Adjuvant misoprostol or mifepristone for cervical preparation with osmotic dilators before dilation and evacuation.

OBJECTIVES: This study aimed to compare effectiveness and safety of cervical preparation with osmotic dilators plus same-day misoprostol or overnight mifepristone prior to dilation and evacuation (D&E). STUDY DESIGN: We conducted a retrospective cohort analysis of 664 patients initiating abortion between 18 and 22 weeks at an ambulatory health center. We abstracted medical record data from two consecutive 12-month periods in 2017 to 2019. All patients received overnight dilators plus: 600 mcg buccal misoprostol 90 minutes before D&E (period 1); 200 mg oral mifepristone at time of dilators (period 2). Our primary outcome was procedure time. We report frequency of patients experiencing any acute complication, defined as unplanned procedure (i.e., reaspiration, cervical laceration repair, uterine balloon tamponade) or hospital transfer and bleeding complications. RESULTS: We observed higher mean procedure time in the mifepristone group (9.7 ± 5.3 minutes vs 7.9 ± 4.4, p = 0.004). After adjusting for race, ethnicity, insurance, body mass index, parity, prior cesarean, prior uterine surgery, gestational age, provider, trainee participation, and long-acting reversible contraception initiation, the difference remained statistically significant (relative change 1.09, 95% CI 1.01, 1.17) but failed to reach our threshold for clinical significance. The use of additional misoprostol was more common in the mifepristone group, but the use of an additional set of dilators was not different between groups. Acute complications occurred at a frequency of 4.1% in misoprostol group and 4.3% in mifepristone group (p = 0.90). CONCLUSIONS: We found procedure time to be longer with adjunctive mifepristone compared to misoprostol; however, this difference is unlikely to be clinically meaningful. Furthermore, the frequency of acute complications was similar between groups. IMPLICATIONS: Overnight mifepristone at the time of cervical dilator placement is a safe and effective alternative to adjuvant same-day misoprostol for cervical preparation prior to D&E and may offer benefits for clinic flow and patient experience.

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review.

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Intimate Partner Violence Among Sexual Minority Women: A Scoping Review.

Intimate partner violence (IPV) is prevalent among sexual minority women (SMW). However, compared to IPV research with heterosexual women and other LGBTQ+ population groups, SMW are understudied. We conducted a scoping review to examine the current state of knowledge about IPV among SMW, and to identify gaps and directions for future research. A search of Medline, Embase, CINAHL, and PsycINFO databases returned 1,807 papers published between January 2000 and December 2021. After independent reviewers screened these papers for relevance, 99 were included in the final review. Papers were included if they used quantitative methods and reported IPV data on adult SMW separately from other groups. Findings confirmed high rates of IPV among SMW and highlighted groups with particular vulnerabilities, including non-monosexual women and SMW of color. Risk factors for IPV in this population include prior trauma and victimization, psychological and emotional concerns, substance use, and minority stressors. Outcomes include poor mental and physical health. Findings related to the effects of minority stressors on IPV and comparisons across sexual minority groups were inconsistent. Future research should focus on IPV perpetration; mechanisms underlying risk for IPV, including structural-level risk factors; and understanding differences among SMW subgroups.

Same-Day Compared With Overnight Cervical Preparation Before Dilation and Evacuation Between 16 and 19 6/7 Weeks of Gestation: A Randomized Controlled Trial.

We performed a double-blind, placebo-controlled, randomized noninferiority trial to compare same-day osmotic dilators plus misoprostol with overnight osmotic dilators alone for cervical preparation before dilation and evacuation (D&E) between 16 0/7 and 19 6/7 weeks of gestation. The primary outcome was procedure time. The study was halted early owing to poor accrual. However, the median procedure time was 5.7 minutes in the same-day group compared with 4.2 minutes in the overnight group. The median absolute difference in procedure time was 1.5 minutes, which corresponded to a 35% increase in procedure time (relative difference 35%, one-sided 95% CI -Inf to 52%). Same-day cervical preparation with osmotic dilators plus buccal misoprostol before D&E may be a timely option. Clinical Trial Registration: ClinicalTrials.gov, NCT03002441.

Unintended and teen pregnancy experiences of trans masculine people living in the United States.

