abortion Flashcards
induced abortion
percentage
non natural termination of pregnancy (post implantation)
20.8/1000
Personhood
At conception At implantation (7 days) When fetus resembles a person At quickening (16-20 weeks) 15% viability outside the womb with intervention (24 weeks) Viability with intervention (28 weeks) At birth
Reasons for abortion
Unwanted pregnancy Population control Risk to woman’s health Fetal defects (physical or neurological( Rape or incest
Roe v Wade 1973
1st trimester (1st 12 weeks) -On demand
2nd trimester (13-24 weeks) Restrictions: danger to woman’s health (physical or mental), fetal defects, facilities and personnel performing procedure are regulated by state
3rd trimester (> 24 weeks) State regulations vary Danger to woman’s health
1992 changes Legal until fetus is viable on its own (22 weeks) State regulation (variable) – but danger to woman’s health rules
Woman health issue to consider
Therapeutic abortion
Diabetes
Kidney disease
Cardiovascular disease
(also includes fetal defects)
Chemical abortion
1st trimester Prostaglandins (Misoprostol) -Oral or vaginal suppository -Uterine smooth muscle contraction -< 7 weeks -Can also cause diarrhea (GI tract smooth muscle also affected)
Misoprostol + methotrexate
- Inhibits DNA synthesis (affects rapidly dividing cells in trophoblast)
- Injection
Abortion pill
Mifepristone (RU-486) – “Abortion Pill”
Blocks progesterone receptors
- Prevents ovulation
- Prevents implantation
- Causes abortion *
Mifepristone + Misoprostol combination
- Up to 10 weeks; oral administration
- Cramping and bleeding resembling an early miscarriage
Surgical abortion
Suction aspiration or vacuum
Up to 15 weeks
Manual syringe or electric vacuum
Dilatation and evacuation (D&E)
15-18 weeks
Dilation of cervix followed by evacuation of uterus
Suction or with surgical instruments
Dilatation and curettage (D&C)
Curette used for removal
Risks
Heavy bleeding
Infection
Not all tissue is removed
Physical damage
Tearing of cervix
Scarring of uterus
Tearing of uterus/hysterectomy (more advanced pregnancies)
Menstrual regulation
Induction of uterine bleeding due to delay in menstruation
Performed without confirmation of pregnancy
Tube inserted into uterus
Hand-held syringe used to apply suction
*legal in places where abortion is illegal
vacuum extraction
and complications
how long does it take?
Anesthetic agent applied to cervix
Tube inserted into uterus
Suction applied
Collection examined for embryonic and placental tissue
May be followed by scraping (curette)
Performed within 10 minutes
Complications
Bleeding, cramping, infection
Laminaria tent
used in D&C
Insertion of dried seaweed – absorbs water and swells (5 hours prior to procedure)
Prevents cervical tearing and uterine perforation that occurs with use of metal instruments for dilation
2nd trimester induced abortions (13-24 weeks)
how long does it take?
More complicated and riskier
-Maternal death rate is higher than for childbirch
Weeks 12-15
-Uterine wall is thin and more easily perforated
Placental is highly vascularized
-Excessive uterine bleeding
D&E - most common
-Dilation with laminaria
-Removal with suction and surgical instruments
-30 minutes
-Supported by anesthetics and pain medications (analgesics)
(may also be used for miscarriages)
Intra amniotic saline
Rarely used
Injection of saline (urea, KCl)
-Through abdominal and uterine wall
Kills the fetus and induces delivery
Causes uterine contractions
-Increases uterine secretions of prostaglandins
Placental delivery issues
-Subsequent currette
Fetus may be born alive
-Dies of respiratory failure
3rd trimester induced abortion
Digoxin administration into fetus – cardiac arrest (fetal death)
Dilation for several days
Delivery
D&E
High risk of injury and hemorrhage, maternal death
Future fertility complications
