Abortion Flashcards
1) Demographics of abortion 2) Medical abortion techniques 3) Surgical abortion techniques 4) Indications for abortion
What percentage of abortions in the US happen in the first trimester?
Over 90%
What’s the strongest risk factor for abortion-related mortality?
Gestational age. (abortion is safest at < 8wks)
How is surgical abortion performed? Up to how many weeks can you use this?
Plastic cannula with suction.
- Can be used up to 12-13 weeks
How is gestational age determined with greater confidence that date of last period?
Ultrasound
What must you do after abortion surgery, considering it’s a blind surgery?
Try to find pregnancy tissue among the tissue removed.
What 3 tissues are you looking for post-abortion?
1) Endometrium
2) Placenta
3) Fetus (depending on gestational age)
2 types of tissue seen at 5-7 weeks?
1) Decidua
2) Trophoblastic villi
3 types of tissue seen at 8-9 weeks?
1) Decidua
2) Placenta
3) +/- embryo/fetus
3 types of tissue seen at 9-12 weeks?
1) Decidua
2) Placenta (very dense and pink)
3) Fetal parts
3 modalities for medical abortion?
1) Mifepristone + misoprostol
2) Methotrexate + misoprostol
3) Misoprostol alone
Up to what gestational age can medical abortion be done?
70 days
Mechanism of medical abortion, broadly?
Bleeding and uterine contractions that lead to expulsion of embryo/fetus.
Mifepristone MoA? Efficacy and time it takes to work?
Blocks progesterone activity, 93-98% effective, abortion happens in 4-6 hours.
What is misoprostol?
Prostaglandin E1 analgoue.
3 advantages of misoprostol?
1) Heat stable (no refrigeration)
2) Inexpensive
3) Widely available
Physiological effects of misoprostol? 3 adverse effects?
Stimulates uterine contractions
Softens cervix
(treats ulcers?)
Adverse effects: Nausea/vomiting, diarrhea, fever/chills.
3 changes that happen to allow abortion in mifepristone + misoprostol?
1) Decidual necrosis
2) Uterine contractions
3) Cervical softening/priming/ripening
Methotrexate MoA? How long does it take abortion to be completed?
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.
Important tests to run before doing an abortion?
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)
Surgical abortions after 1st trimester are almost always special situations. 3 examples?
1) Abnormality detected in fetus.
2) Obstetrical complication.
3) Disenfranchised population.
How soon after abortion can a woman get pregnant again? Implication?
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)
Long winded synopsis of abortion demographics…
- 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)
What % of US women have had at least 1 abortion in their lifetime?
40%
What % of pregnancies are unplanned??
49%
What is the risk of death from abortion compared to going through delivery?
Giving birth is 11X more risky than having an abortion
Where is abortion more dangerous?
- In other countries where it’s illegal and done in unsafe ways (causes hemorrhage, infection, death from anesthesia)
