Lucy Michie

Speeches:

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    Asurvey of attitudes of staff working within a
    sexual and reproductive health centre, towards
    undertaking early medical termination of
    pregnancy
    Michie, L1,2; Cameron, S1,2
    1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
    Edinburgh,UK
    Introduction: In Scotland, most termination of pregnancy (TOPs)
    are provided in hospital departments of Obstetrics and
    Gynaecology. Since high quality contraceptive provision should be
    integral to TOP, this raises the question of whether TOP services
    would be better provided by clinicians in community sexual and
    reproductive health services (SRH). We aimed to determine views
    of these clinicians about potentially offering TOP services

    Methods: An anonymous internet questionnaire of staff working
    in a large SRH service in Edinburgh (Chalmers) was conducted
    between January and March 2012. The questionnaire consisted
    mainly of ‘drop-down’ list options with additional free text
    response to some questions.
    Results: A 69% response rate was obtained. (62 out of 90;
    doctor = 22, nurses = 25, admin staff = 15). The majority of
    responders (69%) felt that provision of abortion services would be
    a natural extension to existing services and the majority, (69%)
    would be personally willing to provide abortion care. Only 11%
    stated that they would refuse to be involved in TOP care due to
    moral objections. Respondents agreed that TOP care from this
    setting would offer advantages for women including better
    provision of contraception (71%) and better management of
    sexual infection (53%), amongst others. Only 23% of responders
    (n = 14) felt there would be some disadvantage to offering
    abortion services from this setting.
    Conclusion: Most staff felt that providing TOP services within a
    community SRH service is a natural extension to existing services
    and that this would offer improved contraception and sexual
    health care to women undergoing TOP.

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    Asurvey of professionals in sexual and
    reproductive health in the United Kingdom, about
    attitudes towards provision of termination of
    pregnancy care within community sexual and
    reproductive health (SRH) clinics
    Michie, L1,2; Cameron, S1,2
    1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
    Edinburgh, UK
    Introduction: In the UK, termination of pregnancy (TOP) services
    are predominantly based within National Health Service hospitals.
    However, community based sexual and reproductive health (SRH)
    clinics that provide specialist contraceptive services could offer an
    alternative setting and may provide high quality on-going
    contraception. We sought to determine the attitudes of those
    working within SRH towards participating in TOP and views on
    which setting is most appropriate for TOP care.
    Methods: A questionnaire was distributed to attendees at a large
    UK sexual and reproductive health scientific meeting in April
    2012. Information obtained included demographics, respondents
    current experience of TOP care and their response to a series of
    statements concerning, attitude and willingness to participate in
    and location of TOP care.
    Results: An 82% response rate was obtained (165 of 200). Eighty-
    eight percent (n = 146) of respondents were female. Ninety-five
    percent (157) were doctors and 4% (6) were nurses. Almost all
    responders already had some involvement in TOP care (97%
    n = 160); 78% (29) refer patients on to hospital TOP services,
    64% (106) assess patients and provide information, 62% (103)
    sign documents authorising TOP and 14% (24) undertake the
    procedure or administer medication. Whilst 78% (128) agree TOP
    care services (for 1st trimester, uncomplicated cases) would be
    best suited to community SRH, 51% (83) believe it should be
    divided across community, hospital and charity services.

    Conclusion: The overwhelming majority of doctors and nurses in
    SRH agreed that abortion services would be best delivered from a
    community SRH setting and would be willing to participate in
    providing this service.

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    Review of telephone follow-up of women having
    early medical termination of pregnancy
    Michie, L1,2; Cameron, S1,2; Johnstone, A1,2;
    Dewart, H1,2
    1 NHS Lothian; 2 University of Edinburgh, UK
    Introduction: Telephone follow-up2 weeksaftermedical
    terminationofpregnancy(TOP)(£9 weeksofgestation)withaself-
    performedlowsensitivityurinepregnancy(LSUP)test,was
    introducedatahospitalTOPserviceinEdinburgh.Womenwho
    screened‘positive’attelephonefollow-up(ongoingpregnancy
    symptoms,scantbleeding,orLSUPresult)subsequentlyattended
    foranultrasound.Apreviousserviceevaluationconfirmedthatthis
    waseffectivefordetectingongoingpregnancyandhadgoodfollow-
    uprates.Wesoughttodetermineifthismethodoffollow-up
    continuedtobesuccessfulduringtheyearfollowingitsintroduction

    Methods: Retrospective computerised database review of outcome
    of telephone follow-up of women having a medical TOP
    (£9 weeks of gestation) over 12 months (March 2011–February
    2012).
    Results: One thousand and eighty-four women of mean age
    25 years had a medical TOP during this period. One hundred and
    twelve women were scheduled to attend the clinic for follow-up
    and three women did not require follow-up as complete TOP was
    confirmed on the day of treatment. Ten women (out of 969)
    attended hospital before the planned telephone contact (1%). Of
    the 959 requiring telephone follow-up, 656 (68%) were
    successfully contacted. Two of those who were not contactable
    had ongoing pregnancies. Five hundred and seventy-three (87%)
    of those contacted, screened ‘negative’ with no false negatives
    occurring. Of the 83 (13%) who screened ‘positive’, three had
    ongoing pregnancies. The sensitivity of follow-up was 100% and
    specificity was 88% (95% CI 84.9–90.1).
    Conclusion: Although slightly lower follow-up rates were obtained
    in the 12 months following initial introduction, telephone follow-
    up with LSUP was shown to be effective for detecting ongoing
    pregnancy.

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    Objectives: In October 2017, The Scottish Government approved a patient’s place of residence as a place where treatment for abortion can occur. Women up to 9+6 weeks gestation, can be administered mifepristone in a medical facility and given misoprostol to take home and self-administer 24-48 hours later. The option of early medical abortion at home (EMAH) has been available in our service since April 2018. Following ultrasound assessment of gestation, women who are under 9 weeks are offered the options of EMAH, medical abortion in hospital or surgical abortion.  We aim to identify any demographic characteristics which may determine if a woman is more likely to choose EMAH, as opposed to hospital management.
    Methods: A prospective review of the records of all women who attend over 4 months from April to July, who are 9 weeks or less and choose medical abortion. To be eligible for EMAH they must live in Scotland, be 16 years or over, have an adult with them on the day of abortion, not require an interpreter and have no significant medical conditions. We will analyse demographic data for those who choose EMAH and those who have medical abortion in hospital. 
    Results: In the first four weeks of offering EMAH to eligible patients, 184 women have been less than 9 weeks gestation and chosen medical abortion. 92 of them were booked to have medical abortion in hospital, and 92 EMAH. Upon completion of data analysis for the first 4 months, we will present the proportion of women who wished medical abortion that were eligible for EMAH, the proportion who chose EMAH and any demographic differences that exist between those choosing home and hospital management.
    Conclusions: We will determine if any demographic differences exist between women who opt for home or hospital management of medical abortion.