7/31/2019 Misoprostol Use in Postabortion Care
1/144
OI[JW^J[UJ@
V[F IA
WJ[UMNJ^UIJA
KM^F
M [f~tikf Ef`itf~y Ujj`hiu
7/31/2019 Misoprostol Use in Postabortion Care
2/144
7/31/2019 Misoprostol Use in Postabortion Care
3/144
I[NA< =/9;;796/46/>
Kmum`jb +< OWMKUH>/F==
>7== Iwm{!
W~jevkfe ia ucf Vaiufe [umuf{ jd Mof~ikm!
[vbbf{ufe kiumuija< Iwm{ mae Tfauv~f [u~mufbif{ Iaajtmuija{! >7==! Oi{jw~j{uj` v{f ia wj{umnj~uija km~f< M{f~tikf ef`itf~y ujj`hiu! Kcmwf` Ci`` AK< Iwm{!
Iwm{ i{ m ajaw~ju j~bmai|muija ucmu rj~h{ m~jvae ucf rj~`e uj iak~fm{f rjofa{ mni`iuy uj fsf~ki{f ucfi~{fsvm` mae ~fw~jevkuitf ~ibcu{ f{wfkim``y ucf ~ibcu uj {mdf mnj~uija! Rf {ffh uj f`ioiamuf va{mdf mnj~/uija mae ucf ~f{v`uiab efmuc{ mae ialv~if{ mae uj fswmae rjofa{ mkkf{{ uj kjow~fcfa{itf mnj~uija km~fiak`veiab kjau~mkfwuija mae ~f`mufe ~fw~jevkuitf cfm`uc iadj~omuija mae km~f! Rf {u~itf uj dj{uf~ m `fbm`wj`iky mae {jkim` fati~jaofau {vwwj~uitf jd rjofa{ ~ibcu{ uj omhf ucfi~ jra {fsvm` mae ~fw~jevkuitfcfm`uc efki{ija{ d~ff`y mae {mdf`y!
Iwm{ i{ m ~fbi{uf~fe 67=#k)#;) ajaw~ju j~bmai|muija! M`` kjau~invuija{ uj Iwm{ m~f ums efevkuin`f uj ucfdv`` fsufau m``jrfe ny mr!
Dj~ oj~f iadj~omuija j~ uj ejamuf uj Iwm{2
Kcmwf` Ci`` AK >26=5 V[M
=/9=9/942/276>
iwm{Giwm{!j~b
rrr!iwm{!j~b
W~iaufe ja ~fkyk`fe wmwf~!
W~jufkuiab rjofa{ cfm`ucMetmakiab rjofa{ ~fw~jevkuitf ~ibcu{
7/31/2019 Misoprostol Use in Postabortion Care
4/144
Mkhajr`febfofau{
Mbf~f Umef`f !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
M`y{ja Cyoma !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Moiam Ej~myi !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Moomavf` Bf{{f{{fr !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Maa @fjam~e !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
M{cfnf~ Bfumkcfr !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
M{uf~ U{fbmyf !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Myf`f Efnfnf !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Myi{cm Eijw !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
M||m Hm~mo !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Nftf~`fy Riaihjdd !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ni`` Wjrf`` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Niaum Nf``j Emanmum !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
N~iebfu Jhfhf !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Kma{m{ Ov``ibma !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Km~j` Jev`m/Jnjayj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Km~j` Umuvm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
K`mi~f Time~j !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Embamkcfr M`fomyjc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Efnj~mc Avkmuj`m !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Eff ^feriaf !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ef~flf M`fomyjc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Eimam B~ffaf Dj{uf~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ej``iam Jef~m !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Ejvb`m{ Cvnf~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Flihf Jli !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~imF``fa I{~mf` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Foomavf` ^rmov{cmilm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Uma|maim
Ftf`iam N~lf{{ja !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Df`ikim Jlfofa !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
D`j~fakf Jhj~jahrj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Bf|mkc Mn~mcm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FucijwimBjeria J! Mhmnm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
B~mkif`m [m`tmej~/Emti`m !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Cmd{m M`umd Wmhi{uma
7/31/2019 Misoprostol Use in Postabortion Care
5/144
Ia{cm Cmoemai !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Wmhi{uma
Lm`ef{m Bvyj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Lfmaaf Fry !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Lfaaif J~kvuu !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Lfaaidf~ [j`ioma !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ljmkcio J{v~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Ljma Cfm`y !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ljca Aymov !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Lj{fwc Hm~malm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Lj{fwc ^voialj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Lvma Lj{f Tm``flj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Hmni~ V! Mcofe !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Hm~fa Ofkh{u~juc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Hmucf~iaf Uv~af~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Hf``y Kv`rf`` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Vaiufe Hiabejo
H~i{uia [rma{ja !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
@mi`m [cmc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Wmhi{uma
@m~f Emrcm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
@i{m Ofoof` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Om`kj`o Wjuu{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Omavf` Jyianj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Om~uiaf Cj`{uja !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Om~y Dlf~{ume !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[MOmucfr Jhjc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Ofhef{ Meom{v !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Of`maif Wfm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
O`jeif Cvauf~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Oj``y Oj~ma !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Ov`mu Dfaum !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FucijwimAmaky Aymbm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
Aej`m W~mum !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Aihi O{iwm/Aefnf`f !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Av~iyf Am`ma [mcia Cjejb`vbi` !!!!!!!!!!!!!!!!!!!!!V[M
Av~iyf J~umy`i !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Aymaem @mnj~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[MJarf/Javmbv`vkci Kcm~iuy V|jmomhm !!!!!!!!Aibf~im
Wci` Em~afy !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
W~iucm Ni{rm{ Iaeim
7/31/2019 Misoprostol Use in Postabortion Care
6/144
^ikhy @v !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
^jnya [aff~iabf~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
^jej`dj Bjof| Wjakf ef @fja !!!!!!!!!!!!!!!!!!!!!!M~bfauiam
[meimc Mc{ma Wm` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Wmhi{uma
[mm Mc{ma !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
[m~mc Wmkhf~ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
[mvoym mom mj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
[cm~id Ojcmoofe I{omi` Cj{{mia !!!!!!!!!!!!!!!!Nmab`mef{c
[cm~ja M~{kjuu/Oi``{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
[cm{cv M~mym !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
[ihi~muv Hmi`mai !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
[j`joja Hvonv !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
[v`f [mmemuv !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
[v{ma Jvhj !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Hfaym
[v{cff`m Fabf`n~fkcu !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Um`fojc Emc !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
Um~~m H! OkAm``y !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[M
Um{affo Dmuiom !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Wmhi{uma
Uf{dmaf{c Nf`my !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Uf{dmyf Fae~im{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Uf{dbmyf Cmi`f{f`m{{f !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
Ucmah/Bje Jhj{va !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Aibf~im
U~mki Nmi~e !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!V[MVwfhm ef [i`tm !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Vaiufe Hiabejo
Yj`maef Cylm|i !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!F}vmuj~im` Bviafm
Yjam{ Bfumkcfr !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fucijwim
7/31/2019 Misoprostol Use in Postabortion Care
7/144
7/31/2019 Misoprostol Use in Postabortion Care
8/144
Jtf~tifr
Rcmu i{ ucf {f~tikf ef`itf~y ujj`hiu:
Oi{jw~j{uj` dj~ v{f ia wj{umnj~uija km~f< M {f~tikf ef`itf~y ujj`hiuw~j/tief{ iadj~omuija mae ujj`{ uj cf`w ei{u~iku j~ amuijam`/`ftf` k`iai/kima{ dmki`iuy omambf~{ j~ w~jb~mo omambf~{ uj #=) iaiuimufucf v{f
jd oi{jw~j{uj` m{ m ofeikm` u~fmuofau dj~ iakjow`fuf mnj~uija j~#>) iaufb~mufoi{jw~j{uj` iauj fsi{uiab wj{umnj~uija km~f #WMK) {f~/tikf{ ucmu m`~fmey v{f omavm` tmkvvo m{wi~muija #OTM)! Ucf ujj`/hiu mio{ uj dmki`iumuf ucf mni`iuy jd m`` uywf{ jd cfm`uc dmki`iuif{ #{vkc
m{ cj{wium`{ cfm`uc kfauf~{ k`iaik{ mae omuf~aiuy cjof{) uj jddf~oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uija {j m{ uj iak~fm{frjofa{ mkkf{{ uj WMK {f~tikf{! Ucf ujj`hiu kma nf memwufe mu ucfkjvau~y `ftf`! V{f~{ {cjv`e efuf~oiaf ucf `ftf` jd k`iaikima rcj kma
ef`itf~ oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uija mu ucf `jkm``ftf` nm{fe ja k`iaikima{ mni`iuy uj wf~dj~o kj~f kjowfufakif{!=
Rcj {cjv`e v{f uci{ ujj`hiu:Uci{ ujj`hiu i{ ofmau dj~ uc~ff mveifakf{< w~jb~mo omambf~{ muucf amuijam`*ei{u~iku `ftf`{ dmki`iuy omambf~{ mae k`iaikima{! Ajuf
=!; Rcmu m~f wj{umnj~uija km~f #WMK) {f~tikf{: !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ;
=!5 Rcy v{f oi{jw~j{uj` ia ucf w~jti{ija jd wj{umnj~uija km~f: !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ;
Ojev`f >! W`maaiab dj~ {f~tikf ef`itf~y !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 6Um~bfu mveifakf{< Dmki`iuy omambf~{ mae w~jb~mo omambf~{ mu ucf amuijam`*ei{u~iku `ftf`{
>!= Iau~jevkuija !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 6
Ujj` >M! Fati~jaofaum` m{{f{{ofau bvief !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 2
>!> [umaem~e{, bvief`iaf{ mae w~jujkj`{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9
>!; [ufw/ny/{ufw w`maaiab !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =7
Ujj` >N! Kcfkh`i{u dj~ w`maaiab dj~ kcmabf ia {f~tikf ef`itf~y !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =;
>!5 Fa{v~iab {v{umiamn`f {vww`y jd oi{jw~j{uj`!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =6
Ujj` >K! F{uiomuiab oi{jw~j{uj` {vww`y affe{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =2
>!6 Meeiuijam` ~f{jv~kf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =9
Ojev`f ;! M{{f{{iab yjv~ dmki`iuy !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >=Um~bfu mveifakf< Dmki`iuy omambf~{
;!= Iau~jevkuija !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >=
;!> Ojef`{ dj~ iaufb~muiab oi{jw~j{uj` iauj wj{umnj~uija km~f {f~tikf{ !!!!!!!!!!!!!!!!!!!!!!! >>
Ujj` ;M! Oiaiovo ~f}vi~fofau{ dj~ u~fmuofau jd iakjow`fuf mnj~uija riucoi{jw~j{uj` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >;
Ujj` ;N! Dmki`iuy m{{f{{ofau!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >6
;!; V{iab ucf ~f{v`u{ jd ucf dmki`iuy m{{f{{ofau ujj` !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ;6
;!5 Meeiuijam` ~f{jv~kf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ;6
7/31/2019 Misoprostol Use in Postabortion Care
11/144
7/31/2019 Misoprostol Use in Postabortion Care
12/144
Ojev`f 4! Fa{v~iab cibc }vm`iuy {f~tikf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9=Um~bfu mveifakf{< K`iaikima{ dmki`iuy omambf~{ mae w~jb~mo omambf~{ mu ucf amuijam`*ei{u~iku `ftf`{
4!= Iau~jevkuija !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9=
4!> Ojaiuj~iab uj m{{f{{ mae iow~jtf }vm`iuy jd {f~tikf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9=4!; [is ojaiuj~iab m~fm{ jd oi{jw~j{uj` v{f ia WMK {f~tikf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9=
4!5 Eftf`jwiab m ojaiuj~iab w`ma uj fa{v~f cibc }vm`iuy jd {f~tikf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!! 9>
Ujj` 4M! Iaeikmuj~{ ny dmki`iuy `ftf`!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 96
4!6 Bmucf~iab iadj~omuija dj~ ojaiuj~iab !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 92
Ujj` 4N! [f~tikf ef`itf~y `jbnjjh !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 99Ujj` 4K! Ojauc`y {f~tikf ~fwj~u !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =7=
Ujj` 4E! [vwf~ti{j~y mae wf~dj~omakf }vm`iuy iow~jtfofau kcfkh`i{u !!!!!!!!!!!!!!!!!! =7;
Ujj` 4F! Wmuifau {mui{dmkuija ~mwie m{{f{{ofau !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =72
4!4 Kjowi`iab mae {yaucf{i|iab ojaiuj~iab emum!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =79
4!2 Eftf`jwiab m rj~hw`ma dj~ kjauiavjv{ }vm`iuy iow~jtfofau !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! =79
4!3 Meeiuijam` ~f{jv~kf{ !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ===
^fdf~fakf{ ny Ojev`f !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ==;
Maafs =< K`iaikm` m{{f{{ofau ~fdf~fakf bvief< Jtf~tifr jd oi{jw~j{uj` dj~ucf omambfofau jd iakjow`fuf mnj~uija !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!==9
Maafs >< [f`fkufe wvn`ikmuija mn{u~mku{ ja oi{jw~j{uj` v{f iawj{umnj~uija km~f#Ja`y mtmi`mn`f ja ucf ujj`hiu KE j~ ja`iaf mu cuuwE< F{uiomuiab oi{jw~j{uj` {vww`y affe{ {w~fme{cffu#Ja`y mtmi`mn`f ja ujj`hiu KE j~ ja`iaf mu cuuw
7/31/2019 Misoprostol Use in Postabortion Care
13/144
@i{u jd mk~jayo{
MKJB !!!!!!!!!!!!!Mof~ikma Kj``fbf jd Jn{ufu~ikima{ mae Byafkj`jbi{u{
MF!!!!!!!!!!!!!!!!!!!!Metf~{f ftfau
MIE[ !!!!!!!!!!!!!!!Mk}vi~fe ioovajefkifaky {yae~jof
FoJK !!!!!!!!!!!!!Fof~bfaky jn{ufu~ik km~f
DFDJ !!!!!!!!!!!!!!!Di~{u/uj/fswi~f ~{u/jvu
DIBJ !!!!!!!!!!!!!!!Iauf~amuijam` Dfef~muija jd Byafkj`jby mae Jn{ufu~ik{CIT !!!!!!!!!!!!!!!!!Cvoma ioovajefkifaky ti~v{
CU[W!!!!!!!!!!!!!!!Cfm`ucy uioiab mae {wmkiab jd w~fbamaky
IVE !!!!!!!!!!!!!!!!!Iau~mvuf~iaf eftikf
IVDE !!!!!!!!!!!!!!!Iau~mvuf~iaf dfum` efmuc
@OW !!!!!!!!!!!!!!!!@m{u ofa{u~vm` wf~ije
O$F !!!!!!!!!!!!!!!!Ojaiuj~iab mae ftm`vmuija
OI[ !!!!!!!!!!!!!!!!!Omambfofau iadj~omuija {y{ufo
OTM !!!!!!!!!!!!!!!!Omavm` tmkvvo m{wi~muija
ABJ !!!!!!!!!!!!!!!Ajabjtf~aofaum` j~bmai|muija
WMK !!!!!!!!!!!!!!!!!Wj{umnj~uija km~f
WJK !!!!!!!!!!!!!!!!W~jevku{ jd kjakfwuija
WWC !!!!!!!!!!!!!!!!!Wj{uwm~uvo cfoj~~cmbf
^C !!!!!!!!!!!!!!!!!!!^fw~jevkuitf cfm`uc
[MF!!!!!!!!!!!!!!!!!![f~ijv{ metf~{f ftfau
[UI !!!!!!!!!!!!!!!!!!![fsvm``y u~ma{oiuufe iadfkuija
TM !!!!!!!!!!!!!!!!!!!!Tmkvvo m{wi~muija
TKMU !!!!!!!!!!!!!!Tm`vf{ k`m~ikmuija mae muuiuvef u~ma{dj~omuija
RCJ !!!!!!!!!!!!!!Rj~`e Cfm`uc J~bmai|muija
7/31/2019 Misoprostol Use in Postabortion Care
14/144
OJEV@F =! Iau~jevkuija
UM^BFU MVEIFAKF[779)! Ucf Rj~`e Cfm`uc J~bmai|muija #RCJ)efaf{ va{mdf mnj~uija m{ uf~oiamuija jd ma vaiaufaefe w~fbamakyfiucf~ ny iaeitievm`{ `mkhiab ucf afkf{{m~y k`iaikm` {hi``{ j~ ia mafati~jaofau ucmu ejf{ aju kjadj~o uj oiaiovo ofeikm` {umaem~e{j~ njuc #RCJ =99;)! Ucf RCJ f{uiomuf{ ucmu >=!4 oi``ija va{mdf
mnj~uija{ umhf w`mkf fmkc yfm~ afm~`y m`` jd rcikc jkkv~ ia eftf`jw/iab kjvau~if{ #RCJ >7==m)! Va{mdf mnj~uija{ ~f{v`u ia ucf efmuc{ jdma f{uiomufe 52777 rjofa maavm``y m`oj{u m`` w~ftfaumn`f #RCJ>7==m) mae omay oj~f rjofa {vddf~ ialv~if{ mae `jab/uf~o cfm`ucw~jn`fo{! Mej`f{kfau mae yjvab rjofa nf`jr ucf mbf jd >5 m~f ei{/w~jwj~uijamuf`y mddfkufe ny va{mdf mnj~uija mkkjvauiab dj~ 54 wf~/kfau jd efmuc{ d~jo va{mdf mnj~uija ia ucf eftf`jwiab rj~`e #RCJ
>772)! Ucf ombaiuvef jd va{mdf mnj~uija tm~if{ ny bfjb~mwcik ~fbijamae riucia ~fbija{ ny kjvau~y!
