Speeches
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Oct. 22, 2010, 08:00
Improving the Provision of Contraception of the Day of Medical Abortion
Helen Nixon and Audrey Brown, NHS Greater Glasgow and Clyde, UK
Introduction:
Annually over 13000 women undergo therapeutic abortion in Scotland. Over 25% of these abortions are carried out in women who have previously undergone abortion. One strategy to reduce the number of abortions is to ensure the provision of reliable contraception on the day of abortion.
Objectives:
To describe national campaigns to increase uptake of long-acting reversible contraception, and to improve contraceptive provision at the time of medical abortion,
to describe a local training programme to achieve the national standards
to compare the provision of reliable contraception at the time of medical abortion before and after the introduction of the above
Methods: Case notes of women requesting medical abortion and accessing our abortion assessment clinic were reviewed for a 3 month period in 2007 (n=180) and 2010 (n= 157). Method of contraception chosen at the time of abortion assessment was recorded, as was method of contraception provided on the day of abortion.
Results:
% requesting method in 2007
% supplied with method in 2007
% requesting method in 2010
% supplied with method in 2010
COCP
33
39
31
38
POP
13
16
7
6
Implant
19
1
32
26
IUD/IUS
11
0
10
0
DMPA
14
18
11
11
Barrier
1
4
3
3
Nil/undecided
9
22
6
16
TOTAL
100
100
100
100
Discussion: Women who choose the oral or injectable contraception are usually provided with the method on the day of medical abortion in both 2007 and 2010. Although 19% of women chose a contraceptive implant in 2007, only 1% of women were fitted with an implant on the day of medical abortion. Several national campaigns, and local projects to enable medical abortion unit staff to fit contraceptive implants, took place during 2008 and 2009. Between 2007 and 2010, there was an increase in number of women choosing a contraceptive implant, from 19% to 32%. In addition, a contraceptive implant was fitted on the day of medical abortion in 26% of women, compared to 1% three years previously. Intra-uterine contraceptive methods are not fitted on the day of medical abortion in our unit. Despite around 1 in 10 women choosing this method, they cannot be provided with their chosen method at the time of abortion. Most women fail to return for interval IUD/IUS insertion, potentially leaving them at risk of further pregnancy. Consideration should now be given to improving timely provision of intra-uterine methods.
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Oct. 20, 2012, 04:00
Increasing access to safe
abortion servicesMedical abortion with mifepristone and a
prostaglandin analogue was developed into a
safe and effective method for induced abortion
in the 1980’s. Today the prostaglandin analogue
of choice is misoprostol and medical abortion
is a safe option for termination of pregnancy
at all gestational lengths. However, several
barriers remain that limit global access to safe
abortion services. Simplifying medical abortion
could potentially contribute to increased access
and acceptability. Possible approaches include
the option to self-administer misoprostol at
home. Another possibility is task sharing with
midlevel providers to allow these health care
professionals to be more involved with the care
of healthy women undergoing medical abortion.
This possibility is likely to have major impact
to increase access to safe induced abortion in
countries were medical resources are scarce. A
simplified treatment regimen may also include
home self-evaluation of complete abortion, an
option which is currently being investigated. -
Oct. 14, 2006, 11:00
Infection related mortality following medical abortion in North America
Mary Fjerstadt, Clinical Training Director, Planned Parenthood
Consortium of Abortion Providers, El Cajon, USA
Among an estimated 560,000 women who have had medical abortion with mifepristone
and misoprostol in North America, there have been 6 deaths related to infection:
One death in Canada during clinical trials: C. sordellii
Four deaths in California: C. sordellii
One death in western U.S.- C. perfringens
FDA and CDC held a meeting in May 2006 to discuss what is known and unknown about
C. sordelii. Since the FDA/CDC meeting and the publication of the article in the New
England Journal of Medicine about the C. sordellii deaths and mifepristone abortion,
reports of C. sordellii following spontaneous abortion and childbirth have emerged.
This presentation will discuss the conclusions of the FDA/CDC meeting, the clinical
presentation of the cases, the hypotheses that have been put forward to explain why these
infectious deaths have occurred, and the system of adverse event reporting in the U.S.
and Planned Parenthood. -
Oct. 25, 2008, 11:00
In Iraq “illegal termination of pregnancy” still happens!
Inas Alhamdani, Taghreed Alhaidari (Iraq)
Al Elwyia Maternity Teaching Hospital and College of Medicine, Baghdad University, Baghdad, Iraq
irhfpa@yahoo.com
Background. 55.000 unsafe abortions take place all over the world, with 95% in developing countries and with more than 200 maternal deaths per day. In the Arab World 5% of all maternal deaths are due to unintended abortion related complications. The 2003, the UNFPA reports showed that Iraq has an increase in spontaneous and unsafe abortions but with no data on the exact number of illegal terminations.
