THE ABORTION AND CONTRACEPTION IN MODERN …...2019/03/10 · 57.3 50.5 45.8 40.5 35.6 32.2 28.2 25.8 24.6 22.9 21.1 19.6 17.0 209.2 201.0 191.9 173.7 156.2 128.3 106.6 96.0 73.1

RUDN-University.

MEDICAL INSTITUTE

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY WITH COURSE OF

PERINATOLOGY

Honored scientist of Russia, Corresponding member of RSA,

Head at the Department of obstetrics and gynecology with course perinatology

M. D., Professor Radzinskiy Victor Evseevich

THE ABORTION AND

CONTRACEPTION IN MODERN

RUSSIA

FERTILITY BY WORLD REGIONS (in 1000 population) AND MATERNAL

MORTALITY

47.7 47.4 46.6 44.3

40.2

37.1 35.6 35.0

42.7 41.1

37.8

30.7

25.3

21.4 19.3 19.0

41.8

38.5 38.1

28.8

24.8

19.8 18.6 18.0

24.6

22.0

17.7 15.4 15.1 13.8

13.7 13.0

21.4 19.1

16.7

14.3

11.5 10.2 10.8 11.0

390 400

300

200

0

50

100

150

200

250

300

350

400

450

0

10

20

30

40

50

1950-19551960-19651965-19701980-19851990-19952000-20052005-2010 2015

Ma

tern

al m

ort

alit

y

10

0 0

00

bir

th)

Fert

ility

1000 p

opula

tion

Africa

Latin America

Аsia

Sou Аmerica

Еurop

Маternal mortality

UN, World Population Prospect . World Population Data Sheet

FERTILITY IS DECLINING WORLDWIDE

ВОЗ

523000

590000

530000

358000

287000 289000 303000 260000

130000 100000

0

200000

400000

600000

1990 2000 2005 2008 2010 2013 2015 2030

fact

plan

- 75%

- 44%

100%

25

75

medical reasons

non-medical reasons

The global slowdown in the birth rate

Changing attitudes to reproduction (number of children is

replaced by a medium dynasty)

Reducing the number of abortions

The increase in standard of living

Availability of basic medical care

The increase in migratory activity

CONTRA-VERSION OF MATERNAL MORTALITY

In Russia, the goal has been achieved in 2012 maternal mortality rate was 11.5 per

100,000 live births (in 1990 - 47,4) (Russian Statistics)

? MM-has decreased

since

2015

THE FACTORS REDUCING MATERNAL MORTALITY

The use of contraception

Medical abortion (-20 000)

Minimum utilization of antenatal care

Hospital births (delivery)

Osmo-therapy preeclampsia (-30 000...35 000)

Organ-preserving methods of treatment of bleeding

Regional anesthesia (-13 000)

Modern perinatal technologies

Only three

positions have

reduced

(decreasing)

maternal

mortality

THE STRUCTURE OF CAUSES OF MATERNAL MORTALITY IN THE

WORLD (2015, %)

28

27

14

11

9

8 3

Previous state

bleeding

eclampsiya

Infections

Delivery complications

abortion

Embolism

303.000

ВОЗ

REDUCING THE NUMBER of CHILDREN BORN IN RUSSIA (2015/2016,

thousand people-203000)

14,8

10,8 5,4

8,1

5,3

THE DECREASING in the NUMBER of REGISTERED

MARRIAGES IN RUSSIA (2015/2016, thousand)

-155.000

49,6

40,7 21,9

20,8

15,7

6,1

5,2

15,0

DYNAMICS OF THE NUMBER OF CHILDREN BORN IN RUSSIA

(thousand)

2,782

1,904

2,203

2,375

1,989

1,364

1,267

1,397

1,502

1,480

1,714

1,789

1,797

1,902

1,896

1,913

1,944

1,893

1,688

1000 1500 2000 2500 3000

1960

1970

1980

1985

1990

1995

2000

2002

2004

2006

2008

2010

2011

2012

2013

2014

2015

2016

2017

THE PROBLEM OF MODERN REPRODUCTIONS

- Reproductive behavior

Extragenital diseases, diseases of

the reproductive system, STIs,

abortion ...…

Initiation

of sexual activity

The average

age

of nulliparous

women

12 years

of "FREE FLIGHT"

90.3

75.1 64.5

57.3 50.5 45.8

40.5 35.6 32.2 28.2 25.8 24.6 22.9 21.1 19.6 17.0

209.2 201.0

191.9

173.7

156.2

128.3

106.6 96.0

73.1

59.7 49.7 46.9 42.3 38.9 36.8 37.6

0

50

100

150

200

250

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2013 2014 2015 2016 2017

на 1000 женщин фертильного возраста на 100 родов

ABORTION IN RUSSIA

All 621 127 (2017)

