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First-trimester surgical abortion practice in Canada in 2012
Regina-Maria Renner1, Vivien Hu2, Édith R Guilbert3
1Clinical Associate Professor of Obstetrics and Gynaecology at the University of British Columbia in Vancouver and a co-investigator in the Contraception and Abortion Research Team in the Women's Health Research Institute at BC Women's Hospital and Health Centre.
Objective:
To evaluate practices among first-trimester surgical abortion facilities and providers in Canada in 2012 and examine the characteristics of the surgical abortion work force.
Design:
Self-administered paper or electronic survey adapted from a survey previously fielded in the United States.
Setting:
Canada.
Participants:
Facility administrators and physicians.
Main Outcomes Measures:
Descriptive statistics on reported first-trimester surgical abortion practice and provider demographic characteristics.
Results:
Eighty-three percent of identified facilities (78 of 94) and 178 physicians responded. Of the respondents, 99% of facilities and 96% of physicians provided first-trimester surgical abortions. Responding facilities provided 68,154 first-trimester surgical abortions in 2012. This represented 96% of their reported total (combined medical and surgical) first-trimester abortions. More than half (55%) of responding facilities were community based, while 45% were hospital affiliated. Most physician providers were female (68%) and were family doctors (59%). Preoperatively, 96% of physicians routinely used ultrasound and 89% gave perioperative antibiotics. Almost half (48%) used manual vacuum aspiration, but less than 35% did so beyond 9 weeks after the last menstrual period. At most facilities, most procedures were performed under combined local anesthesia and intravenous sedation (73%); only 7% indicated deep sedation or general anesthesia were used exclusively. Postoperatively, 81% of physicians performed immediate tissue examination and 96% offered postabortion contraception on the same day as the abortion. Other assessed outcomes included medication regimens and cervical preparation, with a high degree of consistency among facilities and physicians.
Conclusion:
First-trimester surgical abortion providers are mostly family physicians and most are female. Practices across Canada were mostly uniform and followed evidence-based guidelines. Uptake of the most recent Canadian practice guidelines may help further standardize patient care and improve routine perioperative antibiotic use and immediate tissue examination.
