Exploring best practices for transitioning to outpatient miscarriage management

Exploring best practices for transitioning to outpatient miscarriage management

Abstracts / Contraception 90 (2014) 298–351 P24 EXPLORING BEST PRACTICES FOR TRANSITIONING TO OUTPATIENT MISCARRIAGE MANAGEMENT Fuentes L Ibis Reprod...

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Abstracts / Contraception 90 (2014) 298–351

P24 EXPLORING BEST PRACTICES FOR TRANSITIONING TO OUTPATIENT MISCARRIAGE MANAGEMENT Fuentes L Ibis Reproductive Health, Oakland, CA, USA Dennis A, Douglas-Durham E, Grossman D Objectives: Many women experience miscarriage in their lifetime. Though miscarriage can safely be managed expectantly, medically or surgically in a variety of outpatient settings, it is most often treated surgically in an operating room. We aimed to understand the facilitators and barriers to providing comprehensive miscarriage care in a variety of clinical settings and to identify best practices for moving toward a model of outpatient, comprehensive care. Methods: We conducted 30 in-depth interviews with staff at 15 facilities. Interviews were conducted with staff who had a range of responsibilities at a variety of facility types. All interviews were recorded, transcribed and then coded in Atlas.ti. Data were analyzed using framework analysis methods. Results: Successful transitions to outpatient miscarriage management occurred in settings with one or more “champions” with previous training and exposure to outpatient aspirations; organized education or training about the advantages and procedures of outpatient aspirations; and, in the case of emergency-department-based aspirations, good relationships with emergency department attending physicians and staff. These key factors helped address common misgivings about the prospect of transitioning miscarriage care in facilities that had only an operating room option, including perceptions that outpatient aspirations for miscarriage are complicated, time consuming and stressful for patients. Conclusions: Our findings provide insights into how miscarriage care is handled and possible methods of expanding the scope of care offered. Quantitative work is needed to understand the prevalence of barriers and facilitators to offering comprehensive miscarriage management. Evidencebased interventions can then be implemented to ensure women have access to compressive care.

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Results: There was no difference at recruitment in the health and development of existing children by study group. However, over 3.5 years following receipt or denial of abortion, the trajectories of well-being of the two groups of children diverged. Preliminary data showed lower indicators of child development among children whose mothers carried an unwanted pregnancy to term than children whose mother received the abortion. Additional analyses will examine bonding, health and caregiving. Conclusions: This analysis indicates that the introduction of an unwanted sibling may have effects that redound upon existing children’s health, development and well-being.

http://dx.doi.org/10.1016/j.contraception.2014.05.046

P26 CHANGES IN ABORTION STATISTICS IN TEXAS AFTER ENFORCEMENT OF THE TWO-VISIT REQUIREMENT Grossman D Ibis Reproductive Health, Oakland, CA, USA White K, Hopkins K, Potter JE

EFFECT OF AN UNWANTED PREGNANCY CARRIED TO TERM ON EXISTING CHILDREN’S HEALTH, DEVELOPMENT AND CARE

Objectives: In October 2011, Texas enforced legislation requiring an additional visit for an ultrasound at least 24 h before an abortion. This analysis examines changes in abortion statistics after this law went into effect. Methods: We analyzed state-level data on abortions performed on Texas residents in 2011 and 2012 and compared the change in the number of abortions with historical trends using a Poisson regression model. For 2011 and 2012, we also compared the number of abortions performed on women younger than 18, and by gestational age and procedure type. Results: In 2011, 70,003 abortions were performed on Texas residents, compared with 66,098 in 2012, a decline of 5.6%. This was a significantly steeper decrease in the annual number of abortions compared with that observed between 2008 and 2011 (3.4%, pb.001). Abortions among women younger than 18 declined 17.8% between 2011 and 2012 (from 2326 to 1911, pb.001). While abortions performed at less than 12 weeks declined 6.2%, abortions that occurred after 13 weeks increased 1.9% between 2011 and 2012 (from 5109 to 5204, pb.001). Surgical abortion declined 7.9%, while medical abortion increased 0.9% between 2011 and 2012 (from 18,164 to 18,335, pb.001). Changes in county-level abortion rates will also be presented. Conclusions: After the two-visit requirement was enforced, there was a steep decline in the number of abortions, particularly among teens. Given the simultaneous cuts in family planning funding, it is unlikely these changes were due to improved contraceptive use. There was also a relative increase in second-trimester abortion. The relative increase in medical abortion mirrors national trends.

D Greene Foster University of California San Francisco, San Francisco, CA, USA

http://dx.doi.org/10.1016/j.contraception.2014.05.047

http://dx.doi.org/10.1016/j.contraception.2014.05.045

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Objectives: The most common reason women give for seeking an abortion is that they cannot afford a(nother) child. The majority of American women having abortions are already mothers; about one third of women seeking an abortion say that their reason for terminating this pregnancy is the desire to care for children they already have. Considering both the anticipated reductions in caregiving ability and increases in poverty that accompany the introduction of an unintended child to a family, the effects on existing children may be significant. Methods: We used data from the prospective longitudinal Turnaway Study, which follows women on both sides of the gestational limit of 30 abortion facilities across the country. We compared trends in child development, health and caregiving for existing children younger than 5 among two groups of women: women who received an abortion just prior to the limit (n=224 children) and women who were just beyond the limit and carried the pregnancy to term (n=83 children).

P27 SAFETY OF FIRST-TRIMESTER UTERINE EVACUATION IN THE OUTPATIENT SETTING FOR WOMEN WITH COMMON CHRONIC CONDITIONS Guiahi M University of Colorado Anshutz Medical Center, Aurora, CO, USA McCormick G, Sheeder J, Teal S Objectives: A factor that limits abortion access is providers’ concern over women’s baseline medical conditions. We compared the safety of outpatient first-trimester uterine evacuation between women with medical comorbidities and healthy peers.