Hearings in Russian

State Duma (July 2014)

legal-

medical

abortion

339 577 (2017)

The Ministry of health of the Russian Federation

ABORTION AND CHILDBIRTH IN RUSSIA

THE DISTRIBUTION OF ABORTIONS BY AGE GROUPS (%)

7.8

25.2 26.4

21.1

13.8

5.1

0.5

BEFORE 19 20-24 25-29 30-34 35-39 40-44 AFTER 45

50%

repeatedly!!!


NOT SATISFIEDS

ABORTION among ADOLESCENTS IN RUSSIA (% of the total number

of abortions in age group)

95

70

53

7 10

5

30

48

93 90

0

20

40

60

80

100

befor 15 years 15-17 years 15-19 years after 19 years from total number

nulliparous multiparous

shows about dysfunctional outcomes and affect the

frequency of teenage pregnancy

TEEN (ADOLESCENTS) PREGNANCY (per 1,000 girls 15-19

years)

ВОЗ, 2012

USA

40

Western

Europe

24

Africa

117

The WORLD in General

50

Russia

30

Southeast

Asia

54

America in

General

68

less than 10 more than 100

Finland 9 Venezuela, Guyana 101

Italy, Saudi Arabia 7 Никарагуа Nikaparya 109

Denmark, Cyprus, China, Tunisia, Sweden 6 Who d'ivoire, 111

Netherlands, Singapore, Slovenia, Japan 5 Tanzania 116

Algeria, Switzerland 4 Nigeria, Somalia 123

Korea 2 Angola 165

CNDR 1 Malawi 177

«ВЫДЕРЖКА ИЗ БИОГРАФИИ

СОВРЕМЕННОЙ ДЕВУШКИ-ПОДРОСТКА»

10

11

12

13

14

15

16

17

Initiation of sexual activity

(46%)

Abortion

Smoking (38%)

Narcotic's (10%)

Alcohol (95%)

Somatic

(75%)

Gynecological

(40-60%)

Diseases

THE PROPORTION OF ABORTIONS IN THE FIRST

PREGNANCY (%)

7,3% - ?%


POST-ABORTION RISKS FACTORS

pregnancy complications [A]

Premature births at 22-32 weeks [A]

Premature rupture of the membranes [A]

The birth of underweight baby [A]

Placenta accreta [A]

Endometriosis [A]

Repeat abortion [B]

Taylor et.al. Obstetrics and Gynecology, 1993

Hendricks, et.al. Journal of OB&GYN Research, 1999

Kathryn M. Curtis et al., Am J Obstet Gynecol 2002

Human Reproduction, 2004

Shah et al., BJOG 2009;116:1425–1442

Michel Makhlouf. Am J Obst & Gyn. Supplement to JANUARY 2011

3 RULES OF PROTECTION OF THE REPRODUCTIVE HEALTH OF

ADOLESCENTS (WHO)

The prevention of unwanted pregnancy, use reliable methods of contraception

Prevention of STIs – use a condom

Warning desperate, reckless behavior – conviction and common sense

REPRODUCTIVE EDUCATION (the College Ministry of health of Russia, 2002)

SURGICAL ABORTION IS THE MAIN CAUSE OF

REPRODUCTIVE PROBLEMS

Surgical abortion

Implantation disorders,

miscarriage ,

infertility

Autoimmune

process

Hypoxia ,

«oxidative stress»

Chronic

inflammatory

answer

PREGNANCY IN INFLAMED ENDOMETRIUM

(chronic endometritis)

25% - in population

64% -with recurrent pregnancy loss (miscarriage)

morphological and

immunohistochemical

verification of signs of

the chronic inflammation

of the basal layer of the

endometrium

Proven

symptoms of the

inflammatory

process

Implantation disorders,

miscarriage,

infertility

Autoimmune

process

Hypoxia ,

«oxidative stress

Chronic

inflammatory

answer

THE RELATIONSHIP OF INFLAMMATORY AND

AUTOIMMUNE FACTORS

It is important to remember that the Clinician!

Persistent endometritis

Autoimmune inflammatory

changes in the endometrium

not only violate receptivity

But also underlie the formation

of proliferative diseases of the

reproductive system

Autoimmune inflammatory changes in the

endometrium –and proliferative diseases

MEDICAL ABORTION IN PUBLIC INSURANCE (number of

regions)

14 20

54

2012 2014 2016

PARADOXES OF MODERNITY

7500

2200

0

2000

4000

6000

8000

10000

medicamentose abortion surgical abortion

Payment procedures (RUB)

Share holding


But doctors

prefer

curettage…

Why?


