SM_226b: Pregnancy Termination

Question 1

Unintended pregnancies can result in ____, ____, or ____

Answer 1

Unintended pregnancies can result in birth, abortion, or miscarriage / fetal demise

Question 2

First trimester uterine evacuation is performed using ____, ____, and ____

Answer 2

First trimester uterine evacuation is performed using suction, no touch sterile tip technique, and cervical dilation

• Adequate dilation necessary for patient safety: use rigid dilators, can use misoprostol for ripening (buccal 1 hr prior to procedure)

Question 3

Cervical dilation for first trimester uterine evacuation involves ____ and ____

Answer 3

Cervical dilation for first trimester uterine evacuation involves mechanical dilation and prostaglandin pre-treatment

Question 4

Electric vacuum aspirator uses ____

Answer 4

Electric vacuum aspirator uses an electirc pump or suction machine connected via flexible tubing

• Has a plastic or metal cannula
• Typically used in centralized settings with high caseloads

Question 5

Manual vacuum aspirator has a ____, ____, and ____

Answer 5

Manual vacuum aspirator has a locking valve, semi-flexible plastic cannula, and is portable and reusable

• Efficacy is same as electric vacuum (98-99%)

Question 6

Abortion during first trimester is completed when ____

Answer 6

Abortion during first trimester is completed when products of conception are identified

Question 7

Pain management techniques during abortion are ____, ____, and ____

Answer 7

Pain management techniques during abortion are local, local + IV, or nitrous

• With addition of focused breathing, visualization, or localized massage

Question 8

Paracervical block is ___

Answer 8

Paracervical block is when a local anesthetic is injected into 2-6 sites at a depth of 3-7 mm in the vaginal portion of the cervix in the vaginal fornices

Question 9

Mifepristone is responsible for ____, ____, ____, ____, and ____

Answer 9

Mifepristone is responsible for

• Decidual necrosis
• Increased endogenous prostaglandin production
• Formation of gap junctions within myometrium
• Cervical dilation
• Increased sensitivity to exogenously administered prostaglandin

Question 10

____ is an antiprogestin that is used as an abortifacient

Answer 10

Mifepristone is an antiprogestin that is used as an abortifacient

Question 11

____ is a prostaglandin analogue that is used as an expulsion agent

Answer 11

Misoprostol is a prostaglandin analogue that is used as an expulsion agent

Question 12

Describe when not to use medical abortion agents

Answer 12

DO NOT use medical abortion agents in women with

• Confirmed or suspected ectopic pregnancy
• IUD in place
• Long-term corticosteroid use
• Hemorrhagic disorders or inherited porphyrias
• Concurrent anticoagulant use
• Chronic adrenal failure
• Allergy to mifepristone, misoprostol, or other prostaglandin

Question 13

Assess completion of abortion by ____ and perform ____ for retained products of conception if unsuccessful

Answer 13

Assess completion of abortion by sonography and perform manual vacuum aspiration for retained products of conception if unsuccessful

Question 14

Compare medical vs surgical abortion

Answer 14

Medical vs surgical abortion

Question 15

Describe abortion in the second trimester

Answer 15

Abortion in the second trimester

• Many indications for evacuation
• General categories of uterine evacuation are the same but methods vary due to larger fetus and changing uterine responsiveness to medications
• 90% accomplished surgically
• Both medical and surgical abortions safer for mother throughout second trimester than continuation of pregnancy