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Effect of Janus kinase/signal transduction and activator of transcription 3 pathway inhibitor on skeletal muscle function in severely burned rats and the mechanism

Zhonghua Shao Shang Za Zhi. 2021 Mar 3;37(3):1-8. doi: 10.3760/cma.j.cn501120-20200120-00030. Online ahead of print.

ABSTRACT

Objective: To observe the functional changes of skeletal muscle in severely burned rats, and investigate the possible effects and mechanisms of Janus kinase/signal transducer and activator of transcription 3 (JAK/STAT3) pathway inhibitors on skeletal muscle function. Methods: The experiment research method was applied. One hundred and twenty male Wistar rats of 8-weeks-old were divided into sham injury group, simple burn group, and burn+JAK/STAT3 inhibitor group according to the random number table, with 40 rats in each group. Rats in simple burn group and burn+JAK/STAT3 inhibitor group were inflicted with 50% total body surface area full-thickness scald in back and abdomen, and rats in sham injury group were sham injured. Rats in burn+JAK/STAT3 inhibitor group were intraperitoneally injected with JAK/STAT3 inhibitor ruxolitinib. On post injury day (PID) 0, 1, 4, 7, and 14, 8 rats in each group were used to measure the specific force generated by extensor digitorum longus in optimal length stimulated with pulse frequency of 20, 40, 60, 80, 100, 120, 140, 160 Hz using a multichannel electrophysiological instrument, and specific force in fatigue period of extensor digitorum longus in optimal length stimulated with pulse frequency of 50 Hz for 0, 10, 20, 30, 60, 120, 180, 240, 300 s. On PID 0, 1, 4, 7, and 14, carbonyl compound content of extensor digitorum longus was determined by ultraviolet spectrophotometry, and ATP content of extensor digitorum longus was determined by micrometry. Data were statistically analyzed with analysis of variance for factorial design, Bonferroni test, and t test. Results: (1) Compared with sham injury group, specific forces of extensor digitorum longus of rats in simple burn group were significantly decreased after stimulated with all the pulse frequency on PID 0, 1, 7, and all the pulse frequency except for 20 Hz on PID 4, and pulse frequency of 20 and 40 Hz on PID 14 (P<0.05 or P<0.01). Compared with simple burn group, specific forces of extensor digitorum longus of rats in burn+JAK/STAT3 inhibitor group were significantly increased after stimulated with all pulse frequency except for 20 Hz on PID 1 and all the pulse frequency on PID 4, 7, and 14 (P<0.05 or P<0.01). (2) Compared with sham injury group, specific forces of extensor digitorum longus of rats in simple burn group were significantly decreased in fatigue period at all the stimulation time points except for 240 s on PID 7 (P<0.05 or P<0.01). Compared with simple burn group, specific forces of extensor digitorum longus of rats in burn+JAK/STAT3 inhibitor group were significantly increased in fatigue period at all stimulation time points except for 240 s on PID 4, and all stimulation time points on PID 7 and 14 (P<0.05 or P<0.01). (3) The carbonyl compound content of extensor digitorum longus of rats in simple burn group on PID 0, 1, 4, 7, and 14 was (0.651±0.155), (0.739±0.194), (0.618±0.086), (0.813±0.162), (0.615±0.115) nmol/mg, which were significantly higher than (0.196±0.0190, (0.156±0.004), (0.169±0.023) (0.156±0.027), (0.175±0.008) nmol/mg of rats in simple burn group (t=7.219, 6.491, 10.938, 9.182, 11.589, P<0.01) and (0.538±0.069), (0.369±0.059), (0.273±0.061), (0.334±0.109), (0.318±0.101) nmol/mg of rats in burn+JAK/STAT3 inhibitor group (t=2.446, 4.689, 8.355, 5.754, 6.097, P<0.05 or P<0.01). (4) The ATP content in extensor digitorum longus of rats in simple burn group on PID 1, 4, 7, and 14 was significantly lower than that in sham injury group (t=7.159, 7.591, 7.473, 4.026, P<0.01) and burn+JAK/STAT3 inhibitor group (t=2.295, 2.575, 2.453, 2.997, P<0.05). Conclusions: After severe burn, the specific force of extensor digitorum longus in rat decreased significantly after stimulated with different pulse frequencies, and the extensor digitorum longus in rat was prone to fatigue. Blocking the JAK/STAT3 signaling pathway could reduce the oxidative stress of muscle protein and increase ATP content, thereby reducing the muscle strength decline caused by burn and improving the muscle strength decline during fatigue.

