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
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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
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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
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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
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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
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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
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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
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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
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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
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