Abortion

Question 1

What percentage of abortions in the US happen in the first trimester?

Answer 1

Over 90%

Question 2

What’s the strongest risk factor for abortion-related mortality?

Answer 2

Gestational age. (abortion is safest at < 8wks)

Question 3

How is surgical abortion performed? Up to how many weeks can you use this?

Answer 3

Plastic cannula with suction.

- Can be used up to 12-13 weeks

Question 4

How is gestational age determined with greater confidence that date of last period?

Answer 4

Ultrasound

Question 5

What must you do after abortion surgery, considering it’s a blind surgery?

Answer 5

Try to find pregnancy tissue among the tissue removed.

Question 6

What 3 tissues are you looking for post-abortion?

Answer 6

1) Endometrium
2) Placenta
3) Fetus (depending on gestational age)

Question 7

2 types of tissue seen at 5-7 weeks?

Answer 7

1) Decidua

2) Trophoblastic villi

Question 8

3 types of tissue seen at 8-9 weeks?

Answer 8

1) Decidua
2) Placenta
3) +/- embryo/fetus

Question 9

3 types of tissue seen at 9-12 weeks?

Answer 9

1) Decidua
2) Placenta (very dense and pink)
3) Fetal parts

Question 10

3 modalities for medical abortion?

Answer 10

1) Mifepristone + misoprostol
2) Methotrexate + misoprostol
3) Misoprostol alone

Question 11

Up to what gestational age can medical abortion be done?

Answer 11

70 days

Question 12

Mechanism of medical abortion, broadly?

Answer 12

Bleeding and uterine contractions that lead to expulsion of embryo/fetus.

Question 13

Mifepristone MoA? Efficacy and time it takes to work?

Answer 13

Blocks progesterone activity, 93-98% effective, abortion happens in 4-6 hours.

Question 14

What is misoprostol?

Answer 14

Prostaglandin E1 analgoue.

Question 15

3 advantages of misoprostol?

Answer 15

1) Heat stable (no refrigeration)
2) Inexpensive
3) Widely available

Question 16

Physiological effects of misoprostol? 3 adverse effects?

Answer 16

Stimulates uterine contractions
Softens cervix
(treats ulcers?)
Adverse effects: Nausea/vomiting, diarrhea, fever/chills.

Question 17

3 changes that happen to allow abortion in mifepristone + misoprostol?

Answer 17

1) Decidual necrosis
2) Uterine contractions
3) Cervical softening/priming/ripening

Question 18

Methotrexate MoA? How long does it take abortion to be completed?

Answer 18

Blocks folate metabolism -> kills rapidly dividing cells.
Takes 3-7 days to complete abortion, bleeding/expulsion of pregnancy material can take up to 45 days.
Not preferred over mifepristone/misoprostol for medical abortion.

Question 19

Important tests to run before doing an abortion?

Answer 19

Pregnancy test
CBC (for anemia, risk of infection)
STI test
Rh factor (to see if needs Rhogam)
Ultrasound (to confirm pregnancy is in the uterus)

Question 20

Surgical abortions after 1st trimester are almost always special situations. 3 examples?

Answer 20

1) Abnormality detected in fetus.
2) Obstetrical complication.
3) Disenfranchised population.

Question 21

How soon after abortion can a woman get pregnant again? Implication?

Answer 21

Within a month.
Contraception counseling (and maybe LARC usage) is very important.
(can place IUD right then and there, can start OCs same day misoprostol is started)

Question 22

Long winded synopsis of abortion demographics…

Answer 22

• Rates of abortion skyrocketed after legalization (1970’s) –> but # of abortions in US has been stable for past 20 years
• White women make up highest % of people who get abortions
• In past years, higher # of low SES women have been getting abortions (better access to care)
• High % of counties in US still don’t have abortion providers (Medicaid allowed for state’s to make decisions about this)

Question 23

What % of US women have had at least 1 abortion in their lifetime?

Answer 23

40%

Question 24

What % of pregnancies are unplanned??

Answer 24

49%

Question 25

What is the risk of death from abortion compared to going through delivery?

Answer 25

Giving birth is 11X more risky than having an abortion

Question 26

Where is abortion more dangerous?

Answer 26

• In other countries where it’s illegal and done in unsafe ways (causes hemorrhage, infection, death from anesthesia)