4/16 Abortion

Question 1

when is abortion done?

Answer 1

before 20 weeks gestation, calculated from the date of onset of last menses

Question 2

∆ btwn early and late abortion?

Answer 2

Early abortion: before 12 weeks

Late abortion: from 12-20 weeks

Question 3

∆ btwn spontaneous and induced abortion?

Answer 3

spontaneous: complete, incomplete, threatened, inevitable, missed, or septic (see 4/14 for descriptions)
induced: intentional medical or surgical termination of a pregnancy; can be elective or therapeutic abortion

Question 4

∆ btwn elective or therapeutic abortion

Answer 4

both are induced, but

elective - performed for a woman’s desires

therapeutic - performed for reasons of maintaining health of the mother (her life is in danger)

Question 5

DHMC definition of abortion?

Answer 5

conclusion of a pregnancy by any means before the fetus is sufficiently developed to survive (viability)

Question 6

generally accepted gestational age of viability?

Answer 6

23 wks

@ 22 wks = fetus will NOT live
@ 23 wks = substantial increase in survival (25% survival), but these fetuses will usually have life-long handicaps
@ 24 wks = 55%

Question 7

definition of a safe abortion?

Answer 7

abortion done by a qualified professional under legal circumstances

Question 8

who is most likely to terminate an unwanted pregnancy? least likely?

Answer 8

woman at 14yo = most likely

woman at 30-34yo = least likely

Question 9

who generally gets the most later term abortions?

Answer 9

women who are fewest resources (usually <15yo)

Question 10

T/F US: abortion rates are on the decline

Answer 10

True

Question 11

Where does the highest rates of abortions occur?

Answer 11

Africa, 29/1000

Latin America, 31/1000.

Almost all are unsafe

Question 12

T/F The more restrictive a country’s abortion law, the higher are the rates of unsafe abortion and related mortality

Answer 12

True

Question 13

T/F Neither legal status or health risk deters women from terminating unwanted pregnancies

Answer 13

True

Question 14

What used to be a major component of maternal mortality?

Answer 14

Death from illegal abortion - Urethral catheters were a way to intentionally introduce bacterial infections into the uterus to get them into the hospital so that their pregnancy can be terminated; Hospital wards were filled with patients suffering from septic “spontaneous abortion”

Question 15

Where is abortion legal and safe? How does this affect the abortion rate?

Answer 15

N. America - abortion rate is actually lower (21 per 1000) than countries where abortion is illegal and not at all safe

Western Europe - contraception is also readily available to all; word’s lowest abortion rate

Question 16

T/F Restricting access to safe abortion does not save fetuses, but it often kills their mothers

Answer 16

True

Question 17

3 options that a pregnant woman has?

Answer 17

1) continuing the pregnancy and keeping the child
2) continuing the pregnancy and placing the child for adoption
3) induced abortion of a non-viable gestation (<23 wks)

Question 18

How does abortion procedures change depending on the stage of pregnancy?

Answer 18

The further along the pregnancy is the wider you have to dilate and the hardest it is to remove the embryo (more suction required)

Question 19

When is abortion complete?

Answer 19

The procedure is not complete until adequate contraception is provided; If the patient got pregnant after the abortion, then contraceptive method failed

Question 20

What abortion procedures are performed during the 1st Trimester of pregnancy and when?

Answer 20

Manual Vacuum Aspiration: up to 5-10 wks

D&C: Up to 12-13 weeks

Medical Abortion w/ Mifepristone (RU486): < 63 d with alternate regimens)

Question 21

When is manual vacuum aspiration usually done?

Answer 21

Up to 5-10 wks

Question 22

What steps must be done if the manual vacuum aspiration is performed?

Answer 22

1) Cervical dilation required to introduce cannula to evacuate the pregnancy (not required if 6 mm diameter cannula used)

2) Examination of aspirated tissue is essential because it’s still early in the pregnancy and it is easy to miss
3) Rh Prophylaxis – RhoGAM is given to Rh(-) patients due to risk of Rh sensitization after abortions

Question 23

Simplest, safest, least expensive abortion method?

