Our Research Program
At Willow Women’s Clinic, we have an active research program to improve the care of women having abortions and needing contraception. Here are our publications from the oldest to the most recent.
1. Wiebe, ER. Retention of Products of Conception After Therapeutic Abortion. Can Med Assoc J l986;134:505
2. Wiebe ER. New benefit of beta-blockers? Can Med Assoc J 1989;139:198.
3. Herbert CP, Wiebe ER. That notwithstanding clause again. Can Med Assoc J 1989;141:97-8.
4. Wiebe, ER. Post-partum Misery: A family physician’s perspective. Can. Fam. Phys. 1990;36:1285-1287
5. Wiebe ER, Elwood E. Tuberculosis of the ribs: A report of three cases. Resp Med 1991;85(3):251-3
6. Wiebe ER. Genital injuries in sexual assault victims. Can Med Assoc J. 1991;144(6)644,647
7. Wiebe ER. Comparison of the efficacy of different local anesthetics and techniques of local anesthesia in therapeutic abortions. Am J Obstet Gynecol l992;167:131-4
8. Wiebe ER, Wiebe A. Fragile X Syndrome. Can. Fam. Phys. 1994;40:290-295
9. Wiebe ER, Rawling M. Pain Control in abortion. Int J Gynec Obstet. 1995;50:41-46
10. Wiebe ER. Abortions induced with methotrexate and misoprostol. Can Med Assoc J. 1996;154(2):165-70
11. Wiebe ER, Rawling M, Janssen P. Comparison of the effectiveness of 0.5% and 1% lidocaine for first trimester abortions. Int J Gynecol Obstet.1996;55:71-2.
12. Wiebe ER. N of 1 trials: Managing patients with chronic fatigue syndrome: two case reports. Can Fam Phys 1996;42:2214-7.
13. Wiebe ER. Choosing between surgical abortions and medical abortions induced with methotrexate and misoprostol. Contraception 1997;55:67-71.
14. Wiebe ER. Abortion induced with methotrexate and misoprostol: A comparison of various protocols. Contraception;1997;55:159-63.
15 Wiebe ER, Janssen PJ. Management of spontaneous abortions in family practices and hospitals. Fam Med 1998;30:293-6.
16. Wiebe ER, Rawling M. Vaginal misoprostol to prepare the cervix before first trimester abortion. Int J Gynecol Obstet 1998;60:175-6.
17 Rawling M, Wiebe ER. Pain control in abortion clinics. Int J Gynecol Obstet 1998;60:293-5.
18. Wiebe ER. Comparing abortion induced with methotrexate and misoprostol to methotrexate alone. Contraception 1999;59:7-10.
19. Creinin M, Wiebe E, Gold M. Methotrexate and misoprostol for early abortion in adolescent women. J Ped Adolesc Gynecol 1999;12:71-7.
20. McGregor MJ, Le G, Marion SA, Wiebe ER. Examination for sexual assault: Is the presence of documented physical injury associated with charge laying? CMAJ 1999;160:1565-9.
21. Wiebe ER. Oral methotrexate compared to injected methotrexate when used with misoprostol for abortion. Am J Obstet Gynecol 1999;181:149-52.
22. Wiebe ER, Janssen PJ. Reducing surgery in management of spontaneous abortion by family doctors. Can Fam Phys 1999;45:2364-9.
23. Wiebe ER. Tamoxifen compared to methotrexate when used with misoprostol for abortion. Contraception 1999;59:265-70.
24. Wiebe ER, Janssen PJ. Women’s experiences with conservative management of spontaneous abortions. Can Fam Phys 1999;45:2355-60.
25. McGregor MJ, Wiebe ER, Marion SA, Livingstone C. Why don’t women report sexual assault to police?: 5 years of data from the Vancouver Sexual Assault Service. Can Med Assoc J 2000;162:659-60.
26. Wiebe ER, Janssen P, Hales S. Time lost from work in women choosing medical or surgical abortions. J Am Med Women’s Assoc 2000;55:202.
27. Wiebe ER, Comay S, McGregor MJ, Ducceschi S. Offering HIV prophylaxis to sexual assault victims – sixteen months experience in a sexual assault service. Can Med Assoc J 2000;162:641-5.
