Clinical: Therapeutic Abortion Flashcards
Define abortion
The willful termination of pregnancy before 20 weeks (because after this point the fetus may survive)
What is an “abortion” over 20 weeks gestation called?
Immature termination of pregnancy (NOTE: only done if risk of health of mother or fetus)
Date that abortion was criminalized in Canada
1869
Date that abortion law was amended in Canada
1969
Describe the amended abortion law in Canada
- 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
Compare the pregnancy associated mortality with that of induced abortion
- Pregnancy = 8.8 deaths/ 100,000 live births
- Induced abortion = 0.6 deaths/100,000 live births
6 aspects of abortion work up
- 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
9 steps to abortion technique
- Speculum
- Antisepsis
- Anesthesia
- DIlatation
- Aspiration
- 50 mm Hg negative pressure
- Laminaria
- Blier forceps
- Prophylactic antibiotics
2 aspiration devices
- Karman cannula
- Sorenson curette
8 complications of surgical abortion
- Incomplete abortion
- Hemorrhage
- Infection
- Continuing pregnancy
- Perforation
- Local anesthetic reaction
- Vagal syndrome
- Post abortal syndrome
How to differentiate between a local anesthetic reaction and a vagal syndrome
Both involve convulsions, but local anesthetic reaction has a rapidly bounding pulse, whereas you cannot find pulse in vagal syndrome
Define post abortal syndrome
Blood clot; cannot come through cervical opening
When can early medical termination be used?
Up to 63 days after LMP
3 early medical abortion agents
- Mifepristone (RU-486)
- Misoprostol
- Methotrexate
4 tests that must be performed with abortion
- Pregnancy test
- Ultrasound
- Hemoglobin or hematocrit
- Blood type (give anti-d immune globulin if required
2 advantages of medical abortion
- Usually avoids invasive procedure
- Usually avoids anaesthesia
4 disadvantages of medical abortion
- 2 or more visits
- Moderate to heavy bleeding
- Requires follow-up
- Need compliant reliable patient
2 disadvantages of surgical abortion
- Invasive procedure
- Sedation can be used
4 advantages of surgical abortion
- Usually one visit
- Bleeding light
- Follow up not as necessary (compared to medical)
- One step process
7 contraindications for abortion
- Ectopic pregnancy
- IUD in place
- Undiagnosed adnexal mass
- Corticosteroid therapy
- Anemia
- Coagulopathy or anticoagulation
- Most serious systemic diseases
When is late medical termination use?
Genetic terminations to allow autopsy of the fetus to guide management of future pregnancies
4 parts to late medical termination
- Laminaria
- Misoprostol (Cytotec)
- Pain management
- Retained placenta
5 abortion methods no longer used
- Hypertonic saline 20%
- Hypertonic urea 40%
- Hypertonic glucose 50%
- Hysterotomy
- Hysterectomy
