Woman-centered abortion care: Reference manual - AbortionDocs.org

233 Pages·2005·1.42 MB·English

Woman-Centered Abortion Care
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Alyson G.Hyman,MPH e
Laura Castleman,MPH,MD
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Ipas works globally to increase women’s ability to exercise their sexual and reproductive rights and to reduce abor-
tion-related deaths and injuries. We seek to expand the availability, quality and sustainability of abortion and related
reproductive-health services, as well as to improve the enabling environment. Ipas believes that no woman should
have to risk her life or health because she lacks safe reproductive-health choices.
ISBN: 1-882220-87-0
© 2005 Ipas.
Produced in the United States of America.
Suggested Citation: Hyman, Alyson G. and Laura Castleman. 2005. Woman-centered abortion care: Reference manual.
Chapel Hill, NC, Ipas.
Editors: Marty Michaels, Jill Molloy, Kezia Scales
Illustrations: Stephen C. Edgerton
Cover Design and Layout: Valerie Holbert
Glossary: Evangeline Christie and Karah Fazekas
Printed on recycled paper.
The illustrations and photographs used in this publication are for illustrative purposes only. No similarity to any actual
person, living or dead, is intended.
Ipas Woman-Centered Abortion Care:Reference Manual
Woman-Centered Abortion Care:
Reference Manual
Acknowledgments
This manual was based in large part on the 2004 Ipas curriculum Woman-
Centered Postabortion Care: Reference Manual byJeannine Herrick, Katherine
Turner, Teresa McInerney and Laura Castleman. The authors are deeply grateful
to these colleagues for laying the groundwork for this reference manual.
We also want to especially thank: Joan Healyfor her extensive technical
guidance and review; Marty Jarrell for her unending patience as we made
revisions to reflect scientific changes that occurred during the writing of this
manual; and Karah Fazekas for her tireless logistical and editorial work.
The authors are grateful to Sally Girvin for her technical assistance on the
Medication Abortionmodule and Jill Molloy for her technical assistance on the
Reproductive Rightsmodule.
This manual has been greatly strengthened by the support and contributions of
our partner organizations. Specifically, we thank the following individuals for
their reviews and comments:
• Jean Ahlborg, MD, EngenderHealth
• Marianne Parry, MD, Marie Stopes International
• Lorelei Goodyear, Allison Bingham and Michelle Folsom, PATH
• Ann Gerhardt, National Abortion Federation
In addition, we are grateful for the field experience and technical expertise
contributed by the following Ipas staff and consultants:
• Traci Baird
• Sangeeta Batra, MD
• Maria de Bruyn
• Amy Entwistle
• Rivka Gordon
• Leila Hessini
• Ann Leonard
• Teresa McInerney
• Philip Mwalali, MD
• Charlotte Hord Smith
• Karen Trueman
• Judith Winkler
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Ipas Woman-Centered Abortion Care:Reference Manual
About Ipas
Ipas is dedicated to the belief that every woman has a basic right to
reproductive- and sexual-health care and to make her own reproductive and
sexual choices. We work globally to increase access to high-quality reproductive-
health care and to improve women’s ability to exercise their reproductive rights,
especially their right to safe, legal abortion. We concentrate on preventing
unsafe abortion, improving treatment of its complications and reducing its
consequences. We strive for women’s empowerment by increasing access to
services that enhance their reproductive and sexual health.
The International Conference on Population and Development (ICPD) and its five-
year review (ICPD+5) provided a clear mandate to all signatory governments:
make abortion care safe and accessible to women in their communities. Ipas is
dedicated to scaling up safe abortion services globally and to the full extent of
local laws through training, service-delivery improvement, advocacy, research
and provision of reproductive-health technologies.
Scaling upis defined as achieving universal access to high-quality,
sustainable abortion-care services.
•Achieving universal access ensures that wherever a woman seeks help
when she has unprotected sex, unwanted sex or an unwanted pregnancy,
she will find the care she needs, whether it be information, referral, or
clinical or related services. Universal access to abortion requires that every
public and private facility in a country's health system is trained and
equipped and has other measures in place to ensure women’s access to
abortion-related care.
•Achieving sustainability in abortion-care services requires political
leadership, policy development, financial resources and an adequate
health-system infrastructurewith trained health-careproviders.
