Abortion

Question 1

What is the definition of abortion?

Answer 1

removal of fetus or embryo from the uterus before the stage of viability

Question 2

1 in ___ women in the US will have an abortion by the age of 45

Answer 2

4

Question 3

What proportion of abortions occur prior or at 8w GA? What percentage occur in the first 13 weeks?

Answer 3

2/3, 91%

Question 4

What abortion methods are available for an induced abortion vs. a SAB at <10w, 10-12w, 12-14w, and >14w?

Answer 4

<10w
- Induced: medication (mifepristone and misoprostol), aspiration (D&C)
- SAB: medication (misoprostol only), aspiration (D&C)
10-12w
- Induced: aspiration (D&C)
- SAB: medication (misoprostol only), aspiration (D&C)
12-14w
- Induced: cervical prep often required for aspiration
- SAB: cervical prep often required for aspiration
>14w
- Induced: cervical prep and D&E
- SAB: cervical prep and D&E

Question 5

What are the options for cervical prep?

Answer 5

• medical: misoprostol
• dilation: synthetic (dilapan) or natural (seaweed)

Note: for dilation, the dilator is placed in the cervix 4-48h prior to procedure where it swells to 3-4x dry size and exerts radial pressure which releases prostaglandins and allow cervix to open

Question 6

What are the 2 types of evacuation used up to 14w GA? >14w GA?

Answer 6

• up to 14w: manual vacuum aspiration, electric vacuum aspiration
• after 14w: D&E (most common - 96%), LIA (4%)

Question 7

How safe is abortion?

Answer 7

• prior to 9w GA: chance of death is <1 in 100,000 (comparable to using a tampon)
• after 20w GA: chance of death is 12 in 100,000
• birth: chance of death is 14 in 100,000

Note: abortion is less risky than driving a car, lip, and colonoscopies

Question 8

What are some indications for abortion?

Answer 8

• life/social circumstances
• maternal health
• miscarriage or IUFD
• pregnancy complications (placental abruption, PRM before viability, early severe preeclamsia, HELLP syndrome, fetal anomalies)