Eva Macun

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    Analysis of medical abortion in first trimester in a small regional hospital in Slovenia

    Eva Macun, General Hospital Jesenice, Slovenia

    Introduction: Medical abortions have been performed in General Hospital Jesenice since 2005. The first attempts were made during our participation in the WHO supported study which was coordinated by Gynecological Department of the University Medical Center in Ljubljana. Both drugs that are used regularly for medical abortions (mifepriston and misoprostol) are not register at the Agency for Medicinal Products and Medical Devices of Slovenia. Therefore a special approval is needed for their import. Our doctors needed time to accept the method but since 2009 two thirds of all abortions have been performed using this method. One step forward has been made and a clinical pathway for medical abortion is being prepared. Our final goal is to make the method widely available, to educate all the involved professionals and to make it possible for home use.

    Methods: In the current presentation an analysis of all performed medical abortions from 2005 to 2009 is shown. All data were collected by hand. A WHO protocol was used for medical abortions under 9th week of pregnancy. Women were given 200mg of mifepriston orally and after 36-48 hours 800µg of misoprostol vaginally. For women, who were pregnant 9 to 12 weeks, the protocol was adjusted for every single pregnancy.

    Criteria for successful abortion that we used after 14 days were: no gestational sac, endometrial lining thinner than 15 mm, if there were hiper- and hipoechogenic areals in the endometrial lining from 15 to 20 mm, we prescribed uterotonic and antibiotic therapy  and ultrasound control after menstrual period. In case of prolonged bleeding we did a curettage.

    In other cases we took this as unsuccessful abortion and completed it with a curettage.

    Results:We performed 124 medical abortions in this time. Till 49 days of amenorrhea we performed 75 abortions: 3 patients needed curettage, because there remnants of trophoblast in the endometrial lining after 14 days. Success rate  of  the method in our department was 96%.

    Between 7th  and 9th  week we performed 39 abortions. Two needed additional curettage (5%).

    We also performed 10 abortions between 9th and 12th weeks. All were successful.

    All together the  success rate was 93.4%. for abortions performed in women who were pregnant less than 12 weeks. We found no complications (heavy bleeding, infection).

    Conclusions:In our department the method is very successful. We see a lot of  potentials in promoting medical abortion in Slovenia, because we have really good experience with it, our patients prefer medical over surgical abortion, we need less professionals, we will make a clinical pathway for hospital use. But our goal is to perform medical abortion at home, because the method is safe. In this project good cooperation would be achieved with local gynecologists who will follow the patients at home.

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    Medical abortion in Slovenia: where are we?

    Eva Macun General hospital Jesenice, Jesenica, Slovenia - eva.macun@sb-je.si

    Introduction: In Slovenia abortion is legal on demand up to 10 weeks of pregnancy. Later abortion can be done after approval of the Commission for abortion. It can be performed in 14 gynaecological departments. Slovenia has a national register of fetal death up to 500g. Institutions that perform abortions are obliged to report all known fetal deaths, with demographic data and procedure. Methods: We checked the fetal death database for method of abortion on demand for Slovenia for the years 2007-2011. We interviewed doctors in all Ob/Gyn departments. We asked them how many percent of abortion were medical in the year 2014. Possible answers were: <50%, >50% and >90%. We asked them also if women can be given misoprostol for home use. Results: In the year 2007 there were 5176 abortions on demand in Slovenia; 4660 (90%) were surgical and 123 (2.4%) were medical abortion and some other methods. In the following years the rate of medical abortions increased (Table 1). In year 2011 there were 4263 abortions ; 2153 (50.5%) were surgical and 1602 (37.6%) were medical abortions.

    Table 1: The rates of medical and surgical abortions in Slovenia, 2007 - 2011

    Year 2007 2008 2009 2010 2011

    Surgical

    Abortion number 4660 4099 3560 2604 2153 % 90.0 82.8 76.5 60.2 50.5

    Medical number 123 434 734 1345 1602

    Abortion % 2.4 8.8 15.8 31.1 37.6

    Results of interviews show that in year 2014 four Ob/Gyn departments use medical abortion in 50% or less. Four departments use it in more than 50% and less than 90%. Six departments use medical abortion in more than 90%. Three of the latter give misoprostol to women for home use. Conclusions: Use of medical abortion is increasing in Slovenia. There are departments that give misoprostol for home use.