Surgical termination of pregnancy for fetal anomaly: what role can an independent abortion service provider play?

We describe the safety and acceptability of a surgical TOPFA service delivered by an independent-sector abortion provider. Non-identifiable data for women undergoing TOPFA at British Pregnancy Advisory Service from 1 January 2015 to 31 March 2016 was extracted from existing databases. Anonymous feedback was obtained using a questionnaire. Women (n = 389) were treated along a specialised care pathway within routine abortion lists. The anomalies were chromosomal (64.0%), structural (30.8%), suspected chromosomal and/or structural or unknown (5.1%). The termination method was vacuum aspiration (41.9%) or dilation and evacuation (58.1%). No complications were reported. Feedback (173 women, 122 partners) indicated care was sensitive (99.6%), supportive (100.0%), knowledgeable (99.2%), and helpful (100.0%). Most (92.1%) reported the right amount of partner involvement. All of the respondents were likely/very likely to recommend the service. A cross-sector approach safely and satisfactorily increases the choice of TOPFA methods. Impact Statement What is already known on this subject? A surgical abortion in the first and second trimesters has been demonstrated to be safe and acceptable, if not preferable, to a medical induction for most women, including those seeking a termination of pregnancy for a foetal anomaly (TOPFA). However, most hospitals in Britain only offer a medical TOPFA in the second trimester, often due to a lack of skills to provide a surgical alternativ...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research

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ConclusionsVBAC does not confer an increased risk of OASI after a first delivery by caesarean section when compared with nulliparous women. The rate of successful VBAC may be contributory and suggests that the risk conferred by VBAC may be unit-specific. Unit and national-level audit is necessary to investigate this risk further.
Source: International Urogynecology Journal - Category: OBGYN Source Type: research
ConclusionsIn the case of vaginal delivery in the presence of nuchal cord, as the number of nuchal cord loops increased, so did the number of adverse delivery outcomes. While 3 loops were associated with higher incidence of intrauterine fetal death, intrauterine growth restriction, increased operative vaginal deliveries, and low Apgar scores, 1 loop was not associated with adverse perinatal outcomes.
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
CONCLUSION: Rural pregnant adolescents of low SES have the highest odds for adverse pregnancy outcomes. Social determinants of health that affect adolescent pregnancies need further examination to identify high-risk subgroups and understand pathways to health disparities in this vulnerable population. PMID: 31047831 [PubMed - as supplied by publisher]
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
We describe below how metagenomic and nutritional data were integrated into the algorithm in Tobalina et al. (2015). Metagenomic Data From Vallès et al. (2014), we collected 454 pyrosequencing metagenomic data of the gut microbiota of 13 Spanish infants at five different time points during the first year after birth (1 week and 1, 3, 7 months, and 1 year). For the second time point considered (1 month), we only have data for 9 out of 13 infants and, therefore, we have 61 samples overall. Information on sex, type of delivery, antibiotic exposure, and feeding habits for these infants is provided in Supplementary Tab...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Authors: Phunyammalee M, Buayaem T, Boriboonhirunsarn D Abstract The aims of this study were to determine prevalence of childbirth fear among uncomplicated pregnant women in Siriraj Hospital and possible associated factors. A total of 305 uncomplicated, singleton pregnant women were enrolled during early third trimester. All participants were interviewed regarding baseline demographic, social, economic, family, and obstetric characteristics. Fear of childbirth (FOC) was evaluated by Thai version of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ). W-DEQ scores and level of FOC were compared betw...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery.
Source: BMC Pregnancy and Childbirth - Category: OBGYN Authors: Tags: Research article Source Type: research
Abstract OBJECTIVE: Increased fetal size is associated with labor dystocia and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically was associated with increased risk of operative delivery. METHOD: The Genesis Study recruited 2,392 nulliparous patients with a vertex presentation in a prospective multicenter study to examine prenatal and intra-partum predictors of cesarean delivery. Participants had ultrasound and clinical evaluation performed between 39 0/7 and 40 6/7 weeks' gestation. Data on fetal biometry was not revealed either to patients ...
Source: The Ultrasound Review of Obstetrics and Gynecology - Category: Radiology Authors: Tags: Ultrasound Obstet Gynecol Source Type: research
The objective of this study was to use TGCS to evaluate potential associations between EA and cesarean and assisted vaginal delivery rates, according to the TGCS groups.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research
This study aimed to determine the association between variations in obstetric practice (between hospitals) and maternal birth trauma.MethodsThis was a retrospective ancillary analysis involving 660 nulliparous women carrying an uncomplicated singleton term pregnancy in a prospective perinatal intervention trial at two Australian tertiary obstetric units. They had been seen antenatally and at 3 –6 months postpartum for a standardized clinical assessment between 2007 and 2014. Primary outcome measures were sonographically diagnosed LAM and external anal sphincter (EAS) trauma.ResultsThe incidence of LAM avulsion (...
Source: International Urogynecology Journal - Category: OBGYN Source Type: research
AbstractPurposeTo characterize and understand the demographics (age and body mass index, BMI) of a cohort of women who delivered at a single institution over an 11-year period. The purpose of this analysis is to look for effects over time of demographic characteristics on mode of delivery.MethodsRetrospective analysis of singleton deliveries between 2004 –2014,n = 27,729; level 1 perinatal center, university hospital setting. Data were extracted from the digital birth registry. All statistical analyses were done using R version 3.5.1. Variables analyzed were: age, BMI, and mode of delivery (in...
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
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