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Mediboina A, Badam RK, Chodavarapu S. Assessing the Accuracy of Information on Medication Abortion: A Comparative Analysis of ChatGPT and Google Bard AI. Cureus 2024; 16:e51544. [PMID: 38318564 PMCID: PMC10840059 DOI: 10.7759/cureus.51544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
Background and objective ChatGPT and Google Bard AI are widely used conversational chatbots, even in healthcare. While they have several strengths, they can generate seemingly correct but erroneous responses, warranting caution in medical contexts. In an era where access to abortion care is diminishing, patients may increasingly rely on online resources and AI-driven language models for information on medication abortions. In light of this, this study aimed to compare the accuracy and comprehensiveness of responses generated by ChatGPT 3.5 and Google Bard AI to medical queries about medication abortions. Methods Fourteen open-ended questions about medication abortion were formulated based on the Frequently Asked Questions (FAQs) from the National Abortion Federation (NAF) and the Reproductive Health Access Project (RHAP) websites. These questions were answered using ChatGPT version 3.5 and Google Bard AI on October 7, 2023. The accuracy of the responses was analyzed by cross-referencing the generated answers against the information provided by NAF and RHAP. Any discrepancies were further verified against the guidelines from the American Congress of Obstetricians and Gynecologists (ACOG). A rating scale used by Johnson et al. was employed for assessment, utilizing a 6-point Likert scale [ranging from 1 (completely incorrect) to 6 (correct)] to evaluate accuracy and a 3-point scale [ranging from 1 (incomplete) to 3 (comprehensive)] to assess completeness. Questions that did not yield answers were assigned a score of 0 and omitted from the correlation analysis. Data analysis and visualization were done using R Software version 4.3.1. Statistical significance was determined by employing Spearman's R and Mann-Whitney U tests. Results All questions were entered sequentially into both chatbots by the same author. On the initial attempt, ChatGPT successfully generated relevant responses for all questions, while Google Bard AI failed to provide answers for five questions. Repeating the same question in Google Bard AI yielded an answer for one; two were answered with different phrasing; and two remained unanswered despite rephrasing. ChatGPT showed a median accuracy score of 5 (mean: 5.26, SD: 0.73) and a median completeness score of 3 (mean: 2.57, SD: 0.51). It showed the highest accuracy score in six responses and the highest completeness score in eight responses. In contrast, Google Bard AI had a median accuracy score of 5 (mean: 4.5, SD: 2.03) and a median completeness score of 2 (mean: 2.14, SD: 1.03). It achieved the highest accuracy score in five responses and the highest completeness score in six responses. Spearman's correlation coefficient revealed no correlation between accuracy and completeness for ChatGPT (rs = -0.46771, p = 0.09171). However, Google Bard AI showed a marginally significant correlation (rs = 0.5738, p = 0.05108). Mann-Whitney U test indicated no statistically significant differences between ChatGPT and Google Bard AI concerning accuracy (U = 82, p>0.05) or completeness (U = 78, p>0.05). Conclusion While both chatbots showed similar levels of accuracy, minor errors were noted, pertaining to finer aspects that demand specialized knowledge of abortion care. This could explain the lack of a significant correlation between accuracy and completeness. Ultimately, AI-driven language models have the potential to provide information on medication abortions, but there is a need for continual refinement and oversight.
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Affiliation(s)
- Anjali Mediboina
- Community Medicine, Alluri Sita Ramaraju Academy of Medical Sciences, Eluru, IND
| | - Rajani Kumari Badam
- Obstetrics and Gynaecology, Sri Venkateswara Medical College, Tirupathi, IND
| | - Sailaja Chodavarapu
- Obstetrics and Gynaecology, Government Medical College, Rajamahendravaram, IND
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Characteristics and Indications of Legal Abortion among the Pregnant Women in Lorestan Province of Iran during 2017–2019. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/8816785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Legal abortion is a challenge from the viewpoint of ethics and religion. The present study was conducted to investigate the frequency of fetal and maternal indications of legal abortion and also the maternal characteristics in Lorestan Province of Iran. Methods. As a descriptive cross-sectional study, all the cases with issued permits for legal abortion were selected by a census during 2017–2019. Descriptive data analysis was used to report the results. Event rates with Poisson 95% confidence intervals (CIs) were calculated based on the regional population. Results. A total of 305 cases were selected. The mean age of the mothers was 31.61 ± 7.48 years, and the mean of gestational age was 15.76 ± 2.80 weeks. Demographically, most cases were from Khorramabad city (101 cases) followed by Borujerd (51 cases) and Doroud (46 cases). The overall event rate was 1.732 per 10,000 individuals (95% CI: 1.543–1.938) of the general population of the region per 3 years. Fetal disturbance of the brain and spine was the most prevalent reason of abortion (24.92%, 95% CI: 19.63%–31.19%) followed by Down syndrome (19.34%, 95% CI: 14.73%–24.95), hydrops fetalis (12.79%, 95% CI: 9.09%–17.48%), and anencephaly (12.79%, 95% CI: 9.09%–17.48%). Conclusion. From each 10,000 individuals of the population, one to two cases of legal abortion were screened per 3 years. More than 90% of cases had fetal indication. In cities with lower event rates, we should plan for better screening.
