Speeches
-
Oct. 14, 2006, 05:00
How to overcome the resistance against medical abortion
Mirella Parachini, MD
San Filippo Neri Hospital, Rome, Italy
OBJECTIVE: To understand how it is possible to overcome the resistance against medical
abortion in order to improve the right of women to choose.
RESULTS: Since the introduction of a pharmacological method to induce early abortion
there has been a strong resistance to it, even in those countries where legal abortion is
allowed with surgical techniques. Today the question about the choice of the method
seems to replace the historical debate about the interruption of an unwanted pregnancyamong pro-life groups and conservative politicians. Many claim that the “abortion pill”
makes women less responsible for their behaviour. On the other hand, even among those
not ideologically against abortion, there is a refusal of medical abortion concerning the lack
of health care assumed with a “self abortion”. Moreover in some countries abortion clinics
are refusing to offer it for fear of legal repercussions. Both medical and surgical abortion
are currently safe and effective when performed by trained practitioners according to
tested protocols under adequate conditions. However anti-choice campaigners try to
involve the public opinion and doctors about the risks of the drug, in an attempt to oppose
the access of the drugs in some countries, like in Canada, Australia and Italy. It is
therefore necessary to increase the information, considering that any medical procedures
is submitted to a scientific control, but keeping out of the debate ideological aims to
maintain restrictions on women’s right to choose.
CONCLUSIONS. There is a strong resistance at various levels against medical abortion
and a continuous scientific debate is requested from the abortion providers, beyond
ideological arguments. -
Oct. 13, 2006, 02:00
How to verify success hCG or ultrasound
Christian Fiala, MD, PhD, Gynmed Clinic, Vienna, Austria
Objectives: Medical abortion with Mifepristone and Misoprostol is effective in 95-98.6% of
cases. We compared ultrasound examination and HCG testing to determine the
effectiveness of the treatment.
Study Methods: 217 women with an unwanted pregnancy up to 49 days of amenorrhea
were treated between 26 April and 10 November 1999. They received 600mg Mifepristone
and 400µg Misoprostol 48 hours later. Expulsion was not verified routinely. An ultrasound
examination and HCG test was performed on day one and between days 6-18.
Results: The treatment was successful in 98.6 % of cases. A total of three curettages had
to be performed; one for continued pregnancy, missed abortion and haemorrhage
respectively. One patient had a missed abortion but expelled after hormone withdrawal.
Expulsion of the sac was verified in six patients. HCG levels at the control visit dropped to
3 % in average (SD 3) ranging from 1-17 % in all cases of successful abortion, with three
exeptions of 27%, 32% and 44%. The two missed abortions and the persistent pregnancy
led to an HCG rate of 91%, 159 % and 7900% respectively.Endometrium measured 10 mm on average (SD 4) at the control visit in the cases of
successful abortion, ranging from 1-24 mm. Diagnosis of successful treatment could be
based on ultrasound examination in only 66% of cases, owing to the early stage of the
pregnancy in the remaining cases.
Conclusion: Measuring HCG level before and after treatment gave a reliable result in
98.5% of successful abortions, compared to 66% with ultrasound examination. -
Oct. 25, 2008, 02:00
Ibuprofen and paracetamol for pain relief during medical abortion
D.S. Seidman, A. Livshitz, R. Machtinger, G. Yerushalmi, Y. Ben David, M. Spira, A. Moshe-Zahav, L. Lerner Geva, E. Schiff (Israel)
Department of Ob. & Gyn., Women and children's research unit and Gertner Institute for Epidemiology, Sheba Medical Center, both affiliated to Sackler School of Med., Tel-Aviv University, Tel-Aviv, Israel
dseidman@tau.ac.il
Background. Non-steroidal anti-inflammatory drugs (NSAIDs) have long been avoided in pain relief protocols for medical abortion because of concern over their potential inhibition of prostaglandin induced uterine contractions.
Objective. To determine whether the use of the ibuprofen for pain relief is effective and whether it can adversely affect the outcome of medical termination.
Methods. In a prospective double-blind controlled study 120 women undergoing medical abortion with 600 mg oral mifepristone and 400 mcg oral misoprostol were randomized to receive ibuprofen or paracetamol when pain relief was necessary.
Results. Ibuprofen was found significantly more effective (p<0.0001) for pain relief after medical abortion compared with paracetamol. Other parameters that significantly influenced the pain score after administration of the analgesics included the pain score before the analgesia and abortion in the past. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% versus 8.5%).
Conclusions. Ibuprofen was found highly efficient for pain reduction during medical abortion and more effective than paracetamol. We also found that a past history of a surgical or medical abortion was predictive for high pain scores. Importantly we found that despite its anti prostaglandin effects ibuprofen did not interfere with the action of misoprostol and was not associated with an increase in surgical interventions.
