psychological distress levels during surgical management of first-trimester undesired or failed pregnancy under local anesthesia. Methods: Women were randomized to receive doula support or routine care during office manual vacuum aspiration (MVA). The primary outcome was pain score measured on a 100-mm visual analog scale. Secondary outcomes included satisfaction, validated psychometric scores and women's sense of personal empowerment postprocedurally. Data were collected prior to, immediately following and 1 month following the procedure. Results: The sample consisted of 70 women. While levels of reported pain did not differ between the doula and control groups (70.7±24.5 mm vs. 59.7±32.5 mm, p=.11, respectively), women who received doula support experienced a statistically significant decrease in postprocedure anxiety after we controlled for baseline anxiety (OR, − 11.6; 95% CI, − 22.9 to − 0.2; p= .04). Relief was the most common emotion reported by 60% of women in both groups, regardless of procedure indication. There was no significant difference between groups regarding satisfaction with the procedure (86.2%±23.4 vs. 93.4%±13.5, p=.12), a sense of empowerment (0.11%± 0.31 vs. 0.12%±0.30, p=.93) and perceived ability to cope following the procedure (36.3%±28.1 vs. 42.0%±27.1, p=.39). Of women who received doula support, 97% reported that this was beneficial and that they would recommend a doula to other women having such a procedure. Outcomes: Doula support during office MVA for undesired or failed pregnancies is well received and may address unmet psychosocial needs of women undergoing this procedure.
INTRODUCTION:
Twelve percent of elective abortions are performed during the second trimester despite increased cost and morbidity. As health insurance is a major factor affecting abortion access nationally, we assessed risk factors associated with elective second trimester abortion among a well-insured population of women.
METHODS:
This IRB approved retrospective cohort study of women who obtained second trimester abortions at Kaiser Permanente Northern California (KPNC) between 2015 and 2016 used electronic medical records to identify the cohort and elective vs non-elective abortion indication, early (<16 weeks) vs late (≥16 weeks) second trimester abortion status, and demographic and clinical characteristics. Data were analyzed using descriptive and bivariate analyses.
RESULTS:
Of the 400 procedures randomly reviewed, 197 (49%) were performed in the second trimester, and of these, 95 (48%) were elective. Elective procedures were more likely to occur earlier in the second trimester (P<.0446). The mean age (standard deviation) of women undergoing an elective procedure was significantly younger at 26.5 (7.0) vs 33.5 years (5.7) (P<.0001). Women with a prior abortion were more likely to undergo an elective procedure (P<.0136). There were variations in elective status according to race/ethnicity (P<.0001); Black women were more likely to have an elective abortion. There were no differences in elective status according to gravidity, parity, history of irregular menses, or body mass index.
CONCLUSION:
Women who had a prior abortion, were younger, or Black were more likely to undergo elective termination. Further analyses are needed to identify factors independently linked to second trimester elective abortion in an insured population.
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