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Taiwanese Journal of Obstetrics &... Nov 2020Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented... (Review)
Review
Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.
Topics: Abortion, Induced; Betacoronavirus; COVID-19; Contraception; Coronavirus Infections; Family Planning Services; Female; Humans; Pandemics; Pneumonia, Viral; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2; Telemedicine
PubMed: 33218393
DOI: 10.1016/j.tjog.2020.09.005 -
The Western Journal of Medicine Sep 1975A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and... (Review)
Review
A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy.
Topics: Abortion, Criminal; Abortion, Eugenic; Abortion, Legal; Abortion, Therapeutic; Adjustment Disorders; California; Female; Guilt; Humans; Male; Psychotic Disorders
PubMed: 1099808
DOI: No ID Found -
Drugs - Real World Outcomes Sep 2021Depression and antidepressant treatment are widespread among women of childbearing age.
BACKGROUND
Depression and antidepressant treatment are widespread among women of childbearing age.
OBJECTIVE
This study evaluates the association between duloxetine exposure during pregnancy and spontaneous and elective abortions.
PATIENTS AND METHODS
The nationwide, observational study based on register data from Denmark included women with a recorded pregnancy in the birth register or an abortion in the patient register between 2004 and 2016. Duloxetine-exposed women were compared with (1) duloxetine non-exposed, (2) selective serotonin reuptake inhibitor (SSRI)-exposed, (3) venlafaxine-exposed, and (4) women discontinuing duloxetine before pregnancy. Exposure status was based on records of redeemed prescriptions. Cox regression with adjustments and propensity score matching was applied.
RESULTS
The data from 1,019,957 pregnancies were used, including 1,212 pregnancies exposed to duloxetine. Duloxetine-exposed women had an increased hazard ratio (HR) for spontaneous abortions compared with SSRI-exposed women: propensity score matched HR 1.25 [95% confidence interval (CI), 1.00-1.57]. No increased hazard was observed for duloxetine-exposed women compared with duloxetine non-exposed: 1.08 (95% CI 0.89-1.31); venlafaxine-exposed: 1.08 (95% CI 0.82-1.41); and duloxetine discontinuers: 0.99 (95% CI 0.76-1.30). An increased HR of elective abortions was observed in duloxetine-exposed women compared to duloxetine non-exposed: 1.41 (95% CI 1.25-1.59); SSRI-exposed: 1.32 (95% CI 1.15-1.51); and duloxetine discontinuers: 1.46 (95% CI 1.23-1.75), but not to venlafaxine-exposed women: 1.09 (95% CI 0.93-1.27).
CONCLUSION
There was no increased risk of spontaneous or elective abortion associated with exposure to duloxetine. The increase risk observed for women exposed to duloxetine in comparison with SSRI-exposed for spontaneous and in comparison with all groups (except venlafaxine-exposed) for elective abortion suggested confounding.
PubMed: 34008161
DOI: 10.1007/s40801-021-00252-9 -
Fertility and Sterility Mar 2023To define the decidual microenvironment in euploid and aneuploid missed abortions and elective termination of pregnancies. (Observational Study)
Observational Study
OBJECTIVE
To define the decidual microenvironment in euploid and aneuploid missed abortions and elective termination of pregnancies.
DESIGN
Prospective, multicenter, observational study.
SETTING
Tertiary hospital and descriptive analysis of transcriptomic data.
PATIENT(S)
A total of 34 patients experienced abortions, including 6 women who underwent elective terminations of pregnancy of unplanned pregnancies and 28 cases with missed abortions. All patients underwent their operations from Sep, 2021 to Sep, 2022.
INTERVENTION(S)
All women underwent villous copy number variation sequencing. Meanwhile, single-cell RNA sequencing were performed in the decidual tissues of 16 women, and reverse transcription quantitative polymerase chain reaction were performed in the decidual tissues of 18 women.
MAIN OUTCOME MEASURE(S)
Single-cell RNA sequencing was used to explore the changes in the microenvironment of decidual tissues in abortions.
RESULT(S)
Single-cell RNA sequencing indicated that the microenvironment of the decidual tissue of the missed-abortion group was altered, and that the stromal cells (SCs), natural killer cells, macrophages, and epithelial cells all reflected functional imbalances compared with the elective terminations of pregnancy group. We also noted a correlation between the proportion of senescent SCs and chromosomal abnormalities in missed-abortion embryos. The proportion of senescent decidual SCs in the decidual tissue of missed-abortion patients with common chromosomal abnormalities of the fetus was higher, and this was not conducive to fetal growth and was closely related to missed abortion. In addition, we ascertained that the strength of the HLA-KIR interaction between NK1 and NK2 subsets and non-senescent stromal cell subsets in the missed abortion decidual tissues was weakened, potentially playing a role in the occurrence of missed abortion.
