Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Yale University School of Nursing

First Advisor

Ivy M. Alexander

Abstract

A retrospective chart review was conducted to assess for a relationship between previous Cesarean section delivery and failure of subsequent medication abortion. Several studies have shown a positive relationship between parity and failure of subsequent medication abortion; however, these studies did not isolate method of delivery (Cotte, Monniez, and Norel 2008; Ashok, Templeton, Wagaarachchi, & Flett, 2002; Niinimäki, Martikainen, and Talvensaari-Mattila, 2004; Bartley, Tong, Everington, & Baird, 2000). The sample was 196 women who underwent medication abortion and returned for a two week follow-up appointment at an urban women's health clinic during 2005-2010. The protocol for medication abortion was 200mg Mifepristone orally followed by 400mcg of misoprostol vaginally or buccally administered 12-24 hours later. Failure was defined as positive pregnancy test at follow-up. Demographic and outcome data was collected from patient self-report pre-procedure intake and follow-up questionnaire forms. Parity regardless of delivery type increased the risk of failure (p=0.0422) but previous Cesarean section did not (p = 0.6141). Duration of cramps experienced after Misoprostol insertion were negatively correlated with age (r = -0.25448). A positive correlation was found between longer cramp duration and smoking status. Future studies may benefit from a focus on other outcome measures--such as onset and duration of cramping or bleeding--rather than simply procedure failure or success, and a larger prospective study with formal clinician-guided measure is recommended.

Comments

This is an Open Access Thesis.

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