Lecture 1: Intro & Abortion Flashcards
Well women recommendation visits:
Unique for 13-19 y/o? Other 3 started at this age?
What is started at 19-39 y/o?
Only difference in testing b/t 40-64 and > 65 age groups?
Unique for 13-19 y/o = Menarche
- others =
1. STI/HIV testing
2. HPV vaccine
3. Contraception
What is started at 19-39 y/o (only diff b/t 13-19 group)?
- Cervical Cytology
Only difference in testing b/t 40-64 and > 65 age groups? BOTH: - Cervical Cytology - Mammo - Colorectal screening - Bone mineral density
ONLY do CBE in 40-64 y/o
Confirming preg w/lab tests:
Which type of pregnancy test is qualitative?
Which type of pregnancy test is quantitative?
- What levels = possible + result?
- what levels are definitive?
- how do the levels change in a norm preg
Other method than lab testing to confirm preg?
urine pregnancy test = qualitative
B-hCG = quantitative (blood test)
- > 5 = possible +
- > 25 = definitive confirmation of preg
- double every 2-3 days in norm preg
Other method to conifrm preg = TVUS
TVUS & preg confirmation:
What should be present at 5 wks? 6-7 wks?
At what level of b-hCG is normal IUP visualized?
5 wks –> gestational sac + yolk sac
6-7 wk –> gestational sac + fetus
norm IUP visualized at b-hCG > 1500-2000
If performing abortion in 1st trimester what can be given PO to complete abortion? (2)
- what is time frame for medical abortion w/pill?
- what lab value required to do this method
- dosing (days) for each?
What is given ppx for this type of abortion/length?
- Mifepristone + Misoprostol
- can be done up 9 wks gestation
- must have b-hCG of > 10
day 1 = mifepristone
day 2-3 = misoprostol
Ppx = doxycycline for 7 days
What type of drug is Mifepristone/what does it cause? What about Misoprostol?
Main complication a/w this type of abortion?
Mifepristone
- anti progesterone –> stops preg from growing
Misoprostol
- PGE1 analog –> induces uterine contractions–> expel fetus
main complication= bleeding
What is given for medical abortion injection occurring in 1st trimester?
Although rarely done, when is this method used?
Methotrexate + Misoprostol
used for ectopic preg
What is done after medical pill/injection abortion?
US to confirm abortion completed
Two types of surgical abortion done in the 1st trimester?
- Vacuum aspiration
2. Manual Vacuum aspiration
Surgical abortion in 1st trimester:
Vacuum aspiration: What is given to cause cervical dilation? when?
Next step?
2 Benefits of MVA (manual vacuum aspiration?
V. Aspiration:
- Misoprostol at 13+ wks –> cervical dilation
- suction uterine contents
MVA
- dont need electricity
- can do earlier than VA (6+ wks)
Two types of surgical abortion performed in the 2nd trimester?
Which one can be performed later in preg? when?
Which has higher complication rate (so rarely done unless mom at risk)?
What do they both require prior the surgery? What is it made of?
- D & E (dilation & evacuation)
- D & X (dilation & extraction)
- done later –> 21+ wks
- higher complication rate (rarely done)
BOTH: require input of laminaria into vagina–> dilate cervix
- sterile, compressed seaweed
6 complications of ALL surgical abortions
- Incomplete abortion
- Uterine perforation
- Cervical trauma
- Infection
- Bleeding
- Adhesions
Note: adhesions only affect ability to stay preg
What is the definition of SAB (spontaneous abortion)/ Miscarriage
- what is it often d/t
loss of preg < 20 wks gestation
often d/t chrom abnormalities
4 major RFs for SAB?
- adv maternal age
- previous SAB
- Smoking
- Meds/Substances
- EtOH, cocaine, NSAIDs
NSAIDs = PG inhib
Complete abortion:
- how does cervical os look?
- POC expelled?
- what seen on sono?
- Tx?
- cervical os = CLOSED
- POC EXPELLED
- Sono –> empty uterus
- Tx = none
INcomplete abortion:
- definition
- how does cervical os look?
- POC expelled?
- what seen on sono?
- Tx?
- incomplete = misscarriage in process
- cervical os = OPEN/DILATED
- Some POC retained/visible
- Sono –> no IUP, debris in uterine cavity
- Tx = intervention to complete the abortion