28. Wiebe ER. A randomized trial of aromatherapy to reduce anxiety before abortion. Effect Clin Pract 2000;4:166-9.
29. Wiebe ER, Switzer P. Arteriovenous malformations of the uterus associated with medical abortion. Int J Gynecol Obstet 2000;71:155-8.
30. Wiebe ER, Janssen PJ. Time lost from work among women choosing medical or surgical abortions. Women’s Health Issues 2000;10:327-32.
31. Rawling MJ, Wiebe ER. Randomized controlled trial of fentanyl for abortion pain. Am J Obstet Gynecol 2001;185:103-7.
32. Wiebe ER. Misoprostol administration in medical abortion. A comparison of three regimens. J. Reprod Med 2001;46(2):125-9.
33. Wiebe ER, Janssen PJ. Universal screening for domestic violence in abortion. Women’s Health Issues 2001;11:436-41.
34. Trussell J, Wiebe E, Shochet T, Guilbert E. Cost savings from emergency contraceptive pills in Canada. Obstet Gynecol 2001;97:
35. Wiebe ER. Pain control in medical abortion. Int J Gynecol Obstet 2001;74:275-80.
36. Obstet Gynecol. 2002 May;99(5 Pt 1):813-9.
Comparison of abortions induced by methotrexate or mifepristone followed by misoprostol.
Wiebe E, Dunn S, Guilbert E, Jacot F, Lugtig L.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
OBJECTIVE: To compare the effectiveness, side effects, and acceptability of medical abortions induced by methotrexate and misoprostol with abortions induced by mifepristone and misoprostol.
METHODS:This was a multicenter, randomized, nonblinded, controlled trial comparing 50 mg/m(2) of methotrexate followed 4-6 days later by 800 microgram of vaginal misoprostol with 600 mg of oral mifepristone followed 36-48 hours by 400 microgram of oral misoprostol.
RESULTS: There were 518 women in the methotrexate group and 524 women in the mifepristone group. In the methotrexate group, 21 women required suction curretage, two for continuing pregnancy, eight because of physician request (usually for excessive bleeding), and 11 because of patient request. In the mifepristone group, 22 women needed surgical termination, 17 because of physician request, and five because of patient request. By day 8, only 386 (74.5%) in the methotrexate group had completed the abortion compared with 474 (90.5%) in the mifepristone group, and the mean number of days from beginning to completion was 7.1 for methotrexate and 3.3 for mifepristone (P =.001). There were no differences in complications, and side effects were similar. Acceptance was slightly higher with mifepristone (88.0%) than with methotrexate (83.2%).
CONCLUSION: Abortions induced with mifepristone completed faster than those induced with methotrexate, but the overall success rates, side effects, and complications were similar. Acceptance rates were slightly higher with mifepristone than methotrexate (P =.03).
PMID: 11978292 [PubMed - indexed for
37. Wiebe ER, Sent L, Fong S, Chan J. Barriers to use of oral contraceptives in ethnic Chinese women presenting for abortion. Contraception 2002;65:159-63.
38. 1: Contraception. 2003 Mar;67(3):219-21.
The effect of lorazepam on pain and anxiety in abortion.
Wiebe E, Podhradsky L, Dijak V.
Department of Family Practice, University of British Columbia, 1013-750 West Broadway, Vancouver V5Z 1HP, British Columbia, Canada. email@example.com
In this double-blind study, 104 women were randomized to receive 1 mg lorazepam or placebo prior to a first-trimester abortion. In addition, 262 women were allowed to choose whether or not to take the lorazepam. The outcome measures were 11-point verbal pain scales of pain during the abortion and anxiety measured before premedication and during the abortion. The mean anxiety and pain scores did not differ significantly in the lorazepam and placebo groups of the randomized trial. In the observational group, the women who took lorazepam had their mean anxiety score drop from 5.5 to 4.7 while in those who did not take it, the score rose from 3.8 to 4.9. This study indicates that giving oral benzodiazepines preoperatively is neither helping nor hurting our patients but the placebo effect can be helpful to make our patients more comfortable.