Aim. To assess how wide the problem is, throughout a survey performed in 2007 at one of the big maternity centers in Baghdad; that is Al Elwyia Maternity Teaching Hospital.
Methodology. The current work presents an observational longitudinal study, including 322 women who present cases of illegal termination of pregnancy from a total of 3100 women who terminated their pregnancy before 24 weeks of gestation for any indication during the year 2007. All those women had a direct interview with special questionnaire, clinical examination was conducted thereafter.
Results. Out of the total 3100 women admitted for termination of pregnancy, 322 were confirmed to have illegal termination. That represents 10. 4% of the total. Most of the patients (62%) were between 20-30 years old, with 69.9 % already having children. The most common mode of termination was the combined medical and surgical method, which has been performed by medical or paramedical staff (86,9 %). In 93.7 % of cases, pregnancy was confirmed by ultrasound. Failed contraception due to improper pills intake represents 53% of the cases. Decision for termination was taken by the wife herself in 64% of cases; mainly due to financial reasons. The most common presentation was septic abortion (86%), with 89.4% requiring 1 to 3 units of blood transfusion.
Conclusion and Recommendations. Illegal termination of pregnancy is still an ethical, religious and medical problem all over the world, including our country. The main determining factor for termination of pregnancy amongst those women seemed to be the fact that it was unwanted and/or unplanned; either due of inappropriate timing, problems in the relationship itself, or due to social and economic implications, which are important issues in Iraq. The main problems encountered were improper contraceptive use in spite of very good awareness and/or the desire to use, as well as the abuse of misoprostol (which is not yet approved in our country) by pregnant women and paramedical staff . There is a real need for thorough attention to update our national family planning and access to contraception policy, in order to meet the emerging social demands.There is also an urgent need to integrate abortion care related services into the overall reproductive health care, as part of a broader and safer motherhood plans.
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Oct. 2, 2014, 12:00
Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion
Veronique Berard1, Christian Fiala2 ,6, Sharon Cameron3, Teresa Bombas4, Mirella Parachini5, Kristina Gemzell-Danielsson6 1ICB - CNRS, Division MaNaPI, Département Nanosciences, Université de Bourgogne, Dijon, France, 2Gynmed Clinic, Vienna, Austria, 3Chalmers Centre, NHS Lothian, Edinburgh, Scotland, UK, 4Obstetric Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 5San Filippo Neri Hospital, Rome, Italy, 6Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden - mparachini@gmail.com
Objectives: Misoprostol (Cytotec®), is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Cytotec® tablets are packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions. The effect of prolonged exposure upon bioactivity of misoprostol and resultant clinical efficacy is unknown. Therefore, this study was undertaken to assess possible changes in tablets exposed to usual European temperature and humidity conditions. Design and Methods: To compare the pharmaco-technical characteristics (weight, friability), water content, misoprostol content and decomposition product content (type A misoprostol, type B misoprostol and 8-epi misoprostol) of misoprostol tablets Cytotec® (Pfizer) exposed to air for periods of 1 to 720 hours (30 days), to those of identical non-exposed tablets. Four hundred and twenty tablets of Cytotec® (Pfizer) were removed from their alveoli blister and stored at 25°C/60% relative humidity. Water content, and misoprostol degradation products were assayed in tablets exposed from 1 to 720 hours (30 days). Comparison was made with control tablets (N=60) from the same batch stored in non-damaged blisters. Results: By 48 hours, exposed tablets demonstrated increased weight, friability, and water content (+78.8%) compared to controls. Exposed tablets also exhibited a decrease in Cytotec® active ingredient (misoprostol) dosage (-5.1% after 48 hours) and an increase in the inactive degradation products (+ 25% for type B, +50% for type A and +60% for 8-epi misoprostol after 48 hours) compared to controls. Conclusion: Exposure of Cytotec® tablets to ‘typical' European levels of air and humidity results in significant time-dependent changes in physical and biological composition that could impact adversely upon clinical efficacy. Health professionals should be made aware of the importance of appropriate storage and handling of Cytotec® tablets.
