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Beverly Winikoff

Publications and source records attributed to Beverly Winikoff.

33 records · Page 2Linked to original sources
PubMed2004

Acceptability of home-use of misoprostol in medical abortion.

INTRODUCTION: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. MATERIALS AND METHODS: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. RESULTS: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner's choice of home-use and felt that their presence and support had been valuable. DISCUSSION: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Expanding medical abortion in Tunisia: women's experiences from a multi-site expansion study.

From November 2000 to July 2001, 321 consenting women were enrolled at four sites across the country in an effort to demonstrate that mifepristone medical abortion could safely be used by providers throughout Tunisia. Women who met the study's inclusion criteria were given 200 mg oral mifepristone and offered the choice of taking 400 microg oral misoprostol 2 days later either at home or at the clinic. At follow-up, women were examined to determine completed abortion status and surveyed to gauge their satisfaction with the method. Ninety-six percent of women had a successful abortion using this method. Women expressed a strong preference for home use of misoprostol, indicating that it is more confidential (34%), easier (28%) and requires fewer clinic visits (28%). The high rate of success, demonstrated safety and acceptability of the method in new facilities and with new providers suggests that medical abortion can be safely expanded to new settings with reasonable levels of training and supervision.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Two regimens of misoprostol for treatment of incomplete abortion.

OBJECTIVES: Misoprostol shows promise for treatment of incomplete abortion. We evaluated 2 simple misoprostol regimens to estimate whether they were effective in treating incomplete abortion. METHODS: A total of 169 women was randomly assigned to either a single or double dose of 600 microg misoprostol. The women, who would have received a surgical evacuation of the uterus for incomplete abortion, were patients at 2 hospitals in Bangkok, Thailand. The 2 groups of women were compared for success of treatment (no need for surgical evacuation), side effects, and acceptability. RESULTS: Sixty-six percent of women in the single-dose group and 70% of women in the double-dose group had complete abortions with misoprostol. More than 90% of women in the single- and double-dose groups reported that the side effects were tolerable; frequency of side effects was similar between the 2 groups. Women found the treatment acceptable. Approximately 90% of women in both groups would recommend the treatment to a friend. Acceptability and efficacy were different at the 2 participating clinics. CONCLUSION: Misoprostol is an effective treatment for incomplete abortion. Simple regimens may be as effective as more complicated ones and a single dose of 600 microg should be further evaluated in larger trials.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Ectopic pregnancy and medical abortion.

OBJECTIVE: Medical abortion regimens have become more widely used to terminate early pregnancies. Medical abortion providers are concerned to diagnose and exclude women with ectopic pregnancy before initiating treatment, as with any early pregnancy termination. Yet, there is little information about whether the various pretreatment screening methods used are adequate. We reviewed published literature to determine the overall success of screening for ectopic pregnancy before medical abortion treatment. DATA SOURCES: We searched MEDLINE for articles on medical abortion regimens published before July 2003. METHODS OF STUDY SELECTION: We selected English language articles of studies of medical abortion with sample sizes greater than 100, which reported on ectopic pregnancy diagnosed after medical abortion treatment. Fifty-seven of 85 prospective studies and randomized trials (69%) met these inclusion criteria. We also included data from 2 unpublished studies because they were large and well-controlled and because they included serious adverse events known to us, which we did not deem fair to exclude from our analysis. TABULATION, INTEGRATION, AND RESULTS: Each article was reviewed by one author. Data from selected studies were compiled, and the frequency of ectopic pregnancy diagnosed after medical abortion treatment was calculated. Ectopic pregnancy was diagnosed very infrequently following medical abortion procedures, occurring in only 10 of 44,789 (0.02%) women. CONCLUSION: The very low frequency of ectopic pregnancies diagnosed after medical abortion treatment demonstrates that the various pretreatment screening methods that providers use to exclude patients with ectopic pregnancies are successful. Further, there is no evidence to suggest that medical abortion treatment leads to unusual complications for women with ectopic pregnancies.

Abortion, Induced↗
PubMed2004

A fatal case of Clostridium sordellii septic shock syndrome associated with medical abortion.

BACKGROUND: Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, Clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. CASE: A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. CONCLUSION: The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.

Abortion, Therapeutic↗
PubMed2004

Is home-based administration of prostaglandin safe and feasible for medical abortion? Results from a multisite study in Vietnam.

