medical and surgical abortion Flashcards
Antibiotics
Induced abortion/dilation and evacuation:
– Doxycycline 100 mg orally 1 hour before
procedure and 200 mg orally after procedure
– Metronidazole 500 mg orally twice daily for 5 days
When is cervical prep recommended
by 12-14 weeks
Misoprostol
• 400 mcg vaginally/buccally 3‐4 h, orally 8‐12 h, or
sublingually 2‐4 h before the procedure
Diagnosis of Bleeding
Cervical laceration • Retained tissue • Uterine atony • Placental abnormality • Perforation • Coagulopathy
Hematometra
Intense cramping • Minimal bleeding • Diaphoresis • Vasovagal reaction • Uterine enlargement on exam • On u/s, re‐accumulation of blood is seen
Treatment
– Immediate re‐suctioning
– Uterotonics
High risk uterine perforation
– Lateral defect – Suction was on at the time of perforation – Larger defect (>1.2 cm) – Acute pain or symptomatic blood loss – Sighting of bowel elements
What do you do if perforation and excessive bleeding?
Can consider completing the procedure under ultrasound guidance
Mifepristone
– Anti‐progestin
– Necrotizes the decidua, softens the cervix, increases
uterine contractility and prostaglandin sensitivity
up to 10 weeks gestation
misoprostal
teratogen
max dose
Possible limb and facial abnormalities
Max dose: 1400 mcg in 24 hours
Contraindication of medical abortion
• Anemia, Hgb <9.5 g/dL
• Confirmed or suspected ectopic pregnancy
• IUD in place
• Current long‐term systemic corticosteroid therapy
• Chronic adrenal failure
• Known coagulopathy or anticoagulant therapy
• Intolerance or allergy to mifepristone
• Severe liver, renal, respiratory disease, uncontrolled
hypertension or cardiovascular disease
Medical Regimen
On Day 1: 200 mg of mifepristone taken by
mouth
• 24‐48 hours after taking mifepristone: 800 mcg
of misoprostol taken buccally, at a location
appropriate for the patient
• About 7 to 14 days after taking the mifepristone,
follow up with a healthcare provider
- Failure rate: 2% to 7%
• Continuing pregnancy rate: 1% to 3%
Clostridial toxic shock
Hemoconcentration and significant leukocytosis without
fever, rapid progression to refractory hypotension and death
Incomplete abortion Medical Termination
Misoprostol 600 mcg orally
or 400 mcg sublingually
Missed Abortion Medical termination
800 mcg vaginally or 600
mcg sublingually, repeat in
3‐24 hours for two
additional doses
Labor Induction Abortion
miso 800 mcg loading than 400 mcg vaginally q 3 hours
Labor induction with prior c-section
miso 400 mcg vaginally q 6 hrs