I. DAGOUSSET gave a report on the technique of abortion using mifepristone +
misoprostol, practised at the Orthogenic Centre at BROUSSAIS Hospital in
Using this method, this centre has performed 15,000 terminations up to 49
days of amenorrhoea, using 600 mg mifepristone + 400 µg misoprostol. An
additional dose of 400 µg of misoprostol would be administered, if the first
procedure shows no sign of success within 3 hours after the first dose. This has
increased the success rate to 98.6%.
Concerning the psychological indications and contra-indications of this
procedure, C. FIALA (Austria) pointed out that this method, which lasts 48
hours, is conducted in a way which calls for some degree of participation by
the patient. Appropriate counselling is therefore required
Clinica Dator, Spain
Objectives: 1. To study depressive symptoms, anxiety and get and subjective evaluation of the stress that women who have decided a termination withstand.
2. To investigate, taking in account a pre and post IVE evaluation, if the termination itself might cause a trauma or a depressive psychological disorder dealing with anxiety.
3. To find out the differences that could exist in the sample, according to the previous goals, relative to age, nationalities, studies degree and other variables.
Methodology: The random sample is formed by 620 women that came to Clinica Dator (any day of the week) from December 2009 to April 2009. We got the evaluation by a questionnaire that was divided into several sections: personal data, information concerning the partner, their own stress valuation about the unwanted pregnancy and the termination (ranking from 0 to 5) and the consideration of the anxiety and depression Goldberg scale.( ). 163 Women came back for the check-up (26% of the whole sample).
Results: Age range: from 12 to 48 years. A 15% had psychiatric treatment precedents and main causes were depression (31%) and anxiety (28%).
The stress result of the unwanted pregnancy got a average grading of 3, 24 (DT: 1,45) and the stress due to the termination 2,81 (DT: 1,55), medium-high level in both cases.
Anxiety average is 5, 02: 57,6 % of the sample are over the cut-off point in probability of anxiety. Depression average: 3, 78 (DT = 2, 49), 65% of this women are over the cut-off point witch represents a likely depressive disorder.
To study the pre-post changes, women who came back for the check-up are compared to the ones of rest of the sample: there is not noteworthy differences in anxiety and depression level pre-post IVE regarding age, nationality, kind of job, study degree. There is an statistical significant difference in pre and post IVE anxiety. The anxiety average pre IVE is 5, 16 and decreases to 3, 15 after the termination. (Repeated measurements, F = 57, 37; p = 0.000; Eta2= 0.29). Depression average falls from 3, 82 before the IVE to 2, 18 after it (Repeated measurements, F = 54, 97; p = 0.000; Eta2 = 0, 27).
Both, depression and anxiety get better in 52, 5% of the sample, get worse in a 10, 7% and remain the same in a 2% of the cases. In the rest, 34, 8% of the sample, progress differently in relation to anxiety and depression. No epidemiologic variables were found to predict worsening. The analysis was carried out by logistics regression of the symptoms of both, depression (9 symptoms) and anxiety (9 symptoms), and the variables that turned out to be predictive were: feeling not much energetic, being unable to concentrate and feeling worse mood in the morning (Model: Chi 2 = 34, 07; p = 0.000; R2 Nagelnerke: 0,52). Those who had previous psychiatric treatment didn’t show any different symptoms with regard to the rest of the sample.
Conclusions: Stress produced by an unwanted pregnancy is medium-high short. More than 50% of women suffer, before the termination, an anxiety and depression level over the cut-off point in the mixed anxiety and depressed mood probability.
In most of the cases this level decreases after the termination, except a roughly 10% that feels worse, in this sense, after the IVE.
According to our information it is not truth that termination generates a trauma, or a psychiatric pathology. Most of women who do a termination feel better after it, except a low percentage with more significant anxiety and depression symptoms afterwards than before it.
George C Denniston MD MPH, President, Doctors Opposing Circumcision, Clinical Asst
Professor, (retir) Dept of Family Medicine, University of Washington, Seattle, WA US
Inserting 7 Quinacrine (Atabrine) pellets into the uterine cavity via an IUD inserter two
times one month apart provides effective permanent sterilization. Already 200,000 women
in 50 countries have benefited from this procedure, developed by Dr Jaime Zipper of
Santiago Chile. The procedure is quick and comfortable, and can be provided by health
care professionals, with fully informed consent. Abortion providers are ideally suited to
offer this procedure.
