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
