Abstract
Objectives
To assess whether first-trimester aspiration abortion practices of US providers agree
with evidence-based policy guidelines.
Study design
We sent surveys by mail or electronically to all abortion facilities in the United
States identified via professional networks and websites from June through December
2013. Administrators reported on the volume of procedures performed at their site(s)
through 13 weeks 6 days' gestation and on clinic services. Clinicians reported on
personal demographic characteristics and abortion practices. We reviewed guidelines
from key US professional organizations to determine how well reported practices aligned
with available recommendations and the extent to which guidelines have changed since
the time of the survey.
Results
We identified 703 clinical sites in the United States; 383 (54%) sites responded,
256 of which offer first-trimester aspiration abortions. Most providers identified
as obstetrician-gynecologists (74%) and female (64%); 52% were less than 50 years
old compared to 36% in 2002. Overall, reported practices follow evidence-based guidelines,
including routine administration of periprocedure antibiotics (85%), use of misoprostol
for cervical ripening in the late first trimester (94%), pain management practices,
and same-day contraception provision (98%) including long-acting devices (76%). Less
evidence-based practices include routine preprocedure ultrasound (99%), not providing
abortion before 5 weeks' gestation (66%), restrictive fasting policies, and prolonged
and postprocedure antibiotic provision.
Conclusion
Overall, the first-trimester aspiration abortion practices revealed in our survey
agree with professional evidence-based policy guidelines, though some related to preprocedure ultrasound use, very early abortion provision,
preanesthesia fasting protocols, and antibiotic regimens deserve attention.
Implications
In this third cross-sectional survey of US abortion practices (prior surveys 1997
and 2002), first-trimester aspiration abortion providers are younger than before,
reflecting an improvement in the “graying” of the abortion provider workforce. Research
and education are needed to further improve evidence-based practice in abortion care.
Keywords
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Article info
Publication history
Published online: August 17, 2018
Accepted:
August 13,
2018
Received in revised form:
August 13,
2018
Received:
May 4,
2018
Footnotes
☆Declarations of interest: none.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