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Ipas Woman-Centered Abortion Care:Reference Manual
About This Manual
The primary purpose of this reference manual is to provide guidance to health-
care personnel on improving the quality of care available to women seeking
abortion services. This manual introduces the Ipas MVA Plus®and Ipas EasyGrip®
cannulae, and explains the manual vacuum aspiration (MVA) abortion procedure
in detail. It also explains medication-abortion methods that use the medications
misoprostol and mifepristone. All the methods described here offer women safe,
effective options for first-trimester uterine evacuation.
Although this reference manual provides extensive information on abortion-care
provision, it is not intended to serve as a self-guided learning tool. It is designed
to be used as a participant’s manual during trainer-facilitated individualized and
group-based courses that include simulated practice and clinical practice with
clients under the supervision of an experienced provider; as a learner’s resource
to help refresh and strengthen participants’ skills after completion of a course;
and as a reference document for those seeking up-to-date information on
comprehensive abortion care.
Health-care providers planning to conduct courses on abortion care should obtain
the manual’s companion piece, Woman-Centered Abortion Care: Trainer's
Manual,which supplies educational materials, trainer's notes and competency-
based evaluation tools, and is written to encompass multiple adult-learning
styles.
The Woman-Centered Abortion Care: Reference Manualis useful to a broad
audience, including sexual- and reproductive-health clinicians, trainers, program
managers, health educators, social workers, outreach workers and other health-
care workers. The 12 modules bring a woman’s-rights perspective to abortion-
caretraining and service delivery.The manual is divided into two parts. Section I:
High-Quality Abortion Careis intended for a wide range of health-facility
workers, including administrative personnel and other non-clinicians. These five
modules address quality-of-care issues, including client-provider communication,
women's rights to high-quality reproductive-health care, and recommendations
for monitoring services and ensuring community linkages.
Section II: Clinical Carefor Womenfocuses on technical information and is
intended for a clinical audience that deals directly in abortion care, including
physicians, nurse midwives, counselors and others. The seven modules in
Section IIare in the order in which a woman typically receives care; however,
facilities may vary the steps of care according to their own settings and needs.
For example, some health-carecenters provide contraceptive services after
counseling and prior to the abortion procedure, whereas others provide
contraceptive counseling and supplies only after the procedure. This manual
provides information on both MVA and medication abortion. Whenever possible,
choices in uterine-evacuation methods should be made available to women. It is
recommended that the techniques introduced in this manual be included in
clinical protocols for abortion-related services at health-care centers and
systems.
Ipas’straining strategies place equal emphasis on improving the technical quality
of abortion care and on the overall quality of care that women receive. This
comprehensive approach requires learners to reflect on values, attitudes and
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Ipas Woman-Centered Abortion Care:Reference Manual
myths associated with abortion and to focus services on the needs and desires of
each woman receiving care. Ipas also recommends Effective Training in
Reproductive Health: Course Design and Delivery. Reference Manualand
Trainer’s Manual, acurriculum designed to develop core training skills for
professionals in various areas of reproductive health, including administration,
policy and advocacy.
