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ABORTIONS - IN THE YOUTH

ABORTIONS - IN THE YOUTH. The Problem of Unsafe Abortions. Each year over 50 million women who experience an unintended pregnancy undergo an induced abortion Of these . . . 20 million unsafe abortions are estimated to take place annually worldwide 55,000 / day

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ABORTIONS - IN THE YOUTH

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  1. ABORTIONS - IN THE YOUTH

  2. The Problem of Unsafe Abortions • Each year over 50 million women who experience an unintended pregnancy undergo an induced abortion • Of these . . . • 20 million unsafe abortions are estimated to take place annually worldwide • 55,000 / day • Resulting in more than 80,000 maternal deaths.

  3. Youth at the highest risk • Estimates of abortions in young girls range from 1 to 4.4 million each year in developing countries • Young girls account for 53 - 74% of septic abortions

  4. 16 12 8 4 Complication Rate % 4 8 12 16 20 Weeks of Amenorrhoea Earlier Abortions are Definitely Safer Four fold rise in complications with late abortions

  5. Unwanted PregnancyMedical or Surgical Abortion ??

  6. First Trimester Surgical AbortionManual Vacuum Aspiration • MVA syringe (60 ml) with double valve adapter • Flexible plastic cannulae • Colour coded cannulae • Diameters 4 to 12 mms • Can be dismantled - for effective cleaning & sterilization Simple, effective, affordable, easy to use technology

  7. First Trimester Surgical AbortionMVA Procedure

  8. First Trimester Medical Abortion • Is the most effective method at gestations less than 7 weeks Dosage • Mifepristone (RU486) in 200 g oral dose after 36 – 48 hours • Misoprostol 400 g orally or 800 g vaginally • Failed procedure managed by MVA / EVA Overall complete abortion rate of 94-97% - RCOG Evidence based guideline Sept 2004

  9. Progesterone Blockade Decidual Necrosis Cervical Ripening Rhythmic Uterine Contractions Detachment Expulsion Abortion Mifepristone-MisoprostolClinical Effects

  10. First Trimester Surgical Abortions Adjunct Use of Prostaglandins • Preoperative IM 15 methyl PGF2 125 – 250 ug to minimize blood loss Or • Preoperative oral / vaginal misoprostol 400 g to induce preoperative cervical dilation - Macisaac et al, Obs Gyn, 1999 Medical and surgical techniques may be made complimentary to make induced abortion even safer

  11. Medical Abortion : Use & Abuse • Suitable selection of cases • Confirm the completeness of the procedure • Retained products can lead to PID, irregular bleeding • “Over the Counter” approach should be strongly discouraged • Simplicity of the method does not mean it should be used as an alternative to contraception

  12. Medical Methods for Early Abortion FOGSI Statement – 2002 • FOGSI recognises the universal evidence on the safety & effectiveness of mifepristone-misoprostol for MTP up to 49 days as approved for use by the Drug Controller of India • It is stressed that under existing laws these methods can only be administered by gynecologists & RMPs recognised for performing MTPs by the MTP Act of 1971

  13. Medical Methods for Early Abortion FOGSI Statement – 2002 • FOGSI recommends close monitoring of distribution & that the medical profession & the pharmaceutical industry exercise due diligence in their promotion & use • It is also vital that consumers be educated & counselled regarding its advantages, drawbacks, risks & limitations

  14. Study Controls Successful 98% 92% termination Induction - 19 hrs 35 hrs abortion interval Second Trimester Medical Abortions • Extraamniotic ethacridine lactate in 315 cases • Extraamniotic 15 methyl PGF2 250 g after 6 hours Combination reduces time taken and increases effectiveness - Bhathena, Sheriar, Walvekar & Guillebaud, Br J Obs Gyn, 1990

  15. Second Trimester Medical Abortions Prospective trial in 148 women - Wong et al, Hum Rep, 2000 Effectiveness well established – regime awaits official sanction

  16. Second Trimester Surgical Abortions • Effective non surgical methods have made hysterotomy obsolete • Marginal role for aspirotomy in early second trimester abortions only when performed by skilled, trained clinicians under USG guidance - WHO, 1995 Medical methods are the preferred technique for second trimester abortion

  17. Induced Abortion - Making a Choice Medical Vs Surgical

  18. Surgical – Vacuum Aspiration Effective – 99 % Use up to over 12 weeks Usually a single visit Mandatory backup for failed medical abortion Surgical procedure & some anesthetic requirement Higher risk of cervical & uterine trauma Medical – Mifepristone and Misoprostol Effectiveness : 92 – 97 % Use up to 49 days (63 days) Demedicalized treatment on an outpatient basis Affords greater confidentiality Use limited to early pregnancy Multiple visits & follow ups - by ultrasound when indicated Higher risk of hemorrhage & failure First Trimester AbortionPoints and Counterpoints

  19. Concept – Dr. Duru Shah • Contributors Dr. Nozer Sheriar • Editors Dr. Sangeeta Agrawal Dr. Reena Wani

  20. We acknowledge the efforts of our : Coordinators : Dr. Sangeeta Agrawal - Central Dr. Narendra Malhotra - North Dr. Hema Divakar - South Dr. P. C. Mahapatra - East Dr. Uday Thanawala - West In bringing the FOGSI YOUTH EXPRESS to your city.

  21. This Youth Express has been possible through an educational grant from : Charak Pharma Pvt. Ltd CIPLA Ltd. Emcure Pharmaceuticals Ltd GlaxoSmithKline Pharmaceuticals Limited Glenmark Pharmaceuticals Ltd. Metropolis Health Service (India) Pvt.Ltd. Organon India Ltd Roche Pharmaceuticals Ltd. Sandoz Private Limited USV Limited Wyeth Limited

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