Speeches
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Sept. 10, 2004, 02:00
Waiting period: Do women need it?
Kristina Hänel-Groh, MD, has 10 years of experience as a sex therapist and abortion doctor in a Family Planning Centre. Is the owner of an abortion clinic and is the author of the book: “Die Hölle der Löwin. Geschichten einer Abtreibungsärztin”.
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In several countries exists a prescription by law which demands from women a waiting time between the counselling and the abortion itself. This time is in Germany 4 days up to seven days in other countries.
This lecture is based of interviews from women which at one hand had an abortion and on the other hand from persons which are working as counsellors.
The following questions had been given to the women:
- At what time the pregnancy was noticed
- When did they do the decision for an abortion
- Is the prescribed waiting time helpful for the decision
The following questions had been given to the counsellors:
- How many women had already done their decision, when the came to the counselling
- Is counselling in general helful for the women
- Is the demanded waiting time itself helpful
Purpose of this lecture is to ask, if the prescribed waiting time is useful or if it’s more a medical risk because the abortion could be done later then.
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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.
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Oct. 19, 2012, 09:00
What is the outcome of pregnancies that continue
following administration of mifepristone?
Olver, M; Scherf, C; Noble, N
Cardiff and Vale NHS Health Board, UK
Introduction: The number of medical terminations of pregnancy
(TOPs) in England and Wales in 2010 compared with the year
2000 shows an 8% increase. Despite the rapid increase there is
little published evidence regarding the risks to a continuing
pregnancy after mifepristone administration.
Objectives: To investigate the outcome of all cases of continuing
pregnancy after administration of mifepristone +/- misoprostol in
the Cardiff and Vale University Health Board over a period of
4 years.
Methods: A retrospective case note review of all women with
unplanned pregnancies who wished to continue their pregnancy
after administration of mifepristone. Women were identified by
non-attendance or cancellation for misoprostol, follow-up cases
and searching antenatal records. The review period was 2007–2011.
Results: Twenty cases of continuing pregnancies were identified.
Of these, 10 resulted in live birth, five in miscarriage, two were
lost to follow-up and three needed a second TOP procedure (one
of them was given Clause E, fetal abnormality).
Conclusion: This case series shows the most common
complication following mifepristone administration is miscarriage
in the first trimester. Those pregnancies leading to live birth did
not result in adverse fetal outcomes. However, due to the small
sample size, damage to the fetus cannot be ruled out and
therefore close monitoring throughout pregnancy should be
performed. This detailed case review highlighted the need for
more work in this area to enable clinicians to provide correct
advice to women in these difficult situations. -
Sept. 11, 2004, 11:00
Where is the evidence : results from clinical trials
Helena von Hertzen , MD, DDS,
Since 1990 Medical Officer, UNDP/UNFPA,WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Managerial responsibility for the research initiated and carried out by the Research Group on Post-ovulatory Methods for Fertility Regulation, and for the research on breast-feeding with emphasis on its birth spacing effect.
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The absolute efficacy of emergency contraception (EC) can only be investigated in placebo controlled trials. As such trials have never been undertaken, we do not know with certainty how effective emergency contraceptive pills are. It is evident that the copper IUD is very effective when used for EC, as there were no pregnancies among nearly 2000 women who had a copper IUD inserted after unprotected intercourse.
Different hormonal EC regimens have been compared in large randomized controlled trials (RCT), which constitute a sound tool to estimate a difference between treatments if properly conducted. It should be noted, however, that comparison of pregnancy rates between trials is subject to bias as women's characteristics and eligibility criteria usually differ. The main outcome in efficacy trials of EC is the occurrence of pregnancy, which is a rare event even if no EC is used: it has been estimated that even without treatment only some 8% of women would become pregnant after one act of unprotected intercourse. Thus, the trial size has to be large enough to provide power for treatment comparisons. Such large RCTs have demonstrated that both levonorgestrel and mifepristone are more effective and better tolerated than the regimen of combined oral contraceptives.
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Oct. 25, 2008, 04:00
Where should medical abortions take place?
Elisabeth Aubény (France)
10, rue du Docteur Lancereaux, 75008, Paris, France
aubeny@orange.fr
Medical abortion takes places in 2 stages: the administration of mifepristone which inter00:rupts the pregnancy then, 48h later, the administration of a prostaglandin which results in expulsion of the uterine content. Where should these two medicines be provided and taken? Mifepristone is currently bought by the doctor and taken by the woman in his presence. Why should the woman not buy mifepristone herself at the pharmacy with a medical prescription and then take it, like any other medicine, at home? Fear of a black market? Prostaglandins. The regimen for Misoprostol administration varies from one country to another. In many countries administration of misoprostol takes place in a hospital centre, followed by a 3h monitoring period due to fear of serious adverse events including and haemorrhage at the time of expulsion. Experience shows that, for pregnancy of less than 49 DA, this precaution is not medically necessary with a regimen of mifepristone 600 mg + oral misoprostol 400µg. For this reason in Sweden and France the administration of misoprostol “at home”is now authorised. Studies have demonstrated that this approach is also possible up to 63 DA but with a different regime: mifepristone 200 mg + misoprostol 800µg by vaginal or buccal route. This technique is authorised in Sweden and practiced in the USA (900,000 cases) without related problems. This “at home” administration of misoprostol allows avoidance of one consultation and thus simplifies the method. It is very well accepted by the women who chose it: greater intimacy and confidentiality. However, certain women prefer to be in a medical environment at the time of administration of misoprostol and during the hours that follow. It is important that women are able to choose between the two options. From 63 DA until the end of the first trimester medical abortion is not legally authorised anywhere. However, it is sometimes used. In this case, it is essential that the women take misoprostol in hospital and that they are monitored until expulsion has taken place as bleeding may be heavy and pain must be actively managed. Also at these later gestations products of conception are more visible and must be disposed of appropriately. When using gemeprost, this requires to be stored in a freezer, and the administration must take place in a hospital centre.
