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CNAA / Theses / 2009 / June /

Optimising efficiency of implementing medical abortion in Republic of Moldova


Author: Railean Ludmila
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2009
Scientific adviser: Olga Cerneţchi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Victor Ghicavîi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 23 June, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document0.42 Mb / in romanian

Keywords

medical abortion, Mifepristone, Misoprostol, Izoturon

Summary

The present study was conducted to assess the efficacy and safety of a simplified regimen Mifepristone-Misoprostol and combined regimen Mifepristone-Izoturon for interruption of early pregnancy in Republic of Moldova. The obtained result demonstrated that the simplified regimen Mifepristone 200 mg – Misoprostol 400 μg orally is safe and efficient for termination of pregnancies of ≤ 56 days in Moldova and represent a suitable alternative for surgical abortion. The success rate was 95, 42±1, 69%.

At the same time, our data demonstrated that Izoturon, a specific nitric oxide synthase inhibitor, in combination with Mifepristone represent a efficient and safe alternative for termination of pregnancies of ≤ 56 days, with lower degree and duration of vaginal bleeding and significantly lower incidence of pain during the process of abortion. The success rate of oral Mifepristone 200 mg –Izoturon 400 mg vaginally regimen was 95, 23±3, 29%.

We noticed a lower level of anxiety and emotional instability of women after the use of Mifepristone-Izoturon regimen. These changes suggest that less vaginal bleeding and lower incidence and intensity of pain, lack of necessity in analgesic drugs, after Izoturon administration have a positive effect with a decrease of psycho-vegetative symptoms, improving the adaptation of female organism during the process of abortion. The established benefits of the medicine Izoturon offer a new strategy for early pregnancies termination.

Our findings demonstrated the efficiency and high satisfaction with home use of Misoprostol/Izoturon. Women noticed the convenience, autonomy and great compatibility with their home or work duties. Detailed instructions about the way and the time of Misoprostol/Izoturon administration, possible side effects and the moment of return to the clinic for the follow-up visit are crucial.

Our results showed the necessity of counseling before and after abortion and psychological support for women that terminate their pregnancy. This must include information on the choice of abortion method, complete information on the difference between the medical and surgical abortion, information on degree and amount of bleeding, on possible complications and side effects like incomplete abortion or ongoing pregnancy. All these will reduce the negative effect of abortion on the women's physical and psychical health as well as maternal morbidity and mortality.