THE ABORTION AND CONTRACEPTION IN MODERN …...2019/03/10 · 57.3 50.5 45.8 40.5 35.6 32.2 28.2...
Transcript of THE ABORTION AND CONTRACEPTION IN MODERN …...2019/03/10 · 57.3 50.5 45.8 40.5 35.6 32.2 28.2...
RUDN-University.
MEDICAL INSTITUTE
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY WITH COURSE OF
PERINATOLOGY
Honored scientist of Russia, Corresponding member of RSA,
Head at the Department of obstetrics and gynecology with course perinatology
M. D., Professor Radzinskiy Victor Evseevich
THE ABORTION AND
CONTRACEPTION IN MODERN
RUSSIA
FERTILITY BY WORLD REGIONS (in 1000 population) AND MATERNAL
MORTALITY
47.7 47.4 46.6 44.3
40.2
37.1 35.6 35.0
42.7 41.1
37.8
30.7
25.3
21.4 19.3 19.0
41.8
38.5 38.1
28.8
24.8
19.8 18.6 18.0
24.6
22.0
17.7 15.4 15.1 13.8
13.7 13.0
21.4 19.1
16.7
14.3
11.5 10.2 10.8 11.0
390 400
300
200
0
50
100
150
200
250
300
350
400
450
0
10
20
30
40
50
1950-19551960-19651965-19701980-19851990-19952000-20052005-2010 2015
Ma
tern
al m
ort
alit
y
10
0 0
00
bir
th)
Fert
ility
1000 p
opula
tion
Africa
Latin America
Аsia
Sou Аmerica
Еurop
Маternal mortality
UN, World Population Prospect . World Population Data Sheet
FERTILITY IS DECLINING WORLDWIDE
ВОЗ
523000
590000
530000
358000
287000 289000 303000 260000
130000 100000
0
200000
400000
600000
1990 2000 2005 2008 2010 2013 2015 2030
fact
plan
- 75%
- 44%
100%
25
75
medical reasons
non-medical reasons
The global slowdown in the birth rate
Changing attitudes to reproduction (number of children is
replaced by a medium dynasty)
Reducing the number of abortions
The increase in standard of living
Availability of basic medical care
The increase in migratory activity
CONTRA-VERSION OF MATERNAL MORTALITY
In Russia, the goal has been achieved in 2012 maternal mortality rate was 11.5 per
100,000 live births (in 1990 - 47,4) (Russian Statistics)
? MM-has decreased
since
2015
THE FACTORS REDUCING MATERNAL MORTALITY
The use of contraception
Medical abortion (-20 000)
Minimum utilization of antenatal care
Hospital births (delivery)
Osmo-therapy preeclampsia (-30 000...35 000)
Organ-preserving methods of treatment of bleeding
Regional anesthesia (-13 000)
Modern perinatal technologies
Only three
positions have
reduced
(decreasing)
maternal
mortality
THE STRUCTURE OF CAUSES OF MATERNAL MORTALITY IN THE
WORLD (2015, %)
28
27
14
11
9
8 3
Previous state
bleeding
eclampsiya
Infections
Delivery complications
abortion
Embolism
303.000
ВОЗ
REDUCING THE NUMBER of CHILDREN BORN IN RUSSIA (2015/2016,
thousand people-203000)
14,8
10,8 5,4
8,1
5,3
THE DECREASING in the NUMBER of REGISTERED
MARRIAGES IN RUSSIA (2015/2016, thousand)
-155.000
49,6
40,7 21,9
20,8
15,7
6,1
5,2
15,0
DYNAMICS OF THE NUMBER OF CHILDREN BORN IN RUSSIA
(thousand)
2,782
1,904
2,203
2,375
1,989
1,364
1,267
1,397
1,502
1,480
1,714
1,789
1,797
1,902
1,896
1,913
1,944
1,893
1,688
1000 1500 2000 2500 3000
1960
1970
1980
1985
1990
1995
2000
2002
2004
2006
2008
2010
2011
2012
2013
2014
2015
2016
2017
THE PROBLEM OF MODERN REPRODUCTIONS
- Reproductive behavior
Extragenital diseases, diseases of
the reproductive system, STIs,
abortion ...…
Initiation
of sexual activity
The average
age
of nulliparous
women
12 years
of "FREE FLIGHT"
90.3
75.1 64.5
57.3 50.5 45.8
40.5 35.6 32.2 28.2 25.8 24.6 22.9 21.1 19.6 17.0
209.2 201.0
191.9
173.7
156.2
128.3
106.6 96.0
73.1
59.7 49.7 46.9 42.3 38.9 36.8 37.6
0
50
100
150
200
250
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2013 2014 2015 2016 2017
на 1000 женщин фертильного возраста на 100 родов
ABORTION IN RUSSIA
All 621 127 (2017)
Hearings in Russian
State Duma (July 2014)
legal-
medical
abortion
339 577 (2017)
The Ministry of health of the Russian Federation
ABORTION AND CHILDBIRTH IN RUSSIA
THE DISTRIBUTION OF ABORTIONS BY AGE GROUPS (%)
7.8
25.2 26.4
21.1
13.8
5.1
0.5
BEFORE 19 20-24 25-29 30-34 35-39 40-44 AFTER 45
50%
repeatedly!!!
