{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:18:35Z","timestamp":1770905915012,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T00:00:00Z","timestamp":1706400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether clinical outcomes among clients undergoing medical abortion after 12\u2009weeks' gestation differ by provider cadre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized controlled trial conducted among eligible clients seeking abortion between 13 and 20\u2009weeks' gestation. Participants seeking in\u2010facility abortion were randomized to receive care from a mid\u2010level provider (nurse\/midwife) or physician. The primary outcome was median time to expulsion with non\u2010inferiority margin of \u22121.5\u2009h between provider groups. Quantile median regression models assessed non\u2010inferiority. Secondary outcomes included retained placenta, complications, and patient acceptability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After randomization and eligibility assessment by the provider, 171 women participated in the study: 81 in the physician group and 90 in the mid\u2010level provider group. Their average age was 24\u2009years, the mean gestational age was 16\u2009weeks, and 65% were nulliparous in both groups. The median time to expulsion did not differ significantly, being 8.1\u2009h for the mid\u2010level group and 6.6\u2009h for the physician group. The adjusted median difference was 0.8\u2009h (95% confidence interval [CI] \u20131.15 to 2.66), within the non\u2010inferiority margin. Retained placenta occurred similarly: 30.0% (<jats:italic>n<\/jats:italic>\u2009=\u200924) of the physician group and 20.5% (<jats:italic>n<\/jats:italic>\u2009=\u200918) of the mid\u2010level provider group (adjusted risk difference [ARD] 7.6%, 95% CI \u20132.81 to 18.06). Complications occurred in 7% of cases, including 5.0% (<jats:italic>n<\/jats:italic>\u2009=\u20094) of patients in the physician group and 8.9% (<jats:italic>n<\/jats:italic>\u2009=\u20098) in the mid\u2010level provider group (ARD \u20134.7%, 95% CI \u201312.43 to 3.12). Patient acceptability did not differ by group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Training mid\u2010level providers to provide abortion services after 12\u2009weeks' gestation independently of physicians is feasible and may result in comparable clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15392","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T07:58:27Z","timestamp":1706515107000},"page":"1268-1276","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Can mid\u2010level providers manage medical abortion after 12\u2009weeks' gestation as safely and effectively as physicians? 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