Please select the eligibility criteria that correspond to the clinical trial below.
Title: Task Sharing to Improve Post Abortion Care at District Health Care Level- Trial in Uganda
Brief Summary: Uganda is one of the countries with highest fertility rate in the world, 6.7 children per women. It is estimated that 56 percent of all pregnancies are unintended and the contraceptive prevalence rate in Uganda is 23 percent. Unwanted pregnancy is common and induced abortion is illegal. Unsafe abortion is responsible for significant morbidity and mortality among women in Uganda. Almost 40% of admissions to emergency obstetric care units in Uganda due to unsafe abortion is reported and considered high in international comparison. Studies have revealed that trained midlevel providers can deliver safe post abortion care (PAC) for incomplete abortion and use manual vacuum aspiration. The prostaglandin E1 analogue misoprostol has been shown to be an effective tool in the treatment of incomplete abortions. This option is so far under-used in developing countries, especially outside the larger hospitals and private clinics. One significant limiting factor in providing safe PAC is the lack of providers. So far technical training has been mainly limited to physicians. The long-term goal of this project is to provide evidence based information that will contribute to the development of strategies to increase women's access to high level post- abortion care at primary health care level provided by midlevel providers in Uganda. A task shift to midlevel provider in providing treatment of incomplete abortion will increase access to safe PAC and is a key to Millenium Development Goal 5. Misoprostol treatment of incomplete abortion remains underused and in accessible to a majority of women in Uganda because national regulations restricts its prescription and supervision to doctors. However, the safety of misoprostol treatment should make it amenable to provision by midlevel providers. Training of midlevel providers in misoprostol treatment of incomplete abortion will support task shifting in places where doctors are costly and scarce. By evaluating the effectiveness of mid-level providers (midwives); administering misoprostol treatment of incomplete abortion the project is attempting to contribute to the reduction of maternal mortality and morbidity and safeguard high quality of post-abortion care. A direct economic impact can also be expected due to reduced treatment costs of complications from unsafely induced abortion and incomplete abortions. The involvement of midlevel providers in medical treatment of incomplete abortion has previously not been systematically evaluated in African primary health care setting.


Options:
A: Inclusion Criteria:

Early pregnancy failure, 6-14 weeks postmenstrual with

* a crown-rump length ≥ 6mm and no cardiac activity OR
* a crown-rump length \<6mm and no fetal growth at least one week later OR
* a gestational sac with absent embryonic pole for at least one week.

  * At least one week after diagnosis OR a discrepancy of at least one week between crown-rump length and calendar gestational age
  * Intra-uterine pregnancy
  * Women aged above 16 years
  * Hemodynamic stable patient
  * No signs of infection
  * No signs of incomplete abortion
  * No contraindications for mifepristone or misoprostol

Exclusion Criteria:

* Patient does not meet inclusion criteria, discovered after randomization
* Inability to give informed consent
* Known clotting disorder or use of anticoagulants
* Known risk factors for, or presence of, a cardiovascular disease
* Language barrier
B: Inclusion Criteria:

* women presenting with a positive urine test and uterine size equivalent to or up to 9 +0 weeks (63 days) of gestation
* opting for medical abortion and
* residing in an area where follow-up is feasible.
* woman agrees for a follow up contact at 10-14 days.

Exclusion Criteria:

* women with contraindications to medical abortions,
* haemoglobin level less than 85 (Hb \< 85) and
* age less than 18 years.
C: Inclusion Criteria:

* All women above 18 years of age
* Less than 12 weeks of gestation.
* Pregnancy is confirmed by pregnancy test or ultrasound scan.
* missed abortion
* Normal general and gynecological examination.
* The size of the uterus on pelvic examination was compatible with the estimated duration of pregnancy

Exclusion Criteria:

* Hemodynamically unstable.
* Suspected sepsis with temperature 38 °C.
* Concurrent medical illness e.g. hematological, cardiovascular, thromboembolism, respiratory illnesses, recent liver disease or pruritus of pregnancy.
* Presence of intrauterine contraceptive device (IUCD).
* Suspect or proven ectopic pregnancy.
* Failed medical or surgical evacuation before presentation.
* Known allergy to misoprostol.
D: Inclusion Criteria:

* bleeding and contractions during pregnancy

Exclusion Criteria:

* women with known allergy to misoprostol,
* a uterine size more than 12 weeks of gestation,
* suspected ectopic pregnancy,
* unstable hemodynamic status and chock,
* signs of pelvic infection and/or sepsis.

Answer: D