OBJECTIVES: To study the efficacy and acceptability of a simplified medical abortion regimen in Vietnam. DESIGN: Open-label study. SETTING: One peri-urban and three urban hospitals and four urban maternal-child health family planning clinics located in Northern, Central and Southern Vietnam. SAMPLE: A total of 1601 women seeking abortion services from January 2001 to December 2001. METHODS: Consenting women presenting for abortion services with gestations less than 56 days LMP who met the inclusion criteria were given 200 mg mifepristone and offered the choice of either home or clinic administration of 400 microg oral misoprostol two days later. MAIN OUTCOME MEASURE: Complete abortion rate of 89.2% (n= 1395), with 1.5% (n= 24) of the women lost to follow up. The majority of women (>90%) reported that their medical abortion experience was either 'very satisfactory' or 'satisfactory'. RESULTS: There was a strong preference for home administration of misoprostol, with more than four-fifths of the study population selecting to administer the prostaglandin at home. Location of misoprostol administration did not affect efficacy rate. Regardless of location selected, women expressed a high degree of satisfaction with the medical abortion experience. CONCLUSIONS: Medical abortion with the option of home administration of misoprostol is safe and feasible for introduction into the Vietnamese healthcare system.

Abortifacient Agents, Steroidal↗
PubMed2003

Bringing emergency contraception over the counter: experiences of nonprescription users in France, Norway, Sweden and Portugal.

Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about women's experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills.

Access to Information↗
PubMed2003

Adaptation of kangaroo mother care for community-based application.

OBJECTIVE: Working with a multidisciplinary team of Ecuadorians, Bangladeshis and Americans, we developed a simple protocol for community-based implementation of kangaroo mother care (CKMC) that does not require birth weight or clinical judgment to identify which newborns should receive CKMC. CKMC could stabilize newborns and possibly reduce neonatal mortality where there is little medical care for newborns and low birth weight (LBW) is common. STUDY DESIGN: During their CKMC training, community-based workers identified 35 expectant or recently delivered women in the pilot study area and taught them about CKMC. Women were interviewed at 1 month postpartum to evaluate their experience with CKMC. RESULTS: In all, 77% of mothers initiated skin-to-skin care and 85% with LBW babies did so (37% were LBW). CKMC mothers delayed newborn bathing. Few slept upright with their newborns. CONCLUSIONS: CKMC was quickly and popularly adopted. A randomized controlled cluster trial is planned to determine whether CKMC reduces neonatal mortality.

Adult↗
PubMed2002

Could American women use mifepristone-misoprostol pills safely with less medical supervision?

Medical methods of early abortion differ from surgical methods in that women themselves can potentially administer the regimens. As currently researched and offered, however, the main regimen used for medical abortion, mifepristone-misoprostol, is highly medicalized, involving several clinic visits and extensive physician involvement. We re-examined the role of clinical supervision in each step of the abortion process, using data collected during a large clinical trial of mifepristone-misoprostol abortions in the US, fielded during 1994-1995. The trial was carried out in 17 geographically diverse centers, including private, public, and nongovernmental organization clinics, and enrolled 2121 women, aged 18-45 years, seeking early abortion (< or =63 days since last menstrual period). Women received 600 mg oral mifepristone, followed 48 h later by 400 microg oral misoprostol. Evidence suggests that most women can handle most steps of the medical abortion process themselves, effectively and safely. The utility of clinic visits to ingest mifepristone and misoprostol is questionable. For many women, even the follow-up visit could perhaps be replaced by telephone follow-up, combined with home pregnancy tests. Alternatives to the present protocol might allow greater control, comfort, and convenience at lower cost. Where clinician involvement might be useful, mid-level health care providers typically possess the skills necessary to offer the method safely, implying that physicians might be necessary only as complications arise. Future research useful for determining the optimal amount of medical involvement to provide mifepristone-misoprostol safely and effectively should include self-screening tests, label comprehension tests, calendars to aid in calculating gestational age, and the development of special pregnancy tests with telephone follow-up.

Abortion, Induced↗
PubMed2002

Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra, India.

As several important policy questions remain regarding the use of medical abortion in developing countries, we investigated the safety, efficacy, and acceptability of mifepristone-misoprostol abortion in the outpatient family planning departments of two urban hospitals and one rural hospital in India. Nine-hundred women (with gestations of < or =63 days in the urban sites and < or =56 days in the rural site) received 600 mg mifepristone followed 48 h later by 400 microg oral misoprostol in the clinic. Four point four percent or fewer urban women and 1.0% rural women were lost to follow-up. Perfect and typical-use failure rates were low at all sites. While rural women reported fewer side effects at all sites, the vast majority of women were satisfied with their medical abortions. Medical abortion can be offered safely, effectively, and acceptably in the outpatient family planning departments of urban and rural hospitals in India.

