Speeches
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Oct. 19, 2012, 09:00
Self-assessment of success of early medical
termination of pregnancy: a service evaluation
Cameron, S1,2; Glasier, A1,2; Dewart, H1,2;
Johnstone, A1,2; Burnside, A1,2; Paterson, B1,2;
Hunt, L1,2; Rahimi-Rizi, J1,2
1 NHS Lothian, UK; 2 University of Edinburgh, UK
Introduction: In a recent study, we demonstrated that telephone
follow- up with a self-performed low sensitivity urine pregnancy
(LSUP) test was effective to determine the success of early medical
TOP (<9 weeks of gestation). In the latter study, one half of
women surveyed stated that they would have chosen self
assessment (without a telephone call), if available. We
subsequently introduced self-assessment with a self-performed
LSUP test to our hospital TOP service in Edinburgh, Scotland.
Women choosing this option were given detailed information on
symptoms that may indicate an ongoing pregnancy and advised to
contact the service if symptoms or LSUP suggested ongoing
pregnancy.
Methods: Ongoing service evaluation of self assessment with
LSUP test as a method of follow up after early medical TOP,
consisting of review of the proportion of women choosing this
follow-up, contacting the service, and the efficacy for detecting
ongoing pregnancies.
Results: To date, out of a total of 89 women having early medical
TOP, 66 have opted for self-assessment (74%), 18 for telephone
follow-up (20%) and four for a clinic follow up with ultrasound
(4%). Only three of the first 66 women (4.5%) choosing self
assessment have contacted the service, because of pain/bleeding
(n = 1), discharge (n = 1) and a positive LSUP (n = 1). To date
there have been no known ongoing pregnancies in the self
assessment group.Conclusion: Initial findings suggest that self-assessment with a
LSUP test is a popular choice for women. Few women contact the
service, suggesting that women are confident in managing follow-
up in this way. -
Oct. 14, 2006, 02:00
Selfperception of Swedish gynaecologists performing abortions
Meta Lindström, Umeå University, Department of Clinical Sciences, Obstetrics and
Gynecology, Sweden
Background. The Swedish gynecologists possess three decades of experiences of
working with legal abortion. It is of great importance both for women in society and for the
gynecologists themselves to learn from their experiences. The aim of our study was to
describe Swedish gynecologists’ clinical and emotional experiences when working in
abortion care. Further aims were to elucidate their perception of women’s motives for
having abortion as well as looking for possible demographic and gender differences.
Methods. A questionnaire comprising both structured and semi-structured questions was
sent to a random sample of 269 Swedish gynecologists. The response rate was 85%.
Results. The female gynecologists were younger (27-59 yrs) and numerically more than
the males (33-66 yrs). Almost all believed that gynecologists should be involved in abortion
care, and half were opposed to the privilege of refusing to work with TOP (termination of
pregnancy). The gynecologists supported the shift from surgical to medical abortions but
not to them being managed in primary healthcare. A few gynecologists (n=42) had
considered changing their job because of TOP being part of their work. Misgivings
occurred sometimes in connection with surgical and late abortions (n=60 and n=108
respectively). Few gynecologists (n=33) had felt inadequate when encountering abortion
patients and more than half thought that working with TOP was a positive experience. The
gynecologists expressed that continuing professional development and ongoing guidance
of TOP matters were important.
Conclusions. In general, Swedish gynecologists have no doubts about taking part in and
performing TOP. However, there are differences in opinions especially regarding surgical
and late term abortions. Due to the fact that female gynecologists were younger and
therefore had fewer years of work with TOP comparisons of females’ and males’
experiences could not be done. Trends of gender differences were noticed concerning the
right of having possibility to refuse taking part in TOP on personal grounds and with male
gynecologists feeling to a higher extent inadequacy compared with females meeting the
abortion seeking women. Gynecologists’ clinical and emotional experience, as expressed
in this study, as well as their perception of women’s motives for abortions, indicate that
they have gained deep insights and developed their professionalism in their work with
TOP. -
Oct. 2, 2014, 12:00
Sexual behaviour and knowledge on contraception and STIs among Slovenian secondary-school students: differences regarding type of school
Bojana Pinter1, Tinkara Srnovrsnik1, Fani Ceh2 1Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia, 2The National Educational Institute, Ljubljana, Slovenia - bojana.pinter@guest.arnes.si
Objective: To present the differences among secondary-school students on sexual behaviour and their knowledge on contraception and sexually transmitted infections (STIs), regarding type of school. Methods: The study was done on 969 randomly selected 3rd grade Slovenian secondary-school students of both genders by self-administered questionnaire in year 2012. Descriptive statistics and chi-square test were used. Results: Students were attending professional school, vocational school or gymnasium (12.6 %, 43.9 % and 43.5 %). Their average age was 17.5 +/- 0.7 years. Sexual intercourse have ever had was shown in 64.8 % of vocational-school students, 59.5 % of professional-school students and 47.2 % of gymnasium students (p < 0.001). Use of effective contraception (condom, hormonal contraception or double method) at last sexual intercourse was high (87.4 %) with no differences regarding type of school. Self-assessment of knowledge on different types of contraception revealed better knowledge among gymnasium students. Self-assessment of knowledge on STIs revealed poorer knowledge among vocational-school students. Vocational-school students were more likely to get information on sexuality from their parents and less likely from the internet than others; books and magazines were more often used by gymnasium students. Gymnasium students would more often use books and magazines, friend's advice or internet to get more information on sexuality. Sexuality education was most frequently performed in gymnasium (77.0 %) and least frequently in vocational school (64.7 %) but in the latter students were more satisfied with it. Conclusions: There were significant differences among secondary-school students in sexual behaviour and knowledge on contraception and STIs, regarding type of the school. Systematic sexuality education is needed to minimize the differences.
