Speeches
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Oct. 15, 2016, 11:00
CS08.1
Simplified medical abortion screening
Rodica Comendant1, Mark Hathaway2, Ginger Gillespie3, Elizabeth Raymond4
1Reproductive Health Training Centre, Clinical Hospital #1, Chisinau, Moldova, Republic of Moldova, 2carafem, Washington, DC, USA, 3Institute for Family Health, New York, NY, USA, 4Gynuity Health Projects, New York, NY, USAIntroduction: Currently, most providers perform an ultrasound or pelvic examination before medical abortion to assess the duration and location of the pregnancy. These evaluations are expensive, time-consuming and uncomfortable and they must be done by a skilled clinician in a medical setting. Our pilot study is designed to assess the safety and acceptability of offering medical abortion to selected women without either procedure.
Methods: We will recruit women requesting medical abortion in Moldova, the United States, and Mexico. To be eligible, a woman must be certain that her last menstrual period started within the prior 56 days, not have recently been using hormonal contraceptives, have no risk factors for or symptoms of ectopic pregnancy and not have had an ultrasound or examination in this pregnancy. Some sites exclude women with evidence of uterine enlargement on abdominal palpation. Each subject is treated with a standard regimen of mifepristone and misoprostol and followed until the abortion is complete.
Results: Up until May 2016 182 women had been enrolled at three sites. In Moldova 76% of all women having medical abortion at the study site have joined the study. In the United States the proportion is much lower; many abortion clients were ineligible because of irregular menses or contraceptive history and some prefer to have an ultrasound. Of the 175 subjects, with complete follow-up to date, 94% had complete pregnancy termination without additional treatment, 2% had surgical aspiration and 3% had extra misoprostol. No serious complications have occurred related to the absence of initial ultrasound and examination. Most subjects (89%) were pleased with omitting the screening ultrasound and pelvic examination. We will present updated data at the meeting.
Conclusion: Simplifying the screening procedures for medical abortion appears safe and could substantially increase access to this service. -
Oct. 24, 2008, 09:00
Sociologic Aspects of Legalized Abortion in Portugal. 1 Year Experience
Renato Martins, Marisa Moreira, Teresa Bombas, Teresa Sousa Fernandes, Paulo Moura (Portugal)
Genetics, Reproduction and Fetal Maternal Medicine Department, Coimbra University Hospitals, Portugal
renato.alessandre@gmail.com
Introduction. According to United Nations, about 13% of maternal deaths in world were attributed to complications after non safe abortions. In Portugal, in last decades, ten maternal deaths occurred per year due to complications of illegal abortion. Since, July 16th of 2007 abortion is legal before ten weeks.
Objectives. Characterization of the female population that came to our Service for abortion.
Material and Methods. We analysed the clinical files of medical abortion appointment during the period of 1 year from 16th July 2007.
Results. We included 298 females. Average age 28,2±7,6 years.(11,8% adolescents and 20,1% more than 35 years). We reported a 10% of non Portuguese women in our sample. Almost 52% were married. In this sample the authors report an average of 27% of women that had no contraceptive method in use before the abortion. In 90% of the cases this was the first abortion, and the majority of women pointed out economics reasons to justify it. Nearly 90% had a medical interruption, with few cases of complications associated to the method.
Conclusions. The great group of women that come for abortion are not adolescents as it was firstly expected. The majority are Portuguese and live with their partner. A great number of women are not users of Family Planning Services.
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Oct. 14, 2006, 02:00
Summary of current evidence
Helena von Hertzen, MD, WHO, Geneva
During the last ten years the use of misoprostol has escalated in the area of reproductive
health due to its many advantages compared to other prostaglandins, and a substantive
scientific evidence has accumulated suggesting that misoprostol is safe and effective for
various indications, provided the dosage is correct. However, with very few exceptions,
misoprostol has not been licensed for use in obstetrics and gynaecology and this has left
many doctors unsure of their position regarding the use of an off-label drug.
Depending on the indication the strength of scientific evidence varies: experts will agree
e.g. on the benefits of misoprostol compared to other available options for labour induction
and medical abortion. Consequently, misoprostol has been included in the complementary
list of WHO Essential Medicines Library: 25 microgram tablet for the induction of at-termlabour; and the termination of pregnancy of up to 9 weeks (200 microgram tablets) to be
used after mifepristone pretreatment.
More research results may be needed to assess whether evidence-based guidance can be
given regarding other indications. Clinicians agree that cervical priming prior to vacuum
aspiration, or other gynaecological procedures, has become easier thanks to misoprostol.