The Ministry of health of the Russian Federation
NOT SATISFIEDS
ABORTION among ADOLESCENTS IN RUSSIA (% of the total number
of abortions in age group)
95
70
53
7 10
5
30
48
93 90
0
20
40
60
80
100
befor 15 years 15-17 years 15-19 years after 19 years from total number
nulliparous multiparous
shows about dysfunctional outcomes and affect the
frequency of teenage pregnancy
TEEN (ADOLESCENTS) PREGNANCY (per 1,000 girls 15-19
years)
ВОЗ, 2012
USA
40
Western
Europe
24
Africa
117
The WORLD in General
50
Russia
30
Southeast
Asia
54
America in
General
68
less than 10 more than 100
Finland 9 Venezuela, Guyana 101
Italy, Saudi Arabia 7 Никарагуа Nikaparya 109
Denmark, Cyprus, China, Tunisia, Sweden 6 Who d'ivoire, 111
Netherlands, Singapore, Slovenia, Japan 5 Tanzania 116
Algeria, Switzerland 4 Nigeria, Somalia 123
Korea 2 Angola 165
CNDR 1 Malawi 177
«ВЫДЕРЖКА ИЗ БИОГРАФИИ
СОВРЕМЕННОЙ ДЕВУШКИ-ПОДРОСТКА»
10
11
12
13
14
15
16
17
Initiation of sexual activity
(46%)
Abortion
Smoking (38%)
Narcotic's (10%)
Alcohol (95%)
Somatic
(75%)
Gynecological
(40-60%)
Diseases
THE PROPORTION OF ABORTIONS IN THE FIRST
PREGNANCY (%)
7,3% - ?%
The Ministry of health of the Russian Federation
POST-ABORTION RISKS FACTORS
pregnancy complications [A]
Premature births at 22-32 weeks [A]
Premature rupture of the membranes [A]
The birth of underweight baby [A]
Placenta accreta [A]
Endometriosis [A]
Repeat abortion [B]
Taylor et.al. Obstetrics and Gynecology, 1993
Hendricks, et.al. Journal of OB&GYN Research, 1999
Kathryn M. Curtis et al., Am J Obstet Gynecol 2002
Human Reproduction, 2004
Shah et al., BJOG 2009;116:1425–1442
Michel Makhlouf. Am J Obst & Gyn. Supplement to JANUARY 2011
3 RULES OF PROTECTION OF THE REPRODUCTIVE HEALTH OF
ADOLESCENTS (WHO)
The prevention of unwanted pregnancy, use reliable methods of contraception
Prevention of STIs – use a condom
Warning desperate, reckless behavior – conviction and common sense
REPRODUCTIVE EDUCATION (the College Ministry of health of Russia, 2002)
SURGICAL ABORTION IS THE MAIN CAUSE OF
REPRODUCTIVE PROBLEMS
Surgical abortion
Implantation disorders,
miscarriage ,
infertility
Autoimmune
process
Hypoxia ,
«oxidative stress»
Chronic
inflammatory
answer
PREGNANCY IN INFLAMED ENDOMETRIUM
(chronic endometritis)
25% - in population
64% -with recurrent pregnancy loss (miscarriage)
morphological and
immunohistochemical
verification of signs of
the chronic inflammation
of the basal layer of the
endometrium
Proven
symptoms of the
inflammatory
process
Implantation disorders,
miscarriage,
infertility
Autoimmune
process
Hypoxia ,
«oxidative stress
Chronic
inflammatory
answer
THE RELATIONSHIP OF INFLAMMATORY AND
AUTOIMMUNE FACTORS
It is important to remember that the Clinician!
