Contraception最新文献_第7页

OBSTETRIC-RELATED EMTALA VIOLATIONS POST-DOBBS: A DIFFERENCE-IN-DIFFERENCES ANALYSIS 产后产科相关emtala违规：差异中的差异分析

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111071

LR Woskie, N Brower-Snelson

Objectives

EMTALA mandates that hospitals receiving Medicare funding provide stabilizing treatment, which includes abortion. But many states have abortion bans that lack, or only broadly articulate, exceptions related to a pregnant person’s health, leading to significant legal debate. We therefore sought to evaluate the impact of Dobbs v Jackson Women’s Health Organization on obstetric-related violations.

Methods

We used a nationwide sample of federal EMTALA violations (excluding Rhode Island, Delaware, and Hawaii) from 2017 to the end of 2023. We ran a two-way fixed effects difference-in-differences model comparing “conflict” states, ie, those whose state policy had no health exception in the post-Dobbs period (n=6) to non-conflict states. We examined obstetric-related violations as a share of all EMTALA filings as the primary dependent variable and used the 2022 Dobbs ruling as our intervention, employing state and month fixed-effects to account for unobservable differences by location and seasonality in healthcare utilization. We tested alternate treatment groups and examined changes in emergency department utilization as sensitivity analyses.

Results

Difference-in-differences results suggested that Dobbs led to a statistically significant increase in obstetric-related EMTALA violation filings, with 10.5% (95% CI, 8.1-12.9%; p <0.001) more violations filed per month in states with no health exception (Oklahoma, Idaho, South Dakota, Arkansas, Texas, and Mississippi) than in states with a health exception in the post-policy period, from 2022 through 2023.

Conclusions

Our analysis of Freedom of Information Act-acquired data indicates that the Dobbs ruling led to an increase in obstetric-related EMTALA violations when state law conflicted with federal policy.

目的emtala要求接受医疗保险资助的医院提供稳定治疗，其中包括堕胎。但是，许多州的堕胎禁令缺乏与孕妇健康有关的例外情况，或者只是笼统地阐明，这导致了重大的法律辩论。因此，我们试图评估多布斯诉杰克逊妇女健康组织案对与产科有关的侵权行为的影响。方法：我们使用了2017年至2023年底全国范围内的联邦EMTALA违规样本（不包括罗德岛州、特拉华州和夏威夷）。我们运行了一个双向固定效应差异模型，比较“冲突”国家，即那些国家政策在后多布斯时期（n=6）没有健康例外的国家与非冲突国家。我们将产科相关违规作为所有EMTALA文件的份额作为主要因变量，并使用2022年Dobbs裁决作为我们的干预措施，采用州和月固定效应来解释医疗保健利用中不可观察到的地点和季节性差异。我们测试了替代治疗组，并检查了急诊科使用率的变化作为敏感性分析。结果差异中的差异结果表明，Dobbs导致与产科相关的EMTALA违规申请在统计上显著增加，在没有健康例外的州（俄克拉何马州、爱达荷州、南达科他州、阿肯色州、德克萨斯州和密西西比州），每月的违规申请比在政策后时期（2022年至2023年）有健康例外的州多10.5% （95% CI, 8.1-12.9%; p <0.001）。结论对《信息自由法》获得的数据的分析表明，当州法律与联邦政策相冲突时，多布斯裁决导致了与产科相关的EMTALA违规行为的增加。

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引用次数: 0

ASSOCIATION OF ABORTION RESTRICTIONS AND HYSTEROTOMY FOR PREVIABLE DELIVERY 流产限制与子宫切开术对早产的影响

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111073

SJ Lambert, K Fiske, G Petryk, S Horvath

Objectives

We aimed to determine the proportion of previable hysterotomy in the US and any differences by geographic region or state-level abortion restrictions.

Methods

Absolute numbers and proportions of previable “cesarean deliveries” from 2014 to 2023 were obtained using publicly available data from the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Data were analyzed by census region and state-level abortion restriction category determined by the Center for Reproductive Rights: illegal, hostile, not protected, protected, and expanded access, via chi-square test.

