Giovanna Scasselatti

Ponencia:

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    Activity of a termination of pregnancy department
    Scassellati, G; Bologna, M; Di Felice, M;
    Valeriani, D
    San Camillo Forlanini Hospital, Rome, Italy
    Termination of pregnancy (TOP) has been carried out in our
    hospital since 1978, the year in which TOP became legal in Italy.
    Our department is one of the most important TOP departments
    in Rome: during 2011, 2098 women were admitted to our hospital
    for a TOP, almost 30% of TOPs performed in the Lazio region. It
    is also the only hospital in Rome to use pharmacological TOP
    (mifepristone).
    Our department provides a complete service for women in the
    event of unwanted pregnancy. Besides the clinical activity, we
    guarantee psychological support during all the phases of a TOP.

    Since 2001, with the increase of the number of TOP requested
    by immigrant women, our department established a service of the
    so-called ‘intercultural mediation’ with the aim of preventing
    unwanted pregnancy and spreading the regular use of
    contraception among immigrants.
    A relevant part of our activity is dedicated to the clinical
    follow-up of women to ensure counselling and to encourage and
    help them to use a contraceptive method. We also ensure
    gynaecological consultation, a specific space for reproductive
    health care, with the aim of reaching women with difficulty
    accessing gynaecological treatments (women with lower level of
    education, housewives, immigrants) and to facilitate their access
    to public hospitals.

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    Cultural and linguistic mediation

     

    Giovanna Scassellati and Teresa Perales, San Camillo-Forlanini Hospital – Rome

     

    Since 2002, at the gynaecological ambulatory of the DH/DS 194 there is a service of cultural mediation. This service, supported by the Rome municipality, is particularly useful in order to establish continuative relationships with foreign women with the aim of clarifying the motivations of voluntary abortion and enacting preventive measures for abortion. 1.120 women were examined in the year 2002, 1.315 in 2003, and 407 in the first four months of 2004. The service is precious because often medical and paramedical personnel lacks adequate time for such activities, since an interview with a patient requires around 40 minutes on the average in order to be useful and explicative. Furthermore, the service is a useful tool to understand the real motives that drive foreign women to resort to abortion.

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    Doctors working in a public hospital
    Giovanna Scassellati, MD, 
    Hopsitial St. Camillo, Rome
    Abortion is legal and part of medical practice in Italy since 1978.
    In these 28 years it is allowed only if interruptions of pregnancy are performed in public
    hospitals.
    Pharmacological abortion, widely used in many countries in Europe, is not allowed in Italy
    and this because mifepristone (RU 486) is not registered yet.
    This limitation causes frustration on doctors and nurses and it is necessary operate on
    patients all the times even though a lot of patients could succeed using medical abortion.
    In Turin, northern Italy, in S. Anna Hospital, Dr. Viale has been the first doctor who
    received special permission by the Ministry of Health to start a clinical trial with RU 486, on
    October 2005.
    It seems a little strange to start experimentations using a drug well known in the whole
    medical world since 1980.
    Italian women are not different from the French or Spanish ones.

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    Local Anaesthesia compared to General Anaesthesia

    Giovanna Scassellati (Italy)

    Azienda Ospedaliera S.Camillo, Rome, Italy

    We beavered to abait the general anaesthesia in the IVG operation.

    We have dispensed to women 250 questionary on the 2008, with psycologic and pain ratings and we have allocated the questionary at first of abortion and after abortion, so we have perceived that women prefer local anaesthesia and they are supported in the rate.

    On patients undergones in local anaesthesia operation, 30 minutes before the operation to be effected pre-medication.

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    Medicated IUD after induced abortion

    Giovanna Scassellati (Italy)

    Azienda Ospedaliera S.Camillo, Rome, Italy

    We report our experience of the use of progesterone medicated IUDs (Mirena® Bayer Schering) as contraception after induced abortion.