BACKGROUND: Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities. AIMS: This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs. METHODS: As a part of the United States-based SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth, semi-structured interviews were conducted between March 2017 and August 2018 with 10 trans masculine people, ages 20-59 years, who experienced a teen or unintended pregnancy. Audio-recorded interviews were professionally transcribed, then analyzed using immersion/crystallization and thematic analysis approaches. The themes were contextualized using sociodemographic survey data. RESULTS: The four themes that were developed from participants' narratives highlighted: 1) how trans masculine people navigated having a pregnant body (e.g., heightened gender dysphoria due to being pregnant); 2) the importance of the cultural environment in shaping experiences as a trans masculine pregnant person (e.g., pregnancy and gender-related job discrimination); 3) the development of the pregnancy over time (e.g., decision-making processes); and 4) how pregnancy (and gender identity) affected relationships with other people (e.g., adverse family of origin experiences). DISCUSSION: This study identified a number of risk factors for teen and unintended pregnancies among trans masculine people including physical and sexual abuse as well as ineffective use of contraception. This research also identifies unique needs of this population, including: relieving gender dysphoria, combating discrimination, and ensuring people feel visible and welcome, particularly in reproductive healthcare spaces. Public health practitioners, healthcare providers, and support networks (e.g., chosen family) can be key sources of support. Attention to risk factors, unique needs, and sources of support will improve reproductive healthcare and pregnancy experiences for trans masculine people.

The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners.

BACKGROUND: Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. OBJECTIVE: Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. METHODS: This United States National Institutes of Health-funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study-a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner's minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner's minority stress, hazardous drinking, and IPA perpetration. RESULTS: Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. CONCLUSIONS: The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28080.

Acceptance of HPV vaccination at the abortion visit at a clinic in New York City in 2017 to 2018.

OBJECTIVES: Human Papillomavirus vaccination remains a public health concern. Our primary objective was to examine whether eligible people, in an underimmunized population, seeking abortion find the abortion visit an acceptable opportunity to receive the Human Papillomavirus (HPV) vaccine. Our secondary objectives include comparing vaccine acceptors to vaccine decliners on knowledge and attitudinal factors related to the HPV vaccine. STUDY DESIGN: We conducted a cross sectional study in which we offered free HPV vaccine series initiation and completion to eligible patients presenting for abortion services at an outpatient health center. We administered surveys to both vaccine acceptors and decliners, to assess utilization of health services, knowledge of the HPV vaccine, and reasons for not having initiated or completed the vaccine series previously. RESULTS: 101 study participants were offered HPV vaccination; 50 participants accepted and 51 participants declined. All participants completed the survey. Seven of fifty vaccine acceptors completed the vaccine series. Vaccine acceptance was associated with new knowledge that HPV causes cervical cancer. (acceptors = 72.0%, decliners = 52.9%, p = 0.05) The most common reason among both groups for not previously initiating the vaccine was "No one offered it to me" (acceptors = 58.0%, decliners = 53.5%, p = 0.46). A considerable number of participants had not previously heard of the HPV vaccine, 44% of those who accepted, and 35.3% of those who declined (p = 0.64) vaccination at the time of their abortion. CONCLUSION: The abortion visit offers an important opportunity to start or to finish the HPV vaccine series. Most patients are receptive to receiving additional services and were never previously offered the HPV vaccine. Practices and policies aimed at utilizing missed opportunities for HPV vaccine catch up can increase HPV vaccine prevalence among young adult women to reduce lifetime risk for cervical cancer. IMPLICATIONS: The abortion visit may be an opportunity for HPV vaccination catch up in an underimmunized population. Abortion providers may consider offering patients other preventive health care services.

