MV Smith, J Turk, R Mercier, J Steinauer, K Vinekar
{"title":"多布斯手术后妊娠位置不明的管理:美国莱恩计划调查","authors":"MV Smith, J Turk, R Mercier, J Steinauer, K Vinekar","doi":"10.1016/j.contraception.2024.110629","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.</div></div><div><h3>Results</h3><div>Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the <em>Dobbs v Jackson Women’s Health Organization</em> decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p<0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.</div></div><div><h3>Conclusions</h3><div>State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"NAVIGATING PREGNANCY OF UNKNOWN LOCATION MANAGEMENT AFTER DOBBS: A SURVEY OF RYAN PROGRAMS IN THE US\",\"authors\":\"MV Smith, J Turk, R Mercier, J Steinauer, K Vinekar\",\"doi\":\"10.1016/j.contraception.2024.110629\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.</div></div><div><h3>Results</h3><div>Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the <em>Dobbs v Jackson Women’s Health Organization</em> decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p<0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.</div></div><div><h3>Conclusions</h3><div>State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.</div></div>\",\"PeriodicalId\":10762,\"journal\":{\"name\":\"Contraception\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Contraception\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S001078242400324X\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Contraception","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S001078242400324X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
方法 我们于 2024 年 3-4 月对所有美国瑞安住院医师培训项目主任(n=113)进行了一项横断面电子调查。我们使用 Guttmacher 州人工流产限制分类法,比较了限制性与非限制性人工流产环境下瑞安项目的机构和州政策对 PUL 管理的影响。为不想要的 PUL 提供诊断性子宫吸引术(UA)是次要结果。我们用费雪精确检验比较了回复比例。结果来自 31 个州的 68 名(60%)Ryan 计划负责人做出了回复。其中 26 个(38.2%)来自限制堕胎政策的州。六个项目(8.8%)在多布斯诉杰克逊妇女健康组织案判决后改变了 PUL 管理。与保护性州的项目相比,限制性州的项目更有可能报告州政策 "严重 "或 "一定程度上 "限制了他们护理 PUL 患者的能力(50% vs. 2.4%,p<0.001),很少或从未提供诊断性子宫吸引术(30.8% vs. 7.1%,p=0.02),并认为机构领导力是提供诊断性子宫吸引术的障碍(19.2% vs. 2.4%,p=0.03)。最常被提及的提供诊断性 UA 的机构障碍是人员配备和教职员工的舒适度/意愿,这两个因素在各州堕胎氛围上没有显著差异。项目应努力解决在不想要的 PUL 情况下提供诊断性子宫吸引术的障碍。
NAVIGATING PREGNANCY OF UNKNOWN LOCATION MANAGEMENT AFTER DOBBS: A SURVEY OF RYAN PROGRAMS IN THE US
Objectives
We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.
Methods
We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.
Results
Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the Dobbs v Jackson Women’s Health Organization decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p<0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.
Conclusions
State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.
期刊介绍:
Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.