Speeches
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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.
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Oct. 19, 2012, 09:00
Medical management of unwanted pregnancy in
France: modalities and outcomes. The aMaYa study
Nisand, I; Bettahar, K
Gynaecolgy Department CHU Strasbourg, France
Background/Methods: Since WHO recommendations in 2003, the
use of medical termination of pregnancy (MToP) has become
wider in Europe, particularly in France where it concerns more
than 50% of TOPs. However, there are still different practices
according to various guidelines or drug approvals. Following the
recent update of French recommendations (December 2010), a
new observational study was performed to assess in real life
modalities and outcomes in mToP.
Results: One thousand five hundred and eighty-seven women
(mean age: 27.6 ± 6.8; minor: 3.3%) were included by 48 French
specialised centres from September 2011 to April 2012. At the
inclusion, when women were given mifepristone, the gestation of
pregnancy was £49 days of amenorrhoea (DA) for 71.7% of
patients and >49 DA for 28.3% with >63 DA for 2.1%. Most of
the time pregnancy dating was done by ultrasound. The most
frequently used protocol was the one recommended by the French
authorities (mifepristone 600 mg-misoprostol 400 lg oral) and
concerned 35.4% of patients. But other protocols were given
(mifepristone 600 or 200 mg in association with misoprostol
800 lg) for respectively 23.4% and 13.5%. Gemeprost
prostaglandin was used by 1.4% of patients only.
Eighty-one percent of patients attended the follow-up visit
3 weeks after inclusion. There was no ongoing pregnancy although
10% of patients were lost to follow-up. Successful abortion rate
was 94.4%, 5.6% of patients requiring a secondary surgical
procedure. Seventeen serious adverse events (1.1%) were reported
(mainly major bleeding).
Conclusion: Although a relatively wide range of therapeutic
strategies in MToP, this study emphasises a satisfactory success
rate of 95% strongly consistent with the literature.