Abortion care / Unplanned preg Flashcards
The sites of uterine perforation at surgical TOP by % incidence
Anterior wall 40% Cervical canal 36% Lateral wall 38% (21% right lateral 17% left lateral) Fundus 13% Posterior wall 13%
Pre-abortion assessment steps
Confirm pregnancy + gestation Pmhx and medication and allergies O+G hx, STI risk assessment, cervical hx social history + DV + safeguarding discuss pregnancy options Offer additional decision support explain procure options and risks Check patient fulfils abortion act criteria CT test and HIV Rh status contraception plan consent HSA1 x2 dr signatures
Average CRL at 6/40
0.5cm
Average CRL at 14 / 40
8cm
Average CRL at 11/40
4cm
At what gestations is early medical abortion carried out?
<10 weeks
what type of medication is mifepristone
and how does it work?
Synthetic steroid and progesterone receptor antagonist.
Inhibits the normal action of progesterone on the uterus which maintains a pregnancy.
Sensitizes the uterus to respond to prostaglandins
what type of medication is misoprostal
and how does it work?
Prostaglandin E1 analogue
Causes the uterus to contract and expel pregnancy tissues
Procedure steps for early medical abortion
200mg mifepristone PO
24-48 hours later = 800mcg misoprostal PV (unlicensed)
Abortion occurs 4-6 hours later
Common symptoms during medical abortion
Cramping pain and bleeding with passage of tissue
Nausea Vomiting Diarrhoea Headache Dizziness Flushing / sweats
At what gestations can MVA be performed?
<12 weeks
Anesthetic options for MVA
none
local anaesthetic
conscious sedation
general anaesthetic
when should cervical preparation be considered before surgical abortion?
In all cases
Misoprostal 400mcg in 1 hour before surgery if vaginal miso (3 hours if buccal)
or osmotic dilator (>14 weeks)
Steps for performing MVA under LA
Bimanual ex
LA to anterior lip
Tenaculum anteriorly
Complete cervical block at 3, 6, 9 o’clock positions
Dilate cervix
Engage MVA to create vacuum
Introduce plastic cannula
Attach aspirator
Release vacuum
Slow rotation and in+out motion to evacuate products
Empty and repeat until complete (gritty sensation)
At what gestations is dilation and evacuation STOP recommended
> 14 weeks
Method of dilatation and evactuation STOP
Cervical preparation General anesthetic Cervical dilation upto 24mm Crushing forceps and removal of fetus under ultrasound guidance Suction curettage to ensure empty cavity
Protocol commonly used for medical abortion 9-13 weeks
200mg mifepristone PO 36-48hours later 800mcg misoprostal PO or PV 3 hourly 400mcg misoprostal PO upto a maximum of 4 doses. Analgesia PRN