Iu i{ iowj~umau uj hajr yjv~ kjvau~y{ mnj~uija `mr{ mae uj nf mrm~fjd ucf w~ftm`fakf jd va{mdf mnj~uija riucia yjv~ kjvau~y! Cjrftf~nfkmv{f wj{umnj~uija km~f #WMK) ejf{ aju dm`` vaef~ ucf {mof `fbm`~f{u~miau{ m{ mnj~uija w~jti{ija iu kma nf w~jtiefe ftfa ia {fuuiab{rcf~f mnj~uija i{ i``fbm`!
7/31/2019 Misoprostol Use in Postabortion Care
15/144
7/31/2019 Misoprostol Use in Postabortion Care
16/144
iauf~tm` dj~ fswv`{ija #K`m~h fu m`! >772) m rjoma {cjv`e nf bitfauci{ jwuija id {cf i{ k`iaikm``y {umn`f! Fswfkumau omambfofau ~f}vi~f{km~fdv` dj``jr/vw cjrftf~ uj m{{f{{ rcfucf~ fswv`{ija cm{ jkkv~~fe
j~ uj m{kf~umia rcfucf~ ucf rjoma affe{ meeiuijam` u~fmuofau!
=!; Rcmu m~f wj{umnj~uija km~f #WMK){f~tikf{:
Wj{umnj~uija km~f kja{i{u{ jd m {f~if{ jd iauf~tfauija{ ef{ibafe ujomambf m rjoma w~f{fauiab mduf~ {wjaumafjv{ j~ iaevkfe mnj~uija#riuc j~ riucjvu kjow`ikmuija{)! WMK i{ ma iowj~umau kjowjafau jd
kjow~fcfa{itf ~fw~jevkuitf cfm`uc {f~tikf{ nfkmv{f iu {mtf{ rjofa{`itf{ mae ~fevkf{ oj~nieiuy!
Ia =99; `fmeiab ~fw~jevkuitf cfm`uc j~bmai|muija{ mae ejaj~ mbfa/kif{ dj~ofe ucf WMK Kja{j~uivo #rrr!wmk/kja{j~uivo!j~b) ia wm~uuj w~jojuf WMK m{ ma fddfkuitf {u~mufby uj mee~f{{ ucf b`jnm` w~jn`fojd iakjow`fuf mnj~uija! Ucf ojef` dj~ wj{umnj~uija km~f {vwwj~ufeny ucf WMK Kja{j~uivo kja{i{u{ jd tf f`fofau{ #Riah`f~ fu m`!
>777)< U~fmuofau jd iakjow`fuf mae va{mdf mnj~uija mae mnj~uija/
~f`mufe kjow`ikmuija{ ucmu m~f wjufauim``y `idf/uc~fmufaiab8
Kjva{f`iabuj iefauidy mae ~f{wjae uj rjofa{ fojuijam` maewcy{ikm` cfm`uc affe{ mae jucf~ kjakf~a{8
Kjau~mkfwuitf {f~tikf{ mae iadj~omuija uj cf`w rjofa w~ftfau
ma varmaufe w~fbamaky j~ w~mkuikf ni~uc {wmkiab8
^fw~jevkuitf mae jucf~ cfm`uc {f~tikf{ ucmu m~f w~fdf~mn`y w~j/tiefe ja {iuf j~ tim ~fdf~~m`{ uj jucf~ mkkf{{in`f dmki`iuif{ ia k`iai/kima{ afurj~h{8
Kjoovaiuy mae {f~tikf/w~jtief~ wm~uaf~{ciw{ uj w~ftfauvarmaufe w~fbamakif{ mae va{mdf mnj~uija ojni`i|f ~f{jv~kf{
uj cf`w rjofa ~fkfitf mww~jw~imuf mae uiof`y km~f dj~ kjow`ikm/uija{ d~jo va{mdf mnj~uija mae fa{v~f ucmu cfm`uc {f~tikf{ ~ffkumae offu kjoovaiuy fswfkumuija{ mae affe{!
=!5 Rcy v{f oi{jw~j{uj` ia ucf w~jti{ijajd wj{umnj~uija km~f:
Oi{jw~j{uj` cm{ nffa v{fe {mdf`y dj~ iakjow`fuf mnj~uija ia omayeiddf~fau kjvau~if{ mae cm{ aju nffa m{{jkimufe riuc may `jab/uf~ofddfku{ ja rjofa{ cfm`uc #Byaviuy Cfm`uc W~jlfku{ >779)! Oj~fjtf~oi{jw~j{uj` u~fmuofau cm{ tf~y oiaiom` {f~tikf ef`itf~y ~f}vi~f/
http://www.pac-consortium.org/http://www.pac-consortium.org/7/31/2019 Misoprostol Use in Postabortion Care
17/144
oi{jw~j{uj`)! Ucf~f i{ ma iak~fm{iab njey jd ftiefakf ja ucf v{f jdoi{jw~j{uj` uj u~fmu iakjow`fuf mnj~uija772)!
Oi{jw~j{uj` i{ m {iow`f ufkcaj`jby ucmu i{ fm{y uj {uj~f #aj ~fd~ib/f~muija ~f}vi~fe mae m `jab {cf`d `idf) mae v{f ia m ~mabf jd {fu/uiab{ ny m ~mabf jd k`iaikima{! Oi{jw~j{uj` dj~ wj{umnj~uija km~fkma {umae m`jaf rcf~f OTM i{ aju dfm{in`f j~ kjow`fofau OTM
rcf~f ucf~f m~f fsi{uiab WMK {f~tikf{!
Oi{jw~j{uj` dj~ ucf u~fmuofau jd iakjow`fuf mnj~uija cm{ nffak`iaikm``y {uveife ia {fuuiab{ m{ eitf~{f m{ ucf Vaiufe [umuf{ ucfVaiufe Hiabejo mae ia `jr/~f{jv~kf kjvau~if{ {vkc m{ Nv~hiamDm{j Fbywu Bcmam Oj|moni}vf mae Uma|maim #Ni}vf fu m`!>772 Emnm{c fu m`! >7=7 Emj fu m`! >772 [crfhf~f`m fu m`! >772
Umy`j~ fu m`! >7==)!Ia {uveif{ ~ftifriab mkkfwumni`iuy oj~f ucma 97 wf~kfau jd rjofacmtf ~fwj~ufe nfiab {mui{fe j~ tf~y {mui{fe riuc oi{jw~j{uj` dj~ucfi~ wj{umnj~uija u~fmuofau #Emj fu m`! >772 Byaviuy Cfm`uc W~jl/fku{ >779 Abjk fu m`! >776 [crfhf~f`m fu m`! >772 Rffh{ fu m`! >776)!M dfm{ini`iuy {uvey ia Aibf~im {cjrfe cibc mkkfwumni`iuy uj rjofa
mojab m `m~bf`y Ov{`io wjwv`muija ia ucf aj~uc! Ucf {mof {uvey
{cjrfe ucmu wm~uikiwmuiab k`iaikima{ #iak`veiab ejkuj~{ oieritf{mae av~{f{) m`{j ~fwj~ufe m cibc efb~ff jd {mui{dmkuija #Iwm{ Aibf~immae [JBJA >7==m Iwm{ Aibf~im mae [JBJA >7==n)!
Emum d~jo {ftf~m` {uveif{ {cjr ucmu ia omay {fuuiab{ ~fj~bmai|/iab {f~tikf{ ny ~fk`m{{idyiab WMK u~fmuofau m{ ma jvuwmuifau km~f
w~jkfev~f {vn{umauim``y ~fevkf{ ucf ~f{jv~kf{ v{fe dj~ WMK m`jabriuc ucf kj{u mae mtf~mbf `fabuc jd rjofa{ {umy ia cfm`uc dmki`i/
uif{5 #Ni``iab{ mae Nfa{ja >776)!
Oi{jw~j{uj` kma {vn{umauim``y ~fevkf {f~tikf kj{u{ m``jriabrjofa uj {ffh u~fmuofau dj~ iakjow`fuf mnj~uija mu ucf w~iom~y
km~f `ftf` mae ucv{ ~fevkiab ucf km{f`jme mu uf~uim~y km~f dmki`iuif{#D@M[JB >772)!
;! Mn{u~mku{ d~jo {f`fkufe wvn`i{cfe
{uveif{ m~f mtmi`mn`f mu< cuuw< [f`fkufewvn`ikmuija mn{u~mku{ ja oi{j/
w~j{uj` v{f ia wj{umnj~uija km~fmtmi`mn`f ja ucf ujj`hiu KE j~ mu
cuuw
7/31/2019 Misoprostol Use in Postabortion Care
18/144
OJEV@F >! W`maaiab dj~ {f~tikf ef`itf~y
UM^BFU MVEIFAKF[M Fati~jaofaum`m{{f{{ofau bvief
>N Kcfkh`i{u dj~w`maaiab dj~kcmabf ia {f~tikfef`itf~y
>K F{uiomuiaboi{jw~j{uj` {vww`yaffe{
>!= Iau~jevkuija
Rcfa w`maaiab uj iau~jevkf oi{jw~j{uj` dj~ wj{umnj~uija km~f#WMK) {f~tikf{ mu ucf dmki`iuy `ftf` iu i{ jdufa cf`wdv` m`ucjvbc aju ~f/}vi~fe uj ej {jof n~jmef~ uciahiab mnjvu {f~tikf ef`itf~y affe{ ucfwj{umnj~uija km~f ucmu i{ kv~~fau`y mtmi`mn`f #id may) mae ucf wj`ikif{
ucmu ri`` bvief {f~tikf iow`fofaumuija! #Dj~ m `i{u jd f{{fauim` {f~tikfef`itf~y ~f}vi~fofau{ {ff Ujj` ;M< Oiaiovo ~f}vi~fofau{ dj~u~fmuofau jd iakjow`fuf mnj~uija riuc oi{jw~j{uj !) Ia meeiuijauj `myiab ucf b~jvaerj~h dj~ afr j~ fswmaefe WMK {f~tikf{ uci{ef`inf~muitf w~jkf{{ {cjv`e m`{j f{umn`i{c j~ iak~fm{f {vwwj~u dj~ ucfv{f jd oi{jw~j{uj` dj~ wj{umnj~uija km~f! Riucjvu rief~ ia{uiuvuijam`{vwwj~u iu ri`` nf cm~e uj eftf`jw mae {v{umia m w~jb~mo!
Ojev`f > w~jtief{ yjv riuc bviemakf mae ujj`{ uj kjaevku ma fati/~jaofaum` m{{f{{ofau ~ftifr kv~~fau wj`ikif{ mae {f~tikf{ mae f{/
uiomuf oi{jw~j{uj` {vww`y affe{! Rcf~f yjv rj~h mae ucf w`maafe{kjwf jd ucf oi{jw~j{uj` dj~ wj{umnj~uija km~f w~jb~mo ri`` efuf~/oiaf ucf {kjwf jd ucf m{{f{{ofau mae wj`iky*{f~tikf ~ftifr! Yjv~f{uiomuf jd oi{jw~j{uj` {vww`y affe{ ri`` nf nm{fe ja yjv~ km{f`jmemae ucf tm~ijv{ v{f{ yjv w`ma dj~ oi{jw~j{uj`!
UJJ@[ IA UCI[
OJEV@FM!
Fati~jaofaum` m{{f{{ofau bvief
V{f uci{ bvief uj cf`w effwfa yjv~ vaef~{umaeiab jd ucf fati~jaofau ia rcikc yjv rj~h uj nfuuf~ eftf`jw
mae iow`fofau oi{jw~j{uj` dj~ wj{umnj~uija km~f {f~tikf{! Ucf fati~jaofaum` m{{f{{ofau omy nf m{ {iow`fm{ kjatfaiab m offuiab jd hajr`febfmn`f wfjw`f uj ei{kv{{ ucf kv~~fau {iuvmuija mae wf~kfitfe affe{ j~
~ftifriab emum uj vaef~{umae ucf efomae dj~ wj{umnj~uija km~f {f~tikf{ ia yjv~ {fuuiab! M{ yjv kjaevkuucf m{{f{{ofau omhf {v~f uj kja{ief~ ucf affe{ jd {wfkim` wjwv`muija{ {vkc m{ rjofa ia k~i{i{*fof~bfaky{iuvmuija{ yjvuc ~fdvbff{ rjofa `itiab riuc CIT*MIE[ kjoof~kim` {fs rj~hf~{ rjofa dmkiab {fsvm`tij`fakf mae wfjw`f iowmkufe ny jucf~ cfm`uc kjaeiuija{ {vkc m{ iadfkuijv{ ei{fm{f{!
Wvn`ik cfm`uc kjaufsu
Vaef~{umae ucf {i|f mae bfjb~mwcik ei{u~invuija jd ucf wjwv`muija!
Ajuf ucf omuf~am` oj~um`iuy ~muf #mu ucf amuijam` ~fbijam` j~ `jkm` `ftf`{)!
Ajuf ucf w~jwj~uija jd omuf~am` oj~um`iuy muu~invumn`f uj va{mdf mnj~uija!
Ajuf ucf fsufau jd omuf~am` oj~nieiuy muu~invumn`f uj kjow`ikmuija{ jd va{mdf mnj~uija!
Kjvau ucf avonf~ jd rjofa u~fmufe dj~ mnj~uija kjow`ikmuija{ ojauc`y mae*j~ maavm``y ia ucfkmukcofau m~fm jd ucf cj{wium` ei{u~iku j~ jucf~ `jkmuija!
