16. Abortion care

Question 1

EMA

Answer 1

Early medical abortion, <10 weeks

Question 2

Drugs for EMA:

Answer 2

• Mifepristone 200 mg (anti-progesterone, PO)

- Misoprostol 800 mcg (prostaglandin analogue, 24-48h later at home, vaginal/buccal/sublingual)

Question 3

Steps of EMA:

Answer 3

• Starts 2-3h after misoprostol
• Heavy bleeding with clots for up to 2weeks
• Lower abdominal pain
• Most complete within by 4 hours, all by 24h

Question 4

Medical abortion

Answer 4

Inpatient abortion >10 weeks

Mifepristone 200mg PO, then 3-hourly misoprostol

Question 5

How to prevent live birth in medical abortion?

Answer 5

• Feticide recommended from 22 weeks
• Digoxin: intraamnionic, intrafoetal, intracardiac
• Potassium chloride: intracardiac

Question 6

Types of medical abortion:

Answer 6

• Vacuum aspiration (<14 weeks): aspiration electric/manual suction, local or GA.
• Dilatation and evacuation (14-24weeks): cervical preparation with misoprostol and removal of foetus and placenta using forceps and vacuum.
• Surgical abortion: GA, 1 week of vaginal bleeding

Question 7

Prophylaxis of medical abortions:

Answer 7

• Abx (Azithromycin 1g oral OR Doxycycline 100mg bd for 7 days; Metronidazole 1g rectal or 800mcg oral)
• Anti-D (prophylactic for all Rh-ve, non-sensitised women, administered within 72h)