Persistent endometritis
Autoimmune inflammatory
changes in the endometrium
not only violate receptivity
But also underlie the formation
of proliferative diseases of the
reproductive system
Autoimmune inflammatory changes in the
endometrium –and proliferative diseases
MEDICAL ABORTION IN PUBLIC INSURANCE (number of
regions)
14 20
54
2012 2014 2016
PARADOXES OF MODERNITY
7500
2200
0
2000
4000
6000
8000
10000
medicamentose abortion surgical abortion
Payment procedures (RUB)
Share holding
The Ministry of health of the Russian Federation
But doctors
prefer
curettage…
Why?
THE STRUCTURE OF CAUSES OF MATERNAL MORTALITY IN THE
RUSSIAN FEDERATION IN 2017(%)
The Ministry of health of the Russian Federation
31.3
14.4
13.5
12.3
11.7
7.4
4.9 3.1 1.7 EGD
Embolism
Bleedeng
Abortion
Hypertensy
EUP
Sepsis (obstr)
Аnaestesiya
Others
163
MATERNAL MORTALITY AFTER ABORTION IN the RUSSIAN
FEDERATION (abs.)
The Ministry of health of the Russian Federation
276 246 205 155 149 126 124 99 101 76 73 75 93 72 53 36 26 30 31 26 20
1027
798
690
572 538
529 493
440 404
387 389 387
459
332 311
252 244 232 207 199 163
1992 1995 1997 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
died after abortion
died total
«after abortion»
is not a means
consequence of
abortion
Induced ABORTIONS IN the RUSSIAN FEDERATION (% of the total
number of abortions)
1.61 1.70 1.86
2.20 2.15 2.31
2.98
4.16
2.42
2.70
2.63
3.50
4.20
2.80
0.79
1.08
1.54
2.00 2.23 2.25
0.36
0.14 0.10 0.04 0.01 0,004 0.02 0,003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2015 2016 2017
for medical reasons (indications)
for social reasons (indications)
DYNAMICS OF ILLEGAL ABORTION IN THE RUSSIAN
FEDERATION
7708
4900 4537
2639
1838 1476
1221 1309 1002
264 170 349 355
0.27
0.20 0.21 0.13
0.10 0.09 0.09 0.10 0.09
0.03 0.02
0.05 0.06
0
0.1
0.2
0.3
0.4
0.5
0
2000
4000
6000
8000
10000
1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2015 2016 2017
abs.numb % total number abortion
Since 2003 have not increased , but
reduced
THE STRUCTURE OF CAUSES OF MATERNAL MORTALITY IN THE
RUSSIAN FEDERATION ON THE TIMING OF THE ONSET (2017)
78.5
1.8
12.3
7.4
During pregnancy up to 22 weeksand in the postpartum period
Every 5 pregnant woman dies in the first half
of pregnancy
21,5%
CAUSES OF DEATH AFTER ABORTION IN THE RUSSIAN
FEDERATION (2017)
31.3
14.4
13.5
12.3
11.7
7.4
4.9 3.1 1.7 EGD
Embolism
Bleeding
Abortion
Hypertens
ECP
Sepsis
Anaestesiya
Other
20
5
6
2
2 5
Only 50% of maternal mortality is
abortion −the"usual" reasons
(bleeding, sepsis)
the rest from other causes
ABORTION AND MATERNAL MORTALITY IN RUSSIA (2017)
6 (30%)after abortion
medical indications
20 (12,3%)
After abortion
Total died 163
THE RISK OF DEATH (1:N)
Regular flights− 1 : 10 000 000
Med. abortion (legal)
−
1 : 300 000
Spontaneous abortion− 1 : 8 000
Unspecified (illegal abortion)
−
1 : 4 000
For med. indications − 1 : 3 000
100 times!
THE PROTOCOL OF ABORTION IN LATE PREGNANCY
Terms of pregnancy
(weeks, days)
Regimens
Source
Mifepristone Time interval
Misoprostol
12-13 weeks 6 days
200 mg 1 tablet orally
once
24-48 800 mcg (4 tablets) once in the vagina,
then again at a dose of 400 mcg (2
tablets) in the vagina or under
the tongue every 3 hours (before the
termination of pregnancy)
WHO, 2012; RCOG, 2015;
14-21 weeks 6 days
12-48 WHO, 2012;
Medical abortion regimens for a period of 12 to 21 weeks
6 days having proven effectiveness [22,37,39].
«Artificial termination of pregnancy in the late stages for medical reasons in the
presence of fetal abnormalities» Treatment protocol, 2018. The Ministry of health of
the Russian Federation
HORMONPHOBIA - OBSTACLE TO CONTRACEPTION
ABORTION
Hormone phobia
patients and doctors!!!
MOTIVATION of REPRODUCTIVE BEHAVIOUR (abs.)