PMID: 12618257 [PubMed - indexed for MEDLINE]
39. Wiebe E, Guilbert E, Jacot F, Shannon C, Winikoff B. A fatal case of Clostridium sordellii septic shock syndrome associated with medical abortion. Obstet Gynecol 2004;
40 Contraception. 2004 Dec;70(6):463-6.
Comparing vaginal and buccal misoprostol when used after methotrexate for early abortion.
Wiebe ER, Trouton K.
Department of Family Practice, University of British Columbia, 1013-750 West Broadway, Vancouver, British Columbia, V5Z 1H9, Canada. firstname.lastname@example.org
OBJECTIVE: The primary objective of this study was to determine if buccal misoprostol was as effective as vaginal misoprostol in medical abortions. The secondary objectives were to compare side effects and acceptability.
METHODS: This was a randomized controlled trial of 600 microg misoprostol by the buccal or vaginal routes used 3 to 6 days after 50 mg/m2 methotrexate. The participants were women presenting for abortion at 49 days or less gestation. The outcome measures were the number of women who had aborted by Day 8, side effects and acceptability.
RESULTS: Day 8 completion rate was 53.5% for the buccal route and 67.5% for the vaginal route (p = 0.012). Side effects were similar in the two groups except that there was more burning with the buccal route. Overall acceptability and route acceptability were similar in the two groups.
CONCLUSIONS: When used after methotrexate for early abortion, the vaginal route for misoprostol is more effective and preferred to the buccal route.
PMID: 15541407 [PubMed - indexed for MEDLINE]
41. 1: Contraception. 2004 Jun;69(6):493-6.
Ethnic Chinese women’s perceptions about condoms, withdrawal and rhythm methods of birth control.
Wiebe ER, Janssen PA, Henderson A, Fung I.
Department of Family Practice, University of British Columbia, 1013-750 West Broadway, Vancouver, BC, V5Z 1H9 Canada. email@example.com
OBJECTIVE: To gain a better understanding of ethnic Chinese women’s perceptions and experiences of using barrier and rhythm methods of contraception in order to improve contraceptive counseling at abortion clinics.
DESIGN: Qualitative descriptive study.
SETTING: Urban abortion clinic.
PARTICIPANTS: Forty ethnic Chinese women presenting for abortion. METHOD: Data were collected in semi-structured interviews by one interviewer who is fluent in English, Mandarin and Cantonese. Transcribed interviews were systematically analyzed to identify salient themes.
MAIN FINDINGS: All of the women interviewed had used condoms (none with spermicide), 20 had used rhythm and 17 withdrawal, usually a combination of two or three of these methods. Many women noted that these methods are under male control and talked about the difficulty negotiating their use with partners. The majority of women using rhythm were unable to correctly identify “safe periods.” Copyright 2004 Elsevier Inc.
PMID: 15157795 [PubMed - indexed for MEDLINE
42. J Obstet Gynaecol Can. 2004 Oct;26(10):881-5.
Anxieties and attitudes towards abortion in women presenting for medical and surgical abortions. [Article in English, French]
Wiebe ER, Trouton KJ, Fielding SL, Grant H, Henderson A.
University of British Columbia,Vancouver, BC.
OBJECTIVE: To examine the differences in anxiety levels and attitudes towards abortion between women having an early medical abortion and women having a surgical (manual vacuum aspiration) abortion.
METHODS: Women who presented for an early medical abortion or a surgical abortion at an urban, free-standing abortion clinic were invited to participate in this study. Fifty-nine women having a medical abortion and 43 women having a surgical abortion answered questionnaires before their scheduled abortion, and again 2 to 4 weeks after the abortion. Thirty women were interviewed about their answers.
RESULTS: Anxiety levels were similar in both groups before the abortion procedure. Anti-choice views about abortion were seen in 60.5% of women having a medical abortion and in 37.3% of women having a surgical abortion (P = .027). Women who were pro-choice had a mean anxiety score of 5.0 (range, 0-10) before and 2.7 after the abortion, whereas women who were anti-choice had a mean anxiety score of 5.2 before and 4.4 after the abortion (P = .005).
CONCLUSION: It is important for providers of abortion care to understand that women undergoing a medical abortion may be more ambivalent about abortion than women undergoing a surgical abortion, and women who are anti-choice but having an abortion may have unresolved anxiety after the procedure.
