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Evaluation of the abortion provider stigma scale
306
Abstracts / Contraception 90 (2014) 298–351
Methods: After IRB approval, the medical histories and procedure outcomes of women receiving first-trimester uterine evacuations between Jan. 2, 2009, and March 7, 2014, were examined. We compared women without medical problems with those reporting diabetes, hypertension, obesity (BMI ≥30 or weight ≥200 lb), HIV, epilepsy, asthma, thyroid disease, or bleeding or clotting disorders. We compared incidence of any of the following: resuction, uterine perforation, estimated blood loss (EBL) N100 cc and cervical laceration. Results: A total of 1960 women met inclusion criteria; 597 (30%) had at least one comorbidity. When compared with women without medical morbidities, women with common chronic conditions were older (age 28.3± 6.7 vs. 27.3±6.7, pb.01), less likely to be primigravidas (29.1% vs. 35.7%, p=.005) and more likely to have had a prior cesarean section (24.9% vs. 15.7%, pb.001) There was no difference between groups regarding gestational age or indication for evacuation. The overall complication rate was 2.9%, and there was no difference between groups (OR=0.9, 95% CI 0.5–1.6) or between any of the women with individual morbidities and well women. The only significant predictor of complication was history of cesarean delivery (OR=1.9, 95% CI 1.1–3.4). Conclusions: Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared with healthy peers. While a careful medical history is always required, providers may feel reassured that complications remain rare. http://dx.doi.org/10.1016/j.contraception.2014.05.048
P28 EVALUATION OF THE ABORTION PROVIDER STIGMA SCALE Martin L University of Michigan, Dearborn, Dearborn, MI, USA
P29 PREDICTORS OF EXTRAMURAL DELIVERY IN SECONDTRIMESTER DILATION AND EVACUATIONS Havard A University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA Rible R, Chen A Objectives: Delivery outside of the operating room setting, also known as an extramural delivery, is a rare but potentially devastating complication for women undergoing second-trimester dilation and evacuation (D&E). Unscheduled deliveries can be emotionally traumatic for both the patient and care providers involved. Our primary objective was to identify risk factors associated with extramural delivery. Methods: This is a case–control study of women undergoing a D&E at a single institution between 14 weeks and 0 days and 23 weeks and 6 days of estimated gestational age from 2008 to 2013. An internal electronic database was reviewed to gather pertinent information regarding patient characteristics, preoperative preparation and all associated outcomes and complications. Statistical analysis included the Student t test, the χ2 test and logistic regression. Results: From Jan. 1, 2008, to Dec. 31, 2013, 1394 second-trimester dilation and evacuations were performed at UCLA. The frequency of extramural delivery was 2.58% (n=36). The odds of experiencing an extramural delivery were increased by 72% per additional laminaria placed on preoperative day 1 (pb.001) and by 89% among patients who received digoxin preoperatively (p=.039). Neither the number of days of laminaria placement nor the location of the digoxin injection (intraamniotic versus intrafetal) was a significant predictor of extramural delivery. Conclusions: Patients who receive laminaria on preoperative day 1 and digoxin prior to their scheduled D&E are more likely to experience an extramural delivery.
