Contraception最新文献

{"title":"IMPACT OF DOBBS ON SEVERE EARLY PREGNANCY MORBIDITY AT AN ACADEMIC HOSPITAL IN UTAH","authors":"SE Nourse,&nbsp;A Gero,&nbsp;TT Hunt-Smith,&nbsp;DK Turok,&nbsp;LM Gawron,&nbsp;R Simmons,&nbsp;MP Debbink,&nbsp;JS Sanders","doi":"10.1016/j.contraception.2025.111075","DOIUrl":"10.1016/j.contraception.2025.111075","url":null,"abstract":"<div><h3>Objectives</h3><div>We evaluated the relationship between <em>Dobbs v Jackson Women’s Health Organization</em> and severe early pregnancy morbidity (SEPM) in pregnancies less than 24 weeks.</div></div><div><h3>Methods</h3><div>We identified pregnant patients at University of Utah hospital from January 2017 to December 2023 with diagnosis codes, blood product administration records, or intensive care transfer records indicating SEPM at less than 24 weeks. We defined SEPM using CDC severe maternal morbidity (SMM) diagnosis codes, ACOG/SMFM SMM criteria, or abortion-related morbidity including hemorrhage, pelvic infection, or damage to pelvic organs. We reviewed records to verify the presence of SEPM and assessed preventability using the Alliance for Innovation on Maternal Health SMM review form. We performed an interrupted time series analysis comparing the pre- and post-<em>Dobbs</em> rate of SEPM per 10,000 pregnancies per month and the rate of preventable events per 100 SEPM events per quarter. A sensitivity analysis excluded years affected by the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>At baseline, we saw 16 SEPM events per 10,000 pregnancies (95% CI, 10.7-20.4). Prior to <em>Dobbs</em>, the rate of SEPM declined by 0.03 events per 10,000 pregnancies each month (-0.14, 0.10). Immediately following <em>Dobbs</em>, we found a non-significant increase in severe early pregnancy morbidity of 1.0 event per 10,000 pregnancies (-5.4, 7.4) and an additional monthly decline of -0.1 severe morbidity events per 10,000 pregnancies (-0.50, 0.34). An increase in proportion of preventable SEPM was noted immediately following <em>Dobbs</em> of 18 preventable events per 100 SEPM events (6.7, 29.5).</div></div><div><h3>Conclusions</h3><div>Following the <em>Dobbs</em> decision, overall rate of SEPM events did not increase, though the rate of preventable events increased.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111075"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US ABORTION BANS AND MATERNAL AND PREGNANCY-ASSOCIATED DEATH: IMPACTS AND DATA ISSUES","authors":"SO Bell,&nbsp;AM Franks,&nbsp;A Ozinsky,&nbsp;S Anjur-Dietrich,&nbsp;CE Margerison,&nbsp;EA Stuart,&nbsp;A Feller,&nbsp;A Gemmill","doi":"10.1016/j.contraception.2025.111098","DOIUrl":"10.1016/j.contraception.2025.111098","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study is to estimate the impact of US abortion bans on maternal and pregnancy-associated mortality and investigate data quality issues.</div></div><div><h3>Methods</h3><div>This study used biannual (eg, January-June) counts of maternal and pregnancy-associated deaths among females aged 15-44 from restricted death certificate data compiled by the National Center for Health Statistics for all 50 states and the District of Columbia for 2012 through 2023. The outcomes include maternal and pregnancy-associated mortality rates, calculated as the number of deaths per 100,000 live births. We identified maternal deaths using ICD-10 codes and pregnancy-associated deaths via the pregnancy checkbox on the death certificate. Analyses used a Bayesian panel data approach to model counterfactual predictions of maternal and pregnancy-associated mortality rates in the 14 states that imposed a complete or six-week abortion ban.</div></div><div><h3>Results</h3><div>State-specific model diagnostics indicate potential data quality concerns. These concerns are most apparent for maternal mortality data in Alabama, and less so in Georgia. Model estimates suggest a significant increase in the pregnancy-associated mortality rate above what would have been expected in the absence of these bans; we found no corresponding detectable increase in maternal mortality. Assessing mortality trends by race and ethnicity imply the increase in pregnancy-associated mortality is concentrated among non-Hispanic Black individuals.</div></div><div><h3>Conclusions</h3><div>Results from this study suggest that abortion bans may increase pregnancy-associated mortality, though data quality concerns and stochastic variation in this rare outcome limit the certainty of this finding.