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Reproduction Week 1 > Lecture 12: Abortion > Flashcards

Lecture 12: Abortion Flashcards

1
Q

What is the abortion rate of abortions?

A

Decreased through 80s and 90s but now has stabilized

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2
Q

When are most abortions done in pregnancy trimester?

A

Nearly 90% of abortions occur in the first three motnhs of pregnancy
Decline of abortion nowadays

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3
Q

What are the demographics of people who receive abortions?

A

Majority is white women but black women PROPORTIONATELY have more abortions
Lower socioeconomic status have become a greater proportion now

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4
Q

How many abortion clinics are available in country?

A

Less and less over the years so healthcare providers are less and less exposed to it
Women have to travel far to get abortions

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5
Q

What is abortion?

A

Expulsion from the uterus of an embryo or fetus before viability. Abortion may be either spontaneous or induced

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6
Q

How common is induced abortion in US?

A

40% of American have had an abortion…uh bullshit…I think you mean women who have had miscarriages…definitely not induced abortion lol
Often requires psycho-social interventions

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7
Q

What are the two leading reasons for abortions?

A
  1. Finances

2. Not ready for responsibility

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8
Q

How many pregnancies are unintended?

A

49%

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9
Q

How safe are abortions?

A

Abortion is one of the SAFEST surgical procedures for women
Risk of death associated with abortion is approximately 0.6 per 100,000 and the risk of major complications is less than 1%
Earlier procedures are safer
Abortions at <8 weeks is LOWEST risk of death

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10
Q

What is the risk factor for abortion related mortality?

A

Gestational age

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11
Q

What is EGA?

A

Estimated Gestational Age

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12
Q

What is the pre-procedure work up of first trimester abortion?

A

Medical and social history
Counseling
Informed consent
Labs = pregnancy test, Rh factor, hematocrit/hemoglobin,

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13
Q

How are basic components of uterine contents?

A
  1. endometrium
    • decudua, glands, vessels, hemorrhage
  2. Placenta
    • villi, cord, yolk sac
  3. Fetus
    • embryo or fetal parts
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14
Q

What recognizable tissue at 5-7 weeks?

A
  1. decidua

2. trophoblastic villi

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15
Q

What recognizable tissue at 9-12 weeks?

A
  1. decidua
  2. placenta (opaque, dense, pink)
  3. fetal parts
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16
Q

What are the options for abortion?

A
  1. surgical abortion
  2. medication abortion
    -mifepristone and misoprostol
    OR
    -methotrexate and misoprostol
    OR
    -misoprostol
    Causes bleeding and uterine contractiosn that lead to expulsion of pregnancy tissue
    Currently used for terminations up to 63 days gestation
17
Q

What are the three medications that are used for abortion?

A
  1. Mifepristone + Misoprostol
  2. Methotrexate + Misoprostol
  3. Misoprostol alone
    Causes bleeding and uterine contractions that lead to expulsion of pregnancy tissue
    Used 63 days after gestation
18
Q

What are side effects of medication abortion?

A
  1. nausea
  2. diarrhea
  3. vomiting
  4. headache
  5. infection, bleeding
19
Q

What is the MoA of mifepristone?

A

Anti-progestin = blocks progesterone
This is what induces menstruation during menstrual cycle
Derivative of norethindrone
Binds progesterone receptor with high affinity

20
Q

What is the MoA of misprostol?

A

Prostaglandin E1 analog
Prostaglandin produces flu like symptoms
Stimulates uterine contraction

21
Q

What is norethindrone?

A

Important drug in contraceptives
Blocks progesterone receptor
Precursor of mifepristone

22
Q

What is the MoA of Mifepristone + Misoprostol?

A

Decidual necrosis + uterine contractions + cervical ripening

Leads to detachment and expulsion

23
Q

What is the MoA of methotrexate?

A

Anti-folate
Blocks division of rapidly dividing cells
Can prevent ECTOPIC PREGNANCY
3-45 days for completion of abortion
90-95% effective, given once intramuscularly
Side effects: leukopenia, alopecia, pneumonitis
Less used because of mifepristone is approved

24
Q

What is alopecia?

A

Baldness or loss of hair

25
Q

What are the physiologic effects of misoprostol?

A
  1. stimulates contractions
  2. softens and primes cervix
  3. Prevents/treats ulcers
  4. Nausea/vomiting, diarrhea
  5. Fever, chills, flu-like symptoms
26
Q

What are the doses of mifepristone and misoprostol needed?

A

Medical abortion = mifepristone 200 mg + misoprostol 800mcg

27
Q

When is pregnancy possible after abortion?

A

Pregnancy is possible in the first month post abortion
IUD insertion after abortion
-not recommended after septic abortion
-can be done at 1 week followup to abortion

Reproduction Week 1 (13 decks)

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