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Oct. 15, 2016, 04:00
PS05.1
Integrating abortion training in sexual and reproductive health care
Johannes Bitzer
University Hospital Basel, Basel, SwitzerlandPreventing unwanted pregnancies is a main objective of sexual and reproductive health care. This is achieved by women and men-friendly contraceptive services including patient centred counselling, availability of all methods, shared decision making, follow-up care etc. In reality, women are still very often confronted with unwanted pregnancies which they experience as a threat to their global health. These women need a high standard of abortion care including easy and rapid access to abortion services; non discriminative, empathic care; shared decision making about the available methods; safe and professional procedures by well trained professionals; qualified and appropriate follow up including postabortion contraception.
These qualities should be provided by recognised abortion training for health care professionals in the field of sexual and reproductive health
Abortion training: The training has to be based on 3 elements:a) Knowledge:
- Knowledge about epidemiological data, early and late pregnancy development, endocrine and non endocrine factors involved in pregnancy development, diagnostic procedures to determine the pregnancy week, diagnosis of missed and threatened abortion
- Knowledge about medical and non medical abortion techniques (dosages, timing, procedure) efficacy, risks, side effects, Standard operating procedures
- Knowledge about postabortion contraceptionb) Skills:
- Case for medical abortion. Exact procedure
- Technique of surgical abortion (simulation) assisting, performing under supervision, performing alone
- IUD and implant insertionc) Attitudes:
Group discussion about ethical and psychosocial, sociocultural aspects of abortion and critical incident reporting -
Oct. 2, 2014, 12:00
Integrating abortion within a community sexual and reproductive health service: a qualitative study of the experiences of women and health professionals
Carrie Purcell1, Sharon Cameron1 ,2, Anna Glasier1, Julia Lawton1, Jeni Harden1 1University of Edinburgh, Edinburgh, UK, 2NHS Lothian, Edinburgh, UK - carrie.purcell@ed.ac.uk
Background: Abortion in Scotland has historically been provided in a hospital setting. The availability of early medical abortion (EMA), and the possibility for women at early gestations choosing to go home to pass the pregnancy (soon after receiving misoprostol form the abortion service), have enabled the provision of abortion from an integrated community sexual and reproductive health (SRH) service. However, little is known about the impact of the clinical setting on the experiences of staff involved in the EMA service. This paper presents findings from the staff experience arm of a qualitative evaluation of EMA provision in both SRH and hospital settings. Objectives: - To examine the experience of nurses, nursing aides, doctors and sonographers involved in EMA provision. - To explore whether, and in what ways, the clinical setting shapes this experience - To highlight areas for good practice/ improvement Method: Qualitative interviews (N=35) were conducted with staff involved in EMA provision at one SRH-based and two hospital-based abortion services in central Scotland, between October 2013 and April 2014. Interviews were coded using NVivo 10 software and analysed thematically. Results: Staff in both settings emphasised the importance of team working and cited the quality of care offered as a success of the EMA service. They also described experiencing challenges, including: boundaries between roles, training, resource constraints, adjustment to change, and the perceived marginalisation of abortion services. Relative differences were identified between clinical settings, for example: nursing staff in the SRH setting described greater involvement with post-abortion contraceptive uptake; nursing aides in the SRH context expressed more negative views on their work role. Conclusions: There are many similarities of experience across staff groups and between clinical settings. Differences between the settings reflect the benefits and the challenges of the new SRH service.
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Oct. 19, 2012, 09:00
Interval insertion of IUDs after induced termination
of pregnancy: do women come back?
Melville, C; McInally, J; Struthers, G; Crombie, A
NHS Ayrshire & Arran, UK
Background: Long-acting reversible contraceptive methods are
recognised as the most effective methods of contraception. Our
termination of pregnancy (TOP) service offers IUD insertion at
the time of surgical TOPs however IUD insertion is not available
at the time of medical TOP. In 2010 we launched a post-TOP
IUD fitting service. Women are offered an appointment 28 days
after their medical procedure in line with FSRH guidance. We
reviewed this service in order to inform future provision and to
determine whether women would return for this appointment.
Methods: A retrospective review of cases was performed using the
electronic patient record (Eclipse) and the ward appointment
diaries. The number of IUD appointments arranged, the number
of patients who attended, and the type of IUD inserted were
collected for the first 12 month period of the service (January–
December 2010).
Results: In the first year of the service, 76 IUD fitting
appointments were made for women after induced TOP. Of these
76, 29 women attended (38%). The DNA (did not attend) rate
was 62%. Nineteen IUS devices were inserted and 10 copper
IUDs.
Conclusion: Although the DNA rate of 62% is high, this is
reflected in other similar services and for other follow up
appointments after induced TOP. Ideally, IUD insertion would beavailable at the time of all induced TOPs, however with our
current staffing model this is not possible. To increase attendance
at the IUD service, we recommend using a text reminder service.