    Between February 2007 and February 2008 255 women who came to our centre for the implementation of Law 194/1978 (the one that legalised induced abortion in our country) were enrolled.

    Among these patients who underwent IUD insertion we selected a number of those who, because of specific clinical situations (history of menometrorrhagia, uterine fibromatosis, endometriosis, etc.), needed the application of the progesterone medicated IUD. These women, in number of 22, underwent a gynaecological examination and a transvaginal pelvic ultrasound examination immediately after application of the device, two weeks after the operation and then every six months.

    All these 22 patients demonstrated a perfect situation and satisfaction both on the basis of clinical and ultrasound objectivity and also regarding the symptomatology, with a progressive reduction of menstrual flow and dysmenorrhoea.  None of the IUDs had to be removed or repositioned, to our great satisfaction and that of the patients. Thanks to this positive experience, which is still underway, we are strongly in favour of an increasing use of post-surgical IUDs.

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    Therapeutic Termination

     

    Giovanna Scassellati, Daniela Valentini, and Maurizio De Felice,San Camillo-Forlanini Hospital – Rome

     

    Since January 2004 we executed 34 THERAPEUTIC TERMINATIONs using Misoprostol for vaginal application with a dosage of 600 mg and continuing, after 8 hours, with a dosage of 200 mg every hour. In all cases we never exceeded the total dosage of 800 mg. 30 of the 43 patients have easily reached the expulson within the first 12 hours with a maximum of 24 hours. We performed 2 Ceaserian cuts as a result of a lack of response to the induction (one in a woman with a pulmonary neoplasia at the 4th stage and the other without cervical dilatation in a woman that had already undergone a Ceaserian cut). The vaginal application has proved to be better than that per os, with greatly reduced side effects.

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    The utilization of misoprostol per os in therapeutic termination

     

    Giovanna Scassellati, MD,San Camillo-Forlanini  Hospital – Rome (Italy)

     

    From January 2000 to December 2003 we peformed 223 THERAPEUTIC TERMINATION with Misoprostol at the following dosage: 600 mg per os every 3 hours with a maximum of 3 applications a day. Of the total, 220 cases ended in a vaginal delivery and 3 required the execution of an operative delivery (Ceasarian Cut) because of a lack of response to induction. The utilization of Misoprostol has reduced the times of abortive labour that in some cases ends within 24 hours since the beginning of the treatment. Side effects, whenever present, were contained (vomit, diarrhoea, fever). [Only one patient showed an allergical reaction that imposed an immediate stop of the treatment.]

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    Use of misoprostol for priming in Italy

     

    Giovanna Scassellati, Daniela Valentini, Maurizio Bologna and  Maurizio De Felice

    San Camillo-Forlanini Hospital, Rome - Italy

     

    We report our clinical experience with Misoprostol, a drug registered in Italy exclusively for its gastroprotective action, in the pharmacological induction of VIP within the 90th day of gestation. The protocol that we used provided for the vaginal application of Misoprostol, with the dosage of 400 mg one hour before surgery, in a randomized sample of 50 women (double-blind trial), all adult and consenting, and this in order to induce a passive dilatation of the cervical channel, thus making the surgical intervention easier. Besides the excellent clinical result we underline its low cost, especially if compared with other drugs with a similar therapeutic action.

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    What do women want in Italy?

                                                                                    

    Giovanna Scassellati, Maurizio Bologna, Maurizio De Felice, Daniela Valeriani andAntonietta Turi, San Camillo-Forlanini Hospital – Rome,  Italy

     

    In the year 2003, 500 women using the services of DH/194 filled a questionary:

    -   80% of them responded that prefer medical abortion, although they did not have a thorough knowledge of  the technique, because they want to avoid any kind of surgery;

    -   they find the present bureaucratic procedure extremely long and inquiring;

    -   foreign women, especially Rumanian, live hospital procedures with great annoyance because they are not culturally accustomed to undergo presurgery analyses and the interview with the anaesthetist.