Chapter 31 Abortion

Question 1

almost 90% of abortions occur in the 1st trimester, complication risk of induced abortion is __

Answer 1

<1%

Question 2

1st trimester medical abortion using combination of mifepristone and misoprostol are more successful than using misoprostol as single agent

Answer 2

true

Question 3

infection following medical abortion infection remains <1%, comparable to spontaneous abortion and early surgical abortion

Answer 3

true

Question 4

manual aspiration and electric vacuum aspiration can effecitvely used for 1st trimester abortion. the difference can allow for lower cost and resources to be expended while offering same quality of care

Answer 4

true.

Question 5

medical abortion - some women equateit to having a heavy menses or miscarriage and ARE ABLE TO CARRY ON THEIR USUAL DAILY ROUTINES WITHOUT SIGNIFICANT INTERRUPTIONS

Answer 5

TRUE.

Question 6

Mifepristone is a ___ antagonist that causes decidual necrosis in pregnant uterus, softens cervix, and increases prostaglandin sensitivity. when combined with a prostaglandin analogue, it is effective for medical abortion

Answer 6

progesterone antagonist.

Question 7

regimen approved by FDA: for up to 49 days gestation

Answer 7

day 1: mifepristone 600mg
day2: misoprostol 400mcg orally
day14 followup to ensure completion of abortion; asiration of gestational sac is performed if still present.
EFFICACY: 92% (decreases with advancing gestation).

Question 8

evidence based alternative regimen up to 63 days gestation

Answer 8

day1: mifepristone 200mg orally
day2: day 1- day3: misoprostol 800mcg vaginally or bucally (MAY be SELF-ADMIN by pt)
day7-day14: follow up to ensure completion of abortion.
EFFICACY: 98%

Question 9

MISOPROSTOL

Answer 9

inexpensive prostaglandin analogue.

Question 10

misoprostol approved by FDA for prevention and treatment of

Answer 10

gastric ulcers caused by NSAIDS

Question 11

off label use of misoprostol

Answer 11

medical abortion, cervical ripening before surgical abortion, evacuation of uterus in cases of embryonic or fetal death, induction of labor, prevention of postpartum hemorrhage

Question 12

misoprostol can be taken via oral, buccal , sublingual, vaginal, rectal routes.

Answer 12

true

Question 13

for 1st trimester abortions, it has been determined that ___ route has better efficacy

Answer 13

vaginal (2004). HOWEVER, a recent study compared serum concetration and uterine contraction effects between vaginal and buccal misoprostol; SIMILAR uterine tone and activity were noted between vaginal and buccal routes (2006)

Question 14

studies have shown misoprostols efficacy as a sole abortifacient; therefore, it can be used as a single agent in settings where mifepristone or methotrexate is not available.

Answer 14

true.

Question 15

in pregnancies up to 12 weeks, misoprostole alone is given ___ ; every __ for up to ___

Answer 15

800mcg per vagina
every 3 to 12 hours
for up to 3 doses.
success rates ranged 83%-97%

Question 16

METHOTREXATE and Misoprostol. methotrexate blocks

Answer 16

dihydrofolate reductase required for DNA synthesis.

Question 17

methotrexate commonly available to treat

Answer 17

neoplastic disorders, multipe rheumatologic disorders, asthma, crohn’s disease, and ectopic pregnancies.

Question 18

methotrexate + miso for medical abortion up to 49 days gestation. (low dose sufficient).

Answer 18

true

Question 19

methotrexate destabilizes the pregnancy by inferfering with

Answer 19

cytotrophoblastic DNA synthesis and requires additional effect of misoprostol to expel the pregnancy.

Question 20

dose of MTX + miso

Answer 20

50mg/msquared of methotrexate given IM
day 3-day7 800 mcg misoprostol vaginally.
(50mg oral MTX as effective as 50mg IM)

Question 21

repeat 800mcg misoprostol dosing can be administered until expulsion of persistent gestational sac.

Answer 21

true

Question 22

Efficacy approaches that aof mifepristone, with misoprostol regimens but requires greater time to completion, up to

Answer 22

4 weeks in 15-25% of users. with multiple interval visits.

Question 23

MTX is teratogen.

Answer 23

close f/u required for women who have failed MTX-miso regimen.

Question 24

precautions for medical abortion.

Answer 24

1. long term steroid use or ADRENAL insufficiency if using mifepristone
2. RENAL or LIVER disease (applicable to MTX)
3. IUD should be removed before initiation of medical abortion
4. confirmed / suspected ectopic preg
5. coagulopathy / current use of anticoagulants
6. inherited porphyria if using mifepristone ( abnormal heme production)
7. Breastfeeding mothers can pump and dump breast milk during medical abortion.
8. precaution: lack of access to a provider for expeditious uterine aspiration in the event of excess bleeding or PERSISTENT cardiac activity at 2 weeks after onset of medical abortion.

Question 25

Side Effects and complications of medical abortion:

Answer 25

1. vaginal bleeding, abdominal cramping, nausea, vomiting, diarrhea, flushing, chills.
2. bleeding resembles heavy period or a spontaneous miscarriage
3. light bleeding and spotting can last for 1-3 weeks; avg 9-13days. heaviest period of bleeding occurs when abortion is occurring and persists for 1-4 hours.
4. pain of medical abortion described as cramping.
5. 1% women experience uterine bleeding that requires uterine aspiration
6. temp > 100.4F or 38C sustained (more than 4 hrs) or begins more than 6-8 hrs after miso warrants clinical assessment.

Question 26

SURGICAL ABORTION, SUCTION

cannual size is chosen to match diameter in millimeters with gestational age in weeks +/- 1mm

Answer 26

true

Question 27

return to ovulation can occur as early as __ after abortion

Answer 27

day 8