Abortion Flashcards
What is abortion?
Removal or expulsion of embryo or fetus from the uterus before viability
Spontanous abortion- miscarriage
Induced abortion: termination of pregancy
What rights do medical professionals have when it comes to abortion?
Right to conscientious objection, however even those who wish to abstain from involvement of the procedure must be trained in and recognise the need for evidence based counselling and safe abortion care, incl referral pathways
Why is unsafe abortion so worrying?
Each year 22 million unsafe abortions are estimated to take place- resulting in death of around 47,000 women
Around 5 million women suffer injury as a result of complications due to unsafe abortion- often leading to chronic disability
When can abortion be performed?
During first 24 weeks of pregnancy as long as certain criteria defined in the Abortion Act 1967 are met
What criteria from the Abortion Act 1967 need to be fulfilled for an abortion to take place?
Pregnancy may be terminated by a registered medical practioner, if 2 registered medical practioners are of the opinion that:
- Pregnancy has not exceeded its 24th week and continuance of pregnancy would involve risk, greater than if the pregnancy were terminated of injury to the physical or mental health of the pregenancy woman or any existing children of her family; or
- the termination id necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
- the continuance of the pregnenacy would invole risk to the life of the pregnant woman, greater than if he pregancy were terminated; or
- there is substanial risk that if the child were born it would suffer from such physical or mental abnormalites as to be seriously handicapped
Procedures for TOP?
Medical: Mifepristone (anti-progesterone) and a Prostaglandin- induces contractions–> results in expulsion of the pregnancy (e.g. Misoprostol), with or without fetocide- applies to TOP done after 21 weeks- fetal medicine terminations where there is a fetal abnormality diagnosed. After 22 weeks- fetocide is recommended, with potassium chloride- this is to avoid a situation where fetus is born alive
Surgical (GA)
Suction evacuation (1st trimester)
Dilatation and evacuation (2nd trimester)
Characteristics of medical abortion?
Avoids surgery
mimics miscarriage
controlled by the woman and may take place at home (less than 9 weeks)
Takes times- hours to days
Women experience bleeding and cramping, and potentially some other side effects (nausea, vomitting)
may require more clinic visits than surgical abortion
When may a medical abortion be necessary?
For severely obese women
If the woman has had uterine malformations or fibroids or has had previous cervical surgery
if the womn wants to avoid surgical intervention
if pelvic exam is not feasible or is unwanted
Characteristics of surgical abortion?
Quick procedure
Complete abortion is easily verifed by evaluation of aspirated products of conception
takes place in a healthcare facility
sterilisation of the woman or placement of an IUD may performed at the same time as the procedure
requires instrumentaiton of the uterus
small risk of uterine or cervical injury
timing of abortion controlled by facility and provider
What regimes are available for medical TOP before 14 weeks?
- at up to 63 days of gestation, mifepristone 200mg orally, followed 24–48 hours later by misoprostol 800 micrograms given by the vaginal, buccal or sublingual route; if misoprostol is provided for a woman to use at home, a single dose of 800 micrograms should be provided
- from 64 days to 13 weeks and 6 days, mifepristone 200mg orally, followed 24–48 hours later by misoprostol 800 micrograms given by the vaginal, buccal or sublingual route, followed by misoprostol 400 micrograms every 3 hours until abortion occurs
- If mifepristone is not available, and for all gestations up to 13 weeks and 6 days, misoprostol 800 micrograms given by the vaginal, buccal or sublingual route, followed by misoprostol 400 micrograms every 3 hours until abortion occurs
Regimes for surgical TOP before 14 weeks?
Either manual or electric vacuum aspiration:
* No lower limit of gestation for surgical abortion, but below 7/40 the risk of failure is higher.
* Cervical preparation is advised to minimize cervical trauma
* During vacuum aspiration, the uterus should be emptied using the suction cannula (and forceps, if required) only.
* Use of medications containing either oxytocin or ergometrine are not recommended for prophylaxis to prevent excessive bleeding either at the time of vacuum aspiration or afterwards.
* Sharp curettage should not be performed
Regimes for medical TOP from 14 weeks?
At 14 weeks of gestation and above, medical abortion should be undertaken in a medical facility.
The regimens are as follows:
* Mifepristone 200 mg orally, followed 12–48 hours later by misoprostol 800micrograms vaginally, followed by misoprostol 400micrograms orally or vaginally every 3 hours until abortion occurs; if after 24 hours abortion does not occur, mifepristone can be repeated 3 hours after the last dose of misoprostol, and 12 hours later misoprostol may be recommenced
* Where mifepristone is not available, misoprostol 800 micrograms followed by misoprostol 400 micrograms every 3 hours until abortion occurs
Surgical TOP from 14 weeks?
Surgical abortion can be performed by trained providers using:
vacuum aspiration using large bore cannulae
dilatation and evacuation (D&E)- difficult and usually at specialised centre.
UHL performs surgical abortions only before 14 weeks
Complications of TOP?
- surgical and medical methods fo abortion carry a small risk of failure to end the pregnancy (1-2%)
- Need for further intervention to complete the procedure e.g. surgical intervention following medical abortion or re-evacuation following surgical abortion
- The following complications may occur:
1. haemorrhage requiring transfusion- risk is lower than first trimester abortions (<0.1%) rising to around 0.4% 20 weeks
2. Uterine rupture in association with second-trimester medical
Complications of surgical TOP
Cervial trauma <1% lower with cervical prepation
Uterine perforation 0.1-0.4 % lower for 1st trimester abortions- can lead to bowel trauma due to suction
Further treatment (e.g. blood transfusion, laparoscopy, laparotomy or hysterectomy) may be reuqired, should one of these complications occur
Upper genital tract infection of varying degree of severity is unlikely, but may occur after medical or surgical abortion and is usally associated with pre-existing infection