Hassinger J, Harris L Objectives: We revised a scale measuring abortion providers’ experiences of stigma, using an expanded item pool and larger sample. Methods: We created a 49-item question pool using previous measures, qualitative data and expert review. We administered questions to 298 abortion providers prior to participation in the Providers Share Workshop. We used factor analysis to reduce the number of items and establish scale validity and reliability. Higher scores reflect greater stigma (range 45–225). We assessed reliability using Cronbach’s alpha. To test construct validity, Pearson correlation coefficients were calculated between the stigma scales, the Maslach Burnout Inventory (MBI) and the K10 measure of psychological distress. We used multivariate regression analysis to assess relationships between social and demographic characteristics (age, sex, education, job, religion, religiosity, political identification) and stigma. We used Stata SE/12.0 (Statacorp, 2012) for analyses. Results: Factor analysis revealed a 45-item 5-factor model: worries about disclosure, internalized states, social judgment, social support and discrimination (Cronbach’s alphas 0.79–0.94). Our stigma measure was correlated with psychological distress (r=0.40, pb.001) and with MBI’s emotional exhaustion (r=0.27, pb.001) and depersonalization (0.23, pb.001) subscales, and was inversely correlated with MBI’s personal accomplishment (r=−0.15, pb.05) subscale. Regression analysis showed that Jewish providers (compared with Christians) and Independents (compared with Democrats) experienced increased stigma (coefficients, 14.4 and 20.0, respectively). Additional associations were found between demographic variables and subscales. Conclusions: Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma among abortion providers and may help evaluate stigma reduction programs. http://dx.doi.org/10.1016/j.contraception.2014.05.049
http://dx.doi.org/10.1016/j.contraception.2014.05.050
P30 BLOOD LOSS AT THE TIME OF SURGICAL ABORTION UP TO 14 WEEKS IN ANTICOAGULATED WOMEN: A REGISTRY CASE SERIES Kaneshiro B University of Hawai’i John A. Burns School of Medicine, Honolulu, HI, USA Tschann M, Jensen J, Bednarek P, Texeira R, Edelman A Objectives: To describe estimated blood loss (EBL) with surgical abortion before 14 weeks’ gestation in therapeutically and prophylactically anticoagulated women. Methods: Clinicians involved in a private professional listserv (Family Planning Fellowship) were invited to report cases of women who were anticoagulated and undergoing surgical abortion up to 14 weeks’ gestation via a secure online interface. No changes in the care of patients were stipulated and no patient identifiers were collected. Clinicians were contacted 30 days postprocedure to capture postoperative complications. Results: Fifty-two cases were reported between February 2011 and October 2013. Anticoagulant therapy included low molecular weight heparin (57.7% of women), heparin (11.5%) and warfarin (30.8%). Providers reported continuation of therapeutic anticoagulation during the procedure in 48.1% of women, subtherapeutic anticoagulation in 19.2% of women and reversal prior to the procedure in 32.7% of women. EBL was less than 50 mL for 27/35 patients who continued the anticoagulant (therapeutic and subtherapeutic) and for 15/17 of those who reversed it
Abstracts / Contraception 90 (2014) 298–351
Methods: After IRB approval, the medical histories and procedure outcomes of women receiving first-trimester uterine evacuations between Jan. 2, 2009, and March 7, 2014, were examined. We compared women without medical problems with those reporting diabetes, hypertension, obesity (BMI ≥30 or weight ≥200 lb), HIV, epilepsy, asthma, thyroid disease, or bleeding or clotting disorders. We compared incidence of any of the following: resuction, uterine perforation, estimated blood loss (EBL) N100 cc and cervical laceration. Results: A total of 1960 women met inclusion criteria; 597 (30%) had at least one comorbidity. When compared with women without medical morbidities, women with common chronic conditions were older (age 28.3± 6.7 vs. 27.3±6.7, pb.01), less likely to be primigravidas (29.1% vs. 35.7%, p=.005) and more likely to have had a prior cesarean section (24.9% vs. 15.7%, pb.001) There was no difference between groups regarding gestational age or indication for evacuation. The overall complication rate was 2.9%, and there was no difference between groups (OR=0.9, 95% CI 0.5–1.6) or between any of the women with individual morbidities and well women. The only significant predictor of complication was history of cesarean delivery (OR=1.9, 95% CI 1.1–3.4). Conclusions: Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared with healthy peers. While a careful medical history is always required, providers may feel reassured that complications remain rare. http://dx.doi.org/10.1016/j.contraception.2014.05.048
P28 EVALUATION OF THE ABORTION PROVIDER STIGMA SCALE Martin L University of Michigan, Dearborn, Dearborn, MI, USA
P29 PREDICTORS OF EXTRAMURAL DELIVERY IN SECONDTRIMESTER DILATION AND EVACUATIONS Havard A University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA Rible R, Chen A Objectives: Delivery outside of the operating room setting, also known as an extramural delivery, is a rare but potentially devastating complication for women undergoing second-trimester dilation and evacuation (D&E). Unscheduled deliveries can be emotionally traumatic for both the patient and care providers involved. Our primary objective was to identify risk factors associated with extramural delivery. Methods: This is a case–control study of women undergoing a D&E at a single institution between 14 weeks and 0 days and 23 weeks and 6 days of estimated gestational age from 2008 to 2013. An internal electronic database was reviewed to gather pertinent information regarding patient characteristics, preoperative preparation and all associated outcomes and complications. Statistical analysis included the Student t test, the χ2 test and logistic regression. Results: From Jan. 1, 2008, to Dec. 31, 2013, 1394 second-trimester dilation and evacuations were performed at UCLA. The frequency of extramural delivery was 2.58% (n=36). The odds of experiencing an extramural delivery were increased by 72% per additional laminaria placed on preoperative day 1 (pb.001) and by 89% among patients who received digoxin preoperatively (p=.039). Neither the number of days of laminaria placement nor the location of the digoxin injection (intraamniotic versus intrafetal) was a significant predictor of extramural delivery. Conclusions: Patients who receive laminaria on preoperative day 1 and digoxin prior to their scheduled D&E are more likely to experience an extramural delivery.
