Gestational dating using last menstrual period and bimanual exam for medication abortion in pharmacies and health centers in Nepal

Averbach, Sarah; Puri, Mahesh; Blum, Maya; Rocca, Corinne H.

doi:10.1016/j.contraception.2018.06.004

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Nurses and midwives (as well as auxiliary nurse midwives) can legally provide abortions (Andersen et al, 2016). Medical abortions can be provided up to 63 days of gestation in government‐certified health facilities (Averbach et al, 2018)…”

Section: Resultsmentioning

confidence: 99%

“…The routine nursing and midwifery tasks described in the articles were pregnancy diagnosis and options counselling (Levi et al, 2009), pharmacological and nonpharmacological pain relief (Lindström, Wulff, Dahlgren, & Lalos, 2011), administration of anti‐D, and antibiotic prophylaxis (Cappiello, Beal, & Simmonds, 2011), handling the products of conception (Andersson, Gemzell‐Danielsson, & Christensson, 2014; Mauri, Ceriotti, Soldi, & Guerrini Contini, 2015; Michalik et al, 2019; Mizuno, 2011; Nicholson, Slade, & Fletcher, 2010), gestational dating, bimanual examination (Averbach, Puri, Blum, & Rocca, 2018) screening for domestic violence, postabortion contraception care (Purcell, Cameron, Lawton, Glasier, & Harden, 2016), referrals (Grace, 2016), health education (Cappiello et al, 2011; Halldén, Lundgren, & Christensson, 2011), counselling (Hulme‐Chambers et al, 2018), prescription of abortion drugs (Simmonds, Beal, & Eagen‐Torkko, 2017), administration of abortion drugs, manual vacuum aspiration abortions (MVA) (Berer, 2009; Bridgman‐Packer & Kidanemariam, 2018; Paul, Gemzell‐Danielsson, Kiggundu, Namugenyi, & Klingberg‐Allvin, 2014), postabortion phone counselling (Dawson, Bateson, Estoesta, & Sullivan, 2016), peer education (Puri, Regmi, Tamang, & Shrestha, 2014; Puri, Tamang, Shrestha, & Joshi, 2015), care of or referral for postabortion complications (Hulme‐Chambers et al, 2018; Yegon et al, 2019), screening and treatment of sexually transmitted infections and human immunovirus (Yegon et al, 2019) and management of postabortion complications (Cleeve et al, 2019; Paul et al, 2014; Yarnall et al, 2009; Yegon et al, 2019). These tasks were not ubiquitous.…”

Section: Resultsmentioning

confidence: 99%

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The role of nurses and midwives in the provision of abortion care: A scoping review

Mainey

O’Mullan

Reid‐Searl

et al. 2020

Journal of Clinical Nursing

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Aims and objectives: To define the role and scope of the nurse and midwife within the global context of abortion. Background: An estimated 56 million women seek abortions each year; nurses and midwives are commonly involved in their care (Singh et al., 2018, https://www.guttm acher. org/sites/ defau lt/files/ report_pdf/abort ion-world wide-2017.pdf). As new models of abortion care emerge, there is a pressing need to develop a baseline understanding of the role and scope of nurses and midwives who care for women seeking abortions. Design: The review design was Arksey and O'Malley's five-stage methodological framework. The review follows the PRISMA-ScR checklist. Methods: MEDLINE, CINAHL, Scopus and ScienceDirect were used to identify original research, commentaries and reports, published between 2008-2019, from which we selected 74 publications reporting on the nursing or midwifery role in abortion care. Results: Nurses and midwives provide abortion care in a variety of practice. Three themes emerged from the literature: the regulated role; providing psychosocial care; and the expanding scope of practice. Conclusions: The literature on nursing and midwifery practice in abortion care is broad. Abortion-related practices are potentially over-regulated. Appropriately trained nurses and midwives can provide abortions as safely as physicians. The preparation of nurses and midwives to provide abortion care requires further research. Also, healthcare organisations should explore person-centred models of abortion care.Relevance to clinical practice: Abortion care is a common procedure performed across many healthcare settings. Nurses and midwives provide technical and psychosocial care to women who seek abortions. Governments and regulatory bodies could safely extend their scope of practice to increase women's access to safe abortions.Introduction of education programmes, as well as embedding practice in person-centred models of care, may improve outcomes for women seeking abortions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The role of nurses and midwives in the provision of abortion care: A scoping review

