Speeches
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Oct. 24, 2008, 09:00
Medical abortion in France. The benefits of a complex procedure
Pascale Roblin, A. Agostini, F. Bretelle, R. Shojai (France)
University Hospital of Marseille, France
pascaleroblin@yahoo.fr, raha.shojai@ap-hm.fr
Objective. Medical abortion in an ambulatory setting is possible in France since 2004. However, many physicians have been reluctant to use this new option at the office because of the complexity of the protocol. Our aim was to evaluate the feasibility of this procedure in a private practice and to show it’s benefit in terms of contraception counselling.
Patients and methods. A prospective study was realized among 300 consecutive women, with gestational age less than 49 days, choosing a medical abortion at a general practionner’s office. Under the French law, patients had to undergo five supervised visits (V). The first visit (V1) was to inform patients on the procedure and proposition to encounter a social worker for alternatives to abortion. V2 was for medical examination, cervical cytology, screening for IST and counselling on contraception. After a reflection period of seven days, the third visit was for administration of 600mg of mifepristone under the physician’s supervision. The fourth visit was for administration of 400µg of oral misoprostol at the office. Medications were bought by the physician at the pharmacy. Women were not obliged to remain under supervision and could depart within minutes of receiving medications but were not given the possibility to take the medications themselves at home. They had access to a 24-hour hotline and walk-in emergency service. The fifth visit was for post-abortion control at 10 days with HCG and/or sonography.
Results.Among the 300 patients, 10 (3%) were lost at follow-up. The rate of complete abortion with no major complications among the 115 patients with a known outcome was 97%. Four patients (3,5%) required surgical aspiration : 2 for haemorrhage, 1 for incomplete abortion and 1 for continuation of pregnancy. Seventy-six women (63%) fully adhered to the protocol and came to the 5 scheduled visits. The mean number of visits at the office was 4,1. An unscheduled visit was required in 7 cases (6%) for repeat administration of misoprostol and 19 patients (16%) phoned for advice. The reflection period of seven days was not possible to respect in 55% of cases because of the time limit of 49 days but all patients had at least 48 hours to confirm their decision. None of our patients requested to encounter a social worker. Concerning contraception, 75% had no use of birth control methods and only 2 women used emergency hormonal contraception. At the control visit, 46% opted for oral contraception and 38% for a long term reversible method (IUD or implant). Overall rate of satisfaction for the method was 78%.
Conclusions.Our findings confirm that medical abortion in a general solo practice is a safe and acceptable procedure. A complex procedure based on five visits at the office may be a shortcoming and considered as a setback in the era of increased patient autonomy. In our view it improves patient-doctor relationship which is essential for counselling in post-abortion contraception.
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Oct. 2, 2014, 12:00
Medical abortion in Slovenia: where are we?
Eva Macun General hospital Jesenice, Jesenica, Slovenia - eva.macun@sb-je.si
Introduction: In Slovenia abortion is legal on demand up to 10 weeks of pregnancy. Later abortion can be done after approval of the Commission for abortion. It can be performed in 14 gynaecological departments. Slovenia has a national register of fetal death up to 500g. Institutions that perform abortions are obliged to report all known fetal deaths, with demographic data and procedure. Methods: We checked the fetal death database for method of abortion on demand for Slovenia for the years 2007-2011. We interviewed doctors in all Ob/Gyn departments. We asked them how many percent of abortion were medical in the year 2014. Possible answers were: <50%, >50% and >90%. We asked them also if women can be given misoprostol for home use. Results: In the year 2007 there were 5176 abortions on demand in Slovenia; 4660 (90%) were surgical and 123 (2.4%) were medical abortion and some other methods. In the following years the rate of medical abortions increased (Table 1). In year 2011 there were 4263 abortions ; 2153 (50.5%) were surgical and 1602 (37.6%) were medical abortions.
Table 1: The rates of medical and surgical abortions in Slovenia, 2007 - 2011
Year 2007 2008 2009 2010 2011
Surgical
Abortion number 4660 4099 3560 2604 2153 % 90.0 82.8 76.5 60.2 50.5
Medical number 123 434 734 1345 1602
Abortion % 2.4 8.8 15.8 31.1 37.6
Results of interviews show that in year 2014 four Ob/Gyn departments use medical abortion in 50% or less. Four departments use it in more than 50% and less than 90%. Six departments use medical abortion in more than 90%. Three of the latter give misoprostol to women for home use. Conclusions: Use of medical abortion is increasing in Slovenia. There are departments that give misoprostol for home use.
