Lecture 12: Abortion Flashcards
What is the abortion rate of abortions?
Decreased through 80s and 90s but now has stabilized
When are most abortions done in pregnancy trimester?
Nearly 90% of abortions occur in the first three motnhs of pregnancy
Decline of abortion nowadays
What are the demographics of people who receive abortions?
Majority is white women but black women PROPORTIONATELY have more abortions
Lower socioeconomic status have become a greater proportion now
How many abortion clinics are available in country?
Less and less over the years so healthcare providers are less and less exposed to it
Women have to travel far to get abortions
What is abortion?
Expulsion from the uterus of an embryo or fetus before viability. Abortion may be either spontaneous or induced
How common is induced abortion in US?
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
What are the two leading reasons for abortions?
- Finances
2. Not ready for responsibility
How many pregnancies are unintended?
49%
How safe are abortions?
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
What is the risk factor for abortion related mortality?
Gestational age
What is EGA?
Estimated Gestational Age
What is the pre-procedure work up of first trimester abortion?
Medical and social history
Counseling
Informed consent
Labs = pregnancy test, Rh factor, hematocrit/hemoglobin,
How are basic components of uterine contents?
- endometrium
- decudua, glands, vessels, hemorrhage
- Placenta
- villi, cord, yolk sac
- Fetus
- embryo or fetal parts
What recognizable tissue at 5-7 weeks?
- decidua
2. trophoblastic villi
What recognizable tissue at 9-12 weeks?
- decidua
- placenta (opaque, dense, pink)
- fetal parts
What are the options for abortion?
- surgical abortion
- 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
What are the three medications that are used for abortion?
- Mifepristone + Misoprostol
- Methotrexate + Misoprostol
- Misoprostol alone
Causes bleeding and uterine contractions that lead to expulsion of pregnancy tissue
Used 63 days after gestation
What are side effects of medication abortion?
- nausea
- diarrhea
- vomiting
- headache
- infection, bleeding
What is the MoA of mifepristone?
Anti-progestin = blocks progesterone
This is what induces menstruation during menstrual cycle
Derivative of norethindrone
Binds progesterone receptor with high affinity
What is the MoA of misprostol?
Prostaglandin E1 analog
Prostaglandin produces flu like symptoms
Stimulates uterine contraction
What is norethindrone?
Important drug in contraceptives
Blocks progesterone receptor
Precursor of mifepristone
What is the MoA of Mifepristone + Misoprostol?
Decidual necrosis + uterine contractions + cervical ripening
Leads to detachment and expulsion
What is the MoA of methotrexate?
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
What is alopecia?
Baldness or loss of hair
What are the physiologic effects of misoprostol?
- stimulates contractions
- softens and primes cervix
- Prevents/treats ulcers
- Nausea/vomiting, diarrhea
- Fever, chills, flu-like symptoms
What are the doses of mifepristone and misoprostol needed?
Medical abortion = mifepristone 200 mg + misoprostol 800mcg
When is pregnancy possible after abortion?
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