^ftifr ucf uywf{ jd omuf~am` kjow`ikmuija{ oj{u jdufa {ffa ia cfm`uc/km~f dmki`iuif{ ia ucf kmukc/ofau m~fm!
Ajuf ucf vaofu affe dj~ kjau~mkfwuija!
@fbm` mae ~fbv`muj~y kjaufsu ^ftifr fsi{uiab `mr{ mae wj`ikif{ mae ucfi~ fddfku{ ja ucf w~jti{ija jd mnj~uija km~f #njuc u~fmuofau
jd mnj~uija kjow`ikmuija{ mae `fbm` mnj~uija)! @mr{ ucmu m~f kja{ief~fe ~f{u~ikuitf {jofuiof{ wf~/oiu `fbm` {mdf mnj~uija{ ia km{f{ jd ~mwf mae dj~ jucf~ kjowf``iab ~fm{ja{! Wmy muufauija uj may ~fbv`m/uija{ ucmu mddfku km~f dj~ mej`f{kfau{ j~ vaom~~ife rjofa!
Efuf~oiaf ucf uywf{ jd k`iaikima{ rcj kma kv~~fau`y u~fmu iakjow`fuf mnj~uija!
Wm~uaf~ riuc m ajabjtf~aofaum` j~bmai|muija j~ jucf~ mbfaky uj ~ftifr ucf {umuv{ jd oi{jw~j{uj`iak`veiab iu{ ~fbi{u~muija mae mww~jtfe iaeikmuija{ iak`v{ija ja ucf amuijam` f{{fauim` ofeikiaf{ `i{uoiai{u~y jd cfm`uc efki{ija{ mnjvu iu{ v{f mae kv~~fau ftiefakf/nm{fe v{f #wf~ `mnf` j~ jdd/`mnf`)!
[f~tikf ef`itf~y kjaufsu
Ajuf ucf mtmi`mni`iuy jd WMK {f~tikf{ iak`veiab dmki`iuif{ ucmu w~jtief vuf~iaf ftmkvmuija riuc OTMmae*j~ oi{jw~j{uj`! Ajuf ucf dmki`iuif{ `jkmuija{ ucfi~ ei{u~invuija ~f`muitf uj ucf avonf~ jd rjofa
jd ~fw~jevkuitf mbf mae ucfi~ {umdab `ftf`{ mae cjv~{!
^ftifr ucf rmy{ ia rcikc rjofa uywikm``y ~fmkc ucf cfm`uc dmki`iuif{!
7/31/2019 Misoprostol Use in Postabortion Care
21/144
7/31/2019 Misoprostol Use in Postabortion Care
22/144
>!> [umaem~e{, bvief`iaf{ mae w~jujkj`{
Iu i{ iowj~umau uj ~ftifr w~ftmi`iab {umaem~e{ bvief`iaf{ mae w~j/ujkj`{ uj fa{v~f ucmu ucfy dmki`iumuf mkkf{{ uj km~f mae ucmu ucfy fa/kjowm{{ ucf v{f jd oi{jw~j{uj`! Id eftf`jwiab j~ vwemuiab amuijam`
{umaem~e{ mae bvief`iaf{ i{ nfyjae ucf {kjwf jd yjv~ w~jlfku kja/{ief~ ejkvofauiab ucf ~f{v`u{ jd ucf v{f jd oi{jw~j{uj` dj~ wj{um/nj~uija km~f ia lv{u jaf dmki`iuy j~ bfjb~mwcik m~fm! Yjv kma ucfa v{f
ucf ~f{v`u{ uj fakjv~mbf m n~jmef~ ~ftifr mae vwemuiab jd amuijam`ejkvofau{ mae e~vb v{mbf wj`ikif{!
Amuijam` {umaem~e{ m~f tf~y eiddf~fau d~jo `jkm` j~ ia{uiuvuijam` w~j/ujkj`{! Ia bfaf~m` amuijam` {umaem~e{ m~f aju ~ftifrfe ~fbv`m~`y jakf
ucfy m~f mww~jtfe! Ucv{ amuijam` {umaem~e{ {cjv`e nf m{ n~jme maeaja/{wfkik m{ wj{{in`f {j ucmu `jkm` ia{uiuvuija{ kma d~ff`y iow`f/
ofau vw/uj/emuf k`iaikm` w~jujkj`{ m{ {kifakf ftj`tf{! Dj~ fsmow`frcf~f m amuijam` {umaem~e oibcu mww~jtf oi{jw~j{uj` dj~ wj{umnj~/uija km~f iu rjv`e nf `fdu uj ucf `jkm` j~ ia{uiuvuijam` w~jujkj` uj `myjvu ucf {wfkik ~fbiofa{ kjau~miaeikmuija{ f`ibini`iuy mae {j dj~uc!
I{{vf{ uj kja{ief~ rcfa eftf`jwiab j~ ~ftifriab{umaem~e{, bvief`iaf{ mae w~jujkj`{776! [umaem~e{ maebvief`iaf{ ujj`hiu! Kcmwf` Ci`` AK!; [ufw/ny/{ufw w`maaiab2
Rcfucf~ w`maaiab dj~ ucf iau~jevkuija jd afr {f~tikf{ riuc oi{j/w~j{uj` j~ iaufb~muiab oi{jw~j{uj` dj~ wj{umnj~uija km~f iauj fsi{uiabWMK {f~tikf{ w`maaiab {cjv`e nf m km~fdv` mae ucjvbcudv` w~jkf{{!Ucf w`maaiab w~jkf{{ jvu`iafe ia ucf kcfkh`i{u nf`jr kma bvief yjvia vaef~{umaeiab ucf affe{ jd yjv~ kjoovaiuy mae wmuifau{ maecf`w yjv ef{iba mww~jw~imuf mae dfm{in`f {f~tikf{ uj offu ucj{f
affe{!
Eiddf~fau wfjw`f ri`` cmtf eiddf~fau iefm{ mnjvu cjr uj iow~jtf{f~tikf{ j~ k~fmuf m afr w~jb~mo! Iu i{ ucf~fdj~f iowj~umau ev~iab ucfw`maaiab wcm{f uj f`ikiu m`` ~f`ftmau wf~{wfkuitf{ mae iefm{ f{wf/kim``y d~jo hfy `fmef~{ rcj{f {vwwj~u i{ iowj~umau uj ucf w~jb~mo{
{vkkf{{ mae d~jo ucf wfjw`f yjv~ w~jb~mo ri`` {f~tf iak`veiab mej/`f{kfau{ mae jucf~ {wfkim` wjwv`muija{!
W`maaiab dj~ kcmabf{ ia {f~tikf ef`itf~y iatj`tf{ {is hfy {ufw{< iefa/uidyiab w~ij~iuif{ {fuuiab jnlfkuitf{ eftf`jwiab m rj~hw`ma u~miaiab{umdd mu m`` `ftf`{ w`maaiab dj~ cibc }vm`iuy mae w`maaiab dj~ {v{umia/mni`iuy # Ujj` >N< Kcfkh`i{u dj~ w`maaiab dj~ kcmabf ia {f~tikfef`itf~y)! Ucf kcfkh`i{u ri`` cf`w yjv omhf {v~f ucmu yjv m~f kja{ie/f~iab m`` ucf tm~ijv{ f`fofau{ ucmu m~f f{{fauim` ia eftf`jwiab {f~tikfef`itf~y riuc oi{jw~j{uj`! M{ w`maaf~{ rj~h uc~jvbc ucf kcfkh`i{uucfy {cjv`e umhf ucf dj``jriab kja{ief~muija{ iauj mkkjvauN m~fmemwufe d~jo< OkIaf~afy Uf~f{m
U~mki @! Nmi~e M`y{ja B! Cyomamae Momaem N! Cvnf~! >77=! M
> [ u i nl ui
7/31/2019 Misoprostol Use in Postabortion Care
24/144
>! [fu {wfkik jnlfkuitf{
Jnlfkuitf{ {cjv`e ~ffku ucf affe{ jd rjofa mae ucf kjoov/aiuy! Iu i{ m`{j iowj~umau ucmu jnlfkuitf{ nf mkciftmn`f riucia ucfbitfa uiof d~mof mae riuc mtmi`mn`f ~f{jv~kf{! Ucf{f jnlfkuitf{
{cjv`e cf`w efaf yjv~ afsu {ufw{ dj~ iau~jevkiab j~ iaufb~muiaboi{jw~j{uj` iauj wj{umnj~uija km~f {f~tikf{!
;! Eftf`jw m rj~hw`ma
Uciah uc~jvbc ucf {ufw{ ucmu ov{u nf umhfa uj mkkjow`i{c fmkcjnlfkuitf! M{{iba ~f{wja{ini`iuy dj~ fmkc mkuitiuy mae eftf`jw muiof`iaf dj~ kjow`fuija! Uciah mnjvu ucf rcj rcmu rcfa cjrmae rcf~f jd fmkc {ufw! Yjv ri`` m`{j affe uj eftf`jw m nvebfu
dj~ yjv~ rj~hw`ma mae w`ma dvaeiab dj~ yjv~ mkuitiuif{ mae {f~/tikf{!
5! U~mia {umdd mu m`` `ftf`{
M`` {iuf u~miaiab {cjv`e nf kjaevkufe riuc yjv~ {umdd iak`veiabtm`vf{ k`m~ikmuija fsf~ki{f{ ucmu ri`` cf`w ~fevkf {uibom maeei{k~ioiamuija mu ucf dmki`iuy `ftf`! Ia meeiuija m`` {umdd {cjv`e
cmtf m bfaf~m` vaef~{umaeiab jd cjr wj{umnj~uija km~f {f~tikf{m~f w~jtiefe uj rjofa! Diam``y k`iaikima{ {cjv`e ~fkfitf {wfkiku~miaiab ja ucf w~jti{ija jd WMK mae oi{jw~j{uj` v{f ia WMK!
6! W`ma dj~ cibc }vm`iuy
Yjv {cjv`e iefauidy rmy{ uj ojaiuj~ ucf w~jb~mo mae fa{v~fcibc }vm`iuy #{ff Ojev`f 4< Fa{v~iab Cibc ]vm`iuy [f~tikf{)! Ia m
dmki`iuy/nm{fe w~jb~mo iatj`tf ucf {umdd mae wmuifau{ ia efaiabiaeikmuj~{ jd cibc }vm`iuy {f~tikf!
4! W`ma dj~ {v{umiamni`iuy
Uj bvm~mauff ucf fddfkuitfaf{{ jd {f~tikf{ iu i{ k~iuikm` uj w`makcmabf{ ia {vkc m rmy ucmu ucfy ri`` faev~f jtf~ uiof! Eiddf~fauw~jb~mo{ ri`` ~f}vi~f eiddf~fau mkuija{ uj mkciftf {v{umiamni`iuy
nvu kf~umia f`fofau{ m~f vaitf~{m``y iowj~umau77okb
oi{jw~j{uj`
umn`fu{affefe
wf~ej{f!
^fkj~eucf
avonf~
jd
rffh{ucmu
uywikm``y
f`mw{f
nfurffa
j~ef~
w`mkfofaumae
ef`itf~yujyjv~
dmki`iuy!
F}vm`{#Mtf~mbf
emi`ykm{f`jme)
#&jd
km{f`jmev{iab
oi{jw~j{uj`)
F}vm`{
#Mtf~mbf
emi`y
oi{jw~j{uj`
km{f`jme)
#O
i{jw~j{uj`
umn
`fu{
aff
efewf~
ej{f)
#2emy{)
#Cjr`jab
iuumhf{
uj~fkfitf
oi{jw~j{uj`
mduf~yjv
j~e
f~iu)
F}vm`{#Mtf~mbf
emi`yoi{jw~j{uj`
km{f`jme)
#Oi{jw~j{uj`
umn`fu{affefe
wf~ej{f)
F
}vm`{
#Avonf~
jdumn`fu{
dj
~fkm{ufeuj
v{fwf~emy)
#Avonf~jd
{f~tikfemy{wf~
o
jauc)
F}vm`{#Avonf~
jdumn`fu{
dj~fkm{ufeujv{f
wf~ojauc)(
#Nvddf~ujmtjie
{ujkhjvu)
Idiuumhf{`f{{
ucma5rffh{uj
~fkfitfoi{jw~j{
mduf~yjvj~ef~iu
yjv~omsiovo
iatfauj~y`ftf`r
f}vm`>#avon
jdumn`fu{dj~fkm{u
ujv{fwf~ojauc
Idiuumhf{5
rffh{j~`jabf~,
yjv~omsiovo
iatfauj~y`ftf`r
f}vm`;#
Avon
jdumn`fu{dj~fkm{u
ujv{fwf~ojauc
;7
5
46
;
>
;
=>
4
9
>
27
;94
657
;jaucfmk
kjowmayiabKEdj~ma
fskf`{w~fme{cffuucmur
i``cf`wyjvkjow`fufucfkm`kv`muija{!
>!6 Meeiuijam` ~f{jv~kf{
7/31/2019 Misoprostol Use in Postabortion Care
32/144
Kfauf~{ dj~ Ei{fm{f Kjau~j` mae W~ftfauija #KEK)! >773! Wjkhfubvief uj omambiab kjau~mkfwuitf {vww`if{! Mu`maum BM< KEK! cuuw779! KJWF dj~ kjow~fcfa{itf mnj~uija km~f{f~tikf< M ujj`njjh uj mkkjowmay ucf KJWF cmaenjjh! Afr Yj~h7=7!wed
Iauf~amuijam` Dfef~muija jd Byafkj`jby mae Jn{ufu~ik{ #DIBJ)!>779! Oi{jw~j{uj` [mdf Ej{mbf Bvief`iaf{! cuuw! F{{fauim` f`fofau{ jd wj{umnj~uijakm~f< Ma fswmaefe mae vwemufe ojef`! cuuw
7/31/2019 Misoprostol Use in Postabortion Care
33/144
7/31/2019 Misoprostol Use in Postabortion Care
34/144
~ftifriab ucf dmki`iuy{ r~iuufa wj`ikif{ w~jkfev~f{ mae {umaem~e{ dj~m`` m{wfku{ jd {f~tikf ef`itf~y! Yjv {cjv`e m`{j fsmoiaf ucf amakim`
7/31/2019 Misoprostol Use in Postabortion Care
35/144
m`` m{wfku{ jd {f~tikf ef`itf~y! Yjv {cjv`e m`{j fsmoiaf ucf amakim`mae nvebfuiab {y{ufo ia j~ef~ uj efuf~oiaf cjr yjv ri`` wv~kcm{f
{vww`if{ mae ofeikiaf{ ~f`mufe uj ucf u~fmuofau jd iakjow`fuf mnj~/uija riuc oi{jw~j{uj` #{vkc m{ oi{jw~j{uj` OTM kjau~mkfwuitf
{vww`if{ mae iadfkuija w~ftfauija {vww`if{)! Diam``y efuf~oiaf ucfmtmi`mni`iuy mae {kcfev`f jd {umdd mn`f uj w~jtief wj{umnj~uija km~f!
