Women's preferences for pain control during first-trimester surgical abortion: a qualitative study.
Journal - Contraception
BACKGROUND: To explore women's preferences for pain control during first-trimester surgical abortion. STUDY DESIGN: Pre- and postoperative semistructured individual interviews were conducted with 40 women divided into eight strata by anesthesia choice, age and prior vaginal delivery status. We identified key themes in the interviews and analyzed baseline characteristics and responses to close-ended questions within and across the strata. RESULTS: For most women, pain control options were not the primary concern in choosing a clinic for an abortion. Women who received intravenous (IV) sedation had lower pain scores and were more likely to report that they would recommend that method to a friend than women who received local anesthesia alone. Women described the pain as a cramping, tugging, pulling and scraping sensation. Respondents recommended IV sedation for a woman who was very anxious or could not tolerate pain, even though more nausea and vomiting may occur. CONCLUSIONS: Most women felt that pain control decisions should be individualized.Copyright © 2011 Elsevier Inc. All rights reserved.
Future abortion provision among US graduating obstetrics and gynecology residents, 2004.
Journal - Contraception (United States )
BACKGROUND: This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice. STUDY DESIGN: In this cross-sectional study, we surveyed all 1148 fourth-year residents in obstetrics and gynecology graduating from US training programs in 2004. RESULTS: Of 494 respondents, 187 (39%) planned to perform elective abortions after residency. In multivariable analysis controlling for various factors, the following were independently associated with plans to perform pregnancy termination in the future: pre-residency intentions to provide pregnancy termination [odds ratio (OR), 10; 95% confidence interval (CI), 5.3-18.9; p<.001], performing more than 50 first-trimester abortions during residency (OR, 5.1; 95% CI, 1.3-19.6; p=.02) and plans to enter academic practice (OR, 2.5; 95% CI 1.1-6.2; p=.04). CONCLUSIONS: Intentions before residency to provide pregnancy termination services was the strongest predictor of future abortion provision.
Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial.
Journal - Obstetrics and gynecology (United States )
OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I.
|ISSN : ||0029-7844|
|Mesh Heading : ||Administration, Oral Adult Anesthetics, Intravenous Conscious Sedation Female Humans Hypnotics and Sedatives Pain Pain Measurement Patient Satisfaction Pregnancy Young Adult|
|Mesh Heading Relevant : ||Abortion, Induced therapeutic use methods administration & dosage prevention & control|
Interventions for pain with intrauterine device insertion.
Journal - Cochrane database of systematic reviews (Online) (England )
BACKGROUND: Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES: To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. SEARCH STRATEGY: We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. MAIN RESULTS: Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. AUTHORS' CONCLUSIONS: No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.
|ISSN : ||1469-493X|
|Mesh Heading : ||Anti-Inflammatory Agents, Non-Steroidal Female Humans Ibuprofen Intrauterine Devices Misoprostol Naproxen Oxytocics Pain Randomized Controlled Trials as Topic therapeutic use therapeutic use therapeutic use therapeutic use therapeutic use prevention & control|
|Mesh Heading Relevant : ||adverse effects drug therapy|
Uses of misoprostol in obstetrics and gynecology.
Journal - Reviews in obstetrics and gynecology (United States )
Misoprostol is a synthetic prostaglandin E(1) analogue that is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Due to its wide-ranging applications in reproductive health, misoprostol is on the World Health Organization Model List of Essential Medicines. This article briefly reviews the varied uses of misoprostol in obstetrics and gynecology.