Lucy Michie
Speeches:
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Asurvey of attitudes of staff working within a
sexual and reproductive health centre, towards
undertaking early medical termination of
pregnancy
Michie, L1,2; Cameron, S1,2
1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
Edinburgh,UK
Introduction: In Scotland, most termination of pregnancy (TOPs)
are provided in hospital departments of Obstetrics and
Gynaecology. Since high quality contraceptive provision should be
integral to TOP, this raises the question of whether TOP services
would be better provided by clinicians in community sexual and
reproductive health services (SRH). We aimed to determine views
of these clinicians about potentially offering TOP servicesMethods: An anonymous internet questionnaire of staff working
in a large SRH service in Edinburgh (Chalmers) was conducted
between January and March 2012. The questionnaire consisted
mainly of ‘drop-down’ list options with additional free text
response to some questions.
Results: A 69% response rate was obtained. (62 out of 90;
doctor = 22, nurses = 25, admin staff = 15). The majority of
responders (69%) felt that provision of abortion services would be
a natural extension to existing services and the majority, (69%)
would be personally willing to provide abortion care. Only 11%
stated that they would refuse to be involved in TOP care due to
moral objections. Respondents agreed that TOP care from this
setting would offer advantages for women including better
provision of contraception (71%) and better management of
sexual infection (53%), amongst others. Only 23% of responders
(n = 14) felt there would be some disadvantage to offering
abortion services from this setting.
Conclusion: Most staff felt that providing TOP services within a
community SRH service is a natural extension to existing services
and that this would offer improved contraception and sexual
health care to women undergoing TOP. -
Asurvey of professionals in sexual and
reproductive health in the United Kingdom, about
attitudes towards provision of termination of
pregnancy care within community sexual and
reproductive health (SRH) clinics
Michie, L1,2; Cameron, S1,2
1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
Edinburgh, UK
Introduction: In the UK, termination of pregnancy (TOP) services
are predominantly based within National Health Service hospitals.
However, community based sexual and reproductive health (SRH)
clinics that provide specialist contraceptive services could offer an
alternative setting and may provide high quality on-going
contraception. We sought to determine the attitudes of those
working within SRH towards participating in TOP and views on
which setting is most appropriate for TOP care.
Methods: A questionnaire was distributed to attendees at a large
UK sexual and reproductive health scientific meeting in April
2012. Information obtained included demographics, respondents
current experience of TOP care and their response to a series of
statements concerning, attitude and willingness to participate in
and location of TOP care.
Results: An 82% response rate was obtained (165 of 200). Eighty-
eight percent (n = 146) of respondents were female. Ninety-five
percent (157) were doctors and 4% (6) were nurses. Almost all
responders already had some involvement in TOP care (97%
n = 160); 78% (29) refer patients on to hospital TOP services,
64% (106) assess patients and provide information, 62% (103)
sign documents authorising TOP and 14% (24) undertake the
procedure or administer medication. Whilst 78% (128) agree TOP
care services (for 1st trimester, uncomplicated cases) would be
best suited to community SRH, 51% (83) believe it should be
divided across community, hospital and charity services.Conclusion: The overwhelming majority of doctors and nurses in
SRH agreed that abortion services would be best delivered from a
community SRH setting and would be willing to participate in
providing this service. -
Review of telephone follow-up of women having
early medical termination of pregnancy
Michie, L1,2; Cameron, S1,2; Johnstone, A1,2;
Dewart, H1,2
1 NHS Lothian; 2 University of Edinburgh, UK
Introduction: Telephone follow-up2 weeksaftermedical
terminationofpregnancy(TOP)(£9 weeksofgestation)withaself-
performedlowsensitivityurinepregnancy(LSUP)test,was
introducedatahospitalTOPserviceinEdinburgh.Womenwho
screened‘positive’attelephonefollow-up(ongoingpregnancy
symptoms,scantbleeding,orLSUPresult)subsequentlyattended
foranultrasound.Apreviousserviceevaluationconfirmedthatthis
waseffectivefordetectingongoingpregnancyandhadgoodfollow-
uprates.Wesoughttodetermineifthismethodoffollow-up
continuedtobesuccessfulduringtheyearfollowingitsintroductionMethods: Retrospective computerised database review of outcome
of telephone follow-up of women having a medical TOP
(£9 weeks of gestation) over 12 months (March 2011–February
2012).
Results: One thousand and eighty-four women of mean age
25 years had a medical TOP during this period. One hundred and
twelve women were scheduled to attend the clinic for follow-up
and three women did not require follow-up as complete TOP was
confirmed on the day of treatment. Ten women (out of 969)
attended hospital before the planned telephone contact (1%). Of
the 959 requiring telephone follow-up, 656 (68%) were
successfully contacted. Two of those who were not contactable
had ongoing pregnancies. Five hundred and seventy-three (87%)
of those contacted, screened ‘negative’ with no false negatives
occurring. Of the 83 (13%) who screened ‘positive’, three had
ongoing pregnancies. The sensitivity of follow-up was 100% and
specificity was 88% (95% CI 84.9–90.1).
Conclusion: Although slightly lower follow-up rates were obtained
in the 12 months following initial introduction, telephone follow-
up with LSUP was shown to be effective for detecting ongoing
pregnancy. -
Objectives: In October 2017, The Scottish Government approved a patient’s place of residence as a place where treatment for abortion can occur. Women up to 9+6 weeks gestation, can be administered mifepristone in a medical facility and given misoprostol to take home and self-administer 24-48 hours later. The option of early medical abortion at home (EMAH) has been available in our service since April 2018. Following ultrasound assessment of gestation, women who are under 9 weeks are offered the options of EMAH, medical abortion in hospital or surgical abortion. We aim to identify any demographic characteristics which may determine if a woman is more likely to choose EMAH, as opposed to hospital management.
Methods: A prospective review of the records of all women who attend over 4 months from April to July, who are 9 weeks or less and choose medical abortion. To be eligible for EMAH they must live in Scotland, be 16 years or over, have an adult with them on the day of abortion, not require an interpreter and have no significant medical conditions. We will analyse demographic data for those who choose EMAH and those who have medical abortion in hospital.
Results: In the first four weeks of offering EMAH to eligible patients, 184 women have been less than 9 weeks gestation and chosen medical abortion. 92 of them were booked to have medical abortion in hospital, and 92 EMAH. Upon completion of data analysis for the first 4 months, we will present the proportion of women who wished medical abortion that were eligible for EMAH, the proportion who chose EMAH and any demographic differences that exist between those choosing home and hospital management.
Conclusions: We will determine if any demographic differences exist between women who opt for home or hospital management of medical abortion.