W~jb~mo omambf~{ k`iaikima{ mae jucf~ ~f`ftmau {umhfcj`ef~{ kma m``
wm~uikiwmuf ia v{iab ucf dmki`iuy m{{f{{ofau ujj`! Iu i{ bfaf~m``y oj{uw~jevkuitf uj f{umn`i{c m {om`` ufmo jd wfjw`f riuc eiddf~fau {hi``{mae wf~{wfkuitf{ uj km~~y jvu ucf m{{f{{ofau8 uci{ kma omsioi|f ucf~ikcaf{{ jd ucf iadj~omuija bmucf~fe! Dj~ fsmow`f m ~f`ifd mbfaky
omy rmau uj iau~jevkf oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fufmnj~uija iauj cfm`uc/km~f {f~tikf{ ia m ~fdvbff kmow! Ia uci{ ia{umakfucf dmki`iuy m{{f{{ofau ufmo oibcu iak`vef ucf kmow{ av~{f omambf~`jbi{uik{ mae {vww`if{ omambf~ m ~fw~f{faumuitf d~jo ucf ~fdvbffrjofa{ b~jvw mae m {umdd ofonf~ jd ucf ~f`ifd mbfaky!
;!> Ojef`{ dj~ iaufb~muiab oi{jw~j{uj` iaujwj{umnj~uija km~f {f~tikf{
Iau~jevkuija jd oi{jw~j{uj`
[umae/m`jaf w~iom~y km~f {f~tikf{ iak`veiab dmoi`y w`maaiab
k`iaik{ kma jddf~ oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uijarcfucf~ j~ aju OTM i{ mtmi`mn`f! Cjrftf~ ucf~f {cjv`e nf m ~fdf~~m`
`iah dj~ OTM m{ m nmkhvw rcfa affefe! M oi{jw~j{uj` jwuija mu ucf`jrf{u `ftf` jd ucf cfm`uc {y{ufo m``jr{ k`iaikima{ uj ~fmkc afr wjwv/`muija{ jd rjofa mae ucf~fny fswmae wjiau{ jd {f~tikf!
Iaufb~muija jd oi{jw~j{uj`
Iaufb~muiab oi{jw~j{uj` u~fmuofau iauj fsi{uiab WMK {f~tikf{ m``jr{rjofa m kcjikf jd w~fdf~~fe ufkcaj`jbif{ mae wjufauim``y iak~fm{f{
ucf avonf~ jd k`iaikima{ mn`f uj jddf~ WMK!
Iaufb~muiab oi{jw~j{uj` u~fmuofau iauj fof~bfaky {f~tikf{ {vkc m{fof~bfaky efwm~uofau{ omy m`{j iak~fm{f ucf avonf~ jd k`iaikima{mn`f uj jddf~ WMK! Dv~ucf~oj~f iu kjv`e efk~fm{f dmki`iuy affe{ iauf~o{ jd w~jkfev~f ~jjo{ mae f}viwofau dj~ km~f!
Iaufb~muiab oi{jw~j{uj` u~fmuofau iauj nm{ik mae fof~bfaky jn{ufu/
~ik mae afrnj~a km~f {f~tikf{ cm{ ucf metmaumbf jd dv~ucf~ fswmae/iab ucf avonf~ jd k`iaikima{ mn`f uj jddf~ WMK! Dv~ucf~oj~f iu `iah{WMK {f~tikf{ uj omuf~am` cfm`uc {f~tikf{ rcikc kma kmwium`i|f jak`iaikima {hi`` {fu{ mae oj~f kjow~fcfa{itf`y mee~f{{ rjofa{ ~fw~j/
KJAU^MKFWUIJA< MAF[[FAUIM@ F@FOFAU
Aj omuuf~ rcmu ucf ojef`,kjau~mkfwuitf kjva{f`iabmae {f~tikf{ m~f maf{{fauim` kjowjafau jdWMK {f~tikf{ dj~ rjofarcj ri{c uj ef`my j~w~ftfau w~fbamaky!
Uc~jvbc ucf dmki`iuym{{f{{ofau, yjv kma m{{f{{cjr kjau~mkfwuitf {f~tikf{kma nf iow~jtfe uj mee~f{{rjofa{ affe{ maew~jtief oj~f kjau~mkfwuitfkcjikf{! Id ucf ia{uiuvuijakmaaju jddf~ m wm~uikv`m~kjau~mkfwuitf ofucje,iefauidy jucf~ kjau~mkfwuitfw~jtief~{ ia ucf kjoovaiuy
7/31/2019 Misoprostol Use in Postabortion Care
36/144
7/31/2019 Misoprostol Use in Postabortion Care
37/144
Ujj` ;N!
Dmki`iuy m{{f{{ofau
7/31/2019 Misoprostol Use in Postabortion Care
38/144
Dmki`iuy m{{f{{ofau
Ucf dmki`iuy m{{f{{ofauujj`dmki`iumuf{kjow~fcfa{itf {iuf m{{f{{ofau! Kjaevkuiab m ucj~jvbc dmki`iuym{{f{{ofau ri`` cf`w yjv bmucf~ tm`vmn`f iadj~omuija affefe dj~ iau~jevkiab oi{jw~j{uj` dj~ wj{umnj~uijakm~f {f~tikf{! Oj~fjtf~ iefauidyiab mae mee~f{{iab bmw{ kma cf`w yjv iow~jtf }vm`iuy jd km~f! Ucf ujj` ejf{
aju w~f{k~inf {wfkik bjm`{ nvu cibc`ibcu{ hfy m~fm{ ucmu m~f iowj~umau ia w~jtieiab cibc }vm`iuy {f~tikf!Cjrftf~ ucf{f f`fofau{ m~faju f{{fauim`uj w~jtieiab oi{jw~j{uj` u~fmuofau! Dj~ fsmow`f m`ucjvbc cmtiabm wmuifau rmiuiab m~fm i{ w~fdf~mn`f d~jo m cibc }vm`iuy {umaewjiau #f{wfkim``y ia m nv{y dmki`iuy) iu i{ aju m~f}vi~fofau dj~ {f~tikf w~jti{ija!
Efwfaeiab ja yjv~ ~j`f yjv omy v{f m`` j~ wm~u jd uci{ m{{f{{ofau ujj`! Yjv kma m`{j eitief vw {fkuija{ jd ucf
ujj` mojab eiddf~fau ofonf~{ jd ucf m{{f{{ofau ufmo riuc ofonf~{ mee~f{{iab wm~uikv`m~ {fkuija{ mkkj~eiabuj ucfi~ fswf~ui{f! Ei{u~iku cfm`uc omambf~{ omy ae uci{ mww~jmkc cf`wdv` dj~ m{{f{{iab w~iom~y km~f kfauf~{ia ucfi~ ei{u~iku! M k`iaikima rcj rmau{ uj mee oi{jw~j{uj` u~fmuofau uj m ~v~m` cfm`uc wj{u omy v{f {fkuija{ jducf ujj` uj m{{f{{ ucf {iuf{ kmwmkiuy uj {um~u {f~tikf{!
I! DMKI@IUY IADJ^OMUIJA
Amof< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Uywf #Wvn`ik*W~itmuf)< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
M{{f{{j~{< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Emuf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ ZZZZ
Ejf{ uci{ dmki`iuy w~jtief ucf dj``jriab {f~tikf{:
Omavm` tmkvvo m{wi~muija #OTM) Yf{ Aj
[cm~w kv~fuumbf Yf{ Aj
W~fbamaky uf~oiamuija Yf{ Aj
U~fmuofau jd {fkjae/u~iof{uf~ mnj~uija Yf{ Aj
Kjau~mkfwuitf {f~tikf{ Yf{ Aj
7/31/2019 Misoprostol Use in Postabortion Care
39/144
III! WJ[UMNJ^UIJA KM^F #WMK) [F^TIKF [UMUI[UIK[Ucf {iuf {cjv`e cm f m ~fbi{uf~ dj~ ~fkj~eiab {f~ ikf{ Ucf ~fkj~e {cjv`e nf iow~j fe uj kmwuv~f WMK
7/31/2019 Misoprostol Use in Postabortion Care
40/144
Ucf {iuf {cjv`e cmtf m ~fbi{uf~ dj~ ~fkj~eiab {f~tikf{! Ucf ~fkj~e {cjv`e nf iow~jtfe uj kmwuv~f WMK
rcf~f uci{ ejf{ aju m`~fmey fsi{u!
]vf{uija Ma{rf~
^ftifr `jb{ ~fkj~e{ mae*j~ wmuifau kcm~u{! Cjromay wj{umnj~uija kjow`ikmuija{ rf~f {ffa iaucf dmki`iuy ia ucf `m{u uc~ff ojauc{:
Efmuc{< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
[ftf~f kjow`ikmuija{< ZZZZZZZZZZZZZZZZZZ
Oiaj~*ojef~muf kjow`ikmuija{< ZZZZZZZZZZ
Ej ucf ~fkj~e{ `jjh kjow`fuf #f!b! `jbnjjh{ m~f``fe jvu mae vw/uj/emuf):
Yf{ Aj
I{ ucf~f m {v~tfi``makf {y{ufo dj~ ojaiuj~iabomuf~am` efmuc{ mae jucf~ metf~{f ftfau{:
Yf{ Aj
Rcmu jucf~ iadj~omuija i{ ~jvuiaf`y kj``fkufe iaucf `jbnjjh{:
@i{u! Hajra m``f~bif{
;! Mkvuf j~ kc~jaik i``af{{f{ j~ kjaeiuija{
5! N~ifd jn{ufu~ik mae kjau~mkfwuitf ci{uj~y
m! @OW
n! W~fbamaky {yowujo{
k! Rcfa n`ffeiab nfbma n`ffeiab wmuuf~a{ mae mojvau jd n`ffeiab
e W ` i i * i
7/31/2019 Misoprostol Use in Postabortion Care
63/144
e! Wf`tik wmia* k~mowiab
I{ wmia*k~mowiab iauf~oiuufau #`ihf kjau~mkuija{) j~ kja{umau:
[ftf~iuy jd wmia*k~mowiab ja m {km`f jd = uj =7 #=7?rj~{u wmia Itf ftf~ df`u)
N! Km~~y jvu maki``m~y uf{uiab #id iaeikmufe mae mtmi`mn`f)
=! Cfojb`jnia j~ cfomujk~iu
>! V`u~m{jvae< aju ~jvuiaf`y affefe uj eimbaj{f iakjow`fuf mnj~uija
;! W~fbamaky uf{uiab< aju ~jvuiaf`y affefe uj eimbaj{f iakjow`fuf mnj~uija
K! Wf~dj~o wcy{ikm` fsmo
=! Jnumia tium` {iba{< n`jje w~f{{v~f ufowf~muv~f wv`{f
>! M{{f{{ bfaf~m` mwwfm~makf< wm``j~ ftf` jd faf~by mae m`f~uaf{{ monv`muj~y aj iaeikmuija jd
mkvuf ei{u~f{{
;! Wf~dj~o wf`tik fsmo mae m{{f{{ rffh{ @OWOTM j~ ~fdf~ dj~
{ftf~f kjow`ikmuija{
Fswfkumau omambfofauJ^
^fwfmu oi{jw~j{uj`J^
U~fmu riuc OTM
Vuf~iaf {i|f => rffh{ @OWMeoiai{uf~ oi{jw~j{uj`,
Vuf~iaf {i|f 1=> rffh{ @OWOTM j~ jucf~ vuf~iaf ftmkvmuija
ofucje{ {v~bf~y j~ jucf~w~jkfev~f{ uj u~fmu
kjow`ikmuija{ m{ affefe
Fswfkumau omambfofauJ^
^fwfmu oi{jw~j{uj`J^
U~fmu riuc OTM
Kjau~mkfwuitf kjva{f`iab mae ofucje w~jti{ija
^FDF^ ID AFKF[[M^Y^FDF^ ID AFKF[[M^Y
, Kcfkh f`ibini`iuy! Oi{jw~j{uj` ~fbiofa{ m~f 477okb j~m` j~ 577okb {vn`iabvm`!
7/31/2019 Misoprostol Use in Postabortion Care
71/144
Ujj` 6E!
Wmuifau kcm~u
K`iaikima{ omy memwu ucf{f kcm~u{ m{ affefe j~ iaufb~muf ucf iadj~omuija iauj fsi{uiab kcm~u{! Oj~fiadj~omuija ja v{iab emum bmucf~fe d~jo ucf kcm~u{ dj~ ojaiuj~iab wv~wj{f{ i{ iak`vefe ia Ojev`f 4<
7/31/2019 Misoprostol Use in Postabortion Care
72/144
Fa{v~iab cibc }vm`iuy {f~tikf{! Meeiuijam` ~f{jv~kf{ dj~ oj~f efumi`fe wmuifau kcm~u{ mu ucf uf~uim~y `ftf` kmanf djvae f`{frcf~f!=9
=3! Uci{ ujj` rm{ memwufe d~jo< Tfauv~f [u~mufbif{ Iaajtmuija{! >779! KMK omavm` jd jwf~muija{! Vawvn`i{cfe!
=9! Df{kiam ^!C! N! Ef Ovkij O! Mn~fv B! Om~uaf| L!@! Em| ^j{{f``j @! Omiaf~j ^! Bof| Wjakf ef @fa O! ^v/niaj mae O! Ominj! >779! Wf~iamum` iadj~omuija {y{ufo #WI[)< Wf~iamum` k`iaikm` ~fkj~e kjow`fofaum~y dj~o dj~ rjofa
WMUIFAU KCM^U DJ^ OI[JW^J[UJ@ V[F IA WJ[UMNJ^UIJA KM^F
Amof< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZEmuf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Mbf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZKjaumku iadj~omuija< ZZZZZZZZZZZZZZZZZ
^fdf~~fe d~jo #dmki`iuy amof mae {iuf)< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
^fm{ja dj~ ~fdf~~m`< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Ofeikm` mae jn{ufu~ik ci{uj~y
Emuf jd `m{u ofa{u~vm` wf~ije< ZZZZZ * ZZZZZ * ZZZZZ
Vuf~iaf {i|f< ZZZZZ#rffh{)ZZZZZ#emy{)EE OO YY
7/31/2019 Misoprostol Use in Postabortion Care
73/144
Tmbiam` n`ffeiab: Yf{ Aj Ev~muija ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Wf`tik wmia j~ k~mowiab: Yf{ Aj
Wm{{fe ui{{vf j~ w~jevku{ jd kjakfwuija: Yf{ Aj
Rm{ {cf v{iab m kjau~mkfwuitf rcfa {cf bju w~fbamau uci{ uiof:, Yf{ Aj
[wfkidy uywf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
,Id IVE ia w`mkf ~fojtf nfdj~f meoiai{uf~iab oi{jw~j{uj`!
Kv~~fau ofeikmuija{< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Hajra m``f~bif{ uj e~vb{ j~ jucf~ mbfau{: Yf{ Aj
@i{u< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Ci{uj~y jd mafoim j~ n`ffeiab*k`juuiab ei{j~ef~{: Yf{ Aj
Ef{k~inf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
[v~bikm` ci{uj~y: Yf{ Aj
Ef{k~inf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
May jucf~ cfm`uc kjaeiuija{: Yf{ Aj
@i{u< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Wcy{ikm` fsmo
Tium` {iba{77okb umn`fu{ vaef~ucf ujabvf vaui` ucfy ei{{j`tfj~ dj~ ;7 oiavuf{8 {rm``jrmay ~fomiaiab d~mbofau{!#[iab`f ej{f)
OI[[FE MNJ^UIJA * MAFON^YJAIK BF[UMUIJA
Oi{jw~j{uj` ej{f ^jvuf Uioiab
377okb=m >m >n Tmbiam` [iab`f ej{f
J
477okb=m >m ; 5 [vn`iabvm` Bitf ftf~y ; cjv~{ dj~ momsiovo jd ; ej{f{J [iab`f ej{f,
, [vn`iabvm` oi{jw~j{uj` 477okb {vn`iabvm``y ftf~y ; cjv~{ dj~ m omsiovo jd ; ej{f{ i{ jaf~fkjoofaefe ~fbiofa8 m {iab`f {vn`iabvm` ej{f jd oi{jw~j{uj` 477okb omy m`{j nf v{fe id `fduuj rj~h dj~ =/> rffh{ #va`f{{ ucf~f i{ cfmty n`ffeiab j~ iadfkuija)
779! Oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uija< Ma iau~jevkuj~y bviefnjjh!
cuuw772! Kjowm~i{ja jd oi{jw~j{uj` mae omavm`
tmkvvo m{wi~muija dj~ ucf u~fmuofau jd iakjow`fuf mnj~uija! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{ 93>>/>>4!
