Advertisement
Original research article| Volume 104, ISSUE 5, P502-505, November 2021

Termination of pregnancy services in Irish general practice from January 2019 to June 2019

      Abstract

      Objective

      To describe how a general-practitioner-delivered community medical abortion service is provided in Ireland, including a description of the unique model of care delivered within the framework of new legislation. To investigate the characteristics and contraceptive choices of women attending in the first six months of the service.

      Study Design

      Twenty-seven general practitioners conducted a retrospective chart review. We described the service and analyzed demographic characteristics, treatment outcomes, adverse events, and contraception use. We defined treatment success as complete abortion without surgical intervention.

      Results

      Twenty-seven general practitioners from the Southern Task Group on Abortion and Reproductive Topics (START) group collected data from 475 women who had attended requesting medical abortion from January 1st 2019 to June 30th 2019. Out of these, 315 (66%) were more than 25 years old, and 261 (55%) had at least one child. The mean gestational age at initial presentation was 49 days. Five (1%) had a gestational age which exceeded 84 days. Four hundred and twenty (89%) proceeded with community medical abortion following an initial consultation. The process was completed without the need for surgical intervention in 412 (98%) cases. Six (1.4%) women had a mild post-treatment infection, and received community treatment with oral antibiotics. Thirty-three (7.9%) patients were referred to hospital for additional evaluation following treatment. Two hundred ninety (69%) adopted contraception post abortion; only 160 (34%) were using contraception prior to pregnancy.

      Conclusion

      The general-practitioner-delivered community medical abortion service described in the study is safe, effective, and accessible for the majority of, but not all women seeking abortion. The model of care used in Ireland provides an ideal opportunity to discuss contraceptive choice.

      Implications Statement

      This review provides demographic, efficacy, and safety data for the general-practitioner-provided community medical abortion service in Ireland. An effective and largely accessible model of care is demonstrated. These findings can help inform legislative review, clinical guidelines, and generate hypotheses for future research.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wu S.
        Medical abortion in China.
        J Am Med Women Assoc. 2000; 55 (204): 197-199
        • Jones RK
        • Henshaw SK.
        Mifepristone for early medical abortion: experiences in France, Great Britain and Sweden..
        Perspect Sex Reprod Health. 2002; 34: 154https://doi.org/10.2307/3097714
        • de Costa C
        • Douglas H
        • Hamblin J
        • Ramsay P
        • Shircore M.
        Abortion law across Australia - a review of nine jurisdictions.
        Aust N Z J Obstet Gynaecol. 2015; 55: 105-111https://doi.org/10.1111/ajo.12298
        • Ngo TD
        • Park MH
        • Shakur H
        • Free C.
        Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review.
        Bull World Health Organ. 2011; 89: 360-370https://doi.org/10.2471/BLT.10.084046
      1. Safe Abortion: Technical and Policy Guidance for Health Systems - WHO, World Health Organization Staff, World Health Organization, UNAIDS - Google Books n.d. https://books.google.ie/books?hl=en&lr=&id=DmA0DgAAQBAJ&oi=fnd&pg=PA3&ots=RH26JzBRmS&sig=ueoxv5n3vTu8PV4CNHaQKCBOmSE&redir_esc=y#v=onepage&q&f=false (Accessed June 28, 2020).

      2. Thirty-sixth Amendment of the Constitution Act 2018 – No. C36 of 2018 – Houses of the Oireachtas n.d. https://www.oireachtas.ie/en/bills/bill/2018/29/ (accessed June 28, 2020).

      3. Health D of. Health (Regulation of Termination of Pregnancy) Act 2018 - Annual Report on Notifications 2019 n.d. https://www.gov.ie/en/publication/b410b-health-regulation-of-termination-of-pregnancy-act-2018-annual-report-on-notifications-2019/ (accessed February 20, 2021).

      4. Network AS. Ireland's report on abortions carried out in 2019 - Abortion Support Network n.d. https://www.asn.org.uk/news-and-events/asnresponsetoroi2019abortionstats/ (accessed February 20, 2021).

        • Mishtal J.
        • Duffy D.
        • Chavkin W.
        • Reeves K.
        • Chakravarty D.
        • Grimes L.
        • Stifani B.
        • Horgan P.
        • Murphy M.
        • Favier M.
        • Lavelanet A.
        Policy Implementation – Access to Safe Abortion Services in Ireland Research Dissemination Report.
        UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia. Geneva, Switzerland, 2021: 1-37
      5. RCPI » Interim clinical guidance on termination of pregnancy under 12 weeks n.d. https://www.rcpi.ie/news/publication/interim-clinical-guidance-on-termination-of-pregnancy-under-12-weeks/ (accessed June 28, 2020).

      6. ICGP. Interim clinical support for termination of pregnancy in general practice 2019:39. https://www.icgp.ie/go/courses/women_s_health/test?spId=91C418E5-32C7-46A5-B409C2C701279C8F (accessed February 20, 2021).

