patients. Providers also identified multiple areas of ethical concern, including issues related to confidentiality, patient and provider autonomy, and nonmaleficence. Conclusions: Many abortion providers in North Carolina are negatively affected by this regulation. Providers expended significant resources to minimize the impact on patients. State-mandated counseling may interfere with the therapeutic relationship and raises several ethical concerns.
http://dx.doi.org/10.1016/j.contraception.2014.05.057
Abstracts / Contraception 90 (2014) 298–351
P34 DEMOGRAPHIC TRENDS IN WOMEN SEEKING TERMINATION OF PREGNANCY FOR FETAL ANOMALY AT A FREE-STANDING ABORTION CLINIC: A NEGLECTED POPULATION? Linton A Northwestern University, Chicago, IL, USA Lichtenberg ES, Gawron L Objectives: Recent legislation restricting gestational limits may have limited access to safe, affordable procedures. Fetal anomalies are often not detected until after 14 weeks, therefore restrictions disproportionately affect women seeking termination of pregnancy for fetal anomaly. Our aims were to assess trends in this population at a free-standing abortion clinic. Methods: We performed a manual, retrospective chart review collecting social, demographic and medical data from all patients seeking termination of pregnancy for fetal anomaly at 14 weeks or later with a live fetus from 2008 through 2013 at an abortion clinic in Chicago, IL. Descriptive statistics were calculated; we used Poisson regression models and Spearman correlations for trend analyses on Stata Version 12. Results: The sample consisted of 331 women. Patients terminating a pregnancy because of fetal anomaly increased annually from 2.0% (n=49) to 4.3% (n=68), while second-trimester abortions decreased 37% over this period. Participant median age was 32 (range 14–45), parity was 1 (range 0–7) and gestational age 21+3 weeks (range 14–24 weeks). Women identified as Caucasian (58%), married (71%) and college educated (56.5%). Median monthly income was $1200 (range $0–$50,000). Some 69% had private insurance, 23% Medicaid and 55% used coverage. Physicians referred 77% and insurance companies 9%. Median travel distance was 47.5 mi (range 0–634 mi). Trend analyses identified fewer insurance referrals (IRR=0.21, CI 0.04–1.00) and increasing travel distance (p=.0015) as significant changes over this period. Conclusions: Despite a national abortion decline, we found increasing free-standing clinic utilization by women ending a pregnancy because of fetal anomaly. These women, whose social and demographic characteristics vary from national abortion data, were adversely affected by policies that impact provider availability and abortion insurance coverage.
http://dx.doi.org/10.1016/j.contraception.2014.05.055
P35 VAGINAL MISOPROSTOL VERSUS CONCENTRATED OXYTOCIN FOR MIDTRIMESTER LABOR INDUCTION: A RETROSPECTIVE CHART REVIEW McDonald M University of Iowa Hospitals and Clinics, Iowa City, IA, USA Stockdale C, Che W, Castaneda A, Johnson K, Lagneaux A, McConnell L, Hardy-Fairbanks A Objectives: To date, no studies have compared misoprostol versus concentrated oxytocin without concomitant use of vaginal prostaglandins for pregnancy interruption in the midtrimester. We sought to compare efficacy and safety of these two regimens to improve patient counseling and outcomes. Methods: Charts of all midtrimester inductions between 2003 and 2013 were reviewed for demographic characteristics, primary induction agent, indication for induction, time to delivery, need for additional procedures and adverse outcomes.
Results: Some 228 women underwent induction of labor, and 52 (22.8%) were induced with oxytocin. The two groups were similar in race, religious beliefs, education and gestational age at time of induction. Misoprostol was more often used in primigravidas, while oxytocin was more often used in women with prior cesarean delivery. Length of induction was similar between the two groups (11:43 h vs. 11:33 h; p=.91). Women in the oxytocin group were significantly more likely to require dilation and curettage to remove placenta (3.4% vs. 0.0%; pb.0001), to have fever or require antibiotics (32.6% vs. 10.3%, p=.004) and to have any complications secondary to induction (33.3% vs. 6.8%; pb.0001). No uterine ruptures or cervical lacerations occurred in either group. Conclusions: Misoprostol used for labor induction in the midtrimester appears to be safer and associated with less risk for subsequent procedures than concentrated oxytocin. Given these findings, misoprostol appears to be the superior induction agent and should be used preferentially for pregnancy interruption for appropriate patients, even those with a history of prior cesarean delivery.
http://dx.doi.org/10.1016/j.contraception.2014.05.056
P36 “IT'S PERSUASION DISGUISED AS INFORMATION”: THE EXPERIENCES AND ADAPTATIONS OF A BORTION PROVIDERS PRACTICING UNDER A NEW LAW Mercier R Jefferson Medical College, Department of Obstetrics and Gynecology, Philadelphia, PA, USA Bryant A, Buchbinder M, Britton L Objectives: In 2011, North Carolina passed the Women’s Right to Know Act, which mandates a 24-h waiting period and counseling with specific, state-prescribed information prior to abortion. We investigated experiences of abortion providers following implementation of this law. Methods: We conducted semistructured interviews with 31 abortion providers (17 physicians, 9 nurses, 1 physician assistant and 3 clinic administrators) in North Carolina. Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using a grounded theory approach. We identified themes in four general areas: institutional adaptation, provider and patient emotional response, perceived impact on the patient–physician relationship and ethical conflicts. Results: Provider responses to the law were not uniform. While almost all providers described the law in negative terms, there was variation in how the law affected practice and the perceived effect on patients. Many providers described extensive alterations in clinic practices to comply with regulations while simultaneously minimizing burdens for patients. The most troubling aspect of the law for many providers was the state-mandated counseling. Providers indicated that biased language and inappropriate content in counseling could interfere with establishing trust and rapport, though they developed strategies to mitigate the practical and emotional impact on the patients. Providers also identified multiple areas of ethical concern, including issues related to confidentiality, patient and provider autonomy, and nonmaleficence. Conclusions: Many abortion providers in North Carolina are negatively affected by this regulation. Providers expended significant resources to minimize the impact on patients. State-mandated counseling may interfere with the therapeutic relationship and raises several ethical concerns.
http://dx.doi.org/10.1016/j.contraception.2014.05.057