PMID: 15507198 [PubMed - indexed for MEDLINE]
43. J Obstet Gynaecol Can. 2005 Mar;27(3):247-50.
Antichoice attitudes to abortion in women presenting for medical abortions.
Wiebe ER, Trouton KJ, Fielding SL, Klippenstein J, Henderson A.
University of British Columbia, Vancouver, British Columbia, Canada.
OBJECTIVE: To examine attitudes of women presenting for elective abortions.
METHOD: Women presenting for elective abortion induced with medication at an urban free-standing abortion clinic were given semistructured interviews about their attitudes to abortion.
RESULTS: Of the 60 women interviewed, 26 voiced antichoice attitudes. These interviews were transcribed and analyzed for themes. The women with antichoice attitudes were similar to the women with prochoice attitudes in age, education, and religion but were less likely to be white (61.8% of prochoice women identified themselves as white, compared with 30.8% of antichoice women, P = 0.02). The antichoice women felt most strongly that other women should not be allowed to have an abortion if they gave as their reason, “want no more children,” “not married,” or “cannot afford.” The most common themes were that one needed “enough” reasons to have an abortion and that women should take better precautions to prevent conception.
CONCLUSION: It is important for abortion clinic staff to realize that many women coming to an abortion clinic have antichoice views. These views may affect a woman’s ability to recover emotionally after the procedure and will therefore have implications for the kind of supportive care women need both before and after the abortion.
PMID: 15937598 [PubMed - indexed for MEDLINE
44. Wiebe ER, Greiver M. Family Physicians’ experiences with implementing Cognitive Behavioural Therapy in their practice: a qualitative study. Can Fam Phys 2005;51:992-3.
45. Contraception. 2006 Mar;73(3):271-3. Epub 2005 Oct 19.
Comparing patients' telephone calls after medical and surgical abortions.
Wiebe E, Fowler D, Trouton K, Fu N.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada V5Z 1H9. firstname.lastname@example.org
OBJECTIVE: The purpose of this study is to monitor the content, timing of and response to telephone calls from medical and surgical abortion patients in order to improve the counseling and nursing care and allay patient's concerns.
METHODS: There were 43 calls from a possible 626 surgical patients and 100 calls from a possible 671 medical patients. Calls were considered preventable in 67% of the medical patients and 46.5% of the surgical patients. Women who were having their first abortion were more likely to place preventable calls.
CONCLUSIONS: Calls could be reduced by explaining variations in normal bleeding and how to use analgesics and providing this information in diagrammatic form on an information sheet.
PMID: 16472569 [PubMed - indexed for MEDLINE]
46. Hum Reprod. 2005 Jul;20(7):2025-8. Epub 2005 Apr 14.
Intra-cervical versus i.v. fentanyl for abortion.
Wiebe ER, Trouton KJ, Savoy E. Department of Family Practice,
University of British Columbia, Canada. email@example.com
BACKGROUND: The majority of abortions are performed using a para-cervical block (without general anaesthesia) and involve a significant amount of pain. If fentanyl was given with the lidocaine in the para-cervical block, it potentially could improve pain control while decreasing side effects and avoiding i.v. access for women having abortions.
METHODS: This was a randomized double-blind placebo-controlled trial of two treatment arms: (i) para-cervical block with 100 microg of fentanyl i.v; or (ii) para-cervical block with 100 microg of fentanyl intra-cervically (i.c.) for first trimester abortion. The setting was a free-standing urban abortion clinic. The outcome measures were pain scores and side effects.
RESULTS: A total of 104 women received the fentanyl i.v. and 98 received the fentanyl i.c. The two groups were similar with respect to age, gestational age, obstetric history, anxiety and depression. Pain scores (0-10) were 4.7 and 5.7 for dilation (P = 0.01) and 3.8 and 5.6 for suctioning (P < 0.001) in the i.v. and i.c. groups, respectively. Side effects were similar, but more women in the i.v. group received anti-emetics. More women in the i.c. group were dissatisfied with the pain control.
CONCLUSION: I.v. fentanyl is more effective than i.c. fentanyl for pain control in abortion.
PMID: 15831513 [PubMed - indexed for MEDLINE]
47. BJOG. 2006 Jun;113(6):621-8.
Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial.
