Speeches
-
Oct. 13, 2006, 09:00
Advantages of the Implementation of a Quality Control System in a Abortion Clinic
Rodríguez, E.; Gómez, M.; Serrano, J.; González, M.; Martin, M. Rubio, C.
Clínica El Sur, Sevilla, Spain
Quality control programs are being used more often to promote business . Since they have
been proved to be very effective we believe that they could also be implemented in the
medical sector, specifically in interruption of pregnancy. After four years of quality control
program which we have implemented in our clinic it has been succesfull. In colabaration
with other specialist we have brought this poster so that it might encourage others to
introduce this program in their clinics.
The supervision, and certification of a quality control program by an international
enterprise which specialises in QUALITY CONTROL means describing, documenting and
making protocols with regards to all the practices in that business, establishing a
consensus on the standards at all levels.
The main objective of our quality management program is client satisfaction. It involves
establishing mechanisms in order to obtain a continuos improvement in the service which
we offer i.e. performing abortions. It also involves monitoring the results of these
standards. In order to achieve this we plan the objectives of organization, formation of our
personal, control and analize our desviations that occur so that we can rectify them and
hence securely value the most important areas of our enterprise, suppliers, products,
maintance of our equipment, infrastucture, the satisfaction of our clients etc. -
Sept. 11, 2004, 04:00
A good law is not enough
Pierre Moonens MD, Member of the Board of the “Fédération de Centres de Planning Familiaux”, member of the Board of “Gacehpa”, Belgium. Co-founder and Vice President of Fiapac
In my daily work at a southern family planning of Belgium, a third of our clients are coming from Luxemburg. They do not find an opportunity to be aborted in their own country. This situation is very surprising: the Luxemburg’s law is very similar to the Belgian one, and any way those women should find the possibility to be helped by their own medical structures, but it does not work.
Why is it so?
Which “bad reasons» do give the possibility to those medical structures not to apply their law?
Even in Belgium, we do not use all the potentialities of our so said “good law”.
What did we loose in Belgium with the introduction of our so said “good law”, in comparison with the previous so said “bad obsolete law”?
How has it be possible in Spain, with such a weak law, to develop a so “liberal” situation for women asking for abortion?
Some tactical and ethical reflections when the opportunity appears to improve a national
law about abortion.
-
Oct. 20, 2012, 04:00
Alternative ways for follow up Women who choose outpatient medical abortion
are typically given an appointment for a follow up
visit several days to two weeks after they have
used the medications. Yet almost no women
require intervention or additional treatment at
such follow up visits. Providers and women have
sought safe ways to reduce the number of women
who need to return to the clinic. This presentation
discusses strategies to reduce the need for
universal return visits, including telemedicine, use
of various electronic media, and the development
and promise of semi-quantitative pregnancy tests,
including data from recent research. -
Oct. 22, 2010, 02:00
Anaesthesia: local vs general
Andre Seidenberg, Switzerland
Local anaesthesia as the safest analgesic method for a surgical abortion up to 12 weeks could fall into oblivion in many high standard countries. WHO (2003), British (RCOG 2004) and French (ANAES 2001) official guidelines recommend to favour local in preference to general anaesthesia.
These guidelines refer mainly to an old but very large American CDC study on mortality (Peterson 1981, Lawson 1994). Nevertheless the evidence to favour local in preference to general anaesthesia was confirmed by several new studies with morbidity parameter as end points (Osborn 1990, Thonneau 1998, Pons 2004).
Deaths from abortion are very rare in developed societies with good access to legal medical care. In the US 8.5 deaths per 1 million abortion were registered in the CDC-study. Nearly four times more death cases were recorded after general than after local anaesthesia. In-depth analysis of the large data set revealed this disadvantage of general anaesthesia, both among those woman whose death was directly caused by the anaesthesia as well among those whose died through causes not directly connected to the analgesic technique. Confounding factors like sterilizations, pre-existing diseases or gestational age had no crucial influence: general anaesthesia remained 2.5 times riskier than local anaesthesia.
No doubt general anesthesia techniques have improved during the past 3 decades. E.g., Halothane had undesired effects on the uterus. Nevertheless, the younger studies exhibit more perforations of the uterine wall, cervical lesions and severe bleedings through general anaesthesia than through local anaesthesia (Soulat 2006, Osborn 1990).
Even so, we want to point to the fact that local anaesthetics could be lethaly overdosed. Experience and good surgical technique are of high importance for surgical abortion (Hern 1990). The technique of local anaesthesia for surgical abortion was described in a dissertation monograph by Ambassa 2007. Independent of the lower costs, many women prefer to have an abortion under local anesthesia rather than under general anesthesia, when given the choice (Bachelot 1992).