For the counsellor
Christiane Der Andreassian, Hospital Broussais, Paris, France
To give information takes time.
Counselling doesn’t need necessary to be done by doctors.
Well trained, nurse or midwife who belongs to the team can easily do it.
Make sure that woman‘s decision to abort is firmly settled.
Listen to the woman’s motivation behind her choice of the method.
Ensure a proper understanding of the method.
Make sure that women is psychologically able to take upon herself and to comply with the
schedules of the appointments, in particular coming back for ultra sound and follow up visit
Be able to reach an emergency area, during the following 2 weeks, in case of problems.
Discuss any concerns at the follow up visit.
What the women say
Avantages of medical abortion
- Pill, no surgical intervention
- Its more natural
- No doctors touching my body
- Conscious and self experience
- Choose to come back for the misoprostol at the clinic or to stay home in their
Disadvantages of medical abortion
- Not sure when abortion will take place
- More blood loss
- Anxious about cramps, nausea, or eventually diarrhoea
Receive the patient in her request,
- With respect
- With a positive attitude,
- Listen to her in the glo
bality of her situation.
- And of course, provide her with the advice’s most relevant to her choice.
- Giving her the relevant information fitted to her case,
- Understand that the team is available if she needs help.
- Allow her to take responsibility for her own actions with more autonomy and confidence
all along the procedure.
A patient correctly informed will be more comfortable and will improve the chances of
succes of method.
on health professionals’ attitudes toward abortion in two public maternity hospitals
in Salvador da Bahia
Sylvia de Sordo, Brasil
In this presentation I will discuss some key findings of my qualitative study on health professionals’ attitudes toward legal and illegal abortion in Salvador da Bahia (Brazil). Through this study I investigated the impact of the Brazilian scientific and political debate on abortion and maternal morbidity and mortality and the resulting expansion of legal abortion services, on physicians’ attitudes toward both legal and illegal abortion.
This study was carried out through participant observation, short questionnaires and semi-structured interviews with obstetricians-gynecologists and other health professionals working in two public maternity hospitals of Salvador da Bahia. The first one is located in one of the outlying urban areas where the highest rates of maternal mortality are found. This hospital doesn’t have any legal abortion service, while the second one, which is located in a middle class neighborhood, is the only Hospital which offers a legal abortion service in Salvador, one of the leading cities in terms of maternal mortality-morbidity due to unsafe abortions.
One of the main objectives of this study was to examine if the increasing establishment of legal abortion services influenced physicians’ attitudes toward abortion, toward women who have them illegally or ask to have legal abortions, as well as toward the law. Another objective was to evaluate which characteristics - socio-demographic, religiosity, professional experience, knowledge (of abortion and epidemiology of maternal morbidity and mortality, of the Brazilian Law regarding abortion) - influence physicians’ attitudes toward both legal and illegal abortion and how. The Brazilian Ministry of Health and FEBRASGO (Brazilian Federation of Gynecology and Obstetrics) are interested in promoting the establishment and expansion of legal abortion services in public maternity hospitals. My study will therefore provide new data which will have immediate relevance, both from a scientific point of view, and from a policy point of view.
H.Dewart , S.T.Cameron, A.Glasier and A.Johnstone - Dean Terrace Centre, NHS Lothian, Royal Infirmary of Edinburgh, Department of Reproductive and Developmental Sciences, University of
Edinburgh, United Kingdom
Background and methodology: Research has shown that many women would prefer to be at home rather than in hospital, to pass the final stage of an early medical abortion. A pilot was therefore conducted over six months at a hospital abortion service in Edinburgh, Scotland, that allowed women up to 8 wks gestation to be discharged home soon after misoprostol administration. An anonymous questionnaire of womens’ experiences was conducted one to two weeks later. An audit of the numbers of abortions performed by each method, during the pilot and the same period the previous year, was also conducted.
Results:A total of 250 women chose to go home after misoprostol. This corresponded to 34% of the total number of women having an early medical abortion. A 24% increase in the total numbers of women having a medical method (n=142) was observed compared to the same period the previous year. A total of 100 women completed questionnaires out of 145 distributed (69%). The commonest reasons given for choosing to go home were, to have treatment sooner (53%) and to be in the privacy of one’s own home (47%). Most women stated that bleeding (81%) and pain (55%) were as, or not as bad as expected. Most would recommend this method to a friend (84%).
