Sara Newmann | University of California, San Francisco (original) (raw)

Papers by Sara Newmann

Research paper thumbnail of Cervical preparation for surgical abortion from 20 to 24 weeks' gestation

Contraception, 2008

Although less than 2% of abortions in the United States occur after 20 weeks, procedures performe... more Although less than 2% of abortions in the United States occur after 20 weeks, procedures performed at more advanced gestations are associated with increased morbidity and mortality. Adequate cervical preparation before dilation and evacuation (D&E) at 20 or more weeks' gestation reduces procedural risk. However, few clinical trials have included sufficient information on best practices for cervical preparation in this gestational age range. For procedures at 20 or more weeks' gestation, at least 1 day of cervical preparation is recommended. Evidence is less clear that the procedure is faster or safer with the use of either serial dilation over more than 1 day or adjuvant misoprostol. Osmotic dilators are preferable to misoprostol, but there are insufficient data to support either laminaria or Dilapan as the preferred dilator. Fewer Dilapan are needed to gain the same amount of dilation as laminaria. The Society of Family Planning recommends preoperative cervical preparation before D&E between 20 and 24 weeks. Further studies are needed to clarify the best means to prepare the cervix to minimize abortion complications and improve outcome in this gestational age range.

Research paper thumbnail of Predictors of contraception knowledge and use among postpartum adolescents in El Salvador

American journal of obstetrics and gynecology, 2005

This study was undertaken to describe demographics and contraceptive familiarity and use among po... more This study was undertaken to describe demographics and contraceptive familiarity and use among postpartum adolescents in El Salvador. Questionnaire-guided interviews were conducted in Spanish with 50 postpartum adolescents at an urban, public hospital in El Salvador. Open-ended questions included assessments of education, partnership status, and contraceptive knowledge and use patterns. The median age of subjects was 17 years, 84% were nulliparous, 80% had partners, and 6% were married. Eighty-four percent of the women reported contraception knowledge and 18% reported contraception use. Educational experience and literacy predicted contraceptive knowledge (P = .008 and .001, respectively), but not use. After delivery and postpartum contraception education, 58% of the subjects stated intention to use contraception. Having a partner and living with him were predictors of intent to use contraception (P = .001 and .002, respectively). Being single negatively predicted intention to use c...

Research paper thumbnail of Providers' Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya

AIDS research and treatment, 2013

Objective. To inform an intervention integrating family planning into HIV care, family planning (... more Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Over...

Research paper thumbnail of Cervical preparation for second trimester dilation and evacuation

Research paper thumbnail of Cervical preparation for second trimester surgical abortion

Research paper thumbnail of Same-Day Synthetic Osmotic Dilators Compared With Overnight Laminaria Before Abortion at 14–18 Weeks of Gestation

Obstetrics & Gynecology, 2014

To increase access to early second-trimester surgical abortion by determining noninferiority of s... more To increase access to early second-trimester surgical abortion by determining noninferiority of same-day synthetic osmotic dilators compared with overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation. We enrolled women between 14 and 18 weeks of gestation and randomized them to same-day synthetic osmotic dilators or overnight Laminaria. Study participants and clinicians were blinded to group assignment. The primary outcome was procedure duration. The trial was powered to assess noninferiority of synthetic osmotic dilators to exclude a mean difference of 5 minutes or longer. We enrolled 72 patients: 36 were randomized to same-day synthetic osmotic dilators and 36 to overnight Laminaria. Mean procedure duration was 8.1 and 5.9 minutes, respectively, with a mean difference of 2.1 minutes (97.5% confidence interval -0.3 to 4.5). Same-day synthetic osmotic dilators resulted in less initial cervical dilation than overnight Laminaria (mean circumference 48 compared with 60 mm Pratt, P<.001) and required more mechanical dilation (69% compared with 27%, P=.001). There was no difference in complications, all of which were minor, or in the median procedural difficulty score rated by physicians. Most patients in both groups would choose a same-day procedure if necessary in the future. Despite less initial cervical dilation and a greater need for mechanical dilation, same-day synthetic osmotic dilators are not inferior to overnight Laminaria with respect to procedure duration. Same-day osmotic dilation is preferred by patients and may be a reasonable alternative to overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00775983. I.