      7. Institue of Obstetricians and Gynaecologists.Interim Clinical Guidance Termination of pregnancy under 12 weeks 2018:46. http://startireland.ie/resources/FINAL.pdf (accessed February 20, 2021).

      8. My Options freephone line - HSE.ie n.d. https://www2.hse.ie/services/unplanned-pregnancy-support-services/my-options-freephone-line.html?gclid=EAIaIQobChMIgbD71YCl6gIVRbTtCh1qVQmTEAAYASAAEgITCvD_BwE&gclsrc=aw.ds (accessed June 28, 2020).

        • Schonberg D
        • Wang LF
        • Bennett AH
        • Gold M
        • Jackson E
        The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: A systematic review.
        Contraception. 2014; 90: 480-487https://doi.org/10.1016/j.contraception.2014.07.004
        • Bracken H
        • Clark W
        • Lichtenberg E
        • Schweikert S
        • Tanenhaus J
        • Barajas A
        • et al.
        Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol.
        BJOG. 2011; 118: 17-23https://doi.org/10.1111/j.1471-0528.2010.02753.x
        • Raymond EG
        • Bracken H.
        Early medical abortion without prior ultrasound.
        Contraception. 2015; 92: 212-214https://doi.org/10.1016/j.contraception.2015.04.008
        • Abbas D
        • Chong E
        • Raymond EG.
        Outpatient medical abortion is safe and effective through 70 days gestation.
        Contraception. 2015; 92: 197-199https://doi.org/10.1016/j.contraception.2015.06.018
        • Gatter M
        • Cleland K
        • Nucatola DL.
        Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days.
        Contraception. 2015; 91: 269-273https://doi.org/10.1016/j.contraception.2015.01.005
        • Raymond EG
        • Shannon C
        • Weaver MA
        • Winikoff B.
        First-trimester medical abortion with mifepristone 200 mg and misoprostol: A systematic review.
        Contraception. 2013; 87: 26-37https://doi.org/10.1016/j.contraception.2012.06.011
        • WHO
        Clinical practice handbook for safe abortion.
        WHO, 2020 (http://www.who.int/reproductivehealth/publications/unsafe_abortion/clinical-practice-safe-abortion/en/)
        • WHO
        Safe abortion: technical and policy guidance for health systems.
        WHO, 2018 (http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/)
        • Costescu D
        • Guilbert E
        • Bernardin J
        • Black A
        • Dunn S
        • Fitzsimmons B
        • et al.
        Medical Abortion.
        J Obstet Gynaecol Can. 2016; 38: 366-389https://doi.org/10.1016/j.jogc.2016.01.002
        • Cleland K
        • Creinin MD
        • Nucatola D
        • Nshom M
        • Trussell J.
        Significant adverse events and outcomes after medical abortion.
        Obstet Gynecol. 2013; 121: 166-171https://doi.org/10.1097/AOG.0b013e3182755763
      9. Philip NM, Shannon CC, Winikoff B. Critical issues in reproductive health misoprostol and teratogenicity : reviewing the evidence report of a meeting 2002.

        • da Silva Dal Pizzol T
        • Knop FP
        • Mengue SS.
        Prenatal exposure to misoprostol and congenital anomalies: systematic review and meta-analysis.
        Reprod Toxicol (Elmsford, NY). 2006; 22: 666-671https://doi.org/10.1016/j.reprotox.2006.03.015
      10. The use of mifepristone for medical abortion. n.d.

        • Chen MJ
        • Creinin MD.
        Mifepristone with buccal misoprostol for medical abortion.
        Obstet Gynecol. 2015; 126: 12-21https://doi.org/10.1097/AOG.0000000000000897
        • Raymond EG
        • Shochet T
        • Bracken H.
        Low-sensitivity urine pregnancy testing to assess medical abortion outcome: a systematic review.
        Contraception. 2018; 98: 30-35https://doi.org/10.1016/j.contraception.2018.03.013
        • Cameron ST
        • Glasier A
        • Johnstone A
        • Dewart H
        • Campbell A.
        Can women determine the success of early medical termination of pregnancy themselves?.
        Contraception. 2015; 91: 6-11https://doi.org/10.1016/j.contraception.2014.09.009
        • Raymond EG
        • Weaver MA
        • Tan YL
        • Louie KS
        • Bousiéguez M
        • Lugo-Hernández EM
        • et al.
        Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy.
        Obstet Gynecol. 2016; vol. 127 (Lippincott Williams and Wilkins): 306-312https://doi.org/10.1097/AOG.0000000000001274
        • Okusanya BO
        • Oduwole O
        • Effa EE.
        Immediate postabortal insertion of intrauterine devices.
        Cochrane Database Syst Rev. 2014; : 2014https://doi.org/10.1002/14651858.CD001777.pub4
        • Dzuba I
        • Chong E
        • Hannum C
        • Kurbanova D
        • Lichtenberg E
        • Lugo Hernández E
        • et al.
        Outpatient mifepristone–misoprostol medical abortion through 77 days of gestation.
        Contraception. 2016; 94: 389https://doi.org/10.1016/j.contraception.2016.07.027