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Oct. 13, 2006, 09:00
Medical abortion in the hospital or at home - Let the woman chose
Monica Johansson and Marianne Racke, midwifes, Karolinska University Hospital, Division
of Gynecology and Obstetrics Stockholm, Sweden
Introduction: The Board of Healt and Welfare approved medical abortion up to 9 weeks gestation in Sweden in September 1992. Today a majority of induced abortions are performed before 8 weeks and more than 50% of first trimester abortions are medical. The percetage varies between 30 to 90% between different hospitals. Hme-user of misoprostol is approvided since September 2004.
Procedure: Woman with a pregnancy length up to 63 days of amenorrhea, requesting medical abortion, are given the choice between the standard protocol of administration of misoprostol at the hospital and possibility of taken it at home.Information is given by a midwife at the first telephone contact, At the visit in the abortion clinic (day 1) the gestational age is established by menstrual history and confirmed by physical examination and endovaginal ultrasound examination. Whomen are counseled by gynecologist, as well as by a trained and experienced nurse-midwife.
The patients received 200 mg mifepristone orally at the hospital on day 1. The women are also given 4 tablets of misoprostol ( 200µg per tablet) to take vaginally at home 24-48h after mifepristone together with pain prophylaxis. The first follow –up to assess the outcome of treatment is performed by a thelephone call by the midwife within a few days after the treatment.
Follow-up: Is performed on day 14 after the medical abortion.Outcome is evaluated using a urinary HCG test with cut-off value of 500 IU/ml. If necessary, a gynecological examination, an ultrasound examination and seum HCG is performed.Follow-up is mandatory following medical abortion and also includes contraceptive counseling.
Discussion: Home-user of misoprostol reduce the number of visit and improve access to medical abortion. Our data shows a high acceptabilly among women and their partners and confirms the safety and efficacy of home-use of mosoprostol. Women should be pffered this choice to allow more flexibility and privacy in their abortions.
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Sept. 11, 2004, 09:00
Medical abortion in the private practice,
Gabriele Halder
Specialist in OB/Gyne
Working in private practice
Head of the Family Planning Centre Berlin
This presentation gives you an overview and in depth analysis about induced medical abortion with the abortion pill Mifegyne© ( Mifepristone ) and the Prostaglandin Cytotec© ( Misoprostol) in practical experience as a practicing gynaecologist.
The description of the problems in Germany in terms of having to deal with the german federal law and the regulations about the specific distribution channels of the abortion pill is considered as well as the increased requirements in the fields of care and consulting service for the female patients.
The complexity in practice and the fact that in Germany the existence of prohibition for advertisment of induced abortions in general is another hurdle for the application of Mifegyne©. This is one section of the many reasons why last year 2003 only a percentage of 6,12 % of all induced abortions in Germany were done the non -surgical way.
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Oct. 13, 2006, 02:00
Medical abortion in the private practice, the French compromise
Sophie Eyraud, MD; Sophie Gaudu, MD
Hôpital Antoine Béclère, Centre de régulation des naissances, Clamart, France
In France, women who decide to get an abortion have been able to access the abortion pill
through their regular doctor outside the hospital context since November 2004.
Under the new French legislation, which only covers abortions in the first 49 days of
pregnancy, a contract must be signed between the doctor and a referral hospital which
agrees to address any complications that may arise. In one sense, this method may seem
to involve excessive supervision: first because many visits are required and second
because the drugs must be taken in the presence of the doctor. But allowing physicians to
practice non-surgical abortions considerably increases the number of doctors available for
the procedure. This law renders abortion more accessible to French patients and for that
reason we see it as a major advance for women's right to choose.
Immediately following the passing of these new measures, we organized a network
between hospitals and doctors working outside of hospitals in order to foster the practice
of non-surgical abortion. The network REVHO* was funded by the Ile de France region’s
public health care system and its activities included training doctors and evaluating the
quality of the care and the satisfaction of patients and health care professionals.
We report the first year's results here:
- In 2005 the network included 59 physicians (primary care and gynecologists) and 7
hospitals.