CONCLUSION(S)
The decidualization of SCs in the missed-abortion decidual tissues was impaired, the clearance of senescent SCs by NK cells was weakened, the killing toxicity of non-senescent SCs was enhanced, macrophages were insufficiently resident at the maternal-fetal interface, and epithelial cell differentiation was unbalanced-all creating a maternal microenvironment that was not conducive to fetal growth. We posit that interfering with the expression of dysregulated genes in the missed-abortion decidual tissues and reversing the maternal microenvironment might constitute an effective means toward improving the clinical outcome of missed abortions. Intriguingly, we observed a correlation between stromal cell senescence and embryonic chromosomal abnormalities. Thus, we hypothesize that the DIO2 marker of senescent SCs can be used as a risk indicator for the occurrence of missed miscarriages with chromosomal abnormalities of the embryos, and that it can be applied to guide the clinical diagnosis and treatment of recurrent abortion.
CLINICAL TRIAL REGISTRATION NUMBER
NCT04425317.
Topics: Female; Humans; Pregnancy; Abortion, Habitual; Abortion, Missed; Chromosome Aberrations; Decidua; DNA Copy Number Variations; Prospective Studies; Iodothyronine Deiodinase Type II
PubMed: 36528108
DOI: 10.1016/j.fertnstert.2022.12.016 -
Family Medicine Oct 2019The role of training in the declining rate of family physicians' provision of women's reproductive health care is unclear. No requirements for abortion training exist,...
BACKGROUND AND OBJECTIVES
The role of training in the declining rate of family physicians' provision of women's reproductive health care is unclear. No requirements for abortion training exist, and curricula vary widely. This study assessed the impact of program-level abortion training availability on graduates' feelings of training adequacy and their postgraduate practice in reproductive health.
METHODS
We conducted secondary analysis of graduate survey data from 18 family medicine residency programs in the Northwest categorized by whether or not their program routinely offered abortion training (opt out or elective rotation). We used bivariate analyses and logistic regression to compare groups on preparation for training and current clinical practice of women's health procedures.
RESULTS
Six of 18 programs included in the study had routinely available abortion training for graduates (N=408). In bivariate analysis, these programs with routine abortion training had significantly more graduates who report feeling prepared to perform abortions (19% vs 10%; P=.01), but no difference in likelihood to provide abortion care postresidency compared to programs without routine abortion training. In adjusted analyses, graduates of programs with routine abortion training were significantly less likely to feel prepared for performing colposcopies (OR=0.45, 95% CI, 0.26-0.78; P<.01) and to actually perform them in practice (OR=0.32, 95% CI, 0.18-0.57; P<.001); all other differences are attenuated.
CONCLUSIONS
Program-level abortion training alone is not enough to overcome the systems- and individual-level barriers to increasing the numbers of trained family medicine residency graduates who provide abortion care and other reproductive care in practice. More must be done to create opportunities for family physicians interested in providing full-spectrum care in their postgraduate practices to be able to do so.
Topics: Abortion, Induced; Curriculum; Family Practice; Female; Humans; Internship and Residency; Male; Physicians, Family; Reproductive Health Services; Surveys and Questionnaires; United States
PubMed: 31596932
DOI: 10.22454/FamMed.2019.219951 -
BMC Pregnancy and Childbirth Jul 2017Elective abortions show a secular decline in high income countries. That general pattern, however, may mask meaningful differences-and a potentially rising trend-among...
BACKGROUND
Elective abortions show a secular decline in high income countries. That general pattern, however, may mask meaningful differences-and a potentially rising trend-among age, income, and other racial/ethnic groups. We explore these differences in Denmark, a high-income, low-fertility country with excellent data on terminations and births.
METHODS
We examined monthly elective abortions (n = 225,287) from 1995 to 2009, by maternal age, parity, income level and mother's country of origin. We applied time-series methods to live births as well as spontaneous and elective abortions to approximate the denominator of pregnancies at risk of elective abortion. We used linear regression methods to identify trend and seasonal patterns.
RESULTS
Despite an overall declining trend, teenage women show a rising proportion of pregnancies that end in an elective termination (56% to 67%, 1995 to 2009). Non-Western immigrant women also show a slight increase in incidence. Heightened economic disadvantage among non-Western immigrant women does not account for this rise. Elective abortions also show a sustained "summer peak" in June, July and August. Low-income women show the most pronounced summer peak.
CONCLUSIONS
Identification of the causes of the increase over time in elective abortion among young women, and separately among non-Western immigrant women, represents key areas of further inquiry. The unexpected increase over time in elective abortions among teens and non-Western immigrants in Denmark may signal important social and cultural impediments to contraception. The summer peak in abortions among low-income women, moreover, conflicts with the conventional assumption that the social and demographic composition of mothers who electively end their pregnancy remains stable within a calendar year.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Denmark; Emigrants and Immigrants; Female; Humans; Income; Lebanon; Live Birth; Maternal Age; Pakistan; Parity; Pregnancy; Seasons; Somalia; Turkey; Young Adult; Yugoslavia
PubMed: 28676084
DOI: 10.1186/s12884-017-1397-2 -
Frontiers in Psychology 2020There are two types of voluntary interruption of pregnancy: elective and therapeutic abortion. These forms are different for many reasons, and it is reasonable to assume...