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Oct. 24, 2008, 02:00
Should gynaecologists be obliged to perform abortions?
Marc Bygdeman (Sweden)
Department of Woman and Child Health, Division for Obstetrics and Gynecology, Karolinska Hospital, S171 76, Stockholm, Sweden
bygdeman@privat.utfors.se
In 1999 the U.N. General Assembly agreed that “where abortion is not against the law, health systems should ensure that such abortion is safe and accessible”. The woman has the right to be treated with respect, empathy and understanding of there difficult situation. However, some health care providers may find that providing care would present for them a personal moral problem – a problem of conscience. Respect for conscience is important but the effect when exercised by physicians and/or other health care personal is to fustrate or negate patients’ legal right of access to abortion. To force gynecologists to perform abortion may therefore not be in the best interest of the woman. It should, however, be stated that conscientious refusal is only valid for performing the abortion. All health care providers, independent of their attitude to abortion, must provide the woman with accurate and unbiased information about their legal rights, the procedure and have the duty to refer the woman in a timely manner to other providers willing to perform abortion. Conscientious refusal to perform abortion is a personal matter and should not be applied to health-care institutions. As in some European countries medical care should be organized so that a woman can obtain an abortion at anytime and to ensure the availability of an adequate number of providers so that women are able to exercise their right to abortion.
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Oct. 14, 2006, 09:00
Should ultrasound be shown to the woman?
Lotti Helström, MD, PhD, Department of Women’s Health, Stockholm South Hospital,
Sweden
There is an ongoing discussion whether to show the ultrasound screen or picture to the
woman and/or her male partner at the pre abortion medical examination or not. It has been
clamed that the picture might influence her in her decision and force her to feel guilt or
shame of her wish to terminate her pregnancy. On the other hand the picture might help
her to realize and clearly view her situation and thus help to the right choice. There is a
point in regarding the woman as the only individual able to make the right choice and see
the medical staff only as her servants, serving her with the information that she needs for
making the complex decision about how to realize her maternity in this specific situation.
Hers is the choice, to see or not, and to choose the information necessary. -
Oct. 2, 2014, 12:00
Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a checklist in Rajasthan, India: study protocol and intervention adaptation of a randomized controlled trial
Mandira Paul2, Kirti Iyengar1 ,4, Sharad Iyengar4, Kristina Gemzell-Danielsson1, Birgitta Essén2, Marie Klingberg-Allvin3 ,1 1Karolinska Institutet, Stockholm, Sweden, 2Uppsala University, Uppsala, Sweden, 3Dalarna University, Falun, Sweden, 4Action Research, Training for Health (ARTH) Society, Udaipur, India - mandira.paul@kbh.uu.se
Background: The WHO suggests that simplification of the medical abortion regimen will contribute to an increased acceptability among women and providers. It is expected that home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. This study protocol describes an RCT that aims to evaluate the efficacy of home-based self-assessment after a medical abortion and the acceptability and feasibility of the intervention in a low-resource setting. Method/Design: The study is a randomised, controlled, non-superiority trial that will evaluate the effectiveness and acceptability of self-assessment using a low-sensitivity pregnancy test and a checklist two weeks after medical abortion. Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. Eligible women randomised to the self-assessment group will use the low-sensitivity pregnancy test and the checklist at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. To ensure feasibility of the self-assessment intervention an adaptation phase took place at the selected study sites before study initiation. This was to optimize and tailor-make the intervention and the study procedures and resulted in the development of a pictorial instruction sheet on how to use the low-sensitivity pregnancy test and the checklist of danger signs after a medical abortion. Discussion: In this paper, we will describe the study protocol for a randomized controlled trial investigating the efficacy of simplified follow-up in terms of home-based self-assessment, two weeks after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor.
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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. 2, 2014, 12:00
Social counselling in the field of the rights to family planning and to termination of pregnancy
Zlata Licer, Lili Dreu University Medical Centre Ljubljana, Division of Gynaecology, Ljubljana, Slovenia - zlata.licer@kclj.si
The right to family planning and to artificial termination of pregnancy is a basic human right. Social counselling on an individual basis should enable people to choose freely to have children and to have access to social rights during periods of distress. Expert assistance in decision-making is necessary in different stages of life, especially among vulnerable groups of women, which consist mainly of a) adolescents, b) women with a pregnancy over 10 weeks and c) women over 35 years of age. Counsellors must treat their sexual and reproductive health as their basic human right and take into account all their needs. For example, adolescents must have a right to comprehensive sex education, education for equal gender relations and youth-friendly and accessible reproductive healthcare. Women with a pregnancy over 10 weeks are usually in a difficult social situation while older women tend to feel more emotionally vulnerable. In the field of artificial termination of pregnancy counsellors need to be especially attentive to provide their clients with all the relevant information which enables the clients to make autonomous decisions in relation to their reproductive health.