intro to apr network · 4/4/2020 · abortion pill/chemical abortion two different chemicals to...

Intro to APR Network

William Lile, Jr,. DO

APR, Medical Advisor

Christa Brown BSN, RN, LAS

Director of Medical Impact

Introduction of APRChrista Brown BSN, RN LAS

Why chemical abortion?

Fast-paced society

“Convenience”

“Privacy”

Abortion on demand

Heartbeat International-Please do not share without written permission.

Why chemical abortion?

More “natural” way to

terminate

Done at the earliest

stages of pregnancy

Privacy of their own home


What is chemical abortion?

Non-surgical abortion

Abortion pill, RU-486

Medication abortion

Chemical abortion


Mifepristone/RU-486

Developed by French company

Rousseau Uclaf in 1980

Company that created Zyklon B pellets

(subsidiary of Hoechst AG)

Zyklon B (Cyanosil)- Powered gas chambers during the Holocaust at

extermination camps

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Availability online


At least 72 unique websites –30 abortion websites and 42 pharmacy websites

“pain-free” abortion but also lists painful side effects

“100% working”

“Completely safe, effective, pain-free and infection-free”

“Harmless and successful” “early stage pregnancy execution”https://lozierinstitute.org/fact-sheet-online-sales-of-mifeprex-and-misoprostol-for-self-abortion/

https://lozierinstitute.org/fact-sheet-online-sales-of-mifeprex-and-misoprostol-for-self-abortion/

Women on the Web

Organization created to push chemical abortion on

nations where it is prohibited by law or they feel not easily accessible

Between 2010 and 2012, 1,642 women ordered abortion pills over the

internet from Women on Web, and had an abortion

at home, in Ireland.

https://en.wikipedia.org/wiki/Women_on_Web

Abortion Pill/Chemical Abortion

Two different chemicals to

end a pregnancy:

mifepristone and misoprostol.

First, a pill called mifepristone.

Mifepristone blocks the

body's own progesterone,

stopping the

pregnancy from growing

Chemical

Abortion

Combination more

than 95% effective

during the first 49 days of pregnancy

Used in second

trimester of pregnancy

in some countries


Chemical Abortion

Day One: mifepristone 200-600 mg (po)

6-72 hours later: misoprostol 400-800 mcg (po, buccal mucosa, or vaginally)

Pregnancy is passed within 2 to 24 hours after misoprostol tablets

Day Seven-Fourteen: confirmation of fetal demise and empty uterus

Mifepristone

Progesterone receptor antagonist.

Considered a progesterone receptor modulator.

70% oral absorption

After first-pass, 40% available

Binds to progesterone receptor twice as well as progesterone.

Some actions of progesterone

Prepares endometrium

Develops placenta

Inhibits contractions

Keeps cervix closed


Symptoms chemical abortion


Cramping and vaginal

bleeding

Side effects : nausea,

weakness, fever/chills,

vomiting, headache,

diarrhea, and dizziness

Complications in at least 1/5

women: infection,

incomplete abortion,

hemorrhage

Mifepristone


Incomplete abortion - 20-40% of the time uterus not emptied

Rates of surviving embryo were <1% before 49 days and 9% if given at 57-63 days.

Thus the need for misoprostol

https://www.ncbi.nlm.nih.gov/pubmed/19888037


Spitz IM et al. “Early pregnancy termination with mifepristone and misoprostol. NEJM 338:18 (April 30, 1998) 1241-47.



Taking Back

It is scientifically indisputable that

every

human life—including unique DNA and all other

building blocks of life—

starts at the moment of

conception.


Taking Back


Abortion ends the

life

of a whole,

separate,

unique,

living human.

The Truth

Denying women

the truth

denies them real

choice.

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Taking back

Every innocent

human life—

whether born or

not—

is valuable,

precious, and

worthy of full

protection.


Taking Back

Women often

regret their

abortions—

sometimes that

regret sets in right

away.


A Second Chance

to Choose


Women deserve to

know the whole truth

including choices she

can make every step of

the way.

