Anne Vérougstraete

Ponencia:

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    Fears: sterility, sexuality, bleeding, infection
    Anne Verougstraete MD
    Gynaecologist; Brussels, Belgium
    -Sjerp-Dilemma: Family Planning and Abortion Centre: Vrije Universiteit Brussel
    -Hôpital Erasme: Université Libre de Bruxelles
    What is the influence of fear of “sterility”on contraception use and abortion?
    Is there a risk of sterility after induced abortion?
    Is there an increased risk of spontaneous abortion, preterm delivery, stillbirth, ectopic
    pregnancy, placenta praevia …. in a subsequent pregnancy?
    Are women with short-term complications after induced abortion more at risk to have
    problems in a subsequent pregnancy?
    Is there a link between induced abortion and breast cancer??
    What is the influence of sexuality on contraception use and abortion? What about
    contraception use and sexuality? And what about sexuality after abortion?
    What is the risk of bleeding and infection after abortion? What can we do about it?
    The actual knowledge and evidence will be discussed.

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    How frequently is it done? Possible reasons for the huge regional differences

    Anne Verougstraete (Belgium)

    Sjerp-Dilemma-VUB: Family Planning and Abortion Centre: Vrije Universiteit Brussel; Hôpital Erasme: Université Libre de Bruxelles (Obstetrics), Belgium

    Surgical abortion is a very safe procedure and with local anaesthesia it is safer than with general anaesthesia. This has been repeated by WHO (2003), the RCOG (2004) and ANAES (2001).

    In Europe, there are huge regional differences in the anaesthesia used for surgical abortion, and in a given region, some hospitals perform the procedure only under local anaesthesia and others only under general anaesthesia. It seems very unlikely that these differences reflect the choice of women!

    Possible reasons for the regional differences:

    • Routine habits in hospitals;
    • the hospital earns more money if the procedure is done under general anaesthesia;
    • poor management of local anaesthesia, so that the procedure is too painful;
    • no proper accompaniment available in surgery wards of hospitals;
    • a growing number of women choose “not to be there” at the moment of the abortion;
    • general anaesthesia is no option in outpatient abortion centres.

    Conclusion. Local anaesthesia is, medically speaking, safer than general anaesthesia. With a proper technique (priming of the cervix, local anaesthesia and oral painkillers) and a good accompaniment, it is accepted by most women. Ideally, women should have the right to choose which anaesthesia they want for their abortion. In the workshop we will discuss how it is in your region, and the reasons why.

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    Quick start and extended use of hormonal contraception

    Anne Verougstraete, Gynaecologist, Family Planning and Abortion Centre Vrije Universiteit Brussel,

    Hôpital Erasme Université Libre de Bruxelles (Obstetrics), Brussels, Belgium

    Heath care providers usually advise women to wait until the next menses before starting hormonal contraception. The idea is to avoid the use of hormones in a beginning undetected pregnancy. An alternative is to start hormonal contraception immediately with a back-up birth control method for the first seven days. For long-acting methods (implants and injectables), the necessity of doing a pregnancy test after 2-3 weeks should be evaluated.

    When women come for contraceptive advice, their motivation to start a method is high and the risk of an unwanted pregnancy may also be high. We therefore should have good reasons to delay the start of the chosen contraception. The advantages, disadvantages and management of quick start of oral contraception, patch, vaginal ring, implant and injectable will be discussed.

    Extended use of hormonal   contraception is becoming more common.  A  woman  can  chose continuous

    use or insert a break every 3 or 4 months in the following situations: at the woman’s choice, headaches or migraine during the hormonal free interval, painful or heavy withdrawal bleeds, absent withdrawal bleeds, endometriosis, premenstrual syndrome, suspicion of decreased efficacy for any other reason.

    The advantages, disadvantages, management and risks will be discussed. Quick start and extended use of hormonal contraception should be offered and discussed with women.

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    Special aspects: Minors, Virginity                       Anne Verougstraete(B)

     

    Gynaecologist working in SJERP-DILEMMA VUB (family planning and abortion centre of the Flemish Free University in Brussels) and in Cesar De Paepe Hospital in Brussels.

     

    Premarital virginity for girls is an important value in traditional Moroccan and Turkish culture and for a majority of men and women. This value seem to have more importance when the educational level is low. Most of the second-generation Moroccan boys in Brussels want to marry a virgin, and most girls agree.

    The girls who have premarital sex usually bear the blame for having said “yes” and often carry the entire responsability if they get pregnant.

    Due to conflicting norms and values, migrant girls may have more difficulties to use contraception properly.

    In most families male dominance is the traditional norm and the girls have usually integrated the feminine role model since childhood. It is therefore often more difficulties for them than for European girls to be assertive and persuade unwilling boys to use condoms.

    So the girls who break the traditional rules are not only more at risk for unwanted pregnancy but also for acquiring STI and HIV.

    The selfesteem of the girls who lost their virginity is often low and they may be very anxious about their chances in future life.

     

    In the workshop, the following topics will be discussed:

     

    How do we deal with minor migrant girls who want an abortion?

                What about parental consent??

                Is it a good idea to use mifepristone and misoprostol??

                Specific contraception counseling??

                Specific psychologic support??

               

    Should we do virginity repair???

    if we do:

    - which technique do we use?

    - which recommendations can we make to providers dealing with a demand of virginity repair?

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    Pain and abortion: women’s perspective, including cultural aspects

     

    Anne Verougstraete1 1-Sjerp-Dilemma-VUB: Family Planning and Abortion Centre: Vrije Universiteit Brussel, Brussels, Belgium, 2-Hôpital Erasme: Université Libre de Bruxelles (Obstetrics), Brussels, Belgium - ann.verougstraete@telenet.be

     

    Surgical abortion: Surgical abortion is a very safe procedure and with local anaesthesia it is even safer than with general anaesthesia. In Europe, there are huge regional differences in the anaesthesia used for surgical abortion, and in a given region, some institutions perform the procedure only under local anaesthesia and others only under general anaesthesia. It seems very unlikely that these differences reflect the choice of women! A growing number of women choose "not to be there" at the moment of the abortion, while others prefer to be in control even if this means they will feel some pain.

    Given the choice, many women appreciate emotional support during the surgical abortion procedure; some may want respect for a desired scheme (silence, music etc). Recently hypnotic techniques have been introduced in medical care: it is now used in emergency medicine, during interventional radiology, diagnostic procedures and surgical treatments. In some hospitals breast cancer operations and thyroid operations are performed under local anaesthesia and hypnosis so that general anaesthesia is not needed. There is growing interest in also using hypnosis during abortion procedures to reduce anxiety and pain, in women who desire it.

    Medical abortion: Most women prefer home use of misoprostol but it is important to maintain the option to reside in the medical setting for those who wish. At home, women appreciate the possibility to have personal phone support or support by mobile phone messages in order to better manage pain and bleeding by reducing anxiety and stress. Conclusion: Woman-centred care should respect pain management and some rituals women wish for their abortion. In a lot of settings, women do not have this choice!