You can reach her a lcarr@mjhlifesciences.com.

Lindsey Carr, Editor

Investigators conducted a study to gather a baseline assessment of abortion incidence and service delivery prior to 

They collected data from all facilities known to have provided abortion services in the US in 2019 and 2020 and examined abortion incidence by state, region, and nationally and combined data on number of abortions with population data to estimate abortion rates. Additionally, they looked at the number of abortion clinics, trends in medication abortion and service disruptions and changes in abortion protocols due to COVID-19. They then compared their findings to the previous Abortion Provider Census from 2017.

As for their findings, they ultimately documented 930,160 abortions in 2020, which was an 8% increase from 2017. Abortion incidence, investigators found, increased in all 4 regions of the country and in majority of states between 2017 and 2020. The total number of clinics providing abortion care stayed stable nationally, but increased in the Midwest and West, declining in the Northeast and South. For medication abortions, investigators found a total of 492,210 in 2020, which was a 45% from 2017. They also found that a substantial minority of clinics adjusted protocols in response to COVID-19, most commonly adopting remote pre- and post-abortion counseling.

The investigators ultimately found that the long-term decline in abortion in the US has reversed. The number of abortions increased overall between 2017 and 2020 and the abortion rate increased 7%. They also found that the overwhelming majority of abortions (96%) were provided by abortion clinics, and they play an important role in access to care. According to investigators, while there were changes in clinic numbers for many states, they were not always in ways that suggested increased abortion.

Perhaps most interestingly, investigators found that medication abortions provided in a clinical setting increased substantially during the study period, and for the first time, accounted for the majority of abortions in 2020.

Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. 

Perspectives on Sexual and Reproductive Health

. Published online November 20, 2022. doi:10.1363/psrh.12215

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This week on Contemporary OB/GYN: December 5 to December 9

Hear from Kimberly Kho, MD, as she discusses her presentation at AAGL's 51st Global Congress on MIGS in Aurora, Colorado regarding alternatives to hysterectomy and uterine-preserving options for fibroids. 

Part 2: Alternatives to hysterectomy & uterine-preserving options for fibroids

Part 1: Alternatives to hysterectomy & uterine-preserving options for fibroids

During a poster presentation at AAGL’s 51st Global Congress on MIGS, Elizabeth Miasma, MD, LLM, University of Toronto, St. Michael’s Hospital, discussed her research on mindfulness practices to optimize resident surgical performance.

The project’s goal was to develop and assess a feasible and meaningful mindfulness-based cognitive therapy (MBCT) curriculum for surgical residents. Investigators measured secondary outcomes pre- and post-intervention, which included surgical performance, anxiety, confidence, and burnout.

The project was carried out in an urban Canadian post-graduate ob-gyn training program. Residents participated in a 12-week MBCT curriculum for busy trainees. Miazga and her team conducted focus groups before, immediately after, and 3 months after completion of the MBCT course.

Of 61 residents, 12 enrolled in the program (20%) and 8 completed the course (67%). According to the results, residents were significantly less anxious (p<0.001) and more confident with the surgery (p=0.007) after the MBCT curriculum. According to Miazga, there were no changes in burnout or surgical evaluations. A qualitative theme that was raised was that mindfulness tools were regularly brought into the operating room and had a perceived beneficial impact by residents. Notably, the changes were seen 3 months post-intervention. The findings showed that the biggest barrier to mindfulness was time. Program participants felt that the residency program should support ongoing MBCT training to promote a positive culture shift in the department.

Miazga and her team concluded that a modified MBCT program for surgical trainees is feasible and desirable for ob-gyn residents and significantly improved anxiety and surgical confidence. Possible expansion of this study to other surgical specialties, Miazga said, are necessary and could lead to reducing barriers brought up by other study participants.

Miazga E. Patient Experiences with a Multidisciplinary Fibroid Program. Presented at: AAGL’s 51st Global Congress on MIGS; December 2, 2022; Aurora, Colorado.

During a poster presentation at AAGL’s 51st Global Congress on MIGS, Elizabeth Miasma, MD, LLM, University of Toronto, St. Michael’s Hospital, discussed her research on mindfulness practices to optimize resident surgical performance. 

Mindfulness in the operating room

Laura Kenyon, MD, University of Texas Southwestern Medical Center, discussed the findings from a randomized control trial during an oral session at AAGL’s 51st Global Congress on MIGS in Aurora, Colorado.

The study included patients at 2 large academic institutions undergoing outpatient laparoscopic hysterectomy via conventional laparoscopic technique with the minimally invasive gynecologic surgery team between February 2019 and November 2020. Patients with chronic pain, current opioid use more than 1 week, or requiring planned overnight hospitalization were excluded. Primary outcome data was available for 51 participants—24 control, 27 intervention.

For the ice pack group, ice packs were placed on patients’ abdomens in the operating room. Pain was assessed multiple times throughout the study via Visual Analog Scale (VAS). Narcotic requirement was assessed using morphine milligram equivalent (MME). MME requirements did not differ between groups (p=0.63). According to the findings, 84.8% of participants felt their pain was adequately controlled. All subjects were prescribed 20 tablets of oxycodone. On average, they used 2.9 (SD 3.4) tablets after discharge. Of participants, 87% said they would use again in the future and 82.6% would recommend ice to others.

Kenyon and her team concluded ice packs to be an acceptable supplement for postoperative management with high patient satisfaction and no adverse effects. It is worth noting, hoever, cryotherapy did not significantly impact postoperative reported pain or narcotic use. Providers caring for postoperative patients should be aware, Kenyon said, of the unintentional consequences of overprescribing opioids and should consider reducing the number of tablets prescribed, especially as there has been consistent evidence that shows patients require less than half the quantity prescribed.

In short, Kenyon and her team concluded that ice packs increased patient satisfaction and did not cause any adverse effects. They did not impact postoperative reported pain or narcotic use.

Kenyon L. Ice-Pop: Ice Packs for Post-Operative Pain, a Randomized Controlled Trial. Presented at: AAGL’s 51st Global Congress on MIGS ; December 3, 2022; Aurora, Colorado.