-
Oct. 20, 2012, 11:30
Dr. Comendant holds a PhD as an obstetrician
gynaecologist. She is the Director of the
Reproductive Health Training Center (RHTC)
of Republic of Moldova, and since 2005 has
served as the Coordinator of the International
Consortium for Medical Abortion. In this capacity,
she successfully supported the development of
the ICMA regional networks in Latin America,
Asia, and Eastern Europe. Additionally, Dr.
Comendant is the National Coordinator of Safe
Abortion Programme of the Reproductive Health
Strategy of Republic of Moldova, an attendant
Professor of the Department of Obstetrics and
Gynecology of State University of Medicine
and Pharmacy of Moldova, a regional and
international trainer in safe abortion methods,
a senior consultant for Gynuity Health Project,
USA, and a consultant for the WHO Strategic
Assessment of Abortion in several countries.
ICMA: global, regional and national networking to
reduce the burden of unsafe abortion
In spite of increased attention to sexual and
reproductive health and rights, and particularly
to maternal mortality, in spite of the development
of effective technologies to make abortion very
safe, pregnancy-related deaths and unsafeabortion remain a major public health problem in
largeparts of the world.
There are many organisations working worldwide
to improve women’s access to safe abortion
services – through advocacy, law and policy
reform, capacity building, service delivery, training,
information sharing and networking. Everyone
feels there is a growing need to link together and
combine the efforts towards ensuring the right to
safe abortion in all the countries. It was agreed an
international movement is needed to challenge the
growing threat posed by conservative political and
religious forces who are seeking to turn the clock
back, block efforts to improve laws and provide
services, and exclude abortion from maternal
mortality reduction and family planning initiatives.
This is why representatives of several dozen
NGOs from all world regions, consulted and
called together by the ICMA and it’s four affiliated
regional networks (ASAP, EEARC, CLACAI and
ANMA), in 2011-12, decided to launch the
International Campaign for Women’s Right to
Safe Abortion in April 2012, which after only a few
months has been endorsed by more than 620
groups and individuals all over the world. -
Oct. 23, 2010, 09:00
Impact of legalizing abortion in Portugal in 2007
Mara Carvalho, Portugal
In Portugal, in the past February 11th of 2007, 59,3% of the Portuguese voted “Yes” to a new abortion law and a certainty became evident: an important majority of the Portuguese society identified a persons’ autonomy as an ethical principle, ensuring a free and universal access to safe abortion by woman’s request up to 10 weeks of gestation. This legal framework allows you to have real numbers on abortion, thereby being able to identify vulnerable groups, access the implications and interpretation of possible changes over time.
In this new setting, the estimated numbers were around 20,000 abortions per year, by woman’s request. In a study made by APF - the Family Planning Association - the number predicted was around 17 000. After the implementation of the law the number of abortions by woman’s request up to 10 weeks was similar to predicted (18 014 in 2008 and 18 951 in 2009), about 70% were performed in the public health system and, of those, the medical abortion was the method chosen in 96% of cases.
Over the past few years have been reported less severe complications (infection / sepsis and
uterine perforation) related to abortion5. It was recently made public the report of the Maternal Deaths 2001-2007. During this period, in 14 of 92 maternal deaths reported, the cause of death was associated with unsafe abortion. Are not yet published the data of maternal deaths in 2008 -2009, but preliminary analysis indicates that there have been no deaths related to abortion after the legalization.Analysing the data we conclude that the big majority of abortions since 2007 were performed in a legal and safe context, the portuguese public health system was capable to properly respond to the abortion requests and regarding the ratio between medical and cirurgical abortion, we realize that medical abortion is the elected method.
In Portugal, three years after the legalization, it’s still urgent to inform all the women that they have a new right of choice with access to non-directive and specialized support and care, to implement consistent Sexual Education policies and improve the abortion network, including medical abortion performed by family physicians.
-
Oct. 22, 2010, 08:00
Improving the Provision of Contraception of the Day of Medical Abortion
Helen Nixon and Audrey Brown, NHS Greater Glasgow and Clyde, UK
Introduction:
Annually over 13000 women undergo therapeutic abortion in Scotland. Over 25% of these abortions are carried out in women who have previously undergone abortion. One strategy to reduce the number of abortions is to ensure the provision of reliable contraception on the day of abortion.
Objectives:
To describe national campaigns to increase uptake of long-acting reversible contraception, and to improve contraceptive provision at the time of medical abortion,
to describe a local training programme to achieve the national standards
to compare the provision of reliable contraception at the time of medical abortion before and after the introduction of the above
Methods: Case notes of women requesting medical abortion and accessing our abortion assessment clinic were reviewed for a 3 month period in 2007 (n=180) and 2010 (n= 157). Method of contraception chosen at the time of abortion assessment was recorded, as was method of contraception provided on the day of abortion.
