Speeches
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Oct. 13, 2006, 02:00
How to introduce medical abortion in a country, the example of NZ
Margaret Sparrow; MD, New Zealand
In 1999 New Zealand abortion providers considered that New Zealand women should be
offered the choice of medical abortion. As no pharmaceutical firm was interested in
importing mifepristone, five doctors formed a not-for-profit company Istar Ltd. The name is
derived from Ishtar or Istar, an ancient Babylonian goddess of love, fertility and war.
In May 2000 Istar signed an agreement with the French manufacturer, Exelgyn and
applied to Medsafe, Ministry of Health for approval of a new prescription medicine.
On August 30 2001 Mifegyne 200mg was approved by the Minister of Health Hon Annette
King and gazetted for use in New Zealand for abortion only.
To comply with the law all abortions in New Zealand must be “performed” in a licensed
institution. For fear of prosecution most clinics except the one at Wellington Hospital,
chose not to use Mifegyne. Second trimester abortions in hospitals were not affected and
the first medical abortion using Mifegyne was carried out in Wellington Hospital in October
2001.
In April 2003 Mr Justice Durie in the High Court Wellington ruled that a woman must take
both sets of pills (Mifegyne, followed 48 hours later by prostaglandin) in a licensed
institution, but she does not need to stay on licensed premises between taking the pills,
nor does she need to stay on licensed premises until the abortion is complete. Clinics are
now able to perform early abortions within these limits.
Our experience demonstrates that with persistence, obstacles can be overcome. -
Oct. 14, 2006, 05:00
How to overcome the resistance against medical abortion
Mirella Parachini, MD
San Filippo Neri Hospital, Rome, Italy
OBJECTIVE: To understand how it is possible to overcome the resistance against medical
abortion in order to improve the right of women to choose.
RESULTS: Since the introduction of a pharmacological method to induce early abortion
there has been a strong resistance to it, even in those countries where legal abortion is
allowed with surgical techniques. Today the question about the choice of the method
seems to replace the historical debate about the interruption of an unwanted pregnancyamong pro-life groups and conservative politicians. Many claim that the “abortion pill”
makes women less responsible for their behaviour. On the other hand, even among those
not ideologically against abortion, there is a refusal of medical abortion concerning the lack
of health care assumed with a “self abortion”. Moreover in some countries abortion clinics
are refusing to offer it for fear of legal repercussions. Both medical and surgical abortion
are currently safe and effective when performed by trained practitioners according to
tested protocols under adequate conditions. However anti-choice campaigners try to
involve the public opinion and doctors about the risks of the drug, in an attempt to oppose
the access of the drugs in some countries, like in Canada, Australia and Italy. It is
therefore necessary to increase the information, considering that any medical procedures
is submitted to a scientific control, but keeping out of the debate ideological aims to
maintain restrictions on women’s right to choose.
CONCLUSIONS. There is a strong resistance at various levels against medical abortion
and a continuous scientific debate is requested from the abortion providers, beyond
ideological arguments. -
Oct. 13, 2006, 02:00
How to verify success hCG or ultrasound
Christian Fiala, MD, PhD, Gynmed Clinic, Vienna, Austria
Objectives: Medical abortion with Mifepristone and Misoprostol is effective in 95-98.6% of
cases. We compared ultrasound examination and HCG testing to determine the
effectiveness of the treatment.
Study Methods: 217 women with an unwanted pregnancy up to 49 days of amenorrhea
were treated between 26 April and 10 November 1999. They received 600mg Mifepristone
and 400µg Misoprostol 48 hours later. Expulsion was not verified routinely. An ultrasound
examination and HCG test was performed on day one and between days 6-18.
Results: The treatment was successful in 98.6 % of cases. A total of three curettages had
to be performed; one for continued pregnancy, missed abortion and haemorrhage
respectively. One patient had a missed abortion but expelled after hormone withdrawal.
