Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion. METHODS: Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes. DISCUSSION: The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion.Trial registrationClinicalTrials.gov Identifier NCT01174225.     

Effectiveness of abortion as birth control.

Several models used to study the effectiveness of abortion in population limitation are examined. The Keyfitz model, based on the probability that an individual woman will conceive in a given month, is extended and public implications of legal abortions are discussed. A model more appropriate for a population of women rather than a single woman can be developed by relating the probability of conception and the sterile intervals to the number of birth and the number of women in the population. The effectiveness of abortion as a birth control method is studied using this model and includes: 1) abortion effectiveness combined with efficient contraception (95% effective); 2) the sensitivity of abortion to gestation when a contraceptive of lower efficiency is used; 3) these effects modified for prolonged lactation; 4) the effect of changing the monthly probability of conception and the monthly efficiency of contraception. Abortion later in pregnancy is advantageous when efficient contraception is absent. The effectiveness of abortion to gestation is approximately the same whether lactation is included or absent, although abortion is more effective at all gestations and for all contraceptives efficiencies in the absence of lactation. The sensitivity of the effectiveness of abortion to the probability of conception decreases as monthly effectiveness of contraception increases. The probability of conception and the monthly effectiveness of contraception are difficult parameters to measure in the population. The effect of abortion averaged over the entire population at risk of pregnancy is different from its effect on certain subgroups. For U.S. females the probability of conception may be between .06 and .16, and from the model it is indicated that the effectiveness of abortion would be from 1 to 1.13 abortions per live birth. The application of the model suggests that the expenditures for abortion services in this population are a reasonable investment, although investment for efficient contraception is also suggested.     

Before and after therapeutic abortion

Surveys conducted after therapeutic abortion were used to evaluate contraceptive use, to assess early physical and emotional effects and to provide feedback to the hospital nurses on their counselling role. The follow-up rate was only 53%. Of those who cooperated 82.9% were using effective contraception three months after abortion. Subjective morbidity was greater than anticipated. The main emotional response was relief coupled with some guilt and depression in a significant minority. The occurrence and significance of the after effects of abortion should be explained in advance. Training workshops for abortion counsellors would be useful. The surgical termination of pregnancy is only a small part of a comprehensive abortion service.     

早期妊娠妇女人工流产的因素调查

目的：了解早期妊娠行人工流产妇女的人群特征,探讨导致妇女人工流产的相关因素,为减少非意愿妊娠提供干预依据。方法：采用整群抽样方法,对丰台区四家二级医院计划生育门诊同期行人工流产的妇女进行问卷调查。结果：共回收调查问卷4381份。调查对象中,平均年龄26岁（16．54岁）,本市户籍占26．8％,外地户籍73．2％;已婚65．33％,未婚34．67％;文化程度初、高中占62．5％;职业列前三位的分别是服务员23．5％、公司职员18．2％、个体工商户10．5％;重复流产为37-3％。非意愿妊娠占83．24％,,非意愿妊娠的原因,39．53％是未避孕,43．71％为避孕失败,而避孕失败的原因中又以避孕套避孕失败居首;意愿妊娠占Ⅲ6．7鹞％,最终选择终止妊娠的原因分别为个人工作因素、情感因素及优生考虑。结论i为降低l妇女非意愿妊娠及重复流产率,对育龄妇女,尤其是流动、未婚人群,需广泛开展性健康教育及避孕方式知情选择,加强避孕知识以及人工流产危害的宣教,指导避孕方法的正确使用,同时,各级医院亟待开展流产后服务。     

Biobrane versus 1% silver sulfadiazine in second-degree pediatric burns

Partial-thickness burns in children have been treated for many years by daily, painful tubbing, washing, and cleansing of the burn wound, followed by topical application of antimicrobial creams. Pain and impaired wound healing are the main problems. We hypothesized that the treatment of second-degree burns with Biobrane is superior to topical treatment. Twenty pediatric patients were prospectively randomized in two groups to compare the efficacy of Biobrane versus 1% silver sulfadiazine. The rest of the routine clinical protocols were followed in both groups. Demographic data, wound healing time, length of hospital stay, pain assessments and pain medication requirements, and infection were analyzed and compared. Main outcome measures included pain, pain medication requirements, wound healing time, length of hospital stay, and infection. The application of Biobrane to partial-thickness burns proved to be superior to the topical treatment. Patients included in the biosynthetic temporary cover group presented with less pain and required less pain medication. Length of hospital stay and wound healing time were also significantly shorter in the Biobrane group. None of the patients in either group presented with wound infection or needed skin autografting. In conclusion, the treatment of partial-thickness burns with Biobrane is superior to topical therapy with 1% silver sulfadiazine. Pain, pain medication requirements, wound healing time, and length of hospital stay are significantly reduced.     

