1. Therapeutic Abortions in Northern BC
Dr Jocelyn Black

2. I have no commercial or personal bias to declare.
⅓ of women have abortions
In 2012, only 4% abortions in Canada were medical--this was before the legalization of mifepristone in 2015 (but still not found in clinics until 2017)

3. Presentation summary
Overview of the difference between medical and surgical abortion.
Review services currently available in Masset and QCC.
Discuss services available in Northern BC.
Discuss services available in Vancouver.
Ideas on how we can better provide services in Masset.
Resources for health care providers
First trimester <14wk

4. 1a. Medical abortion Methotrexate and misoprostol
Mifepristone and misoprostol
Use of 2 medications to end a pregnancy
Allow for greater privacy, usually avoid clinics associated with abortion
Able to still care for family while having MA, sense of control over process, avoids surgery and sedation
Improved access
In 2012, only 4% abortions in Canada were medical--this was before the legalization of mifepristone in Canada

5. Methotrexate and misoprostol
Intramuscular methotrexate and buccal misoprostol
Inexpensive for those without coverage
Doubles as treatment for possible ectopic (PUL)
Success rate 82% at 14d
CONS
Longer process of completion
Available up to 7wk GA
Less effective than mifepristone/misoprostol
Teratogenic
Methotrexate 50mg/m2 and vaginal miso 800mcg 3-7d later
MTX works in prevention of cell division to terminate pregnancy, then miso causes uterus contraction and cervical dilation to pass the pregnancy
Need VERY reliable FU because success rate is low and very dangerous with teratongenic mtx

6. Mifepristone and misoprostol
1st choice for MA by SOGC
Mifepristone is oral anti-progestin, misoprostol is taken buccally/vaginally 48-72h later
Success rate 7wk GA 95-98%, 10wk GA is 87-98%
“Likely safe” in breastfeeding women
CONS:
Expensive
Been available in CHina and France since 1988
Available in US since 2000
Mifepristone causes uterine contractility, endometrial degeneration and separation between uterus and pregnancy
$350 if not covered (NIHB covered, QC, AB, NB, ON, NS)-- NOT BC
Previously required completion of a course to prescribe but not anymore. Is still recommended. Working on having midwives able to prescribe as well.
Please let me know if you are interested in learning more about this drug, there is a course on SOGC and I have the reading materials from this course.

7. 1b. Surgical abortion Dilation and curettage Dilation and evacuation
Manual vacuum aspirator
Reasons for women to choose surgical abortion include
-efficacy
-speed of termination
-sedation with procedure
-FU not necessary
Risks of all are similar- perforation, bleeding, post op infection, RPOC

8. Dilation and curettage
Provided in an OR by an obstetrician or GP with advanced training, requiring an anesthetist and under a general anesthetic.
Sequential dilation of the cervix and then currettage of the uterus with metal instruments to empty the uterus.

9. Dilation and evacuation
Provided in an OR or ambulatory care setting by an OBS or a GP with advanced training under a general anesthetic or procedural sedation.
Sequential dilation of the cervix with metal instruments and removal or pregnancy with a vacuum device from the uterus.

10. Manual vacuum aspiration
Provided in an ambulatory care setting by OBS or GP with advanced training under procedural sedation by a trained nurse.
Sequential dilation of the cervix and evacuation of the pregnancy from the uterus by a hand-held manual vacuum device.
This is the most utilized option for 1st trimester terminations in Vancouver and argued as the safest.
Only recommended up to 12wk GA
Also can be used in RPOC for miscarriages

12. 2. What do we do on island?
Masset: we currently have two staff physicians who are licensed to prescribe mifegymiso and one half time staff physician who has privileges for first trimester ultrasounds for the purpose of TA. No surgical TAs are available.
Queen Charlotte City: one staff physician providing MVA for up to 7w4d GA with a nurse or MD for procedural sedation, with first trimester dating ultrasound.

13. 3. Services in NorthWEST BC
Prince Rupert: One physician provides surgical abortions by D&C up to 12-14wk GA. They will have an US done and do lab work necessary.
Terrace: One physicianprovides surgical abortions by D&E up to wk GA. They will perform an US and all lab work necessary.
Smithers: One physician provides medical abortions up to 10wk GAin a clinic setting where she will perform an US and all lab work necessary.

14. Prince George: Physician referral to another physician for MAs up to 7wk, gynecologist doing SAs
**Warning there is a clinic called “Pregnancy Care Centre” in PG that will show up top of Google search for PG abortion but it is a Christian oriented clinic and does not provide abortions*
I am unable to provide resources for doctors in Northern BC outside of Haida Gwaii providing MAs as these are now more frequently GPs in clinic who do not specialize in abortions.
Dr referral for medical to 7wk, then otherwise to hospital for surgical
No clinics

15. 4. Services in Vancouver
Willow Women's clinic: medical abortions up to 10wk GA
Everywoman’s clinic: medical up to 9wk, surgical up to 13w6d by MVA and D&E
Elizabeth Bagshaw clinic: medical up to 9wk, surgical up to 16w6d by MVA or D&E
CARE program: surgical up to 23wk by MVA or D&E or D&C
*NB* there are services in Seattle if your patient is over 23wk and needs a TA, CARE will help arrange these

16. 5. How can Masset do better?
Introducing MVA to our community.

17. 6. Resources for health care providers
If someone’s own doctor will not refer them, or if they do not want to go to their family doctor, they call the Sex Sense Line ( or for more information.

18.
counselling post-TA
counselling post-TA
Pregnancy Options Service

19. Presentation summary
Overview of the difference between medical and surgical abortion.
Review services currently available in Masset and QCC.
Discuss services available in Northern BC.
Discuss services available in Vancouver.
Ideas on how we can better provide services in Masset.
Resources for health care providers

20. Any questions?