=k! Emj N! L! N`vo N! Ucifnm [! mbcmtma O! Jvfe~mfbj L! @mahjmaef mae N! Riaihjdd! >772! I{ oi{jw~j{uj` m {mdf fd/dfkuitf mkkfwumn`f m`uf~amuitf uj omavm` tmkvvo m{wi~muija dj~ wj{umnj~uija km~f: ^f{v`u{ d~jo m ~maejoi|fe u~im` ia
http://gynuity.org/resources/info/guidebook-on-misoprostol-for-treatment-of-incomplete-abortion/http://gynuity.org/resources/info/guidebook-on-misoprostol-for-treatment-of-incomplete-abortion/7/31/2019 Misoprostol Use in Postabortion Care
79/144
dfkuitf mkkfwumn`f m`uf~amuitf uj omavm` tmkvvo m{wi~muija dj~ wj{umnj~uija km~f: ^f{v`u{ d~jo m ~maejoi|fe u~im` ia
Nv~hiam Dm{j Rf{u Md~ikm! NLJB< Ma Iauf~amuijam` Ljv~am` jd Jn{ufu~ik{ $ Byafkj`jby ==5< =;43/=;26!
=e! Eijw Myi{cm [cfi`m ^mbcmtma Lfma/Wif~~f ^mhjujtmj ^jeikm Kjofaemau Wmv` E! N`vofaucm` mae Nftf~`y Riaihjdd!
>779! Kjowm~i{ja jd urj ~jvuf{ jd meoiai{u~muija dj~ oi{jw~j{uj` ia ucf u~fmuofau jd iakjow`fuf mnj~uija< m ~maejo/i|fe k`iaikm` u~im`! Kjau~mkfwuija 29< 564/54>!
=f! [crfhf~f`m N! ^! Hm`vovam ^! Hiwiab`i A! Om{cmhm F! Rf{ucfiof~ R! K`m~h mae N! Riaihjdd! >772! Oi{jw~j{uj` dj~u~fmuofau jd iakjow`fuf mnj~uija mu ucf ~fbijam` cj{wium` `ftf`< ^f{v`u{ d~jo Uma|maim! N~iui{c Ljv~am` jd Jn{ufu~ik{ mae
Byamfkj`jby ==5 #==)< =;4;/=;42!
=d! Emnm{c ^m{cm Ojcmofe Kcf~iaf ^momema Fome Em~ri{c Aftiaf Cm{{mafia Lfaaidf~ N`vo mae Nftf~`y Riaihjdd!
>7=7! M ~maejoi|fe kjau~j``fe u~im` jd 577/b {vn`iabvm` oi{jw~j{uj` tf~{v{ omavm` tmkvvo m{wi~muija dj~ ucf u~fmu/ofau jd iakjow`fuf mnj~uija ia urj Fbywuima cj{wium`{! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{ ===#>)m! Bfo|f``/Emaif`{{ja H! W! K! Cj ! Bof| Wjakf ef @fa fu m`! >772! Oi{jw~j{uj` uj u~fmu oi{{fe mnj~uija ia ucf ~{u
u~iof{uf~! Iauf~amuijam` Ljv~am` jd Byafkj`jby $ Jn{ufu~ik{ 99 [vww` >< [=3>/=36!
>n! Abjk A! U! A! L! N`vo F! Rf{ucfiof~ U! U! T! ]vma mae N! Riaihjdd! >775! Ofeikm` u~fmuofau jd oi{{fe mnj~uija v{/
iab oi{jw~j{uj`! Iauf~amuijam` Ljv~am` jd Byafkj`jby $ Jn{ufufu~ik{ [vww` >775832!
;! Umab Ji [cma Kcm~m{ Y!U! Jab Hm Yv U{f F~af{u C!Y! Ab [cm~ja R!C! @ff mae Wmh Kcvab Cj! >774! M ~maejoi|fe
u~im` uj kjowm~f ucf v{f jd {vn`iabvm` oi{jw~j{uj` riuc j~ riucjvu ma meeiuijam` = rffh kjv~{f dj~ ucf omambfofau jd~{u u~iof{uf~ {i`fau oi{km~~imbf! Cvoma fw~jevkuija >=!
5! Umab J! [! R! A! U! @mv F! C! Y! Ab [! R! C! @ff mae W! K! Cj! >77;! M w~j{wfkuitf ~maejoi|fe {uvey uj kjowm~f ucfv{f jd ~fwfmufe ej{f{ jd tmbiam` riuc {vn`iabvm` oi{jw~j{uj` ia ucf omambfofau jd ~{u u~iof{uf~ {i`fau oi{km~~imbf!
Cvo fw~je =3772! Ia{u~vkuija{ dj~ v{f< Oi{jw~j{uj` dj~ w~ftfauija jd wj{uwm~uvo cfoj~~cmbf!
cuuw7=7! U~fmuofau jd wj{u/wm~uvo cmfo/j~~cmbf riuc {vn`iabvm` oi{jw~j{uj` tf~{v{ jsyujkia ia rjofa aju fswj{fe uj jsyujkia ev~iab `mnjv~< m ejvn`f/n`iae~maejoi{fe aja/iadf~ij~iuy u~im`! Ucf @makfu ;26< >=7/=4!
2! N`vo Lfaaidf~ Nf~tf~`y Riaihjdd [cfi`m ^mbcmtma m{cm Emnm{c Ojcmofe Kcf~iaf momema Nf~am Ei`nm|N`moi Emj Li`` Ev~jkcf~ [f~em~ Ym`tmk Myi{cm Eijw I`mam B! E|vnm mae Abvyfa Uci Acv Abjk! >7=7! U~fmuofau jd
wj{u/wm~uvo cmfoj~~cmbf riuc {vn`iabvm` oi{jw~j{uj` tf~{v{ jsyujkia ia rjofa ~fkfitiab w~jwcy`mkuik jsyujkia< mejvn`f/n`iae ~maejoi{fe aja/iadf~ij~iuy u~im`! Ucf @makfu ;26#92=7)< >=2/>;!
3! ^jym` Kj``fbf jd Jn{ufu~ikima{ mae Byamfkj`jbi{u{ #^KJB)! >779! W~ftfauija mae omambfofau jd wj{uwm~uvo cfoj~/~cmbf! B~ffa/Ujw Bvief`iaf Aj 6>! @jaeja< ^KJB W~f{{!
9m! Rj~`e Cfm`uc J~bmai|muija ^fw~jevkuitf Cfm`uc @in~m~y! >7==! Oi{jw~j{uj` dj~ kf~tikm` ~iwfaiab mae iaevkuija jd `mnj~!Kjoofaum~y ny Mnef`/M`ffo C!
cuuw77=! Tmbiam` oi{jw~j{uj` dj~ iaevkuija jd `mnj~< >6 t{! 67 vb
ej{f ~fbiofa! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{ 2>6;7!
=7! Ucf Iauf~amuijam` Dfef~muija jd Byafkj`jby mae Jn{ufu~ik{ #DIBJ)! >772! Oi{jw~j{uj`< fkjoofaefe Ej{f{! @jaeja7=7! Uiu~mufe j~m` oi{jw~j{uj` {j`vuija kjowm~fe riuc iau~mtfajv{
6!6 W~fwm~iab rjofa dj~ rcmu uj fswfku
Kjva{f`iab i{ ma iaufb~m` wm~u jd rjoma/kfauf~fe WMK {f~tikf{ maew~fwm~iab rjofa dj~ rcmu uj fswfku nfdj~f ev~iab mae mduf~ u~fmu/ofau riuc oi{jw~j{uj` i{ m hfy wm~u jd ucf k`iaikima{ kjva{f`iab ~j`f!V{iab {iow`f aja/ufkcaikm` `mabvmbf cfm`uc/km~f {umdd {cjv`e cf`w
rjofa vaef~{umae ucf faui~f u~fmuofau mae dj``jr/vw w~jkf{{ nf/d c h ei i M ei i d i `
RCMU I[ KJVA[F@IAB:
Kjva{f`iab i{ m {u~vkuv~feiauf~mkuija ia rcikc mwf~{ja tj`vaum~i`y ~fkfitf{
fojuijam` {vwwj~u mae
http://gynuity.org/resources/read/misoprostol-for-prevention-of-postpartum-hemorrhage-en/http://apps.who.int/rhl/pregnancy_childbirth/induction/CD000941_abdel-aleemh_com/en/index.htmlhttp://www.figo.org/files/figo-corp/Misoprostol_Poster_2.pdfhttp://www.figo.org/files/figo-corp/Misoprostol_Poster_2.pdfhttp://apps.who.int/rhl/pregnancy_childbirth/induction/CD000941_abdel-aleemh_com/en/index.htmlhttp://gynuity.org/resources/read/misoprostol-for-prevention-of-postpartum-hemorrhage-en/7/31/2019 Misoprostol Use in Postabortion Care
80/144
w wdj~f ucfy umhf may ofeikmuija{! May ei{kv{{ija jd oi{jw~j{uj` u~fmu/
ofau {cjv`e kjtf~ ucf dj``jriab ujwik{775)!
7/31/2019 Misoprostol Use in Postabortion Care
81/144
Ujj` 6D!
N~jkcv~f{ dj~ rjofa
Uci{ ujj` i{ iaufaefe uj nf bitfa ny k`iaikima{ uj rjofa! Iu i{ ~fkjoofaefe ucmu dmki`iuif{ wikh jaf ~jvufdj~ oi{jw~j{uj` meoiai{u~muija ucmu ucfy nf`iftf ri`` nf oj{u mkkfwumn`f uj kjoovaiuif{ mae fm{if{u uj
meoiai{uf~! Ia meeiuija ucf{f omuf~im`{ {cjv`e nf memwufe dj~ yjv~ `jkm` {fuuiab!,
J~m` meoiai{u~muija
7/31/2019 Misoprostol Use in Postabortion Care
82/144
J~m` meoiai{u~muija5cjv~{m~f
omyiaeikmufiadfkuij
a!
^fm{{v~fucfrjomaucmukci``{maedftf~m~fkjooja{ieffddfku{jauc
ucmuoi{jw~j{uj`i{umhfa!
Mauiwy~fuik{idaffefe#A[MIE{{v
kcm{invw~jdfam~fnjucmam`bf{ik{m
mauiwy~
fuik{)
Rjoma{cjv`enfia{u~vkufeujkj
aumkumk`iaikimaiddftf~`m{
u{oj~fuc
j~{um~u
{mayemymduf~ucfemyoi{j
w~j{uj`i{umhfa!
iuiabomyjkkv~mae
uywikm``y~f{j`tfriucia>uj4cjv~{!
^fm{{v~fucfrjomaucmuamv{fmm
aetjoiuiabm~fwj{{in`f{ieffddfku{!
Mamauifofuikomynfw~jtiefe!
~{mduf~oi{jw~j{uj`i{umhfa,iuv{vm``y~f{j`tf{r
iuciamemy!
uje~iahw`fauyjdvie{!
^fm{{v~fucfrjomaucmueim~~cfm
i{{jofuiof{m{{jkimuferiucoi{jw~
maewm{{f{}vikh`y!
fswfkufefddfku{,
{ieffddfku{maekjo
wikmuija{
7/31/2019 Misoprostol Use in Postabortion Care
87/144
7/31/2019 Misoprostol Use in Postabortion Care
88/144
7/31/2019 Misoprostol Use in Postabortion Care
89/144
Ujj` 6C!
Kjau~mkfwuitf wjkhfu bvief
Ucf ujj` nf`jr w~jtief{ iadj~omuija mnjvu rcfa tm~ijv{ ofucje{ jd kjau~mkfwuija kma nf {um~ufe mduf~oi{jw~j{uj` u~fmuofau m{ rf`` m{ ajuf{ dj~ kja{ief~muija ~fbm~eiab fmkc ofucje!
Kma nf v{fe ftfa id
7/31/2019 Misoprostol Use in Postabortion Care
90/144
KJAU^MKFWUITF
OFUCJE
RCFA
OFUCJE KMA
NF JDDF^FE
AJUF[
Kjaejo{ Mu ~{u ti{iu Kma nf v{fe m{ ma iauf~ioofucje< dj~ rjofarcj kmaaju efkiefmnjvu m kjau~mkfwuitf,j~ rcj kmaaju nfjddf~fe ucfi~ ofucje jdkcjikf ioofeimuf`y mduf~u~fmuofau jd iakjow`fufmnj~uija!
Ialfkumn`f{ Mu ~{u ti{iu Kma nf v{fe ftfa idiadfkuija i{ w~f{fau!
J~m kjau~mkfwuitf{ Mu ~{u ti{iu Kma nf v{fe ftfa idiadfkuija i{ w~f{fau!
Iau~mvuf~iafeftikf{
Mu dj` jr/vw ti{iu Omhf {v~f ucmu u~fmuofaui{ {vkkf{{dv`8 {cjv`e ajunf v{fe ia ucf w~f{fakf jdmkuitf iadfkuija!W~jtief kjaejo{ j~ jucf~ufowj~m~y ofucje{ vaui`ucf dj``jr/vw ti{iu!
KJAU^MKFWUITF WJKHFU BVIEF
Wjkhfu ~fdf~fakf dj~ k`iaikima{
Dj~ oj~f iadj~omuija, w`fm{f ti{iu rrr!iwm{!j~b*ofeikm`mnj~uija OWMKUH6C/F==
Iow`mau{ Mu ~{u ti{iuKma nf v{fe ftfa idiadfkuija i{ w~f{fau!
[uf~i`i|muija Mu dj``jr/vw ti{iuW~jtief kjaejo{ j~ jucf~ufowj~m~y ofucje{ vaui`ucf dj``jr/vw ti{iu!
Eimwc~mbo Mu ~{u ti{iuKja{ief~ ~fuuiab,efwfaeiab ja bf{umuijam`
mbf!
Kjau~mkfwuitflf``if{, djmo{,umn`fu{ j~ `o{
Mu ~{u ti{iuKma nf v{fe ftfa idiadfkuija i{ w~f{fau!
[hia wmukcf{ Mu ~{u ti{iuKma nf v{fe ftfa idiadfkuija i{ w~f{fau!
Tmbiam` ~iab Mu ~{u ti{iuKma nf v{fe ftfa idiadfkuija i{ w~f{fau!
Fof~bfakykjau~mkfwuitf wi``{
Mayuiof
W~jtief fof~bfakykjau~mkfwuitf wi``{ iametmakf m{ m nmkh/vwofucje!
7/31/2019 Misoprostol Use in Postabortion Care
91/144
7/31/2019 Misoprostol Use in Postabortion Care
92/144
uija{< jaf ucmu i{ `fdu riuc ucf ~fdf~~iab dmki`iuy mae jaf ucmu i{ bitfauj ucf rjoma uj umhf uj ucf ~fdf~~fe dmki`iuy!
