4/16 Abortion Flashcards
when is abortion done?
before 20 weeks gestation, calculated from the date of onset of last menses
∆ btwn early and late abortion?
Early abortion: before 12 weeks
Late abortion: from 12-20 weeks
∆ btwn spontaneous and induced abortion?
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
∆ btwn elective or therapeutic abortion
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)
DHMC definition of abortion?
conclusion of a pregnancy by any means before the fetus is sufficiently developed to survive (viability)
generally accepted gestational age of viability?
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%
definition of a safe abortion?
abortion done by a qualified professional under legal circumstances
who is most likely to terminate an unwanted pregnancy? least likely?
woman at 14yo = most likely
woman at 30-34yo = least likely
who generally gets the most later term abortions?
women who are fewest resources (usually <15yo)
T/F US: abortion rates are on the decline
True
Where does the highest rates of abortions occur?
Africa, 29/1000
Latin America, 31/1000.
Almost all are unsafe
T/F The more restrictive a country’s abortion law, the higher are the rates of unsafe abortion and related mortality
True
T/F Neither legal status or health risk deters women from terminating unwanted pregnancies
True
What used to be a major component of maternal mortality?
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”
Where is abortion legal and safe? How does this affect the abortion rate?
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
T/F Restricting access to safe abortion does not save fetuses, but it often kills their mothers
True
3 options that a pregnant woman has?
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)
How does abortion procedures change depending on the stage of pregnancy?
The further along the pregnancy is the wider you have to dilate and the hardest it is to remove the embryo (more suction required)
When is abortion complete?
The procedure is not complete until adequate contraception is provided; If the patient got pregnant after the abortion, then contraceptive method failed
What abortion procedures are performed during the 1st Trimester of pregnancy and when?
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)
When is manual vacuum aspiration usually done?
Up to 5-10 wks
What steps must be done if the manual vacuum aspiration is performed?
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
Simplest, safest, least expensive abortion method?
manual vacuum aspiration - requires early recognition of pregnancy, but does not require electricity
When is manual vacuum aspiration used?
1st Trimester Abortion Failed Medical Abortion Incomplete Abortion Missed Abortion “miscarriages” Postabortal Hematometria
complications of manual vacuum aspiration?
Pelvic infection
Retained products of conception
Uterine perforation
What steps must be done if D&C is performed?
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))
after-care instructions for D&C?
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
Complications of D&C?
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
when is D&C usually done?
Up to 12-13 weeks
When is Medical Abortion w/ Mifepristone (RU486) usually done?
< 49 d with confirmed ßhCG and US dating
or < 63 d with alternate regimens
what is the standard protocol if Medical Abortion w/ Mifepristone (RU486) is done?
Mifepristone (RU486) on d1, followed Misoprostol (prostaglandin) on d3
RU486 = terminates the pregnancy
Misoprostol = uterine contraction (to expel the pregnancy)
What is a serious complication of Medical Abortion w/ Mifepristone (RU486) is done?
Clostridium sordellii – fatal infection
What abortion procedures are done in the 2nd Trimester?
Dilatation and evacuation (D&E)
Dilatation and extraction (D&X), Induce labor
Abortifacients
What is Dilatation and evacuation (D&E)?
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
complications of Dilatation and evacuation (D&E)?
improperly placed laminaria
infection
What is Dilatation and evacuation (D&E)?
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
What can you use to induce labor as a form of abortion?
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
Complications of labor?
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
What are Abortifacients and how are they used in abortion?
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