RUSSIAN FEDERATION IN 2017(%)


31.3

14.4

13.5

12.3

11.7

7.4

4.9 3.1 1.7 EGD

Embolism

Bleedeng

Abortion

Hypertensy

EUP

Sepsis (obstr)

Аnaestesiya

Others

163

MATERNAL MORTALITY AFTER ABORTION IN the RUSSIAN

FEDERATION (abs.)


276 246 205 155 149 126 124 99 101 76 73 75 93 72 53 36 26 30 31 26 20

1027

798

690

572 538

529 493

440 404

387 389 387

459

332 311

252 244 232 207 199 163

1992 1995 1997 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

died after abortion

died total

«after abortion»

is not a means

consequence of

abortion

Induced ABORTIONS IN the RUSSIAN FEDERATION (% of the total

number of abortions)

1.61 1.70 1.86

2.20 2.15 2.31

2.98

4.16

2.42

2.70

2.63

3.50

4.20

2.80

0.79

1.08

1.54

2.00 2.23 2.25

0.36

0.14 0.10 0.04 0.01 0,004 0.02 0,003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2015 2016 2017

for medical reasons (indications)

for social reasons (indications)

DYNAMICS OF ILLEGAL ABORTION IN THE RUSSIAN

FEDERATION

7708

4900 4537

2639

1838 1476

1221 1309 1002

264 170 349 355

0.27

0.20 0.21 0.13

0.10 0.09 0.09 0.10 0.09

0.03 0.02

0.05 0.06

0

0.1

0.2

0.3

0.4

0.5

0

2000

4000

6000

8000

10000

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2015 2016 2017

abs.numb % total number abortion

Since 2003 have not increased , but

reduced


RUSSIAN FEDERATION ON THE TIMING OF THE ONSET (2017)

78.5

1.8

12.3

7.4

During pregnancy up to 22 weeksand in the postpartum period

Every 5 pregnant woman dies in the first half

of pregnancy

21,5%

CAUSES OF DEATH AFTER ABORTION IN THE RUSSIAN

FEDERATION (2017)

31.3

14.4

13.5

12.3

11.7

7.4

4.9 3.1 1.7 EGD

Embolism

Bleeding

Abortion

Hypertens

ECP

Sepsis

Anaestesiya

Other

20

5

6

2

2 5

Only 50% of maternal mortality is

abortion −the"usual" reasons

(bleeding, sepsis)

the rest from other causes

ABORTION AND MATERNAL MORTALITY IN RUSSIA (2017)

6 (30%)after abortion

medical indications

20 (12,3%)

After abortion

Total died 163

THE RISK OF DEATH (1:N)

Regular flights− 1 : 10 000 000

Med. abortion (legal)

−

1 : 300 000

Spontaneous abortion− 1 : 8 000

Unspecified (illegal abortion)

−

1 : 4 000

For med. indications − 1 : 3 000

100 times!

THE PROTOCOL OF ABORTION IN LATE PREGNANCY

Terms of pregnancy

(weeks, days)

Regimens

Source

Mifepristone Time interval

Misoprostol

12-13 weeks 6 days

200 mg 1 tablet orally

once

24-48 800 mcg (4 tablets) once in the vagina,

then again at a dose of 400 mcg (2

tablets) in the vagina or under

the tongue every 3 hours (before the

termination of pregnancy)

WHO, 2012; RCOG, 2015;

14-21 weeks 6 days

12-48 WHO, 2012;

Medical abortion regimens for a period of 12 to 21 weeks

6 days having proven effectiveness [22,37,39].

«Artificial termination of pregnancy in the late stages for medical reasons in the

presence of fetal abnormalities» Treatment protocol, 2018. The Ministry of health of

the Russian Federation

HORMONPHOBIA - OBSTACLE TO CONTRACEPTION

ABORTION

Hormone phobia

patients and doctors!!!

MOTIVATION of REPRODUCTIVE BEHAVIOUR (abs.)

70 17 8

1 pack,

2 pack 3 pack

Free COC

PARADOXES OF MODERNITY

90.3

75.1

64.5

57.3

50.5 45.8

40.5 35.6

32.2 28.2

25.8 24.6 22.9

21.1 19.6

17.0

24.5 24.6 24.7 24.5 23.6 22.2 22.7 23.4 24.0 25.3 24.7 24.5 24.6

24.8 24.7 23.2

0

20

40

60

80

100

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2013 2014 2015 2016 2017

Induc.abortion (1000 woman fertil age)

ПРЕРВАННЫЙ

ПОЛОВОЙ АКТ?