In addition to the sequential regimen with mifepristone, misoprostol may be used alone to
induce abortion in settings where mifepristone is not available, provided a somewhat lower
effectiveness is acceptable. Misoprostol may also be useful in the treatment of incomplete
abortion, intrauterine fetal death, or in the prevention, and perhaps also in the treatment, of
postpartum haemorrhage, but experts need to agree whether there is enough evidence to
recommend its routine use for these indications. -
Oct. 24, 2008, 09:00
The effectiveness of ultrasound and s-βhCG measurement in predicting failure after medical abortion
Raquel Maciel, Maria Céu Rodrigues, Teresa Oliveira, Fátima Sousa, Lurdes Lima, Paulo Sarmento (Portugal)
Centro Hospitalar do Porto - Maternidade Júlio Dinis, Porto, Portugal
raquelmaciel@gmail.com
Objective. Diagnostic tests’ effectiveness in predicting failure after medical abortion has been subject of discussion in some studies. We compared ultrasound findings and β-hCG levels and tried to determine its cut-off value that would allow us to excuse a routine ultrasound examination as follow-up.
Methods.In 49 women who had opted to interrupt the pregnancy, with a mean gestacional age of 50 days, ultrasound examination and serum β-hCG were performed prior and around the 20th day after medical treatment. On the follow-up we considered as ultrasound findings the endometrial thickness – virtual or with heterogeneous content – the presence of an empty gestacional sac or an embryo arrest, and compared them with their corresponding s-hCG levels – its decrease %, its initial level % and its absolute final value.
Results.Treatment was successful in 92%. There was evidence of a close relation between ultrasound images and their β-hCG levels. The sensitivity of the ultrasound examination was 100% and its specificity was 49%. Despite the ratio of β-hCG initial level’s sensitivity, with a 1,3% cut-off, was the same as the one with a 0,8% cut-off (75%), the specificity of the first revealed to be more favorable (93,3% vs 86,6%).
Conclusion.The percentage of β-hCG initial level determination, combined with clinical examination, can be an effective method in predicting the success of the medical treatment, as an initial procedure. Therefore, ultrasonography should only be considered in prompt cases.
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Oct. 2, 2014, 12:00
The feasibility of offering medical abortions by telemedicine: two years’ experience
Ellen Wiebe1 ,2, Cheryl Couldwell2 1University of BC, Vancouver, Canada, 2Willow Women's Clinic, Vancouver, Canada - ellenwiebe@gmail.com
Objective: To describe the results of our programme of providing medical abortions by telemedicine. Methods: We did a retrospective chart review May 2012 - May 2014. Women saw a physician and counsellor by Skype videoconferencing for screening, information and consent. They went to a local laboratory for hCG tests for initial screening, the day of the medication and one week later. The medications were couriered or a prescription was faxed to a local pharmacy. At the follow-up visit by Skype we discussed her experience and her blood test results. If the hCGs had fallen by 80% in one week, we told her the abortion is completed and she needed no further follow-up. If she needed more medication, surgery or further blood tests, we arranged these. See www.willowclinic.ca. Results: In 24 months we saw 23 women for medical abortions by telemedicine and 65 were seen in clinic for the first visit and booked for telemedicine follow-up. Of the 88 women, three women were lost to follow-up (3.4%), four had surgery (4.5%) and 14 (15.9%) needed another follow up (more misoprostol or just another hCG). During that time, we saw 3757 women for the usual in-clinic medical abortions. Conclusions: This method of providing telemedicine abortions is feasible in our setting and may improve access to abortions. The main innovation in this programme is that the patients were in their own homes using their own technology (a computer or smart phone) and yet we provided the same physician and counseling services as we did in our clinic. Most women prefer to come to the clinic.
