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Pain Management in Abortion Care

Oviedo, Johana; Denny, Colleen C
Both medication and procedural abortion are associated with pain. The experiences of pain depend on both physical and emotional factors. Several pain management options are available for abortion, depending on abortion type, clinical setting, and patient considerations, and a comprehensive approach is necessary to optimize pain management.
PMID: 37750662
ISSN: 1532-5520
CID: 5609362

Abortion Care in the United States — Current Evidence and Future Directions

Jung, Christina; Oviedo, Johana; Nippita, Siripanth
ORIGINAL:0017078
ISSN: 0012-3692
CID: 5573462

Abortion Care in the United States - Current Evidence and Future Directions

Jung, Christina; Oviedo, Johana; Nippita, Siripanth
Abortion Care in the United StatesAbortion services are a vital component of reproductive health care. Jung and colleagues review medication abortion and procedural abortion as well as implications of increasing restrictions on access in the United States.
PMID: 38320010
ISSN: 2766-5526
CID: 5632542

Private Conversations, Public Debate [Comment]

Nippita, Siripanth; Jung, Christina; Oviedo, Johana D; Quinn, Gwendolyn P
PMID: 35917426
ISSN: 1536-0075
CID: 5287672

Factors associated with participant and provider pain rating during office-based first-trimester vacuum aspiration

Oviedo, Johana D; Ohly, N Tanya; Guerrero, Jacqueline M; Castaño, Paula M
OBJECTIVE:The objective was to describe factors associated with reported pain and assess correlations between participant and provider pain assessments during first-trimester vacuum aspiration. STUDY DESIGN:Participants and providers in a trial evaluating music for pain reduction reported procedure-related pain using a 100-mm visual analog scale. RESULTS:The mean participant-reported maximum pain was 65.9±23.0 compared to 41.3±22.0 by provider assessment. Provider-reported scores correlated poorly with participant maximum pain (r=0.28) and participant maximum pain adjusted for baseline (r=0.27). Previous abortion (60.5 versus 71.4, p=.02) and immediate intrauterine device insertion (46.1 versus 68.6, p=.03) were associated with lower participant-reported pain. CONCLUSIONS:Providers underestimate pain reported during vacuum aspiration; provider estimates correlate poorly with participant self-report. IMPLICATIONS:To improve management of pain during first-trimester vacuum aspiration, we need to better understand factors that influence patient and provider pain rating. When assessing patient pain in this setting, providers should not assume a baseline of zero pain.
PMID: 29317229
ISSN: 1879-0518
CID: 4418532

The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche"