Abortifacient Agents↗
PubMed2002

Misoprostol for women's health: a review.

OBJECTIVE: To review published literature on misoprostol for women's health indications to provide a synthesis of available information and highlight areas in need of additional research. DATA SOURCES: Studies were identified through searches of medical literature databases including MEDLINE, Cochrane Database, and Popline, in addition to a review of references from identified articles. STUDY SELECTION: We included all studies reported in English and published before March 31, 2001, which evaluated the efficacy of misoprostol alone for labor and delivery, evacuation of the uterus after pregnancy failure and induced abortion. Studies were not excluded based on quality or sample size. TABULATION, INTEGRATION, AND RESULTS: Misoprostol shows promise for all of the women's health indications addressed. Currently available data, though, are often hard to interpret because of variations in regimen, dose, and outcome measures. The low cost, ease of administration and storage, and widespread availability of misoprostol make it particularly appealing for developing countries. Because many of the women's health problems for which misoprostol could be prescribed currently cause significant mortality and morbidity, increased access to and information on use of misoprostol could help improve women's health especially where these problems are most severe. CONCLUSION: Further research is needed to identify optimal regimens for misoprostol for obstetric and gynecologic health indications. Registering misoprostol with national drug regulatory authorities for any of several women's health indications could help increase access to and safe use of this drug. Provider training would be a logical subsequent step.

Abortifacient Agents↗
PubMed2002

Effects of iron supplementation on maternal hematologic status in pregnancy.

OBJECTIVES: Prenatal iron supplementation has been the standard recommendation for reducing maternal anemia in developing countries for the past 30 years. This article reviews the efficacy of iron supplementation on hemoglobin levels in pregnant women in developing countries. METHODS: Data from randomized controlled trials published between 1966 and 1998 were pooled. Meta-analyses of the relative change in maternal hemoglobin associated with iron supplementation were stratified by initial hemoglobin levels, duration of supplementation, and daily gestational supplement dose and supplementation with other nutrients. RESULTS: Iron supplementation raises hemoglobin levels. Its effects are dose dependent and are related to initial hematologic status. The extent to which iron supplementation can reduce maternal anemia is unclear. CONCLUSIONS: The extent to which maternal hemoglobin levels can be increased by recommended prenatal supplementation is limited and has uncertain physiological benefits. Other approaches, including food fortification and prevention and treatment of other causes of anemia, require methodologically rigorous evaluation to find effective answers to this global problem.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

Effectiveness of lifesaving skills training and improving institutional emergency obstetric care readiness in Lam Dong, Vietnam.

Essential obstetric care is promoted as the prime strategy to save women's lives in developing countries. We measured the effect of improving lifesaving skills (LSS) capacity in Vietnam, a country in which most women deliver in health facilities. A quasi-experimental study was implemented to assess the impact of LSS training and readiness (availability of essential obstetric equipment, supplies, and medication) on the diagnosis of life-threatening obstetric conditions and appropriate management of labor and birth. The intervention (LSS training and readiness) was provided to all clinics and hospitals from 1 of 3 demographically similar districts in southcentral Vietnam, to hospitals only in another district, with the third district serving as the comparison group. Detection of life-threatening obstetric conditions increased in both experimental clinics and hospitals, but the intervention only improved the management of these conditions in hospitals. Management of life-threatening obstetric conditions is most effective in hospitals. The intervention did not clearly benefit women delivering in clinics.

Adolescent↗
PubMedDate not supplied

Where is the "E" in MCH? The need for an evidence-based approach in safe motherhood.

Measuring the impact of obstetric interventions on maternal mortality and/or morbidity is especially difficult in developing countries, where most maternal deaths occur. Therefore, program planning has been based on theory rather than proved effectiveness. After reviewing both the strategies that have been promoted to reduce maternal mortality and the adequacy of existing evidence used to justify their selection, the investigators highlight reasons why rigorous criteria for the selection and evaluation of interventions should be adopted. Adequate evaluation of intervention effectiveness under real-life conditions in developing countries is an efficient way to identify interventions for large-scale program replication and could speed progress in reducing maternal deaths.

Developing Countries↗