Abstract
Objective
Despite women's preference for induction of labor (IOL) or dilation and evacuation
(D&E) for pregnancy termination in the setting of second trimester fetal or pregnancy
abnormality, many women are not given a choice between delivery methods. We investigated
patient and clinical related factors associated with selecting IOL or D&E.
Methods
This retrospective cohort experienced pregnancy termination at 17–24 weeks of gestation
for fetal anomaly, intrauterine fetal demise, or premature previable rupture. We compared
the demographic, reproductive, social, and clinical experience variables between women
who select IOL and D&E, adjusting for confounders through logistic regression.
Results
One hundred eleven women (21.6%) selected IOL and 403 (78.4%) selected D&E. Greater
proportions of women of color (p < .01), lower education (p < .01), lower employment (p < .01), and lower status jobs (p < .01) selected IOL. Women selected D&E more often for chromosomal anomaly (p < .01). In adjusted analyses, women with intrauterine fetal demise (odds ratio [OR],
9.8; 95% confidence interval [CI], 2.8–34.7), premature previable rupture (OR, 110;
95% CI, 23.0–526.8), prior substance use disorder (OR, 35.5; 95% CI–2.7, 473.7), or
counseling from obstetrics (OR, 3.3; 95% CI–1.3, 8.4), pediatrics (OR, 3.3; 95% CI–1.3,
8.6), or social services (OR, 12.6; 95% CI, 4.2–37.3) had higher odds of selecting
IOL.
Conclusions
Patient characteristics, medical factors, and type of counseling are associated with
the selection between D&E and IOL for anomalous pregnancies. Institutional, regional,
and state policies should permit women both delivery methods to preserve autonomous
decision-making at the time of pregnancy termination.
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References
- A randomized comparison of medical abortion and surgical vacuum aspiration at 10-13 weeks gestation.Human Reproduction. 2002; 17: 92-98
- A comparison of medical induction and dilation and evacuation for second-trimester abortion.American Journal of Obstetrics and Gynecology. 2002; 187: 393-397
- Pain of first-trimester abortion: A study of psychosocial and medical predictors.Pain. 1989; 36: 339-350
- Labor induction abortion in the second trimester.Contraception. 2011; 84: 4-18
- Prenatally diagnosed fetal conditions in the age of fetal care: Does who counsels matter?.American Journal of Obstetrics and Gynecology. 2012; 206: 409.e1-409.e11
- Does professional orientation predict ethical sensitivities? Attitudes of pediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination.Journal of Medical Ethics. 2014; 40: 117-122
- Psychological outcomes of medical versus surgical elective first trimester abortion.Nursing for Women’s Health. 2012; 16: 296-307
- Reasons U.S. women have abortions: Quantitative and qualitative perspectives.Perspectives on Sexual and Reproductive Health. 2005; 37: 110-118
- Impact of clinic closures on women obtaining abortion services after implementation of a restrictive law in Texas.American Journal of Public Health. 2016; 106: 857-864
- Midtrimester abortion by dilatation and evacuation versus intra-amniotic instillation of prostaglandin F2 alpha: A randomized clinical trial.American Journal of Obstetrics and Gynecology. 1980; 137: 785-790
- Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: A pilot randomized controlled trial.British Journal of Obstetrics & Gynaecology. 2004; 111: 148-153
- State laws and policies: Targeted regulations of abortion providers.(Available:)www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providersDate: 2018Date accessed: April 10, 2018
- Dilation and evacuation.in: Paul M. Lichtenberg E. Borgatta L. Grimes D.A. Stubblefield P.G. Creinin M.D. Management of Unintended and Abnormal Pregnancy. John Wiley & Sons, New York, NY2009
- Comparison of medical abortion with surgical vacuum aspiration: Women’s preferences and acceptability of treatment.British Medical Journal. 1993; 307: 714-717
- Women’s perceptions on medical abortion.Contraception. 2006; 74: 11-15
- Comparing medical versus surgical termination of pregnancy at 13-20 weeks of gestation: A randomised controlled trial.British Journal of Obstetrics and Gynaecology. 2010; 117: 1512-1520
- Characteristics of women who undergo second trimester abortion in the setting of a fetal anomaly.Contraception. 2012; 85: 63-68
- Women’s decision making regarding choice of second trimester termination method for pregnancy complications.International Journal of Gynecology and Obstetrics. 2012; 116: 244-248
- Abortion incidence and service availability in the United States, 2014.Perspectives on Sexual and Reproductive Health. 2017; 49: 17-27
- Surgical versus medical methods for second trimester induced abortion.Cochrane Database of Systematic Reviews. 2008; : CD006714
- The Safety and Quality of Abortion Care in the United States.The National Academies Press, Washington, DC2018
- Second trimester termination of pregnancy: A review by site and procedure type.Contraception. 2008; 77: 155-161
- 2010 SOC User Guide.(Available:)
Biography
Emily Maistrellis, MSc, was a graduate student of the Harvard T.H. Chan School of Public Health in the Department of Society, Human Development and Health at the time of this study. She is now with the Program on Global Health Justice and Governance at Columbia University Mailman School of Public Health, where she conducts research on abortion policy, health systems access, and sexual and reproductive health, rights, and justice.
Biography
Elizabeth Janiak, MA, ScD, is Instructor in Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. She conducts interdisciplinary social science investigations of how policy, health systems, and provider-level factors affect the availability and quality of domestic abortion and contraceptive care.
Biography
Raina Hammel, MD, is a resident physician in Obstetrics and Gynecology at Tufts University School of Medicine. Her interests include family planning and patient advocacy.
Biography
Shelley Hurwitz, PhD, is Director of Biostatistics in the Center for Clinical Investigation at Brigham and Women's Hospital, faculty member at Harvard Medical School. Research areas include women's health, behavioral and psychosocial research, patient-oriented physiologic research, and clinical trial design.
Biography
Laurent Delli-Bovi, MD, is Assistant Professor in Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School with a private practice that specializes in abortion and general gynecology.
Biography
Deborah Bartz, MD, MPH, is Assistant Professor, Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, with a practice specializing in family planning at Brigham and Women's Hospital. She is the Director of Education for the Connors Center for Women's Health and Gender Biology.
Article info
Publication history
Published online: May 10, 2019
Accepted:
April 4,
2019
Received in revised form:
March 21,
2019
Received:
April 12,
2018
Footnotes
Funding Statement: Partial support for this research was provided by a grant received through the Department of Obstetrics, Gynecology, and Reproductive Biology at Brigham and Women’s Hospital. The authors report no conflicts of interest.
Data Statement: Data not available owing to confidentiality concerns and sensitivity of clinical content.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
