Elective Termination of Pregnancy Flashcards
Surgical options
Manual vacuum aspiration
D&C
D&E
Manual vacuum aspiration
More than 99% effective but needs to be 7-8 wks EGA or less
D&C
Up to 16wks
D&E
After 16 wks
Use laminaria first, then introduce large cannula; may need forceps
Can use U/S to guide
Medical abortion
Mifepristone
Methotrexate
Both decline greatly in efficacy after 7 wks. If fail, need to do suction D&C
Mifepristone for abortion
Progesterone antagonist.
Can use up to 49d from LMP (7 weeks)
Use with PO or PV prostoglandin analog (misoprostol) 36-48h later
Confirm completion in 2 wks with serum b-HCG or U/S
Methotrexate for abortion
Inhibits DHFR / interferes with DNA synth / prevents placental villi proliferation
Used off label as abortifacent (but approved for ectopics) within 49d of LMP
Also use with misoprostol 6-7d later
Confirm completion in 2 wks with serum b-HCG or U/S
Side effects of medical abortion
Abd pain, cramps, N/V/D, excessive bleeding
Induction of labor
Also an option if 2nd trimester (esp if later on)
Cervical ripening agents, amniotomy, high-dose oxytocin
Use fetacidal agents (intraamniotic saline / digoxin / intracardiac KCl) to prevent live birth
If tissue needed for karyotype, etc what type of abortion should you do?
Should do medical abortion (mifepristone / misoprostol) prior to 49days, or induction with prostaglandins if 8 0/7 or later).
What should you give to an Rh- mother at the time of termination?
Make sure to give RhoGAM if Rh negative (at time of termination) - both medical & surgical!
What medication should be given at the time of termination to prevent endometritis?
Give abx (doxy, ofloxacin, or ceftriaxone) to prevent postabortion endometritis
When is abortion legal?
Termination is legal if < 24 wks (threshold of viability) or later if abnormality incompatible with life