Results

Between 2014 and 2023 across the US, 32,165 deliveries from 17 through 21 weeks were reported as “live births.” Of those, 814 (2.5%) were delivered via hysterotomy and reported as “cesarean delivery.” The South had a higher proportion of previable hysterotomy than the rest of the US (3.1% vs. 2.1%, p<0.001). The proportion of previable hysterotomy was higher in states where abortion is illegal than in all other states (3.9% vs. 2.1%, p<0.001). Among 73,371 previable fetal deaths (20-23 weeks) between 2014 and 2022, some 2,480 (3.4%) were managed via hysterotomy, with a higher proportion occurring where abortion is illegal (4.7% vs. 3.0%, p<0.001).

Conclusions

At previable gestational ages, interventions to improve neonatal survival are futile. Hysterotomy increases the rate of maternal complications and complicates care in future pregnancies. Yet, 2.5% of previable “live births” and 3.4% of previable fetal deaths were managed with hysterotomy. Proportions were highest in the South and in states with abortion bans, representing significant preventable morbidity as a potential impact of restrictive abortion policies.

目的：我们的目的是确定在美国子宫切除术前的比例和任何地理区域或州一级的堕胎限制的差异。方法使用美国疾病控制和预防中心广泛的流行病学研究在线数据（CDC WONDER）数据库的公开数据，获得2014年至2023年可预防的“剖宫产”的绝对数字和比例。数据通过卡方检验按人口普查地区和生殖权利中心确定的州一级堕胎限制类别进行分析：非法、敌对、不受保护、受保护和扩大获取。结果2014年至2023年，全美有32165例17至21周的分娩被报告为“活产”。其中，814例（2.5%）通过子宫切开分娩，并被报道为“剖宫产”。南部比美国其他地区有更高的预先子宫切开术比例（3.1%对2.1%,p<0.001）。在堕胎为非法的州，预先切除子宫的比例高于其他所有州（3.9%对2.1%,p<0.001）。2014年至2022年期间，在73,371例可预防的胎儿死亡（20-23周）中，约2,480例（3.4%）通过子宫切除术进行了处理，其中堕胎非法的比例更高（4.7%对3.0%,p<0.001）。结论在可孕龄前，通过干预提高新生儿存活率是无效的。子宫切开术增加了产妇并发症的发生率，并使今后妊娠的护理复杂化。然而，2.5%可预防的“活产”和3.4%可预防的胎儿死亡是通过子宫切开术处理的。南方和禁止堕胎的州的比例最高，这是限制性堕胎政策的潜在影响，可预防的发病率很高。

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引用次数: 0

TRENDS IN MISOPROSTOL PRESCRIBING AND DISPENSING ACROSS NORTH CAROLINA PHARMACIES 北卡药房米索前列醇处方和配药的趋势

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111119

L Joudeh, C Muir, V Miller, A Schultz

Objectives

The aim of this study is to assess misoprostol dispensing practices across North Carolina pharmacies. We sought to identify trends in misoprostol dispensing in low access healthcare counties, rural counties, and by pharmacy type.

Methods

We used a secret-shopper approach to assess whether pharmacies dispense misoprostol. The secret-shopper called in the role of clinic staff. Chi-squared tests and Fisher’s exact tests were used for statistical analysis.

Results

Of the 100 counties in North Carolina, 94 (94%) counties were contacted. Ninety-nine (99%) counties had a chain pharmacy represented and 95 (95%) had an independent pharmacy represented. Some 173 (77.6%) pharmacies dispensed misoprostol, 12 (5.4%) had conditional dispensing practices, and 38 (17.0%) did not dispense misoprostol. Chain pharmacies were more likely to dispense misoprostol 96 (55.5%) compared to independent pharmacies 77 (44.5%) (p<0.0001). Chain pharmacies were also more likely to be in urban areas 72 (53.2%) compared to rural areas 55 (46.8%) (p<0.01). There was no difference in the proportion of pharmacies dispensing misoprostol in rural vs urban counties (p=0.935). There was no difference in proportion of pharmacies dispensing status by low access healthcare counties vs. counties not designated as low access (p=0.518). The most common reasons for not dispensing misoprostol were unavailable in stock (18) and expense of stocking for limited use (5).

