Provider Training Shapes Attitudes, Treatment Choices for Early Pregnancy Failure

July 26, 2011

Currently in the United States, early pregnancy failure (EPF) appears to be predominantly treated by expectant management and operating room–based uterine evacuation, even though research data have demonstrated that misoprostol and office uterine evacuation can safely evacuate a uterus in the context of induced abortion. In addition, research data indicate that women accept and actually prefer treatment with office uterine evacuation or misoprostol after EPF. So why aren’t these procedures being performed more regularly?

Currently in the United States, early pregnancy failure (EPF) appears to be predominantly treated by expectant management and operating room–based uterine evacuation, even though research data have demonstrated that misoprostol and office uterine evacuation can safely evacuate a uterus in the context of induced abortion. In addition, research data indicate that women accept and actually prefer treatment with office uterine evacuation or misoprostol after EPF. So why aren’t these procedures being performed more regularly? One hypothesis is that lack of training may be among the barriers for clinicians in performing this procedure. To examine this potential relationship and barrier, Dr Vanessa K. Dalton, assistant professor in the department of obstetrics and gynecology at the University of Michigan Medical School in Ann Arbor, and colleagues explored the knowledge and attitudes toward treatment options for EPF and previous training in office-based uterine evacuation.

Data were collected from surveys of 308 eligible obstetrician-gynecologists who were randomly selected from the membership list of the American Congress of Obstetricians and Gynecologists as part of a previous study of EPF treatment patterns. The surveys were designed via consensus and literature review and collected information pertinent to provider and practice characteristics (eg, age, sex, and practice setting); use of office procedures in general; current treatment practices for EPF; knowledge and attitudes about different EPF treatment options; barriers to adopting office uterine evacuation and misoprostol; and previous training.

While 67% of respondents had received training in office-based uterine evacuation, only 20% said they had previous training in induced abortion techniques. As expected, those respondents who reported prior training in office uterine evacuation and/or induced abortion also reported more frequency using office uterine evacuation in the past 6 months as compared to those providers without any training. Furthermore, the operation room was used more often by those respondents who did not have any induced abortion training.

Previous training also impacted respondents’ views about in-office versus operating room procedures. Specifically, those who had prior induced abortion training were less likely to believe that operating room procedures were safer than in-office procedures. Those with training also had more favorable views of misoprostol use and office uterine evacuation as treatment options for EPF. The association between any training and positive views was evident even after controlling for provider sex, number of years in practice, and practice type.

“Our findings suggest that women may be treated differently for EPF, depending on whether their obstetrician-gynecologist had prior training in office uterine evacuation and, in particular, induced abortion training,” Dalton and colleagues wrote. “This study suggests that training experiences, especially in induced abortion, increase the likelihood of offering office-based uterine evacuation for EPF later in practice. Early clinical experiences and residency training in family planning are fundamental opportunities for students and physicians to comfortably gain knowledge, technical skills, and expertise.”

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References:

Reference
Dalton VK, Harris LH, Bell JD et al. Treatment of early pregnancy failure: does induced abortion training affect later practices? Am J Obstet Gynecol. 2011;204(6):493.e1-6.