Speeches
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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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Oct. 19, 2012, 09:00
Unplanned pregnancy- a common reason for
ectopic pregnancy
Kopp Kallner, H
Karolinska Instiutet, Department of Obstetrics and Gynecology,
Danderyd Hospital, Stockholm, Sweden
Objectives: The primary objective of this study was to investigate
what proportion of ectopic pregnancies arises as a consequence of
unplanned pregnancies and the proportion of women receiving
contraceptive counselling after treatment.
Background: Ectopic pregnancy is a potential life threatening
condition. It has a negative impact on future fertility which is
often desired. It is often forgotten that an ectopic pregnancy can
be a consequence of an unplanned pregnancy.
Methods: This was a retrospective study of a total of 68 patients’
electronic medical records. Inclusion criteria were a certain
diagnosis of an ectopic pregnancy and first visit at Danderyd
Hospital AB between 1 June 2011 and 30 November 2011.Results: Fifty-four percent of the ectopic pregnancies were a
consequence of an unplanned pregnancy, 31% were planned and
information was missing for 15% of the patients. In the group of
patients with unplanned pregnancy 70% of the patients in need of
counselling on future contraceptives did not get it upon
completed treatment.
Conclusions: A large proportion of ectopic pregnancies are a
result of unplanned pregnancy. The individual and the healthcare
system have a lot to gain by ectopic pregnancy prevention which
can be achieved by increased use of contraceptives which protect
patients against all unplanned pregnancies. Patients with
unplanned ectopic pregnancies should receive counselling on
future contraceptives after finished treatment. -
Oct. 2, 2014, 12:00
Unwanted pregnancy and contraceptive practice in Latvia
Arta Spridzane1, Areta Tula1, Lasma Lidaka2, Ilze Viberga2 1Riga Stradins University, Riga, Latvia, 2University of Latvia, Riga, Latvia - tula.areta@gmail.com
Objectives. To understand determinants of unwanted pregnancy and investigate factors influencing the decision to terminate pregnancy in Latvia. Materials and methods. Cross-sectional descriptive study based on semi-structured anonymous questionnaires consisting of 47 questions on determinant factors of unwanted pregnancy - given to patients undergoing elective abortion in 40 medical institutions all over Latvia (October 2012 - April 2013). Data analysis: MS Excel 2007, CIA, SPSS 19. Approved by the Central Medical Ethics committee of Latvia. Results. A total of 731 eligible questionnaires were analyzed. The average age of women undergoing elective abortion was 29.2 years. For 47.5% of women this procedure was the first abortion in their life and in 14.6% of cases this was the termination of their first pregnancy. 15% of women were on maternity leave. 84% of respondents had a steady sexual relationship with one partner. 77% of partners supported the decision to terminate the pregnancy. 21% of women had not used any contraceptive method during the intercourse that resulted in the unwanted pregnancy: 28.3% had used withdrawal, 7% - spermicide, and 7% - calendar method. Condoms had been used in 31.6% and COC in 6.4% of cases. 74.3% of women were informed about the emergency contraception pill and 62.4% of study participants knew that it can be acquired over-the-counter, however, only 2% of respondents who were aware of emergency contraception, had used it. 28.2% of women considered emergency contraception harmful to their health. 55% of women stated that they had not made a decision regarding future contraception method following the procedure. Conclusions. Women undergoing elective abortion in Latvia do not use highly effective contraceptives and avoid the use of emergency contraception. Moreover, they have not decided what method of contraception they will use after the procedure thus being at increased risk for repeated unwanted pregnancy and another abortion.
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Oct. 19, 2012, 11:30
Update on contraceptive
developments Although contraceptive use showed a steady
increase worldwide, the needs of a significant
percent of couples have not yet been met, as
unscheduled pregnancies increased.
While implants and IUDs require a health provider
for a proper insertion, vaginal rings, a mid-acting
method, have the advantage of being user-
controlled. While long-acting methods seem
preferable for women with compliance issues,
daily transdermal gels or sprays have shown high
acceptability as the methods can be used privately.
