Reception

The first contact with the patient in most of the cases will have it by telephone. At this moment all the information is already facilitated to him that can need. Once in the Clinic, it is in the reception where their personal data take shelter and the previous information necessary to be able to open their clinical history.

Social Work Department

Here the personal and social data are completed and the different requests or valuations of partial or total freepaid of the expenses of trip and/or the intervention are analyzed, in individual for the patients outside Spain: Italy, Portugal, France, etc.

This can also be made of telephone form or in writing: mail or fax.

Ultrasound Department

In this following step determines the gestacional age, by means of the accomplishment of an abdominal or vaginal ultrasound if it were necessary.

Clinical Analices Department

Is extracted a sanguineous sample in order to make complete hemogram, sanguineous group, Rh, and coagulation tests. In more than 12 weeks gestations is also asked for fibrinogen and TPTA. This analytical is expandable according to each patient.

Psico-psychiatry Department

Here values the emotional state of the patient, its degree of anxiety, stress,… and evaluates the necessity or not that it receives some psychological support type and/or additional therapy during or after the process.

At the same time our specialists in psychiatry issue the corresponding legal ruling that authorizes the abortion within the assumption of Psychic Health.

Obstetrics Department

Here values the patient obstetrical conditions (cervical parity, conditions, …) whom candidate to one or another type will abortion technique do.

Anesthesia and Resuscitation Department

Here determines if the patient is susceptible to be operated under local anesthesia (single in cases of inferior gestations of first trimester to 10 weeks) or general sedación or another anesthetic technique.

Based on clinical history, of the result of the analytical one and this exploration one settles down if the patient reunites the conditions necessary to be taken part or not in an institution of Cirugia Mayor Ambulatoria (CMA) like ours.

In the independent centers of CMA of a hospital like ours, according to the international norms of this specialty, can be taken part until patients of the level ASA 3aof the Anesthesiology American Society.

FIRST QUARTERLY ABORTION PROTOCOL
(Up to 12 weeks)

0.5mg atropine IM are administered, 600 mg. of oral Ibuprofeno and 5 mg of oral Diazepan (optative), in the cases of local anesthesia.

The patients can be taken part with local anesthesia or general sedación, according to medical indication and desire of the ownpatient.

The used technique is the one of aspiration (or Karman method) with atraumátic plastic material. After the aspiration the cavity with a legra.

All the process is made under ultrasound direct control.

Systematically, in all cases are administered the vaginal or buccal 400mcg of Misoprostol, in order to obtain a good expansion before initiating the procedure. This allows to reduce the anesthetic and surgical time sensibly us, obtaining a greater comfort for the patient, specially in the cases with local anesthesia.

Our center has used east procedure with misprostol (Cytotec) in more than 30.000 women before aborting throughout last the 10 years with excellent results (to see section publications).

The discharge takes place between 1 and 3 hours after the procedure, according to the anesthesia type. Before one gives a leaf of instructions, telephones to him of urgency, … and antibiotic medication (each 100 Doxiclina mg 12h) and uterotonic.

To the 14 days a revision is made post-I abort in our center or the center of Familiar Planning or gynecologist that us has sent it.

2º QUARTERLY PROTOCOL
(12 to 24 WEEKS)

Our protocols are based on the internationally surgery accepted criteria.

• Selection of the case according to anesthetic and surgical criteria.
• Selection of the procedure according to the case and its circumstances.
• Selection of the discharge criteria: immediate, deferred or transfer to entrance center.

Once made the passage by these 6 departments, each case is studied and analyzed by the Medical Committee and the social-ethic Committee of the Center and once obtained the approval of both it is come to the accomplishment of the abortion according to the technique assigned by the Medical Committee:

1. To ASPIRATION in gestation pregnancies of 12 to 15 weeks.
2. EXPANSION and EVACUATION (DyE) in gestation pregnancies of 15 to 19/20 weeks.
3. INDUCTION FARMACOLOGICA in gestation pregnancies of more than 19/20 weeks.

Most of the cases of 15 weeks, according to medical criterion are premedicaly with 200 mg. of mifepristona 12-48 before the procedure and with prostaglandins PG 1 (Misoprostol) the operation day or inductive process.

In case of methods A and B the vaginal dose of misoprostol used is 600 mcg and 800 in the case of the method C, except previous, whose protocol is different. The passage to operating room takes place 2 hours after the administration of this medication and 1.15 h. if they take mifepristona previous.

In the methods A and B it is made blockade paracervical and/or cervical infiltration with Epinefrina to 2%.

The surgical act and/or the expulsion is made under general sedation and with direct undersound control peroperatory

All the cases of more than 15 weeks take to analytical control to the 2 hours post intervention or post expulsion (Inductions).

In the case of the Inductions (method C) the stay is authorized of 1 or 2 relatives during the night (in case that the expulsion of the fetus extends) in order that the patient can be intermitently accompanied by somebody near one his surroundings.

In the methods A and B the RESTRICTED discharge takes place to 2-4 hours of the procedure. In method C the discharge takes place if the general state of the patient is correct to the 6 hours.

It is given to the antibiotic patient, uterotonic medication, as well as one detailed leaf of Instructions: urgency telephones, …, and a prescription to acquire an inhibitor of the lactancy (single as of the 15 weeks).

To the 24 hours a telephone control of the patient is made or in clinic if it comes.