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Oct. 2, 2014, 12:00
Training: ultrasound for midwives involved in abortion care
Monica Johansson, Eneli Salomonsson Karolinska Universitetssjukhuset Sesam gyn dagvård, Stockholm, Solna, Sweden - monica.el.johansson@karolinska.se
Background: The aim of the course was to teach both theoretical and practical aspects of ultrasound diagnostics to those who are active in the field of abortion care. Material and Methods: The target audience was midwives and OBGYN residents active in the field of abortion care who had completed a 3-day theoretical course on induced abortion. The curriculum included two half days of lectures and two afternoon sessions with practical training involving simulators or patients at the abortion care unit at Karolinska University Hospital. The theoretical parts included lectures on ultrasound technique, ultrasound devices, ethics, the legal situation, communicating with patients, ultrasound findings in normal and pathological early pregnancies (until week 9+0) and an update on medical abortion care. After having completed the course and a written exam, participants continued practical training under supervision of a local mentor. A minimum of 50 supervised and 50 independent examinations should be documented and approved by the course leaders. 18 midwives and 1 doctor took part in the ultrasound course in 2013. Of the midwives 14 are now certified and work independently. Results: Introduction of midwifery- led abortion clinics has resulted in: shortened waiting times, time saved for patients and staff, better continuity and reduced costs for the clinic. Significance: Training midwives in medical abortion care will help to shorten waiting times, reduce costs and help to better allocate healthcare resources.
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Sept. 10, 2004, 02:00
Use of levonorgestrel-releasing IUS (Mirena®) following medical termination of pregnancy
Oskari Heikinheimo and Satu Suhonen MD, Department of Ob&Gyn, Helsinki University Central Hospital, Finland
Immediate insertion of levonorgestrel-releasing IUS (Mirena®) following first trimester surgical abortion is safe and effective.
We evaluated the post-abortal contraceptive practices among 417 women who chose medical termination of pregnancy (MTP) during the first year of use of MTP in our hospital between August 2000 and 2001. MTP was offered to women with unwanted pregnancy with duration of up to 56 days, and it was carried out by administration of 200 mg of mifepristone on day 0 (visit I) followed by 0.4 mg of misoprostol administrered vaginally on day 2 (visit II). A 3rd visit was scheduled at 3 weeks to control the outcome of MTP.
Future contraception was planned during visit I. 61% of women chose combined oral contraceptive (COC, whereas 29% of women chose intrauterine contraception. A total of 65 women opted for Mirena® (i.e. 16%) and 53 women (i.e. 13%) for Cu-IUD. Of the IUD’s 55% (66% of the Cu-IUDs and 46% of the Mirena® IUSs) were inserted on visit III, and 25% at a later occasion at the clinic. The insertions were uneventul, and no complications requiring removal of the IUD occurred.
We conclude that similarly as following surgical abortion, Mirena® is a safe contraceptive option also following medical abortion. Despite the slight bleeding, Mirena® can be inserted at the time of control visit at approximately 3 weeks following MTP.
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Oct. 13, 2006, 02:00
Very early medical abortion
Peter Safar MD Head of Department*,**, Christian Fiala MD, PhD**
Humanis Klinikum Korneuburg*, Gynmed Clinic Vienna, Austria**
Positive heart rate,fetal viability or at least the presence of the cul de sac in ultrasonografic
scanning are at the moment still the basic conditions for most of the abortion service
providers to start with the medical induced abortion.
But the wish of many women, after a clear decision making is different:
they want to start the procedure as soon as possible!
Presenting case reports we describe our standarts, procedures and follow up programmes
for patients which allowes us to start medical abortion with Mifepristone and Misoprostol
right after the early detection (postive HCG test) of an unwanted pregnancy..
Following our guidelines we are able to minimize the risks and the complications of
undetected ectopic and molar pregnancies. -
Oct. 22, 2010, 02:00
Very early surgical abortion
Patricia Lohr, MD, MPH, Medical Director bpa, United Kingdom
The availability of highly sensitive pregnancy tests means women are now able decide very early in pregnancy if they want to have an abortion, often before an intrauterine gestation can be visualised on ultrasound. Medical abortion with mifepristone and misoprostol is one method of terminating very early gestations; however for some women a surgical option will be preferable. This talk will review safe and effective means of performing surgical abortion before 7 weeks gestation and discuss the risks and benefits as compared to medical abortion with mifepristone and misoprostol.
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Sept. 10, 2004, 09:00
What do women want in Italy?
Giovanna Scassellati, Maurizio Bologna, Maurizio De Felice, Daniela Valeriani andAntonietta Turi, San Camillo-Forlanini Hospital – Rome, Italy
In the year 2003, 500 women using the services of DH/194 filled a questionary:
- 80% of them responded that prefer medical abortion, although they did not have a thorough knowledge of the technique, because they want to avoid any kind of surgery;
- they find the present bureaucratic procedure extremely long and inquiring;
- foreign women, especially Rumanian, live hospital procedures with great annoyance because they are not culturally accustomed to undergo presurgery analyses and the interview with the anaesthetist.