title: Acceptability and clinical outcomes of first- and second-trimester surgical abortion by suction aspiration in Colombia.
abstract: OBJECTIVE
  Since partial decriminalization of abortion in Colombia, Oriéntame has provided legal abortion services through 15 weeks gestation in an outpatient primary care setting. We sought to document the safety and acceptability of the second trimester compared to the first-trimester surgical abortion in this setting.
  
  
  METHODS
  This was a prospective cohort study using a consecutive sample of 100 women undergoing surgical first-trimester abortion (11 weeks 6 days gestational age or less) and 200 women undergoing second-trimester abortion (12 weeks 0 days-15 weeks 0 days) over a 5-month period in 2012. After obtaining informed consent, a trained interviewer collected demographic and clinical information from direct observation and the patient's clinical chart. The interviewer asked questions after the procedure regarding satisfaction with the procedure, physical pain and emotional discomfort. Fifteen days later, the interviewer assessed satisfaction with the procedure and any delayed complications.
  
  
  RESULTS
  There were no major complications and seven minor complications. Average measured blood loss was 37.87 mL in the first trimester and 109 mL in the second trimester (p<.001). Following the procedure, more second-trimester patients reported being very satisfied (81% vs. 94%, p=.006). Satisfaction was similar between groups at follow-up. There were no differences in reported emotional discomfort after the procedure or at follow-up, with the majority reporting no emotional discomfort. The majority of women (99%) stated that they would recommend the clinic to a friend or family member.
  
  
  CONCLUSIONS
  Second-trimester surgical abortion in an outpatient primary care setting in Colombia can be provided safely, and satisfaction with these services is high.
  
  
  CONCLUSIONS
  This is one of the first studies from Latin America, a region with a high proportion of maternal mortality due to unsafe abortion, which documents the safety and acceptability of surgical abortion in an outpatient primary care setting. Findings could support increased access to safe abortion services, particularly in the second trimester.
authors.affiliation: Fundación Oriéntame, Bogotá, Colombia. Electronic address: tdepineres@globalhealth.ucsf.edu.
authors.forename: Teresa
authors.initials: T
authors.lastname: DePiñeres
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baum
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control; D015331:Cohort Studies; D003105:Colombia; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009939:Organizations, Nonprofit; D010149:Postoperative Pain / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000208:ethnology; D019106:Postoperative Hemorrhage / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011320:Primary Health Care; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014592:Uterine Hemorrhage / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control; D014619:Vacuum Curettage / Q000009:adverse effects* / Q000523:psychology; D055815:Young Adult
keywords: Abortion complications; Abortion safety; Primary care; Termination of pregnancy; Vacuum aspiration