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Reproduction > Abortion > Flashcards

Abortion Flashcards

1
Q

What % of women have had an induced abortion?

A

40%

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2
Q

What is the safest and most common time to have an abortion?

A

<8 weeks=lowest risk of death. Most common is first trimester

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3
Q

What is safer? Abortion or pregnancy?

A

ABORTION! at all stages of preg

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4
Q

What is the strongest risk factor for abortion related mortality?

A

Gestational age

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5
Q

How is an early pregnancy abortion completed, how long can it be used, and how does it work?

A

Via vacuum aspiration which can be used up to 12-13 week gestation. It is inserted through the cervix and tissue is removed.

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6
Q

What must the tissue removed contain?

A

The tissue removed must be examined and should contain: 1. endometrium (decidua, glands, vessels, hemorrhage) 2. placenta (dep on gestational age, villi, cord, yolk sac) 3. embryo/fetus.

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7
Q

How do you perform a tissue inspection?

A
  1. Strain and rinse tissue 2. Place in clear container of water 3. Hold over strong light 4. IDENTIFY TROPHOBLASTIC TISSUE 5. Tissue volume must correlate with gestational age
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8
Q

What is recognizable tissue at 5-7wks

A

Decidua (lines uterus during preg) and trophoblastic villi

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9
Q

What is recognizable tissue at 8-9wks

A

Decidua, placenta (formally trophoblastic tissue), embryo/fetus

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10
Q

What is recognizable tissue at 9-12wks

A

Decidua, placenta (opaque, dense, pink), fetal parts

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11
Q

What are the 3 medication regimens one can use to induce abortion?

A
  1. Mifepristone and misoprostol (FDA approved) 2. Methotrexate and misoprostol 3. Misoprostol alone
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12
Q

What is the MOA of mifepristone? How effective is it and is it FDA approved?

A

Binds progesterone receptor with high affinity causing abortion (competitive inhib) in 4-6 hours. It is 93-98% effective, req at least 2 provider visits and is approved by the FDA

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13
Q

What is misoprostol, is it FDA approved and what are some advantages?

A
  • Prostaglandin E1 analog causes uterine contraction and cervical softening
  • FDA approved for prevention and treatment of gastric and duodenal ulcers (used off label for abortion)
  • Heat stable, inexpensive, widely available
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14
Q

What are the physiologic effects of misoprostol?

A

stimulates uterine contractions, softens and primes cervix, prevents ulcers, causes nausea/vomiting/diarrhea, causes fevers and chills

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15
Q

What is the MOA of Mifepristone and Misoprostol together?

A

Mifepristone induces the abortion .

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16
Q

What is the typical clinical process for mifepristone/misoprostol abortion?

A

Day 1:

  • Counseling and informed consent, including consent for aspiration procedure if method fails
  • Medical and social hx
  • Lab work
  • Ultrasound

Day2-5:

  • Mifepristone on site (200mg, but FDA req 600mg)
  • Misoprostol + prescrip for pain at home
  • Vaginal bleeding and cramping begins 2-5 hours post administration of misoprostol
  • Bleeding can last 2-4 wks, followup after 1-2 wks req to confirm expulsion
17
Q

What is the MOA of Methotrexate? How long does it take, how effective is it etc?

A

Anti-folate: blocks division of rapidly dividing cells

  • Takes 3-45 days for completion of abortion
  • 90-85% effective
  • Req 2+ visits
  • Off-lable (really a cancer drug)
  • Can have bad rare side effects like alopecia, leukopenia, etc
  • Usually take in combo with mesoproxal
18
Q

What is the MOA of Misoprostol?

A

Prostaglandin analog, causes uterine contractions, used in conjunction with mifepristone or methotrexate

19
Q
A
20
Q

How effecatious is Mifepristone/Misoprostol and up to how many days can you use it?

A

94-98% successful, up to 70 days gestation

21
Q

How soon is post-abortion contraceptive care available after an abortion?

A

In first month post abortion. IUDs can be inserted immediately (but not after a septic abortion) after a surgical abortion and 1 week after a medical abortion

22
Q
A

Reproduction (23 decks)

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