Shannon C, Wiebe E, Jacot F, Guilbert E, Dunn S, Sheldon WR, Winikoff B.
Gynuity Health Projects, New York, NY, USA. firstname.lastname@example.org
OBJECTIVE: To compare the efficacy, adverse effects and acceptability of the three most common misoprostol regimens used with mifepristone for medical abortion.
DESIGN: Randomised nonblinded trial.
SETTING: Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area.
POPULATION: Women of reproductive age.
METHODS: Consenting women presenting for abortion services with gestations less than 56 days and who met inclusion criteria were given 200 mg mifepristone orally and then randomised into three misoprostol study groups: (group I) 400 micrograms of oral misoprostol, (group II) 600 micrograms of oral misoprostol, and (group III) 800 micrograms of vaginal misoprostol. Misoprostol was self-administered at home 24-48 hours following mifepristone, and participants were instructed to take a second similar misoprostol dose at 24 hours after the initial dose if bleeding was less than a normal menstrual period. MAIN OUTCOME
MEASURES: Successful abortion without surgery was 94.1%, with no significant differences across the three study groups (94.7% in group I, 93.4% in group II, and 94.3% in group III; P= 0.975).
RESULTS: Efficacy and adverse effects did not differ significantly across the three study groups. Pain increased significantly across the study and the gestational age groups and was associated with lower acceptability.
CONCLUSIONS: There appears to be a range of safe and effective options for early medical abortion with mifepristone including a choice between oral and vaginal administration of misoprostol.
PMID: 16709204 [PubMed - indexed for MEDLINE
48. Contraception. 2006 Jun;73(6):623-7. Epub 2006 Apr 17.
Ethnic Korean women's perceptions about birth control.
Wiebe ER, Henderson A, Choi J, Trouton K.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada V5Z 1H9. email@example.com
CONTEXT: We see many Korean women in our clinics and we have found them to have negative attitudes to hormonal contraception. We need to understand their perceptions and experiences with contraception in order to improve the effectiveness of our contraceptive counseling.
METHODS: This was a qualitative descriptive study, conducted in an urban family practice office. The participants were a convenience sample of 40 ethnic Korean women. Data were collected in semistructured interviews by one interviewer who is fluent in English and Korean. Transcribed interviews were analyzed to identify salient themes.
RESULTS: There was a deep distrust of hormonal methods of contraception and belief that hormones caused permanent harm. Unlike the findings in our other studies of Asian women, these women were satisfied with their usual methods of combining condoms, rhythm and withdrawal. They described good communication with their partners (which is necessary for the effective use of their chosen approaches).
CONCLUSION: When counseling Korean women about contraception, it is important to discuss the cultural bias against hormonal contraception involving beliefs that hormones cause permanent harm. It is also important to recognize the very successful use of condoms, rhythm and withdrawal by these couples.
PMID: 16730496 [PubMed - indexed for MEDLINE
49. Int J Gynaecol Obstet. 2006 Jul;94(1):60-1. Epub 2006 May 6.
Anemia in early pregnancy among Canadian women presenting for abortion.
Wiebe ER, Trouton KJ, Eftekhari A.
Department of Family Practice, University of British Columbia, Canada. firstname.lastname@example.org
PMID: 16678824 [PubMed - indexed for MEDLINE]
50. Int J Gynaecol Obstet. 2006 Dec;95(3):286-7. Epub 2006 Sep 25.
Misoprostol alone vs. methotrexate followed by misoprostol for early abortion.
Wiebe ER, Trouton KJ, Lima R.
University of British Columbia, Vancouver, Canada. email@example.com
PMID: 16997301 [PubMed - indexed for MEDLINE]
51. Int J Gynaecol Obstet. 2007 Mar;96(3):212-8. Epub 2007 Feb 5.
Alternatives to mifepristone for early medical abortion.
Moreno-Ruiz NL, Borgatta L, Yanow S, Kapp N, Wiebe ER, Winikoff B.
Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA. Nilda.Moreno@bmc.org
OBJECTIVE: To review published reports of first-trimester medical abortion regimens that do not include mifepristone.
METHODS: Reports listed in Pubmed and Medline on prospective and controlled trials of the efficacy of misoprostol, alone or associated with methotrexate, for first-trimester abortion were analyzed if they included more than 100 participants and were published since 1990.