Results:
% requesting method in 2007
% supplied with method in 2007
% requesting method in 2010
% supplied with method in 2010
COCP
33
39
31
38
POP
13
16
7
6
Implant
19
1
32
26
IUD/IUS
11
0
10
0
DMPA
14
18
11
11
Barrier
1
4
3
3
Nil/undecided
9
22
6
16
TOTAL
100
100
100
100
Discussion: Women who choose the oral or injectable contraception are usually provided with the method on the day of medical abortion in both 2007 and 2010. Although 19% of women chose a contraceptive implant in 2007, only 1% of women were fitted with an implant on the day of medical abortion. Several national campaigns, and local projects to enable medical abortion unit staff to fit contraceptive implants, took place during 2008 and 2009. Between 2007 and 2010, there was an increase in number of women choosing a contraceptive implant, from 19% to 32%. In addition, a contraceptive implant was fitted on the day of medical abortion in 26% of women, compared to 1% three years previously. Intra-uterine contraceptive methods are not fitted on the day of medical abortion in our unit. Despite around 1 in 10 women choosing this method, they cannot be provided with their chosen method at the time of abortion. Most women fail to return for interval IUD/IUS insertion, potentially leaving them at risk of further pregnancy. Consideration should now be given to improving timely provision of intra-uterine methods.
-
Oct. 20, 2012, 04:00
Increasing access to safe
abortion servicesMedical abortion with mifepristone and a
prostaglandin analogue was developed into a
safe and effective method for induced abortion
in the 1980’s. Today the prostaglandin analogue
of choice is misoprostol and medical abortion
is a safe option for termination of pregnancy
at all gestational lengths. However, several
barriers remain that limit global access to safe
abortion services. Simplifying medical abortion
could potentially contribute to increased access
and acceptability. Possible approaches include
the option to self-administer misoprostol at
home. Another possibility is task sharing with
midlevel providers to allow these health care
professionals to be more involved with the care
of healthy women undergoing medical abortion.
This possibility is likely to have major impact
to increase access to safe induced abortion in
countries were medical resources are scarce. A
simplified treatment regimen may also include
home self-evaluation of complete abortion, an
option which is currently being investigated. -
Oct. 14, 2006, 11:00
Infection related mortality following medical abortion in North America
Mary Fjerstadt, Clinical Training Director, Planned Parenthood
Consortium of Abortion Providers, El Cajon, USA
Among an estimated 560,000 women who have had medical abortion with mifepristone
and misoprostol in North America, there have been 6 deaths related to infection:
One death in Canada during clinical trials: C. sordellii
Four deaths in California: C. sordellii
One death in western U.S.- C. perfringens
FDA and CDC held a meeting in May 2006 to discuss what is known and unknown about
C. sordelii. Since the FDA/CDC meeting and the publication of the article in the New
England Journal of Medicine about the C. sordellii deaths and mifepristone abortion,
reports of C. sordellii following spontaneous abortion and childbirth have emerged.
This presentation will discuss the conclusions of the FDA/CDC meeting, the clinical
presentation of the cases, the hypotheses that have been put forward to explain why these
infectious deaths have occurred, and the system of adverse event reporting in the U.S.
and Planned Parenthood. -
Oct. 2, 2014, 12:00
Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion
Veronique Berard1, Christian Fiala2 ,6, Sharon Cameron3, Teresa Bombas4, Mirella Parachini5, Kristina Gemzell-Danielsson6 1ICB - CNRS, Division MaNaPI, Département Nanosciences, Université de Bourgogne, Dijon, France, 2Gynmed Clinic, Vienna, Austria, 3Chalmers Centre, NHS Lothian, Edinburgh, Scotland, UK, 4Obstetric Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 5San Filippo Neri Hospital, Rome, Italy, 6Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden - mparachini@gmail.com
Objectives: Misoprostol (Cytotec®), is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Cytotec® tablets are packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions. The effect of prolonged exposure upon bioactivity of misoprostol and resultant clinical efficacy is unknown. Therefore, this study was undertaken to assess possible changes in tablets exposed to usual European temperature and humidity conditions. Design and Methods: To compare the pharmaco-technical characteristics (weight, friability), water content, misoprostol content and decomposition product content (type A misoprostol, type B misoprostol and 8-epi misoprostol) of misoprostol tablets Cytotec® (Pfizer) exposed to air for periods of 1 to 720 hours (30 days), to those of identical non-exposed tablets. Four hundred and twenty tablets of Cytotec® (Pfizer) were removed from their alveoli blister and stored at 25°C/60% relative humidity. Water content, and misoprostol degradation products were assayed in tablets exposed from 1 to 720 hours (30 days). Comparison was made with control tablets (N=60) from the same batch stored in non-damaged blisters. Results: By 48 hours, exposed tablets demonstrated increased weight, friability, and water content (+78.8%) compared to controls. Exposed tablets also exhibited a decrease in Cytotec® active ingredient (misoprostol) dosage (-5.1% after 48 hours) and an increase in the inactive degradation products (+ 25% for type B, +50% for type A and +60% for 8-epi misoprostol after 48 hours) compared to controls. Conclusion: Exposure of Cytotec® tablets to ‘typical' European levels of air and humidity results in significant time-dependent changes in physical and biological composition that could impact adversely upon clinical efficacy. Health professionals should be made aware of the importance of appropriate storage and handling of Cytotec® tablets.