Discussion and Conclusions: Discharge home for the final stage of a medical abortion was highly acceptable to women. Since availability is not limited by hospital bed space, more women can be treated by medical methods
Freedom of conscience is a human right
recognised in the Universal Declaration of Human
Rights of 1948. Accordingly, the U.N. International
Covenant on Civil and Political Rights provides
that “Everyone shall have the right to freedom
of thought, conscience and religion” (Art.18(1)).
Conscience is thereby expressed as separate
from religion. Individuals may, of course, base
their conscience on their religious beliefs, but
the Covenant establishes that religion has
no monopoly on conscience. A common
invocation of conscience regarding abortion is in
conscientious objection to participation, which is
often based on religious convictions.
Conscientious commitment is the reverse of
conscientious objection. It arises when healthcare
providers feel conscientiously committed to
offer patients advice and services to which
administrators of their healthcare facilities such
as hospitals are opposed in principle, for religious
or comparable reasons. Institutions such as
hospital corporations cannot claim human rights
such as conscientious objection. Health facility
administrators must accommodate service
providers’ rights of conscience, such as to
recommend and offer services the providers
conscientiously consider to be in their patients’ best
interests, and, with patients’ consent, to provide,
or refer patients for, such services, including lawful
abortion, without discrimination, in the same way
that facility administrators must accommodate
providers’ rights of conscientious objection.
Thoai D. Ngo, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Research and Metrics Team, Health System Department, Marie Stopes International,
Background: Home-use of misoprostol can reduce the number of clinic visits required and improve access to medical abortion. We conducted a systematic review to assess the efficacy, safety, and acceptability of medical abortion administered at home versus at clinic.
Methods: The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Popline were searched for randomized and non-randomized prospective studies of medical abortion at home versus clinic. The main outcomes of interest were failure to achieve complete abortion, side effects, and acceptability. We calculated relative risks (95% CIs), and pooled estimates using a random-effects model.
Findings: Nine studies met the inclusion criteria (n=4,522 participants). All studies used a mifepristone-misoprostol combination for medical abortion. The proportion of women who had a complete abortion in home-based groups (n=3,478) ranged from 86% in India to 97% in Albania, with average success of 89.7%. Complete abortion in clinic-based groups (n=1,044) ranged from 80% in Turkey to 99% in France, with average success of 93.1%. Pooled analyses indicate that there is no difference in complete abortion between home-based (n=3,215) and clinic-based (n=593) intervention groups (OR=1.11; 95% CI: 0.65, 1.91). Serious complications of abortion were rare. Acceptability data indicate that women using self-administered medical abortion at home were more likely to be satisfied, to choose the method again, and to recommend medical abortion to a friend than women who opted for medical abortion at the clinic.
Interpretations: Evidence from prospective cohort studies suggests that the option of home-use of misoprostol for medical abortion is efficacious, safe, and acceptable to women living in both resource-limited and resource-rich settings. This option allows women greater flexibility and privacy in the abortion process, and could increase access to and acceptability of medical abortion.
Risk factors for repeat termination of pregnancy:
implications for addressing unintended pregnancy
Ngo, T1; Keogh, S1; Nguyen, T1; Le, H2; Kiet, P2;
1 Marie Stopes International; 2 Hanoi Medical University, Vietnam
Objective: Vietnam has one of the highest pregnancy termination
rates in the world; 26 terminations of pregnancy (TOPs) per 1000
women. We explored factors associated with having repeat TOPs
in three provinces in Vietnam.
Methods: A cross-sectional survey was conducted from September
to December 2011 among abortion clients at 61 health facilities in
Hanoi, Khanh Hoa and Ho Chi Minh City. After their procedure,
women participated in an exit interview asking about socio-
demographic factors, contraceptive use, and knowledge and
experience of TOP services. The primary outcome was repeat TOP
Results: A total of 1233 women were interviewed. The median
age was 28 years; 92.5% had secondary education; 77.8% were
married; and 31.9% had no children. Half the respondents were
not using contraception prior to their recent pregnancy. The
prevalence of repeat TOP was 32.9%. A signiﬁcantly higher
proportion of repeat TOP compared to ﬁrst time TOP clients
intended to adopt long-acting contraceptive methods, particularly
the IUD (35% vs. 23%, P £ 0.001), in future. In a multivariate
model, individuals living in Hanoi, older women, and those with
two (vs. fewer) children were more likely to have a repeat TOP
(P < 0.001). While women with ‡2 daughters (vs. 1) were more
likely to have a repeat TOP (P = 0.03), women with no sons
(vs. 1) were less likely to have one (P = 0.03).