Conclusions

Independent pharmacies were less likely to dispense misoprostol. Given that independent pharmacies are more likely to serve rural communities and racial and ethnic minorities, further research and interventions are needed to expand access to misoprostol through independent pharmacies.

目的本研究的目的是评估米索前列醇在北卡罗莱纳州药房的配药实践。我们试图确定米索前列醇在低可及医疗保健县、农村县和按药房类型分配的趋势。方法采用秘密购物者法对药店是否配发米索前列醇进行评估。这个神秘购物者自称是诊所工作人员。采用卡方检验和Fisher精确检验进行统计分析。结果在北卡罗莱纳州100个县中，有94个县（94%）被联系。99个县（99%）有连锁药店，95个县（95%）有独立药店。173家（77.6%）药房有米索前列醇配药，12家（5.4%）药房有条件配药，38家（17.0%）药房未配药。连锁药店配发米索前列醇96（55.5%）的比例高于独立药店77 (44.5%)（p<0.0001）。连锁药店在城市地区的比例为72(53.2%)，而在农村地区的比例为55 (46.8%)（p < 0.01）。农村县与城市县配药米索前列醇的比例差异无统计学意义（p=0.935）。低可及性卫生保健县与非低可及性卫生保健县的药房配药状况比例无差异（p=0.518）。不配发米索前列醇最常见的原因是库存不足（18）和有限使用的库存费用(5)。结论独立药房配药米索前列醇的比例较低。鉴于独立药店更有可能为农村社区和种族和少数民族服务，需要进一步研究和干预措施，以扩大通过独立药店获得米索前列醇的机会。

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引用次数: 0

DUAL LOYALTY, MEDICAL ETHICS, AND ABORTION BANS 双重忠诚，医德和堕胎禁令

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111106

W Arey, M Heisler, T McHale, H Miller, L Green, P Shah

Objectives

We aimed to examine clinicians’ experiences of dual loyalty, defined as conflict between professional duties to a patient and obligations to the interests of a third party such as the state, when providing care under restrictive abortion bans.

Methods

We conducted semi-structured interviews with clinicians providing care in Louisiana a year post-Dobbs v Jackson Women’s Health Organization (May to November 2023) and in Florida (July to August 2024) after the six-week abortion ban went into effect. In this secondary thematic analysis, we examined the code for participants’ responses about experiences of dual loyalty.

Results

We interviewed 30 healthcare workers and trainees in Louisiana and 25 in Florida; the analytic sample contained 48 participants who described an experience of dual loyalty. Participants described having to deny care to patients that they had the knowledge and skills to care for as a primary example of dual loyalty. Many noted that this was necessary to protect the care that they could offer, by complying with the law to not lose their licenses. Participants also described interference with their medical judgment and having to deviate from the standard of care. Several participants highlighted conflicted thoughts about having to break the law to adhere to their medical ethics. Participants often described feeling moral distress from being unable to adhere to medical ethics.

Conclusions

Participants’ experiences of dual loyalty highlight a moral obligation to provide abortion care, which is being negatively impacted by abortion bans. This could be seen as a new form of conscientious objection, where clinicians object to abortion bans as being antithetical to medical ethics.

我们的目的是研究临床医生的双重忠诚经验，定义为在限制性堕胎禁令下提供护理时，对患者的专业责任与对第三方（如国家）利益的义务之间的冲突。方法：我们在dobbs v Jackson妇女健康组织（dobbs v Jackson Women Health Organization）一年后（2023年5月至11月）和佛罗里达州（2024年7月至8月）对提供护理的临床医生进行了半结构化访谈。在这个次要的主题分析中，我们检查了参与者对双重忠诚经历的反应代码。结果在路易斯安那州和佛罗里达州分别采访了30名和25名医护人员和培训生；分析样本包含48名参与者，他们描述了双重忠诚的经历。参与者描述不得不拒绝照顾病人，他们有知识和技能来照顾作为双重忠诚的主要例子。许多人指出，这对保护他们可以提供的医疗服务是必要的，因为他们遵守法律，不会失去执照。参与者还描述了他们的医疗判断受到干扰，不得不偏离护理标准。几位与会者强调了必须违反法律以遵守医德的矛盾想法。参与者经常描述由于无法遵守医学伦理而感到道德上的困扰。结论参与者的双重忠诚经历突出了提供堕胎护理的道德义务，这正在受到堕胎禁令的负面影响。这可以被视为一种新形式的良心反对，临床医生反对堕胎禁令，认为这与医学伦理背道而驰。

