scholarly journals Abortion Opt-in Experience in Third-Year Clerkship

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Rebeca C. Martinez ◽  
Rodolfo Bonnin ◽  
Zoe Feld ◽  
Suzanne Minor
Keyword(s):  
Medical Education ◽  
Medical Abortion ◽  
First Trimester ◽  
Second Trimester ◽  
Level Of Involvement ◽  
Medical Practitioners ◽  
Clinical Exposure ◽  
Abortion Care ◽  
Florida International University ◽  
Reproductive Aged Women

Introduction: Despite the public health imperative that all medical practitioners serving reproductive-aged women know the components of abortion care and attain competency in nondirective pregnancy options counseling, exposure to abortion care in US medical school education remains significantly limited.  Methods: Florida International University Herbert Wertheim College of Medicine offers an opt-in clinical exposure to abortion care during the obstetrics and gynecology clerkship. During clerkship orientation, students watched a recorded presentation reviewing components of abortion care and emphasizing that participating students may increase or decrease involvement at any time without explanation. Students opting in completed a form specifying their desired level of involvement for each component as “yes,” “no,” or “not sure.”   Results: Of 350 clerkship students over 23 6-week rotations, 98 (28%) chose to opt in, with opt-in form data available for 90 students. Ninety students chose to observe counseling for first- and second-trimester surgical abortion and medical abortion. Seven students used the option “no” for history taking and examine second trimester fetal parts. Twenty-four students marked “not sure” for participating in evacuation of first-trimester pregnancy. Discussion: This educational intervention proved feasible and offers an opportunity for students to have experiential learning about abortion care in an inclusive, respectful manner. This experience may be incorporated into undergraduate and graduate medical education. Providing learners the opportunity for exposure to abortion care improves their overall medical education and will impact the care they provide as future clinicians.

Abortion

2019 ◽  
Author(s):  
Nisha Verma ◽  
Siripanth Nippita
Keyword(s):  
Pregnancy Termination ◽  
Healthcare Providers ◽  
Medical Abortion ◽  
First Trimester ◽  
The United States ◽  
Decision Making Process ◽  
Basic Information ◽  
Second Trimester ◽  
Dilation And Curettage ◽  
Cervical Preparation

Individuals may have a variety of reasons to end a pregnancy. Healthcare providers should provide support during the decision-making process and should be able to give patients basic information about their options depending on gestational age. In the United States, clinicians can offer first-trimester medical abortion with mifepristone and misoprostol up to 10 weeks’ gestation. Uterine aspiration or dilation and curettage are options throughout the first trimester. Options in the second trimester include induction abortion with medications, or a surgical procedure (dilation and evacuation) which may require cervical preparation at later gestational ages. Clinicians should assess the patient’s desire for fertility following an abortion and may offer contraception or preconception advice, as appropriate. This review contains 13 figures, 6 tables, and 61 references. Key Words: abortion, dilation and curettage, dilation and evacuation, mifepristone, misoprostol, pregnancy termination

scholarly journals An Overview of Comprehensive Abortion Care at Tertiary care Teaching Hospital

2019 ◽  
Vol 2 (1) ◽  
pp. 149-154
Author(s):  
Sunita Bhandari ◽  
Yam Dwa ◽  
Smrity Maskey ◽  
Manisha Bajracharya ◽  
Minaxi Thakur
Keyword(s):  
Mental Health ◽  
Teaching Hospital ◽  
Maternal Mental Health ◽  
Care Service ◽  
First Trimester ◽  
Second Trimester ◽  
Total Study Population ◽  
Abortion Care ◽  
Comprehensive Abortion Care ◽  
Post Abortion

Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics & Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of pregnancy. The reason in the first trimester was completed family (39.25%) and the main reason for the second trimester was maternal mental health (48.71%). Among the total study population, 16.37% (n=28) accepted contraception. The most common accepted contraceptive method was implant (n=14; 8.1%), followed by inj. depot medroxyprogesterone acetate (n=8; 4.6%).Conclusions: The prevalence of second-trimester abortion is high despite the availability of first-trimester comprehensive abortion care service. The main reason for induced abortion in first trimester was completed family and in second-trimester was maternal mental health. Post-abortion contraceptive acceptance among comprehensive abortion care clients was very low.

