No abstract

In the aftermath of the Supreme Court’s Dobbs vs. Jackson Women’s Health decision, acute care surgeons face an increased likelihood of seeing patients with complications from both self-managed abortions and forced pregnancy in underserved areas of reproductive and maternity care throughout the USA. Acute care surgeons have an ethical and legal duty to provide care to these patients, especially in obstetrics and gynecology deserts, which already exist in much of the country and are likely to be exacerbated by legislation banning abortion. Structural inequities lead to an over-representation of poor individuals and people of color among patients seeking abortion care, and it is imperative to make central the fact that people of color who can become pregnant will be disproportionately affected by this legislation in every respect. Acute care surgeons must take action to become aware of and trained to treat both the direct clinical complications and the extragestational consequences of reproductive injustice, while also using their collective voices to reaffirm the right to abortion as essential healthcare in the USA.

For many transgender individuals, pursuing gender-affirming surgery (GAS) to minimize gender incongruencecommonly referred to as gender dysphoria-is a medically necessary element of comprehensive genderaffirming health care. Patients who undergo GAS report high postoperative satisfaction rates, and research indicates that GAS improves quality of life and emotional well-being, and eases gender dysphoria. This article is 1 of several articles in the current issue, summarizing the available surgical interventions for alleviating gender incongruence among transgender patients. This part briefly reviews and examines surgical aspects of masculinizing GAS for transmasculine patients.

INTRODUCTION: We compared the frequency of complications for dilation and evacuation (D&E) and induction of labor (IOL) for treatment of second-trimester intrauterine fetal demise (IUFD). METHODS: We performed a retrospective cohort study of women with an IUFD between 14-24 weeks who underwent D&E or IOL at a university hospital between June 2009 and June 2019. We defined complications a priori as: 1) infection, 2) uterine atony, 3) retained products of conception, 4) hemorrhage, 5) uterine perforation (D&E only), 6) uterine aspiration (IOL only), 7) cervical laceration (D&E only), 8) uterine rupture, 9) unplanned admission, 10) readmission within 14 days, 11) blood transfusion, 12) intensive care unit admission, 13) removal or injury to an organ, 14) uterine rupture, 15) cardiopulmonary arrest, 16) any other unplanned surgery, and 17) death. We also assessed a composite of major complications, defined as complications 8-17. We assessed differences in composite complication frequency with chi-squared and Fisher’s exact tests. RESULTS: Of the 119 women who met inclusion criteria, 41 underwent D&E and 78 underwent IOL. In our preliminary analysis, 29.2% (12/41) women in the D&E group and 24.4% (19/78) in the IOL group (P=.56) experienced any complication. No women in the D&E group experienced a major complication and 3 women in the IOL group experienced a major complication (3.8%, P=.55). CONCLUSION: D&E and IOL had comparable complication rates for women in our study. Patients should be offered both options in the treatment of a second-trimester IUFD.

INTRODUCTION:The human papillomavirus (HPV) vaccine is an important component of comprehensive sexual and reproductive health care and has the potential to completely eradicate cervical cancer. However, many women make it to adulthood without receiving a single vaccine. The abortion visit is an important health care access point for high-risk, unvaccinated individuals.METHODS:Patients (N=20) were recruited from the waiting room at a Chicago Planned Parenthood. Phase 1 included participants completing a 29-question assessment on HPV knowledge, HPV testing, and HPV vaccination. Phase 2 consisted of a randomized control trial of English-speaking patients, aged 18–26, presenting for a medication abortion (N=50). Primary outcome was uptake of vaccine; secondary was HPV knowledge via the same knowledge assessment tool used in phase 1. Patients were randomized to the interventional video or “usual care.” All patients were offered an HPV vaccine during medication abortion counseling.RESULTS:Knowledge scores significantly improved from preintervention (0.68 [±0.06]) to postintervention (0.77±0.05) (P=.03). Patients from the video intervention group demonstrated higher vaccine uptake (16%) compared to the “usual-care” group (0%) (P=.04). HPV knowledge assessment was significantly different between arms, with usual-care patients scoring 60% versus video intervention patients at 72%.CONCLUSION:There was significant improvement in knowledge assessment scores and vaccine uptake among the video intervention group. Video education is an effective tool in increasing HPV knowledge and uptake.