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Smith P, Cooper N, Dhillon-Smith R, O’Toole E, Clark TJ, Coomarasamy A. Core Outcome Sets in Miscarriage Trials (COSMisT) study: a study protocol. BMJ Open 2017; 7:e018535. [PMID: 29150474 PMCID: PMC5701979 DOI: 10.1136/bmjopen-2017-018535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION 'Core outcome sets' are an agreed, standardised set of outcomes based on what key stakeholders (clinicians, patients, their partners, researchers, service developers, funding organisations and so on) consider the important outcomes in the management or prevention of a condition. This paper describes the rationale and design for the development of Core Outcome Sets for Miscarriage Trials. METHODS AND ANALYSIS Systematic reviews, interviews and focus groups with patients and their partners will be conducted to identify potential core outcomes that will be introduced into a modified Delphi survey. To ensure all key stakeholders are included, patients, partners, clinicians, charities and researchers will be invited to take part in the modified Delphi survey. There will be three rounds of scoring and rescoring during the Delphi survey to reach consensus regarding outcomes to be included in the core set, which will be subsequently refined through face-to-face consensus discussions. ETHICS AND DISSEMINATION The use of core outcome sets allows results from different studies to be compared and combined, thereby reducing inconsistency and aiding interpretation of study findings. It also means research is more likely to report relevant outcomes and so can reduce reporting bias. Understanding which outcomes are important to patients has the potential to act as a driver to improve both the quality and cost-effectiveness of miscarriage services.
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Affiliation(s)
- Paul Smith
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Natalie Cooper
- Women’s Health Research Unit, Barts and The London School of Medicine, Queen Mary University of London, London and Barts Health NHS Trust, London, UK
| | - Rima Dhillon-Smith
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Emily O’Toole
- Women’s Voices Involvement Panel, Royal College of Obstetricians and Gynaecologists, London, UK
| | - T Justin Clark
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
| | - Arri Coomarasamy
- Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women’s Hospital, Birmingham, West Midlands, UK
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Maxwell L, Voetagbe G, Paul M, Mark A. Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana. BMC Public Health 2015; 15:586. [PMID: 26104025 PMCID: PMC4478624 DOI: 10.1186/s12889-015-1875-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/26/2015] [Indexed: 11/11/2022] Open
Abstract
Background Understanding what factors influence the receipt of postabortion contraception can help improve comprehensive abortion care services. The abortion visit is an ideal time to reach women at the highest risk of unintended pregnancy with the most effective contraceptive methods. The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method. Methods We used retrospective cohort data collected from 64 health facilities in three regions of Ghana. The dataset includes information on all abortion procedures conducted between 1 January 2008 and 31 December 2010 at each health facility. We used fixed effect Poisson regression to model the associations of interest. Results More than half (65 %) of the 29,056 abortion clients received some form of contraception. When midwives performed the abortion, women were more likely to receive postabortion contraception compared to house officers (RR: 1.18; 95 % CI: 1.13, 1.24) or physicians (RR: 1.21; 95 % CI: 1.18, 1.25), after controlling for facility-level variation and client-level factors. Compared to women seen by house officers, abortion clients seen by midwives and physicians were more likely to receive a long-acting and permanent rather than a short-acting contraceptive method (RR: 1.46; 95 % CI: 1.23, 1.73; RR: 1.58; 95 % CI: 1.37, 1.83, respectively). Younger women were less likely to receive contraception than older women irrespective of provider type and indication for the abortion (induced or PAC). Conclusions When comparing consultant physicians, house officers, and midwives, the type of abortion provider is associated with whether women receive postabortion contraception and with whether abortion clients receive a long-acting and permanent or a short-acting method. New strategies are needed to ensure that women seen by physicians and house officers can access postabortion contraception and to ensure that women seen by house officers have access to long-acting and permanent contraceptive methods. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1875-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren Maxwell
- Institute for Health and Social Policy, McGill University, 1130 Pine Ave West, Montréal, QC, H3A 1A3, Canada. .,Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
| | - Gertrude Voetagbe
- Ipas Ghana, No. 8 Akosombo Road, Airport Residential Area, Accra, Ghana.
| | - Mary Paul
- Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
| | - Alice Mark
- Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA.
