BACKGROUND: Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion.
METHODS: A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified.
RESULTS: Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05).
CONCLUSIONS: In this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

BACKGROUND: Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia.
METHODS: The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 μg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient.
RESULTS: The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ± 20.5 seconds, and the time to obey verbal command was 54.5 ± 20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9.
CONCLUSIONS: The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 μg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.

BACKGROUND: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China.
METHODS: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy.
RESULTS: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71-4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74-7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14-0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10-0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy.
CONCLUSIONS: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW.
Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited.To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy.Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week.The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW.

OBJECTIVE: We present prenatal diagnosis of de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis on prenatal ultrasound.
METHODS: A 40-year-old, gravida 2, para 1, woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 46,XY. Level II ultrasound at 22 weeks of gestation revealed bilateral hydronephrosis and right clubfoot. At 23 weeks of gestation, repeat amniocentesis revealed the result of arr [GRCh37] 10p12.1p11.23 (26,182,512-29,826,276) × 1 dn with a 3.6-Mb microdeletion of 10p12.1p11.23 encompassing the genes of MYO3A, GAD2, APBB1IP, PDSS1, ABI1, ANKRD26, YME1L1, MASTL, ACBD5, PTCHD3, RAB18, MKX, ODAD2, MPP7, WAC and BAMBI. The pregnancy was subsequently terminated, and a malformed fetus was delivered with facial dysmorphism of low-set ears, broad forehead and flat nasal bridge. Array comparative genomic hybridization (aCGH) analysis of umbilical cord confirmed a 3.6-Mb 10p12.1p11.23 microdeletion encompassing WAC.
CONCLUSIONS: Application of aCGH is useful in the pregnancy with a normal fetal karyotype and abnormal fetal ultrasound.

OBJECTIVE: Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP).
METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software.
RESULTS: A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81-2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92-1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88-15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38-2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001-2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution.
CONCLUSIONS: This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women\'s fertility.

OBJECTIVE: This study aimed to evaluate the effectiveness of post-abortion care services in Chinese women who have undergone induced abortion.
METHODS: A systematic literature search was conducted in five databases from January 2011 to June 2023 (PROSPERO registration CRD42023440458). Estimates of intervention effects were represented as relative risk (RR) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the strength of recommendations.
RESULTS: The meta-analysis of 42 randomized controlled studies involving 70,126 participants indicated that post-abortion care services could significantly increase rate of effective contraceptive use (RR = 2.33, 95%CI = 1.80-3.00, 10 studies, GRADE (Medium)), reduce repeat abortion rate (RR = 0.26, 95%CI = 0.20-0.36, 19 studies, GRADE (High)), increase follow-up visit rate (RR = 1.37, 95%CI = 1.06-1.75, 5 studies, GRADE (Very low)) in one year after abortions, and improve patient satisfaction rate (RR = 1.37, 95%CI = 1.03-1.83, 9 studies, GRADE (High)).
CONCLUSIONS: Post-abortion care services could help increase the rate of continuation of post-abortion effective contraceptives, prevent repeat abortions, and promote female fertility. Exploring strategies for better provision of post-abortion services requires more high-quality research.

BACKGROUND: Repeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women.
METHODS: We used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15-49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables.
RESULTS: Of the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25-34 years (AOR:2.16;95%CI = 1.66-2.79) or 35-49 years (AOR:2.95;95%CI:2.18-3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25-12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03-2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33-1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07-1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49-0.93), Northern (AOR:0.46;95%CI:0.24-0.88), Upper West (AOR:0.24; 95%CI: 0.12-0.50) and Upper East (AOR:0.49; 95%CI = 0.24-0.99) regions were less likely to have repeat induced abortion.
CONCLUSIONS: The study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

暂无摘要。

BACKGROUND: Unintended (unwanted) pregnancy is a sexual and reproductive health issue with psychosocial consequences for the individual, their family, and society. However, the relationship between social support and related mental health issues, like depression and the effects of childhood adversity, is poorly studied. This study aims to explore the connections between childhood adversity, perceived social support, and depressive symptoms in pre-abortion women (women who have decided to have an abortion) in a clinical setting, based on the common risk factor approach and social support theory.
METHODS: A total of 299 pre-abortion Chinese women 18-45 years were recruited in a hospital in Shantou, China. Hierarchical linear regression analyses were employed to examine the relative effects of childhood adversity and sources of social support on depressive symptoms, controlling for sociodemographic influences.
RESULTS: The results show that 37.2 percent of participants reported at least one adverse experience in childhood. More than half of the respondents were at risk for depression. Results of regression analysis showed that childhood adversities were negatively associated with depressive symptoms before sources of social support were entered into the model. However, when the sources of perceived social support were added, the effect of childhood adversity was not significant. Perceived social support explained the additional 15 percent variance in depressive symptoms. Additionally, being married (β = -.12, p < .05) and number of siblings (β = .13, p < .05) were significantly related to depressive symptoms.
CONCLUSIONS: Pre-abortion women are at risk of mental health problems. Peer and familial social supports can alleviate the influence of childhood adversity on depression among pre-abortion Chinese women. Strengthening the role of various sources of social support can help to improve the mental health conditions of pre-abortion women.

This article aims to report the comprehensive and up-to-date analysis and evidence of the insertion rate, expulsion rate, removal rate, and utilization rate of immediate placement of intrauterine devices (IUDs) versus delayed placement after artificial abortion. PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang databases were comprehensively searched up to January 12, 2024 for studies that compared immediate versus delayed insertion of IUDs after abortion. The evaluation metrics included the number of IUD insertion after surgical or medical abortions, the frequency of expulsion and removal at 6 months or 1 year, the number of continued usage, pain intensity scores, the number of infections, the duration of bleeding, and instances of uterine perforation during or after IUD insertion. Ten randomized controlled articles were eligible, comprising 11 research projects, of which 3 projects involved the placement of an IUD after surgical abortion, and 8 projects involved the placement of an IUD after medical abortion. This included 2025 patients (977 in the immediate insertion group and 1,048 in the delayed insertion group). We summarized all the extracted evidence. The meta-analysis results indicated that for post-surgical abortions, the immediate insertion group exhibited a higher IUD placement rate than the delayed insertion group. After medical abortions, the immediate insertion group showed higher rates of IUD placement, utilization, and expulsion at 6 months or 1 year. The two groups showed no statistically significant differences in the removal rate, post-insertion infection rate, pain scores during insertion, and days of bleeding during the follow-up period. Compared to delayed placement, immediate insertion of IUDs can not only increase the usage rate at 6 months or 1 year but also enhance the placement rate.