Expulsion of the sac was verified in six patients. HCG levels at the control visit dropped to
3 % in average (SD 3) ranging from 1-17 % in all cases of successful abortion, with three
exeptions of 27%, 32% and 44%. The two missed abortions and the persistent pregnancy
led to an HCG rate of 91%, 159 % and 7900% respectively.Endometrium measured 10 mm on average (SD 4) at the control visit in the cases of
successful abortion, ranging from 1-24 mm. Diagnosis of successful treatment could be
based on ultrasound examination in only 66% of cases, owing to the early stage of the
pregnancy in the remaining cases.
Conclusion: Measuring HCG level before and after treatment gave a reliable result in
98.5% of successful abortions, compared to 66% with ultrasound examination. -
Oct. 25, 2008, 02:00
Ibuprofen and paracetamol for pain relief during medical abortion
D.S. Seidman, A. Livshitz, R. Machtinger, G. Yerushalmi, Y. Ben David, M. Spira, A. Moshe-Zahav, L. Lerner Geva, E. Schiff (Israel)
Department of Ob. & Gyn., Women and children's research unit and Gertner Institute for Epidemiology, Sheba Medical Center, both affiliated to Sackler School of Med., Tel-Aviv University, Tel-Aviv, Israel
dseidman@tau.ac.il
Background. Non-steroidal anti-inflammatory drugs (NSAIDs) have long been avoided in pain relief protocols for medical abortion because of concern over their potential inhibition of prostaglandin induced uterine contractions.
Objective. To determine whether the use of the ibuprofen for pain relief is effective and whether it can adversely affect the outcome of medical termination.
Methods. In a prospective double-blind controlled study 120 women undergoing medical abortion with 600 mg oral mifepristone and 400 mcg oral misoprostol were randomized to receive ibuprofen or paracetamol when pain relief was necessary.
Results. Ibuprofen was found significantly more effective (p<0.0001) for pain relief after medical abortion compared with paracetamol. Other parameters that significantly influenced the pain score after administration of the analgesics included the pain score before the analgesia and abortion in the past. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% versus 8.5%).
Conclusions. Ibuprofen was found highly efficient for pain reduction during medical abortion and more effective than paracetamol. We also found that a past history of a surgical or medical abortion was predictive for high pain scores. Importantly we found that despite its anti prostaglandin effects ibuprofen did not interfere with the action of misoprostol and was not associated with an increase in surgical interventions.
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Oct. 20, 2012, 11:30
Dr. Comendant holds a PhD as an obstetrician
gynaecologist. She is the Director of the
Reproductive Health Training Center (RHTC)
of Republic of Moldova, and since 2005 has
served as the Coordinator of the International
Consortium for Medical Abortion. In this capacity,
she successfully supported the development of
the ICMA regional networks in Latin America,
Asia, and Eastern Europe. Additionally, Dr.
Comendant is the National Coordinator of Safe
Abortion Programme of the Reproductive Health
Strategy of Republic of Moldova, an attendant
Professor of the Department of Obstetrics and
Gynecology of State University of Medicine
and Pharmacy of Moldova, a regional and
international trainer in safe abortion methods,
a senior consultant for Gynuity Health Project,
USA, and a consultant for the WHO Strategic
Assessment of Abortion in several countries.
ICMA: global, regional and national networking to
reduce the burden of unsafe abortion
In spite of increased attention to sexual and
reproductive health and rights, and particularly
to maternal mortality, in spite of the development
of effective technologies to make abortion very
safe, pregnancy-related deaths and unsafeabortion remain a major public health problem in
largeparts of the world.
There are many organisations working worldwide
to improve women’s access to safe abortion
services – through advocacy, law and policy
reform, capacity building, service delivery, training,
information sharing and networking. Everyone
feels there is a growing need to link together and
combine the efforts towards ensuring the right to
safe abortion in all the countries. It was agreed an
international movement is needed to challenge the
growing threat posed by conservative political and
religious forces who are seeking to turn the clock
back, block efforts to improve laws and provide
services, and exclude abortion from maternal
mortality reduction and family planning initiatives.