Progesterone receptor modulators (PRMs) to be
used within 120 hours of unprotected intercourse
have a definite role as emergency contraceptives.
Continuous low-dose administration of a PRM
from a vaginal ring has been shown to block
ovulation and induce amenorrhoea.
Contraceptives combined with other agents
should provide dual protection against both
pregnancy and another preventable conditions.
Dual protection methods are tested as vaginal
gels or rings delivering both a contraceptive and
an agent active against HIV transmission. In
addition, the potential of PRMs to prevent breast
cell proliferation or the neuroprotective effects
of progesterone and derived molecules are new
areas of research for contraception with added
medical benefits. These dual-purpose methods
may increase users’ compliance, thus reducing
failures and unwanted pregnancies.Men now tend to accept responsibility for the
couple’s fertility control, leading to a growth in male
contraceptives needs. Non-hormonal methods
for men target the maturation of germ cells, or the
sperm motility and activity. Novel approaches in
women target meiosis as well as genes involved
in follicular rupture. These methods will hopefully
enter clinical testing during the current decade. -
Oct. 19, 2012, 09:00
Uptake of independent counselling in addition to
termination of pregnancy consultation
Nixon, H; Brown, A
Sandyford, NHS Greater Glasgow and Clyde, UK
Sandyford is an integrated sexual health service with over 100 000
visits annually. Our termination of pregnancy and referral
(TOPAR) service sees over 1500 women annually and offers
information, assessment and admission for medical and surgical
termination of pregnancy (TOP). There is access to a trained
counsellor if wished.
Recently in the UK, there have been demands to make
additional counselling or a ‘cooling off’ period compulsory.
Aim: To assess: uptake of counselling in addition to the TOPAR
consultation; and relationship between time to TOP and eventual
decision.
Methods: Records of women attending from September to
November 2011 were accessed to record:
(i) certainty of decision at first visit.
(ii) uptake of additional counselling.
(iii) waiting time to TOP date and final outcome to proceed to
TOP or continue the pregnancy.
Results: Of 384 women with confirmed pregnancies at
consultation:
(i) Twenty-six decided to continue the pregnancy.
(ii) Three hundred and forty-one wanted a TOP and this was
arranged.
(iii) Twenty-eight subsequently did not attend for a TOP and
continued the pregnancy.
(iv) Seventeen women wished more time to consider their
decision and were offered an appointment with a trained
counsellor – two women accepted.
(v) Sixof the undecided women continued thepregnancy,
including the two women who attended for counselling and 11 had
aTOP.
(vi) Neither time to the TOP or gestation influenced the
decision to abort or continue the pregnancy.
Our results suggest that the vast majority of women do not
wish or need additional counselling and that introducing a
‘cooling off’ period or delay would not alter the decision.Post Abortion Family Planning (PAFP) is a key part of any
comprehensive TOP service as this is a vital opportunity in which
to provide family planning, to avoid future unwanted pregnancies.
In order to understand the factors that may impact on the
uptake of PAFP, MSI undertook a baseline survey of all clients
accessing services in four of the MSI country programmes. The
data was collected for 1 month, September 2011.
In total 4081 clients availed themselves of TOP services across
MSI centres in Ethiopia (1974), Nepal (1160), Vietnam (888), and
Zambia (59).
The average age of clients was 27–29 years. Ethiopia was the
only programme with a lower than average age of 22 years.
Eighty-three percent of TOP were performed at under 9 weeks
of gestation. Medical TOP was chosen by an average of 61% of
women: Zambia (90%), Vietnam (76%), Ethiopia (62%), Nepal
(16%).
Sixty-eight percent of women had not been using any
contraception when they became pregnant. Thirteen percent were
using male condom, 9% the oral contraceptive pill, 4% injection,
1% emergency contraception, and 1% traditional methods. No
one had been using implants, IUDs, male or female sterilisation as
a method of contraception when they became pregnant.
This review reflects the baseline factors of MSI clients,
including the low use of contraception in women seeking TOP,
and highlights variables to consider when providing PAFP and
informing the ongoing MSI PAFP project that focuses on
increasing levels of PAFP uptake. -
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.