Speeches
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Sept. 15, 2018, 04:30
All restrictions to access abortion services, legal logistic financial, creates social inequality. Women with access to financial means and information will always be able to access safe abortion services and women without the financial resources are most affected by these obstacles. abortion laws. Women on Waves and Women on Web use new technology (drones, robots, internet, apps) and research, to break the taboo around abortions and change policies and laws and in the same time make sure women have access to contraceptives and safe medical abortions. This presentation will highlight some of the work, achievements and challenges in the past years.
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Oct. 4, 2014, 11:00
FAQ, Frequently Asked Questions in abortion care
Ellen Wiebe1, Philippe Faucher2 1University of BC, Vancouver, Canada, 2Hôpitaux Universitaires Est Parisien, Paris, France - ellenwiebe@gmail.com
Women presenting for abortion come with questions, both voiced and unvoiced. They often believe misinformation about exaggerated risks of infertility and depression and many are worried about pain. Abortion providers want to choose the best protocols and to relieve the unnecessary anxiety and pain. In this session we will address four issues. 1. Pain control: How can we best relieve the anxiety about pain and the pain of medical and surgical abortions? We will discuss the use of local and general anaesthesia, intravenous sedation, oral medications and non-pharmaceutical methods of pain control. 2. Antibiotic prophylaxis: What is the evidence about preventing endometritis in medical and surgical abortions? We will present the number needed to treat (NNT) with antibiotic prophylaxis in order to prevent each case of endometritis so that we can make the best choices for our patients. 3. Reproductive outcome: What is the actual risk of infertility (including Asherman's syndrome), miscarriage, premature delivery and abnormal placental insertion after abortions? We know these risks are low, but we need to address the anxieties of our patients as well as our colleagues. 4. Long-term sequelae: What are the actual risks of psychological problems and of breast cancer after abortions? There has been so much bad science on these topics and we need to assess the validity of the evidence. We will also address the issue of how to communicate this evidence effectively to our patients and our colleagues.
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Oct. 15, 2016, 02:00
CS15.2
Practical management of midtrimester abortion
Linda Hunt
Royal Infirmary, Edinburgh, UKThis presentation will cover the practical aspects of managing mid trimester medical abortion as conducted by a nurse midwife.
It will draw upon experience from a Scottish hospital setting in Edinburgh where all mid trimester abortions have been performed medically using mifepristone and misoprostol for more than 25 years (approximately 120 per year). The presentation will cover management of complicated cases including the scarred uterus and twin pregnancy. It will also give practical advice for how to manage pain relief and how long to wait before intervention for retained placenta. -
Oct. 15, 2016, 11:00
CS10.2
RCOG Leading Safe Choices: Training abortion providers in South Africa
Alison Fiander3, Judith Kluge1 ,2
1University of Stellenbosch, Western Cape Province, South Africa, 2Tygerberg Hospital, Western Cape Province, South Africa, 3Royal College of Obstetricians and Gynaecologists, London, UKThe Choice-on-Termination-of-Pregnancy ACT of 1996 changed laws in South Africa from highly restrictive to more liberal laws for abortion provision. It legalised abortion-on-demand for women in the first trimester and allowed abortion provision for socio-economic reasons, amongst others, up to 20 weeks gestation. The law also allowed trained registered nurses to provide both surgical and medical abortions in the first trimester. In the ensuing years, non-governmental organisations such as Marie Stopes and IPAS assisted the Department of Health with training of nursing staff. Following withdrawal from South Africa by some NGO's a void was left in comprehensive abortion care training. Additionally, other ongoing challenges to ensuring designated TOP facilities had trained staff to provide abortion services continued. In 2011 only 57% of designated abortion facilities were providing abortion services. A persistent high proportion of abortions are performed in the second trimester. Forty present of women who had a second trimester abortion had initially presented to a health facility in the first trimester but had the procedure delayed at the facility or by a requirement to refer to other health facilities. Women still have unsafe abortions, accessing illegal abortion providers. Unsafe abortions also occur in legal facilities due to lack of training and services failing to meet minimum standards.
The RCOG Leading Safe Choices initiative aims to improve the competence and standing of abortion care providers. It has recently been implemented in Western Cape Province, South Africa with the training of master trainers in December 2015. Subsequent Comprehensive Abortion Care training was initiated in March 2016. The Best Practice paper on Comprehensive Abortion Care was included in the Western Cape Province Department of Health Abortion Policy in 2016. Progress regarding this initiative in South Africa will be presented. -
Oct. 15, 2016, 11:00
CS11.2
Reasons for the use of medical versus surgical abortion in Europe
Alberto Stolzenburg
Clínica Ginecentre, Málaga, SpainAlthough most countries in Europe have similar abortion laws and belong to the most advanced category in the world, the implementing regulations can in practice facilitate or hinder access to abortion care. In the same way, since the legalisation of Mifepristone in France in 1988, the use of specific drugs in the abortion practice has spread in Europe unevenly but there are still significant differences from one country to another.