This is why representatives of several dozen
NGOs from all world regions, consulted and
called together by the ICMA and it’s four affiliated
regional networks (ASAP, EEARC, CLACAI and
ANMA), in 2011-12, decided to launch the
International Campaign for Women’s Right to
Safe Abortion in April 2012, which after only a few
months has been endorsed by more than 620
groups and individuals all over the world. -
Oct. 22, 2010, 08:00
Immediate adverse events after second trimester medical termination of pregnancy - results of a nationwide registry study
Maarit J. Mentula, M.D., Maarit Niinimäki, M.D., Ph.D., Satu Suhonen, M.D., Ph.D., Elina Hemmiki, M.D., DrPH., Mika Gissler, M.Soc.Sc., Dr. Phil., Oskari Heikiheimo, M.D., Ph.D.
From the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland (M.M., O.H.), the Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland (M.N.), the City of Helsinki Health Care Centre Unit for Maternity and Child Health Care and Health Promotion (S.S.), The National Institute for Health and Welfare, Helsinki, Finland (M.G., E.H.),
The Nordic School of Public Health, Gothenburg, Sweden (M.G.).
Objective: To assess the rate of adverse events following medical second trimester termination of pregnancy (TOP) and to compare it to those in the first trimester medical TOP.
Methods: This register based cohort study included 26,053 women, who underwent medical TOP in Finland between 1st January 2000 and 31st December 2006. Women were identified from the Abortion Registry. Adverse events related to medical TOP within 6 weeks were searched from the Hospital Discharge Registry. The rate and risk factors for adverse events were estimated during 2003 to 2006.
Results: The rate of surgical evacuation of second trimester medical TOP decreased during the first three years of the study period and thereafter stabilized at 39.5%.Second trimester TOP increased the risk of surgical evacuation (OR 9.3; 95% CI 8.1 to 10.7), especially immediately after fetal expulsion (OR 41.0; 95% CI 32.9 to 51.0). Also the risk of infection was elevated (OR 2.1; 95% CI 1.5 to 2.9). Increased length of gestation did not influence the risk of surgical evacuation or infection in the second trimester medical TOP.
Conclusions: The medical TOP during second trimester is generally safe. Surgical evacuation because of residual tissue is avoided in more than half of the cases, though it is much more common than in first trimester medical TOP. More wide use of medical TOP decreased the use of surgical evacuation. The risk of surgical evacuation and infection does not increase by gestational weeks in the second trimester TOP.
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Oct. 23, 2010, 09:00
Impact of legalizing abortion in Portugal in 2007
Mara Carvalho, Portugal
In Portugal, in the past February 11th of 2007, 59,3% of the Portuguese voted “Yes” to a new abortion law and a certainty became evident: an important majority of the Portuguese society identified a persons’ autonomy as an ethical principle, ensuring a free and universal access to safe abortion by woman’s request up to 10 weeks of gestation. This legal framework allows you to have real numbers on abortion, thereby being able to identify vulnerable groups, access the implications and interpretation of possible changes over time.
In this new setting, the estimated numbers were around 20,000 abortions per year, by woman’s request. In a study made by APF - the Family Planning Association - the number predicted was around 17 000. After the implementation of the law the number of abortions by woman’s request up to 10 weeks was similar to predicted (18 014 in 2008 and 18 951 in 2009), about 70% were performed in the public health system and, of those, the medical abortion was the method chosen in 96% of cases.
Over the past few years have been reported less severe complications (infection / sepsis and
uterine perforation) related to abortion5. It was recently made public the report of the Maternal Deaths 2001-2007. During this period, in 14 of 92 maternal deaths reported, the cause of death was associated with unsafe abortion. Are not yet published the data of maternal deaths in 2008 -2009, but preliminary analysis indicates that there have been no deaths related to abortion after the legalization.Analysing the data we conclude that the big majority of abortions since 2007 were performed in a legal and safe context, the portuguese public health system was capable to properly respond to the abortion requests and regarding the ratio between medical and cirurgical abortion, we realize that medical abortion is the elected method.