Research paper thumbnail of Who opts for voluntary counseling and HIV testing when offered in an urban clinic?

Contraception, 2007

Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abor... more Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has declined by 37% due, in part, to the lack of routine educational and training opportunities for health service professionals. Our study examines the ways in which Ob/Gyn residency programs describe, discuss and highlight abortion training opportunities on their institutional websites.

Research paper thumbnail of HIV voluntary counseling and testing at an abortion clinic: missed opportunities for diagnosis

Contraception, 2013

Most abortion clinics in the US do not provide opt-out HIV testing, and thus women electing abort... more Most abortion clinics in the US do not provide opt-out HIV testing, and thus women electing abortion may not receive adequate screening for HIV. We sought to determine whether the standard practice of offering voluntary HIV counseling and testing (VCT) services to women electing abortion results in detection of undiagnosed HIV infection. Two thousand twenty-five women electing abortion were consecutively offered VCT at a public hospital-based, urban abortion clinic. Unlinked, anonymous HIV surveillance testing was conducted subsequent to voluntary testing without patients knowing of the surveillance study testing at the time. Multivariable analysis was used to determine factors associated with opting for VCT. Of the 13 women (0.6%) who tested positive for HIV, 8 had been previously diagnosed. Of the 5 women without previous diagnosis, only 1 opted for VCT. Overall, 530 (26%) women opted for VCT. Factors associated with opting for VCT in multivariable analysis (odds ratio, 95% confidence interval) were sex with an injection drug user (1.9, 1.1-3.2), presenting in the second trimester (1.3, 1.0-1.6), economic hardship (1.3, 1.0-1.5), partner difficulties (1.8, 1.3-2.4) and having public health insurance (1.6, 1.2-2.3). HIV testing via VCT did not effectively diagnose previously undiagnosed HIV infections among women seeking abortion in this clinical setting.

Research paper thumbnail of Cervical preparation for surgical abortion from 20 to 24 weeks' gestation

Contraception, 2008

Although less than 2% of abortions in the United States occur after 20 weeks, procedures performe... more Although less than 2% of abortions in the United States occur after 20 weeks, procedures performed at more advanced gestations are associated with increased morbidity and mortality. Adequate cervical preparation before dilation and evacuation (D&E) at 20 or more weeks' gestation reduces procedural risk. However, few clinical trials have included sufficient information on best practices for cervical preparation in this gestational age range. For procedures at 20 or more weeks' gestation, at least 1 day of cervical preparation is recommended. Evidence is less clear that the procedure is faster or safer with the use of either serial dilation over more than 1 day or adjuvant misoprostol. Osmotic dilators are preferable to misoprostol, but there are insufficient data to support either laminaria or Dilapan as the preferred dilator. Fewer Dilapan are needed to gain the same amount of dilation as laminaria. The Society of Family Planning recommends preoperative cervical preparation before D&E between 20 and 24 weeks. Further studies are needed to clarify the best means to prepare the cervix to minimize abortion complications and improve outcome in this gestational age range.

Research paper thumbnail of Predictors of contraception knowledge and use among postpartum adolescents in El Salvador

American journal of obstetrics and gynecology, 2005

This study was undertaken to describe demographics and contraceptive familiarity and use among po... more This study was undertaken to describe demographics and contraceptive familiarity and use among postpartum adolescents in El Salvador. Questionnaire-guided interviews were conducted in Spanish with 50 postpartum adolescents at an urban, public hospital in El Salvador. Open-ended questions included assessments of education, partnership status, and contraceptive knowledge and use patterns. The median age of subjects was 17 years, 84% were nulliparous, 80% had partners, and 6% were married. Eighty-four percent of the women reported contraception knowledge and 18% reported contraception use. Educational experience and literacy predicted contraceptive knowledge (P = .008 and .001, respectively), but not use. After delivery and postpartum contraception education, 58% of the subjects stated intention to use contraception. Having a partner and living with him were predictors of intent to use contraception (P = .001 and .002, respectively). Being single negatively predicted intention to use c...