Factors associated with immediate abortion complications.

OBJECTIVE: To identify factors associated with increased risk of immediate complications from induced abortion. DESIGN: Retrospective analysis of a provincial database. SETTING: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. POPULATION: Women in Ontario aged 15 to 44 years who underwent an induced abortion in the province (without concurrent sterilization) between Jan. 1, 1992, and Dec. 31, 1993. OUTCOME MEASURES: Recording of complications at the time of the procedure, gestational age, type of procedure, place of abortion (hospital or clinic), and patient''s age, parity and history of previous abortion (spontaneous or induced). RESULTS: During the study period 83 469 abortions were performed that met our inclusion criteria. Immediate complications were reported in 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient''s age, parity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications; however, gestational age, method of abortion and place of abortion were significant risk factors (p < 0.001). The odds ratio (OR) for having a complication from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks, compared with having one after abortion at 9 weeks or earlier, and increased to 3.3 (95% CI 2.23 to 5.00) after abortion between 17 and 20 weeks. Compared with surgical dilatation and curettage (D&C), instillation of saline and instillation of prostaglandins were more likely to be associated with immediate complications (OR 24.0, 95% CI 13.22 to 43.70, and OR 11.7, 95% CI 6.43 to 21.18, respectively), whereas both suction D&C and insertion of a laminaria tent were less likely to be associated with immediate complications (OR 0.4, 95% CI 0.26 to 0.67, and OR 0.3, 95% CI 0.19 to 0.52, respectively). Compared with women who had an abortion in a free-standing clinic, the risk for immediate complications was greater among those who had an abortion in a hospital, especially a teaching hospital (OR 1.9, 95% CI 1.38 to 2.58), a nonteaching hospital with 200 to 399 acute care beds (OR 3.1, 95% CI 2.27 to 4.21) and a nonteaching hospital with fewer than 200 acute care beds (OR 5.9, 95% CI 4.04 to 8.64). CONCLUSION: The risk of immediate complications from induced abortion is very low. Unlike in previous studies, the woman''s age, parity and history of previous spontaneous or induced abortions were not found to be risk factors. However, advancing gestational age and procedures involving instillation of saline or prostaglandins were predictive factors of immediate complications.     

Abortion as a backup method for contraceptive failure in China

Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women's sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50.1%, 75.3% and 80.2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women's social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.     

A study of contraception as related to unwanted pregnancy

A study was made of 150 women requesting therapeutic abortion. Mechanical failure of the contraceptive method used accounted for unwanted pregnancy in 89 (59%) women. In the remainder no method of contraception was used by either partner. Among women requesting abortion, failure to use contraceptives was commoner in the younger and unmarried than in older and married women.The data obtained were analyzed in an attempt to explain the failure and avoidance of contraception. Suggestions are made as to how to discourage the use of abortion as a method of contraception.     

不同人群人工流产术围手术期预防用多西环素临床分析

目的:分析不同人群人工流产术围手术期预防用多西环素的临床疗效。方法:采用回顾性调查方法,抽取本院2012年要求行人工流产术的日间手术住院患者4073例,分为正常人群和高危人群。正常人群中预防用多西环素者(预防组)2007例,未预防用抗菌药物组(未预防组)688例,高危人群中预防组865例,未预防组513例。对比分析不同人群预防组和未预防组术后1个月的手术部位感染率和远期(1年)并发症发生率。结果:正常人群预防组的手术部位感染率及远期并发症发生率分别为2.14%、7.77%,均分别显著低于未预防组的6.54%、11.05%(P0.05),而高危人群预防组分别为4.62%、10.06%,与未预防组的4.68%、12.09%比较,差异均无统计学意义(P0.05)。结论:围手术期预防用多西环素可降低人工流产术中正常人群的手术部位感染率和远期并发症发生率,而对于高危人群的作用不明显,因此术前应对患者的高危感染因素进行积极治愈或纠正后,预防用药价值可能较大。     

Knowledge,Attitude, Practice,and Determinants Emergency Contraceptive Use among Women Seeking Abortion Services in Dire Dawa,Ethiopia

Background

Unplanned pregnancy from casual sex, unplanned sexual activity, and sexual violence are increasing. Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in Ethiopia particularly in major cities. Yet the use of EC is very low and abortion rate in cities is high compared to the national average.

