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Manual vacuum aspiration treatment of incomplete abortion and retained products in the emergency room setting
Abstracts / Contraception 86 (2012) 173–186 Results: At 2 weeks, 20% were taking the POP. Of those not taking the pill, 28% planned to fill their prescription but had not yet done so, and 65% gave another reason such as not receiving a prescription or misunderstanding when to start the POP. At 8 weeks, 31% reported taking the POP. Thirty-one percent had been sexually active since delivery. Twenty-seven percent of subjects not taking the POP or not using any other method had resumed sexual activity. At 6 months, 23% were taking the POP. Several demographic parameters were predictive of continuation. Specifically, Hispanic race, speaking Spanish, increasing age and parity, and more education were predictive. Prior pill use was not predictive of continuation. Conclusions: POP uptake/continuation rates are low in our postpartum population. Many patients are not being counseled regarding proper use of the POP. Several factors may predict continuation with POP. A small portion of our population is at risk for unintended pregnancy at 8 weeks postpartum, highlighting the importance of counseling in the immediate postpartum period. A38 MANUAL VACUUM ASPIRATION TREATMENT OF INCOMPLETE ABORTION AND RETAINED PRODUCTS IN THE EMERGENCY ROOM SETTING Quinley K Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA Kinariwala M, Datner EM, Schreiber CA Objectives: Manual vacuum aspiration (MVA) is a low-cost, low-risk, highly effective way to treat active miscarriage that is widely used in the outpatient setting, but is perfectly suited to treat women presenting to emergency departments (EDs). The Hospital of the University of Pennsylvania (HUP) recently began treating women with incomplete abortion and retained products of conception in the ED. We evaluated patient characteristics, time to procedure and complications of MVA in this setting. Method: Cases of all patients treated in the HUP ED with MVA for firsttrimester heavy bleeding in the setting of early pregnancy failure or retained products of conception from March 1, 2011, to February 24, 2012, were reviewed in this quasiexperimental study. Descriptive statistics described populations and outcomes. Frequencies and proportions summarized categorical variables. Continuous variables were summarized by means and standard deviations. Results: Nine patients underwent MVA in the ED, and four patients were referred for dilation and evacuation in the operating room. Of the nine treated in the ED, six were treated with MVA for incomplete abortion, and three were treated for retained products. Average time from triage to MVA was 372 min (SD±145), and mean time from procedure to ED exit was 95 min (SD±83). The mean total time spent in the ED was 471 min (SD±175) for patients receiving MVA. There were no serious adverse events or complications from the manual vacuum aspiration procedure. Conclusions: Manual vacuum aspiration is a safe and efficient way to treat bleeding from spontaneous abortions and retained products of conception in the ED. A39 PHYSICAL WELL-BEING AND PSYCHOLOGICAL WELL-BEING ARE RELATED IN THE IMMEDIATE POSTABORTION PERIOD Quinley K Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Ratcliffe S, Schreiber C
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Objectives: The vast majority of women who undergo abortion do physically and psychologically well in the long term. Little data, however, describe how women fare in the immediate postabortion period, when patients have left the clinical setting, and interventions may be most impactful. We sought to evaluate predictors of women who may need additional postprocedural physical or psychological care. Method: Preprocedural needs assessment questionnaires and postprocedural nursing assessments were collected via retrospective chart review for patients presenting to the Hospital of the University of Pennsylvania from February to October 2011. We included all patients who underwent first- or second-trimester surgical abortion during the study period. Selfreported responses to physical and psychological well-being questions before and after abortion, plus anticipated postprocedural psychological coping, were scored. Univariate analyses were performed using Student's t test. Spearman correlation coefficients determined correlation between physical and psychological scores. Multivariable logistic regression was performed to identify independent associations. Results: Sixty-two patients out of 148 had complete questionnaires. Women with more highly negative preprocedural psychological states reported worse physical well-being scores after abortion (pb.001). Patients predicting they would suffer psychological morbidity after abortion reported worse postprocedural physical scores (pb.001). Poor preprocedural psychological states correlated positively with poor postprocedural physical scores (pb.001). Women in our study period tended to overestimate the postprocedural discomfort they would experience (p=.001). Conclusions: Poor physical well-being following abortion can be predicted by negative psychological states before abortion, in addition to patient anticipation of pain and poor psychological coping after abortion. These correlations highlight opportunities for focused patient counseling, and for individualized patient care. A40 KNOWLEDGE AND UTILIZATION OF FAMILY PLANNING METHODS: A STUDY