Clinical Associate Professor of Obstetrics and Gynaecology at the University of British Columbia in Vancouver and a co-investigator in the Contraception and Abortion Research Team in the Women's Health Research Institute at BC Women's Hospital and Health Centre.
Medical student in the Faculty of Medicine at the University of British Columbia and a research assistant in the Contraception and Abortion Research Team in the Women's Health Research Institute at the time of the study.
Can Fam Physician. 2023 Jan;69(1):36-44. doi: 10.46747/cfp.690136.
OBJECTIVE: To evaluate practices among first-trimester surgical abortion facilities and providers in Canada in 2012 and examine the characteristics of the surgical abortion work force. DESIGN: Self-administered paper or electronic survey adapted from a survey previously fielded in the United States. SETTING: Canada. PARTICIPANTS: Facility administrators and physicians. MAIN OUTCOMES MEASURES: Descriptive statistics on reported first-trimester surgical abortion practice and provider demographic characteristics. RESULTS: Eighty-three percent of identified facilities (78 of 94) and 178 physicians responded. Of the respondents, 99% of facilities and 96% of physicians provided first-trimester surgical abortions. Responding facilities provided 68,154 first-trimester surgical abortions in 2012. This represented 96% of their reported total (combined medical and surgical) first-trimester abortions. More than half (55%) of responding facilities were community based, while 45% were hospital affiliated. Most physician providers were female (68%) and were family doctors (59%). Preoperatively, 96% of physicians routinely used ultrasound and 89% gave perioperative antibiotics. Almost half (48%) used manual vacuum aspiration, but less than 35% did so beyond 9 weeks after the last menstrual period. At most facilities, most procedures were performed under combined local anesthesia and intravenous sedation (73%); only 7% indicated deep sedation or general anesthesia were used exclusively. Postoperatively, 81% of physicians performed immediate tissue examination and 96% offered postabortion contraception on the same day as the abortion. Other assessed outcomes included medication regimens and cervical preparation, with a high degree of consistency among facilities and physicians. CONCLUSION: First-trimester surgical abortion providers are mostly family physicians and most are female. Practices across Canada were mostly uniform and followed evidence-based guidelines. Uptake of the most recent Canadian practice guidelines may help further standardize patient care and improve routine perioperative antibiotic use and immediate tissue examination.
目的：评估 2012 年加拿大早期妊娠手术流产机构和提供者的实践，并检查手术流产工作人员的特征。
设计：改编自美国先前进行的调查的自我管理纸质或电子调查。
设置：加拿大。
参与者：设施管理员和医生。
主要观察指标：报告的早期妊娠手术流产实践和提供者人口统计学特征的描述性统计数据。
结果：确定的 94 个设施中的 83%（78 个）和 178 名医生做出了回应。在答复者中，99%的设施和 96%的医生提供了早期妊娠手术流产。参与调查的医疗机构在 2012 年共进行了 68154 例早期妊娠手术流产。这代表了他们报告的总（包括医疗和手术）早期妊娠流产的 96%。超过一半（55%）的答复机构是社区型的，而 45%是医院附属的。大多数医生提供者是女性（68%），是家庭医生（59%）。术前，96%的医生常规使用超声检查，89%的医生给予围手术期抗生素。近一半（48%）使用手动真空抽吸，但不到 35%的医生在末次月经后 9 周以上使用。在大多数机构中，大多数程序都是在局部麻醉和静脉镇静联合下进行的（73%）；只有 7%表示深度镇静或全身麻醉是唯一使用的。术后，81%的医生立即进行组织检查，96%的医生在流产当天提供流产后避孕。其他评估结果包括药物治疗方案和宫颈准备，机构和医生之间存在高度一致性。
结论：早期妊娠手术流产提供者主要是家庭医生，而且大多数是女性。加拿大各地的做法基本一致，遵循循证指南。采用最新的加拿大实践指南可能有助于进一步规范患者护理，并改善常规围手术期抗生素使用和立即组织检查。
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