Introduction of safe first-trimester induced-abortion technologies in the Sverdlovsk Region: Operational research of the second-phase project of the Ministry of Health of the Russian Federation and the World Health Organization

Background. Physicians’ inadequate awareness of the safe induced-abortion technologies recommended by the WHO, no practical skills in first-trimester abortion by vacuum aspiration (VA), and administrative restrictions on the use of VA at less than 6 weeks of gestation are responsible for the application of outdated procedures (dilatation and curettage). Objective: to evaluate the impact of an education course on safe pregnancy termination on the introduction and quality of medical care to women; to comparatively assess two types of introducing VA into the practical activity of a healthcare facility: to conduct education courses and to use an administrative method (Ministry of Health of the Sverdlovsk Region Order No. 1229-п dated 29 October 2012). Subjects and methods. The investigation covered 24 obstetricians/gynecologists from 6 outpatient and inpatient facilities of Yekaterinburg and Sverdlovsk Region, half of whom had attended an education course on safe methods of abortion. The results were assessed determining the level of the physicians’ knowledge and the statistical indicators of the participating facilities. Results. In the inpatient facilities, the personnel of which had been trained, the rate of VA use was 23%, reaching 100%; and in those where the physicians had not, the rate was only 7.5%, reaching 85%. In the outpatient facilities, the rate of applying safe pregnancy termination technologies was 44.5% in both groups, reaching 100%. The physicians who had been trained started using VA 6 months earlier than those who had not. The educational course contributed to the better quality of medical care to women because of abortion, by considerably reducing the number of complications (by 20 times in the outpatient facilities and by 5 times in the inpatient facilities), hospital admissions for complications (by 5 times), and instrumental revisions of the uterine cavity. Conclusion. The administrative methods for introducing the up-to-date abortion techniques are insufficient to upgrade the quality of medical care to women with undesirable pregnancy and must be accompanied by the goal-oriented training of healthcare workers.

undesirable pregnancy, abortion, vacuum aspiration, staff training