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111098"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TELEHEALTH EQUITY AMONG PATIENTS WITH MEDICAID","authors":"T Thompson,&nbsp;C Brander,&nbsp;J Ko,&nbsp;UD Upadhyay","doi":"10.1016/j.contraception.2025.111133","DOIUrl":"10.1016/j.contraception.2025.111133","url":null,"abstract":"<div><h3>Objectives</h3><div>Telehealth, which now comprises 20% of all abortion care, has been celebrated as a mechanism to improve health equity by making abortion care more convenient and affordable. However, many patients with Medicaid are not able to use their insurance to pay for their telehealth abortion. We sought to document and compare patient experiences between those who could and could not use their Medicaid insurance to pay for their abortion.</div></div><div><h3>Methods</h3><div>Working with six telehealth clinics serving patients across the US, we recruited telehealth abortion patients who indicated they had Medicaid insurance, regardless of whether they were able to use their insurance, to participate in an online survey. Patients were eligible if they were enrolled in Medicaid, were at least 14 years old, had had a medication abortion within the last 1-6 weeks, and were fluent in English or Spanish. The survey was available in English and Spanish and contained questions about participant demographics, pregnancy history, and their recent telehealth abortion experience.</div></div><div><h3>Results</h3><div>Among 359 enrolled participants, about half (n=159) could not use their Medicaid insurance to cover their abortion. Those in this group spent an average of $261 for their abortion care (range: $0-$970). Those with no Medicaid coverage were significantly more likely to report that their financial stress was worse than before the abortion (35% vs. 4%, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Medicaid coverage makes a difference even for telehealth abortion, which is a less costly abortion option. These findings support efforts to overturn telehealth and Medicaid coverage restrictions, and establish coverage and payment parity for telehealth services.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111133"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CRIMINALIZATION CONCERNS AMONG PEOPLE SEEKING FACILITY-BASED ABORTION CARE POST-DOBBS","authors":"R Schroeder,&nbsp;LJ Ralph,&nbsp;S Kaller,&nbsp;M Antonia Biggs","doi":"10.1016/j.contraception.2025.111059","DOIUrl":"10.1016/j.contraception.2025.111059","url":null,"abstract":"<div><h3>Objectives</h3><div>Following <em>Dobbs v Jackson Women’s Health Organization</em>, efforts to criminalize pregnancy-related healthcare have increased. This study describes concerns around criminalization among people seeking facility-based abortion.</div></div><div><h3>Methods</h3><div>The Burden Study aims to recruit 800 people aged ≥15 seeking abortion at six facilities in three abortion-supportive states (California, Illinois, and New Mexico) that serve many out-of-state patients. We surveyed people presenting for abortion care regarding their concerns about “getting into trouble with the law,” both personally and for their support people (prompts: “[I]/ [Someone who helped me get care] might get in trouble with the law for seeking care to end this pregnancy”). Using descriptive statistics and logistic regressions, we examined associations between concerns about criminalization and out-of-state travel for care.</div></div><div><h3>Results</h3><div>From January to April 2025, we recruited 557 people at five facilities; 539 completed questions about legal concerns. Participants’ median age was 26; 34% had Medicaid/other state insurance coverage; and 62% traveled out-of-state for their abortion. While 15% of participants reported that they were “very” or “somewhat” worried about getting into trouble with the law for seeking abortion care, this proportion was higher for out-of-state participants (21% vs. 5%, p&lt;0.001). Fewer participants (10%) were worried about a support person getting in trouble with the law, although concerns were also higher among out-of-state participants (12% vs. 5%, p=0.004).</div></div><div><h3>Conclusions</h3><div>Concerns about criminalization related to abortion are prevalent among people seeking abortion post-<em>Dobbs</em>, particularly among those traveling from out-of-state, and may impact people’s care-seeking behaviors and mental health.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111059"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VARIATION IN OB-GYN RESIDENTS’ ABORTION-RELATED SKILLS","authors":"A Beasley,&nbsp;G Sierra,&nbsp;E King,&nbsp;J Keller,&nbsp;T Ogburn,&nbsp;K White","doi":"10.1016/j.contraception.2025.111057","DOIUrl":"10.1016/j.contraception.2025.111057","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess variation in abortion-related skills Ob-Gyn residents anticipate having upon program completion.