Lecture - 1 Intro/Abortion Flashcards
Hyde Amendment Codification Act (1976)
you can use federal funds for an abortion, unless:
- the pregnancy was a result of rape or incest
- the woman suffers from a life-endangering physical disorder, illness, or injury
Title X
allows clinics that get federally funding to change fees depending on how much the person makes to make it more affordable for those that need it
CA screening and birth control
Federal Abortion Ban of 2003
partial birth abortion
could be charged as a criminal as a provider for doing this
What is a minor and what can they consent for?
12 - 17 years of age
can consent (without parental consent)
- contraception
- STI services
- prenatal care
- adoption
- abortion
regulations vary by state
say the pt came in and said “i want to start BC, and also I have a sore throat. NO. I will give you BC, but you have to go to your pediatrician for the sore throat”
What is considered the “reproductive years”?
ages 19-39
Cervical cytology guidelines
21 - 29 q 3 years
q5 years with HPV 30-65
stop at age 65
Why do we stop HPV screening at 65?
since the cancer is so slow growing the risk and hardship of treating don’t outweigh the benefits
When does clinical breast exam start?
19 years old
___% of all pregnancies are unintended
45
unintended includes mistimed and unwanted
Which age groups have the highest unintended pregnancies?
18-24 years old
1 in ___ women will have an abortion by the age 45
4
How do you test for pregnancy?
UPT - urine pregnancy test (qualitative)
-detects serum BhCG levels >25 mIU/mL
BhCG quantitative blood test
<5 mIU/mL is negative
>25 mIU/mL is definitely positive
between the two its most likely pregnant
For a pregnant pt, what do you expect to see in regards to their BhCG?
levels should double every 2-3 days
After confirming the pt is pregnant, what is the first test you do?
H and H to make sure the pt isnt anemic
Rh status –if negative give Rhogam
TV US
Transvaginal ultrasound
you can see IUP (intrauterine pregnancy)
>1500 to 2000 BhCG level
this US is needed to confirm that the pregnancy is in the uterus
What level does the BhCG need to be in order to see anything on US?
1500 to 2000 mIU/mL
What medication abortion can be done in the first trimester?
pills - mifepristone (mifeprex) + misoprostol (cytotec)
injection - methotrexate + misoprostol
MIfespristone
Mifeprex - antiprogesterone - stops growth
medical abortion pill that must be given in the office under supervision
can be performed up to 9 weeks gestation
involves heavy bleeding and passage of pregnancy at home
requires Hbg >10
contraindications:
- ectopic pregnancy
- severe anemia
- coagulopathy
- anticoag therapy
- long tern corticosteroid use
- current IUD in place
- adrenal failure
What are the contraindications of Mifepristone?
- ectopic pregnancy
- severe anemia
- coagulopathy
- anticoag therapy
- long tern corticosteroid use
- current IUD in place
- adrenal failure
When can you used Mifespristone?
for uterine pregnancies up to 9 weeks
Misoprostol
this is the second part of the mifespristone-misoprostol treatment pill abortion
synthetic prostaglandin (PGE1)
4 bills to be dissolved in the cheek 6-48 hours after mifespristone treatment in the office
expect heavy cramping and bleeding within 1-4 hours
In addition to mifepristone and misoprostol, what else are you giving these pts?
doxycycline twice daily for 7 days
remember that doxycycline is a category D drug
You gave the pt mifepristone in the office and sent them home on misoprostol and doxycycline, when do you need to see the pt again?
In 2 weeks to follow up and confirm with TV US to confirm complete
What are complications of medication induce abortion?
incomplete abortion –requires suction aspiration surgery
bleeding - may require transfusion –can occur up to 4 weeks later
Methotrexate
injection for ectopic abortion
used for ectopic pregnancy ONLY
send pt home on misoprostol
Vacuum Aspiration
same surgical procedure done for miscarriage
first trimester surgical
suction curettage, suction aspiration, D and C
misoprostol used 13+ weeks to soften and dilate cervix
performed up to 16 weeks gestation
done in office –pt given Versed –can stay awake if they wish –will be uncomfortable
low complication rate
Manual Vacuum Aspiration
MVA
rarely used surgical first trimester abortion
can be used in third world countries since you don’t need electricity
performed BEFORE 6 week gestation
Second trimester surgical abortion
D and E - dilation and evacuation
D and X - dilation and extraction
D and E
Dilation and evacuation
performed after 16 weeks gestation (16-21 weeks)
banned in 2 states
requires cervical dilation via laminaria (compressed seaweed)
D and X
dilation and extraction (partial birth abortion)
performed after 21 weeks gestation
pretty sure this is illegal
requires 1-2 days of laminaria
What are potential complications of surgical abortion?
incomplete abortion uterine perforation cervical trauma infection - endometritis bleeding anesthesia related intrauterine adhesions
When is intrauterine adhesion complications the highest?
after multiple procedures leading to miscarriage
How does abortion affect your ability to get pregnant?
you can GET pregnant again but your ability to STAY pregnant is at risk d/t scar tissue and integrity of cervix
SAB
spontaneous abortion or miscarriage
pregnancy loss before 20th week of gestation
MC complication of early pregnancy
Chromosomal abnormalities account for 50% of all miscarraiges
What is the most common complication of early pregnancy?
SAB - miscarriage
50% d/t chromosomal abnormalities
pregnancy loss before 20th week of gestation
What are the 3 most serious risk factors of miscarriage?
advanced maternal age
previous spontaneous abortion (SAB)
maternal smoking
Complete SAB?
sxs: abdominal cramping, vaginal bleeding
PE: cervical os closed, no visible POC (product of conception)
US: empty
Tx: none
- BC education
- supportive counseling
Incomplete SAB?
miscarriage in progress
sxs: abdominal cramping, vaginal bleeding +/- tissue
signs: cervical os open; POC visible in cervical canal
might see POC from cervical os or in vagina
US: no IUP; debris in uterine cavity
Tx: intervention to complete process
- D and C or suction aspiration
- Misoprostol if < 12 weeks
follow up in a week or so
What is the treatment for incomplete spontaneous abortion?
intervention to complete process
D and C or suction aspiration
Misoprostol if <12 weeks
Missed abortion
non-viable pregnancy that has not yet expelled sxs: none, cervix closed US: embryo with no cardiac activity Labs: declining hCG levels tx: medication or surgical intervention -misoprostol -suction aspiration -expectant management
Blighted Ovum
missed abortion
- anembryonic pregnancy
- fertilized egg implants in uterus, but embryo never develops
sxs: non, cervix closed
US: large GS with yolk sac; no embryo
Labs: declining hCG levels
tx: suction aspiration, misoprostol, or expectantly
Threatened abortion
vaginal bleeding without cervical changes
sxs: spotting, cervical os closed
US: viable IUP
tx: watch and wait
Inevitable abortion
vaginal bleeding with cervical changes sxs: abdominal cramping, mod-heavy bleeding cervical os open US: viable IUP tx: expectantly manage suction aspiration
since the cervix is open there is nothing you can do
if the pt was >24 weeks we would intervene but not really any earlier
How does threatened abortion differ from inevitable abortion?
threatened has light bleeding while inevitable has mild to heavy bleeding
threatened has closed cervical os
inevitable abortion is open os
