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  • Title: Induced abortion: an audit of reported current practice among consultant gynaecologists in Scotland.
    Author: Penney GC, Templeton A.
    Journal: Br J Obstet Gynaecol; 1994 Jun; 101(6):523-8. PubMed ID: 8018643.
    Abstract:
    OBJECTIVE: To obtain an overview of current abortion practice in Scotland for comparison with agreed criteria for good quality care based on literature review. DESIGN: Postal questionnaire survey. SUBJECTS: All 132 consultant gynaecologists practising in the NHS in Scotland. RESULTS: Response rate 92%. The survey revealed regional inequalities in the availability of services, particularly with regard to early medical abortion and second trimester procedures. It also revealed great individual variations in many areas of practice notably in screening for genital tract infection, the use of cervical predilatation, contraceptive provision, and follow up. Several aspects of practice compared poorly with the agreed criteria for good quality care. CONCLUSIONS: The postal questionnaire approach achieved a good response rate and has provided an informative overview of current practice on a national basis. Variations in the provision of services and in clinical practice, both among regions and among individual consultants, have been identified. Elements of abortion care in which great variations exist and in which current practice compares poorly with the agreed criteria have been highlighted as appropriate areas for the development of national guidelines and for educational initiatives. Such a questionnaire approach to assessing current practice can complement, and possibly replace, some aspects of casenote review audit. A questionnaire was sent to all 132 consulting gynecologists in Scotland in September, 1992, to examine current abortion practices so researchers could compare abortion practices with criteria for good quality care. The response rate was 92%. Inequalities in the availability of abortion services existed among regions. For example, the maximum gestation at which abortion was available ranged from 12 weeks in region 13 to 24 weeks in regions 2 and 4. Yet, the Birth Control Trust and the Scottish Home and Health Department recommend that all Health Boards provide second trimester abortion. Further, early medical abortion was available on a very limited basis in 13 hospitals of 8 of the 13 Health Boards. 23 of 26 gynecology units had a centralized referral telephone system. Individual differences existed in terms of quality of care. For example, 29% took no special precautions to manage potential genital tract infection. Just 22% took genital swabs of all cases. 35% did of selected cases. 3% administered prophylactic antibiotics in all abortion cases. Just 39% would predilate the cervix in all patients, even though the risk of cervical damage is great in young and multiparous women. Just 49% would discuss and provide contraception as part of postabortion care. 28% did not suggest any follow-up. 14% did not advocate day case care when medically appropriate. Most gynecologists used medical abortion in the second trimester. Gynecologists at only 3 of the 26 gynecology units used mifepristone as a pretreatment to facilitate second trimester prostaglandin abortion. Even though quality of care criteria call for contraceptive provision and postabortion care and counseling, few gynecologists considered these aspects of care to be important. The questionnaire can complement, perhaps even replace, the casenote review audit to assess current abortion practice.
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