- 2503 women interrupted a pregnancy with the help of a doctor belonging to the network.
- No serious complication arose.
- The average duration of pregnancy was 6 weeks.
- The average age of the patients was 29 years.
- The success of the method (defined as the absence of a need for surgical intervention)
was 98%.
- Mild complications included:- progressive pregnancy (0.7%)
- full retention of the egg (1.2%)
- significant hemorrhages (0.7%)
- partial retention of the ovular products (2.5%),
The experience of the REVHO network successfully created close linkage between
doctors working in the city and the hospital, thus encouraging the development of the
procedure with the full support of professionals and great satisfaction of the patients .
According to this initial evaluation, the introduction of non surgical abortion outside the
hospital appears to be both safe and efficient.
* REVHO : Réseau Entre la Ville et l’Hôpital pour l’Orthogénie (network between the city
and the hospital for family planning) -
Oct. 22, 2010, 02:00
Medical abortion overtaking surgical in Norway
Mette Løkeland, Department of Obstetrics and Gynecology, Haukeland University Hospital, Norway
Co-author: Line Bjørge
Norway has abortion on request, completely free of charge and easily accessible at every gynaecology ward up to 12 weeks of gestation. Health personnel have the right to opt out form performing the procedure but not to treat the patients. Each clinic is obliged to make sure they have enough staff that is willing to do the procedure.
Medical abortion with mifepristone and misoprostol was introduced for abortion up to 9 weeks gestation in 1998. Gradually medical abortion has become an option at the majority of all gynaecology wards in Norway. In 2005 medical abortion for gestational age 9-13 weeks was introduced and is now available in all the five health regions.
At Haukeland University Hospital medical abortion was made the method of choice for early termination of pregnancy up to 9 weeks gestation and in 2007 for terminations of pregnancy at 9-13 weeks gestation. Medical abortion was made method of choice due to the general medical view that conservative treatment should always be preferred to surgical when the methods give equivalent treatment outcome. If there are personal or medical reasons the surgical method will be used instead. Home use of misoprostol was introduced as a voluntary choice in 2006 for terminations up to 9 weeks gestation.
Since 1998 the percentage of all abortions in Norway performed medically has increased every year. In 2007 the amount was 45.3% and the preliminary figures for 2008 show 55.9%. This give us reason to think there is a change in Norway from surgery to medical abortion.
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Oct. 2, 2014, 12:00
Medical abortion performed at home
Marija Rebolj Stare University Clinical Centre Maribor, Maribor, Slovenia - mitzirs@gmail.com
Introduction: At the University Clinical Centre, Maribor, the start of medical abortions was in the year 2006, with a full service from July 2007. With the recognition of its course and a lack of major complications, we decided to perform medical abortions up to 63 days of gestation in the outpatient clinic. A complete working plan was done, with exact briefings for all enrolled. Methods: On 24 February 2014 we started with outpatient medical abortions. At visit all reports (ultrasound report, blood haemoglobin level, blood type, Rh factor, ICT) and possible contraindications were evaluated. In case of uncertainty we repeated tests. Written explanation and patient consent, ambulance report, strict instructions were featured, for term and preterm control if needed. Analgesic therapy was prescribed. Oral intake of mifepristone 200 mg was followed, after 36-48 hours, with vaginal insertion of 4 pills of misoprostol 200 mcg. We advised attendance of adult and one week of sick leave. Two weeks later we performed follow-up. Results: Between 24 February and 3 April.2014, 47 patients aged 16.4-41.3 years, were enrolled. Average gestation was 52 (37-62) days. Seven didn't come to check-up; they probably had no problems. In 4 patients medical abortion failed and pregnancies were ongoing. Two had surgical abortion and 2 medical by extended protocol - one complete, one with curettage due to residua. For 36 patients medical abortion was successful. At 30 patients was complete, 6 had residua (15-31 mm) with high βHCG level (460-21164). Two were directed to hysteroscopy and 4 had curettage. Prophylactic antibiotic therapy was given once, prior to curettage. No transfusion was needed. Conclusions: Medical abortion at home proved to be safe for gestations up to 63 days of duration. Complications such as bleeding, residua or infection did not occur more often than at hospitalization. Failed medical abortions tended to occur; that confirms a need for a check-up some patients are avoiding.