September 26, 2019
Greetings,
September 28th is International Safe Abortion Day. We mark this day by celebrating so many around the world who work tirelessly to provide safe abortion services. We also take this moment to re-invest in our own efforts to increase access to abortion through our research and community partnerships. The 28th also marks the anniversary of the approval of mifepristone in the United States. It’s hard to believe it has been 19 years! Finally, in this edition of our e-newsletter, we focus our Spotlight on another key area of our work-- hypertension in pregnancy, highlighting a recent clinical trial that was published in the Lancet last month comparing three oral anti-hypertensive drugs for severe hypertension in pregnancy.
Warm wishes,
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Beverly Winikoff
President
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Medical abortion telemedicine pilot launched in Mexico
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Gynuity has been working with local experts to conduct a review of the current legal and health frameworks for the provision of health care by telemedicine in Mexico. This review revealed that the necessary conditions exist for a remote model to provide medical abortion services. Such a service could ease access difficulties for people who cannot locate timely appropriate care either because of a lack of providers or distance from health facilities. We adapted the US
TelAbortion
protocol to align with the local conditions and, in April, launched a pilot study to evaluate the acceptability and feasibility of the model in collaboration with abortion service providers in Mexico. As part of this project, we are collaborating with two Planned Parenthood Global partners in southern Mexico. For more information, visit the Clinical Trial database at
https://clinicaltrials.gov/
, identification No. NCT03931460 or contact
TeleILE@gynuity.org
.
Click here for information in Spanish
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New thought piece examines potential for medications that blur the line between contraception and abortion
So-called "contragestive" medications (e.g. mifepristone) have been deemed a disruptive technology because they blur the distinction between contraception and abortion. In the latest edition of Conscience Magazine, Dr. Beverly Winikoff lays out a roadmap for the potential of these drugs in her piece, “
Will a New Kind of Pill Be the Holy Grail We Seek?
”
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TelAbortion project reaches milestone
The
TelAbortion
direct-to-patient medical abortion study enrolled its 500th participant earlier this month. We currently have 6 sites offering TelAbortion services in 8 states, with plans to add 3 more states later this fall. In addition, results from the first few years were recently published in
Contraception
.
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Medical abortion commodities database
Gynuity has worked closely with IPPF and Concept Foundation to develop the
Medical Abortion Commodities Database
. The purpose of the database is to improve access to country-level information on the availability of different brands of mifepristone, misoprostol and combipacks that can be used by a range of organizations including governments, private sector pharmaceutical distributors and NGOs either currently providing or planning to offer safe abortion services. Read
IPPF’s new blog piece
describing efforts to date and plans for the database going forward.
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Mifepristone's Multiple RH Indications: An overlooked Opportunity for Expanding Access
Gynuity Health Projects, with a grant from the Innovation Fund of the Reproductive Health Supplies Coalition, assembled a
brief
with information regarding four reproductive health indications for mifepristone, beyond early medical abortion. This brief reviews the current evidence around Early Pregnancy Loss, Intrauterine Fetal Death, Cervical Preparation, and Second Trimester Abortion. These additional indications for mifepristone may provide an avenue for registration of the drug in places where early medical abortion is limited.
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New Peer-Reviewed Articles
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Raymond, E., Chong, E., Winikoff, B., Platais, I., Mary, M., Lotarevich, T., Castillo, P.W., Kaneshiro, B., Tschann, M., Fontanilla, T., Baldwin, M., Schnyer, A., Coplon, L., Mathieu, N., Bednarek, P., Keady, M., Priegue, E. TelAbortion:
Evaluation of a direct to patient telemedicine abortion service in the United States
. Contraception. 2019 Sep;100(3):173-177.
Easterling, T., Mundle, S., Bracken, H., Parvekar, S., Mool, S., Magee, L.A., von Dadelszen, P., Shochet, T., Winikoff, B.
Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial
. Lancet. 2019 Aug 1. doi: 10.1016/S0140-6736(19)31282-6. [Epub ahead of print]
Blum, J., Karki, C., Tamang, A., Shochet, T., Shrestha, A., Tuladhar, H., Karki, A., Sharma, J., Abbas, D., Dragoman, M., Winikoff, B.
Feasibility of a hospital outpatient day procedure for medication abortion at 13–18 weeks gestation: findings from Nepal
. Contraception. 2019 DOI: https//doi.org/10.1016/j.contraception.2019.08.007.
Sheldon, W.R., Durocher, J., Dzuba, I.G., Sayette, H., Martin, R., Velasco, M.C., Winikoff. B.
Early abortion with buccal versus sublingual misoprostol alone: A multicenter, randomized trial
. Contraception. 2019 May;99(5):272-277.
Anger. H.A., Dabash, R., Durocher, J., Hassanein, N., Ononge, S., Frye, L., Diop, A., Beye Diop, S., Burkhardt, G., Darwish, E., Ramadan, M.C., Kayaga, J., Charles, D., Gaye, A., Eckardt, M., Winikoff, B.
The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum hemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomized trial
. BJOG. 2019 Aug 13. doi: 10.1111/1471-0528.15903. [Epub ahead of print]
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Hypertension in Pregnancy
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Hypertension is the most common medical disorder in pregnancy, complicating one in ten pregnancies. Treatment of severely increased blood pressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low resource environments. In collaboration with colleagues at Government Medical College and Daga Women’s College in Nagpur, India our research
team
compared the efficacy and safety of three oral drugs, labetalol, nifedipine retard, and methyldopa for the management of severe hypertension in pregnancy.
All oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs are viable initial options for treating severe hypertension in pregnancy in low-resource settings. Most importantly, a structured approach of routine blood pressure monitoring and the use of oral antihypertensive medications may reduce delays in treatment in a broad range of settings. Read the full article at
The Lancet
.
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As a next step, we are now examining the feasibility of implementing standardized treatment protocols with oral antihypertensive medications in settings outside of tertiary level health facilities. Specifically, with the support of a grant from the
Innovation Fund of the Reproductive Health Supplies Coalition
we are assessing the presence of enabling policies and essential supplies (blood pressure measurement devices and antihypertensive medications) for the management and treatment of hypertensive disorders of pregnancy in three countries (India, Mexico and Uganda). The findings, we hope, will provide guidance on how best to ensure the availability of these essential maternal health supplies.
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