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引用次数: 0

THE PRICE OF LATER ABORTION CARE IN THE US 美国晚期堕胎护理的价格

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111115

TA Weitz, M Wilson Schwartz

Objectives

We aimed to document the price of abortion care after 23 weeks of pregnancy.

Methods

We identified 131 healthcare facilities that publicly advertised offering post-23-week abortion care in August 2024. From November 6, 2024 to April 7, 2025, undergraduate research assistants (RAs) posed as mystery clients to inquire about the price of care. They called each facility twice for each two-week pregnancy period at/above 23 weeks (ie, 23-25 weeks; 25-27 weeks). We calculated the range, mean and median price for each two-week difference.

Results

RAs made 522 calls, successfully connecting with facility personnel 418 times (80%). RAs successfully obtained information on the service price in 55% of calls (n=228). In response to 189 calls, RAs obtained a specific price and in 39 calls RAs obtained a price range. Specific prices ranged from $1,054-$82,670 (median $3,000) for 23-week abortions (n=131), $1,959-$12,195 (median $6,500) for 25-week abortions (n=23), $5,585-$13,900 (median $9,500) for 27-week abortions (n=17), $9,800-$16,800 (median $11,400) for 29-week abortions (n=7), 14,500-$19,800 (median $19,000) for 31-week abortions (n=7), and $15,500-$19,000 (median $15,500) for 33-week abortions (n=3).

Conclusions

One of the most recognized barriers to abortion care is needing to raise the money to pay for the abortion, yet little public data exist on the price of abortion later in pregnancy. This study sought to fill this information gap. We provide information on the range of prices for care over two-week gestational durations. Unfortunately, later abortion care price transparency is still limited as almost half of all calls to facilities that publicly advertised offering this care did not result in price information.

目的了解妊娠23周后流产护理的价格。方法选取了在2024年8月公开宣传提供23周后流产护理的131家医疗机构。从2024年11月6日至2025年4月7日，本科生研究助理（RAs）假扮神秘客户询问护理价格。他们在怀孕23周以上（即23-25周；25-27周）每两周给每家医院打两次电话。我们计算了每两周差异的范围、平均值和中位数价格。结果共拨打电话522次，成功接通设施人员418次（80%）。RAs在55%的呼叫中成功获得了服务价格信息（n=228）。在189个电话中，评级机构获得了一个特定的价格，在39个电话中，评级机构获得了一个价格区间。具体价格从23周堕胎（n=131）的1,054- 82,670美元（中位数为3,000美元），25周堕胎（n=23）的1,959- 12,195美元（中位数为6,500美元），27周堕胎（n=17）的5,585- 13,900美元（中位数为9,500美元），29周堕胎（n=7）的9,800- 16,800美元（中位数为11,400美元），31周堕胎（n=7）的14,500- 19,800美元（中位数为19,000美元）和15,500- 19,000美元（中位数为15,500美元）33周堕胎（n=3）。结论流产护理中最常见的障碍之一是需要筹集资金支付流产费用，但关于妊娠后期流产费用的公开数据很少。这项研究试图填补这一信息空白。我们提供有关两周妊娠期护理价格范围的信息。不幸的是，后来的堕胎护理价格透明度仍然有限，因为几乎一半的电话设施，公开宣传提供这种护理没有导致价格信息。

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引用次数: 0

“LIKE A BUSINESS TRANSACTION”: BLACK WOMEN’S TRUST IN ABORTION HEALTHCARE IN OHIO “像商业交易一样”：俄亥俄州黑人妇女对堕胎医疗的信任

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111085

SE Bostic, H Sihra, A Norris Turner, D Bessett, T Odum

Objectives

Growing research has examined the prevalence of medical mistrust among Black people and its impact on healthcare access, adherence, and outcomes. However, trust in the context of abortion has been seldom studied. These preliminary findings shed light on Black women’s conceptualizations of trust in their experiences with abortion and reproductive healthcare with the emergent theme of abortion as transactional.

