David Baird
Speeches:
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About 15% of pregnancies
terminate spontaneously in the
first trimester .The majority of these miscarriages
are unrecognized clinically.. As the levels of
progesterone fall expulsion of the products of
conception occur spontaneously and resumption
of cyclical ovarian activity with 2-3 months.
Modern methods of medical abortion using
mifepristone and a prostaglandin simulate closely
the mechanisms which occur in spontaneous
abortion suggesting that it is likely that the
majority will resolve spontaneously without further
intervention(Baird 2002) . Blockage of the action
of progesterone with mifepristone results in
powerful uterine contractions which together with
an increased sensitivity to prostaglandin leads to
expulsion of the fetus and placenta.(Baird 2002).
Extensive research over the last 30 years has now
identified a simple regimen (Mifepristone followedby misoprostol) which is highly effective(on-
going pregnancy<1%), is free from serious
side effects and does not require sophisticated
facilities(WHO2003). Several studies have shown
that abortion can be safely delivered by relatively
unskilled health workers (mid-level providers
MLP) who have been trained to follow an agreed
protocol of treatment(Shannon &Winnikoff 2009
Warriner et al2011). By devolving provision of
abortion to MLP the access to abortion should
be greatly widened. As predicted in the original
report of medical abortion with mifepristone and
gemeprost that “this combination would have
particular application in countries where skilled
medical and surgical experience are in short
supply” (Rodger & Baird 1987 )