scholarly journals Perspectives on self-managed abortion among providers in hospitals along the Texas–Mexico border

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Raifman ◽  
Sarah E. Baum ◽  
Kari White ◽  
Kristine Hopkins ◽  
Tony Ogburn ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Termination ◽  
Expectant Management ◽  
Clinical Intervention ◽  
Structured Interviews ◽  
Local Resources ◽  
Provider Experiences ◽  
Study Team ◽  
Mexico Border ◽  
Provider Knowledge

Abstract Background Following self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking. Methods The study team conducted semi-structured interviews with physicians, advanced practice clinicians, and nurses who had experience with patients presenting with early pregnancy complications in emergency and/or labor and delivery departments in five hospitals near the Texas-Mexico border. Interview questions focused on respondents’ roles at the hospital, knowledge of abortion services and laws, perspectives on SMA trends, experiences treating patients presenting after SMA, and potential gaps in training related to abortion. Researchers conducted interviews in person between October 2017 and January 2018, and analyzed transcripts using a thematic analysis approach. Results Most of the 54 participants interviewed said that the care provided to SMA patients was, and should be, the same as for patients presenting after miscarriage. The majority had treated a patient they suspected or confirmed had attempted SMA; typically, these cases required only expectant management and confirmation of pregnancy termination, or treatment for incomplete abortion. In rare cases, further clinical intervention was required. Many providers lacked clinical and legal knowledge about abortion, including local resources available. Conclusions Treatment provided to SMA patients is similar to that provided to patients presenting after early pregnancy loss. Lack of provider knowledge about abortion and SMA, despite their involvement with SMA patients, highlights a need for improved training.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

A medical method of early pregnancy termination using tamoxifen and misoprostol

Contraception ◽  
1998 ◽  
Vol 58 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Daniel R Mishell ◽  
John K Jain ◽  
James D Byrne ◽  
Maria D.C Lacarra
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Termination

scholarly journals Tuberculosis stigma and perceptions in the US-Mexico border

2013 ◽  
Vol 55 (Supl.4) ◽  
pp. 498 ◽  
Author(s):  
Eva M Moya ◽  
Mark W Lusk
Keyword(s):  
Health Care Access ◽  
El Paso ◽  
Structured Interviews ◽  
Care Access ◽  
Tb Treatment ◽  
Related Stigma ◽  
Health Related ◽  
Mexico Border ◽  
Fear Of Rejection ◽  
The Impact

Objective. To examine the experiences and perspectives on the disease and stigma from the vantage point of the persons affected by TB in El Paso, Texas, and Juárez, México to inform research on health-related stigma and interventions. Materials and methods. Semi-structured interviews to study TB-related stigma and the impact on access and healthseeking behaviors with 30 Mexican-origin adults (18 years and older) undergoing TB treatment. Results. Barriers to accessing health services for TB; emotional distress due to their deteriorated physical and emotional condition; reactions ranging from depression, sadness; doubt, anger, and fear of rejection; distancing, fear of contagion, stigma, and feeling of discriminated against, and isolation from loved ones were reported. Conclusion. Stigma associated with TB is a barrier to health care access and to quality of life in tuberculosis management. Stigma adversely shapes the experience of treatment and recovery. Stigma is not a naturally occurring phenomenon, but something created by people and as such it can be “un-done” by those people as part of a collective which comprises society.

scholarly journals Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

2020 ◽  
Vol 9 (8) ◽  
pp. 3144
Author(s):  
Reshma Sajan K. K. ◽  
Mumtaz P. ◽  
Chandrika C. V. ◽  
Abdul Vahab ◽  
Hassan Sheikh Imrana
Keyword(s):  
Success Rate ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
First Line ◽  
Proper Selection ◽  
Fetal Demise ◽  
Incomplete Miscarriage ◽  
Selection Of ◽  
Anembryonic Pregnancy

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

Early Pregnancy Termination

2007 ◽  
pp. 443-457
Author(s):  
Beverly Winikoff ◽  
Batya Elul
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Termination

scholarly journals Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

2020 ◽  
Vol 302 (5) ◽  
pp. 1279-1296
Author(s):  
Anna Fernlund ◽  
Ligita Jokubkiene ◽  
Povilas Sladkevicius ◽  
Lil Valentin
Keyword(s):  
Logistic Regression ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
Treatment Success ◽  
Expectant Management ◽  
Crown Rump Length ◽  
Multivariable Logistic Regression ◽  
Vaginal Deliveries ◽  
Gestational Sac

Abstract Purpose To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Methods This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression. Results Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment. Conclusions Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

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