</div></div><div><h3>Methods</h3><div>In January 2024, as part of the CREOG exam, Ob-Gyn residents self-reported their anticipated ability to provide miscarriage and abortion care after residency. We categorized 12 key skills as medical (counseling/medication management), procedural (uterine aspiration/evacuation), and medical/procedural for abortion. We computed percentage of PGY3/4 residents who indicated that they would be able to competently and independently perform each skill. We used chi-squared tests to evaluate the association between state policy context and abortion training importance when signaling programs and medical, procedural, and abortion-specific skills.</div></div><div><h3>Results</h3><div>PGY3/4 respondents (n=1,660), anticipated being able to perform 10 of 12 (SD=1.7) skills, on average. Confidence was lowest for dilation and evacuation procedures (64%) and highest in management of spontaneous abortion complications (99%). Although 95% were confident they would achieve all core medical skills, fewer were confident about achieving all procedural (63%) and abortion-related skills (71%). A higher percentage of residents in abortion-protected states vs. restricted states anticipated competence in procedural (73% vs. 46%) and abortion-related skills (81% vs. 55%; all p&lt;0.001). Residents who considered abortion training important were more confident about medical (96% vs. 92%; p=0.01), procedural (73% vs. 42%; p&lt;0.001), and abortion-related skills (81% vs. 50%; p&lt;0.001) than those for whom abortion training was less important.</div></div><div><h3>Conclusions</h3><div>Graduating residents, particularly those in more restricted states or for whom abortion training was less important, are not confident in their ability to independently and competently perform several core patient care skills.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111057"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHARMACIST-PRESCRIBED MEDICATION ABORTION: A QUALITATIVE EXPLORATION IN MASSACHUSETTS","authors":"A Youm,&nbsp;S Filippa,&nbsp;IR Carter-Bolick,&nbsp;SE Baum,&nbsp;S Rafie,&nbsp;KO White,&nbsp;KM Treder,&nbsp;A Wollum","doi":"10.1016/j.contraception.2025.111087","DOIUrl":"10.1016/j.contraception.2025.111087","url":null,"abstract":"<div><h3>Objectives</h3><div>Efforts to increase access to medication abortion in the US are urgently needed. We gathered the perspectives of key partners in Massachusetts to explore expanding medication abortion access through a pharmacist-prescribed care model.</div></div><div><h3>Methods</h3><div>Between January and October 2024, we conducted 31 interviews with patients, pharmacists, policymakers, clinicians, and advocates in Massachusetts. Interviews explored views on pharmacy-based medication abortion access, key patient support needed, and the barriers and facilitators to implementation. Interviews were analyzed thematically using MAXQDA.</div></div><div><h3>Results</h3><div>Participants were largely supportive of the model, indicating that pharmacist-prescribed medication abortion could improve access, particularly for communities who face barriers, including young people, unhoused individuals, and those in rural settings or with limited transport. Other benefits included faster access to care compared to in-clinic or telemedicine models. However, a variety of challenges were raised, including a lack of confidential counseling spaces, concerns around reimbursement for pharmacists’ services, and limited staff time and resources. Key factors for successful implementation were thought to include comprehensive follow-up care, enhanced privacy in pharmacies, affordable pharmacist training, insurance coverage of patient care and pharmacist counseling, and coalitions comprising community organizations and abortion providers.</div></div><div><h3>Conclusions</h3><div>Our findings contribute to the growing body of literature showing the potential benefits of expanding pharmacists’ role in abortion care in the US and highlights the importance of addressing structural and financial challenges for successful implementation and expansion of abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111087"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ELIGIBILITY FOR MEDICATION ABORTION WITH ASYNCHRONOUS SCREENING VS. IN-PERSON CARE","authors":"L Ralph,&nbsp;C Baba,&nbsp;K Ehrenreich,&nbsp;N Morris,&nbsp;MA Biggs,&nbsp;M Cervantes,&nbsp;T Kromenaker,&nbsp;G Moayedi,&nbsp;J Perritt,&nbsp;N Kapp,&nbsp;E Raymond,&nbsp;K White,&nbsp;K Blanchard,&nbsp;D Grossman","doi":"10.1016/j.contraception.2025.111084","DOIUrl":"10.1016/j.contraception.2025.111084","url":null,"abstract":"<div><h3>Objectives</h3><div>Asynchronous, no-test screening for medication abortion has recently expanded rapidly. However, there is minimal evidence on how asynchronous clinician assessment of medication abortion eligibility using patient-reported health history and symptoms compares with eligibility determined through synchronous, in-person care.