Methods

We are conducting semi-structured, in-depth interviews with Black women in Ohio, asking them to describe their abortion and reproductive healthcare experiences. We used an iterative, inductive coding approach to analyze interview transcripts, allowing for insights from early interviews to inform ongoing data collection and refinement of codes.

Results

Many participants describe their abortion experience as being “like a business transaction,” with providers “just doing their job,” and the clinic “feeling like an assembly line” where “nothing moves without the payment,” highlighting the impersonal, bureaucratic, and commodified aspects of their care. Preliminary findings indicate transactional abortion experiences, with themes of clinical detachment, emotional distance, and perceived commodification of care. However, these experiences were not monolithic; some participants also reported moments of emotional connection and validation within clinical settings, reflecting the negotiation of trust and necessity under constrained circumstances of limited choice for care, resources, and time.

Conclusions

These initial findings complicate binary notions of medical trust and mistrust, suggesting that Black women navigate abortion care through nuanced and conditional forms of trust. Understanding these negotiations offers crucial insight into how reproductive healthcare systems can better address the specific needs and experiences of Black women.

越来越多的研究调查了黑人中普遍存在的医疗不信任及其对医疗服务获取、依从性和结果的影响。然而，在堕胎的背景下，信任很少被研究。这些初步研究结果揭示了黑人妇女在堕胎和生殖保健方面的信任概念，以及堕胎作为交易性的新兴主题。方法我们正在对俄亥俄州的黑人妇女进行半结构化的深入访谈，要求她们描述她们的堕胎和生殖保健经历。我们使用了一种迭代的、归纳的编码方法来分析访谈记录，允许从早期访谈中获得洞察力，从而为正在进行的数据收集和代码的改进提供信息。结果许多参与者将他们的堕胎经历描述为“像一笔商业交易”，提供者“只是在做他们的工作”，诊所“感觉就像一条流水线”，“没有钱就什么都不动”，突出了他们护理的非人情味、官僚主义和商品化方面。初步发现表明事务性流产经验，与临床脱离，情感距离和感知的商品化护理的主题。然而，这些体验并不是单一的；一些参与者还报告了在临床环境中情感联系和验证的时刻，反映了在有限的护理，资源和时间选择的限制情况下信任和必要性的谈判。这些初步发现使医疗信任和不信任的二元概念复杂化，表明黑人妇女通过微妙和有条件的信任形式来进行堕胎护理。了解这些谈判对生殖保健系统如何更好地满足黑人妇女的特殊需求和经历提供了至关重要的见解。

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引用次数: 0

RACIAL DISCRIMINATION AND PERSON-CENTERED CONTRACEPTIVE CARE IN THE US SOUTHEAST 种族歧视与美国东南部以人为本的避孕护理

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111070

AA Luke, A Newton-Levinson, S Narasimhan, MD Livingston, C Gary, S Parikh, JM Sales, SK Redd, WS Rice

Objectives

We assessed how lifetime experiences of general and stereotype-based racial discrimination during family planning care relate to patient perceptions of person-centered care during their most recent family planning visit.

Methods

People of color aged 18-44 living in Southern states who can become pregnant and sought family planning services in the past year (n=339) completed a cross-sectional survey from August to September 2024. Patient-centered care was measured dichotomously, using Dehlendorf's four-item scale with “excellent” ratings on all items. Racial discrimination was assessed using a seven-item version of the Bird-Bogart scale, examined as a count of discrimination types (0-7) and as two subscales (general and stereotype discrimination). We conducted descriptive, bivariate, and multivariable logistic regression analyses adjusting for sociodemographic variables.