Transcutaneous Electrical Nerve Stimulation to Reduce Pain With Medication Abortion: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether high-frequency transcutaneous electrical nerve stimulation (hfTENS) reduces pain during medication abortion. METHODS: We conducted a randomized, placebo-controlled trial. Participants who were undergoing medication abortion with mifepristone and misoprostol through 70 days of gestation either received active 80 Hz hfTENS or sham to use for a minimum of 60 minutes within 8 hours of misoprostol. Maximum pain on an 11-point numerical rating scale at 8 hours after misoprostol was the primary outcome. We estimated 20 per group for 80% power to detect a 2-point difference and up to 10% attrition. Secondary outcomes included a maximum pain score at 24 hours, additional analgesia use, the difference in score before and after treatment, the experience of side effects, abortion outcomes, and acceptability. We collected data at baseline, time of misoprostol (0-hour), 8-hour and 24 hours using real-time electronic surveys, and at follow-up. RESULTS: Between June 2019 and March 2020, we screened 251 patients and randomized 40-20 each to hfTENS or sham-with one postrandomization exclusion and two patients lost to follow-up. Baseline characteristics were similar. Median maximum pain scores at 8 hours were 7.0 (interquartile range 3.0) and 10.0 (interquartile range 3.0) for hfTENS and sham, respectively. The distribution of these scores was lower among hfTENS users compared with sham (mean rank 15.17 vs 22.63, P=.036). High-frequency TENS users also experienced a significant reduction in posttreatment pain score (-2.0 [interquartile range 2.5] vs 0 [interquartile range 1.5], P=.008). We found no statistically significant differences in use of additional analgesia, distribution of maximum pain scores at 24 hours, side effects, or measures of acceptability. CONCLUSION: High-frequency TENS reduced maximum pain scores within 8 hours of misoprostol and reduced pain scores immediately after treatment compared with placebo. High-frequency TENS offers an effective nonpharmacologic option for pain management during medication abortion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03925129.

Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth.

Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.

Dimensions of Sexual Orientation as Predictors of STI-Related Outcomes Among Women: An Examination of 2011-2017 National Survey of Family Growth Data.

Background: To estimate sexual orientation associated disparities in sexually transmitted infection (STI)-related outcomes across multiple dimensions of sexual orientation. Methods: Using pooled 2011-2017 National Survey of Family Growth data (N = 16,854), we performed bivariate and multivariable logistic and multinomial regression analyses to estimate associations between sexual identity, behavior in the past 12 months, and attraction, and past-year STI treatment, receipt of the human papillomavirus (HPV) vaccine, and age at first HPV vaccination in cisgender women. Results: Bisexual-identified women (adjusted odds ratio [AOR] = 1.53, 95% confidence interval [CI] = 1.10-2.14) and who were sexually active with both men and women in the past 12 months (AOR = 1.64, 95% CI = 1.03-2.55) had significantly higher odds of past-year STI treatment, compared with their nonsexual minority counterparts. Lesbian-identified women (AOR = 0.44, 95% CI = 0.27-0.75) and women with female partners only (AOR = 0.32, 95% CI = 0.12-0.87) had significantly decreased odds of having initiated the HPV vaccine compared with their heterosexual counterparts. Women with both male and female partners who initiated the HPV vaccine had significantly higher odds of having received the vaccine during the latest age range, 18-25 years old (AOR = 2.32, 95% CI = 1.21-4.45) compared with women with male partners only. Conclusions: Sexual minority women continue to be at risk for poor sexual health outcomes, and these outcomes differ by specific components of sexual orientation.

Comparing Receipt of Cervical Cancer Screening and Completion of Human Papillomavirus Vaccination Using a New Construct of Sexual Orientation: A Serial Cross-Sectional Study.

Purpose: We assessed differences in receipt of cervical cancer screening and completion of the human papillomavirus (HPV) vaccine series between sexual minority and non sexual minority women by using two sub-constructs of sexual orientation-gender of sexual partners and anatomy of sexual partners. Methods: We employed a serial cross-sectional design by using medical record data from August 2012 through August 2016 from an urban health center to compare receipt of cervical cancer screening and completion of the HPV vaccine series. In Wave 1 of the study, gender of sexual partners was the construct used. In Wave 2 of the study, anatomy of sexual partners was the construct used. Multivariable logistic regression analyses were conducted to determine the odds of being up-to-date on cervical cancer screening and completion of the HPV vaccine series among sexual minority women compared with non sexual minority women, with n = 729 in Wave 1 and n = 740 in Wave 2 of the study. Results: Sexual minority women in Wave 2 were significantly less likely to be up-to-date on cervical cancer screening than non sexual minority women (odds ratio = 0.457, p = 0.012, 95% confidence interval 0.248-0.843). We did not find a statistically significant association between receipt of cervical cancer screening and sexual minority status in Wave 1. No significant association between sexual minority status and completion of the HPV vaccine series was found in either Wave. Conclusion: This study provides important information for clinicians and researchers regarding a disparity in cervical cancer screening practices among sexual minority women, utilizing a novel approach for identifying these women.

