David Baird


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    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 followed

    by 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 )