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Gyn Induced Abortion
| Question | Answer |
|---|---|
| What percentage of induced abortions occur in the first 12 weeks of pregnancy? | 88% (according to 1998 data) |
| ___ percent of all US counties lack an abortion provider | 87% |
| ___ percent of induced abortions are repeat procedures | 44% |
| ___ % of induced abortions are done via curettage | 81%. 9.9% by medication |
| ___% of US women seeking abortion are younger than 25 | 52% |
| 81% of women seeking an induced abortion are | unmarried |
| 54% of women used a contraceptive method the month they became pregnant. Of pill users, ___% had inconsistet use | 76% |
| Consideration for minors | mandatory waiting periods, parental consent/notification for minors, mandated couseling topics required in some states |
| Consequence of not giving Abx to women with induced abortions | post-abortal endometritis occurs in 5-20% of these women. Prophylactic abx reduced 1/2 of peri-abortal endometritis in all groups |
| Sequelae of infection post abortion | infertility, ectopic pregnancy, chronic pelvic pain |
| Non-surgical early gestation techniques | Mifepristone, Methotrexate, Misoprostol |
| Non-surgical late gestation techniques | Intravaginal Prostaglandins, Intraamniotic abortifacients (hypertonic saline, Urea, prostaglandins) |
| Surgical Abortion Techniques | Manual Vacuum Aspiration, Dilation and Curettage, Dilation and Evacuation |
| Cervical Preparation in Surgery | Prostaglandins, Rigid Dilators, Osmotic Dilators (laminaria, dilapan, lamicel) |
| Analgesi/Anesthesia in Surgery | NSAIDs, Opioids, Anxiolytics, Paracervical Block, Regional or General Anesthesia |
| Delayed complications of abortion | More than 72 hours post procedure, 1% of cases, retained products, infection, ongoing pregnancy, breast cancer |
| the embryo or fetus dies in utero, but products of conception are retained | Missed abortion |
| Roe v. Wade 1973 | Right to choose abortion until viability. Planned Parenthood v. Danforth, 1976: reaffirmed that viability is a medical judgment |
| Legal aspects at the state level | State may regulate induced abortion after 3 months. If you are a minor, you need permission from a parent/grandparent with whom you have lived from at least 6 months. |
| Evaluation of patient requesting IAB | Is the patient pregnant? Hx of pregnancy complications, medical/surgical hx, estimated gestational age, US if equivocal |
| To determine if the patient is pregnant | HCG, document LMP and whether LMP was normal |
| Patient Examination | External Genitalia: lesions, Vaginal: septa, infection, Cervix: lesions, mucopus (cyanosis) |
| Lab Tests | wet prep for vaginal infections, GC/chlamydia testing, other STD testing if indicated (offer), Current pap smear, Hct, Rh(D)status |
| At 12 weeks, your uterus is the size of a | grapefruit. Nulliparous, non-pregnant women's uterus is firm, walnut-size |
| Leiomyomas and uterus high in the pelvic correlate with what gestational size? | Large. Non-viable pregnancy, missed abortion and ectopic pregnancies correlate to small size |
| When should a woman be given Rhogam? | If woman is Rh negative |
| Methods of IAB | Suction currettage, surgical currettage, manual vacuum aspiration (MVA), medical abortion |
| Which is standard of care, suction or sharp currettage? | Suction. More rapid evacuation of the uterus, less blood loss, lower risk of uterine perforation, lower risk of synechiae or Asherman's syndrome |
| Another technique of abortion in developing countries that can be performed as early as 4 weeks from Last Menstrual Period. | manual vacuum aspiration. With suction/surgical currettage earlier IAB is risky due to higher potential for missed products of conception |
| Complications of abortive techniques | Vasovagal reaction (usually dilation), retained products of conception, uterine perforation, cervical injury, pelvic infection, hemorrhage, hematometra, DIC (extremely rare) |
| Strongest risk factor for abortion-related mortality | Gestational age. Lowest risk of death occurs when abortions<8weeks. Risk of mortality before 9 weeks 1/500,000 |
| When can medical abortions be used? | When a woman is less than 49 days from LMP |
| FDA approved medical abortion regimen | Day 1: Mifepristone (Rhogam if Rh negative), Day 3: Misoprostol, Day 14: f/u with US, surgical completion if necessary |
| Alternative medical regimen | lower dose mifepristone, vaginal misoprostol, Use up to 63 days LMP, NOT FDA APPROVED. Vaginal misoprostol as underground IAB |
| Sequelae of abortion | Relief, guilt, sadness, sense of loss, multiple procedures: possible risk of incompetent cervix |
| The pregnancy with the highest mortality rate is | ectopic pregnancy: 31.9/100,000 |
Created by:
ltm12