Objectives

To assess knowledge, attitude and practice and determinants on the use of emergency contraception among women obtaining abortion service at selected health institutions in Dire Dawa, Eastern Ethiopia.

Methods

A facility based cross-sectional study was conducted on 390 women selected by multi-stage random sampling technique. The samples were generated from government and private for non profit health facilities. Participant’s knowledge and attitude towards emergency contraception were measured using composite index based on 7 and 9 questions, respectively and analyzed using mean score to classify them as knowledgeable or not, and have positive attitude or not. Practice was assessed if the women reported ever use of emergency contraception. Determinants of use of emergency contraception were analyzed using logistic regression.

Result

Out of 390 women interviewed, 162 women (41.5%) heard about EC, only 133 (34.1%) had good knowledge, and 200 (51.3%) of the respondents had positive attitudes towards to EC. Ever use of EC was reported by 38 (9.7%). Age, living arrangement, education, marital status, religion were found to be significantly associated with the use of emergency contraceptives. Women with poor knowledge were less likely to use EC compared to the knowledgeable ones [AOR = 0.027, 95% CI (0.007, 0.105)].

Conclusion

The study identified that most respondents lack adequate knowledge on the method of EC. In addition ever use of EC is very low.

Recommendations

Health professions should give attention in increasing knowledge and uptake of Emergency Contraception.     

Induced abortion in Sri Lanka: who goes to providers for pregnancy termination?

The sociodemographic characteristics of abortion seekers and the reasons they give for procuring termination were studied in 356 clients selected from two abortion clinics in the city of Colombo. Nearly 80% were Buddhists and about 10% were Christians. Almost all had some formal education but only 20% were employed outside the home. Over 95% were currently married and at the peak of their childbearing age. More than one-half were aged 30 years or over, while adolescents only constituted about 3%. Fourteen per cent were nulliparous and about two-thirds had one or two living children at the time of obtaining the abortion. A significantly high proportion also had a very young child. In total, the 356 women had had 1130 pregnancies, and the mean rate of abortion was 42 per 100 pregnancies. Over one-quarter had had more than one abortion and about 10% had had three or more. Almost all abortions were performed within the first trimester with a mean gestation period of 6 weeks. About one-third of the clients were using some method of contraception at the time they became pregnant. The most common reasons cited for the present abortion were 'pregnancy too soon after previous delivery', 'no more children desired' or 'curtailment of opportunity for foreign employment'. Unmarried women constitute a special group of abortion seekers who have different needs and behave differently from married women. Their needs are not currently being met by reproductive health programmes in Sri Lanka, and it is important that they should be given special attention in the future. An interesting finding is that a significant minority of the abortion seekers answered negatively to the question regarding providing medical facilities for abortions without difficulty. This underscores the ambivalence many people have to abortion.     

Prévalence de l'infection cervicale à Chlamydia trachomatis dans une population féminine consultant pour contraception.

OBJECTIVES: To determine the prevalence and risk indicators of cervical infection due to Chlamydia trachomatis among female patients consulting for contraception and to evaluate an enzyme immunoassay for the detection of C. trachomatis in this setting. DESIGN: Prevalence study. Endocervical specimens were analysed by means of culture and enzyme immunoassay. C. trachomatis infection was diagnosed through culture. SETTING: A hospital family planning clinic in Trois-Rivières, Que. SUBJECTS: All 533 female patients who consulted for contraception between November 1986 and March 1988. Results of culture were available for 495 patients. MAIN OUTCOME MEASURE: Demographic, epidemiologic and clinical information was collected by means of a standard questionnaire and a gynecologic examination. MAIN RESULTS: The prevalence rate of chlamydial infection was 9% (45/495). Enzyme immunoassay detected 37 (82%) of the infections. The mean age of the patients was 19.8 years, and 98% of the infections were diagnosed in those aged 25 years or less. The variables significantly associated with C. trachomatis infection were having more than one sexual partner in the preceding year (odds ratio [OR] 2.9; 95% confidence limits [CL] 1.7 and 5.0) and having more than one partner in the preceding 3 months (OR 2.3; 95% CL 1.2 and 4.3). These two indicators would have detected 58% and 22% of the infections respectively. CONCLUSIONS: Screening for C. trachomatis infection by means of enzyme immunoassay should be proposed to all female patients aged 25 years or less consulting for contraception in our clinic. Such screening may prove to be an effective preventive measure in other similar clinical settings.     