Kaelin Agten, Andrea; Cali, Giuseppe; Monteagudo, Ana; Oviedo, Johana; Ramos, Joanne; Timor-Tritsch, Ilan
BACKGROUND: The term "cesarean scar pregnancy" (CSP) refers to placental implantation within the scar of a prior cesarean delivery. The rising numbers of cesarean deliveries in the last decades have lead to an increased incidence of CSP. Complications of CSP include: morbidly adherent placenta, uterine rupture, severe hemorrhage, and preterm labor. It is suspected that CSPs implanted within a dehiscent scar ("niche") behave differently compared to those implanted on top of a well healed scar. To date there are no studies comparing pregnancy outcomes between CSPs implanted either "on the scar" or "in the niche". OBJECTIVES: To determine the pregnancy outcome of CSP implanted either "in the scar" or "in the niche". MATERIAL AND METHODS: This was a retrospective two-center study of 17 patients with CSP diagnosed between 5-9 weeks gestation (median 8 weeks). All CSPs were categorized as either implanted or "on the scar" (Group A) or "in the niche" (Group B), based on their first trimester transvaginal ultrasound examination. Clinical outcomes based on gestational age at delivery, mode of delivery, blood loss at delivery, neonate weight and placental histopathology were compared between the groups using Mann-Whitney U-test. Myometrial thickness overlying the placenta was compared between all the patients requiring hysterectomy and those who did not, using Mann-Whitney U test. Myometrial thickness was also correlated with gestational age at delivery using Spearman's correlation. RESULTS: Group A consisted of 6 patients, and 11 patients were in group B. Gestational age at delivery was lower in group B (median 34 weeks, range 20-36 weeks) than in group A (median 38 weeks , range 37-39 weeks), p=0.001. In group A, 5 patients were delivered via cesarean delivery (with normal placenta) and one underwent a cesarean-hysterectomy for placenta accreta. In group B, 10 patients had a cesarean-hysterectomy for placenta increta/percreta and one patient underwent gravid-hysterectomy for vaginal bleeding at 20 weeks. Blood loss was increased, but not significantly higher in group B (median 1200ml, 600-4000ml) than in group A (median 700ml, 600-1400ml) p=0.117. Myometrium was statistically significantly thinner in the patients group requiring hysterectomy (median 1mm, range 0-2) than in than in the group that did not (median 5mm, range 4-9mm), p=0.001. Myometrial thickness showed a positive correlation with the gestational age (r=0.820, p<0.0005). CONCLUSION: Patients with CSP implanted "on the scar" had a substantially better outcome compared to patients in which the CSP implanted "in the niche". Myometrial thickness below 2mm in the first trimester ultrasound is associated with morbidly adherent placenta at delivery.
PMID: 28115056
ISSN: 1097-6868
CID: 2418332

A randomized controlled trial of daily text messages versus monthly paper diaries to collect bleeding data after intrauterine device insertion

Nippita, Siripanth; Oviedo, Johana D; Velasco, Margarita G; Westhoff, Carolyn L; Davis, Anne R; Castaño, Paula M
OBJECTIVE:Bleeding data in contraceptive trials are often collected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection. STUDY DESIGN/METHODS:This trial randomized participants 1:1 to use text messages or paper diaries to report on bleeding experienced during the 90 days after intrauterine device (IUD) insertion. Participants chose either the copper T380A or the 52-mg levonorgestrel IUD. Our primary outcome was number of days of reported bleeding data. We hypothesized that data gathered with daily text messages would have fewer missing values than paper diaries. Intention to treat analyses used the rank-sum test to compare medians. RESULTS:Two hundred thirty women enrolled, and randomization yielded groups similar in baseline characteristics. Twenty percent of participants provided no bleeding data; of these, 77% were assigned to paper diaries. With 90 days of reporting, approximately 20% in each group provided complete bleeding data. The text group reported a median of 82 days [interquartile range (IQR) 40-89] and the paper group reported a median of 36 days (IQR 0-88) (p≤.001). The number of responses received decreased gradually over the 90-day period but was always higher in the text group. Women who had attained higher levels of education did well regardless of data collection modality, while response rates of text messages were greater among those with a high school education or less (p<.01). CONCLUSIONS:Participants reporting bleeding via text messages provided more complete data than women using paper diaries. IMPLICATIONS/CONCLUSIONS:Depending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.
PMCID:4967589
PMID: 26363433
ISSN: 1879-0518
CID: 3980072

90-Day Bleeding Patterns After Intrauterine Device Insertion A Prospective Parallel Cohort Study [Meeting Abstract]

Nippita, Siripanth; Velasco, Margarita G.; Oviedo, Johana D.; Westhoff, Carolyn L.; Davis, Anne R.; Castano, Paula M.
ISI:000339079900024
ISSN: 0029-7844
CID: 3980142

Text Messages Compared With Monthly Paper Diaries Collecting Bleeding Data After Intrauterine Device Insertion [Meeting Abstract]

Nippita, Siripanth; Velasco, Margarita G.; Oviedo, Johana D.; Westhoff, Carolyn L.; Davis, Anne R.; Castano, Paula M.
ISI:000339079900025
ISSN: 0029-7844
CID: 3980152