7/31/2019 Misoprostol Use in Postabortion Care
93/144
7/31/2019 Misoprostol Use in Postabortion Care
94/144
7/31/2019 Misoprostol Use in Postabortion Care
95/144
6!9 @fm~aiab d~jo metf~{f ftfau{
Metf~{f ftfau{ #MF{) m~f kjow`ikmuija{ ucmu m rjoma {vddf~{ ev~/iab j~ ioofeimuf`y mduf~ cf~ u~fmuofau ucmu affe uj nf iatf{uibmufedv~ucf~! Iatf{uibmuija djkv{f{ ja rcfucf~ ucf ftfau{ rf~f u~fmuofau/~f`mufe mae rcfucf~ mae cjr ucfy kjv`e cmtf nffa w~ftfaufe! M
{f~ijv{ metf~{f ftfau #[MF) i{ jaf ucmu i{ `idf/uc~fmufaiab ~f{v`u{ iawf~omafau iowmi~ofau jd njey dvakuija j~ wf~omafau emombf uj
njey {u~vkuv~f j~ afkf{{iumuf{ ofeikm` j~ {v~bikm` iauf~tfauija uj` e # ` i e
MAM@Y\IAB METF^[FFTFAU[
Mam`y|iab rcy ma metf~{fftfau #MF) jkkv~~fe i{ m
afkf{{m~y {ufw uj ~fevkfucf ~i{h jd ~fkv~~fakf! Uci{uywf jd mam`y{i{ i{ nf{u
7/31/2019 Misoprostol Use in Postabortion Care
96/144
w~fk`vef wf~omafau iowmi~ofau #{ff Ujj` 6L< [f~ijv{ Metf~{fFtfau dj~o)! M`ucjvbc iakjow`fuf mnj~uija iacf~fau`y `fme{ uj
{jof kjow`ikmuija{, oj{u m~f fm{i`y u~fmufe8 {f~ijv{ kjow`ikmuija{m~f ~m~f ia ~jvuiaf wj{umnj~uija km~f!
Metf~{f ftfau{ omy ~f{v`u d~jo wmuifau dmkuj~{ cvoma f~~j~ j~ia{uiuvuijam` w~jn`fo{ nvu v{vm``y jkkv~ mduf~ ov`uiw`f dmkuj~{ kjofujbfucf~ ev~iab m {iab`f ftfau!
Rcfa ma metf~{f ftfau cm{ jkkv~~fe ucf ~{u {ufw i{ uj km~f dj~ucf rjoma iatj`tfe mae m`{j cj`e ma iaiuim` kjatf~{muija riuc ucfwmuifau mae*j~ cf~ dmoi`y! Ia uci{ kjatf~{muija yjv {cjv`e {umuf tf~yn~ify rcmu i{ hajra mnjvu ucf kjow`ikmuija fsw~f{{ ~fb~fu ucmu ucf
rjoma fswf~ifakfe m kjow`ikmuija mae w~jtief m{{v~makf ucmu ucfftfau i{ nfiab umhfa {f~ijv{`y mae ri`` nf ucj~jvbc`y mam`y|fe!
Oj{u MF{ iatj`tf {y{ufo dmi`v~f! Ftfa id ma iaeitievm` k`iaikima efo/ja{u~muf{ `mkh jd lvebofau j~ iamef}vmuf {hi`` ucf {y{ufo `ihf`y cm{aju w~jtiefe ucf u~miaiab ojaiuj~iab j~ ofauj~iab affefe uj {vw/
wj~u }vm`iuy jd km~f! Ia m lv{u kv`uv~f ucf bjm` i{ ucf~fdj~f uj {vwwj~u~mucf~ ucma n`mof ucf iatj`tfe {umdd rci`f `fm~aiab d~jo ucf ftfau!
[j`vuija{ ucmu djkv{ ja {y{ufo{ iow~jtfofau ~mucf~ ucma iaeitiev/m`{ m~f oj~f `ihf`y uj `fme uj MF ~fwj~uiab w~ftfauija mae iow~jtfejvukjof{! Oj~fjtf~ iatj`tiab ucf faui~f ufmo ia km{f {uveif{ jd MF{kma cf`w {umdd vaef~{umae ucf km{kmef jd ftfau{ ucmu `fe uj ucf kjo/w`ikmuija mae rcfucf~ mae cjr iu kjv`e cmtf nffa mtf~ufe! Cjrftf~{jof kjow`ikmuija{ kmaaju nf dj~f{ffa j~ mtf~ufe!
M`` cfm`uc {f~tikf{ k~fmuf jwwj~uvaiuif{ uj `fm~a iatm`vmn`f `f{{ja{
f{wfkim``y rcfa ucf {f~tikf{ m~f afr! Iu i{ iowj~umau ucfa uj w~jtiefjwwj~uvaiuif{ dj~ {umdd uj efn~ifd mduf~ iow`fofaumuija jd {f~tikf{ jd/df~iab oi{jw~j{uj` dj~ wj{umnj~uija km~f cm{ nfbva {j ucmu {umdd kma`fm~a d~jo km{f {uveif{ ~ftifr emum ojaiuj~ u~fae{ ~mi{f }vf{uija{mae mee~f{{ m~fm{ jd kjadv{ija! Id m {y{ufo fsi{u{ ucmu m``jr{ `jkm` maeamuijam` cfm`uc {f~tikf{ uj mkkf{{ uci{ iadj~omuija ucf{f fauiuif{ kma
v{f ucf iadj~omuija uj vaef~{umae u~fae{ iefauidy affe{ mae {vwwj~u
`jkm` {f~tikf{!
yw ymkciftfe ny mww~jmkcf{ucmu {vwwj~u ~mucf~ ucman`mof ucf {umdd iatj`tfe!Ev~iab ucf kjv~{f jd ucfmam`y{i{, ucf {iuf ftm`vmuf{ucf {y{ufo ia rcikc ucf MFjkkv~~fe, iefauif{ wj{{in`fkmv{f{ dj~ ucf ftfau, mae~fkjoofae{ kcmabf{ ujucf {y{ufo uj iow~jtf km~fia ucf dvuv~f! Ia m lv{ukv`uv~f, ucf faui~f ufmo i{
iatj`tfe ia ~fwj~uiab maevaef~{umaeiab ucf mam`y{i{jd MF{!
7/31/2019 Misoprostol Use in Postabortion Care
97/144
Ujj` 6L!
[f~ijv{ metf~{f ftfau dj~o
V{f uci{ dj~o uj ejkvofau m`` metf~{f ftfau{ jkkv~~iab ev~iab wj{umnj~uija km~f #WMK)! Kjaumku `jkm`mvucj~iuif{ id ucf~f i{ m kjcf{itf ojaiuj~iab {y{ufo ia w`mkf j~ id yjv m~f ~f}vi~fe uj ej {j mae w~jtief ucfdj``jriab iadj~omuija riucia >5 cjv~{ jd `fm~aiab jd m afr {f~ijv{ metf~{f ftfau j~ id yjv m~f vwemuiab
iadj~omuija w~ftijv{`y ~fwj~ufe ja uci{ dj~o! Ia ucf {wi~iu jd `fm~aiab dj~ iow~jtfofau ~ftifr uci{iadj~omuija m{ m ufmo uj efuf~oiaf id mayuciab kma nf kcmabfe uj iow~jtf }vm`iuy jd km~f mae*j~ jvukjof{!
7/31/2019 Misoprostol Use in Postabortion Care
98/144
]vf{uija ^f{wja{f
=! Wmuifauiadj~omuija
Amof< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Mbf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
>! [f~ijv{ Metf~{fFtfau
[ftf~f m``f~bik ~fmkuija uj e~vb
[cjkh
W~jdv{f n`ffeiab `fmeiab uj ucf affe dj~ u~ma{dv{ija
Fkujwik w~fbamaky va~fkjbai|fe mu uiof jd w~jkfev~f j~ rcfa oi{jw~j{uj`
rm{ bitfa
W~j`jabfe j~ eidkv`u {v~bikm` w~jkfev~f #dj~ fsmow`f vuf~iaf wf~dj~muija)
[iba{ jd iadfkuija ~f}vi~iab cj{wium`i|muija mae IT mauinijuik u~fmuofau
Ef{k~inf {iba{< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Jucf~ eimbaj{i{< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
;! Jvukjof jd[f~ijv{ Metf~{fFtfau
Efmuc
@idf/uc~fmufaiab fswf~ifakf
Afr j~ w~j`jabfe cj{wium`i|muija
Wf~{i{ufau*{ibaikmau ei{mni`iuy j~ iakmwmkiuy
Vuf~iaf wf~dj~muija
[v~bikm` ~fwmi~ ~f}vi~fe: Yf{ Aj
Jucf~
[wfkidy< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
5! ^f{j`vuija Kjauiaviab
^f{j`tfe< ZZZZZ * ZZZZZ * ZZZZZ
EfmucEE OO YY
]vf{uija ^f{wja{f
6! U~fmuofau#om~h m`` ucmumww`y)
Ajaf
N`jje u~ma{dv{ija
Afr*w~j`jabfe cj{wium`i|muija
Vuf~iaf ftmkvmuija
IT*mauinijuik{
7/31/2019 Misoprostol Use in Postabortion Care
99/144
[v~bf~y ef{k~inf< ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
Wmuifau ~fdf~~fe #{wfkidy rcf~f)
Id uci{ rjoma i{ ~fuv~aiab dj~ ftmkvmuija w`fm{f iaeikmufcf~ emuf jd iaiuim` ti{iu
7/31/2019 Misoprostol Use in Postabortion Care
100/144
7/31/2019 Misoprostol Use in Postabortion Care
101/144
7/31/2019 Misoprostol Use in Postabortion Care
102/144
7/31/2019 Misoprostol Use in Postabortion Care
103/144
7/31/2019 Misoprostol Use in Postabortion Care
104/144
>! [f~tikf vui`i|muija< Rcmu {f~tikf{ m~f nfiab w~jtiefe mae uj cjromay rjofa jtf~ rcmu wf~ije jd uiof:
;! K`iaikm` {f~tikf{< M~f {f~tikf{ w~jtiefe wf~ ucf ofeikm` maek`iaikm` w~jujkj`{: Ucf{f iak`vef v{iab mww~jw~imuf ufkcaj`jbif{dj~ u~fmuofau jd iakjow`fuf mnj~uija v{iab oi{jw~j{uj` kj~~fku/`y mae kja{i{ufau`y w~jtieiab rjofa riuc mkkv~muf iadj~omuija
iak`veiab ~jvuiaf kjau~mkfwuitf kjva{f`iab mae ofucje w~jti/{ija!
5! Kjow`ikmuija{ mae ~fdf~~m`< Cjr omay rjofa m~f fswf~ifak/
MA IOWJ^UMAUOF[[MBF MNJVUOJAIUJ^IAB
Uci{ ojev`f w~jtief{ md~mofrj~h dj~ eftf`jwiabm ojaiuj~iab w`ma dj~oi{jw~j{uj` v{f iawj{umnj~uija km~f! Id mojaiuj~iab {y{ufo m`~fmey
i u i c `uc d i`iu
7/31/2019 Misoprostol Use in Postabortion Care
105/144
iab wj{u/w~jkfev~f kjow`ikmuija{: Cjr omay rjofa m~f nfiab~fdf~~fe uj jucf~ dmki`iuif{:
6! ^fkj~ehffwiab mae omambfofau jd {f~tikf{< M~f {f~tikf{ w~jw/
f~`y ejkvofaufe: M~f {f~tikf{ nfiab ~va fdkifau`y:
4! Jtf~m`` }vm`iuy< Rcmu m~f k`iaikima{ wf~{wfkuitf{ ja }vm`iuyjd {f~tikf{: Rcmu kcm``fabf{ ej ucfy dmkf: Rcmu m~f rjofa{wf~kfwuija{ ja }vm`iuy jd {f~tikf{: Cjr ej rjofa uciah ucmu{f~tikf{ oibcu nf iow~jtfe:
4!5 Eftf`jwiab m ojaiuj~iab w`ma ujfa{v~f cibc }vm`iuy jd {f~tikf{
K~fmuiab m }vm`iuy ojaiuj~iab w`ma iak`vef{ efuf~oiaiab ucf m{wfku{jd {f~tikf{ uj nf ojaiuj~fe efkieiab ja ucf ofucje{ mae ujj`{ ucmuri`` nf v{fe uj bmucf~ iadj~omuija f{umn`i{ciab nfakcom~h{ mae{umaem~e{ jd }vm`iuy mae efuf~oiaiab ~j`f{ mae ~f{wja{ini`iuif{ dj~iow`fofauiab ucf ojaiuj~iab w`ma!
Ojaiuj~iab w`ma{ ri`` tm~y ny `ftf` evf uj ~f{jv~kf{ mtmi`mn`f maeucf ojaiuj~iab jnlfkuitf{ ucfo{f`tf{! Ujj` 4M< Iaeikmuj~{ ny dm/ki`iuy `ftf` w~jtief{ bviemakf iauj rcmu {cjv`e nf iak`vefe ia ojai/uj~iab w`ma{ mu ucf kjoovaiuy cfm`uc kfauf~ cj{wium` mae ei{u~iku*~fbijam` cfm`uc {y{ufo `ftf`{! M`` jd ucf iaeikmuj~{ kj~~f{wjae uj jafjd ucf {is ojaiuj~iab m~fm{ jd oi{jw~j{uj` v{f ia WMK {f~tikf{ `i{ufe
ia {fkuija 4!;!Ia bfaf~m` cfm`uc kfauf~{ mae `m~bf~ fauiuif{ {cjv`e djkv{ ja k~fmu/iab ojaiuj~iab {y{ufo{ ucmu kj``fku iadj~omuija uj iow~jtf }vm`iuy!@m~bf~ dmki`iuif{ mae cfm`uc {y{ufo{ oibcu m`{j iak`vef ofm{v~fofau{jd ucf iowmku jd ucfi~ {f~tikf{ ia ucf kjoovaiuy {vkc m{ ~fevkfecj{wium`i|muija{ dj~ mnj~uija/~f`mufe kjow`ikmuija{! Ia meeiuija m``
dmki`iuif{ {cjv`e fa{v~f ucmu ucfy m~f offuiab bjtf~aofau j~ ejaj~
~fwj~uiab ~f}vi~fofau{!
V{f Ujj` 4M rcfa ef{ibaiab yjv~ ojaiuj~iab w`ma uj efkief
fsi{u{ ia yjv~ cfm`uc dmki`iuy,v{f ucf iadj~omuija iauci{ ojev`f uj iaufb~mufojaiuj~iab jd oi{jw~j{uj`
{f~tikf{ iauj yjv~ fsi{uiab{y{ufo! Rcfucf~ yjvm~f memwuiab ma fsi{uiabojaiuj~iab w`ma j~ k~fmuiabm afr jaf, nf {v~f uj dv```ucf ~fwj~uiab ~f}vi~fofau{m{ iaeikmufe ny yjv~ dmki`iuy,ei{u~iku, ~fbijam`, mae*j~amuijam` bvief`iaf{!
Dj~ fsmow`f yjv kma v{f Ujj` 4N
7/31/2019 Misoprostol Use in Postabortion Care
106/144
m{{f{{ofau{ jd wmuifau {mui{dmkuija #{ff Ujj` 4F< Wmuifau {mui{dmk/uija ~mwie m{{f{{ofau) j~ d~jo jucf~ iadj~omuija {vkc m{ wmuifau~fkj~e{!
7/31/2019 Misoprostol Use in Postabortion Care
107/144
7/31/2019 Misoprostol Use in Postabortion Care
108/144
Ajmeeiuij
am`ajuf{!
u
Ajmeeiuij
am`ajuf{!
