Geographic Access to Early Pregnancy Loss Management.
| Autor: | Krashin JW; Department of Obstetrics and Gynecology, the Department of Geography and Environmental Studies, and the Department of Emergency Medicine, University of New Mexico, Lovelace Medical Center, and the Department of Economics, Applied Statistics, and International Business, New Mexico State University, Albuquerque, New Mexico; and the Department of Obstetrics & Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania., Black P, Brannen E, Gard CC, Lin Y, Greenwood-Ericksen M, Trujillo VY, Burkhardt G, Schreiber CA |
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| Jazyk: | angličtina |
| Zdroj: | Obstetrics and gynecology [Obstet Gynecol] 2024 Mar 01; Vol. 143 (3), pp. 435-439. Date of Electronic Publication: 2024 Jan 11. |
| DOI: | 10.1097/AOG.0000000000005505 |
| Abstrakt: | Early pregnancy loss (EPL) is common, but patients face barriers to the most effective medication (mifepristone followed by misoprostol) and procedural (uterine aspiration) management options. This cross-sectional geospatial analysis evaluated access in New Mexico to mifepristone and misoprostol and uterine aspiration in emergency departments (comprehensive) and to uterine aspiration anywhere in a hospital (aspiration) for EPL. Access was defined as a 60-minute car commute. We collected data from hospital key informants and public databases and performed logistical regression to evaluate associations between access and rurality, area deprivation, race, and ethnicity. Thirty-five of 42 (83.3%) hospitals responded between October 2020 and August 2021. Two hospitals (5.7%) provided comprehensive management; 24 (68.6%) provided aspiration. Rural and higher deprivation areas had statistically significantly lower adjusted odds ratios for comprehensive management (0.03-0.07 and 0.3-0.4, respectively) and aspiration (0.03-0.06 and 0.1-0.3, respectively) access. Mifepristone and uterine aspiration implementation would address disparate access to EPL treatment. Competing Interests: Financial Disclosure Jamie W. Krashin indicated that this article discusses off-label use of mifepristone, which does not have an FDA indication for management of early pregnancy loss. Eric Brannen received stipends from Dr. Yan Lin as her doctoral student. Courtney A. Schreiber reports receiving payment from UpToDate. Her institution received funding from Athenium and IBX. The other authors did not report any potential conflicts of interest. (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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