RESULTS: The efficacy of regimens using misoprostol alone ranged from 84% to 96%, and when misoprostol was used with methotrexate the efficacy ranged from 70% to 97%. Efficacy rates were influenced by follow-up interval. Treatment for infection, bleeding, and incomplete abortion were infrequent with both methods (0.3%-5%).
CONCLUSION: Alone or in combination with methotrexate, misoprostol is an efficacious alternative to mifepristone for the medical termination of pregnancy.
PMID: 17280669 [PubMed - indexed for MEDLINE]
52. J Obstet Gynaecol Can. 2007 Aug;29(8):615-6.
A 15-year-old Chinese IUD. [Article in English, French]
PMID: 17714612 [PubMed - indexed for MEDLINE]
53. Int J Gynaecol Obstet. 2008 May;101(2):192-3. Epub 2008 Mar 4.
Comparison of four regimens of misoprostol after methotrexate for early abortion.
Wiebe E, Hempstock W.
University of British Columbia, Vancouver, Canada.
PMID: 18164010 [PubMed - in process]
54. J Obstet Gynaecol Can. 2008 Apr;30(4):327-31.
Access to abortion: what women want from abortion services.
Wiebe ER, Sandhu S.
Department of Family Practice, University of British Columbia, Vancouver BC.
Objective: Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services.
Methods: Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses.
Results: Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic.
Conclusion: Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.
1: Contraception. 2008 Nov;78(5):405-8. Epub 2008 Jul 30. Links
Comparing continuation rates and side effects of hormonal contraceptives in East Asian and Caucasian women after abortion.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada V5Z 1H9. firstname.lastname@example.org
BACKGROUND: The purpose of this study was to determine whether East Asian women had more side effects and a higher discontinuation rate than Caucasian women when choosing to use hormonal contraceptives. STUDY DESIGN: This was an observational cohort study of usual care using questionnaires for 2 months after being given hormonal contraceptives following an abortion in Vancouver, Canada. RESULTS: In the first month, 73 (64.4%) of the 110 East Asian and 86 (80.4%) of the 107 Caucasian women took any of the sample provided (p=.020). In the second month, 52 (47.3%) of the East Asian and 62 (57%) of the Caucasian women used the prescription to buy and take their hormonal contraception (p=.12). Total side effects were similar, but there was more nausea in the East Asian women (23.3% vs. 8.1%) (p=.03) and more acne in the Caucasian women (8.2% vs. 20.9%) (p=.05). CONCLUSIONS: There may be both physiological and cultural differences leading East Asian women to use less hormonal contraception.
Contraceptive failure related to estimated cycle day of conception relative to the start of the last bleeding episode.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada. email@example.com
BACKGROUND: The objective of this study was to estimate the menstrual cycle day of conception in women presenting for abortion. STUDY DESIGN: This was a retrospective chart survey in two urban free-standing abortion clinics. RESULTS: There were 913 charts reviewed of women presenting for an abortion at less than 63 days’ gestation as determined by endovaginal ultrasound who were “sure” of the date of their last normal menstrual period. The estimated mean cycle day of conception determined by sonographically estimating length of gestation was 14.6. There were 26 (26.3%) of 99 women using cyclic hormonal contraception who conceived before 10 days after the onset of withdrawal bleeding compared to 100 (14.7%) of 679 who conceived before 10 days after the onset of their last menstrual period who were using all other forms of contraception, including “none” (p=.005). No other differences in the proportions conceiving early in the cycle were observed with respect to age, ethnicity or obesity. CONCLUSION: These data suggest that there is a sizeable subset of women who ovulate earlier after onset of withdrawal bleeding when using 21/7 hormonal contraceptives than after onset of menses when not using hormonal contraception. It is possible that women using hormonal contraceptives may have a higher risk of pregnancy if they ovulate sooner after the onset of bleeding.
57. Contraception. 2009 Dec;80(6):575-7. Epub 2009 Aug 22.
Women’s experience of viewing the products of conception after an abortion.
Department of Family Practice, University of British Columbia, Vancouver, BC V5Z 1H9, Canada. firstname.lastname@example.org
The objectives of this study were to assess perceptions of women viewing the products of conception after abortion and to assess the feasibility of offering this choice.