We classify the countries as follows:
- Countries with high prevalence of medical abortion
- Countries with prevalence of medical over surgical abortion
- Countries where both methods are used with similar frequency
- Countries with a predominance of surgical over medical abortion
- Countries with high prevalence of surgical abortion
The main reasons affecting the use of medical versus surgical abortion are:
- Legislation, administrative and health regulations
- Legalisation of Mifepristone
- Legal and off-label use of prostaglandins (Misoprostol)
- Where (type of health care facility, inpatient and outpatient care)
- Public or private institution
- Who performs abortions (gynaecologists, general practitioners, nurses, midwives)
- Conscientious objection
- Preference for usual practice ("culture") by health professionals and also the women
- Access to continuing vocational training, dissemination of knowledge (medical guidelines: WHO, RCOG, IPPF, NAF etc.)
- Scientific research, especially use of drugs in abortion care
- Political factors (conservative or liberal governments)
- Economic factors
- Cultural and religious factors
This paper reviews the impact of these factors in different European countries and regions.
Proposals are presented to improve the availability of the most appropiate method for each woman, according to their special circumstances.
Our top priorities: medical safety and free method choice for the women -
Sept. 14, 2018, 04:00
Medical and surgical methods of abortion are highly effective, safe, and acceptable to women. Women value being offered a choice of methods and receiving a preferred method is a strong predictor of satisfaction with care. For women who do not have a strong preference for a particular method, clinical trial evidence suggests that randomisation to a surgical abortion results in higher satisfaction rates than randomisation to a medical abortion.
While providers may wish to optimise women’s abortion experience by offering a choice of methods, this can be challenging with the increasing shift toward medical methods and the very early gestational ages at which women now present for abortion care. Surgical abortion under general anaesthesia may be cost-prohibitive and the predominance of medical abortion in some settings can reduce opportunities for obtaining surgical skills. Providers may be uncertain of whether or how to offer surgical abortion in the earliest weeks of pregnancy.
This talk will address the evidence supporting the offer of a choice of abortion methods and will discuss less resource intensive models of outpatient surgical abortion care as well as a protocol for providing surgical abortion before a gestational sac is visible on ultrasound. -
Sept. 15, 2018, 01:00
The scientific community emphasizes the evident need to utilize an effective contraceptive method as rapidly as possible following an abortion. After surgical procedure: There is no question in regards to the convenience of inserting intrauterine contraceptives immediately after a surgical termination, if the woman so desires. Like many other groups we offer this presentation with 250 IUD inserted immediately after a surgical termination, at the end of the procedure through out 2015 and 2016. The results after a year of follow up, are equivalent to others that are usually published on the the subject of continuation, expulsion, failure and satisfaction of the IUD. When shall the IUD be inserted following a MToP? In our opinion, as soon as possible, that is, in the first follow up visit after the procedure. There is no benefit in delaying the insertion. Therefore we refuse the notion of delayed insertion (3-4 weeks after the abortion) and we recommend an early insertion (between 5 and 14 days after the MFP intake.) Often, the follow up visit is the only opportunity for the patient to begin using an adequate contraceptive. The benefits of LARC over SARC are evident. We will present a study of the early insertion of 115 IUD after MToP through out 2015 and 2016. The results, as we will prove, are similar to in IUD users in general.
Our recommendation:
-Insert the IUD as soon as possible
-Take advantage of the opportunity of follow up visit
-Let none leave the follow up visit without an adequate contraceptive.
References:
1.-Heikinheimo O, Gissler M,Suhonen S. Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion. contraception. 2008;78:149-154
2.-Cameron ST, Berugoda N,Johnstone A, et al.Assesment of a “fast track” referral service for intrauterine contraception following early medical abortion. J Fam Plann Reproductiva Health Care. 2012;38:175-178
3.-National Institut for health and Welfare. official Statistics from Finland. Induced abortion 2015 (Internet). Published Oct 2016. Available from: http/urn.fi/URN:NBN:fife2016102025429 -
Sept. 15, 2018, 02:00
The future would be to expand this service to the legal gestation age of 23+6 weeks. This service has exponentially expanded over the past 3 years to cater for women with complex co-morbidities, which require a multi-disciplinary team involvement. I shall present the unit’s case load, complexities and methods of achieving a safe outcome with the focus for ensuring a high uptake of long acting reversible contraceptives.