An Exploratory Study of Transgender New Yorkers' Use of Sexual Health Services and Interest in Receiving Services at Planned Parenthood of New York City.

Purpose: Transgender individuals experience barriers to healthcare, including discrimination in care provision and lack of knowledge about transgender health. We assessed New York City (NYC) transgender and gender nonconforming individuals' sexual and reproductive health (SRH) needs, access to services, and interest in receiving services from Planned Parenthood of NYC (PPNYC). Methods: We conducted an anonymous Internet-based survey of transgender individuals residing in NYC from September to December 2014 by using snowball sampling. Results: Data were analyzed from 113 surveys. Although 74% (71/96) of respondents avoided or delayed healthcare in the past year, most respondents adhered to medically indicated SRH screenings. In the past year, 64% (45/70) and 67% (46/69) of respondents were tested for HIV and other sexually transmitted infections, respectively. In the past 3 years, 80% (39/49) of respondents received clinical breast/chest examinations and 83% (35/42) of eligible individuals received Pap tests. Respondents most often received care at LGBT specialty clinics (35% [37/105]) or at private doctors' offices (31% [32/105]). Eighteen percent (19/107) had ever been to a Planned Parenthood health center. On a four-point scale, respondents rated the following factors as most influential on whether they would seek care at PPNYC: assurance that staff received transsensitivity training (mean 3.8), the existence of gender identity nondiscrimination policies (mean 3.7), and the availability of transgender-specific services, such as hormone therapy (mean 3.7). Conclusions: Although the majority of transgender individuals in our sample received recommended SRH screenings, respondents reported barriers to accessing needed medical care. Healthcare organizations interested in better serving the transgender community should ensure a high level of training around transsensitivity and explore the provision of transgender-specific services.

Manual compared with electric vacuum aspiration for abortion at less than 6 weeks of gestation: a randomized controlled trial.

OBJECTIVE: To evaluate whether manual or electric vacuum aspiration results in greater immediate confirmation of completed abortion at less than 6 weeks of gestation. METHODS: Five hundred pregnant women presenting for surgical abortion with mean gestational sac diameter of less than 12 mm or no visible sac on ultrasonography were randomized to manual or electric vacuum aspiration. Tissue examination was performed by operating physicians, not blinded to group assignment, and by trained medical assistants, blinded to group assignment. Patients with no products of conception on gross inspection underwent repeat aspiration as necessary and serial human chorionic gonadotropin monitoring. All patients were scheduled for follow-up visits. The primary outcome was detection of products of conception in patients with subsequently confirmed completed abortion. RESULTS: From April 2010 to October 2011, 252 patients were randomized to manual vacuum aspiration and 248 to electric vacuum aspiration. One hundred eighty-two (82%) patients in the manual vacuum aspiration group had products of conception identified and subsequently confirmed completed abortion compared with 164 (76%) patients undergoing electric vacuum patients (P=.13, relative risk 0.83, 95% confidence interval [CI] 0.64-1.07). In pregnancies of sac size 3 mm or less, including no visible sac, five of 29 (17%) patients undergoing manual vacuum aspiration had accurate identification of products of conception compared with four of 31 (13%) patients undergoing electric vacuum aspiration (P=.64, relative risk 0.85, 95% CI 0.44-1.63). Tissue reports of physicians and medical assistants had 90% concordance. Seventy-nine (16%) patients required human chorionic gonadotropin monitoring to confirm completed abortion. There were seven (1.4%) ongoing pregnancies, including four false-positive products of conception results and, among the latter, one presumed ectopic pregnancy. CONCLUSION: Our study supports providing abortions to women who request them before 6 weeks of gestation using either manual or electric vacuum aspiration. Early aspiration is highly effective, although human chorionic gonadotropin monitoring may be necessary to confirm complete abortion. LEVEL OF EVIDENCE: I.

Late termination of pregnancy for lethal fetal anomalies: a national survey of maternal-fetal medicine specialists.