PMID:33706427 | DOI:10.3760/cma.j.cn501120-20200120-00030

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Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in burn children: a prospective randomized controlled study

Zhonghua Shao Shang Za Zhi. 2021 Mar 3;37(3):1-6. doi: 10.3760/cma.j.cn501120-20200210-00048. Online ahead of print.

ABSTRACT

Objective: To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in burn children. Method: From November 2018 to December 2019, 196 burn children who were admitted to the Department of Burns of West China Hospital of Sichuan University and met the inclusion criteria were enrolled in the prospective randomized controlled study. The patients were divided into traditional pain management group (97 patients, 51 males and 46 females, aged 1 to 6 years) and stepped pain management group (96 patients, 55 males and 41 females, aged 1 to 6 years) according to the random number table. Children in traditional pain management group were treated with traditional acute pain care, while the children in stepped pain management group were treated with stepped acute pain management (moderate pain was treated with oral administration of acetaminophen sustained-release dry suspension, and severe pain was treated with morphine intravenous injection) after admission. The revised COMFORT behavior scale was applied to compare the resting pain levels of children in the two groups within 3 days after burn (1, 9, and 17 o’clock per day).The adverse reactions of patients in the stepped pain management group during the treatment period were recorded. The occurrence of PTSD one month after injury was evaluated in both groups by the PTSD alternative algorithm. Data were statistically analyzed with independent sample t test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher’s exact probability test. Results: The pain scores of children in stepped pain management group were lower than traditional pain management group at 1, 9, and 17 o’clock on post injury day (PID) 1, 1, 9, and 17 o’clock on PID 2, and 1, 9, and 17 o’clock on PID 3 (t=2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71, P<0.05 or P<0.01). The pain scores of children in both groups showed a decreasing trend over time. Of the 96 children in stepped pain management group, 84 children were treated with oral administration of acetaminophen sustained-release dry suspension, and 12 children were treated with morphine intravenous injection. No adverse reactions occurred during the treatment period. The incidence of PTSD of children in stepped pain management group was 3.12% (3/96), which was significantly lower than 14.43% (14/97) in traditional pain management group, P<0.05. Conclusions: The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in burn children.

PMID:33706428 | DOI:10.3760/cma.j.cn501120-20200210-00048

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Effects and mechanism of Eleutheroside E on the growth of human hypertrophic scar fibroblasts

Zhonghua Shao Shang Za Zhi. 2021 Mar 3;37(3):1-8. doi: 10.3760/cma.j.cn501120-20200219-00072. Online ahead of print.

