Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists.

Objectives: The aim of the study was to understand the rates of first-trimester medication and procedural abortion provision, sufficiency in abortion training, and factors associated with abortion provision among obstetrician-gynecologists (OB/GYNs) in Massachusetts.

Study Design: Electronically fielded surveys of a census of OB/GYNs in Massachusetts in 2021 queried physicians on abortion provision, training, practice type, and demographics. Using weighting to account for nonresponse, we generated estimates of the proportion of OB/GYNS providing abortion and used multivariate regression analysis to explore factors associated with abortion provision including practice type, physician sex, and sufficient abortion training.

The impact of lifetime intimate partner violence on abortion method choice.

Objective(s): To evaluate if the type of abortion patients prefer differs for those with a history of intimate partner violence (IPV) compared to those without a history of IPV.

Study Design: We compared choice of medication versus procedural abortion between those with a history of lifetime IPV and those without a history of IPV among patients seeking abortion at 11 weeks' gestation or less. Secondarily, we compared preferred abortion characteristics and assessed reproductive autonomy.

Spatial Disparities in Mifepristone Use for Early Miscarriage and Induced Abortion Among Obstetrician-Gynecologists Practicing in Massachusetts.

Background: About 25% of pregnancies end in early miscarriage or abortion annually in the United States. While mifepristone is part of the most effective medication regimen for miscarriage and abortion, regulatory burdens and legal restrictions limit its provision in obstetric-gynecological practice. The extent of geographic disparities in mifepristone use is unknown.

Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use.

Objectives: We estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use.

Methods: We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor.

hCG trends after mifepristone and misoprostol for undesired pregnancy of unknown location.

Objectives: To describe human chorionic gonadotropin (hCG) trends for patients with a pregnancy of unknown location (PUL) presenting for medication abortion by management strategy and outcome.

Study Design: This retrospective cohort study included patients presenting for medication abortion with a PUL at ≤42 days gestation managed with either (1) immediate mifepristone with serial hCG follow-up (same-day-start) or (2) hCG testing every 48 to 72 hours ± ultrasonography to confirm pregnancy location followed by treatment (delay-for-diagnosis). The primary outcome was percent hCG change over time between presentation and diagnosis, summarized using a multivariate regression model.

Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation.

Objectives: This study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting.

Study Design: In this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group.

Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum.

Introduction: Despite the need for providers skilled in second-trimester dilation and evacuation (D&E) procedures, there are few second-trimester abortion training opportunities for OB/GYN residents and other health care trainees. Barriers to such training include restrictive state laws and institutional policies, lack of trained faculty, and limited procedural volume. Simulation-based D&E training is, therefore, a critical tool for OB/GYN residents and other medical professionals to achieve clinical competency.

Management of early pregnancy loss among obstetrician-gynecologists in Massachusetts and barriers to mifepristone use.

Objectives: To measure the prevalence of early pregnancy loss management types among obstetrician-gynecologists in Massachusetts, and delineate barriers, facilitators, demographic and practice-related factors associated with mifepristone use for early pregnancy loss.

Study Design: We surveyed a census of obstetrician-gynecologists in Massachusetts. Descriptive statistics measured the prevalence of offering expectant, misoprostol-alone, mifepristone and misoprostol, dilation and curettage in the office and operating room, and multivariate logistic regression analysis evaluated barriers and facilitators to mifepristone use.

At-home urine pregnancy test assessment after mifepristone and misoprostol for undesired pregnancy of unknown location.

Objectives: The ideal assessment after mifepristone and misoprostol for undesired pregnancy of unknown location (PUL) is unknown.

Study Design: We prospectively followed patients at Planned Parenthood League of Massachusetts (2019-2021) with PUL who received immediate mifepristone and misoprostol with serial at-home urine pregnancy tests (UPT) and in-office serum HCGs.

Results: Of 13 patients, 10 had a successful medication abortion.

Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks.

Objective: Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E).

Study Design: This retrospective, noninferiority, cohort study compared complication rates for same-day versus overnight cervical preparation with D&E between 14 and 16 weeks gestation. Cervical preparation was achieved with misoprostol, osmotic dilators, or both.

Continuation rates of two different-sized copper intrauterine devices among nulliparous women: Interim 12-month results of a single-blind, randomised, multicentre trial.

Background: The most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users.

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location.

Objective: To compare immediate initiation with delayed initiation of medication abortion among patients with an undesired pregnancy of unknown location.

Methods: This retrospective cohort study used electronic medical record data from the Planned Parenthood League of Massachusetts (2014-2019) for patients who requested medication abortion with a last menstrual period (LMP) of 42 days or less and pregnancy of unknown location (no gestational sac) on initial ultrasonogram. Clinicians could initiate medication abortion with mifepristone followed by misoprostol while simultaneously excluding ectopic pregnancy with serial serum human chorionic gonadotropin (hCG) testing (same-day-start group) or establish a diagnosis with serial hCG tests and repeat ultrasonogram before initiating treatment (delay-for-diagnosis group).

The impact of the COVID-19 pandemic on abortion care utilization and disparities by age.

