Elective termination of pregnancy

Question 1

what are the options for first-trimester abortion?

Answer 1

suction curettage
manual vacuum aspiration
medical abortion (mifepristone, MTX)

Question 2

what are options for 2nd trimester abortion?

Answer 2

surgical evacuation

induction of labor

Question 3

what to consider if mom is Rh-

Answer 3

give RhoGam at time of abortion

Question 4

how does maternal mortality change with GA at time of abortion?

Answer 4

further along in pregnancy, higher the maternal mortality

Question 5

when can manual vacuum aspiration be done?

Answer 5

up until week 7

Question 6

diff b/w suction curretage & manual vacuum aspiration?

Answer 6

suction curettage is attached to a vacuum machine, and sharp curretage is done afterwards. Manual vacuum is done with a self-locking vacuum syringe, need to manually move cannula in and out of uterus; don’t follow with sharp curettage

Question 7

SEs of suction curettage:

Answer 7

infection
bleeding
uterine perforation
incomplete abortion
if 3 or more dilations, increased risk of cervical insuff'y & Asherman syndrome

Question 8

what is mifepristone?

Answer 8

PG R blocker => block stim of endometrial growth => detachment of embryo

Question 9

when can mifepristone be used and how?

Answer 9

up to 49d after LMP
c/b used with a PG analogue
given PO then followed by another PO or vaginal dose 36-48h later

Question 10

what kind of f/u does a chemical abortion need?

Answer 10

u/s or serial b-hCGs 2 weeks later

Question 11

when & how is MTX used?

Answer 11

within 49d of LMP, then misoprostol 1 week later

f/u 2 w later with u/s or serial b-hCGs

Question 12

effectiveness of chemical abortions?

Answer 12

mifepristone + MTX together works best

don’t work well beyond 7 w

Question 13

SEs of medical abortion?

Answer 13

ab’l pain, cramps
N, V, diarrhea
prolonged bleeding (normal is 10-17d)

Question 14

what is most common reason for 2nd trimester abortion?

Answer 14

congenital anomalies

Question 15

which is safer, D&E or induction of labor?

Answer 15

D&E up to 16w. Beyond 16w they’ve got similar m&m

Question 16

how is D&E performed?

Answer 16

paracervical block + IV sedation
laminaria inserted 1d prior
suction cannula inserted into uterus
forceps may be needed

Question 17

what are complications of D&E?

Answer 17

cervical lac
hemorrhage
uterine perf
infection
retained POCs

Question 18

when is induction of labor used?

Answer 18

at more advanced GA

Question 19

how is induction of labor done?

Answer 19

cervical ripening agents
amniotomy
high-dose oxytocin
can also do hypertonic saline or PG F2alpha installation

Question 20

SEs of induction of labor

Answer 20

retained placenta
incomplete abortion
hemorrhage
infection

Question 21

how does maternal morbidity with D&E and IOL compare to that for pregnancy and delivery?

Answer 21

its lower