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  • 1
    Language: English
    In: Contraception, September 2018, Vol.98(3), pp.205-209
    Description: To determine if offering patients a choice of adjunctive nonpharmacologic pain management during first-trimester aspiration abortion results in lower pain scores when compared with standard care. We enrolled women receiving first-trimester aspiration abortion at the University of Hawaii. We randomized patients to standard care (control) or standard care plus a choice of nonpharmacologic pain management options (intervention). Standard care was ibuprofen 800 mg orally at least 30 min preprocedure, lidocaine paracervical block and anticipatory guidance from the provider. We measured pain on a 100-mm visual analog scale immediately postprocedure with adequate sample size to detect a 20-mm difference in pain scores. Seventy-four women participated in the trial and reported an overall mean pain score of 61.9±27.0. Participants in the control and intervention groups reported similar overall mean pain scores (control 60.6±28.8, intervention 63.3±28.5). We found procedure time, complications, provider-perceived case difficulty and patient satisfaction with pain management to be similar between groups. Providers underestimated participant pain compared to participants' own scores (mean physician estimate of participant pain: 46.3±18.5, mean participant pain score: 61.9±27.0, p〈.01). Intervention group participants most frequently selected ambient music (59%) as the nonpharmacologic intervention. Forty-one percent (15/37) of participants in the intervention group chose more than one nonpharmacologic intervention. Participants in the control group reported similar pain scores to participants in the intervention group. Procedure time and difficulty were similar between the two groups. Incorporating patient choice into a nonpharmacologic pain management model did not result in lower pain scores. This approach did increase the patient's visit time. Abortion providers frequently use nonpharmacologic pain management in the United States, and these techniques did not negatively impact patient pain scores in our study.
    Keywords: Abortion ; First-Trimester ; Nonpharmacologic ; Pain Management ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 2
    Language: English
    In: Contraception, June 2018, Vol.97(6), pp.500-503
    Description: Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24 weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.
    Keywords: Abortion ; Survey ; Uterotonic ; Misoprostol ; Methylergonovine ; Vasopressin ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 3
    Language: English
    In: Contraception, July 2017, Vol.96(1), pp.19-24
    Description: Some providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage, although evidence to support this is scarce. We sought to describe the association between prophylactic oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E. We performed a chart review of 730 women at 14 to 26 weeks’ gestation who had a D&E at our institution between May 2010 and May 2014 to assess the association between prophylactic oxytocin use and EBL. We determined whether sociodemographic and health-related factors were associated with excessive blood loss (EBL≥250 mL) and whether oxytocin use was associated with complications, including hemorrhage (i.e., EBL≥500 mL or interventions for bleeding). We performed univariate analyses and multivariable regression models to evaluate the relationship between health-related factors and EBL≥250 mL. Providers used prophylactic oxytocin in 59.9% of procedures. Asian (p=.005 and Native Hawaiian/Pacific Islander (p=.005) race, nulliparity (p=.007) and higher gestational age (p〈.001) were associated with prophylactic oxytocin use. We found no difference in mean EBL (116.2±105.5 mL versus 130.7±125.5 mL, p=.09), EBL≥250 mL (31.4% vs. 68.6%, p=.15) or complications (6.1% vs. 7.1%, p=.73) including hemorrhage (1.4% vs. 5.3%, p=.14) between those who did not receive prophylactic oxytocin and those who did. No transfusions occurred in either group. In multivariable regression modeling, the adjusted OR for excessive blood loss was 0.42 (95% confidence interval 0.16–1.07) with prophylactic oxytocin use. Prophylactic oxytocin use during D&E was not associated with hemorrhage or transfusion in our population. Routine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.