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Goodfellow L, Care A, Alfirevic Z. Controversies in the prevention of spontaneous preterm birth in asymptomatic women: an evidence summary and expert opinion. BJOG 2020; 128:177-194. [PMID: 32981206 DOI: 10.1111/1471-0528.16544] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/11/2023]
Abstract
Preterm birth prevention is multifaceted and produces many nuanced questions. This review addresses six important clinical questions about preterm birth prevention as voted for by members of the UK Preterm Clinical Network. The questions cover the following areas: preterm birth prevention in 'low-risk' populations; screening for asymptomatic genital tract infection in women at high risk of preterm birth; cervical length screening with cerclage or vaginal pessary in situ; cervical shortening whilst using progesterone; use of vaginal progesterone in combination with cervical cerclage; and optimal advice about intercourse for women at high risk of preterm birth.
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Affiliation(s)
- Laura Goodfellow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
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Abstract
Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications [1].
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Kc S, Gissler M, Klemetti R. The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study. Acta Obstet Gynecol Scand 2020; 99:651-659. [PMID: 32128786 DOI: 10.1111/aogs.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. MATERIAL AND METHODS First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). RESULTS Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI 1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. CONCLUSIONS The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Reija Klemetti
- Department of Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Costescu D, Guilbert É. No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:750-783. [PMID: 29861084 DOI: 10.1016/j.jogc.2017.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care. INTENDED USERS Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs. TARGET POPULATION Women with an unintended or abnormal first or second trimester pregnancy. EVIDENCE PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched. VALUES The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request. BENEFITS, HARMS, AND/OR COSTS IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.
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Abstract
When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman’s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.
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Affiliation(s)
- Sharon Cameron
- Chalmers Centre, NHS Lothian & University of Edinburgh, 2a Chalmers Street, Edinburgh, EH3 9ES, UK
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No 360 - Avortement provoqué : avortement chirurgical et méthodes médicales au deuxième trimestre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:784-821. [DOI: 10.1016/j.jogc.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Smith GC. Universal screening for foetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2018; 49:16-28. [DOI: 10.1016/j.bpobgyn.2018.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/15/2018] [Indexed: 12/22/2022]
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Omani-Samani R, Mansournia MA, Sepidarkish M, Almasi-Hashiani A, Safiri S, Vesali S, Amini P, Maroufizadeh S. Cross-sectional study of associations between prior spontaneous abortions and preterm delivery. Int J Gynaecol Obstet 2017; 140:81-86. [PMID: 29023747 DOI: 10.1002/ijgo.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/07/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate associations between a history of spontaneous abortion and preterm delivery during subsequent pregnancies. METHODS The present secondary analysis included cross-sectional survey data related to all deliveries at 103 hospitals in Tehran, Iran, between July 6 and 21, 2015. Trained midwives interviewed patients within 24 hours of delivery. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to investigate associations between spontaneous abortion and preterm delivery. RESULTS Data were included from 4991 deliveries. A history of spontaneous abortion (OR 1.50, 95% CI 1.21-1.87; P=0.001) and history of recurrent spontaneous abortion (OR 3.74, 95% CI 1.90-7.37; P=0.001) were associated with increased odds of preterm delivery in comparison with no such history. Similarly, one (OR 1.33, 95% CI 1.04-1.70; P=0.023), two (OR 1.78, 95% CI 1.15-2.74; P=0.009), or at least three prior spontaneous abortions (OR 4.10, 95% CI 2.08-8.08; P=0.001) were associated with increased odds of preterm delivery compared with none. Population attributable fractions of 9.49% (95% CI 3.36-15.12) and 2.00% (95% CI 0.57-3.56) were calculated for histories of spontaneous abortion and recurrent pregnancy loss, respectively. CONCLUSION History of spontaneous abortion and history of recurrent pregnancy loss were associated with increased odds of preterm delivery. A greater number of spontaneous abortions corresponded to greater odds of preterm delivery.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad A Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Risk factors of preterm birth in France in 2010 and changes since 1995: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46:19-28. [DOI: 10.1016/j.jgyn.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/09/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
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Goldberg AB, Allen RH. Misoprostol before first trimester surgical abortion: a patient-centered approach. Contraception 2016; 94:576-577. [DOI: 10.1016/j.contraception.2016.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Cameron S, Fiala C, Gemzell-Danielsson K. Routine misoprostol before all surgical abortions. Contraception 2016; 94:575-576. [PMID: 27263044 DOI: 10.1016/j.contraception.2016.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/15/2022]
Affiliation(s)
| | - Christian Fiala
- Gynmed Clinic, Vienna, Austria; Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Abstract
OBJECTIVE This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. INTENDED USERS Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. TARGET POPULATION Women with an unintended first trimester pregnancy. EVIDENCE Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). BENEFITS, HARMS AND/OR COSTS Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. SUMMARY STATEMENTS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care RECOMMENDATIONS Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care.
