Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Center on Gender Equity and Health, University of California, San Diego, San Diego, CA, USA.
Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal.
Contraception. 2018 Oct;98(4):296-300. doi: 10.1016/j.contraception.2018.06.004. Epub 2018 Jun 21.
To evaluate whether conducting a bimanual examination prior to medication abortion (MAB) provision results in meaningful changes in gestational age (GA) assessment after patient-reported last menstrual period (LMP) in Nepal.
Women ages 16-45 (n=660) seeking MAB at twelve participating pharmacies and government health facilities, between October 2014 and September 2015, self-reported LMP. Trained auxiliary nurse midwives assessed GA using a bimanual exam after recording LMP. We compared GA assessments as measured via patient-reported LMP alone versus via LMP plus bimanual exam.
Overall, 660 women (326 at pharmacies, 334 at health facilities) presented for MAB, and 95% were able to provide an LMP. Overall agreement between LMP alone and LMP with bimanual exam was 99.3%. If LMP alone had been used without bimanual exam, fewer than one in 200 women would have been given MAB beyond the legal gestational limit. Among the three women who were ≤63 days by LMP but >63 days by bimanual exam, only one would have received MAB beyond 70 days gestation. Fewer than one in 600 women would not have received MAB care when eligible by adding a bimanual exam.
There was high agreement between LMP alone and LMP plus bimanual exam. Routine bimanual exam may not be essential for safe and effective MAB care for women who are able to report an LMP. Removing the bimanual exam requirement could decrease barriers to provision outside of currently approved clinical settings and allow for expanded abortion access through provision by providers without bimanual exam training or facilities.
Routine bimanual exams may not be essential for safe medication abortion provision by trained clinicians in pharmacies and health facilities in low resource settings like Nepal.
评估在尼泊尔为药物流产（MAB）提供药物前进行双手检查是否会导致根据患者报告的末次月经（LMP）后对妊娠龄（GA）评估产生有意义的变化。
2014 年 10 月至 2015 年 9 月期间，在 12 家参与的药店和政府卫生机构寻求 MAB 的年龄在 16-45 岁的妇女（n=660）自我报告了 LMP。经过培训的助理护士助产士在记录 LMP 后使用双手检查评估 GA。我们比较了仅通过患者报告的 LMP 测量的 GA 评估与通过 LMP 加双手检查测量的 GA 评估。
总体而言，660 名妇女（326 名在药店，334 名在卫生设施）接受了 MAB 治疗，95%的妇女能够提供 LMP。仅使用 LMP 与 LMP 加双手检查的总体一致性为 99.3%。如果仅使用 LMP 而不进行双手检查，不到 1/200 的妇女会在法律妊娠限制之外接受 MAB。在通过 LMP 为≤63 天但通过双手检查为>63 天的三名妇女中，只有一名会在妊娠 70 天以上接受 MAB。当添加双手检查时，不到 1/600 的妇女会因为不符合条件而无法获得 MAB 护理。
仅使用 LMP 与 LMP 加双手检查之间存在高度一致性。对于能够报告 LMP 的妇女，常规双手检查可能不是安全有效的 MAB 护理所必需的。取消双手检查要求可以减少在当前批准的临床环境之外提供服务的障碍，并允许通过没有双手检查培训或设施的提供者提供药物流产服务，从而扩大堕胎机会。
在尼泊尔等资源匮乏的环境中，对于经过培训的临床医生在药店和卫生设施中进行安全的药物流产提供服务而言，常规双手检查可能不是必需的。