Conclusions: Repeat TOP remains high in Vietnam. Strengthening
post-TOP family planning interventions is critical to reduce the
high number of repeat unintended pregnancy in Vietnam.
Safety and effectiveness of termination services
performed by doctors versus midlevel providers: a
Ngo, T1,2; Park, MH1,2
1 Marie Stopes International; 2 London School of Hygiene & Tropical
Objective: We review the evidence that compares the effectiveness
and safety of termination of pregnancy (TOP) procedures
administered by mid-level providers (MLPs) versus doctors.
Methods: We conducted a systematic search of published studies
assessing the effectiveness and/or safety of TOP provided by MLPs
compared to doctors. The Cochrane Central Register of
Controlled Trials, EMBASE, MEDLINE and Popline were searched
for trials and comparison studies. The primary outcomes were:
(i) incomplete or failed TOP and; (ii) measures of safety (adverse
events and complications) of TOP procedures administered by
MLPs and doctors. Odds ratios and their 95% conﬁdence intervals
(CIs) were calculated for each study.
Results: Two prospective cohort studies (n = 3821) and two
randomised controlled trials (RCTs) (n = 3821) were included.
Three thousand seven hundred and forty-nine women underwent
a procedure administered by an MLP and 3893 women underwent
a physician-administered procedure. Three studies used surgical
TOP with maximum gestational ages ranging from 12 to 16+
weeks; a medical TOP study had maximum gestational ages up to
There was no difference in incomplete/failed TOP for
procedures performed by MLPs compared to doctors in RCTs of
surgical (OR: 2.00; 95% CI: 0.85, 4.68) and medical TOP (OR:
0.69; 95% CI: 0.34, 1.37). One prospective cohort study showed
increased odds of incomplete/failed TOP among MLPs versus
physician groups (OR: 4.03; 95% CI 1.07–15.28).
None of the included studies found a difference in the odds of
overall complications between provider groups.
Conclusions: Based on this evidence, there is no indication that
procedures performed by MLPs are less effective or safe than
those provided by physicians.
Meghan Doherty, IFPA Policy & Advocacy Officer, Ireland
Abortion is criminalised in almost all circumstances in Ireland. Since 1983, a succession of referenda, high-profile legal cases and the annual exile of approximately 5,000 women and girls to England, has characterised Ireland’s official policy towards women and girls’ need for safe and legal abortion services. Legislators have consistently abdicated their responsibility in this area, even pro-choice legislators, largely because they fear malicious attacks from anti-choice groups. These fears are not unfounded, however, the influence of anti-choice groups is on the wane and the majority of the Irish population now support access to abortion services in Ireland.
Ireland in 2010 is a much different place than it was in 1983 but the abortion discourse is often stuck in that era. In response, the IFPA has been working with a new generation of advocates to reclaim the public debate on abortion and articulate a pro-choice position based on international human rights standards, equal access to health services and connections to a broader social justice movement. This is a proactive strategy that represents a shift away from reactive and ad-hoc campaigns whereby the agenda has customarily been set by anti-choice groups. As media spokespeople, community organisers, bloggers, youth leaders and engaged citizens, young women and men in Ireland are succeeding in changing the language and tone of public discussion on abortion and are focussed on holding policy-makers accountable for the realisation of reproductive rights in Ireland.
Daniela Draghici, Roumania
Central and Eastern Europe (CEE) is a region where abortion rates remain high, despite efforts to encourage contraceptive use and secure supplies of modern methods. Strategic assesments in Roumania, Moldova, Russia, and Ukraine have shown that abortion remains the preferred method of fertility conrol because it is often cheaper than contraception and widely available. Abortion, however, remains of low quality; unsafe abortions account for 24% of maternal deaths (WHO, 1998).
