ArticlesAccuracy of assessment of pregnancy duration by women seeking early abortions
Introduction
Each year about 180 million women worldwide become pregnant.1 Very little research has explored women's own understanding of a key feature of pregnancy—duration of gestation. A few studies in women who carried their pregnancies to term compared various methods to assess duration of gestation according to how well the methods predict delivery dates,2, 3 diagnose prematurity, or identify premature infants at greatest risk of death.4, 5 None of those studies looked at women's own abilities to estimate their pregnancy durations.
For many women, however, pregnancy does not lead to birth. Yet no study has investigated estimation of pregnancy duration in relation to induced abortion. There are good reasons for this lack of research. Conventional methods of induced abortion require the woman to visit a health-care provider. During the visit, the clinician calculates the pregnancy duration and treats the woman according to a professional estimate of this variable. In this context, a woman does not need to calculate her pregnancy duration.
Now, however, advances in early medical abortion create a compelling reason to study women's ability to self-assess pregnancy duration. In particular, the widely used mifepristone-misoprostol regimen consists simply of two sets of pills, typically taken orally 48 h apart. The regimen has proved safe, effective, and acceptable in both more developed and less developed countries.6, 7, 8 In principle, at least, the regimen is so safe when used at the earliest durations of gestation (taken as 8 weeks and under for the purposes of this paper)9 that women could be counselled about mifepristone-misoprostol during routine reproductive health care and could keep a dose of the treatment on hand for use when needed. Medical involvement and expense would be limited to necessary back-up.
Such advance distribution protocols, however, are currently unknown. Typical protocols require three clinic visits: one to confirm pregnancy, assess pregnancy duration, and administer mifepristone; a second to give misoprostol and observe that all is well; and a third to confirm that the abortion is complete and to offer a back-up procedure if it is not. Is such strict, costly, and intrusive medical involvement warranted? The answer depends on whether women themselves can manage several tasks traditionally handled by medical professionals, including diagnosis of the need for abortion, and later, accurate assessment of whether the abortion is complete.10 Since the efficacy and safety of mifepristone-misoprostol decrease with advancing gestation,9, 11 perhaps the most critical of these steps is correct self-assessment of pregnancy duration before the treatment is started.
Data from a multicentre trial of medical abortion by means of mifepristone-misoprostol8 suggest that women do know the information necessary to underpin accurate assessment of pregnancy duration: 99.9% of the 799 Chinese, Cuban, and Indian women in that study offered an exact date (accurate or not) for the start of their last menstrual period (LMP) and 92.4% of estimates derived from the dates women offered fell within 1 week of physicians' estimates. Moreover, estimates based on the dates reported by the women predicted the likelihood of a complete medical abortion better than physicians' estimates.11 That dataset, however, precluded a full exploration of self-assessment of pregnancy duration because it excluded women whose LMP had been more than 56 days before presentation (according to clinical estimates). Also, participants were not required to convert the dates they gave into durations of pregnancy. To investigate more fully, we undertook this observational study.
Section snippets
Participants
The study took place between May, 1997, and March, 1998, at two large, urban clinics (a free-standing abortion clinic in Atlanta, USA, and a large government-funded clinic in Pune, India). Women presenting at these clinics for first-trimester abortion were informed about the study and were eligible if they believed that their pregnancy duration was less than 13 weeks, although knowledge of the dates of the LMP or the date of unprotected intercourse was not a requirement. We excluded women
Results
In each site, we failed to reject our null hypothesis that at least 90% of women could assess their gestational durations well enough to avoid the caution zone. Of the first-trimester abortion clients seen during the study period, 222 (11.5%) of 1933 at the Atlanta clinic and 200 (64.1%) of 312 in Pune took part in the study. In Atlanta, study staff were available during only a small proportion of the clinic shifts, and we do not know the total number of eligible women, or any of their
Discussion
For this study, we took the providers' estimates (irrespective of the method used to generate them) as correct. These estimates would govern routine provision of mifepristone-misoprostol, and we wanted to see how closely women on their own could match the estimates they would typically be given by medical professionals.
We found that the vast majority of women presenting for first-trimester abortions in Atlanta and in Pune and equipped only with a simple worksheet and calendar could judge
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2020 developments in the provision of early medical abortion by telemedicine in the UK
2021, Health PolicyCitation Excerpt :In addition to the evidence supporting the abortion itself during TEMA, it has also been demonstrated that women can reliably date their pregnancies according to their menstrual history, thereby minimising the risk of them undergoing an EMA at a later gestational stage. A study between the US and India found that only 9.8–10 % (woman’s estimate based on last menstrual period) and 3.4–7.7 % (woman’s estimate based on date of last unprotected intercourse) of women fell within the ‘caution zone’, which was defined as the woman dating her pregnancy at <9 weeks but her healthcare provider dating it at ≥9 weeks [14]. The first country in the UK to instigate TEMA in response to the COVID-19 threat was England (see Table 1).
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2016, Journal de Gynecologie Obstetrique et Biologie de la ReproductionPreterm birth: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data
2016, VaccineCitation Excerpt :Its limitations are discussed as being a determinant based on self-reporting and therefore felt to be imprecise. Studies have shown, however, that women who were certain of their LMP were accurate in their assessment of pregnancy duration compared with their ultrasound dating [71]. When information about the LMP is absent or uncertain, estimates of gestational age can be determined from a clinical assessment including the description of pregnancy symptoms such as nausea, fatigue, tender swollen breasts, frequent urination, a pelvic examination when performed in the first trimester and fundal height (FH) ascertainment.
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2015, ContraceptionCitation Excerpt :The corresponding proportion in the Ellertson study was 7.8%. Of women with GAs > 70 days by ultrasound, the proportion with certain LMPs > 56 days prior was similar in the two studies: 56/72 (78%) in the Bracken study [2] and 32/39 (78%) in the Ellertson study [11]. Our analysis of data from a recent study of more than 4200 medical abortion patients conducted at 10 clinics in the United States in the past decade suggests that, in selected women, confirmation that GA is no more than 63 or 70 days of gestation can be effectively obtained by history alone [2].