The macro determinants of medical abortion rates in Europe: a matter of gender equality?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Miani
Keyword(s):  
Health System ◽  
Gender Equality ◽  
Gender Equity ◽  
Violence Against Women ◽  
Gender Gap ◽  
Medical Abortion ◽  
First Trimester ◽  
Structural Factors ◽  
Trimester Abortion ◽  
Abortion Care

Abstract Background Medical abortion is one of the WHO recommended methods for safe and effective first trimester abortion. It is often seen as an emancipating procedure allowing women to be more in control of their abortion, as opposed to surgical procedures where the surgery is “done to” the woman by a doctor. In countries where medical abortion is legal and available, rates of medical abortion (vs. surgical abortion) vary greatly, e.g. in Europe from 24% to 98%. We hypothesised that these differences may mirror how empowered women are in different aspects of their lives and be in part explained by gender (in)equality at the country level. Methods We conducted correlation and regression analyses to assess the association between medical abortion rates and gender inequality in Europe, using several macro-level markers of gender equality such as national gender equality indices and rates of violence against women. The relevance of other structural factors, such as health system and abortion care characteristics was also investigated. Results Seventeen countries were included. Although the sample size was small, results pointed toward an association between several markers of economic gender equality and medical abortion rates. The Gender Gap Index (corr. coeff: 0.52, p = 0.03) and its economic component (corr. coeff: 0.64, p = 0.005), as well as the economic component of the Gender Equity Index (corr. coeff: 0.68, p = 0.003), were all positively associated with the outcome. Other dimensions of gender equality (e.g. political participation; violence against women) and health system factors (e.g. date of introduction of the method; type of abortion providers) were not associated with the outcome. Conclusions Our results suggest that women's empowerment in the economic sphere may have repercussions on the use of abortion care, potentially influencing what method of abortion the women ask for and what method they are offered. Key messages Barriers to the use of medical abortion go beyond the law (if a method is legal/available or not) and include structural determinants, such as gender equality. Higher levels of economic gender equality are associated with higher rates of medical abortion, highlighting the relationship between gender equality and choice of method of abortion.

scholarly journals Determinants and Outcome of Safe Second Trimester Medical Abortion at Jimma University Medical Center, Southwest Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Yibeltal Siraneh ◽  
Ahadu Workneh
Keyword(s):  
Waiting Time ◽  
Gestational Age ◽  
Medical Center ◽  
Medical Abortion ◽  
First Trimester ◽  
P Value ◽  
Second Trimester ◽  
Southwest Ethiopia ◽  
Maternal Morbidity And Mortality ◽  
Moderate Anemia

Background. Although the vast majority of abortions are performed in the first trimester, still 10–15% of terminations of pregnancies have taken place in the second trimester globally. As compared to first trimester, second trimester abortions disproportionately contribute to maternal morbidity and mortality especially in low-income countries where access to safe second trimester abortion is limited. The objective of this study was to identify factors affecting and outcome of induced safe second trimester medical abortion in Jimma University medical center, Southwest Ethiopia. Methods. Institution based cross-sectional study design was used to conduct a study among women who seek safe second trimester medical abortion services and admitted at gynecology ward. All (201) eligible study subjects included were those who came for safe medical abortion service during data collection period. Data collected using pretested structured questionnaire through exit-interviewing and some clinical data abstracted from their chart. The data was entered into EpData version 3.1 then exported to SPSS version 21.0 for analysis. Variables with P-value less than 0.25 in bivariate analysis were entered into the final predictive model. Multivariable logistic regression was used to identify determinants with 95% CI and P-value < 0.05. Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05. Ethical clearance was obtained and confidentiality kept using codes and patient’s chart number. Results. In this study the response rate was 98.1%. Out of 201 women who participated in the study and were addmitted for safe second trimester medical abortion, 154 (76.6%) of them had complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication. Previous experience of abortion [AOR= 6.00, 95% CI= (3.77, 8.88)], gestational age [AOR=0.90, 95% CI= (0.07, 0.99)], parity [AOR=2.38, 95% CI= (1.04, 3.69)], cervical status [AOR=8.00, 95% CI= (5.72, 10.02)], overall waiting time for more than two weeks [AOR=0.53, 95% CI= (0.50, 0.96)], overall waiting time for two weeks [AOR=0.05, 95% CI= (0.01, 0.45)], and moderate anemia -(Hgb:7-10g/dl)-[AOR=0.07,95% CI= (0.01, 0.16)] were independent predictors for outcome of safe second trimester medical abortion. Conclusion. This finding implied that proportion of complete abortion without any complication overweighs incomplete abortions with one or more complication through induced safe second trimester medical abortion method. The outcome is strongly determined by gestational age, cervical status, previous experience of abortion, parity, moderate anemia, and overall waiting time. Induced second trimester medical abortion is already known as an effective and safe method. However, much should be done to reduce proportion of incomplete abortions by minimizing overall waiting time through intervening at low gestational age. Therefore, it is recommended that safe second trimester medical abortion services should be continued under a certain legal circumstances so as to reduce maternal morbidity and mortality.