APR empowers women

with real choices

APRNetwork

Nearly 1,000 women have successfully stopped their abortions and saved their children through APRN—a hotline and network of over 900 medical professionals, operated by Heartbeat International, which is the world’s largest affiliation of pregnancy help organizations.


APRN Advisory Team

Dr. George Delgado

Dr. Matt HarrisonDr. Brent Boles

Dr. William Lile

Dr. Karen Poehailos

Dr. Robert Snyder

APR

Hotline

OptionLine staffed 24/7 to assist women in need

Reversal calls routed to APR Healthcare Team

Reversal explained, intake completed

Connected with a local APR Network Provider

Immediate Help for Women

CALL OUR 24/7

HELPLINE:

(877) 558-0333

Go to website for chat

Email [email protected]


mailto:[email protected]

APR Hotline

The science behind the protocol

Dr. William Lile

Who is the

patient?

"A patient is a person

no matter how small."

—Dr. William Lile

Progesterone

Indications

LPD

Preterm Labor

IVF

Ethics of

Treatment

There is reasonable

evidence that

suggests progesterone therapy after

mifepristone can

improve embryo

survival and

pregnancy

continuation.

Off Label or Off Base?

Off label use of medications is readily

accepted and practiced.

Current mifepristone abortion protocol

was an off label use until March 2016.

Our off label use of progesterone is no

different since progesterone and 17-OH

progesterone is approved in pregnancy.

Ethics of Treatment

Cutting-edge application of a

time-tested, FDA-approved

treatment used for decades to

prevent miscarriage and

preterm birth

Emergency, ongoing doses of

progesterone to counteract

the effects of the first

abortion pill.


Why

Progesterone?

Mifepristone blocks progesterone

Destabilizes pregnancy

Bio-identical progesterone

Anecdote to mifepristone

Oral Protocol

Prometrium brand or progesterone generic micronized oral capsules 200 mg, two capsules (400 mg) by mouth ASAP and bedtime on day 1 (must be at least 5 hours apart). 200mg, two capsules (400 mg) AM and PM on day 2 and 3.

Continue progesterone 200mg, two capsules (400mg) at bedtime until the end of first trimester or according to your clinical judgment.


Vaginal Protocol

Prometrium brand or progesterone generic micronized oral capsules 200 mg, two capsules (400 mg) inserted vaginally ASAP AND at bedtime day 1 (must be at least 5 hours apart). 200mg, two capsules (400 mg) AM and PM on day 2 and 3.

Continue progesterone 200mg, two capsules (400 mg) inserted vaginally daily at bedtime until the end of first trimester or according to your clinical judgment.


Intramuscular Protocol

Compounded progesterone in oil 200mg (100mg/ml or 50mg/ml) intramuscularly (IM) ventral or dorsal gluteal muscle, slowly over 2-3 minutes as soon as possible after the ingestion of mifepristone.

Continue progesterone in oil, 200 mg IM once a day for two more days.

Continue progesterone in oil, 200mg IM every other day until day 14 after mifepristone ingestion.

Continue progesterone in oil, 200 mg IM twice a week until the end of the first trimester. Consider tapering the progesterone after the first trimester, according to your clinical judgment.


https://www.ncbi.nlm.nih.gov/m/pubmed/31094126/

https://www.ncbi.nlm.nih.gov/m/pubmed/31094126/

More Progesterone

Some clinicians monitor progesterone levels

after the first trimester and administer

progesterone if the levels are low.

See Hilgers TM The Medical and Surgical

Practice of NaProTECHNOLOGY 2006, The Pope Paul VI Institute for the Study of Human

Reproduction or www.naprotechnology.com.

Additional APR

Instructions


If prescribing oral, prescribe enough for one

week at a time with refills.

Provide ultrasound as soon as possible to

confirm embryonic viability and intrauterine

location.

If less than 6 weeks after LMP, consider

monitoring serial HCG levels and provide

ultrasound at 6 weeks.

Additional APR Instructions


Ultrasound every 1-2

weeks during the first

trimester.

Plan for ongoing care.

