Alongkone Phengsavanh MD History of abortion in Laos No medical abortion in the past Methods of Induced abortion in the past Dilatation and Curettage Forceful massage Falling from the height ID: 1032087
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1. Overview of Abortion in LaosAlongkone Phengsavanh MD
2. History of abortion in LaosNo medical abortion in the pastMethods of Induced abortion in the pastDilatation and CurettageForceful massageFalling from the heightHerbal Uterine insertionUterine insertion of Detergent etc
3. Complications of abortion in the pastVaginal bleedingUterine perforationSepticemiaTrauma to abdominal organetc
4. Where Safe Abortion is Unavailable, Women Seek Unsafe Abortion.Methods of unsafe abortion:Ingestion of herbs, bleach, and toxic chemicalsVoluntary blows to the stomach, intentional fallsVaginal insertion of sharp tools, twigs, harmful chemicalsSham procedures, covak’s procedure (Vera Drake), untrained or unskilled providers Source: Grimes, David, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday Okonofua and Iqbal Shah. 2006. Unsafe abortion: The preventable pandemic. Lancet, 368(9550): 1908-19.
5. “ Ya chine ““ Ya Chine “ is abortificients which was illegally imported from China in border of Lao provincesMifepristoneMisoprostolWrong dosageNo indicationNo insert paper
6. Misoprostol Registration in LaosLao MMR 197 mother died /100,000 Live birthMisoprostol was registered as Cytotec on 1999-2002 for gastric ulcerMisoprostol was added in the WHO essential drug list for MCH drugs.Misoprostol was added in the Lao national essential drug list on 2011 Misoprostol was registered in Laos on 2013page 6
7. Clinical handbook for safe abortion carePre-abortionInformation, counselling and decision-makingMedical historyPhysical examinationLaboratory and other investigationsDiscussing contraceptive optionsAbortionInfection prevention and controlPain managementMethods for medical abortionMethods for surgical abortion (including cervical preparation)Post-abortionPrior to discharge from the health care facilityAdditional follow-up with a health care providerPost-abortion contraceptionAssessing and managing abortion complicationsFilename
8. Summary of WHO recommendationsFilename
9. 2012 FIGO Recommendations
10. Lao National Guidelines for safe abortionPregnancy up to 9 weeksPregnancy : 9-12 weeksPregnancy > 12 weeks – Refer to WHO guidelinesPre-abortion careAbortion carePost abortion careSeptic abortion
11. Threaten AbortionHydroxy progesterone (Proluton depot) 1 amp / week for 3 weeks +Natural progesterone (Utrogestan) 200mg 1 tab , 3 or 4 times perday until bleeding is stoppedContinue by Utrogestan 100 mg until 36 weeks of pregnancy
12. Induced AbortionMedical AbortionMifepristone + MisoprostoneMisoprostone onlySurgical AbortionManual Vaccum Aspiration (MVA)Electrical Vaccum Aspiration (EVA)
13. Surgical Abortion < 12 – 14 weeksVacuum aspiration is the recommended technique (up to 12-14 weeks)Replace D&CNo need to use sharp curettage routinely
14. Incomplete AbortionMisoprostol 200 mcg : 3 tabs oral or vaginal routeMVA
15. Septic abortionEvacuation of retained product conceptusMisoprostolMVAAntibiotic useCeftriazone or ampicillineGentamycineMetronidazol