BACKGROUND
There are two types of voluntary interruption of pregnancy: elective and therapeutic abortion. These forms are different for many reasons, and it is reasonable to assume that they can have negative consequences that can last until a subsequent gestation. However, no study has analyzed the psychological experience of gestation after a previous abortion, distinguishing the two forms of voluntary interruption of pregnancy.
OBJECTIVE
This study aims to explore the level of prenatal attachment and centrality of pregnancy in nulliparous low-risk pregnant women with a recently (<3 years) previous elective or therapeutic abortion.
METHODS
A total of 34 nulliparous pregnant women with a history of abortion (23 elective and 11 therapeutic abortion), aged from 27 to 48 years (mean = 37.17), were recruited in the maternity ward of a public hospital of the metropolitan area of Tuscany and Lombardy (Italy) during the third trimester of gestation. The participants filled out a battery of questionnaires aimed at assessing prenatal attachment and centrality of pregnancy.
RESULTS
Analyses of variance showed that women with a history of elective abortion reported a higher centrality of pregnancy than women with a past therapeutic abortion. On the contrary, women with a past therapeutic abortion reported higher prenatal attachment.
CONCLUSION
Elective and therapeutic abortions are different experiences that impact the way women experience a subsequent pregnancy. Future research should further investigate the psychological experience of gestation after abortion.
PubMed: 33424718
DOI: 10.3389/fpsyg.2020.607879 -
Journal of Pregnancy 2010The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic...
The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic Stress Disorder (PTSD) symptoms after controlling for socio-demographic and personal history variables. Online surveys were completed by 374 women who experienced either a 1st trimester abortion (up to 12 weeks gestation) or a 2nd or 3rd trimester abortion (13 weeks gestation or beyond). Most respondents (81%) were U.S. citizens. Later abortions were associated with higher Intrusion subscale scores and with a greater likelihood of reporting disturbing dreams, reliving of the abortion, and trouble falling asleep. Reporting the pregnancy was desired by one's partner, experiencing pressure to abort, having left the partner prior to the abortion, not disclosing the abortion to the partner, and physical health concerns were more common among women who received later abortions. Social reasons for the abortion were linked with significantly higher PTSD total and subscale scores for the full sample. Women who postpone their abortions may need more active professional intervention before securing an abortion based on the increased risks identified herein. More research with diverse samples employing additional measures of mental illness is needed.
Topics: Abortion, Induced; Adult; Analysis of Variance; Child; Child Abuse, Sexual; Crime Victims; Decision Making; Domestic Violence; Female; Gestational Age; Health Status; Humans; Logistic Models; Mental Health; Pregnancy; Pregnancy Trimesters; Sexual Partners; Stress Disorders, Post-Traumatic; Surveys and Questionnaires
PubMed: 21490737
DOI: 10.1155/2010/130519 -
The Linacre Quarterly Aug 2013It was quoted recently in the literature that "The risk of death associated with childbirth is approximately 14 times higher than with abortion." This statement is... (Review)
Review
It was quoted recently in the literature that "The risk of death associated with childbirth is approximately 14 times higher than with abortion." This statement is unsupported by the literature and there is no credible scientific basis to support it. A reasonable woman would find any discussion about the risk of dying from a procedure as material, i.e., important and significant. In order for the physician-patient informed consent dialogue to address this critical issue, the physician must rely upon objective and accurate information concerning abortion. There are numerous and complicated methodological factors that make a valid scientific assessment of abortion mortality extremely difficult. Among the many factors responsible are incomplete reporting, definitional incompatibilities, voluntary data collection, research bias, reliance upon estimations, political correctness, inaccurate and/or incomplete death certificate completion, incomparability with maternal mortality statistics, and failing to include other causes of death such as suicides. Given the importance of this disclosure about abortion mortality, the lack of credible and reliable scientific evidence supporting this representation requires substantial discussion.
PubMed: 30083002
DOI: 10.1179/2050854913Y.0000000004 -
AMA Journal of Ethics Dec 2018In abortion care, the term "elective" is often used as a moral judgment that determines which patients are entitled to care. Secular health care organizations that...
In abortion care, the term "elective" is often used as a moral judgment that determines which patients are entitled to care. Secular health care organizations that attempt to avoid controversy by allowing "therapeutic" but not "elective" abortions are using medical terminology to reinforce regressive social norms concerning motherhood and women's sexuality because what distinguishes pregnant women with medical indications for abortion is that they originally wanted to become mothers or, in cases of rape, that they did not consent to sex. Secular health care organizations should stop denying the moral agency of patients and physicians who conclude abortion is morally acceptable and should only use the word when billing codes require it. Regardless of reason, the proper label for all abortion is health care.
Topics: Abortion, Induced; Adult; Female; Humans; Mothers; Pregnancy; Pregnant Women; Stereotyping; Terminology as Topic
PubMed: 30585581
DOI: 10.1001/amajethics.2018.1175