Answer 23

manual vacuum aspiration - requires early recognition of pregnancy, but does not require electricity

Question 24

When is manual vacuum aspiration used?

Answer 24

1st Trimester Abortion
Failed Medical Abortion
Incomplete Abortion
Missed Abortion “miscarriages”
Postabortal Hematometria

Question 25

complications of manual vacuum aspiration?

Answer 25

Pelvic infection
Retained products of conception
Uterine perforation

Question 26

What steps must be done if D&C is performed?

Answer 26

cervix must be dilated wider to permit appropriate diameter suction curettes

usually a blind procedure – cannula is rotated around the uterus until it sucks out the fetus

NSAID prophylaxis for pain or local (paracervical block), spinal, conscious sedation, or general anesthesia (note that patients still feel it because it’s viscerally innervated (not the same as the dental nerve blocks where the nerve is directly blocked))

Question 27

after-care instructions for D&C?

Answer 27

infection – take antibiotics as prescribed; no sex, douching, use of sanitary pads/tampons, or inserting anything into the vagina for 2 weeks

fever – monitor closely; call if T = 38.0 (100.4), esp if there is abdominal tenderness or a foul smelling vaginal discharge

bleeding – no standard bleeding pattern; but call if a pad is soaked every ½ hour for 4-5 hours

Question 28

Complications of D&C?

Answer 28

infection
bleeding
pain/cramping
pregnancy sx (breast tenderness, nausea)
breast fullness about the third day or even milk
mild depression in the first few days from a drop in hormones

Question 29

when is D&C usually done?

Answer 29

Up to 12-13 weeks

Question 30

When is Medical Abortion w/ Mifepristone (RU486) usually done?

Answer 30

< 49 d with confirmed ßhCG and US dating

or < 63 d with alternate regimens

Question 31

what is the standard protocol if Medical Abortion w/ Mifepristone (RU486) is done?

Answer 31

Mifepristone (RU486) on d1, followed Misoprostol (prostaglandin) on d3

RU486 = terminates the pregnancy

Misoprostol = uterine contraction (to expel the pregnancy)

Question 32

What is a serious complication of Medical Abortion w/ Mifepristone (RU486) is done?

Answer 32

Clostridium sordellii – fatal infection

Question 33

What abortion procedures are done in the 2nd Trimester?

Answer 33

Dilatation and evacuation (D&E)
Dilatation and extraction (D&X), Induce labor
Abortifacients

Question 34

What is Dilatation and evacuation (D&E)?

Answer 34

Mechanical and suction removal of fetal parts after cervical dilation

cervix dilator with Laminaria – seaweed stems that take up water from the cervix and exerting gentle pressure to expand the cervix

usually done under general anesthesia (compared to earlier pregnancies), but is not required

Question 35

complications of Dilatation and evacuation (D&E)?

Answer 35

improperly placed laminaria

infection

Question 36

What is Dilatation and evacuation (D&E)?

Answer 36

dilate cervix, fetal body is extracted, leaving the head. A cannula is then introduced into the head and sucked brain, which collapses the skull, which is delivered last

Question 37

What can you use to induce labor as a form of abortion?

Answer 37

1) Misoprostol = uterine contraction (to expel the pregnancy)
2) Prostaglandin vaginal suppositories
3) High dose oxytocin – as effective as PGE2 when used in appropriate doses, but risk of H2O intoxication
4) Hysterotomy – pregnancy is removed abdominally (mini C-section); usually done as a life-saving maneuver when things have gone awry

Question 38

Complications of labor?

Answer 38

1) Complications of local anesthetic
2) Cervical shock - vasovagal syncope resulting from stimulation of the cervical canal (dilation) -> patients become hypotensionsive (decr. HR);

3) Cervical lacerations
Hemorrhage (due to uterine atony)

4) Post abortal syndrome (when uterus doesn’t contract well enough; results in a blood clot that causes the uterus to contract even more)
5) Uterine perforation

Question 39

What are Abortifacients and how are they used in abortion?

Answer 39

Intracardiac KCl or Digoxin - may be used in conjunction with other techniques to terminate the fetus’ life before the procedure

other stuff that can be used:
Prostaglandins
hypertonic saline
hypertonic urea