Sept13 M3-Therapeutic abortion Flashcards
def of abortion
voluntary interruption of pregnancy before 20 weeks OR before 500 g (no viability at this point)
current law on abortion
- allowed
- under provincial control
- decision between woman and physician
barriers to abortion
- distance to facilities
- wait times
- gestational limits (more advanced gestation = need more skilled provider)
- MD refusal to refer
- lack of trained providers
most abortions done where here
- CLSCs (Quebec)
- outpatient clinics
mortality rate from abortion vs having a baby
- abortion = 0.3 deaths in 100 000 abortions
- having baby = 8.8 deaths in 100 000 live births
best thing to do with patient hesitant to continue a pregnancy, get an abortion
push them to continue with the pregnancy. usually feel better after
things to do with the patient
- determine exact gestational age
- explore reason for this choice
- check if ambivalence
- obtain informed consent
- review contraception
- ID support group
workup before abortion
- confirm pregnancy by US
- determine blood type
- check rubella status if primigravida
- check Hb (make sure not seriously anemic before you start)
- blood type + give anti-D Ig if required
- STD screen or prophylactic Abx
- image for discrepant size, dates (viability, ectopic, uterine anomalies)
diff procedures for abortion
- medical (early 0-16 weeks vs late 16-20 weeks)
- surgical (0-9 weeks, 10-16 weeks, 16-20 weeks)
complications of surgical abortion
- incomplete abortion
- hemorrhage
- infection
- continuing pregnancy
- perforation (hole in uterus and suction abdo content)
- local anesthetic reaction
- vagal syndrome
- post abortal syndrome (uterus keeps bleeding and not able to contract, severe cramping pain, mass at pubic symphysis level)
- *99% NO COMPLICATIONS**
early medical abortion is used when
up to 63 days after the LMP (meaning max 7 weeks gestational age)
agents used for early medical termination and imp principle
- mifepristone 200 mg oral
- misoprostol 800 ucg buccal (between gum and cheek below jaw line) 24-48 hrs later
- once start procedure, must complete it*
when to use prophylactic Abx in abortion
only in surgical abortion (reduces infection risk by 50%)
NOT in medical
what to avoid with misoprostol
CAN NOT give it vaginally. serious problems and deaths from clostridium
problems with Canadian abortion program (medical abortion)
- meds not covered (300$)
- training requirement for MD and pharmacists
- gestation age constraint (49 days)
- nurses excluded
- meds must be taken in front of MD
- 6% of medicals have to be completed with curettage ultimately
(imp?) contraindications to medical therapy (abortion)
- ectopic pregnancy
- IUD in place
- undx adnexal mass
- CS therapy
- anemia
- coagulopathy or aco use
- most serous systemic diseases (heart, lung, liver)
when is late medical termination used
for genetic terminations to allow the autopsy and guife the management of future pregnancies
late medical termination works how
- misoprostol many times at a specific intervals until it works
- pain management
methods NO LONGER USED for abortion
- hypertonic saline
- ’’ urea
- ’’ glucose
- hysterotomy (C section to do it)
- hysterectomy unless indication to do it (can then use it as abortion method)
late effects of abortion
- no long term physical effects (25% have negative emotions 1st week post abortion but then it resolves)
- no long term psychological effects
- patients happier when they choose surgical vs medical
factors affecting the emotional response in abortion
- maternal age (older = more accepting)
- pressure to make a decision or decisional conflit
- interpersonal violence
- Hx of depression
- moral discomfort
- poor social support
how to help emotional resp to abortion
- normalize the common reactions (tell them it’s normal)
- convey non judgmental, supportive and private environments