Issues in Law and Medicine 2017

https://www.dropbox.com/s/60ynmym00sf0r7m/Screenshot%202017-09-04%2011.11.16.png?dl=0

Reversal Rates

High Dose Oral Protocol 68% Reversal Rate (p <.001, CI 0.51-0.84)

Injection Protocols 64% Reversal Rate (p <.001, CI 0.56-0.72)

All Groups 48% Reversal Rate (p <.001, CI 0.44-0.52)

Injection 6-8 100% Reversal Rate ( p <.001, CI 0.67-1.0)

Gestational Age and

Reversal

5 weeks gestational age: 25%





Birth Defects

and Preterm

The birth defect rate is

no greater than the

general population (2.7% vs. 3%).

The preterm delivery

rate was lower than

the general

population

(2.7% vs. 10%).

The Research

o Peer-reviewed study shows 64-68% success rate

o APR triples chances of live birth

o 1,000 mothers have successfully rescued their babies

Delgado, G. M.D.,Condly, S. Ph.D., Davenport, M.M.D., M.S., Tinnakornsrisuphap, T. Ph.D., Mack, J. Ph.D., NP, RN, Khauv, J. B.S., and Zhou P., A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine, Volume 33, Number 1, 2018.

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Birth Defects and

Preterm

Birth defect rate not increased

Preterm delivery rate lower

Progesterone routinely & safely used in

pregnancy

Medical Management of First

TrimesterAbortion. ACOG Practice Bulletin 143

March 2014, reaffrrmed 2016).

Mifepristone

Mifepristone does not cause birth

defects.

The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin Number 143, March 2014:

“No evidence exists to date of a

teratogenic effect of mifepristone.”

Misoprostol (Cytotec)

If both medications are

taken:

Two to four-fold increase in

birth defects

Progesterone Safety

A 1999 FDA review- no risk of birth defects in pregnant women taking progesterone.

Pope Paul VI Institute -There is no credible evidence to suggest that its use to support pregnancy is in any way teratogenic or responsible for any malformations.

All of the available evidence strongly supports its safety when used in pregnancy.

Unleashing the power of a woman’s cycle: Progesterone Support in Pregnancy. Pope Paul VI Institute- NaPro Technology Web Site. https://www.naprotechnology.com/progesterone.htm. Retrieved July 11, 2018.

Vaux NW and Rakoff AE: Estrogen-progesterone therapy: A new approach in the treatment of habitual abortion. Am J Obst Gynec 50:353, 1945.Jones, GES: Some newer aspects of the management of infertility. JAMA 141:1123, 1949.

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https://www.naprotechnology.com/progesterone.htm

Conclusions

Our growing case series supports the conclusion that the effects of mifepristone can be stopped by the administration of progesterone.

Our goal is to have the progesterone out-compete the mifepristone at the progesterone receptor.

There is no scientific evidence suggesting that mifepristone significantly increases the risk of birth defects.

Progesterone and 17-hydroxyprogesterone caproate are safe in pregnancy.

A

Physician’s

Perspective

Assisting clients & Enrolling in Network -Christa

Advertising APR


Park benches near clinics

Billboards

Newspapers

School ads

Yard signs

Bathroom ads

(restaurants and bars)

Social Media

Google Ads

Available to You

Hotline staffed by nurses

Model standing orders

Model policies and procedures

Protocol

Advice available from nurses and APR

Advisory Team

Protocol & sample policies

Sample documents

Research articles

Statements of support

APR for NextLevel


APR Data Tool

Virtual Center

Outcome report

Accommodates needed research

How do we

enroll?


Submit the information

Receive confirmation

Be ready to take calls

https://aprnworldwide.com/

https://aprnworldwide.com/

What do

clients say?

Thankful moms

Healthy babies

“I’m so glad she’s here and I’m proud to be her mommy. Thank you again to the nurses for your help. So glad your organization exists. It’s the best thing you can do-give second chances…”


Abortion Pill Reversal

APR is safe.

APR is effective.

Women given the opportunity to reverse the effects of mifepristone (RU-486) are very grateful.

We are here to help you implement APR in Ireland.

intro to apr network · 4/4/2020 · abortion pill/chemical abortion two different chemicals to...

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