Background: A variety of state-level restrictions were placed on abortion care in response to the COVID-19 pandemic, leading to drops in utilization and delays in time to abortion. Other pandemic-related factors also may have impacted receipt of abortion care, potentially exacerbating existing barriers to care. Massachusetts is an ideal setting to study the impact of these other pandemic-related factors on abortion care utilization because there was no wide-scale abortion policy change in response to the pandemic.

Gender diversity among aspiration-abortion patients.

Objective: Describe the array of gender identities among procedural abortion patients.

Study Design: Cross-sectional survey of abortion patients in three clinics in Massachusetts. Following aspiration abortion procedures and prior to discharge, patients self-administered a survey on a tablet.

Contraception After Surgical Abortion in Patients With Opioid Use Disorder.

Objectives: This study describes the prevalence of medications for opioid use disorder (MOUD) among surgical abortion patients, evaluates long-acting reversible contraception (LARC) uptake after surgical abortion among patients on MOUD, and identifies predictors of immediate postabortion LARC uptake among individuals on MOUD.

Methods: We performed a secondary analysis of data from a retrospective observational cohort study of LARC uptake immediately after surgical abortion up to 21 weeks gestation at Planned Parenthood League of Massachusetts between October 2012 and April 2017. We estimated proportions and analyzed predictors of LARC uptake among women on MOUD using logistic regression analysis to control for possible confounders.

State and federal abortion restrictions increase risk of COVID-19 exposure by mandating unnecessary clinic visits.

Objective: To quantify the number of medically unnecessary clinical visits and in-clinic contacts monthly caused by US abortion regulations.

Study Design: We estimated the number of clinical visits and clinical contacts (any worker a patient may come into physical contact with during their visit) under the current policy landscape, compared to the number of visits and contacts if the following regulations were repealed: (1) State mandatory in-person counseling visit laws that necessitate two visits for abortion, (2) State mandatory-ultrasound laws, (3) State mandates requiring the prescribing clinician be present during mifepristone administration, (4) Federal Food and Drug Administration Risk Evaluation and Mitigation Strategy for mifepristone. If these laws were repealed, "no-test" telemedicine abortion would be possible for some patients.

Time Trends in Massachusetts Adolescents' Postabortion Contraceptive Uptake.

Purpose: The purpose of the study was to assess uptake of postabortion contraception across changes in insurance regulations and insurance type used on the day of abortion, accounting for demographic characteristics and consent type (parental vs. judicial) for abortion among Massachusetts adolescents.

Methods: We conducted a retrospective record review of 1,375 minors (≤17 years) presenting for their first lifetime surgical abortion at a statewide network of abortion clinics between 2010 and 2016.

Prevalence and predictors of initiation of intrauterine devices and subdermal implants immediately after surgical abortion.

Objectives: To estimate uptake of long-acting reversible contraception (LARC) methods immediately after surgical abortion in a system that makes these methods readily available, and to determine demographic, medical, social, and visit-specific predictors of immediate post-abortion intrauterine device (IUD) and implant initiation.

Study Design: We performed a retrospective cohort study of LARC (levonorgestrel intrauterine system [IUS], copper IUD, and subdermal implant) initiation at the time of surgical abortion up to 21w0d gestation at Planned Parenthood League of Massachusetts from 2012 through 2017. We calculated proportions of IUD and implant initiation and used mixed effect logistic regression to estimate predictors of each outcome.

Massachusetts' Parental Consent Law and Procedural Timing Among Adolescents Undergoing Abortion.

Objective: To describe individual-level delay in obtaining abortion associated with use of the Massachusetts judicial bypass system, which legal minors (aged 17 years or younger) use to obtain abortion without consent of a parent or legal guardian in the setting of Massachusetts' parental consent law for abortion.

Methods: We conducted a retrospective cohort study of 2,026 abortions among minors at a large, statewide network of abortion clinics between 2010 and 2016. Delay was defined as the number of calendar days between the minor's first call to the clinic to schedule an abortion, and the day the abortion was received.

"Without any indication": stigma and a hidden curriculum within medical students' discussion of elective abortion.

Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term "elective" in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care.

Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers.

Objective: To describe the role of worksite characteristics, job role and abortion stigma in clinical abortion workers' occupational stress.

Study Design: We recruited nurses, medical assistants and counseling staff who provide abortion care at five hospitals and four freestanding clinics in Massachusetts. Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty and socially taboo) using the Abortion Providers Stigma Scale; job strain through the Job Content Questionnaire; and emotional burnout through the Depersonalization, Emotional Exhaustion and Personal Accomplishment subscales of the Maslach Burnout Inventory.

A randomized comparison of intravenous sedation using a dosing algorithm compared to standard care during first-trimester surgical abortion.

Objective: The objective was to compare the safety and efficacy of an algorithm for abortion intravenous sedation dosing (AAID) to standard dosing during first-trimester surgical abortion.

Study Design: This was a randomized, single-blinded, controlled trial in which women undergoing first-trimester surgical abortion received fentanyl and midazolam dosed per either an algorithm or clinic standard. Patient-level factors including weight, airway risk, anxiety, and drug and alcohol use determined AAID doses.