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The aim of the study was to evaluate pain following overnight osmotic cervical dilator placement for second trimester dilation and evacuation (DE).A retrospective cohort study surveyed pain and quantified prescription opioid use among 100 women who underwent overnight osmotic cervical dilator placement for DE. Participants were given opioid and non-steroidal anti-inflammatory (NSAID) prescriptions and were asked to rate their level of pain on a Likert scale (1-10). Demographic and medical information was abstracted from electronic medical records. Bivariate analyses of demographic and clinical characteristics by pain score and opioid use were conducted. Multivariate linear regression analyses were performed for pain score. A multivariate logistic regression model was fitted for factors associated with opioid use.Gestational age ranged from 14 to 23 weeks (average 19 ± 3 weeks). The mean score of worst pain experienced was 5.3 out of 10. Participants reported 3.4 h of moderate pain (4-6 out of 10) and 1.0 h of severe pain (7-10 out of 10); 54% of women took at least one opioid (mean 2.8 ± 1.5). Multivariate analysis showed that higher pain was associated with younger age (Most participants with overnight cervical dilators for DE experienced at least moderate pain and used opioid pain medication in addition to NSAIDs when available. A shared decision-making model may be appropriate for determining which patients may benefit from opioids.

Objective Evaluate satisfaction and experience with telemedicine consultation and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Study Design Cross-sectional evaluation of British Pregnancy Advisory Service (BPAS) clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. We sent a text message with a link to a web-survey 2 to 3 weeks postabortion. Questions assessed satisfaction and experiences with a service model including telephone consultation and provision of medicines by mail or collection from the clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Our primary outcomes were overall satisfaction (5-point Likert scale) and reported contact with a health care provider. Results A total of 1,333 clients participated. Respondents described home use of medications as “straightforward” (75.8%) and most were “very satisfied” (78.3%) or “satisfied” (18.6%) overall. Being “very satisfied” was associated with parity (aOR 1.53, 95% CI 1.09−2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44−3.44). Health care provider contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62, 95% CI 1.79−7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48−9.28) were associated with health care provider contact. If needed in the future, most would prefer consultation by phone (74.3%) and home use of mifepristone and misoprostol (77.8%). Conclusions Satisfaction with telemedicine and home use of mifepristone and misoprostol is high. Most clients do not need health care provider support when administering medicines at home or post abortion.

OBJECTIVE To compare contraception choices of those who are undergoing abortion procedures for fetal indications or surgical management of pregnancy loss with those who are having abortions for another indication. METHODS We conducted a cross-sectional study at University of California, Irvine, from December 1, 2017, through December 31, 2018, and included gestational ages up to 24 0/7 weeks. We abstracted data from electronic medical records and analyzed them using descriptive statistics, χ2, Fisher exact tests, and a multivariate logistic regression model for primary outcome (whether a contraception method was chosen) and secondary outcome (whether a long-active reversible contraception was chosen). RESULTS Those with fetal indication were less likely to choose contraception than those with other indication (68/134, 50.7% vs 142/158, 89.9%, P

This study evaluated homeless women's contraception knowledge and demonstrated improved knowledge following efficacy-based contraceptive counseling. Women were surveyed using a pre-test then post-test following standardized efficacy-based contraceptive counseling. 47 women participated. 13/19 (68.4%) of reproductive-aged women were not using contraception. After education there was significant increase in good-excellent self-rated knowledge (35, 75.5% vs 44, 93.6%

Objective: Evaluate satisfaction and experience with telemedicine and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Design: Cross-sectional evaluation. Setting: British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Population: 1,144 clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. Methods: We sent a text message with a link to a web-survey 2-3 weeks after treatment. Questions evaluated satisfaction and experiences, including telephone consultations and provision of medicines by post or collection from clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Main Outcome Measures: Overall satisfaction (5-point Likert scale) and reported contact with a healthcare provider (HCP). Results: Respondents primarily described home use of medications as ‘straightforward’ (75.8%) and most were ‘very satisfied’ (78.3%) or ‘satisfied’ (18.6%) with their overall experience. Being ‘very satisfied’ was associated with parity (aOR 1.53, 95% CI 1.09-2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44-3.44). HCP contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62 95% CI 1.79-7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48-9.28) were associated with HCP contact. If needed in future, most (77.8%) would prefer home use of mifepristone and misoprostol and pills by post (68.9%). Conclusions: Satisfaction with home use of mifepristone and misoprostol is high. Most clients do not need HCP support during or after home use, but aftercare should be available.

To compare contraception choices of those who are undergoing abortion procedures for fetal indications or surgical management of pregnancy loss with those who are having abortions for another indication.We conducted a cross-sectional study at University of California, Irvine, from December 1, 2017, through December 31, 2018, and included gestational ages up to 24 0/7 weeks. We abstracted data from electronic medical records and analyzed them using descriptive statistics, χ2, Fisher exact tests, and a multivariate logistic regression model for primary outcome (whether a contraception method was chosen) and secondary outcome (whether a long-active reversible contraception was chosen).Those with fetal indication were less likely to choose contraception than those with other indication (68/134, 50.7% vs 142/158, 89.9%, P.001), and among those choosing contraception those with fetal indication were less likely to choose long-acting reversible contraception (LARC) (19/68, 27.9% vs 94/142, 66.2%, P.001). Differences remained significant in multivariable analysis that controlled for age, gestational age in weeks, race, parity, procedure type, and comorbidities (among those with fetal indication for choosing any contraception: adjusted odds ratio [aOR] 0.11, 95% CI 0.05-0.23; choosing LARC: aOR 0.17, 95% CI 0.07-0.39).Only half of those seeking abortion for a fetal indication or surgical management of pregnancy loss were interested in contraception.

BackgroundObstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment.ObjectivesThis study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda.MethodsA descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience.FindingsFifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53).ConclusionStudy participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment.

Context: Homeless individuals have comparatively poorer health, however few gender specific assessments exist. Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs. Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses. Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted. Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men.

Selective progesterone receptor modulators (SPRMs), such as mifepristone and ulipristal acetate, are being studied for a variety of uses. They have already proved useful for women’s health in terms of contraception and are continuing to be studied in innovative ways to improve the lives of women through novel and acceptable contraceptive methods with potential added health benefits. These drugs are showing promise in the treatment of leiomyoma, endometriosis, and breast disease. Studies are ongoing on contraception efficacy, new indications, long-term safety, and side effects.

Objective: To identify barriers to accessing information and treatment regarding obstetric fistula (OF) unique to Niger encountered by women referred to the National Referral Fistula Center. Method: A questionnaire was administered at the National Referral Fistula Center to 29 women with OF. Qualitative and quantitative statistics were computed. Results: The average individual was 30.4 years old, illiterate and from a rural area. 76.0% had antenatal care, the average labor time was 3.04 days, and 88.0% had a physician-assisted delivery. Barriers to information included rural dwelling, lack of education, lack of understanding of cause despite contact with health care workers, lack of knowledgeable resources to seek advice from or lack of ability/interest, not given specific information about availability of treatment, and not utilizing available resources to disseminate information. Barriers to treatment included lack of information regarding condition and treatment, traditional healer utilization, inability to access adequate care for condition, delay for childbirth recovery, permission needed to seek treatment, cost, timely treatment unavailable, and lack of social support. Conclusion: Improving efficiency of getting women to the hospital at time of delivery, prompt referrals for OF, and using cell phones for disseminating information or accessing transport may benefit women with OF in Niger.