ABSTRACT

Objective: To investigate the effects and mechanism of Eleutheroside E on the growth of human hypertrophic scar fibroblasts (Fbs). Methods: The experimental research method was used. The hypertrophic scar tissue was collected from 6 patients with hypertrophic scar [1 male and 5 females, aged 20 to 51 (37±8) years] admitted to the Department of Burns and Plastic Surgery of General Hospital of Northern Theater Command, from October 2018 to March 2019. The third to seventh generations of human hypertrophic scar Fbs were cultured for the follow-up experiments. Cells were divided into normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, and 10 μL normal saline, Eleutheroside E at the final molarity of 100, 200, and 400 μmol/L were added to cells in the corresponding groups. Cells were divided into small interfering RNA (siRNA)-negative control alone group, siRNA-thrombospondin 1 (THBS1) alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group. Cells in siRNA-negative control alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were transfected with siRNA-negative control, cells in siRNA-THBS1 alone group and siRNA-THBS1+400 μmol/L Eleutheroside E group were transfected with siRNA-THBS1. At 24 h after transfection, cells in siRNA-negative control alone group and siRNA-THBS1 alone group were added with 10 μL normal saline, cells in siRNA-negative control+400 μmol/L Eleutheroside E group and siRNA-THBS1+400 μmol/L Eleutheroside E group were added with Eleutheroside E at the final molarity of 400 μmol/L, respectively. At 0 (immediately), 12, 24, 36 and 48 h after treatment, the cell proliferation activity was detected by thiazolyl blue assay. Cells were divided into normal saline group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, siRNA-negative control alone group, siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group and siRNA-THBS1+400 μmol/L Eleutheroside E group. The corresponding treatments were the same as before. At 24 h after treatment, the apoptosis was observed by Hoechst 33258 staining. Cells were divided into normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, siRNA-negative control alone group, siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group. The corresponding treatments were the same as before. At 24 h after treatment, the protein expression level of THBS1 of cells was detected by Western blotting. The number of sample in each group at each time point was all 3. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, independent sample t test, and Bonferroni correction. Results: At 0 h after treatment, the absorbance values of cells in normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group were similar (P>0.05). At 12, 24, 36, and 48 h after treatment, the cell absorbance values of cells in 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group were significantly lower than those of normal saline group (t=7.64, 28.94, 13.69, 5.87, 6.96, 22.83, 14.75, 11.52, 21.09, 20.15, 29.52, 23.12, P<0.05 or P<0.01). At 0 h after treatment, the cell absorbance values of cells in siRNA-negative control alone group, siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group were similar (P>0.05). At 12, 24, 36 and 48 h after treatment, the cell absorbance values of cells in siRNA-THBS1 alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were significantly lower than those in siRNA-negative control alone group (t=7.14, 44.87, 20.67, 40.98, 9.26, 11.08, 15.33, 20.56, P<0.05 or P<0.01); the absorbance values of cells in siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group were similar (P>0.05). Compared with that in normal saline group, the number of apoptotic cells in 200 μmol/L Eleutheroside E group and 400 μmol/L Eleutheroside E group were increased at 24 h after treatment. At 24 h after treatment, compared with that in siRNA-negative control alone group, the numbers of apoptotic cells in siRNA-THBS1 alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were increased, while the number of apoptotic cells in siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group were similar. At 24 h after treatment, the protein expression levels of THBS1 of cells in 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group (0.87±0.12, 0.38±0.07, 0.20±0.09) were significantly lower than 1.83±0.17 in normal saline group (t=16.61, 16.17, 17.29, P<0.01). At 24 h after treatment, the protein expression levels of THBS1 of cells in siRNA-THBS1 alone group and siRNA-negative control+400 μmol/L Eleutheroside E group (0.61±0.07, 0.58±0.07) were significantly lower than 1.86±0.07 in siRNA-negative control alone group (t=71.06, 83.80, P<0.01), the protein expression levels of THBS1 of cells siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group (0.63±0.11) were similar (P>0.05). Conclusions: Eleutheroside E can inhibit the growth of human hypertrophic scar Fbs by down regulating the expression of THBS1.

PMID:33706429 | DOI:10.3760/cma.j.cn501120-20200219-00072

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Predictors of Initiation of Medication for Opioid Use Disorder and Retention in Treatment Among U.S. Pregnant Women, 2013-2017

Obstet Gynecol. 2021 Mar 10. doi: 10.1097/AOG.0000000000004307. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe trends and factors associated with medication administration for opioid use disorder (OUD) and retention in treatment among pregnant women with OUD.

METHODS: This is a retrospective, nationwide, cross-sectional analysis of treatment episodes for primary OUD among pregnant women from 2013 to 2017. The primary outcome was initiation of methadone, buprenorphine, or naltrexone. Secondary outcomes were retention in treatment defined as length of treatment episode lasting six months or greater, and completion of treatment. Descriptive statistics and logistic regression were applied to describe trends in, and identify factors associated with the outcomes.

RESULTS: There were 42,239 treatment episodes for primary OUD among pregnant women who reported using heroin (65.0%, 27,459), synthetic opioid (33.2%, 14,034), or nonprescribed methadone (1.8%, 746) between 2013 and 2017. Medications for OUD were administered in 47.4% (20,013) of episodes. Retention in treatment occurred in 16.6% of episodes without medications for OUD, and 37.8% of episodes with medications for OUD (P=.01). The rate of medication administration for OUD increased from 41.0% in 2013 to 52.0% in 2017; however, retention rates declined from 39.0% to 33.0% among treatment episodes with medication for OUD. History of at least one prior treatment episode was associated with both administration of medications for OUD and retention in treatment.

CONCLUSION: In spite of current guidelines, most treatment episodes for OUD during pregnancy did not involve administration of medications for OUD. Although administration of medications for OUD has improved over time, retention in treatment is lagging. These findings highlight gaps in the U.S. addiction care system.

PMID:33706349 | DOI:10.1097/AOG.0000000000004307

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Length of the Second Stage of Labor in Women Delivering Twins

Obstet Gynecol. 2021 Mar 10. doi: 10.1097/AOG.0000000000004308. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the length of the second stage of labor in twin deliveries and to compare the length of the second stage in twin and singleton gestations.