FROM POSTCONFLICT SOUTH SUDAN Seifeldin Abdalla M University of Medical Sciences and Technology, Reproductive and Child Health Research Unit, Khartoum, Sudan Elmusharaf K Objectives: To measure the knowledge and utilization of family planning methods in postconflict South Sudan. Method: An analytical cross-sectional study design was conducted in Renk town, Upper Nile state, from May 2010 to April 2011 in which a total of 381 women in their reproductive age were interviewed using a structured questionnaire. Results: The mean age of the women in the study was 28.3 years, and 93.7% were married. Fifty-eight percent were Muslims, and 42% were Christians. A total of 28.9% had no formal education, and only 36.5% had primary education; 18.9% were employed, and 91.9% were permanent residents of the area. Results revealed that 28% had never heard of any family planning methods. Of the women that have heard, 61.9% heard of the pill, 57% heard of the rhythm/calendar method, 38.3% heard of the injectables, and only 12.9% heard of the condom. Moreover, only 17.1% have been taught to use the pills, 10.1% the rhythm method and only 3.9% the injectables. Regarding utilization, 16.3% have used the pill, 14.2% the rhythm method and only 5.5% the injectables. Most of the women (92.5%) use the methods to delay pregnancy rather than to avoid it. A total of 27.8% are not using a method because they have not heard of them, and 13.6% lack the information to use them. Conclusions: Improved family planning education, access and support are urgently needed for women in postconflict settings. Understanding of the local context is important in increasing demand for family planning services.
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Objectives: The vast majority of women who undergo abortion do physically and psychologically well in the long term. Little data, however, describe how women fare in the immediate postabortion period, when patients have left the clinical setting, and interventions may be most impactful. We sought to evaluate predictors of women who may need additional postprocedural physical or psychological care. Method: Preprocedural needs assessment questionnaires and postprocedural nursing assessments were collected via retrospective chart review for patients presenting to the Hospital of the University of Pennsylvania from February to October 2011. We included all patients who underwent first- or second-trimester surgical abortion during the study period. Selfreported responses to physical and psychological well-being questions before and after abortion, plus anticipated postprocedural psychological coping, were scored. Univariate analyses were performed using Student's t test. Spearman correlation coefficients determined correlation between physical and psychological scores. Multivariable logistic regression was performed to identify independent associations. Results: Sixty-two patients out of 148 had complete questionnaires. Women with more highly negative preprocedural psychological states reported worse physical well-being scores after abortion (pb.001). Patients predicting they would suffer psychological morbidity after abortion reported worse postprocedural physical scores (pb.001). Poor preprocedural psychological states correlated positively with poor postprocedural physical scores (pb.001). Women in our study period tended to overestimate the postprocedural discomfort they would experience (p=.001). Conclusions: Poor physical well-being following abortion can be predicted by negative psychological states before abortion, in addition to patient anticipation of pain and poor psychological coping after abortion. These correlations highlight opportunities for focused patient counseling, and for individualized patient care. A40 KNOWLEDGE AND UTILIZATION OF FAMILY PLANNING METHODS: A STUDY FROM POSTCONFLICT SOUTH SUDAN Seifeldin Abdalla M University of Medical Sciences and Technology, Reproductive and Child Health Research Unit, Khartoum, Sudan Elmusharaf K Objectives: To measure the knowledge and utilization of family planning methods in postconflict South Sudan. Method: An analytical cross-sectional study design was conducted in Renk town, Upper Nile state, from May 2010 to April 2011 in which a total of 381 women in their reproductive age were interviewed using a structured questionnaire. Results: The mean age of the women in the study was 28.3 years, and 93.7% were married. Fifty-eight percent were Muslims, and 42% were Christians. A total of 28.9% had no formal education, and only 36.5% had primary education; 18.9% were employed, and 91.9% were permanent residents of the area. Results revealed that 28% had never heard of any family planning methods. Of the women that have heard, 61.9% heard of the pill, 57% heard of the rhythm/calendar method, 38.3% heard of the injectables, and only 12.9% heard of the condom. Moreover, only 17.1% have been taught to use the pills, 10.1% the rhythm method and only 3.9% the injectables. Regarding utilization, 16.3% have used the pill, 14.2% the rhythm method and only 5.5% the injectables. Most of the women (92.5%) use the methods to delay pregnancy rather than to avoid it. A total of 27.8% are not using a method because they have not heard of them, and 13.6% lack the information to use them. Conclusions: Improved family planning education, access and support are urgently needed for women in postconflict settings. Understanding of the local context is important in increasing demand for family planning services.