Research paper thumbnail of Providers' Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya

AIDS research and treatment, 2013

Objective. To inform an intervention integrating family planning into HIV care, family planning (... more Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Over...

Research paper thumbnail of Cervical preparation for second trimester dilation and evacuation

Research paper thumbnail of Cervical preparation for second trimester surgical abortion

Research paper thumbnail of Same-Day Synthetic Osmotic Dilators Compared With Overnight Laminaria Before Abortion at 14–18 Weeks of Gestation

Obstetrics & Gynecology, 2014

To increase access to early second-trimester surgical abortion by determining noninferiority of s... more To increase access to early second-trimester surgical abortion by determining noninferiority of same-day synthetic osmotic dilators compared with overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation. We enrolled women between 14 and 18 weeks of gestation and randomized them to same-day synthetic osmotic dilators or overnight Laminaria. Study participants and clinicians were blinded to group assignment. The primary outcome was procedure duration. The trial was powered to assess noninferiority of synthetic osmotic dilators to exclude a mean difference of 5 minutes or longer. We enrolled 72 patients: 36 were randomized to same-day synthetic osmotic dilators and 36 to overnight Laminaria. Mean procedure duration was 8.1 and 5.9 minutes, respectively, with a mean difference of 2.1 minutes (97.5% confidence interval -0.3 to 4.5). Same-day synthetic osmotic dilators resulted in less initial cervical dilation than overnight Laminaria (mean circumference 48 compared with 60 mm Pratt, P<.001) and required more mechanical dilation (69% compared with 27%, P=.001). There was no difference in complications, all of which were minor, or in the median procedural difficulty score rated by physicians. Most patients in both groups would choose a same-day procedure if necessary in the future. Despite less initial cervical dilation and a greater need for mechanical dilation, same-day synthetic osmotic dilators are not inferior to overnight Laminaria with respect to procedure duration. Same-day osmotic dilation is preferred by patients and may be a reasonable alternative to overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00775983. I.

Research paper thumbnail of Who opts for voluntary counseling and HIV testing when offered in an urban clinic?

Contraception, 2007

Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abor... more Introduction: In 2000, approximately 1.31 million abortions were performed in the US, making abortion one of the most common procedures experienced by women of reproductive age. However, since 1982 the number of abortion providers has declined by 37% due, in part, to the lack of routine educational and training opportunities for health service professionals. Our study examines the ways in which Ob/Gyn residency programs describe, discuss and highlight abortion training opportunities on their institutional websites.

Research paper thumbnail of HIV voluntary counseling and testing at an abortion clinic: missed opportunities for diagnosis

Contraception, 2013

Most abortion clinics in the US do not provide opt-out HIV testing, and thus women electing abort... more Most abortion clinics in the US do not provide opt-out HIV testing, and thus women electing abortion may not receive adequate screening for HIV. We sought to determine whether the standard practice of offering voluntary HIV counseling and testing (VCT) services to women electing abortion results in detection of undiagnosed HIV infection. Two thousand twenty-five women electing abortion were consecutively offered VCT at a public hospital-based, urban abortion clinic. Unlinked, anonymous HIV surveillance testing was conducted subsequent to voluntary testing without patients knowing of the surveillance study testing at the time. Multivariable analysis was used to determine factors associated with opting for VCT. Of the 13 women (0.6%) who tested positive for HIV, 8 had been previously diagnosed. Of the 5 women without previous diagnosis, only 1 opted for VCT. Overall, 530 (26%) women opted for VCT. Factors associated with opting for VCT in multivariable analysis (odds ratio, 95% confidence interval) were sex with an injection drug user (1.9, 1.1-3.2), presenting in the second trimester (1.3, 1.0-1.6), economic hardship (1.3, 1.0-1.5), partner difficulties (1.8, 1.3-2.4) and having public health insurance (1.6, 1.2-2.3). HIV testing via VCT did not effectively diagnose previously undiagnosed HIV infections among women seeking abortion in this clinical setting.