</div></div><div><h3>Methods</h3><div>We recruited patients seeking in-person medication abortion at five facilities in three US states from July to December 2024. Before their appointment, participants completed a survey on medication abortion eligibility criteria; their responses were blinded and reviewed asynchronously by an onsite clinician who assessed eligibility. Participants then proceeded with routine care, and we abstracted clinical encounter data. We examine concordance between clinician asynchronous review of patient self-reported eligibility and in-person clinical encounter.</div></div><div><h3>Results</h3><div>Of 260 approached, 172 enrolled and 146 met the criteria to have clinicians review survey responses. Overall, 112 (77%) were eligible for medication abortion on clinician review of survey responses; reasons for ineligibility were gestational duration (n=17), ectopic concern (n=15), and another contraindication (n=4). During the clinical encounter, 90% (n=132) were eligible for medication abortion; reasons for ineligibility were negative pregnancy test/miscarriage (n=8), gestational duration (n=5), ectopic concern (n=1) and another contraindication (n=1). Concordance on eligibility between clinician review of patient-reported survey responses and clinical encounter was 114/146 (78%). Six cases were eligible on clinician review but deemed ineligible during clinical encounter (3 gestational duration; 3 not pregnant). Twenty-six were ineligible on clinician review but deemed eligible on clinical encounter.</div></div><div><h3>Conclusions</h3><div>Results suggest current asynchronous, no-test screening for medication abortion is conservative, and results in more people screening out of no-test care vs. being given medications when medication abortion is contraindicated.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111084"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POSTPARTUM PERMANENT CONTRACEPTION ACCESS FOR NONCITIZENS AFTER EXPANDING MEDICAID","authors":"LD Brown,&nbsp;E Zhao,&nbsp;M Bielman,&nbsp;L Pritchett,&nbsp;A Mueller,&nbsp;C Sufrin","doi":"10.1016/j.contraception.2025.111069","DOIUrl":"10.1016/j.contraception.2025.111069","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to determine if expansion of Medicaid to noncitizen pregnant patients through the Maryland Healthy Babies Equity Act (HBEA) impacted fulfillment of postpartum permanent contraception (PC).</div></div><div><h3>Methods</h3><div>We conducted a retrospective, observational, interrupted time series analysis of patients who underwent postpartum PC within the Johns Hopkins Health System from January 2019 to September 2024. We included all deliveries at Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Howard County General Hospital. Maternal demographics, delivery information, neonatal outcome, and postpartum contraception methods were extracted from EPIC. Citizenship status was confirmed via manual chart review. We compared postpartum PC rates before and after HBEA implementation for citizens and noncitizens. Mixed effects logistic regression was used to compare postpartum PC rates before and after HBEA implementation, stratified by citizenship.</div></div><div><h3>Results</h3><div>There were 35,996 deliveries among 30,007 individuals at Johns Hopkins hospitals during the study period. Individuals’ mean (SD) age was 30.9 years (5.7). Some 25,652 (85.5%) were citizens, and 4,355 (14.5%) were noncitizens. Among noncitizens, postpartum PC rates increased from 8.5% (332/3,925) pre-HBEA to 12.5% (134/10,755) post-HBEA. Among citizens, rates remained stable from 5.4% (1,346/25,003) pre-HBEA to 5.3% (318/5,993) post-HBEA. The increase in postpartum PC rate from pre to post-HBEA among noncitizens was significantly greater than the change in postpartum PC rate among citizens (p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Expansion of Emergency Medicaid under the HBEA to include postpartum care was associated with a significant increase in postpartum PC among noncitizens. Such policy changes help overcome systemic barriers to