Characteristics include: unsafe technologies, low level of motivation and training of providers, no counseling or choice of methods, and no post-abortion free contraception. Manual Vacuum Aspiration (MVA) and Medical abortion (MA) drugs are registered in several CEE countries; nevertheless, access to these methods is very limited especially for vulnerable groups (youth, low income families, HIV positive women, etc).
The Eastern European Alliance for Reproductive Choice (EEARC) purports to raise awareness, sensitize providers, motivate women’s groups, develop new evidence-based training curricula, and to improve access to and quality of safe abortion, including medical abortion services. EEARC has a multidisciplinary membership structure and works to collect and disseminate evidence-based information on safe abortion, including medical abortion, through country reports shared across the network. The Alliance is actively increasing its membership and promotes exchange of advocacy strategies and educational materials across the network.
Through presentations at national and international conferences, members of EEARC have raised awareness about the need for better access to safe abortion services, including medical abortion, especially to audiences of providers and women's organizers. This presentation will review EEARC's network development, awareness raising, and advocacy activities and discuss their impact in a challen-ging environment, including their success in building of broader support for safe abortion, including medical abortion that has been demonstrated among healthcare providers and women's organizations. The Alliance is working as a catalyst to coalesce advoca-cy efforts to counteract restrictions recently imposed by governments and parliaments in CEE countries. Country examples from Lithuania, Moldova, Roumania, Russia, and Ukraine will be presented in the context of regional challenges in maintaining abortion rights amidst an increa-sing conservative opposition movement.
Detection of violence against women via screening at the occasion of request for pregnancy termination
C.D. Liengme, F. Coquillat, M. Demierre, P. Hohlfeld, S.-C. Renteria (Switzerland)
Family Planning Center, Psycho-social Unit, Department for Obstetrics and Gynecology of University Hospital of Lausanne (CHUV), Switzerland
Introduction. In Switzerland one out of five women is subject to interpersonal violence at least once in her life and 24 women die from such violence every year. Several surveys show that the problem of violence is generally underestimated as only about one case out of twenty is detected. Again surveys show that women would like to be questioned about violence when consulting a doctor.
In the summer of 2007 a new chapter concerning present and past violence was introduced into medical files. Doctors or midwives complete these files, while they are taking the medical history of women requesting a termination of pregnancy. The Family Planning Centre carried out a research to see what changes resulted from the introduction of this chapter and also to see which effects, if any, taking care of women after detection had on the spiral of violence.
Material and Methodology. This quantitative retrospective survey covered 2 four-month periods, the first extending from January to April 2007 and the second from January to April 2008. The data that were analyzed were collected from the medical files kept by doctors and midwives on women requesting a termination of pregnancy or re-considering the idea, and from the files of the Family Planning Centre advisors, who interview all the women concerned according to the protocol for termination of pregnancy at the Gynecology and Obstetric Department of the Lausanne University Hospital (CHUV)
Results. During these two periods a total of 451 women were taken care of. 82 of them admitted being or having been victims of violence, 21 out of 201 (10%) during the first period, and 61 out of 250 (25%) during the second period. These numbers show an increase of 150% in detected cases. A detailed analysis of the data collected concerning these 82 women will be presented: the type of violence, requests for help, legal and medical assistance provided.
Conclusion. Our study confirms the importance, for health professionals who take care of these women, of paying systematic attention to the fact that they may be or have been victims of violence. Women who are victims of violence are thus able to talk about it, to be listened to, informed and helped according to their specific needs. In the case of requests for a termination of pregnancy after a rape, the fact that the victim claims having been raped, allows the biological proof of sexual contact to be registered and kept on file.
Risk factors for failure in medical abortion
Marie Duriez, MD, Philippe Lefebvre, MD
Service d’Orthogénie (Hospital Family Planning Service), Roubaix, France
Aim: To identify potential risk factors of inefficiency for elective medical termination of
pregnancy based on records of failures of this technique in a hospital environment.
Patients and methods: A retrospective study was conducted on elective medical
pregnancy terminations performed up to 49 days post amenorrhoea in the Family Planning
Service of Roubaix hospital between January 1st 2001 and December 31st 2005. The
service's termination protocol consists in an oral dose of 600mg mifepristone, followed by
an oral dose of 400µg misoprostol 48 hours later. A 2nd oral dose of misoprostol (400µg) is
given 3 hours later if there has been no expulsion.
