Best Practice in abortion care 2022 Flashcards
2 methods of abortion
Medical: Misoprostol/Mifepristone
Surgical: MVA, EVA. D&E
Risk of continuing pregnancy
- Medical
- Surgical
- Medical 1-2/100
- Surgical 1/1000 (higher if < 7 weeks)
Need for further intervention to complete the procedure <14 weeks
- Medical
- Surgical
- Medical 70/1000
- Surgical 35/1000
Need for further intervention to complete the procedure >14 weeks
- Medical
- Surgical
- Medical 13/100
- Surgical 3/100
Risk of infection
- Medical
- Surgical
Both <1/100
Risk of bleeding requiring transfusion <20 weeks
- Medical
- Surgical
- Medical < 1/1000
- Surgical < 1/1000
Risk of bleeding requiring transfusion >20 weeks
Both 4/1000
Surgical
Risk cervial injury
Risk uterine perforation
Risk cervial injury: 1/100
Risk uterine perforation 1-4/1000
Medical risk of uterine rupture
1/1000 in 2nd trimester
How to determine gestation pre-abortion
LMP
If not reliable LMP and USS not available, examination
Contraindications to medical abortion
- Known or suspected ectopic
- Prv allergic reason
- Severe unctonlled asthma (cannot have mife)
- Chronic adrenal failure (cannnot have mife)
- Inherited porphyria (cannnot have mife)
Considerations and additional care for medical
- Longterm steroids - mife may inhibit steroid
- Anticoauglation - need to be stopped
- Bleeding disorder - consider clinical setting
- Symptomatic anaemia
- IUD in place, ideally removed, or can be expelled during precede but need XRAY to confirm post procedure
Considerations surgical
- Bleeding disorder
- Abnormal placentation
- Anticoagulation
- Severe CV disease
- High BMI
- Distorting uterine cavity
- FGM 3
STI screening
Best practice to screen without delaying
Give Tx dose if signs and symptoms and treat partner
Is prophylactic Abx required
For surgical management
oral doxycycline 100mg twice a day for 3 to 7 days, starting within 2 hours of the procedure (there is evidence that a 3-day course is as effective as a 7-day course).
When is anti-D required
Offer > 12 weeks within 72 hours
Medical abortion < 12 weeks regime
Mife 200mg, 24-48hrs later miso 800mcg
If no delivery within 4 hours, further 400mcg
Medical abortion 12-24 weeks regime
Undertake in medical facility
Mife 200, 24-48hrs 800mcg, 400mcg every 3 hours until aborition
> 24 weeks, lower dose/long interval
When to consider fetocide?
If > 20 weeks, termination for lethal fetal abnormalirt
Surgical abortion < 14weeks
Vacuum aspiration (electrical or manual)
Antibiotic prophylaxis for STOP?
Metronidazole or doxycycline or penicillins
Surgical 14-24 weeks method
D&E - dilation and evacuation
Cervical preparation before surgical
< 12/40: Mife 200mg PO 24-48hrs before, miso 400mcg SL 1-2 hours, or vaginally 2-3 hours
12-18+6
Medication and/or osmotic dilators
19-24 both
Incomplete abortion and no sign of infection <14 weeks
Miso
400mcg SL/buc/vaginally
600mcg PO (if missed also give mife)
or
surgical
Incomplete abortion and no sign of infection >14 weeks
14-24 weeks:
Miso 400mcg SL/buc/vaginally every 3 hours
or surgical
If infection + failed abortion
Abx immediately
If shock - IV ampicillin, Metronidazole and gent
→ transfer to specilist unit
Post abortion concraceptives
All fine
Medical - can have IUD once tissues expelled
If septic MEC 4
Cervical proportion before surgical management < 12 weeks
Mife 200mg 24-48hrs before
or
Miso 400mcg S/L 1-2 hours
Miso 400mch PVB/Buc 2-3 hours before
Cervical proportion before surgical management 12-18+6 weeks
Mife + miso
or
osmotic dilators + mife/miso or both
Cervical proportion before surgical management 19-24 weeks
Osmotic dilators + Mife + miso
Which bacteria causes donovanosis? How does it present?
Klebsiella granulomatsis - a firm papule that later ulcerates, 90% genital
‘Donovan bodies’ Gram -ve
