Objective : To demonstrate the effectiveness of medication abortion with the implementation of telemedicine and a no-test protocol in response to the COVID-19 pandemic. Study design : This is a retrospective cohort study of patients who had a medication abortion up to 77 days gestation at the University of Hawai‘i between April and November 2020. Patients had the option of traditional in clinic care or telemedicine with either in clinic pickup or mailing of medications. During this time, a no-test protocol for medication abortion without prior labs or ultrasound was in place for eligible patients. The primary outcome was the rate of successful medication abortion without surgical intervention. Secondary outcomes included abortion-related complications. Results : A total of 334 patients were dispensed mifepristone and misoprostol, 149 (44.6%) with telemedicine with in-person pickup of medications, 75 (22.5%) via telemedicine with medications mailed, and 110 (32.9%) via traditional in person visits. The overall rate of complete medication abortion without surgical intervention was 95.8%, with success rates of 96.8, 97.1, and 93.6% for the clinic pickup, mail, and clinic visit groups, respectively. Success for those without an ultrasound performed prior to the procedure was 96.6%, compared to 95.5% for those with ultrasound. We obtained follow up data for 87.8% of participants. Conclusions : Medication abortion was safe and effective while offering multiple modes of care delivery including telemedicine visits without an ultrasound performed prior to dispensing medications. Implications : Incorporating telemedicine and a no-test protocol for medication abortion is safe and has the potential to expand access to abortion care. All care models had low rates of adverse events, which contradicts the idea that the Risk Evaluation and Mitigation Strategy increases the safety of medication abortion.
BackgroundFish consumption is common among the cultures of Hawaii, and given public health attention to mercury exposure in pregnancy, it is important to better understand patterns of fish consumption and mercury in pregnancy. This study examined the influence of maternal fish consumption during pregnancy on umbilical cord mercury (Hg) concentrations in a multiethnic cohort of women in Hawaii.MethodsThis secondary analysis of a prospective cohort pilot study examined antenatal seafood consumption and neonatal outcomes in Hawaii. The first 100 eligible women who consented were enrolled. After delivery, umbilical cord blood and a dietary survey were obtained.ResultsMost women (86%) consumed seafood during the month prior to delivery. Overall, 9% of women consumed more than the recommended limit of 12 ounces/week. Seafood consumption varied significantly by ethnicity and income, with 30% of poor women consuming more than the recommended limit. Seafood consumption did not vary by age or education.Umbilical cord blood Hg levels were 5 μg/L or more in 44% of women. Filipina were significantly less likely to have elevated Hg levels compared with non- Filipina (p < .05). Mercury levels did not vary by other demographic characteristics.Women reporting consumption exceeding 12 ounces fish per week were significantly more likely to have cord blood Hg levels of 5 μg/L or more, but mean Hg concentrations were not significantly higher (6.1 ± 3.3 v 5.0 ± 3.7). The odds ratio for elevated Hg, however, was significant among seafood-consumers compared with non-consumers (5.7; 95% confidence interval: 1.2, 27.1).ConclusionsDespite Environmental Protection Agency (EPA) guidelines, a significant portion of pregnant women consumed more than the recommended amount of seafood, which was associated with race and income. Further, almost half of study participants had cord blood Hg concentrations at or exceeding 5 μg/L.
OBJECTIVE: To evaluate whether prophylactic pregabalin reduces the level of maximum pain experienced with mifepristone-misoprostol medical abortion. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial of women initiating a medical abortion up to 70 days of gestation. After taking mifepristone, participants were randomized to a capsule of pregabalin 300 mg or a matched placebo to be taken at the time of buccal misoprostol. All participants were dispensed ibuprofen and oxycodone with acetaminophen as additional analgesia to be taken as needed. Electronic surveys were sent via text message link at six time points over 72 hours to assess the primary outcome of maximum pain, as well as secondary outcomes such as analgesic use and adverse effects. RESULTS: From June 2015 to October 2016, 110 women were randomized to receive 300 mg of pregabalin or a matched placebo. Demographic characteristics were similar between groups. The primary outcome of maximum pain score in the pregabalin group was 5.0 versus 5.5 in the placebo group (standard deviations 2.6 and 2.2, respectively; p=0.32). More participants in the pregabalin group did not need additional analgesia. No ibuprofen was taken by 27% of the pregabalin group versus 12% placebo (p=0.04). No oxycodone with acetaminophen was taken by 69% of the pregabalin group versus 50% placebo (p=0.04). Satisfaction scores for the abortion process were highest in the pregabalin group (very satisfied: 41% versus 22%; p=0.03), as were satisfaction scores for the analgesic regimen (very satisfied: 47% versus 22%; p=0.006). CONCLUSION: Maximum pain scores were not significantly different between the pregabalin and placebo groups, though women who received pregabalin were less likely to require any iv ibuprofen or oxycodone with acetaminophen, and were more likely to report higher satisfaction scores.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.