Every patient is required to return 15 days later to check their βHCG levels.
Failure is defined as ongoing pregnancies, total or partial retentions, and cases requiring
emergency surgery. Success is defined as complete abortion requiring no additional
surgical or medical treatment.
Five items were analysed: patient age, patient parity, duration of pregnancy, βHCG levels
on the day mifepristone (D1) was given, and the dose of misoprostol received.
Results: 1,975 medical terminations were performed during this period. 125 (6.33%) of
these patients did not return to be checked and have been excluded from the study. The
analysis was thus performed on 1,850 patients.
The method was a success in 97.08% of cases (1,796/1,850). 54 failures (2.92%) were
recorded, including 7 ongoing pregnancies (0.38%) .
Patients for whom the method resulted in a success compared to patients who had failures
have a significantly lower age.The duration of pregnancy was not different for the two
Nulliparous (873/1,850) patients had significantly fewer failures (12/873: 1.37%) than
multiparous patients (42/977: 4.30%).
Age is significantly higher for failures amongst the nulliparous patients. Conversely, for
patients who have had at least one child, age is not a determining factor.
28 patients did not receive any misoprostol because they expulsed prior to the 48th hour
(1.51%). Amongst the 673 patients who received only a single dose of misoprostol, 11
(1.63%) required additional actions including one emergency admission for haemorrhage.
Amongst those who received two doses of misoprostol, 43 failed (3.74%), including 2 re-
admitted the same day for haemorrhages and 1 for pelvic pains.
Discussion and conclusion: The overall efficiency results for the method are excellent
despite an exhaustive and detailed analysis of the failures.
The various studied factors have demonstrated that there is an increase in failure rates for
the method with parity and, to a lesser extent, with the patient's age.
High plasma beta HCG levels also seem to be more often associated with failures of the
method. The addition of a second dose of misoprostol is likely to increase the chances of
an expulsion during the hospital stay but, this non-comparative retrospective study can not
conclude on the beneficial effect of a second dose of misoprostol on overall efficiency.
Finally, it should be noted that none of the criteria evaluated in this study can be used as a
diagnosis factor to predict the outcome of an elective termination as none of them has the
sensitivity / specificity that is required to identify 'at risk' patients from amongst other
Abortion among minors. A French perspective
A. Durrieux, Pascale Roblin, A. Agostini, F. Bretelle, R. Shojai (France)
University Hospital of Marseille, France
Objective.The rate of abortions among teenagers is steadily increasing in France. We aimed to analyse the medical and social characteristics of minor patients requesting an abortion in order to improve preventive actions.
Patients and Methods.A retrospective analysis of 184 minor patients requesting an abortion in our department between 2005 and 2007. Minors represented 16% of the population requesting an interruption of pregnancy in our center.
Results.Mean age was 16.2 years (rang 14-17), 10% had already a child and 5% had repeat abortions during this period. Mean gestational age at abortion was 63 days. One third had a medical abortion and 70% surgical aspiration with general anaesthesia. The adolescents were accompanied during the procedure by their companion in 26% of cases. In 35% of cases, teenagers came with no family members and were accompanied by a social counsellor. Teenagers had been referred to the abortion clinic through a family physician in 47% of cases, through the Family Planning associations in 11% and had come directly to our center in 43% of cases. Concerning contraception, 51% had declared using a condom, 25% used no method and 16% used an oral contraceptive. None of our patients used a dual contraception combining a condom and hormonal contraceptives. Only 5% had used an emergency hormonal contraception. Post abortum contraception prescriptions were : 75% oral contraception, 6% long term reversible contraceptions (IUD or implant) and 4% contraceptive patch or vaginal ring. 15% of the teenagers refused a contraception prescription. At the post abortum visit 46% did not show up for further explanations on their contraceptive method.
Conclusion.Minors accessed at our abortion center at advanced gestational ages often unaccompanied by their companions. Condoms were frequently used by minors but seem insufficient in preventing unwanted pregnancies. Use of emergency contraception was exceptional. Post abortion contraception was mainly tailored on oral contraceptives and follow-up visit attendance for further contraceptive counselling was low. Other contraceptive options such as IUD or implants were underutilized in post abortum and need to be evaluated.