18) induced Abortion. Flashcards
what is abortion?
ermination of pregnancy and death of the fetus
abortion can happen two ways which are they?
can be spontaneous or induced
abortion can be induced and this is legal unto the?
24th week of gestational age - but this number differs among countries
and exceptions :if fetal anomaly inconsistent with extrauterine life is identified later pregnancy termination is possible
continuation of pregnancy impose serious health issue on mother
resulting from rape
First Trimester (Up to 12 Weeks) what can be used to induce abortion/
Medical - up to 10 weeks
first oral tablet of Mifepristone - is an anti progestin
progesterone is an important hormone that keeps the pregnancy going
+
24-48 hrs after taking this
vaginal misoprostol tablets or oral (PGE1) - dilation and effacement of the cervix , along with strong contraction of the uterus
= 2 weeks follow up to see if abortion is complete where there is bleeding and abdominal cramps
-ultrasound, b-hcg
best result acquired in less than 7 weeks
Methotrexate and misoprostol
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Surgical
GOLD STANDARD
Suction evacuation -6-12weeks (dilation and curettage)
suction aspiration
vacuum aspiration
describe suction and evacuation ?
misoprostol vaginal tablets given 6 hours prior to procedure to ripen the cervix so when hegar dilator used you can start with 6
or laminaria and lamicel used the day before
general anesthesia
speculum inserted
the anterior lip of the cervix is held with tenaculum
greater than 10 weeks - sponge holding forceps
a strong pull from this will straight the cervical anal and passage of other instruments
(if misoprostol not given start with a smaller hegar number)
6 metal hegar dilator inserted and held in a pen like manner progressively increasing in size
amount of dilation = gestation uterocervical length +2
flexible plastic suction catheter or MTP cannula inserted which is attached to a plastic syringe or electric vacuum extractor
the cannula in the uterus must be rotated clockwise and anticlockwise to get all the products of conception.
the other hand must be placed on the fundus to minimise the risk of perforation
continue till no more products are aspirated and air bubbles start appearing in suction cannula , the bleeding s reduced
and the cervical canal tends to close down
then we use sharp curette to get rid of any addition pieces of conception by scrapping all the walls of the uterine cavity
uterine massage is done - uterus should be small and firmer than than before
what is the complication of suction and evacuation without the curette
because it is done blind , parts of conception can still be in the uterus or placenta -
leading to hemorrhage and infection
what is the complication of dilation and suction evacuation and curettage ?
incomplete abrtion - hemorrhage and infection
uterine perforation - curette
cervical laceration
complication of future pregnancy - due to abortion related trauma and injury to the cervix = sponatenos miscarriage ,preterm labour
injury to intrabdominal structure such as bladder and intestines
curettage - aSherman syndrome
after dilation suction evacuation curettage why is it very important to visualise the products of conception sucked and destroyed ?
to ensure they include fetal parts
gestational sac
chorionic villi and not just decidua
if not seen <6wks pregnancy
ectopic pregnancy
perforation
what is the post operative management in first trim ?
contraception MUST start from the next day - because ovulation starts early as 20 days
rh negative - anti
what are the side effects of prostaglandins ?
nausea
vomitting
diarrhoea
heavy bleeding
what are the second trimester methods of termination of pregnancy ?
medical mifepristone oral and 48hrs later misoprostol vaginal tablets
dinoprostone - PGE1 - vaginal suppository
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surgery
13-24 weeks
dilation and evacuation
describe dilation and evacuation ?
cervix needs to be prepared 24-48 hrs with laminaria (sterilised seaweed which absorbs water)
/ misoprostol / mifepristone
general anesthesia
speculum used access and see the cervix
then suction tube is placed inside
amniotic fluid is suctioned through the catheters first
then we use a sopher clamp used to tear the baby and delivered out
the hardest part is the head which is crushed with gopher clamp - we know the skull is crushed when a while substance comes out of the cervix (baby’s brain)
a curette is used to get rid of the placenta and any other products of conception scarping the line of the uterus
the abortinist always assembles the baby parts to know that there is two legs and all the pieces
what are the major complication risk for dilation and evacuation?
same complication
as dilation and suction evacuation and curettage