Chlamydial infection among females attending an abortion clinic: prevalence and risk factors.

To determine the prevalence of Chlamydia trachomatis infection and the epidemiologic risk factors for chlamydial infection in the Quebec City region, screening was done with an enzyme immunoassay in 920 females who attended an abortion clinic between November 1985 and June 1986. The organism was detected in 105 (11.4%) of the patients. After adjustment for confounding variables, four variables were found to be independent risk factors for chlamydial infection: age 24 years or less (prevalence ratio 3.0 [p less than 0.001]), two or more sexual partners during the previous year (prevalence ratio 1.8 [p = 0.001]), no contraception or the use of a nonbarrier method (prevalence ratio 1.9 [p = 0.030]) and living in an urban area (prevalence ratio 1.6 [p = 0.046]). The results confirm that chlamydial infection is prevalent in this population. The identified risk factors may prove useful in determining the target population for screening programs.     

Hospital Admission following Induced Abortion in Eastern Highlands Province,Papua New Guinea – A Descriptive Study

Background

In Papua New Guinea abortion is restricted under the Criminal Code Act. While safe abortions should available in certain situations, frequently they are not available to the majority of women. Sepsis from unsafe abortion is a leading cause of maternal mortality. Our findings form part of a wider, mixed methods study designed to identify complications requiring hospital treatment for post abortion care and to explore the circumstances surrounding unsafe abortion.

Methods

Through a six month prospective study we identified all women presenting to the Eastern Highlands Provincial Hospital following spontaneous and induced abortions. We undertook semi-structured interviews with women and reviewed individual case notes, extracting demographic and clinical information.

Findings

Case notes were reviewed for 56% (67/119) of women presenting for post abortion care. At least 24% (28/119) of these admissions were due to induced abortion. Women presenting following induced abortions were significantly more likely to be younger, single, in education at the time of the abortion and report that the baby was unplanned and unwanted, compared to those reporting spontaneous abortion. Obtained illegally, misoprostol was the method most frequently used to end the pregnancy. Physical and mechanical means and traditional herbs were also widely reported.

Conclusion

In a country with a low contraceptive prevalence rate and high unmet need for family planning, all reproductive age women need access to contraceptive information and services to avoid, postpone or space pregnancies. In the absence of this, women are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk and putting an increased strain on an already struggling health system. Women in this setting need access to safe, effective means of abortion.     

先天性心脏病患儿术后并发医院感染的危险因素及其病原菌分布和药敏实验分析

目的:统计先天性心脏病(CHD)患儿术后医院感染的病原菌分布及细菌耐药性情况,分析影响CHD患儿术后医院感染的危险因素。方法:回顾性选取2010年3月-2017年10月我院行CHD手术治疗的患儿3800例,收集临床标本进行致病菌培养并进行药敏试验,统计CHD术后医院感染患儿病原菌种类及主要致病菌的耐药情况,分析影响CHD患儿术后医院感染的危险因素。结果:3800例CHD患儿术后医院感染率为3.13%(119/3800),共分离出菌株172株,G^-菌、G⁺菌、真菌分别占55.81%(96/172)、26.74%(46/172)、17.44%(30/172)。肺炎克伯雷菌、大肠杆菌对头孢类抗生素高度耐药,鲍曼不动杆菌检出率逐年增高,且仅对多黏菌素B保持敏感;肺炎链球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌对大环内脂类抗生素、克林霉素、青霉素高度耐药,对万古霉素和替加环素保持敏感。术后医院感染与年龄、体重、病程、手术时间、体外循环时间、机械通气时间、ICU停留时间、住院时间、合并肺动脉高压、吸痰次数、静脉营养、应用丙种球蛋白或白蛋白有关(P<0.05),且合并肺动脉高压、体外循环时间≥100 min、机械通气时间≥120 h、吸痰次数≥5次/d是CHD患儿术后医院感染的危险因素(P<0.05)。结论:G^-菌、G⁺菌是CHD患儿术后医院感染的主要致病菌,且对常用抗生素高度耐药,此外鲍曼不动杆菌的检出率和耐药性上升极为明显,合并肺动脉高压、体外循环时间及机械通气时间过长、吸痰次数多的CHD患儿医院感染风险升高。     