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Urquia ML, Moineddin R, Jha P, O'Campo PJ, McKenzie K, Glazier RH, Henry DA, Ray JG. Sex ratios at birth after induced abortion. CMAJ 2016; 188:E181-E190. [PMID: 27067818 DOI: 10.1503/cmaj.151074] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking. METHODS We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions. RESULTS Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births. INTERPRETATION High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy.
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Affiliation(s)
- Marcelo L Urquia
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont.
| | - Rahim Moineddin
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Prabhat Jha
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Patricia J O'Campo
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Kwame McKenzie
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Richard H Glazier
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - David A Henry
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
| | - Joel G Ray
- Centre for Global Health Research (Jha), St. Michael's Hospital; Centre for Research on Inner City Health (Urquia, O'Campo, Glazier), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital; Dalla Lana School of Public Health (Urquia, Jha, O'Campo, Henry), University of Toronto; Department of Family and Community Medicine (Moineddin, Glazier), University of Toronto; Centre for Addiction and Mental Health (McKenzie), University of Toronto; Department of Psychiatry (McKenzie), University of Toronto; Institute for Clinical Evaluative Sciences (Urquia, Moineddin, O'Campo, Glazier, Henry, Ray), Toronto, Ont
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Lemmers M, Verschoor M, Hooker A, Opmeer B, Limpens J, Huirne J, Ankum W, Mol B. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum Reprod 2015; 31:34-45. [DOI: 10.1093/humrep/dev274] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/08/2015] [Indexed: 12/29/2022] Open
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Abstract
PURPOSE OF REVIEW In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly--a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries. RECENT FINDINGS Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries. SUMMARY Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.
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Stewart H, McCall SJ, McPherson C, Towers LC, Lloyd B, Fletcher J, Bhattacharya S. Effectiveness of peri-abortion counselling in preventing subsequent unplanned pregnancy: a systematic review of randomised controlled trials. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 42:59-67. [DOI: 10.1136/jfprhc-2014-101096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 08/10/2015] [Indexed: 01/17/2023]
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Oliver-Williams C, Fleming M, Wood AM, Smith G. Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980-2008: a historical cohort study. BJOG 2015; 122:1525-34. [PMID: 25626593 PMCID: PMC4611958 DOI: 10.1111/1471-0528.13276] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the relationship between previous miscarriage and risk of preterm birth changed over the period 1980-2008, and to determine whether the pattern varied according to the cause of the preterm birth. DESIGN Linked birth databases. SETTING All Scottish NHS hospitals. POPULATION A total of 732 719 nulliparous women with a first live birth between 1980 and 2008. METHODS Risk was estimated using logistic regression. MAIN OUTCOME MEASURES Preterm birth, subdivided by cause (spontaneous, induced with a diagnosis of pre-eclampsia, or induced without a diagnosis of pre-eclampsia) and severity [extreme (24-28 weeks of gestation), moderate (29-32 weeks of gestation), and mild (33-36 weeks of gestation)]. RESULTS Consistent with previous studies, previous miscarriage was associated with an increased risk of all-cause preterm birth (adjusted odds ratio, aOR 1.26; 95% confidence interval, 95% CI 1.22-1.29). This arose from associations with all subtypes. The strongest association was found with extreme preterm birth (aOR 1.73; 95% CI 1.57-1.90). Risk increased with the number of miscarriages. Women with three or more miscarriages had the greatest risk of all-cause preterm birth (aOR 2.14; 95% CI 1.93-2.38), and the strongest association was with extreme preterm birth (aOR 3.87; 95% CI 2.85-5.26). The strength of the association between miscarriage and preterm birth decreased from 1980 to 2008. This was because of weakening associations with spontaneous preterm birth and induced preterm birth without a diagnosis of pre-eclampsia. CONCLUSIONS The association between a prior history of miscarriage and the risk of preterm birth declined in Scotland over the period 1980-2008. We speculate that changes in the methods of managing incomplete termination of pregnancy might explain the trend, through reduced cervical damage.
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Affiliation(s)
- C Oliver-Williams
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M Fleming
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - A M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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