Results

Some 71.7% of respondents reported at least one type of discrimination during lifetime family planning care, while 24.8% of respondents reported excellent patient-centered care. Each additional discrimination type experienced was associated with 33% lower odds of excellent person-centered care (aOR=0.67; 95% CI, 0.58-0.77), when we adjusted for sociodemographics. Analysis of discrimination subscales revealed that both general healthcare (aOR=0.56; 95% CI, 0.46-0.67) and stereotype-based discrimination (aOR=0.50; 95% CI, 0.36-0.69) were associated with lower odds of excellent person-centered care.

Conclusions

Lifetime experience of racial discrimination in family planning settings is significantly associated with reduced odds of reporting excellent patient-centered care at the most recent family planning visit. These findings highlight the need for structural interventions to address racism within family planning care.

目的：我们评估了在计划生育护理中普遍的和基于刻板印象的种族歧视的终生经历与患者在最近的计划生育就诊中对以人为本的护理的看法之间的关系。方法在2024年8月至9月期间，年龄在18-44岁、居住在美国南部各州、在过去一年中可以怀孕并寻求计划生育服务的有色人种（n=339）完成了一项横断面调查。以病人为中心的护理是两分法测量的，使用Dehlendorf的四项量表，所有项目都被评为“优秀”。种族歧视的评估采用Bird-Bogart量表的七项版本，作为歧视类型的计数（0-7）和两个子量表（一般歧视和刻板印象歧视）进行检查。我们进行了描述性、双变量和多变量逻辑回归分析，调整了社会人口变量。结果71.7%的受访者表示在终身计划生育服务中存在至少一种歧视，24.8%的受访者表示在终身计划生育服务中存在以患者为中心的良好服务。当我们调整社会人口统计学因素时，每增加一种歧视类型，获得以人为中心的优质护理的几率就会降低33% （aOR=0.67; 95% CI, 0.58-0.77）。对歧视亚量表的分析显示，普通医疗保健（aOR=0.56; 95% CI, 0.46-0.67）和基于刻板印象的歧视（aOR=0.50; 95% CI, 0.36-0.69）与较低的以人为本的优质护理相关。结论在计划生育环境中，终生的种族歧视经历与最近一次计划生育就诊中报告优秀的以患者为中心的护理的几率显著降低相关。这些发现突出表明，需要采取结构性干预措施来解决计划生育护理中的种族主义问题。

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引用次数: 0

BLEEDING EXPERIENCE AFTER MEDICATION ABORTION PRIOR TO FETAL CARDIAC ACTIVITY 胎儿心脏活动前药物流产后出血经验

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111074

AK Hoover, AE Heyse, MA Cohen, P Goedken, C Cwiak

Objectives

The purpose is to elucidate the bleeding experience after very early medication abortion in the setting of an abortion ban at fetal cardiac activity. The aims are to characterize the duration and quantity of bleeding and cramping, symptoms, and efficacy.

Methods

This is a prospective cohort study. A survey was administered prior to abortion initiation. Follow-up surveys were administered via text message daily for three days, weekly for four weeks, and once at six weeks. Chart abstraction was performed to obtain demographic and follow-up data.

Results

Some 250 participants were enrolled. At baseline, 73% of respondents reported typically moderate menses and 76% reported pregnancy symptoms. On days 1-3, participants reported bleeding at rates of 84.4%, 95.6%, and 98.4%, respectively. Less than half of respondents reported bleeding heavier than menses. Cramping on days 1-3 was noted at rates of 88.0%, 86.7%, and 79.2%, respectively. More than half of respondents reported cramping heavier than with menses on days one and two. At one week, 93.2% reported continued bleeding, with 24.0% heavier, 30.0% like, and 46.0% lighter than menses; 51.6% reported cramping, and 65.2% reported pregnancy symptoms resolved. At two weeks, 51.9% reported bleeding, 29.9% reported cramping, and 65.6% reported pregnancy symptoms resolved. At six weeks, approximately 73.0% of respondents had resumed menses while 11.3% had a positive pregnancy test.

