Abortion is legal and widely available in Vietnam, yet a 1997 national assessment identified a significant gap in second trimester abortion services. Delaying abortion increases the risk of morbidity and mortality. However, in Vietnam, women between 13-18 weeks gestation must wait until after 18 weeks. Doctors then induce an abortion with a procedure that requires a three-day hospital stay and is widely deemed unsafe. The dilation and evacuation (D&E) procedure is considered the most effective, safest method for second trimester abortion. Ipas worked with the Ministry of Health to introduce a D&E procedure for abortion from 13-16 weeks gestation. Vietnamese physicians have only limited access to electrical evacuation, the method commonly used in the U.S. Instead, this D&E procedure was modified for effective use in resource-poor settings. Specifically, it combines manual vacuum aspiration (MVA) with forceps evacuation. To our knowledge, this has not been done before. Senior physicians at the Hanoi Obstetrics and Gynecology Hospital were trained in D&E. These physicians subsequently conducted more than 100 D&E procedures. Supervisors closely monitored provider skills and client outcomes. Successful abortion took place in 100% of the cases. Only one major complication occurred, in a patient with pre-existing risk factors. This method of D&E appears to be an appropriate, safe technology to fill the gap in abortion services in Vietnam. It improves safety, decreases procedure time, and saves clients and facilities needed resources. This procedure may be appropriate in other resource-poor settings where safe, effective abortion services in the second trimester are lacking.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Describe the gap in abortion services between 13 and 18 weeks gestation in Vietnam. 2. Articulate the D&E procedure introduced to fill this gap in services
Keywords: Access and Services, Vietnam
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Ipas is a non-profit international reproductive health organization which provides technical assistance in training, service delivery, research and policy as well as produces and distributes manual vacuum aspiration instruments
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Ms. Hyman is an employee of Ipas, a non-profit international reproductive health organization which provides technical assistance in training, service delivery, research and policy as well as produces and distributes manual vacuum aspiration instruments.