OGCO-E8 Methods for mid trimester (14-24 weeks) termination of pregnancy Flashcards
METHODS FOR MID-TRIMESTER (14-24 WEEKS) TERMINATION OF PREGNANCY
What are alternative methods for TOP in mid trimester (14-24 weeks) who fail misoprostol or when misoprostol is unsuitable?
- Vaginal Dinoprostone pessary 3mg every 3-4 hours with a maximal exposure of 24 hours.
- Carboprost 0.25mg i.m.i every 1.5 – 3.5 hours (Frequency of administration depends on monitoring of uterine contractions. If contractility is not adequate after several 0.25mg doses, increase to 0.5mg doses. Total dose should not exceed 12mg.)
If there is significant vaginal bleeding/large amount of leaking how may mid trimester (14-24 weeks) TOP be done?
Misoprostol may be given orally or sublingually
How are TOP mid trimester managed for patients with high risk of uterine scare rupture?
Pretreated with mifepristone 200mg 24-48 hours before starting misoprostol.
Misoprostol regimen can be modified. 50mg can be started as a cervical ripening dose after cervical preparation with hygroscopic dilator. The ripening dose can be repeated after 4-6 hours until the cervix becomes soft and dilating.
Than abortifacient dose can then be started at 100mcg every 4-6 hours. The assessment done by doctor.
How is Mx of 3rd stage of labor done with patients with heart disease, mitral valve stenosis, obliterative vascular disease, venoarterial shunts, hypertension, sepsis, hepatic or renal impairment etc.
Syntocinon instead of syntometrine (more effective but more AE) given after passage of abortus to reduce risk of post partum hemorrhage.
What should be monitored for if TOP uses combination of prostaglandins and oxytocin infusion?
There may be overstimulation of the uterus resulting in uterine scar rupture. Although uterine scar is not a contraindication to the use of misoprostol but the patient should be monitored closely for SS of uterine rupture.
