scholarly journals Efficacy of Misoprostol as a Post Abortion Care

2014 ◽  
Vol 8 (2) ◽  
pp. 71-74
Author(s):  
M Jha ◽  
NS Chitrakar ◽  
B Shakya ◽  
R Jha
Keyword(s):  
Single Dose ◽  
Early Pregnancy ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Obstetrics And Gynaecology ◽  
Incomplete Abortion ◽  
Post Abortion Care ◽  
Oral Misoprostol ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Aims: This study was done to find the efficacy of Misoprostol as a post-abortion care in our setting. Methods: Women with incomplete abortion of gestational age ≤ 12 weeks or uterine size ≤ 12 weeks with open cervical os, haemoglobin ≥ 9 gm% and stable physical condition; were given 600 microgram Misoprostol orally and were observed for 24 hours for complete expulsion. If the patient failed to expel within 24 hours of Misoprostol administration manual vacuum aspiration or suction evacuation was done. Results: One hundred and twenty-two women were enrolled in the study. Among them, 41% had complete expulsion within 24 hours of administration of misoprostol and 49% had incomplete expulsions. The success rate was high in the group of < 8 weeks of pregnancy. Among 50 (41%) successful cases, 38 (76%) belonged to 8 weeks of gestation by bimanual examination (p = 0.02). Conclusions: Single dose of oral Misoprostol was effective, safe and alternative method to the management of incomplete abortion compared to the manual vacuum aspiration or suction evacuation in case of early pregnancy abortion.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 71-74 DOI: http://dx.doi.org/10.3126/njog.v8i2.9778

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Statistical Significance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: This collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the province of Kinshasa, Democratic Republic of Congo sought to understand how midwives have integrated manual vacuum aspiration (MVA) for post abortion care. Methods: A positive deviant approach to Creswell’s mixed method comparative case study design was used to identify midwives who have integrated MVA post training and to explore enabling factors. Case group comparisons of positive and non-positive deviant midwives provided further interpretations. Results: All 102 midwives invited to be surveyed were recruited. They included 34% who reported practicing MVA post training. No statistical significance was found between the two groups’ demographics and facility type. Overall, groups had positive attitudes regarding midwifery, MVA, and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for its overall impact on the diffusion of midwifery led MVA to improve access to safe respectful reproductive care.

scholarly journals Midwives’ Integration of Post Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Midwives’ integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsty M. Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF. Methods Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison gro cup and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies. Conclusion Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Statistical Significance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Scientific AbstractBackground: This collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the province of Kinshasa, Democratic Republic of Congo sought to understand how midwives have integrated manual vacuum aspiration (MVA) for post abortion care.Methods: A positive deviant approach to Creswell’s mixed method comparative case study design was used to identify midwives who have integrated MVA post training and to explore enabling factors. Case group comparisons of positive and non-positive deviant midwives provided further interpretations.Results: All 102 midwives invited to be surveyed were recruited. They included 34% who reported practicing MVA post training. No statistical significance was found between the two groups’ demographics and facility type. Overall, groups had positive attitudes regarding midwifery, MVA, and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for its overall impact on the diffusion of midwifery led MVA to improve access to safe respectful reproductive care.

scholarly journals Safe abortion service and post abortion care: Understanding complications

1970 ◽  
Vol 2 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Sudha Thapa ◽  
Indira Satyal ◽  
Kasturi Malla
Keyword(s):  
Induced Abortion ◽  
Abortion Rate ◽  
Uterine Perforation ◽  
Safe Abortion ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Comprehensive Abortion Care ◽  
Post Abortion

Aim: To see if unsafe abortions are getting lesser after the establishment of comprehensive abortion care (CAC) Unit since March 2004. Methods: Retrospective study of women admitted with complication of abortions [induced (medically/criminal) or spontaneous] during the entire ten years period after the inception of post abortion care (PAC) Unit 2095 May -2007 April; the last 3 years overlapping the service years of CAC Unit establishment. Result: CAC and PAC units both are using manual vacuum aspiration (MVA) to procure uterine evacuation. CAC clients in the last 3 years have reached to a little less than 10,000. This is close to MVA services provided in the PAC Unit in the last 10 years amounting to 11,519. But the number (n=3958) of service provided by the PAC Unit for a complete period of three years 2058-2060 (April 2001 - April 2004) showed a slight increase to (n=4323) as the CAC Unit became functional during the 2061-2063 (15th April 2004- 2007). The complications observed in PAC unit while providing MVA are much more than CAC unit (5.75%: 2%). But the nature of complication is much more serious in CAC Unit, 10 of them needing laparotomy for 20(0.02%) cases of uterine perforation. The induced abortion rate within the hospital, three years before and during CAC services is almost similar (4.07%: 4.34%). Seriousness of the problem has definitely reduced during recent 3 year's period (Baisakh 2061-2063 Chaitra) i.e. 52: 34 except for an unfortunate rise in uterine perforation from 8 to 29 cases, 10 being from the CAC Unit. Conclusion: Though the number of complicated cases of induced abortion seeking hospitalization has not changed much after inception of CAC services in the recent three years, there is definitely a decline in the admission of more serious complicated cases of induced abortion in the recent years with unfortunate rise in number of cases of uterine perforation.   doi:10.3126/njog.v2i1.1476 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 44 - 49 May -June 2007

scholarly journals Post-abortion care with misoprostol – equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016157 ◽  
Author(s):  
Marlene Makenzius ◽  
Monica Oguttu ◽  
Marie Klingberg-Allvin ◽  
Kristina Gemzell-Danielsson ◽  
Theresa M A Odero ◽  
...  
Keyword(s):  
Equivalence Trial ◽  
Low Resource ◽  
Contraceptive Counselling ◽  
Abortion Care ◽  
Incomplete Abortion ◽  
Post Abortion Care ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Randomised Controlled ◽  
Post Abortion