7/31/2019 Misoprostol Use in Postabortion Care
109/144
Jtf~m``
}vm`iuy
Wf~kfa
ujdwmuifau{rcjma{rf~y
f{ujfibcuj~oj~f}vf{uija{
ia
Ujj`4F772 Va{mdf mnj~uija< B`jnm` mae
~fbijam` f{uiomuf{ jd ucf iakiefakf jd va{mdf mnj~uija mae m{{jkimufeoj~um`iuy ia >77;! 6uc feiuija! Bfaftm< RCJ!
Rj~`e Cfm`uc J~bmai|muija! >7==m! Va{mdf mnj~uija< B`jnm` mae~fbijam` f{uiomuf{ jd ucf iakiefakf jd va{mdf mnj~uija mae m{{jkimufeoj~um`iuy ia >773! 4uc feiuija! Bfaftm< RCJ!
Rj~`e Cfm`uc J~bmai|muija! >7==n! Vafeiufe ~fwj~u jd ucf =3uc fswf~u
kjooiuuff ja ucf {f`fkuija mae v{f jd f{{fauim` ofeikiaf{! Bfaftm7==k! W~ij~iuy ofeikiaf{ dj~ ojucf~{ maekci`e~fa! Bfaftm< RCJ!
O e ` > W` i d i e `i
7/31/2019 Misoprostol Use in Postabortion Care
128/144
Ojev`f >< W`maaiab dj~ {f~tikf ef`itf~y
Nmi~e U~mki @! O!Ti~biaim Kcmonf~{ mae Kcm~`juuf F! Cj~e! =993!Iow`fofauiab wj{umnj~uija km~f! Ufkcaikm` ~f{jv~kf{ dj~ wj{umnj~uija
km~f tj`vof =! Km~~nj~j AK< Iwm{!
Iwm{! >773! OTM {v{umiamn`f {vww`y rj~hnjjh! Kcmwf` Ci`` AK< Iwm{!
Iwm{! >776! [umaem~e{ mae bvief`iaf{ ujj`hiu! Vawvn`i{cfe!
Omambfofau [kifakf{ dj~ Cfm`uc! =99>! Iow~jtiab Kjau~mkfwuitf[vww`y Omambfofau! Ucf Dmoi`y W`maaiab Omambf~ =#5)!
OkIaf~afy Uf~f{m U~mki @! Nmi~e M`y{ja B! Cyoma mae Momaem N!
Cvnf~! >77=! M bvief uj w~jtieiab mnj~uija km~f! Ufkcaikm` ~f{jv~kf{ dj~mnj~uija km~f! Kcmwf` Ci`` AK< Iwm{!
W~ftfauija jd Wj{uwm~uvo Cfoj~~cmbf Iaiuimuitf #WJWWCI)! >772!W~ftfauija jd wj{uwm~uvo cfoj~~cmbf< Iow`fofauiab mkuitf omambf/
ofau jd ucf uci~e {umbf jd `mnj~ #MOU[@)< M ~fdf~fakf omavm` dj~cfm`uc km~f w~jtief~{! [fmuu`f< WMUC!
W~ftfauija jd Wj{uwm~uvo Cfoj~~cmbf Iaiuimuitf #WJWWCI)! >773![f`fkuija jd m vuf~jujaik e~vb ia u~jwikm` k`iomuf{! [fmuu`f< WMUC!
Ojev`f ;< M{{f{{iab yjv~ dmki`iuy
Nmi~e U~mki @! O! Ti~biaim Kcmonf~{ mae Kcm~`juuf F! Cj~e! =993!Iow`fofauiab wj{umnj~uija km~f! Ufkcaikm` ~f{jv~kf{ dj~ wj{umnj~uijakm~f tj`vof =! Km~~nj~j AK< Iwm{!
Iwm{ Md~ikm M``imakf! >779! [f~tikf ef`itf~y wjiau m{{f{{ofau ujj` dj~iaiuimuija jd oi{jw~j{uj` dj~ wj{umnj~uija km~f*ofeikm` mnj~uija {f~tikf{!Vawvn`i{cfe!
Iwm{ Aibf~im! >779! Dmki`iuy m{{f{{ofau ujj` dj~ iaiuimuiab oi{jw~j{uj` dj~ucf u~fmuofau jd iakjow`fuf mnj~uija! Vawvn`i{cfe!
7/31/2019 Misoprostol Use in Postabortion Care
129/144
{ja jd urj ~jvuf{ jd meoiai{u~muija dj~ oi{jw~j{uj` ia ucf u~fmuofaujd iakjow`fuf mnj~uija< m ~maejoi|fe k`iaikm` u~im`! Kjau~mkfwuija29< 564/54>!
Df{kiam ^!C! N! Ef Ovkij O! Mn~fv B! Om~uaf| L!@! Em| ^j{/{f``j @! Omiaf~j ^! Bof| Wjakf ef @fa O! ^vniaj mae O!Ominj! >779! Wf~iamum` iadj~omuija {y{ufo #WI[)< Wf~iamum` k`iaikm`
~fkj~e< Kjow`fofaum~y dj~o dj~ rjofa vaef~bjiab mnj~uija< Di``iabia{u~vkuija{ mae efaiuija jd uf~o{ #K@MW*R^! [kifauik Wvn`ikmuija8
=645!7>!) Ojauftiefj< K@MW*R^!
Dmvaef{ Mainmf! >776! V{f jd oi{jw~j{uj` v{f ia jn{ufu~ik{ mae by/afkj`jby! D@M[JB
Bj`enf~b M N O N B~ffanf~b mae W E Em~afy >77= Oi{jw~j{uj`
7/31/2019 Misoprostol Use in Postabortion Care
130/144
Bj`enf~b M!N! O!N! B~ffanf~b mae W!E! Em~afy! >77=! Oi{jw~j{uj`mae w~fbamaky! Afr Fab`mae Ljv~am` jd Ofeikiaf ;55#=)779! Oi{jw~j{uj` dj~ u~fmuofau jd iakjo/w`fuf mnj~uija< Ma iau~jevkuj~y bviefnjjh! Afr Yj~h< Byaviuy Cfm`ucW~jlfku{!
Byaviuy Cfm`uc W~jlfku{! >772! Ia{u~vkuija{ dj~ v{f< Oi{jw~j{uj` dj~w~ftfauija jd wj{uwm~uvo cfoj~~cmbf! Afr Yj~h< Byaviuy Cfm`ucW~jlfku{!
Cf~~ikh Lfmaaiaf Hmucf~iaf @! Uv~af~ Uf~f{m OkIaf~afy mae @mv~m
Km{u`foma! >775! Rjoma/kfauf~fe wj{umnj~uija km~f< ^fdf~fakf omav/m`! Kcmwf` Ci`` AK< Iwm{!
[crfhf~f`m N! ^! Hm`vovam ^! Hiwiab`i A! Om{cmhm F! Rf{ucfiof~R! K`m~h mae N! Riaihjdd! >772! Oi{jw~j{uj` dj~ u~fmuofau jd iakjo/w`fuf mnj~uija mu ucf ~fbijam` cj{wium` `ftf`< ^f{v`u{ d~jo Uma|maim!
NLJB< Ma Iauf~amuijam` Ljv~am` jd Jn{ufu~ik{ $ Byafkj`jby ==5 #==)772! Oi{jw~j{uj`)< [=47[=42!
Umy`j~ L! M! Eijw L! N`vo J! Ej`j mae N! Riaihjdd! >7==! J~m`oi{jw~j{uj` m{ ma m`uf~amuitf uj {v~bikm` omambfofau dj~ iakjow`fufmnj~uija ia Bcmam! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu/~ik{ ==>< 57/55!
Tfauv~f [u~mufbif{ Iaajtmuija{! >779! KMK omavm` jd jwf~muija{!Vawvn`i{cfe!
Rffh{ M! mae M! Dmvaef{! >772! Oi{jw~j{uj` ia jn{ufu~ik{ mae by/afkj`jby! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{ 99 #>)<
Fhrm~v Li`` Ev~jkcf~ mae D`j~fakf Oi~fonf! >776! M ~maejoi|feu~im` jd oi{jw~j{uj` kjowm~fe riuc omavm` tmkvvo m{wi~muija dj~iakjow`fuf mnj~uija! Jn{ufu~ik{ mae Byafkj`jby =74 #;)< 657/652!
Rj~`e Cfm`uc J~bmai|muija! >77;! [mdf mnj~uija< Ufkcaikm` mae wj`ikybviemakf dj~ cfm`uc {y{ufo{! Bfaftm< RCJ!
Ojev`f 4< Fa{v~iab cibc }vm`iuy {f~tikf{
Cf~~ikh Lfmaaiaf Hmucf~iaf @! Uv~af~ Uf~f{m OkIaf~afy mae @mv~mKm{u`foma! >775! Rjoma/kfauf~fe wj{umnj~uija km~f< ^fdf~fakf omav/m`! Kcmwf` Ci`` AK< Iwm{
7/31/2019 Misoprostol Use in Postabortion Care
131/144
MAAFS =< K`iaikm` m{{f{{ofau ~fdf~fakfbvief< Jtf~tifr jd oi{jw~j{uj` dj~ ucfomambfofau jd iakjow`fuf mnj~uija
M! Iau~jevkuija
Iakjow`fuf mnj~uija jkkv~{ rcfa m w~fbamau rjoma w~f{fau{ riuc tmbiam` n`ffeiab k~mowiab mae majwfa kf~tis! [cf omy m`{j nf wm{{iab w~jevku{ jd kjakfwuija #WJK)! Oi{jw~j{uj` w~jtief{ m {mdf mae fd/d ui u u u i i i ` u n ui #Kc u ` =996 K` h u ` >772 Ei
7/31/2019 Misoprostol Use in Postabortion Care
132/144
dfkuitf rmy uj u~fmu rjofa fswf~ifakiab iakjow`fuf mnj~uija #Kcvab fu m`! =996 K`m~h fu m`! >772 Eijw
fu m`! >779 Byaviuy Cfm`uc W~jlfku{ >779 ^i||i >772 [crfhf~f`m fu m`! >772)! [uveif{ cmtf ~fwj~ufe cibc{mui{dmkuija riuc oi{jw~j{uj` mojab rjofa #Ni}vf fu m`! >772 Emj fu m`! >772 [crfhf~f`m fu m`! >772Rffh{ fu m`! >776) mae m w~fdf~fakf dj~ ofeikm` tf~{v{ {v~bikm` u~fmuofau #Emnm{c fu m`! >7=7 Eijw fu
m`! >779)! Oi{jw~j{uj` cm{ {ftf~m` ajumn`f metmaumbf{ iak`veiab fm{f jd v{f mae `jr kj{u #RCJ >77;Yjv mae Kcvab >776)! ^fbm~eiab fm{f jd v{f ucf e~vb kma nf meoiai{uf~fe ny k`iaikima{ riuc oiaiom`u~miaiab tim {ftf~m` ~jvuf{ kma nf v{fe ia ~fojuf m~fm{ riucjvu affe jd {wfkim`i|fe f}viwofau kma nf{f`d/meoiai{uf~fe mtjie{ imu~jbfaik ialv~y mae ~fevkf{ ~i{h jd wf`tik iadfkuija! Oi{jw~j{uj` ~f}vi~f{ aj~fd~ibf~muija j~ {wfkim` u~ma{wj~u j~ {uj~mbf kjaeiuija{ ucjvbc {jof omavdmkuv~f~{ ~fkjoofae w~jufku/
iab ucf w~jevku d~jo cfmu mae cvoieiuy #WJWWCI >773)!
N! Oi{jw~j{uj` v{f{, meoiai{u~muija mae ojef jd mkuija
Oi{jw~j{uj` i{ m w~j{umb`maeia F= mam`jbvf! Rcfa umhfa ev~iab w~fbamaky iu kmv{f{ ucf kf~tis uj {jdufa
mae ucf vuf~v{ uj kjau~mku! Oi{jw~j{uj` cm{ {ftf~m` v{f{ ia jn{ufu~ik{ mae byafkj`jby rcikc iak`vef u~fmu/ofau jd iakjow`fuf mnj~uija mae oi{km~~imbf8 u~fmuofau jd oi{{fe mnj~uija #iak`veiab iau~mvuf~iaf dfum`
efmuc)8 `mnj~ iaevkuija8 w~ftfauija mae u~fmuofau jd wj{uwm~uvo cfoj~~cmbf8 kf~tikm` w~ioiab8 maew~fbamaky uf~oiamuija #D@M[JB >772 Bj`enf~b fu m`! >77= Rffh{ mae Dmvaef{ >772 RCJ >77;)!>Nfkmv{f ucf vuf~v{ nfkjof{ ovkc oj~f {fa{iuitf uj ucf fddfku{ jd oi{jw~j{uj` m{ w~fbamaky metmakf{ej{f{ jd oi{jw~j{uj` dj~ `mnj~ iaevkuija m~f ovkc`jrf~ ucma ej{f{ dj~ ~{u/u~iof{uf~ wj{umnj~uija km~fu~fmuofau!
^jvuf{ jd oi{jw~j{uj` meoiai{u~muija iak`vef j~m` {vn`iabvm` nvkkm` tmbiam` mae ~fkum`! [vn`iabvm` maej~m` ~jvuf{ cmtf ucf }vikhf{u ja{fu jd mkuija #Umab fu m`! >772)! Dj~ ucf u~fmuofau jd iakjow`fuf mnj~uija
oi{jw~j{uj` 577okb {vn`iabvm``y mae oi{jw~j{uj` 477okb j~m``y cmtf {ioi`m~ {mdfuy mae fddfkuitfaf{{w~j`f{ rcfa v{fe riuc vuf~iaf {i|f `f{{ ucma j~ f}vm` uj => rffh{ @OW #`m{u ofa{u~vm` wf~ije) #Eijw fum`! >779 Byaviuy Cfm`uc W~jlfku{ >779)!
= Uci{ cm{ nffa memwufe d~jo< Nisny Kfauf~ dj~ Wjwv`muija Cfm`uc mae [v{umiamni`iuy mae Tfauv~f [u~mufbif{ Iaajtm/
uija{! >7=7! Oi{jw~j{uj` ia jn{ufu~ik{ mae byafkj`jby< K`iaikm` bvief`iaf{ w~jujkj` dj~ wcy{ikima{ mae oieritf{8 maeJ{v~ L! L! Hm~malm K! Hibbvaev O! Jbvuv mae F! Amhi~ilm! >779! Oi{jw~j{uj` dj~ ucf omambfofau jd iakjow`fuf mae
e n ` ` ` d e ` d `` n` c e
Oi{jw~j{uj` dj~ ucf u~fmuofau jd oi{{fe mnj~uija mae mafon~yjaik bf{umuija
M`ucjvbc uci{ ujj`hiu djkv{f{ ja ucf iaeikmuija jd oi{jw~j{uj` dj~ ucf u~fmuofau jd iakjow`fuf mnj~uijaoi{jw~j{uj` m{ ajufe kma m`{j nf v{fe dj~ ucf u~fmuofau jd oi{{fe mnj~uija mae mafon~yjaik bf{umuija!Nfkmv{f njuc uywf{ jd fm~`y w~fbamaky `j{{ iatj`tf `iuu`f uj aj n`ffeiab mae m k`j{fe kf~tis oi{jw~j{uj`u~fmuofau i{ aju m{ fddfkuitf dj~ ucf{f iaeikmuija{ m{ iu i{ dj~ iakjow`fuf mnj~uija! Ucf ej{mbf dj~ oi{{femnj~uija mae mafon~yjaik bf{umuija i{ oi{jw~j{uj` 377okb tmbiam``y j~ oi{jw~j{uj` 477okb {vn`iabvm`/
`y ftf~y uc~ff cjv~{ dj~ m omsiovo jd uc~ff ej{f{! U~fmuofau jd oi{{fe mnj~uija riuc {vn`iabvm` oi{j/w~j{uj` cm{ aju nffa rief`y {uveife! M {iab`f {vn`iabvm` ej{f jd oi{jw~j{uj` 477okb omy m`{j nf fddfk/uitf! ^fwj~ufe {vkkf{{ ~muf{ dj~ oi{jw~j{uj` u~fmuofau jd oi{{fe mnj~uija tm~y rief`y! Dj~ oj~f efumi`fe
iadj~omuija mnjvu ucf ~fwj~ufe v{f jd oi{jw~j{uj` u~fmuofau dj~ oi{{fe mnj~uija {ff Byaviuy Cfm`ucW~jlfku{ iau~jevkuj~y bviefnjjh Oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uija!
