Andreja Štolfa Gruntar and Bojana Pinter, Department of Obstetrics and Gynecology, University Medical
Centre Ljubljana, Slovenia
Medical abortion was introduced as a method of first trimester induced abortion 20 years ago, when as one of WHO collaborating centres in the area of reproductive health our Department of obstetrics and gynecology was offered the possibility to carry out the studies investigating the efficacy and safety of abortion inducing drugs, although the drugs had not been registered in Slovenia.
Until 7 years ago medical abortion was performed only in women enrolled in various WHO studies. However, when the direct import of the needed drugs (mifepristone and misoprostol) became possible, we started to perform early medical abortions on a regular basis in women who decided on this method for early abortion of an unwanted pregnancy. Knowing the method well we wanted it to become the predominant method of early abortion. But since there was no agreement among gynecologists that it should be the method of choice for an early abortion, women still choose the method they prefer. Dilatation and curettage under general anesthesia is still the most frequently used method, although some women decide on endometrial aspiration without anesthesia, too.
The reasons why women decide on a surgical abortion under general anesthesia are: not being aware of what is being done, fear of pain, gynecologist's advice. Many gynecologists still advise their patients the abortion done under general anesthesia, because it has been done successfully for years, and as they are still sceptical about medical methods due to the lack of knowledge and personal experience.
Our intention is to increase the percentage of medical abortions among the eligible women wanting to end an unwanted pregnancy. Due to the aforementioned reasons our aim has not been achieved yet. There are around 1500 early abortions to end an unwanted pregnancy at the Department per year (e.g. 1546 in 2006, 1334 in 2008). Of these there are 13,5% endometrial aspirations without anesthesia, 55,6% surgical abortions under general anesthesia, and only 30,9% medical abortions. Obtaining good results with medical abortion and spreading the knowledge among patients and gynecologists, and with efficient motivation for medical instead of surgical procedure, the rates of early medical abortion to end an unwanted pregnancy have been slightly increasing, but the rates could be further improved. So in March 2010 we organized a seminar to promote medical abortion as the first choice method and to exchange experience with other abortion-care practitioners in the rest of Slovenia.