-
Oct. 22, 2010, 08:00
Analysis of medical abortion in first trimester in a small regional hospital in Slovenia
Eva Macun, General Hospital Jesenice, Slovenia
Introduction: Medical abortions have been performed in General Hospital Jesenice since 2005. The first attempts were made during our participation in the WHO supported study which was coordinated by Gynecological Department of the University Medical Center in Ljubljana. Both drugs that are used regularly for medical abortions (mifepriston and misoprostol) are not register at the Agency for Medicinal Products and Medical Devices of Slovenia. Therefore a special approval is needed for their import. Our doctors needed time to accept the method but since 2009 two thirds of all abortions have been performed using this method. One step forward has been made and a clinical pathway for medical abortion is being prepared. Our final goal is to make the method widely available, to educate all the involved professionals and to make it possible for home use.
Methods: In the current presentation an analysis of all performed medical abortions from 2005 to 2009 is shown. All data were collected by hand. A WHO protocol was used for medical abortions under 9th week of pregnancy. Women were given 200mg of mifepriston orally and after 36-48 hours 800µg of misoprostol vaginally. For women, who were pregnant 9 to 12 weeks, the protocol was adjusted for every single pregnancy.
Criteria for successful abortion that we used after 14 days were: no gestational sac, endometrial lining thinner than 15 mm, if there were hiper- and hipoechogenic areals in the endometrial lining from 15 to 20 mm, we prescribed uterotonic and antibiotic therapy and ultrasound control after menstrual period. In case of prolonged bleeding we did a curettage.
In other cases we took this as unsuccessful abortion and completed it with a curettage.
Results:We performed 124 medical abortions in this time. Till 49 days of amenorrhea we performed 75 abortions: 3 patients needed curettage, because there remnants of trophoblast in the endometrial lining after 14 days. Success rate of the method in our department was 96%.
Between 7th and 9th week we performed 39 abortions. Two needed additional curettage (5%).
We also performed 10 abortions between 9th and 12th weeks. All were successful.
All together the success rate was 93.4%. for abortions performed in women who were pregnant less than 12 weeks. We found no complications (heavy bleeding, infection).
Conclusions:In our department the method is very successful. We see a lot of potentials in promoting medical abortion in Slovenia, because we have really good experience with it, our patients prefer medical over surgical abortion, we need less professionals, we will make a clinical pathway for hospital use. But our goal is to perform medical abortion at home, because the method is safe. In this project good cooperation would be achieved with local gynecologists who will follow the patients at home.
-
Oct. 2, 2014, 12:00
A national campaign to de-stigmatize abortion in France: why?
Danielle Gaudry, Marjorie Agen, Shiva Bernhard Le Planning Familial, Paris, France - d.gaudry001@wanadoo.fr
Abortion and contraceptive methods are a fundamental part of Human Rights: women have a right to choose whether to be pregnant or not. WHO guidelines about safe abortions demonstrate that the legalization and improved safety and accessibility of abortion are essential for women's health: postabortion deaths disappear, postabortion complications, including accidental infertility, are reduced. In the August 2011 report to the UN "Right of everyone to enjoyment of the highest attainable standard of physical and mental health" the Special Rapporteur considers "the impact of criminal and other legal restrictions on abortion conduct during pregnancy; contraception and family planning and the provision of sexual and reproductive education and information. Some criminal and other legal restrictions in each of those areas, which are often discriminatory in nature, violate the right to health by restricting access to quality goods, services and information. They infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity." It is violence against women to oblige them to stay pregnant when they don't choose to be pregnant. In French society, as well as other European countries, the model of pregnancy and maternity in a heteronormative family is prevalent. Traditionalists, in the "la manif pour tous" movement, dream about a social standard where women are the complement of men and where equality between the sexes doesn't exist. The rejection of the Estrella report by the EU parliament and the "one of us" initiative have demonstrated easily that "obscurantism is at our doorstep" (Veronique Keyser). Some official decisions recently taken in France, including the 100% refund for abortion and the change of law on the reference to distress, are positive signs, and the campaign in Luxembourg for instance, contribute to lifting the taboo on the right to abortion. Many hospitals and abortion centres however have disappeared since 2001, with governmental budget cuts resulting in the merger of French hospitals. Women are obliged to wait two to three weeks for an appointment, often traveling 60 to 80 km to access surgical or medical abortion. These facts are real difficulties in the exercise of the right to abortion. For these reasons, it is critical to provide a communication platform to women, their relatives, and medical professionals, to allow a debate about abortion without prejudice or guilt. So, the Planning Familial has created a website where everyone can improve abortion rights, by answering a questionnaire, monitoring social networks and forums, sharing the poster and the site address. More than 1,000 questionnaires have been completed to date, since April 2014. We would like to present the site "l'avortement, un droit à defendre" to the FIAPAC.
-
Oct. 24, 2008, 09:00
And after the Referendum?
Matilde Salta, Mara Carvalho, Vasco Freire (Portugal)
Médicos pela Escolha – Doctors for Choice in Portugal
medicospelaescolha@gmail.com
In Portugal, in the past 11th of February of 2007, a certainty became evident: that an important majority of the Portuguese society identified clandestine, illegal abortion like a Public Health problem, legitimizing the right to safe abortion by the woman’s request, as part of a plenum exercise of Sexual and Reproductive Rights, Universal Human Rights.