7/31/2019 Misoprostol Use in Postabortion Care
133/144
K! ^fbiofa{ mae fdkmky jd oi{jw~j{uj` u~fmuofau dj~iakjow`fuf mnj~uija
Dj~ ucf wv~wj{f{ jd {umaem~ei|muija mae uj mtjie kjadv{ija iu i{ meti{mn`f ucmu `jkm` fswf~u{ mae mvucj~i/
uif{ {f`fku jaf oi{jw~j{uj` ~fbiofa uj v{f ia ucfi~ kjvau~y! Dj~ oj~f efumi`fe iadj~omuija ja oi{jw~j{/uj` meoiai{u~muija mae ej{iab {ff Ujj` 6F< Ej{mbf km~e!
Vuf~iaf
[i|f
Oi{jw~j{uj`
ej{f^jvuf Uioiab [vkkf{{; ^fdf~fakf{
Vw uj =>
rffh{
477okb J~m` Uc~ff >77okb umn`fu{
umhfa mu jakf!
9=/99 wf~kfau #Ni}vf fu m`! >772 Emj fu
m`! >772 Eijw fu m`! >779[crfhf~f`m fu m`! >772
Umy`j~ fu m`! >7== Rffh{fu m`! >776)
577okb [vn`iabvm` Urj >77okb umn`fu{vaef~ ucf ujabvf dj~ ;7
oiavuf{ ucfa {rm``jr ucf~fomiaiab wi`` d~mbofau{!
96/93 wf~kfau #Emnm{c fu m`! >7=7 Eijwfu m`! >779)
OI[[FE MNJ^UIJA! Id rjoma i{ ia {cjkh j~ k`iaikm``y va{umn`f, efuf~oiaf ucf fuij`jby jd ucf kjaeiuija maeu~fmu j~ ~fdf~ mkkj~eiab`y
Id rjoma i{ kja{kijv{ j~ m dmoi`y ofonf~ i{ w~f{fau ae jvu *
Omambfofau jd u~fmuofau fddfku{
Wmia
Vuf~iaf kjau~mkuija{ rcikc ucf rjoma fswf~ifakf{ m{ k~mowiab m~f afkf{{m~y uj fswf` ucf w~je/vku{ jd kjakfwuija mae ~f{ievm` ui{{vf! Invw~jdfa j~ jucf~ aja/{uf~jiem` maui/iamoomuj~y e~vb{#A[MIE{) {cjv`e nf w~jtiefe m~jvae ucf uiof jd oi{jw~j{uj` meoiai{u~muija j~ {cj~u`y ucf~fmduf~#dj~ fsmow`f invw~jdfa 577/477ob j~m``y ftf~y {is cjv~{)! Bjje kjva{f`iab mae fojuijam` {vwwj~u
omy m`{j m``ftimuf masifuy mae ~fevkf wf~kfwuija{ jd wmia!
N`ffeiab
Mojvau mae ev~muija jd n`ffeiab ri`` tm~y d~jo rjoma uj rjoma ~mabiab d~jo n`ffeiab `ibcuf~
ucma m ofa{u~vm` wf~ije uj n`ffeiab ovkc cfmtif~ ucma m ofa{u~vm` wf~ije! Wm{{mbf jd k`ju{ mae*j~ui{{vf i{ fswfkufe! Ia jaf ~maejoi|fe k`iaikm` u~im` jd ;77 rjofa ~fkfitiab oi{jw~j{uj` dj~ wj{umnj~/uija km~f u~fmuofau >5 wf~kfau jd rjofa v{iab j~m` oi{jw~j{uj` mae >4 wf~kfau jd rjofa v{iab
7/31/2019 Misoprostol Use in Postabortion Care
138/144
w b w w b
{vn`iabvm` oi{jw~j{uj` fswf~ifakfe cfmty n`ffeiab ia ucf urj cjv~{ mduf~ umhiab oi{jw~j{uj` #Eijw fum`! >779)! Rjofa {cjv`e nf w~fwm~fe riuc dv``/ucikhaf{{ {maium~y wme{ j~ {ioi`m~ k`juc{ v{fe `jkm``y!W~jtief iadj~omuija mnjvu ucf aj~om` ~mabf jd n`ffeiab mae rm~aiab {iba{ ucmu {cjv`e w~jowu ucfrjoma uj km`` cf~ k`iaikima j~ {ffh v~bfau ofeikm` km~f!
>! Wj{{in`f {ief fddfku{
K`iaikima{ {cjv`e ei{kv{{ ucf {ief fddfku{ rjofa omy fswf~ifakf mduf~ umhiab oi{jw~j{uj` iak`veiab5 cjv~{ #K`m~h fu m`! >772)! W~j`jabfe j~ {f~ijv{ {ief fddfku{ riuc oi{jw~j{uj` u~fmuofau m~f ~m~f #N`vofu m`! >772 Bfo|f``/Emaif`{{ja fu m`! >772)!
Omambfofau jd {ief fddfku{
M`` rjofa {cjv`e nf kjva{f`fe ucmu kci``{*dftf~ amv{fm*tjoiuiab mae eim~~cfm m~f wj{{in`f {ief fddfku{ jdoi{jw~j{uj` u~fmuofau! [yowujomuik u~fmuofau #{vkc m{ meoiai{u~muija jd ma mauifofuik) i{ aju ~jvuiaf`y
afkf{{m~y nvu omy nf cf`wdv` ia {f`fku km{f{ #dj~ fsmow`f ia m rjoma rcj i{ m`~fmey tjoiuiab j~ rcjcm{ w~ij~ fswf~ifakf riuc oi{jw~j{uj` kmv{iab tjoiuiab)! Id affefe mauiwy~fuik{ kma nf w~jtiefe dj~ ucfu~fmuofau jd kci``{*dftf~! Ma fsmow`f i{ invw~jdfa 577/377ob ftf~y {is cjv~{!
;! Rm~aiab {iba{
Oj{u rjofa ri`` aju fswf~ifakf {f~ijv{ kjow`ikmuija{ m{ m ~f{v`u jd umhiab oi{jw~j{uj` dj~ ucf u~fmuofaujd iakjow`fuf mnj~uija! Cjrftf~ rjofa {cjv`e nf kjva{f`fe ja ucf rm~aiab {iba{ ucmu rjv`e iaeikmuf
ucmu ucfy cmtf m kjow`ikmuija! Id rjofa fswf~ifakf jaf jd ucf `i{ufe rm~aiab {iba{ ucfy {cjv`e ioofeimuf`y{ffh cf`w d~jo m cfm`uc kfauf~ k`iaikima!
Cfmty n`ffeiab
[jmhiab urj dv``/ucikhaf{{ {maium~y wme{ wf~ cjv~ dj~ urj kja{fkvuitf cjv~{
Cfmty n`ffeiab ucmu jkkv~{ mduf~ n`ffeiab cme {`jrfe ejra j~ {ujwwfe
Dff`iab ibcu/cfmefe j~ ei||y m{ n`ffeiab kjauiavf{
[ftf~f wmia, ftfa ja ucf emy jd oi{jw~j{uj`, ucmu ejf{ aju bfu nfuuf~ riuc ofeikmuija, ~f{u, j~ mcfmuiab wme
Dff`{ tf~y {ikh
Omambfofau jd cfmty n`ffeiab
Vuf~iaf ftmkvmuija #tmkvvo m{wi~muija) i{ afkf{{m~y id ucf~f m~f ~fumiafe w~jevku{ jd kjakfwuija mae
cfmty n`ffeiab! Cfoj~~cmbik ei{j~ef~{ {cjv`e nf u~fmufe mkkj~eiab`y id ucfy m~f ucf kmv{f! Mafoim~f{v`uiab d~jo cfmty n`ffeiab ~f}vi~iab u~fmuofau i{ ~m~f #Emnm{c fu m`! >7=7) nvu mafoim kma kjfsi{um{ m kjaeiuija ia omay ~fw~jevkuitf mbf rjofa! Ia ucj{f km{f{ mafoim {cjv`e nf u~fmufe m{ afkf{/{m~y ia meeiuija uj ucf tmkvvo m{wi~muija dj~ mkvuf n`ffeiab!
Id wf~{i{ufau n`ffeiab j~ iauf~oiuufau oi`e #aju {ftf~f) k~mowiab ejf{ aju iow~jtf ny ucf uiof jducf dj``jr/vw ti{iu m ~fwfmu ej{f jd oi{jw~j{uj` j~ tmkvvo m{wi~muija {cjv`e nf kja{ief~fe! Id ucfrjoma i{ u~fmufe riuc m ~fwfmu ej{f jd oi{jw~j{uj` iu i{ meti{mn`f uj ~f/ftm`vmuf ucf rjoma mbmia ia
7/31/2019 Misoprostol Use in Postabortion Care
139/144
w w b
jaf uj urj rffh{! #[ff C< Dj``jr/vw)!
Id n`ffeiab i{ w~jdv{f j~ w~j`jabfe mae cfmty ucf rjoma {cjv`e cmtf tmkvvo m{wi~muija!
Id n`ffeiab cm{ nffa cfoj~~cmbik j~ w~jdv{f*w~j`jabfe n`jje u~ma{dv{ija omy nf afkf{{m~y ia ~m~fkm{f{ uj ~f{uj~f cfojeyamoik {umni`iuy!
Omambfofau jd iadfkuija
[iba{ jd iadfkuija iak`vef3!
Ni}vf K! O! V{u N! Efnj~m F! Kcjab F! Rf{ucfiof~ mae N! Riaihjdd! >772! Kjowm~i{ja jd oi{jw~j/{uj` mae omavm` tmkvvo m{wi~muija dj~ ucf u~fmuofau jd iakjow`fuf mnj~uija! Iauf~amuijam` Ljv~am` jdByafkj`jby mae Jn{ufu~ik{ 93< >>>/>>4!
Nisny Kfauf~ dj~ Wjwv`muija Cfm`uc $ [v{umiamni`iuy mae Tfauv~f [u~mufbif{ Iaajtmuija{! >7=7! Oi{jw~j/
{uj` ia jn{ufu~ik{ mae byafkj`jby< K`iaikm` bvief`iaf{ w~jujkj` dj~ wcy{ikima{ mae oieritf{!
N`vo L! N! Riaihjdd H! Bfo|f``/Emaif`{{ja W!K! Cj ^! [kcimtja mae M! Rffh{! >772! U~fmuofau jd ia/kjow`fuf mnj~uija mae oi{km~~imbf riuc oi{jw~j{uj`! Iauf~amuijam` Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{99#[)< =34=39!
7/31/2019 Misoprostol Use in Postabortion Care
142/144
Kcvab U!H! @!W! Kcfvab U!Y @fvab K!L! Cmiaf{ mae M!O! Kcmab! =996! Oi{jw~j{uj` ia ucf omambfofaujd {wjaumafjv{ mnj~uija! NLJB< Ma Iauf~amuijam` Ljv~am` jd Jn{ufu~ik{ $ Byafkj`jby =7>#=7)< 3;>/356!
K`m~h R! K! [cmaaja mae N! Riaihjdd! >772! Oi{jw~j{uj` dj~ vuf~iaf ftmkvmuija ia iaevkfe mnj~uijamae w~fbamaky dmi`v~f! Fswf~u ^ftifr jd Jn{ufu~ik{ mae Byafkj`jby >< 42/=79!
Emnm{c ^m{cm Ojcmofe Kcf~iaf ^momema Fome Em~ri{c Aftiaf Cm{{mafia Lfaaidf~ N`vo mae
Nftf~`y Riaihjdd! >7=7! M ~maejoi|fe kjau~j``fe u~im` jd 577/b {vn`iabvm` oi{jw~j{uj` tf~{v{ omavm`tmkvvo m{wi~muija dj~ ucf u~fmuofau jd iakjow`fuf mnj~uija ia urj Fbywuima cj{wium`{! Iauf~amuijam`Ljv~am` jd Byafkj`jby mae Jn{ufu~ik{ ===#>)< =;=/=;6!
Emj N! L! N`vo N! Ucifnm [! ^mbcmtma O! Jvfe~mfbj L! @mahjmaef mae N! Riaihjdd! >772! I{ oi{jw~j/{uj` m {mdf fddfkuitf mkkfwumn`f m`uf~amuitf uj omavm` tmkvvo m{wi~muija dj~ wj{umnj~uija km~f: ^f{v`u{d~jo m ~maejoi|fe u~im` ia Nv~hiam Dm{j Rf{u Md~ikm! NLJB< Ma Iauf~amuijam` Ljv~am` jd Jn{ufu~ik{ $Byafkj`jby ==5< =;43/=;26!
Eijw Myi{cm [cfi`m ^mbcmtma Lfma/Wif~~f mhjujtmj jeikm Kjofaemau Wmv` E! N`vofaucm` maeNftf~`y Riaihjdd! >779! Kjowm~i{ja jd urj ~jvuf{ jd meoiai{u~muija dj~ oi{jw~j{uj` ia ucf u~fmuofau jd
iakjow`fuf mnj~uija< m ~maejoi|fe k`iaikm` u~im`! Kjau~mkfwuija 29< 564/54>!
Dmvaef{ Mainmf! >776! V{f jd oi{jw~j{uj` v{f ia jn{ufu~ik{ mae byafkj`jby! D@M[JB!cuuw772! Oi{jw~j{uj`< ~{u/`iaf ucf~mwy dj~ iakjow`fuf oi{/
km~~imbf ia ucf eftf`jwiab rj~`e! NLJB< Ma Iauf~amuijam` Ljv~am` jd Jn{ufu~ik{ $ Byafkj`jby ==2< =;;2/=;;9!
Bj`enf~b M!N! O!N! B~ffanf~b mae W!E! Em~afy! >77=! Oi{jw~j{uj` mae w~fbamaky! Afr Fab`mae Ljv~am`jd Ofeikiaf ;55#=)779! Oi{jw~j{uj` dj~ u~fmuofau jd iakjow`fuf mnj~uija< Ma iau~jevkuj~y bvief/njjh! cuuw
7/31/2019 Misoprostol Use in Postabortion Care
143/144
Uci{ ujj`hiu i{ w~jojufe ny ucf dj``jriab j~bmai|muija{/F==
Id yjv~ j~bmai|muija i{ iauf~f{ufe ia nfiab meefe m{ m w~jojuiab mbfaky uj dvuv~f w~iauiab maeja`iaf tf~{ija{ jd uci{ ujj`hiu, w`fm{f kjaumku oi{jdj~wmkGiwm{!j~b!
7;6>9=,7#=4(#%*2(=!#=0%
Top Related