Clinical: Therapeutic Abortion

Question 1

Define abortion

Answer 1

The willful termination of pregnancy before 20 weeks (because after this point the fetus may survive)

Question 2

What is an “abortion” over 20 weeks gestation called?

Answer 2

Immature termination of pregnancy (NOTE: only done if risk of health of mother or fetus)

Question 3

Date that abortion was criminalized in Canada

Answer 3

1869

Question 4

Date that abortion law was amended in Canada

Answer 4

1969

Question 5

Describe the amended abortion law in Canada

Answer 5

• Abortion allowed if continuation was deemed a threat to a patient’s physical or emotional health
• Had to be done by a licensed MD in a certified healthcare facility after approval by an abortion committee comprising at least 3 MDs on staff

Question 6

Compare the pregnancy associated mortality with that of induced abortion

Answer 6

• Pregnancy = 8.8 deaths/ 100,000 live births
• Induced abortion = 0.6 deaths/100,000 live births

Question 7

6 aspects of abortion work up

Answer 7

• Confrim pregnancy with HCG/Ultrasound
• Determine blood type
• Check rubella status if primigravida
• Check hemoglobin
• STD screen or prophylactic antibiotics
• Imaging discrepant size/dates
  
  • Viability
  • Ectopic
  • Uterine anomaly

Question 8

9 steps to abortion technique

Answer 8

1. Speculum
2. Antisepsis
3. Anesthesia
4. DIlatation
5. Aspiration
6. 50 mm Hg negative pressure
7. Laminaria
8. Blier forceps
9. Prophylactic antibiotics

Question 9

2 aspiration devices

Answer 9

• Karman cannula
• Sorenson curette

Question 10

8 complications of surgical abortion

Answer 10

• Incomplete abortion
• Hemorrhage
• Infection
• Continuing pregnancy
• Perforation
• Local anesthetic reaction
• Vagal syndrome
• Post abortal syndrome

Question 11

How to differentiate between a local anesthetic reaction and a vagal syndrome

Answer 11

Both involve convulsions, but local anesthetic reaction has a rapidly bounding pulse, whereas you cannot find pulse in vagal syndrome

Question 12

Define post abortal syndrome

Answer 12

Blood clot; cannot come through cervical opening

Question 13

When can early medical termination be used?

Answer 13

Up to 63 days after LMP

Question 14

3 early medical abortion agents

Answer 14

• Mifepristone (RU-486)
• Misoprostol
• Methotrexate

Question 15

4 tests that must be performed with abortion

Answer 15

• Pregnancy test
• Ultrasound
• Hemoglobin or hematocrit
• Blood type (give anti-d immune globulin if required

Question 16

2 advantages of medical abortion

Answer 16

• Usually avoids invasive procedure
• Usually avoids anaesthesia

Question 17

4 disadvantages of medical abortion

Answer 17

• 2 or more visits
• Moderate to heavy bleeding
• Requires follow-up
• Need compliant reliable patient

Question 18

2 disadvantages of surgical abortion

Answer 18

• Invasive procedure
• Sedation can be used

Question 19

4 advantages of surgical abortion

Answer 19

• Usually one visit
• Bleeding light
• Follow up not as necessary (compared to medical)
• One step process

Question 20

7 contraindications for abortion

Answer 20

• Ectopic pregnancy
• IUD in place
• Undiagnosed adnexal mass
• Corticosteroid therapy
• Anemia
• Coagulopathy or anticoagulation
• Most serious systemic diseases

Question 21

When is late medical termination use?

Answer 21

Genetic terminations to allow autopsy of the fetus to guide management of future pregnancies

Question 22

4 parts to late medical termination

Answer 22

1. Laminaria
2. Misoprostol (Cytotec)
3. Pain management
4. Retained placenta

Question 23

5 abortion methods no longer used

Answer 23

• Hypertonic saline 20%
• Hypertonic urea 40%
• Hypertonic glucose 50%
• Hysterotomy
• Hysterectomy