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Avcioglu SN, Altinkaya SÖ, Küçük M, Zafer E, Sezer SD, Yüksel H. Second trimester abortion as a cause of maternal death: a case report. Pan Afr Med J 2015; 22:261. [PMID: 26958124 PMCID: PMC4765355 DOI: 10.11604/pamj.2015.22.261.7208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/31/2015] [Indexed: 11/11/2022] Open
Abstract
Each year, an estimated 529 000 maternal deaths occur worldwide. In literature, it is known that maternal mortality can occur during pregnancy, peripartum and also in postpartum period. Although very rare, maternal deaths may occur after spontaneous abortion. In present case, 37 year old G5P4 (Caesarean Section) women was admitted to Adnan Menderes University, Obstetrics and Gynecology clinic with diagnosis of missed abortion at 18 weeks' gestation. She had been hospitalized in the public maternity hospital for five days due to abortus incipience and prolapse of amnion membranes but had no contractions. Fetal heart beats ceased at the second day of hospitalization. Medically induced abortion was recommended but not accepted by the patient. At the fifth day of hospitalization, she was referred to our clinic due to deterioration of general health condition, low blood pressure and tachycardia. In emergency department, it was determined that she was not oriented, had confusion, had blood pressure of 49/25 mmHg and tachycardia. In ultrasonographic examination, 18 week in utero ex fetus was determined and there was free fluid in abdominopelvic cavity. The free fluid was suspected to be amniotic fluid due to rupture of uterus. Laparotomy was performed, no uterine rupture, hematoma or atony was observed. However during laparotomy, a very bad smelling odor, might be due to septicemia, was felt in the operation room. Cardiac arrest occurred during that operation. In autopsy report, it was concluded that maternal death was because of remaining of inutero ex fetus for a long time. In conclusion, although very rare, maternal deaths after spontaneous abortion may occur. Because spontaneous abortion is a common outcome of pregnancy, continued careful, strict monitoring and immediate treatment of especially second trimester spontaneous abortion is recommended to prevent related, disappointing, unexpected maternal deaths.
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Affiliation(s)
- Sümeyra Nergiz Avcioglu
- Department of Gynecology and Obstetrics, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Sündüz Özlem Altinkaya
- Department of Gynecology and Obstetrics, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Mert Küçük
- Department of Gynecology and Obstetrics, Mugla Sitki Koçman University, School of Medicine, Mugla, Turkey
| | - Emre Zafer
- Department of Gynecology and Obstetrics, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Selda Demircan Sezer
- Department of Gynecology and Obstetrics, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Hasan Yüksel
- Department of Gynecology and Obstetrics, Adnan Menderes University, School of Medicine, Aydin, Turkey
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van den Akker OBA. The psychological and social consequences of miscarriage. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.11.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Miscarriage is a common complication of early pregnancy that can have both medical and psychological consequences such as depression and anxiety. The need for routine surgical evacuation with miscarriage has been questioned because of potential complications such as cervical trauma, uterine perforation, hemorrhage, or infection. OBJECTIVES To compare the safety and effectiveness of expectant management versus surgical treatment for early pregnancy failure. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 February 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 4 of 4), PubMed (2005 to 11 January 2012), POPLINE (inception to 11 January 2012), LILACS (2005 to 11 January 2012) and reference lists of retrieved studies. SELECTION CRITERIA Randomized trials comparing expectant care and surgical treatment (vacuum aspiration or dilation and curettage) for miscarriage were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors assessed trial quality and extracted data. We contacted study authors for additional information. For dichotomous data, we calculated the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI). For continuous data, we computed the mean difference (MD) and 95% CI. We entered additional data such as medians into 'Other data' tables. MAIN RESULTS We included seven trials with 1521 participants in this review. The expectant-care group was more likely to have an incomplete miscarriage by two weeks (RR 3.98; 95% CI 2.94 to 5.38) or by six to eight weeks (RR 2.56; 95% CI 1.15 to 5.69). The need for unplanned surgical treatment was greater for the expectant-care group (RR 7.35; 95% CI 5.04 to 10.72). The mean percentage needing surgical management in the expectant-care group was 28%, while 4% of the surgical-treatment group needed additional surgery. The expectant-care group had more days of bleeding (MD 1.59; 95% CI 0.74 to 2.45). Further, more of the expectant-care group needed transfusion (RR 6.45; 95% CI 1.21 to 34.42). The mean percentage needing blood transfusion was 1.4% for expectant care compared with none for surgical management. Results were mixed for pain. Diagnosis of infection was similar for the two groups (RR 0.63; 95% CI 0.36 to 1.12), as were results for various psychological outcomes. Pregnancy data were limited. Costs were lower for the expectant-care group (MD -499.10; 95% CI -613.04 to -385.16; in UK pounds sterling). AUTHORS' CONCLUSIONS Expectant management led to a higher risk of incomplete miscarriage, need for unplanned (or additional) surgical emptying of the uterus, bleeding and need for transfusion. Risk of infection and psychological outcomes were similar for both groups. Costs were lower for expectant management. Given the lack of clear superiority of either approach, the woman's preference should be important in decision making. Pharmacological ('medical') management has added choices for women and their clinicians and has been examined in other reviews.
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Affiliation(s)
- Kavita Nanda
- Clinical Sciences, FHI, Research Triangle Park, North Carolina, USA.