Conclusions

Bleeding with medication abortion prior to fetal cardiac activity was similar to menses while cramping was heavier. Bleeding, cramping, and pregnancy symptoms had resolved by two weeks in most patients. Patient counseling on expectations should be adjusted accordingly.

目的探讨在胎儿心脏活动禁止流产的情况下，早期药物流产后的出血情况。目的是描述出血和痉挛的持续时间和数量、症状和疗效。方法前瞻性队列研究。在堕胎开始前进行了一项调查。后续调查通过短信进行，连续三天每天一次，四周每周一次，六周一次。进行图表抽象以获得人口统计和随访数据。结果共纳入受试者250人。在基线时，73%的应答者报告典型的中度月经，76%报告妊娠症状。在第1-3天，参与者报告的出血率分别为84.4%、95.6%和98.4%。不到一半的受访者报告出血比月经更严重。第1-3天抽筋的发生率分别为88.0%、86.7%和79.2%。超过一半的受访者表示，在第一天和第二天，痉挛比月经时更严重。1周时，93.2%报告持续出血，其中24.0%较月经重，30.0%类似，46.0%较月经轻；51.6%报告痉挛，65.2%报告妊娠症状缓解。两周时，51.9%报告出血，29.9%报告痉挛，65.6%报告妊娠症状缓解。在6周时，大约73.0%的受访者恢复了月经，11.3%的人怀孕试验呈阳性。结论胎心活动前药物流产出血与月经相似，但痉挛加重。大多数患者的出血、痉挛和妊娠症状在两周内消失。患者对期望的咨询应作相应调整。

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引用次数: 0

DOCTORS, FAMILY, OR PEERS? WHO TEENS SEEK WHEN NAVIGATING CONTRACEPTIVE SIDE EFFECTS 医生，家人，还是同龄人？青少年在面对避孕药具的副作用时会找谁

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111077

EK Wanyonyi, V Manthena, M Quasebarth, S Knifton, J Klugman, K Rivlin, L Hasselbacher

Objectives

Peers and cultural norms play critical roles in shaping adolescent attitudes. We explored spheres of influence in adolescent contraceptive decision making around side effects.

Methods

We conducted semi-structured interviews exploring experiences with contraception from December 2023 to September 2024 among adolescents aged 13 to 18. We recruited via flyers in Illinois clinics providing adolescent reproductive healthcare, snowball sampling, and targeted social media. Interviews examined side effect experiences and who adolescents sought support from when navigating side effects. Interviews were transcribed and qualitatively analyzed for themes using Dedoose.

Results

We interviewed 27 adolescent participants (41% Black, 37% White, 19% multiracial, 11% Hispanic or Latino). Adolescents described family members (parents, siblings, cousins, aunts) as holding the strongest influence over their contraceptive decision making related to side effects, especially when a family member had a negative experience. Adolescent participants sought advice from family members when experiencing a side effect, managing side effects, and deciding whether they should continue a method based on their side effect experiences. Respondents also continued or switched contraceptive methods based on provider recommendations and described relying less on peer advice, since many stated their peers were not yet using contraception. Many shared concerns about encountering misinformation on social media, though some reported supplementing side effect information gained from a parent or provider with user experiences shared on social media.

Conclusions

Given the significant role that family members play in influencing adolescent experiences with navigating contraception, educational interventions should incorporate family members into contraceptive counseling while continuing to center individual privacy and autonomy.

