Divya Dethier, Reni Soon, Taylor Ronquillo, Zarina Wong, Mary Tschann
{"title":"妊娠小于和大于 6 周时药物流产结果的比较。","authors":"Divya Dethier, Reni Soon, Taylor Ronquillo, Zarina Wong, Mary Tschann","doi":"10.1016/j.contraception.2024.110691","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43 to 56 days gestation.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study in 2022, comparing 142 patients accessing MAB at ≤42 days with 200 patients at 43 to 56 days. We sought to detect a 7% difference in MAB success with 80% power and alpha of 0.05. We assessed follow-up responses and unscheduled contacts with the health care system.</p><p><strong>Results: </strong>Abortion success rates were similar between the ≤42-day and 43 to 56-day groups (94.3% vs 97%, p = 0.226). Those ≤42 days had more unscheduled office visits (13% vs 6%, p = 0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42-day group answered that bleeding (11.7% vs 1.9%, p = 0.006) and cramping (10.5% vs 2.9%, p = 0.035) were not heavier or worse than a period and that they had no pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p = 0.034). Patients ≤42 days gestation less often had a pretreatment ultrasound (48% vs 64%, p = 0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p = 0.027).</p><p><strong>Conclusions: </strong>Patients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should adapt anticipatory guidance and counseling for this population.</p><p><strong>Implications: </strong>Access to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the health care system.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of medication abortion outcomes at less than and greater than 6 weeks gestation.\",\"authors\":\"Divya Dethier, Reni Soon, Taylor Ronquillo, Zarina Wong, Mary Tschann\",\"doi\":\"10.1016/j.contraception.2024.110691\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43 to 56 days gestation.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study in 2022, comparing 142 patients accessing MAB at ≤42 days with 200 patients at 43 to 56 days. We sought to detect a 7% difference in MAB success with 80% power and alpha of 0.05. We assessed follow-up responses and unscheduled contacts with the health care system.</p><p><strong>Results: </strong>Abortion success rates were similar between the ≤42-day and 43 to 56-day groups (94.3% vs 97%, p = 0.226). Those ≤42 days had more unscheduled office visits (13% vs 6%, p = 0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42-day group answered that bleeding (11.7% vs 1.9%, p = 0.006) and cramping (10.5% vs 2.9%, p = 0.035) were not heavier or worse than a period and that they had no pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p = 0.034). Patients ≤42 days gestation less often had a pretreatment ultrasound (48% vs 64%, p = 0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p = 0.027).</p><p><strong>Conclusions: </strong>Patients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should adapt anticipatory guidance and counseling for this population.</p><p><strong>Implications: </strong>Access to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the health care system.</p>\",\"PeriodicalId\":93955,\"journal\":{\"name\":\"Contraception\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Contraception\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.contraception.2024.110691\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Contraception","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.contraception.2024.110691","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:比较两组患者的结果和特征:比较两组患者的预后和特征:妊娠≤42天和妊娠43-56天接受药物流产(MAB)的患者:我们进行了一项回顾性队列研究,比较了2022年所有142名妊娠≤42天接受药物流产的患者与200名妊娠43-56天接受药物流产的患者的特征和结果。我们力图在80%的功率和0.05的α值条件下检测出人流手术成功率7%的差异。我们比较了随访反应和与医疗系统的计划外联系:≤42天组和43-56天组的人工流产成功率相似(94.3% vs 97%,p=0.226)。≤42天组的非计划门诊频率更高(13% vs 6%,p=0.01),但电话或急诊就诊率没有差异。妊娠≤42 天组有更多的人流成功患者回答出血量(11.7% 对 1.9%,P=0.006)和痉挛(10.5% 对 2.9%,P=0.035)不比月经量多或严重,而且流产前没有怀孕症状(15.8% 对 6.0%,P=0.034)。妊娠不足 42 天的患者较少在治疗前进行超声波检查(48% 对 64%,P=0.004)。未事先进行超声波检查的患者更常需要吸宫术来完成流产(6.8% vs 2%,p=0.027):结论:使用标准化问题评估人工流产成功率时,≤42 天接受人流手术的患者成功率相似,但计划外就诊次数更多,症状更模糊。临床医生应考虑针对这一人群调整预期指导和咨询:启示:随着法律对人工流产的限制越来越多,尽早进行人工流产变得越来越重要。尽管人流手术成功了,但较早妊娠者对标准随访问题的反应可能不同,与医疗保健系统的互动也可能更多。
Comparison of medication abortion outcomes at less than and greater than 6 weeks gestation.
Objectives: To compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43 to 56 days gestation.
Study design: We conducted a retrospective cohort study in 2022, comparing 142 patients accessing MAB at ≤42 days with 200 patients at 43 to 56 days. We sought to detect a 7% difference in MAB success with 80% power and alpha of 0.05. We assessed follow-up responses and unscheduled contacts with the health care system.
Results: Abortion success rates were similar between the ≤42-day and 43 to 56-day groups (94.3% vs 97%, p = 0.226). Those ≤42 days had more unscheduled office visits (13% vs 6%, p = 0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42-day group answered that bleeding (11.7% vs 1.9%, p = 0.006) and cramping (10.5% vs 2.9%, p = 0.035) were not heavier or worse than a period and that they had no pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p = 0.034). Patients ≤42 days gestation less often had a pretreatment ultrasound (48% vs 64%, p = 0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p = 0.027).
Conclusions: Patients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should adapt anticipatory guidance and counseling for this population.
Implications: Access to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the health care system.