To order these and other Ipas resources, contact Ipas at:
P.O. Box 5027
Chapel Hill, NC 27516 USA
Telephone: [phone]
Toll free (in the United States): 800-334-8446
Fax: [phone]
Email: [email protected]
www.ipas.org
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Ipas Woman-Centered Abortion Care:Reference Manual
Woman-Centered Abortion Care: Reference Manual
Table of Contents
Overview and Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
2.0 Key Elements of Woman-Centered Abortion Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
3.0 Upholding Women’s Rights in an Abortion-Care Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
4.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Reproductive Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
2.0 Reproductive Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
3.0 Barriers to Legal Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
4.0 Providers as Advocates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
5.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Appendix A: Treaty Monitoring Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Appendix B: Statements From Health Professional Associations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Appendix C: Common Regulatory and Administrative Barriers to Obtaining Safe Abortion . . . . . . . . . . . . . . . . . . . .30
Community Linkages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
2.0 Community Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
3.0 Programmatic Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
4.0 Summary ................................................................................36
Appendix A: Potential Audiences and Topics for Information, Education and Communication on Abortion . . . . . . . .38
Uterine Evacuation Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
2.0 Vacuum Aspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
3.0 Medication Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
4.0 Sharp Curettage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
5.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Appendix A: Complications Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Monitoring to Improve Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
2.0 What Is Monitoring and Why Is It Important? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
3.0 Keys to Effective Monitoring Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
4.0 Four Steps of Effective Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
5.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Appendix A: Written Consent Form – Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Appendix B: Written Consent Form – Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Appendix C: Sample Clinical Protocols Checklist for MVA Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
2.0 What Is Counseling? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
3.0 Voluntary Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
4.0 Counseling in the Abortion Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
5.0 Privacy,Confidentiality and Informed Decisionmaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
6.0 Counselors’ Values, Attitudes and Empathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
7.0 Effective Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
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8.0 Women’s Feelings and Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
9.0 Making Referrals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
10.0 Closing a Counseling Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
11.0 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
12.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Appendix A: Additional Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Contraceptive Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
2.0 Importance of Contraceptive Counseling and Method Provision After an Abortion . . . . . . . . . . . . . . . . . . . . . .88
3.0 Models of Service Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
4.0 Women’s Fertility Goals Following an Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
5.0 Rights to Privacy, Confidentiality and Informed Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
6.0 Involvement of Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
7.0 Essential Elements of Contraceptive Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
8.0 Medical Eligibility for Contraceptive Use After an Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
9.0 Emergency Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
10.0 Special Contraceptive-Counseling Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
11.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Appendix A: Individual Factors and Counseling Recommendations and Rationales . . . . . . . . . . . . . . . . . . . . . . . . . .99
Appendix B: Guidelines for Selection of Contraception by Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
Appendix C: Contraceptive Counseling for Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Infection Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
2.0 Infection Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
3.0 Elements of Infection Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
4.0 Management of Occupational Exposure .......................................................117
5.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Appendix A: Sharps Container . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
Appendix B: Mixing Instructions to Produce 0.5% Chlorine Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
Clinical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
2.0 Client History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
3.0 Psychosocial Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
4.0 Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
5.0 LaboratoryTests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
6.0 Ultrasound Exam and Ectopic Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
7.0 Reproductive-Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
8.0 Special Populations to Consider During Clinical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
9.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Appendix A: Provision of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Appendix B: Female Genital Cutting (FGC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Uterine Evacuation Procedurewith Ipas MVA Plus® ..................................................135
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
2.0 Instrument Features, Care, Use and Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
3.0 Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
4.0 Uterine Evacuation Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
5.0 Post-Procedure Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
6.0 Follow-Up Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
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Ipas Woman-Centered Abortion Care:Reference Manual
Appendix A: Comparison of Ipas Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Appendix B: Methods for Processing Ipas MVA Plus®Aspirator and Ipas EasyGrip®Cannulae . . . . . . . . . . . . . . . .170
Appendix C: Approaches to Pain Management During MVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172
Appendix D: Suggested Equipment and Supplies for Uterine Evacuation Procedure with Ipas MVA Plus® .......174
Appendix E: Misosprostol as Cervical Preparation for First-Trimester Abortion Using Vacuum Aspiration . . . . . . .175
Appendix F: Sample Clinical Referral Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Appendix G: Discharge Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Appendix H: Sample Follow-Up Visit Medical Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
Medication Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
2.0 Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184
3.0 Mifepristone Plus Misoprostol Regimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
4.0 Misoprostol-Alone Regimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
5.0 Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
6.0 Side Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
7.0 Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
8.0 Instructions Prior to Leaving the Clinic and Care Afterwards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
9.0 Follow-Up Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194
10.0 Summary ...............................................................................194
Appendix A: Medication Abortion with Mifepristone and Misoprostol – Questions and Answers . . . . . . . . . . . . . .199
Appendix B: Sample Information Sheet for Mifepristone and Misoprostol Medication Abortion . . . . . . . . . . . . . . .201
Appendix C: Abortion Induction with Misoprostol (Cytotec®)in Pregnancies up to Nine Weeks LMP . . . . . . . . . . .203
Appendix D: Early Medication Abortion with Misoprostol – Questions and Answers . . . . . . . . . . . . . . . . . . . . . . . .206
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
2.0 Complications of Vacuum Aspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
3.0 Complications of Medication Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
4.0 Rarer Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
5.0 Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
6.0 After-Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
7.0 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
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Notes
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