Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Obstetrics & Gynaecology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa.
Contraception. 2019 Sep;100(3):209-213. doi: 10.1016/j.contraception.2019.04.009. Epub 2019 Apr 25.
To identify key delays and associated factors in women's pathway to second-trimester abortion that could inform strategies to increase earlier presentation.
We performed a secondary analysis using data collected from May 2012 to June 2013 as part of a randomized controlled trial among women having abortion at 13.0-20.0 weeks at a public hospital in South Africa. We used ultrasound and participant interview data to calculate 3 key intervals: (1) conception to suspicion of pregnancy, (2) suspicion to first healthcare visit for abortion, and (3) first healthcare visit to abortion procedure. We compared intervals for women at 13-15.0 weeks versus 15.1-20.0 weeks gestation at abortion using Wilcoxon rank-sum tests and tested for associations between gestational age at key events using multivariable linear regression.
Median (interquartile range[IQR]) durations for the 3 intervals among women at 13-15 weeks (n=93) compared to 15.1-20 weeks (n=63) gestation were: (1) 36 days (IQR 21-53 days) versus 62 days (36-71 days), p<.001; (2) 29 days (IQR 15-46 days) versus 23 days (IQR 11-39 days), p=.64; (3) 14 days (IQR 7-21 days) versus 14 days (IQR 12-21 days), p=.32. Multivariable logistic regression showed marginal associations between gestational age at suspicion of pregnancy and no prior pregnancy (aOR=3.8, 95% CI 1.0-14.6) and living in informal housing (aOR=3.1, 95% CI 1.0-9.1). Gestational age on the day of the abortion procedure was significantly associated with living in informal housing (aOR=3.1, 95% CI 1.4-6.6).
The only differences in delay in obtaining second trimester abortion between South African women having an earlier and later second trimester procedure is due to longer time to suspect pregnancy.
Interventions to improve early pregnancy recognition should be explored and referral processes should be streamlined to avoid unnecessary delays accessing abortion care and possibly reduce the proportion of abortions performed later in the second trimester in South Africa.
确定女性进入妊娠中期流产路径中的关键延误及其相关因素，为制定旨在提高早期就诊率的策略提供信息。
我们对 2012 年 5 月至 2013 年 6 月期间在南非一家公立医院进行的妊娠 13.0-20.0 周的妇女进行的一项随机对照试验中收集的数据进行了二次分析。我们使用超声和参与者访谈数据来计算 3 个关键间隔：（1）受孕至怀疑怀孕，（2）怀疑怀孕至第一次流产就诊，（3）第一次流产就诊至流产手术。我们使用 Wilcoxon 秩和检验比较了妊娠 13-15 周（n=93）和 15.1-20 周（n=63）的女性在这 3 个间隔的差异，并使用多变量线性回归检验了关键事件时的胎龄与关键事件之间的关联。
妊娠 13-15 周的女性（n=93）和 15.1-20 周的女性（n=63）在 3 个间隔中的中位（四分位距[IQR]）持续时间分别为：（1）36 天（IQR 21-53 天）vs 62 天（36-71 天），p<.001；（2）29 天（IQR 15-46 天）vs 23 天（IQR 11-39 天），p=.64；（3）14 天（IQR 7-21 天）vs 14 天（IQR 12-21 天），p=.32。多变量逻辑回归显示，怀疑怀孕时的胎龄与无既往妊娠（比值比[aOR]=3.8，95%置信区间[CI] 1.0-14.6）和居住在非正式住房（aOR=3.1，95% CI 1.0-9.1）之间存在边缘关联。流产当天的胎龄与居住在非正式住房显著相关（aOR=3.1，95% CI 1.4-6.6）。
南非妇女在妊娠中期获得第二阶段流产的唯一差异是怀疑怀孕的时间更长。
应探索改善早期妊娠识别的干预措施，并简化转诊流程，以避免不必要的延误接受流产护理，并可能减少南非妊娠中期后期进行的流产比例。
