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).
