Maastricht, 15-16 octobre 1999: „Third FIAPAC-Konferenz“

  • 10:00-
    16:00
    Antibiothérapie et avortement
    Chair:
    • Pierre Moonens, BE
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      In France from 1990 to 1995 1,000,000 legal abortions were carried out. There
      were 4 deaths linked without certitude to an infection, 1 0/00 peritonitus and
      about 1% of minor complications with up to 12 weeks of amenorrhia There are
      few long term post-infection effects.
      Women with a history of pelvic infection run a real risk of infectious complications.

      The speaker quotes an American study:
      1/1400 abortion leads to hospitalisation.
      1/4500 leads to a serious infection.
      What antibiotic therapy: 1 dose of DOXYCYCLINE 200mg 2 hours before, 200mg
      12 hours after.

      To recap:

      At the moment the incidence of infection is not known.
      The majority of centres do not practise a systematic antibiotic therapy.

      The discussion underlined the different medical practices. In Spain
      DOXYCYCLINE is systematically used for 5 days, in Germany there is screening
      for Chlamydia with treatment in positive cases.

      The specific case of Russia where women under go a high number of abortions
      shows a linked rise in the incidence of Chlamydia.

      In conclusion: although this is a quantifiable field consensus is not possible

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      Chlamydia: 5 to 20%
      Gonorrhoea: 0.2 to 3%
      Current practices: Prophylaxy if the woman is under 30 years of age
      DOXYCYCLINE 300mg the day before and then 100mg/ day for 2 days or 200mg
      for 7 days.

      Prescription of METRODINAZOL over 18weeks amenorrhia taking into account
      that the risk increases with the length of pregnancy. The conclusion of the Dutch
      practice is that all women asking for abortions must be treated.

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      Austria: only in hospitals
      Germany: not available  under study
      Greece: hospital
      Holland: judged not useful
      Spain: price not yet defined
      Switzerland: RU486 = poison so forbidden

      In France:
      Reminder of the law. 75% of cost paid back.
      A week to think over before taking MIFEPRISTONE as well as a psycho-social
      counselling session. Ultrasound between D10  D14 if there is a doubt. Result: 98.5% success rate. Continued pregnancy 1 0/00. 

      Doctors are badly paid.

      In Austria:
      Abortions are carried out by doctors in their private surgeries with out time given
      to think it over. The Church puts pressure on the public hospital system.
      40 000 abortions per year.
      Only one public hospital prescribes MIFEPRISTONE.
      Consultations take place by phone. There is a lack of information.
      Success rate of 97%.

      Choice of method:

      In France:
      The method is perceived as being less aggressive, "natural.
      It represents 14% of the legal abortions in 1990 and 30 to 40% in 1998.

      In Austria:
      The choice is made in relation to how early in pregnancy the request is made.
      A non-surgical method with the possibility of the partner being present.
      The question as to whether the method should be available up to the 63rd day is
      being asked.

      The discussion showed the advantages that would arise from "de-medicalising
      this method and using it at home (defended by A. BUREAU  France) up to the
      49th day of amenorrhe.

      It was accepted that studies must be carried out to reduce the dose of
      MIFEPRISTONE to 200mg and to look into different protocol.

      This third seminar ended after a series of rich and formative exchanges on the
      practices of the different participants.

      A change in the statutes was decided by the founder members. From now on the
      F.I.A.P.A.C. , for democratic and voting reasons, is no longer an association of
      associations but an association of individual members. The membership fee for
      2000 is 250 F.

      It was decided to meet again in Paris for the 4th seminar on 24th and 25th
      November 2000.

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      98% of abortions are carried out in non-hospital situations with very few medical
      staff. The antibiotics prescribed are chosen in relation to the age, the sexual
      precociousness and the number of partners.
      The talk underlined the frequency of asymptomatic carriers , the increase in the
      occurrence of Chlamydia 3%. Gonorrhoea tending to disappear.

      The criteria for screening are thus defined:
      &Mac183; More than 2 partners per year
      &Mac183; Request for abortion
      &Mac183; Before putting in an I.U.D.
      &Mac183; Partner infected with a S.T.D.
      &Mac183; The pill before 18
      &Mac183; Abdominal pains
      &Mac183; Screening for S.T.D.

      Treatment : 200mg DOXYCYCLINE for 2 days.
      Abortion postponed for a week in the case of Chlamydia