Mainey

O’Mullan

Reid‐Searl

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…(35) Indeed, WHO technical guidance does not require ultrasound con rmation of gestational age for early medication abortion, (5) and last menstrual period is the typical assessment for pregnancy dating in many study contexts. (37,38) Furthermore, studies assessing the effectiveness of telemedicine for abortion, home administration of misoprostol, and telephone follow-up after a clinic-based medication abortion have demonstrated the reliability of self-report of completion based on structured criteria. (39,40) Our study also suffered from loss-to-follow-up.…”

Section: Discussionmentioning

confidence: 99%

Self-managed medication abortion outcomes: results from a prospective pilot study

Moseson¹,

Jayaweera²,

Raifman

et al. 2020

Preprint

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Background: To evaluate the feasibility of conducting a prospective study to measure self-managed medication abortion outcomes, and to collect preliminary data on safety and effectiveness of self-managed medication abortion, we recruited callers to accompaniment groups (volunteer networks that provide counselling through the out-of-clinic medication abortion process by trained counselors over the phone or in-person).Methods: In 2019, we enrolled callers to three abortion accompaniment groups in three countries into a prospective study on the safety and effectiveness of self-managed medication abortion with accompaniment support. Participants completed up to five interview-administered questionnaires from baseline through six-weeks after taking the pills. Primary outcomes included: (1) the proportion that had a complete abortion; and (2) the proportion who experienced any warning signs of potential or actual complications.Results: Over the 30-day recruitment period, we enrolled 227 participants. At the one-week follow-up, two participants (1%) reported a miscarriage prior to taking the pills, and 202 participants (89% of those enrolled and 99% of those who participated in the one-week survey) had obtained and taken the medications. Three weeks after taking the medications, 192 (95%) participants reported feeling that their abortion was complete, and 189 (94%) felt their abortion was complete and had not reported a surgical intervention. Three (1.5%) received a surgical intervention, two (1%) received antibiotics, and five (3%) other medications. Participants did not report any major adverse events.Conclusion: These results establish the feasibility of conducting prospective studies of self-managed medication abortion in legally restrictive settings. Further, these prospectively collected pilot data suggest that self-managed medication abortion with accompaniment support may be safe and effective. Trial Registration: ISRCTN95769543

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“…9 Previous work has found that gestational dating based on the reported last menstrual period (LMP) was accurate when compared to LMP and a bimanual exam over 99% of the time. 10 Finally, a noninferiority study based on a harm-reduction approach found that trained pharmacists could provide safe and effective medication abortion. 11 The COVID-19 pandemic has most recently and acutely elucidated the importance of opportunities for people to get medical care as close to their residence as possible to reduce exposure to the risk of transmission.…”

Section: Discussionmentioning

confidence: 99%

Predictors of prior unsuccessful pharmacy abortion attempts among women presenting for abortion in government certified clinics in Nepal

Ahlbach

Puri²,

Daniel

et al. 2022

Intl J Gynecology & Obste

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Objective Although abortion in Nepal is broadly legal and free of charge, many women seek abortion care outside the legal system, including from pharmacies. We evaluated the prevalence of, and factors associated with, prior unsuccessful abortion attempts among women presenting to 14 randomly‐selected government approved abortion health facilities across Nepal. Methods Eligible participants were recruited in 2019 by trained research staff from certified abortion facilities. Participants (n = 1160) completed research staff‐administered baseline surveys. We used multivariable mixed‐effects logistic regression models to evaluate factors associated with having attempted pharmacy abortion prior to coming to the health facility. Results Almost one in seven (14%) women had tried to end their pregnancy before presenting to a participating clinic, often (9%) using medication obtained from a pharmacy. Women who lived farther from the clinic (aOR 1.28 per log hours travel time, 95% CI 1.10–1.49) and who reported financial difficulty in accessing the clinic (19% vs. 10%, aOR 2.10, 95% CI 1.20–3.70) had increased odds of having tried to access abortion through a pharmacy. Conclusion Integrating pharmacies into the legal network of abortion providers may improve access to safe care, particularly for rural women with financial and practical travel limitations.

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Gestational dating using last menstrual period and bimanual exam for medication abortion in pharmacies and health centers in Nepal

Abstract: Routine bimanual exams may not be essential for safe medication abortion provision by trained clinicians in pharmacies and health facilities in low resource settings like Nepal.

Cited by 6 publications

References 17 publications

The role of nurses and midwives in the provision of abortion care: A scoping review

The role of nurses and midwives in the provision of abortion care: A scoping review

Self-managed medication abortion outcomes: results from a prospective pilot study

Predictors of prior unsuccessful pharmacy abortion attempts among women presenting for abortion in government certified clinics in Nepal

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