同伴和文化规范在形成青少年态度方面起着关键作用。我们探讨了青少年避孕决策中副作用的影响范围。方法对2023年12月至2024年9月13 ~ 18岁青少年进行半结构化访谈，探讨其避孕经历。我们通过伊利诺斯州提供青少年生殖保健的诊所的传单、雪球抽样和有针对性的社交媒体进行招募。采访调查了副作用的经历，以及青少年在应对副作用时向谁寻求支持。访谈记录和使用Dedoose对主题进行定性分析。结果我们采访了27名青少年参与者（41%的黑人，37%的白人，19%的多种族，11%的西班牙裔或拉丁裔）。青少年认为家庭成员（父母、兄弟姐妹、表兄弟姐妹、阿姨）对其避孕药具的副作用影响最大，特别是当家庭成员有负面经历时。青少年参与者在遇到副作用时向家人寻求建议，管理副作用，并根据他们的副作用经历决定是否应该继续使用这种方法。受访者还根据提供者的建议继续使用或改变避孕方法，并表示较少依赖同伴的建议，因为许多人表示他们的同伴尚未使用避孕措施。许多人都担心在社交媒体上遇到错误信息，尽管有些人报告说，他们从父母或提供者那里获得的副作用信息与社交媒体上分享的用户体验相辅相成。鉴于家庭成员在影响青少年避孕经验方面的重要作用，教育干预应将家庭成员纳入避孕咨询，同时继续以个人隐私和自主权为中心。

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引用次数: 0

AWARENESS OF ABORTION PILLS-BY-MAIL OPTIONS AMONG PATIENTS TRAVELING OUT-OF-STATE FOR ABORTION 在州外堕胎的患者中，堕胎药邮寄选择的意识

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111122

AL Woodcock, A Gero, S Elliott, C Sexsmith, T Proaño, DK Turok, J Sanders

Objectives

We aimed to understand if patients who traveled out-of-state for abortion care were aware of abortion medication by mail options and explore predictors of awareness.

Methods

From September 2024 to February 2025, we recruited patients who traveled out of their home state to receive an abortion at 15 Planned Parenthood clinics in Oregon, Washington, and Utah. Eligible participants were aged 18 or older and spoke English or Spanish. Survey questions included awareness of the option for medication abortion pills by mail and reasons for participants’ decision to travel for abortion. We assessed differences in and predictors of awareness of pills by mail using chi-squared test for categorical data and logistic regression.

Results

The final analytic sample included 113 respondents. Most participants, 82 (73%), identified their gestational age to be <11 weeks. A minority of participants were aware of pills by mail (n=41, 36.9%) and most (34/41, 83%) desired a medication abortion. Among those who were aware, 21 (59%) learned about the pills by mail option online and 10 (22%) from social media; only five (12%) learned of this option from a healthcare provider. Participants provided no dominant reason for traveling. Those aware of pills by mail were more likely to complete the survey in Spanish (OR, 3.66; 95% CI, 1.03-13.10) and have public health insurance vs. no insurance (OR, 3.85; 95% CI, 1.25-11.86).

Conclusions

Most participants traveling out of state for abortion were unaware of pill by mail options despite being <11 weeks’ gestation. A majority of those aware of the option still wanted a medication abortion in person.

目的了解外州流产患者是否通过邮寄方式了解流产药物，并探讨其知晓程度的预测因素。方法：从2024年9月到2025年2月，我们招募了离开家乡到俄勒冈州、华盛顿州和犹他州的15家计划生育诊所接受堕胎手术的患者。符合条件的参与者年龄在18岁或以上，会说英语或西班牙语。调查问题包括通过邮寄方式选择堕胎药的意识以及参与者决定旅行堕胎的原因。我们使用卡方检验对分类数据和逻辑回归评估邮寄药片意识的差异和预测因素。结果最终分析样本共113人。大多数参与者，82人（73%），确定他们的胎龄为11周。少数参与者通过邮件知道避孕药（n=41, 36.9%），大多数参与者（34/41,83%）希望药物流产。在知情的人中，21人（59%）通过在线邮件选项了解药物，10人（22%）从社交媒体了解药物；只有5人（12%）从医疗保健提供者那里了解到这种选择。参与者没有提供旅行的主要原因。那些通过邮件了解药片的人更有可能用西班牙语完成调查（OR, 3.66; 95% CI, 1.03-13.10），并且有公共健康保险与没有保险的人相比（OR, 3.85; 95% CI, 1.25-11.86）。结论：尽管怀孕11周，大多数出国堕胎的参与者都不知道邮寄避孕药的选择。大多数知道这种选择的人仍然希望亲自进行药物流产。

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引用次数: 0