Women presenting for abortion at two abortion clinics were given a questionnaire asking if they wished to view the products of conception. A second questionnaire was given to women who had viewed products of conception about their perceptions. Clinic staff members were interviewed after completion of the study.
The study revealed that 152/508 (28.7%) of women having abortions chose to view the products of conception and 98/122 (83.1%) found that viewing did not make it harder emotionally. Older women and those who had children were less likely to want to view products of conception (p=.037) and more likely to find it harder if they did (p=.05). All 11 clinic staff members interviewed were positive about offering this service.
It is feasible to offer women having abortions the choice to view the products of conception and for most, viewing does not make it emotionally harder for them.
Department of Family Practice, University of British Columbia, British Columbia, Canada. email@example.com
OBJECTIVES: To gain a better understanding of women’s perceptions and experiences of viewing the ultrasound (US) before an abortion. METHODS: This mixed-methods study included questionnaires and interviews. Women presenting for medical and surgical abortion at two urban abortion clinics completed questionnaires asking if they wished to view the US image and those women who had done so answered questions about their perceptions. A randomly selected ten women were interviewed six weeks later about their perceptions. The interviews were audio-taped, transcribed and analysed for salient themes. RESULTS: The 350 participants had a mean age of 27.6 years, 0.68 births, and were at a mean of 49.1 days gestation at the time of the procedure. Most women (254/350, 72.6%) chose to view the US and 179/219 (86.3%) found it a positive experience. Older women and those who had children were less likely to want to view the US image (p = 0.001). All ten interviewees recommended that this choice be offered to every woman and recommended more communication between care providers and patients at the time of the US. None of the women changed her mind about having the abortion after having seen the US. CONCLUSIONS: Offering the choice to view the ultrasound is both feasible and beneficial to women having abortions. Our findings support those of the only other study published on the subject.
PMID: 19340704 [PubMed - indexed for MEDLINE]
Methotrexate with or without misoprostol to terminate pregnancies with no gestational sac visible by ultrasound.Wiebe ER.
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
PMID: 19464005 [PubMed - as supplied by publisher]
60. J Obstet Gynaecol Can. 2010 Apr;32(4):335-8.
Motivation and experience of nulliparous women using intrauterine contraceptive devices.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver BC.
Use of an intrauterine contraceptive device (IUD) has not been recommended to nulliparous women in the past. There is now good evidence that there is no increased risk of pelvic inflammatory disease or infertility in nulliparas who use IUDs and the recommendations have changed. Our objective was to understand more about the motivations and experience of nulliparous women using IUDs.
This was a mixed method study. First, we asked 44 nulliparous women who had had an IUD inserted within the previous six months about their reasons for seeking the IUD, their history with other forms of contraception, their perception of the insertion experience, and their feelings after insertion. Questionnaires were then distributed to 154 nulliparous women presenting for IUDs, asking about their past experience with hormonal contraception.
The main theme arising from the interviews was a desire to avoid hormonal contraception. Other reasons for choosing the IUD were greater contraceptive effectiveness than other methods, convenience of use, and lower cost. Responses to the questionnaire indicated that 138 women (89.7%) had used hormonal contraception in the past and, of those, 98 (63.0%) complained of mood side effects, 64 (41.6%) of sexual side effects, and 64 (41.6%) of physical side effects.
The most important motivation for nulliparous women in this study to choose IUDs was to avoid the potential or actual side effects of hormonal contraception. Despite experiencing some discomfort at the time of insertion, this group of nulliparous women was very positive about using IUDs for contraception.
61. J Obstet Gynaecol Can. 2010 Jul;32(7):673-8.
Natural family planning: physicians’ knowledge, attitudes, and practice.
Department of Family Practice, University of British Columbia, Vancouver, BC.
To assess physicians’ knowledge, attitudes, and practice with respect to four evidence-based natural family planning (NFP) methods: Standard Days, cervical mucus, basal body temperature, and the lactational amenorrhea method.