In Portugal, three years after the legalization, it’s still urgent to inform all the women that they have a new right of choice with access to non-directive and specialized support and care, to implement consistent Sexual Education policies and improve the abortion network, including medical abortion performed by family physicians.
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Oct. 22, 2010, 08:00
Implementing Resident Training in Abortion: Summary of Ryan Programs in Ob-Gyn Residency Programs in the US and Canada
Jema Turk, F.Preskill, G.Patel, U.Landy and J.Steinauer, USA/Canada
Objectives: The Kenneth J. Ryan Residency Training Program in Abortion and Family Planning (Ryan Program) provides technical and financial support to help US and Canadian obstetrics and gynecology (ob-gyn) residency programs comply with the Accreditation Council for Graduate Medical Education mandate to integrate abortion into training. Since 1999, 54 Ryan Programs have been established in 28 states and in two Canadian provinces. A total of approximately 1600 residents have been trained through the Ryan Program since its inception. Our objective was to describe the clinical and departmental impacts in the Ryan Programs.
Methods: All 54 Ryan training programs are systematically reviewed through pre- and post-rotation surveys completed by residents, and through annual reports, site reviews, and yearly on-line surveys completed by Ryan Program directors, department chairs, and residency program directors. Programs and residents undergo extensive evaluation during the first two years of active funding. Thus, the data discussed here represent evaluation pursued in the first two years of program existence.
Results: A total of 746 residents have completed pre- and post- rotation surveys to date, giving a total response rate of 70%. On average, residents spend 15 days in clinics providing abortion and/or contraception care. The location of training varies between in-hospital clinics (45%), out-of-hospital clinics (40%), and a combination (15%). During the Ryan Program rotation, residents provide pregnancy options counseling, routine and complex contraceptive services, cervical preparation, and perform first-trimester manual uterine aspirations and electric uterine aspirations, medication abortions, and second-trimester dilation and evacuation procedures. Comparing pre- with post-rotation surveys, residents’ self-assessed competence in first and second-trimester uterine aspiration increases significantly, as well as the intention to provide all techniques of abortion after residency. In addition, residents, Ryan Program directors, department chairs and residency program directors describe a variety of benefits beyond residents’ skills in abortion care. These include residents’ skills in counseling, contraception, ultrasound, and outpatient surgery; improved continuity of care for patients; and improved appeal of the residency programs to medical student applicants.
Conclusions: The Ryan Program has been successful in integrating abortion and family planning into 54 (21% of all) US and Canadian ob-gyn residency programs. These rotations have led to approximately 1300 ob-gyns graduating with proficiency in abortion care, and over 75 percent plan to include these skills in their subsequent practice. In addition, the Ryan Program’s successes have contributed to reinforcing the importance of training in family planning as a central part of obstetrics and gynecology.
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Oct. 14, 2016, 02:00
CS04.1
Improving access to abortion care
Sam Rowlands
Bournemouth University, Bournemouth, UKThe following ways of overcoming barriers to access to abortion will be presented: Elabouration by Health ministries as to precisely what the abortion law allows; Exemptions or reimbursement in jurisdictions in which women have to pay for abortions; Drafting by professional societies of country-specific abortion guidelines or dissemination of international guidelines for the benefit of health care professionals; Advocacy by clinicians for improved clinical standards in abortion care; Wide dissemination of information about abortion services to allow choice for women; Availability of medical and surgical methods of abortion at all legal gestations; More first trimester procedures offered within a primary care setting; The option of making appointments via a centralised booking system; Delivery of services as close to women’s homes as possible; Special arrangements for women who live far away from cities or towns; Seamless care pathways for the whole of a woman’s journey; Greater participation in all elements of abortion procedures by staff other than doctors; Tightly regulated and monitored conscientious objection; Information and postabortion care provision by clinicians in jurisdictions in which self-administered abortion is prevalent.