{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T10:47:58Z","timestamp":1767005278404,"version":"3.48.0"},"reference-count":58,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real\u2010time self\u2010reported pain and stress throughout the medical abortion process, their fluctuation over time, and to examine whether age, parity, gestational age, adverse childhood events (ACE), and contextual factors (e.g., analgesics intake, bleeding) were associated with pain and stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>This one\u2010group, single center, exploratory cohort study (conducted 2020\u20132023) used ecological momentary assessment (EMA). A population\u2010based sample of women \u226518\u2009years of age presenting for first trimester medical abortion at \u22649th week of gestation was approached after mifepristone intake. Sixty women aged 30.40\u2009\u00b1\u20096.61\u2009years were included in this study. EMA commenced with mifepristone intake and entailed four prompts per day over a consecutive 7\u2010day period. Main outcomes included self\u2010reported pain and stress measured using visual analog scales (VAS). Secondary outcomes were clinical and demographic data as well as psychological measures. Data were analyzed using multilevel models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reported pain and stress varied not only throughout the abortion process but also between women, showing an increase on Day 3 (misoprostol intake) and a gradual decrease thereafter. While age, gestational age, and parity were not significantly related to pain, higher self\u2010reported stress, more bleeding, more analgesic intake, and a higher number of ACEs were associated with higher pain levels. Higher stress levels, in turn, were associated with more ACEs, parity, analgesics intake, treatment\u2010related events, and weekdays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results highlight large interindividual variations in women's pain and stress experiences during first trimester medical abortion and thus emphasize the need for individualized counseling and pain treatment. Screening for ACEs, along with using event\u2010based EMA protocols for future pain\u2010management research, may promote tailored care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70109","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T02:18:36Z","timestamp":1764382716000},"page":"176-185","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Women's real\u2010time pain and stress during medical abortion: An ecological momentary assessment study"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0081-7489","authenticated-orcid":false,"given":"Anna","family":"Felnhofer","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-6600","authenticated-orcid":false,"given":"Anja C.","family":"Feneberg","sequence":"additional","affiliation":[{"name":"Department of Psychology University of M\u00fcnster  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3243-0238","authenticated-orcid":false,"given":"Oswald D.","family":"Kothgassner","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3404-3546","authenticated-orcid":false,"given":"Johanna X.","family":"Kafka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6451-7349","authenticated-orcid":false,"given":"Christian","family":"Fiala","sequence":"additional","affiliation":[{"name":"Gynmed Clinic for Abortion and Family Planning  Vienna Austria"},{"name":"Department of Women's and Children's Health, Karolinska Institutet, and WHO Collaborating Centre Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.04.003"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2004.06.005"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14904"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.03.018"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003934"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/13625187.2017.1315092"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2010.07.014"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.2307\/3030230"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2005.07.006"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S399209"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)30138-4"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.08.009"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2022.08.005"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/13625187.2014.950730"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013525.pub2"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2010.08.006"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(00)00090-1"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/13625187.2014.1002032"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.17"},{"volume-title":"Stress, Appraisal, and Coping","year":"1984","author":"Lazarus RS","key":"e_1_2_13_21_1"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.12.007"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399339109515952"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.10.008"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13920"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2022.10.010"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2022.03.003"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002787"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00153.x"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4954"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1263161"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.752"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqs140"},{"issue":"11","key":"e_1_2_13_34_1","first-page":"394","article-title":"Validity and reliability of visual analogue scale (VAS) for pain measurement","volume":"2","author":"Begum MR","year":"2019","journal-title":"J Med Case Rep Rev"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2020.1755030"},{"key":"e_1_2_13_37_1","unstructured":"R: A Language and Environment for Statistical Computing [computer program]. Vienna Austria: R Foundation for Statistical Computing. 2018. Available fromhttps:\/\/www.R\u2010project.org\/"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.1406.5823"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v082.i13"},{"key":"e_1_2_13_40_1","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001","volume-title":"Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence","author":"Singer JD","year":"2003"},{"issue":"2","key":"e_1_2_13_41_1","first-page":"275","article-title":"Comparison between oral and vaginal administration of misoprostol on uterine contractility","volume":"93","author":"Gemzell Danielsson K","year":"1999","journal-title":"OG Open"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199804303381801"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(00)00181-5"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2007.09.006"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.4584-12.2013"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.12.018"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yfrne.2022.100994"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ajp.0000149795.08746.31"},{"key":"e_1_2_13_49_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpain.2022.923866","article-title":"The influence of adverse childhood experiences in pain management: mechanisms, processes, and trauma\u2010informed care","volume":"3","author":"Tidmarsh LV","year":"2022","journal-title":"Front Pain Res (Lausanne)"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.03.002"},{"key":"e_1_2_13_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002049"},{"key":"e_1_2_13_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.886"},{"issue":"10","key":"e_1_2_13_53_1","first-page":"2033","article-title":"Emotional distress among couples involved in first\u2010trimester induced abortions","volume":"46","author":"Lauzon P","year":"2000","journal-title":"Can Fam Physician"},{"key":"e_1_2_13_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.13765"},{"key":"e_1_2_13_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2020.100582"},{"key":"e_1_2_13_56_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0115957"},{"key":"e_1_2_13_57_1","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001906"},{"key":"e_1_2_13_58_1","doi-asserted-by":"publisher","DOI":"10.1037\/amp0000768"},{"key":"e_1_2_13_59_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-018-00008-x"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T10:43:33Z","timestamp":1767005013000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":58,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/aogs.70109"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70109","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"type":"print","value":"0001-6349"},{"type":"electronic","value":"1600-0412"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"assertion":[{"value":"2025-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}