COUNSELING ABOUT CONTRACEPTION AFTER THE FIRST

BIRTH (%)

Having an abortion in the

next pregnancy

1907 1917 1927 1937 1947 1957 1967 1977 1987 1997 2007 2017

THE priorities change ...do NOT DISTURB the WOMAN. SHE

KNOWS WHAT SHE WANTS

1917

Women's suffrage 2017

40% senior management positions

held by women – more than in any

other country in the world

100 лет

The USE of CONTRACEPTIVE METHODS (%)

Respondents younger than 50 years with a partner at the time of the

survey

Methods Woman Man

All methods,

в том числе: 79,5 81,3

condoms 30,3 38,0

IUD- IUC 20,4 18,9

tablets 14,1 14,7

the calendar method, 14,5 11,3

coitus interruptus 13,6 11,7

douching 2,9 2,2

others 5,2 5,9

No methods 20,5 18,7

Only modern methods 51,8 56,9

Combination modern and traditional methods 13,1 12,9

Only traditional methods 14,6 11,5

Respondents numbers 2273 1561

http://www.demoscope.ru/weekly/2010/0409/tema02.php

Росстат, 2014

Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской

Федерации. Министерство здравоохранения РФ, ЦНИИОИЗ. Москва, 2014.

http://demoscope.ru/weekly/2014/0623/reprod01.php

The abortion rate is not dependent on

the use IUD

The higher percentage using the IUD,

the higher the level of abortion

THE PROPORTION OF WOMEN IN RUSSIA, USING IUD, THE

TOTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE

THE LEGALITY OF ABORTION IN THE WORLD

12%

23%

25%

40%

Allowed on request women

Allowed only at health reasons

Permitted for

social reasons

Allowed by

medical

indications

AMBULATORY ABORTION:TRANSITION PERIOD TO

EFFECTIVE CONTRACEPTION

This situation brings the world to realization of the

ideology of the who-1969 – the woman herself, without

the help of a doctor, diagnose the pregnancy and does

medical abortion

GOOD OR BAD?

The world does not know the answer to this

question (Lisbon, ICMA,2010).

INTERACTION WITH INTERNATIONAL ORGANIZATIONS IS

FUNDAMENTALLY IMPORTANT

EASTERN EUROPEAN ALLIANCE FOR REPRODUCTIVE CHOICE

EDUCATION AND ACCESS TO METHODS OF FAMILY

PLANNING

Training schoolgirl, students

The basic Foundation of family planning

Teaching students of all Universities

Training of the population knowledge of planned

contraception.

Knowledge of emergency contraception

Training of doctors understanding the importance of HC physician of

any specialty Proactive identification of needs of women

↓ ABORTION

↑ FERTILITY

The scientific PROJECT of the Department of OBSTETRICS AND

GYNECOLOGY WITH COURSE PERINATOLOGY RUDN University

Prevention, early diagnosis and treatment

of disorders of reproductive health of

students of universities and colleges of

the Russian Federation

Scientific bases of health protection of

students

TECHNOLOGY PROVIDE CONTRACEPTIVE ASSISTANCE

TO THE STUDENT YOUTH RUDN- UNIVERSITY

Specialized free admission on reproductive health and

contraception in the medical center of RUDN- UNIVERSITY ( with

the support of "Gedeon Richter")

ADVICE

The use of interactive algorithm selection of contraceptives

SELECTION ALGORITHM

Active informing all students in the two academic hours in all

faculties

INTERACTIVE SELECTION

Permanent sexual partner

% safe sexual relations

% using modern methods of contraception

PERFORMANCE CRITERIA

Girls with a history of abortions

EFFECTIVENESS of IMPLEMENTATION-improvement of

reproductive behavior

67.6

82.8

68.5

91.1

11.4

5.2

18.7

25.3

0

20

40

60

80

100

non-inform group-target

permanent partner (р<0,01)

safe sex.relationsh

abortion in anamnesis (р=0,013)

use COC (р=0,019)

Documents

THE ABORTION AND CONTRACEPTION IN MODERN …...2019/03/10 · 57.3 50.5 45.8 40.5 35.6 32.2 28.2 25.8 24.6 22.9 21.1 19.6 17.0 209.2 201.0 191.9 173.7 156.2 128.3 106.6 96.0 73.1