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Oct. 2, 2014, 12:00
Whether contraception is effective enough
Galina Dikke1, Liubov Erofeeva2 1Russian Peoples Friendship University,, Moscow, Russia, 2All-Russian Association for Population and Development, Moscow, Russia - erofeevfamily@mail.ru
Relevance. Despite the wide choice of contraception in Russia the number of unwanted pregnancies is 41%, most of them are terminated artificially totalling about 1 million per year. Objectives: To study the frequency of the contraception methods used, their effectiveness in the population of the Russian women. Material and methods. In-depth and structured interviews conducted with 1027 women aged 18-45 years in 7 Federal Russian districts in 34 localities. Anonymous survey of 161 patients who applied for abortion on request. Results. Contraception was used by 85%, 15% did not use it. Modern methods (LNG IUSs) used - 46%, condoms - 45%, natural/traditional - 32%. Two methods simultaneously used by 38%. Condoms the most popular - 45%, COC - 30%, coitus interruptus - 23%. LARC: copper IUDs - 11%, releasing systems used by 4.5%. 3 months before this pregnancy 52% used contraception: natural methods - 9%, traditional amounted to 14%, modern - 87% (IUD - 16%, COC - 60%, condoms - 25%). In the structure of hormonal methods, proved ineffective were: COC - 37%, transdermal patch - 27%, vaginal ring - 16%, injection - 6%. 56% of women were looking for, but could not get a doctor's consultation for family planning. Discussion. Half of women who became unwillingly pregnant were using modern contraceptive methods. Nearly 60% of the "failure" is among COCs users, which is 2.5 times higher than among condom users, which does not coincide with the theoretical data on these methods effectiveness (the Pearl Index for condoms is higher than for COCs). Conclusion. The reason for the lack of effectiveness of hormonal methods is its inappropriate use by the consumers because of the limited accessibility to medical care and advice on this matter. Another possible reason is the prevalence of traditional methods and the lack of LARCs among promoted ones.
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Oct. 20, 2012, 04:00
About 15% of pregnancies
terminate spontaneously in the
first trimester .The majority of these miscarriages
are unrecognized clinically.. As the levels of
progesterone fall expulsion of the products of
conception occur spontaneously and resumption
of cyclical ovarian activity with 2-3 months.
Modern methods of medical abortion using
mifepristone and a prostaglandin simulate closely
the mechanisms which occur in spontaneous
abortion suggesting that it is likely that the
majority will resolve spontaneously without further
intervention(Baird 2002) . Blockage of the action
of progesterone with mifepristone results in
powerful uterine contractions which together with
an increased sensitivity to prostaglandin leads to
expulsion of the fetus and placenta.(Baird 2002).
Extensive research over the last 30 years has now
identified a simple regimen (Mifepristone followedby misoprostol) which is highly effective(on-
going pregnancy<1%), is free from serious
side effects and does not require sophisticated
facilities(WHO2003). Several studies have shown
that abortion can be safely delivered by relatively
unskilled health workers (mid-level providers
MLP) who have been trained to follow an agreed
protocol of treatment(Shannon &Winnikoff 2009
Warriner et al2011). By devolving provision of
abortion to MLP the access to abortion should
be greatly widened. As predicted in the original
report of medical abortion with mifepristone and
gemeprost that “this combination would have
particular application in countries where skilled
medical and surgical experience are in short
supply” (Rodger & Baird 1987 ) -
Sept. 10, 2004, 02:00
Practical aspects of abortion
Who is paying for abortions in Europe?
A comparative study
Christian Fiala, Sophie Hengl, Chantal Birman
Christian Fiala, MD
Gynmed Ambulatorium, Vienna
Karolinska Institute, Division of Woman Child Health, Stockholm
Introduction: Despite the steadily growing attention for abortion practices, little is known about the economic aspects of abortion. Although medical, psychological, political and legal issues have been recurrently raised within an international context, there clearly remains a lack of comparative data on the actual costs of abortions. The present study provides an overview on abortion costs throughout Europe including cost coverage and refund policies of national health care systems.
Material and Methods: Data were collected with a questionnaire, which was sent out to abortion providers, gynecologists, hospitals, family planning centers, and health care organizations. Responses were processed qualitatively as well as descriptively. The costs of abortions in each country were interpreted relatively to the per capita indicator of the Gross Domestic Product (GDP); this allowed for more accurate comparisons of the results.
Results:Abortion costs vary considerably throughout Europe. Even within the European Union, patients’ costs for the abortion range from € 0 to € 517,-. However most countries in Western Europe provide full or almost full refund to a majority of women. In contrast, most women in Eastern Europe as well as in Austria have to pay by themselves. And there are still a few countries where due to the persisting pressure of the Catholic church women have no access to abortion at all because of its illegal status: Ireland, Malta, Poland, and Portugal.
Conclusion: We are currently engaged in the application of evidence-based medicine as well as in joint international efforts to further improve the health care systems. With regard to the access to abortion in Europe, the particularly heterogeneous economic conditions seem to reflect an “evidence-free zone”. There seems to be insufficient communication and cooperation among health care professionals regarding the practical aspects of abortion. It seems essential to recall that easy access to free contraception and abortion services is not a mere luxury; rather, it is the very basis for the high standards both of women’s reproductive health and generally, life in society.