Spontaneous and Induced Abortion 3 Flashcards
Describe in layman's terms to a classmate medical options for uterine evacuation during the first trimester.
1
Q
What are the medical agents used for abortion during the first trimester?
A
- Mifepristone - antiprogestin
- Misoprostol - prostaglandin analogue
2
Q
What is the FDA approved regimen for medical abortion? What is the commonly used regimen?
A
- FDA-approved
- 600 mg Mifepristone
- 400 mcg Misoprostol
- 92% efficacy
- Commonly used
- 200 mg Mifepristone
- 800 mcg Misoprostol
- 96-98% efficacy
- less expensive
3
Q
What are some other regimens to induce abortion aside from Mifepristone/Misoprostol?
A
- Misoprostol 800 mcg vaginally
- Repeat dose on day 3 if indicated
4
Q
What are some indications for clinician follow-up after a medical abortion?
A
- Heavy bleeding with dizziness, lightheadedness
- Worsening pain not relieved with medication
- Flu-like symptoms lasting >24 hrs
- Fever or chills
- Syncope
- Any questions
5
Q
When is medical abortion contraindicated?
A
- 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
6
Q
What are the advantages vs. risks of medical abortion?
A
-
Advantages
- avoids instrumentation
- abortion within 24 hours
- can use oral pain medication
- part of the process is at home
-
Risks
- retained products of conception
- infection and bleeding
7
Q
What are the advantages vs. risks of vacuum aspiration?
A
- Advantages
- can be done in one visit
- procedure takes 5-10 minutes
- may be used in early pregnancy
- anesthesia/sedation is available
- Risks
- uterine perforation (1/1000)
- retained products of conception
- infection
- bleeding
8
Q
What is the appropriate follow-up after a medical abortion?
A
- Assess completion of abortion by
- patient history
- serial HCGs or sonography
- speculum and/or bimanual exam as indicated
- Documentation of missed follow-up
- If incomplete or unsuccessful, MVA can be used for retained POC
9
Q
What are methods of abortion in the second trimester?
A
- General categories the same, but methods vary because of larger fetus and changing uterine responsiveness to medications
- 90% of second trimester abortions in the US accomplished surgically
- Both medical and surgical abortion safer for mother throughout second trimester than continuation of pregnancy
-
D and E procedure
- cervical preparation
- osmotic dilators
- laminaria leads to prostaglanding productionand dilation
- misoprostol can be added for certain patients
- uterine evacuation
- cervical preparation