We undertook a cross-sectional survey of a random sample of family physicians and all gynaecologists in British Columbia (n = 460) who have women of reproductive age in their practice, as well as all affiliated residents (n = 239). Main outcome measures were (1) physicians’ attitudes towards NFP and their perceptions of its effectiveness; (2) the relationship between physicians’ demographic factors, their personal experience or beliefs, and their attitudes and knowledge; and (3) how these factors affect the counselling physicians offer their patients.
The survey response rate was 44%. Only 3% to 6% of physicians had correct knowledge of the effectiveness in perfect use of the NFP methods cited in this study. Fifty percent of physicians who responded mention NFP to their patients as an option for contraception, and 77% of physicians mention NFP as an option to couples trying to conceive. Family physicians and residents were much more likely than gynaecologists or gynaecology residents to mention NFP during counselling. Older physicians were more likely to mention NFP than younger physicians and also had more personal experience with NFP.
Most physicians in our study underestimated the effectiveness of NFP methods, and only a small proportion of physicians provide information about NFP during contraceptive counselling. Physicians need better understanding of modern methods of NFP to provide evidence-based contraceptive counselling to selected highly motivated patients who prefer NFP as a contraceptive choice.
62. Wiebe Ellen R, Najafi Roya, Sohail Naghma, Kamani Alya. Muslim women having abortions in Canada: Attitudes, beliefs and experiences. (2011) Can Fam Phys 57:e134-e138.
Objective To improve understanding of the attitudes, beliefs, and experiences of Muslim patients presenting for
Design Exploratory study in which participants completed questionnaires about their attitudes, beliefs, and
Setting Two urban, free-standing abortion clinics.
Participants Fifty-three self-identified Muslim patients presenting for abortion.
Main outcome measures Women’s background, beliefs, and attitudes
toward their religion and toward abortion; levels of anxiety, depression,
and guilt, scored on a scale of 0 to 10; and degree of pro-choice or antichoice
attitude toward abortion, assessed by having respondents identify
under which circumstances a woman should be able to have an abortion.
Results The 53 women in this study were a diverse group, aged 17 to 47
years, born in 17 different countries, with a range of beliefs and attitudes
toward abortion. As found in previous studies, women who were less
pro-choice (identified fewer acceptable reasons to have an abortion) had
higher anxiety and guilt scores than more pro-choice women did: 6.9
versus 4.9 (P = .01) and 6.9 versus 3.6 (P = .004), respectively. Women who
said they strongly agreed that abortion was against Islamic principles also
had higher anxiety and guilt scores: 9.3 versus 5.9 (P = .03) and 9.5 versus
5.3 (P = .03), respectively.
Conclusion Canadian Muslim women presenting for abortion come from
many countries and schools of Islam. The group of Muslim women that
we surveyed was so diverse that no generalizations can be made about
them. Their attitudes toward abortion ranged from being completely prochoice
to believing abortion is wrong unless it is done to save a woman’s
life. Many said they found their religion to be a source of comfort as
well as a source of guilt, turning to prayer and meditation to cope with
their feelings about the abortion. It is important that physicians caring
for Muslim women understand that their patients come from a variety
of backgrounds and can have widely differing beliefs. It might be helpful
to be aware that patients who hold more anti-choice beliefs are likely
to experience more anxiety and guilt related to their abortion than prochoice
63. Wiebe ER, Trouton KJ (2011) “Does using tampons or menstrual cups increase early IUD expulsion rates?” J Obstet Gynaecol Can 33:S44
64. Wiebe E (2011) Barriers to access and use of contraception in immigrant women presenting for abortion J Obstet Gynaecol Can 33:S45
65. Wiebe ER, Kaczorowski J, MacKay J. (2011) Why are response rates in surveys of clinicians declining? Can Fam Phys (in press).
66. Wiebe ER, Byzcko B, Johnson M. Benefits of manual vacuum aspiration for abortion 2011 Int J Gynecol Obstet;114:155-6
67. Wiebe ER. (2111) Cohort study: Adolescent girls undergoing medical abortion have lower risk of haemorrhage, incomplete evacuation or surgical evacuation than women above 18 years old Evid Based Med ;ebmed100064Published Online First: 4 July 2011
68. Wiebe ER, Brotto L, MacKay J. Characteristics of women who complain of mood and sexual side effects from hormonal contraception 2011 J Obstet Gynaecol Can (in press)