The Safety and Quality of Abortion Care in the United States (2018) / Chapter Skim
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5 Conclusions
5 Conclusions
Pages 159-168
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From page 159... ...
abortion care responded comprehensively to the scope of this study. Therefore, the committee does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.
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From page 160... ...
The drug should not be used for women with confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; an intra terineu device in place; chronic adrenal failure; concurrent long-term systemic corticosteroid therapy; hemorrhagic disorders or concurrent antioagulant c therapy; allergy to mifepristone, misoprostol, or other prostaglandins; or inherited porphyrias. Obesity is not a risk factor for women who undergo medication or aspiration abortions (including with the use of moderate intravenous sedation)
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From page 161... ...
Reliable research uses documented records of a prior abortion, analyzes comparable study and control groups, and controls for confounding variables shown to affect the outcome of interest. Physical health effects The committee identified high-quality research on numerous outcomes of interest and concludes that having an abortion does not increase a woman's risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation (after a D&E abortion)
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From page 162... ...
If moderate sedation is used, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. For D&Es that involve deep sedation or general anesthesia, the facility should be similarly equipped and also have equipment to provide general anesthesia and monitor ventilation.
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From page 163... ...
; • elay care unnecessarily from a clinical d standpoint (e.g., mandatory waiting periods) ; • rohibit qualified clinicians (family medicine p physicians, certified nurse-midwives, nurse practitioners, and physician assistants)
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From page 164... ...
Regulations that require medically unnecessary equipment, services, and/or additional patient visits increase cost, and thus decrease efficiency.
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From page 165... ...
To provide aspiration abortions, the clinician should also be skilled in the technical aspects of an aspiration procedure. To provide D&E abortions, the clinician needs the relevant surgical expertise and sufficient caseload to maintain the requisite surgical skills.
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From page 166... ...
If moderate sedation is used during an aspiration abortion, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. D&Es that involve deep sedation or general anesthesia should be provided in similarly equipped facilities that also have equipment to monitor ventilation.
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From page 167... ...
Quality requires that care be respectful of individual patient preferences, needs, and values so that patient values guide all clinical decisions. The committee did not identify gaps in research that raise concerns about these conclusions and does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.
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From page 168... ...
Availability of providers APCs can provide medication and aspiration abortions safely and effectively, but the committee did not find research assessing whether APCs can also be trained to perform D&Es. Addressing the needs of women of lower income Women who have abortions are disproportionately poor and at risk for interpersonal and other types of violence.
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