70 17 8
1 pack,
2 pack 3 pack
Free COC
PARADOXES OF MODERNITY
90.3
75.1
64.5
57.3
50.5 45.8
40.5 35.6
32.2 28.2
25.8 24.6 22.9
21.1 19.6
17.0
24.5 24.6 24.7 24.5 23.6 22.2 22.7 23.4 24.0 25.3 24.7 24.5 24.6
24.8 24.7 23.2
0
20
40
60
80
100
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2013 2014 2015 2016 2017
Induc.abortion (1000 woman fertil age)
ПРЕРВАННЫЙ
ПОЛОВОЙ АКТ?
COUNSELING ABOUT CONTRACEPTION AFTER THE FIRST
BIRTH (%)
Having an abortion in the
next pregnancy
1907 1917 1927 1937 1947 1957 1967 1977 1987 1997 2007 2017
THE priorities change ...do NOT DISTURB the WOMAN. SHE
KNOWS WHAT SHE WANTS
1917
Women's suffrage 2017
40% senior management positions
held by women – more than in any
other country in the world
100 лет
The USE of CONTRACEPTIVE METHODS (%)
Respondents younger than 50 years with a partner at the time of the
survey
Methods Woman Man
All methods,
в том числе: 79,5 81,3
condoms 30,3 38,0
IUD- IUC 20,4 18,9
tablets 14,1 14,7
the calendar method, 14,5 11,3
coitus interruptus 13,6 11,7
douching 2,9 2,2
others 5,2 5,9
No methods 20,5 18,7
Only modern methods 51,8 56,9
Combination modern and traditional methods 13,1 12,9
Only traditional methods 14,6 11,5
Respondents numbers 2273 1561
http://www.demoscope.ru/weekly/2010/0409/tema02.php
Росстат, 2014
Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской
Федерации. Министерство здравоохранения РФ, ЦНИИОИЗ. Москва, 2014.
http://demoscope.ru/weekly/2014/0623/reprod01.php
The abortion rate is not dependent on
the use IUD
The higher percentage using the IUD,
the higher the level of abortion
THE PROPORTION OF WOMEN IN RUSSIA, USING IUD, THE
TOTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE
THE LEGALITY OF ABORTION IN THE WORLD
12%
23%
25%
40%
Allowed on request women
Allowed only at health reasons
Permitted for
social reasons
Allowed by
medical
indications
AMBULATORY ABORTION:TRANSITION PERIOD TO
EFFECTIVE CONTRACEPTION
This situation brings the world to realization of the
ideology of the who-1969 – the woman herself, without
the help of a doctor, diagnose the pregnancy and does
medical abortion
GOOD OR BAD?
The world does not know the answer to this
question (Lisbon, ICMA,2010).
INTERACTION WITH INTERNATIONAL ORGANIZATIONS IS
FUNDAMENTALLY IMPORTANT
EASTERN EUROPEAN ALLIANCE FOR REPRODUCTIVE CHOICE
EDUCATION AND ACCESS TO METHODS OF FAMILY
PLANNING
Training schoolgirl, students
The basic Foundation of family planning
Teaching students of all Universities
Training of the population knowledge of planned
contraception.
Knowledge of emergency contraception
Training of doctors understanding the importance of HC physician of
any specialty Proactive identification of needs of women
↓ ABORTION
↑ FERTILITY
The scientific PROJECT of the Department of OBSTETRICS AND
GYNECOLOGY WITH COURSE PERINATOLOGY RUDN University
Prevention, early diagnosis and treatment
of disorders of reproductive health of
students of universities and colleges of
the Russian Federation
Scientific bases of health protection of
students
TECHNOLOGY PROVIDE CONTRACEPTIVE ASSISTANCE
TO THE STUDENT YOUTH RUDN- UNIVERSITY
Specialized free admission on reproductive health and
contraception in the medical center of RUDN- UNIVERSITY ( with
the support of "Gedeon Richter")
ADVICE
The use of interactive algorithm selection of contraceptives
SELECTION ALGORITHM
Active informing all students in the two academic hours in all
faculties
INTERACTIVE SELECTION
Permanent sexual partner
% safe sexual relations
% using modern methods of contraception
PERFORMANCE CRITERIA
Girls with a history of abortions
EFFECTIVENESS of IMPLEMENTATION-improvement of
reproductive behavior
67.6
82.8
68.5
91.1
11.4
5.2
18.7
25.3
0
20
40
60
80
100
non-inform group-target
permanent partner (р<0,01)
safe sex.relationsh
abortion in anamnesis (р=0,013)
use COC (р=0,019)