95-OR: Plasma miRNAs Levels at First Trimester of Pregnancy Predict Insulin Sensitivity Estimated at the Second Trimester of Pregnancy

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 95-OR
Author(s):  
CÉCILIA LÉGARÉ ◽  
VÉRONIQUE DESGAGNÉ ◽  
FRÉDÉRIQUE WHITE ◽  
MICHELLE S. SCOTT ◽  
PATRICE PERRON ◽  
...  
Keyword(s):  
Insulin Sensitivity ◽  
First Trimester ◽  
Second Trimester ◽  
First Trimester Of Pregnancy ◽  
Plasma Mirnas

Application and Evaluation of Case-Based Learning as a Part of Early Clinical Exposure for Undergraduate Medical Education Program

2020 ◽  
Vol 5 (08) ◽  
pp. 284-288
Author(s):  
Vandana Daulatabad ◽  
Prafull K. ◽  
Dr. Surekha S. Kadadi-Patil ◽  
Ramesh S. Patil
Keyword(s):  
Medical Education ◽  
Research Centre ◽  
Muscle Physiology ◽  
Case Scenario ◽  
Clinical Exposure ◽  
Clinical Scenarios ◽  
Case Based Learning ◽  
Nerve Muscle ◽  
Case Based ◽  
Early Clinical Exposure

Introduction: Medical Education is witnessing a significant transition and global shift towards competency based medical education (CBME) which includes early clinical exposure (ECE) program to help students apply and correlate principles of preclinical subjects with clinical scenarios, in various forms and in a variety of settings. One of the easy and feasible methods of ECE being Case Based Learning (CBL), our study aimed to design a case scenario and to evaluate impact of case base learning as a part of ECE module in first year undergraduate medical teaching program in nerve muscle physiology. Methods: The present study was conducted in 96 students at Ashwini Rural Medical College Hospital and Research Centre, Solapur after obtaining institutional ethics committee approval. 3 hrs session of CBL was conducted for a case scenario on myasthenia gravis in the nerve muscle physiology module. The students’ responses on pre-test, post-test and their insights regarding the CBL were taken through a pre validated questionnaire using 5-point Likert scale. Results: High impact of CBL was seen as significant improvement in student’s performance. Maximum students felt CBL to be easy method of learning and was highly appreciated through their feedback. Conclusion: CBL was found to have positive impact on understanding and perception of topic. CBL helped students to understand, evaluate, analyze, diagnose and interpret the case, paving them towards newer approach of self-directed and vertical integrated learning. CBL is easier, feasible an effective method among other early clinical exposure methods as it involves students in deeper and self-directed active learning, encouraging and promoting them to reach higher levels of cognitive domain of Bloom’s taxonomy. This method will be very useful in its practical implementation during online classes for ECE module in the threat of COVID 19 situation as well.

scholarly journals Plasma retinol-binding protein 4 in the first and second trimester and risk of gestational diabetes mellitus in Chinese women: a nested case-control study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Chuyao Jin ◽  
Lizi Lin ◽  
Na Han ◽  
Zhiling Zhao ◽  
Zheng Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Binding Protein ◽  
First Trimester ◽  
Retinol Binding Protein ◽  
Second Trimester ◽  
Retinol Binding Protein 4 ◽  
Plasma Retinol

Abstract Background To assess the association between plasma retinol-binding protein 4 (RBP4) levels both in the first trimester and second trimester and risk of gestational diabetes mellitus (GDM). Methods Plasma RBP4 levels and insulin were measured among 135 GDM cases and 135 controls nested within the Peking University Birth Cohort in Tongzhou. Multivariable linear regression analysis was conducted to assess the influence of RBP4 levels on insulin resistance. Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval (CI) between RBP4 levels and risk of GDM. Results The GDM cases had significantly higher levels of RBP4 in the first trimester than controls (medians: 18.0 μg/L vs 14.4 μg/L; P < 0.05). Plasma RBP4 concentrations in the first and second trimester were associated with fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI) in the second trimester (all P < 0.001). With adjustment for diet, physical activity, and other risk factors for GDM, the risk of GDM increased with every 1-log μg/L increment of RBP4 levels, and the OR (95% CI) was 3.12 (1.08–9.04) for RBP4 in the first trimester and 3.38 (1.03–11.08) for RBP4 in the second trimester. Conclusions Plasma RBP4 levels both in the first trimester and second trimester were dose-dependently associated with increased risk of GDM.

Investigation of a variable mifepristone to misoprostol interval for second trimester medical abortion

Contraception ◽  
2018 ◽  
Vol 97 (5) ◽  
pp. 462 ◽  
Author(s):  
A Henkel ◽  
K Lerma ◽  
PD Blumenthal ◽  
KA Shaw
Keyword(s):  
Medical Abortion ◽  
Second Trimester
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