SM198 Spontaneous and Induced Abortion

Question 1

Clinical diagnosis of an abnormal pregnancy

Answer 1

Failure to demonstrate an appropriate rise in hCG and to identify an intrauterine gestation by ultrasound

Question 2

What percentage of pregnancies are unintended? What percentage of those end in termination?

Answer 2

50%, 50%

Question 3

When do most induced abortions happen?

Answer 3

First trimester, <12 weeks

Question 4

What is the risk for death from a uterine evacuation?

Answer 4

At 9 weeks gestation or less, 1 in 500k. Very safe. Safer than having a full-term delivery. Second term abortions are a little less safe, 3 in 100k.

Places with restricted abortion access or where abortion is illegal have higher mortality rates. Dropped in the US after Roe v. Wade.

Question 5

Medical abortion

Answer 5

Mifepristone: increases uterine sensitivity to exogenously administered prostaglandins, most notably PGE1 agonsists such as misoprostol

Misoprostol: heat stable and inexpensive, leads to expulsion of tissue

Side effects: dizziness, lightheadedness, flu-like symptoms, fever, chills

Question 6

Surgical abortion (D&C): EVA vs. MVA

Answer 6

EVA (electrical vacuum aspirator): electric, noisy, not portable, more expensive, continuous suction, bigger capacity

MVA (manual vacuum aspirator): mechanical, quiet, portable, cheaper, variable suction, smaller capacity

Question 7

How do you confirm an abortion is complete?

Answer 7

Identification of products of conception (POC)

Question 8

Do you need to wait until after 6 weeks to do an abortion?

Answer 8

No, that’s what people used to think, not necessary

Question 9

What type of anesthesia is most commonly used?

Answer 9

Local > local + IV > general

Question 10

Medical abortion contraindications

Answer 10

Ectopic pregnancy, IUD, chronic steroid use, hemorrhagic disorders, anticoagulant use, adrenal failure, allergy to drugs

Question 11

Medical vs. surgical: success rate

Answer 11

Medical: 92-99%

Surgical: 99%

Question 12

Medical vs. surgical: number of visits

Answer 12

Medical: 2+

Surgical: 1

Question 13

Medical vs. surgical: procedure time

Answer 13

Medical: within 24 hours of second dose

Surgical: 5-10 minutes

Question 14

Medical vs. surgical: anesthesia?

Answer 14

Medical: no

Surgical: yes

Question 15

Medical vs. surgical: clinic or at home?

Answer 15

Medical: much can be done at home

Surgical: clinic

Question 16

Medical vs. surgical: risks

Answer 16

Medical: retained products of conception, infection and bleeding

Surgical: uterine perforation (1/1000), retained products of conception (1%), infection, and bleeding