PERU POSTABORTION PROGRAM
Miguel Gutiérrez MD
Project Coordinator
Jhony Juárez MD
Consultant
PERU POSTABORTION PROGRAM

GOAL : To improve the reproductive health
status of poor women in Peru and
contribute to the reduction of
maternal deaths

PURPOSE: To improve the quality and
availability of treatment for the
complications of incomplete
abortion and postabortion family
planning and counseling services
PERU POSTABORTION
PROGRAM
OUTPUTS




Introduction of MVA technique in MOH
hospitals
Improved integration achieved between
postabortion care and family planning services
Development of appropiate IEC materials for
postabortion patients
Increased awareness of health professionals of
issues relating to abortion and the treatment of
its consequences
PERU POSTABORTION
PROGRAM
PROGRAM´S PHILOSOPHY

Humane care of incomplete abortion

Out-patient care of incomplete abortion when
it is medically appropriate.

Use of MVA for the evacuation of ovular
remainings.

Provision of information and contraceptive
services inmediately after the abortion.
PERU POSTABORTION
PROGRAM
PROGRAMS PHILOSOPHY

Diagnosis and treatment of sexually transmited
diseases.

Early diagnosis of secondary infertility and
referral in order to receive treatment.

Identifying problems related to sexual violence
which could affect women’s reproductive
health and the respective referral to receive
treatment.
PERU POSTABORTION
ACTIVITIES

Hospitals assesments

Training

Monitoring and Follow-up
Advocacy

PROGRAM
PERU POSTABORTION PROGRAM
PATHFINDER´S
POSTABORTION CARE
TRAINING MODEL
Miguel Gutiérrez MD
Jhony Juárez MD
Elizabeth Aliaga MA
PERU POSTABORTION
PROGRAM
MODULE TRAINING
Objective

To develop skills among health providers to
improve the quality of postabortion care throught
the:




Sensitize about abortion
Use of MVA technique
Counseling for postabortion patients
Provision of postabortion family planning
PERU POSTABORTION
PROGRAM
Specific Learning Objectives
1. Explain the impact of unsafe abortion on maternal
mortality and morbidity.
2. Identify unwanted pregnancy as a major cause of
unsafe abortion.
3. Demostrate sensitivity throughout the postabortion
care process.
4. Explain counseling procedures, skills, and attitudes
appropiate for MVA services.
PERU POSTABORTION
PROGRAM
Specific Learning Objectives
5. Explain the steps needed to assess the condition of a
woman presenting with symptoms of a septic or
incomplete abortion.
6. Describe possible complications of incomplete or
septic abortion and their appropiate management.
7. Evaluate the methods of uterine evacuation following
incomplete abortion in the first trimester.
8. Demonstrate the preparation of MVA equipment.
PERU POSTABORTION
PROGRAM
Specific Learning Objectives
9. Demonstrate infection prevention procedures for the
provider.
10. Demonstrate how to process MVA instruments for
reuse.
11. Summarize pain control procedures appropiate for
MVA.
12. Demonstrate the PAC MVA procedure on an
anatomical model.
13. Demostrate how to manage complications during the
MVA procedure.
PERU POSTABORTION
PROGRAM
MODULE TRAINING
Simulated Skills Practice




Manual Vaccum aspiration (MVA)
Paracervical block.
Proper infection prevention procedures.
Counseling.
PERU POSTABORTION
PROGRAM
Simulated Skills Practice
Using the Five-Step Method of Demonstration
and Return Demostration.
1. Overall Picture.
2. Trainer Demonstration.
3. Trainer/Participant Talk-Through.
4. Participant Talk-Trough.
5. Guided Practice.
PERU POSTABORTION
PROGRAM
MODULE TRAINING
Clinical Practicum Objectives
Trainees will demostrate the following:
 History taking.
 Physical examination.
 Manual Vaccum Aspiration.
 Paracervical Block.
 Proper infection prevention procedures.
 Counseling
PERU POSTABORTION
PROGRAM
Training /Learning Methodology










Participants handouts.
Discussion.
Brainstorming.
Role play.
Demonstration/Return demonstration.
Trainer presentation/short lecture.
Case studies
Group exercises.
Simulation practice.
Clinical practicum.
PERU POSTABORTION
PROGRAM
CONTINOUS TRAINING
Through:

Formal courses of predermined length by
experienced trainers

Replicas of formal courses developed by the
personnel previously trained in formal courses

In service

Internships
PERU POSTABORTION
PROGRAM
TRAINING METHODOLOGY
(Materials)
1. Training Modules:
Clinical
 Counseling

2. Pelvic model to perform practices of
the MVA technique
3. Brochures
PERU POSTABORTION
PROGRAM
MVA PROCEDURE
PATHFINDER´S MODEL