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7
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Nwogu-Ikojo EE, Ezegwui HU. Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria. J OBSTET GYNAECOL 2009; 27:835-7. [DOI: 10.1080/01443610701718883] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gomes MM, Saunders C, Ramalho A, Accioly E. Serum vitamin A in mothers and newborns in the city of Rio de Janeiro. Int J Food Sci Nutr 2009; 60:282-92. [PMID: 19306225 DOI: 10.1080/09637480701752210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Retinol and carotenoid levels were determined spectrophotometrically in the blood of 222 mothers at delivery and in the umbilical cord of the newborns. We observed an important prevalence of vitamin A deficiency (VAD) among mothers and newborns (25.4% and 46.2%, respectively) as well as carotenoid inadequacy (52.3% and 92.6% in mothers and newborns, respectively), and an increased risk of VAD development among newborns whose mothers had VAD (odds ratio = 4.79). We found an increased risk of carotenoid inadequacy when VAD was already present in both groups (odds ratio = 2.21 and odds ratio = 6.85 in mothers and newborns, respectively). There were relationships between previous abortion and maternal VAD (P=0.022) and lower carotenoid levels among newborns (P=0.019), as well as inadequate maternal serum carotenoid levels and interdelivery interval less than 18 months. These findings suggest the need for interventional actions to prevent retinol and carotenoid inadequacy, and low antioxidant reserves.
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Affiliation(s)
- Mirian M Gomes
- Grupo de Pesquisa em Vitamina A, Universidade Federal do Rio de Janeiro, State of Rio de Janeiro, Brazil.
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Hodgson DT, Lotfipour S, Fox JC. Vaginal Bleeding Before 20 Weeks Gestation Due to Placental Abruption Leading to Disseminated Intravascular Coagulation and Fetal Loss After Appearing to Satisfy Criteria for Routine Threatened Abortion: A Case Report and Brief Review of the Literature. J Emerg Med 2007; 32:387-92. [PMID: 17499692 DOI: 10.1016/j.jemermed.2006.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 05/26/2006] [Accepted: 08/03/2006] [Indexed: 11/23/2022]
Abstract
We present a case of placental abruption with concomitant disseminated intravascular coagulation in a woman who presented with vaginal bleeding. A 32-year-old pregnant woman at 17 and 4/7 weeks gestation with a 1-month history of intermittent abdominal pain presented to our Emergency Department (ED) with 1 h of vaginal bleeding. Upon initial history, the patient reported that she was diagnosed with "blood behind the placenta" the day before and was discharged on pelvic precautions. An ED ultrasound confirmed the sub-amniotic hematoma with placental hematoma and a viable intrauterine fetus. A low fibrinogen level was suggested for disseminated intravascular coagulation and increasing hemorrhage necessitated dilation and evacuation and multiple units of blood products on an emergent basis. Only a few cases have been described in the literature demonstrating disseminated intravascular coagulation in patients at fewer than 20 weeks gestation with routine ultrasound findings of live intrauterine pregnancy and subchorionic hemorrhage.
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Affiliation(s)
- Danner T Hodgson
- Department of Emergency Medicine, University of California-Irvine School of Medicine, Irvine, California, USA
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Trussell J, Jordan B. Reproductive health risks in perspective. Contraception 2006; 73:437-9. [PMID: 16627027 DOI: 10.1016/j.contraception.2006.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 11/16/2022]
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Grimes DA. Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999. Am J Obstet Gynecol 2006; 194:92-4. [PMID: 16389015 DOI: 10.1016/j.ajog.2005.06.070] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 06/15/2005] [Indexed: 11/18/2022]
Abstract
The comparative safety of pregnancy outcomes has clinical and public health importance. Using national statistics for 1991 to 1999, I estimated the risk of maternal death associated with various outcomes. Abortion (legal and spontaneous) was associated with the lowest risk, live birth intermediate risk, and ectopic pregnancy and fetal death the highest risk.
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Affiliation(s)
- David A Grimes
- Family Health International, Research Triangle Park, NC 27709, USA.
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Fischer M, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukens V, Whiteman DB, Iton A, Cheung M, Dassey DE, Shieh WJ, Zaki SR. Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. N Engl J Med 2005; 353:2352-60. [PMID: 16319384 DOI: 10.1056/nejmoa051620] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.
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Affiliation(s)
- Marc Fischer
- Centers for Disease Control and Prevention, Atlanta, USA.
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Affiliation(s)
- David A Grimes
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570, USA.
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Abstract
BACKGROUND The 1998 public awareness campaign on Safe Motherhood called attention to the issue of maternal mortality worldwide. This paper focuses upon maternal mortality trends in the United States and Canada, and examines differentials in maternal mortality in the United States by maternal characteristics. METHODS Data from the vital statistics systems of the United States and Canada were used in the analysis. Both systems identify maternal deaths using the definition of the World Health Organization's International Classification of Diseases. Numbers of deaths, maternal mortality rates, and confidence intervals for the rates are shown in the paper. RESULTS Maternal mortality declined for much of the century in both countries, but the rates have not changed substantially between 1982 and 1997. In this period the maternal mortality levels were lower in Canada than in the United States. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. CONCLUSIONS Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. Maternal mortality rates have been stable recently, despite evidence that many maternal deaths continue to be preventable. Additional investment is needed to realize further improvements in maternal mortality.
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Affiliation(s)
- D L Hoyert
- Division of Vital Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA
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