medical and surgical abortion Flashcards

1
Q

Antibiotics

A

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

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2
Q

When is cervical prep recommended

A

by 12-14 weeks
Misoprostol
• 400 mcg vaginally/buccally 3‐4 h, orally 8‐12 h, or
sublingually 2‐4 h before the procedure

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3
Q

Diagnosis of Bleeding

A
Cervical laceration
• Retained tissue
• Uterine atony
• Placental abnormality
• Perforation
• Coagulopathy
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4
Q

Hematometra

A
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

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5
Q

High risk uterine perforation

A
– 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
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6
Q

What do you do if perforation and excessive bleeding?

A

Can consider completing the procedure under ultrasound guidance

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7
Q

Mifepristone

A

– Anti‐progestin
– Necrotizes the decidua, softens the cervix, increases
uterine contractility and prostaglandin sensitivity

up to 10 weeks gestation

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8
Q

misoprostal

teratogen

max dose

A

Possible limb and facial abnormalities

Max dose: 1400 mcg in 24 hours

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9
Q

Contraindication of medical abortion

A

• 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

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10
Q

Medical Regimen

A

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%
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11
Q

Clostridial toxic shock

A

Hemoconcentration and significant leukocytosis without

fever, rapid progression to refractory hypotension and death

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12
Q

Incomplete abortion Medical Termination

A

Misoprostol 600 mcg orally

or 400 mcg sublingually

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13
Q

Missed Abortion Medical termination

A

800 mcg vaginally or 600
mcg sublingually, repeat in
3‐24 hours for two
additional doses

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14
Q

Labor Induction Abortion

A

miso 800 mcg loading than 400 mcg vaginally q 3 hours

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15
Q

Labor induction with prior c-section

A

miso 400 mcg vaginally q 6 hrs

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16
Q

COP IOL

A

20-100 units of oxytocin over 3 hours
off 1 hour
increase to 300 units over 3 hours

17
Q

How long to wait for the placenta

A

around 4 hours but may depend on bleeding

can give 10 im of pitocin

18
Q

No expulsion after 24 hours of miso

A

Stop and do an ultrasound

- If not effective in 2-3 days may need surgery.

19
Q

Who is recommended to have a D&E

A

previa after 24 weeks

prior c-section and previa