The MVA procedure occurs in 2 distinct phases.
 Phase
1: “Metal Phase”
• When you will be using a speculum, cleaning the cervix and
applying a tenaculum and performing a paracervical block,
if necessary.
 Phase
2: “Plastic Phase”
• Is the part of the procedure during which you will be using
the plastic MVA equipment (syringe and cannula)
PERU POSTABORTION
PROGRAM
MVA PROCEDURE
PATHFINDER´S MODEL

In order to practice the best infection prevention
technique possible and decrease the risk of
contamination, it is helpful to prepare the sterile
instrument tray (a Mayo stand or table covered
with a sterile drap or cloth) in two parts:
1
part, approximately 60% of the table is absolutely
“no touch”.
 2 part, approximately 40% of the table is the “gloved
hand”.
MVA PROCEDURE
Prepare sterile instrument tray
“No Touch” Area
“Gloved hand” Area
PERU POSTABORTION
PROGRAM
MVA PROCEDURE
PATHFINDER´S MODEL

Phase 1: “Metal Phase”
 Put
the following material in the “no touch” space:
• Ring forceps (except for the handles)
 Put
the following materials in the “gloved
hand”space:
•
•
•
•
Speculum.
Forceps for cleaning the cervix.
Tenaculum (or vulsellum forceps).
Syringe (10cc with 1% lydocaine) and needle extender (for
paracervical block)
• Cotton or gauze balls
MVA PROCEDURE
PATHFINDER´S MODEL
PERU POSTABORTION
PROGRAM
MVA PROCEDURE
PATHFINDER´S MODEL

Phase 2: “Plastic Phase”
 Put
the following material in the “no touch” space:
• Cannulae (except for adaptor ends)
• Dilators ( if neccesary)
 Put
the following materials in the “gloved
hand”space:
• Adaptor ends of cannulae.
• MVA syringe
MVA PROCEDURE
PATHFINDER´S MODEL
PERU POSTABORTION
PROGRAM
COUNSELING


Is an important space where people can receive
support and information when being in a critical
situation. Counseling means not only to guide or
to provide information, but also to strengthen
personal self-esteem and to understand personal
experiencies.
Is face to face, personal and confodential
communication in which one person helps to
another to make decisions and then to act on them
PERU POSTABORTION
PROGRAM
COUNSELING MODEL
Counseling is performed in three diferent care
phases and has accurate obsjectives:
 Before
the procedure
 During the procedure
 After the procedure
PERU POSTABORTION
PROGRAM
COUNSELING MODEL

Before the procedure
• Identify the emotional situation of patient and help her to
manage fears or anguishes
• Inform on anatomical aspects of reproductive organs.
• Inform on pain management/controlling.
• Identify her reproductive intentions and the possibility to
use postabortion contraception

During the procedure
• help patient by maintaining an active communication.
• Help her to control pain.
• Be “the brigde” between physician-patient
PERU POSTABORTION
PROGRAM
COUNSELING MODEL

After the procedure
• Inform on postabortion family planning and other issues of
reproductive health(STD/HIV, cervix or breast cancer
detection, sexual violence, etc)
• Inform on alarm signs.
• Give the post-procedure indications.
• Co-ordinate the control visit.
PERU POSTABORTION
PROGRAM
PATHFINDER´S POST ABORTION CARE MODEL
Patient
Medical Evaluation
Diagnosis
Before
MVA Procedure
Contraception
Recovery
Discharge
During
After
C
o
u
n
s
e
l
i
n
g
LIMA
ANCASH
ICA
COLOMBIA
CUZCO
AREQUIPA
CHILE
TACNA
PUNO
MADRE DE DIOS
BRASIL
APURIMAC
AYACUCHO
UCAYALI
LORETO
JUNIN
PASCO
HUANUCO
SAN MARTIN
Hospitals Trained
OCEANO
PACIFICO
LAMBAYEQUE
PIURA
CAJAMARCA
ECUADOR
AMAZONAS
Distribution of Hospitals where training
courses were conducted 1997- 2001Sept.
BOLIVIA
PERU POSTABORTION
PROGRAM
Number of professionals trained

Physicians
421

Midwives
215

Nurses
249

TOTAL:
885
PERU POSTABORTION
PROGRAM
OUTLOOK TO 2001
1. Introduction of Peru Postabortion Program in :


28 Hospitals (MOH)
15 Health Centers (MOH)
2. To achieve a change of attitudes towards the
women with incomplete abortion in health
professionals
3. To offer postabortion counseling in 100% of
patients
PERU POSTABORTION
PROGRAM
OUTLOOK TO 2001
4. To increase postabortion contraception
5. To offer ambulatory treatment for postabortion
uncomplicated patients and to use MVA in 60% of
cases
6. To improve the quality of postabortion care in
43 MOH hospitals
7. Institutionalization of Postabortion Program