OBJECTIVE: The objective was to ascertain the practices and opinions of US maternal-fetal medicine specialists regarding termination of pregnancy as a management option following late diagnosis of lethal fetal anomalies. STUDY DESIGN: We conducted a cross-sectional mail survey of all US members of the Society of Maternal Fetal Medicine to ascertain how they manage pregnancies diagnosed with lethal fetal anomalies after 24 weeks of gestation. We analyzed the proportion of respondents that discuss termination of pregnancy as a management option, barriers to offering or accessing late termination services, and respondents' opinions about what anomalies are lethal and when pregnancy termination should be permitted. RESULTS: The response rate was 41% (869/2119). Nearly all (93%) respondents discuss delivery near term or when complications arise, while 75% discuss the option of termination of pregnancy soon after the diagnosis of lethal fetal anomalies. Only 52% of the physicians indicated that their patients could obtain termination of pregnancy after 24 weeks at their affiliated medical centers or through providers within 50 miles. Real or perceived legal restrictions represented the most common reason for lack of local services. The proportion of respondents that felt strongly or very strongly that termination of pregnancy should be allowed was 76% for lethal anomalies and 58% for anomalies likely to result in significant long-term impairment. CONCLUSION: Although limited by a modest response rate, our study found that physicians do not consistently discuss immediate termination of pregnancy as an option following late diagnosis of lethal fetal anomalies, and they face numerous barriers to providing these services. IMPLICATIONS: This national survey supports the need for improved services for pregnant women who desire later termination of pregnancy following diagnosis of serious fetal anomalies. Helpful efforts might include educating physicians about the laws and regulations governing late termination of pregnancy, forging more consistent standards of care, and improving collaboration between MFM specialists and family planning providers to enhance access to care.

Prophylactic compared with therapeutic ibuprofen analgesia in first-trimester medical abortion: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of two oral analgesic regimens in first-trimester medical abortion. METHODS: We randomly assigned 250 participants undergoing first-trimester abortion with mifepristone and misoprostol at three clinics to two ibuprofen regimens: therapeutic (800 mg every 4-6 hours as needed for pain) or prophylactic (800 mg starting 1 hour before the misoprostol dose, then every 4-6 hours for 48 hours regardless of pain, then as needed). We asked each participant to record her maximum pain on a scale of 0-10 daily thereafter. RESULTS: Of participants assigned to the prophylactic and therapeutic regimens, 111 of 123 (90%) and 117 of 127 (92%), respectively, provided follow-up data. More than 80% of the participants in each group complied with their assigned treatment. Participants in the prophylactic group used substantially more ibuprofen than those in the therapeutic group (median of nine and four tablets, respectively). The mean maximum pain score was 7.1 in the prophylactic group and 7.3 in the therapeutic group (standard deviations 2.5 and 2.2, respectively); the difference was not statistically significant (P=.87, adjusted for site). Duration of pain, verbal pain ratings reported at follow-up, and use of other analgesics did not differ significantly by group (all P>.05). No significant benefit of the prophylactic regimen was apparent in any population subgroup. Abortion failure and ibuprofen side effects in the two groups were similar. CONCLUSION: We found no evidence that prophylactic administration of ibuprofen reduces pain severity or duration in first-trimester medical abortion. The average pain severity experienced by participants using both regimens was high. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01457521. LEVEL OF EVIDENCE: I.

Safety of digoxin for fetal demise before second-trimester abortion by dilation and evacuation.

BACKGROUND: Digoxin is used to induce fetal demise before dilation and evacuation (D&E) abortion. Published data on the safety of digoxin in abortion care are limited. STUDY DESIGN: We conducted a retrospective cohort study with historical controls at a large family planning center. We reviewed the records of patients at 18 to 24 weeks' gestation who received digoxin before D&E from May 15, 2007 (date the center initiated digoxin use), through March 31, 2008. We also reviewed the records of patients who presented for D&E without digoxin from February 22, 2006, through May 12, 2007. We compared the rates of immediate complications. RESULTS: We included 566 digoxin patients and 513 controls. Eleven spontaneous abortions occurred in the digoxin cohort; none occurred among controls (p<.001). We found 19 cases of infection in the digoxin cohort and three among controls (odds ratio 5.91; 95% confidence interval 1.74-20.07). Eleven digoxin patients were admitted to a hospital after the preoperative visit; no controls were admitted (p<.001). CONCLUSIONS: Patients who received digoxin before D&E were more likely to experience spontaneous abortion, infection and hospital admission than controls who underwent D&E without digoxin.