Abortion Care

Question 1

Gestational age that most clinics offer medical abortion through.

Answer 1

63 days (9w0d)

Question 2

FDA approved regimen for medical abortion (include dose, route, timing).

Answer 2

200mg PO mifepristone + 800mcg of PV / buccal / SL misoprostol 24 hours later

Question 3

Mechanism of action for mifepristone

Answer 3

Progesterone receptor antagonist - causes decidual necrosis in uterus, cervical softening, increased uterine contractility, increased prostaglandin sensitivity (5x)

Question 4

Mechanism of action for misoprostol

Answer 4

Prostaglandin analogue - causes uterine contractions and thinning of cervix

Question 5

Most common side effects of mifepristone/misoprostol

Answer 5

BLEEDING, CRAMPING (normal) - nausea, vomiting, diarrhea, headache, dizziness, thermoregulatory effects

Question 6

List contraindications to medical abortion

Answer 6

Allergies to mifepristone/misoprostol, confirmed or suspected ectopic pregnancy, IUD in place, current long-term corticosteroid use, chronic adrenal failure, known coagulopathy or on anticoagulation. Anemia is a relative contraindication.

Question 7

Which artery(s) can you inadvertently inject with lidocaine during a cervical block?

Answer 7

Uterine arteries - located at 3 and 9 o’clock. Important to draw back prior to injection to make sure you are not in a blood vessel.

Question 8

Type of dilators that are measured in French (circumference)

Answer 8

Pratt (9-79F)

Question 9

Type of dilators that are measured in mm (diameter)

Answer 9

Hegar (1-26mm)

Question 10

Osmotic dilator made from seaweed. Time from insertion to maximum dilation (in hours).

Answer 10

Laminaria. 12-24 hours. Apply radial force and induce local prostaglandin synthesis.

Question 11

Osmotic dilator made from synthetic material. Time from insertion to maximum dilation (in hours).

Answer 11

Dilapan S. Approximately 4 hours. Apply radial force, dilates to 4x original size, more than Laminaria.

Question 12

Typical antibiotic prophylaxis for surgical abortion.

Answer 12

200mg doxycycline PO x1 pre-op.

Question 13

Do patients undergoing surgical abortion need Rhogam if Rh negative?

Answer 13

Yes, usually given at time of mifepristone.

Question 14

Which contraceptive methods are options after medical abortion?

Answer 14

All except IUD. IUD can be placed 1 week after once abortion has been confirmed to be complete.

Question 15

Which contraceptive methods are options after surgical abortion?

Answer 15

ALL of them. Except in cases of septic abortion where an IUD is not an option.

Question 16

What are potential complications of surgical abortion?

Answer 16

Infection, hemorrhage, cervical laceration, uterine perforation. Risk increases with gestational age.