    Keywords: Abortion ; Dilation and Evacuation ; Oxytocin ; Hemorrhage ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 4
    Language: English
    In: Contraception
    Description: We sought to develop an updated fetal foot length-to-gestational week reference range from patient-reported last menstrual period (LMP), ultrasound, and best-estimate for gestational age based on American College of Obstetricians and Gynecologists' (ACOG) pregnancy dating guidelines. Subsequently, we aimed to determine the impact, if any, of race/ethnicity on our findings and compare our measurements to commonly referenced ranges. We performed a chart review of 610 dilation and evacuation records with gestational ages 14 weeks 0 days to 21 weeks 6 days from October 2012 to December 2014 in Honolulu, Hawaii. We analyzed records containing pathology-measured fetal foot length and three gestational age estimation methods using ANOVA tests, determined if race/ethnicity affected fetal foot length, and compared our measurements to previously published studies. Linear regression analysis demonstrated that ultrasound-derived gestational age dating provided the best-fit regression formula with an R-squared and adjusted R-squared value of 0.92. Patient body mass index (p=.15), parity (p=.15), and race (p=.99) did not affect the equation. Mean fetal foot length per gestational age differed from historically referenced ranges by 0.36–3.92 mm in either direction. Our population's fetal foot length per gestational age differed from ranges typically referenced by pathologists following abortion at all gestational ages, using all three methods of fetal gestational age estimation. As gestational age increased, the variability of fetal foot length measurements per gestational week increased. If post-abortion fetal foot length measurements are obtained, it is important to use an updated reference range. Reference ranges frequently used by pathologists to assess fetal foot length following abortion may be outdated, limiting their utility. If facilities routinely obtain these measurements to estimate gestational age, it is important to use an updated reference range.
    Keywords: Abortion ; Pathology ; Fetal Foot Length ; Family Planning ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 5
    In: Journal of Midwifery & Women's Health, May 2016, Vol.61(3), pp.331-338
    Description: Byline: Mary Tschann, Jennifer Salcedo, Bliss Kaneshiro Keywords: first-trimester abortion; pain management; nonpharmaceutical; nonpharmacologic; integrative; critical review Introduction First-trimester aspiration abortion is associated with moderate to severe pain. The effectiveness of adjunctive therapies for pain control is not well understood. This critical review summarizes the existing literature regarding nonpharmacologic interventions to reduce pain during first-trimester office-based abortion. Methods PubMed and Google Scholar were searched using the following search terms in various combinations: "abortion," "pain," "nonpharmaceutical," "nonpharmacologic," "anxiety," "fear," "pain management," "pain reduction," "anxiety reduction," "complementary and alternative medicine," and "integrative medicine." Seven articles meeting inclusion criteria were entered into a matrix for comparison. Findings from each study are summarized describing design, results, and themes. These results are summarized to provide evidence-based clinical guidelines and identify areas for further research. Results None of the nonpharmacologic interventions studied were significantly associated with a reduction in pain or anxiety scores. However, women in many studies strongly endorsed future use of these techniques. Discussion The data included in this critical review did not demonstrate a relationship between the nonpharmacologic interventions and pain or anxiety scores, yet participants endorsed these as positive and helpful. Women found value in these supportive interventions, and ongoing investigation into these techniques is warranted. Biographical information: Mary Tschann, MPH, is a Junior Researcher for the Department of Obstetrics, Gynecology, and Women's Health at the University of Hawaii, John A. Burns School of Medicine. She is also a doctoral student in Clinical Research at the University of Hawaii. Jennifer Salcedo, MD, MPH, MPP, is an obstetrician-gynecologist and Assistant Professor at the Department of Obstetrics, Gynecology, and Women's Health at the University of Hawaii, John A. Burns School of Medicine. Dr. Salcedo also directs family planning and adolescent health residency education for the department. Bliss Kaneshiro, MD, MPH, is an obstetrician-gynecologist and Associate Professor with Tenure at the Department of Obstetrics, Gynecology, and Women's Health at the University of Hawaii, John A. Burns School of Medicine. Dr. Kaneshiro is also the medical director for Hawaii's Title X Program.
    Keywords: First‐Trimester Abortion ; Pain Management ; Nonpharmaceutical ; Nonpharmacologic ; Integrative ; Critical Review
    ISSN: 1526-9523
    E-ISSN: 1542-2011
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