The new abortion law respects a person’s autonomy as an ethical principle, ensuring a free and universal access to safe abortion, a procedure performed by or with the help of qualified health care professionals. This new legal setting allows us to have concrete numbers about abortion, so that, by evaluating the numbers, we identify vulnerable groups, try to know its causes and consequences and provide the necessary support and interpret possible variations over the time, with longitudinal studies.
The DGS – Direcção Geral da Saúde (General Health Bureau in Portugal) predicted for the year after the implementation of the law 20000 abortions. In a study made by APF – Associação para o Planeamento da Família (the Family Planning Association) the number predicted was around 17000 abortions a year. Still awaiting annual results, in the first 5 months of law application, 6000 abortions were registered, and after eleven months the number was 12000, numbers a bit low when compared with the initial predictions. Why this happened and what can happen next are important discussions in terms of evaluating the effectiveness of the system and constantly, the level of information of the people.
Regardless of if the next annual numbers corroborate or not the tendency of the first eleven months, it is necessary to stretch the experience in other European countries where abortion is legal for several years: clandestine abortion tends to become almost absent with the legalization, but it’s a process with several years of evolution; the diminishing of the abortion rate and the raising of the women/couples doing effective contraception (to avoid unwanted pregnancies) is fundamentally related with the implementation of an effective Sexual Education and Health Care policies that improve the access to Family Planning and modern Contraception. In Portugal, one year after the implementation of the law, it’s still urgent to:
- Inform all the women that they have a new right of choice, an informed choice, with access to non-directive and specialized, support and care.
- Implement consistent Sexual Education policies, with obvious medium/long term benefits in preventing other Public Health Problems, like all the STDs.
Improve the Family Planning and abortion network. For example: creating conditions so that medical abortion is accessible to women in all the public primary care health services; equip the national health system with more human and technical means that answer not only to the needs of the women that want to interrupt their pregnancies, but also to the ones related to requests for definitive chirurgical contraceptive methods; all the hormonal contraceptives should be freely distributed.
-
Oct. 13, 2006, 08:00
Abortion then & now
Margaret Sparrow MD, New Zealand
Abortion has been present throughout history and in all cultures. This historical perspective
is to remind us of what has happened in the past, so that we have a better understanding
of the present which will assist us as we develop good practice guidelines for the future. In
the past women frequently risked their health, their fertility and their lives with unsafe
procedures and in many parts of the world they still do. The use of traditional methods has
been common but many treatments for self-abortion are unsafe or ineffective. Whenever
safe medical services are unavailable illegal abortionists will flourish. Poor women are the
most vulnerable often paying with their lives. In many countries including my own, New
Zealand, abortion is still regarded as a crime rather than as a medical procedure or as a
matter of personal human freedom. Laws in many countries have been a barrier to change
but changes have occurred through public and professional awareness, protest activity,
commissions, petitions, court cases, feminism and by advances in medical technology.
Now, in developed countries where abortion is legal, it is the most common gynaecological
operation and one of the safest. -
Oct. 22, 2010, 08:00
A pilot study on women’s experiences with misoprostol at home or in the hospital in medical abortion up to 63 days of pregnancy.
Monica Johansson, Eneli Salomonsson and Helena Ekberg, Dept of Woman and Child Health,
Division of Obstetrics and Gynecology, Karolinska Institutet / Karolinska University Hospital, Sweden
Background: Home-use of misoprostol in medical abortion up to 63 days of pregnancy was approved in Sweden in 2004. It is now an increasingly popular option for women undergoing first trimester induced abortion. The experiences with misoprostol at home or in the hospital were explored among abortion seeking women.
Methods: Mifepristone 200 mg was given orally in hospital under nursing supervision. Women were provided with misoprostol tablets 800 g and advised to take them vaginally 36–48 hours later either at home or in the hospital. A follow-up visit was performed a few weeks after the misoprostol treatment.
The main outcome measures were:
1) acceptability assesses as satisfaction with the choosen method.
2) feasibility, assessed through successful completion of abortion at home without the need for hospital admission.
In addition contraceptive choice and uptake was investigated.
Results: A total of 53 women participated in this pilot study. Of these, 29 women aborted at home and 24 in the hospital. The majority of women were satisfied with their choice of method and place of treatment. Two women per group reported not being satisfied. No surgical interventions were reported but two women per group had unscheduled visits to the clinic before the Follow-up (FU).
Follow-up was performed after a mean of 24 or 20 days among women who administered misoprostol at home or in the clinic, respectively. At that time all women except two per group reported that they considered it highly important to avoid another pregnancy at the moment. Six or 7 women per group had had sex before the FU. Among them 6 and 4 women, respectively, had not started any contraceptive method. In the first group (home-use of misoprostol) 6 women had started contraception before the FU and 12 started at the FU while in the second group 9 women started before the FU and 7 at FU.
Conclusions: This study supports that women should be free to choose their preferred location of the induced medical abortion. The reason why so many women postpone post abortion contraception despite stressing the importance to avoid a pregnancy needs to be further explored.