25: Elective termination

Question 1

First trimester abortion options include ?

Answer 1

suction curettage, manual vacuum aspiration, D/C, and medication abortion (MTX, MFP) up until week 9

Question 2

90% percent of all abortions in the US are achieved using ?

which can be performed anytime during the first trimester but is most effective between ? weeks’ gestation.

Answer 2

suction curettage.

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Question 3

complications of suction curettage?

Answer 3

infection, bleeding, and perforation of the uterus

Question 4

Mifepristone (RU 486) is an abortifacient that blocks ?

Answer 4

progesterone stimulation of the endometrial lining, thus causing detachment of the embryo.

Question 5

Methotrexate is a chemotherapeutic agent that blocks ?

Answer 5

dihydrofolate (DHF) inhibitor that interrupts placental proliferation.

Question 6

Both mifepristone and methotrexate are used in combo with ? effective in what window of time?

Answer 6

a prostaglandin (often misoprostal) 
and have high efficacy rates (92% to 98%) for medical termination when used within 63 days of the LMP. (about 2 months)

Question 7

During the second trimester, abortion may be achieved via ? or ?
which one is safer?

Answer 7

D/E or IOL.

D/E has lower maternal mortality and morbidity compared to IOL

Question 8

D/E is similar to suction curettage (D/C) but requires ?

Answer 8

wider cervical dilation and the use of special forceps and curets to assist with the extraction of the larger volume of fetal parts.

Question 9

Complications of D/E

Answer 9

cervical laceration, hemorrhage, infection, uterine perforation, and retained tissue.

Question 10

IOL techniques

complications?

Answer 10

cervical ripening with a prostaglandin, and amniotomy along with induction of labor with high-dose oxytocin.
complications: retained placenta, hemorrhage, infection, and cervical laceration.

Question 11

Maternal morbidity is ? for suction curettage ? for D/E and ? for induction of labor compared to ? for term pregnancy and delivery.

Answer 11

0.1 per 100,000 for suction curettage
4 in 100,000 for D/E
8 in 100,000 for IOL
7.7 in 100,000 for term pregnancy and delivery.

Question 12

For early pregnancies up to 10 weeks of gestation, ? (similar to suction curettage) can be performed.

Answer 12

manual vacuum aspiration

no sharp curettage

Question 13

The typical protocol used for termination involves ?

Answer 13

a single oral dose (200 to 600 mg) of RU 486 (Mifepristone) followed by a buccal (400 to 800 mcg) or vaginal (800 mcg) dose of misoprostol (Cytotec) 24 to 48 hours later.

Question 14

MTX administration ?

CI in pts with ?

Answer 14

IM or PO within 49 days of the LMP, followed by misoprostol (Cytotec) 6 to 7 days later.

Question 15

efficacy rates of both mifepristone and methotrexate decline for pregnancies greater than ? gestation.

Answer 15

7 weeks’

Question 16

CIs to medical abortion

Answer 16

Pregnancy +63 days from LMP, Pregnancy with an IUD in place, Obstruction of the cervical canal, Ectopic pregnancy, Gestational trophoblastic disease, Chronic systemic steroid use
Bleeding disorder, chronic adrenal failure, Allergy to mifepristone or misoprostol, Inability to sign the consent agreement because of lack of competence

Question 17

2nd trimester abortions, when and why?

Answer 17

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Congenital fetal abnormalities are the primary reason
-others: severe hyperemesis, previable PPROM, life-threatening maternal conditions, and undesired pregnancy.

Question 18

Osmotic dilators

Answer 18

dilators are placed into the cervix the day before the procedure and gradually dilate and soften the cervix as they absorb the cervical moisture
-synthetic (Lamicel, Dilapan) or natural (seaweed-based laminaria).

Question 19

if IOL ? to prevent live birth

Answer 19

Feticidal agents (intraamniotic saline or digoxin and intracardiac potassium chloride) can be used in conjunction with prostaglandins to circumvent the possibility of live birth.