Abortion Practices and Challenges in Laos: A Detailed Overview

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Abortion practices in Laos have evolved from historical unsafe methods to the introduction of safer options like Misoprostol. The past involved dangerous techniques leading to complications, pushing women towards unsafe abortions, including the illegal use of Ya Chine. With the registration of Misoprostol and the development of clinical handbooks for safe abortion care, Laos is making progress towards ensuring safer reproductive health practices for women.

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Overview of Abortion in Laos Alongkone Phengsavanh MD

History of abortion in Laos No medical abortion in the past Methods of Induced abortion in the past Dilatation and Curettage Forceful massage Falling from the height Herbal Uterine insertion Uterine insertion of Detergent etc

Complications of abortion in the past Vaginal bleeding Uterine perforation Septicemia Trauma to abdominal organ etc

Where Safe Abortion is Unavailable, Women Seek Unsafe Abortion. Methods of unsafe abortion: Ingestion of herbs, bleach, and toxic chemicals Voluntary blows to the stomach, intentional falls Vaginal insertion of sharp tools, twigs, harmful chemicals Sham procedures, covak s procedure (Vera Drake), untrained or unskilled providers Source: Grimes, David, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday Okonofua and Iqbal Shah. 2006. Unsafe abortion: The preventable pandemic. Lancet, 368(9550): 1908-19.

Ya chine Ya Chine is abortificients which was illegally imported from China in border of Lao provinces Mifepristone Misoprostol Wrong dosage No indication No insert paper

Misoprostol Registration in Laos Lao MMR 197 mother died /100,000 Live birth Misoprostol was registered as Cytotec on 1999-2002 for gastric ulcer Misoprostol was added in the WHO essential drug list for MCH drugs. Misoprostol was added in the Lao national essential drug list on 2011 Misoprostol was registered in Laos on 2013 page 6

Clinical handbook for safe abortion care Information, counselling and decision-making Medical history Physical examination Laboratory and other investigations Discussing contraceptive options Infection prevention and control Pain management Methods for medical abortion Methods for surgical abortion (including cervical preparation) Prior to discharge from the health care facility Additional follow-up with a health care provider Post-abortion contraception Assessing and managing abortion complications Pre-abortion Abortion Post-abortion Filename

Summary of WHO recommendations Filename

2012 FIGO Recommendations

Lao National Guidelines for safe abortion Pregnancy up to 9 weeks Pregnancy : 9-12 weeks Pregnancy > 12 weeks Refer to WHO guidelines Pre-abortion care Abortion care Post abortion care Septic abortion

Threaten Abortion Hydroxy progesterone (Proluton depot) 1 amp / week for 3 weeks + Natural progesterone (Utrogestan) 200mg 1 tab , 3 or 4 times perday until bleeding is stopped Continue by Utrogestan 100 mg until 36 weeks of pregnancy

Induced Abortion Medical Abortion Mifepristone + Misoprostone Misoprostone only Surgical Abortion Manual Vaccum Aspiration (MVA) Electrical Vaccum Aspiration (EVA)

Surgical Abortion < 12 14 weeks Vacuum aspiration is the recommended technique (up to 12-14 weeks) Replace D&C No need to use sharp curettage routinely