Hassinger J, Harris L Objectives: We revised a scale measuring abortion providers’ experiences of stigma, using an expanded item pool and larger sample. Methods: We created a 49-item question pool using previous measures, qualitative data and expert review. We administered questions to 298 abortion providers prior to participation in the Providers Share Workshop. We used factor analysis to reduce the number of items and establish scale validity and reliability. Higher scores reflect greater stigma (range 45–225). We assessed reliability using Cronbach’s alpha. To test construct validity, Pearson correlation coefficients were calculated between the stigma scales, the Maslach Burnout Inventory (MBI) and the K10 measure of psychological distress. We used multivariate regression analysis to assess relationships between social and demographic characteristics (age, sex, education, job, religion, religiosity, political identification) and stigma. We used Stata SE/12.0 (Statacorp, 2012) for analyses. Results: Factor analysis revealed a 45-item 5-factor model: worries about disclosure, internalized states, social judgment, social support and discrimination (Cronbach’s alphas 0.79–0.94). Our stigma measure was correlated with psychological distress (r=0.40, pb.001) and with MBI’s emotional exhaustion (r=0.27, pb.001) and depersonalization (0.23, pb.001) subscales, and was inversely correlated with MBI’s personal accomplishment (r=−0.15, pb.05) subscale. Regression analysis showed that Jewish providers (compared with Christians) and Independents (compared with Democrats) experienced increased stigma (coefficients, 14.4 and 20.0, respectively). Additional associations were found between demographic variables and subscales. Conclusions: Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma among abortion providers and may help evaluate stigma reduction programs. http://dx.doi.org/10.1016/j.contraception.2014.05.049
http://dx.doi.org/10.1016/j.contraception.2014.05.050
P30 BLOOD LOSS AT THE TIME OF SURGICAL ABORTION UP TO 14 WEEKS IN ANTICOAGULATED WOMEN: A REGISTRY CASE SERIES Kaneshiro B University of Hawai’i John A. Burns School of Medicine, Honolulu, HI, USA Tschann M, Jensen J, Bednarek P, Texeira R, Edelman A Objectives: To describe estimated blood loss (EBL) with surgical abortion before 14 weeks’ gestation in therapeutically and prophylactically anticoagulated women. Methods: Clinicians involved in a private professional listserv (Family Planning Fellowship) were invited to report cases of women who were anticoagulated and undergoing surgical abortion up to 14 weeks’ gestation via a secure online interface. No changes in the care of patients were stipulated and no patient identifiers were collected. Clinicians were contacted 30 days postprocedure to capture postoperative complications. Results: Fifty-two cases were reported between February 2011 and October 2013. Anticoagulant therapy included low molecular weight heparin (57.7% of women), heparin (11.5%) and warfarin (30.8%). Providers reported continuation of therapeutic anticoagulation during the procedure in 48.1% of women, subtherapeutic anticoagulation in 19.2% of women and reversal prior to the procedure in 32.7% of women. EBL was less than 50 mL for 27/35 patients who continued the anticoagulant (therapeutic and subtherapeutic) and for 15/17 of those who reversed it