METHODS: This is a retrospective cohort study from three large hospitals in Israel. Clinical data were collected from the electronic medical record. The primary outcome was the length of the second stage (the time from documented 10-cm dilation until spontaneous vaginal delivery of the first twin). Multivariable linear regression was used to examine the association of clinical factors with the length of the second stage. The length of the second stage in twin and singleton pregnancies was compared.

RESULTS: From 2011 to June, 2020, there were 2,009 twin deliveries and 135,217 singleton deliveries. Of the twin deliveries, 655 (32.6%) of the patients were nulliparous (95th percentile length of the second stage 3 hours and 51 minutes), 1,235 (61.5%) were parous (95th percentile 1 hour 56 minutes), and 119 (5.9%) were grand multiparous (five or more prior deliveries) (95th percentile 1 hour 24 minutes). In women delivering twins, epidural use was associated with a statistically significant increase in the length of the second stage of 40 minutes in nulliparous patients and 15 minutes in parous patients. In all groups, the length of the second stage was longer in patients delivering twins compared with singletons. Second-stage length longer than the 95th percentile in twins was associated with admission to the neonatal intensive care unit and need for phototherapy.

CONCLUSION: Second-stage labor is longer in twins than singletons and is associated with obstetric history. Normal ranges for the second stage may be useful in guiding clinical practice.

PMID:33706361 | DOI:10.1097/AOG.0000000000004308

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Effect of Medical-Grade Polyurethane Sponges on Sinus Membrane Perforation With a Lateral Window Approach

J Oral Implantol. 2021 Feb 1;47(1):25-29. doi: 10.1563/aaid-joi-D-19-00137.

ABSTRACT

The most commonly reported complication during the sinus elevation surgical procedure is the perforation of the Schneiderian membrane. The aim of this retrospective study was to compare the rate of sinus membrane perforation during lateral window augmentation using either conventional sinus curettes or medical-grade polyurethane sponges. This retrospective study included patients who received a lateral window approach for sinus floor elevation. The sinus elevation procedures using medical-grade polyurethane sponges (test) or conventional curettes (control) were recorded and analyzed. All subjects’ demographic data and preexisting conditions were evaluated. A total of 38 procedures met inclusion criteria, and those data were evaluated for analysis. There were no statistically significant differences in demographic data or preexisting conditions including age, sex, treatment location, presence and absence of septum, Schneiderian membrane thickness, and residual bone height between test and control groups. The membrane perforation rate was 7% in the test group and 43% in the control group; however, this difference did not reach statistical significance (P = .064). Within the limitations of this study, although there was no statistically significant reduction of sinus membrane perforation with the use of medical-grade polyurethane sponges, the decreased incidence of perforation might be of clinical significance.

PMID:33706369 | DOI:10.1563/aaid-joi-D-19-00137

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Quality of Life after Rhinoplasty-A Prospective Study

Facial Plast Surg. 2021 Mar 11. doi: 10.1055/s-0041-1725174. Online ahead of print.

ABSTRACT

As our previous studies have shown, cosmetic surgery has a positive correlation with postoperative well-being. The aim of this study was to prospectively examine the postoperative changes in quality of life (QoL) after a rhinoplasty. Thirty-four patients who underwent septorhinoplasty performed by a single surgeon from July 2015 to October 2018 reported in indication-specific self-developed and different validated questionnaires (FLZM or Fragen zur Lebenszufriedenheit Module, Freiburg Personality Inventor, Rosenberg self-esteem scale, Functional Rhinoplasty Outcome Inventory 17 [FROI-17], and Glasgow Benefit Inventory [GBI]) on the status of their QoL preoperatively (T0) and 6 months’ follow-up (T1). Our goal was to assess the difference in psyche and self-esteem and to get objective insights into the effect of the operation. Significant improvements in QoL in terms of general module, health, and appearance were noted. The general part of the FLZM showed increasing T1 values in the sum scores (p = 0.005). With regard to the item “health,” T1 was better than the norm data (p = 0.003). The statistically significant improvement for the item nose appearance (p < 0.0001) after operation and T1 versus reference data (p < 0.010) should be highlighted. The subjective patient ratings showed statistically significant T1 improvements for all items of the FROI-17: overall nose (p < 0.0001), nasal function (p = 0.001), general/further symptoms (p = 0.006), and confidence increased by aesthetic changes (p < 0.0001). Furthermore, the GBI score shows an improved QoL after rhinoplasty (p < 0.0001). Based on the assessment of a variety of disease- and nondisease-specific validated questionnaires, numerous improvements in the QoL of the patients were observed. Therefore, we support septorhinoplasty as a meaningful procedure regarding QoL improvement. The level of evidence is Level II prospective cohort study.