改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。     

Incidence of Induced Abortion in Uganda, 2013: New Estimates Since 2003

BackgroundIn Uganda, abortion is permitted only when the life of a woman is in danger. This restriction compels the perpetuation of the practice in secrecy and often under unsafe conditions. In 2003, 294,000 induced abortions were estimated to occur each year in Uganda. Since then, no other research on abortion incidence has been conducted in the country.MethodsData from 418 health facilities were used to estimate the number and rate of induced abortion in 2013. An indirect estimation methodology was used to calculate the annual incidence of induced abortions ─ nationally and by major regions. The use of a comparable methodology in an earlier study permits assessment of trends between 2003 and 2013.ResultsIn 2013, an estimated 128,682 women were treated for abortion complications and an estimated 314,304 induced abortions occurred, both slightly up from 110,000 and 294,000 in 2003, respectively. The national abortion rate was 39 abortions per 1,000 women aged 15–49, down from 51 in 2003. Regional variation in abortion rates is very large, from as high as an estimated 77 per 1,000 women 15–49 in Kampala region, to as low as 18 per 1,000 women in Western region. The overall pregnancy rate also declined from 326 to 288; however the proportion of pregnancies that were unintended increased slightly, from 49% to 52%.ConclusionUnsafe abortion remains a major problem confronting Ugandan women. Although the overall pregnancy rate and the abortion rate declined in the past decade, the majority of pregnancies to Ugandan women are still unintended. These findings reflect the increase in the use of modern contraception but also suggest that a large proportion of women are still having difficulty practicing contraception effectively. Improved access to contraceptive services and abortion-related care are still needed.     

The use of induced abortion as a contraceptive: the case of Mongolia

After the onset of liberlization of the Mongolian economy in 1989, the laws governing abortion were relaxed. Furthermore, the availability and use of modern contraceptives also started to improve. The Demographic Survey of Mongolia, conducted during June-July 1996, collected information on different aspects of abortion. This paper presents the results on the prevalence of induced abortion and other related issues. It was found that in the absence of adequate knowledge and availability of modern contraceptives in Mongolia. the prevalence of induced abortion was relatively high. About 24% of women undergoing abortion were using it as a contraceptive because they thought it to be a safe method of contraception. Though the abortion rules stipulate counselling on the use of modern contraceptives just after an abortion, only 60% of women undergoing an abortion were given such counselling.     

Hospital Physicians' Influence on Gastrointestinal Protection during Treatment with Non-Steroidal Anti-Inflammatory Drugs and Acetylsalicylic Acid and the Impact on Prescribing in Primary Care

Background

The aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA.

Methods

This study included all elderly patients (75+) admitted to hospital in the period of 1^st April 2010 to 31^st March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay.

Results

In total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0%) and 597 of 1994 user of low-dose ASA (29.9%) had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0%) and 647 of 961 (67.3%) were initiated without concomitant use of GI protection. When hospital physicians initiated GI protection, 26.8–51.0% were continued in primary care after discharge.

Conclusions

During hospital stay, the use of GI protection increases, but when new treatment with NSAIDs or low-dose ASA is initiated in hospital, the use of gastrointestinal protection is low. The low use of GI protection is carried on in primary care after discharge.     

Laminaria augmentation of intra-amniotic PGF2α for midtrimester pregnancy termination

In our hands, intra-amniotic PGF₂α 40 mg for midtrimester pregnancy termination had a mean infusion to abortion interval of 29.4 hr. However, pretreatment of 230 patients with laminaria tents inserted 14–18 hr before PGF₂α infusion resulted in a dramatically reduced time to abortion (14.3 hr mean) with a low incidence of gastrointestinal and other side effects. Laminaria tents inserted at the same time as PGF₂α infusion in 26 patients also resulted in reduced time to abortion (18.6 hr mean). In the laminaria pretreated group, the infusion to abortion interval was indirectly related to the number of laminaria inserted and not to the nulliparous or parous state. Although we have made significant strides in shortening the abortion interval in the hospital, retained placentae and blood loss persist as problems related to the use of prostaglandin for abortion.