postpartum care for low-income, noncitizen individuals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111069"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OBSTETRIC-RELATED EMTALA VIOLATIONS POST-DOBBS: A DIFFERENCE-IN-DIFFERENCES ANALYSIS","authors":"LR Woskie,&nbsp;N Brower-Snelson","doi":"10.1016/j.contraception.2025.111071","DOIUrl":"10.1016/j.contraception.2025.111071","url":null,"abstract":"<div><h3>Objectives</h3><div>EMTALA mandates that hospitals receiving Medicare funding provide stabilizing treatment, which includes abortion. But many states have abortion bans that lack, or only broadly articulate, exceptions related to a pregnant person’s health, leading to significant legal debate. We therefore sought to evaluate the impact of <em>Dobbs v Jackson Women’s Health Organization</em> on obstetric-related violations.</div></div><div><h3>Methods</h3><div>We used a nationwide sample of federal EMTALA violations (excluding Rhode Island, Delaware, and Hawaii) from 2017 to the end of 2023. We ran a two-way fixed effects difference-in-differences model comparing “conflict” states, ie, those whose state policy had no health exception in the post-<em>Dobbs</em> period (n=6) to non-conflict states. We examined obstetric-related violations as a share of all EMTALA filings as the primary dependent variable and used the 2022 <em>Dobbs</em> ruling as our intervention, employing state and month fixed-effects to account for unobservable differences by location and seasonality in healthcare utilization. We tested alternate treatment groups and examined changes in emergency department utilization as sensitivity analyses.</div></div><div><h3>Results</h3><div>Difference-in-differences results suggested that <em>Dobbs</em> led to a statistically significant increase in obstetric-related EMTALA violation filings, with 10.5% (95% CI, 8.1-12.9%; p &lt;0.001) more violations filed per month in states with no health exception (Oklahoma, Idaho, South Dakota, Arkansas, Texas, and Mississippi) than in states with a health exception in the post-policy period, from 2022 through 2023.</div></div><div><h3>Conclusions</h3><div>Our analysis of Freedom of Information Act-acquired data indicates that the <em>Dobbs</em> ruling led to an increase in obstetric-related EMTALA violations when state law conflicted with federal policy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111071"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSOCIATION OF ABORTION RESTRICTIONS AND HYSTEROTOMY FOR PREVIABLE DELIVERY","authors":"SJ Lambert,&nbsp;K Fiske,&nbsp;G Petryk,&nbsp;S Horvath","doi":"10.1016/j.contraception.2025.111073","DOIUrl":"10.1016/j.contraception.2025.111073","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to determine the proportion of previable hysterotomy in the US and any differences by geographic region or state-level abortion restrictions.</div></div><div><h3>Methods</h3><div>Absolute numbers and proportions of previable “cesarean deliveries” from 2014 to 2023 were obtained using publicly available data from the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Data were analyzed by census region and state-level abortion restriction category determined by the Center for Reproductive Rights: illegal, hostile, not protected, protected, and expanded access, via chi-square test.</div></div><div><h3>Results</h3><div>Between 2014 and 2023 across the US, 32,165 deliveries from 17 through 21 weeks were reported as “live births.” Of those, 814 (2.5%) were delivered via hysterotomy and reported as “cesarean delivery.” The South had a higher proportion of previable hysterotomy than the rest of the US (3.1% vs. 2.1%, p&lt;0.001). The proportion of previable hysterotomy was higher in states where abortion is illegal than in all other states (3.9% vs. 2.1%, p&lt;0.001). Among 73,371 previable fetal deaths (20-23 weeks) between 2014 and 2022, some 2,480 (3.4%) were managed via hysterotomy, with a higher proportion occurring where abortion is illegal (4.7% vs. 3.0%, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>At previable gestational ages, interventions to improve neonatal survival are futile. Hysterotomy increases the rate of maternal complications and complicates care in future pregnancies. Yet, 2.5% of previable “live births” and 3.4% of previable fetal deaths were managed with hysterotomy. Proportions were highest in the South and in states with abortion bans, representing significant preventable morbidity as a potential impact of restrictive abortion policies.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111073"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}