ObjectiveTo assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.DesignA multicentre randomised controlled equivalence trial. The study was not masked.SettingsGynaecological departments in two hospitals in a low-resource setting, Kenya.PopulationWomen (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis.Interventions600 µg misoprostol orally, and contraceptive counselling by a physician or midwife.Main outcome measuresComplete abortion not needing surgical intervention within 7–10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was –4% to 4%. Secondary outcomes were analysed descriptively.ResultsThe proportion of complete abortion was 94.8% (768/810): 390 (95.4%) in the midwife group and 378 (94.3%) in the physician group. The proportion of incomplete abortion was 5.2% (42/810), similarly distributed between midwives and physicians. The model-based risk difference for midwives versus physicians was 1.0% (–4.1 to 2.2). Most women felt safe (97%; 779/799), and 93% (748/801) perceived the treatment as expected/easier than expected. After contraceptive counselling the uptake of a contraceptive method after 7–10 days occurred in 76% (613/810). No serious adverse events were recorded.ConclusionsTreatment of incomplete abortion with misoprostol provided by midwives is equally effective, safe and accepted by women as when administered by physicians in a low-resource setting. Systematically provided contraceptive counselling in PAC is effective to mitigate unmet need for contraception.Trial registration numberNCT01865136; Results.

scholarly journals Quality Of Post-Abortion Care In Java, Indonesia: An Essential Services Analysis 

2020 ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Dilation And Curettage ◽  
Essential Services ◽  
Post Abortion

Abstract Background High maternal mortality in Indonesia persists despite economic growth and a reform that extended health insurance to all Indonesians. Quality of obstetric health services, in general, has been identified as a factor for this; in addition, the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC) services. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we used the essential services framework to measure the health system’s capacity to offer PAC. We then used this framework to explore how Java’s capacity to offer PAC could change given two hypothetical reforms. Finally, we calculated the proportion of PAC patients treated using each of four different procedures. Results No emergency obstetric health centers (PONEDs) are adequately staffed or authorized to offer basic PAC services, while 46% of all hospitals in Java have the full set of services needed. These proportions increase in hypothetical scenarios in which PAC authorization is expanded to midwives, general physicians, and PONED facilities. Eighty-eight percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Allowing clinicians other than Ob/Gyns to perform uterine evacuation and offering first-trimester PAC service in PONEDs would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol would lower the burden of treatment for patients, reduce costs to the health system, and facilitate the task-shifting efforts needed to expand access to this life-saving service.

scholarly journals Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

2019 ◽  
Vol 19 (1) ◽  
pp. 38
Author(s):  
Kehinde F. Ibiyemi ◽  
Munir'deen A. Ijaiya ◽  
Kikelomo T. Adesina
Keyword(s):  
Treatment Group ◽  
Intrauterine Device ◽  
Randomised Trial ◽  
First Trimester ◽  
Secondary Outcome ◽  
Vacuum Aspiration ◽  
Incomplete Abortion ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Manual Vacuum Aspiration

Objectives: This study aimed to compare the efficacy of oral misoprostol with manual vacuum aspiration (MVA) in first trimester incomplete abortions. Methods: This randomised controlled trial study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between April 2014 and November 2015. Pregnant women who presented with clinical features of incomplete abortion at a gestational age of 13 weeks or less were included. Patients who had profuse vaginal bleeding, an intrauterine device in situ, signs of pelvic infections or who were younger than 18 years old and had no accompanying adults to give informed consent were excluded. A total of 200 participants were randomly and equally allocated to either the MVA or misoprostol treatment group. The treatment group were given 600 μg of misoprostol orally. The primary outcome measure was complete uterine evacuation, while secondary outcome measures included the need for additional surgical evacuation for failed treatment, adverse effects/complications, acceptability of and satisfaction with the treatment. Results: Both misoprostol and MVA had high complete evacuation rates, yet MVA was significantly higher (99% versus 83%, relative risk [RR]: 0.84, confidence interval [CI]: 0.766–0.918; P <0.001). Significantly more women in the misoprostol group required additional MVA for failed treatment than in the MVA treatment group (17% versus 1%, RR: 16.67, CI: 2.260–12.279; P <0.001). No significant difference was found between the misoprostol and MVA treatment groups in terms of satisfaction (92.7% versus 89.8%, RR: 1.04, CI: 0.946–1.127; P = 0.473). Conclusion: Treatments with misoprostol and MVA had high complete uterine evacuation rates, as well as high rates of acceptability and satisfaction. However, MVA had a significantly higher complete evacuation rate than misoprostol.Keywords: Misoprostol; Abortion Techniques; First Trimester; Incomplete Abortion; Nigeria.

Sign in / Sign up

Export Citation Format

Share Document