Monica Johansson et al.


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    A pilot study on women’s experiences with misoprostol at home or in the hospital in medical abortion up to 63 days of pregnancy.

    Monica Johansson, Eneli Salomonsson and Helena Ekberg, Dept of Woman and Child Health,

    Division of Obstetrics and Gynecology, Karolinska Institutet / Karolinska University Hospital, Sweden

    Background: Home-use of misoprostol in medical abortion up to 63 days of pregnancy was approved in Sweden in 2004. It is now an increasingly popular option for women undergoing first trimester induced abortion. The experiences with misoprostol at home or in the hospital were explored among abortion seeking women.

    Methods: Mifepristone 200 mg was given orally in hospital under nursing supervision. Women were provided with misoprostol tablets 800 g and advised to take them vaginally 36–48 hours later either at home or in the hospital. A follow-up visit was performed a few weeks after the misoprostol treatment.

    The main outcome measures were:

    1) acceptability assesses as satisfaction with the choosen method.

    2) feasibility, assessed through successful completion of abortion at home without the need for hospital admission.

    In addition contraceptive choice and uptake was investigated.

    Results: A total of 53 women participated in this pilot study. Of these, 29 women aborted at home and 24 in the hospital. The majority of women were satisfied with their choice of method and place of treatment. Two women per group reported not being satisfied. No surgical interventions were reported but two women per group had unscheduled visits to the clinic before the Follow-up (FU).

    Follow-up was performed after a mean of 24 or 20 days among women who administered misoprostol at home or in the clinic, respectively. At that time all women except two per group reported that they considered it highly important to avoid another pregnancy at the moment. Six or 7 women per group had had sex before the FU. Among them 6 and 4 women, respectively, had not started any contraceptive method. In the first group (home-use of misoprostol) 6 women had started contraception before the FU and 12 started at the FU while in the second group 9 women started before the FU and 7 at FU.

    Conclusions: This study supports that women should be free to choose their preferred location of the induced medical abortion. The reason why so many women postpone post abortion contraception despite stressing the importance to avoid a pregnancy needs to be further explored.

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    Medical abortion at  9+1 to 12+0 weeks of gestation - a pilot studyon efficacy, bleeding and women´s experiences

    Monica Johansson, Department of Women´s and Children´s Health, Division of Obstetrics

    and Gynecology, Karolinska Institutet/Karolinska University Hospital, Sweden

    Background:Medical abortion up to 9+0 weeks gestation was approved in Sweden in 1992.  Today a majority of induced abortions are medically induced and performed before the eight’s week of gestation. The standard method for termination of pregnancy in the late first trimester is still surgical using vacuum aspiration. However, more recently medical abortion has become increasingly used also beyond 63 days of gestation.

    Objectives: The objectives of this pilot study were to evaluate women´s experiences with late first trimester abortion and to collect data on efficacy, bleeding and side effects.

    Methods: All women received mifepristone 200 mg orally under nursing  supervision, followed by 800 micrograms misoprostol self administered vaginally 48 hours later. Misoprostol was repeated every 3 hours orally, to a maximum of five doses if needed. A clinical examination including ultrasonography if needed was performed prior to discharge If expulsion had not occurred women were kept in hospital over night and vacuumaspiration performed the following day. Follow-up was performed 3 weeks after treatment. Bleeding and side effects were reported two times from the intake of mifepristone until follow-up.

    Results: A total of 14 pregnant women with gestational age 9+1 to 12+0 weeks were included. The successful termination rate was 85,7 %. Surgical evacuation was carried out in 2 (14,2 %) women and only 3 (21,4 %) estimated bleeding more than a regular period. Most women 13 (92,8 %) found the method of treatment highly acceptable.

    Conclusion: Medical abortion is a highly acceptable method for termination of pregnancy also in late first trimester and could safely be offered to more women.

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    Training: ultrasound for midwives involved in abortion care

    Monica Johansson, Eneli Salomonsson Karolinska Universitetssjukhuset Sesam gyn dagvård, Stockholm, Solna, Sweden -

    Background: The aim of the course was to teach both theoretical and practical aspects of ultrasound diagnostics to those who are active in the field of abortion care. Material and Methods: The target audience was midwives and OBGYN residents active in the field of abortion care who had completed a 3-day theoretical course on induced abortion. The curriculum included two half days of lectures and two afternoon sessions with practical training involving simulators or patients at the abortion care unit at Karolinska University Hospital. The theoretical parts included lectures on ultrasound technique, ultrasound devices, ethics, the legal situation, communicating with patients, ultrasound findings in normal and pathological early pregnancies (until week 9+0) and an update on medical abortion care. After having completed the course and a written exam, participants continued practical training under supervision of a local mentor. A minimum of 50 supervised and 50 independent examinations should be documented and approved by the course leaders. 18 midwives and 1 doctor took part in the ultrasound course in 2013. Of the midwives 14 are now certified and work independently. Results: Introduction of midwifery- led abortion clinics has resulted in: shortened waiting times, time saved for patients and staff, better continuity and reduced costs for the clinic. Significance: Training midwives in medical abortion care will help to shorten waiting times, reduce costs and help to better allocate healthcare resources.