Labour induction for termination of pregnancy with severe fetal anomalies after 24 weeks' gestation: a case series and systematic review of the literature.

PURPOSE: Under some circumstances, individuals choose to undergo pregnancy termination for foetal anomalies in the second half of pregnancy. This report provides objective information on the clinical management of such cases and a systematic review of the literature on labour induction outcomes for third-trimester abortion using mifepristone-misoprostol. MATERIALS AND METHODS: The study is a case series describing outcomes for labour induction abortion for foetal anomalies, at gestational age 24 weeks and beyond. A systematic review was performed, searching PubMed, Embase, and Cochrane databases. Two independent authors reviewed and quality assessed the data from the articles. RESULTS: During a two-year period, 15 patients met inclusion criteria. Fourteen patients received mifepristone and misoprostol, and one received oxytocin. All delivered vaginally. Thirteen patients delivered within 24 hours of the first misoprostol dose, and half delivered within 12 hours. The average interval from misoprostol initiation to foetal expulsion was 15.5 hours in our series. The systematic review identified nine articles for inclusion, all retrospective studies. Labour induction protocols for mifepristone-misoprostol, reporting of gestational age, and key comparisons varied greatly. CONCLUSIONS: The case series illustrates successful termination of pregnancy primarily using combined mifepristone-misoprostol. Certainty of current evidence is low, based on the GRADE framework. Future research is necessary on third-trimester outcomes with mifepristone-misoprostol.

Discrimination, Microaggressions, and Perceptions of Institutional Response in an Academic Obstetrics and Gynecology Department.

Introduction Discrimination in the workplace remains a barrier to advancing diversity and inclusion in the physician workforce. This study sought to examine experiences of discrimination, microaggressions, and perceptions of the institution's response in an academic obstetrics and gynecology department. Method All obstetrics and gynecology faculty, fellows, and residents were invited to complete an anonymous, Institutional Review Board-approved cross-sectional survey from February through June 2019. The survey incorporated questions from multiple validated tools on discrimination, microaggressions, perceptions of the institution's response, and opportunities for comments. Data are presented as the frequency with percent and were analyzed using Stata (StataCorp, College Station, USA); two of the authors reviewed and deductively coded the qualitative data. Results The response rate was 58% (87/151), with 30% of the respondents identifying as trainees and 75% identifying as female. Thirty respondents (35%) identified as non-Caucasian. Fifty-four respondents (62%) had ever experienced discrimination and 63 (72%) reported ever experiencing microaggressions at work; of those, 14 (22%) experienced microaggressions several times per week. Of the 69 respondents (79%) who experienced microaggressions and/or discrimination, 49 (71%) felt their experiences were due to gender, and 26 (38%) felt that they were due to race/ancestry. Only 41 respondents (59%) felt that the institution was fair to all employees, and 17 (25%) did not believe diversity was managed effectively. Conclusion Most physicians in the department experienced microaggressions or discrimination, with gender or race/ancestry as common inciting factors. A small but notable portion of respondents would prefer the institution to manage diversity differently. These findings merit further investigation about how to address discrimination in academic medicine.