PMID:33706388 | DOI:10.1055/s-0041-1725174

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A Meta-Analysis of Brain-Derived Neurotrophic Factor Effects on Brain Volume in Schizophrenia: Genotype and Serum Levels

Neuropsychobiology. 2021 Mar 11:1-14. doi: 10.1159/000514126. Online ahead of print.

ABSTRACT

AIM: The Val66Met single-nucleotide polymorphism (SNP) on the BDNF gene has established pleiotropic effects on schizophrenia incidence and morphologic alterations in the illness. The effects of brain-derived neurotrophic factor (BDNF) on brain volume measurements are however mixed seeming to be less established for most brain regions. The current meta-analytic review examined (1) the association of the Val66Met SNP and brain volume alterations in schizophrenia by comparing Met allele carriers to Val/Val homozygotes and (2) the association of serum BDNF with brain volume measurements.

METHOD: Studies included in the meta-analyses were identified through an electronic search of PubMed and PsycInfo (via EBSCO) for English language publications from January 2000 through December 2017. Included studies had conducted a genotyping procedure of Val66Met or obtained assays of serum BDNF and obtained brain volume data in patients with psychotic disorders. Nonhuman studies were excluded.

RESULTS: Study 1 which included 52 comparisons of Met carriers and Val/Val homozygotes found evidence of lower right and left hippocampal volumes among Met allele carriers with schizophrenia. Frontal measurements, while also lower among Met carriers, did not achieve statistical significance. Study 2 which included 7 examinations of the correlation between serum BDNF and brain volume found significant associations between serum BDNF levels and right and left hippocampal volume with lower BDNF corresponding to lower volumes.

DISCUSSION: The meta-analyses provided evidence of associations between brain volume alterations in schizophrenia and variations on the Val66Met SNP and serum BDNF. Given the limited number of studies, it remains unclear if BDNF effects are global or regionally specific.

PMID:33706323 | DOI:10.1159/000514126

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Comparison of the Prediction Model of Adolescents’ Suicide Attempt Using Logistic Regression and Decision Tree: Secondary Data Analysis of the 2019 Youth Health Risk Behavior Web-Based Survey

J Korean Acad Nurs. 2021 Feb;51(1):40-53. doi: 10.4040/jkan.20207.

ABSTRACT

PURPOSE: The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis.

METHODS: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0.

RESULTS: A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model.

CONCLUSION: Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.

PMID:33706330 | DOI:10.4040/jkan.20207

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Contraception Choice Among Those Seeking Abortion for Fetal Indication or Management of Pregnancy Loss

Obstet Gynecol. 2021 Mar 10. doi: 10.1097/AOG.0000000000004315. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare contraception choices of those who are undergoing abortion procedures for fetal indications or surgical management of pregnancy loss with those who are having abortions for another indication.

METHODS: We conducted a cross-sectional study at University of California, Irvine, from December 1, 2017, through December 31, 2018, and included gestational ages up to 24 0/7 weeks. We abstracted data from electronic medical records and analyzed them using descriptive statistics, χ2, Fisher exact tests, and a multivariate logistic regression model for primary outcome (whether a contraception method was chosen) and secondary outcome (whether a long-active reversible contraception was chosen).

RESULTS: Those with fetal indication were less likely to choose contraception than those with other indication (68/134, 50.7% vs 142/158, 89.9%, P<.001), and among those choosing contraception those with fetal indication were less likely to choose long-acting reversible contraception (LARC) (19/68, 27.9% vs 94/142, 66.2%, P<.001). Differences remained significant in multivariable analysis that controlled for age, gestational age in weeks, race, parity, procedure type, and comorbidities (among those with fetal indication for choosing any contraception: adjusted odds ratio [aOR] 0.11, 95% CI 0.05-0.23; choosing LARC: aOR 0.17, 95% CI 0.07-0.39).

CONCLUSION: Only half of those seeking abortion for a fetal indication or surgical management of pregnancy loss were interested in contraception.

PMID:33706340 | DOI:10.1097/AOG.0000000000004315